January 8, 2018 WE MADE IT!!! The 0500 meet up at the airport was certainly early, but everyone was able to get through the check-in process efficiently. We had some great American Airlines employees helping us check in our 30 bags filled with everything from medications and toilet paper to jock straps and toothbrushes. And miracle #1 was that we did not have to pay for our bags! We had a nice long layover in Ft. Lauderdale, which allowed for long walks through the terminal and lunch. It definitely felt good to stretch our legs! Once we arrived in Port-au-Prince, we made it through customs and were able to swat away everyone who attempted to “help” us with our bags. A few of us had to check our carry on bags all the way through which added some extra anxiety, but they all made it to Haiti! We had about a two-hour journey to the house. Fifteen of us made the trip standing on the back of a pick up truck! We were able to watch the sunset and test our balance as we navigated through the busy streets. I am confident that there are zero traffic laws in Haiti. All of our suitcases were piled in the back of a dump truck and all the men sat on top of them! A few people followed in a van. We safely arrived at Willem’s home! The power was off when we arrived at around 7:00pm so we unloaded the suitcases with the help of phone flashlights and headlamps. We had an amazing dinner with rice and peas, chicken, pasta salad, and some fresh veggies. After dinner, we had a team meeting to discuss our plan of action for the first day of clinic. We have a well-rounded team filled with doctors, nurse practitioners, NP and pharmacy students, nurses, and some other special talents. We were told that there were lots were already people lining up at the clinic this morning. People come from all over Haiti to be seen at our clinic, so many people will be spending the night on the ground outside to wait for us to arrive tomorrow. How crazy is that? Willem talked about about how impatient Americans are when our doctor is running late. We have magazines and TVs while we wait, whereas the people of Haiti would wait for days with nothing to do just to be able to be seen. We learned about the logistics of who will be at what station and what our roles are. The providers met and reviewed protocols, common ailments for our clinic, and tips for teamwork and smooth workflow. It will be a fast-paced morning to get the clinic open again! We are going to move extra efficiently to make sure as many people as possible are seen - we don’t want people having to sleep at the clinic two nights in a row. Sorry for the delayed email! More after clinic! Audrey and the Little
By Little Team

January 9, 2018 Day 1 at the clinic is complete!! It was a crazy day and we saw SO many different types of patients. 214 in total!! We think this may be a record. If it keeps up like this, we could see over 1,100 patients this week! We think we were able to see everyone who had arrived the day before, which was great. Coffee was made and people began gathering in the kitchen around 0630 this morning. Unfortunately, the roosters in the yard woke some of us up much earlier than that! The Haitian coffee is incredible and we certainly have lots of it. We had a breakfast of egg bake, bananas, and oatmeal. The morning was very rushed as people were packing their bags, making PB&Js for lunch, and trying to get out the door. The newcomers of the group quickly realized how exhausting the hike up to clinic is. It’s a beautiful journey but it is definitely not for the weak and feeble - everyone who attempted made it up safely! The near asthma attacks make for some great breaks to take in the view. We had nine stations at the clinic which made for a higher number of patients being able to be seen. The patients line up outside the clinic and are given their medical records to hold on to. Once they get into the clinic, their vitals are taken (height, weight, temperature, blood pressure, and heart rate) and they are told what station to go to. We have teams specializing in OB and women’s health, pediatrics, and adults. It was cool to see the teamwork amongst the providers when we had a complicated case or people needed to bounce ideas off of each other. We also saw some goats and a cow on the way home from clinic today! It’s so fun waving at the kids in the village and seeing all the homes. It gives us a good opportunity to practice some of our french creole greetings! Most of us were able to “shower” (more like dump water on various parts of your body) and change before dinner, which consisted of salad, sloppy joe’s, mac and cheese, kale/carrot/squash sauté. We had good conversations and were able to do a group debrief on how the day went and what we could change for tomorrow’s workflow. After dinner, a group counted TUMS while the providers and nurses discussed a few cases from the day. One project we are working on categorizing is all of our medications into level of safety during pregnancy. Everyone has SO much knowledge to share. More tomorrow!! Thank you for your patience with our Haitian WiFi! Audrey and the Little By Little Team

