The Meaning of Community by James Morgan

In a recent NY Times article1, columnist David Brooks wrote about the importance of grassroots projects and strong community bonds . On reading it I immediately thought of the Lamp community, among whose members  are residents of Cite Soleil, our intrepid medical staff, as well as the many supporters like you who believe in our mission of working — and being — with and for those on the margin.

In particular Brooks writes  that the “neighborhood is the unit of change.” That is, communities grow  when local people act locally. Affluent communities can raise taxes or issue bonds, and build  places like a vibrant community  health center. But poor areas, which arguably need such places even more, don’t have that option , and thus the  need for  outside assistance. Lamp for Haiti is an example of such a transformative place. We have become a vital link to health and an integral part of the Bwa Nef  section of Cite Soleil . And we have done so not because we gave handouts, but because we have intentionally walked with the poor, and collectively we have grown stronger.

Brooks comments further about  a deep skepticism that permeates communities when locals feel “betrayed again and again by outsiders…” who don’t carry through on pledges to stay involved. Like any strong mature relationship, residents are not looking for handouts. Rather they’re seeking  committed partnerships.

In Cite Soleil, a very poor sprawling slum on the fringe of Haiti’s capital, there are many reminders of groups’ — governmental and otherwise – having left behind some brick and mortar structure, with no plan or funding for its future use, or even its maintenance.  In many cases these ghost remnants make matters worse. Not only are they decrepit eyesores, but they also serve as reminders of the social distrust Brooks writes about.  It’s as if he had   been interviewing area residents in 2005, the year we began our work in Haiti. We faced that same deep skepticism for several years before we would become an intrinsic part of that community.

If, as Brooks asserts, part of the answer to the puzzle of community development lies in  understanding that the “neighborhood is the unit of change”, I would contend further that we need a broader vision of who our neighbors really are.  Are they just those who live close to where I live?  Though Cite Soleil residents live far away, Lamp’s supporters clearly don’t see geography as a limiting factor when considering that question. For almost 15 years Lamp for Haiti has successfully worked   to empower residents in one of the poorest corners of the globe,  helping  foster health and pride in that community.  We don’t give handouts, but we do accompany. Lamp has never wavered in our commitment. We have been there in the wake of an earthquake, monsoons, gang wars, political unrest, and now a global pandemic.  Neighborliness requires consistency — acting in a way that demonstrates a long term commitment in authentic partnership with local people. But it also requires resources, a  hand up when my neighbor is in need.

Thank you for your caring commitment to this important project. Your willingness to stay engaged during this difficult time is a (not surprising ) testament to the generous spirit, so pervasive in the Lamp community.

James Morgan, MD
Co-Founder and Chair of the Board

 (1) https://www.nytimes.com/2020/04/23/opinion/income-inequality.html

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Lamp for Haiti’s COVID-19 Update

Dear Friends-

I am writing to update you about Lamp’s local preparation in Haiti for the COVID-19 outbreak, now an official pandemic. 

I have been in discussions with our in-country medical director, Dr Barrere Hyppolite, who in turn has been in regular contact with Ministry of Health in Haiti (MSPP). As of present, there are no confirmed cases in Haiti. 

However, the  coronavirus infection has been diagnosed in the Dominican Republic, which of course shares the island with Haiti. In addition, the greater New York area seems to be the latest “hotspot” of infection, and with its large Haitian diaspora who travel home regularly, it seems inevitable the infection will spread there. Here is a link to an updated map of areas infected worldwide. 

MSPP has announced their capacity to test for coronavirus. If a patient is suspected of having the virus, our staff will contact Ministry of Health. The patient is sent to a dedicated testing site, and the specimen is processed at the National Laboratory in Port-au-Prince. 

Our staff has been instructed on personal protection and we are in the process of trying to procure more equipment (goggles and gowns) to keep them safe.  Masks are provided to staff and to patients who cough. Hand washing and hygiene education is being given by our nursing staff to patients awaiting care at Lamp. The situation is evolving and under continuous review.

Thanks for reading this update, and for continuing to engage in solidarity with our one human family. 

Please take good care of yourselves and take seriously the need for precautions at this time.

