Monday, December 16, 2013

Haitian Child-Slave Becomes Miracle

(Photo by John Carroll--December, 2013)

(Photo by John Carroll--December, 2013)

During the last two decades I have had the opportunity to meet hundreds of people who have cared for Haitian Hearts children in their homes before and after the children have had heart surgery. These host families from all over the United States  have been wonderful.

In 2003 Haitian Hearts brought six Haitian children on the same flight from Port-au-Prince to the Tampa International Airport. All were sick and needed heart surgery soon. Three of the children would be operated at All Children’s in Saint Petersburg and the other three at St Joseph's Children's Hospital in Tampa.

In the large crowd of people at the airport who greeted us as we got off the plane were Yves and Micki Morency. The Morency’s were to be one of the children’s host parents in Saint Petersburg.

Micki’s incredible story of Louise (not her real name) is posted below. As Micki beautifully describes, Louise’s heart surgery is only one of the miracles experienced by her and witnessed by everyone involved in her care.

Micki has kindly allowed me to post her article on Dispatches from Haiti in the Peoria Journal Star. Thank you, Yves and Micki, for all you have done. Deye mon gen mon (Behind mountains there are mountains).


A Miracle
by Micki Morency

I met Louise for the first time in October 2003, she was sixteen years old. My husband and I went to the airport in Tampa, Florida about 20 minutes north from St Petersburg   where we lived since 1986, with our two daughters. In 2003 they were nineteen and seventeen. The oldest was away in college and the youngest, a senior in high school was preparing to leave home soon. I needed to refill the nest.

I received a call from our local Children's Hospital that they were expecting three Haitian children to arrive the following week for heart surgery through Haitian Hearts of Peoria, Illinois. Would I be interested in hosting the oldest one, since none of them spoke English?

The social worker felt Louise would be happier with a Haitian family, since she was older.  And that is where the first miracle happened. Had she been placed with an American family, I believed that perhaps her story may not have been told today.

We brought Louise home from the airport around ten in the evening. During the trip home I tried to engage her in conversation, but I could barely elicit a response. I realized that she was shy and it would take time before she felt comfortable with us.

When we got home, she hesitated to enter the house. I took her hand and we walked through the door. I offered her a snack. While she was eating, I kept talking. I loved to meet people and learn their stories as I shared mine. As usual my husband sat at the kitchen counter observing, but not saying much. Finally I asked her age. She looked at me and thought for a couple of seconds and said, “My Aunt said I am nineteen years old.”

I thought it odd. The hospital said she was either fourteen or sixteen, but we figured we’d confirm that once she arrived. She looked no older than twelve, even though her facial expression told a different story. She looked weary and old. She was 4’8” and weighed 84 lbs. I asked to see her passport, she handed me a manila envelope with her documents.

Her birth certificate indicated she was sixteen years old, and I gently told her. She just stared at me with no sign of understanding. There was no reaction, and I immediately thought: how come she didn’t know her age? That was bizarre, for a teen coming from the capital.

It was late, so I took her upstairs to our guest room. She looked like she just entered a magic place. Her jaw dropped and her brown eyes with the thick and long lashes bulged. Louise stood on the threshold and I had to prod her into the room. She looked at the queen bed and asked me, “Where should I sleep?” I pointed to the bed. She looked confused.

I assisted her with all the gadgets in the bathroom. I turned down the bed, and tucked her in. I woke up in the middle of the night to check on her, and I was shocked to find her sleeping on the floor under the comforter. I decided to let her rest. I went back to my room, but could not sleep. I was confused about her behavior. However, slowly a picture was forming in my mind of what this child life might have been like in Haiti.

The next morning, I went in the room to help her get ready for her first pre-op appointment. I found her sitting on the floor with a very scared look on her face. As I helped her in the shower, I noticed the scars on her back. I asked her what happened, she said dispassionately, “They beat me all the time.” I froze. The anger would come later. After breakfast of oatmeal with lots of sugar we headed to the hospital.

“Louise, why did you sleep on the floor last night? I asked, while driving to the hospital.

“I never slept on a bed before, Auntie, and I didn’t want to get in trouble with the master of the house,” she replied.

I laughed. I realized she was talking about my husband. I had to explain to her that I was actually the “master” in the house, but more importantly that beds were made to be slept on, and I expected her to sleep on it.

When we got to the hospital, I was so excited to take the elevator with her, because I knew she’d never been on one.  As the door was closing I asked her to push the number three.

“Auntie, I don’t know numbers or letters. I can’t read or write,” she said flatly.

I just stood there with my mouth open. I didn’t know how long until someone got on and asked, “What floor?”

