Monday, July 30, 2012

Insignificant but Important

Whatever you do will be insignificant, but it is very important that you do it.
Let's work together for a better tomorrow...

M Gandhi

Is OSF's CEO Really Worth 2.2 Million Dollars a Year?

Sister Judith Ann Duvall
Chairperson of OSF St. Francis Healthcare System
(Photo by Peoria Journal Star)

Kevin Schoeplein, CEO of OSF Healthcare System in Peoria, received a salary of 2.2 million dollars in 2009. See this article.

Yet, OSF lets their own Haitian Hearts patients die in Haiti with no medical care. And Sister Judith Ann, pictured above, told me multiple times that OSF would never turn down a Haitian child for medical care. But they have.

Sister refers to OSF as a "sacred ministry." Unfortunately, this sacred ministry is a 5 billion dollar not-for-profit enterprise that has lost its core values.

John A. Carroll, MD

Thursday, July 19, 2012

Words Can't Explain

(Photo by John Carroll)
No chance. Not even close.
Where is the money?
Caracol. Are you kidding?
Very hungry. Won't eat.
Concerned moms, good instincts.
Coughing all the time.
Becoming small.
Tropical depression.
Flat tires. Blown gaskets.
Gas mixed with kerosene.
ER closed for the day.
Chest x-ray? Come back tomorrow.
Bullet proof vest in clinic.
Keep eyes down.
Evicted from tents. Relocated to where?
Schizophrenic but harmless.
Orphans growing up in orphanage.
No birth certificate.
Grinds teeth at night.
Yawns after breastfeeding.
Uterine tenderness and fever after C section.
No oxygen in hospital.
Aquatabs sometimes.
We won’t operate until it strangulates.
Never heard of him. Wrong number.
Cool Prestige, not cold.

Pap padap (Digicel) is real majik.
Inverter won’t power fan. Anopheles like human feet.
No room to breathe.
Noise oppressive.
Natcom flash drive a life saver.
I have seen zombies...
No doctor in ER today.
This is a red zone in Soleil.
Extract teeth instead of restore. Embarrassing.
Wouldn’t he be better off to die in Haiti’s mountains than be deaf and suicidal in the US?
Wharf Jeremy is beyond horrid.
A hungry cry...don’t look at me that way, please.
I still have my breath.
No, I don’t believe in the houngan.
Mangoes really good.
What transparency?
The broker at the wharf.
Haitian National Police told me to put my shirt on. Keep eyes down.
Forced evictions.
Grand theft, but I didn’t do it. Deported.
The lost year.
The cholera numbers just don’t add up.
Adoption office closed. For three months.
If God is willing.
I never see you anymore.
Ninety minutes from paradise.
Vaccine protective?
Smurf babies craving protein.
I have had enough. 

Why not me?
Mon Cher.

John A. Carroll, MD

Tuesday, July 17, 2012

Starvation Hard to Deal With

(Photo by John Carroll--July 17, 2012)

I think the hardest thing for me to deal with is slow starvation in a baby.

I call it a thing because I don't know whether to refer to it as starvation or an illness or a condition or neglect or socioeconomic injustice.

Whatever it is called, starvation is bad.

This morning in clinic the little baby girl above, Sophia, was carried into my office by a very well nourished twenty-some-year old young lady who also had her well nourished three year old daughter with her. They live in Sarthe which is just outside of Cite Soleil.

Sophia is eight months old and weighs nine and one half pounds. Her eyes were pretty bright and she interacted well. She would suck on the toe of her black plastic shoe during the exam. Sophia just seemed very hungry. And very tiny.

The lady told me that her sister abandoned Sophia to her one month ago and that her sister did not breast feed Sophia or feed her much of anything.

I asked the aunt if Sophia is eating with her in her home and she said that she has no money left over to buy Sophia any the answer was "no, not much". She admitted that she and her daughter eat ok, but she repeated that there are no extra resources to buy extra food or powdered milk for Sophia.

When I heard this answer, I had no anger against this lady. (Well, maybe a little, but not very much.) She was right up front with me and told me what was happening. Maybe she could do more, but I am not going to judge that. I don't live in her shack. And at least she brought Sophia here today.

