Haiti Dental Aid Trip
July 12 to July 26 2014
This narrative covers the second dental aid visit to
Haiti of the group For World Wide Smiles in July 2014. The first chronicle of June 24, 2013 contains
general background and history of Haiti that will not be repeated here. The previous trip was spent near the center
of the biggest city, Port Au Prince which differs greatly from the more rural
areas we worked in on this trip. For a
capsule history of Haiti and details of the previous trip read the 7/10 /2013 blog at http://jeffreymbernhardt.blogspot.com/.
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| http://www.nationsonline.org/oneworld/map/haiti_map.htm Our Dental Aid Mission took place in the towns of Port Salut and Port-a-Piment in the lower left bottom third of the map. |
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| Haiti's place in the Caribbean Sea http://www.aschoonerofscience.com/wp-content/uploads/caribean_map.jpg |
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| A hillside community in the outskirts of Port Au Prince |
With a wave of his hand in a vague direction the immigration officer directed us to the “immigration office” which we were unable to find. We entered the first office we could find
surprising its denizen who was obviously not an immigration officer. The
language we had in common were hand gestures and jumping up and down waving our
passports and entry forms. This was adequate
to be escorted to a well hidden office behind two successive doors that was the
administrative office for the immigration service.
In that office there was a cacophony of ink stamps being
pounded on piles of documents by four people.
It took a few minutes for the person who was obviously the boss to look
up from his frenzied stamping. We
explained to him that we were being picked up and taken to a hotel or parish by
a Catholic priest. After the second time
he asked us which hotel, it became clear that he just wanted something to put
down on the form and couldn’t care less if it was accurate or not. So we told him it was the closest hotel to
the airport which was the hotel we stayed in the last time we visited.
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| Street Scene in Port Salut. Note the three people riding the motorcycle entering the picture, a common sight in Haiti. What is unusual in this picture are the riders wearing helmets - something not usually seen in Haiti. |
Satisfied, he wrote down an address on all
the forms and his stamp moving in a blur stamped all the forms and our passports. Without looking up he handed back our
passports and exit documents. No sooner had
I had closed my hand around them he was back to stamping more papers on his
table. In retrospect, we could have
skipped the whole immigration line and walked into the office and no one would
be the wiser.
The country is very densely populated in all the areas we
traveled. In the course of a five hour drive from Port Au Prince to Port Salut, we saw crowds of people walking
in the streets continuously except for only a few minutes of the drive. It is hard to imagine how this many people
living so densely can earn a living in a country with so few exports or
external markets. Compared to Central
American countries we have visited agriculture is conspicuous by its absence.
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| Sherwin and Faria Shinn and our Haitian host negotiating our arrival arrangements for Port-a-Piment |
Our dental aid team this year consisted of Dr. Sherwin
Shinn, dentist and founder of the the organization, For World Wide
Smiles, Faria Shinn, his wife, Dr. Nannette Benedict, a dentist from Santa
Cruz, CA., Sandy Harms, an executive administrative assistant and friend of the Shinn’s who also lives in the Seattle area, Jacob
Bernhardt, Dr. Benedict’s and my son, Stacy Wall, a biology student at San
Francisco State University, and myself, Jeff Bernhardt. During the second week at Port-a-Piment, we
were joined by “Stami” Stamatoula Tsantes, a hygienist from Australia.
We first traveled to Port-Salut and worked in a functioning
clinic. We were allowed to use their
sterilization facility along with several rooms which had air conditioning. Within a few hours of starting to work more
people than we could conceivably work on in several days had shown up.
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| The Port Salute clinic where we worked the first week |
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| Sandy Harms and Jacob Bernhardt at the Port Salut Clinic. A brief break in the hectic day of managing the delivery of care. |
The first day at the Port-Salut clinic we had to choose the
rooms we were going to work in. We
picked out a building separated from the rest that seemed ideal, but were told
that this had been an isolation ward for cholera, and we might not want to work
there. The building was now unoccupied and
it was never made clear to us how thoroughly it had been disinfected, or if
there were plans to thoroughly disinfect it.