After meeting with the medical staff, I learned how serious her condition was, she was born with a hole in her heart, a condition called Tetralogy of Fallot. I explained to Louise as best as I could, because even in our native Creole, she looked at me as if I was speaking Chinese. I kept thinking: What hole did this kid crawl out of? What happened to her? How did she get here?

She had several medical tests that day. Through all the needle sticks she never uttered a word. I held and stroked her small hand with the bent knobby fingers   a side effect of her congenital heart disease. I told her that she will be able to walk more than ten steps without stopping. She’ll be running and jumping ropes, activities she had never been able to do.
With pre-op tests over, it was time to go shopping. We went to the mall and I asked her to choose every time I saw something she might like. The answer was always the same: “I don’t know, you pick, Auntie.” I insisted in her choosing at least the color. She loved red.
We went home with clothes, sandals, underwear, toiletries and I saw the hint of a first smile. She kept looking in the back of the car, furtively as if the bags might suddenly disappear. She was exhausted. When we got home I fed her and she took a nap on the bed.
After several hours, I went upstairs to check on her. I could hardly make out her outline under the huge comforter, but she had a smile on her face while she was sleeping. I had a hard time rousing her. When she finally awoke, she looked at me with fear in her eyes.
“I’m sorry, Auntie, I overslept. Please show me what you want me to do around the house,” she said, while trying to leap out of the bed.
“It’s ok honey. I only want you to rest and have fun before your surgery,” I replied.
“Thank you, Auntie. The bed felt good and comfortable.”
I reached over and gathered her in my arms and hugged her for a long time. When I let her go, she started crying.
“What’s wrong, honey,” I asked, alarmed that I had hurt her somehow.
“Nobody had ever touched me before, except to beat me,” she hiccupped.    
She lived under horrible conditions. She was the first to get up and the last to lie down. Even though she cooked the meals, she was not allowed to eat, until everyone had seconds, by then there was never enough left for her. Her mother, who lived in the countryside with seven other children, sent Louise to Port-au-prince when she was a sickly five-year old, to live with Annette, who promised to get her medical care. Annette needed a child-slave to take care of her household and her five children. Louise was one of the thousands of children that are used in Haiti as slaves. But, her mother did not know that.
Louise cooked, cleaned, washed clothes and went to market daily. Her day started at four in the morning, because she had to do everything slowly, otherwise she got chest pain. She was beaten frequently for being too slow. She was malnourished, she never saw a doctor and never went to school. She slept on a straw mat under the dining table, so the kids would not purposely step on her swollen hands. The rags she wore were held together with safety pins. Her beautiful long, thick black hair got so matted that Annette frequently chopped it off, rather than combed it.
The second miracle occurred when a neighbor heard about this American doctor who came to Haiti looking for children with cardiac diseases. She took Louise to see Dr. John Carroll, while Annette was out of the house. The third miracle was that medically she was not supposed to live this long with her heart defect, especially under these conditions. There will be many more miracles.
After her surgery we spent a lot of time together, Louise was afraid of everything, people, bugs, noises, being alone, so I took her everywhere. We bonded over the three- month period before she returned to Haiti.  I made financial arrangements for her to go live with Marie, someone I knew and trusted to take care of her, and that decision saved her life again.
Had she returned to live with Annette, I would not be sending money, knowing that she would not care for Louise. I would not have been allowed to contact Louise. It was during one of my weekly call to Louise and Marie, that I learned she was not feeling well. I immediately told her to take Louise to see a cardiologist. He confirmed that she was in congestive heart failure. The patch that was placed over the hole in her heart had come off, and her heart was pumping blood into her lung. That was six months after her return to Haiti.
With the assistance of the hospital and Dr. Carroll once more, we made the necessary arrangements to bring her back as soon as possible. I picked her up at the airport a week later and my own heart hurt. I had to use a wheelchair to transport her. I took her directly to the ER where she was immediately admitted. She was treated for two weeks prior to surgery, to increase her odds of survival.
The surgeon came out to talk to me before the operation.
“She is very sick, so this could go either way. Let’s pray for a miracle.” he said with such sorrow in his eyes.
“Doctor, I believe God brought Louise back here for a reason. He has a purpose for her. She’ll be fine,” I replied, trying hard to contain my need to scream.
“I pray that you’re right,” he said as he reached for my hand and squeezed it with so much compassion.
“I have two little girls at home. I’ll do my very best,” he added, his voice breaking.
I remembered sitting there praying, like I’ve never prayed before. Louise survived the operation and she thrived physically. However, she had a lot of physical and psychological scars to heal. When the surgeon told me that she could no longer live in Haiti, because of her heart, I opened mine and took her in.
Thus, began her journey in the United States. Louise was discharged on a very hot Florida summer day in July and I was so excited to bring her home. I was eager to start caring for her and to reconnect from where we left off.
She had a very high tolerance for pain from the long term abuse she suffered. She refused pain pills, even when I could see her wince when she breathed. Since Louise couldn’t read nor write, the only diversion I could provide was talk to her.
She loved when I talked about life in the US. I shared my personal experience, when I first came from Haiti. She marveled at my ability to speak this “funny language” and still speak Haitian Creole. I explained to her that I had to go to school and that one of the many great things about America, was that one could go to school at any age and become anything.
Her physical healing was very fast. I was amazed how she could run up and down the stairs, like a typical healthy seventeen year old. However, she would tell me that she was scared about the prospect of staying in America, because it all seemed so complicated. There was the refrigerator, the stove, the microwave, the blender, the toaster, the dishwasher, the television set, the remote control, the washer and dryer.
“What about them,” I asked, puzzled.
“I’m overwhelmed” she replied, “How will I ever learn how to operate these machines, when I can’t read.”
She started to cry. I walked over and took her in my arms and whispered “I’ll teach you.”
From that day, she followed me around the house, like my shadow. She might not have been able to read, but she soaked up information like a sponge. Within a couple of weeks, she could use the smaller appliances. Louise was happy and proud of every small achievement, and I lavished praises on her, for I was also very proud of her.
We were both eagerly awaiting her sixth-week post-op check up and clearance, so she could start school. That day finally came. Louise was ready to go to school. We went shopping for school clothes, supplies and a backpack. Her eyes lit up like a five year old getting ready for kindergarten, but in a way she was. She had never been to school before.
The next morning she was up and dressed early. She wore a pair of pink short and matching top that highlighted her light brown skin. Her hair styled in a pony tail made her look even younger than she was. She strapped the backpack on and a big smile on her round face that traveled to her wise eyes, she was ready to go. I tried to get her to eat breakfast, but she just wanted to head out the door.
When we got to the school, her demeanor changed. She stayed very close to me, and was looking curiously around her. I reached for her hand, and without a word, she visibly calmed down. After signing all the papers, I took her to her classroom and introduced her to her teacher. She was a very enthusiastic young lady and I explained Louise’s situation to her. She took Louise by the hand and in a very soothing voice, she welcomed her.
I left and sat in my car in the parking lot and cried, just like I did when I took my daughters to school for the first time. I couldn’t wait to pick her up to find out how her first day went. Well, she talked all the way home, telling me in minute details everything she did, saw, heard and touched.
We had a great routine. I took her to school in the morning, picked her up in the afternoon. We read, did homework, cooked dinner and ate together when my husband got home from work.  My daughters were away in college, but just like that I had another family again.
Louise was born with a hole in her heart, so the abundance of love and forgiveness it carries could overflow and bathe her in this wise and serene aura. It is joyful to be in her presence.