January 10, 2018 Day 2 of Clinic! Today was such a rewarding day at clinic. You could tell that everyone knew the flow of the day and we were all working so well together. A few people switched stations today but for the most part, most people stayed in their roles. We were able to streamline our intake/lab process and get more organized in the store room. All of the suitcases are unpacked, now they are focused on inventorying all the items up there. They are doing great work! Today we saw goiters, scabies, diabetes, obscure skin conditions, possible tuberculosis, and wounds. Our top complaints were hypertension, eye issues, acid reflux, and worms. We saw a total of 210 patients!! Our breakdown was 150 women, 60 men, 70 kids, 140 adults! Yesterday seemed to be lots of people with rendezvous slips (pieces of paper they received the last time they were at the clinic that tells them to come back on a certain day for follow up) for chronic illnesses, whereas today seemed to be more infectious disease. How fun! The providers had great communication and teamwork with the pharmacist which can help consolidate medication lists for patients. The people who work in the pharmacy are doing a phenomenal job keeping up with the amount of prescriptions we have. They are also so great about coming back into the clinic to clarify orders if need be. Julie McCrary also does such thorough education for our patients which is so, so important. Willem says that without education, you have nothing. If we hand our patients a bag full of medication but they don’t know what they are for or how to take them, the medication is essentially useless. The end of the day was slightly rushed because of a looming rain cloud. The Haitians started taking cover and putting jackets on so we knew the rain was legitimate. Luckily we made it home safely and the rain never came! You know you’re being too slow on the goat path when you get passed by men with giant baskets of carrots on their path. Also women in flip flops with babies on their hips. It’s a very hard blow to my self esteem. We were able to change, eat a wonderful dinner outside, and have our nightly rounds. What an amazing day in Haiti! More tomorrow, Audrey and the Little By Little Team

January 11, 2018 Day 3 of Clinic! Edit from yesterday’s email - the men were carrying baskets of carrots on their HEADS! I apologize for the typo! Everyone’s muscles were feeling pretty sore this morning after two days of hiking up the mountain. The shin splints, joint pain, and sore backs are abundant here in Haiti. The mornings seem to go a little smoother each day, as everyone knows what needs to be accomplished before we depart around 0730. We rush to eat during our “business breakfast” so we can get out the door on time. A rain cloud also contributed to the efficiency of the morning. A group of people chose to take the truck up and the rest of braved the potential storm. Again, the rain held out until the afternoon! It definitely dropped the temperature for our hike down the mountain. We had a very high level of acuity for today’s patients and everyone seemed to step up to the plate. Sue said the third day is usually the hardest but we met the day’s challenges head on. We are over the hump! Today we had 244 patients!!! 180 women, 64 men, 73 children, and 171 adults. Worms, hypertension, yeast infections, and acid reflux were the most popular complaints of the day. It’s hard to remember in Haiti that our most of patient’s don’t have access to any over-the-counter medications. We give out so many TUMS, Tylenol, and other common meds that we are so used to being able to pick up at a Walgreens or CVS. We had an amazing casserole made with ground beef and cornmeal for dinner tonight! We also put a bean soup on top which was fabulous. We had our nightly team meeting and are constantly communicating about how to keep improving aspects of the clinic. We are always improving! The providers then met to discuss interesting cases from the day. One of the most difficult things about working at this clinic is our lack of lab tests, x-ray, and MRI machines. Even without blood draws and imaging, Cameron is doing an incredible job in the lab. We are able to do pregnancy tests, swabs for bacterial vaginosis and yeast infections, blood glucose levels, and urine dipsticks. We also found a hemoglobin A1c machine but only have a few strips. We are truly forced to look at symptoms and make our best guess about a diagnosis based on the limited information we have. It’s definitely a challenge for those of us who are used to Western hospitals with all of these resources at our disposal. It is especially difficult when we can’t prescribe certain medications because they require close monitoring. Tomorrow is the anniversary of the Haiti earthquake so we are going to try and close the clinic an hour early so we can learn about and remember the day. A Little By Little team was serving the day the earthquake hit so we have first-hand accounts of what happened. It’s been quite a week! More tomorrow, friends! Audrey and the Little By Little Team

