Journal Entries from workers in Haiti

Dr. Bibiana MacLeod, Regional Coordinator, South America and Caribbean
Enoch Firmin, Community Health Evangelist in Cap Haitian
Liz Fleming, Area Coordinator, Argentina

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January 12, 2011

Today marks the one-year anniversary of the terrible earthquake in Haiti.  That terrible day is simply referred to as "January 12," and is being remembered today by a peaceful march here in the northern city of Cape Haitien. Schools and many businesses were closed today, and all around the country people are meeting in churches, fasting, and praying.

You may remember reading about Anias in earlier updates, he was in Port-au-Prince during the earthquake and during his return home to the north of the country after the quake he was robbed of all of his belongings.  He said that last night he was thinking and praying about "January 12," remembering all of his friends and fellow students that had died.  This morning his first thought and prayer was of "January 12."

One of our new CHE trainers, Jacky, still lives in the capital Port-au-Prince, although she has moved out of the refugee camp.  She is now living in a tent on the grounds of her extended family's former house, which was destroyed in the quake.  Jacky is unable to come to our training tomorrow -- an update on all of our material related to cholera -- because she is afraid to travel due to the ongoing unrest related to the election results.

 Everyone has a story about that day, no one was left unaffected.  When my colleague Evelyne arrived today she was thinking back to that day one year ago.  She left the office here in Cape Haitien to go to her home an hour away.  The earthquake happened while she was en route. When she arrived home everyone was listening to the news, stunned at all of the deaths that they were hearing about in the capital.  When telephone lines were reopened, her son -- who was living in Cape Haitien at the time -- called to tell her that his whole house had shaken.  He was afraid to go to school since it was by the sea and everyone was worried about a tsunami.

Please pray for the Haitian people.  Last year was filled with tragedy:  the earthquake, cholera, and unrest over national elections.
Please pray that the powers of darkness would be defeated and that all people would find their hope in Jesus.

Elizabeth Fleming, M.D.

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December 18

Dr. Liz wrote to tell us that the baby we had been praying so much for died in Cap Haitian.

We also received a desperate letter from the director of the Northeast Health Department, Dr. Pierre, asking for 2000 lts IVs, 60 sprayers for disinfecting, 6,000 catheters, and 20,000 oral rehydration packets. At first it sounded like too large of a request, even though they have 200 patients at just one of their sites. Liz tells me that yesterday in Bayeux they already had 55 patients. Funds are needed to help with room and board for four doctors and six nurses for the Cholera Treatment Unit there. We expect the community leaders to provide housing. However, due to potential water contamination, the clinic would be the best place to prepare food safely for the health workers. We are going to use funds already received to supplement income to the clinic in order to pay salaries for extra nurses and supplies needed, so patients will not be charged for services during this time of crisis.

We only have five loaves and two fish.

Plus a vulnerable team that is finding it difficult to keep working, both due to tiredness and the type of work they are doing that they are not accustomed to. We also want each CHE program to have functioning oral rehydration posts, as well as groups of leaders who will take charge of cleaning the wells and taking care of community problems—such as what to do with the bodies of those who die from cholera. There is limited resources, tired people, discouragement, and a lot of need. What a good place to be in to learn to depend exclusively on the grace of God! Without God's presence and intervention, nothing can be done.

Your prayers will make the difference, please remember this!

Bibiana

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December 10

After yesterday's meeting with the community leaders in Bayeux, ten of them took on the responsibility of starting oral rehydration centers in their respective neighborhoods. This means they will start treating the sick people who need oral rehydration salts while they are on their way to the nearest treating facility. They will also start working with cleaning and maintaining the wells in the community and with the management of cadavers.

Today we all met again, and I asked them to tell me what had happened since we'd seen each other yesterday. Very proudly they shared that the community had responded very positively and six patients were treated at these oral rehydration centers just as planned. So the meeting was very encouraging and we can really see the community is being mobilized. They have been responding with concrete actions. Additionally, a Colombian engineer who works in the area came and offered to help with the technical aspect of well management.

We have two CHE trainers in Bayeux. The community leaders sent us two volunteers from each area (areas where there is no CHE) to be trained tomorrow on how to understand cholera, identify it early, and prevent it. These volunteers will be visiting homes in their community to teach and discover those early cases that aren't going to the hospital or taking oral rehydration in order to treat them rapidly.

The Doctors without Borders (MSF) group arrived at the end of the day to evaluate the possibility of starting a Cholera Treatment Center in the classroom that we constructed a few years ago next to the clinic. Who would have thought that the building would be perfect for a treatment center! It is ideally built for keeping good hygienic practices (infection control) and for control of patient flow (important with cholera to prevent the spread of the disease). Thanks to the generous donations of so many brothers and sisters, this building is now being used to heal the Haitian people.

The baby born in the Ebenezer Clinic (at the Limbe Seminary) has not been progressing very well. He hasn't been breastfeeding and this morning they found him dehydrated and with low blood sugar. Some suspect that he might have cholera. Please pray for his complete recovery. Travis has worked without ceasing to keep intravenous access to help with his hydration and nutrition.

Thank you for your part in this fight,

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December 8

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December 4

Hi, everyone! Our internet has been nearly non-existent recently, and when we've had it it's been slower than the slowest dial-up you can remember. But suddenly today it is running beautifully! Um, when we've had electricity, that is—I think it's gone off five times today.

Thank you all so much for your prayers for little Odlin. I stayed in touch with one of the nurses from Hinche by phone, and I'm happy to say that he continued to slowly get healthier and finally went home! When I think of what he looked like the day he came in, and indeed even the next few days, I am just amazed.