(As 2013 comes to a close, Louise is a healthy and talented 26 year old young woman. jc)

Saturday, November 23, 2013

Saturday, November 16, 2013

Friday, October 25, 2013

Catholic Children's Hospital Neglects Haitians

Friday, October 04, 2013

Tuesday, August 27, 2013

Expensive Salt Water

Monday, July 22, 2013

Sunday, July 07, 2013

Secret History of the Quake

Monday, June 24, 2013

Follow the Dollar (Poor People Have No Chance)

Oniste--June, 2013

Thursday, June 20, 2013

The Apocalypse

Photo by John Carroll

“The apocalypse is not something which is coming. The apocalypse has arrived in major portions of the planet and it’s only because we live within a bubble of incredible privilege and social insulation that we still have the luxury of anticipating the apocalypse.”
― Terence McKenna

Saturday, May 25, 2013

Wednesday, May 22, 2013

Monday, May 13, 2013

Mario Joseph and Father Jean-Juste

Wednesday, May 08, 2013


Photo by Maria King Carroll

"Attitudes are more important than abilities. Motives are more important than methods. Character is more important than cleverness. And the heart takes precedence over the head."

Denis Parsons Burkitt, 1911-1993

(Dr. Burkitt was an Irishman who drove across sub-Saharan Africa in his beat up Ford pick up truck. He found many African kids between the ages of 5 and 8 years who had deadly facial tumors. He biopsied the tumor and it was found to be caused by a virus. Who would have thought that a virus could cause a cancer now called Burkitt's lymphoma?)

