Wednesday, April 05, 2006

The Scandal of Poor People's Disease

The Scandal of Poor People’s Disease

On the Opinion page of the New York Times several days ago, there was an article entitled “The Scandal of the Poor People’s Disease” by Tina Rosenberg. Rosenberg’s idea is that if you have to get sick, it is better to become ill with a disease that infects the rich too. That way more research is done, more medications are registered and used, more lobbying is done for your plight, and you may be helped. For example, due to strong lobbying groups in the US, HIV became a very hot topic quickly which led to very serious research and the development of medications that have extended the lives of many people with the HIV virus all over the world. If the developed world did not have AIDS, this research most likely would not have been done.

Tuberculosis infects one-third of the world’s population. You read that correctly. Two billion people are infected. Not all have the disease, but many are infected and are at risk of developing active TB. In the decade of the 90’s tuberculosis killed more people worldwide than in any decade in human history.

In Haiti, my wife and I spend much of the year working in a pediatric TB clinic. Haiti is full of tuberculosis and it hits children especially hard. Children’s immune systems just do not fight TB well enough and infection can turn into full blown tuberculosis. Fifty percent of children with active TB who are not diagnosed or treated with medications for the disease are dead in 5 years.

There are 8,000,000 new cases of tuberculosis infection each year around the world. Tuberculosis kills 5,000 people EACH day. While there has been a cure for TB for 50 years, virulent new forms of the disease have arisen. Despite this, there have been no new registered drugs for TB in 40 years. The vaccination for TB is 80 years old. As Rosenberg states, TB is an ancient disease and the cure is outdated. What she means is a disease of this magnitude has been targeted by very little research and attempts to control it--until AIDS came along and infected the wealthy nations.

When AIDS became common in the US and Europe, AIDS victims frequently became infected with TB because their immune systems were damaged. AIDS patients around the frequently die from TB. Therefore, public health systems were resurrected in the US and TB was made much more of a priority. As a result, the US has an all time lowest number of TB cases in the nation’s history.

TB attacks the invisible poor people around the world. In the US we have children who are too obese for the car seats that are manufactured. The children my wife and I see each day are too small to sit in these car seats. But they don’t need car seats here because the parents don’t have cars. TB attacks these kids and makes them even smaller.

Sunday, April 02, 2006

The Haitian Cook and St. Augustine

The Haitian Cook and St. Augustine

When Jackson Jean-Baptiste was with Maria and me during the month of December, he was really sick. However, many people here got to know him as much as Jackson would allow. People became attached to him in some way probably due to his fragile condition. He was very thin, spoke softly and deliberately, and walked slowly. But his mind worked very well.

Maria and I got to know him quite well. He told us about his mother’s life. She travels 12 hours once a week to a southern coastal city in Haiti to buy used clothes and sell them on the street near Jackson’s home. She makes the round trip in one day.

His father worked in a quarry. One day, when Jackson was just a boy, while his father was hanging from the side of the cliff by a rope, an enemy of his in the neighborhood, cut the rope with his machete. Jackson’s father plunged to his death suffering a massive head injury. Jackson told us the story impassively. When I asked him if he knew where the man lived that cut the rope, he replied “yes”. Nothing was ever done to bring the man to justice. Jackson seemed to accept that. He couldn’t do anything about it anyway. He was poor.

Last night, the cook approached me near the kitchen. He is a very black man with a kind face and nice smile. He told me that Jackson’s death had “hurt his (the cook’s) chest”. I told him I felt very sad too. The cook just shrugged his shoulders and looked at me with his very expressive eyes. He said, “Doctors are not God. You did all you could for him and God did the rest.” But the cook did not know, and will never know, our riches at home and why we should have helped God with Jackson. We simply did not do our part in Peoria.

The Haitian cook, who works very hard for very little salary, gave us more support regarding Jackson’s death than did any member of the Leaders of the Catholic Medical Center in Peoria that rejected Jackson during his days of suffering and misery when something could have been done. The Catholic Diocese Hierarchy had no supportive words either regarding Jackson as we buried him near Peoria.

Yet, this poor Haitian cook told me how hurt he was that Jackson died. Jackson’s death meant more to this poor man than all the rich men I know at home. A Haitian had lost another Haitian brother. Rich men lose stocks, jobs, money, homes, and objects. The death of Jackson meant nothing to the rich at home.

