Dr. Janice Newsome speaks about Interventional Radiology

Dr. Janice Newsome, mother of Olivia Newsome (GHF ‘18) and doctor at Emory University in Atlanta, Georgia, came to talk to the Global Health Fellows in mid November about her journey into the medical field. Now an Interventional Radiologist at Emory, the path Dr. Newsome took towards her current career is unlike many we have previously heard. She was born in a poor community in Jamaica and was raised by a group of nuns from her community. At age 14, she moved to New York City and entered into a public school system extremely different from the one she had left. In Jamaica she was deemed “smart”, therefore she had focused on math and science classes and it was assumed that she would go into a similar career. Once in New York, she applied to the gifted program at school, not knowing if she was considered gifted or not, and was accepted into the more advanced public school system. After high school, she went through the 6 year undergraduate and medical school program at Icahn School of Medicine at Mount Sinai. She then continues with residency at VCU and a fellowship at Jackson Memorial Hospital. She worked at a few different hospitals before landing at Emory University as a doctor and a teacher.

Interventional Radiology is a recently added specialty, as is usually had fallen as a subspecialty of Radiology. These radiologists perform diagnostic procedures, treat obstructions and bleeding, perform procedures to avoid surgery and treat cancers, just to name a few. Dr. Newsome not only performs procedures, but also is constantly thinking of innovative ways to advance her field. She has five ongoing project designs for devices that will improve the effectiveness and efficiency of procedures. One of those projects is a bio convertible filter for patients whose blood will not clot properly. Typically the patient would have the filter inserted and then removed at a later date through another procedure. Dr. Newsome’s design would eliminate this second procedure, as the device would dissolve on its own. She works with a team of engineers to put her ideas into action and is preparing to present some of her new innovations at the Georgia Tech Capstone Design Expo this December. As well as working at the hospital, Dr. Newsome leads and mentors a group of Interventional Radiology fellows. Ever since she was a little girl in Jamaica, she gravitated toward teaching people anything and everything, and that passion still has not gone away. She believes that being able to share your knowledge and experience with others is a valuable skill and finds this part of her job to be extremely fulfilling.
Throughout her talk, Dr. Newsome reminded us to follow through with our passions, even if obstacles may stand in the way and to take advantage of all opportunities. She dedicated herself to what she loves and it has lead her to be a innovative and progressive leader in her field. Dr. Newsome remains grateful for the opportunities she was given on her own path to Emory and ended her presentation to us with the reminder: “To whom much is given, much is required.”

GHF 2020’s First Week of Community Service

The first day of the 2020’s community service began on Wednesday afternoon at Lifenet Health. As we arrived, we were warmly greeted by Morgan Burgess, the Lifenet Health Foundation Development Coordinator. After we put on our visitor’s badges, we were escorted to a conference room where we were asked to complete a quiz on organ and tissue donations. The quiz was comprised of 15 questions on the most common myths and misconceptions of organ and tissue donations. Each question contained a statement that the test taker had to identify as either fact or fiction. After everyone had completed the test, Mrs. Burgess reviewed each question and gave us the opportunity to take notes and ask questions. Following a detailed discussion about the quiz, Mrs. Burgess introduced us to the 2016 Norfolk Academy Global Health Fellows and Lifenet Health Project. The goal of the project is to create a slogan to promote awareness of organ and tissue donation on a personal and emotional level. We then said our goodbyes and headed back to the Norfolk Academy campus. During the first week of community service the class of 2020 learned two important things. One being the importance of fully understanding a topic before making a strong decision and the other being the value of spreading a positive message in the community to benefit others. I  really enjoyed my first week and I cannot wait to see what week #2 has to offer!

