Monthly Archives: April 2014

Jean Hilaire

April 23, 2014

 My palms are almost perfectly square, and my fingers are short. I think my hands look a little like my father’s whose hands would look something like his father’s in turn, except that my grandfather’s fingers were deformed by the years he spent making furniture after the advent of supermarkets wiped out his very small grocery store.

 All this is just to say that my hands are not large, so I should not be able to enclose a 19-year-old man’s bicep between my middle finger and my thumb. I can’t get my fingers anywhere near around my own very skinny arm anywhere but at my wrist.

 So it was a shock to see just how thin Jean Hilaire had gotten.

I hadn’t seen him in months. When we were selecting new members in Pyèrèt, where he lives, he was always around. He served as our guide, helping us find the households we had been referred to so that we could conduct the surveys we needed to conduct. He made that part of the process easy because he knew everyone and was willing to help.

His mother and younger sister, who is a teenage mother of two, both joined the program, and one of our case managers began working with them. We occasionally heard from Jean Hilaire because one of our other case managers hosts a evangelical call-in show on a local radio station, and Jean Hilaire would call him now and again just to say, “Hi.”

Then he disappeared. As it turned out, the phone he had been using to call us gave out and he couldn’t afford to replace it. Then he went to Port au Prince. His brother-in-law, a young man not much older than he, convinced him to join him there. The brother-in-law would look for work to support his wife and kids, and Jean Hilaire would try to learn a trade. He signed up for a plumbing class.

That was at the beginning of the fall.

Every three months, we bring together all our members for a three-day workshop. They talk about the successes and the failures they’ve encountered over a three-month period. It is a way to build the confidence of members who are moving forward while it motivates those who are lagging behind. It also enables them to share advice about problems that they may share. In late March, I was at the session near Pyèrèt, and I saw Melisiane, Jean Hilaire’s mother. Naturally, I asked for news of Jean Hilaire.

“He’s really sick. Hadn’t you heard?”

I hadn’t heard. So I went by Melisiane’s house to see him after I had done what I wanted to do at the workshop.

It turned out, Jean Hilaire had returned sick from Port au Prince. He was coughing and feverish. He had no appetite. He had spent more than a month, lying in his mother’s house, wasting away. When I found him, he was in a bed hidden behind a curtain, in his mother’s back room. I pushed the curtain to the side, and sat on the edge of the bed with my hand on his forehead. He wanted to sit up to talk to me, but he just couldn’t. He was too weak. I asked him why he hadn’t sent word to me to let me know that he was sick. Didn’t he know how important he was to me? He turned his face away from to the wall and wept. He didn’t know, he said.

Melisiane had made three trips with him to see a local healthcare provider named Mis Marie, but he had only grown worse, despite the medications she prescribed. In Créole, a “mis” is a nurse. But Mis Marie is not a nurse. She has a small business prescribing and then selling simple medications for basic complaints. She lives in downtown Saut d’Eau, and has a wide reputation throughout the county. She probably does a fair amount of good, helping people with minor aches and pains and the sorts of standard illnesses that can be easily diagnosed and treated with simple antibiotics or other straightforward medications.

But she’s a problem, too.  Melisiane was going back and forth to Saut d’Eau, spending money on the motorcycle taxis, the consultations, and the medications, money that she needed to feed her kids. Yet Mis Marie could not treat Jean Hilaire, and she never said anything as simple as, “This case is beyond what I can treat.” She never told Melisiane to take her boy to the hospital, even as Jean Hilaire got worse. He grew weaker and weaker, unable to get out of bed most days. And even when he could have gotten out of bed to sit in the sun, he preferred not to. He was ashamed of his weakness, ashamed of how thin he had become, so ashamed that he was afraid to bathe in the nearby stream, for fear neighbors would see his ravaged body, so ashamed that he had hidden even from Melisiane’s case manager, Zetrenne.

So when I saw him, I told him he had to go to the hospital, and I arranged for him to go the next day. That meant giving them some money to make the trip. Melisiane was still at our workshop, so she sent Jean Hilaire with his younger brother, a teenager named Abraham. Seeing Abraham and Jean Hilaire together was painful. Abraham is not a lot younger than Jean Hilaire, and though their faces are very different, their body types are more or less the same. They are both very thin. But Abraham is healthy, and looking at him next to his older brother made it easier to see just how much weight Jean Hilaire had lost.

They went to the Partners in Health hospital in Mirebalais the next day. It’s a wonderful facility, designed to be Haiti’s premier teaching hospital. It offers first-class care for virtually nothing to anyone who can get there. But it is a little overwhelmed by the number of people it attracts, and so it can be challenging for sick people to navigate. When we have CLM members who need services, we try to accompany them, helping them figure out the series of lines they must stand or sit in. The lines can be confusing. Our close relationship with Partners in Health – it has been our principal partner in the field since the start of CLM – means that PIH staff will go out of their way to help our members. But only if we are there to ask them for extra help. And what they can do, even by going out of their way, is sometimes limited by the strain that a whole nation in need of their services can put on their system.