We agreed on two rooms at the edge of the clinic that had air
conditioning and where the patients could wait outdoors in a shaded area.
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| Our translator in Port Salut, Fleurigin Fenelon, Faria Shin, our host in the country Father Webert Merilan, and Dominique Dorsainvil, who was instrumental in getting us permission to work in the countryside and worked two grueling days as a translator. |
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| Dr. Nannette Benedict and Stacy Wall working on a patient in Port Salut |
For us this was a pleasant surprise since we
were able to communicate fairly well in Spanish, as opposed to French or Creole
where we were helpless without an interpreter.
The Haitians who obtain their higher education in Cuba or the Dominican
Republic are more likely to return to their country after completing their
education than those who train in the US or Europe.
We performed 522 procedures on 273 patients during our two weeks in Haiti. Given the staggering need for care we certainly felt moments of disillusionment at the infinitesimal impact we made on the millions who have no access to any medical care, let alone dental care. The inevitable breakdown of any method we have tried over the years to match the number of waiting patients to the number we can actually see inevitably leads to waiting patients who cannot be treated. The latest addition to our team, "Stami" Stamatoula Tsantes, broke down and cried at the full bench of people we were forced to abandon at the end of our last day of the mission. At the end of our allotted time, we had run out of most of our necessary supplies and could not continue our work under any circumstance.
We performed 522 procedures on 273 patients during our two weeks in Haiti. Given the staggering need for care we certainly felt moments of disillusionment at the infinitesimal impact we made on the millions who have no access to any medical care, let alone dental care. The inevitable breakdown of any method we have tried over the years to match the number of waiting patients to the number we can actually see inevitably leads to waiting patients who cannot be treated. The latest addition to our team, "Stami" Stamatoula Tsantes, broke down and cried at the full bench of people we were forced to abandon at the end of our last day of the mission. At the end of our allotted time, we had run out of most of our necessary supplies and could not continue our work under any circumstance.
An update on some of the measures of the country’s health
since our first trip last year are as follows:
Unemployment which was stuck at about 70% since the earthquake has
decreased painfully slowly to about 65%.
The government has financed the construction of many schools, and the
percentage of children between the ages of 6 and 12 who are attending school
have increased dramatically. The government claim is
that all children of eligible age are attending school but this seems to be an
exaggeration. The higher education picture has not changed much, and most
university degrees have to be obtained abroad.
The United States, Cuba and Dominican Republic were stated to be the
most common university destinations.
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| Our group this year minus Dr. Shinn who took the picture. From left to right, Stacy Wall, Sandy Harms, Faria Shinn, Jacob Bernhardt, Dr. Nannette Benedict, "Stami" Stamatoula Tsantes and Jeff Bernhardt Photo by Dr. Sherwin Shinn |
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| Dr. Shinn working on a patient in Port Salut |
We were in the capital only for a short time this year. During the two hour drive out of the city we
saw fewer tent cities, and fewer UN guard stations. Some of the UN guard stations we passed had been converted to depots for various commodities. One we passed was a depot for beer and soft drinks, but the UN logos and markings had not been removed. We have been told that the
situation in the capital has improved both by American news media and by a
wide range of our contacts in Haiti. It has
been unanimously reported that the crime rate has gone down and many schools
have been built for education through high school. Many governments and non-governmental agencies providing aid have become more sophisticated about seeing that their aid is not totally siphoned off into the pockets of corrupt middle men.
The atmosphere in the countryside is a lot different than
the atmosphere in the center of Port Au Prince. Even though we saw continual crowds of people the duration
of the drive into southwestern Haiti, the density of population in Port Au
Prince is much greater than in the countryside. There are streets
in which literally a thousand people between every corner crowd both sides of the road for blocks.
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| The south western part of the country is less crowded than the Port Au Prince area but there are always people on the roads. |
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| "Stami" Stamatoula Tsantes working on a patient in Port-a-Piment |
Desperation has led people to attitudes and behavior that are
extreme. On the benign side, arriving at
the airport the minute the new arrival steps outside one is accosted by many
new friends who offer to give you special help getting a taxi, carrying luggage
and any other of many services required to transit the fifty feet to the
taxi stands. Once you arrive at the taxi,
your new friend will give you a hug and then demand twenty dollars American for
their invaluable services. Only the
firmest refusal and even a carefully calibrated demonstration of anger will
stop their persistent demands.