2020’s Second Week of Community Service at LifeNet Health

On October 5, 2016, the 20’s cohort of the Global Health Fellows attended the second community service meeting and third overall visit to LifeNet Health, the regional Organ Procurement Organization (OPO). Our overall project is to create a slogan that can spread awareness for organ and tissue donation. During this meeting, we listened to Mrs. Donna Bishop’s story of her life changing experience as a receiver of a vertigraft donation. Later, we discussed language sensitivity. Mrs. Donna Bishop, a receiver of a vertigraft, had been in pain for a year as a result of a vertebrae injury. She had surgery done in which a donated graft would be placed and infused into her spinal column along the C2-C3 vertebrae, which would alleviate the pain. Mrs. Bishop recalled the great relief she had the next morning and her gratitude to the organ and tissue donation program. Her story demonstrates the incredible impact that the donation had on her life. Also, we learned about the importance of language sensitivity in organ and tissue donation. Families who have lost loved ones must be treated with the utmost respect by all organ and tissue donation organizations if the deceased is an organ and tissue donor. That is why these organizations, including LifeNet Health, must be as respectful as possible. As they strive to treat families with respect, they are constantly changing their language to make it more caring and suitable. An example of this is the change from saying “life support” to the more accurate “mechanical support” because saying “life support” gave a false hope to the family that their loved one is still alive while in actuality, the patient may be virtually deceased. Through this, we learned of the intricate system of the organ and tissue donation program and how much the families of the patients matter.

GHF Travels Tobacco Road to UNC!

Submitted by Ingrid Benkovitz (Class of 2019)

Jon Todd (NA ’99) moderates a panel of UNC graduate students

After an early rise on Friday, we embarked to the University of North Carolina, bright-eyed and bushy-tailed. Jonathan Todd, from the Gillings School of Public Health (and an NA alumus!), put together an incredible morning of intellectual, thought-provoking speakers in the field of Epidemiology.  

We first heard from Anna Bauer about her research on Preeclampsia, a fairly common pregnancy complication. The presentation was filled with data that was very helpful in understanding her talk. Next, Christine Gray spoke to us about her research on trauma and abuse among orphans and how the statistics may differ depending on if the children are raised in an institution or a family setting. This conclusive study was able to give us a greater knowledge of the procedure of collecting data in an ethical way and comprehending what it means. Alex Breskin then showed us his research on the Hepatitis C Virus, a virus that was considered non-curable until recently. He was able to emphasize and open our eyes up to the extremity of a somewhat overlooked disease. Jonathan Todd, our last speaker, explained his research about how different doses of statins affect incidence of cardiovascular disease. His presentation was beyond impressive; Norfolk Academy should be proud!!

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NA GHF pose with our UNC panel at the Gillings School of Public Health

While all the speakers specialized in different topics, they all had one thing in common: a truly inspiring passion for what they do. Following these presentations, we were lucky enough to have a panel of more students and workers in the field of Epidemiology. With such an intriguing field, the number of questions we had seemed unending, but sadly, the morning did have to come to an end.

In the afternoon, Fellows traveled to the UNC Challenge Course to grow as a team and to push their physical limits!  The following reflection of the challenge course is from Andrew Thetford (Class of 2017).

After our morning session at UNC and a working lunch on Franklin Street to finish discussion of our case study, the GHFs headed to the University of North Carolina’s challenge course.  This was much different than a lot of us expected.  I assumed we would be on something like the Adventure Park at our local aquarium, but it was much different.  Most of our time was spent on the “Low Ropes Course”, which consisted mainly of team building exercises.  We started off with an icebreaker game, then transitioned quickly to a version of the game “Concentration”.  Each set of cards in the game had an important characteristic necessary to working well as a team.  Appreciating diversity, equality, hard work, and others were all flipped over after several tries by each fellow.

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Gabi Diskin (Class of ’18) explains key components of working as a team

 After completing the first game, we were challenged to pick three of the many traits to become our focus for the day.  Following much deliberating, we decided on focus, positive attitude, and teamwork because they seemed to cover most of the other traits as well.  

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Justine Kaskel (Class of ’17) slows the “water” as it flows downhill

Then, we moved on to a more physical and mentally grueling obstacle.  We had to use cut PVC pipes to move a golf ball down a hill and into a tiny bucket.  This required us to wait for the golf ball to move past our PVC pipe, then quickly transition to the back of the line.  It went on like that for a few rotations, with the first person in line continually moving down the hill and towards the back of the line.  However, it wasn’t as easy as it sounds.  If the ball dropped, we had to walk back up the hill to the starting line and repeat, and we dropped the ball A LOT!  It took 45 minutes of a lot of leadership from the ‘17s and others and a bit of yelling from everyone to finally get the ball into the bucket that was no more than 20 yards away.  

After each activity, we would sit down and talk about what we did and how we could have done better with each other.  We also tried to relate everything back to the three traits we chose at the beginning: focus, positive attitude, and teamwork.  Next, we were instructed to pick our favorite quadrilateral (the group consensus was a trapezoid) and we moved into the shade.  We formed a big circle, donned blindfolds, and were told to take the pile of rope in the center of the circle and form a trapezoid with it, all while wearing blindfolds.  This also took a lot of leadership and talking over one another to succeed, but we made it happen rather quickly.  

