Thursday, July 31, 2014

Free Market and Basic Needs- Lessons from Haiti

I’ve long held the view that ideologies trump solutions every time but the kernel of truth contained in most ideologies could be opportunistically applied to find solutions and to placate those baying for blood at the mention of a worldview he/she opposes.

In my view the “free” market, the laissez faire industry, a social safety net, government control and accountability for the frameworks and infrastructure that constitute the basic needs of people are not contradictory. Moreover what is meant by government control and accountability is situational- it is different in different places, times and situations, and needs constant revision based on equitable principles. Elsewhere I have argued that economic progress as measured in macro terms such as GDP, NNP-MP, Per Capita GDP adjusted for purchasing power parity and so on is insufficient and even counter-productive.
In Haiti, Tom and I had a conversation on how India compares to Haiti. Tom offered the view that India was in worse shape. This is true if you took absolute numbers into consideration- such as the number of HIV/AIDS patients, the number of people below the poverty line, the number of people without access to clean water and sanitation, etc. 

But when I suggested this to a colleague in our company (a white collar professional who is paid highly and would be considered among India’s 1%), he was visibly upset- he mentioned that the per capita figures told a vastly different story. The per capita GDP with or without adjusting for purchasing power is way above Haiti’s. In nearly every social, political and economic indicator, this would appear to be true- from his perspective. In office a few weeks ago, after Mr. Modi became India’s prime minister, my boss and an American colleague were discussing the social challenges in India. The American colleague mentioned the caste system to be at the root of these problems. My boss was not pleased about this and claimed that the caste system had long been abolished and was not operational any longer. He is a Brahmin, and if one allows for some wiggle room, maybe he is just plain ignorant of the realities faced by Indians at the other end of the spectrum. But he too was right in a way- from his perspective.

I think it is important to note that both these points of view are right. I would like to add another view, which I think is the most important among them all. If one were to use the “per capita” point of  view and list every individual in the lowest third of the population (or lowest strata; the exact percentage does not matter in our current consideration), and tried to understand how many of them have access to resources that would be considered basic needs- clean water, equal and real opportunity to jobs, access to those jobs, good education (in the business language of the community), safety from structural violence, punitive justice, roads, sanitation, healthcare, communications, nutrition, shelter and other indicators to be revised as they are added to the list of essentials- one would find that each country would need to aggressively treat the conditions as if they would a dangerous pathology.

Such treatment would need to be initiated first and foremost by the public sector. We entrust some of these duties- such as the machinery for law and order (police, lawyers and the judiciary) to the public sector (lawyers being overseen by the Bar) because we believe it is the fairest method to govern them effectively. The police is the only monopoly on coercion we allow in any country, except in extraordinary circumstances when the military or peacekeepers take on that role. This is because we fear that coercion can and will be abused by any other party. In fact, of course, even the police forces in many countries routinely abuse their authority. This is another reason why the people in the lowest strata in third world countries need protection. Private security is among the most booming businesses in these countries, and with a combination of private security, bribed officers, lawyers and judges, the rich can and often do get away with crimes- while the poor are often mistreated for crimes they may not have committed. So says Gary Haugen in ‘The Locust Effect.’
In ‘Haiti after the Earthquake’, Paul Farmer makes the point that international aid, social workers, short missionaries (like ourselves at HART) and organizations like the UN have bypassed the public sector and set up NGOs, international political outfits, church-based charities and for-profit organizations to do what the public sector should have done. They are both effective at what they do and ultimately destructive in waylaying the foundations that make for good governance- the lasting and self-sustaining institutions in every country that is driven by local leaders and participation.

In India, institutions like the Christian Medical College with campuses in Vellore and Ludhiana were initiated by American missionaries, in particular by the founder, Ida Scudder who arrived in India as a short term (for those days) medical missionary. Today it is among Asia’s largest teaching hospitals, and though it received oversight from a New York charity, it is very local and self-sustaining. There are several such stories in India of institutions that have been created by others, but nurtured by Indians- my own alma mater, Madras Christian College and other such as St. Stephen’s College and Stanley Medical College being examples.
Without local leadership, they will perish- just like the abandoned windmills described by the anthropologist Tim Schwartz in his book ‘Travesty in Haiti’. Noone knew where those windmills came from, who built them or when. Some missionaries let him know that an unremembered foreign aid organization had built them in the early 1990s and the US military personnel helped maintain them during the occupation, but after they left had fallen into disuse and abuse- some people had ripped out their guts. To Schwartz this was an accurate picture of foreign aid in Haiti- its rips gutted by people who had other uses for it.

