Friday, September 30, 2011
Photo by John Carroll
New York Times
September 30, 2011
"Nobody is against empathy. Nonetheless, it’s insufficient. These days empathy has become a shortcut. It has become a way to experience delicious moral emotions without confronting the weaknesses in our nature that prevent us from actually acting upon them. It has become a way to experience the illusion of moral progress without having to do the nasty work of making moral judgments. In a culture that is inarticulate about moral categories and touchy about giving offense, teaching empathy is a safe way for schools and other institutions to seem virtuous without risking controversy or hurting anybody’s feelings."
Tuesday, September 27, 2011
(Photo by John Carroll)
Why would Haiti really need an army?
I have no idea.
Isn't my cholera patient slumped against the tree docile enough? He doesn't appear too threatening, does he?
Please read this article from the Miami Herald.
President Martelly spoke to an almost empty room at the UN.
Too bad for Haiti.
Photo by John Carroll
From the Peoria Journal Star, September 2011--
About 19,000 Peorians, or 18 percent of the city's population, live below the poverty line, according to statistics released Thursday by the U.S. Census Bureau.
That includes about 11,000 blacks, or 38 percent of the city's black population, and nearly 1,500 Latinos, or about 25 percent.
Almost 24 percent of all children in the city live in poverty.
Here are some other statistics for the city:
- 27 percent of families received some type of public assistance last year.
- 21 percent of families with children are in poverty.
- 44 percent of unmarried women who live alone with children fall under the poverty line.
While the statistics are alarming, they also come with a high margin of error because of the sample size and the way the Census Bureau conducted its survey last year. However, the numbers still fall in line with national averages.
"Even with the margin of error, Peoria still has a high number of people who live in poverty. This year's data looks to be that one in five people in Peoria are living in poverty," said Amy Rynell, the director of Heartland Alliance's Social IMPACT Research Center, a private Chicago-based think tank that studies social issues. "Not only is there is a large number of people living in poverty but there is a growing number of people who are living at half poverty rate."
Meg Newell, a spokeswoman for the South Side Mission, sees it every day.
"The human side, for us, that people who never thought that they would be in that position are now in that position. People who five years ago were supporting our food pantry, who were buying extra at the grocery store to donate, are now our customers," Newell said.
She points to the 10 percent increase in food baskets distributed by the mission this year. In 2011 so far, the mission has passed out 4,918 baskets, compared to the 4,433 baskets during the same time period in 2010.
The numbers come from the annual American Community Survey, which is the Census Bureau's effort to keep track of yearly trends by surveying only about 2 percent of the population and then extrapolating estimates from there.
As such, the bureau only provides detailed information for cities and counties with populations of more than 65,000, meaning areas like Woodford County, East Peoria or Pekin would not have any detailed information.
The numbers released Thursday also state the obvious: Those who have less education and poor work history tend to fall below the poverty line.
Photo by John Carroll
Several weeks ago I posted here why MINUSTAH should STAY in Haiti.
I think MINUSTAH should stay in Haiti to dig wells and sanitize the water. Maybe that would save a few lives during the next spike in cholera.
And MINUSTAH shouldn't shoot civilians. That makes sense doesn't it?
This is an article regarding my interview in 2007 of a lady in Cite Soleil who told me her three daughters were shot by a MINUSTAH helicopter hovering above her shack. I examined all three daughters, and all had bullet wounds. And I saw the holes in the corrugated metal roof above me. MINUSTAH denied shooting down from their helicopter.
The Nation reports 10 reasons here why MINUSTAH should LEAVE Haiti.
Greg Grandin and Keane Bhatt | September 26, 2011
An explosive cell phone video  released earlier this month documents the alleged sexual assault of an 18-year-old Haitian man at the hands of five Uruguayan troops belonging to a contingent of the United Nations Stabilization Mission in Haiti located in the southern town of Port-Salut. As the story spreads internationally, MINUSTAH—the UN Stabilization Mission is known by its French acronym—has become the target of demonstrations in Port-Salut , in the Haitian capital Port-au-Prince  and in front of the Uruguayan Ministry of Defense in Montevideo . Defense Minister Eleuterio Fernández Huidobro ordered the immediate repatriation of the soldiers shown in the video, who now await further legal action in jail.