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Ryan Fulmer  (’17) helps Ray Fitzgerald (’19) cross the spider web

After another discussion, we walked into the woods a bit towards “The Spider Web”.  This was a bunch of strings strung randomly across a big wooden frame built to resemble a huge spider web with large, different sized holes in it.  Our challenge was to get everyone from one side of the spider web to the other, without touching the web.  This required us to carefully carry people through each hole.  However, there was a catch.  We could only use each hole twice, so we had to strategize who to put in each hole based on weight and size.  This challenge required a lot of brawn as well as brains, so it took a lot of teamwork to lift one fellow up, pass him or her slowly through a hole several feet across, and transport them into the waiting arms of GHFs on the other side, all without touching the strings.  Oh, and there was a time limit!  The time limit really compressed the amount of time strategizing.  We ended up having to put some of the biggest fellows, like Graham Barbour ‘17, into one of the smallest and most awkward holes.  After this challenge, we talked about what we did well and what we could’ve done better for a little bit, then we walked down to the zipline.

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Climbing to the top!

The zipline is the largest in the Southeast, and sat atop a wooden platform 100+ feet off the ground, connected only by a huge net.  In order to go on the zipline, one had to climb all the way up the net before strapping in and jumping.  After everyone had ridden the zipline, we finished our day with one last reflective activity where everyone picked card with a picture on it, then described how the picture represented some aspect of our day.  While there were the deep, classic people like James Hood ‘19 who said his picture of a road and a far off house represented the challenges we had to face to succeed, there were around seven blunter people who picked pictures of the sun because it was very hot and very muggy outside.

Although it was hot, sweaty, and difficult, I think we as a program finished with a lot of takeaways.  We had picked three core values that are necessary to accomplishing our goals, we had completed every challenge, and we had admitted to our faults and come up with alternative, better ideas after doing so.  We had grown together as a team, and everyone gained valuable experience as both leaders and followers, not to mention the workout everyone got from carrying each other around in the heat.  The Challenge Course was a lot of fun and a great addition to our time at Duke and UNC.

GHF Visit Experts at Duke University

Submitted by Lawson Montgomery ’18

After a great lunch with Dr. Robert Malkin of Duke’s Global Health Institute, we ventured to the Duke Clinical Research Institute and began on a discussion about research ethics from Dr. Ross McKinney. This was very interesting as it gave us the history of ethical issues in clinical research and a deeper understanding on how to conduct a true clinical study. Next, we listened to Dr. Danny Benjamin and his clinical research on different dosages and how they correspond to developmental ages of infants and children. After these two speakers, we had a panel that was composed of Erin Wolfe, Caitlin Grennan, Julia Giner, and Tiffany Bell. All were involved with Duke and all shared their personal paths to Clinical Research and Duke. We then asked questions about a variety of topics which included sickle cell disease and microbiology to mention a few. This panel helped show us that there are a multitude of paths that can be taken in the medical and clinical fields. We want to thank our speakers and panelists for the time they took out of their days. We would also like to thank Dr. Vivian Chu, moderator of panel and specialist in infectious disease, and Amanda McMillan. They were the women responsible for this awesome afternoon of speakers and panelists.

20’s Discuss Their Summer Reading

Submitted by Julia Duarte, GHF ’20

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Seniors Ryan and Justin (’17) lead a discussion on “Diligence”

On a Tuesday afternoon, after the Class of 2020 Fellows were introduced to basic Global Health terms and to their new senior mentors at the Chesapeake Bay Foundation’s Brock Environmental Center, we split up into different groups to discuss our summer reading book, Better, a surgeon’s notes on performance. Author Atul Gawande focused on three main themes: Diligence, Doing Right, and Ingenuity. By telling short stories that enlighten readers about health in a community and on a global scale, Gawande’s writing style intrigued and captivated all of the fellows. Some of the topics discussed included the importance of washing hands, the steps to eradicating polio, the complications of human birth, and many more. The seniors led the new fellows through a discussion about each of book’s themes, asking frequent thought-provoking discussion questions. Some of the questions being discussed included “Do you support or oppose the involvement of physicians in death penalty executions?” and “Do you feel that doctors should always follow the rule book or step away from it when coming across a problem they have never dealt with before?”. These two questions and many more helped steer discussions between the ‘17s and the ‘20s fellows. After reviewing and discussing each theme with different seniors, I came to the conclusion that Gawande had a deeper message behind his book. Not only do these series of stories teach us about medicine; but they also explain how to deal with failure and grow from it. That will determine your character, even if you are not a doctor. Every fellow should keep this lesson in mind as they begin a new year with new challenges.