Every day there are more patients in more communities sick with cholera. There is no sign of this stopping for the next few months, if not longer. There is also a lot of misunderstanding about cholera. It's not uncommon to hear people say they would rather get HIV than cholera. In the past weeks our work has been to:

• Coordinate shipments of IV solution and other supplies to combat cholera.
• Prepare for a Training of Trainers in Port-au-Prince, specifically designed for people who have children's ministries. We were supposed to go to Port-au-Prince on Sunday, but have postponed the training due to continued violence in the city.
• Follow up with the Community Health Evangelists (CHEs) who continue to teach their neighbors from house to house. I've mentioned before the lessons they teach for physical health: what is cholera and how is it spread, how to wash their hands with a simple system using a plastic jug, string, and a stick (most people don't have running water), how to make oral rehydration solution at home, and the importance of using latrines.
• The CHEs have also helped people develop frameworks to process things emotionally and spiritually. Cholera is yet another disaster being faced this year, by people who suffered greatly from the January earthquake and now also violence surrounding national elections. I have heard many people, even young children, say that Haiti is cursed, and cursed by God. What a terrible burden to live under! Our lesson entitled "God and Cholera" leads people to God's Word to learn about God's character and God's heart for us.

On the last day of the feast, the great day, Jesus stood up and cried out, "If anyone thirsts, let him come to me and drink. Whoever believes in me, as the Scripture has said, “Out of his heart will flow rivers of living water." Jesus (recorded in John 7: 37 -38)

And when Jesus speaks in Kreyol, you hear it like this: Dènye jou fèt la, se li ki te pi enpòtan. Jou sa a, Jezi kanpe devan foul moun yo, li di yo byen fò: Si yon moun swaf dlo, li mèt vin jwenn mwen, li mèt vin bwè. Moun ki mete konfyans yo nan mwen, y'ap wè gwo kouran dlo k'ap bay lavi koule soti nan kè yo, jan sa ekri nan Liv la.

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November 28

Hello all!

The message below is a message from Dr. John Jensen and his wife, Sandy, an RN, from Louisbourg, NS. They arrived November 23 in Seminaire Limbe, Haiti, at the Eben Ezer clinic to help for three weeks.

Many of you have contributed with resources for IVs, transportation, training manuals, etc. The need is so large; our small contribution just alleviates a small part of the suffering. But we are called to do so. It is also a tremendous opportunity for the CHE strategy to serve the larger population in training and transformation.

We are also involved in helping find human resources to staff the Cholera Treatment Center in Cap Haitian. We desperately need more nurses, paramedics, people trained in finding a vein to put an IV (sometimes doctors are not familiar with this), and doctors. If there are people available for longer term as helpers, handymen, and water sanitation specialists we can surely receive them and put them to work immediately.

Dr. Liz Fleming in Cap Haitian is coordinating logistics for volunteers. We ask a minimum of a one-week commitment. Anything you can think of to help this nation, please do.

I will be travelling there December 5 for ten days. If the Dominican border is closed, we will try from Ft. Pierce, FL, via Missionary Flights International.

Thanks for becoming God's hands.

Bibiana

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November 18, 2010

Last night I went to the Cap Haitian gymnasium where I was given a tour by the director for Doctors without Borders (MSF) for northern Haiti. MSF has been here for a week and is now seeing only a quarter of the deaths in Cap Haitian compared to the previous week. So much of this has to do with the importance of understanding how easily treatable this disease is, if only patients are hydrated quickly! The MSF director told me that the hospital wasn't quite where they would like it yet, but they were pleased with the improvements. From my perspective it is so much better than the nightmare I lived through in Hinche.

As soon as the roadblocks clear they will be bringing tents to set up outside the gym to enable them to expand to 300 cholera beds. They are now coordinating all cholera treatment in Cap Haitian, although they do work with the health ministry. They have also been working in Limbe, the other area where we would like to send volunteers. They only knew about the two hospitals there, not the 100-bed (and rising) center at Seminaire Limbe, five km from Limbe. That is where Dr. Steve has been working tirelessly and with few staff. MSF plans to return to Limbe (again, as soon as the roadblocks clear). They are coming back to the hotel now so I'm going to see how soon they think they can get through. Dr. Steve only has enough IV fluid for the next 24 hours.

Since we don't usually work with short-term medical volunteers, I'm glad that MSF has accepted to take them under their wing here on the ground – we will just need to coordinate flights, airport pickups, meals, and housing, which will be part of my job the next few weeks. MSF has also offered to train our community health workers on “bucket chlorine.” This means that a person will be stationed at each community water source (if there are too many some will be closed). The worker will have a concentrated chlorine solution and will put a specified amount in each bucket of water collected. In other countries this has reduced the cholera outbreaks to two or three days. However, due to the already widespread nature of Haiti’s epidemic (now in every region of the country) we will likely need people to do this work for a month or two.

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November 17, 2010

Update from Dr. Bibiana MacLeod
Roadblocks around Cap Haitian are preventing supplies from being transferred to the hospitals and clinics. One CHE worker in Limbe has reported passage can only be accomplished on foot. She successfully brought out the last shipment of IV's to Ebenezer Clinic on Sunday.

Meanwhile, Doctors Without Borders (MSF) is offering to train CHE workers on water treatment at the point of water collection in the villages. One village has a serious problem with false beliefs about the water being poisoned and people refusing to drink water. We need to deploy as many volunteer CHEs as we can with the right kind of information and support. If those in the TOT in Limbe this week cannot be trained by MSF, we may need to consider gathering the 60+ volunteer CHE trainers soon for multiplying teaching and strategizing.

Please continue to pray for the unrest to die down, for the roadblocks to be removed, for the medicines to be transported where they are most needed to save lives, and for God's protection on the CHE workers and families.

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November 9, 2010

We urgently need teams of nurses and handymen for Seminaire Limbe, who would be able to keep a regular flow until the Cholera epidemic is over. Would you find in your churches people available? I was on the phone with Dr. Steve James in Eben Ezer clinic in Seminaire Limbe this morning. They have 11 patients on IVs at a time, some of them running fast and many are children. Additionally 22 arrived yesterday. More are expected as the epidemic continues to grow. They are hiring nurses at the local level, but there are not enough, and the Health Department is finding the same problem. Dr. Steve assures me that relationships between foreign and local staff will be addressed by preparing both before arrival on how to deal with cross-cultural issues in emergency situations.