Earlier, as unconfirmed reports of misconduct began to multiply, Defense Minister Huidobro stated  that “among such a large number of people, there will always be someone who behaves wrongly.” Two weeks after the cell phone video was released, MINUSTAH chief Mariano Fernández argued  that “acts of a few should not also tarnish [the image] of thousands of military, police, and civilian personal serving MINUSTAH and Haiti impeccably since 2004.”
However, this is not a case of a few bad apples. MINUSTAH has had a consistently disastrous record of malfeasance in its seven-year military presence—much of it the result of institutional design. Although Brazilian Defense Minister Celso Amorim—charged with the largest contingent of UN soldiers in Haiti—recently discussed  a gradual reduction in troops, he also admitted that no timetable has been drawn up for their eventual withdrawal.
Here are ten reasons why a timetable for a speedy withdrawal of all UN soldiers from Haiti is necessary:
1. Haiti has not experienced an armed conflict, nor has it been a party to an enforceable peace agreement, the criteria for legitimately stationing UN peacekeeping troops. The UN states in its charter  that it shall not “intervene in matters which are essentially within the domestic jurisdiction of any state,” unless they present a threat to peace, breach of the peace or act of aggression. MINUSTAH arrived in Haiti using this justification, which has also allowed it to remain without the consent of the Haitian government. It would now be difficult to reasonably invoke this claim, seven years after MINUSTAH’s arrival and seemingly indefinite presence.
2. UN troops are granted broad  immunity  for crimes committed in Haiti, and are subject to prosecution only in their home countries. Among the different governments participating in MINUSTAH, there are major discrepancies between their domestic laws and their willingness to investigate crimes. Even if prosecutions of peacekeeping troops do take place, it would be difficult to obtain witnesses and dependable evidence from Haiti. Haitians themselves rarely hear about successful punishment abroad, heightening the perception of impunity. As long as this legal structure that fosters a lack of accountability persists, a full withdrawal is the only definite way to prevent future abuse.
3. Just four years ago, over 100 Sri Lankan  MINUSTAH troops—more than 10 percent of the entire brigade—were repatriated to their home country due to allegations of sexual misconduct and abuse , involving underage girls. The UN’s investigative arm found  that “in exchange for sex, the children received small amounts of money, food, and sometimes mobile phones.” Acts of sexual exploitation and abuse were frequent occurrences  at “virtually every location where the contingent personnel were deployed.” There is no evidence  Sri Lankan troops were ever prosecuted . Recent news reports corroborate fresh allegations that Uruguayan soldiers impregnated  local women in Port-Salut, including a 17-year-old girl .
4. MINUSTAH is implicated in last year’s suspicious “suicide” of a Haitian teenager named Gérard Jean-Gilles, who was found hanging inside a UN base in Cap Haitien. Haiti Liberté  reported that former head of MINUSTAH Edmond Mulet obstructed an investigation carried out by Haitian authorities, invoking immunity to prevent the Haitian judiciary from summonsing a Haitian witness in the case.
5. UN peacekeeping troops from Nepal were responsible  for introducing cholera into Haiti in late 2010, most likely by contaminating rivers  with improperly treated human waste. Cholera  proceeded to kill more than 6,200  and infect 440,000 Haitians in just ten months. New scientific research shows that MINUSTAH’s gross negligence most likely caused the lethal epidemic, but Edmond Mulet still refused to admit the possibility of UN culpability. Despite public appeals  by leading cholera and health experts, the United Nations, World Health Organization and Center for Disease Control and Prevention claimed  that an investigation into how the disease arrived in Haiti was not necessary, and could be harmful.
MINUSTAH’s denials further enraged Haitians, whose dramatic anti-UN demonstrations led to protesters being shot dead  by UN troops. Despite this history, the Uruguayan contingent in Port-Sault is still accused  of improperly disposing trash and waste water.
6. The arrival of UN troops to Haiti in 2004 had dubious legitimacy at best, and the banner of a UN coalition is just a less controversial facade for the pursuit of US interests in Haiti. MINUSTAH was created at the behest of the United States, after the Bush administration orchestrated  a coup d’état against Haiti’s democratically elected president, Jean-Bertrand Aristide—a long-held aim . WikiLeaks revealed  that in 2008 former US Ambassador to Haiti Janet Sanderson considered MINUSTAH “an indispensable tool in realizing core [US government] policy interests in Haiti,” especially in “the current context of our military commitments elsewhere.” The “regionally-coordinated Latin American commitment to Haiti would not be possible without the UN umbrella,” which “helps other major donors—led by Canada and followed up by the EU, France, Spain, Japan and others—justify their bilateral assistance domestically.” Sanderson concludes: “Without a UN-sanctioned peacekeeping and stabilization force, we would be getting far less help from our hemispheric and European partners in managing Haiti.”