This aggressive approach of demanding compensation for no useful service has obviously worked for some people in the past and is thus repeated. It only has to work once in a week or two for a family to support itself for that time. Once the showdown is finished and the outcome determined, (which in our case was no additional payment), in spite of high tension during the confrontation, incongruously are no hard feelings and everyone parts on civil terms.
We have long experience with high pressure sales, bribery and begging in Mexico and Guatemala, but the tenor in Haiti is much different. The level of desperation is greater, and the interactions last much longer than our experiences in other countries. Few dealings end in success so the people are tenacious and start with exorbitant demands.
Our hosts were buying some live chickens to bring as a gift to a family who was having us to dinner. There are vendors who have three or four live chickens they carry whose feet are tied with cord. They dash up to the windows of passing cars slowed by the congestion of crowds and cars in the town. The larger towns are quite busy and the roads jammed with people and vehicle traffic. It can take a half hour to get
through town. The negotiations for the chickens lasted about twenty minutes and two vendors ran
alongside the car for at least a half mile before agreeing on particular chickens and a price. The money and the chickens were exchanged through the window as the car moved with the flow of traffic at about 5 miles per hour. At one point before the sale was completed the negotiations got heated to the point that one of the passengers of the car hopped out to bargain and argue, and then both he and the vendor had to run to catch up with the car.
This aggressive approach of demanding compensation for no useful service has obviously worked for some people in the past and is thus repeated. It only has to work once in a week or two for a family to support itself for that time. Once the showdown is finished and the outcome determined, (which in our case was no additional payment), in spite of high tension during the confrontation, incongruously are no hard feelings and everyone parts on civil terms.
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| Drive-by chicken sales |
Our hosts were buying some live chickens to bring as a gift to a family who was having us to dinner. There are vendors who have three or four live chickens they carry whose feet are tied with cord. They dash up to the windows of passing cars slowed by the congestion of crowds and cars in the town. The larger towns are quite busy and the roads jammed with people and vehicle traffic. It can take a half hour to get
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| Patient Before Treatment in Port Salut Clinic Photo by Sandy Harms |
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| Patient After Treatment in Port Salut Clinic Photo by Sandy Harms |
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| Patient Before Treatment at Port Salut Clinic Picture by Sandy Harms |
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| Patient After Treatment at Port Salut Clinic Picture by Sandy Harms |
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| The operation room in the Port-a-Piment clinic. There was a second room dedicated to equipment setup and repair and sterilization, and which had the only reliably working sink. |
through town. The negotiations for the chickens lasted about twenty minutes and two vendors ran
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| Stacy Wall assisting Dr. Benedict in Port Salut |
Another time we needed five gallons of purified water
for our work at the clinic in Port-Salut.
The cost of the water was a little under one dollar US in Haitian
Gourdes. When the water vendor was presented with a US dollar
we were offered a 12 ounce bottle of water.
Our initial insistence that one dollar should buy five gallons was
brushed aside with a shrug and the offer of the 12 ounce bottle repeated. When my son and I both emphatically pointed at the written
price of 40 gourde (less than a dollar US) posted on the wall for five gallons, the merchant shrugged and pointed at a
5 gallon jug. We gave her the dollar and
she filled the five gallon jug. At the end of the transaction everyone smiled.
One of the members of our group went on a walk and passed a
National Police Station. There was a
policeman sitting on the curb in front of the station and as our colleague walked by he politely said “bonjour” and smiled.
The police officer asked him to stop in English and asked him where he
was from. When he replied “America”, the
officer nodded and commanded “I like your watch, give me your watch”. Our team member was not easily intimidated
and replied “no, it’s the only one I have, sorry but I can’t give it to you”. The policeman hesitated, then nodded and said
“okay, go on your way.”
