Saturday, December 24, 2005



Pediatric tuberculosis clinic in Port-au-Prince is a draining experience. All day long you see tired moms with tired, malnourished babies who won’t eat, have fevers, and “used to be big”. The mothers are exasperated that their children won’t grow. They always have colds and coughs. Because the kids don’t get enough to eat, their immune systems don’t function well, and it predisposes them up to all sorts of infections. Close to 100% of poor Haitian children have worms at one time or another in their young lives.

When one mother brings three children to be checked, it is colloquially referred to as a “3-for-1”. That can break the spirit of the physician at the end of the day when he is tired and emotionally beat up by witnessing the results of poverty all day long.

My last “case” the other day was a “3-for- 1”. The mother looked like she was barely alive as she struggled into the office with her 3 children. The oldest was a 5 year old girl, the second oldest was a 4 year old boy, and the baby she was carrying was 18 months.

Mom weighed about 80 lbs and her cheek bones stuck out prominently. She had a blue scarf on her head and rested her head on the desk as she spoke and held the baby on her lap. She was just diagnosed with tuberculosis in her lungs. Her CXR revealed a cavity that had formed in her right upper lung where the tuberculosis was actually eating a hole in her lung tissue. She had a folded stapled piece of paper that said TB Sanitarium on it where she was being referred for the treatment of her tuberculosis. She obviously had no money and could barely even stand. She needed inpatient therapy in the antiquated sanitarium that is known in PAP as a place you go to die. She would need at least 8 months of therapy. If her HIV test came back positive, her therapy would be longer if she lived long enough to receive it.

The baby lay in a prone position on her lap and was dozing. He would stir now and then during the exam. At one point he urinated all over his mother’s lap as she lay with her head on my desk. Urine dripped down her legs onto the floor. The mother didn’t notice. My finger ran down the baby’s spine to find a fairly large lump in the middle of the thoracic spine area. This could only be one thing….Potts disease. Potts disease was named after Sir Percival Potts who described this malady too many embarrassing years ago. When TB gets in the blood and seeds the spine, the bone can become infected and break leaving the patient with a broken vertebrae and frequently an abscess that runs down the side of the spine. In Haiti with a mother who is coughing up TB germs (“red snappers”), her baby is at high risk for developing some form of TB. This pathetic poor baby had Potts disease in my opinion.

The other two kids were terribly dirty and malnourished but seemed to be like normal kids. I screened them for TB as well due to the fact they were exposed to their mother as well and had immune systems that were less than ideal.

The baby’s CXR and thoracic spine showed TB in both locations—the lung and the spine. A vertebral body in the middle of the back was squished due to bony destruction caused by the TB germ that hunts babies like this.

Several days later, they returned with the mother’s sister who looked poor, but not on the verge of death like the children’s mom. I explained to the aunt that she needed to bring the baby back in 2 days and we would admit the baby to the inpatient ward at the pediatric TB hospital. This seemed to cheer the aunt up because now she would only be responsible for the older brother and sister while the mother with the blue scarf languished in the sanitarium where most go to die.

Saturday, December 17, 2005

Jean-Baptiste's Last Request

Date: 17 Dec 2005 17:24:44 -0000From: "Realname" To:,, paul.s.kramer@osfhealthcare.orgSubject: From Jackson Jean-Baptiste to Sister Judith Ann
Sister, this took Jackson over an hour to write. "Dear Mrs. the president of hospital to Peoria,Today I'm decide to writing your because I feel I can not keep any more. Mrs. the president I'm asking you from time to time for give me a chance, because I think only you and God how can give me a new life again. Mrs...I'm descend in front of your leg for don't let me die, please and please Mrs...I'm with for your answer. What now to be able to suffer any more."Jackson Jean-BaptistePort-au-Prince, HaitiDecember 17, 2005

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Haitian Priest and Prisoner...Who Cares?