Dr. Steve asks for three nurses at a time and a handyman that would help solve problems with plumbing, electricity, generators, car troubles, etc. Also, we will need more nurses for the Health Department and Bayeux, as far as I know, but the one in Limbe is an immediate need. I can help figure out costs of room and board, plus if they can bring cash the clinic is spending about $1,000 US a week to buy diesel for the generator in order to have electricity all night, food, medical supplies, and cleaning with Chlorox if available.

Please, pass this along. Contact me if people become available.
THANKS,
Bibiana

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November 4, 2010

The following is Dr. Liz Fleming's email as she is in Port au Prince for two weeks, maybe traveling some due to the Cholera epidemic:

I arrived yesterday morning to the hospital in Port-au-Prince, and got to work in the OB ward yesterday. We helped deliver four babies in one hour! (I was working with a midwife, and we called in an ER nurse and a nephrologist to help!)

I have a computer and e-mail access today, but then I'll be working all night tonight in the hospital. That is a prayer concern, as the nights can be busy. I think I'll only have two nurses with me, and you know I haven't been practicing much medicine lately! Tomorrow they tell me I'll leave for either St. Marc or Hench, places where they are battling cholera. There has not been any cholera in Port-au-Prince (except for a few imported cases), but I just heard today that Limbe (20km from Cap Haitien, where our training is due to be held the week I get back) just got swamped and are overwhelmed.

Our team in the north (Cap Haitien) is getting a shipment of cots today for the local health ministry to dispense, and more and more oral rehydration salts are arriving and being ordered with money that has been donated. Our team is very busy. Our volunteers are going everywhere they can to teach about hand washing, latrines, treatment of diarrhea with oral rehydration, and purification of water.

Please pray that concern over cholera will be a catalyst for people to really see the importance of hygiene (in all the ways I mentioned above), and that in this way long-lasting good will be brought out of tragedy. Please pray for our team, the few staff and the hundreds of volunteers, that God would give them wisdom and strength and multiply their efforts. Pray also that they would look to God to be their strength and their wisdom at this time, and that their concern and presence in the different villages would reflect God's love and care for all people.

Blessings,
Liz

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October 25

Dear brothers and sisters,

You are true collaborators in so many strategic places! What has been happening in the last few days in Haiti has made a huge impact on the population. Everyone now wants to learn what we have been teaching here for years. They ask questions, come to meetings, and want to know details. A felt need, such as the fear of a cholera epidemic entering a community due to contaminated water or lack of hygiene, makes a big difference in the effectiveness of the facilitators when it comes time to putting things in practice. Tipitap (a small jug with water to wash hands which hangs from a tree), SODIS (solar water disinfection in plastic bottles), using latrines, and hygiene practices which prevent contamination of water and food—all of a sudden we are able to spread these powerful tools! God does not want us to be sick, and he has given us local resources to fight this. We need to use these resources to be healthy in all senses of the word.

We have been working with the local authorities in our response to the outbreak, and they have opened many doors for us to enter new communities and broaden the coverage in the communities we already working with. This morning the director of the Public Health Department of the Northern Department (province) was very glad to meet with me. I shared the SODIS manual with him and gave him the generator and bags of IV fluid we had bought with offerings from Canada and the Dominican Republic. He looked at the SODIS manual and asked, “How can you teach this in the at-risk communities?” Of course I told him that we have 28 people trained for this work, many of whom live in the places where he wants training. So he gave me five communities: Plaisance, Limbe, Camp Coq, Port Margot, and Cap Haitian. In all of these we have facilitators close by who can train volunteers to teach from house-to-house.

We are preparing 500 hygiene packs for the Community Health Evangelism volunteers (CHEs). These packs have soap, chlorine for water treatment, string for the Tipitaps, cholera brochures (thanks Jody for your impeccable timing), cholera lessons (thanks Steve Sethi for the updated version), instructions for Tipitaps, and recommendations from the Public Health Department. Tomorrow the local Medical Ambassadors team will meet to standardize the teaching. We have a lot of work ahead of us! We are trying to find funds so that our collaborators have enough money for transportation and food in the next two weeks, during which they will be busy organizing the visits in each of these five communities. We also made copies for the health department of some brochures and books about management of this epidemic. They taught us how to treat well water and water tanks, and they also put the person in charge of such treatment at our disposal to go to the communities with us.

Doug and Dan, two brothers in the Lord from Detroit, have been with us since Saturday. They separated the chlorine (bought in bulk) into bags for distribution, cut the string for the Tipitaps, made photocopies, and carried heavy boxes. They were a real encouragement to us in our work. We went with them to CHE communities yesterday (Sunday). In Bayeux we were able to make a contingency plan in case cholera reaches the community. The CHE volunteers made commitments to not only visit the homes that regularly receive their teaching, but also neighboring communities. In the other community we visited, Bas Duty, the CHE volunteers made the same commitment. They proposed visiting each school and motivating the teachers to install Tipitaps next to each latrine, as well as teaching SODIS to the children and their parents.

These have been long nights, writing and requesting help to get tents and pay for cots, antibiotics, and packets of Oral Rehydration Salts. We have now gotten all these items and they are on their way. We go to bed thinking of new ideas and rise again in the morning full of energy despite having slept only a few hours, trying to make the day count as much as possible.

Two of our computers and several thumb drives have been infected with multiple viruses, and Liz has been working hard to clean them. These problems have added to our frustration since so many things aren’t working. We also have limited internet access, which is really draining. Liz is preparing to go work in Port-au-Prince for 15 days, starting on Sunday, October 31. As soon as she comes back, there is a five-day training in Cap Haitian and another one in Port-au-Prince 15 days later. These will be busy months, although we are praying and hoping that the outbreak will just be a bad memory by this weekend. We haven’t heard of any new cases. There are 3,050 people infected and there have been 253 deaths. The few cases we’ve had in the north came from the outbreak zone and they haven’t spread here.