Sophia has also been having a fever and diarrhea so I started the medical workup today and empirically treated her with antibiotics.

Sophia gobbled up one half plate of pureed rice here in the clinic and fell asleep a very content appearing baby.

People, something is very wrong here. There were many malnourished babies in clinic today. Sophia was just one of them. So many many of Haiti's babies are starving or very under nourished all over this country.

I admitted Sophia to our long term malnutrition clinic where she will get a hot meal and shower every day until she improves significantly on her growth curve. But this is not the long term answer for all of Haiti's starving children. Children are damaged when they are allowed to starve or near starve at this young fragile age.

We can't let them suffer and hunger in the first place before we decide to do something.

In the end I think we are going to have a lot to answer for.

John A. Carroll, MD

Sunday, July 15, 2012

A House Call in Haiti

Jean-Ronel and Manaika
(Photo by John Carroll, MD--July 14, 2012)

Many years ago while working in a free clinic in Peoria, I came to realize how a house call could teach much more about a patient than seeing patients in the office. Office visits are artificial and don’t tell you near as much about the patient.

I remember visiting a 90 year old patient of mine in Peoria who weighed 350 pounds. She showed me where the racoon fell through the ceiling of her closet in her bedroom and then was shot dead by a family member. I also noticed how far away her meds were kept from her and how dificult it was for her to actually access her medication. Her handicapped son George, replete with tuxedo, sang beautiful songs, but didn’t help much with her health care. I wouldn’t have learned this information with a simple office visit.

Yesterday in clinic in Soleil a father brought his three year old daughter to clinic. It is not often that fathers bring their kids to pediatric clinic in Haiti. He seemed to be a very caring father. The little girl who had a congested cough and impetigo all over her legs.

They seemed to be pretty poor--I would say close to the bottom of Haiti’s poor class.

The father’s name is Jean-Ronel and his daughter is Manaika.

I asked the father where Manaika’s mother was. Frequently when the father brings the child to the doctor the mother is selling goods on the street, has sick kids at home, just had a baby, or is sick herself.  However, Jean-Ronel told me that his wife had died suddenly on December 17, 2010. He said that his wife had died due to the spell cast by the houngan.

I treated Manaika yesterday with medication for impetigo and institued empiric treatment for worms and iron deficiency. However, I wanted to see Jean-Ronel’s and Manaika’s living conditions and I wanted to talk to him more about their lives.  

I needed to make a Haitian house call. 

I got Jean-Ronel’s cell phone number from him before he left and told him I would call him today to arrange a  visit to his house and talk to him about his life in Haiti. He agreed.

So today I met Jean-Ronel on a street corner here in Sarthe, a huge northern section of Port-au-Prince. 
It was a typical Saturday morning in Port-au-Prince. Temperature in the sun today had to be about 100 F. We inched slowly in traffic about four miles north along very congested Route National 1 to his neighborhood called Lizon.

About 45 minutes later we arrived at the place he calls home. The front door to the very unfinished cinderblock house was a piece of plywood that Jean-Rinol removed to let us enter the house. Looking to the north one can see mountains in the distance.

Jean-Ronel’s brother Nazair, the owner of the house proudly showed me each room. He named the rooms as the kitchen, the living room, the dining room, the bathroom, etc. This all seemed normal conversation except all the rooms were empty and most had no roof. Nazair told me that he had been building this house for 10 years now assembling it block by block. Cement isn't cheap in Haiti. Nazair lives here with his wife Vela, their three children, Jean-Ronel and Manaika.

So after the house tour, I sat down in a plastic white chair in a roofless hall and listened while Jean-Ronel spoke. 

Jean-Ronel is 31 years old and is very thin. He wears a baseball cap.

He was born and raised in Mirebalais, a village 30 miles north of Port-au-Prince.  He completed 10 years of education but had no money to finish his secondary school.  And because he had Nazair and his wife Vela here in Lizon he decided to move here a few years before the earthquake. There just were not any opportunites for him in Mirebalais.

