So, I just did one of those things that makes me question my career choices – I booked next week’s travel from the hotel room of this week’s travel. That’s just f’ed up for a non-sales, non-corporate kinda guy. I did so, not just for me, but for a colleague who will be traveling with me. Yeah, I’m that person who says “we have tickets to the customer site next Wed. Meet me at the airport.” Also, I provided manager level support to some of the the people I’ve – what – HIRED in my current role.

What the hell is going on?

The gig this week is stressful – I seem to be in a role where people look at me, I bang my fist on the table and say “That’s stupid! We could replace the whole system for that much money!” Then other people find a better solution and I get paid. Sometimes I say “that won’t work.” I’m almost always right, because they stop trying their dumbass hack at that point and do something else. is one of the only people to have ever stood up to me in one of those moods – and his idea (the idea that lived!) is carrying the whole company these days. F-ed up, I tell you. They seem to think that I can work miracles just by hanging around for the next 8 weeks. Perhaps I can. Maybe the miracles would have happened anyway. Who knows? That’s the big question. I feel like a catalyst. Does the catalyst know that it’s essential? Does the catalyst have these doubts?

Tomorrow, I deliver “training.” God help them. I’m in a mood – and 7 hours of sleep won’t change a damn thing.

Anyone who thinks that I know what I’m doing here is sadly mistaken. If anything, I’m just going as fast and as hard as I can, and hoping that I can sort of glide over the pot holes through velocity alone. Velocity and RAAAAAAAAAAGE.

_earthshine_ posted most eloquently yesterday, and all I can say is “yes, that.”

Exchanged some text messages with my sister justkidding_nr:

The animal must bathe and feed itself prior to reporting for labor

She replied:

The animal's feet hurt from standing. Boss animal talking. Prob. important. Animal must stay awake until naptime. F-ing february

To which I said (much later):

The animal drinks alcohol to stop the thinking. Brain meats hurting. Too much thinking.

We’re back to something approximating “normal,” here at the family compound just south of Boston proper. Valentine’s day is proceeding smoothly, with flowers, cupcakes, and all that. Partying was had last night with simianpower et al. Tomorrow evening, I depart for a week in Hampton, VA – doing the bidding of our government overlords.

Life as usual. So I thought: “What’s more romantic than brewing a batch of beer on valentine’s day?”

Nothing. That’s what. There’s nothing more romantic than that.

I’ve got just about the simplest beer recipe I’ve ever made. I’m doing a two gallon boil with four pounds (one can) of pale malt extract, plus a pound of sugar. Couple of pounds of darker specialty grains, cracked and steeped. With just that, prior to getting it back to boiling, the wort tasted damn fine. Malty and sweet with slight toasted overtones. I’ve got a few ounces of Northern Brewer hops, split 2/3 and 1/3 for bittering and aroma, respectively. The aromatic hops are going to go in with 15 minutes left in the boil – which ought to give me a very, very mildly hopped beer. I’ll clarify it with Irish Moss, bring it up to five gallons, and toss in the British Ale yeast.

This is a relative of the Bass Ale clone that I made last year for art weekend – but with less control freak measurement and tuning. Instead, I’m tasting as I go – and keeping an eye on things. This is not entirely by choice. Because of the way I bought my ingredients – I’ve had to do more weighing and measuring than I usually do (bought decent sized bags of each component and measured them out for this recipe). Also, my thermometer is broken.

On the plus side – I’ve got an awesome new stainless steel brew pot. tells me that it can also be used for soup – but that’s just crazy talk. This is a four gallon stainless steel pot. What else could it be for except for beer?

What makes it “Dorchester’s Best,” you may ask? Historically, I’ve bought spring water from the grocery store for my beer. This time, I took it right out of the tap. Let’s see how much it matters. My guess is that this process will yield an absolutely fine and tasty beer that will once again be a hit with the non beer-o-philes at art weekend. For the beer-o-philes, I’ll make something next weekend. Something dark. Something strong. Something hoppy and bitter and complex. Oh yes. I laugh maniacally and pet my cat, just thinking about it.

Like I said – back to normal around these parts.

I’ve returned to something approximating a normal routine after the trip to Haiti. I’ll admit to the usual disappointment that “everything,” didn’t change. By no means did we fix the country, or even come close (not that such was ever our intent). As on previous trips, we helped a few individuals who needed help. Most of the trip was about touching people who are sleeping in the streets and vacant lots near their ruined homes and workplaces. Perhaps 10% of our patients received direct medical help for immediate medical problems. The other 1350 (give or take) at least got to interact with three separate people who touched them and listened to their stories. They got to sit in the shade for a few hours. They got clean water if they wanted it and emergency food if they needed it. They left with a couple of bags of over the counter medications that might help with aches and pains, congestion, and getting to sleep.

