Have yourself a Haiti-focused Christmas (or Chanukah if you hurry)

In time for the holiday shopping season and with inspiration from the "shameless commerce division" at Car Talk, I thought I would share a few Haiti-centric ideas for your gift giving and/or receiving list. The list is definitely limited so if any of you have a recommendation to add please share them in a comment.

Books - There are some fabulous books by Haitian and Haitian American authors and some good books about Haitian history out there. Here are a few that I have read:

• Any of the short stories, novels or memoir by Edwidge Danticat a contemporary Haitian-American author who is even Oprah-endorsed
• Graham Green's classic novel The Comedians which is set in and around an actual hotel in Port-au-Prince hotel during Papa Doc days. It's a great story and if you read it, I'll send you pictures from the real locale so you can see the pool where the dead body was found.
• The Serpent and the Rainbow, a very engaging non-fiction book written by a botanist about his search for the plants used to induce Zombies in Voudou. Wes Craven (a Wheaton alumni) made a film version a few years ago ....haven't seen that and heard it isn't great in the way it portrays Haiti and Haitians....but definitely recommend the book. I'm in the middle of it right now.
• Most of the books by or about Paul Farmer are worthwhile reads - The Uses of Haiti will give you the most background on US-Haiti relations, Pathologies of Power and Infections and Inequalities address global health and human rights issues more broadly, and Mountains Beyond Mountains tells you Paul's incredible life story to date in which Haiti plays a starring role. Paul has very particular views on human rights & development and Haitian politics that I'm still trying to develop my own response to....but all the more reason for you to read his work and then we can talk about it!

Music - Music is at the core of Haitian life and culture. Haiti has some unique musical genres including rasin, konpa and troubadour....many of which are highly danceable. (If you are in or around Manhattan, check out the Caribbean club SOB which has a weekly night featuring Haitian performers). I have absolutely loved exploring the live music scene here in Port-au-Prince and hope there will be time for much more of it when my work life gets a little less crazy. Some of these bands are based in the USA and you might be able to purchase their music online. If you check out the web links and can't find a place to buy the music, let me know and I can pick it up for you here in P-au-P. Here are a few of the bands I've seen so far ....

• My favorite musical experience to date was seeing the up-and-coming artist Belo in concert during my first week in Haiti in 2006. He is a fantastic song writer and performer whose debut CD Lakou Trankil talks about things that matter including social injustice...and love. His work doesn't fall into a single category but if you like Reggae or folk or just good music you will like Belo. Not sure how easily you can find his CD in the US yet, but you can check out one or two music videos posted on youtube.
• RAM plays rasin music which is one of the styles most connected with voudou. The group was founded by Richard Morse the present owner of the Hotel Olaffson, the setting of Graham Greene's novel, who is the US-born son of a famous Haitian musician mother and an Ivy-league professor father. Almost every Thursday night they play a live show at the hotel that starts around 11pm and continues into the am hours. I'd try to describe it but you just kind of have to experience it. It's going to be one of our first stops if my brother Emil ever comes to Haiti.
• Konpa is probably the most popular form of Haitian music - there is this one rift that you can hear over and over in almost any konpa song that immediately gives its origins away. I don't think that most konpa is musically amazing....but I do think that most Konpa is totally entertaining...especially if you have someone to dance with. Krezi and T-Vice are two boy-bands who are played all the time on the radio. I prefer Djakout Muzik's sound.
• Troubadour music has a classic folksy storytelling quality that I really like. I've heard this guy named Wooley play several times and really love his music. He is accompanied by a women with a deep captivating voice....but I haven't managed to find them online yet.

Arts and crafts: Of all the country's I've experienced, Haiti definitely has the strongest tradition of painters. All over Port-au-Prince you see canvases with bright paintings by copycat artists for sale on the road sides. Many of them are good in their own right. Sequined flags used in voudou are considered collector's items. Metal art made from oil drums is another Haitian craft that I personally love.

• Haitian painters can be found through a number of online galleries based in Haiti and in the USA. Here are a few links ArtMedia Haiti, Galerie Macondo , MedaliaArt . It's fine art and the prices reflect that.
• A number of non-profit artisan sites have Haitian metal art and sculpture. Check out these sites: Ten Thousand Villages, A Greater Gift , Pacha World

Donations: For those who have it all, sometimes the best gift is nothing material at all. There are a number of wonderful Haitian and international organizations doing good things in Haiti who would gladly receive a donation in the name of your loved one. I will try to update this if I can but here are a few that I know of and would personally choose to support: Beyond Borders, RNDDH, Partners in Health,

Drinking my words

Back in September I wrote a post lamenting the loss of Gimmee coffee and expressing my rather reluctant committment to drinking local coffee when I am in Haiti. Well, I am happy to report that I was wrong to be so pessimistic about the potential for actual enjoyment of my morning coffee here in Port-au-Prince. Haitian coffee is good stuff...very good stuff. Turns out it was the nasty, boxed, imported-from-France*, UHT milk that was ruining a wonderful cup of joe during my previous stints here. I am now enjoying my coffee the same way I like my chocolate - sans milk - and now 6am doesn't feel quite so early as it it did before.

