Twenty-Eight and Counting

Twenty-Eight and Counting

I counted the number of kids and young adults on the Haitian Hearts list today that need heart surgery. There are 28. The cases are evenly divided between congenital heart disease and rheumatic heart disease. They all need heart surgery.

Some of the 28 patients are OSF-SFMC patients that have been operated in Peoria. OSF refuses to care for these children now. They will die without surgery and other medical centers don’t really jump at the chance to operate international children that have been operated somewhere else. So these Haitian Hearts patients are really in trouble. I examine them here and Haitian Hearts pays for their medication from Peoria, but they need the surgical cure.

Pictured above are four patients that are representative of the 28 on the list that need heart surgery.

The girl at the top is Mirlande. She has the beret with USA printed on it. She is 14 years old and has been short of breath for two years. She can’t walk up a hill very well at all and Port-au-Prince is built on the side of a mountain. Mirlande has a leaky mitral valve that was caused by rheumatic fever that has put her in chronic congestive heart failure. She needs a new mitral valve.

The baby boy below Mirlande, being held by his father, is Ocean. He is 14 months old. If you look closely, you can see that his left chest is larger than his right chest. The reason for this is that his heart is large and pushing the left side of his chest outward. He has a very ominous sounding murmur due to a hole between the lower chambers of his heart called a ventricular septal defect. Each time his heart beats, it sends too much blood to his lungs and too much blood back to his heart. He needs the hole patched in surgery. A good pediatric heart surgeon and team can do this very easily. Before the heart lung bypass machine was available, cardiologists around the world knew their patients had ventricular septal defects, but could do nothing about it except treat them medically. At autopsy, the hole could be seen quite easily. If Ocean does not have surgery, it will not be due to lack of heart lung bypass machines. The technology is in the developed world to help the pediatric heart surgeon perform successful surgery. The problem is the will is not there to help kids like Ocean.

The third photo down is Joseph. He is 16 years old and has rheumatic heart disease that has destroyed his mitral valve. He needs surgery very soon or he will die. He is an excellent student, has a passport, and is ready to travel.

The last child on the list is Jhiny. She is 14 years old. I examined her for the first time and she has a hole between the upper chambers of her heart. This is called an atrial septal defect. She is chronically short of breath. You can see that the left side of her chest is larger than the right side because her heart is sick and enlarged. She needs surgery too. Interestingly, a medical center in the United States evaluated her echocardiogram four years ago and sent her mother a letter stating that Jhiny was "invited" to their medical center for repair for a mere $27,500 dollars but if she stayed longer than seven days, she would be charged $1,500 dollars per day. This seems kind like a cruel letter to send. Her Haitian mother could not afford this since her income is less than $100 dollars per year. So Jhiny is four years sicker.

If anyone out there in cyberspace has any ability to help these kids, please do so soon. If you have a good contact with an administrator or someone who sits on the board of a medical center, please contact them. As a rule, physicians love to take care of international patients, especially kids with heart problems, and will waive their fees.

Thank you.

John Carroll, MD
drjohn@mtco.com
309-648-1087

Guns in Sun City

Guns in Sun City

At night in Port-au-Prince, my wife and I watch the sunset over the ocean. It is beautiful from where we are sitting, but we know all is not well below us in the slum. Cite Soleil (Sun City) is a slum built on a garbage dump on the Bay of Port-au-Prince. We often hear gunshots from automatic weapons coming from that direction. The sounds are very scary to hear and we are two miles away.

Who is shooting? We never know, but we do know the guns are powerful. It could be coming from the gangs in Cite Soleil or from MINUSTAH, the acronym for the United Nations forces in Haiti. The UN forces are at about 8,000. Haiti’s national police do not have the weapons or the training to take on the gangs in the slum and won’t go near them. Almost, no one, except people that live in Soleil can come and go, and they do so only with trepidation.

Two weeks ago President Preval asked the gang leaders to turn in their weapons in an attempt to restore order in this country of constant chaos plagued with armed robbery, car jackings, and kidnappings in the middle of the day. President Preval made it clear that blood would be shed if the guns were not turned over. The gang leaders responded that they would turn in their guns yesterday, but then changed their minds. The gangs blame MINUSTAH for continuing their violent assaults in the streets of Cite Soleil and their leaders state that MINUSTAH doesn’t really want “peace and disarmament because they want a justification for their presence here (Haiti).”

Several months ago, my wife and I “toured” Cite Soleil with the protection of two gang leaders. Soleil looks and smells horrible as usual, but the pock marked bullet ridden buildings are very scary and sad to look at. This dump is the home for hundreds of thousands of people. The gang leaders insisted that all they want are jobs which can provide them with enough money to feed their families.

