Why a blog?

December 18, 2013

Why a Blog?

After some prodding and a lot of consideration, I’ve started a blog. My name is Chris Buresh. I’m lucky enough to be married to my wife Ginny and have 4 amazing and healthy children, Eve, Charlie, Tess, and Penelope. I live in Iowa, where I work in as an emergency department physician, but also spend some time and a ton of mental energy in Haiti.


This is the family- clearly not in Iowa, but we don't have too many family photos


My wife, Ginny also a MD has accompanied me down to Haiti serving as an OBGYN


Charlie and Eve


 Tess and Penelope

This blog is mostly about the latter

I first went to Haiti in the fall of 2002, and I don’t think that there’s a day that’s gone by when I haven’t thought of it since. In January of 2012 some friends of mine and I started the Community Health Initiative, Haiti. We are a group that started to provide high quality, evidence based, continuous primary care to isolated populations in rural Haiti that had no other access to care. Since then, we’ve evolved to take on a number of public health projects as well. We’ve learned that it’s better to keep someone healthy than to try and treat them once they're sick. I mostly wanted to start blogging because I think that CHI has a good story to tell. We have met so many amazing people since we’ve started out. We’ve made some incredible compatriots and lost some very dear friends. It is something that I literally think about all of the time. I still haven’t figured out where this falls on the spectrum between an engaging passion and an unhealthy obsession, so maybe that’s something else that this blog will be good for. It’s cheaper than therapy.


The Year in Review

As we round out another calendar year, I’ve been astounded at what has happened during 2013. It’s really our first full year in existence and it has been intense. We’ve had lots of clinics (over 8200 patients) and rolled out a new electronic medical records system. We’ve had a lot of community meetings and done a lot of surveys in our communities in Haiti. In fact, I’m thinking that they’re a bit tired of the blan coming around pestering them with questions. We’ve learned a ton, though. We’ve learned that 66% of the people drink out of the river and the rest either buy water from tanker trucks playing (the same music as ice cream trucks) music through loudspeakers, or get their water from the public taps that operate twice per week. We’ve tested all of the water, and it’s almost all positive for coliform bacteria. Those are the bacterial that live in your colon (not saying anything about your hygiene. They live in mine, too). That means folks are drinking diluted poo. The water from the trucks, the expensive stuff, was poo-free half of the time, but folks rinsed their buckets out in the river before filling them up. Not surprisingly, our surveys revealed rampant diarrhea. More shockingly, 35% of houses reported that they’d had a child die recently. The most common causes were fever, diarrhea, and voodoo.


Imagine this being your only source of water... not very appealing huh


CHI launched the Gadyen Dlo system, distributing 500 water treatment buckets in late 2012 

To help address this, we have put in a road, worked on some water treatment systems, revamped our community health worker program, installed 27 composting latrines, and put in 2 new wells. In Haiti they say “Tet chage”, which translates as “that blows my mind”. At this time last year we were just trying to figure out how to get the medicines ordered and people to sign up to volunteer for clinics. The pace of growth this year has been astronomical. Here’s a video recap.

Amazing Stuff on the Road Ahead

I think what I’m most excited about, though, is what’s coming up for 2014. When we talk to people in Do Digue and the rest of our communities, their priorities are clean water (check), healthcare (doing it), latrines (done), economic opportunities, and schools. We employ about 65 people on every trip, but income once per quarter isn’t enough to send anyone to school or supplement your diet for long. That’s where the recycling program comes in.


Over 40,000 lbs of plastic is imported into Haiti each day

We are going to partner with Thread (www.thread.org), Executives Without Borders (www.executiveswithoutborders.org) and Samaritan’s Purse (www.samaritanspurse.org) to open up a plastic recycling depot in Arcahaie.


People bring us plastic and we pay them by the pound. We then crush it and transport it to Port-au-Prince, where we sell it at a mark-up. The people that collect the plastic can make enough to send a child to school. Alternatively, since our depot will be right next to the market, they can use it like an ATM machine. They turn in plastic, get some money, and can buy some good food to feed their family. This program literally turns garbage into food and education. It also provides more jobs and, with any luck, enough income for us to start expanding our local programs. Executives Without Borders estimates that Haiti needs about 2,000 of these centers to deal with the 1.2 million pounds of new plastic that comes in to Haiti every month. Ours would be the 25th center. The market for this is wide open. In fact, this self-sustaining, community-empowering, street-cleaning, family-feeding, kid-teaching program could be our biggest game changer yet. This is a huge deal.

The other huge deal for us is the roll out of the Helping Babies Breathe (HBB) curriculum. HBB (http://www.helpingbabiesbreathe.org) is a class that was developed by the American Academy of Pediatrics that teaches people how to resuscitate a baby in the first minute of life.

Jean Yves

Guirline, one of our Community Health Workers, and Djelin.  Djeline is the proud big sister of Yves Jean, who is just minutes old in this photo

86% of the women in our community give birth at home. Sometimes they have a Fem Sage (lay midwife) there and sometimes they don’t. I’ve seen a lot of deliveries, both in and out of the hospital in Haiti. They are brutal. There are some really interesting techniques for getting the mom to push the baby out that mostly involve hurting mom so that she wants to get it over with. However, whether kids are born in or out of the hospital, they’re usually set aside to fend for themselves while the attendant deals with the placenta. Not surprisingly, 3.5% of all kids born in Haiti die before they reach a month of age. That’s about 10 dead newborns in Haiti for every one in the US. About 1/3 of these die right after their born, the majority of the rest of them succumb to diarrhea or other infections in the first few weeks.

