Sunday, August 1, 2010

Back home again

By Michelson Dorime, EMT/ Pre-Med

Photo by Tamara Fitzpatrick

Day 1 is in the books…

I arrived yesterday (Sunday July 18th) to very little change in the country. Piles of rubble, dilapidated houses, deep road-cavities still litter Port-Au-Prince while vendors, tap-tap drivers, bourettiers, and motorcyclist navigate to find opportunities to eat. Words cannot express the disappointment I felt when I saw that little rubble has been removed, the number of tents have not decreased, and ownership/initiative on the part of the government has not taken place. (Deep sigh). Nevertheless, it feels good to be back home. I am always impressed by the speed with which dormant memories come rushing back as I take in familiar scents and sounds. The sight of Fresco (the rough equivalent of slushies) vendor, his cart bell, and his chant of “marchand fresco, achete fresco-fresco vendor, buy fresco” immediately reminds me of the taste of the shaved ice topped mango flavored syrup childhood treat.

I was happy to see that the flow of patients at L’hopital Adventiste D’Haiti has decreased significantly. Every square inch of the hospital yard used to be covered with tents in which patients with severe maladies and in different stages of recovery took refuge. Now, the yard is clear enough for young boys to run around and play soccer. Today, the ED staff saw a total of 80 patients whose case severity ranged from pediatric cold and flu complaints to adult hernia complaints and a rare hydrocephalus case. Once I got passed the excitement of seeing a rare case, it was sad to realize the mother must have an incredibly difficult time taking care for her 2 year old child with this horrible condition. Ultimately, there was little any of the hospital staff could do for the child, but luckily we are not the only show in town. The child was referred to Medishare, another medical NGO, where he will have a shunt placed in his brain so that his CSF can drain down to his stomach. Needless to say, I was excited to learn this!

At the morning meeting for the hospital staff, a young man from the Loma Linda Team lead the meeting with a sermon of sorts which tackled the question; what exactly compels a person to leave the comforts of his home, support of his friends and family, and security of his country to come to Haiti to serve people whom he has never met. His message particularly resonated with me because it was a question that I was wrestling with because: I spent the last of my money on tickets to Haiti even though my mountain of bills grow everyday; my mother, sisters, and brother have a growing list of needs with which I would like to help; And I would like to take some time to finish up medical school applications and enjoy the last bit of my summer. Why am I here? Even though I was born here, it goes beyond a patriotic sense of duty or a need to be some sort of hero because I often send clothes, goods, and money to friends and family in Haiti. And, I am painfully aware that in reality heroes are often the ones who sacrifice too much and die too early. As such, I am not rushing to fill that job position. So, what am I doing here?

The young man from the Loma Linda Team made a really good point: In the states a day filled with tough cases/tasks which leaves you frustrated and physically taxed is generally considered a bad day. However, the same day in Haiti is universally considered a good day. I suspect that the reason for the difference has to do with the gratifying task of desperately trying to match lives with resources in impossible situations. Because of the great need in…well, everything, it result of most efforts are immediate and pronounced. It’s incredibly gratifying. After reflecting on that point, I have decided that I am here not necessarily to save lives. Far from it, I am here to inspire actions. Nothing more, nothing less. So, the currently problem of infrastructure and security which is preventing the country from creating viable systems to govern the politics, economics, and social aspect of the country can be solved. It is, in fact a very real possibility. If a boy with no money and armed with just a blind sense to serve can do it, then certainly a country of resilient people can pulled themselves out of poverty.

Day 2 was crazy…

We started administering the MVF, Mirror Visualization Feedback, which helps amputee patients alleviate pain from their phantom limb. Sounds crazy, right? You should see it in action. The cause of phantom limb pain has to do with brain signal firing between the missing limb and the somatosensory cortex. I am still trying to understand the specific mechanism myself. However, the idea is that the patient places the good limb across from a mirror and the phantom limb behind the mirror. The patient then looks into the mirror on the side with good limb and makes "mirror symmetric" movements (i.e. clapping hands). Because the patient is seeing the reflected image of the good hand moving, it appears as if the phantom limb is also moving. Through the use of this artificial visual feedback it becomes possible for the patient to "move" the phantom limb, and to unclench it from potentially painful positions. It’s important because patients often complain about pain/discomfort in their phantom limb.