Jean-Ronel says that he can read and write some. He said he has been to southern Haiti only once and has never been north. Mirebalais and Port-au-Prince are almost all he knows

Upon arriving in Port he and his wife had Manaika in 2008. His wife was about 15 years older than Jean-Ronel.

The earthquake occured on January 12, 2010 and Jean-Ronel, his wife, and Manaika were living in a rented house. And it was not damaged in the quake and none of them were hurt. So they stayed there.

I asked Jean-Ronel what happened to his wife.  He told me that she had an argument with a woman one day in December 2010. Some bad words were exchanged. Jean-Ronel left the house one day shortly after the argument to run some errands on the streets.  When he arrived back at the house later in the day his wife was gone. His wife's family told them that she laid down during the day and died. Her family insisted that she died because an illness was sent to her by the houngan because of her argument with the lady a few days before. And they had already transported her body to the morgue.

I asked Jean-Ronel if he believed in the houngan and he said no that he did not but his wife’s family did. I asked Jean-Ronel what religion he is and he said Catholic. But when I asked him what church he goes to he said the “The Church of God” locally in Lizon. I told him that was not a Catholic church. He looked surprised and just shrugged. He also volunteered that he has never been baptized.

So after his wife’s death, he and baby Manaika, unable to pay rent any longer, moved to a tent city in Sarthe, and stayed there for four months. But the living conditions in the tent was so bad that Nazair accepted them into his house in Lizon which is where they remain today.

Jean-Ronel and Manaika sleep on a mat on the floor of the bathroom which is just an empty room with a rocky uneven floor and a blue tarp for a roof.

I asked Jean-Ronel if he had ever heard of cholera. He said yes he had heard of it on the radio but did not know what it was. So after almost two years of cholera ravaging Haiti, Jean-Ronel didn’t know what cholera was.

I explained to him that cholera is an illness that causes vomiting and diarrhea.  I asked Jean-Ronel where he would take his daughter if she got ill from cholera and he said he did not know where to take her. He had no idea at all.  However, Vela, his sister in law who was listening in to our conversation, commented that cholera causes diarrhea, vomiting and death and she would take any ill family member to Foyer St. Camille if they became ill. (This is a hospital set up by an Italian order of Catholic priests and nuns several miles from their house in Lizon. It no longer has an active Cholera Treatment Unit, but Vela does not know that.)

When I asked Jean-Ronel where they get their drinking water, he replied that they buy it from a truck which has treated water inside it. But I saw no cistern to store the water.  I saw no Culligan water bottles. And so I asked them again where they get their drinking water and Vela pointed down the road. She said they get it from a hand pump which pumps up water from the water table (anba woch).  Vela said that they purify that water only when they have AquaTabs which she buys at the boutique. And this depends on whether she has a few extra cents for the AquaTabs.

I asked Jean-Ronel how often the family eats and he said twice per day. But Vela overruled him again and said that they only eat once per day. And that is rice and bean sauce. No eggs, meat, milk for anyone.

I asked Jean Ronel if he was happy with his life. He said yes right away because he still has “souf”...which means he was still breathing.

I asked him what he wishes for. He said he wishes for a job and that his Manaika is cured of her illness.

I asked him if he knows the population size of Haiti. He said he had no idea. I asked him to try and guess and he said that he couldn’t.

I asked Jean-Ronel what he thought of President Martelly. He said he is a good president. I asked him why and he said that President Martelly is putting kids in school around Haiti.  

Many Haitians have strong ideas regarding US politics and our president. Over the years President Clinton was well liked and George W. Bush was not so well liked by Haitians in my very informal surveys.  

When I asked Jean-Ronel what he thought of President Obama he said that he does not know because he (Jean-Ronel) “does not live in Miami”. (Poor Haitians refer to the entire United States as “Miami”.)

I asked Jean-Ronel what he thought of me. He said that I was “not a bad person”.

I asked Jean-Ronel what he thought of MINUSTAH. He said they were good because they enforced security in Haiti. (I don’t think he knows that MINUSTAH costs 2 million dollars each day to have them here occupying Haiti. But I doubt that fact would change his mind at all. Big sums of money mean absolutely nothing to dirt poor Haitians who have only a couple of cents in their pocket.