7. MINUSTAH is a highly partisan political force in a sovereign country and actively meddles in Haiti’s domestic affairs. For example, a cable  from 2006 demonstrates that Edmond Mulet, then head of MINUSTAH, “urged US legal action against [forcibly exiled president] Aristide to prevent [him] from gaining more traction with the Haitian population and returning to Haiti.”
8. MINUSTAH’s mandate prioritizes security and military issues, contributing little to social and economic development. In 2010, the UN Security Council apportioned a whopping $850 million  annual budget for MINUSTAH—nine times what it raised to fight the cholera that MINUSTAH had inadvertently introduced. Similarly, in the wake of the devastating earthquake of February 26, 2010, Reuters reported  that MINUSTAH put more emphasis on “handling security and looking for looters” than relief work and humanitarian assistance. Further compounding this problem, MINUSTAH soldiers cannot even communicate with most Haitians, who speak Creole, and are not typically accompanied by translators.
9. MINUSTAH has a record of spectacular failure in achieving its stated goal of providing stability. The distinguished medical journal The Lancet  showed that 8,000 people—many of whom were supporters of deposed president Aristide—were murdered or disappeared in Port-au-Prince alone during a time when MINUSTAH was solely responsible for maintaining security. A 2005 Harvard Law School report  found that MINUSTAH “effectively provided cover for the police to wage a campaign of terror in Port-au-Prince’s slums.” US priorities—hence, MINUSTAH’s priorities—were clear after the 2004 coup, according to a leaked cable  from March 2005. James Foley, the top-ranking US diplomat in Haiti at the time, pushed for MINUSTAH “to take decisive action against the both armed rebels and pro-Aristide gangs, particularly in Port-au-Prince, for all the obvious reasons, but also to protect itself from charges of bias.” Considering that Aristide enjoyed broad support, particularly among the poor (he was elected with over 90 percent  of the vote in 2000), Foley’s recommendation had wide-ranging consequences
10. MINUSTAH has generated violence through repeated, indiscriminate use of force in densely populated urban areas, killing dozens of innocent civilians in raids. On July 6, 2005 , MINUSTAH troops fired 22,000 rounds of ammunition  into the Port-au-Prince slum of Cité Soleil in just seven hours, leading a Doctors Without Borders medic to report  that “we treated twenty-seven people for gunshot wounds. Of them, around twenty were women under the age of 18.” A mechanic whose intestines were ripped apart by gunfire claimed that UN troops shot him in the back while he was walking down the main avenue. “Every day the Minustah is shooting people,” he explained. “They shoot in any direction and at any person, even babies, it doesn’t matter.”
Despite such carnage, a State Department cable  from June 1, 2006, shows that wealthy Haitian elites pressured the US and UN to continue military sweeps in poor neighborhoods. Timothy Carney, then the top US diplomat in Haiti, acknowledged that “such an operation would inevitably cause unintended civilian casualties given the crowded conditions and flimsy construction of tightly packed housing in Cité Soleil.” But instead of advocating an end to the bloody maneuvers, Carney proposed enlisting “private sector associations” to “quickly assist in the aftermath of such an operation, including providing financial support to families of potential victims.”
MINUSTAH continued its ruthless policy of incursions: half a year later, another raid left at least nine dead . Slum inhabitant Rose Martel remarked, “They came here to terrorize the population; I don’t think they really killed the bandits, unless they consider all of us as bandits.”
No member of the UN has faced criminal penalties for these actions.
Countries such as Brazil, Nepal, Jordan, Uruguay, Sri Lanka, Argentina and Chile are engaged in a deeply resented military occupation. No amount of tinkering or symbolic reductions in size will address the gravity of the indictments against MINUSTAH. The troops should not be in the country in the first place, and have only added to the disasters the Haitian people confront.
The UN needs to end its occupation of Haiti.
