Thursday, August 31, 2006

Twenty-Eight and Counting

Twenty-Eight and Counting

I counted the number of kids and young adults on the Haitian Hearts list today that need heart surgery. There are 28. The cases are evenly divided between congenital heart disease and rheumatic heart disease. They all need heart surgery.

Some of the 28 patients are OSF-SFMC patients that have been operated in Peoria. OSF refuses to care for these children now. They will die without surgery and other medical centers don’t really jump at the chance to operate international children that have been operated somewhere else. So these Haitian Hearts patients are really in trouble. I examine them here and Haitian Hearts pays for their medication from Peoria, but they need the surgical cure.

Pictured above are four patients that are representative of the 28 on the list that need heart surgery.

The girl at the top is Mirlande. She has the beret with USA printed on it. She is 14 years old and has been short of breath for two years. She can’t walk up a hill very well at all and Port-au-Prince is built on the side of a mountain. Mirlande has a leaky mitral valve that was caused by rheumatic fever that has put her in chronic congestive heart failure. She needs a new mitral valve.

The baby boy below Mirlande, being held by his father, is Ocean. He is 14 months old. If you look closely, you can see that his left chest is larger than his right chest. The reason for this is that his heart is large and pushing the left side of his chest outward. He has a very ominous sounding murmur due to a hole between the lower chambers of his heart called a ventricular septal defect. Each time his heart beats, it sends too much blood to his lungs and too much blood back to his heart. He needs the hole patched in surgery. A good pediatric heart surgeon and team can do this very easily. Before the heart lung bypass machine was available, cardiologists around the world knew their patients had ventricular septal defects, but could do nothing about it except treat them medically. At autopsy, the hole could be seen quite easily. If Ocean does not have surgery, it will not be due to lack of heart lung bypass machines. The technology is in the developed world to help the pediatric heart surgeon perform successful surgery. The problem is the will is not there to help kids like Ocean.

The third photo down is Joseph. He is 16 years old and has rheumatic heart disease that has destroyed his mitral valve. He needs surgery very soon or he will die. He is an excellent student, has a passport, and is ready to travel.

The last child on the list is Jhiny. She is 14 years old. I examined her for the first time and she has a hole between the upper chambers of her heart. This is called an atrial septal defect. She is chronically short of breath. You can see that the left side of her chest is larger than the right side because her heart is sick and enlarged. She needs surgery too. Interestingly, a medical center in the United States evaluated her echocardiogram four years ago and sent her mother a letter stating that Jhiny was "invited" to their medical center for repair for a mere $27,500 dollars but if she stayed longer than seven days, she would be charged $1,500 dollars per day. This seems kind like a cruel letter to send. Her Haitian mother could not afford this since her income is less than $100 dollars per year. So Jhiny is four years sicker.

If anyone out there in cyberspace has any ability to help these kids, please do so soon. If you have a good contact with an administrator or someone who sits on the board of a medical center, please contact them. As a rule, physicians love to take care of international patients, especially kids with heart problems, and will waive their fees.

Thank you.

John Carroll, MD

Tuesday, August 22, 2006

Guns in Sun City

Guns in Sun City

At night in Port-au-Prince, my wife and I watch the sunset over the ocean. It is beautiful from where we are sitting, but we know all is not well below us in the slum. Cite Soleil (Sun City) is a slum built on a garbage dump on the Bay of Port-au-Prince. We often hear gunshots from automatic weapons coming from that direction. The sounds are very scary to hear and we are two miles away.

Who is shooting? We never know, but we do know the guns are powerful. It could be coming from the gangs in Cite Soleil or from MINUSTAH, the acronym for the United Nations forces in Haiti. The UN forces are at about 8,000. Haiti’s national police do not have the weapons or the training to take on the gangs in the slum and won’t go near them. Almost, no one, except people that live in Soleil can come and go, and they do so only with trepidation.

Two weeks ago President Preval asked the gang leaders to turn in their weapons in an attempt to restore order in this country of constant chaos plagued with armed robbery, car jackings, and kidnappings in the middle of the day. President Preval made it clear that blood would be shed if the guns were not turned over. The gang leaders responded that they would turn in their guns yesterday, but then changed their minds. The gangs blame MINUSTAH for continuing their violent assaults in the streets of Cite Soleil and their leaders state that MINUSTAH doesn’t really want “peace and disarmament because they want a justification for their presence here (Haiti).”

Several months ago, my wife and I “toured” Cite Soleil with the protection of two gang leaders. Soleil looks and smells horrible as usual, but the pock marked bullet ridden buildings are very scary and sad to look at. This dump is the home for hundreds of thousands of people. The gang leaders insisted that all they want are jobs which can provide them with enough money to feed their families.

Each morning in clinic, I see babies carried by their mom or dad who have walked out of Cite Soleil that morning, sometimes dodging bullets, to get rudimentary medical care for their child. They are risking their sick baby’s life and their lives to venture out of the slum. The parents act like parents in the states. They want the best for their children and will do anything they can to provide it including going through gunfire to get it. I often ask myself what that parent would be doing in the United States. Would they be using a computer, would they be working in a bank, or would they be a mechanical engineer? These parents have no real jobs even though they work all the time to put a little food on their children’s plates at night. But their hopes for their children are the same as ours.

