This is our fourth operational day, which after a year of planning, feels huge. Liz and I were joking last week that we’ve been throwing “launch” parties for the pilot clinic for about a year (see: C2C at the Institute of Contemporary Art, November 16, 2009), and last week the clinic opened with neither pomp nor circumstance. Truth be told, we’d been working with ICC/Grace Children’s and MSH on an inauguration event to celebrate the resurgence of the hospital as a fully functional healthcare provider in Port-au-Prince. The invitation list included several heads of Haitian ministries (e.g. of health, foreign affairs, finance) and the entire diplomatic corps. Unfortunately, John Steinbeck might as well have coined the phrase “the best laid schemes of mice and men go oft awry” specifically for Port-au-Prince, and after a cholera outbreak and promises of Hurricane Tomas’ deluge, the ceremony was called off. And so the C2C clinic opened quietly. But hey – I’ll take an open clinic any way it wants to come.

We’ve so far seen a daily average of about forty-five women and their babies, and reports from C2C’s Project Coordinator, Handy Tibert, at Grace Children’s Hospital suggest that everyone’s adapting to the space very well, and vice versa. The clinic was committed as maternal care center, and is staffed by two gynecologists, a midwife and two nurses. The pharmacy space should be fully functional by the end of today and the head laboratory technician continues to transition services into the C2C lab. This is all coordinated in conjunction with the C2C program staff but decisions are made and “actioned” by the leadership of Grace Children’s Hospital. This partnership relationship has been interesting. It’s new for GCH to have a partner as hands-on as C2C: the way we explain ourselves seems almost entirely novel in this environment – we aren’t donors, we’re partners; we don’t do anything for GCH, rather we do everything with them. This isn’t a typical aid relationship, but then again, we aren’t your typical aid organization.

C2C is committed to expanding access to critical primary care for maternal and pediatric populations, and the clinic is our vehicle. However, we don’t believe it’s enough to provide “access” simply via the facility. We don’t drop a clinic down, dust off our hands, and say “you’re welcome.” Far from it. In fact, having been in the trenches the past few months, I’d actually say that it isn’t until we drop a clinic that the real work begins. Once the clinic is set up and we begin evaluating the systems it absorbs (e.g. medical record keeping, pharmaceutical inventory management, efficiency/comprehensiveness of lab diagnostics), we start making recommendations for improvements. C2C’s entire bent is monitoring and evaluating the quality of the services patients receive at our facilities. This may only be our pilot, but eventually we want the C2C moniker branded with quality standards – marketing both to patient and partner NGO populations.

We’re in the early, early stages of second site development, and making certain that the emphasis we put on being hands-on around quality assurance is front and center in our preliminary conversations. There’s a sweet spot between micromanaging and donating, and we’re honing in on it. In the meanwhile, check out a few photos taken by Handy’s phone. Not great quality, and we’ll have to get him to take a break from setting up the lab to capture a few real shots.

NPR report on single moms struggling with camp life in Haiti.

In response to news of Hurricane Tomas, we’ve received a number of inquiries about the safety of C2C’s President and Chairman of the Board, who had planned to be in Port-au-Prince this week to monitor the newly open clinic (a clinic update to follow). I want to thank everyone for their concern – late Tuesday night the trip was canceled, so Liz and Keith are safely in Massachusetts.

The 1.3 million people virtually trapped in tent camps in Port-au-Prince, however, are significantly less-safe. Yesterday, the Haitian government made what some (I) might call an absurd public announcement to evacuate tent shelters and find secure housing. I mean no disrespect by this, but if it had been possible, wouldn’t many people have left the IDP camps months ago? I mean, it’s almost insulting, “We haven’t been able to provide an alternative, but we’ve figured out that tents aren’t a good long-term or hurricane-term solution and we advise that you get out of dodge.” Every man for himself, eh?

Because of the city’s poor drainage, streets strewn with rubble, and lack of trees or vegetation, flash floods could hit and rush through the dense tent camps. Also, cholera is a water-borne bacterial disease: poor drainage and sanitation plus a deluge of rain (estimated between 10″-15″) will complicate efforts to control the spread of the disease.

In sum, Liz and Keith have postponed their trip, and Haitians: look for high ground. A quick note on this: shipping containers make excellent housing structures. Check out Haiti Green Home.