Monday, September 26, 2011
(Photo by John Carroll)
Halting cholera’s rampage in Haiti
The Washington Post
By Editorial, Published: September 22
THE CHOLERA EPIDEMIC in Haiti, which began 11 months ago and quickly became the worst such outbreak in modern history, has exacted a jaw-dropping human toll. So far it is reported to have killed nearly 6,500 people and sickened almost a half-million — 5 percent of the country’s population. And public health experts believe those official figures badly undercount the number of victims.
Here’s another number to consider: $20 million. That’s about what it would cost to vaccinate every person in Haiti against the disease.
To date, almost no one in Haiti has received the vaccine. Sensibly, public health workers have scrambled to identify and treat cholera victims, saving many thousands of lives in the process. At the same time, the country has struggled, in the wake of last year’s devastating earthquake, to improve access to decent sanitation and clean water, shortages of which provided ideal conditions for cholera to spread.
Cholera vaccines are not a magic bullet and are not available in adequate numbers at the moment. The global stockpile is estimated as sufficient for only 200,000 people. Even if manufacturers ramped up production to full capacity, it would take several years to make enough for everyone in Haiti — and doing so would mean neglecting cholera outbreaks elsewhere in the world.
In addition, the vaccine, although relatively effective, hardly ensures immunity, and it generally lasts just two years, after which a booster dose would be required. Some health workers also worry that administering the vaccine, which involves two doses taken at least a week apart, would be difficult.
Still, there are compelling reasons to add vaccinations to the arsenal of public health weapons that has been deployed against cholera in Haiti. After a severe spike in infections during this summer’s rainy season, transmission of the disease has tapered off somewhat, but cholera is still killing Haitians at a rate of at least 10 a day and sickening tens of thousands more each month. Experts believe that cholera, which had never been documented in Haiti, is now endemic there; tragically, it is likely to be a fact of Haitian life for years.
The country’s emphasis must remain on infrastructure and public education, so that more Haitians have access to clean water and understand the critical importance of basic sanitation and cleanliness. There can be no letup in the efforts that have been made to treat cholera victims in slums and rural areas with oral rehydration salts and other interventions that are highly effective in saving lives.
But those efforts should be supplemented with an ambitious vaccination program starting as soon as practicable. A recent study showed that if only 5 percent of the population in the most vulnerable areas were vaccinated, it would cut the number of cholera cases by 11 percent, and if 30 percent of Haitians got the vaccine, it would reduce infections by 55 percent and save 3,320 lives. Surely that would be a worthwhile return on a very modest investment.
© The Washington Post Company
Wednesday, September 21, 2011
Tuesday, September 20, 2011
Monday, September 12, 2011
Saturday, September 10, 2011
(Photo by John Carroll, September 2011)
See this from Crofs Blog:
Fuelled by the HIV pandemic and the spread of drug-resistant strains, tuberculosis (TB) has re-emerged as a major threat to global health. TB is a curable disease that continues to affect millions of people globally each year, and is a leading cause of death in HIV positive people.
According to the 2009 WHO Report on Global TB Control, there were 9.4 million new TB cases in 2008, out of which 1.4 million (14%) were HIV positive (78% of them were in Africa and 13% in Southeast Asia). Mortality from TB was 1.7 million, and about 0.5 million of these deaths were in People Living with HIV (PLHIV), who are at a much increased risk of contracting TB.
In high burden HIV settings (like the sub Saharan region) more than 70% of TB patients are living with HIV. So, universal access to HIV care cannot be achieved without addressing TB.
To make matters worse, over the last decade, 5 million people developed drug-resistant TB, but less than 1% had access to appropriate treatment, and 1.5 million died. Only 7% of the estimated 440,000 MDR-TB cases in 2008 were reported to the World Health Organization (WHO), and only about 1% of the patients were enrolled under programs to provide internationally quality assured treatment. India is home to 2.5 million people living with HIV and bears one fourth of the estimated global burden of MDR-TB.
Infection with HIV further complicates management of MDR TB, and data from many settings suggest that mortality from MDR TB in HIV infected patients is very high. So MDR TB/HIV is the Perfect Storm and we cannot wait any more to let it pass.
In resource limited settings, which carry most of the burden of MDR TB and co infection with HIV, there is insufficient access to quality assured diagnostic capacity, which results in delays of diagnosis and probably in deaths, especially among the PLHIV.