In Mountains beyond Mountains, Tracey Kidder describes when he first met Paul Farmer during the occupation in the 1990s. Farmer had gone into the US military compound to speak to a captain about apprehending a murderer who was running amok. People were losing faith in the military because they had failed to bring him to justice. The captain replied that he would love more than anything else to slam him, but he did not as yet have enough evidence that it was he who committed the crimes, though everyone in the village knew for sure. He said he had to follow due process, and without it the military leadership would lose all credibility and would jeopardize its own integrity. Farmer argued back that in a country which (at the time) had no constitutional law, arguing for due process was not logical. Kidder states it was an unusual sight- Farmer who clearly considered himself a champion of human rights arguing for penalty without trial and the captain who had come to Haiti as an occupier arguing for due process.

This highlights the tension between providing direct assistance and building systems which support lasting changes. Both are necessary- and indeed people like Farmer have been doing both. Haugen and his organization have been successful in working with local law enforcement- in spite of widespread corruption and different motives- in creating such lasting change.

In the end local leadership- represented by the public sector- must be responsible for the basic needs of the people. All else is icing on the cake and must be subject to the vagaries of the free market. This is true for India, China, Brazil, Haiti and even the US. If there are 2 million HIV/AIDS affected Indians while the economy has been among the fastest  growing and the third largest in GDP by purchasing power parity ($5.42 trillion) terms in the world, is India really in better shape than Haiti? Ask me another.

Tuesday, July 29, 2014

Even More Post-Mission Thoughts

Local doctors, nurses, physicians’ assistants, medium and short term missionary doctors, social workers, the long term missionary-priest. This would be my ideal mini-ecosystem for medical care in the village in Haiti that we serve.

The advantages of having local professionals is clear. What is less clear is how a well-paid team of professionals can invigorate the economy. High-paying jobs create an average of 4 other jobs in developing economies- I can’t cite the source at this time, but as someone with a business, accounting and economics background working in an industry which has created over 3 million jobs in technology in India and 12-15 million ancillary jobs in the process, I can speak with some personal knowledge to this fact.

A Haitian doctor would earn $6500-7000 a year. Even if half the money goes directly into the local economy (and it will because she would need to build a home, purchase grocery, pay service providers who will maintain the premises, coo, clean, attend to kids and perform several other functions), the economy would prosper so much more. Add to this the other roles I mentioned and it would build a core economic mini-ecosystem in the village. In addition, the medium and short term missionaries could help in building an EMR with internet connection for use by all future teams who come to assist.

In addition to this, a doctor needs to learn more and perhaps teach other aspiring doctors.

What would this cost? Here are my estimates:

·         Doctor’s salary: $6500
·         3 nurses: $4000 X 3 = $12000
·         1 physician’s assistant: $4000
·         EMR maintenance and hardware (high estimate): $2000
·         Doctor’s training and ongoing learning: $2000

For about $27,000 a year, we could support this team of professionals. What would take for it to be a committed figure, given that we are slowing down on funding the constructing church building? A core amount to be raised and entrusted for 2 years- this would leave 1 year’s expenses in escrow, earning interest at 2% or more at a local bank and paying for future increases in pay, while allowing the mission to fund the current year’s pay.


I went to the Wheaton Public Library to get another copy of Gary Haugen's 'The Locust Effect' for Alma (I already have a digital copy on Amazon). But I couldn't find one, though I did find Paul Farmer's 'Haiti after the Earthquake'. There is a touching passage about an incident Farmer encountered a week after the quake- this speaks so much of the Haitian heart for God and his people:

"Late one evening, about a week after the quake, I spent the better part of an hour trying to convince a gasping, skeletal, young woman, her lungs half-consumed by tuberculosis, not to join the exodus that had emptied the wards after yet another aftershock. We were both inside when the shaking began, and I remember putting a hand out to steady her oxygen tank, which weighed almost as much as she did. Never had I imagined such a scene: grasping the top of a heavy tank inside a trembling building and trying to comfort a patient and wondering whether the whole place was about to come down.

