Thursday, November 30, 2006

Pigs and Puddles

This pig and puddle are right outside the front door of our medical clinic in Cite Soleil.

No wonder the patients waiting for us everyday have typhoid fever, diarrhea, malaria, dengue fever, and a host of other water borne illnesses. Hundreds of thousands of people in Haiti's slums have no clean water for themselves or for their children.

As Aristide and Farmer would say, "This is indecent poverty".

Should the baby you see below, examined in the clinic a few feet away from the fetid water and pig, be part of this indecency?

"To designate a hell is not, of course, to tell us anything about how to extract people from that hell, how to moderate hell's flames. Still, it seems a good in itself to acknowledge, to have enlarged, ones's sense of how much suffering is caused by human wickedness there is in the world to share with others."

Susan Sontag
(Taken from Paul Farmer's lecture at University of Utah, March 30, 2005)


Mirlande is 14 years old. She lives in the central plateau of Haiti in the Artibonite about two hours north of Port-au-Prince. It is a fertile valley with rich black dirt and adequate rainfall. Rice,sugar cane,and tropical fruits are abundant.

Mirlande has valvular heart disease due to rheumatic fever. She needs her mitral valve repaired or replaced. She cannot walk far due to her heart failure.

I have her on multiple medications to decrease the stress on her heart.

She needs heart surgery very soon in the United States or her days in the beautiful Artibonite Valley are numbered.


Rounds of automatic gunfire will definitely cause guys to jump off the open window sills in the clinic. This happened yesterday. As things became quiet, they would wander back over to the windows and timidly look out onto the street. Women vendors could be seen running. However, inside the clinic the patients barely flinched.

One can hear about the United Nations and the gangs warring in Soleil, but to be in the slum, working the medical clinic, with the gunshots so close is the real thing.

The variety of patients were the same as usual in the slum. After checking about 100 patients, treating them, and giving them the best disposition we could under the circumstances, we left Soleil in our ugly white “mobile medical van”. It has two huge home made flags with pineapples painted on them. Coursing through the narrow streets we could hear rounds of gunshots again from an unknown location.

We followed a UN tank of soldiers pictured in the photo above. Their faces appeared very tense. I didn’t know if it was good or bad that we were so close to the tank. Were the gunshots headed for them? If we followed too closely would the soldier who had his rifle aimed at our windshield shoot? Did they know we were “friendly”?

The UN tank in front of us turned to the left and we continued straight ahead to take a different way out of Soleil. A few hundred yards down the street were UN tanks that were parked to the right of us. As our driver laughed, some of us sank low in our seats just in case because the soldiers were obviously edgy and their arms were aimed right at our vehicle. Our Haitian doctor wisely summarized the situation and said, “You never know.”

We made it out of the slum just fine. But most of our patients did not nor did their 200,000 neighbors that live there. They are caught every day between poverty and bullets.

The young man pictured below was shot by UN forces and underwent a right leg amputation. His brother, who looks like he is a twin, was shot in the left leg by UN forces also and has a lower leg fracture that never united so his left foot just hangs at the bottom of his leg. The brothers both have crutches and forearms with tatoos.

I asked them why the UN comes into Soleil and shoots. Their answer was that the UN does not like young people in dread locks who are “dragons” (chimere).

Sunday, November 26, 2006

Angel and Stanley

Angel is five years old and is pictured at the top of this post. Stanley is 13 years old and pictured at the bottom.

I examined Angel in Haiti several weeks ago. Her heart revealed an ominous sounding murmur. Her echocardiogram shows complex congenital heart disease.

I examined Stanley today. He was in the back seat of a car and had to be carried to a wall that he sat on while I examined him. His mother and father are dead and he lives with his aunt here in Port-au-Prince. He put his head on her shoulder as she stood by him supporting him.

Stanley can only sleep in a sitting position because he is in congestive heart failure and is drowning. His heart valves sound very ill on exam. Stanley’s abdomen and legs are intensely swollen with fluid. The inside of his eyelids are white indicating anemia.

Angel needs no medication at present but I gave Stanley digoxin, furosemide, and potassium, antibiotics, and iron supplement.

Both Angel and Stanley need heart surgery to stay alive.

They are numbers 34 and 35 on the Haitian Hearts list of children destined to die as we look the other way.