The Dominican-Haitian border has been closed, but they confirmed today that they will let foreigners through who are going back to their home countries through the border. Tomorrow Liz, Dan, Doug, and I will go to the border. Liz will renew her visa and return to Cap Haitian by motorcycle with Anias, while the rest of us will go on to Santiago.

This will be my last report for this trip. If you need more information, please write to me at bibianamacleod@aol.com since Liz won’t have Internet access in the next few weeks.

Thank you all for your incredible prayer support and offerings.

Bibiana

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Cholera Outbreak in Haiti-October 22

Many of you have already heard that yet another tragedy has struck in this suffering country.  Starting in the Artibonite Department (that is the name of the state that is in the center of the country), it has been spreading to the north.  There are two cases in Limbe and one in Port-au-Prince.  There have been 157 deaths.

Cholera starts abruptly and deaths occur due to rapid dehydration.  It is easy to treat with oral rehydration and IV fluids.  The SODIS method that we have been teaching since March is proven to be effective against cholera and is the cheapest way to purify drinking water. 

Bob Dell and I went to greet the director of the Public Health Department for the Northern Department today, but the director seemed very rushed since he's been going from meeting to meeting to establish a response strategy to the out break that has now spread into his region.  The National Public Health Ministry has been concentrating its efforts on the most-affected zone and informed him that they have no resources to prepare the Northern Department for this new disaster.  He shared with us the need for resources to prepare the local hospitals with the following:  IV fluids, oral rehydration solution, disposable gowns and shoe-covers, gloves, buckets, liquid and powdered chlorine, special cots for cholera patients (they have a hole in the middle due to the intense and explosive diarrhea cholera patients get), plastic sheeting to go under the beds so that they can be washed with chlorine (they are contaminated by the buckets that are placed under the cots to receive the diarrhea from the patient).  As you can see, this is a terrifying prospect.  We know that the general population isn't prepared for this new challenge.  We see their vulnerability, and we hope that this small group of 26 people who came to our training and are so well-prepared to teach solar water disinfection (SODIS), will multiply miraculously like the loaves and fishes to feed thousands.

Cholera outbreak in Haiti - October 22, 2010

Letter from Bibiana, October 20, 2010

Dear Brothers and Sisters in Christ,

Four of us have been traveling together:  Liz Fleming, Carlos Martinez, Bob Dell, and I.  We came for a brief visit to Port-au-Prince to visit the Petionville refugee camp and meet with some friends and brothers and sisters in the Lord who are interested in our CHE training in December.  Yesterday (Tuesday) we went to the JP Hospital there, and Liz gave them her volunteer contract for the first two weeks in November.  The tent where the volunteer physicians and nurses are housed was destroyed in a storm a few weeks ago.  We thank God that none of the volunteers were hurt.  However, the storm was so intense that many of the tents in the camp needed to be replaced.  There were some people wounded in the camp, but none seriously. 

We met with Pastor St. Cyr, who is planning to send at least two of his church members to the December training.  Luidgi Larco was very grateful to receive the three suitcases with medications and nutritional supplements.  We are distributing what we brought to various places, since there are several health centers that we want to support.  It is so wonderful when we bring things that people have asked for, and this is all thanks to the financial support of many who helped us in Canada, who also helped us to dispose of the donated items that hadn't been asked for.  I'm also grateful to those in the Dominican Republic who helped us to use the $1300 that was donated to buy antibiotics, asthma medication, pregnancy tests, and cough medicine.  A new contribution from the Dominican Republic has been promised:  durable medical equipment that we really need but didn't have enough money to purchase.  We were able to buy two 5.5 kilowatt generators.  One will go to Bois de Laurence, a very isolated community in the northeast, where the clinic does not have electricity and only occasionally can get a generator on loan.  We offered the second generator to the health department in the north, since they had given us a list of ten clinics that need generators.  I don't know which one has the greatest need, so we'll speak with the health department director later this week. 

More than 36,000 people still live in the Petionville refugee camp.  Some people were moved to more permanent places but new residents keep arriving since living in the camp means receiving help from the non-governmental organizations (NGOs).  The government has asked that the NGOs stop giving things away since in the long run this damages people's sense of personal responsibility and reduces their need to look for alternative solutions to their problems.  It is very difficult to control this problem. 

Luidgi is looking for work because he has no income at this point.  His wife, Jackie, received us in her tent.  She was very interested to know when we would have a training she could go to.  We decided to invite her to the SODIS course that Bob and Carlos are doing tomorrow and the next day in Cap Haitien.  This will enable her to introduce SODIS in the camp.  Yesterday she brought her neighbor's baby to us who had multiple fractures.  He is two-months-old, his parents are very young, and it appears that the fractures are spontaneous.  We hope that Liz can see him again in the hospital when she comes back in two weeks, so that they can identify the problem and know how to follow long-term. 

October 16

God never stops surprising us.  Yesterday we went to visit a CHE program near the capital city (of the Dominican Republic).  We
traveled there with the vehicle we’ll be taking to Haiti on Sunday. Part of the rubber on the back tire fell off.  Thankfully we didn’t
get into an accident, just lost time due to having to buy a new tire. We thanked God that it happened in a place without much traffic, and
also that we were able to fix it now, thus preventing bigger problems in Haiti.

We bought medications with the money we had leftover after purchasing the generators.  However, when I saw the quantity of things we were
planning to take to Haiti I realized that it would be impossible for it all to fit in my car.  Today the church in Savica was meeting to
pray from 7 to 8 am, so Flor, Hiram, and I went.  One of our prayers was that we would find someone to help us haul our cargo.  After the
prayer time I took the car to my usual mechanic since the air conditioning had stopped working yesterday.  There I met someone I
knew a long time ago in Haiti, a man named Amos, who had come to pick up his vehicle.  I asked him if he was hauling back many things and he
said yes.  However, next week he’s coming back to the Dominican Republic to get a pickup truck and he would have plenty of space then
to take our things.  Praise God!  Both yesterday and today, as different problems happened, we found that there were hidden solutions
which blessed us.