(**This is merely saying that it is imported from across an ocean. It is NOT intended to be a patriotic political statement in the line of "freedom fries" served in the US Congress.)

Selective memory

Saturday, December 1 came and went for me this year just like any other day. I had breakfast with my friend Lindsay, helped my housemates put on a baby shower for the couple we live with, and then tried to do a little work around the house. It was a good day – but I always wish it would feel like something much more than that.

December 1 is World AIDS Day. A day to remember the millions who have died, and to gather hope for the 40M people currently living with HIV as well as the more than 5 billion people in the world who are not infected. Yet this year, even though I work in an HIV-focused clinic, the day passed for me with nothing more than a music video on MTV acknowledging the significance the day holds.

On a more personal level, Sunday, December 1, 2002 is the day in which I was involved in a terrible accident on the way to a World AIDS Day event sponsored by World Relief Mozambique. Early that Sunday morning our double cab pick-up, filled with more than a dozen teenage volunteers in the bed of the truck, was hit head-on by a semi trailer on a road leading out of Maputo, Mozambique. Six people in our car died very gruesome deaths, including the driver who was seated next to me.

Every year, I try so hard to think of a way to remember that day in a way that seems adequate to the pain that the others in that car felt, a way that honors the family members who lost someone they dearly love, and in a way that acknowledges my own gratefulness to God for the fact that I walked away with little more than a sore back and a few small scars on my arm.

Yet somehow each year the day just seems to slip by. No one else ever reminds me of it. I sometimes try to tell other people the story, but each time I tell it, it sounds less and less like my own story and more like something I heard from someone else. Just as my physical scars are fading, the memories of the intense images and feelings I experienced on December 1, 2002 are also fading.

In post 9/11 USA, there was a sudden surge in bumper stickers, window placards, and t-shirts bearing the words "Never Forget" over a silhouette of the twin towers. I've always been disturbed by this. In the context of the Iraq war, widespread fear of terrorism and immigration battles, they invoke a need for revenge, a sense of prolonged bitterness and justified resentment. In such a context, we must begin to forget. Otherwise we will never move forward. We will never seek or find peace with those we labeled as enemies on that day. In the Christian faith, we talk about God’s forgiveness that is accompanied by totally forgetting our wrongdoing. Forgetting can be as powerful as remembering.

I’m beginning to accept the truth of this in my own story – it is good that I have begun to forget what happened on December 1, 2002. Otherwise I might spend the rest of my life in constant fear of the next truck coming down the road. I might, as some days I have wished I could, just plant myself in a rest stop and refuse to go on.

December 1 is World AIDS Day and it will be World AIDS Day for the rest of my lifetime and likely that of my children and grandchildren too. I am thankful that the day is marked in a way that will always remind me that it is part of my story and the story of millions of others affected by HIV/AIDS. However, I am also letting myself forget some things about that day too. There are, God-willing, too many roads still to be traveled and many more days to be both remembered and forgotten.

A brief tribute to the end of a Heidkamp institution

Missing Thanksgiving in Chicagoland was not something to be taken lightly this year. November 22, 2007 market the end of an institution - the Emil N. Heidkamp Senior Family Thanksgiving.

The first time I ever sat around a single table for a Thanksgiving meal was about two or three years ago when I was living on the East Coast and joined a friend's family for their celebration. Before then all I knew of Thanksgiving was a church basement in the northwest Chicago suburbs filled with at least a dozen tables and 50-100 Heidkamps. depending on the year.

It wasn't just aunts, uncles and cousins (of which there are plenty- my Dad is one of 12 kids), but great aunts, great uncles and second cousins. It wasn't just one turkey - it was two or three. It wasn't football - it was my great uncles Dick and Don reciting the Cremation of Sam McGee. It was poker at one table and Trivial Pursuit at another. It was balancing spoons on your nose. It was being one of the only kids in the room who couldn't say the Hail Mary. It was lots and lots and lots of noise.

A few years ago one of my best friends from high school was at a church event when she heard another woman describing her family's plans for Thanksgiving: subterranean gathering in a a Catholic church, two twin great uncles who used to be priests and then married nuns reciting poetry. My friend had to ask. The woman was my cousin Nicole.

My parents said almost 120 people showed up this year to mark the end of an era. I'm really disappointed I couldn't make it 121.