Clinics, Kidnappings, and The Baron

The following is an account of two trips with a mobile medical team in Port-au-Prince. I can’t mention the names of anyone, because, as the Haitians say, things are “hot” in Haiti.

Father and his mobile medical team picked me up in the morning. The plan was to work in two slums in Port-au-Prince. There were about six Haitian guys on his medical team in the vehicle. Father told me that he needed to pick up the body of an old man that died and give it a proper burial before we headed for the slum and the clinics. Another missionary had notified Father of his death the day before.

Our driver drove us down to airport road and we headed across Route National 1. The cemetery was on one corner and UN tanks on the other. We headed a few feet down the Route National 1 and then took a hard left down a dirt road for two miles. I hadn’t been on this road for over one year. There was no traffic due to the kidnappings and carjackings over the last several years. The soccer fields were empty.

At the end of the dirt road we turned right onto notorious Route 9 which leads directly out of the slum. We headed north into the countryside for several miles.

The sugar cane fields looked really healthy to the east. Passing over a bridge revealed ladies down on the edge of the little brown river washing their clothes.

The missionary bringing the body was not at the second bridge as was planned and so Father called him with his cell phone. He said he was just several minutes away. A small crowd of people stopped on the edge of the road to see what we were doing. A man selling popcorn wrapped in cellophane bags came along and sold us about 10 bags that everyone seemed to dive into like we were at a movie.

Father proudly showed us his cardboard coffin he had made for the newly deceased man. It was in the shape of a coffin and looked quite impressive as we laid it on the highway behind our truck. Father remarked how the coffins in the future will have a coat of brown varnish on them as well as a symbol of his order. As we munched the popcorn, we all stared approvingly at the coffin.

Father takes the dead quite seriously in Haiti and he does all he can to give them a proper burial. He believes this is the highest form of charity. Father receives calls like this all of the time and has purchased some spots in the cemetery that we passed to bury the remains. If he did not, the families of the deceased have no money for a proper burial, and the bodies go from a general morgue to a field where pigs eat them and they rot in the sun.

As promised, a white van came from the north with a white man driving. A Haitian man was in the front passenger seat. The white man had a nice peaceful smile as he opened the back of the van. Lying on a green Styrofoam cushion was the body that needed a proper burial. It was covered with a white sheet. The deceased’s left elbow was sticking out just a little.

The popcorn was put down, and we carefully lowered the body into the cardboard coffin and slipped the lid back on. Father said about 5 minutes of prayer in Creole including the Our Father and a song as we stared down at the coffin on the highway. Everything was done with respect as the people on the side of the road watched. We then lifted the coffin into the back of our truck, some guys climbed in beside it, and the rest sat up front in the two cabs. We turned around in the middle of the road and went zooming back into Port-au-Prince.

Upon arriving back at the cemetery in the city, the graveyard man seemed happy to see us. He looked like he was about 80 years old, had a very distinguished face, with a full head of gray, straight hair.

We scooted the coffin out of the medical van and carried it to a vault that had the side panel removed by two men. Peering down into the hole that would be the body’s resting place forever revealed a drop off of several feet. Another couple of prayers were said by Father and we slid the casket down into the dark hole and it landed with a clunk.

We walked several yards away where there is a “Baron’s Cross” to honor Baron Samdi who is chief of the Gede Spirits. These spirits are responsible for the dead, cemeteries, and procreation. Believers honor the Gede as well as their dead relatives in the cemetery.

At the foot of Baron’s cross, which was made out of stone, were burned human bones. I could identify femurs and humerii. A small empty bottle of rum was on the ground and a Haitian coin and two Gillette razors were carefully placed on one of the arms of the Baron’s cross.

After leaving the cemetery, we piled back into the mobile medical van, passed some white UN tanks, and headed for La Saline. We stopped once on the way and purchased some small bags of water to have clean water to mix with the powdered antibiotics for the babies.

La Saline is another slum on the ocean front. There are four main slums in Port-au-Prince with an 8 square mile area. These slums are homes to hundreds of thousands of unfortunate people.

I have been coming to Haiti for 25 years and La Saline was the worst area I have seen. I won’t try and describe the garbage, sewage, heat, people, and traffic as we inched our way through the slum. No written words do it real justice.

