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| Photo by John Carroll--February 25, 2012 |
Sunday, February 26, 2012
Saturday, February 25, 2012
Cite Soleil
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| Photo by John Carroll--February 25, 2012 |
Que lastima!!
Tuesday, February 21, 2012
Deconstruction of a Haitian Heart
Beth
Teledjol is a Haitian word which means gossip or rumor mill. It is the way news is spread in Haiti. Facebook is here too but teledjol is still king.
When Haitian Hearts comes to Haiti it doesn’t take long before we are seeing patients with heart problems.
The other day a polite 16 year old girl showed up with a “heart problem”. I will call her Beth.
Beth came with her mother who does laundry at a hotel in Port-au-Prince. Mother makes 5 dollars per day and she commutes a long ways via public transportation.
Beth lives in downtown Port-au-Prince with her mother and siblings in a place called Carrefour Feuilles.
Beth told me that in October, 2011 she became short of breath and started coughing up blood. She was hospitalized in LaPlaine for ten days and got better. Her doctor told her she had a heart problem and started her on a strong diuretic (furosemide).
However, Beth told me that she is still short of breath with exertion. She takes her furosemide daily, but she does not know the dose and only had a couple of pills left in a crumpled tiny baggy.
At the appointment with me Beth did bring her chest x-ray and an echocardiogram. Both had been done last fall when she was sick.
I like to talk with patients and examine them before I look at their test results. I want to make my diagnosis with just the history and physical and quantitate a pre-test probability of disease BEFORE I look at test results. Test results can lead physicians astray because tests frequently "lie" and test results need to be combined with the patients exam to arrive at a proper diagnosis.
Beth appeared calm and not short of breath. Her oxygen level (pulse oximeter) was 98%. Her skin was warm and dry.
However, Beth’s blood pressure was bothersome. It was 132/50 in her right arm. That sounds good, but there is too much of a gap between the top (systolic) and bottom (diastolic) number. And in Haiti that frequently means that her aortic valve is not competent. In other words, her aortic valve may be leaking which allows blood to flow in the reverse fashion when the heart is resting between beats. This allows too much blood to flood her main pumping chamber (left ventricle) with blood which can hurt the chamber over time because of volume overload.
Her neck did not reveal any distended neck veins. This was good because it means that the venous return of blood was entering the heart unobstructed-- not blocked from a totally failing heart.
Beth’s heart exam revealed a heart that was slightly enlarged. And sure enough, listening along the left border of her sternum revealed a high-pitched decrescendo murmur during diastole..which meant that her aortic valve is leaking.
Inching the stethoscope out to the apex of her heart below her left breast revealed another murmur. It was loud, medium pitched, and radiated to her left armpit. This told me that her mitral valve was also leaking.
In Haiti these findings mean that Beth most likely had at least two bad heart valves from rheumatic fever that she unknowingly acquired as a child. (Rheumatic fever is caused by strep throat that is never treated with penicillin. The body’s immune system attacks the strep bacteria and can attack the heart valves at the same time.)
So I peeked at her chest x-ray. It showed a slightly enlarged heart (not too bad) and a big left atrium (not too good). This meant that her mitral valve was indeed leaky and maybe tight (stenotic) too. The good news about her chest x-ray was that her lung fields are clear...no fluid in the lungs.
Her echocardiogram, which cost her mother $80 US here in Port-au-Prince, showed both her aortic valve and mitral valves to be diseased and leaky, but the function of her heart muscle is good. The left ventricle is beating well because the heart muscle has not been damaged to the point where it is stretched so much that it can't contract efficiently.
So what now?
Beth needs heart surgery. And she needs it sooner rather than later. She does not have the cardiac cachexia brought about by a severely weak heart...yet. She can still withstand the organized assault of heart surgery.
Haiti is in shambles. Her heart surgery cannot be safely done here.
So I told Beth and her mother to start working on obtaining her Haitian passport and Haitian Hearts would start looking for a medical center to accept her.
I also started her on other medications to help her heart beat stronger, diurese more fluid, penicillin to prevent further rheumatic fever, and an aspirin to keep her blood thin so she does not form a blood clot in her distended left atrium and have a stroke.
And all of this was caused because she lacked basic health care. No treatment for a sore throat when she was a kid.
John A. Carroll, MD
www.haitianhearts.org
Monday, February 20, 2012
Sunday, February 19, 2012
Saturday, February 18, 2012
Why We Bring Haitians to the States for Heart Surgery
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| Photo by John Carroll--February 18, 2012 |
Including this dying lady, there are four adult patients in the tiny internal medicine unit. St. Catherine's is the only hospital for hundreds of thousands of people in Soleil.