With this therapy, a patient can look at the reflection of their actual limb in order to manipulate their phantom limb. Well, I was skeptical too, even though the top MVF specialist in the country told me all about it, but it is only today that I became a believer. We found an 85-year old female patient living on the hospital grounds who lost her left leg in the Earthquake. We pitch the idea to her and, honestly to my surprise, she was up for it. I thought she would dismiss the idea because it sounds crazy. We gave her a mirror (on which she immediately wanted her name written so that nobody could steal it) and I started explaining it to her. This woman was hands-down the most optimistic human being I have ever met.

When we asked her how she felt about losing her limbs, she responded, “so many beautiful people lost their lives, I am very lucky to have lost only my leg.” I was absolutely stunned by her selflessness. I cannot say that I would feel the same way if I lost my left. Actually, I am pretty sure that I would absolutely be bitter if I was in her position. But, not her. Instead she is humble and grateful. How? I would love to be become that selfless, humble, and grateful. I started to explain to her how to use the mirror. It was tough at first for her to understand but when she told me “mwen ka senti lot petit mwen an- I can feel my other child” referring to her phantom leg, I knew that she got it. Folks, let me tell you, MFV is powerful! Watching her play with actual limb and then feeling it in her phantom limb was incredible. Awesome!

For the rest of the day, I vitalized and triaged patients in the ED. My clinical skills have really improved. I am quite good with the manual BP cuff and my differential diagnosed skills have in particular have improved. I am the importance of new event versus chronic events, interviewing the patient from head to toe, what to look and listen for with certain complaints. Seriously, I can’t wait to do this on a full-time basis! We saw a total of 92 patients today and it felt like it. No rare cases today.

On a completely different, I have not been able to contact with Yanick, a patient for whom Michelle gave me a package (clothes and such) to delivery. The three phone numbers are no longer valid. I will investigate the address tomorrow.

Day 3 was another high volume day in the ED…

but this time it was much less intense because there weren’t visitors just hanging out in the ED, random passer-bys cutting through the ED to get to other departments of the hospital, less friends of friends lobbying staff to be skipped to the head of the queue. Instead, there was an organized triage area equipped with a seating area, a number system for adults and children, and Kenny (Premed kid from San Diego who speaks Creole pretty well) was taking vitals and while I took history. As a result, there was a nice flow of service, which made the entire environment so much more pleasant.

Most of the cases were not medically impressive, however the patients themselves were inspiring. Mothers and the elderly particularly touched my heart because they not only were physically strong (minus some wear and tear) but they were mentally strong as well. For example, one 30 year old woman told me that she has 4 children ranging from age 4mo to 12 years old who she feeds by selling some of the food she makes. This way, she is able feed her family and earn a little money. As smart as that is, that’s not even the best part.

When I asked her where she gets the ingredients to cook the meals, she told me she exchanges the some of the meal for the ingredients. So, with one given meal she is able to feed four children, earn some money, and barter for ingredients. That is nothing short amazing! Are you serious, I asker her? She, in a cocky voice says, “Oui. Mange’m bon kon sa-yeah, my food is that good.” We shared a laugh over her entrepreneurial spirit and my amazement and we both independently moved on. That’s how it is in Haiti; amazing things happen and then you just move on. It doesn’t make headline news, no books are written about, and no studies are done to analyze it. For better or for worse, everyone just keeps moving.

