Haitian Vaccinations

The national vaccine immunization program in the United States, directed principally at children, is one of the most successful examples of effective preventitive care. One of the most dramatic examples of the benefits of apporopriate immunization is the marked derease in cases of invasive Haemophilus influenzae type b infection since the introduction of this vaccine in 1987. Incredibly, the number of cases of children younger than five years of age in the United States declined by >99% by 2000.

Haitian children have access to standard vaccinations including diphtheria, tetanus, pertussis, measels, mumps, and rubella. They can also recieve oral polio vaccine and BCG vaccine (to prevent tuberculosis). However, very few Haitian children have access to "second generation" vaccines like Haemopilus influenzae described above. This bacteria can be particularly bad causing infections at multiple sites including meningitis and sepsis.

Other vaccines that only Haitian children with means have access to include hepatitis A and B, pneumococcus, influenza, meningococcus, and varicella-zoster(chicken pox).

All of these vaccines are considered "standard of care" for U.S. children that live only 90 minutes away from their Haitian neighbors.

The Wooden Bell

A couple of days ago, after clinic was over, I was eating with the sisters that run the clinic, malnutrition center, and school just outside of Port-au-Prince. Our talk concerned Haiti and its serious unending problems. The sister at the head of the table is from Spain and had been asked to leave Cite Soleil several months ago after gunfire between the United Nations and slum gangs blew big holes in the sister's convent wall as they were forced to lie on the floor to avoid the bullets.

In clinic, the babies with malnutrition and neglect have no real chance. Another difficult problem is babies that show up without a mother. This occurs frequently. The sister from Spain said, "When the Haitian mother dies, you may as well bury their baby at the same time." Unfortunately, this is not far from the truth. Aunts, grandmas,fathers,and neighbors usually are not good substitutes for the absent mother.

Today, the lady at the top of this post showed up where we are staying. Her name is Heureuse. Heureuse lives with Michael, her one year old boy, and her three year old daughter in a notorious slum on the edge of Port-au-Prince called Carrefour.

Heureuse had heart surgery at OSF in Peoria about 4 years ago and Haitian Hearts brings her medicine each trip that keeps her alive. We examine her and a recent echocardiogram here in Haiti shows that Heureuse needs to return for more valve surgery. OSF in Peoria will not accept Heureuse even though the doctors that took care of her several years ago would be glad to have her back and take care of Heureuse at no charge.

When Heureuse dies here, she will leave her two young children. She and her babies live with Michel's father. (The father of her daughter is dead.) Neither child is doing great now from a nutrition standpoint and when Heureuse is gone, both of her children will be at high risk for disease and death.

In todays (10/17/06) Peoria Journal Star there is a 20 page supplement that is entitled "Building a Medical Powerhouse". The articles report the 562 million dollars being spent in Peoria by the two major hospitals and the University of Illinois School of Medicine. They are all located approximately 4 blocks from each other. The local health-care community is lauded for taking the Peoria economy to "new heights" with the jobs and employment that the medical expansion creates.

OSF is building a new 8 story Children's Hospital as part of its 234 million dollar addition. Paul Kramer, Director of Children's Hospital, is quoted as saying that he wants a "world class" facility. However, it will never be "world class" when OSF and Mr. Kramer and other secular leaders dismiss the suffering of Heureuse and refuse to allow her to return to OSF for surgery. Mr. Kramer has his blinders on even though he knows the majority of the "world" live in the same "class" as Heureuse and her children. How can OSF be "world class" when they ignore the cry of the "global community" and focus on Peoria's economy.

New technology and research and jobs for any community are good. However, one obscenity lies in the difference in Peoria's half-billion dollar medical projects and Haiti's extreme poverty. The other obscenity is OSF's negligence of former patients that do not have technology, jobs, and research in their slum.

A Haitian proverb says, "No one hears the cry of the poor or the sound of a wooden bell". The good news for OSF is that Heureuse is "out of sight and out of mind". Her death will not be reported in Peoria and her children's struggles will never be known.

Peoria and its medical community are the losers when they deny health care to those who need it most. If OSF and its leaders really thought big, they would think of Heureuse and her children.

Dear Senator...

Dear Senator Raoul,

We hope that the benefit for GCH was very successful. My brother-in-laws and sister-in-law really enjoyed themselves on Saturday night and were very happy to meet you.