It was the best we could do.

The most popular question I’ve gotten, when people hear that I went, was “how is it?” Here’s what I say: It’s bad. It’s very bad. The city is ruined. Many streets look normal until you realize that you’re looking at 2nd floors that are resting on the ground. The people are still hungry. One mark of this disaster will be a population with a sizable proportion of amputees. I expect many buildings to be rebuilt with an eye to handicapped access. Another mark will be years of psychological issues. We took to calling it “Earthquake Survivor Syndrome.” A constellation of symptoms – inability to sleep, sour stomach, headaches, body pain, night terrors, and so on. All perfectly reasonable reactions to having your home destroyed, relatives killed, and sleeping on the ground for weeks with no end in sight.

The challenge for Haiti in the next decade will be to leverage the disaster, horrible as it was, into an opportunity. Haiti remains the poorest nation in our hemisphere. It’s perhaps an hour by air from Miami. As I’ve been saying to people over the past four years – this situation is in our backyard.

At some point in the not too distant future, the flavor of the aid that we provide will need to change. Usually, my group charges a nominal fee for clinic visits. Not much – and certainly nowhere near enough to cover our expenses – but charging prevents us from undercutting local care providers. If we always gave away free care, people would simply wait for the free doctors rather than keeping local doctors employed. We want to wind up as a supplement to local capability – not a replacement. Similarly, when we build a school or a clinic – we are very careful to build a Haitian team who are responsible for it – and then provide the resources they need in order to take the lead on construction and operation.

Obviously, on this trip, everything was free. But sometime soon, outright aid needs to become partnership instead. Managing that transition will be a challenge for everyone. This is the difference between the Partners in Health approach, and (for example) the Doctors Without Borders. The latter roll in with team after team of highly trained doctors and staff – but then they roll out again. PiH stays to build capability from the bottom up.

What can we do that would help the most? I honestly do not know.

I do want to give shout-outs to some groups I saw working down there:

* We saw some really high grade shelters and tents provided by Rotary International, Canada, and Coleman. I’m sure that a lot of other groups provided shelters, but those three were everywhere.

* The Dominican Red Cross were everywhere.

* “Save the Children” had truck after truck of supplies rumbling around town.

* The US armed forces were omnipresent – and we heard a rumor that these men and women were volunteering their non-deployment time (i.e: time that they could have been working at a US base and living with their families) to serve in Haiti.

* And of course, Partners in Health.

One of the few shots of Jen and I together in Haiti. Most of the time, the cameras were pointed outwards.

I think that the most dangerous idea in modern America today is this:

Educated, intelligent, and successful people are unsuited to positions of political power and leadership.

This is a meme that could actually take us down, and I think that we need to meet it head on. I could care less about the “debate” over evolution – except insofar as it affects school curricula. There is no debate, and we shouldn’t dignify the fringe any more than we dignify flat-earthers and scientologists. With regard to gay marriage and open homosexuals serving in the military, I think that we’re just waiting for (as Dr. King put it), “the past to die.” The majority of the other big political arguments these days seem to be marketing and smokescreen to me. Nobody is actually arguing in favor of socialism anymore – so to staple that label on someone is simple schoolyard name calling.

This idea that we should preferentially select leaders who are proud and belligerent in their ignorance – this one is really dangerous.

This is the distilled and purified form of the “just another guy,” “one of us,” and “like to have a beer with ‘im,” genre. It’s the idea that you should elect the good ole boy rather than the college grad. The PTA / Hockey mom rather than the lawyer. The dude in the pickup truck rather than the woman with a career of civil service. Oddly enough, this awful idea is being advanced by the party most likely to object strongly to any form of affirmative action over the past few decades.

These ideas are not all bad in their generic strengths. I do support charismatic national and local leaders. I think that if all else were truly equal – a leader who was unlikable and unpersuasive would be a poor choice. What I’m talking about is the scorn of the football team for the national honor society. “NEEEERDS,” cry the Tea Party, “DWEEEEEBS!”

Is this really what it comes down to? Churchill said something to the effect that the biggest problem with Democracy is that you get who they pick.

A friend recently described the current political situation as one where, “we’ve got a guy in the White House capable of more nuance than anyone in recent memory, and a political culture that can’t deal with any nuance at all.” Our current mode of political discourse does not encourage nuance. It’s the sound bite rather than the thought. The thought rather than the argument. The argument rather than the philosophy.

I don’t know what to do – but if the majority of voters decide to consistently vote against the smart people – I suspect that we’ll make some seriously bone-headed moves in the next few years.

