Oh Haiti Day: Food

“I’m hungry, Blan. Feed me, Blan. Give me money Blan” I’ve been hearing this a lot. Usually in Creole, sometimes in English. Yesterday a 5 year old said this to Matt and I. We said – you want to work we’ll give you money. Today he showed up ready to roll, and picked up 4 grocery sacks of trash around the compound for a whole quarter. Anytime kid.

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Aside from pregnancy and babies – my favorite topic is FOOD! Growing up a Bender, our work and play revolves around food. There is a special place in my heart for gardens, farmer’s market, and chopping melons in the back room of the store. Thus, I was overjoyed when the topic of nutrition came up today in class.

Food has a unique importance in Haiti. The obvious feature is it’s scarcity, but the behaviors that have developed from this have taken me aback. The “me me” mentality creates dichotomies even between parents and their children. This really sank in for me after my third or fourth day here, when Matt and I drug 15 of the junior league workers out into the community to see if people were using their chlorine tablets to clean the water. We walked a long ways in the hot sun, and they were sweaty and tired – so Matt and I offered to treat them to a meal and drinks by a street vendor. I was happy to reward them, and ran to buy soda and juice while Matt negotiated with the lady manning the large black pot of broth and floating fish parts. We ended up paying about $3 a person for a plateful of rice, beans, meat, and a drink, nothing right? The workers each hustled to get their own plate filled and grab their drink of choice first, with mutual disrespect for each other. They gobbled up seats, food, and drinks, and I was just standing watching in the corner, a bit flabbergasted. Not a single person said thank you. I didn’t even eat. Partly because I didn’t want to sound greedy, partly because it looked nasty, but mostly because it wasn’t offered and I didn’t know how to ask for it.

Matt had spoken up the mentality produced by receiving handouts and having a hungry belly – but seeing it was a little bothersome. When I was a guest in different Latin American cultures, I was offered a seat, water, and food almost any place I went. This gets uncomfortable too, because you see how little people have and don’t want them to waste their chicken/mangos/rice on you – and sometimes their goat head stew just isn’t appetizing. But the theme of generous hosting had obviously spoiled me. I sort of sound like a selfish brat, but it really bothered me that there was no appreciation.

Back to nutrition class. These ladies hand out vitamins on the reg, but it was clear they had no idea what was in them or what functions the vitamins had. They couldn’t even name a single source of protein, calcium, or iron. Rice rice and rice? No. After a lot of guessing and discussion, we made a table of vitamins, where they come from, and how it benefits the human body. We talked about which vitamins are most important for pregnant ladies, and how all the important vitamins for babies are in breast milk.

As usual, class and clinic sort of run together. Today is not a clinic day, but patients know they we won’t turn them away. Worked out well today, because an excellent teaching case walked in the door. Well, was carried in the door. It was a 23-day-old baby girl. She was extraordinarily calm, barely moving in fact. Mom said she had a stomach cold. Some more questioning on diet and nutrition leads to unwanted answers. She’s eating “Gerber” or mashed up foods. This includes mashed up crackers, cookies, etc. 23 days old. This baby shouldn’t have anything but a tit in her mouth. I was a little frustrated with the mother’s ignorance, in the US this would be arguably called child neglect and endangerment, and the kid would be taken away by DHS if they didn’t change their practice. I brought the mother and baby in front of the health workers to “work-up” the baby’s “stomach cold”. They immediately got to the root of the problem and began lecturing in passionate Creole about the importance of breastfeeding. Made me proud, but didn’t solve the problem. Angie left us a few bottles of formula, so Mahalia (who has a baby girl of her own and is furious about this situation) mixed up a bottle and I tried to feed the baby. She wasn’t taking. She is probably so backed up from all the crap in her stomach, and hasn’t been strengthening her sucking muscles. I’m hoping she hasn’t forgotten how to squeeze those cheeks. I told mom to go sit in my room, and they aren’t leaving until I see that baby sucking a tit. An hour later, they were released, with about 15 seconds of successful feeding. Mom still just didn’t get it. We are going to visit them tomorrow, and hold an education session within her community on breastfeeding and children nutrition. I unfortunately agreed to this before asking where they live – sounds like we will be leaving at 5am to catch a moto, then a tap tap, then a moto, then walk an hour to get to their mountain village. Damn.