The patient's name was Natasha, and she was alone, except for a young man sitting on the bed next to her. I assumed he was a family member, or perhaps a nurse's aide. It turned out that he was a Good Samaritan, who'd never met Natasha before. He'd just traveled from a town south of Port au Prince with his own sister, badly injured when the quake destroyed their modest house. His sister had died a few hours before, he said, and he'd not yet decided where to go. So he lay down, alone in a fog of grief, in an empty hospital bed.

And then the ground started to shake again. He leapt up to join the general exodus, but saw Natasha straining against her life-saving contraptions, including the oxuyen tank. He stayed in the building and did his best to calm her. Blood was seeping from around the IV catheter in her arm; panicked, she was also tugging against the tube that piped oxygen into her nose. Claire Pierre and I arrived just then and begged him to stay until we could find a staff member to assume these duties. They were both there the next day, still unassisted, but by then he was sitting next to her, reading from a well-thumped Bible. He had also gone out into the fractured streets and found her something to eat."

Monday, July 14, 2014

More Post Mission Thoughts

Some more thoughts, having to do with my attitude towards short term missions. STMs or as we call in our church STAMP trips have been criticized a lot, and for good reason. Most such trips do for people what they could or should do for themselves, thereby creating dependency and eventually destruction of industries which could prosper without such intervention. Donating food, clothes money, etc have a place- but they cannot make up the whole mission.

HART in my view has been more successful than most other trips. Some of the reasons, I think, as these:

1. Each STAMP trip revolves around supporting an anchor missionary stationed long-term. In this case the anchor missionary is Father Roosevelt who is local and invested long-term. There is great trust between him and his people. Often a foreign long-term missionary lacks this trust, but does carry a lot of trust from his church or support teams back home. The inverse in true in cases where the anchor missionary is a local leader. In HART's case both these problems are non-existent. Father Roosevelt is not supported for his daily living by the Detroit churches, he is invested in his people and he carries enormous trust in Detroit. Each time he visits there is great love and affection, and many STAMP trips have over several years seen his work for themselves and come away impressed.

2. In HART's case there are 2 'medium-term' missionaries, one of whom is committed enough to go to Haiti at least once each quarter. He also spearheads the construction effort for the church HART is building in Haiti. The accountability is stronger with these missionaries' efforts. But such medium-term missions arise out of personal desire and investment into the people. They have found their own personal missions- in the case of one, supporting orphans with medical care and other resources. The bond between the local mission and the overseas church becomes stronger with this quarterly contact.

3. STAMP missionaries are committed to go each year to the same country. In our church each year different STAMP missions target different countries. I remember a STAMP trip to India a couple of years ago, and another one a few years previously, but the frequency of contact and constant investment isn't there. In HART's case there are a few countries they are invested in- Haiti, Uganda, Cameroon, and some others- but this list is limited, and the team is committed to travel to these places each year. The number of people on each team is limited to 25 people but the wait-list is 25 people-strong.

4. Medical care is sorely needed in this region- this does not necessarily create dependency. Without this medical care the people simply will not get any other such care. Best of all, the missionaries make it clear they they are there because they love Jesus. The youngsters who go with the team live in spartan facilities with 25 people to 3 restrooms, having 2 meals a day, supplemented with energy bars they bring with them. Eventually though I think HART would benefit from having a Haitian missionary doctor stationed long term and supported by the church financially.

5. HART is made up of people from 3 different parishes. This is great, and creates the best form of accountability. Also it provides critical mass for the number of people who could be a part of such trips.

6. The 'No Negativity' clause works wonders. Mission trips are often compromised by hurt feelings, sarcasm and other such issues. Most of the time HART missionaries were kind- I can vouch for this, as I myself messed up on several occasions- particularly my lack of care in keeping my sickness to myself- but people were forgiving.