Picture pages, picture pages

Here are some photos with captions of happenings in recent weeks including birthday celebrations, jet setting to south Florida, and Thanksgiving dinners.

For those who would like to see and hear more about my work at the clinic - those photos and stories will come in the months ahead. So far the work has been heavily administrative and I generally try to avoid taking photos, especially photos I would post, without actually having a relationship of some sort with the person in the photo.

AIDS in America - a Haitian disease?

In 1982 the Centers for Disease Control (CDC) officially described AIDS as the disease of the "4 H's" - homosexuals, hemophiliacs, heroin addicts and Haitians. Not yet knowing that HIV is transmitted through body fluids, the CDC labeled an entire country's population as being at risk of HIV for no other reason than their country of origin.

In 1982, some of the first cases of HIV outside of the US and Europe were reported in Haiti. It was an extremely professional and progressive team of Haitian researchers from the clinic where I work who recognized and documented karposi's sarcoma, an infection associated with AIDS, in a group of young Haitian men. No reports of similar cases had come in yet from Africa or Asia - so it was assumed by the CDC that AIDS was a Haitian disease (not that Haiti was quicker to identify and report an emerging global epidemic).

Significant consequences accompanied the labeling of AIDS as a "Haitian" condition by the US government. In the 1980's and 1990's people of Haitian descent in the United States were prohibited from donating blood. The tourist trade in Haiti collapsed partly under the stigma of AIDS and has not yet recovered.

25 years later, being Haitian is no longer considered an HIV risk factor, but some researchers are still trying to point to Haiti as the source of the AIDS epidemic in the USA. There has been quite a bit of press recently about a study that examined the genetic material from five HIV-infected Haitian who immigrated to the United States in the early 1980s. They were looking at the mutation patterns of the virus in these five people. Based on their limited analysis, the authors jump to a conclusion that it was a single Haitian immigrant the late 1960's who was responsible for bringing the disease to the US. The authors were some of the same people who worked at the CDC in the early 1980's....is this a coincidence or might they have professional reasons for wanting to justify their previous policy decisions to blacklist Haitians?

Check out this NPR interview with Dr. W. Johnson the Director of the Division of International Medicine at Cornell's Medical School who is a close friend and mentor to the director of the clinic where I work. He has some fantastic sound bytes that question the validity of the study including its methods, its conclustions and implications for racism and bias in medicine.

People like to talk about science as being unbiased but the reality is that scientists usually have an easier time finding what they set out looking for than what they are not expecting to see. Unfortuanately in the case of Haiti, the consequences of such widely publicized biases continue to be devastating as it perpetuates the completely unfounded racism, fear, and mistrust directed at many Haitians and Haitian immigrants ,,,, so much so that several members of the Haitian community have even threatened a law suit against the researchers who published their conclusions.

UPDATE - Here is a link to a commentary on the study above by Edwidge Dandticat, a wonderful (Oprah endorsed) Haitian-American writer. Read her editorial and then check out some of her fabulous books. Here is a link to a Dec 8 editorial in the Miami Herald about the study by the former USAID Haiti director.

In a spirit of thanksgiving...with a little lamentation too

Many of you have heard me describe my seasons living outside of the US as living in the extremes - where the highs are higher and the lows are lower than I ever experience back in North America. While at times I do find life in my homeland a bit hectic, I definitely find my life here exhausting..... in the best just-danced-three-hours-at-a-Haitian-boy-band-concert sort of way and in the worst I-want-to-stay-in-bed-with-the-covers-over-my-head-and-never-speak-to-anyone-ever-ever-again sort of way. I used to think of myself as an emotionally stable person..... I used to think of myself as a lot of things before this whole PhD process started : )

I'm reaching the 6-week mark of being back in Haiti so in order to get folks up to date on the personal side I thought I'd just make a laundry list of my thanksgivings and lamentations. I will let you decide which are which. Feel free to overlook, skim or dig in.