But the minute Jean Hilaire got to the front of the line, the hospital staff knew what they should be looking for: his cough, his fever, his loss of weight all suggested tuberculosis. The older novels I like to read call the disease “consumption,” and it’s easy to see why. Jean Hilaire had wasted away to almost nothing.

The first thing that the PIH doctor did for him was to prescribe a series of tests: blood tests, but also a chest x-ray and a series of sputum samples. For the latter, Jean Hilaire was told to come to the hospital three times on consecutive days. But the first trip to the hospital wore him out so terribly that it was a couple of days before he could make his second trip. He just couldn’t get out of bed.

But the tests eventually showed clearly enough that Jean Hilaire was suffering from tuberculosis, and PIH immediately put him on a multi-drug regimen that will last six months. He’ll have to come into the hospital every month for refills, and we’ll need to follow him closely to ensure that he stays with the treatment.

We’ll need to keep an eye on his family as well. Between his mother, his siblings, and his two nephews, there are nine people crowded into a two-room house. And the PIH doctor’s instructions that tell him to stay someplace well ventilated only mock the reality that the family faces. We think it is perfectly likely that others will start to show symptoms, and then it will be our job to get them to the right care – not from Mis Marie, but from the fine PIH hospital – right away.

But things are looking up. Jean Hilaire has started to feel up to getting up and about. He needed a pair of sandals, and when Zetrenne gave him a few gourds to buy a pair, he wanted to go to the local market himself. We asked him not to. The crowded market is the last place we should be sending a young man with TB.

Two Goats for Three

March 5, 2014

Recently, I was back in court again with Safine. It turns out that her first trip to Judge Patrick’s courtroom did not solve her problems with Maxo, the father of her two youngest children. This time, she was the one filing the complaint. Maxo attacked her, hurting her badly enough that she had to go to the hospital. Normally, her case manager, Hilaire, would have accompanied her through this process, but he had been called away first thing in the morning to help another CLM member, so he asked me to fill in for him.

The woman he needed to help lives in the farthest pocket of Mazonbi, a secluded area in the southwest corner of our territory. Her name is Mimose, and her home is remote even within Mazonbi. Invisible from the narrow footpath that runs about 100 feet above it, you have to know where to step into a field of pigeon peas to find the trace of a path that winds downward through a series of jagged boulders to the small yard.

Mimose had borrowed a telephone the night before to call Hilaire. She was terribly distressed. A neighbor name Marc had killed two of her goats – large, healthy, pregnant ones – when they wandered into his unplanted garden. It was a huge setback.

So Hilaire got on his motorcycle early on a Thursday morning, and went off to see what he could do. When he got to Mazonbi, he found the beheaded goats hanging from a tree at the edge of Marc’s field. He tried talking to Marc about it, but Marc wouldn’t give him the time of day.

So he went to Dumisso. He is the secretary of the Village Assistance Committee for Mazonbi and Laferyè, a neighborhood along a ridge just east of the ridge the Mazonbi sits on. Dumisso told Hilaire that they really needed to do something. He had heard that community members in Mazonbi who had not been selected for CLM were jealous of the CLM members’ progress, and were saying that they would kill any of the goats they got their hands on. Dumisso felt that if we did not take a stand, our members’ losses would start piling up.

Hilaire went from Dumisso to the KASEK. A KASEK is a local elected official. In rural areas, they employ assistants, who are paid a couple of dollars to deliver messages, bring people the KASEK wants to see to him or her, or perform other minor duties. In this case, the KASEK sent his assistant to the man to let Marc know he wanted to see him. Marc responded that the KASEK should mind his own business.

Hilaire then took the assistant to see where the goats’ carcasses were hanging in the tree, and put him and Mimose on the back of his motorcycle so that Mimose could file a complaint in Judge Patrick’s court.

This is where things first got complicated. Our motorcycles are designed to take a passenger, but they are not designed for two. Hilaire is a very strong man, and he has a lot of experience with a motorcycle on bad roads, so he took a chance. He managed to get them up the terrible rocky road that leads out of Mazonbi and down to the highway in Fon Cheval. Going down from Fon Cheval to the courthouse in Trianon should have been much easier. But Hilaire hit a small patch of loose gravel on a sharp curve in the road, and because of all the extra weight behind him, the wheel slid out from under him. He and Mimose were both scraped up in the fall. Nothing too serious, but their wounds needed some attention. He got them to a small clinic just downhill from the courthouse.

By the time they got to the courthouse, we were finishing up Safine’s case against Maxo. Judge Patrick was instructing us all to go to the higher court in Mirebalais the next day. Since blood had been drawn, he said, the case went beyond his authority as justice of the peace. He would prepare a document for the higher judge in Mirebalais, and have us take it down the next day.