7. Often having heart for missions means saying No to a trip. In this case Tom let me know that his wife did not come because she felt it would be good for some others to be a part of the trip. A true missionary is intentional this way.

I have not yet been on a college church mission trip. But I sometimes wonder if our mission trips could learn from this one. We usually have an anchor missionary who is financial supported by the church and other churches, but local missionaries who partner with them (if they exist) are not heard of at all. In our church we pray for the missionaries we support but not local partners. Such partners also do not come to our church to interact with us. The lack of communication, except in the form of periodic emails requesting prayer and detailing small events, makes for an impoverished form of partnership. Considering that our missionaries are supported financially (each family getting $4000-$5000 a month), this is strange.

We pride ourselves on being a sending church- the fact that half of our annual budget of $6 M goes into missions speaks for itself. Besides this the STAMP teams support themselves, and the long term missionaries raise funds from among the congregation as well as other congregations, which is not a part of the $3 M missions budget. It is likely much higher than the 3 HART parishes put together. We are present in several countries- I wonder if we are spreading ourselves too thin in this way. Alma and I support 2 missionary families in India financially, but the inadequate communication and partnership is not a good thing. There is a lack of clarity as to their work, and there is typically no mention of local ministry partners, no requests for prayer for such people, no introduction of such people to the team in the US.

Medical missions in my view are an excellent way to minister to people. I do not see a focused effort to build such teams in our church. A lot of point to ponder.

Tuesday, July 8, 2014

Post-mission thoughts

I'm still processing all that Haiti meant to me, and I look back and realize that 9 days have the power to change the course of a life. I had not actually expected this though I was told this time and again. The common mission model is that of having an anchor missionary in a place and having teams of short term missions full of eclectic people with varied skills come in to do focused work throughout the year. The anchor missionary should be accountable and trustworthy in order to be able to do this effectively. To avoid situations wherein teams of short term missionaries go to third world countries to build a house that noone lives in or paint a building that then gets abandoned, the missionary needs to plan for these short term trips in advance.

I'm glad to say that our Haiti trip works well in that limited sense. It is only once a year that it happens, but Wayne State University is going in December, and I believe other teams go there as well. Father Roosevelt is clearly a man of the people with his heart firmly planted in Point a Raquette. He lives in modest conditions, and while there are those in the US who would ask why he is building a church when he could use the money to help the material needs of people (like a disciple famously asked Jesus why a woman would spend so much money on buying a perfume to wash his feet rather than spend it on the poor), he knows his people and they love him- it is so obvious.

I also see genuine faith. The petty differences in denominational affiliation that mark us out in the US or for that matter in India do not apply here. Protestants here seem not to carry so much baggage from the protesting attitude stemming from Reformation history against the Catholic church. Catholics on the other seem very similar to protestants in their worship. The sermons I heard and conversations I had with both US and Haitian leaders in Haiti point to this fact. The "bipolar gospel" or the "evangelical two-step" that makes a firm distinction between salvation of our souls and the desire to see God's justice accomplished among the poor also doesn't seem to exist. The people I met were worshipers and seekers of justice. There is no such thing as a "mercy ministry"- it is part of the package.

I've thought long and hard about going back with the same group. It opened my eyes to be part of a Catholic group, the leaders of which are Christian in every way that I consider myself to be. But I wonder if the future holds another opportunity to make more opportunities to go with another group. HART has a group of 25 who go yearly- they also have a waitlist that is 25-strong. After 5 years of serving God in this way, this has become an established mission group. They also go to Uganda, Cameroon and other places.

Father Roosevelt tried hard to get Joyce to return independent of the group. She wasn't sure, but clearly there is great need for more people to go. If we can have another group going to Haiti it would help the cause. I checked with Tom to make sure there would be no issues concerning a different denomination serving with him- he assured me that there would not be.

