John pulls up in the Toyota and greets us with a big smile and good English. I climb in front with *Nancy on my lap, while Shiela arranges the diaper bag and *Martin beside her, before adjusting baby Jane on her lap. All three of the children are dressed like we might be on our way to a fete (party) or legliz (church),with Nancy in a purple plaid dress, Jane in black on white polka dots, and Martin in a handsome collar shirt with khaki shorts, but we are headed to Milot (MEE-low) Hospital. I am accompanying Sheila for the children's routine HIV appointments where they receive the medications and care that keep them healthy. There is no outward sign of the deadly disease within that has already taken the life of their parents and threatens theirs.
Rains have soaked the land every night in recent days, so the difficult dirt road is even more challenging to navigate that usual, with puddles the size of small ponds connected by narrow muddy rivers. We do not pass many of the moto's that usually populate the roads, and it relives me to know there are some conditions even too tough for them. John is a cautious driver and moves slowly through the dips and mounds. It is reassuring, knowing the children are only restrained by the limited strength of our arms. After a few miles we reach the tar road. It is welcome relief to our jostled bones and tense abdominal muscles. The rest of the drive is fairly comfortable with Nancy nestled cozily under my chin.
As you enter the outskirts of Milot, the Citadel stands on a mountaintop above, square and formidable The streets are busy with school children in their bright, coordinating uniforms, and food vendors line the street in anticipation of the day's traffic. We pass the hospital dormitory compound on the right, where visiting medical professionals and other longer term doctors and nurses live. It is gated and guarded, and the cement block walls of buildings have stained glass in typical Catholic style. Beautiful fruited and flowering trees dress the grounds.
The hospital is not much further ahead on the left. Nancy doesn't want to walk, so I carry her as we cross the busy road. The main entrance is clean and crowded with vendors, security, men and women dressed in scrubs, and nursing students dressed in prim white aprons with white hose and knee socks, reminiscent of U.S. army nurses of WWII. The sick are interspersed, arriving on foot, carried by concerned loved ones, or occasionally in wheel chairs.
The hospital itself, is a collection of whitewashed buildings connected by narrow sidewalks, corridors, and courtyards. People sit everywhere on benches or squatting on the side of walkways. Doors leading into various departments are crowded with those who wait for appointments. Pediatrics on the left, across from radiology, then little a little room with a placard overhead reading, "department of community nutrition", and so on.
We wind through most of the grounds, climb a flight of stairs, and arrive at the HIV clinic on the second floor. There is a short hallway with 4 chairs on the right and a wooden bench on the left. Five doors open into the hallway, but all are closed. Already 2 women wait. One has a small baby dressed in a purple sleeper and wrapped in a warm blanket. The baby sleeps on her lap, with no hint at the ailment that brings them here, The mother smiles gently as we sit down across from her. The other women has a small baby wrapped similar to the first. She tells the first woman her baby is sick and she has a worried expression which fades, but does not disappear, when we greet her. Her baby lays on the bench beside her, motionless, asleep.
Though we have arrived a 1/2 hour late, it does not appear we have missed out on anything. Medical staff are in a meeting. Occasionally someone leaves the room to take a phone call, but otherwise the door remains closed. After an hour or more, the meeting ends and a nurse, then the doctor, come to begin seeing the patients that now fill the seats and bench.
The children in our care are remarkably patient. There is no play area. No office books or magazines. No brightly colored murals or decal to distract them from boredom. Madame Ga, the depot supervisor, has packed some snacks, powdered milk and water, a couple of fisher price animals, and two books. The snacks are the most effective pacifiers.
One hour turns to two, and then three. During this time Martin announces he has to go to the bathroom and proceeds to start peeing out the door. Sheila grabs him and brings him to the base of the stairs to at least have him pee on the grass. This happens one more time.