We headed to Waf Jeremy (Jeremy’s Wharf), a pathetic zone inside of Saline. It sits right on the brown colored Port-au-Prince Bay which flows in from the Caribbean. Because we couldn’t move in the traffic, we got out and carried the picnic sized coolers filled with medication to the shanty Father uses as a clinic. The streets were black puddles and mud with pigs, people, and men pulling incredible loads on carts.

Upon arriving in the clinic, which had a dirt floor and corrugated metal walls, we found a 12 year old girl lying on an old green army cot surrounded by many of the patients. She had an IV hung with solution dripping in. Father said a quick prayer for her and for a successful clinic day and we started. I walked around the clinic and picked out the five sickest adults and babies and they were drug and carried out to Father’s vehicle where they were transported to another clinic in the city where they could be admitted and given “more comprehensive care”. Two adults acted confused as if they had typhoid fever from the fetid water in La Saline.

I was assigned an “office” in the corner. It had a chair and a small table for me to write. The patients chair legs were stuck in the hard black mud and was not moveable. Adults and children would file in over the morning with hernias, abscesses, hypertension, heart failure, and malnutrition.

The clinic pharmacy was set up a few feet away from me where we could treat some of the basic tropical diseases that we encountered. We also had a point-of-care lab tests which included HIV. Patients were given rendez-vous for the following week depending on their illness and need for follow up.

Behind the steel wall a few feet away was a classroom which shared the same wall as our clinic. Children that were neatly dressed in red and white uniforms and appeared to be kindergarten were in the classroom. There were no chalkboards, books, pencils,
papers, crayons, or anything academic that I could see. The teacher sat at the door talking on her cell phone.

When clinic was almost over, I heard gunshots in the distance. It was hard to tell exactly where they originated. Our vehicle came back for us and we walked about a one quarter mile through the narrow paths by women doing their laundry in large plastic bowels in the mud and kids in uniform leaving school for the day. People in the neighborhood waved good by to us. Some of our patients were walking with us. They were glad to be getting home because of the gunshots.

We left for Cite Soleil for our second clinic. Turning off of the main street into Soleil revealed four UN tanks with blue helmets seen barely poking out of the top. Two Jordanian UN troops were killed several weeks ago in a skirmish with one of the gangs in Soleil.

The roads in Soleil were cleaner than in La Saline but some were completely blocked with large rocks to keep the UN forces out. Clinic was held in a two story house made of cinderblock. There was no electricity and no running water. The ground floor was packed dirt. The upstairs floor was cement. It was nice and cool in the building—there were no windows and a breeze came through large spaces in the cinderblock. I checked pediatric patients downstairs and adults upstairs.

The Soleil children are usually accompanied by their mother and most were babies. I worked in a room that was dark and so I sat by the door to get as much light as I could to examine them and write a brief medical note.

The babies and children were malnourished and many had fever. They were very docile and made little eye contact. The mothers were appreciative of anything we attempted to do for their children. They picked up their children’s medication in a room near the front door.

Upstairs the adults had the same complaints as most poor Haitians. However, some were just very stressed living in Soleil with the constant warfare between the gangs and the UN forces. The cinderblock wall behind my table had four bullet holes from the UN’s powerful weapons.

After we had been working about an hour, a local gang leader with dreadlocks ascended the steps with his machine gun slung over his shoulder. He was just seeing how things were going and quietly talked with Father for awhile and left.

Clinic mercifully ended about 3:30 PM and we packed and left. However, Father had been sent a message that another more important gang leader wanted to see him before we left Soleil.

We stopped in his neighborhood and Father visited him for about 40 minutes. The gang leader there is considered the most vicious of the five leaders in Cite Soleil. He had a big smile but his eyes were very cold. Murals were painted on the wall of the Sacred Heart of Jesus and another wall had a brightly painted machine gun. A Che Guervera flag flew in the breeze over the cement compound. Young men walked close by with their 45’s in their right front pocket. If I hadn’t seen the guns, it just looked like a cleaner neighborhood in Soleil. After the meeting was over, we left for home.

Father has a good relationship with all of the gang leaders which has allowed him to negotiate for the release of 60 people ransomed and held in Cite Soleil during the last year.