A recurring piece of conversation is the capability to implement EMR. Each year they talk about it but where there is scant internet access (except in the rectory) and difficulty in carrying networking equipment, computers and printers, not to mention the money needed to customize the EMR for the Haitians' needs, it has become a tough task. Although this is the case, I have an idea to create spreadsheet-based EMR that is not networked. Just like the triage forms we use now, we could fill out this information in a spreadsheet-based form which would then be consolidated into a table. The data from the triage, nurses, doctors and the pharmacy would then be consolidated at the end of the trip, and uploaded to a central location. It would need laptops (preferably tablets) with Microsoft Excel installed in each, as well as portable light printers capable of printing 1000 forms each day. Each station (doctor/nurse/triage/staff) would need to have one. Clearly this would limit our ability to carry pills and equipment due to baggage restrictions, but if we could get this equipment to Haiti as a one-time expense, it would help future missionaries. I will talk to Tom about creating this.

Another thought I have been having is about creating awareness. Tom and I talked about the intentionality of missions. Most of us in the team could afford to buy a ticket to Haiti and back with our own money. But one of us, Dr. Post created a letter that he sent to friends and associates in order to raise funds for the trip. This way a partnership could be established and more people could share in the riches of God's kingdom- the rules of which are to serve people that he came to save. Both Tom and I have had conflicting thoughts about publishing our activities on social media, in that we need to be careful to draw a line of distinction between promoting ourselves and sharing the news of God's transformation of the Haitian people. This is tough because our own motives are often mixed.

Friendships are among the most treasured souvenirs of this trip. Besides the friendships among missionaries, the bond between people in Haiti and myself is a priceless thing I would not trade for anything. It has been a very long time since I have seen people go out of their way to do something out of love, even simple things. This opens up a whole new dimension of Jesus' character that I have seen but also seen it fading away over the years.

More such thoughts, and I will try to pen these down in the next few days...

Friday, June 20, 2014

Days 7½ and 8 in Haiti

Day 7 had its share of patients that tugged at one’s heart, particularly one of Joyce’s. She had cervical cancer that was very advanced and there was no way to treat it. Joyce says it had to be at least 3 years late. I kept thinking of Dr. Paul Farmer’s concept of the “long defeat”. He says, “How about if I say, I have fought for my whole life a long defeat. How about that? How about if I said, that’s all it adds up to is defeat? I have fought the long defeat and brought other people on to fight the long defeat, and I’m not going to stop because we keep losing. Now I actually think sometimes we may win. I don’t dislike victory.

Sara Groves who took inspiration from this wrote a song called the long defeat. She makes the point that we are “so conditioned for a win, to share in victors’ stories, but in the place of ambition’s din, I have heard of other glories.” And “I can't just fight when I think I'll win; That's the end of all belief; And nothing has provoked it more than a possible defeat.”

I think of the cross, a criminal’s death, so much what seemed then a long defeat, and yet the battle is not ours but the Lord’s, and it ends in victory that will last. And we know that the Christian faith wears the resurrection on its sleeve clearly for all to see. But this doesn't come without the terrible darkness of Good Friday. Again, quoting Dr. Farmer responding to his classmates at Duke and Harvard who frequently challenged his faith, "“You want crucifixionYou ba----ds, I’ll show you crucifixion.

We spent the evening of Day 7 on the rooftop, and shared our one big takeaway from the trip. We went around in a circle and I was towards the end. For some reason my fevered brain kept thinking of only one thing- how cool it would be to have a zipline from the rooftop to Port au Prince. I wasn’t thinking much, so I said some things that came to mind. On more sober reflection, I think the one takeaway is the same I experience when I come across great acts for God- seeing Christ in the lives of people who are committed to Him. In these days of scandals involving priests, evangelists, megachurch pastors and other ecclesial or various leaders of faith, we need a Pauline (or Petrine if you are Catholic) figure towering above the rest to look up to. I’m glad to say that I have seen many such living saints, and this has been a rampart for my faith. We sat there on the rooftop against the darkening sky and I heard distant drumbeats eerily floating to us from the forests below. Dave told me those were voodoo drums. There is a lot of voodoo around the area. It felt strange to hear them with the mountain silhouetted against the sky in the night on one side and the glimmering lights of Port au Prince against the Atlantic Ocean downhill on the other. One of those moments when I think to myself, “Where have I come?”