Nancy also indicates she has to use the bathroom. Her journey is not quite as simple as Martin's. Though there is a bathroom near the clinic, no one has the key when we need it, so I leave with Nancy to take her to the public bathrooms across the road. This is the kind of adventure no one wants or needs. The public restroom is manned by a janitor with a mop, which somehow does little to reassure me about sanitation. There are not separate entrances for men or women, rather one large room with separate stalls that lock individually and a roll of toilet paper suspended on a wire by the front door, should you chose to it before going into your stall. Once inside the stall, the toilet area is a raised, tiled area, with what can best be described as having a sunken urinal in the middle, and a place to put your feel on either side. Not knowing the best approach with a young child, I simply took her underwear off, and held her suspended in a swing-like position over the hole. I was grateful to have stuffed a small role of toilet paper and a bottle of hand sanitizer in my purse before leaving. I had the pleasure of taking Nancy to this bathroom twice. I chose to hold it.
Nearing 4 hours of waiting Martin's name is called. Sheila takes him into the nurse's office where he is weighed and vitals are recorded. The same happens with Jane and Nancy, followed by more waiting. Finally the doctor calls each child's name. Blood samples had been collected the day before, so Dr. is beautiful, friendly, and smart, and speaks good English, which she uses out of kindness for me. She reviews the results and blood counts, does a brief physical, and makes recommendations. Jane and Martin have gained weight and height and their numbers have remained good. Nancy also gained height and weight and was free from illness, however her number had dropped significantly from her last visit, meaning her anti-retroviral medications are no longer do the job they need to do. There will be a clinical review of the HIV cases on Thursday, so Nancy's case will be reviewed. Dr. Michelle will recommend an adjustment in medication to address the change in numbers in order to keep Nancy healthy. This means we'll be back for more labs and appointment in the next two week which is not so pleasant, but we are grateful to have a good HIV clinic available to serve our precious little ones.
Dr. Michelle has written orders and prescriptions, and though I had hoped we were done, we still have a few more stops to make. We load up the diaper bag, now filled with empty snack and milk containers, and books a little worse for wear, and haul the kids back down the stairs to a small office. Here we will pick up the ARV medications and have our order sheet stamped in order to pick up the rest of the prescriptions at the regular pharmacy. The pharmacist looks over the orders, selects medications, throwing the information pamphlet over his right shoulder in the general direction of the garbage can, sticks a new label on the bottle, and hands them to Sheila. He says I am learning Creole faster than Sheila, which is strange considering we have never met and he has no idea how long I have been in Haiti, not mention Sheila is fluent enough to translate effectively with almost anyone I meet.
We leave this office and go a few doors down where we need to get another specialized medicine for Martin. He has to pee. Again. So Sheila takes him outside while I await the packet of TB meds being prepared. Sheila and Martin return, we gather up our load once again, and proceed to our final stop for the day -- the main pharmacy.
The pharmacy is basically a walk up counter with doors wide open in order to allow people to spill out onto the sidewalk. Something about it reminds me of walking up to a carnival booth. The wait is long. I take Martin and Nancy to "entertain" while Sheila keeps Jane and stands in line. During her wait, Jane's diaper rumbles loudly to announce a delightful "poop up the back" event while Sheila waits helplessly in line. She digs in the diaper bag for a blanket to contain the mess and resumes her wait. After about 45 minutes she finally reaches the front of the line and gets the needed prescriptions.
While waiting for Sheila, John finds me waiting. I ask him to take some money and buy a few drinks for all of us, and a little lunch for himself, as he has been waiting the entire time of our visit, as well. We meet up to walk back to the vehicle together, relieved to be on our way home. After finishing their drinks all three children fall asleep on laps or against shoulders for the bumpy ride home and for the first moment in hours all of us are content and relaxed.
Though this trip for a routine check has been challenging, I know that our children are the lucky ones. Kids die of HIV or for lack of access to basic medical care in Haiti. Haitians know there is no use going to the hospital unless you have the money up front to pay. Those without money or means to buy needed medications suffer with illness or malnutrition, and some are left orphaned from the illness they did nothing to deserve. Our little ones have known of needle sticks and bitter medicine, lethargy and discomfort in their young lives, but they do not yet worry about mortality. That worry is for those who love and care for them now and the families that await them through adoption.
*The real names of the children are not used in order to product their identity.