...6:30 am mornings with Haitian coffee and Henry Nouwen...5;30 mornings with Haitian coffee and too many unwritten emails....6am mornings crying on the phone to my parents when i probably missed my Haitian coffee.....two weeks of a respiratory infection.....five days (and counting) with conjunctivitis....zero days of GI disfunction.... two weeks with a completely dead computer....one week (and counting) with a no-longer-dead but now virally infected computer .... one day (and counting) with a lost mobile phone and no other way to reach or be reached by people in P-au-P.... finding out that the one person I really really wanted to have join our project team but never thought would be available is actually looking for a new job...conducting an entire meeting in Kreyol and realizing that everyone understood almost everything....finally feeling like things might be coming together even if I still have a pit in my stomach just thinking about it... being granted a corner of space in the clinic.....being able to open the door to that space after three weeks of constant harassement to get the keys ...trying again and again to actually get a call through to my advisor but it just not happening....my advisor offerring to squeeze in a last minute 2-day trip to Haiti...four baby hats knitted with four more in the que..... friends who send birthday packages where the shipping vastly exceeds the material (but not the spiritual) value of the contents ....7 days of waiting for someone to get to the post office to actually pick up the package...birthday cakes make by neighbor who is a baker extraordinaire.... birthday emails sent by family and friends.... joint birthday celebrations pulled together in 48 hours that include the death of a goat and lots of rice and beans.... the Haitian friend who call at just the right time to remind me why borders are meant to be crossed.... five adults living in a two bedroom house... four weeks sleeping on a futon mattress on the floor.... five nights in my own bedroom while housemates travel to the US... two nights alone in a hotel on A-1-A beachfront avenue.... airtunes speakers in the living room....a renewed sense of music as food for the soul....girls night out to a Haitian boy-band concert with my friend L who is the younger sister of a Wheaton classmate and who welcomed me over to her place on 30 minutes notice last Tuesday night to cry, laugh and drink beer on the patio even though my eyes were pink and oozing puss...... impromptu weeknight pancake dinner and arrested development screening with housemates and mcc'ers.... discovering I have the same random $13 housewife dress as my Canadian friend M thus confirming the fact that I knew we were meant to be friends from the moment I met her and her husband.... vacationing friend K with a fabulous apartment who is letting me stay there for the two weeks he is away...housemates who plan and pull together an amazing Thanksgiving dinner and don't mind that I spent most of the day locked in a bedroom trying to work instead of helping them cook or clean....a visit to Haiti by one of my best friend's fiancees G which ended with dinner with another Baltimore acquaintance who happened to run into G at the Haitian hotel's bar....being reminded again and again that even unprayed prayers are answered...... and that there are a lot of prayers yet to be prayed before this is all through....

Finding the yellow brick road

Flipping channels in a Fort Lauderdale hotel room last week (more to come about that), I caught a glimpse of that cinema classic The Wizard of Oz. It was the scene where they discover that the yellow brick road had not led them to a great-and-powerful wizard but rather to a dude from Kansas whose hot air balloon went astray. Yet, even in his less than great-and-powerful condition, he showed them that along the yellow-bricked way the scarecrow had gained wisdom, the lion had gained courage, the tin man had gained compassion and Dorothy had gained a renewed appreciation for her community of origin.

I was struck by just how well their little story captures this PhD experience. I know this is a little cheesy but bear with me. It's late here and I should just be sleeping.

Almost every day, I have daydreams of two years from now when I reach the Emerald City of my "B exam" - the day I defend my final thesis and officially receive my degree. The reality is that I am still somewhere back in Munchkinland dumbly declaring that I am not in Kansas anymore.

I still have to find my travel companions (i've finally identified a team of 4 people who will hopefully be joining me in the next week or so). map out the yellow brick road (finalize my research proposal by January and defend it an my A exam back in Ithaca in February) and then skip along that shimmering path while watching for lions and tigers and bears (spend 9 months implementing the intervention and collecting data plus a year or so to analyze and write it up).

I won't go as far as comparing my thesis advisor to Belinda the Good Witch (she is however both kind and extremely intelligent), but I am hopeful that when I arrive at the B exam , the traits I've acquired along the way are not so different those Dorothy and her companions found - plus a bit about nutrition and a Kreyol vocabulary.

Anyone got an extra pair of ruby slippers they want to DHL to Port-au-Prince?

Layers of meaning

My personal computer has been out of comission for over a week. There have been a number of blog-worthy happenings since then but most of them involve sharing photos and so must wait until I get my Picasa program back up and running. It seems like a good time to share some of the Creole proverbs that I learned a few weeks ago in rural Haiti.

Kreyol is the Creole word for Haiti's local language. I usually describe it as what it sounds like French people are saying when heard by a non-French speaker (e.g. moi) with a number of words of African/English/ Spanish origin mixed in.

Creole's richness and complexity comes not so much from the words themselves but rather in the way they are combined to create meaning. When my urbanite Haitian friend heard a blan friend of mine using Creole proverbs in his daily speech she said that his Creole was more genuine than her's.... which is probably true. Literally speaking Creole is not the same as really speaking Kreyol.

I've plateued a bit in my own language learning now that I can speak enough to survive. I am hopeful that I will kickstart it again with some lessons sooner than later. Speaking and understanding Kreyol is essential to understanding Haiti.

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
Fanm potomitan la via. Women are the pillar of life.

Rayi chen me di dan'l blan. Hate the dog if you see white teeth. (I'm trying to remember the explanation for this one....I think it's to only hate if provoked e.g. dog is snarling at you.... but I could be wrong)

Yon sel dwat pa manje kalalo. One finger alone cannot eat okra.