We woke early in the morning on Day 8 and packed up our things and waited for the bus to Port au Prince, which was magnificently late. We often joke among friends about Indian Stretchable Time. It has nothing on Haitian Time. Clearly due to the non-existent infrastructure, the concept of time here is different from the world of our workaday world. The only way to deal with this and maintain one’s sanity is to relax and take on a laissez faire attitude towards unimaginable delays and unforeseen circumstances such as a flat tire in the middle of nowhere. Thankfully we did not suffer from the latter problem this time around, but Tom shared that it happened last year on the way back downhill.
A local bank on the way downhill

Prior to leaving we said goodbye to everyone. The kids were the most difficult to part with. I have never seen more trust, more smiles, or more innocence anywhere else. I took pictures with some of them- Jonathan who lives with Father Roosevelt at the rectory, little girls Missena and Gyn (?) both aged 9, a year younger than my daughter Emma. As the bus drove off, I felt a hollow feeling in my stomach, which I realized was not hunger, but an indication of how much I missed Alma and the kids. I kept thinking of these kids. It is no wonder that these missionaries broach the question of adoption each time they come. As I looked at the little girls when we drove away, I thought to myself: When I return the year after next, if HART will have me, will they retain their trust, their smiles? Will they suffer much when they, as they undoubtedly will, go through chikungunya, HTN and God forbid, the terrible ailments we saw? My thoughts turned to how it would be if these girls were with us at our home in Wheaton, playing with Emma and David, how wonderful it would be. People who know me well know I almost never tear up, but as these thoughts raced through my mind I couldn't hold back. Thank God I had my sunglasses on.
Missena and Gyn

With Jonathan (right) and his friend 

We drove through Port au Prince and stopped at Patrick’s home because his daughter was sick. Joyce examined her and thought it must be the beginning of chikungunya. While Joyce was with the patient, I talked at length to Dr. Carol about Paul Farmer- she said she will read it and ask her kids to read it as well. I never tire of recommending it to people, though I give them the disclaimer about slightly colorful language, especially if they are Christian.  

Then we stopped at a store called 'The Apparent Project' ( where we bought arts and crafts created by local artisans. I bought a beaded necklace for Alma made out of clay. They make these necklaces because Haitians eat clay from the acute hunger. It is a reminder of this horrendous plight. I bought similar other things for the kids. We ran into a blonde girl working there and talking in Creole to the Haitians working there. She said 5 years ago she had come to explore, didn't know Jesus, and had now changed and working there in marketing. Tom, to my surprise, jumped in and said, "We are Catholics." He let me know he does to surprise non-Catholic believers and to see their reaction. The girl kept smiling but I think she was surprised. Then Tom pointed to me and said, "We are all Catholics except him- he is a Wheaton boy. We decided to take him with us." She said they get a lot of people from Wheaton. I wonder who.

We then drove to our hotel, a Best Western, the only one of its kind in the city. This area of town is called Petionville, the wealthy area of town. Sean Penn has a home here. That is not saying it looks like it could belong in Hollywood, much less in Bollywood. But it does have the consuls and diplomats’ residences. We entered the hotel, and let out a collective gasp. It was very much like a US hotel. Tom and I are sharing a room. Looking out our window it felt odd to see the dirt and grime of Port au Prince and the clean order of our hotel room. It is a 4 ½ star hotel. I looked at our bags which traveled downhill separately from us, in a pickup truck. They were covered with thick grey dust.

Later today we plan to go to a local orphanage to distribute rice, beans, medicines and candy. 

Thursday, June 19, 2014

Day 7 in Haiti

I feel much better though I’m yet to completely recover. I’d rather fall sick at home than here but at a place where there are 6 doctors and 5 nurses, there is no denying the care you receive if you do fall sick. I got plenty of meds, helpful advice and a lot of TLC, including a shout out from a nurse about my prayers for the people. What more does an affirmation junkie need?

This is not our last day in Haiti but is the day we wrap up the medical camp. We go to Port au Prince tomorrow morning to spend the day at a nice hotel by Haiti standards. I guess we can only take so much of sharing space in cramped rooms and bathroom rules that declare “if it’s yellow let it mellow, but if it’s brown flush it down”. I can’t say I won’t be relieved. The hotel also lessens our “reverse culture shock” when we reenter the US, which the missionaries have reported in the past.