Monday, May 06, 2013

Thursday, May 02, 2013

Social Injustice in Medicine

Science has revolutionized medicine but there was no revolution and no plan for ensuring equal access. Excellence without equity is what you now inherit. It’s the chief human rights problem of twenty-first-century medicine, and only when we’re all under general anesthesia of the soul will we be able to ignore it as the century marches on.

Farmer, Paul (2013-03-02). To Repair the World (p. 18). University of California Press. Kindle Edition.

Wednesday, May 01, 2013

More than Technology

Tuesday, April 30, 2013

Tuesday, April 23, 2013

Illness as a Moral Experience

Looking at medicine this way reinforced my belief that the structure and demands of medical schools and hospitals create obstacles to caregiving. How to revivify caregiving in medicine became the issue. Teaching about illness experiences remains important. Yet the moral–emotional core of those experiences deserves greater primacy — as does the social suffering that affects everyone, but especially marginalized people already injured by poverty, isolation, and other forms of structural violence.
Another orienting issue is the lived relationship between patient (and family) and clinician. Here the anthropological model of exchange based in reciprocity can counterbalance the market model's infiltration into even the most intimate parts of health care. The anthropological perspective suggests that care resembles gift exchange between individuals whose relationship to each other really matters. Stories and meanings are exchanged, but also the raw experience of responsibility and emotional sensibility. Over time, caregiving changes the moral life of both caregiver and care receiver. Ultimately, caregiving is about doing good for others, and doing good in the world, as naive as it may sound, is what medicine is really about. That's what draws people to its practice, even if it's also about technology, biomedical science, and markets. That moral core of medicine may seem abstract, until you see health professionals passionately struggling to be useful, compassionate, responsive, and responsible while working with the indifference of bureaucratic rules, the cold counting and costing of institutional audits, and hard-to-balance personal demands on their time and concern.
Modern medical practice's greatest challenge may be finding a way to keep caregiving central to health care. That way will turn on structural and economic developments, technologies, and therapeutic models, but also on the importance that professionals ascribe to patients' deep experience and to such enduring moral practices of caring as the laying on of hands, the expression of kindness, the enactment of decency, and the commitment to presence — being there for those who need them. This is the embodied wisdom medical students need to learn and we all must remember. It is the lesson for the art of living and the art of medical practice that emerges from my 40 years of rethinking and reliving this subject.

Arthur Kleinman, M.D.
New England Journal of Medicine 2013; 368: 1376-1377

Sunday, April 07, 2013


Haiti's Infrastructure
(Photo by John Carroll---April 7, 2013)

I just love the word "infrastructure". We all love to talk about Haiti's infrastructure.

Merriam-Webster defines infrastructure as: The underlying foundation or basic framework (as of a system or organization).

The infrastructure in the picture above is in LaPlaine. This depicts Haiti's infrastructure pretty well.

And this infrastructure looked like this before the earthquake of 2012. Nothing has changed about this infrastructure except possibly the cow.

Haitians raise their families in this infrastructure. And they watch their babies die due to the infrastructure.

Haitians don't like infrastructure so much.  It is not just an academic discussion or exercise for them.

LaPlaine---April 7, 2013

John A. Carroll, MD

Saturday, April 06, 2013

She Makes Me A Slave (Addendum)

(Photo by John Carroll--April 6, 2013)

Mom speaks fast. No one usually listens. She needs her say.

Willgesta is 11 months old and was born at home. She has been sick for two months.

The spaces between her tiny ribs suck in with each breath. But she fights like a tiger. 

Please give her the breast, her cry is bad.

I have been to five hospitals and clinics and doctors.

No one does anything for her.

Receipts she has paid spill onto the table from a black garbage sack.

They say she has a hole in her heart. Her echo report is in Cange, of course.

Her weight has gone down and she has fevers and sweats.

Yes, she may have tuberculosis, but please fix her heart.

No, she has no passport.

I have six other children and they are "mal mange".

But she makes me a slave...I can’t let her cry.

I've called you many times but you don't answer.

I will bring you some limes.

Will you just take her and fix her heart?

(Addendum 4/7/2013: Willgesta was admitted to the best children's hospital in Port-au-Prince yesterday afternoon.)

John A. Carroll, MD

Haitian Woman

Haitian Woman
(Photo by John Carroll)

Friday, April 05, 2013

Hope Keeps Us Alive

(Photo by John Carroll, April 1, 2013)

Thursday, April 04, 2013

Best Western Hotel Grand Opening in Haiti

(Photo by John Carroll--April 4, 2013)

Beauty in Soleil

Photo by John Carroll (April 3, 2013)
The "worst slum in the western hemisphere" is filled with people like this.