When I asked Jean-Ronel if he had any questions for me, he asked me what would my questions and photos do to solve his own problems. I told him "probably nothing" but this information could make people aware of Haitian problems like his and maybe it could help Haitians “collectively” in the future.

Conclusion and Recommendation:

Lets face it, Haiti is a broken place. The situation here is inhumane, terrible, outrageous, unthinkable, and embarrassing. ( I worked last week with an American dentist who described her experience here as embarrassing....she meant that her Haitian patients’ teeth were so bad, she was having a very difficult time extracting them. And it was embarrasing for her to exctact teeth rather than restore them.)

In my opinion Jean-Ronel has no good chance at having a much better life at least by our Western definition. He lacks the basics to survive with any dignity.

His daughter Manaika has a chance if the system could be fashioned to work for her over the next twenty years. She doesn’t need an i-Phone, an i-Pad, or an i-Pod. She needs i-Basics. She needs security, clean water,  nutritious food, a good education, and a chance at a good job when she is 23 years old. Manaika does not need to be in an orphanage. She needs to be with her father and her cousins in Lizon. And she needs to be hugged.

Would Jean-Ronel and Manaika survive a bad case of cholera today if left to their own devices? Probably not unless his sister in law Vela intevened quickly. And right now she made it clear that she would take them to the wrong place for hydration. Thus, education has to occur from the ground up if we really want to help the Jean-Ronel, Manaika, and there extended family.

So can Haiti change?

I don’t understand words like neoliberal economy or globalization very well.  But I do understand what Jesus said. He said to take care of the poor. And if all the emphasis in Haiti with the billions of dollars that was pledged to Haiti since the earthquake were for the poor, everyones life in Haiti would improve...even the 1% of the people who own 50% of Haiti’s wealth.

The poor Haitian community, about 10 million of them, need to be put first. And the rest would follow. The poor should be our preference.

House calls can be sobering events. One may hear stories of fallen raccoons or even worse.  But they can teach a lot about people we care for and want to help.

John A. Carroll, MD

Thursday, July 12, 2012

The Emergency Room in Cite Soleil

Emergency Area Waiting Room--St. Catherine's Hospital, Cite Soleil
(Photo by John Carroll--July 12, 2012)

Cite Soleil has an "guestimated" population of 300,000 people. Nobody really has any idea in my opinion.

The Emergency Room at St. Catherine's Hospital is open Monday-Sunday from 8AM-4PM.

There are three stretchers inside the tiny ER.

The ER physician usually shows up...but not always.

The baby above, who is very anemic, had a scalp abscess incised and drained today.

Can you imagine the havoc if the Peoria area had one tiny ER with three stretchers for our entire population and was open only eight hours each day?

John A. Carroll, MD

Wednesday, July 11, 2012

I Gotta Kid with a Fixable Heart Problem...

(Photo by John Carroll--July 12, 2012)

Dear Everyone,

You need to see this guy. I will post his picture tomorrow. Promise. (See above.)

Woodson is a three year old boy who lives here in Port-au-Prince.

I examined Woodson for the first time in February in the pediatric clinic in Cite Soleil. He has a loud heart murmur because he has a hole in the wall separating the lower chambers of his heart. This hole is called a ventricular septal defect (VSD). And because he has this abnormal opening blood rushes from the left ventricle through this hole and lands in the right ventricle creating audible turbulence, i.e. the murmur.

Congenital heart disease afflicts 1% of newborns worldwide and the most common defect is VSD.

Woodson's mother is a lovely intelligent gal and she brought him to clinic today. I examined him again and he seems ok.  His heart is slightly enlarged because it is "working overtime". But the blood pressure in his lungs is fine.

I continued his furosemide 10 mg BID and gave him a quick course of anti-worm medication and a vitamin with iron.

His sickle test is negative and his HIV is pending...will have results tomorrow.

Woodson needs heart surgery to patch the hole. This surgery cannot be done safely in Haiti today. Someday this surgery will be available to the Woodsons of Haiti, but that day has not yet arrived. And our Woodson can only wait so long.