January 12, 2018 Hello!!! Today was our second to last day at clinic and the anniversary of the tragic and devastating earthquake that shook Haiti and killed over 250,000 people! We had our typical breakfast with a few special words from Willem....and then made our way up the mountain! Thankfully, the hike seems to get easier every time we do it. We still get passed by the locals, but we’ve definitely gained some endurance. Once we arrived at clinic, Willem gave us a tour of the school. It’s right next door to the clinic! They have students in preschool all the way through high school. We learned that 40-45 students graduate from this high school every year - some have graduated and became teachers at the school! They know the value of education and want to give back to their village. Before Willem’s school, barely anyone in Gramothe went to high school. Children walk 3-4 hours from all around the mountains to get to school. Willem has really instilled the importance of education into the people of Haiti. All of the children also get a meal at school because, “when you are hungry, you cannot learn.” We also learned about how difficult it was for the people in Gramothe (the village that the clinic, school, and church are in) to get clean water. The people knew about a spring at the top of the mountain, but they were afraid to go up there because of voodoo. Once Willem educated people about the realities of voodoo, they had a whole new source to get their water. Now, the people on the mountain have been able to produce many crops throughout the year: bananas, leeks, onions, tomatoes, and potatoes. Even though today’s clinic hours were shortened (due to our school tour and our earthquake remembrance), we still managed to see 239 patients!!! 164 women, 75 males, 68 kids, and 171 adults. Fun fact: Willem’s house sits at 3,190 feet of elevation. To get up to the clinic, it’s about 900 feet up! Our hike is roughly 4 miles for the day. For our entire week, that’s about 10,000 feet of climbing and 20 miles of hiking! (Thanks to Josh for doing the math!) Our day at clinic ended with a rainstorm...but we saw a DOUBLE RAINBOW! Someone yelled and we all stopped what we were doing to look out the window. The sunshine came out after the rain and the sky was crazy beautiful! What’s amazing is that a fog rolled in minutes later and completely covered the entire mountain. Definitely a special tribute to all who perished during the earthquake. A group of us decided to brave the storm and hike. We had rain coats, panchos, and garbage bags to shield us from the rain. The steep decline of the mountain plus the rain and mud made for quite a slippery trip. I fell more than once (don’t worry, most of your loved ones stayed upright). I must have looked so pathetic because this kind Haitian man who was walking UP the mountain turned around to hold my hand and guide me down for a few minutes. We all made a train and were side stepping down the mountain while trying to hold each other up. Luckily, the road has grooves carved into the sides which allows you to dig your foot in for a little stability. The whole ordeal only added an extra half an hour on to our trip, and everyone made it down the mountain alive - one way or another! Those who took the truck told me it was quite bumpy ride. When we all got back, we spent some special time reflecting on all the pain and suffering Haiti experienced during the earthquake January 12, 2010. We  heard Sue, Brian, Dawn, and Willem’s stories from the earthquake. We talked about how amazingly strong, faith-filled and resilient the people of Haiti are and how much progress the country has made since 2010. As Americans, we can return to our country and share the stories of our new friends back in Haiti - we are able to be advocates for this country and these people. During our evening pathology rounds, we discussed a confusing skin condition that puzzled even Sue! Lindsey also saw a child today who Sue had seen back in August. Over the summer, she was severely malnourished and was suffering from a zinc deficiency. When Lindsey saw her today, she had gained a significant amount of weight and Sue was able to see how much better the little girl looked! We also talked about a patient with heart failure and discussed the pros and cons of different medication courses. We’ve also had a number of difficult diabetic patients which are interesting to learn about. It’s been an amazing week so far - we can’t believe we only have one more day of clinic left. Thanks for following on our journey!!! Audrey and the Little By Little Team