I have to give you a very grim medical report from Haiti. After 25 years of working in Haiti, I have never seen conditions so bad. The people here suffer so much from things that they shouldn’t even have like tuberculosis, malaria, and malnutrition.

Every day I have to force myself to walk to clinic and be part of this desperation. I can barely get in the front door of the pediatric clinic when I arrive because of the crowd that starts accumulating at 5 AM.

During the last year, we have brought a drug called ceftriaxone each trip to Haiti. It is a high powered antibiotic that can be given as a shot and will last for 12-24 hours before the baby needs a second shot. When I see a very sick infant, I give the shot quickly in the clinic. If there is no room at GCH or the baby does not meet the requirements for admission, I have the baby come back in the morning and admit it to GCH if there is a bed, or I take it to another hospital in PAP, and repeat the dose of ceftriaxone. If the baby survives this fiasco of medical care and the baby looks better, I convert the baby over to less expensive antibiotics that can be taken orally.

When I arrived at GCH clinic this morning, there had to be about 250 people crammed into the clinic (includes parents). My first patient was a 3 day old with a temperature of 102 F. I gave it a shot of ceftriaxone and sent the baby home with advice to mother to bring back tomorrow. The baby should have been admitted, but I couldn’t. Three day old babies with fevers are considered pediatric emergencies.

My next patient was a 16 day old baby boy who weighs four and one half pounds. His temperature was 102.5. His mother was very young and she had never given him breast milk, powdered milk, or anything other than water. His picture is attached and he is emblematic of Haiti. I baptized him with stagnant dirty water in a plastic bowl in my office. There was no running water in the clinic today.

I gave this pathetic baby a shot of ceftriaxone immediately and called a missionary who drove to the clinic, picked him up, and took him to another clinic/hospital where we admitted him. Sending him to the General Hospital is not a good option usually. (For one thing, his young mother had no idea where the General Hospital was in PAP!!)

The rest of my clinic day did not go much better. The acuity of disease here is horrible.

Over the years my wife and I have brought thousands of dollars of ceftriaxone specifically for patients at GCH. Since we are about out of this medication at this point, Maria’s parents purchased 300 more dollars worth of ceftriaxone in Peoria last week that I called in to our local pharmacy in Peoria, and sent to us by DHL. We followed the package’s progress via the internet. It arrived in PAP on Friday, but we received no call from DHL until this morning (Monday).

DHL is about one mile from here and they said that we owed them 5,473 gourdes for Haiti customs tax. This comes out to about $144 US. The entire package sent from Peoria has the ceftriaxone for many, many sick babies, and some germ-x soap, and some protein bars which totals about $350 US.

The Haitian government is asking us, to pay almost half of the cost of the package in customs taxes. The delivery by DHL was also very expensive and paid for generously by Maria’s parents. The ceftriaxone was also paid for by Haitian Hearts (Maria’s parents again).

DHL came this morning to deliver the package, but I refused to accept it or pay for it (the customs tax). This is absolutely outrageous. I explained that it contains medication for sick and dying babies, but no one seems to care. I am on my last couple of vials of ceftriaxone that we had from a previous trip and from this trip.

I don’t want to quit working at GCH but I strongly feel like terminating my work there until this problem can be addressed. It is just so difficult to have the medication ordered, purchased, and close by, but not available for the kids that need it most. This of course is not GCH fault or responsibility. Haitian Hearts pays for chest x-rays and medication everyday at GCH for patients who I see in the clinic, and know they have no money to pay for the x-rays and medications at GCH or anwhere else. We also admit them to other hospitals, and Haitian Hearts pays for these admissions also. I don’t want to quit working---I love what I do and who I work with, but if I have no ceftriaxone to take to the clinic, I will be baptizing the first 10 patients I see each morning. This work can feel very futile on a good day. It is just SO difficult as a physician to have my hands tied and not be able to do what is right for people that have no say so in their future.

Senator Raoul, will you get me a meeting with anyone you can think of that has influence at the level of national customs in Haiti. I would be glad to speak with President Preval or the Haitian Senate leader. A very powerful person needs to spend one day in the GCH clinic to see the problems at ground level. Someone needs to step up to the plate in the new Haitian administration. I need this medication now and Haitian Hearts will not pay for it again. We already paid for it in Peoria and sent it down here as fast as we could. The DHL truck drove away with it this morning….a very sad thing to see, especially if you are a sick Haitian baby.