Each morning in clinic, I see babies carried by their mom or dad who have walked out of Cite Soleil that morning, sometimes dodging bullets, to get rudimentary medical care for their child. They are risking their sick baby’s life and their lives to venture out of the slum. The parents act like parents in the states. They want the best for their children and will do anything they can to provide it including going through gunfire to get it. I often ask myself what that parent would be doing in the United States. Would they be using a computer, would they be working in a bank, or would they be a mechanical engineer? These parents have no real jobs even though they work all the time to put a little food on their children’s plates at night. But their hopes for their children are the same as ours.

When people with big guns fight, the little people are always caught in the middle. The kids that cannot go to school, get a good meal, or obtain basic medical care, suffer the consequences. A simple medical problem can and does become life threatening as the guns keep firing in Sun City.

Two Haitian Babies on Hunger Strike

Two Haitian Babies on Hunger Strike
Port-au-Prince, Haiti
August 9, 2006


Two Haitian babies from Port-au-Prince are on a hunger strike. Blackson, aged seven months, and Saintvil, aged four months, are the two babies identified. Authorities believe that hundreds of thousands of other Haitian babies are in hiding and doing the same.

Blackson is from Cite Soleil. His main dislike is the continuing violence in his slum that has not allowed his mother to sell crackers and soda on the corner to earn enough to buy him any powdered milk during the last month. Her milk is gone with her own medical problems. Gang violence is the main problem with nearby shootings occurring almost everyday. But Soleil has never been good since it was built on a garbage dump on the edge of the ocean, and most residents have no clean water, enough food, electricity, work, schooling, medical care, or hope. Blackson’s mother is 19 years old and reports that he has a fever, his hair has turned orange and is falling out, and his skin is swollen. He is also refusing the baked mud pies that she makes for him each morning

Saintvil is from downtown Port-au-Prince close to St. Joseph’s Church. Saintvil’s mother is 16 years old and takes him to a free medical clinic run by the Missionaries of Charity sisters on Saturday mornings. He is one of 500 babies that show up. Like Blackson, Saintvil has orange hair and a high fever. He also has sores that have crusted and become bloody scabs over much of his body. Saintvil’s mother reports that he has bloody diarrhea and has a nasty cough. His blood count appears very low with his skin appearing almost white. He refuses to eat for similar reasons as Blackson.

Both babies declined treatment at the General Hospital in Port-au-Prince and insisted on being taken to the Missionaries of Charity home for their care. Their mothers report that they are very upset with the shooting of a sister in a city two hours north of Port-au-Prince over the weekend.

Blackson and Saintfil refused to be interviewed for this story.

"Secretary Annan, Ferna is Dead..."

Attention: Secretary-General Kofi Annan, United Nations


Dear Secretary Annan,


Pediatric Clinic in Port au Prince this morning began as usual. The first baby was seven months old, had a fever, and was breathing 84 times per minute. Both lung fields had wheezing and crackling sounds. The baby was fussy but not especially toxic appearing. I took him to the rehydration room and started bronchodilator aerosol therapy which he seemed to like. The baby was also given a shot of a strong antibiotic and sent home to return tomorrow.

The second baby was a four day old that I saw yesterday with a fever of 103. The baby had been born at home with a midwife (matron) helping with the delivery. The only source of fever that I found was an umbilical cord that was tied off with a dirty piece of string. The matron had cut the cord with a Gillette. I gave this baby a big dose of antibiotics and advised the mother that fever in a baby this age could be very dangerous and even deadly. As she promised, she returned to the clinic today. The baby was afebrile today and looked ok. We changed the umbilical dressing again and gave the baby another shot of antibiotics.

Secretary Annan, as I was beginning to call the third patient into the room, my office door burst open. Falling into the room was the sobbing mother of Ferna who we admitted to the hospital in April. Her face was contorted in pain, sweaty, and tears were flowing as she was screaming, “Ferna died!” I tried to deny this was happening, but after so many years in Haiti, I knew almost immediately this was indeed happening and this is how death takes Haitian children and destroys their mothers. Ferna’s mother is named Yanick.

I literally drug Yanick into my office as she knelt on one knee and sobbed uncontrollably. I closed the door as all the mothers and babies in the waiting area were witnessing the grief of this young mother. I stood over her and rubbed her back not knowing what else to do. Her shoulders were shaking in grief. She told me that she had just come to the hospital across the street to visit Ferna and was told by the nursing staff that Ferna had a seizure and died last night. Ferna’s bed was empty. She had lost her ten month old precious child.