We’re hoping that HBB will be able to help these kids, and the evidence from other countries is that it does. For well over 90% of births, the only thing that needs to be done is to warm and dry the baby, suck out the mouth and nose, and put it on mama’s chest. That’s all it takes. But nobody does it. We are going to teach every pregnant woman in our community, and their support person, and anyone else that might be present at birth, how to do this and why it is important. That’s all it takes to save lives.

new_baby.jpegNew born check up

We’ve also been giving out safe delivery kits. These have some clean yarn, a new clean razor blade, some alcohol wipes, a baby blanket, and a baby hat inside. These are made by some super-dedicated volunteers here in the US and they come down with us on every trip. We give them to pregnant women in their 3rd trimester and teach them how to use them. This kit prevents infection of the cord and neonatal tetanus, which is often seen in Haiti, that comes from cutting the cord with a rock or piece of glass. We are hoping and praying that when we repeat our survey a few years from now we will see a big drop in the number of houses that tell us that they have lost a child.

We are so fortunate to have had such an amazing year. We couldn’t have done it without the 180 volunteers that have traveled with us to Haiti so far or the 12 folks that have given up huge chunks of their time to stay down there, to volunteer, and to bring these ideas into being. We couldn't do any of it without our amazingly committed Haitian friends and staff.  And absolutely none of this would be possible without the thousands of people who have donated their hard earned cash. We’ve worked hard to transform that money and those well wishes into good things for our communities in Haiti and look forward to an unparalleled 2014 with our friends, supporters, volunteers, and partners.





Dec. 26, 2013

I hope that everyone had a great Christmas and is looking forward to 2014.  I hope that you all had time to spend with family and friends, and a little time to reflect on the things that are important.  I have to say, that those things sort of hit me at funny moments this year.  The first was not super surprising, I guess. It happened when I was reading a blog by a blogosphere goddess and Haiti vet, Tara Livesay that talked about how people living in poverty probably experience a bit more of the true meaning of Christmas than the rest of us.  http://livesayhaiti.blogspot.com/2013/12/o-holy-night.html?spref=fb   Not to romanticize starving or struggling to get by, but I think it is true that there are a lot of things that preempt our meditations about the Christmas season.   Doorbuster deals, mailing lists for family Holiday cards, Christmas cookies, school parties, work parties, stringing lights, stringing popcorn (if you’re my wife), picking out trees, opening advent calendars, and planning menus are all ways of enjoying (or at least surviving) the Christmas season, but that’s hardly what’s really important, right?  It certainly is a lot different from the way that Christmas is experienced in Haiti or many other parts of the world. 


I think that this dichotomy has hit me the most painfully today.  We had a great Christmas by any standard.  We started celebrating on December 7th, and kept things going pretty steadily up until today.  In fact, even today the kids had a special day with their Canadian grandparents.  As I tried to put the house back together in the aftermath of the assault on wrapping paper I got a little overwhelmed.  Where are we going to put all of these toys and all of this stuff?  Talk about a First World problem, right?  Don’t get me wrong, I am super grateful for all of the love shown to my kids, my wife, and I over the last few weeks.  It really is breath taking.  I can’t help but feel a little ambivalent about it all sometimes, though.  It can be so much. 


  Alliance and Kristi


I think about Alliance, our country manager, who has moved away from his 80 year old grandmother and 12 year old daughter to work for us.  I think about how he’s staying to look after our volunteers instead of spending the holiday with his family and what a sacrifice that is.  I think of Nick and Kayla, spending their first Christmas as a family in Haiti with their new dog Milo.  I also think about Caitlin, who will be with us for nearly another year.   She spent part of her time growing up in Haiti and speaks Creole practically like a native, but she has to be missing her family back in the US right now.  All of these folks are sacrificing so much to see the hopes and dreams of our communities in Haiti brought into being.  It’s very humbling and I’m so grateful for them.  Their Christmas this year has got to be so different from the ones that we had. 



Kayla, Milo, and Nick


Guirline, Shella, Caitlin, Widlyne, and Nola 

Another way that this gulf struck me repeatedly this week as I’ve spent more time with Penelope, our 16 month old.  I’m usually trying to wrangle the older 3 as she clings desperately to her mother.  She’ll only come near me if there are no better options in the room.  We’ve been alone together a few times this week, which has been nice for me.  She insists on feeding herself.  She also is unfortunately suffering from some sort of GI problem that has left her diapers hopelessly outmatched.  It has struck me that, were we living in Haiti, I’d be worried that any day might be her last.  Our surveys have found that this is exactly how a huge number of kids in our community die.  Here, it is sort of an inconvenience.  We do a lot of laundry (in our indoor washing machine with matching dryer) and bathe her a few times per day when she has managed to completely overwhelm both her diaper and her onesie (in the clean, warm, and drinkable water that gets pumped straight in to our house).  In the season of Christmas miracles, I’ve been obsessed with the every day miracle that we take for granted; Indoor plumbing, easily disposed of human waste, and uncontaminated temperature controlled water.  I’m going to work on giving thanks every time I go to a faucet, flush a toilet, or get myself a nice cool drink. 


Penelope is now feeding herself

The good news is that things are getting better in Haiti.  Now a lot of folks in our community of Do Digue can go to the bathroom in a dignified and private manner thanks to the composting latrines that are nearly done.  500 families down there can now drink good clean water without the fear that it may lead to explosive and sometimes fatal intestinal distress.  Hundreds of people have access to some new pump that bring clear, cool, and clean water from an aquifer 200 feet down.  It’s not the modern engineering marvel of indoor plumbing, but it’s a big step in the right direction.  I hope that when the ghost of Christmas Present visits me many years from now, we’ll be able to reflect together on how the people of Do Digue, and those all around Arcahaie,,celebrate the Christmas season without want or fear.  Merry Christmas everyone, and may all of us look forward to 2014 with faith and hope!