Thank you very much for all you do.

Sincerely,

John

You may forward this e mail to anyone you think can resolve this problem.

Starving in Haiti

This mother, who was covered with sweat, brought her 3 year old in her right arm and 2 year old in her left arm to the clinic yesterday from a small village north of us. It cost 75 cents for each girl for the doctor visit and medication.

The 3 year old weighs 13 lbs. and the her 2 year old sister weighs 16 lbs. Both have fever, cough, and diarrhea. Both have no access to daily nutritious food, clean water, or medical care. Both are starving.

Peoria's major two hospitals are beginning 534 million dollar hospital expansions. The two hospitals are one block away from each other in a city of 113,000.

Tuberculosis and Cavities

The major site of infection of tuberculosis is the lungs. Tuberculosis causes the lymph nodes in the lung to enlarge, can appear like pneumonia, can cause extensive scarring, and even cause part of the lung to cave in and form cavities.

Cavitary lung disease from any cause is considered quite dangerours because of the destruction of lung tissue and also due to the fact that the cavities contain pus and bacteria.

When I listened to the lung of this little girl, I could hear hollow sounds over the cavity which are called amhoric, like the sounds made by blowing across the mouths of jars used in antiquity (amphora). When my stethescope moved slightly away from the cavity, the hollow sound disappeared. This is different than tubular breath tones heard in areas of consolidation like pneumonia without a cavity.

This girl would be considered infectious for tuberculosis because the cavity can contain more tuberculosis germs and she can spread them with a cough or just talking to someone. As a rule, children are not considered transmitters of tuberculosis. Identifying a pediatric tuberculosis case in the community means that there is an unidentified adult(s) that is/are spreading the disease.

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Alternative Medicine in Haiti

Alternative Medicine in Haiti

I saw this young lady in the clinic today. She is 23 years old and lives a few miles from the clinic but it takes her at least 30 minutes to get there down the dirt road leading to the clinic with huge holes, mud, and water.

She was very weak when she arrived and had to be pulled into the clinic. She was also very short of breath. Her blood pressure was 104/0. Her blood was drawn at our lab next door which revealed a hemoglobin of 3. She should have a hemoglobin of 14. She has very little blood cells circulating to carry oxygen to her cells. Her organs are starving for oxygen.

There are many causes of anemia in Haiti with iron deficiency at the top of the list. I don’t know if she has sickle cell anemia. She could have both.

She has no money to go to a public hospital and has no family member to take care of her in the hospital. So hospitalization in Haiti is not an option. She desperately needs a blood transfusion and we need to find the reason for her severe anemia. So I gave her a shot of intramuscular iron and some iron supplements to take orally. We also gave her a high protein drink and some corn curls as she sat in a chair with a smile on her face and devoured them.

I told her to come back to the clinic tomorrow for more injectable iron which is sometimes dangerous to give because of allergic reactions. But that is the best alternative for her now to quickly restore her iron. Haiti has given her no more “alternatives” than this. She smiled and said she would come back, but I realize now it is a national holiday. I had forgotten. I think she had too. Hopefully, she will return in two days.

I practice “alternative medicine” in Haiti and am very embarrassed.

Haitian Fathers

Haitian fathers care about their children. They work as hard as they can to provide for their family. There is much work in Haiti but few jobs. And the jobs that do exist don't pay hardly anything. But Haitian men do work and can probably outwork anyone anywhere. I have seen them do incredible physical labor, such as clearing very heavy rocks from a huge field overlooking the Caribbean Sea, that I did not think was possible...and they did it with their bare hands.

This two year old girl, Chevalier, has a congenital heart defect known as a ventricular septal defect. It is a very common congenital heart problem which allows too much blood to flow back to the lungs through a little hole in the heart that shouldn't be there. After a few years, the heart can become enlarged and weak because it is receiving excessive blood. Also, the lungs can develop high blood pressure and refuse to receive blood from the heart which leads to death.

Chevalier has nothing irreversible right now. Her heart and lungs work well but she needs cardiac surgery now to close the hole in her heart. She will do well if she is operated before permanent damage is done.

Her father cares about her. She loves her father. He is depending on Haitian Hearts to find a hosptial in the United States to operate Chevalier.

