Tuesday, May 12, 2009
Haiti's Rheumatic Fever
Rheumatic fever is a disease of poverty and social injustice.
Most of the reduction in cases of rheumatic fever is attributable to improved living conditions, which have resulted in less overcrowding and better hygiene, with reduction of transmission of group A streptococci.
In the mid 20th century, children with rheumatic fever occupied many of the beds in pediatric wards in industrialized countries--indeed, entire hospitals were dedicated to the treatment of, and rehabilitation from, rheumatic fever. But in the latter half of the 2Oth century, rheumatic fever receded as an important health problem in almost all wealthy countries.
Today, most physicians in these countries are unlikely ever to see a case of acute rheumatic fever, and their experience with rheumatic fever, and their experience with rheumatic heart disease will be limited to heart-valve lesions in older patients who had rheumatic fever in their youth.
Sunday, May 10, 2009
A Mother's Love
This lady ran barefoot through the streets of Soleil carrying her seizing two year old daughter.
Her daughter, Abagaille, started having a fit out of the blue last Thursday morning. She hadn't had a fever and never had seizures prior to this one.
Mom and her 7 kids live in Beleco which is about one and one-half miles from the pediatric clinic.
As Abagaille seized, this lady suffered. She cried, shook her head, and extended her arms pleading to her God to stop this. But she held on to Abagaelle and kept running.
When I examined Abagaille, she seemed post ictal, and then would clench her teeth and seem to smile. But she blinked when I touched her eyelids and cried when she received an IM injection. Her vital signs were stable.
Abagaille's seizures stopped. Her blood glucose came back at 47. We gave her sips of powdered milk forumla. She looked around and appeared normal.
I should have done much more from a diagnostic workup, but I couldn't under the circumstances, that I should not explain.
Mom was relieved that her terrible seizures had stopped, and I told mom to come back the next morning.
Mom and Abagaielle returned the next morning and both looked fine.
The hundreds of thousands of people in Soleil like Abagaielle and her mom deserve so much more.
Henri Andrique
Henri had a Ross procedure 10 years ago.
Because he had severe aortic insufficiency from rheumatic heart disease, his damaged aortic valve was replaced with his own healthy pulmonic valve. A pulmonic valve homograft was placed in his pulmonic position.
He has occasional shortness of breath and his exam today revealed a systolic and diastolic murmur over his pulmonic valve position.
Overall, aside from his "Haitian thinness" he looked pretty good.
He has no job of course.
Henri will have an echo tomorrow in Port-au-Prince.
Faces of Soleil
Merlinda is five months old and has a hole in her heart. She needs heart surgery.
She has a mom and dad that give her great care.
We need to find a medical center to accept her for evaluation and treatment.
Haiti's Scourges...Rheumatic Fever and Sydenham's Chorea
Sydenham's Chorea (SC) is the name of Rodolphe's problem. That is why he is making the funny movements with his left hand.
SC is one of the five major manifestations of rheumatic fever. It is thought to occur when the immune system attacks part of the brain called the basal ganglia. Cortical structures of the brain can be involved also.
Emotional lability (laughing, crying, etc.) may precede the chorea (abnormal movements).
The prognosis is good even without treatment.
Rodolphe is the third Haitian patient I have seen with SC.
Saturday, May 09, 2009
Happy Mother's Day, Maria
Dear Maria,
Thanks for being the best mom Luke could ever have.
I remember the look on your face when you saw him for the first time. You opened your arms and heart to Innocent on Haitian Mother's Day.
Luke's face was thoughtful and your face was happy when you saw his feet feel grass for the first time.
You carefully lifted him and held him on the big wall overlooking Delmas 31 so the bad guys below wouldn’t see him.
You knew he wanted to read at GCH, and you taught him during the seven months of terror in Haiti. Luke's neurons began firing, as you predicted, and they haven't stopped.
Luke never wanted to be away from you in Haiti. You were the first woman never to turn your back on him and are now the only woman he trusts. He really needed you. Much longer, and he wouldn’t have been able to need anyone.
You (and we) still have our work to do with the Lukester, but you “gave him a chance,” as the Haitians say.
If Luke’s biological mom could thank you on Mother's Day, she would. And I know for certain, no matter what world she is in right now, she wants Luke to be with you.
Forever.
Love,
John
Ti Pierre Dies
Haitian Hearts could not find a medical center for Ti Pierre and he died.
The principal of his school in Port-au-Prince called me yesterday to tell me this terrible news. She was very frustrated with his death.
Ti Pierre needed a new mitral valve. That is all he needed.
She said he is in a better place now. I am sure he is.
New Haitian Hearts Patients
This week, on the same day, I examined three new patients with congenital heart problems.
I will describe two of the cases. (My satellite signal for the internet is weak right now. I will load pictures of the kids as soon as the signal improves.)
The first patient is five month old Merlinda. She lives with her mom and dad just north of Port-au-Prince.
Merlinda had a fever of 101.5 F and a heart rate of 180/minute. However, she did not appear to be in any respiratory distress. She avidly took her mother's breast. I think her fever was from a recent vaccination.
Merlinda appeared quite healthy.
Her exam revealed a loud blowing murmur to the left of her sternum that radiated everywhere across her chest. The murmur was classic for a hole between the lower chambers of her heart (ventricular septal defect).
Sometimes these holes can "heal themselves", but the location of this hole is up high on the septum and not as amenable to seal over on its own.
So Haitian Hearts will begin its search for a medical center to evaluate and possibly operate Merlinda.
The second patient is Jimi.
Jimi is 5 years old and weighed 17 kilograms. He was brought to me by his father.
Last August, during the hurricaine season, heavy rains caused the river to rise near their home. Their home was flooded, a wall was destroyed, and they lost their garden. Both Jimi and his father are rail thin.
Jimi's heart exam was the same as Merlinda's above.
Jimi was so sweet and did not say a word.
We will do our best with Jimi too. His father has already started on Jimi's passport.
If any one out there in cyberspace has any connections with pediatric medical centers for these two kids, we really need your help.
Thanks.
Dr. John
haitianhearts@gmail.com
Wednesday, May 06, 2009
Faces of Soleil
Here was the first patient in pediatric clinic this morning.
And things didn't improve.
About two hundred patients showed up even though four hours of heavy rain last night flooded Port-au-Prince. And since water runs down hill, the Soleil clinic courtyard was inundated with water.
The only hospital in Soleil, across the flooded field from the clinic, had water in the main hallway. And lying on a bench in the main hallway was the uncovered body of a young man who had come in yesterday with an abscess on his neck. His arms were tied together resting on his abdomen.
American Airlines flights come in and go out over Soleil. The noise of their engines is deafening inside the hospital. Miami is 91 minutes away.
This is Soleil Today
This is Cite Soleil today.
The baby girl is 21 months old and weighs 8.5 kg. She had been staying with Grandma in Croix-du-Bouquet, but Grandma ran out of food.
Grandma returned the baby to the baby's 22 year old mom who lives in Waf Soleil. Mom has three other kids at home.
Mom walked into the clinic office carrying this lethargic baby. The baby is severely malnourished with a combination of marasmus and kwashiorkor.
Kwashiorkor means "condition of the displaced child".
The baby was admitted into the community based malnutrition program and will start on F-75 milk.
There are 13 million other babies like this one worldwide. And two million will die this year.
Hopefully, this Waf Soleil baby girl won't be one of them.
Faces of Soleil
Pharmacy technician in Soleil clinic. She fills approximately 800 prescriptions each day and hands them through the pharmacy window.
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