GHF 2020: Intake!

Submitted by Laura Read, GHF ’20

The first day of the 2016 Global Health Fellows retreat began on a sultry Tuesday afternoon in the Brock Environmental Center, a building with towering silver wind turbines and metallic solar panels that produces 83% more energy than it uses. Inside the one of the world’s greenest buildings, the senior (GHF ’17s) and freshmen (GHF ’20s) fellows interviewed each other on the fastest rolling chairs known to mankind. After we got to know everyone, we began our discussions about what this is all about – how we’re going to make the world a better place through community health and prosperity.

Infectious diseases, non-communicable diseases, and population-based challenges are just a few of the topics we covered. We learned about the difference between morbidity and mortality and the problems each class of country face with them, and why some issues may be more prevalent than others depending on living conditions. Quality of life and life expectancy were also discussed, and the effect illness takes on it (Disability-Adjusted Life Years). The seniors also showed us informational videos on the topics, including one that covered the span of two hundred years on life expectancy versus income.

Global Health 101, led by the seniors to teach the incoming freshmen class of fellows

Global Health 101, led by the seniors to teach the incoming freshmen class of fellows

After a couple hours of taking notes and learning, we took a stretch break (Mrs. Hall provided earth-shaped cake pops, which were excellent) and headed outside on the deck to play a game. We ordered ourselves numbers one through ten, but we couldn’t talk, and we were blindfolded. The ice was broken, to say the least.

Teambuilding exercise on the porch of the Brock Environmental Center

Teambuilding exercise on the porch of the Brock Environmental Center

Following the game we broke off into small groups to talk about our summer reading book, Better by Atul Gawande, a surgeon’s notes on performance. It was split into three sections, called Diligence, Doing Right, and Ingenuity. We discussed with the seniors the many subjects covered in the book, which included washing hands in hospitals,

Discussing Atul Gawande's book "Better"

Discussing Atul Gawande’s book “Better”

malpractice suits, doctors’ wages, the death penalty, human birth, eradicating polio, and many more. Ethics and responsibility were brought into the conversation.

Then we began talking about needs assessments while working in the field. A needs assessment involves community members in a project, are used to earn respect and support, and help determine the most pressing needs of the community. We also discussed how monitoring and evaluation are essential while working on field projects.

At 4:30, we concluded our first retreat day. I’m definitely looking forward to the rest of the week!

The GHF '17s and '19s kick off the 2016 all-GHF Retreat!

The GHF ’17s and ’19s kick off the 2016 all-GHF Retreat!

Final Day: The Carrie Wortham Birthing Center in Cabestor

Post written by Graham Barbour ’17 and Kara Kaufman ’19 to recount June 16, 2016:

As our week in Hinche drew to a close, we prepared to return to Port-au-Prince with a stop at the new Midwives for Haiti birthing center in Cabestor. As we crammed into the van for the final time, we could not help but feel a sense of nostalgia, knowing that at least for the seniors and Mr. Boland, we would most likely never return to Hinche, with its potholed roads bustling with life, and Clory, with its hills dotted with palms and flame trees, and the Midwives for Haiti porch which witnessed hours of late night card games played in mostly hushed tones.

Winding our way through the switchback mountain roads was at once a warming and saddening experience— as we recognized familiar towns and regions from the previous trips but at the same time were forced to accept that we’ll probably never see them again.

The famous MFH pink jeep used at the Birthing Center now!

The famous MFH pink jeep used at the Birthing Center now!

After a couple hours of driving, we arrived at the Carrie Wortham Birthing Center, a newly opened birthing center named in memory of Carrie Wortham, an American who dedicated her life to helping the underserved women of the Central Plateau; she worked for Midwives for Haiti in-country a few years ago and was a large presence during our first two visits in 2012 and 2013. As we toured the facility, we were astonished to learn that since its opening in November of 2015, the clinic has already helped to deliver 75 children. For deliveries that required special care, mothers were sent to the PIH/ZL/Haitian government hospital in Mirebalais. Even more surprising was that even after the child is born, the clinic continues to help care for the child until six months of age. Although it was sad that Carrie couldn’t see the completion of such an impactful facility, it was powerful to see the extent of the legacy she left in Haiti.