When people with big guns fight, the little people are always caught in the middle. The kids that cannot go to school, get a good meal, or obtain basic medical care, suffer the consequences. A simple medical problem can and does become life threatening as the guns keep firing in Sun City.

Wednesday, August 09, 2006

Two Haitian Babies on Hunger Strike

Two Haitian Babies on Hunger Strike
Port-au-Prince, Haiti
August 9, 2006

Two Haitian babies from Port-au-Prince are on a hunger strike. Blackson, aged seven months, and Saintvil, aged four months, are the two babies identified. Authorities believe that hundreds of thousands of other Haitian babies are in hiding and doing the same.

Blackson is from Cite Soleil. His main dislike is the continuing violence in his slum that has not allowed his mother to sell crackers and soda on the corner to earn enough to buy him any powdered milk during the last month. Her milk is gone with her own medical problems. Gang violence is the main problem with nearby shootings occurring almost everyday. But Soleil has never been good since it was built on a garbage dump on the edge of the ocean, and most residents have no clean water, enough food, electricity, work, schooling, medical care, or hope. Blackson’s mother is 19 years old and reports that he has a fever, his hair has turned orange and is falling out, and his skin is swollen. He is also refusing the baked mud pies that she makes for him each morning

Saintvil is from downtown Port-au-Prince close to St. Joseph’s Church. Saintvil’s mother is 16 years old and takes him to a free medical clinic run by the Missionaries of Charity sisters on Saturday mornings. He is one of 500 babies that show up. Like Blackson, Saintvil has orange hair and a high fever. He also has sores that have crusted and become bloody scabs over much of his body. Saintvil’s mother reports that he has bloody diarrhea and has a nasty cough. His blood count appears very low with his skin appearing almost white. He refuses to eat for similar reasons as Blackson.

Both babies declined treatment at the General Hospital in Port-au-Prince and insisted on being taken to the Missionaries of Charity home for their care. Their mothers report that they are very upset with the shooting of a sister in a city two hours north of Port-au-Prince over the weekend.

Blackson and Saintfil refused to be interviewed for this story.

Sunday, August 06, 2006

"Secretary Annan, Ferna is Dead..."

Attention: Secretary-General Kofi Annan, United Nations

Dear Secretary Annan,

Pediatric Clinic in Port au Prince this morning began as usual. The first baby was seven months old, had a fever, and was breathing 84 times per minute. Both lung fields had wheezing and crackling sounds. The baby was fussy but not especially toxic appearing. I took him to the rehydration room and started bronchodilator aerosol therapy which he seemed to like. The baby was also given a shot of a strong antibiotic and sent home to return tomorrow.

The second baby was a four day old that I saw yesterday with a fever of 103. The baby had been born at home with a midwife (matron) helping with the delivery. The only source of fever that I found was an umbilical cord that was tied off with a dirty piece of string. The matron had cut the cord with a Gillette. I gave this baby a big dose of antibiotics and advised the mother that fever in a baby this age could be very dangerous and even deadly. As she promised, she returned to the clinic today. The baby was afebrile today and looked ok. We changed the umbilical dressing again and gave the baby another shot of antibiotics.

Secretary Annan, as I was beginning to call the third patient into the room, my office door burst open. Falling into the room was the sobbing mother of Ferna who we admitted to the hospital in April. Her face was contorted in pain, sweaty, and tears were flowing as she was screaming, “Ferna died!” I tried to deny this was happening, but after so many years in Haiti, I knew almost immediately this was indeed happening and this is how death takes Haitian children and destroys their mothers. Ferna’s mother is named Yanick.

I literally drug Yanick into my office as she knelt on one knee and sobbed uncontrollably. I closed the door as all the mothers and babies in the waiting area were witnessing the grief of this young mother. I stood over her and rubbed her back not knowing what else to do. Her shoulders were shaking in grief. She told me that she had just come to the hospital across the street to visit Ferna and was told by the nursing staff that Ferna had a seizure and died last night. Ferna’s bed was empty. She had lost her ten month old precious child.

After several minutes of talking, I was able to lift her into the chair where children and their mother’s sit and tried to calm her down some more. Nurses came in the room and put dossiers on my desk barely recognizing the sobbing 29 year old mother in front of them. It wasn’t a sign of rudeness on their part. It was just another routine day in a Haitian pediatric clinic.

Secretary Annan, my heart and insides were repulsed with everything. I didn’t want to see any of the patients or their dossiers that were quickly piling up on my desk. I just wanted to leave. But I knew that would be wrong for many reasons.

After a few more minutes I helped Yanick to the exam table in the office where she laid down and with coaxing was able to slow her breathing. Profuse sweat and tears still flowed freely as she wailed again and again, “Oh Jesus! Ferna is dead”. Her eyes searched my eyes as if she was asking if what she was saying was really true. The pain on her face was so deep.