John A. Carroll, MD

Saturday, March 30, 2013

Holy Saturday Night in Haiti

Sleeping with Mitral Stenosis in Port-au-Prince
(Photo by John Carroll, March 30, 2013)
This is how Marie has been trying to sleep for months. She cannot lie down because she cannot breathe.

Her exam today revealed a very tight mitral valve. The tissue is scarred down and does not let blood normally drain into her left ventricle which is her main pumping chamber. And fluid ends up in her lungs which has caused her right ventricle to become overloaded. And this causes fluid to engorge her liver and causes her abdomen to be painful.

And untreated strep throat caused all of this when Marie was 12 years old and she developed rheumatic fever.

And what really caused most of this is being poor.

What needs to be done?

Marie is on four types of heart medicine which is stopping her from tipping all the way over.  But the "cure" for Marie is heart surgery to replace her mitral valve.

John A. Carroll, MD

Friday, March 29, 2013

Good Friday in Haiti

It is very early Good Friday morning.

Marie just texted me: "Dr mwn pa kapab respire bien ni donmi" ("Doctor I cannot breathe well or sleep.")

Jesus actual cause of death as He hung on His cross was suffocation. Marie is having fluid from her heart backing up into her lungs, which floods her alveoli and impairs oxygen transfer. Marie is suffocating on her cross like our Lord did on His.

Jesus could text no one. Marie can.

Jesus had to die. Marie doesn't.

Our response hasn't changed much in two thousand years.

John A. Carroll, MD

Thursday, March 28, 2013

Sent Home

I sent Marie to a hospital in Port-au-Prince very early yesterday morning. I spoke with one of the hospital doctors on the phone and told him Marie's medical history. He told me that she would be evaluated but that they had no open inpatient beds for her.

Marie called me before noon and was despondent. She said the hospital did nothing for her and she was headed home on a tap tap. She said that "...if I lie down, I will die."

I asked Marie if she could go to the General Hospital in Port-au-Prince right then. She said their staff is on strike.

And OSF remains quiet about Marie in Peoria.

What to do now?


Short video from the New York Times. Could be a satire of all of us who are trying to "help" Haiti.

Wednesday, March 27, 2013

Archbishop Wenski and Pope Francis

Archbishop Wenski has always been a strong supporter of Haiti. Here are his words on our new pope.

Tuesday, March 26, 2013

"They are going to let me die..."

Early this morning Marie texted me: "They are going to let me die, Doctor Carroll."

I quickly called her on Skype. She does not sound good. Marie cannot breathe well or sleep well. She seems to be dying of congestive heart failure due to her mitral valve which has been destroyed.

I have e mailed multiple people in the States and in Haiti requesting help for Marie. She needs to be hospitalized for oxygen and aggressive diuresis. And then she needs valve replacement.

Wednesday, March 20, 2013

Sounds Like Peoria to Me

Tuesday, March 19, 2013

Pope Francis

Clearly defining his vision of his own role, he quoted from scriptural texts to say that as Bishop of Rome, he was endowed with “a certain power.”
But he went on: “Let us never forget that authentic power is service and that the pope too, when exercising power, must enter ever more fully into that service which has its radiant culmination on the Cross.”
“He must be inspired by the lowly, concrete and faithful service which marked St. Joseph and, like him, he must open his arms to protect all of God’s people and embrace with tender affection the whole of humanity, especially the poorest, the weakest, the least important, those whom Matthew lists in the final judgment on love: the hungry, the thirsty, the stranger, the naked, the sick and those in prison.”
New York Times--19 March 2013

Friday, March 15, 2013

Social Sin

"We live in the most unequal part of the world, which has grown the most yet reduced misery the least. The unjust distribution of goods persists, creating a situation of social sin that cries out to Heaven and limits the possibilities of a fuller life for so many of our brothers."

Cardinal Jorge Mario Bergoglio

Tuesday, March 12, 2013


Tuesday, March 05, 2013

With the Greatest Care and Love

OSF-Saint Francis Medical Center (OSF-SFMC) is the largest medical center in Illinois south of Chicago. It used to be called St. Francis Hospital.

OSF's bills are sent to patients from OSF HealthCare Patient and Accounts and Access Center from 7134 Solution Center in Chicago.

After you read what your "total amount due" is there is a statement that says:

"Thank you for choosing OSF HealthCare and OSF Saint Francis Medical Center as your health care provider where we serve persons with the greatest care and love. The balance on this statement is now your responsibility."

When OSF-SFMC was St. Francis Hospital it did serve patients with the greatest care and love.