Here are some pictures of Haiti:

Elizabeth’s pictures
Our pictures

Totally unorganized for the moment.

Here’s one I find poignant:

This man comes each day to the technical school where he lost at least 10 of his friends in the earthquake. He comes because his home is destroyed, his workplace is destroyed, and most of his friends are dead. He escaped through pure luck. He comes to tell people about his friends.

There is a lot of writing about Haiti. I want to write for a moment about Haitians.

The reason that I keep going to Haiti is not that I care so much for the nation. It’s that I’m deeply in love with its people.

Haitians have the most brilliant and unexpected smiles I’ve ever seen. For the most part, they go about their day with a rather closed expression on their faces. This can lead you to think, from candid pictures, that they are a dour or unhappy people. If you wave or smile at a person on the road in Haiti, 9 times out of ten you will be rewarded with a smile like a sudden sunrise. The eyes light, the face brightens, and they return your wave. Similarly, they are guarded and careful at first. Anyone who lives with such hardship would be. However, when you talk openly with them, they are a joyful people. Poor, downtrodden, cautious, misused by the world – but at core joyful like no others I’ve met.

It is no exaggeration to say that the average Haitian I’ve met is happier, in a very real sense, than the average American that I know. That should tell you something about both sides of the equation.

Haitian children sit quietly like no others that I’ve seen. I’ve watched a bench filled with twenty 5 year olds sit quietly, waiting to be seen by the doctor, for hours at a time. Again, when I took a hand or looked into the eyes, that smile would light up the room.

Alan, the architect traveling with us, shared a story: While evaluating buildings, he was standing on one wall, looking at an adjacent wall that was in the process of falling over. Under that wall was a pile of trash. While he watched, a little girl, perhaps 8 years old, wormed her way out from the hole she had dug herself for shelter – in the trash – under the wall that would inevitably fall and would certainly kill her when it did. She flashed him that open, honest Haitian smile. As he put it “my shit was lost.”

redmed‘s translator, living in the street himself, discretely gave what little money he had in his pockets to the poorest patients who passed through her room. “Hide this,” he would say. “Don’t let anyone take it from you.”

Haitians are a clean people. They dressed in their best to see the doctors (to see our motley crew), and to come to church. To see people living in the streets, bathing in shared water in the open – you might think that cleanliness would go. Somehow, from that dusty, dirty, smashed city – impeccably pressed shirts emerge. Blinding whites and colors, shined shoes. Ribbons in children’s hair. I remarked on this in 2006 and it’s still true in 2010.

Haitians are a people of deep, deep faith and strength.

Haitians are a crafty, resourceful people who can make almost anything work.

Haitians have long, long memories. Children in the orphanage in Fondwa remember my name and ask after team members who came in years past.

Of course, no nation is homogeneous. As someone who tries hard to avoid being a stereotypical American traveler (overweight, badly dressed, loud, rude, clueless, culturally insensitive) – I hesitate to make generalizations about any group of people. Obviously, Haiti has suffered from brutal dictators and vicious local gangsters. However – these are my observations of the people I’ve met – and I would share them with you.

Thanks for listening.

Cross posting from the work blog again:

To the below, I will add:

Our drivers on the Dominican side met us with huge smiles, and it was a massive relief to once again commit ourselves into the armed hands of men paid to take care of us. We stopped off at the same gas station from before, declared it the safest place in the entire world, and bought beers for the road. I had some of the best sleep I’ve had all week, face pressed up against the window glass.

We said our goodbyes this morning, gave away most of our supplies (blankets, sleeping pads, spare clothing, water bottles, etc) to the families still sleeping outdoors in the neighborhood near the clinic, and made our way to the border with the Dominican.

We drove the FHM vans all the way through to the Dominican Republic, stopped only once by an armed guard. He banged on the window and demanded to know what we thought we were doing just driving 17 people across an international border. “Medicos,” we replied. “Andele con Dios,” he said as he waved us through.

Of course, it wasn’t really that simple. We guessed that we needed to get our passports stamped to get past customs at the airport tomorrow. Hardy and I collected all 15 passports and took them to the Dominican authorities. There was a $10 per passport fee to get the entry visa into the Dominican. They took that (cash, no receipt) and demanded some sort of “medical identification.” He showed them his military ID, which seemed to suffice.

They then revealed that we would need to get an exit visa from Haiti before they could stamp the passport. So we walked back across the border (ignoring a couple of offers to hire a moped for the 200 yard trip), around the exhausted looking guards who waved us through, and to the Haitian authorities. We set a stack of 15 passports on the counter, explained ourselves, and watched them get stamped through.