The triage area again went well. We took pictures with some kids holding up signs saying thank you to Fed Ex, a church and a minor league baseball team, which sponsored some gifts. I left some of my clothes behind for Father Roosevelt. I will leave my guitar behind after tonight’s worship as well.

Among tough cases, one of the students reported a case of a child having worms in her nose! I have to say that these students will have seen far more unusual cases than even the docs who travel to other third world countries. Haiti is a unique place.

Wednesday, June 18, 2014

Days 5 and 6 in Haiti

The triage area is a now well-oiled machine- it’s amazing what duct tape can do. We sealed off the boundaries and gave definition to the path a visitor needs to take. There is no more jumping the line or squabbles as to who came first. Human beings anywhere are naturally prone to getting ahead of each other when they are desperate to get something for which everyone is clamoring. The way to address this is to give the process definition and set boundaries which are visible. Someone jumping the line when there are clearly marked dividers does so in full view of everyone else. When there are no such markers, standing haphazardly may well mean inviting someone to get ahead. A structure- that’s what makes the US work at airports, movie theaters, Dairy Queen or just about any place. It works just as well in Haiti.

Joyce and I had the opportunity to speak to the crowd of people in the mornings on days 5 and 6. I love how the Haitians interact with the speaker. Unlike in most of our churches, they think of a sermon as a conversation. African Americans tend to do this more often in the US, but I find the Haitian version less a cultural type than it is a normal way to process the word of God.

We found several cases- a girl with chikungunya, covered with rashes, a skinny pregnant woman who ate on 3 times a week as her husband had lost his job 7 years ago and never got another one (she was severely dehydrated), and several others- that makes one wonder how we could live with the ambivalence.

Oriol, one of the choir directors came up and played some songs on the guitar with me. I gave him several pages in a binder that contained musical notation for many hymns and songs. I plan to give the guitar to Father Roosevelt when I leave.

A trip like this brings about several interesting reflections and conversations. One topic that frequently comes up among the missionaries is the question that many ask of us- why go all the way to Haiti when there are so many poor in the US. This is, in my experience, a smokescreen for their guilt. It is usually asked by people who have not themselves done anything for the poor either in the US or anywhere else. This guilt is not necessarily a bad thing. As Paul Farmer says we experience ambivalence when we see poverty juxtaposed against our prosperity. There are 2 choices we could make when we experience this- either do something about it or make excuses. As he says in Mountains beyond Mountains, “among a coward's weapons, cynicism is the nastiest of all”.

In the evening on Day 5, Dr. Tom and I visited the homes of 2 of our Haitian helpers- Markenson and Enock (sic). Markeson is planning to come to Chicago on September 29 with Father Roosevelt, and I would like to meet up with him and Tom. I felt great to visit them and build those relationships. Markenson lost his mom in the 2010 earthquake- her grave site is in the compound of his home, marked by a cross. He lives with his brother. Enock is a younger guy who is very friendly. He introduced us to his family- mom, his younger brother and his friend who was finishing up his dinner at their home. A cow, a bull and chicken roamed about the yard. Funnily enough, after I finished praying for some patients in the triage, he asked me if I were a Catholic or a Protestant. It felt great to tell him I'm a follower of Jesus. Was that a cop out? If it was, I don't care.

I could take hours to write about the great helpers we have- Philippe who doesn't take a lunch break in the triage, Robbins who lost his dad last week and is trying to raise funds for his funeral, all the while spending entire days with us at the clinic, and so many others.

I came down with a cough and mild feverishness on Day 6, but I’m quickly recovering. The chik virus doesn’t bring about sniffles and Dr. Tom told me it is good to have the cold as viruses compete for dominance of the body. So if you have the cold, the chik virus may not get a chance to operate.

We distributed Bibles in church today, the Creole version of NIV. Everyone wanted one- where there is a famine for the word of God people treasure their Bibles.

“I think Farmer taps into a universal anxiety and also into a fundamental place in some troubled consciences, into what he calls "ambivalence," the often unacknowledged uneasiness that some of the fortunate feel about their place in the world, the thing he once told me he designed his life to avoid.”

― Tracy Kidder, Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World