Monday, March 04, 2013


“The breed of the hesitant and the weak ...of those ...who believe in telling the truth but rather than tell a distinguished painter that his paintings are daubs will praise him politely,” he wrote, “this breed of the inconsistent is still one of the main hopes for the continued survival of the human race.” If the goal of being confronted with one’s own inconsistency is to make us more consistent, then there is little to celebrate here.

Leszek Kolakowski
"In Praise of Inconsistency"

Tuesday, February 26, 2013

The UN State of Denial in Haiti

UN tank in Cite Soleil, 2007
(Photo by John Carroll)
In January of 2007 I talked to a lady in Cite Soleil who told me that UN helicopters had hovered over her neighborhood in late-December, 2006 and shot down on them. Three of her daughters were allegedly hit by these UN bullets as they were diving below their beds in the house. I examined the three girls and saw their bullet wounds. And I went to their house and saw the bullet holes in their second floor roof. The holes in the roof were "entry" holes. How did these bullet holes pierce the roof if they did not come from above? And how did the three sisters get shot if the bullets did not come from above?
Nineteen year old Soleil woman shot in left shoulder.
(Photo by John Carroll, January 2007)

In New York City the UN denied that they shot down on Soleil from their helicopter.

In 2009 I was at the funeral of Fr. Gerry Jean-Juste in Port-au-Prince. Father Gerry was a Catholic priest who was a friend to many. However, he was considered dangerous and a threat by the interim Haitian government. (He had also been exiled for 18 years in the United States by the government of Jean-Claude "Baby Doc" Duvalier.)

Right after the funeral mass was over and we were leaving church, I heard six or seven sickening gun shots. A young Haitian man right outside of church had his head blown off by UN soldiers sitting inside a MINUSTAH vehicle. The smoke could be seen exiting their rifle barrels from the back of their truck as they pulled away from the side of the cathedral.

People diving for cover during shooting at Fr. Jean-Juste's funeral.
(Photo by John Carroll, 2009)

However, the MINUSTAH spokesperson said that a rock hit the Haitian guy. I didn't know a rock sounded like rifle shots when it strikes someone in the head. MINUSTAH never admitted to killing this man.

And now the UN says they won't pay up for the cholera outbreak that has killed over 8,000 Haitians from October 20, 2010 until today. And those are only the cholera deaths that we have recorded. Many cholera deaths in Haiti's mountains and slums are never recorded.

Cholera victim, 2011
(Photo by John Carroll)

See this tweet:

John A. Carroll, MD

Portraits of Cholera

Saturday, February 23, 2013

Tuesday, February 19, 2013

Pain Relief in Haiti--A Short Story

Untreated Breast Cancer in a Haitian Woman
(Photo by John Carroll, 2012)

As referenced in a previous post, most Haitians have very difficult lives and many of them suffer from painful conditions that are never treated. And their pain is ignored too not because "Haitians have a higher pain tolerance" but because Haitians are poor.

When Haitians have medical problems that cause pain, they need and deserve pain medication. Pain relief is a basic human right. And ten million Haitians have their fair share of burns, broken bones, and post-operative pain.

Haiti has a huge supply of cancer pain that usually goes untreated too. Cervical cancer and breast cancer plague Haitian women. Screening, diagnostics, and treatment are all deficient.

Yet in over 30 years of working in Haiti, I have never seen morphine ordered even once.

Morphine comes from the poppy plant and was discovered in 1804. It was first marketed for relief of pain in 1817. That is almost two hundred years ago.  Morphine is very effective and costs about two dollars per week per average hospitalized adult. But morphine hasn’t caught on in Haiti yet.

In the United States we tell patients with pain, “We have more morphine than you have pain”. High income countries such as the United States, Canada, and the UK consume 93% of the world’s morphine supply yet 70% of deaths from cancer occur in low and middle income nations.

Every year five million people in the world with cancer die in pain, without access to pain medication. In India 1-2% of patients with cancer are given morphine. In Haiti it is even less.

Neglecting someone's pain from any cause is unconscionable. It is frequently the ultimate and last insult for people without funds or influence.

John A. Carroll, MD

Sunday, February 17, 2013

Haitian Hearts has Two Patients Accepted

Memose--October, 2012
(Photo by John Carroll)

Thirty-four year old Memose was just accepted by a medical center in the United States for reconstructive surgery of her jaw.

Thirteen years ago Haitian Hearts brought Memose to this same medical center for cancer of her right lower jaw. The cancer was resected and her fibula was used as a bone graft to make her a new jaw bone.  It is held together by a titanium plate and screws. After surgery Memose underwent radiation therapy and did very well and returned to her family in Haiti.