I have his echocardiogram at home in Illinois and would be glad to make a copy of the video and send it to anyone who has some influence with a good pediatric heart surgeon and pediatric medical center that would consider operating Woodson.

Thank you very much.

John A. Carroll, MD

Haiti's Little Housing Problem

Project Drouillard in Soleil
(Photo by John Carroll--July 10, 2012)
(These encampments that are home for hundreds of thousands of Haitians are absolutely horrific and inhumane. jc)

Under Tents: Taking Action for Haiti's Homeless
By: Kevin Edmonds

Originally posted July 6, 2012 on NACLA

On July 2, Haitian grassroots organizations and their international allies launched a housing rights campaign called ‘Under Tents’ in response to the failure the Haitian government to “address Haiti’s epidemic of homelessness.” According to Haiti Liberté, the campaign will press for congressional and parliamentary action in the U.S., Canada, and Europe to support the construction of housing for displaced Haitians. Central to the campaign is an online petition addressed to President Martelly, Prime Minister Laurent Lamothe, U.S. Secretary of State Hillary Clinton, and other senior Haitian and American officials to take action to combat Haiti’s severe housing crisis.

Reading recent headlines however, it would be easy—albeit mistaken—to think that progress was being made on the housing front. On July 26, the International Organization of Migration (IOM)reported that the number of displaced Haitians living in the camps had dropped below 400,000 from a high of nearly 1.5 million in the immediate aftermath of the January 2010 earthquake. What the IOM didn’t tell the public was where the displaced people had gone, and why so many had left the camps.

The sad truth is that while the number of people living in the officially designated camps has decreased due to increasingly violent forced evictions where residents have been attacked, and camps have been demolished and burnt down, it does not mean that they have found decent shelter elsewhere. Instead, they are setting up tents, tarps and precarious makeshift houses on the hillsides of Port au Prince—often in worse living conditions than those found in the camps. The harsh reality of Haiti’s homeless has been captured in photos by Bri Kouri Nouvel Gaye, a Haitian independent media group, which has also captured several forced evictions on film as they occurred.

In addition to the photo evidence, last week several significant reports were released which challenged the IOM’s numbers, and provided much needed context to the statement on the decline of homelessness in Port au Prince.

The Centre for Economic and Policy Research dug deeper and revealed that “The IOM touts a 75 percent reduction in the camp population since July 2010, amounting to a decrease of over 1.1 million people. Yet as of April 2012, only 12,000 rental subsidies were given out, 13,000 houses were repaired and just fewer than 5,000 new homes were constructed. In total, these three solutions account for only about 12 percent of the reduction in IDP population. Additionally, about 108,000 transitional shelters have been built, which would account for an additional 42 percent. However this likely overstates the effects of the transitional shelter, as it is estimated that only about 40 percent of transitional shelters actually went to IDPs.”

It is in this discussion where the Under Tents group put forward a set of three essential demands. The group’s press release states that “Haiti’s homeless are demanding that the government immediately halt all forced evictions until public or affordable housing is made available. They request that the Government of Haiti, with the support of its allies and donor governments in the U.S., Canada, and Europe, move quickly to: (1) designate land for housing (2) create one centralized government housing institution to coordinate and implement a social housing plan and (3) solicit and allocate funding to realize this plan.”

The release also highlights the precarious and often dangerous living conditions faced by those in the camps, stating that “The hundreds of thousands still living under plastic tarps and tattered tents face high rates of gender-based and other violence, lack access to clean water and toilets, and cholera treatment. One in five is also at risk of imminent forced eviction.”

Considering the amount of lofty development proposals and promises made compared to the actual building of homes, more than two and a half years later, one would be hard pressed to call the reconstruction effort anything other than a disappointment, and with the high rates of forced evictions, a dangerous one at that.
While it is great to be ambitious—one has to follow through, as high profile announcements such as Prince Charles’  intention of rebuilding the entire downtown area of Port au Prince, to the Clinton Foundation’s construction of a 20,000 seat soccer stadium in Cite Soleil—are more distractions than necessities when so many are without homes.

