July 5th Jacmel, Sud-Ouest, Haiti

Today we awoke at 3:20 to make for Jacmel.  Jacmel itself has a population of about 150,000.  Although it was spared the major damage of the 2010 Haiti Earthquake, it did sustain damage, including the collapse of half of its hospital. It was a long drive, 6 plus hours.  On the way there, Ali, my baby, my 15-year-old baby, was tired, so she snuggled.  In my experience, 15-year-olds are good for a quick hug if you are lucky, but not much into snuggling with their Daddys, so I was happy that she used my shoulder for a pillow.  I could remember so clearly  Ali as a newborn, sleeping in our bed.  I would lie on my side, curled up around her, hyperaware of any movement she makes, not sleeping much, but content to protect and keep her.  I feel much the same today.  By leaning on her, I am not resting, but keeping her head from flopping forward. I am content.
Did I mention the trip is long?  The scenery, though, that we pass through is amazing, up over the mountains.  It is beautiful, a totally different world than the city below.  This is where you can understand where terms like Mountains Beyond Mountains come from.  The air in the mountains in chilly, upper 60's.  the road is a rollicking 1 1/2 lanes of switchbacks,  sheer drop-offs and blind turns.  All taken at 50 mph. Dramamine is used liberally.
In Jacmel, proper, we buy rice at the market 80 pounds.  We then travel to the church.
Haitian churches are not the same as the church you attend.  They are open air.  In the smaller towns and villages, they are spare.  Although Jacmel is large, we are in what I guess could be called a suburb.  Not a rich one.  The timbers are all roughly hewn from the logs they started as.  The post and beams and benches look like some Hollywood prop designer's exaggeration of rustic.
Today we are giving out rice.  This means that we will be busy later on, once everyone has heard.  These kids are cute.  There are some ear infections, a lot of colds, a couple of kids with pneumonia, almost everyone has "vent fe mal" or stomach pain.  Towards the afternoon, I get the teenagers who aren't really sick at all, they just want some entertainment.  They goof off and are silly about my limited Kreyol, but we have a good time.  Since none of these kids is particularly sick, I have time to reflect that a large part of my purpose here is to sift through all the healthy kids and find the ones who are truly ill.  Without a lab.  Without X-rays.  So the ones who are in extremis are not difficult to spot.  It's the ones that may be starting to get something serious that I am concerned about.  Early malaria, early typhoid.  I don't want to miss those.  I may be the last to see them before they really get sick.
Then there is the two that will haunt me: the 9 month old who is the size of a 4 month old who otherwise looks well, and the 12 month old with the heart murmur that sounds abnormal, but otherwise looks well.  At home, both would be referred, both would be worked up.  Here, I talk to the mother of the 9 month old for about 20 minutes through the interpreter, talking about all the things I want her to watch for.  With the 12 month old,  I take the name and number down to put on the list for the next time the Pediatric Cardiologist  comes down on a trip.
The rice is gone.  We've seen about 100 patients, not too much of a workload, but with the drive starting at 4 am, by the time we get home at 8:30 pm, we are exhausted.