Monday, February 27, 2012

By Dr. Carroll

C’est la Vie in Soleil

by John Carroll, MD - - February 26, 2012
Photo by John Carroll - Cite Soleil
The following post is a description of two interviews I had today with young ladies that live in Cite Soleil in Port-au-Prince. My main questions for them revolved around cholera.
But first of all, I want to give a very brief summary of where I think the public water comes from in Soleil. These few sentences will be boring, but they are important. Water engineers and smart people out there, please help me if this is incorrect in any way, and I will correct my mistakes. More than ever in Soleil, access to good water can mean the difference between life and death.
The water that is pumped to Soleil is from a water reservoir in LaPlaine which comes from the water table (anba woch) and this water is pumped underground by pipes to the large imposing water tower sitting at the entrance to Soleil off of Route National 1.
Two white PVC pipes run along the northern side of the water tower. One carries water up and the other carries water down to pipes below the ground and through these pipes water is pumped to “basins” spread all over Soleil. A ‘basin” is a series of pipes and spigots that people have access to in the slum. People come to these basins and fill up white buckets of water, put them on their head, and walk back to their shack. It is up to them to treat their own water with Clorox or aquatabs because it is my understanding that the water from LaPlaine has not been treated.
Another important supply of water to Soleil are water trucks that transport water in to the slum. I don’t know enough to say much about this water’s origin, its purity, or its potability. But these points would not be hard to answer.
The importance of this “chain of flow” of water is to figure out the best places to test and treat the water for cholera.
This is Saturday, February 25, 2012, and there is no pediatric clinic today in Soleil. So my goal was to go the Boston neighborhood in Soleil to check out information regarding cholera. I wanted to find out if the people in Boston have any means to fight the oncoming fourth wave of cholera when the rainy season starts again very soon in April.
I met Natalie the secretary who works in the pediatric clinic in the back of Soleil where I work during the week. Natalie is a great gal and lives in Soleil at Soleil 19, just several blocks from the clinic. She and I were going to walk the mile through the slum to Boston but she had some news for me.
Natalie calmly informed me that there was “a war” going on in the streets between the gangs of Boston and Beleko. These are two large neighborhoods that abut each other in the northwest part of the slum. Natalie said that one of the gang leaders in Beleko was shot and killed two days ago and things were still dangerous in the streets.
She advised me to stay in the back part of Soleil where we were and I could talk to her neighbors about cholera. That seemed like fine advice to me.
So we walked through the little pathways of Soleil to Natalie’s mother’s one room shack and sat down inside the room. It was very clean and not too hot.
Natalie said in a hushed voice that we were sitting right next door to the Soleil gang chief’s shack. I asked her about him and she said he was benevolent to the people around this neighborhood and she referred to him as “Patwon”. She also said the people in Soleil are not as mean as the warring people in Boston and Beleko.
I told her I wanted the Soleil people’s perspective on cholera. I asked Natalie to talk to some people close by that had suffered from cholera or had family members suffer from cholera. She concurred and said “no problem”. Natalie said it would not be hard to find people very familiar with cholera.
She stepped outside of her mother’s place and called out the name “Venise”. A few seconds later a young lady walked in carrying her three-month old baby and sat down in a white plastic lawn chair in front of me.
Venise--Photo by John Carroll
Venise did not know her own age but she states that when she was 19 years old her mother threw her out of the house in Jeremie and somehow she ended up in Soleil. (Jeremie is a city about 10 hours by public transportation from Port-au-Prince.) She does not know how many years she has been in Soleil. She does not have an electoral card or an identity card, and her birth certificate is lost somewhere in Jeremie. Venise appeared to be about thirty years old.
Venise told me that she had never been to school and does not know how to read and write. She has no job and depends on her neighborhood (lakou) in Soleil to support her. Her neighbors give her and her children some food when they have extra. Typical food for Venise and her children are rice, pureed beans, ground corn, and some meat sauce. If the neighbors have no extra food that day, Venise and her children don’t eat.
She lives in a one room shack near Natalie’s mother and her neighbors pay her 550 Haitian dollars (about 70 dollars US) rent each six months to her landlord.
Venise has five children ages 14, 8, 4, 2 and the happy three-month old she was holding. The two oldest children are from one man and the three youngest from second man. She reports the same as most Haitian women in this social strata about her childrens’ fathers: “Yo pa occupe nou…” which means that the men do nothing for her or her kids.
Venise, with the help of her lakou, had her two oldest children in schools in Soleil. But their father took them with him moved them into a tent city in Fort National. However, the father’s girlfriend was beating the two kids so bad, a neighbor in another tent took them in and is letting them sleep and eat whatever she can find for them. Neither of the two kids are in school now.
Venise no longer sees the older kids in Fort National and she has the three youngest children with her in Soleil.
Venise told me that one day in November, 2011 when she was 9 months pregnant with the baby she is holding today, she abruptly started having diarrhea and began to vomit. And so did her eight year old daughter Mimi who still lived with her. They both went to St. Catherine’s Hospital Cholera Treatment Center (CTC), which is just a couple of blocks away, and was run by Doctors Without Borders-Belgium.
Venise said she went into shock quickly and required 23 liters of IV fluid over several days. Mimi required only a couple of IV liters to feel better. They both survived because the CTC was so close and they went quickly. And the CTC was well stocked with supplies and had people who knew what they were doing. Venise delivered the three-month old baby girl a couple of weeks later.