The kidnapping in Haiti is higher than any other country in the western hemisphere. Port-au-Prince is particularly dangerous. People are taken in the street, many in the middle of the day, and delivered to a particular gang in the slum. Calls are made to the captive’s family and prices discussed. With Father’s influence, the ransom is brought to another gang leader and the taken person is hopefully safely transferred as is the money. The kidnapping gang trust the other gang leaders and hope they will avoid a sting by having the other gang involved. The ransom money is used to buy more bullets and rum.

Friday, November 24, 2006

Luke's Flower

Marie-Rose appeared to be about 40 years old. The nurses said that she is the mother of ten children. She had no family members present. When I was called in to check her she was propped up in bed and not responsive. Her eyes were closed and her breathing was fast. The systolic blood pressure was 50 mm Hg in her right arm. Her dossier showed that she had metastatic gastric cancer. I turned her IV to a keep-vein-open rate. Someone placed an oxygen mask on her face.

The nurses and another doctor stood at her bedside and prayed for her. After the prayer, amazingly Marie-Rose opened her eyes and said to everyone, “Thank you for praying for me.” She closed her eyes and the doctor told her not to resist and to go to the next world. A few minutes later she passed away comfortably without efforts to keep her with us.

Shortly after, two men carried a well-worn stretcher up the steps and she was placed in our little morgue. Flowers were placed on the white sheet that covered her body.

The doctor that had prayed at Marie-Rose’s bed told me to place a white flower from the garden on her body. She said that Marie-Rose could now intercede directly for our son Luke and our intentions.

We both knew that Marie-Rose will not resist our requests and we know she appreciated Luke’s flower.

Thursday, November 23, 2006

A Look of Concern

We had clinic yesterday in Cite Soleil.

One patient was a 49 year old man. He had a 6 foot pole which served as his walking stick. He was wobbly when he walked and had a look on his face that he is dying. Beside him was a smiling seven year old son who accompanied him to the clinic in the slum.

They are homeless in one of the worst places on earth and live on the street.

The father said his hip hurts and he has no money for food or school for his boy. He is skin and bones and his face would contort from a worried look to a confused look as he gave his history. He may have HIV and a recurrence of his tuberculosis that was inadequately treated.

Other clinic patients told me that the UN had entered the slum several days ago and shot at the houses. I don’t know why. There were at least four large bullet holes in the cinderblock wall several feet behind me in the clinic.

When we left the clinic yesterday afternoon I saw three white UN tanks entering the area. The UN soldiers had their automatic weapons ready and aimed at us as we passed them in our medical vehicle on the street. The narrow roads, some of them which are blocked with large piles of stones, try to keep the UN soldiers out. However, last night after the sun had set, I heard loud thunder-like explosions coming from the area of the slum and wondered about the look on the sick father’s face was as he and his son huddled in the street in the dark.

Saturday, November 18, 2006

OSF's International Patient Committee

OSF-Children's Hospital of Illinois has an International Patient Committee. This Committee was organized to screen children from overseas to see who will be accepted by Children's. Paul Kramer, Executive Director of Children's Hosptial, and Joe Piccione, OSF Corporate Ethicist, are 2 members of the Committee. Interestingly, no Sister at OSF and no Catholic priest from the Pastoral Care department is on the International Committee.

Mr. Kramer and Mr. Piccione played big roles directly or indirectly in ending Haitian Hearts at OSF several years ago. Mr. Kramer slowed surgery on a Haitian child that needed surgery.

Doug Marshall, OSF attorney, notified me that OSF will not accept any further Haitian Hearts patients. How can this Committee look at the Haitian Hearts patients who were operated at OSF in Peoria 5 years ago with an objective eye? They can't and at least 6 former patients need to return or they will die like Jackson Jean-Baptiste did.

A biased Committee such as this puts the entire Mission of the Sisters in jeopardy.

Please see forum article in todays Peoria Journal Star.

Monday, November 06, 2006

Three Strikes

This shy little girl is eight years old. She was living at a home for sick, dying, and homeless adults in Port-au-Prince. Her mother has no money and could not care for her because she was sick all of the time with a constant cough and short of breath. She had also lost a lot of weight.

Her exam revealed a “wash machine” type of murmur that was very loud high on her chest. She had wet sounds in her lung as well and appeared very ill.

An echocardiogram had already been ordered by another physician which showed this little girl had a connection between her aorta and her lungs (patent ductus arteriosus) which allowed too much blood to flow through her lungs with each heart beat. This caused her heart to go into failure because the heart was receiving too much blood from the lungs.