Later in the day, I met the nicest 68-year-old man who had waited all day for an EKG to rule out cardiac problems before his hernia surgery. It was the funniest exchange because it was just a little bit before the team was due to go home. He comes up to me and says: do you know how long I have waited here?” Despite my best efforts, I just couldn’t hide my true response; “Am I on a game show?” Seriously, who opens with that question to a total stranger? So, we exchanged a few laughs about how long the wait can be and in no time at all we were Homies. I did feel bad for him because all the man needed was an EKG. He waited 8 hours for an opportunity to get an EKG. Even though I was 99 percent sure that the hospital did not have a functioning EKG machine I went to look for one anyway. I figured that’s the least I can do for him. I searched in closets, bathrooms, X-ray, Ortho, and the wards (equipments are often in just the weirdest places.). Just as I was about to call off the search, I had the idea to check out the OR. To my surprise, there was an EKG machine the size of a code-cart sitting in the corner of OR supply closet. I was never so happy to be wrong. By the looks of it, it has been here before Haiti gained its independence. Nonetheless, I turned it on. To my surprise, it responded. The display prompted with the typical questions: name, DOB, ID #, and etc. Even more, when I popped its hood, there was paper, which looked pretty fresh. Now, we are cooking with gas, I thought. Getting it back to the ED was a project because it was missing a wheel.

So, I got my MacGyver-ON. I taped a think piece of carton where the wheel use to be and did a wheel-slide shuffle down the corridor. Needless to say my new Homie was excited because before I left he was complaining that he could not bare the prospect of going home empty handed. The procedure went down as smooth as a baby’s bottom and most importantly the result was normal. He could now have his surgery. I even printed out an extra copy for his personal record. He was definitely happy which made me really happy.

However, not long after a family brought in a patient from the General hospital who had a cancerous tumor which was beyond the point of treatment. They told Rich (ED Resident at BMC), Raja (Internal Medicine doctor from NJ), and I that they had spent the last few days going from hospital to hospital with hopes of finding somewhere that could “cure” her. How cruel? I could not believe that someone in their travels did not tell them that at this point they only make her comfortable…there is no cure for her. (Deep sigh). So, Rich and I pulled the family into the Ultrasound room (the size of most standard cubicles) and explained to the daughter and husband that she is beyond a cure. As you can imagine, they had a tough time accepting the news because the daughter (a nurse by training) suggested chemotherapy and surgical procedures, which she thought could be done in order to save her. The only worse than telling a family that their loved one is dying is repeating it over and over again. Both Rich and I thought that chemotherapy in this case was not a good idea because although it may add more time to her life, it will definitely reduce her quality of life. Her last days should not be spent vomiting from chemo. Ultimately, Rich prescribed vicodin to deal with the pain and the family agreed to return with her home where she can live out the rest of her days comfortably. In an interesting note, the family also decided that they were not going to tell her that she has terminal cancer, with which I agree. Even though I am sure she can feel the finality of her condition, there is no need to confirm it. Its much more human, considering the situation and available resources to allow her to have some hope, no matter how slim, that she recovers from this bout.

Tough day!

Day 4, my passport got stolen…

Last time I remembered seeing it was in my fanny-pack as I stopped on the way to the hotel. I stopped to buy some douce (a solid mixture of shaved coconut, caramel, and brown sugar). It was in the pocket behind loose bills and change. After buying the douce, I threw the fanny-pack over my shoulder and marched home with the team. When I got to the hotel, I went to the bar where I chatted and had a drink with a team from Minnesota. Not too long after I arrived, I took both my backpack and fanny-pack back to my room where I put them in their usual place (in between the two twin beds). That’s the last time I remember seeing it. This morning I could not find it anywhere. I spent the early part of morning tossing my room, talking to staff, and retracing my steps. Nothing! It got stolen, which is not the part that bothered me. Instead, it was the act of steal from those who came to help that offended me. I was never concerned about being stuck in Haiti or anything like that because I had copies of my passport in my backpack and knew that at the very worst the solution to this problem would require a trip the to US embassy. Ultimately, I joined the medical team at the hospital after leaving instructions at the front desk if it is found.

I didn’t have the same zest today in the ED. As you can imagine, I could not stop thinking about my passport. I am pretty sure that I took it back to my room, but I am not 100% certain. Why would anybody steal my pack? Scratch that. I know why. It’s a poor country and they could probably fetch $50-$60 Haitian dollars for it that can then by meals, clothes, transportation, and all sorts of other necessities. So, I guess that I get why it was stolen from a person who is there to help. The rest of my day was spent triaging patients in the ED and translating/interpreting for the MVF program. Like I said before, I just didn’t have the same zest. I worked till 430pm and then went back to the hotel. I was feeling pretty bummed.