Unfortunately, after the 2010 earthquake Memose was lost to follow up. However, she resurfaced on Facebook and let her host family in the States know that she was not doing well. She said that she had a hole in her jaw with recurrent infections at the site of her previous surgery.

In October of 2012, I examined Memose in Port-au-Prince. She looked well aside from her right jaw. As the photograph shows, she has a five centimeter opening over her right mandible which exposes the plate and screws. Memose has radiation induced osteonecrosis, a known complication of radiation exposure.

After my exam, I sent photos and a history and physical to her surgeon in the States. He immediately responded and said he would do all he could to reconstruct Memose's jaw. And the medical center agreed to accept Memose as well. Her wonderful host family from thirteen years ago has her room in their home ready for her. We are working on obtaining her visa now for return to the United States.

I really don't care for Facebook but Facebook is how Memose communicated with her host family and  is the main way we communicate with her. Facebook played a big role in the Egyptian revolution and is playing a big role in saving Memose's life.

Woodson and Mom--January, 2013
(Photo by John Carroll)

The second patient is Woodson.

Woodson is a three year old toddler who lives on the outskirts of Port-au-Prince. In February of 2012, his mother carried him into the pediatric clinic in Cite Soleil.

My exam revealed a very loud murmur over his chest and an echocardiogram proved he had a ventricular septal defect. This is the most common congenital heart disease and is a hole in the wall of the heart that separates the two man pumping chambers.

I put Woodson on some medication which helps rid his lungs of excess water which can collect due to this hole which should not be there.

Woodson has been accepted by a group called CHADASHA which takes Haitian kids to the Dominican Republic for heart surgery. And Woodson will leave for the Dominican Republic with his mother in two weeks for surgery to patch the hole.

Thank you CHADASHA!

John A. Carroll, MD

Archbishop John Myers

Thursday, February 07, 2013

Haitian Pornography

Pierre--February 1, 2013
(Photo by John Carroll)
Amy Wilentz new book is called “Farewell, Fred Voodoo”. In her book Wilentz writes that visitors to Haiti, including herself, tend to be guilty of writing about or photographing Haitians in their despair. She calls this "pornography" when we write about or photograph poor Haitians for its shock value. And the Haitian subject usually never knows what becomes of their story or photo. They hardly ever benefit in any meaningful way.

I agree that this is some form of pornography. But if the story or the photograph may spur someone to do something good for the person or for Haiti I rationalize that it may be less pornographic.

I have found myself in the same spot that Wilentz describes in Haiti many times in 30 years. And I have asked myself: Why am I here? Should I be here? Do I have any right to be here? Am I doing any good to be here and to document what I am seeing?

I realize I am different than the Haitian I am examining or interviewing or photographing in that I can leave Haiti anytime. Wilentz says that poverty is not so bad when you can “snap your fingers” and it comes to an end. In other words we can go home when we have had our fill. But Haitians cannot go home when they’ve had their fill. They ARE home. Most are condemned to live here forever.

Living in Haiti should be wonderful, like the Arawak Indians found it to be centuries ago. But the Arawaks lived with dignity and most Haitians do not. Haitian roofs leak and their kids hair is orange and they vomit worms. And so a million Haitians, give or take a few hundred thousand, have left Haiti with visas or on creaking boats. Many have made it big but many are cleaning bathrooms in South Florida airports and hotels. They do the undignified work we won’t do.

Yesterday I was approached at St. Catherine Laboure Hospital in Cite Soleil by a thin man who was walking with a woman. He had the requisite IV in his arm. Haitians firmly believe that getting IV fluid is good for what ails you and it frequently is.
He politely said hello and came over and sat down next to me on the wooden bench in the courtyard of the hospital. He told me his name is Pierre and that he is from a little village named Lilavois located on the outskirts of Port-au-Prince. He said that he had been a carpenter until he got too weak to work. And then he started telling me his medical problems.

While he was talking I noticed that his facial muscles had wasted away, his arms were thin, and his eyes were yellow and sunken. And his abdomen was conspicuously bulging from underneath his t shirt. Thin Haitian men with bulging abdomens are never good. I have seen too many.

Pierre related that he had come to St. Catherine’s because he had severe pain in his abdomen, weight loss, and yellow eyes for about three months.  He said that he was unable to eat and he couldn’t hardly sleep due to pain. He looked like he had been sick for much longer than three months.

Pierre told me that he is 48 years old and the lady with him identified herself as Pierre’s sister. She seemed to be a gentle lovely soul and obviously very concerned about her brother.

