Kwashiorkor

The word comes from Africa and, literally translated, refers to the child who is ill because he has a new brother or sister and no longer is able to feed at the mother's breast.

Kwashiorkor, or "kwash" (as we refer to it), is one of two types of severe malnutrition. This particular type is a protein-calorie malnutrition. It is due to severely deficient protein and calorie intake that results in hypoalbuminemia. Albumin is need to maintain intact cell walls. And when it is reduced, the cells break down and the person becomes severely edematous.

Here at the Center of Hope, we have the only facility in this part of Haiti dedicated exclusively to the treatment of children with kwash. When they are brought to us, the child is often critically ill. Their tiny arms, legs, and face are often so edematous that the skin has been stretched to breaking. Many have infections, and almost no energy. Often they have low hemoglobin and are very anemic.

There is a protocol we follow in treating these children. Besides antibiotics for infections and vitamins and iron, their little bodies have to be "retrained" to accept protein. So they are given special feedings, in small amounts, around the clock. All this is combined with HUGE amounts of TLC, especially holding and cuddling. And, once recovery is on the way, they are in need of stimulation, including lots of bright colors.

Now, let's make this information come alive as I introduce you to our newest kwash baby. Her name is Gelista. She is 19 months old and came with her mother from a distant mountain village called Castion. The child - and mother - will live here during her entire treatment. As treatment commences, much education is done with the mothers on diet, signs and symptoms of problems, need for lots of bodily contact with the child, etc.

Gelista has lab work done and we discover her hemoglobin is 2.7!! That is so dangerously low that her heart could stop at any time. Also, her body loses its ability to regulate her body temperature and she can become very, very cold. Before all else, she must receive blood - and that can be done only at the hospital. We call the hospital, but by now it is late afternoon, and nothing can be done until morning. So we insert a feeding tube and slowly begin her first feeding. For the night, all we can do is keep her comfortable and warm, and encourage the mother to hold her and talk to her to keep her quiet.

This morning, Gelista was taken to the hospital to receive blood. I will keep you posted on her progress.

The pictures? The first is a "teaching of mothers" session held on the "porch" of the Center. While the kwash nurse teaches, Devon, a volunteer nurse from the US who is presently responsible for the program listens and joins in on the teaching.

The other is a picture of Gelista and her mom right after arriving.

Till next time, may these coming days of Holy Week have special meaning for all of you.

God bless. Mary Ann

Pictures from Saturday's Distribution

For both of these woman - regardless of the weight of their loads, they have a smile on their faces and will go home light of step, for TONIGHT, noone in their house will go to bed hungry!

Leaves

LEAVES ... we don't think of them much, except to watch them bud out in the spring, listen to them rustle in the wind, admire their color in fall, and rake them when they come down before winter.
But here in Haiti, leaves have so many uses! That is what struck me last week in the mountains and today at the Center.
Large leaves make perfect "blankets" to sit on when nursing your baby and waiting for your name to be called to be seen by the foreign doctor.
Long, thin leaves can be rolled together to form a doughnut-like ring to better balance on your head the sack of flower and bottle of oil you have just been given to supplement the food for your family.
And after working on the recalcitrant engine of one of the HHF vehicles, leaves are the perfect "towel" to wipe your hands.
Next time you look at "leaves", remember this story and say a prayer for the people of Haiti.
Mary Ann
PS. I need to make a correction to my last post. The food distributed was through an internation program called CROSS and it centers on needy children. This program has been in place since last year but the amount of food sent was increased to help those families already in the program who had taken in additional children after the earthquake.

A little help goes a long way!

It's Saturday evening. I wanted to add a few pictures to this story, but the internet is S L O W tonight and so, you will have to visualize it yourself. Starting at noon, we distributed what I will call "relief food" to over 300 people. This is food that came through various agencies like Catholic Relief Services and C.A.R.E. as a result of the generosity of people like you following the earthquake. The food was given to families who had opened their hearts and homes to friends and relatives who had lost everything in the earthquake.
Quietly they sat on the chairs, waiting for their turn and clutching the individual cards identifying the new people in the house. (This information had been collected during the past month.)
My job was simple, I checked off their name from the list I had.
When it was their turn, each received flour, wheat, beans, cooking oil, peanut butter, and tuna. There was a given amount for each person. So, if 7 new people had moved into the house, they received 7 times the individual amount. Many people belong to the Save A Family Program and already receive help of one kind or another. This food was to help them with the extra people they had taken into their homes.
I wanted to add pictures, because you could then see some of what I saw. Gratitude.. profound gratitude. This food came from people like you who opened your hearts and pocketbooks to those in need after the earthquake -- just as they had opened their arms, and their homes. God bless us all. Mary Ann

Mountain Post

A "Post" is a scheduled 'clinic' in a mountain village. Yesterday we had scheduled a "prenatal, immunization, adult and child ill visits, dental, and feeding malnourished children" clinic. Our group included almost 30 health care workers, including 2 pediatricians, 2 dentists, one family practice doctor and myself. Except for the prenatal exams, everything was done outdoors.