Doctor Without Borders-Belgium left St. Catherine’s in December and the hospital is now run by MSPP (Public Health Department of Haiti). When Doctors Without Borders was in charge of St. Catherine’s, there was no charge. But now it costs five Haitian dollars (about 75 cents) for a dossier to be made and for a consult with a doctor. If one is admitted to the hospital, MSPP charges one hundred Haitian dollars (12 US dollars) for the use of the bed no matter how long the patient’s stay is in the hospital.
I asked Venise where she gets her water now. She gets her water from some public pipes here in the neighborhood (basin) which comes from the big water tower that sits in the entry way to Cite Soleil. One bucket of water costs one gourde (a few pennies).
She said that she did not treat her water with Clorox or Aquatabs before she got cholera and she doesn’t treat the water now either because she has no money. So she and her kids are drinking this water which is not really clean.
I asked Venise if she is afraid of cholera. She said she is afraid and that “it is coming back.” When I asked her how she knows cholera is coming back, she said “everyone says it is”.
I asked Venise if she was happy with her life in Soleil. She said “Yes, because I have no other place to go.”
Manushka--Photo by John Carroll
The second person I talked to was a polite young lady named Manushka. She said she is 24 years old.
Manushka was born and raised in Soleil and lives in the same neighborhood near Soleil 19 near Natalie and Venise. She has no children but she is the oldest of seven and she feels responsible for her six younger brothers and sisters.
Manushka told me that her mother died in 2000 and stated that her mom “was sick all the time”. Her father buried her mother in Drouillard Cemetery in the slum. This funeral and burial cost her father quite a bit so Manushka could not continue in school and she never went back to school. She has four years of education and can write her name and do simple math.
She told me that 13 months ago her father died from cholera. When I asked her what year that would have been, she did not know.
Manushka said that her father did manual labor on Kafou Aeropo (Airport Corner) and drank water while he was at work. He became sick on a Monday and was taken directly to Doctors Without Borders-Tabarre and died on Wednesday. They did not allow visitors in the cholera tent and so she was unable to see her father until after he died. He is buried in the Drouillard Cemetery too.
Manushka seems very bright.
I asked her if she knows why Haiti has cholera. She said no and then turned the question around on me and asked me if I knew why.
I told her that it was inadvertently introduced here by the MINUSTAH soldiers in central Haiti in 2010.
She just slightly smiled and said nothing.
I asked her if she ever heard this explanation and she said no. I asked her if MINUSTAH was doing a good job in Soleil and she said no. She said they are not doing much good work and that they abuse people by hitting innocent people in Soleil. I asked her if MINUSTAH still shoots in Soleil, and Manushka said no.
When I asked her if the Haitian National Police (HNP) abuse people she said yes. She said they tear up ID cards and hit people in Soleil. However, she said that the HNP needs to be supported over MINUSTAH because the “Haitian police are us…they are from here.”
I asked Manushka if she went to church. She said no. When I asked her what religion she is, she said that she has no religion. I asked her if she was mambo (worship the devil) and she still replied no. She said that she doesn’t believe in God…that she is an atheist.
I asked Manushka if she was happy with her life here in Soleil. She said no because of all the “gang fighting and people running”.
When I asked Manushka where she gets her water, she said it is from the same pipes (basin) where Vanesse gets her water. But Manushka treats her water with Clorox.
When I asked her what Soleil needs, she replied clean water, clean streets, and education for young people. She said that she would like to go to a professional school (I think she meant vocational) and that if she learned something and got a job that would be good for her and good for Haiti too. She would like to become a cosmetologist.
I asked Manushka if she became sick where she would go for medical care. She stated that she has nowhere to go since MSPP took over St. Catherines and charge 25 gourdes for a dossier. And she said that she has no money for any medication that would be prescribed anyway.
When I asked Manushka if the Haitian government was going to do anything to help Soleil, she said no. She said that the Haitian government doesn’t respect the young people of Soleil or think that they have any importance, so they are ignored.
She said the only help Soleil gets is from foreigners coming with trucks of water and Clorox. She viewed this as the only good thing being done for the people of Soleil.
After talking with these two young ladies, Natalie and I left her mother’s room and walked back through Soleil towards the pediatric clinic. I stopped at a basin where women and children were collecting water coming from the pipes. I asked the women if they put Clorox in the water and they said yes and they asked me to buy them more Clorox.
So here are my questions and comments about the water and cholera in Soleil:
Could the water be tested coming from LaPlaine to see if it is cholera free? Can it be tested as it comes out of the spigots at the local basins in Soleil just before it flows into the white buckets?
Can there be a constant supply of Clorox and aquatabs for the hundreds of thousands of people who live here?
Can thousands of liters of Ringer’s Lactate (and IV tubing and setups) be brought to St. Catherine’s NOW so it is ready in one month for the wave of cholera that is to hit.
Can nurses be hired by MSPP for St. Catherine’s CTC NOW so they are ready to begin work. And can cholera community health educators start circulating through Soleil NOW educating people about what is most likely coming back in a few weeks.
Doctors Without Borders and other NGO’s did all they could and saved many lives in Soleil with their CTC. But they are gone from Soleil now and St. Catherine’s Hospital and the CTC are definitely not ready right now for a big hit of cholera patients.
It is time for other agencies to kick in. The Haitian Prime Minister just resigned the other day and there is much political fighting high up in the Haitian government. This instability could easily disrupt the flow of cholera materials that is needed to save lives in Soleil.
The two girls I interviewed are typical of the people of Soleil. They help each other as much as possible under almost impossible circumstances. They want to live as much as we do. We have 16 months of experience with cholera now in Haiti and need to learn from our mistakes. Stopping cholera deaths in Soleil is completely possible. We just have to have the will.
Water Canal--Cite Soleil
John A. Carroll, MD