After several minutes of talking, I was able to lift her into the chair where children and their mother’s sit and tried to calm her down some more. Nurses came in the room and put dossiers on my desk barely recognizing the sobbing 29 year old mother in front of them. It wasn’t a sign of rudeness on their part. It was just another routine day in a Haitian pediatric clinic.

Secretary Annan, my heart and insides were repulsed with everything. I didn’t want to see any of the patients or their dossiers that were quickly piling up on my desk. I just wanted to leave. But I knew that would be wrong for many reasons.

After a few more minutes I helped Yanick to the exam table in the office where she laid down and with coaxing was able to slow her breathing. Profuse sweat and tears still flowed freely as she wailed again and again, “Oh Jesus! Ferna is dead”. Her eyes searched my eyes as if she was asking if what she was saying was really true. The pain on her face was so deep.


I noticed that on the floor next to my desk was a piece of cloth that the mother with the febrile infant had accidentally dropped on the floor when she left my office. I poured cool water on this cloth and placed it on Yanick’s forehead and temples and covered her eyes.

I told her that Ferna was in Heaven and would watch over her now in Haiti and that God wanted her and she couldn’t question that. I told Yanick that Ferna would now help her when she fell under Haiti’s heavy load. She nodded her head. Tears rolled down the side of her face under the wet cloth, but she said nothing. This was all very horrible.

I made the decision then that I needed to get it together, as Yanick had done, and see patients that were waiting. I let Yanick lay there while I examined children all morning and gave their mothers advice. I wondered what Yanick was thinking about all of my “advice” at that point.

The mothers would stare at Yanick as she laid about 8 feet from them as I examined their children. Word had spread in the waiting area that she had lost her baby. No one offered any sort of support for her whatsoever. They all had their own problems with their sick little ones. Severe poverty everywhere is paralyzing.

During the day, I changed her wet compress frequently. Yanick continued to lay supine and remained silent. She may have gone to sleep. Towards the end of the clinic, I offered her Coke which she sat up and drank and then laid back down.

Yanick and her husband come from a city an hour north of Port-au-Prince and had rented a tiny room in a nearby slum named Jeremy City. She needed to get back to the slum to call her husband, who she thought had gone home, and tell him of Ferna’s death. Ferna’s little body will be held in the morgue at our hospital and then transferred to the general hospital morgue downtown where her mother and father will have to retrieve it if they want to bury her near their home. Another problem is they need to hire an ambulance to transport their daughter because no tap-tap driver will knowingly take a corpse. That, of course, is an expensive ordeal and is the reason some Haitians take their loved ones home from the hospital right before they die so they don’t incur the cost of transporting the body. The last few days, Yanick seemed quite concerned when she came to the clinic to visit, but Ferna’s death was not anticipated.

As Yanick and I prepared to leave the clinic, the head nurse told Yanick to protect me because of the frequent kidnappings in the capital as I walked her to her slum. Yanick promised she would as her body was still shaking in distress from her daughter’s death. At that point, I did not know who was helping whom.

Secretary Annan, Yanick and I left the clinic and headed out onto the street that runs in front of the hospital. The sun was out in full and helicopters were circling above us with your arrival and first visit to Haiti. How did Port-au-Prince look from the air?

As we walked up the crowded street Yanick started to weave and began crying again. I lightly held her right elbow. Many people watched us as we proceeded. A number of women tried to help her and talk to her as she kept repeating, “Ferna is dead”. After we walked one half mile one of her leather sandals fell apart and she walked barefoot on the hot cement until another lady retrieved her shoe, fixed it with a piece of wire, and Yanick slipped back into her pathetic sandals.

We soon turned down a paved road as Yanick pointed to the left and after walking another quarter mile arrived in her horrible slum. I asked Yanick if we were close to where she and her husband were staying and she said yes. Dust, squalor, dogs, and debris were everywhere. A few feet later, she began pounding on a door and screamed wildly. The door was opened slightly by a woman and we slipped inside.

There were about 5 adults and 3 kids in a small central area with the whole compound about 40 square feet. The heat inside was unbearable. Their seemed to be no air circulation. Two babies were perched on a green army cot and a smiling eight year old boy was squatting next to them on the dirt floor. The roof was corrugated steel, and three of the four walls were slapped together with steel and pieces of plywood. The fourth wall was made out of 10 foot high compressed garbage.

Yanick immediately began jumping up and down in the dirt, barefoot and screaming that her baby had died. The adults looked at her but only the lady that let us in did anything. She gave Yanick two tablespoons of real strong appearing cold coffee loaded with salt, as Yanick fell into a broken metal chair. Amazingly, a 20 year old looking man was sitting in another beat up chair a few feet away receiving a pedicure from a teenage girl who barely looked up from her job.