My best to you,
James Morgan, MD
Medical Director/Board President
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Why Remember

Tomorrow, we mark the tenth anniversary of one of the most horrific natural disasters on the planet in the past 100 years. A magnitude 7.0 earthquake, or trembleman té, struck just outside the Haitian capital of Port-au-Prince shortly before 5pm on January 12, 2010. In its wake, the earthquake led to the loss of over 100,000 lives, left about one and a half million people homeless and countless lives shattered. 

I was present soon after that earthquake hit, working closely with our Lamp for Haiti health center staff in the huge shantytown known as Cite Soleil, as well as with partner organizations like St Damien’s Hospital and CMMB (Christian Medical Mission Board). I saw massive destruction throughout the city, and heard the cries of wounded and dying. I heard, too, the similarly pitched wails of those scarred by the tragic loss of someone they dearly loved. I smelled death that week, literally; even today the memory of that smell returns unexpectedly from time to time.

So why remind ourselves of such a terrible day?

Some say that recalling the earthquake is too painful, and we ought not conjure that day again. It’s too much to bear. Others have suggested to me that pain is an inevitable part of being human, and even a major disaster is not completely unexpected. As such it is yet one more valley, albeit a deep one, in the roller-coaster that is life. We just need to keep moving forward. 

I would side with those who posit a third perspective. It is a perspective which looks at the catastrophe as a starting point, almost a chance to reset.

It’s no surprise to anyone who follows Lamp’s work or who follows events in Haiti that both human-incited and natural disasters have made daily life in Haiti a challenge. But that challenge has not gone unanswered by most Haitians, and we at Lamp, have walked in solidarity along with them in formulating a concrete response to extreme adversity. 

When we started Lamp back in 2005, we had one doctor and one manager, working two half-days per week. We hadn’t the resources to support anything more. We had to start somewhere, and with trepidation we began to walk on wobbly legs, confident that the mission of Lamp for Haiti would steady our gait. I recall when we had resolved our first “labor concerns” – staff were uncomfortable taking public transportation into Cite Soleil, as they felt they were targets for thieves; they were right, and we soon purchased our first vehicle — it coincided with the end of a remarkable first year. We knew at the time that once the question shifted from “Do we dare even consider trying such a project?“ to “That we are doing this is a given, now how do we navigate the next obstacle?” it would mark a turning point. Once the project’s existence was seen as more than an experiment, but became part of the fabric of a community, then we were confident we could build local support. 

In the wake of the earthquake ten years ago, Lamp staff came together, supported by generous donors, to expand our work and our footprint in Cite Soleil. Initially we hired trucks to dispense water , for example. Next we repaired a local water station in concert with the Haitian Kwa-Wouj (Red Cross). Today we help to manage three water stations, partnering with a local community leader and DINEPA, the water utility. 

We have continued to walk with the mission in our collective mind’s eye. Our programming has grown substantially. We now have 21 (!) staffers in Haiti, including one part-time and three full-time doctors, expanding the breadth of our primary care impact. We recently were asked by the Ministry of Health (MSPP) to become an official vaccine provider in Cite Soleil. (MSPP does not make such requests unless the organization is very well vetted. ) 

It is fitting for us to remember, then, on this day, not only as a way to honor the fallen, but as impetus for us to recalibrate, and reinvigorate and recommit. 

Thanks for being a part of this day, of this work, and of the movement that is Lamp for Haiti. 

– Dr. James Morgan, Jan. 11, 2020

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Reflections from Dr. Morgan at the Clinic

I am happy to be back “home” at Lamp, after we had canceled our three most recent trips due to street protests and insecurity.

Our day started in the usual way, with our driver Anglanes arriving at my apartment with a warm smile, welcoming me back to his country. But that smile faded quickly, as he told me about “blokis” or street barricades that he had to avert to get to work. There is a massive demonstration planned for this Friday, to protest the current president and force him from office, and sometimes things start to heat up a bit in advance of the main event. Vit vit, he said as he hurried me into the van and off we went, doors locked.