How many times we feel hurt in the midst of a crisis, only to discover that God is using it to add blessing to our lives!  Please, keep
praying for the trip tomorrow (Sunday) and the border crossing.  May God continue to grant us favor.

Bibiana
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August 15, 2010

This morning I had the privilege of worshiping God with hundreds of my displaced brothers and sisters. We sang for God’s name to be glorified, we proclaimed how good God is to us, and we renewed our commitment to serve Him with all that we are. During the service a young woman fainted and they took her outside. Liz Carl asked me to go and see what was happening. Apparently she’d had a moment of low blood pressure which was caused by a few different factors—earlier this morning she’d started to have diarrhea and she hadn’t had anything to eat or drink yet. It was also 8:30 in the morning and it was already a little warm in the tent-church where we were meeting. Being dehydrated with an empty stomach was surely enough reason to lose consciousness. I keep asking myself how we can help those who live in the camp to purify the water they drink and cook with in these months that are so hot.

June 4

Liz Fleming, Renee from Canada, Madame Grimard, and I traveled to Bayeux in the afternoon after working all morning in the office completing the manuals for the next week's training.

The car that I drive here in Haiti is my faithful Mitsubishi. We keep it in Santiago for ministerial work there. We heard a strange noise as we were driving along the road (road = dirt/gravel/deep holes/puddles). The noise didn't go away in spite of the fact that we tried to ignore it for a few minutes. Finally we stopped and tried to find where the problem was coming from. It turns out that a nut that holds the stabilizing bar of the rear left wheel had come off, and returning the bar to its original position required more skills than I have. What else could we do but stop the next vehicle that passed, especially if it had a United Nations sign on the door? They didn't help us much, but they tried, and when they left they promised that one of them would return with a nut. Meanwhile, we got out the jack and started to raise the car to see if in taking off the wheel we would have better access to the problem area. Just then a patient from the Bayeux clinic passed by on his motorcycle. He recognized me and was happy to help us. Other people soon joined him—that always make me a bit nervous because everyone has an opinion and they begin to use a lot of force without first understanding the problem.

I decided it was time to call Sandy in Canada (who happened to be in Kyle's dentist's waiting room). I didn't even know how to describe the problem in English, so that wasn't really much help. We simply prayed a few times and then put ourselves in the hands of the volunteers on motorcycles. Within an hour and a half they had gotten a nut and then used a lever to put the bar back in place so that we could keep on.

Despite our late arrival, the clinic employees were patiently waiting for us in Bayeux. We met to discuss how things were going and to prioritize the needs of the clinic, which are primarily reconstruction of all of the buildings at the site. Liz was able to take pictures of the damage in each building and I left them the money that had been raised on different occasions from churches from Cape Breton in Canada. They were very glad and grateful to be able to be able to begin the repair work on the clinic.

At the end of the day we arrived, exhausted, at Madame Grimard's house in Limbe. We stayed there for the next three days.

Thank you so much for “being present with us” on this trip!

Bibiana
   Clinic damage,  Haiti, 6-10              Clinic Damage, Haiti, 6-10           Bayeux Clinic Workers, Haiti, 6-10  

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June 3, 2010

Hello, everyone!

We got to Cap Haitian yesterday and sat down in the office to work right away.  The Haitian training team was already using their new computers, inputting information about the diarrhea survey that was done in 11 of the 31 communities that are implementing CHE.  There are 930 surveys to be evaluated.  Anias was very happy, learning Excel and coming to work dressed very formally.  He travels 40 km from Fort Liberte to Cap Haitian to use the computer one day per week and the rest of the time he visits the communities.  There are already four CHE communities using the SODIS method for water potabilization (SODIS is "solar disinfection").  Anias managed to get 1100 plastic bottles from Port-au-Prince which will help with implementation of this method.  Our biggest challenge has been finding enough bottles for everyone.  We asked him how he felt upon returning for the first time to the capital after the earthquake – back in January he had to leave all of his belongings to escape a sure death.

This morning I had a meeting with Dr. Jazmin, the Public Health Director for the Northern Department (state) of Haiti.  I told him
about the many brothers and sisters from different churches that are ready and willing to come to Haiti or to help in other ways to
strengthen the existing health care system in such times of overwhelming need.  He really appreciated our focus on reinforcing
what is already working well in the country and he told me that the greatest challenges are in assigning professionals to permanently work
in rural health centers.  They have nurses, nursing assistants, and lab technicians, but the government does not have the funds to be able
to hire them.  Another area of need is building reconstruction.  A third request for assistance is for essential medication.  I asked him
if there would be the possibility of complementing these rural clinics with professionals with foreign degrees and licenses.  The challenges
are:  1) they come for such a brief period of time and 2) they do not know the culture or the language.  It would be good to be able to rely on the assistance of French-speaking people to meet medical needs or to teach healthcare professionals.  In terms of contracting
professionals on a local level, the health ministry would hire them for six to twelve months at a time to try to cover immediate needs.

Dr. Jazmin said he will send me a report of his priorities.  He knows (and we both laughed about this) that my priority is the Bayeux
clinic, where I worked for ten years.  For the past ten years they have been doing very well at being self-supporting, but now they need
significant building repairs and provision of basic teams to be able to function better.  In addition to Bayeux, he thinks that there are
at least eight other places where there are needs.  We left it that he would send me the information via e-mail.

We also met today with Demetrius Smith, a young man who is in a wheelchair.  On our previous trip we visited with some people from the
association of handicapped people that he started.  Smith is interested in training his people to do CHE in the city of Cap Haitian.  They have a committee which is already formed and they would like our team to begin to train them as soon as possible.

Today we finished correcting, editing, and printing the lessons for next week's trainings.  We still need to photocopy them and tomorrow
we will bind them to distribute them as the training books.   We are very surprised at the high lodging costs for the training's participants.  We contracted a bus so that everyone can go together on the two and a half hour drive to Gonaives where we will be meeting from the seventh to the tenth of June.