Subject: Haiti and Father Gerard Jean-Juste
Dec 15, 8:54 PM ESTHaitian Priest Said to Need U.S. Doctor By ALFRED de MONTESQUIOU Associated Press WriterPORT-AU-PRINCE, Haiti (AP) -- A jailed Catholic priest who had been considered a potential candidate for Haiti's presidency may have cancer and should be released to seek medical treatment in the United States, his lawyer said Thursday.The Rev. Gerard Jean-Juste, a supporter of ousted Haitian President Jean-Bertrand Aristide, has declined an examination by government doctors because he doesn't trust them, attorney Bill Quigley told reporters outside the jailed priest's church in the capital.Dr. John Carroll, a supporter who examined Jean-Juste in jail, said the priest has swelling in his neck and under his arms and an abnormal white blood cell count, which are possible indications of cancer or an infection."Every day that goes by, we are wasting time," Carroll said. "If this is indeed cancer, his life is in danger."Michel Brunache, chief of staff for interim President Boniface Alexandre, said government doctors had examined the priest and said there was no indication that he had cancer.Jean-Juste has been jailed since July, when Haitian authorities accused him of suspected involvement in the abduction and slaying of a well-known local journalist. Authorities later expanded the investigation to include alleged weapons violations. The priest denies the allegations.The investigating judge, Jean Perez-Paul, has declined to reveal his findings but said he will soon forward his recommendations to a government prosecutor.Jean-Juste, who has been compared to Aristide, a former priest, has emerged as a prominent figure in the ousted president's Lavalas Family party.Lavalas activists had attempted to register Jean-Juste as a presidential candidate in elections, but Haitian authorities ruled he was ineligible because he is in prison and could not appear in person to register his candidacy.Haiti's national elections are scheduled for Jan. 8.© 2005 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. Learn more about our Privacy Policy.

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Samuel is a tall young twenty-something Haitian man that could "have made something of himself" if Haiti hadn't failed him. He appears significantly thinner than when we met him in the dark one night in the middle of a street in PAP. His facial bones are now more prominent but his smile is still perfect.

When Samuel was 8 years old, some other kids doused his pants in gasoline and they caught on fire when he walked too close to something hot. He suffered a bad burn on the lower aspect of his right leg which never really healed. It turned into a twisted, mangled piece of flesh which he was glad to show us in the dark that night. It covered much of his right calf.

We sent Samuel to a hospital on two separate occasions where he underwent skin grafts. The biopsy of the edge of his chronic wound showed cancer. This is not uncommon in burns that are not treated properly and never heal they way they should. The scar tissue makes repeated attempts to heal the wound but instead becomes cancer. Samuel and his leg tried hard, but those that control Haiti didn't do their job.

Samuel was very happy that the skin graft took and that his leg looked and felt better but that did not help the fact that the edges were hiding cancer. He would e mail often asking for as much as he could get from people that have everything. Samuel never stopped asking for more. This behavior can drive people away because enough is never enough for people "like Samuel."

Recently, he e mailed that he had an ulcer the size of a mango in his right thigh area. This only meant one thing to me...his cancer had metastasized. We hospitalized him again and paid for everything. His wounds in his right thigh didn't heal and another biopsy was done and was read as indeterminate. But it is cancer.

We change the dressings now on his large open thigh wound that causes Samuel to cry tears and he doesn't cry easily. We give him the cheap third world pain killers that help him for an hour and I slap some narcotic patches on him occasionally from a friend of mine that died from cancer at home.

Christmas is approaching. Samuel's roommate has said that he will throw him out on the street because of the stench of Samuel's open cancer wound. We gave Samuel 100 more dollars to help him with food and with rent if he gets pictched out. Even if he is trumping us for this money, it is money well spent because Samuel got trumped by Haiti.

I hate to see Samuel or to look into his eyes or hear him plead for more help. I don't want to "help" him anymore. I just want him to die peacefully, but I know that he won't. He asks me for a visa to travel to anywhere for help. I don't go to bat for him. All that nasty paperwork. I won't do it and no one else will either.

Samuel could have made something of himself.

Jean-Baptiste's Last Christmas?