Monday, February 13, 2012
Patient "154" Arrives in USA Today for Heart Surgery
Haitian Hearts patient number 154 arrives today for heart surgery.
Many thanks to his family in Port-au-Prince for never giving up on him and to Miss Ginny and Miss Amy for supporting him through some tough times.
More later.
Many thanks to his family in Port-au-Prince for never giving up on him and to Miss Ginny and Miss Amy for supporting him through some tough times.
More later.
Thursday, February 09, 2012
Impunity in Port-au-Prince
(Photo by John Carroll)
Impunity in Port-au-Prince
By AMY WILENTZ
Port-au-Prince, Haiti
IT has been painful to watch as Jean-Claude Duvalier, who inherited the brutal dictatorship that once ruled Haiti, swanks around the hot spots of Port-au-Prince, flanked by the dregs of his regime — including former members of the dreaded secret police, the Tontons Macoute — as if he were just another member of the capital’s thoughtless, partying elite.
Since his return in 2011 from a 25-year exile, Mr. Duvalier — Baby Doc — has managed to insert himself into semi-polite society, even finagling a seat near the new president, Michel Martelly, at the memorial ceremony for the victims of the 2010 earthquake. The president has filled many positions in his government with former Duvalier officials and their relatives. In short, he is rehabilitating Mr. Duvalier — and along with him, the extrajudicial code he and his father, François Duvalier, governed by. Last month, Mr. Martelly proposed a blanket pardon of Baby Doc — who has been accused of corruption and human rights abuses — telling The Associated Press, “I do believe that we need that reconciliation in Haiti.”
A day later, after a cry of indignation from Haitian and international groups, he claimed he had been misunderstood. But it turned out his pardon wasn’t even necessary. On Jan. 30, the investigating judge on the case recommended that all human rights charges against Mr. Duvalier be dropped and that he be tried instead in a lesser court on charges of financial malfeasance. Amnesty International called the investigation “a sham.”
It is the continuation of Haiti’s tradition of impunity (the veiled meaning of “reconciliation”) that has led directly to the convulsed, inconclusive and violent gyrations the country has made in its attempt to move toward democracy since the overthrow of Baby Doc. Haiti will not achieve real democracy if its justice system remains unwilling to condemn the crimes of the past, punish the perpetrators and make it clear that such abuses will not be tolerated in the future.
In nearly 30 years of power, the Duvalier regimes offered impunity for their operatives. The army and the Tontons Macoute committed gross violations of human rights, including arbitrary arrest, prolonged incarceration without trial, starvation and torture of political prisoners and the persecution and killings of their associates and families.
The violence persisted after Baby Doc fell. While he and his family fled to France aboard a United States cargo plane, crowds wielding rocks and machetes destroyed the homes of known Duvalierists and hunted down and killed dozens of Tontons Macoute.
They did this, a Haitian friend once explained to me, because they knew the courts could not or would not bring the Tontons Macoute to justice. These killings were mostly revenge murders — score settling — and no one in the crowds was jailed or prosecuted for them.
While the country was ostensibly laying the groundwork for democracy, known perpetrators of human rights abuses were only occasionally arrested. Most were promptly released; many escaped. Few have been brought to trial, and even fewer convicted.
In 1987, elections were aborted when a mob of former Tontons Macoute descended on a polling place and slaughtered 34 voters. More were killed in other polling places. It took nine years for Claude Raymond, the former head of Baby Doc’s army and the suspected mastermind of those attacks — if one can use such a term — to be arrested. (In that time, he even presented himself as a candidate for president, though he was excluded from participating in the elections.) He was never tried and died in prison in 2000.
In 1991, Haiti’s first fairly elected president, Jean-Bertrand Aristide, was ousted from office, and in 1994, at least 23 of his supporters were killed by paramilitary forces in Raboteau, a shantytown on the western coast. In 2000, after Mr. Aristide returned to power, 16 of the perpetrators were arrested and found guilty. But after he was overthrown and exiled for a second time, Haiti’s supreme court overturned 15 of those convictions. Only one person connected to the attacks has been incarcerated; he was tried and convicted — of mortgage fraud — in New York. Another person tried in absentia had his Florida lottery winnings garnished and distributed to victims of the massacre.
Today, besides a few bright points — like the conviction last month of eight police officers for killing prisoners after the earthquake — impunity remains the country’s fallback position. It has made a functioning justice system, and therefore democracy, impossible.
That’s why Mr. Duvalier must be prosecuted for his crimes against humanity. If they are dismissed, it will send a cheering message to past and future perpetrators of similar abuses. If he is tried and convicted, those who have relied upon impunity will know that they, too, risk a turn in the dock.
