Thursday, September 27, 2012

A Broken Heart in a Cholera Treatment Center


In June of 2011 I was notified by a physician friend of mine, Dr. Jen in Port-au-Prince, that she had a young patient named Luckner with a serious heart problem. She wanted to know if I would examine him and evaluate him as a candidate for heart surgery through Haitian Hearts.

I agreed to do this but I was located in central Haiti about three hours north of Port-au-Prince. I was working at a Cholera Treatment Center at Albert Schweitzer Hospital. I asked Dr. Jen if Luckner could come up to Schweitzer and I would examine him. She said he would make the trip.

At the Cholera Treatment Center we had a tiny admit room. Hundreds of sick patients were coming every day with cholera. We put IV's in the sickest cholera patients in this room and sometimes we would have six or seven very ill patients in shock slumped in their chairs or lying unconscious on cots. Sometimes the patients were even slumped against each other in these close quarters.

One day a young man showed up. Even though I had never seen him I thought he had to be Luckner. He looked too strong and healthy to be a sick with cholera.

The young man was  Luckner and he looked scared. He was scared to be around so many deathly ill appearing cholera patients. I could tell he wanted to leave the Cholera Treatment Center as fast as possible.

I examined him quickly and could hear the loud murmur coming from his leaky aortic valve.

I assured Luckner that we would help him as much as we could and that he could head back to Port-au-Prince. He seemed to be a perfect candidate for repair or replacement of his aortic valve.

So I e mailed Dr. Jen and explained to her that Haitian Hearts would do what we could to get Luckner admitted into a US medical center for heart surgery.

I sent Luckner's history and physical and his echocardiogram to Dr. Bryan Foy a heart surgeon in Illinois who has operated many Haitian Hearts patients in the past. Dr. Foy reviewed the echo and agreed that Luckner needed surgery.

Dr. Foy operates out of a number of medical centers in northern Illinois. Edward Hospital in Naperville is one of them and they accepted Luckner for surgery.

During the past year Dr. Jen and her group of friends in Port-au-Prince were able to obtain a medical visa for Luckner. And they brought him to Naperville about one month ago. He is with a wonderful host family there.

And guess what? Dr. Foy operated on Luckner several hours ago and replaced his leaky aortic valve. (As I post this Luckner is in stable condition in ICU.)

This fortunate 25 year old man just received a new lease on life. My thanks to EVERYONE for all their help with Luckner during the last year.

John A. Carroll, MD

Tuesday, September 25, 2012

Fear of Engagement

As it turns out, there is no reason to fear engagement. We are not destroyed when patients suffer or die, but rather deepened, becoming better able to open ourselves to the complex lives of the distressed and infirm next time around. Over time, there comes a natural but mysterious adjustment toward equanimity, in which we can hold onto both worlds, that of safety and that of danger, simultaneously, without calamity.

David Watts, M.D.
New England Journal of Medicine
September 27, 2012

Tuesday, September 18, 2012

"I Can't Do My Work Anymore"

Photo by John Carroll-September 18, 2012

This sweet little lady is 78 years old.

She is in the middle of six months of outpatient treatment for tuberculosis and she is doing pretty well.

However, she told me that she can't get her house work done anymore. She smiled, shook her head, and said she has a hard time doing her wash by hand.

House Call in Hell

Sunday, September 16, 2012

We are One Body

Photo by John Carroll

Quoting St. Paul, Dorothy Day wrote: “We are all members one of another, knowing that when ‘the health of one member suffers, the health of the whole body is lowered.’ ”

Forget the Haitian National Palace

Haitian National Palace
(Photo by John Carroll, September 15, 2012)

One of the most beautiful and elegant buildings in the Americas was destroyed in less than a minute on January 12, 2010. The Haitian earthquake crumpled the Haitian National Palace. The quake also destroyed almost all of the other Haitian ministry buildings in downtown Port-au-Prince.  

The Palace had been built using American engineers when the US occupied Haiti from 1915-1934.

This edifice was twice as large as our White House and it represented Haitian politics, ruthless dictators, and failed presidents. Many Haitians considered it a “den of corruption”.

Sean Penn and his charity recently volunteered to knock down the vestiges of the Palace. During the last several weeks Penn used 98% Haitian labor, some American engineers, and big Caterpillar equipment. The sagging cupulos and most of the building are now at gound level.  

The street in front of the Palace is blocked off to traffic and a green mesh has been placed interlacing through the fence surrounding the Palace. The final destruction of this edifice was shrouded by the mesh and semi-hidden from the public.

And now Haitian President Michael Martelly states that he does not know where the funding is going to come from to build a new Palace.

Why build a new Palace?

I can promise you that people are dying just a few blocks away for very stupid reasons. Watching sick three-year olds, thirteen-year olds, young men, and skeletalized old ladies gasping for their last few breaths is horrid. Are their lives not more important than another opulent political building?

Port-au-Prince is morass of misery and not fit for humans. The millions of dollars needed to reconstruct another Palace should be used instead to improve the basics that poor humans require to live with a little dignity. Millions of people in Port-au-Prince are living moment-to-moment, breath-to-breath.

Photo by John Carroll

President Martelly, forget the symbolism. Please attend to the living.

The Haitian National Palace is history. Let it be.  