Last week, C2C President Liz Sheehan and I were down in Port-au-Prince for meetings with partners at MSH, AmeriCares, and Grace Children’s Hospital. We’re rounding the bend of this marathon quest to open the first clinic, and with patients only a few days away – and an inauguration celebration planned for November 4th with guests including US Ambassador Kenneth Merten – we wanted to make sure everything was geared up.

Per usual, this was a great trip. Given all the back and forth we’ve been doing the past few months, I’m always pleased to see the lessons from one trip building upon the last. Each week I’m in Haiti I discover some new layer of complexity that temporarily confuses my Haitian world order until suddenly it snaps the landscape into focus and everything starts making a little more sense. For example, last week I was writing up patient exit surveys so that we can start digging at the heart of the “qualitative experience” in the C2C clinic, and one of my questions is “where else do you go for health information/care” and two of the options are “dokte fey” and “hougan”: an herbalist and male voodoo priest. Speculating about the frequency with which we’ll see either of those two answers pop up, I started talking to Handy Tibert, C2C’s Project Coordinator in Port-au-Prince, about Voodoo, which I’d previously associated with dolls and baby-eating ousted despots (See: Jean-Bertrand Aristide). This is a bit of what I learned (amplified by the incontrovertible source, Wikipedia):

Voodoo is everywhere. Haitians say that their country is about 80% Catholic, 20% Protestant and 100% Voodoo. Haitian voodoo’s what’s known as a syncretic religion: a religion that sought to reconcile opposing truths and faiths simply by combining them. Ask a Haitian for a photo of the voodoo lwa (deity) “Black Danbala” and she’ll show you a man I would call Moses. Ask for St. Peter and she’ll show you Legba. This makes sense: most Haitians’ ancestors were Africans brought to Hispanola with their own beliefs and were forced to adopt the Roman Catholicism of their slavers. The human goal of survival begets compromise; ergo Haitian Voodoo.

My interest with Voodoo is its pervasiveness. Everyone believes in its power; and some of it’s pretty dark. But mostly, it teaches people to think twice before being evil (again, except if you’re Aristide). Also, according to Handy, the person who’s right always wins the day; you’re only vulnerable if you’ve actually wronged someone. I mean, isn’t that the Catholic mantra? Religion’s a fascinating force, and I’m always curious about how it effects people’s perceptions of health and personal efficacy around its maintenance.

I worked in a community in Mozambique last year where some Christian missionaries were teaching poor Mozambicans that deep faith would cure their blindness, malaria, hunger, handicaps, etc. I wonder what voodoo’s panacea is? It’s no wonder that alternative, faith-based “medicines” enter communities lacking access to “Western” medical services with extraordinary power. So actually, I suppose what I’m curious about is how to get the two to work together. In communities where we start seeing the introduction of more modern care (I don’t know if that or Western are the terms I want to use here. Not concerned about being PC but accuracy…) how can we involve traditional healers in a way that’s respectful of the clout they have to generate support for modern interventions?

I’m not sure this will be something we see much of in Port-au-Prince, where modern medicine has an ample track record, and I need to do a lot more research into what Mambos and Hougans (female and male voodoo priests) actually teach about the cause and consequence of illness. Anyway, through these patient experience surveys, it will be interesting to learn about how they synthesize recommendations from traditional healers with the care they receive from C2C’s clinic.

GOOD LOOK: Bionic Lab from GOOD.is on Vimeo.

Below are three videos posted on the Hufffington Post today. The music that opens and closes each was a bizarre choice, so skip ahead to the interviews. It’s nothing new (nothing ever seems to be news from Port-au-Prince…let’s change that) but the lack of movement out of the camps and into “humane” livable housing structures rings especially loudly when the commentary comes from tent city residents themselves. Check it:

From today’s Financial Times:

The European Commission has thrown its weight behind the introduction of a financial activities tax in Europe, which would tax profits and remuneration at banks and other financial services companies, as it considers ways to raise money from the financial sector.

Officials in Brussels said on Thursday that the alternative idea – a financial transaction tax – was less suitable because of a “high” risk that business would simply move to other regions.

Depending on where the FAT (awesome acronym) revenue goes, this could be a great, though perhaps less “profitable” funding source for global development programs (See: yesterday’s post).