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| Dr. Benedict pulling a tooth with Stacy Wall assisting |
For instance, the art of Haiti is of great esthetic and
creative value but essentially has no means to market. When one drives down the street it is common
to see a variety of art in a range of media such as oil paintings, metal
sculptures, painted sheet metal hammered
and cut into different shapes, all kind of craft boxes, jewelry and other more
unconventional mediums. It is hard to
imagine who is buying the art
as most of the time we have seen these stalls
there is no one around but other Haitians going about their daily routines.
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| Jacob Bernhardt and Jeff Bernhardt recording equipment shortages and documenting equipment failures to report to manufacturers who have little experience with their equipment in this kind of environment. |
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| Dr. Shinn and Faria Shinn finishing a restoration |
The desperation of the populace has led to a high crime rate. Many areas of Port Au Prince are too dangerous to visit. There were many areas where it was too dangerous to venture without armed guards and areas that even the UN used to only go in force. Last year we ventured no further on foot from our hotel than the UN guard tower could view easily.
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| Roadside repair in progress. Vehicles are generally repaired where they break down. Most mechanics go to the site of the breakdown. |
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| Edgard Bommier translating for Dr. Shinn and Faria Shinn in Port-a-Piment. |
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| Medical waste pit at the Port Salut clinic which was set afire every day. All manner of plastics, cans, and medical disposables packaging was piled into the pit every day. At the lower left the remains of a mattress can be seen. This site borders the ocean and aside from the pit itself could appear as a tantalizing destination on any travel poster. |
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| The incinerator at Port-a-Piment. Medical waste was burned at least once every day. The incinerator was installed by an NGO aid group. |
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| The incinerator in operation. We could smell the burning waste which included plastics, gloves, packaging and even used syringes anywhere within a quarter mile of the clinic. That said, the incinerator is the most effective means available of mitigating the danger of infectious waste. |
One of our dentists,
Nannette Benedict was unfortunate enough to have a sink she barely touched fall off
the wall, shatter, and a large chunk slice a two and a half inch gash in her
leg. We rushed to the hospital where we were to be working the next morning at shortly after 10pm the night before.
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| The cholera treatment and isolation ward at the Port Salut clinic |
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| The cholera treatment and isolation ward at the Port-a-Piment clinic |
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| The sign on the cholera isolation ward at the Port-a-Piment clinic |
When the doctor started to work on Nannette our son Jacob saw that the lighting in the operatory was inadequate. He retrieved a headlamp from our stocks and carefully placed it on the physician's head and turned it on while the physician was cleaning the wound and applying betadine solution preparatory to the anesthetic injection and stitching. The physician broadly smiled and nodded his thanks. We left him the headlamp and some spare batteries when we finished our work at the clinic.
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| The seven stitches that Dr. Nannette Benedict received after an injury sustained from a falling sink. |
was no insurance or payment required, all staff were involved in the delivery of care.
Although medical care is in extremely short supply for the populous of Haiti, what care there is seemed to be delivered efficiently and in a professional manner.
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| Dr. Ronald Charles who stitched Dr. Nannette Benedict's leg after she was cut by a falling sink. Dr. Charles had never seen a dentist before our visit. |
The physician on duty, Ronald Charles, was a resident who was living
at the hospital and was immediately available for an emergency. He was
supervised by the chief of staff, a plastic surgeon who inspected much of his
work. He received commendations on his stitching of Nannette’s wound from his supervisor the next day. Dr.
Charles was educated at a medical school in the Dominican Republic. As noted before, many Haitian professionals
are educated in the Dominican Republic and Cuba. He had just completed his rounds the year before and his work at the clinic was his residency.
The physician stopped in at our clinic that next morning to
check up on Nannette, and probably out of some curiosity who this stoic woman was
(he had expressed his surprise the night before on her remaining absolutely
still while he worked on injections, debriding and stitching) and if she
was really a dentist. He had never been to a dentist before. Their roles were subsequently reversed as he
had his mouth examined.
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| Dr. Nannette Benedict and Stacy Wall performing one of many extractions |
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| The solar electricity generation panels at the Port-a-Piment Hospital |
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| Colorful buses. The bus in the foreground has a soccer theme. The bus in behind it has a religious theme. |
The second clinic we worked at had a 12,000 watt solar
generation system with battery backup.