January 13, 2018 Hello from the Haiti Team - and our last day of clinic!! Today, our morning started out as usual and actually seemed to be pretty leisurely! We all found ourselves drinking coffee on the balcony and enjoying the sunrise. We have been able to eat most of our breakfasts outside which has been a treat. Our hike up the mountain was still a little slippery. There was mud leftover from the rain yesterday so we contributed to watch our step. It’s hard when there are so many cute kids to wave at on our walk! Everyone was motivated that it was our last time hiking up to clinic! Our statistic from today was 226 patients! Over five days, our total for the week is 1,133 patients!! The best part of the week was learning that we saw every single patient who arrived at the clinic - we didn’t have to turn anyone away! Another team will be coming to the clinic in two weeks which is so rare. Typically, we have to write our rendezvous for months later to follow up on our patients. It’s especially great for the patients with new, high-risk medications to be able to come back so soon. It’s also helpful for our pregnant patients who are nearing delivery and those with wounds that need more consistent care. Mike N. also performed two minor procedures today! He had lots of “scrub nurses” to help. He removed an infected growth off of a nipple and “saved a child’s life” (direct quote by Mike) by draining a large abscess from a one-year-old’s head - it was caused by a rat bite! All of the providers keep talking about what an incredible group this has been. Everyone has so much knowledge to share and really showed that this week. Here’s another fun fact courtesy of Josh: the thing we distributed the most at the clinic is multivitamins with iron. For the week, we gave out a total of 24,625 multivitamins with iron. 3 multivitamins lined up is as long as an inch. Our total vitamin length is 684 feet which is almost 7 football fields!! That’s incredible! Think about that when you take your daily multivitamin tomorrow! After dinner we played the garbage game, something we’ve all been looking forward to this week! We all wrote down 10 famous names and put them in a bowl. They could be anyone - including cartoons and people on TV shows. We then divided into 6 teams. Someone from each team would see how many names they could get their team members to guess in 30 seconds. It’s called the garbage game because you throw the slips of paper on the floor. With 350 names, it ended up being a very long game. The team with Nancy, Wendy, Sara, Sherman, and myself won!!! Everyone’s competitive sides came out and we had a blast. The most popular options were Florence Nightingale, (the first nurse!) Bob Marley, and Tinkerbell. Tomorrow we will make our way up the mountain to church! It’s not in English so it should be an interesting time to people watch and visit with some of the patients we met this week! Everyone in the village wears their best clothes and there is a LOT of singing. More stories tomorrow! Audrey and the Little By Little Team January 14, 2018 Bonswa from Haiti! Something I forgot to add from yesterday’s email: it was crazy scrub day! We all picked out fun scrubs and we got to pick out tops for the men. Kim did a great job finding perfect options for them! Once we went to clinic, we had a fashion show complete with a runway, flashlights, and music. The people waiting for clinic got a kick out of it and it was a fun way start to the day! We got to sleep in a little this morning before breakfast around 8. We were all energized for our last full day in Haiti. Surprise! Yesterday was not our last hike up the mountain! 23 of us packed our change of clothes and braved the mountain. We walked up with many villagers in their dresses and suits. It’s so fun to do this hike because you always end up walking next to someone new. I’ve had such incredible and intimate conversations with many people in this group and that’s been one of the most rewarding parts of this week. Those of us who have been on this trip before agree that this has been a very special group. At church this morning, Mike N. sang the national anthem of Israel in Hebrew. The title means “the city of our soul” in Creole and “the hope” in Hebrew. He told us the song reflects the 2,000-year-old hope of returning to the land of Israel and restoring it as their free nation. It is based on a poem published in Jerusalem in 1886. This song was sung by the Jewish people on their way to the gas chambers at Auschwitz. So how did this song get to Haiti? The Jews left Germany fleeing Hitler and the lucky ones went to Israel. No country wanted to take in the Jews. The United States did not, but Haiti did. The people of Haiti saved many lives after the Holocaust. This song of suffering, pain, and hope is now sung in Creole. It is sung by Haitians to be closer to God and find strength in hard times. It is also one of the few national anthems in a minor key (which means it has a very sad tone). We also learned that Israel was the first county to respond with supplies in Haiti after the earthquake in 2010. We had taken collection at the beginning of church. After lots of singing and some sermons in Creole, Willem went around and asked for a second collection from the Haitian people. We were all very confused because the basket had already been