Back to the Dominican side (hello again to the exhausted guards), received 15 more passport stamps, and returned to the group.

At no point did anyone seem to think that it would be important to see these 15 individuals who were notionally crossing the border. It’s also worth noting that the border crossing is a geographically stunning place, a high mountain lake with chalk cliffs plunging directly into greenish blue water. It was a surreal experience.

This was substantially different than the trip into Haiti, since we bothered to stop at immigration at all. We have neither exit nor entry visas from that trip.

Summary: We’re safely back at the Marriott in Santo Domingo – substantially lighter – and planning to get on a plane home tomorrow.

Posting this under lock and key because the LJ account has been given out as a contact point for the group as a whole. Makes it hard to be my usual blunt self.

I am freakin’ exhausted. We’re doing a good thing down here, no doubt, and it feels good to work at capacity. However, we rise with the sun at around 6am. When I say “rise,” I mean “give up on pretending to sleep on the concrete roof, with the roosters crowing, the dogs howling, and the bugs biting.” We commence clinic between 7:30 and 8:00. We bang out perhaps 150 patients before breaking for lunch at 12:30 or 1, and continue through to wrap up at about sunset at 6. This is hot, sweaty, smelly, intense, emotional work. We’ve been passing nearly 300 people per day through the clinic – and I’ve been watching our limited supplies ebb away. On Sunday, when I saw the reality of 1500 pounds of medical supplies – I started saying “we’ll be giving out hugs, and not much more, by Friday.” I’ve shortened the timeline on that. Tomorrow the hugs will start.

For example: We have a moderate supply of liquid tylenol and a couple of other liquid drugs. They come in half gallon jugs. At first we dosed a 30 day supply of these in specimen cups. Once those ran out, we had about 100 small plastic jars of Azithromycin that we consolidated into ziplock bags and used for liquids (re-labelled, of course). Those ran out today. Tomorrow we start double bagging liquid in those same ziplocks.

Hugs on Friday.

Did I mention that we’ve started seeing flat out, honest to God, Typhoid, Malaria, and TB? Awesome.

Anyway, I am once again called to meet and pray. In a humorous twist, I am offering the devotional this evening. Wish me inspiration. I’m reading from Shantedeva.

From the work blog again:

We just returned from a drive around Cite Soleil and downtown. The devastation there is much, much worse than what we’ve been seeing around the clinic. We’ve basically been in a suburb – the houses are spaced a bit further apart and two story buildings were rare. Therefore, while the devastation is very real – it’s not as packed together and overwhelming. People have space to sleep on the ground on in simple shelters next to their (former) homes.

We did clinic this morning, seeing a mere ~150 people. This brings our total for the week to the high 800’s. Honestly, we could be plus or minus fifty. We try to track patients with a rudimentary chart (piece of paper with name, vitals, chief complaint, evaluation by the doctor, treatment administered, drugs prescribed, and so on) but urgent cases pre-empt that process. I’ve also lost count of how many people have been carried past me in a fireman’s (two man) carry as I worked filling small containers with our limited drug supply.

Google maps and Google Earth have remarkable overhead imagery of the city, updated after the quake. I would encourage everyone to take a look at the national palace, the cathedral, and Cite Soleil for reference on what I’m writing here.

Cite Soleil is built on top of the former garbage dump of the city. Not the most stable of foundations – but it’s also explicitly intended for some of the poorest people in the Hemisphere. The poverty there was intense prior to the quake. When it rains, the sewage from the city flows through Cite Soleil on its way to the sea. We stopped at a church supported by the group I’m with (Family Health Ministries). It would normally seat about 2,000 people, but it is unusable due to many cracks through the foundation and walls.

The architect traveling with our team picked up a fist sized piece of concrete from the foundation and crushed it to powder between his hands. “You couldn’t build a doghouse on this foundation anymore,” were his exact words. Apparently once concrete has set, subjecting it to severe compression and strain will weaken it structurally.

We then drove to the national cathedral and the palace. Frankly, I’ve never felt so safe in Port Au Prince before. You can find footage of those buildings on CNN and so on. It’s a lot more intense up close. A city builds a cathedral as an expression of their hopes and dreams – the architectural pinnacle of what they can accomplish. Seeing that reduced to rubble took a lot out of me.

A lot of buildings looked fairly normal, until you realized that you were looking at a second floor resting at street level.

On the other hand, we passed US, Brazilian, and French military and construction convoys. We chatted with several members of other groups who were getting on with the business of building infrastructure.

People are living in clusters of strangely homogenous tents. Here, a hundred from Coleman. There, 200 from the Rotary.

With that, I will again close and let someone else notify family and friends that they are doing okay.