It was provided by a variety of aid agencies and easily covered the
clinic’s electrical needs since they had no air conditioning. There we were able to work as late as we
wanted and as our work wasn’t causing any financial hardship. We and
other medical aid groups who worked there were appreciated by the staff as
well as the patients.
The availability of electricity without cost resulted in enthusiasm and cooperation of the hospital staff. This is
a good example of appropriate and constructive aid with long term beneficial
consequences. Aside from the installed
solar generation base Haiti imports all of it energy needs at great cost except for charcoal. There is easily enough sun to supply Haiti’s
entire populace with power, but the most recent statistics that I was able to
find, only around 30% of Haitians had access to electricity. Even without storage if decentralized solar and wave generators were put in place many areas would be electrified that now have no electricity.
In Port-a-Piment our group split up and stayed in different facilities. Four of us stayed at the clinic, and the other four stayed in the town of Port-a-Piment at the home of the Catholic priests who sponsored us.
The priest's childhood home had no electricity or running water. The home was set up for running water and electricity, in that there were electrical outlets, sinks and flushing toilets, but water and electricity had never been installed. The toilets were flushed with buckets of water collected during the day. Showering and bathing was performed by pouring water from the buckets over us with smaller handled pitchers provided for this purpose. One house in the block had a well, and the neighbors were considerate in only gathering water from the neighbors home during the daytime. As a result, when a large number of guests were present which happened frequently, the water ran out before morning and the toilets could not be operated.
The climate was very hot and humid. Paradoxically, the temperature actually rose at night, reaching into the nineties Fahrenheit with 100% humidity. We had to sleep in mosquito tents as there were several kinds of mosquitoes that frequented the night. We were concerned about malaria, but it seems that the most
common mosquito present at night was not a carrier. Here is where simple fans could make life much more pleasant. A simple breeze would have made the night temperature bearable, and the mosquitoes are not strong fliers and would be unable to frequent areas with fans.
As it was, the air at night was commonly absolutely still, especially in the prelude to the frequent rain storms. The onset of a storm would be accompanied by a slight breeze, and more spectacularly numerous lightening strikes and thunder coming from many directions. I found it impossible to sleep
in the humid heat, and got up and wandered around in the night. The sounds of the night were fascinating and many times difficult to understand what was making them. One night a beautiful pure tonal bird call was followed by the snarling of a dog. As if the dog had attacked the bird the snarling cut off suddenly. There was a moment of silence followed by the pained yelping of the dog. Whatever had made the original pure tonal call turned out to be more than a match for the dog. Other night sounds included braying donkeys, grunting pigs, roosters calling all night, the running of a few loud generators, fighting cats, various insects and cars passing through the town honking their horns. The last was particularly baffling as we could not figure out why every car passing through the town after midnight would honk their horn continuously until they passed the town limits.
On our second day at the second clinic another team member
joined us. "Stami" Stamatoula Tsantes is a hygienist from
Australia who had learned about Dr. Shinn’s organization from her uncle who attended the last ADA meeting in New Orleans. Dr. Shinn came to her uncle's attention as he was awarded the Humanitarian of the Year award. Stami's presence increased the number of patients we could see significantly.
We saw 147 patients in Port Au Piment, and performed 293 procedures. At this site we saw fewer hospital staff and we had a translator committed to helping us who shared our purpose. The translator in Port-a-Piment displayed an idealism and dedication to
improving the conditions in Haiti that inspired us. He was a physical therapist by training, and on the hospital staff, but took time off from his regular work in order to assist us. His command of English was excellent, and he had been educated in a special program that had been sponsored by Loma Linda University who had set up a satellite facility in Port-Au-Prince in order to train medical personnel.
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| Our translator extraordinaire, Edgard Bommier, in Port-a-Piment |
In Port-a-Piment our group split up and stayed in different facilities. Four of us stayed at the clinic, and the other four stayed in the town of Port-a-Piment at the home of the Catholic priests who sponsored us.