Matt had the idea of creating a survey for parents on what they feed their kids at different ages, as well as measuring babies arm circumferences to assess malnutrition. I’d been wanting to survey more women about birth control (what they’ve tried, how well it worked, and if they’d like an IUD/tubal ligation). One paper with some questions Sharpied on, and a couple hundred copies later, and we have a survey for the community. We teach the girls how to measure kids’ arms, and incentivize them with some sodas. Half of the group goes to the market to teach about nutrition and take blood pressures, and half of the group breaks into pairs to go house to house with our questions. Ready... break!

The junior leaguers hitting the streets for community surveys

Community health workers teaching women about different forms of birth control we have available. Visual aids of the mysterious uterus and cervix are money.

See Matt's post "Fracture" to explain the sling

I stayed back with the interpreter Smith to help me translate some recordings from some women’s “focus groups” I taught the girls to conduct. It’s fun to hear the information that comes from a bunch of women sitting around talking about pregnancy, disease, babies, etc. I’ll share some of that once I have it more digested. For now a summary looks like – “We need food, jobs and schools, kids are expensive, and men don’t help”. Speaking of food – its about 2:30 and lunch still isn’t ready. I’m not too disappointed; I can do without the usual buttered noodles and will hold out for the good stuff at dinner – rice and beans. Mmmm. One of the younger girls runs into the kitchen and says –“You have a patient!” Smith says “Tell them to come back, we don’t have clinic”. I give him an expression saying otherwise, and we both head over to clinic. The man looks an aged 65 years old, and complains of pain in his throat. He said he was eating lunch, and can’t swallow his food. Feels like it’s stuck in his throat.

He looks in a bit of distress, but not bad enough for me to be too worried about aspiration. His lung sounds were beautiful. If there was food, it was in his esophagus. Uncomfortable, but not going to kill him. Next I want to see him swallow. He’s handling his spit pretty well, but I’m curious to see more. Now I should give him a little water or liquid first, but we are currently out of water at the compound (yeah - no drinking, showering, or flushing…Matt’s toilet is still full from this morning). The last bit of water I know to exist is in my water bottle, and the selfish Haitian survival instinct kicks in. I’m keeping it for myself. Let’s move on to solids. I grab a couple Tums from the medicine shelf and instruct him to chew and swallow. This is very uncomfortable for him, and he is nearly gagging trying to get it down. My brain says that gagging means Heimlich. I have never done the Heimlich before, and imagined it going down around a big dinner table, with an emergent gasp from across the table as someone turned blue and brought their hands to their neck. This was a bit odd for me to do such a harsh maneuver on a man just sitting comfortably, but I shrugged; What the heck, let’s give it a try. I awkwardly stand behind the man, bear hugging him. He’s gotta be slightly confused as to why the white girl is seemingly trying to pick him up or crack his back or God knows what. At this point the two little girls (enduringly annoying little sisters by now), are peeking around the corner watching what’s going on. I position my right hand into a fist, just under his rib cage with my left on top for power. I swiftly supinate my right wrist, plunging into his stomach. He gags. Uncomfortably. Other than that, nothing happens. I keep at it. Two pumps, three pumps, four… blaaaaaah. Out it comes. A huge rubbery chunk of meat. And every thing else in his lime green lunch stew. This dude had a good lunch. Carrots, spinach, rice, and stew meat. I felt bad making him loose all those calories. Even more sorry it happened in the middle of the clinic floor and I didn’t have more insight to take you outside! I was as giddy as a freshman getting asked to prom. It worked! Holy shit! Ha! Did I mention I have never done that before? Or seen it! It really does work. Thank you Carole Schafer and all the CPR/First Aid teachers of the world!

He looked at me with a wide-eyed grin of relief, and reached readily to shake my hand. The looks on the faces of my interpreter and the two girls were just priceless. So disgusted.

Awesome.

He immediately feels bad and wants to clean it up. I am still laughing and motioning to him not to worry about it. One of the girls brings him a piece of cardboard and a small jug, still disgusted, and motioning that he better get to work cleaning it up. Did I mention we were out of water? He was just overwhelmed with joy, and kept saying “Merci Ampill”! The pleasure was all mine. As he left, I finally saw the culprit as he opened his mouth in a gaping toothless smile. I’m still shaking my head laughing.

For your food viewing pleasure: a few photos from the nearby bi-weekly farmers market.