Woch nan dlo pa konnen dule woch nan soley. The rock in the water does not know the pain of the rock in the sun.

Men anpil, chay pa lou. Many hands, load is not heavy. (Sound familiar?)

Blans with birthdays

I was a "gringa" in Honduras, a "mzungu" in Kenya, and now I'm a "blan" in Haiti. Being labeled by one of these local terms for foreigners is somehow simultaneously endearing and annoying.

Haiti's term "blan" translated "white" is the name with the most obvious roots of the three. (People say that all foreigners in Haiti are called "blans" regardless of their skin tone, but I met a Nigerian here who says she hasn't been called one yet). However "mzungu"remains my favorite because supposedly its roots are in a Swahili verb which means "to go around in circles"... which isn't so hard to imagine a bunch of British colonialists doing in East Africa....

Anyway, my social world so far in Haiti has been has been much more "blan" than in my other seasons living outside of the US. I am hopeful that I will develop some stronger Haitian ties in the days to come but I must say that it's quite a nice group of 12 or so fellow foreigners that I have met so far.

The crazy thing is that 33% of my little social circle was born in the period between October 31 and November 9. Four birthdays in 10 days translates into a lot of frosted cakes. It kind of makes you wonder what it is about Scoprios that brings them to places like Port-au-Prince, Haiti for such a time as this?

Maybe I'll do a little epidemiological investigation at the joint birthday celebration we are planning to have this weekend. Not quite sure n=4 is a PhD worthy sample size...

PS - I must say I was quite excited about the Mango-Lime Carrot Cake I made for a birthday dinner this last weekend. I know the temperatures are dropping where most of you are ....but here's the recipe in case you get spring fever during the long winter to come.

Mango Lime Carrot Cake
2 cups all purpose flour
2 teaspoons baking powder
1 1/2 teaspoons ground cinnamon
1/2 teaspoons nutmeg
1 1/2 teaspoons baking soda
1 teaspoon salt
2 cups sugar
4 large eggs
1/2 cup mango nectar
2-3 Haitian key limes – zest + juice (about 1 full-size lime)
3/4 cup vegetable oil
2 cups grated carrots
1 81/2-ounce can crushed pineapple in juice, well drained

Preheat oven to 350°F. Butter and flour 13x9x2-inch metal baking pan. Combine first 6 ingredients in medium bowl; whisk to blend. In a separate large bowl, beat 2 cups sugar, eggs, mango juice concentrate, and vegetable oil until smooth. Beat in dry ingredients; stir in carrots pineapple and lime zest + juice. Pour batter into prepared pan. Bake cake until tester inserted into center comes out clean, about 50 minutes. Cool cake completely in pan.

Lime frosting: 1 pkg cream cheese, about 1 cup powered sugar. 1 lime (juice + zest)

More than a chance of rain

As many of you may have heard by now there has been a tropical storm sitting over the Caribbean the last couple of days. I actually learned it was an official tropical storm from a friend whose boyfriend in the US emailed her the satellite images.

For me here in Port-au-Prince that translated into 48 hours of constant rain, no internet or phone access (which depend on satellites that are interupted by the clouds), laundry that wouldn't dry and a welcome reprive from the usually hot temperatures.

For others in Haiti and the Domincan Republic, the last 48 hours were much more serious. The poorest segments of the population tend to live in the areas most prone to flooding- so when so much rain comes so quickly, people can literally drown. For this reason, many people here fear rain.

On Tuesday, the clinic was completely empty as no one wanted to venture out in the downpour to make their appointments. A few more showed up on Wednesday when the rain was a bit lighter but now we have two days of holidays (All Souls and All Saints days) so Monday promises to be crazy.

As of Thursday morning, the rains have stopped but the sun has yet to shine again. I'm sure I'm not the only one looking forward to seeing the usual blue skies again soon.

Welcome to Nollywood

You've heard of Hollywood, and likely Bollywood, but did you know that Nollywood, Nigeria's film industry, produces almost 1,000 movies a year that are distributed throughout Africa and around the globe?

I got my first exposure to Nollywood during my weekend in rural Haiti when I overheard some distinctively African English accents coming from the side of the room where several of the female Haitian staff were watching a movie.

The themes of the movie were universal - love, loss, faith, and betrayal - but the story lines were distinct. Scenes set in modern cities and "Bible believing" churches intersected with those involving ceremonies led by traditional healers and visits to relatives in rural villages.

A woman's mother warns her that her friend is a witch and so she should keep her away from her new husband. The daughter doesn't believe her but sure enough, the friend slips a strange powder into a cup of orange juice and after one sip, the husband falls for the evil friend and begins cheating on his new wife...