In front of the Carrie Wortham Birthing Center in Cabestor, Haiti

In front of the Carrie Wortham Birthing Center in Cabestor, Haiti

We devoured our delicious, traditional Haitian lunch at the birthing center while watching an adorable puppy and a tiny kitten play (both of which we were not able to play with; Mr. Boland’s order.). Having prepared ourselves mentally and physically for the cramped sauna that was our means of transportation, we piled into the van for another two hours until we reached the Operation Blessing, International house in Port-au-Prince where we had stayed at the first night of our trip. Relieved to stretch our limbs, most of us went straight to our rooms and took the naps of our lives. The rest of the evening was spent all together. Dinner consisted of chicken, salad, and rice with the familiar Haitian twist that we have all gotten to know and love over the last week. We also showed each other the pictures we had taken of other people sleeping during the four-hour car ride. The tired bunch all gathered on the dusty roof of the house, looking over the city of Port-au-Prince. That night, there was a certain and almost unexpected peace I felt. The city seemed so small, the problems so manageable, and the people so unbreakable. For the ‘17s, they reflected on the last three years in the program and previous trips. This is very likely their last glimpse of Haiti as a cohort; yet, for the ‘19s this is just the beginning. I reflected on everything I had seen and felt throughout the entire experience: shock, joy, grief, passion, and now this renewed sense of empowerment. I would like to show those who haved funded the projects such as Luci lights, biosand water filters, and clean cookstoves the impact they really do have. While it substantially improves the quality of life, seeing the positive mental impacts they have in-person was the game changer for me. Suddenly, it becomes more than just money and materials and distribution; it becomes bigger than any one person. Giving people hope for the future is the biggest takeaway I have from this trip. I am so grateful for this opportunity. I learned more about global health and myself than I ever imagined possible.

Last Day in Clory: Clean Cookstove Distribution in the Community

Today’s post is written by Madeleine Munn ’19 to recount Tuesday, June 14, 2016:

To say the least, it has been an amazing four days in Hinche. To conclude our visit here, we made the drive/hike to Clory to hand out clean cookstoves. At the school, we were met with a massive group of community members hopefully awaiting a sustainable, environmentally friendly stove that would improve their respiratory health. Most of the IMG_3135people in Clory cook with wood charcoal that emits a smoke harmful for the lungs when inhaled often. Ryan, the brains behind the idea to distribute clean cook stoves, gave an informative presentation on the benefits of this new way of cooking and explained how the cookstoves work. To demonstrate the true capability of the cook stoves, Ryan, Graham, and Helen proceeded to make popcorn in one and handed it out to everyone there. People were grateful for the snack, as there were 80 stoves to give out and the recipient’s name, phone number, and serial number of every stove had to be written down on the same pad of paper. It was great to see the IMG_3145excitement and immediate ownership that people took to their stoves. Finally, after a long, brutally hot day, we took temporary respite in a photo shoot. We managed to pick up our feet and walk to the beautiful overlook of the valley near the school. We all took turns posing with different people and ended up with tons of pictures (mostly of James).

 

IMG_3153 and IMG_3154: Video of cookstove and popcorn distributions

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It was a quiet ride back to the MFH house in Hinche where we were greeted with a hot lunch and cold showers. After a short break, we headed back out, this time just down the road to the Maison Fortune boys’ orphanage. Immediately divided into two groups, the intense games began. Ryan, Nathalie, Graham, and James attempted to tear it up on the soccer field. Turns out, the boys at the orphanage are extremely good and even thought they were too good for the four newbies. Our other game of basketball consisted of Kara, Ingrid, and two boys against Ray, Andrew, and two other boys. Helen and I would jump in for Kara every now and then. Despite some of our height advantage and our spirit, the boys at the orphanage easily beat us. Following all this fun, we said our ‘good games’ and ‘goodbyes’ and climbed back into the van, sweaty and even more exhausted. We ate dinner, cleaned up, and together reflected upon our last four days in Hinche and Clory. Tomorrow, we head back to Port au Prince and then make the journey back stateside Thursday morning.