Haitian fathers care. They work hard. They deserve much more.

Haiti, Heal Thyself

The baby boy pictured above is 16 days old. His name is Kenley. His aunt carried him into clinic two mornings ago and his seventeen year old mom followed behind.

Kenley was born at home, like most Haitian babies. His mother had a fever during pregnancy, but the delivery went well. He was not premature. The aunt, who carried a cell phone, and mother stated that a few days after birth he developed a fever. Amazingly, he has never been offered breast milk or powdered milk. The only liquid Kenley has ever had in his 16 days on earth was boiled water.

His exam revealed an emaciated, shriveled little baby with the wrinkled face of an old man in severe distress. His temperature was 102.5 F. He seemed to be pretty stiff and did not want to be moved much. His fontanelles were sunk and his skin tented when pinched indicating dehydration. He was not jaundiced and his umbillical area looked free from infection.

Kenley was obviously very sick. Infants with fevers are considered medical emergencies. Two hospitals rejected Kenley but we were able to admit him to a "doc-in-the-box" for an IV and antibiotics. His chances for survival are minimal but maybe better than before. I don't now.

Where was Kenley failed? Many places. He was born at home with the help of a midwife. His young, uneducated mother had an infection of some type during her pregnancy which put Kenley at risk for infection. His mother had no prenatal care. Kenley had not been given nutrition of any sort according to his aunt and mother. He had fever for many days and his visit to me was his first encounter with a doctor.
Two hospitals refused to admit him the other morning. His hospitalization now is not in a neonatal intensive care unit. He is being cared for by nonspecialists in a primitive setting. We have no idea what his blood work is or where is infection is originating. He may not even be receving the proper antibiotics.

Haiti's infant mortality rate is very high---one of the highest in the world. Kenley's horrible case can attest to this.

Haiti has been given the bad end of the deal by the international community for hundreds of years. Hundreds of millions of dollars have flowed into Haiti over decades. The money hasn't reached or helped most Haitians.

Haiti needs benevolent leaders. The corruption in Haiti is fierce, almost as bad as the United States. Money needs to trickle down to the Kenley's that are in need. Haiti needs to point the finger at themselves too. It just doesn't need to be this bad here.

Haiti is embarrassing.

Haitian Dwindles

Many children get the "dwindles" in Haiti. They lose weight, have fevers, quit eating the little they were eating, and can’t learn in school.

Such was the case with Angeline who I examined in the clinic yesterday. Angeline is 7 years old and weighs 29 pounds.

Her exam was normal other than appearing quite chachectic as you can see. So I will work her up for tuberculosis. I treated suspected worms living in her gastrointestinal tract empirically and gave her iron and vitamin supplements.

What Angeline really needs is a government that cares about her and thousands of other Haitian kids with the dwindles, and does something about it. Downstream efforts like mine are ok, but Haiti needs upstream efforts that prevent medical problems from occurring in the first place.

Rheumatic Fever in Haiti

Acute rheumatic fever is a febrile illness which can cause arthritis, heart problems, skin rash, and a movement disorder called chorea. Rheumatic fever occurs several weeks after a pharyngeal infection with Group A beta hemolytic Streptoccus. Rheumatic fever continues unabated in developing countries. There are approximately 5-10 million cases each year in poor countries where two-thirds of the world's population lives. Children are the most likely victims between the ages of 5-9 years of age.

It is believed that the body recognizes the streptococcal germ and attacks it and also attacks the heart valves. Something in the valves reminds the immune system of the streptoccus and the valves are attacked also. Therefore, rheumatic fever can lead to damage of heart valves which causes decompensated congestive heart failure and death. We have seen many young teenagers and young adults in Haiti with severe valve problems which are due to rheumatic fever when they were younger. Without heart surgery, most of our patients die very miserable deaths.

With the introduction of antibiotics in the 1950's, there was a decline in rheumatic fever in the United States. Also, with appropriate antibiotics to prevent the recurrence of the disease, rheumatic fever is much more preventable in the developed world.

Haitians, like the 5 year old boy pictured above, lack penicillin for their strep throat, and develop rheumatic fever. His knees were very painful, swollen, and warm. I could not hear a heart murmur, so maybe he will be fortunate and escape the cardiac manifestations. Time will tell.