Ten minutes into the movie, I knew I wasn't going to add the film to any of my personal recommendation lists, but as soon as it was over, the women started another one. In the same way I escape into the stories of Elizabeth Bennett or Bridget Jones, these Haitian colleagues identified with the women of Nollywood. The stories were just far enough out of reach of everyday life to be an escape but within the realm of possibility given Haitian realities...not so different from how Miss Bennett and Mr. Darcy's world is for me.

One of the buzz words in international development is developing "South-South" partnerships which promote learning and sharing of expertise between developing countries. There are huge initiatives headed by international "experts" and intellectuals centered on how to make this happen....

...maybe they should start by visiting their local video store.

PS - I found a link to a documentary "This is Nollywood" that I'd like to try to see when I get back to the US. If any of you see it first, let me know how it is.

Photos from the weekend

Since I know a picture is worth a thousand words, here are links to photos from my weekend trip to rural Haiti and a few of some GHESKIO folks.

A weekend among the Mountains Beyond Mountains

This weekend I went out to rural Haiti to visit my friend Erica from Cornell who works with the agriculture program of Partners in Health. Not only did I get out of Port-au-Prince and get to see a friendly face, but now I can finally tell people that I have visited Cange, the place made famous by Paul Farmer’s biography Mountains Beyond Mountains.

Partners in Health operates from a human rights perspective –that tout moun se moun “all people are people” and therefore have the right to the same standards of care whether they live in Boston, MA or rural Haiti. Their medical complex in Cange is definitely impressive by Haitian standards – providing everything from c-sections to HIV treatment to chemotherapy for free to Haiti’s rural poor. If they cannot provide a needed medical intervention, they will do all they can to ensure the patient is treated at their partner hospital in Boston.

The PIH approach is not without controversy, especially as Paul Farmers’s voice and influence on how people think about issues of global health inequalities is growing. Is it realistic to assume that all over the world, we can build institutions like Partners in Health? Institutions that require incredible amounts of donated outside funds and depend heavily on foreign staff based in the United States to keep functioning.

I am challenged by and extremely thankful for the people like Paul Farmer in the world – who do radical things that others say are impossible and make them possible. Without groups like Partners in Health who were among those who pioneered bringing HIV therapy and advanced TB treatments to the poor, I don’t think we would see the emerging global successes we see now in these areas.

However, I also think there is a danger when we believe that these exceptional personalities will solve the problems of the world. I meet so many people who seem awe struck by Paul Farmer and his work – but it is really hard for anyone short of someone as exceptional as Paul himself to really carry it out. None of us can plan to follow the path he took for his own life – I doubt that he planned it himself.

Problems will only really be solved when everyday sorts of people become involved within the realm of their everyday capacities.

PS – I had a wonderful time escaping the city and hanging with Erica in rural Haiti - which feels like a different country than Port-au-Prince. We went on a hike in the hills and had a fantastic dinner with the family who she is staying it. They taught us a few Haitian proverbs that I’ll post soon.

Medika Manba - the peanut butter medicine

Here is a link to a story featured on the news show 60-Minutes about Plumpy Nut - the same fortified peanut paste that we will be using here in our intervention. Here in Haiti the peanut paste, called Medika Manba in Haitian Creole, is being produced by an organization called Meds and Foods for Kids using locally grown peanuts. The peanuts are combined with imported oil, sugar, dried milk powder and a mixture of vitamins and minerals to produce an extremely energy dense product that tastes like the inside of a Reese's Pieces candy.

The news story focuses on the use of Medika Manba for rehabilitation of seriously malnourished kids in Niger. This approach requires children to eat up to 3kg of it per week! Our plan is to encourage mothers to feed children a smaller daily dose of 65g (about 5 tablespoons) from 6-12 months in order to prevent the child from becoming malnourished in the first place.

At the clinic where I work, children are particularly vulnerable to becoming malnourished during the 6-12 month window. If the mom had qualified to receive free infant formula for the first 6 months, the free supply ends at 6 months because it's very expensive to buy the imported formula in Haiti and the clinic cannot afford to continue paying for it. If the HIV-infected mom was breastfeeding the infant, they are encouraged to stop at 6 months due to the risk of HIV transmission from mom to baby through the breast milk. (The issue of breastfeeding vs. infant formula feeding by HIV-infected moms is an extremely complicated one on in its own right. I'll try to write more about in a future post)

By 12 months, children have developed teeth and can usually eat the foods the rest of the family is eating but before then, they need foods that will meet both their developmental stage and high nutrient needs. Normally liquids like breastmilk or infant formula provide ~60% of a child's calories and many of their vitamins in the 6-12 month time period. The other common "weaning foods" such as porridges made with corn or rice do not contain enough energy or micronutrients to support the growth of children on their own.

Our hope is that by adding the medika manba to porridges or even feeding a small dose to the child directly, there will be be sufficient energy, vitamins and minerals in their diets to support healthy growth and development without breast milk or infant formula.