Someone told Yanick that her husband was in their room. This startled both of us and she walked about 15 feet around the side of the compound. I followed her and looked into a small dark room and saw her husband lying on a thin cloth mat on his stomach. He looked up just briefly at us as Yanick screamed about Ferna’s fate. He then put his head back down and said nothing.

After about 15 more painful minutes, I felt my contributions were extremely minimal at this point, and told Yanick I would see her back at the hospital in the morning. We would talk about what to do with Ferna.

I felt no fear from anyone walking out of the slum that has been the home for this mom and dad as they visited their hospitalized daughter almost everyday since April. What I witnessed today will forever be etched in my brain. The pain of the poor is horrifying. I have seen many babies die in Haiti, but Yanick’s total desperation, grief, and loneliness in a city of three million people were too much.

Ferna had congenital heart disease and tuberculosis. She put up a great fight but the cards were stacked against her from the beginning. We couldn’t find a hospital for her in the United States to repair her heart. Ferna gave us time, but we who have everything didn’t come through.

Secretary Annan, as I walked home, the helicopters continued their security checks as you were arriving to meet with Haiti’s leaders. The misery on the ground is intense. We all hope your meetings with Haiti’s new leaders will be productive.

Sincerely,

John A. Carroll, MD

Ferna

In April we examined a seven month old Haitian girl in the clinic in Port-au-Prince. She only weighed nine pounds and had been having fevers and labored breathing. She was brought to the city by her mother from her home about an hour north of here. Her name is Ferna.

Ferna’s exam revealed a loud murmur over her chest. A murmur is “audible turbulence” from flow of blood through the heart. Some murmurs are considered innocent and others signify real disease. Ferna’s murmur definitely reflected real disease. She also had a fever and crackles in her upper portions of her right lung which most likely meant she had some type pneumonia.

I told Ferna’s mom that she needed to be admitted to the hospital across the street from the clinic. Her mother was very happy to receive the news that her daughter would receive care. However, there was no room in the pediatric section of the hospital, so she and Ferna slept in the hospital courtyard that night and Ferna was admitted the next day.

Her chest x-ray revealed a large heart due to congenital heart disease and her lung fields were filled with an infiltrate that appeared to be tuberculosis.

Several months have passed since Ferna was admitted and she remains in the hospital which is the best place for her in Haiti because she is fed nutritious food prepared in the hospital, gets her medication each day, and her mother gets to visit her. She has been placed on the national Haitian tuberculosis regimen for which is three drugs for two months followed by two drugs for the following six months. Her fevers have abated and she looks some better.

However, her congenital heart disease persists and her echocardiogram performed here in the capital shows a hole in the wall between the lower chambers of her heart which allows too much blood to circulate through her lungs with each heart beat. Therefore, she is taking diuretics to keep her lungs dry.

So now what? Do we successfully treat her tuberculosis and discharge her to her city north of here so she can die from her congenital heart disease that can only be repaired with surgery? If that is the case, why are we treating her tuberculosis so aggressively so she can die from another treatable disease?

Paul Farmer and his colleagues have proven that treatment of multidrug resistant tuberculosis and even HIV is possible to successfully do in resource poor settings, such as Haiti. Treating these hard-to-treat diseases actually improves the general level of care given to poor populations. Who would have predicted this? Would performing heart surgery in Haiti some day increase the overall level of medical care? Extrapolating from Farmer’s research would say that it would.

So if developing world patients receive treatment for HIV and very hard-to-treat tuberculosis, why does Ferna not deserve surgical treatment for the tiny hole in her heart that is wreaking havoc on her circulation and will cause her death? What exactly is the down side to saving Ferna’s life?

I propose that Ferna be operated quickly in the United States. I also propose that no baby in the world should die from a hole in their heart in 2006 due to negligence from the world that has everything. The technology is available and a good repair of a mechanically deficient heart can lead to many good years for the child. With the obscene amount of money spent in the developed world for cosmetics, dog food, cigarettes, and military expenditures, developed countries have no excuse not to operate these children from around the world and set up programs to teach developing world physicians the science of delicate pediatric heart surgery.

I also believe that skilled physicians in the United States that want to perform pro bono surgeries in their medical centers on babies like Ferna should be allowed to do so. Doctors need to do what is right and patching holes in babies that are slowly suffocating is the right thing to do. If Catholic hospital administrators disagree because of medical center costs, they need to figure a way to lower costs.