Tomorrow we leave for Bayeux as soon as we finish making the lesson books.  On Saturday we will visit two CHE communities and on Monday we'll visit one more.  God willing, on Sunday we will be sharing at Haitian churches.  I'll have Liz send you a photo or two that she took today.  She's been a big help for me and I'm grateful to God that she's with me.  Renee, a Christian from Canada who works with
Partner's International Canada, is accompanying us to learn more about CHE.

Bibiana
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Wednesday, June 2, 2010

Dear friends who faithfully follow our updates,

Here I am in Santiago, Dominican Republic with Liz Fleming.  God willing, we are ready to go to Haiti this morning.  We won't have
reliable internet access while in Haiti, so I wanted to let you know some prayer needs.  We will be in Cap Haitian for two days, then we
will go to Bayeux to visit the clinic and evaluate with the local committee what they would like to repair first.  The offerings that we
have received will cover only a third of what is necessary to make the repairs, however it is a very good start and we are very grateful to
God for his provision.

After that we will be visiting new Community Health Evangelism (CHE) programs in the Gonaives area.  We have gotten to know some Christians who started working with us in the past year.  We want to encourage them and provide lessons and a guide that will enable them to continue working towards the holistic transformation of their people.  On June 7 we will start the second series of trainings.  We hope to teach on nutrition and project cycles, training the trainers both to teach these two topics in their communities and also to help their people to write development proposals for other organizations.

I received a message from the missionary Miguel Ovalle, who is in Port-au-Prince.  He started a soccer camp for children who were
victims of the earthquake.  Our trainers taught Miguel's team the counseling lessons they learned in April with Silvia, Delores, and the
rest of us who went on that trip.  We have heard many testimonies of children that were able to open up and express their grief, alongside
other children who consoled them and spoke about the emptiness that God is able to fill.  We are really excited to see how God uses people from afar to equip nationals to work with their own people.  May God continue to give tools to our brothers and sisters there!

We drive from Haiti to the Dominican Republic on June 12 and will be meeting with Dominican Christians who want to be guided to effectively help their brothers and sisters on the other side of the border.  This is a challenge for a people who have never considered Haiti as a mission field for Dominicans, just like the history of the Samaritans and the Jews.  Sending people long-term from here has been
unthinkable!

May God guide us as we work alongside him and may he use us for his glory!  We count on your prayers!!

Bibiana and Liz

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April 7, 2010 --update by Silvia Orlando

This has been a very special Easter! At six o’clock on Sunday morning we celebrated the resurrection of our Lord with other missionaries that are nearby. Later we went to another church in the city where only Haitian Kreyol is spoken. It was a real experience to sing hymns of praise to our Lord in different languages: Kreyol, Spanish, and French! In the afternoon we went to visit some older people who are homebound, showing care for them by singing praise songs.

In the afternoon we went to visit a support group for handicapped people. There we talked about our values (the core values of Community Health Evangelism), our work, and we also shared words of comfort and strength. We brought them a wheelchair that was donated by the Bible Temple in Santiago, Dominican Republic.

We are so grateful to God to have met a Haitian physician who is working at a refugee camp in Port-au-Prince. He lost his house in the earthquake and is living in a ten among those he serves. A few weeks after the earthquake he started to work at the refugee camp and he accepted the Lord there. He is being discipled by a missionary. When we found out about the medical work he is doing there completely on a voluntary basis, and that he lost all of his possessions, Bibiana offered him financial support for the next six months out of the offerings we have received. 

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April 5, 2010

We arrived in Haiti on Monday, March 29, where we attended a three-day conference. The topics included a new children’s series on how children experience grief, how to work with children in a disaster situation, and displaced children. Other topics included stress in adults and how to reduce a community’s vulnerability. These topics are key as we anticipate the arrival of the rainy and hurricane season.

During the conference we listened to testimonies of those who experienced the earthquake. It was a time when we were able to minister to one another and recognize that although the scars will always remain it is very necessary to begin the healing process. There were tears, pain, laughter, singing, and love shown during this time of sharing.

Also during the conference we developed a survey that will be used in the 30 communities represented by the 57 participants attending the conference. The survey will gather information about cases of diarrhea and the hygiene practices of each family. We hope that in every community they will evaluate the responses themselves, and that this will be the beginning of the process to implement practical methods of water purification and hygiene.

Thanks to the offerings that you sent we were able to provide money to one of the clinics for a generator. Additionally, the costs of this conference and the teaching materials for each participant were paid for through your gifts. Thank you to all; the job is getting done! We see that the three objectives we had proposed for this time period are being accomplished. We give thanks to the Lord because He has been guiding us and providing the people and resources for this work.

In Bayeux they need an engineer who can evaluate the medication storage area as well as equipment construction, and groups that can help to repair, paint, and improve the clinic building. I will share more needs later.

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March 5, 2010
We are home for ten days as we prepare our first post-quake short term team with very specific tasks for HAITI. I will be going with people in association with The Water school, (SODIS promotion, with a baseline survey on diarrhea to be done in the next three months, before implementation). The Water school has granted us funds that will help support one CHE trainer to provide communication and very clear help to CHE communities that will be teaching others how to purify water with this simple method. Also, joining the team are two Counselors, one from Argentina and one from Canada, that helped us prepare new lessons on Children, stress and crisis. There is also a new lesson on Disasters called Local Management of Risk. The emphasis of the series is to help people work on their vulnerability factors. So, with the funds raised for HAITI we will be holding an equivalent of an Area Council every three months. We will be planning another Area Council in June. We gather all 54 volunteer trainers to provide these lessons. We hope to have time for prayer, refreshment and sharing emotions too. One team comes from one of the most affected areas. The rest of the trainers will be helping in their own communities, also affected in a more indirect way, with overcrowded homes, clinics, schools and lots of unemployed relatives or friends that need to find a new way of living. Once the CHE workers start visiting homes with new lessons, we hope to see a renewed desire to multiply CHE in other communities. Also, Samaritan’s Purse could be interested in the later phase of their intervention in Haiti to teach those they help today about CHE. Please, be praying for a good and open contact there.