My heart sank for so many reasons. Was I on the verge of creating pornography like Wilentz describes? Should I even talk to Pierre? I knew he was dying.

We walked into the hospital and Pierre laid down in his hospital bed in the Internal Medicine ward and his sister sat at the end of the bed. There were five patients spread out around the ward. Only five patients in the only hospital in Soleil that serves an area of 250,000 people. There were no doctors on site.

I examined Pierre's protuberant abdomen. When I tapped on his abdomen he had shifting dullness due to excess pathologic fluid moving back and forth. And I gently felt for his liver border. Usually an adult’s liver doesn’t extend further than the lower ribs on the right side. But Pierre’s liver border ran way below his ribs down the right gutter of his abdomen. And his distended liver felt rock hard. 

Lower liver border
(Photo by John Carroll)
I finished my exam and said to myself Pierre has liver cancer and he is definitely finished.  

I reviewed his dossier in a cheap blue plastic folder.  During his two day hospitalization he had been given two types of diuretics to try and decrease the fluid in his abdomen. Some labs had been drawn which showed his bilirubin was high. In other words "something" in his liver was blocking the flow of bile and so the bile regurgitated into his bloodstream and turned his eyes yellow. That "something" was most likely cancer.

What was not on his chart was medication written for pain. Pierre had been given nothing for pain. In thirty years in Haiti I have never seen morphine, demerol, dilaudid, or fentanyl ordered for pain.

When poor Haitians get bad diseases that are not treatable in Haiti, like liver cancer, they deserve to have pain medication to ease them during their last days. And narcotic pain medication like morphine is not expensive. But pain is not treated effectively here even at the end of their lives. Haitian lives are painful up to and including their last breath.

So is this pornographic that I am posting about Pierre?

I met Pierre for a reason. Should I not say anything to anyone about this meeting?  Should I just act like Pierre does not exist and that his medical condition is nothing? Should I just shrug and say to myself,  "Gee whiz, this guy needs something for pain."  Should he just be another unknown Haitian carpenter who works very hard his entire life and dies anonymously without any pain medication? Has Pierre nothing to teach us?

So what did I do to assuage my guilt and make the whole experience with Pierre less pornographic?

I talked with Pierre and his sister. I advised him to ask the doctor, if he sees one, for pain medication and if the doctor did not prescribe him any to leave the hospital and try the public hospital down town. I did not expect that hospital to be any better, but it is no worse either. I did not want to guide Pierre in the wrong direction, but it is not happening here in Soleil at St. Catherine's.  

I asked the nurse for pain medication for him.  She opened the cabinet on the ward and we both searched for pain medication. There was nothing there in the cabinet. The nurse was very polite but also very unconcerned there was nothing to offer Pierre for his pain.  She is used to death and painful deaths.

The nurse said Pierre needs to buy his own pain medication. And by that she meant "on the street". Pierre is too sick to do this and so this responsibility would fall on his sister. But she has no money. Obviously, this was not a good option so I gave them a 20 dollar bill to buy pain medication if any Haitian doctor wrote the prescription.

So was I done at this point? Could I go skipping out of this dismal ward all happy?  No, not yet. I realized I had some pain medication in my pack that I take for migraines. There were only a few.  I told him to take half a pill to make them last twice as long. Pierre seemed so happy and swallowed half a pill immediately.  

I also had a bottle of pre-natal multivitamins in my pack. So I gave them to him and also told his sister to take one per day. The vitamins would largely be placebo for Pierre but not for her.

Did I feel guilty about giving dying Pierre vitamins, a small handful of pain meds, and twenty bucks?  Yes I did, especially when they smiled at me and thanked me so much.

But I told myself that I had done more for Pierre than the Haitian government, foreign governments, NGOs, and millions of people worldwide who had pledged 5 billion dollars for Haiti after the earthquake. If Pierre can sleep for a few hours now with the meds I gave him before he returns to his usual state of pain and suffering, then that is good.

Another option would have been for me to tell Pierre that he is dying of liver cancer and that he needs to return to Lilavois before he dies. And if he did this, his kind sister would not have to hire a private tap tap for a lot of money that she doesn’t have and transport his body back to Lilavois for burial. (For some reason, typical Haitians won’t travel on a tap tap with a corpse.)

Should I have said that to him? Should I have taken any fading hope that he may have for life? I would have been honest. But in my opinion this was no time for brutal honesty. It was a time for vitamins, pain meds, a little money, and a little hope.

Someday we will look back on the Pierres of Haiti, and there are many of them, and say we did not do them right. But that day has not arrived. I will continue to do what I can and document what I can while hopefully not creating too much Haitian pornography.  

John A. Carroll, MD