On the way I chatted with Dr. Hyppolite and the nurses and our newest lab tech, Miss Blais.  As we approach the outskirts of Cite Soleil, like he does every day, Dr H. hangs his stethoscope around his thick neck, and it makes both ends of the instrument sort of stick out so one has the sense that it will fall off . He wears it this way, I ‘ve come to learn, deliberately. He wants people to know that if they plan to hold up the vehicle,  they may ultimately be harming themselves or people they care about if the doctor can’t get into work. Thus far, it’s been quite effective.

During my morning meeting with Dr. Hyppolite, we talk about the gangs in the area, and how their presence impacts our staff. Then we talk about medications, and he tells me how we need to deepen our reserve as the needs are growing at Lamp. “It’s a great need, Dr. Jim”. Next we discuss how he wants to take the exam for ACLS (Advanced Cardiac Life Support) as he has taken the course online because it’s not available in Haiti. He has studied it over multiple times and is sure that he can pass it, but he cannot find a way to take it, and can I help him? After telling me about his ultrasound skills that are growing, but which are still not good enough because of limited opportunity to get more training, our conversation comes back to the community, and that despite the troubles and the gangs and the ubiquitous trash and lack of electricity  and poor sanitation… despite these things, he is committed to Lamp, and Lamp is committed to the zone.

As I sit down at my desk, readying for the patients, I feel that I’ve just conversed with one of the most committed doctors I’ve ever known, and I feel privileged to call him colleague and friend.

One of my first patients of the day was Lourdy, about 40 years old with a cough for the past month. She had been to see a doctor at the general hospital about one month ago, and they suggested some medication, but she hasn’t the money and could not afford to buy it. She has asthma, and we were able to give her some medication which will control her symptoms.  She thanked me as she left, and   wished me a good day, smiling and coughing as she did.

There were multiple patients like Lourdy, facing challenges like will I be able to eat tomorrow?, and how will I access medication?   Clearly these are problems not unique to the slums of Cite Soleil, but they are indeed acute here.  But what’s even more clear to me is that committed people, like you who would take the time to read this, or Dr. Hyppolite, who is living this, together play a vital role for this place.  We are having a positive impact.

– Jim (via email from Haiti)

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Nine Years Later

Nine years ago today, at 4:53 pm, a 7.0 magnitude earthquake struck Haiti. With that event, came abrupt devastation and loss of life and suffering.  Accurate counts are hard to come by, but suffice it to say many died, many became amputees, many lost a home.

None of us have given up.

I recall in the aftermath of the tranbleman tè a physical fear that we might not be able to access food or water, and feeling constantly parched. I recall the smells permeating around the city, as bodies began to decay under the rubble. I recall the exhaustion of the seeming never-ending line of patients to be yet seen.  But in particular, I recall one young man whom I was helping to care for. He was about 25, and he had been working in a local business when the building collapsed suddenly. He lay on a thin mattress on the tile floor before me, his left arm crushed. The once sturdy radius and ulna of his forearm were quite literally ground into a sand-like state; the swollen, red soft tissue of the arm belied an insidious growing infection. We gave him fluids and antibiotics and pain medication, and we prepped him for surgery to have an amputation.

And I sat down with him and we talked. “You have to save me”, because, you see, he had a fiancée, and was to be married in a few months. Also, he had a job, and his mother was counting on him to provide for the family. “So you have to save me.” He asked me about my family, and wanted to know what brought me to his country. He had so much pain, he said, but the medicine helped.

I saw many patients that night, stopping to check in on my friend several times before my relief arrived. I tried to reassure him that the surgeons were working as fast as possible. I examined his swollen arm and noted his growing fatigue, and said goodbye one last time.

The next day, I found out my friend died. I wept for him then, knowing that my tears were but a few drops in the sea of tears, and I went back to work.   As we all know now he was one of many who would perish, and yet he left behind people who would not allow their lives to be defined or confined by this tragedy. People like you who would continue to stay engaged in life, and try to make it a little bit brighter.

There exists in certain parlance a simple notion of see, judge, act. We keep our eyes open to the world around us.  Should a certain condition arise, the see-judge-act model suggests we follow observation with deliberation. Is this situation normal? Can I, ought I, involve myself? Finally comes agency. Agency involves risk taking, and engagement.