However, if only one doctor approaches hospital administration regarding operating a child from abroad, he or she can easily be rejected and marginalized. Physicians need to show a united front with the entire pediatric department demanding to treat international cases each year. If administrators disagree, they should be removed from their positions as the Ethical and Religious Directives for Catholic Health Care Services imply (Directive 5). Catholic bishops around the United States need to support these physicians and children like Ferna and not try and just appease the big Catholic Medical Industry in their diocese. The Catholic medical centers need to be challenged to do the right thing and act for the reasons for which they were founded---taking care of the poor who need their care.

The Haitian physicians and medical system are doing their best with Ferna. Her mother now hopes and prays for heart surgery for her baby daughter in the United States. In Haiti, the technology eventually needs to come here for complicated heart surgery that requires bypass. Haitian physicians need to be trained, and Haitian babies need to be operated here in Haiti by Haitian physicians. But in the mean time Ferna is not going to wait for all of us to make this happen.

The clock is ticking. Any advice on what I should tell Ferna’s mother?

When Grandma is Gone....

July 21, 2006

We are working at a clinic in Port-au-Prince right across the street from the hospital where we admit the sickest kids. We walk to this clinic in the morning and pass three Haitian police. The officers, one with an automatic rifle, stop the oncoming traffic to check the registration of the vehicles and verify the driver’s license. Several weeks ago a Haitian lady was attempting to stop a carjacking just outside our clinic in the middle of the day and was shot to death in the street by the thieves.

In the recent couple of weeks, the kidnappings have increased in the capital and all the Haitians tell us the “streets are bad”. Many memos on the internet talk of the renewed chaos and violence in Port-au-Prince. Dozens of kidnappings apparently occurred this month. Deposed President Aristide’s birthday was the other day, so he was blamed again for the violence, even though he now lives in South Africa. We were warned by an American friend, who was a kidnapped last fall, not to walk the streets in this part of PAP, and he offered us a vehicle he sent down for our use. But we feel safer on foot and taking public transportation.

Today was a potpourri of pathology in the Haitian pediatric clinic. All pathology is bad especially if you are the one that has it, live in Haiti, and almost no one cares.

One of our first patients today was a baby girl named Tamaika who weighed about ten pounds and was nine months old. She had been having vomiting and diarrhea for one week and had a temperature of 105 F. Her mother stressed the fact that she has no job or money and could not take the baby to the doctor before today.

The baby was obviously very dehydrated and severely malnourished. Her eyes were sunk and her skin tented when pinched. Her arms and legs were sticks—almost completely devoid of muscle. But, as a true Haitian would, she would swing her arms at me and fought when I attempted to examine her.

A baby like this can be septic along with the dehydration. We brought down Rocephin and gave the baby a big dose immediately and admitted the baby to the hospital for IV antibiotics, fluids, and work up.

A five year old girl, Cynthia, came with chief complaints of two weeks of shortness of breath, fever, lack of appetite, and crying with abdominal pain at night. Her attentive father and mother offered the history at the same time. The girl looked well developed but would scream out in an irritable fashion and then almost fall asleep the next second. Of note were the bounding carotid pulsations on the left side of her neck and the hyperdynamic pulse at her right elbow. This meant that her blood was so thin it was causing her vessels to expand and collapse quicker than normal thicker blood would do. Her conjunctiva where white and her tongue and mucous membranes were very pale. Her liver and spleen were very big and intimately involved in her anemia. Her heart rate was only about 100, so she had compensated for her anemia. In my opinion Cynthia had been this way for awhile. Sickle cell is most likely with some iron deficiency contributing to her severe anemia.

We admitted her also. Her blood was very thin and looked like pink Kool-Aid.
Her hemoglobin returned very low at 2.5 and her white count was very elevated at 59,000. Her father will need to go to the Haitian Red Cross and donate blood and obtain blood for her transfusion.

A beautiful five year old angel was one of our last patients and was brought in by her grandma who appeared to be about 60. According to grandma, the child’s mother had died one and one-half years ago when “she had abdominal pain and became thin” in a city 12 hours from Port-au-Prince. Grandma is now doing another family’s laundry in Port-au-Prince to support the little girl. The girl’s check up was pretty good except for anemia and pneumonia.

At the end of her exam the little girl kissed my wife Maria when she got a piece of gum. As grandma and the little girl left the room Maria wondered what would become of the little girl when Grandma is gone.

"I Can't Breathe"

Suze was a typical patient-- young, attractive, well spoken, and dying. Suze is Haitian and poor and when Maria and I saw her several years ago, she was very thin and barely able to walk due to severe shortness of breath with any exertion. Her heart exam revealed her mitral valve was not working right. She did not have long to live.