Her chest x-ray showed pneumonia which is not uncommon in children that have too much blood shunted to their lung fields. However her pneumonia is tuberculosis.

Thanks to an American missionary who works in Haiti much of the year, a hospital in the United States accepted this girl to close the abnormal connection between her aorta and lungs. We started tuberculosis treatment in Haiti two months ago and continued her on her heart failure medication. She has gained weight and feels much better.

Haiti, heart failure, and tuberculosis are three strikes against her. However, thanks to the intervention of multiple people, she has a good chance now at long term survival.

Haitian Death Squads

Several years ago, while checking kids in the pediatric ward at the General Hospital in Port-au-Prince, I examined a 13 year old girl who I will call Stephanie. She had the cachectic, docile, sick look characteristic of children who have been sick and neglected for quite some time. She appeared very pathetic. Her caring older sister at the side of her bed fed and bathed her and changed her sheets. She told me that Stephanie had a heart problem for an unknown period of time and this was her first hospitalization. Their mother was dead and they were living in a home for girls.

Her heart exam revealed a murmur consistent with a leaky mitral valve. She was in chronic congestive heart failure.

After several months, Haitian Hearts was able to get Stephanie to the States for heart surgery and she eventually did very well after a rocky post-operative course.

Her father told me that Stephanie’s mother had died on January 2, 1992 after suffering a severe beating from the Haitian military. Apparently, her mother was an “Aristide fanatic” according to the father. One day in late December, 1991 Stephanie’s father was returning to his neighborhood on the outskirts of PAP, and his neighbors warned him that five soldiers were in his house and he better leave the neighborhood immediately. Stephanie was 15 days old and she and her siblings had been taken out of the home by vigilant neighbors before the soldiers arrived.

When he returned to his home, he found Stephanie’s mother severely beaten by night sticks and the wooden stocks of the soldiers’ rifles. She was barely conscious. He told me her face, chest, and abdomen were “blue”.

He left the capital immediately and hid on the southern part of the island. (For the next three years he snuck into the capital to check his family.) His mother, Stephanie’s grandmother, took care of his severely beaten wife and took her to the General Hospital in Port-au-Prince where she remained for two weeks. Grandmother bought medicines for her off the street, but surgery could not be done because the hospital lacked the equipment and grandmother lacked the money to purchase it.

Stephanie’s mother was discharged to home where she died a few days later after coughing up “a lot of black blood”. Her father showed me pictures of his wife’s body lying in the casket in her wedding gown, her face still bruised and swollen. She looked like she was in her late 20’s. She and Stephanie look like they could be sisters.

So Stephanie grew up in this slum with untreated rheumatic fever without a mother and with a father on the run from the Haitian military. Her life has improved but Stephanie’s father still talks in a whisper and looks over his shoulder hoping the soldiers do not return.

"He Had a Great Smile"

My wife always said that Dukens had a "great smile". He did.

I followed Dukens in Haiti for about one year. He had severe congestive heart failure due to rheumatic heart disease. He was very weak and could not attend school any longer. He had been a very good student. Dukens was 16 years old.

I was unable to get him accepted into a hospital in the United States for heart surgery to replace his tattered and incompetent valves.

Haitian Hearts treated him with medicine which helped just a little.

One day three weeks ago he told his mother that he was going to die. Fifteen minutes later Dukens and his "great smile" were gone.

Wednesday, November 01, 2006

Dangerous Infections

This 12 year old girl came into the clinic on a recent Friday. Her mother stated that she began to develop an abscess around her right eye two weeks prior. As the picture shows, her right eye was completely swollen shut. Her lymph nodes below her right jaw were enlarged as was the the lymph node in front of her right ear.

Her mother reported that she had a fever. The good news was that when I pried her eyelids open, her right eye moved freely in the socket which meant that she had periorbital cellulits rather than orbital cellulits which would be much more dangerous. Orbital cellulitis can spread to the brain very quickly.

I gave her a shot of ceftriaxone and put her on oral antibiotics and she returned on Monday. The picture below shows the swelling is much improved around her right eye.

It cost 75 cents to get in the clinic each day. That covered everything. This young lady was very fortunate that her mother was able to find the money. Infections like this can become very deadly when they are allowed to progress to this degree.

Poverty is the big killer in Haiti, but this time poverty lost.