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| The inverters, battery chargers, breaker and other control circuitry for the solar electrical generation system at the clinic in Port-a-Piment |
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| Our sleeping quarters in Port-a-Piment |
The climate was very hot and humid. Paradoxically, the temperature actually rose at night, reaching into the nineties Fahrenheit with 100% humidity. We had to sleep in mosquito tents as there were several kinds of mosquitoes that frequented the night. We were concerned about malaria, but it seems that the most
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| Stacy Wall set up a very direct method of communicating with our patients. We could just point to the appropriate sign on the wall in English and Creole which had the most used statements and questions we would need to say or ask. |
As it was, the air at night was commonly absolutely still, especially in the prelude to the frequent rain storms. The onset of a storm would be accompanied by a slight breeze, and more spectacularly numerous lightening strikes and thunder coming from many directions. I found it impossible to sleep
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| One of a myriad of colorful insects |
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| Battery backup for the solar electrical generation system at the clinic in Port-a-Piment |
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| The staff quarters at the clinic at Port-a-Piment. Two members of our team stayed in this facility. |
We saw 147 patients in Port Au Piment, and performed 293 procedures. At this site we saw fewer hospital staff and we had a translator committed to helping us who shared our purpose. The translator in Port-a-Piment displayed an idealism and dedication to
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| Edgard Bommier interpreting for Stami during a dental hygiene session |
Health Department Posters Displayed in the Port-a-Piment Clinic
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| We were not aware the elephantiasis was endemic in Haiti until we saw this health department poster. |
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| This viral disease, Chikungunya, transmitted by mosquitoes has spread to the United States. Unlike Malaria, many of the local people in Port-a-Piment reported contracting this disease. The disease is spread by the same mosquitoes that carry Dengue Fever and these mosquitoes bite in the daytime. |
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| Common family transportation throughout the country. |
While we met many idealistic and honest brokers trying the help the less fortunate, the general level of corruption is high and taken for granted. This level of blatant exploitation and self interest is frustratingly universal especially among the elite who could be instrumental in leading their country out of the morass it is in. However, if we are honest with ourselves we have to admit that American CEO's would act similarly in these circumstances . We see in the United States identical narrow focus on protecting one's self interest and the interests of the corporation one is in charge of. This is routine with no thought of the impact to the larger society. The difference is in an affluent society the impact on the masses of people is not as obvious or extreme and many times it is good marketing to act ethically. Furthermore, in Haiti the biggest business is foreign aid and marketing the poor to attract aid is the largest single portion of the Haitian GNP. This does not only involve Haitians, but a larger number of foreign partners and businesses. See my previous blog at http://jeffreymbernhardt.blogspot.com/
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| Inside the cave at Port-a-Piment. There are almost three kilometers of chambers in this cave. |
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| A cave mouth at Port-a-Piment |
http://www.allempires.com/article/index.php?q=conflict_haiti_dominican ). The difficulties in the past between the two countries certainly color the interactions of today.
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| Cell and relay towers outside Port-Au-Prince. We found few locations where there wasn't cell service and we rarely experienced dropped calls. |
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| Dr. Shinn and Faria Shinn evaluating a patient at the close of a long work day |
The overriding question is can this country advance beyond a poverty stricken nation with the majority of its populace unemployed, uneducated past primary school, the worst health status in the hemisphere and foreign aid as more than half its GNP? Are they in an irreversible downward spiral, or as tragic, a static state from which there is no possible escape? The sight of endless miles of milling crowds of people in the street as we drove through Port Au Prince for two hours does not serve the forces of optimism. The level of corruption and inefficiency visited on the country from inside and outside does not bode well for the herculean efforts required to surmount the colossal obstacles to improvement.
This is not a just a test for Haiti, but for the whole of humankind; a measure of the prospects of the future of civilization. Technology and the interconnectedness in the 21st century insure that the consequences of the poisons of suffering and deprivation seep widely and contaminate even the most isolated enclaves of wealth and privilege. The corruption and greed that has accompanied the world’s efforts in aiding Haiti reflect not so much the situation in Haiti but the ability of the industrialized nations to function adequately within the boundaries of their own efforts at democracy.