She told us how, not long before seeing us, she passed out one day and woke up on a gurney in and emergency department of a small hospital near her home in one of the slums of Port-au-Prince. She was staring out the slats of a window at her friends that were staring in at her. They had carried her limp body to the hospital after she had lost consciousness and taken up a collection of money to get her admitted for medication to treat her heart failure.

Suze survived and came back to the U.S. with us for a mitral valve replacement. Surgical intervention is usually necessary with people like Suze to give them long term relief from their symptoms. After surgery, her personality changed from someone who was waiting for death, to someone who is very happy to be alive.

In Haiti we hear this complaint all of the time: “I can’t walk up the mountain anymore”. Usually it is not from old people but from teenagers that have come to the clinic and have rheumatic heart disease. It breaks your heart to see these kids suffering so much. They want to go to school and be like normal kids--but they can’t due to their sick hearts.

Rheumatic heart disease has been around as long as strep throat has afflicted humanity. For some reason when one gets strep throat, the immune system can attack the heart, joints, brain, and skin. “Antigenic mimicry” and nasty strains of streptococcus are argued as possible causes for rheumatic fever, but no one knows for sure why some people get strep throat and do fine, and others are crippled with its sequelae. Any part of the heart can be attacked and damaged. We examine kids that had acute acute rheumatic fever when they were much younger and show up when they are 18 years old with valves that are destroyed.

The mitral valve is the valve most likely injured in rheumatic fever and may not close well or may not open well or a combination of both. These kids are in a world of hurt because as they years pass, they become unable to do much requiring physical activity because their lungs fill with fluid.

Rheumatic fever is a major public health problem in many developing countries like Haiti. Two-thirds of the world’s population is considered poor and this is where rheumatic fever is found. The magnitude of rheumatic fever in the developing world is the same as in the United States 60 years ago---before widespread use of penicillin. Rheumatic fever is not gone in the United States, but it is not the first thing I think of in an American kid who presents with joint complaints and fever.

There is a real danger that research regarding atherosclerosis in the developing world will divert resources and attention from rheumatic heart disease, cardiomyopathies, and tuberculous pericarditis. These are the three major causes of heart disease in Haiti and Africa. Of the nearly 2.4 million children with rheumatic heart disease living in developing countries, nearly half live in sub-Saharan Africa. According to Lancet, June 10, 2006, “They cause great morbidity and mortality in young, economically active people, but with isolated exceptions, they are largely neglected targets of epidemiological, etiological, and therapeutic research.”

The Lancet continues, “Eradication of rheumatic fever depends on social changes, including improved primary health-care services, elimination of poverty, better housing, and application of existing knowledge on primary and secondary prevention of the disease”.

There are many patients in Haiti that we are treating for rheumatic heart disease. Few will make it out for definitive surgical repair.

Health Disparities Between Races

June 17, 2006

In the USA, race and ethnicity are major factors predicting who will live a long life and who will not.

Lancet, June 10, 2006, reports that, "The life expectancy of an African-American man is 69 years, whereas that of a white man is 75.3. Infant mortality is 5.75 per 1000 livebirths for white infants, 14 for African-American infants.

Buried in Cement

June 17, 2006


The Miami Herald reported a story on May 27, 2006 titled “Embassy Denies Visa for Funeral”.

Menes Daniel, who left Haiti in 1981, died entombed in quick-drying liquid cement in a construction accident in early May. He and two other workers were working in the Bal Harbour high-rise building when the roof collapsed, sending a torrent of wet concrete over them. They died almost immediately.

Mr. Daniel’s funeral was scheduled for June 3 and his common-law wife and two children in Haiti applied for a temporary visa to attend his funeral.

The non-immigrant visa section of the American Consulate in Port-au-Prince denied their request for visas. His Haitian family were unable to provide any evidence of “ties to Haiti that would compel their return from the U. S.” They could not prove they had assets in Haiti to come back to from the U.S. Mr. Daniel had been wiring his family money for years so they could survive in Haiti while he worked in south Florida.

So now Mr. Daniel is dead, his family is stuck in Haiti, and his children will be seeing no more money from him. And his family cannot come and say good by to the man that allowed them to stay alive.

Poaching Nurses

June 14, 2006

Poaching Nurses

The Lancet medical journal June 3, 2006 contains an article “Poaching Nurses from the Developing World”.

The article gives grim statistics. The American Hospital Association reports that here are 118,000 current vacancies of qualified nurses in the U.S. Nursing schools in the U.S. do not have sufficient staff and 32,000 students were refused entry into Baccalaureate level nursing programs in 2005.