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Day Four: M&E, the Azil, and the Girls’ Orphanage

Today’s post, to recount Monday, June 13, 2016, is written by Nathalie Danso ’17 and James Hood ’19:

Early in the morning, we headed off to Clory to finish our Luci Light distribution and monitoring and evaluation of the biosand water filters. The roads were washed out after

Hiking up to Clory.

Hiking up to Clory.

the torrential downpour of the night before so we hiked most of the way to the village from the main road. On our way up, the biosand group stopped to visit some of the houses with filters on the hill. We continued visiting filters for the rest of the morning in Clory and in Pandiassou, a town in between Clory and Hinche. Most of these houses had filters that worked well and seemed to benefit the households. However, there were some instances where the filters had broken or were not being used. One household had tried to move the filter had dropped it on a rock and had broken it in half. There is no way the technician could fix this so the family has been without a filter since September of 2015. It is still being used, though, by a hen that now roosts in its remains. Another house also did not use their filter because they said that they did not trust it. Our monitoring and evaluation of the filters has shown some important lapses in communication, but as we finished collecting the data, we all felt an overwhelming sense that the filters, apart from a few bumps, are part of a successful intervention.

Once we reached the school, the Biosand groups headed off to complete more of their M&E by talking to more families. The Luci Light groups stayed at the school. Ryan and Helen talked with Manno, a community leader, about the upcoming distribution and execution of the clean cookstove project. The remaining ‘19s spent time with the children who had just finished their exams. Ray, Kara, Madeleine, and I used a small book to say

Practicing Creole with the kids of Clory.

Practicing Creole with the kids of Clory.

funny phrases in Creole and the children would in turn say unusual phrases in English. Then, after the 7th graders finished their last exam, Ray, Madeleine, and Ryan gave a quick tutorial alongside a translator on how a Luci light works and how to take care the best care of it. At the same time, Helen, Kara, and I asked a few questions to the teachers of the school relating to attendance and whether they thought the Luci lights had been effective before they broke. I could tell the teachers were thinking very carefully about the answers to the questions and after the questions ended, they told us what they thought would be most helpful to their students. Their greatest visions included a library, computer lab, and effective and complete feeding system. It touched me to see that these teachers expressed no concern for their own wellbeing and devoted their whole attention towards the well-being of their students. I am not sure if I could be that selfless in their circumstances. We distributed the rest of the Luci lights we took with us and departed from the school nervous and excited for the distribution of clean cookstoves tomorrow. After a tasty lunch, the biosand groups went to the Azil Malnutrition Center and the Luci light groups went to the Maison Fortune girls’ orphanage in Hinche.

Nathalie Danso: The Azil – 

This was my third time at the Azil Malnutrition Center. When we arrived, the children had just finished eating. Bursting through the door to the little outside play area where we were waiting, one little girl in a green dress immediately ran towards Ingrid and jumped on her. The other children were a bit less outgoing, but after five minutes we all had our own little gaggle. Some kids tried to use Mr. Boland as a jungle gym while he pushed a little boy in a toy car across the room. I played with several little girls, who all enjoyed being bounced on my knee, but one little boy stayed with me the entire time. I held him on my lap while I played with the other children and carried him on my hip whenever I got up. When it was time to go he would not let me put him down, and started to whimper as I walked away. Leaving him was heartbreaking, but playing with those children and that little boy will always make a memorable part of my last trip to Haiti.

James Hood: Girls’ Orphanage –

When we arrived, we gave out nail polish, coloring books, and bouncy balls. The smaller girls played patty cake with Kara and Madeleine and also attempted to braid their hair. The older ones brought out a soccer ball and played soccer on the pavement using stones as goal posts with Ray, Ryan, and me. We all had fun and ended up drenched in sweat. When talking to a little girl named Julie, she pointed to my arm braces curiously. Since I had absolutely no way of telling her I broke both of them playing soccer in Creole, I used hand gestures. I said “futbol,” pretended to fall back on my wrists, pointed to them, and made a snapping gesture and sound. She thought that was hilarious and must have imitated my gestures at least a hundred times. She would come up to me, point at her wrists, and make the breaking gesture and sound. Eventually we had to leave the orphanage and come back to the Midwives for Haiti house. We ate dinner, recorded M&E responses and ate cake that Madeleine so generously baked to finish our day.

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