An older boy, another orphan, gently unbuttons the strap on her pink dress and lifts her arm, revealing a yellow, golf-ball-sized abscess protruding from black skin.
She starts to cry.
"Mm-hmm," says the doctor, Derek Dephouse of ABC Pediatrics in Asheville. "We're gonna have to fix that."
"Right now?" asks his translator.
"Right now," Dephouse answers, standing to retrieve his scalpel.
In Haiti, scabies is just another endemic ailment. The highly contagious skin disease, which starts as a simple rash, can scab and become infected if left untreated.
It’s worse for the children, who just can't help but scratch.
Happily, for this little girl, relieving the pain is absurdly simple. Moments after the wound is drained she’s smiling again, ready to receive her medicine and disinfectant wash courtesy of Mission MANNA, an Asheville-based nonprofit.
Twice a year, the group’s mobile medical team — staffed by Asheville volunteers, most of them health professionals — visits five rural villages in five days, treating more than 2,000 children each time. A couple of hours up the road from the bustling and broken Port-au-Prince, these villages are clustered in and around the town of Montrouis.
For sick kids, these clinics are like speed dating. First, mothers and orphanage directors check their charges in at registration, where medical charts are kept or created. After being weighed and measured, they wait to see one of the four doctors seated at tables along with their translators.
Once diagnosed, the children are given deworming medicine before heading to the prescription-and-medicine station and, finally, receiving vitamins and a nutritional supplement, if needed.
"Sometimes, providing health care in Haiti feels like paddling upstream," says Dephouse, a seven-year veteran of Mission MANNA medical trips. The energetic, 40-year-old pediatrician is genuinely interested in each new patient and seems to get a kick out of how basic Creole phrases for things like "Open your mouth" and "Diarrhea?" now roll off his tongue.
"All of what we see here is vastly different from what we treat in the States. Our colleges have never seen this," he explains, pointing to a boy whose head is covered with a white, powdery fungus.
According to USAID, Haiti has the highest child-mortality rate in the Western Hemisphere. One in eight children dies by age 5, and more than one-third are malnourished.
"In the States," Dephouse notes, "There are welfare programs so the poor can get by. Here, they just die."
A positive spirit
Recognizing the futility of offering health care without nutrition, Mission MANNA gives the most malnourished children akimile, a locally made supplement. Two Haitian community health workers trained by the Asheville doctors monitor the children year-round and provide basic health support.
Recently, the group launched a project aimed at adding fresh milk to the children's diet. Sixteen local families received female goats, agreeing to give their neighbors the first female offspring.
"Since Mission MANNA works in the same five villages every six months, we are able to see progress," Dephouse reveals. "Although this is a very small area of Haiti, what we are doing is making a difference for these families."
Still, few if any of these children have any other access to medical care, apart from the basic assistance the community workers provide. "If they get sick in the meantime, they suffer through it," says Dephouse, who’s been treating many of these patients for years now. "I feel like their primary care provider."
The reason the team must return every six months is simple: worms.
"You don't have to be a doctor to know worms," notes Haitian translator Tevnel Edmond. "Big belly; can't eat, can't sleep ..."
In this part of the country, many people must rely on the Artibonite River — full of parasites and, now, infected with cholera — for drinking water.
Every child here, it seems, has worms. You can feel them just by touching the kids’ massively engorged bellies. The parasites consume whatever nutrients the child ingests, and Mission MANNA doctors quickly realized that without regular deworming, it would be impossible to keep these kids healthy.
But the medicine has a foul taste, so this year the team has tried a Haitian pudding. "We’re using it like a chaser, to make the medicine go down easier," explains 26-year-old Amy Fisher, a child life specialist at Mission Children's Hospital.
In Asheville, Fisher helps hospitalized children understand their illnesses, but in Haiti, she’s a "worm girl," gently coaxing medicine into the mouths of sometimes reluctant patients. And though the volunteer work is clearly exhausting, the Mission MANNA team seems joyful and eager amid this vastly different culture.
"There’s a positive spirit in Asheville that definitely carries over to our work in Haiti,” notes Todd Kaderabek, Mission MANNA’s board chair. “In fact, it's a requirement to travel with us: a flexible and positive attitude."
A distant memory
Like most Ashevilleans, he says, Mission MANNA’s volunteers are creative, adaptable, open to other cultures and, most importantly, humble. And though the organization is closely tied to Grace Episcopal Church, neither volunteers nor patients must necessarily be Christians.
Some international organizations in Haiti strongly encourage or even require the people they assist to convert, a policy the Asheville team finds unthinkable. "When you tell me you're not going to help someone because their beliefs are different than yours," Kaderabek says, "Well, that's where we part ways."
Physicians working in Haiti often confront extremely challenging religious and ethical dilemmas. The Asheville team sees multiple HIV-positive children and mothers in every village.
Midmorning on the first day, family physician Chad Krisel, a first-time volunteer, approaches Dephouse with a problem: A mother with three young children admits to testing HIV-positive but refuses treatment, because she doesn't believe in the disease.
"See if she'll consider having her children tested," Dephouse advises. "And if they are positive, if she might seek treatment for them."
Free HIV medication is available in Haiti, Dephouse explains, and catching the disease early gives children a fighting chance. But if the mother refuses, there’s nothing they can do. Eventually, she tentatively agrees to have her children tested but doesn’t promise to seek treatment for them if they do carry the virus.
At the end of a long day, everyone agrees that the hardest part is seeing patients who have no hope of treatment.
"It’s very difficult to see a child with a medical condition that could be easily treated in the U.S. in a matter of days suffer for a long period of time, sometimes for life, because the technology isn’t available or there’s no one to perform the procedure," notes Dephouse.
On this trip, the team met a child with bladder exstrophy who, they say, is lucky to be alive. They’re now arranging for surgical repair in Port-au-Prince through a Miami-based mission group.
Mission MANNA is an all-volunteer organization, and the money the Asheville group raises is used exclusively to fund emergency interventions, medicines, consistent nutrition for the most malnourished patients and salaries for the two full-time community health workers.
Kaderabek stresses that the group has no interest in profiting from its relief efforts. "Our focus is on making our operations in Haiti obsolete," he explains. "We want to empower Haitians to become independent of any and all aid: We want them to be self-sufficient."
And despite an abiding love for Haitians and their country, Kaderabek hopes that for them, Mission MANNA will one day be only "a distant memory of less-fortunate times."
Worlds in collision
As anyone who’s worked in Haiti knows, coming home can be the hardest part. Confronting firsthand the stark contrast between the world’s haves and have-nots can be profoundly disturbing.
"So many of us don’t realize how fortunate we are to have been born in this country," Dephouse points out. “We have access to health care of some form on the day we want it. My patients [in Asheville] are used to the American health-care system and have high expectations, as they should. I only wish the kids in Haiti could have such health care at all times."
Meanwhile, the impact of Kaderabek’s experiences with Mission MANNA has extended to his entire family. "My wife has now worked in Haiti, and our kids will, one day soon," he reveals. "We are much more aware of the many advantages we have as Americans and are therefore focused on reaching out to those less fortunate."
Before this trip, Kaderabek's 10-year-old son donated his allowance to help buy some Haitians a goat; his grandmother pitched in the remainder.
"It's seemingly small, but selfless acts like this really make a difference in the lives of the people we work with."
— Lorin Mallorie is a freelance journalist living and working in Haiti. She blogs on the Xpress website; view her video shorts, music videos and publicity pieces at unsungmedia.org.