Saint Augustine wrote:

Let us by our prayers add the wings of piety to our alms deeds and fasting so that they may fly more readily to God. Moreover, the Christian soul understands how far removed he should be from theft of another’s goods when he realizes that failure to share his surplus with the needy is like theft. The Lord says: “Give, and it shall be given to you; forgive, and you shall be forgiven.” (Cf. Luke 6:37,38)

Saturday, April 01, 2006

The Clinic—March 31, 2006

While Maria and I were in Haiti in December, ’05 we didn’t work in Sister Lila’s clinic because the travel would have been too dangerous. Car jacking and kidnappings occurred daily. There were 120 reported kidnappings in December, but only six reported in March. The Haitians that we talk to say the amount of violence has decreased due to the presidential elections that were successfully held on February 7.

When Yvon the driver picked us up today, we were happy to see him. He has been working for sister for years and is very dependable. On airport road, about one mile from where we stay, were concrete road blocks and we pulled over when motioned to do so by UN forces holding carbines. They just asked to see our vehicle's registration papers and were very polite. The soldiers appeared calm talking to the people that walked by. We were gone in two minutes. We saw about 6 white UN tanks on the way to and from the clinic.

Clinic went very well today. Friday is pediatric day and the census was down some (probably about 100 kids) due to the rains at night which fill the puddles in the dirt road and make it very difficult for public transportation to make it down the road.

On the way home, Yvon took a shortcut through Cite Soleil. We went down a new boulevard named after a young man killed by United Nations forces in the last few months. Everything in the slum looked normal to me except the buildings with their walls pockmarked by holes from bullets over the last several years. Gangs and UN forces had fought it out many times.

It was amazing traveling through this slum that is the home to an estimated 200,000 people that had been walled off from the rest of the world for months before the elections. Now kids played on the sidewalks and ladies sold their wares on the street corners as usual. Yvon had a big smile on his face as he drove through…Preval had won and Soleil was quiet for now. Haitians love tranquility.

The Haitian Orphanage

The Haitian Orphanage—-March 30, 2006

Yesterday Maria and I visited an orphanage here in PAP. There are 90 children in the orphanage which has two buildings located about one block apart. The “new” building has had 3 hours of electricity since the Haitian presidential elections on February 7, 2006. It has no generator yet, so kerosene lamps are used at night for light. This building is the home for approximately 50 toddlers and babies. The other building has the older children.

A young mother came to the gate three days ago. She explained that she just delivered her own baby, cut the cord herself, and swaddled up the baby in a towel. The young mom explained that she has no means to care for the newborn. The manager of the orphanage accepted this baby boy who appears perfect. He just was created and has no marks on him, no impetigo, no hair loss from the unrelenting fungal infections that destroy Haitian kids scalps. He survived his delivery without a Lamaze class, a midwife, a doctor, or anyone except his young mom who did all the right things. He has not been put down yet in the Haitian dirt with its plethora of microbes waiting to attack. And he has avoided the mosquito with it’s malarial parasite and virus which causes dengue fever. Most importantly, he doesn’t yet know he has been abandonded by his birth mom who did the right thing….

The orphanage is staffed by Haitian “nannies” who feed the children, bathe them, wipe their noses, change their diapers, and wash their clothes. Last month, in February, a pregnant lady fell in PAP and went into premature labor. She delivered a 1.2 kg baby girl who was put in a neonatal unit in a community hospital. The baby had a gestational age of 6.5 months. Well, the baby ran up an $800 dollar bill and the mother, of course, could not pay it. The hospital told the mother that if she did not pay the bill, they would put her baby up for adoption. The mother showed up at the door of the orphanage and explained the situation to the managers. The managers talked to the administrator of the hospital who cut the bill in half. The orphanage managers then paid $400 dollars to get the baby, gave it back to the mother, and the mother is working off the bill each day as a nanny in the orphanage. She brings the 2 month old baby girl with her to the orphanage. She is very happy to have her baby who is gaining weight and to retain her dignity by working for the people that saved her baby from adoption.

This building also houses a boy and a girl from the province who were sent into the capital with heart murmurs. Both children are 5 years old. The little girl has a hemoglobin of 6 and the little boy’s hemoglobin is 5. The children walk slowly like shy poor little Haitian kids always walk. Neither say anything and do not appear afraid.

Both of their murmurs are probably innocent flow murmurs because the blood is so thin and non viscous. Also, their hearts are somewhat enlarged from malnutrition and anemia, and that stretches the valves, so the valves can be leaky and create a murmur too. They are so anemic because they lack enough iron in their diets and have worms in their intestines. Both like the meals at their new home and take their iron supplements.

Not having enough to eat in 2006 really is immoral. The median annual income in Miami-Dade County per family is $35,900. The average income in Haiti per person each year is estimated to be about $200. (Median and average are not the same, but one can see the gross inequality between US and Haitian people, even if the units are different.)