Matters of life, death and peanut butter

Two weeks ago my advisor and I appeared before Cornell's Institutional Review Board (or IRB in academic speak) to defend our research proposal. All studies involving humans or animals must be reviewed and approved by a panel of university faculty before they can begin. The IRB ensures that risks to the participants are minimal and that provisions are in place to respond in cases of emergency.

Sometimes the IRB approval process is quick - you are approved in 1 or 2 weeks. In our case it took almost 4 months. What was the root of the delay? Peanuts...or more specifically the risk of peanut allergies in young children. Our study involves introducing a peanut-based nutritional supplement to infants starting at age 6 months.

All of you parents of young children are probably nodding your heads. Current American Academy of Pediatrics recommendations are to wait to introduce peanuts until a child is 3 years old. Evidence suggests that rates of peanut allergies have more than doubled in the last decade to 1-1.5% of US children. Peanut allergies are particularly frightening because they can be deadly - and sometimes dramatically so.

In contrast, no Haitian I've talked to so far has ever questioned why we would feed peanuts to young children. Peanuts are grown in Haiti. They are a common food - eaten whole or in the form of a spicy peanut butter spread on bread. A friend who works in rural Haiti said that kids receive locally made peanut butter when they are as young as six months old. People out in her community had never heard of a child getting sick or dying from eating peanuts.

(There is generally accepted but still unproven theory that almost all allergies are lower in populations where children are not slathered with antibacterial soaps or transported in covered strollers that keep them from interacting with the pathogens in their enviornment. Reports from Haiti and Malawi have shown only one case of eczema in more than 10,000 kids treated with the fortified peanut butter we will be using).

Which brings me back to the Cornell IRB - an IRB that cares about protecting kids in Haiti, protecting Cornell as an institution, and protecting me as a researcher. The IRB wanted to know why we would do a study in Haitian children that goes against the American Academy of Pediatrics's guidelines. The fundamental piece of our response was that in Haiti, a country where almost 25% of children suffer from chronic malnutrition, the uknown but seemingly incredibly small risk of dying from a food allergy is just not reasons enough to not go ahead with the trial (with as many safeguards as we can provide)....

It's not only scenarios like that in the movie The Constant Gardner - where TB drugs with known terrible side effects are being tested on Kenyans without due consent - that cause us to question the ethics of research in developing countries.

It's the fact that if we were doing the same nutrition study in the US we could almost 100% guarantee that a child in our study would have access to emergency care at any time including inexpensive life-saving treatments such as an "epi-pen" that are needed to stop an anaphylatic reaction. Help is only a 911 call away.

In Port-au-Prince, a metropolitan area of 3.5 million people, there are fewer than five sites that provide 24-hour medical care. Only 1 or 2 of these emergency sites are likely able to maintain a consistent supply of even the most basic drugs. There is no 911 or ambulance services - most won't have access to any private vehicle at all. We will have everything needed at GHESKIO's downtown clinic - but it's only an outpatient referral site open from 8-4:30pm from M-F. That doesn't help the one mom whose child can't breathe at 11pm.... a mom who if she lived in Palm Beach, instead of P-au-P, would be able to access care for her child.

If it sounds like I'm quickly moving from the ethics of feeding peanut butter to small children to more fundamental questions of global inequality, poverty and injustice - it's because I am, it's inevitable.

Perhaps over your next PB&J you can think about it some more and share some of your thoughts with me!

(PS - I had started this post before I left and wantd to get it up. I promise to post something about life now that I am here in Haiti sooner than later.)

E-ticket "in hand"

Bought my ticket last night. I'll be arriving in Port-au-Prince a week from tomorrow - on Monday, October 15. Flying out of Philadelphia in order to enjoy a quick visit with the Sanderson family which I am really looking forward to. In the mean time I'm preparing for a thesis committee meeting on Wednesday, running some final errands, doing a bit of packing (or at least planning what I will pack the night before I leave), trying to enjoy as much Autumn in Ithaca as I can and saying too many goodbyes.

I'm likely getting rid of my current expensive US cell phone this week and joining a friend's family plan to keep a US number for my visits back. I will send out the new phone number via email when I have it. Skype is a wonderful way to talk for free while I'm in Haiti - I usually have a working internet connection at the house where I stay. All you need is a headset to hook up to your computer and to sign up for a skype login....

The Refrigerator Gallery

I told myself I would stop doing all of these pre-Haiti departure posts but it's just such a convenient way to avoid other more pressing, less creative work... : )

In her mountain retreat house, Laura, a dear friend and former WR colleague, has photos of friends and family covering the entire refrigerator door. I absolutely love it. When I moved to Ithaca two years ago, I followed Laura's example and asked friends and family to send me a photo to display on the fridge in my trailer (not quite the mountain retreat).