The Haitian people want justice, and the international community must support them. Two days ago, on the 26th anniversary of the overthrow of Baby Doc, a small but vocal crowd of his regime’s victims protested in front of the Palais de Justice. They painted the words “Aba impinite” — down with impunity — in blue spray paint on the court’s white wall.
Amy Wilentz is the author of “The Rainy Season: Haiti Since Duvalier.”
Tuesday, February 07, 2012
Tuesday, January 17, 2012
Wednesday, January 11, 2012
Monday, January 09, 2012
Saturday, January 07, 2012
Frederick Douglass
As Frederick Douglass noted, “It is easier to build strong children than to repair broken men.”
Thursday, January 05, 2012
Homicide Rate in Haiti Less than Peoria
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| Photo by John Carroll |
See this article from CHAN website---
Homicide Rate Study Challenges Mainstream Portrait of a ‘Violent’ Haiti
By Roger Annis
Published in Haiti Liberte, Jan 4, 2012
The 2011 Global Study on Homicide by the UN Office on Drugs and Crime (UNODP) has published its world survey for 2011. Its published figures on homicide rates place Haiti very low in comparison to the other countries of the Caribbean and Latin America.
According to the study, Haiti's homicide rate in 2010 was 6.9 per 100,000 population. That compares to Jamaica(highest rate in the Caribbean) at 52, Trinidad at 35, the Bahamas at 28 and neighbouring Dominican Republic at 24. The rate for the U.S. colonies of Puerto Rico and U.S. Virgin Islands (2007 statistics) is 26 and 39, respectively.
The highest murder rates in the world are in Honduras (82), El Salvador (66), Belize (42) and Guatemala (41), all of which are U.S. client states. (By comparison, Nicaragua's rate is 13, Mexico's is 20 and Brazil's is 23 (2009 figures)). Haiti's rate is only marginally higher than the U.S., which is 5.
The UN report does not contain figures for Haiti for the two years of illegal, foreign-appointed government in 2004 and 2005. But during the four years of elected government from 2000 to 2004, the annual rate was high, between 15 and 20. These were the violent years in which paramilitary forces assaulted ordinary Haitians and governing institutions in the destabilizing prelude to the overthrow of the government of Jean Bertrand Aristide in February 2004.
The Global Study on Homicide brings together global, regional, national and sub-national homicide data in one publication. While not necessarily indicative of overall, relative crime figures in each country, it is perhaps the closest that is readily available. Homicide is a very specific, illegal act, the "crime of crimes" that is easily quantified. Other violent crime statistics compiled by the UNODP have two great disadvantages. One, the reporting from countries by the organization is incomplete. Two, definitions and measurements of the different categories of violent crime vary from country to country, as does the capacity to record them.
'Violence' as justification for military occupation
The foreign military intervention that facilitated the overthrow of Aristide in 2004 and became institutionalized through the UN Security Council military force called MINUSTAH has always justified its actions by saying that foreign soldiers are needed to save Haitians from themselves. Officials of the United Nations in Haiti as well as the embassies of the U.S., Canada and Europe never cease to claim that Haiti is permanently threatened with descent into chaos and violence.
International media typically chimes in with its own versions of this fable. Yet, the homicide figures for Haiti fly completely in the face of these claims.
This double speak deliberately confuses and conflates the so-called violence of legitimate protest demanding social and political rights, including measures of self-defence, with the violence of the wealthy elite of Haiti and its backers in the U.S., Canada and Europe as they conspire to keep Haiti poor and keep poor Haitians marginalized in their own country. Thus was the ‘violence’ of the 2000-2004 destabilization period and coup d’etat presented.
Since the earthquake, reporting of popular protests against the ongoing military occupation of MINUSTAH or the slow pace of earthquake aid and reconstruction often suggests, subtly or more brazenly, that descent into chaos constantly looms.
Contemporary media presentations of Haiti sometimes remind the reader of Haitian history of news reporting in the 19th century or early 20th century when naked colonialism still ruled in the colonies or ‘spheres of influence’ of the U.S. and Europe. Newspapers of that era regularly warned of inevitable violence and pillaging by Black people against any and all social order should they succeed in attaining their freedom.
The reported homicide rate for Haiti raises an obvious question: If the rates of crime and violence in Haiti are exponentially lower than neighbouring countries, why, exactly, is a seemingly permanent UN military occupation force of 13,000 foreign soldiers and police in the country in the first place?
Wednesday, January 04, 2012
Where did the Money Go?
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| Photo by John Carroll Cite Soleil |
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