Haiti's Parasites

Haitian women ask for worm medicine all of the time because their children frequently have worms. Jean, the baby in this picture, had vomited over 70 long white worms out of his mouth and nose over the course of 3 days before his mom brought him into clinic. He also had been febrile for one week, and at 28 months of age only weighs 14 lbs. Most likely, this baby has Ascaris, which is type of roundworm. It has a migratory pattern through the lungs and into the digestive tract. Ascaris worms can be as long as 15 inches. Can you imagine the alarm of a mother from the States if her child coughed up a long white worm or dozens of long white worms?

There are approximately 3,200 types of parasites. They can invade the body through food and water intake or through an insect that transmits the parasite like a mosquito or a fly. Parasites live in or on other organisms from which it obtains nutrients to live and frequently harms the organism in the process.

Because most people in Haiti do not have potable water and their living conditions are dismal, they unwillingly ingest the parasites. Parasites can steal vital nutrients from their bodies and they usually attack and hurt the undernourished and weak---like children that sit in the dirt.

Haitian kids have stomach bloating, abdominal pain, diarrhea, malabsorbtion, anemia, pneumonia, and even perforated intestines due to parasites. Their mothers report that their children grind their teeth at night. Studies have shown decreased intelligence in children infected with parasites.

What is the answer? Justice for the poor, which means jobs, education, clean water, nutritious food, all of which will result in a higher standard of living in Haiti. Until that happens, parasites will continue to infest Haiti’s weakest and most susceptible.

No Good Choices

This baby boy was from a small village near the Dominican Republic. His parents couldn't take care of him for financial reasons.

They put him in an orphanage and he was healthy. The director of the orphanage went to the United States and returned to Haiti and found him in this condition. One of the nannies said he fell and broke his leg. There was no more history.

This Haitian baby had to suffer so much as he developed gangrene of his left thigh due to an infection in his deep thigh muscles. His suffering had to be great as he remained at the orphanage neglected. The infection spread to his blood and gave him multiple organ failure.

He appeared to be awake but his eyes were looking nowhere as he lay in a beneficent coma. A unit of blood was being wasted on this dying boy. No medical personnel really thought he would recover.

Fortunately, death came for him a couple of days later. His parents should never have had to place him in a terribly run orphanage that let him rot to death. But when you can't feed your children in Haiti, you don't have good choices.

Moses

On Friday, several days ago, this sweet looking grandma-appearing-woman brought this 5 year old boy to the clinic. His name is Moses (Moise). She named him after the biblical character. I don't remember her specific complaints about Moses.

I asked her if Moses had a mother. She waved her hand "no" behind him and responded the same way to my question about his father. Moses stared straight ahead.

The lady said that one night she heard a baby crying and went out side and found him lying in the street in the rain. She brought him in and is raising him. She knows nothing more regarding Mose's beginnings.

I told her she was doing a good thing. She smiled and said that God picked her to raise Moses. She is only doing her job.

Does This Girl Look Sick?

As stated in a previous post, tuberculosis can be a very sneaky disease.

This young Haitian girl does not appear to be sick especially if you saw her walking down the street and knew nothing about her history. But listening to her left chest with a stethescope revealed an abscence of breath sounds due to a large pleural effusion. A pleural effusion is fluid that collects in the pleural space surrounding the lung. This fluid has also pushed this girl's heart to the right because fluid is not compressible and so something has to give.

Most likely, this fluid is caused by tuberculosis. A hypersensitivty reaction occurs which frequently causes the effusion to form. She is Haitian and physicians have to know what is prevalent and endemic where they practice. If this girl were from Peoria, and had not travelled recently, and had no contacts with adults with tuberculosis, I would not think she has tuberculosis. Unfortunately for her, she lives in Haiti, where getting tuberculosis is almost expected.

I referred her for 8 months of tuberculosis treatment. Her chances for cure are greater than 90%.

A Haitian proverb says, "One sees from where one stands."

Sickle Cell Anemia in Haiti

Sickle cell anemia is a big problem anywhere there are people of black descent. In the United States 1/400 African Americans have sickle cell anemia. Haiti is a country with greater than 8,000,000 black people densely packed onto a small island the size of the state of Maryland. Sickle cell disease is rampant here.