Just as fast as it was gone, word got to me that my passport was found on the shelf of the staff bathroom of the hospital. What?! How did it get there? I used on the way to the hotel (from the hospital). I had lots of questions but ultimately I was happy that it was found and I would not have to make a trip to the US Embassy. Not much longer than I got the news, Matt (ED resident from UMDNJ) delivered it to me. Who found it? Was any non-staff person seen walking away from the bathroom? Was my pack found as well? I had so many questions. It turns out that Pediatric ED resident found it in the women’s staff bathroom along with a couple tubes of derma-bond, but the pack itself was not found. I was angry for a brief moment because even though I understand why someone would steal my pack. I felt that it was wrong considering the work being done and the fact the fact that I am native to the country. Anyway, that ordeal is over and I am never ever letting my passport leave my sight. Whereas before, I used to leave it in my hotel room in the evening and in my pack during the day, now it goes with me wherever I go. Hell, if I had some, I would duck tape it to my leg. So relieved!

The rest of the evening went well. I had lambi (conch) with rice and beans for dinner with the crew. I had a great conversation with Kiyana (MSW from Michigan) and shared some jokes with my roommate Eric (PMR MD from UMDNJ).

Day 5, I couldn’t find some duck-tape but I did find….

Scotch tape. I tried taping the passport to my legs, but the tape was ruining the cover of the passport and hurt my leg because securely taping it to my leg required several rounds of taping which in the end proved to be too tight. The pockets of my cargo shorts are a much better option moving forward.

The day was spent in Leogane, a province 30 minutes west of Port-Au-Prince, at an NGO called The Johannitier which helps amputees by giving them physical therapy, psychosocial services, and prosthetic limbs (mostly legs). The work that they are doing is amazing because the culture is not one, which is traditionally handicap friendly in any reasonable way. Often times, the physically-challenged are teased mercilessly and removed from the any kind of important social role, regardless of the type of amputation. So that means, men who were once providers for their family are often reduced to hermits who simply watch life go by, women who were once caretakers of their family often become a shell of their former self. The stigma that comes with being handicapped in Haiti is serious because it often interpreted as being helpless. The rationale for that is the amputee is no longer able to work in order to bring money for the family or able to do chores and care for the kids to maintain the family. It’s an ugly situation, which is the reality of so many in post-earthquake Haiti. This organization directly tackles this problem like a champ by engaging the amputees in such a way offers them an alternative means of continuing to be productive members of their families.

I was part of the MVF team (Sandy, Eric, Frantz, and Tamara) today. It was again powerful to see if the relieved faces of men, women, and children with missing arms, legs, and even a part of a foot who had been dealing with pain in their phantom limbs since the earthquake. Eric led the training while I translated into Creole and took information for case reports in English. Jumping back and forth between two languages orally while writing in one of the languages is tough. It often took me a while to understand in which language to speak and/or write. In total, we trained a total of 19 PT techs, treated 18 patients, and donated approximately 70 mirrors to the organization. It was a good day!

Day 6, Saturday is the Sabbath…

in the Adventist faith. So, the hospital was not really open for service. There were a few staff available for emergency cases, but generally, from what I understand, the hospital does not get emergency cases nowadays. I found this interesting because it begs the question, where do patients go on Saturdays. I certainly don’t think that illnesses or injuries stop on the Sabbath. Hmm? I slept in till 7:30am and then spent the rest of the morning saying good-byes to patients, hospital staff, and volunteers. The rest of the day was spent canvassing the tents of families who still lived on the hospital grounds in hopes of finding and delivering Michelle’s package to Yanick and her family. I had been trying all week to no avail. The phone numbers I had for the family were no valid, as the operator told me every single time. The address I had was wrong because the house number does not exist. I figured that I would at the very least talk to the patients because Yanick once lived on the hospital grounds. I talked to a few families but no luck. I then I had the idea to speak to Frantz who is the Supervisor of the translators and has a strong pulse on the daily activities going on in the hospital. If anyone would know the whereabouts of Yanick, it would be him. He did not disappoint. As soon as I showed him the picture, he recognized her and pointed me straight to her tent. Luckily for me, she was still living on the hospital grounds. I was elated to deliver the package because it would have been a major disappointment I was not able to find her. She was very grateful for the clothes and the letter from Michelle. In addition to saying “mesi,” she said “Mwen santi rey√®lment espesyal gen yon Ameriken ki ap pense de mwen epi voye m 'kado – I feel real special to have an American think about me and send me gifts.” Needless to say, it made her day. Mission accomplished.