HIV infected patients often have sputum negative and extra pulmonary TB which further complicates diagnosis. Limited quality assured drug access, drug-drug interactions, side effects, pill burden, and long treatment duration add to the problem of treatment adherence.
These issues were raised at the recently concluded 10th International Congress on AIDS in Asia and the Pacific (10th ICAAP). One of the meetings, organized by Medicins Sans Frontieres (MSF), focused on the challenges in scaling up Diagnosis and Treatment of Drug Resistant TB in PLHIV. Results of a case study from MSF HIV project in Mumbai, India, treating MDRTB/HIV co-infections were also shared.
This study is among the first cohorts of HIV/MDR-TB co-infected patients in India. It was a highly resistant cohort with previous exposure to second line TB drugs, mainly in the private health sector. To date, a cohort of 71 HIV infected patients have been diagnosed with MDR TB, 56 cases were confirmed and 15 were suspected. 59 patients were started on treatment. One of these with susceptible TB was excluded from analysis.
Out of the 12 who did not begin treatment, 7 died. Final outcomes (in the 2007 to 2011 cohorts, n=58) were as follows:--13 (22%) were successfully treated, 13 (22%) died, 7 (12%) defaulted, 2 (3%) failed treatment and 23 (40%) are alive in treatment. Thus, overall 20 of the 71 patients died, including the 7 who were not initiated on treatment. All the patients demonstrated significant immunological improvement (increased CD4 counts).
Tuesday, September 06, 2011
(Photo by John Carroll--September 6, 2011--"MINUSTAH and cholera are twins" on the billboard)
"Haiti’s Needless Cholera Deaths"
Published: September 6, 2011
The New York Times
A cholera outbreak has killed more than 6,000 people in Haiti since October and is far from under control. More than 420,000 people have been sickened since the disease emerged in a rural area north of Port-au-Prince, apparently after sewage from an encampment of United Nations peacekeepers contaminated the Artibonite River.
Cholera is preventable and easily treated, but containment has been stymied by the chronic deficiency — or utter absence — of clean water and sanitation systems in Haiti, particularly in the countryside, where cholera hit first and hardest. The cholera mortality rate in Haiti’s vulnerable Southeast region was 5.3 percent in July. Access to proper treatment could keep that rate below 1 percent.
The United Nations’s Pan-American Health Organization, the United States and the rest of the international community should be working with the Haitian Health Ministry to wage a more aggressive and effective effort, which should include not only clean water and sanitation systems but more antibiotics and cholera vaccinations. A cheap, effective cholera vaccine is available, but there are currently fewer than 400,000 doses worldwide. Ramping up manufacturing to make more vaccine could be readily done and would have global benefits.
Cholera victims are among the many casualties of the unfinished rebuilding of Haiti, still choked by rubble and political paralysis. Haiti’s new president, Michel Martelly, a political novice, has been unable to form a government. Donations have lagged, construction plans are stuck on drawing boards and hundreds of thousands are in displaced-persons camps, hot spots of disease and suffering.
A United Nations report in August warned that money and manpower are running short. Staff members assigned to cholera treatment centers was decreasing, it said, as “humanitarian partners are gradually reducing their operations.” In many areas, nongovernmental health organizations are handing treatment facilities over to the Health Ministry, which lacks capacity to support them.
The ministry, like practically every government agency, was flattened in the quake and has barely benefited from the flow of aid. Controlling this epidemic requires building up the public sector — which is the only hope for Haitians after charitable aid dries up.
Monday, September 05, 2011
(Photo by John Carroll--September 5, 2011)
Jenny had heart surgery at OSF-SFMC in Peoria in 1999. At nineteen years of age she looked like a victim from Auschwitz before her heart surgery.
I have been treating her in Haiti for over a decade since her surgery in Peoria. Haitian Hearts has provided her with medication, echocardiograms, and money in Haiti.
Jenny needs more heart surgery, but OSF-SFMC won't take her back. I gave OSF-Children's Hospital of Illinois a check for $23,000 dollars before her surgery in 1999. (All the physicians did pro-bono work.)
Other medical centers believe she is OSF's medical and ethical responsibility. And she is.
Jenny has survived tropical storms, hurricanes, kidnappings, heart failure, a biblical earthquake (she was living in a car), and poverty.
However, I don't think she will survive the greed and power of our Catholic hospital in Peoria.