passed around. People of all ages came to give what little they could. Many more people contributed the second time and we were all amazed. He called Mike back on stage and presented him with the money, explaining that God says if you bless the people of Israel, then you will be double blessed. We were all in shock and brought to tears by their generosity. It was truly incredible to share this morning with our Haitian friends. We then opened the clinic for a few last-minute patients, including our surgical patients from yesterday. We were able to change their dressings and give them pain meds. They will both be seen again by the next team in two weeks! This afternoon we all met with the vendors who set up their shops in the front lawn. They sell jewelry, paintings, wooden items, and metal art. We showered, started packing, and ate a meal around 3:00 outside on the porch. The weather was beautiful and we all enjoyed talking about life at home. We exchanged phone numbers, Instagram handles, and book suggestions. What a week this has been! We are all anxious to get to the airport tomorrow! We will keep you updated on our journey home!! Audrey and the Little By Little Team

January 15, 2018 Hello from Illinois (and California, Florida, Minnesota, and Pennsylvania)!!! This morning, we all woke up and began packing our suitcases. Since our checked baggage is now empty (because all the supplies were brought up to clinic), many of us were able to put our carry on (plus some extra Haitian goodies) into the empty suitcase to be checked. It made the trip home so much easier to not have another back to keep track of! The morning was spent fueling up on coffee, stripping sheets off of the beds, weighing suitcases, and making sure we hadn’t left anything behind. After breakfast, we loaded up the back of the pickup truck with all the suitcases. A few people stood in the back of the truck with the suitcases while the rest of us road in a car with Willem or the van. It seems like every hour is rush hour in Port-Au-Prince. It was hot and busy, but it was fun to see the city in daylight. Our group talked about the cholera outbreak in Haiti after the earthquake and Sue and Leslie’s project about getting chlorohexidine to keep infant’s umbilical cords from getting infected. We all got to the airport safely and were able to check our all our bags with no problem! The Port-Au-Prince airport has two security checkpoints and then you get to the lounge! We drank Diet Cokes, margaritas, Prestige (a Haitian beer), and Haitian rum! We had so much fun together and meeting other people at the airport. Karen even saw her internist from Illinois at bar at the Port Au Prince airport! How crazy! Besides our bumpy landing, it was a smooth ride to Miami! Most of us were able to sit together on the plane which is always fun. Our layover was the perfect amount of time and we all enjoyed exploring the airport. Many of us took over tables at the Island Bar and Grill! We got to eat ribs, burgers, coconut shrimp, and fish tacos! We found cupcakes to eat at the gate and FaceTimed with Jane and Sherman’s grandson, Joseph! We had to spit off from some non-O’Hare passengers when we started boarding our plane. It was hard saying goodbye to these friends we’ve come to love over the past week. How have we only been Haiti for a week? It’s amazing to think about how many lives we were able to impact in such a short period of time. The hardest part about doing this work in Haiti is that it feels like we have only put a drop in the ginormous bucket. There is SO much need in Haiti and it’s easy to get overwhelmed by the amount of poverty we saw on a daily basis. It seems so cliché to think “if I changed one life at the clinic, then it was worth it” - but it’s really true. We all walked away remembering certain patients that really made an impact on us. Whether it is the long time hypertension patient who hugged you when she learned that her blood pressure was normal, or the mother who watched carefully as we showed her how to change her child’s wound dressing. If we were able to provide these patients with Tylenol for their pain, sunglasses for their sensitive eyes, or a cure for their worms, then we have impacted their lives more than we will ever know. I will miss reading these nightly emails out loud to my roommates in room #2 as we lay in our bunk beds under mosquito nets, trying to fall asleep to the sound of barking dogs. Thank you to Sue and Brian Walsh, our fearless leaders. They have perfected this trip and have anticipated so many potential disasters. We will be forever thankful to you for including us on this life-changing journey. Little by little, the resilient people of Haiti are rebuilding this country - and we got to witness it! Also - a special shout out to Josh Howie and his personal hotspot. Without his WiFi, these emails would not have been possible!! Thank you for following along with us this week! We are missing our new friends in Haiti but are very happy to be home! Audrey and the Little By Little Team