With my relocation to Haiti fast approaching, I refuse to leave my gallery behind and so I've found what I think will be an acceptable alternative to the front of a refrigerator.

A few days ago I issued another call for photos. It's been so fun to check my email each day (actually more like each hour) to see whose photo has shown up. I decided that such beautiful faces must be shared so here is a link to my "virtual fridge" - the collection will continue to grow as new photos arrive.

This is an equal opportunity gallery. If I missed you in my call for photos (and assuming I actually know who you are) it's due to a lack of email address in my contact book rather than a lack of desire to have you on display. So please do send me a photo of you and yours.

If you find yourself on display but would prefer not to be online, just let me know and I'll remove the photo.

Say cheese.... not quite sure how to say that in Kreyol yet!

Paying my due respects to Ithaca's Gimme Coffee

There is a question that seems to come up frequently in dinner conversations about life outside of North America - "What food do you miss most when you are away?"

I've often struggled to answer this question since I'm typically very content with the foods served in the places I've lived in Africa, Latin America and most recently the Caribbean. I kind of pride myself in my flexibility when it comes to food. Rice, beans, maize/corn, sweet potatoes and green leafy veggies have become staples in my US diet. I am a bit of a peanut butter snob, preferring the "natural" type, but that's often more available than the processed stuff in the places I go. (Haiti actually has an amazing "spicy" type of peanut butter with red pepper added to it. You will be hearing a lot more about Haitian peanut butter in the days to come as it plays an important role in my research intervention)

With a little creativity in the kitchen and/or the willingess to pay ridiculous prices at the import grocery stores found in all big cities including Nairobi and Port-au-Prince, I can usually satisfy the occasional craving I have for good chocolate or tortilla chips and salsa. Good ice cream is usually a tough one and probably ranked highest on my "most missed" list until....I moved to Ithaca and discovered Gimme Coffee.

I really don't have the words to describe the attachment I've developed over the last year or so to Gimme's "Leftist" roast. It gets me out of bed in the morning. It has changed me from an occassional latte indulger to a pretty strict americano drinker - just so I can have more of that fantastic coffee flavor (thank you Maggie S.). I don't care that the baristas at one of the Gimme branches in Ithaca are frequently snobbish and aloof - something that would keep me from frequenting other establishments. I would have gladly joined in a sit-in to protest the removal of the Gimme coffee trailer on our quad if the newly-opened library cafe hadn't agreed to serve Gimme roasts and to have Gimme train their baristas.

Over my 6 weeks in Haiti this summer I had a foretaste of what it will be like to live without Gimme in the coming year. While I mean no disrespect to Haitian coffee, there was just something "not right" in my mornings. Only when I came back to Ithaca did I realize what it was....no Leftist roast.

You are probably wondering why I am being so meldoramatic. Can't I just carry a couple pounds of my perferred beans to Port-au-Prince with me? I could....but have decided against it. Haiti produces coffee beans - good coffee beans. Haiti should be making good money by growing and exporting coffee. With the complexities of a globalized food system, they are not.

I can buy Haitian coffee in Haiti and so I will. I won't carry my beans from Ithaca - beans that already crossed continents at least once on their way to upstate NY. It's a small step towards supporting a local food system but it's a step I feel morally obliged to take.

In the mean time, I am using a new metric to count down days these last few weeks in Ithaca - Gimmee cups. I have at least 20 cups to go.... better get drinking!

What's in a name?

Some of you may be familiar with the iconic green and white bumper stickers and t-shirts from Ithaca, NY proclaiming that "Ithaca is gorges"....and it's true. The landscape around Cornell is speckled with deep ravines, lovely waterfalls and rolling green hills. Over the last 2 years, I have come to love this landscape - and the people it contains - despite the overwhelming number of days when the sun refused to shine in the sky .... or in the life of this graduate student.

Haiti too is a land of mountains and gorges - a beautiful country that reminds me most of Rwanda...but also in some ways of Ithaca. The peaks and valleys imagery also applies to Haiti's political history and current socio-economic realities - issues that I am only beginning to understand.

My Ithaca season has challenged me in unexpected but ultimately good ways and I trust that process will continue in Haiti. I am hopeful that down the road I will look back and sincerely say "Haiti is Gorges" too.

The best of intentions

What do "the road to hell" and this blog have in common? Good intentions.

As I return to Haiti in mid-October 2007 to continue the research phase of my graduate studies I have very good intentions of keeping friends, familiy, and perhaps some curious onlookers updated on the experiences I have living and working in Port-au-Prince.

I will try to avoid too many stream-of-consciousness-rants common to stressed PhD students and focus instead on sharing the stories of the people, places and ideas I am privileged to encounter along the way.

Thanks for joining me.