We praise the Lord for the blessing of funding. It makes it so much easier to have adequate funding to move along with the opportunities we see to serve our people in Haiti! We pray that the rest of the CHE coordinators around the world will find some way of relief in this matter too.

Thank you all for your prayers on behalf of the Haitian team: Madame Grimard, Enoch, Osse and Evelyn. Continue to pray for these precious brothers and sisters.

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February 4, 2010

Today we concentrated on meeting with the team of Community Health Evangelism (CHE) leaders in Cap Haitian, as well as finding some loved ones with whom we hadn't had contact for a long time. Sandy was able to help on two occasions by using his mechanical skills.
 
Part of the medications we brought were distributed at the clinic in Seminaire Limbe, as well as toys for the refugee children who lost their homes in Port-au-Prince and are staying at a Baptist camp.
 
Those present at the meeting of CHE leaders were: Enoch, Osse, Evelyn, Madame Grimard, Dr. Steve James and his wife Nancy, Sandy, and I. We discussed the role of Medical Ambassadors Haiti in light of the earthquake and its effects on the country.
 
Our mission continues to be the same: awakening in community leaders a vision of holistic transformation and accompanying them in the process, either directly or via other Christian institutions, so that the local church takes ownership of the vision.
 
In light of the earthquake we will concentrate on certain tasks which will be key in the next few months:

• The team recognized the need to support the healthcare work of the clinics and hospitals that are related to CHE programs. We identified at least ten healthcare institutions in the north besides the six that are already receiving donations of medications in the Port-au-Prince area.  The team will visit them to learn what their needs are and in what way your support can best benefit these groups, which are overwhelmed with both the patients that keep arriving from the capital as well as financial needs which are so great that the personnel don't know how they will be sustained financially at this time.
• SODIS: This is a system of solar disinfection to make water potable, which consists of simply putting plastic bottles filled with water in the sun. The method is taught to community groups and schools.  In addition, a survey must be carried out to determine the number of cases of diarrhea in the communities where they will be working, meetings need to be held with the local leadership, and we need to follow-up with those who want to adopt this method.
• Counseling: We recognize there are two stages or needs. First, the emotional support of the leaders of different groups (spiritual, community, or other types of groups) and second to train those leaders to counsel others. Many outside professionals have offered their services and we are already preparing lessons that we trust will help the many cases of post-traumatic stress disorder that we are seeing.
• Funds: We have been planning all of this without the necessary funds to accomplish it. We barely have the money needed to function as a ministry in February and March. We thank God for so many of you who, by giving offerings, have made it possible for us to have these two months covered. God is teaching us to depend on Him in everything, and I believe that this is a process in which the Haitians are growing in their faith. We are sure that God is guiding us and the plans are already underway. The SODIS program is already covered for 2010.  For the rest, we trust in God that it will arrive each month.

If you feel the desire to support these efforts either with your presence or in your professional capacity, please feel free to contact us. The commitment with Haiti must be something that goes beyond the first week of emotion. The country is in ruins, every inch has been affected by the earthquake. The families around us all have eight to ten more people to feed in their houses for who knows how long. The refugee camps will be moved to specific locations, but in the provinces the exodus is having a tremendous impact on both the family economy and local economy. We believe that CHE is a very valuable tool to contribute to the solution of the problem. We will need $50,000 to cover April through December of 2010. This amount includes transportation, meetings with key people, trainings, community visits, partial salaries for seven people, and communication and office costs. 
  
We send our affection and appreciation for all of you who have been giving ideas, sending support, praying, and offering help.

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February 3,  Milot hospital
Sandy and I arrived at midday to Milot, the hospital where Dr. Robin, Jane, and Adrian (from the Northpark Church in Ontario) have been working since Saturday. Dr. Robin is a plastic surgeon and he’s operated on many, many patients since he arrived, sleeping little and spending most of his time receiving those who were burned or had limbs amputated, as well as taking care of all types of wounds.
The hospital in Milot wants to receive tents [the type used for camping] for the family members of the patients that have come from Port-au-Prince and don’t have anywhere to sleep. We’ve met several people in this situation. We met one woman who has two daughters, one of which has had internal hemorrhaging and had already had three different operations. When I asked her where she’d been sleeping she answered, “Wherever I can find where I can sit down.”  

When we arrived Robin was operating on a girl who’d been burned. So while I was waiting for him to finish I went to speak with the hospital’s medical director, Dr. Previl, who is an old friend of mine. He showed us the six military tents that had been donated to shelter 300 more patients and promised to e-mail me with a list of items that are most needed in order for them to function well. The hospital has ever-increasing demands since helicopters keep arriving with more patients from either the hospital ships or the capital – which is in ruins.
Later we visited some friends on our way to the CHE office, and then in the office we met with three of the four Haitian CHE leaders. We all shared how we were feeling and news from the last few days. 

Tomorrow we will be meeting with the CHE leaders again and we will deliver some of the medicines that we brought to a local clinic.
The deep and extensive conversations we have been having with our colleagues here are helping us to get some clarity in this situation, which is so confusing.

We need your prayers. God answers. This morning, on our way to Haiti [from the Dominican Republic], we prayed that God would show us where to look for Esteban and Ramiro, children of Uruguayan missionaries that had stayed here by themselves when their parents needed to return to Uruguay. At that very moment, Ramiro – who had not shown up for school –appeared alongside our vehicle. I gave thanks to God for showing me how He is working in the little things as well as the big

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January 25   Life is almost impossible in Port-au-Prince. Massively, the residents are moving toward the country sides in search of shelter where they can breathe, drink, eat, and sleep. The local hospitals are full of broken people. Just today the US coast guard helicopters finally stopped transporting new patients to a hospital here for surgeries.