Today we have an opportunity to recall in solidarity the pain of the 2010 earthquake. But with agency, with organization, with great hope let’s continue to engage the personhood of one another.

Warmly sent, on this cold January day-

Jim

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Accompaniment (Part 2)

This morning, I accompanied our accompagnateurs, or Community Health Workers, Damas and Miss Salita, and together we walked around the Bwa Nef neighborhood. The role of the CHW is essentially twofold – identifying sick patients who have not been evaluated for a medical problem, as well as following up on those who are already receiving treatment.
Today we passed Wobé, a 2 year old boy who had been unable to walk due to generalized weakness. Earlier this year, our CHWs had identified him while making their rounds in the community and suggested to the mother that Lamp’s child nutrition program could help. She took their advice, and came to our health center to enroll.  Today, having completed  treatment in the  “Medika Mamba” program,  Wobé is a happy 2 year old boy, walking independently alongside his mother.  Seeing this little boy improve, and too, bearing witness to his mother’s proud countenance, was a sublime experience I won’t forget.
And while the specifics of our CHW work are clear, the unwritten concepts that they manifest are even more striking.
In our last newsletter, executive director Henry Reimer wrote about the notion of accompaniment.  Henry described not only the importance of physically walking alongside our brothers and sisters (and two-year olds!) in Cite Soleil, to and from Lamp Health Center, but also the fruits of that accompaniment.
When we accompany another person, it’s hard work. (Today, where it’s about 90 degrees in the shade, our women’s health program alone saw 39 pregnant women. The medical team saw about another 40 general medical patients.)
The fuel for such work lies at the nexus of a firmly held belief in the organization’s mission,  a well-honed, specific skill set, and of course, persistence.
Accompaniment requires active recognition that the ego is always waiting to take center stage if we let it, and so we need to consistently keep the mission in our sight.  Genuine accompaniment requires an ability and willingness to collaborate, and to remain open to new ideas.
Accompaniment requires pressing on, when curveballs – or bullets, or lack of food, or hurricanes – come our way.
Finally, accompaniment involves a posture of vulnerability.  When one assumes such a posture, it invites risk, but certainly through risk great advances can come.  Accompaniment is real life.
I think a good example of accompaniment can be found in a  marriage, where two people commit to one another for the duration.  The marriage vows don’t qualify that commitment but instead they essentially say “I will stick with you and I invite to to stick with me. I don’t know how we’ll navigate through the hard times, but if we stay committed to the relationship I think we can make it work.”
All of us who choose to stay committed to Lamp’s mission do so with because of an inherent optimism and desire to accompany one another.  Wobé’s progress is indicative of the fruits of such a commitment. I thank you for accompanying the stranger, and for your continued support of this work.
Jim
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A story of accompaniment

Many stories at the Lamp make reference to dire threats to health and challenging medical treatment.  This one is about something much simpler.  Ms. Plaisirmon had already had two children when she enrolled in the prenatal care program at the Lamp.  She received a battery of tests and then came regularly to the clinic for the next eight months.  Her health was generally good – she was treated for an infection and mild anemia – and so was that of the baby.  Lamp Community Health Workers (CHWs) came to her home several times to check in on her.  She got an ultrasound and took her prenatal vitamins as prescribed.  She received a delivery kit and an infant kit.  When it came time to deliver, one of the CHWs went with her to the hospital to make sure that she had the support she needed.  In the photo, she is back at home with her new baby boy (dressed in clothes from the infant kit).  Her gratitude is boundless; she recalls the struggles — physical, financial and emotional — she had with her first two deliveries; she sends message after message to Lamp staff, thanking them for their accompaniment.

The idea of accompaniment is one that Dr. Paul Farmer made central to all of his medical theory.  (Dr. Farmer is the founder of Haiti’s best large-scale health organization Partners in Health and was a crucial inspiration for the Lamp in its early days.)  Health is best served, he felt, when the medical profession considers the whole complex of factors that cause ill health.  In low income settings this means that one must accompany each patient, continually overcoming those factors that may block the path to good health.  Ms. Plaisirmon’s story is an ordinary one, but it is an important one for the Lamp.  It is a sign that we are on the right path.

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