As the independent media group Ayiti Kale Je (Haiti Grassroots Watch) remarked “If Haiti’s capital could be re-built from documents alone, reconstruction would be well underway already.”

In the aftermath of the earthquake, Haiti was often cited at as an opportunity to build a stronger and more equitable nation. What we are witnessing is a reconstruction plan that has abandoned the basics—homes, water, sanitation, health and education—yet at the same time 5 star hotels and massive industrial parks for sweatshops are being constructed. As a result some of the most basic priorities are unfortunately being portrayed as unreasonable and impossible demands. 

Yet Jackson Doliscar of the Haitian grassroots organization Forces for Reflection and Action on Housing Matters (FRAKKA in Kreyol) summed up the fundamental mission of the campaign, reminding others that “We are asking simply for quality homes where people can live.”

The campaign will run until World Habitat Day, October 1.

Tuesday, July 10, 2012

A Great Medical Case Anyone?

(Photo by John Carroll--July 10, 2012)

On the way to clinic this morning I spotted this man sitting on a porch.

He is 26 years old and told me that this mass appeared four years ago and has slowly grown. It is not painful.

I examined him and the mass is rock hard and immobile. He had no other masses in his neck (no lymphadenopathy) and appeared healthy.

Over the last 15 years Haitian Hearts has brought a fair number of cases like this back to the States for surgical removal. My guess is that this man has an ameloblastoma.

Ameloblastomas are usually benign and are found in the lower jaw. They originate form dental cells.

And these tumors respond very well to surgery.

However, it takes a skilled maxillofacial surgeon and team to safely remove this tumor because the airway is so close by and the anatomy is complex.

If anyone has any connections to a medical center and surgeon that may accept this young man for surgery, please let me know.

John A. Carroll, MD

Monday, July 09, 2012

Mudpies and Cigarettes

Mudpies and Cigarettes for Sale
(Photo by John Carroll--July 9, 2012)

I am staying with my driver and his family on the outskirts of Cite Soleil. They are lovely people and do all in their power to keep a spoiled blan happy.

In the mornings as we tool down the dirt road towards the clinic in Soleil, many women sit on the side of the road selling their goods. These products range from charcoal, fruits, toothbrushes, soap, clarin (Haitian moonshine), mudpies, and cigarettes.

You say mudpies? Yes, mudpies, and each one costs one Haitian gourde (about 2 cents US).

Mudpies, calle "te" in Creole, are made from a "special dirt" from northern Haiti with just the right amount of salt and butter mixed in. They are baked in the sun and then sold throughout the slums.

Pregnant women in Haiti seem to cough and spit alot (most likely from acid reflux), and I have been told that the mudpies are just wonderful for this.

More commonly mudpies are eaten to ease hunger pains.

And after a mudpie, what could be better than a cigarette to start your day?

John A. Carroll, MD

A Pernicious Plan

Waf Jeremie
(Photo by John Carroll--July 8, 2012)
See this article by Augusta Dwyer.

Sweeping Haitians Back Under the Rug

Wharf Jeremie
(Photo by John Carroll--July 8, 2012)
See this article about Haiti's tent cities.

Thursday, July 05, 2012

Hot Dog Contest not that Impressive

Lovens (Photo by John Carroll)

National news on July 4 in the States included a guy winning the hot dog eating contest in New York. He ate sixty-some hot dogs.

Kind of repulsive.

Lovens, pictured above, is five years old and weighed 14 pounds six weeks ago. He was found sitting in the dirt in his village unable to walk or stand on his own. He was brought to Port-au-Prince and is now in an orphanage and he is eating all he can get his hands on.

Quite a difference between eating to win a contest and eating to stay alive.

Tuesday, July 03, 2012

Death in Haiti Deserves Thought

Photo by John Carroll

"Death in Haiti can be cruel, raw, and often devastatingly premature. There is often no explanation, no sympathy, and no peace, especially for the poor. Death's ubiquity, however, does not mean that it deserves any less attention or thought."

New England Journal of Medicine
July 5, 2012
Antonia P. Eyssallenne, M.D., Ph.D.