I noticed that on the floor next to my desk was a piece of cloth that the mother with the febrile infant had accidentally dropped on the floor when she left my office. I poured cool water on this cloth and placed it on Yanick’s forehead and temples and covered her eyes.

I told her that Ferna was in Heaven and would watch over her now in Haiti and that God wanted her and she couldn’t question that. I told Yanick that Ferna would now help her when she fell under Haiti’s heavy load. She nodded her head. Tears rolled down the side of her face under the wet cloth, but she said nothing. This was all very horrible.

I made the decision then that I needed to get it together, as Yanick had done, and see patients that were waiting. I let Yanick lay there while I examined children all morning and gave their mothers advice. I wondered what Yanick was thinking about all of my “advice” at that point.

The mothers would stare at Yanick as she laid about 8 feet from them as I examined their children. Word had spread in the waiting area that she had lost her baby. No one offered any sort of support for her whatsoever. They all had their own problems with their sick little ones. Severe poverty everywhere is paralyzing.

During the day, I changed her wet compress frequently. Yanick continued to lay supine and remained silent. She may have gone to sleep. Towards the end of the clinic, I offered her Coke which she sat up and drank and then laid back down.

Yanick and her husband come from a city an hour north of Port-au-Prince and had rented a tiny room in a nearby slum named Jeremy City. She needed to get back to the slum to call her husband, who she thought had gone home, and tell him of Ferna’s death. Ferna’s little body will be held in the morgue at our hospital and then transferred to the general hospital morgue downtown where her mother and father will have to retrieve it if they want to bury her near their home. Another problem is they need to hire an ambulance to transport their daughter because no tap-tap driver will knowingly take a corpse. That, of course, is an expensive ordeal and is the reason some Haitians take their loved ones home from the hospital right before they die so they don’t incur the cost of transporting the body. The last few days, Yanick seemed quite concerned when she came to the clinic to visit, but Ferna’s death was not anticipated.

As Yanick and I prepared to leave the clinic, the head nurse told Yanick to protect me because of the frequent kidnappings in the capital as I walked her to her slum. Yanick promised she would as her body was still shaking in distress from her daughter’s death. At that point, I did not know who was helping whom.

Secretary Annan, Yanick and I left the clinic and headed out onto the street that runs in front of the hospital. The sun was out in full and helicopters were circling above us with your arrival and first visit to Haiti. How did Port-au-Prince look from the air?

As we walked up the crowded street Yanick started to weave and began crying again. I lightly held her right elbow. Many people watched us as we proceeded. A number of women tried to help her and talk to her as she kept repeating, “Ferna is dead”. After we walked one half mile one of her leather sandals fell apart and she walked barefoot on the hot cement until another lady retrieved her shoe, fixed it with a piece of wire, and Yanick slipped back into her pathetic sandals.

We soon turned down a paved road as Yanick pointed to the left and after walking another quarter mile arrived in her horrible slum. I asked Yanick if we were close to where she and her husband were staying and she said yes. Dust, squalor, dogs, and debris were everywhere. A few feet later, she began pounding on a door and screamed wildly. The door was opened slightly by a woman and we slipped inside.

There were about 5 adults and 3 kids in a small central area with the whole compound about 40 square feet. The heat inside was unbearable. Their seemed to be no air circulation. Two babies were perched on a green army cot and a smiling eight year old boy was squatting next to them on the dirt floor. The roof was corrugated steel, and three of the four walls were slapped together with steel and pieces of plywood. The fourth wall was made out of 10 foot high compressed garbage.

Yanick immediately began jumping up and down in the dirt, barefoot and screaming that her baby had died. The adults looked at her but only the lady that let us in did anything. She gave Yanick two tablespoons of real strong appearing cold coffee loaded with salt, as Yanick fell into a broken metal chair. Amazingly, a 20 year old looking man was sitting in another beat up chair a few feet away receiving a pedicure from a teenage girl who barely looked up from her job.

Someone told Yanick that her husband was in their room. This startled both of us and she walked about 15 feet around the side of the compound. I followed her and looked into a small dark room and saw her husband lying on a thin cloth mat on his stomach. He looked up just briefly at us as Yanick screamed about Ferna’s fate. He then put his head back down and said nothing.

After about 15 more painful minutes, I felt my contributions were extremely minimal at this point, and told Yanick I would see her back at the hospital in the morning. We would talk about what to do with Ferna.

I felt no fear from anyone walking out of the slum that has been the home for this mom and dad as they visited their hospitalized daughter almost everyday since April. What I witnessed today will forever be etched in my brain. The pain of the poor is horrifying. I have seen many babies die in Haiti, but Yanick’s total desperation, grief, and loneliness in a city of three million people were too much.

Ferna had congenital heart disease and tuberculosis. She put up a great fight but the cards were stacked against her from the beginning. We couldn’t find a hospital for her in the United States to repair her heart. Ferna gave us time, but we who have everything didn’t come through.

Secretary Annan, as I walked home, the helicopters continued their security checks as you were arriving to meet with Haiti’s leaders. The misery on the ground is intense. We all hope your meetings with Haiti’s new leaders will be productive.


John A. Carroll, MD