Day 7, the return home…

is going to be rough. I have a 12:10pm flight out of Port-Au-Prince, a 6:40pm connecting flight in Miami, and if all goes well, I should arrive in Boston around 10 o’clock. Not bad all in all. I am not looking forward to Miami airport because it’s so damn big. Seriously, it literally goes on forever. I remember once the fam and I traversed its vastness in full sprint in order to catch our connecting flight. I have despised since then.

Re-entry is always tougher than expected because of the readjustment. So many people have impacted my life in the last week. The most of which is an 8-year-old boy named Jean Junior. He has been dealt some rough cards so far in life but yet you would never know it as he is always wearing a big, bright smile. He loves learning English, running around, and being a little boy. I am proud to have been part of the means that allowed him to forget his tough situation. I don’t cry often but Jean Junior made me cry on a daily basis because he is that special.

I am hoping to continue the trend of waking up early, maintain some perspective in life, and taking time to enjoy the simple things. With that said, I cannot wait to see La familia. See you soon, Guys!

My Haiti Diary

Photos and entry by Maureen Mahoney-Barraclough

I have been home from Haiti for over a week now. Every day I discover that I am not really all together home yet. Just like my UFGH teammates, many everyday occurrences trigger vivid memories of my time in Haiti. Paved roads, driving my own car, variety and abundance of food, clean water from the tap all remind me of how comfortable (and grateful) I am. But my memories also inspire me since the Haitian people have none of these amenities and yet they were joyful, generous, loving, and appreciative in all my interactions with them.

Also, the several times I was able to walk from our hotel to the hospital, I waved to a family that lived in a tent near our hotel. In a modest tent labeled USAID, I noticed a father and mother, two teenage girls, two young girls, and a very young boy living in a tent that might be 10 foot square, at most. Their tent looked sturdy enough, but it was located next to a garbage heap. In the morning, the father was cooking over an outdoor charcoal fire. The girls were dressed neatly in green and white uniforms walking to school. When I passed by another time, the father was sitting on the stone bench outside the tent reading to the very young boy. The mother was preparing some kind of green vegetable in a towel in her lap. I wondered in amazement where they get clean water, where they bathe, how the girl's uniforms look so clean and pressed.

As I reflect on this, my son and husband are tent camping in Yellowstone. Their tent is in a beautiful pristine environment. They have lots of food available to them, camp showers and toilets, and most importantly, if it gets too rough, they can just drive home to all our routine comforts. I don't wish lack of comfort for anyone; I just wish that everyone everywhere could enjoy the stability and comfort that we do. Through their example, I am reminded every day to be joyful.

As I drive into the paved parking lot for Urgent Care in my hometown to get treatment for my pesky cough, images of the Salle d'Urgence at the Hopital Adventiste in Carrefour, Haiti materialize once again and disorient me. The Salle d'Urgence is a large light brown canvas tent erected over a cement pad, maybe 20x30 feet. There is an open door at either end that provides some circulation in the 100-degree heat and 100 percent humidity. Gray woolen blankets are spread loosely on the cement floor, art supplies are stacked on the wooden benches lining the walls of the tent, our Haitian translator is writing new Creole words for us, and best of all, about 20 children are eagerly awaiting commencement of today's art projects and circle games.

Our translator, Roosevelt, (very proud of his name honoring our 32nd US president) teaches us Creole words like pliye (fold), papye (paper), penti (paint), koule (color), seezors (no explanation necessary). Creole is a lyrical language, the very cadence and inflections of which make me smile.