Dear Sister, Keith, and Paul,Today is day #16 that my wife and I have had Jackson in our room with us in Port-au-Prince. His last two nights have been bad with shortness of breath and a lot of vomiting last night. His mitral valve is tight, as you know, which is his main problem. I am doing what I can for him with medications. Have not been able to get any lab work or a CXR on him in two weeks due to his condition and the violence in the streets. We leave Jackson when we go to work in the clinic during the weekdays and hope he is there when we get back were scheduled to fly back to Peoria this morning but have let the tickets lapse and will stay with Jackson until the end. That is the only reasonable choice. He doesn't trust the Haitian hospitals and for good reason. He doesn't understand OSF either. Amazingly, Jackson still does not have an answer from any of you as to whether you will accept him. Please tell Jackson yes or no. Keith and Paul, that is what you are paid the big bucks make the big decisions, like whether a 21 year old young man will live or die. It shouldn't be a big decision, but you are dragging it out for months and months. Jackson's suffering is inhumane at present. If you were here the last two weeks holding his head and watching his heart beat through his chest wall, you would decide "yes" immediately (I would think). Just think if Jackson were one of your boys when they were that age. You would demand that they get the care they needed. (Keith, on one occasion years ago, you asked me to suture the face of someone close to you, while you cut in front of others to get this done.) But you are not here and never will be, so go on faith and the mission statements of the Sisters. I appeal with you again to do the right thing. Contrary to what your legal counsel implied last year, it is not easy to find hospitals for Haitian kids because of the corporate greed in the US. When hospital corporate leaders are paid enormous salaries and live in huge houses on the north side of Peoria, this isn't exactly living how St. Francis would have advised. So something has to give. What is giving are the Jackson Jean-Baptiste's of the world, not the corporate leaders or administrative life styles. You will all have a "good" Christmas. Jackson's Christmas will be a different type of "good" than yours. The poor really require so little to keep them fairly functional. However, when their infrastructure and technology sink totally below human levels, a few places like Haiti exist, and the Jackson Jean-Baptiste's suffer immensely. They live in "poverty without dignity". We can't keep turning our back on these people. Aside from the moral reasons that just get in the way sometimes, they do the jobs the developed world needs done and for smaller wages, and, for example, can "supply" their nurses to our dwindling supply in the developed world when hospital corporations go recruiting. It would be to your benefit to keep these countries viable to a point...Haiti is off the curve now and is so dysfunctional, it is hard for us to take advantage of the "business opportunities" they would normally offer if they were just a little better off. Jackson is OSF's patient. You never turn away anyone over their race, religion, or inability to pay. Plus, someone is paying for Jackson. The doctors want him in Peoria, even though they are afraid to say due to that fear factor thing. Medtronics will donate the St. Jude's valve, and the perfusionist will do all his work for free as usual.Please accept Jackson at OSF and give him another Christmas.Sincerely,Dr. JohnJackson, is writing a letter to you now. I will e mail it when he is done.

Tuesday, December 13, 2005

Carrot Juice

Whenever I find a child in one of the clinics who suffers from a heart defect, I try and document the patient's findings and obtain an echocardiogram in Port-au-Prince. I place the child on appropriate medication and take his echo to the United States and attempt to find a medical center to accept the child for surgery. One of the most important tools is the echocardiogram because the cardiologist and surgeon can see the heart moving in two dimensions and can make a better assessement of the problem. The CEO of the medical center has to agree, letters need to be written to the American Consulate, a passport and visa need to be obtained, and airline tickets need to be purchased to bring the child to the United States for surgery.

We usually have 20-30 kids on the Haitian Hearts list that need surgery and many need to come as soon as possible. It can take up to 3 years to find a medical center and complete the work for some children. Sometimes I haven't got the job done quickly enough.

I will never forget standing in the courtyard of a guest house one morning in the capital. A lady dressed in black stood off to the side as I talked to multiple other people with medical problems of some type or another. Finally, she made her way over and told me that her son, who I was trying desperately to remember, had been sick and an inpatient at the general hospital in the capital. I knew he was a teenager and that I had taken a slide of him in a hospital on the southern peninsula and had pretty good notes on his "case".

She related that one morning, while still in the hospital, he said to her, "Mama, I just can't do this any more," and fell backwards in his bed. He was dead. The mother told me this quite objectively as I was trying to think about how the staph germs had eaten away his injured valve and destroyed it and him in one final push. I knew I hadn't worked fast enough and could picture his smiling face very clearly now because his mother was on the slide too, her face filled with hope. I told the mother how sorry I was and she just shook her head. She said, "Doctor do you think I did the right thing? I gave him carrot juice to make him better." I told her she had done the right thing. She nodded and headed out the gate to start her day.