When Hilaire and Mimose arrived, Judge Patrick listened to them and agreed to go up to Mazonbi with his security guard and have a look. Hilaire was very sore, but he immediately agreed to lead them there. He asked me to switch motorcycles with him. His clutch had been damaged, and it would have been hard for him to negotiate the Mazonbi road whereas I would just have to coast downhill. So he took my bike, and they went back up the hill.

That evening, I heard from him that things had gone poorly. Marc and his friends had intimidated the judge and his security guard. They had been forced to leave the scene rather than risk a conflict. When Judge Patrick formally invited Marc to a hearing, Marc refused. So Judge Patrick, Hilaire, and the security guard returned to Trianon.

Hilaire was furious. He couldn’t understand why a representative of the government would let himself be chased away by threats. But there wasn’t much he could do. Judge Patrick filled out a warrant for Marc’s arrest, and gave it to Hilaire to bring to the police station down in Mirebalais.

Hilaire took the warrant to the station the next morning while I continued to follow-up with Safine. When we talked midday, he told me that the police had said that they didn’t right then have anyone available whom they could send after the guy.

In the meantime, Marc must have had second thoughts, because when the KASEK sent for him again, he had disappeared. An older relative of his – actually his wife’s cousin – sent word that she wanted to resolve things. She would give Mimose two of her goats if Mimose would let the matter drop.

So Hilaire and I went to Mazonbi with the KASEK, whose name is Lenèl, and Dumisso. Madanm Tibèt was the cousin trying to resolve things. Mimose came with her husband and Madanm Tibèt’s two goats, which her husband, Ozlèn, had already been watching for the older woman.

Madanm Tibèt explained that she couldn’t see why everyone was pursuing Marc. He is a poor man who had killed the goats because they threatened his farmland, which is his livelihood. We explained – with Lenèl’s help – that there are ways to go about things. Haiti’s rural legal code, which dates from the Duvalier years, does allow farmers to kill goats they find eating their crops. But the farmer is supposed to find a local authority to serve as a witness when he or she does so. The thought – I suppose – is that a witness can help a farmer cool down enough to accept monetary damages rather than the life of the goat, which is generally worth much more than the crops that it eats. Marc didn’t bother seeking a witness. He just killed the goats, singling out CLM goats in particular among several goats that were in his garden, and strung them up.

Madanm Tibèt wanted the matter settled because, first, she values peace and her neighborhood and, more importantly, she is a single mother who counts on Marc to farm her land for her. His arrest would be a direct threat to her livelihood.

But there was a problem. Mimose and Ozlèn didn’t want to accept her offer. They gave two reasons. On one hand, the goats Madanm Tibèt was offering were much less valuable than the goats Marc had killed. Their two, large, pregnant goats could have sold for over $70 each. The small mother that Madanm Tibèt wanted to give them with its kid couldn’t have sold for that much combined. On the other hand, Mimose and Ozlèn feel that they’ve had a good relationship with their wealthier neighbor. The fact that she has let Ozlèn care for her goats is good evidence of that. They are worried that her sacrifice will leave a bitter taste in her mouth, that she might come to hold it against them.

Eventually, however, they agreed. Partly, it was because they too wanted the matter settled. Partly, they were convinced when Madanm Tibèt reminded them that she had already lost a goat in their hands. She had left another female for Ozlèn to care for, and it had disappeared. She asked them whether she had ever bothered them about the lost goat, and they had to agree that she hadn’t.

So Lenèl drew up a formal agreement in which Mimose accepted three of Madanm Tibèt’s goats – the two that had been brought to the hearing and the one Ozlèn had lost – in exchange for her two. It was still a loss for her, but it was the best we thought she’d be able to do under the circumstances. So Hilaire encouraged her to sign. Lenèl pleased her by complimenting her for the way she signed her name to the agreement. It’s something she’s learned from Hilaire.

The hearing, held under a tree by the side of the road at the entrance to Mazonbi, took over two hours. It involved a lot of conversation. Much of it was related to the complexity of the problem involved. Some of it related to Dumisso’s desire to make the KASEK, who lives in a distant part of the region, recognize that he wasn’t spending enough time in their neck of the woods. He felt that Lenèl’s inattention was partly responsible for Mimose’s loss, and he said so clearly and at length.

I visited Mimose and Ozlèn a few days later, and they seemed at ease about by the way things had turned out. They were miserably poor when we first found them, but because they work hard and together, they’ve already come a very long way. As such, they present a stunning contrast to Safine, who has to waste a lot of time just working out her final separation from Maxo, a man who doesn’t do the simplest things she would need a partner to do. If this turns out to be their biggest setback, the Mimose and Ozlèn are very likely to be just fine.