All this comes to mind, just by seeing the Urgent Care sign here at home. How I wish I could be in Haiti now. I missed my last day of the Arts and Community program with the children because I developed a nasty cough. I was overcome with disappointment as one of the doctors recommended that I stay at the hotel that day because my cough was probably contagious. She was right; I could not bear to spread my virus to the children. However, I was overwhelmed with happy tears that evening when my teammates, Susan, Chia-ti, and Kiyana brought me a special gift from all the children. They presented me with a packet wrapped in a piece of a silver Mylar blanket tied with pipe cleaners fashioned in a heart shape. Inside the wrapping, was a collection of cards handmade by all of the children. Each card was filled with love and compassion and colorfully decorated with flowers, trees, boats, houses, abstract designs, and even a few drawings of the American flag. Their gift to me gave even deeper meaning to the universal observation that we always receive more than we give on humanitarian missions.

You know, I may never return all together from Haiti. But that's okay. I am grateful to be one of the fortunate ones to be on the receiving end of all the love the Haitian people have to give.

Following are several of my stories about the Arts and Community projects we carried out as part of the UFGH team at the Hopital Adventiste.

Chalk Mural

Yesterday, we discovered the unoccupied tent, Salle d'Urgence. It seemed the perfect site for our UFGH Arts and Community program. It is situated between the hospital building and the small tent city on the hospital grounds; ideal for the hospital patients and those living with their families in the tents. By now, we were already getting to know some of the children. James Ley, maybe 2 or 3 years old with one leg in a plaster cast and his equally young buddy, Stephan Joseph are always together. There's Kerlanda, moving skillfully with her walker and one leg in a brace, 7 year old Loudmia and Mirlanda, long-term patients at the hospital and wheelchair bound, Berlynksi, always smiling and waiting to greet us and Jean Junior, whose father was a hospital patient suffering with typhoid fever. In fact, Jean Junior lived in his father's hospital room with him since his mother had died previously. Then, there's Pierre and Andre, probably at least 18 to 20 years old and wheel chair bound. From toddlers to twenty year olds, the children fill the bare tent with delight.

There are no tables or regular chairs in Salle d'Urgence, but the hospital staff provided us with thick gray woolen blankets donated by a well-intentioned, but seemingly misguided charity. You never know, though; they were valuable to our program! We covered half of the cement floor with the blankets and left the remaining half available for the children to create a floor mural, or "flooral" with colored chalk. In order to open a dialogue with the children, we suggested they begin with drawing pictures of their family and what is important to them. The children embraced the project eagerly. Those who could knelt on the cement floor and drew detailed pictures of themselves and family members, homes, banana and mango trees, and lots of boats on the ocean.

We provided wooden boards and paper to those children in wheelchairs so they could participate, too. Then, as a happy murmur rippled through the group they all suddenly started drawing perfect images of Haiti's national flag. Laughter and chatter filled the room as the children covered the floor and themselves with brightly colored chalk. When they finished, we asked each of them to tell us about their drawing. Francesca, one of the young girls, perhaps 7 years old, described her meticulous drawing of a girl flanked on either side by a lovely flower standing in a flowerpot—as tall as the central girl. She said through our translator, this is me in the middle and this is my brother on this side and my other brother on the other side. I felt a wave of grief wash over me as she went on to explain that her two brothers died in the earthquake. The moment became more beautiful when several other children took an interest in her drawing and gave her an opportunity to talk about her loss. I know now that whenever I see a big flowerpot with a tall flower, I will think of Francesca and her brothers.

Story Boxes

Well, 'story boxes' is a name we made up to describe a project that was inspired by an article about Haitian altar pieces that the UFGH Board members shared shortly after the earthquake. We discussed how altar pieces are rooted in Haitian vodou culture and represent that which is very meaningful to the creators. We observed that sequins and found objects from nature were common materials in altar pieces. Also, altar pieces are never quite finished; they can be augmented with new mementos indefinitely. It seemed relevant to their culture to create something similar like a small decorated box in which the children could keep meaningful items and bits from nature. The story box would be an intimately personal project that is never quite finished just as the healing process is ongoing.

I remember that day as Loudmia and Mirlanda arrived in their wheel chairs to Salle d'Urgence anxious to get involved in today's activity. Loudmia was dressed in a pretty pink and green sundress and her hair normally full of colorful barrettes was wrapped in a scarf. Loudmia is in a wheelchair because her left leg needed to be amputated after the earthquake. Apparently, this day she decided she wanted to work on the gray blankets with the rest of the children. To my amazement, she lifted herself with her delicate but strong arms and launched herself to freedom with the other children and right into my heart. With her gleeful determination, my heart belonged to Loudmia and all these children.

