Thursday, April 28, 2011
Photo by John Carroll
This x ray is of a 60 year old man in clinic the other day in southern Haiti. He had some shortness of breath the last several months and smokes cigarettes. He had dull sounds on auscultation of his right lower chest.
He has a large right pleural effusion and his tuberculin skin test was 13 mm.
I started him on four drug chemotherapy for tuberculosis.
See this article from Crofs Blogs.
Tuesday, April 26, 2011
Sunday, April 24, 2011
Tuesday, April 19, 2011
Photo by John Carroll
Dear Up-and-Coming President Martelly,
I want to be clear in this open letter to you: The entire world of reasonable people wish you the most success as Haiti's new leader.
I happen to work downstream in Haiti and see terrible medical problems all day long everyday.
These problems inflict so much trauma and cut the lives short of so many people.
The photo above is the right breast of a 41 year old Haitian patient of mine with inoperable breast cancer.
She had a breast biopsy in the Dominican Republic (DR) in October, 2010 and has undergone numerous rounds of chemotherapy in the DR.
However, she is now back in Haiti and too weak to travel back to the DR for further treatment. And she is in too much pain to make the rough trip on the roads.
Her right breast is rock hard and has holes that drain pus.
She has large lymph nodes in each armpit and above her collar bone which means that her cancer has spread.
If you could stand by her bedside and hold her hand and talk to this lady, I know you would do your best to prevent this misery from ever happening to another Haitian woman.
And unfortunately, this happens all the time to Haitian women. They don't have access to mammography, they get breast cancer, most don't get any reasonable therapy, and most suffer at the end of their lives needlessly. They don't have adequate pain control and many have NO pain control.
I give her morphine for her pain...just a tiny dose is all it takes to give her about 12 hours of happiness.
When I made rounds an hour ago, her face was kind of wild. I think she knows she is dying. She told me she was "pa bon" tonight as she pointed at her hideous right breast. She asked me if I would pray for her.
Her daughters stand at her bedside with their heads down as I try and teach them how to administer oral morphine to their mom.
My patient's sister called me today from West Palm Beach and inquired about her condition. I explained what I was doing for her and advised the sister that she should call each day.
Mr. Martelly, as you know, no one should live and die like this.
Please remember people like this lady when you are President of Haiti. They are everywhere in Haiti if we just look. She will help you from her spot in Heaven to guide you and provide you with benevolence and knowledge to help you help Haiti's vast population with their many medical problems.
John Carroll, MD
Saturday, April 16, 2011
Friday, April 15, 2011
Saturday, April 09, 2011
Thursday, April 07, 2011
Wednesday, April 06, 2011
Photo by John Carroll
Haiti President-elect Martelly says voters have given him a mandate - Haiti - MiamiHerald.com
I talk to Haitians on the phone everyday. Some are in Haiti and some are in the United States. Most are just happy that the streets of P-a-P were calm after the election results were announced a couple of days ago. So they could walk back from cosmetology school and buy some stuff in the market without having a rock thrown at them. Little things like that make them very happy....who actually wins the presidency is not real important to many Haitians because it doesn't make any difference to them in their daily lives.
They laugh when I ask them if they voted for a new president of Haiti.
I work in extreme conditions in Haiti where people die each day of preventable illnesses. I see the worst of the worst.
Do I think Sweet Micky is going to help the people I examine? Do I think he will help my patient's families get fair paying jobs? Do I think he will make Haiti's roads, schools, and water better?
And about 20% of five million registered Haitian voters actually voted on March 20. So about one million of 10 million Haitians voted. So if Micky beat Mother Manigat by 2:1, 600,000 people out of 10 million people supposedly voted for him.
This is Micky's mathematical mandate.
His opportunity to do good for Haiti is huge. It would be great if he would deliver on just one of his big promises above. It would be great to be pleasantly surprised.
However, I have seen so much "end of the line" barbaric things in Haiti, I am just not a believer in "Sweet Micky".
Sunday, April 03, 2011
Photo by John Carroll
But just because we allowed Rwandans or Darfuris to be massacred, does it really follow that to be consistent we should allow Libyans to be massacred as well? Isn’t it better to inconsistently save some lives than to consistently save none?
New York Times
April 3, 2011
Saturday, April 02, 2011
Photo by John Carroll
Many leaving Haiti’s earthquake settlement camps
The Associated Press
Friday, April 1, 2011
Large numbers of Haitians are leaving the dirty, overcrowded camps that sprang up after last year's earthquake, some lured away by financial incentives from officials and others forced out by landowners.
Many more may be pushed out, with no safe place to go, just ahead of the rainy season that starts in May, the International Organization for Migration said in a report distributed Friday.