Sunday, December 11, 2005

Perfume, Pets, and Pediatrics

Perfume, Pets, and Pediatrics

An article was published in Pediatrics in September, 2003 entitled: “Inequity in Child Health as a Global Issue”. The author is Tony Waterston, MD.

“Poverty, violence, lack of education, abuse and exploitation, and refugee status are among th4 primary determinants of the health of children worldwide. Half of the world’s population, 3 billion people, lives on less than US $1.30 per day. The world’s 225 richest people have a combined wealth equivalent to the annual income of the poorest 2.5 billion people, nearly half of the world’s population.”

The article has a table that lists The World’s Priorities (Annual Expenditures). We spend $6 billion per year for basic education for all but spend $8 billion per year for cosmetics in the US. We spend $9 billion per year for water and sanitation for all but spend $11 billion per year for ice cream in Europe and $12 billion for perfumes in Europe and the US. WE spend $13 billion per year for basic health and nutrition for all but spend $17 billion for pet foods in Europe and the US.

Haiti is located 90 minutes by air from Miami but has one of the highest infant mortality rates in the world. Malnutrition is rampant in children under 5 years of age. Thousands of kids live on the streets and many are sold as restaveks (child slaves). The Haitian family has been disrupted due to economic reasons and political violence.

The median life expectancy is about 50 years of age. The majority of Haitians are unemployed, illiterate, and have no access to potable drinking water, or electricity. Per capita income is US $200. There 1 doctor per 10,000 people in Haiti and even worse in the province (countryside) because most doctors are rural. More Haitian doctors live abroad than in Haiti. There are more Cuban doctors in Haiti than Haitian doctors.

Haiti has no meaningful infrastructure. There are approximately 160 miles of paved road in a country with 12,000 square miles. The state hospitals are tragic and resident physicians who do the majority of the work in these hospitals frequently go on strike because they lack medical supplies and go without paychecks. Technology in these hospitals is lacking. There is, of course, no cardiac bypass technology that is functioning for heart surgery. Patients and their families have to buy their own IV solutions, needles, antibiotics, suture equipment, etc. Family members bring in food for the patients and bathe them.

The US, France, and Canada helped destabilize the democratically elected Haitian president in 2004 and he left the country under duress. A de-facto government run by a Floridian businessman now controls Haiti until new elections can be accomplished.

Kidnappings, carjackings, beheadings, political violence, and gang violence now plague Port-au-Prince. Entire slums housing hundreds of thousands of people are cut off from the rest of the capital by armed thugs. The 7000 UN soldiers have their hands full. The Haitian diaspora is fearful of returning to their country amidst the chaos. Haiti is hell now.

With this background, Paul Kramer, Director of Children’s Hospital of Illinois phoned the American Consulate in Haiti and advised them to grant no more visas to Haitian Hearts patients that needed heart surgery at OSF-CHOI. Doug Marshall, OSF’s, attorney notified them also the following year.

These actions are against the OSF Mission Statements and against the Ethical and Religious Directives written by Catholic moralists and ethicists regarding how Catholic medical centers should treat the poor and marginalized people---like Haitian children.

Haitian Hearts has offered to even pay for FULL CHARGES for Haitian patients and FULL CHARGES were turned down by OSF. OSF now refuses to take care of children operated in the past at OSF who need to return from Haiti for more heart surgery with $10,000 being offered for each child.

Happiness in Haiti

A few years ago a Christian missionary brought a 24 year old Haitian lady to me. The lady's name is Heureuse. She was suffering from a leaky aortic valve for many years. Her home was Benet, a small village on Haiti's southern coast. Her father is dead and her mother would cry over her as she laid swollen with fluid and listeining to tapes made by her sister Evita. Evita's tapes encouraged Heureuse to stay alive and not let Haiti steal her away.

My exam of her heart revealed her valve to be severely incompetent keeping her in congestive heart failure and barely able to function. 6 months later we were able to get her visa and needed to get Heureuse on the plane for the States. Evita traveled all night 5 hours through the Haitian mountains in the dark to retrieve Heureuse from Benet and brought her to Port-au-Prince. Evita refused to let Heureuse die.