As we all gathered together, the children looked inquisitively at the stacks of plain white cardboard boxes each with a cellophane window in the lid. We explained that this box is for them to decorate as they wish and to keep forever—filling it with found treasures and keepsakes. Each child was given a box and access to sequins, sparkling flowers, decals, inkpads, and 'crazy glue' (Creole for any kinds of glue!) The children were engaged for hours meticulously gluing sequins and sparkling flowers and rubbing decals over the entire surface. As I watched them excitedly exploring the magic of decals and the beauty of sequins, I was reminded of the sparkling water of the ocean visible from our hotel. I reflected on the stark contrast between the smooth crystalline water of the bay and the heaps of broken concrete homes still piled precariously in the city. I wondered if this might be a clue as to why most of the children drew pictures of boats on a calm surface of water.

I watched the children transform the plain white boxes into glittering treasures that seemed a metaphor for their bright and sparkling perspective on life. The little treasures they would eventually store in the box would be in a safe place but open to their friends through the little window. In fact, they later went on a nature walk with the team to collect special things from nature to keep in their boxes.

Hospital staff shared with us the next day that our beloved Jean Junior whose father was sick with typhoid tucked his box under his pillow at night.

Mosaic Mural of Haiti

On this morning, Roosevelt, our translator listened intently to our description of a mosaic mural. It is composed of a grid of index cards, each card having a piece of the overall outline of the mural's image. He smiled knowingly and said, oh a 'mystery puzzle'! I hadn't thought of that phrase before, but he was exactly right! Without knowing what that final image is, the children color and decorate their individual card. Here in the US, a mosaic mural is typically created with an important word like HOPE or a symbol important to the students. It is always something meaningful to the group.

Normally, our team would ask the children for their ideas and what they want to include in a project. However, part of the fun and magic of a mosaic mural is coloring the individual index cards without knowledge of the final image. A mystery puzzle! So, our team pondered amongst ourselves appropriate ideas for the image. First, we spent several days getting to know the Haitian children with other art projects in the Salle d'Urgence. We had all witnessed their enthusiasm and love for their country. So, we formulated the idea to make a mural of their country. Preparation involves making a mural-sized outline with a thick black marker of the image that will become the final design. Next, one covers the image with index cards lined up neatly. Each card's grid location is penciled on the back of the card. Then, one tapes all the layers to a window and carefully traces the outline on the cards with a black marker. At that point, one can remove the cards, hide the full design and shuffle and stack the cards for the children to color. I blithely volunteered to enlarge the map of Haiti from a 2-inch outline in the cultural materials provided by our UFGH Director, Zola. I quickly realized what a challenge it would be to enlarge the map in a form recognizable to the children with our limited resources. I felt a little uncertain, so we added the word HAITI boldly outlined in the ocean area of the map, just to be sure.

I remember clearly the children's faces, curious and a little confused, as Roosevelt explained the project to them. They accepted the challenge cheerfully and set to work. In spite of their anticipation to see the final product, they took their time in coloring the cards; some were abstract splashes of color, others were detailed drawings of families, houses, and native trees. And of course, there was a card with a boat on the calm water. Finally, as the children attached the individual index cards to the large blank piece of paper according to the grid location marked on the back of the card, they were excited to discover the outline of their country. The word HAITI helped! Once we enjoyed a few minutes marveling at their creation, Susan, my teammate, and our translator, Roosevelt, asked each of the children what they loved about their country and what they wished for their country. Their responses were poignant and also practical. They loved the native fruits and their families; they wished for school to start again, a good government for Haiti, better water and food, and for Haiti to be strong. Roosevelt and Susan recorded the responses and the team made a border of the children's wishes surrounding the map. Then, the children precociously turned the discussion around and asked all of us what we loved about Haiti and what we wished for their country—a touching example of the dynamic dialogues we experienced every day with the remarkable children of Haiti.