The Medical Ambassadors of Haiti received food supplies and medicines yesterday… The four senior CHE trainers in Cap are thankful to the Dominican CHE trainers. Yesterday afternoon, we visited with some of the 150 victims at the hospital who do not have relatives nearby. We distributed some items and encouraged them through the Bible. It was so hard to listen to their stories; they all acknowledge that God is good all the time. We see real need for psychologists in the country now.

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January 23   I am back in the United States. We will be preparing a new ministry plan in light of the pressing needs that the earthquake has created throughout the country as a whole. The survivors continue to flow from the capital city to the provinces. There is a need to reinforce the local healthcare systems and have a broader program. What is most needed now is good coordination beginning with nationals’ decisions – the Haitian leaders are truly my heroes of this past week. I saw so much effort: from the rescue of the victims, to transportation, to home visits, to medical care by volunteer professionals in spite of their personal losses, that I am truly encouraged to begin to think of a completely new Haiti that will arise from the strength of its people and teamwork with foreigners. WE MUST GET ORGANIZED were the words repeated over and over by local missionaries. We truly feel the greatest strength is in the Haitians themselves, a resource that has not been fully appreciated. We must pray for those who have decision-making power, that they will include the many nationals who want to be part  of the solution.

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January 22   We’ve now visited 11 sites, the last one in Delmas 48 golf club. There are 20,000 refuges, including 4000 children. It was remarkable to see the amount of tents and cardboard structures. In the corner of the camp Dr. Luigi Largo was working with few resources, attending patients who were sobbing and shouting from pain. We were sent to a pharmacy with a list of medications for all 11 sites we visited. We were turned away; I was so disheartened. We went to the UN offices and told our story. They took us very seriously and promised to have all our medications for us tomorrow. We were so thankful. We know how many missionaries are without supplies. I feel that God put me exactly in the right place to be the most effective, networking with others and speaking for those who do not have a voice so that their work will be easier.

In the second phase of the work here, we will consider various factors. STEP’s CHE program has lost two of their CHE workers. Others that survived from that program lost close family members and their homes and belongings. I would like to focus the immediate support on these brothers and sisters while preparing another worker to run a rehabilitation program focused on spiritual and emotional support of the victims, training them in participatory lessons and community ownership.

A CHE trainer in Cap Haitian (a major city in the north) wrote to say the gym is filled with refugees. The local churches are taking offerings every day to prepare food for the people. There is so much to do in the north as well. Many families are arriving from Port-au-Prince to be with relatives in Cap Haitian. May God give us wisdom to channel efforts and resources appropriately. I hope to be able to return to Haiti in the first few days of February.

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January 20   We just experienced a 6.1 earthquake at 6 a.m. Since we sleep dressed and with passport in my pocket, it was a quick flow of people out the door to the yard.

Yesterday we were in Christianville. The clinic there is severely damaged and they started seeing patients yesterday. These people had wounds that had not been cared for before, broken legs and arms, and infected wounds. Some people are getting hurt because they try to go home and start clearing up, moving debris, and wires; they end up getting cuts and bruises. The CHE committee has been helping… We have seen a lot of people who need to talk and express how they feel, to be assured of God’s unshakeable love for them.

SODIS will be a good teaching tool if we can get organized in this chaos. I plan to go to Cap Haitian the first week in February and get our teams to help with planning and priorities.

This afternoon we went to Bolosse to encourage Petion, who is the leader of the CHE program with the STEP organization. His wife’s mother died in the earthquake and her sister’s house was destroyed. Their ministry has 5000 refugees making their home on their lawn – very well organized, without any relief services or any food distribution in that area. The children are playing and singing with Petion’s wife and other volunteers, who are committed to minister to others in spite of their personal losses. During the day the people leave the compound to look for food in the markets and return later to sleep.

We will concentrate support on the following areas:

• Emotional support for victims: training nationals in counseling techniques and spiritual work in times of crisis
• Supporting the victims who have lost their homes and loved ones with a one-time donation, focusing on our CHE partners (STEP) and other relationships that we have through our teams in the north
• Developing relationships to implement SODIS (water purification), followed by CHE training in association with local NGOs and long-term work

January 19   Good news! We’ve heard from Anias. He arrived at his home town on foot, after he was robbed on the way home. However, he survived and we are so happy with this news. (Editor’s note: Anias had been missing since the earthquake on January 12.)

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January 18   We arrived in Port-au-Prince (PAP) at 2:30 p.m. We went with our contact, Miguel, to the Argentine mission of the UN. We passed by gigantic tents with different groups of Americans taking care of about 450 patients. The tents were filled with patients on cots, many of whom had IVs. The Argentine group we needed to meet with was there, working in a tent. They were very happy to see us and took us to the coordinator of the medical unit, Dr. Alonso, who told us that “every grain of sand is needed to make a beach.” Dr. Alonso’s office building was destroyed. He told us that he ran out of the building and the only thing he saw was the dust behind him. Now his “office” is his telephone. He has nothing else to work with, but the work he does is invaluable. What is most needed here are orthopedic surgeons and casting and splinting supplies.
                       
Driving down the streets on the higher side of town one can see some collapsed buildings…the dead bodies that were piling up on the sidewalks are no longer there. They have been removed or burned, although the bad smell in the heavily damaged areas remains due to the bodies that are still buried under the rubble. There were no more tremors today, everything is calm.

People are rationing water. They aren’t using water to wash themselves or even for the toilets or housecleaning. The priority is to use the bare minimum needed to keep the most indispensable things clean and to cook. No local shops are open, but people are receiving food through distributions made by local churches: local leaders prepare the people before the food drops occur so that things go in a more orderly fashion. We distributed our SODIS material (for water purification). We need to mobilize the people on this as quickly as possible.

The search and rescue groups aren’t able to meet the immense needs in so little time. This is one reason the people are very sad, because they would still like to search for survivors… Person after person tells how they were saved from a sure death by a sudden decision, or because they had left the Caribbean Supermarket just in time – many died there, and they still haven’t been able to excavate it completely. Only thirty people were rescued from that building.