John A. Carroll, MD

Sunday, September 09, 2012

AIDS/TB Treatment in Haiti at GHESKIO

In post-quake Haiti, rebuilt AIDS clinic treats more patients
By Anastasia Moloney, Reuters Alertnet, September 5, 2012
PORT-AU-PRINCE (AlertNet) - Tucked away in the Haitian capital is one of the world's leading AIDS treatment and research centres. A clean, tightly-run clinic provides an oasis of calm and order in stark contrast to the crowded, rubbish-strewn streets outside its guarded gates in downtown Port-au-Prince.
Set up 30 years ago, the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections - or GHESKIO - suffered $10 million-worth of damage in the massive earthquake that rattled Haiti in January 2010. The disaster destroyed parts of a clinic, a hospital for tuberculosis (TB) patients and research laboratories across GHESKIO's several sites. And, it has taken until now for the centre to get back on track.
"We have almost rebuilt everything. We have caught up with lost time," GHESKIO Director, Dr Jean William Pape told AlertNet in an interview at the centre's headquarters, near the grassy grounds that served as a makeshift field hospital in the aftermath of the quake. "We are also seeing more patients now than pre-quake times," he added.
Ground-breaking research
Over the decades, tens of thousands of Haitians living with TB and HIV/AIDS have relied on GHESKIO for free, life-saving treatment.
With the help of Haiti's ministry of health and Cornell University in the United States, Pape set up GHESKIO in 1982. He and other Haitian doctors had observed an increase in the number of adults in the Caribbean country mysteriously falling ill and dying from previously treatable diseases such as diarrhoea and Kaposi's sarcoma - a rare type of cancer that can affect the skin and internal organs.
These observations were published a year later in a seminal study that described AIDS before the acronym even existed. As such, GHESKIO was the first institution in the world exclusively dedicated to fighting HIV/AIDS.
"The word AIDS then did not exist. It was coined much later," Pape said. "We published in the New England Journal of Medicine the first cases of AIDS in a developing country. Our patients presented either with Kaposi's sarcoma or opportunistic infections," the Haitian-born doctor explained. "Ninety percent were males and about half had tuberculosis. We had a feeling that this was going to be important."
GHESKIO went on to publish more ground-breaking research, including a paper dispelling an early theory that Haitians were more at risk of catching the AIDS virus than other populations. "I think what unified us most was the fact that the world almost was against us early on. AIDS then was known as the 'four H' disease - homosexuals, heroin addicts, haemophiliacs, and the fourth H being the Haitians," Pape said. "This was a huge mistake. We published data that shows Haitians had the same risk factors as anybody else," said the U.S.-educated doctor, who is also a professor at Cornell University?s Weill Medical College in New York.
In 1996, GHESKIO's research also helped show that AIDS could be transmitted through heterosexual contact. "When we reported the rapid shift from a homosexual population to the heterosexual population nobody seemed to believe it could occur so quickly. But it did," Pape said.
More recently in 2010, following GHESKIO's clinical research on antiretroviral therapy for HIV patients, the World Health Organisation changed its guidelines on its treatment protocol for HIV patients.
Key care provider
Today, GHESKIO provides around 500 TB patients free treatment every year, making it the largest provider of TB care in the Caribbean nation. It also gives free HIV/AIDS services to around 140,000 children and adults every year, including counselling, HIV testing, antiretroviral therapy and nutritional supplements. Despite GHESKIO's reach, HIV treatment coverage in Haiti reaches less than half of those in need, according to UNAIDS.
GHESKIO's focus on preventing mother-to-child transmission of HIV, ensuring a safe blood supply, and AIDS prevention campaigns - including raising awareness about safe sex and condom use - have all helped to lower Haiti's HIV prevalence rates. Today, 2.2 percent of Haiti's adult population is living with HIV, down from 6.2 percent in 1993, Pape said.
"You are not going to die anymore"
Providing HIV patients with free antiretroviral drugs is one thing. However, making sure patients take the cocktail of powerful antibiotics over a course of six months or more when they are supposed to, and correctly, is quite another challenge.
It's a problem Pape and his team are constantly striving to solve. When a patient fails to pick up drugs or misses a medical appointment at the clinic, says Pape, GHESKIO's electronic records system alerts a field worker to visit the patient's home. Patients can also ring a hotline and speak to a doctor. Also, every TB and HIV patient is given an extra two-week supply of medication, an initiative that helped save lives in the chaos following the earthquake.
"In Haiti, there have always been problems of some kind, so we had to develop a contingency plan," Pape said, referring to the nation's troubled history of social unrest and political upheaval.
But perhaps more importantly, patients are given hope. "It's team work," Pape said. "The counsellor, lab technician, field worker and nurse, all of them are involved in indicating to the patient - 'First of all, you are not going to die any more. Now you can think about living and about finding some work. Give us a little time, give us two to three weeks of taking your medicine daily and we'll change your life'."
Pape is now overseeing the building of a new hospital for GHESKIO's TB patients, set to finish in May 2013, after its TB hospital was destroyed in the earthquake.
While GHESKIO is rebuilding, though, Haiti in general is still struggling to recover from the earthquake. "The country has not yet rebuilt. It's going to take some time before the country as a whole can catch up," Pape said.
"But we are a resilient nation, a resilient people and I think that we will be able to go back and do better than what we were doing before the earthquake," he said.