Her surgery went well in the States and she began to smile and wear jeans and look quite chic. She underwent some dental work and learned some English. We then ended her dream and took her back to Haiti.

During the last few years, she has been unable to find work. Evita went to the Dominican Republic and never returned. None of her family has ever heard from her again. Maybe she lives on a battey and is the slave of a buscanero. No one will ever know.

Heureuse lives in a slum in the capital and had a baby. Heureuse showed me a picture of the baby's young father who died shortly after vomiting blood. Heureuse's baby had her assortment of diseases of the poor including impetigo and malnurtrition. How Heureuse and her baby survive here is something that I cannot understand. Maybe Heureuse still hears Evita's voice...

Several months ago Heureuse found us again and said she was about to deliver another baby and had a fever. Her heart sounded leaky again and I decided not to get an echocardiogram. If she survived the pregancy, I would order another echo. She delivered naturally in the general hospital in Port-au-Prince and both she and the baby survived. I don't know how.

Medicines from Peoria have helped her but she needs surgery again. The Peoria hospital will probably refuse her redo surgery that will be identified by the echo we ordered today. Heureuse is not as important to the hosptial and will provide her with no encouragement that has kept her alive.

So Heureuse lives in a city where kidnappings, beheadings, carjackings, and rape are daily events. She has her two babies and Evita is gone. When Heureuse is gone, her two babies will be alone or with many other homeless Haitian street children.

Heureuse smiles a lot in spite of her life in the hell of Haiti. Heureuse means "happiness".

Saturday, December 10, 2005

Abandoned in Haiti

He fled Baby Doc. He worked the streets in Miami. He never really got a parish but the Miami bishop liked him. He worked with boat people that slopped up onto the beach and couldn't draw triangles. He came back to Haiti after Jean-Claude became a gambler on the Riviera. He lived underground. He finally got his own church and set up a feeding program for kids and adults. He preached non violence and justice for the poor. He demanded that Haiti's democratically elected president return from his exile. His homilies were on the radio and went all over Haiti. He lived alone above the sacristy and finally was pulled out through a broken glass window of his church as three kids in his feeding program were being shot as they ran away from the men in black. He got out of jail and then was thrown back in accused of being the killer and torturer of a man as he was preparing to say the dead man's funeral mass. The people in the church spit on him and beat him. A lady who had laid in the morgue a few days before laid on his body and stopped the blows and the bullets that were ready for him.

A few warriors from his parish visit him now in prison and some indestructible church ladies bring him food. But Haitian priests and bishops don't visit because they are part of the state and part of the problem. They even took his day job from him. He looks out the window of his prison and encourages those who walk the hill that it is "no hill for a climber".

The White Haitian Baby

The Haitian baby girl is one year old and doesn't smile. She looks like a blan. I ask the lady holding her if she is her mom. No she is not and calls for the mom in the waiting area. The baby's mom comes in the exam room and is "timid". She says the baby is not developing and has a fever and cough. The baby looks at me without crying, smiling,moving or doing much of anything except looking perplexed. Mother looks healthy. Mother is calm and polite and looks like she cares for the baby somehow even though she had her friend bring her in the exam room. My exam on the baby reveals pale conjunctiva and a huge liver and spleen. Xray shows pneumonia in the right upper lobe. TB? We're in Haiti, so why not? Sickle? Baby is supposed to be black, so why not? I send the baby for admission to the hospital across the street but there are no beds for her so the timid mother shows back up with the baby like I asked her to. I give the baby a shot of Rocephin from my doctor's bag and try and treat her for what will kill her over night. It won't be TB that will do her in. It will be another homicidal quick acting germ...especially if she has sickle cell disease.

Mom returns the next day with this darling baby girl with a cap on her head. The baby actually tried to come to me as I walked into the clinic. I only hurt her with the shot, but all baby's seem smart. They seem to know who wants to hurt them and who doesn't. Mom had no money to get the labs or the medication I prescribed. Baby's fever is down some, so I go with more Rocephin for the weekend and hope to see her on Monday. I never know which baby's will return.

I feel guilty as usual treating these Haitian babies like they are starter babies for a third year medical student on his pediatric rotation at some huge inner city county hospital somewhere. These babies always haunt me as do my medical decision making skills.

This isn't happy pediatrics. It is Haitian pediatrics.