The drive to the village took one and 1/2 hours over rocky, and sometimes steep mountain trails/roads. At times the 'road' was so narrow that it did not allow our vehicle to pass a person walking. Now that is N A R R O W !!

There was only one child so ill with severe respiratory problems that had to be brought back with us.

ALL the prenatal women seen were refugees from the PAP earthquake. The health care worker responsible for the area said that daily he is going house to house (some literally a mountain peak away), registering all the new people.

At the end of the day, the feeding program was done and, as you can see, "sharing" is the way it is done!

I also want to introduce you to "Berline" and "Berlinda"- boy and girl twins, of whom "Berlind" is on the way to recovery from a type of malnutrition in which the body can no longer utilize protein and begins to break down its own cells, causing severe edema often accompanied by infecton and heart/lung failure. Berline, sitting on his mother's lap, now seems to be improving every day. He still shows a little of the "puffy-ness" he had in his face, but he is back to real food and, so the mother hopes, they can soon leave and return to their home in the PAP area. As for his twin, Berlinda, she is a spunky little girl, not above getting into mischief on a daily basis. The whole family, including a younger brother and older sister, are living here at the Center of Hope during Berline's treatment.

Until next time, take care, God bless, and remember to pray for the poor throughout the world.

Mary Ann

The pictures that got missed

This is the akamil being boiled (on the left). And one of the little ones enjoying his rice, vegetables and beans mixture. Sorry that this is a separate post. You need to read the one I did before this one to understand. Take care. God bless Mary Ann

Saturday's Treks

It could be a scene from a Hemmingway novel - the oxen plod along in a circle, powering a press while men put sugar cane into the press. The result is a sweet sugar cane sugar that is further refined into "clarian" - an alcohol as strong as straight vodka (so I am told!). This is a family business with one of the children walking along in the mud urging the oxen on.

We viewed this scene in a village covered by an HHF health worker,where we went to check on the success of the emergency distribution program of food for those families who took in family and other refugees from PAP. One 2 room home, with dirt floor, originally home to 7, now housed 21 people! This was but one example of the way the people of the area opened their arms to more than 3 times the number of people coming into the area.

We also saw the feeding program for the children identified with 2, 3, and even 4th degree malnutrition. The food for the day was a dish of rice fortified with pieces of vegetables and beans and a type of porridge called "akamil", a flour that is 3 parts rice, one part beans, and then sweetened with bananas and coconut. That is the akamil cooking on the pot on the left. All the children were fed the first mixture and those identified as malnourished also received a bowl of akamil. A day when they go home with full tummies - and that doesn't happen often!

An update

The picture aboveis the family I told you about earlier - the 2 children whose mother died in the earthquake taken in by a cousin who has a child of her own. This is the family. Test results showed the one in my arms and his big brother both had Typhoid but were otherwise OK. I had some fried bananas with me and gave them to all the children. Later the 3 year old refused to leave. He didn't want to go home - he wanted to stay with me! Ah-- what a little food can do!

More on the truckload of food stolen - the food was in a truck that does not belong to HHF and the HHF car that was to follow it was detained. We learned that if it would have been known that it was food from HHF it would not have been taken! When word got around that it belonged to HHF, the perpetrators were roundly denounced! That being said, all large distributions are stopped for the present. Too bad, as the mountain people could really use the supplies. But the organization will not endanger its workers if that is what is happening when they go out with food.

Till next time.... Mary Ann

Food Distribution

On Friday, 4 huge truck loads of food, ie 50 pound sacks of beans, soyblend flour, etc arrived and was placed in the depot here at Center of Hope. Plans are for this week to begin distributing them in the villages. Later in the week I will go with one of the trucks and take pictures to post.

This morning one of our trucks left for the area called Moron. When they stopped at the police checkpoint going out of Jeremie, the truck was mobbed and all the food stolen! Everyone is desperate for food! It was such a large mob that the police didn't intervene. Luckily, none of our employees were hurt. It is now probable that our trucks will need UN or military escorts to prevent this from happening again.