Developed countries have long looked upon the developing world as a nearly limitless source of willing labor to fill the nursing shortage. 50,000 nurses have immigrated to the US in the last decade. Most of the countries from which these nurses come are facing extremely serious public-health problems, including epidemics of HIV/AIDS, malaria, and tuberculosis. These are the same problems we see in Haiti everyday. Haiti and the rest of the developing world cannot afford to lose these nurses who frequently manage an entire ward of a hospital when there is no doctor available.

The Lancet reports, “Only 10% of the global burden of disease is concentrated in the Americas, but 37% of all health professionals work there”. A UN report reinforces that this brain drain of health workers is effectively subsiding care in the rich world. Clearly, further migration of workers will be disastrous for developing countries.

OSF-SFMC in Peoria and other large medical centers in the U.S. that attempt to lure nurses from their dirt-poor home countries should realize what they are doing. Diana Mason, editor of the American Journal of Nursing, said the main problem here is the “primary moral issue of draining these countries of their much-needed nursing resources and further undermine their healthcare infrastructure and the health of their people (and thus of their economies).” Mason states that a recent report by the Institute for Women’s Policy Research suggests that the nursing shortage continues as a result of collusion among hospital administrators to keep wages down and of longstanding gender-based wage discrimination. Can you believe it?

According to Lancet, the U.S. Congress should be creating ways to fund and strengthen the nursing infrastructure in the US, thereby developing a local workforce. Nursing salaries could rise and the poaching of nurses from the developing world would no longer be necessary. And most importantly, patients in the Philippines, Africa, and Haiti wouldn’t lie in their hospital beds without care.

Worms

Almost every child we examine in the clinic in Haiti has worms at one time or another. Their mothers mention that the baby defecates worms or coughs them up on a routine basis. I think the Haitian mothers report this with the same amount of emotion that a mother from the United States reports that her baby has the sniffles.
Haitian moms frequently state that the baby grinds its teeth at night or cries out in its sleep or complains of abdominal pain. Also, a depigmentation of skin where the nostrils join the face is another "telltale" sign of being infested with worms.

In Lancet May 6, 2006, the Seminar is "Soil-transmitted Helminth Infections". The article reports:

More than a billion people world wide are infected with at least one species of worm. Of particular interest are the roundworms, whipworms, and hookworms. They are considered together because it is common for a single individual, like the kids we examine in Haiti, to be chronically infected with all of these worms. Such children have malnutrition, growth stunting, intellectual retardation, and cognitive and educational defects.

These soil transmitted worms are one of the world's most important causes of physical and intellectual growth retardation. Yet, despite their educational, economic, and public-health importance, they remain largely neglected by the medical and international community. This neglect stems from three features: first, the people most affected are the world's most impoverished, particularly those who live on less than US $2 per day; second, the infections cause chronic ill health and have insidious clinical presentation; and third, quantification of the effect of these infections on economic development and education is difficult.

So as soon as the Haitian babies quit taking their mother's milk and are placed on the ground, they are subjected to these unrelenting parasites. Haiti's infrastructure breeds all types of parasites which diminish the quality and quantity of life for Haiti's most innocent. Haiti's future adults are compromised from the beginning and Haiti's future as a viable country is jeopardized as well.

Medicine should be politics. They can never be separated. Public health care experts and doctors need to continually repeat how the two are related. Taking care of the infrastructure will take care of people and make the country viable in the competitive world in which we live.

The Dignitaries

The Dignitaries---May 13, 2006

The Haitian grandma sat on the wooden bench in the clinic looking at her 10 month old grandson who lay quietly on his back on her lap. Her eyes were tired and full of despair. He glanced at her with his own tired sunken eyes. He really didn’t look around at others as he should have. He weighed 4 kilograms.

Helicopters flew over the clinic escorting dignitaries from all over the world to hotels for the Haitian presidential election. Neither the gandma nor the baby cared about the noise from the helicopters or the bevy of activity in PAP regarding the inauguration. The baby was too sick and the grandma was out of hope.

The baby had vomiting and diarrhea for 2 days and his mother had died months ago. Grandma is the “primary care provider”. She would gently move the baby on her lap but his head would flop backwards without support and his tiny arms hung down from his side. His breathing was fast because his brainstem told him to breathe as fast as he could to neutralize the acid that has accumulated in his body from his depleted circulation. He had been given IV fluids but the IV was now pulled and he was being sent home because the clinic was closing, we had no room, and grandma had no money for any other hospital.

Before they left,we taught grandma how to slowly give him drinks of water from a plastic cup mixed with powder containing the sodium, potassium, and bicarbonate to perk his body back to life again. He avidly swallowed the solution when she offered it. However, a fair amount fell onto his chest. Grandma has no time for this. She doesn’t even have potable water in her shack. She has other responsibilities too. But the baby needs the fluids to save his life. The baby was trying and grandma did her best. But grandma will give up after a while and the baby will die without a whimper. When grandma softly said, “O Jesu,” she was not using Jesus’ name in vain. She simply meant that she will be burying another little family member soon.