The mean survival of men in the United States with sickle cell disease is 42 years. The mean survival of women in the United States with sickle cell disease is 48 years. The mean survival of men and women in Haiti with sickle cell disease is about 25 years. If you are born with sickle cell disease in the developing world, you are in trouble.

The main problem with sickle cell anemia is that hemoglobin within the red blood cells is formed improperly which causes the blood to be sticky, not flow like it should, and this blood will occlude small blood vessels at the level of the organ and cause organ dysfunction.

So what does this mean for the little girl pictured in this post who was in the middle of a sickle cell crisis when this picture was taken. Pain is a big part of a crisis when blood flow becomes stagnant. Her feet hurt (dactylitis) as did other regions of her body, but she complained mainly of her feet. She did not want to walk.

Sickle cell disease allows infections to become more severe and the leading cause of death with sicklers is infection. However, involvement of renal, pulmonary, bone and joint, and the central nervous system (stokes), occurs frequently with this disease.

In the last several decades, in countries with resources, multiple improvements in the treatment of sickle cell disease has occurred which have improved the quality and quantity of people’s lives. These improvements have not occurred in Haiti on a large scale.

What could be done in Haiti to help kids with sickle cell disease?

1.Infection control and prophylaxis: Educate parents what they should watch for with their child with sickle cell. Fevers have to be respected. Immunizations to prevent bacterial and viral infections. This is not done in Haiti because the poor cannot pay for these “second generation” vaccines. Receive ongoing penicillin prophylaxis to prevent infection. Folic acid needs to be taken each day to build more red blood cells that are chronically being destroyed in the circulation of someone with sickle cell disease.

2.Pain management: Sickle cell disease is one of the most painful diseases on earth. The painful crises come and go. Narcotics are frequently necessary. This is not done in Haiti either.

3.Management of infection: Hospitalization is frequently necessary with appropriate blood tests, IV fluids, and powerful antibiotics. Where do poor people in Haiti go when their child needs to be hospitalized? Very few options exist at present.

4.Transfusion therapy: Blood transfusions and exchange transfusions need to be done. This can be safely done in the hospital setting, but in Haiti? Also, the transfused blood needs to be properly typed and screened and be free of infectious agents.

5.Hydroxyurea is a drug used all over the world to increase the amount of fetal hemoglobin which helps the patient with sickle cell disease. It is not available in Haiti for the poor. Hydroxyurea even decreases the incidence of strokes. A child with a stroke is always bad news.

Once again, Haiti’s medical system and the international community are failing Haiti with another disease. Haitians have big problems with sickle cell disease and it should be a priority.

A Child's Hope

This child, in one of Haiti's orphanages, is looking up. He wants someone to hold him and form him and give him a viable future.

In The Lancet, September 18, 2006, Jens Stoltenberg the Prime Minister of Norway, made these remarks:

"The health of our children affects the economic health of our nations. It makes sense. A healthy child can attend school, and his or her cognitive development and performance can be enhanced. A healthy child can give a helping hand at home and to younger children. When a child survives, the parents need fewer children to ensure their own suport in older age."

"More than 10 million children die each year from diseases that are largely preventable and treatable. More than 99% of these deaths are concentrated among the world's poorest families."

Mahatma Gandhi said, "A man or the government of a country can only be judged by its actions."

Pediatric Pneumonia in Haiti

I admitted three little girls from the clinic this morning to the hospital with pneumonia. The little girl pictured in this post appears to have pneumonia caused by tuberculosis. There are multiple causes of pneumonia including bacteria, viruses, fungi, and parasites.

More than 150 million episodes of childhood pneumonia occur every year in the developing world, accounting for greater than 95% of all new cases worldwide. More than two million children less than five years old die each year in places like Haiti. Pneumonia kills more children than any other illness.

Less than 20% of children worldwide receive antibiotics and only about one half of all children with pneumonia receive appropriate medical care.

Key preventative measures include adequately immunizing the child with Hib (Hemophilus) and pneumococcal vaccines. Haiti provides neither vaccine to its poor population. Adequate nutrition containing zince and encouraging the mother to breast feed help prevent pneumonia. In symptomatic HIV infection, daily administration of trimethoprim-sulfamethoxazole reduces death from pneumonia caused by Pneumocystis.

Cabaret Baby

While doing check-ups on babies in an orphanage, the diretor of the orphanage told me this baby was abandoned on a garbage dump near Cabaret, Haiti when he was just a few months old.

