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