The overall camp population already has dropped by more than half in recent months, to an estimated 680,000, the IOM said, even though almost no new housing has been built and few repairs have been made to dwellings dwellings damaged by the magnitude-7.0 quake on Jan. 12, 2010.
Nearly two-thirds of those who left the camps have gone back to their old neighborhoods, and fewer than half of those are returning to undamaged homes. Many are back in houses that need repair or in makeshift shelters or tents on their property. Others have found new new areas, in houses or apartments, staying with friends or relatives or pitching new camps on their own.
"We came back to the house because we had no choice," said Francois Joseph-Ifanord, 62, who said security guards kicked him off the grounds of a private tennis club court where 30 families were living in shelters. "Now we're living day by day."
Aid groups say the biggest factor has been forced evictions by property owners. In dozens of places, from school yards to shopping plazas, owners already have made people move out.
The IOM said nearly a quarter of the remaining camp dwellers have received pressure from landowners to leave, with an eviction rate that outpaces the ability of Haitian officials and humanitarian workers to provide housing.
Still, government officials are trying to clear away the camps, the most visible symbols of misery in the battered capital.
The exodus is perhaps most evident in Place St. Pierre, a town square in Petionville, in the hills above downtown Port-au-Prince.
Hundreds of people have packed up their tents and tarps, freeing children to once again play soccer in the plaza, restoring a rare open space in a dense urban environment. Local officials paid families $500 _ a year's wage for an average Haitian _ to abandon the square.
While the checks had the desired effect, aid workers say such tactics may only lead people to move to other camps, precarious ravines, or back to houses damaged by an earthquake that the Haitian government says killed more than 300,000 people and left much of the capital in ruins.
"We can't say we support this kind of action," said Luca Dall'oglio, chief of mission for the International Organization for Migration. "The return requires strategy. You have to work on the areas of return, not just in the camps."
Relief workers fear that the area's heavy tropical rains, hurricanes or new quakes could collapse some of the quake-damaged structures.
The ability to relocate quake survivors has been held up by a shortage of land and housing, questions over land titles and a spike in the cost of living. And some have opted to stay in the camps even if they have a home somewhere or relatives outside the capital, because they are living rent-free and they get clean water, health care and free schooling _ all services the government rarely provided before the earthquake.
Relief groups have tried to scale back on free goods for the camps, only to find themselves called on again. When a deadly cholera epidemic broke out in October, humanitarian workers rushed to distribute chlorine tablets, clean water and hygiene kids. When Hurricane Tomas brushed Haiti weeks later, they rushed in again with more of the same.
Delays in the presidential election to pick a successor for outgoing President Rene Preval have also held up efforts to begin reconstruction of housing.
The camp sprawling over the arena-size Place St. Pierre popped up hours after the quake. Some people came from downtown Port-au-Prince, terrified by rumors a tsunami was coming. Others came from the hillside shanties that ring Petionville.
Now the square shows signs of clearing out. In January, Place St. Pierre housed 665 families, mostly sheltering under flimsy tents and tarps held together with seat belts and twine. Officials say only 116 families remain.
"We see it as our duty to move them out of the park," Deputy Mayor Francoise Michel said in her office, across the street from the plaza, which abuts a gingerbread hotel popular with tourists.
Michel says City Hall plans to distribute another round of $500 checks to encourage people to leave Place Boyer, a public square a few blocks away, and then a sports field down the street. The program could serve as a model for other cities in the Port-au-Prince area, she says.
Some humanitarian groups say that the grants are sufficient to pay rent, but not enough to help the homeless on a long-term basis. Relief workers worry that people will end up back in dangerous, damaged homes or camping out in ravines prone to flooding.
"Right now, it's '$500, here you go,'" said Giovanni Cassani, a camp coordinator with the IOM. "But if this project were a bit more fine-tuned and researched it could have a positive impact."
Some people still living at the Place St. Pierre admit they took checks only to move in with someone else at the camp because they needed the money for things other than housing, such as medical emergencies.
"I used the money to save my baby," said Joahanne Cenat, 22, a single mother who works as a vendor.
Others did leave, but not always to better conditions.
Joceline Alcide, a 39-year-old coffee merchant, returned to her Petionville neighborhood, and is using half of the $500 to invest in her business and saving the rest.
Housing? She pitched a tent on the roof of her rickety two-room home in Morne Hercule, a cinderblock slum the color of ash. Engineers tagged the cracked house as too unsafe to occupy.
"It was easier to do this than try to go find another room," Alcide said on the steep stairs leading to her home. "This spot isn't good but I have no choice. This is why I'm here."
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