The director accepted him after the Haitian department of adoption pleaded with her to do so. Haiti has hundreds of thousands of orphans. They all need help. They all need a home.

Cabaret baby checked out great.

Medical Search Engines

I feel real guilty when I sit at the computer and go to my favorite medical search engine. Working in Haiti plays with my mind all of the time.

For example, if I search “pediatric pneumonias” I find all of the latest information that exists. The search engine tells me how to diagnose pediatric pneumonias, which microbe is most likely the cause, what the chest x-rays look like with this type of pneumonia, and which babies with pneumonia should be hospitalized. Everything is nice and neat and the protocols have been developed by specialists that rate their recommendations for clinicians in the trenches like me.

I am very appreciative of the physicians and scientists and researchers who compile information and put it into easily understood written material on search engines for me.

In Haiti, it would be nice to have a search engine available that would give recommendations regarding issues such as these:

1.What does the physician do when the mother can neither read nor write?
2.Who should pay for the chest x-ray for the baby when the mother has no money and no food to give her children?
3.Who will pay for medication when it is needed to treat the pediatric pneumonia?
4.When should I ask the mother and baby to return to the clinic because travel is dangerous and mother needs money for transportation and for the follow up visit for the baby?
5.Who will take care of the mother’s children at home while she is taking her sick baby to the doctor?
6.Who will make sure the mother understands the proper dosing of the baby’s medication including acetaminophen which comes in all different strengths?
7.Where will the mother find clean water to add to the antibiotic powder and where will she refrigerate the medication?
8.Who will sit down and spend some time with the mother explaining the issues regarding the baby that would warn the mother that the baby is failing outpatient therapy?
9.If I "elect" to admit the baby, who will pay for the admission to the hospital? Also, how will mom tell her family that she will be staying with the baby and not returning home for a few days?

If I do a Boolean search, should I search “pneumonia and pediatric and illiteracy and no money and no support and Haiti"?

Eugene

Several mornings ago in clinic, a little girl about four and one half feet tall appeared in front of my desk holding a baby on her hip. I glanced down at one of the dossiers in front of me and asked the girl if the baby’s name was Eugene. She said yes. I asked her where the baby’s mother was and she replied that she is the baby’s mom. Believing that she had not understood my heavily accented Haitian Creole, I asked her again where the mother was. She assured me that she is the mother. I could hardly believe my eyes.

The mother, whose name is Mikerlange, had a beautiful smile, was very polite and not demanding. She is 16 years old. She just wanted her baby to get better. She answered questions regarding two year old Eugene as a seasoned mother would do.

Eugene has had a fever, cough, diarrhea, and lack of appetite. She stated that she and the baby live with her grandmother. Her father is dead and her mother is a domestic and lives in the house that she cleans. Mikerlange rarely sees her mom.

Mikerlange said that she does eat when her grandmother can find them some food. Like most poor Haitians, they have no food in the house. When she offers Eugene food---rice and beans--- he refuses and takes only sips of water. She cannot remember the last time he ate anything.

Eugene’s exam revealed that he weighed 12 pounds and had a fever of 102.5F. He was very irritable and did not want to be examined. He swung at me with his tiny hand.

A chest x-ray revealed pneumonia near the heart margin on the right side.

Eugene and his mom are really not unique in the clinic or in Haiti, except that his mother is quite young. She has no social systems supporting her and her baby in Haiti. She has nothing except her grandmother. Eugene is dying from lack of food and pneumonia. He had no where to go except to his grave. He did not meet the criteria for admission in many Haitian hospitals, so I had one choice…and so did Eugene---I called Chris Nungester.

Chris and Hal Nungester are use to bailing babies out of trouble as well as helping troubled doctors when they have no where to send sick and dying children.

Chris drove to the clinic, picked up Eugene and Mickerlange, and drove them to the orphanage. We worked out a medical plan for Eugene.

Of course, Mikerlange loves the orphanage. She is able to give Eugene the basic care he needs as she watches him receive needed antibiotics and rehydration fluid. Mikerlange will actually chew up food and give it to Eugene to swallow because he is too weak to chew.

Eugene is making slow steady progress over the last several days. Will he survive? Only God knows. But H.I.S. Home for Children and his little mom are giving Eugene the chance that he deserves.