and on the third day

Tomorrow will be my third full day on the job.

Paulo Freire’s Method of Conscientization is about developing critical awareness of groups of people in poor communities, and it has been used by community literacy programs, health workers, and educators through out Latin America, India, and Africa. One principle in the Method of Conscientization is that group leaders must not ask questions with built-in answers, and must be prepared for totally unexpected answers and ideas to questions.

If my question as a group leader is “how to we provide care and compassion (a suffering with) with cleanliness, the answers I witness and receive minute by minute from the nurses, doctors, and staff at Vizitasyon continue to surprise me. Somethings are a bit confusing, I will admit, - - like when the grounds keeper seems to have many complaints about the parts of his job which involve, well, grounds keeping. He would prefer to fill protein bags, and hand off his broom. But then there are the nurses who bathed and shaved an incredibly destitute man - - gravely destitute - - who some of us picked up on the way back from the village. His testicles were literally the size of watermelons, and he has probably not washed in many, many months. The doctors determined that his heart is good for surgery. Treating Camile with dignity was an unexpected answer in this place, in this mountainous island in the sea, full of beauty, and death. And then there was Joselle. She is my age. She was our last patient to leave last night. I had a moment to ask about her. She had a spontaneous miscarriage at home. The nurses told me of her sadness. I saw her father walk her out, through the front door, holding her IV. I knew that my father would do the same exact thing for me.

If you were to ask me what the average day as administrator is like, thus far, I suppose I would hand you a list including: awake at 4 am to those who have traveled through the night for the 8 am opening of the klinik; plan community child deworming mobile unit in order to spend allocated money; run the generator so to fill the cistern with water; do the pay roll; hold sick babies in front of proud mothers; struggle with kreyol; tell local priest that he does not in fact run Vizitasyon- with delicacy; hunt down some Baygone for ants in office; discuss the Gift of Water project with Karen; drink finely prepared granadia juice; ask, ‘well what are they doing in Cange about X, Y, or Z?' Watch the sunset; take a bucket shower; think about the people who were sent home with medicines that require taking with food, knowing they have no food, - and day dream about our nutrition and food program available through our (God-willing) imminent PEPFAR grant and subsequent grants. - And last but not least - - let “the grounds keeper” know that he may not in fact hand his broom to children because “timoune pa travey ici! Ou comprand!?”

Below are a few photos. A photo from the back of where I live and work. A photo of the first building. The medical director Dr. JF (as I call him), and my boss Theresa, from the States who introduced me here, and held meetings, etc. And a photo of the quiet once the day is through.

“We already experience resurrection here and now, in the midst of life, when we rise up against death in life, now, against the oppressions and the hurts to which life here is subjected. In love, resurrection is not merely expected; it is already experienced. For love makes us come alive. And love never gives anyone or anything up for lost. It sees a future in which God will restore everything, and put everything to rights, and gather everything into [God’s] kingdom.” – Jurgen Moltman

medical records for haiti

Partners in Health worked to create Open MRS, an open-source, medical record database designed specifically for the two-thirds world. This program was developed keeping in mind a preferential option for the poor for medical record keeping and medical care, but furthermore, in order to assist in providing accountability for the sake of receiving PEPFAR grants and so on; most clinics and hospitals in Africa are using Open MRS, keeping several million people in the system. So far in Haiti, Partners in Health uses it, and so does Hospital Albert Schweitzer. Being that the Gates Foundation expects its grant recipients to be run like little businesses: data matters, and Open MRS has helped to provide this sort of accountability.

In Haiti, prevention and treatment of HIV/AIDS demands efficient information management, so at my hospital near Miragoane, we are using Open MRS. Today I worked with the President of our Board, Dr. Tom, to discuss ways of making it most efficacious, based upon what we need to track. I suggested that we add a field for how people arrive to the hospital. Basically, - fast donkey or slow donkey? Knowing that paper is a problem in Haiti, I told Dr. Tom that Open MRS is a necessity because we are going to be treating and saving more lives than exist in Haiti pieces of paper. He reminded me that this record keeping is something we must keep in the back of our minds, not in the forefront. When a child is dying of beri-beri in front of me because of a vitamin B deficiency, I need not be yelling at the doctors about getting on their lap tops to log this in. Charting the CD4 counts on women in our HIV / AIDS program will always be secondary to providing care.

Theresa Patterson, my boss, has been very excited about tonight because on "60 Minutes" her friend- - and the founder of Partners in Health, Paul Farmer, was featured for his work in Haiti.

where sin has increased grace abounds (romans 5:20)

Pentecostalism, HIV/AIDS, and the burden of South African women is what my friend Katy researches. Today she lectured on a wide range of issues surrounding the devastating HIV/AIDS problem in sub-Saharan Africa in specific relation to the Church’s failure to care enough (although statistically they care more than non-Christians), turn away from traditional strategies, and zap stigma. As a Christian Ethicist, Katy offers a three pronged approach for the moral response to HIV/AIDS: A Posture of worldliness (ending the bifurcation between the spiritual and the physical); Reading and responding to the situation at hand (the emptying of the church-self to serve as opposed to blindly following moral code); Reframing guilt and innocence (i.e. Christ became guilty out of love). Theologically, Katy’s research can certainly inform my own interest in the anthropology of Haiti’s suffering.

Bonhoeffer has been on my brain a lot lately, and one of his quotes was shared in today's lecture: "I discovered later, and I’m still discovering right up to this moment, that it is only by living completely in this world that one learns to have faith. . . By this-worldliness I mean living unreservedly in life’s duties, problems, successes and failures, experiences and perplexities. In so doing we throw ourselves completely into the arms of God, taking seriously, not our own sufferings, but those of God in the world – watching with Christ in Gethsemane. That, I think, is faith . . . and that is how one becomes a human and a Christian.”

According to Bonhoeffer and divine command theory, God’s yes is bigger than God’s no, and Christians must have full engagement and a posture of worldliness. The numbers say that a third of the world is Christian, and 1.7 million of the 2.5 new HIV/AIDS cases in 2007 are in sub-Saharan Africa. So if Bonhoeffer’s theology were to be adopted by American Christians alone, how long would it take for HIV/AIDS to disappear from Africa, and from the world as a whole?