Everyday I hear new stories of the heartaches caused by the earthquake. I spent over an hour walking with a 2 month old baby, trying to put together a plan to feed this child. His father was killed in PAP's earthquake and the mother "ran off", a term the people use to mean someone who has become mentally unstable and unable to attend to a child. The baby cried and cried, he was hungry! Well, we finally got together a plan for the child to receive needed milk/formula. The director of the center said it is harder to get wetnurses that are not relatives because of the people's fear of HIV/aids. Much education still needs to be done.

As a point of interest - Haiti does not change to daylight savings time, so our time is now the same as time in the Central Daylight Savings Time.

Well, it is 6:30, completely dark, but still 84 degrees. I will probably be in bed by 8! Of course, it is light just before 6 AM and everything again comes to life! (the roosters start at about 5).
More next time. Don't forget to pray for the people of Haiti! God bless. Mary Ann

Visitors

Yesterday I met a man that I had seen on CNN with President Clinton. He the "supreme commander" of all military forces here in Haiti and surrounding area. He came with many other "officials" to see what needs to be done and what had been done for Jeremie and the Grand Danse area. They flew in specifically to meet with Sr. Maryann and Bette to talk about and view results of the relief given for this area. There is a push to give aid to the areas that are receiving survivors from Port Au Prince.
Speaking of survivors, today I met a woman who had taken in 2 children of a cousin killed in PAP's earthquake. The children, ages 3 and 18 months, both had problems. The youngest was malnourished and the oldest appeared "shell-shocked". The cousin who took them in has a baby herself of about 14 months. So we got them set up in our system - both on the feeding program; the youngest to have lab work done to better assess his health status; and the cousin given rice, beans, and cooking oil to help her in providing for the family. Both were fully examined and will now be closely followed in the HHF system. That's how it is done - one problem at a time.

I want to tell you about one of the relief efforts being done: 2 or 3 villages at a time, the health agent identifies families that have taken in a large number of refugees. Of the PAP refugees in these families, people are identified who were merchants on the streets, selling food or clothes, or other products for daily living when they lived in PAP. About 3 or 4 from each village are brought here to the Center. They are each given the things needed to "start over". For example, the woman who sold food on the street is given a home-made bazier (made here in Jeremie), a large cooking pot (also made in the area), and food supplies like oil, rice, cereal, beans, etc. The woman who sold clothes, etc, received a very large bundle of fabric, clothes, etc as well as soap or toothpaste or whatever had been given us. This is all given free to help them begin to earn a living again so they are not so great a hardship on the families who have taken them in.
This is where your relief money went! Besides the truck loads of food that is also distributed. This is what the General and representatives of USAID came to hear about and see.
Well, I have been verbose tonight! Maybe because this is the first time I had a way to communicate for over 2 days.
Take care. God bless. Continue to pray for all of us.

Isn't he beautiful? This little boy was born just a few days ago. But on that very same day he lost his mother. She was just 21 years old and this was her second child. The delivery was uncomplicated and all appeared well. Suddenly she began hemorrhaging and before an ambulance could arrive at the village, she died. The cause? Probably uterine atony.

Today his grandmother brought him and a young woman who will be his wetnurse. (The young woman also has a newborn.)

The nursemidwife here at the Center of Hope took a detailed history of what happened from the moment the woman went into labor until she died. This information will be discussed in detail at a monthly conference that reviews all situations of poor outcomes. The question? Could or How could this have been prevented?

That's all for now. Mary Ann

Arrived!

Hello, everyone! I arrived safe and sound in Jeremie on Thursday about noon. Sr. Maryann Berard and Bette Gabrien met me at the airport and brought me to my new home. To me, the apartment is a PALACE with stove, refrigerator, bathroom and all the "fixings". Once we got my mosquito net hung over the bed, I knew I was home. Right next to me are two other Americans who are also volunteering a year at HHF. In other buildings on the compound are UN soldiers.
Friday began my orientation - and first Creole lessons. (The challenge begins!)

It has been rainy and dreary since I arrived. Even cold at night! You know, cold enough to cover with a sheet.

The effort of helping all the refugees from Port Au Prince is taking high priority. St. Pierre school with it's 700 children, is looking at a way to add 250-300 more. This is the school HHF supports. That means enough clothes, shoes, socks, books, school supplies -- as well as teachers and space. The plan for the present is to try to teach them in the late afternoons and early evenings. As Sr. Maryann says, we don't want these children wandering the streets or soon we will have problems with gangs, stealing, and more!
Well, since it is rainy and the sun doesn't shine, satellite internet is "if-fy". So I will stop for today.
Take care. God bless. And please let those who don't have internet know that all is well.
Peace.
Mary Ann