Haiti has one inauguration each 5 years but we see Haitian babies dying like this everyday. Gastrointestinal diseases along with respiratory tract illnesses cause the majority of deaths in the first year of life around the world. Globally, 4 million babies die in their first month of life. The real problem is poverty which allows these babies to get sick and poor or no medical care to provide relief during their downward swirl. The vast majority of these 4 million deaths are preventable.

We live in the Information Age. The information how to save this baby is well known all over the world. But the system and structure has to be in place to apply the information to save this Haitian baby. By system and structure, I mean a rehydration center, with a nurse that will provide assistance for as long as it takes to rehydrate this baby. The system and structure is what fails these babies, not their grandmas.

So grandma and the grandson headed back into the very hot mid afternoon sun. The roads have been cleaned some and the Haitian National Police are ubiquitous. Much money is being spent at hotels for the local Haitian drink this weekend as journalists, camera crews, and dignitaries meet in upscale locations perched in high cool locations away from the hell that lies below them in the city. The inauguration is Sunday at the National Palace which will be the same day grandma buries her grandbaby for lack of basic drink and a system and structure to sustain.


“Distance negates responsibility.” Guy Davenport

Nadia

Dear Sister Judith Ann, Bishop Jenky, Doug, Keith, Paul, Gerry, and Joe,

Greetings from Haiti.

On Thursday morning, April 23, 2006, Jackson Jean-Baptiste sister Nadia
showed up for the first time since we have been in Haiti this month. It
was the first time we saw her since Jackson's death in January.

As she walked towards us, this very lovely 19 year old girl had a little
smile and was wearing blue jeans and a blue shirt. However, she walked
towards us very unsure of herself and very docile, like poor Haitians
are trained to be. We hugged her and she sat down at our table with us.

After Jackson had died, I called her and told her the unfortunate news.
However, I heard trough the Haitian grapevine that she was not sure that
Jackson was really dead. As we talked the other day about things, her
eyes welled up with tears because she had never seen me in five years
without Jackson close by. Jackson was not appearing from around the
corner and never would.

Nadia started to cry slowly with one huge tear that trickled slowly down
her right cheek. That turned into massive body shaking sobs that went on
for 30 minutes as she lowered her head to her knees.

I told her how sorry we were for Jackson's death. Kleenex after Kleenex
only helped a little. My weak attempts to tell her that Jackson was in a
better place and wasn't suffering anymore did not help much. Nadia
stated that she understood, but Jackson was her "only big brother". She
had lost two other brothers and her father was murdered.

Nadia asked to see the album of pictures that we brought with us of
Jackson's funeral in Illinois. As she paged through the little album,
she sobbed more and shook her head no. I think for the first time she
realized that Jackson was gone and this was all real and it was really
bad. Jackson was indeed buried on the hillside of a little cemetery
overlooking a dreary looking brown cornfield in the Midwest.

Nadia asked why Jackson's face was swollen in the casket and his lips
turned down. I told her that before he died his face was swollen and
that is how he ended up after the morticians work. She stared at the
face of her brother that used to make her laugh by dancing and singing
with the radio on and acting like he was playing the guitar. She told
jokes with him outside their shack in the morning on the mountain
overlooking Port-au- Prince. How could Jackson look so sad in death?
This was all too much.

She also saw photos of all the white Americans that had come to his
funeral and sang for him in the cemetery on that cold and rainy January
day. Nadia saw the faces of his host families at the wake and cemetery.
She saw the statue of St. Martin de Porres at the church where the
funeral Mass was held in Peoria. There was an amazing likeness of the
statue's face and Jackson's live happy face.

After an hour of this misery, Nadia was able to calm down, and we
devised a plan to get a Jackson's heavy suitcase, laden with gifts for
him while he was alive, to his home two hours up the mountain.

Yesterday, on Saturday morning, Nadia returned with a driver to
transport Jackson's belongings and my wife Maria and I to his home to
see his mother for the first time since his death. Jackson's 15 year old
brother Gabriel Moise came along. We threw Jackson's suitcase in the
back of the pickup, and after the driver took a rock he had wedged
between his battery and hood and banged on something in the motor, the
ignition kicked in and we were off through the insanely busy streets of
Port-a-Prince.

Coursing up the mountain was a painful experience. The roads were jam
packed with people and are full of holes and curves, stalled Mack
trucks, and people backing their vehicles down their lane directly at
us.

When we arrived in Jackson's village called La Boul, we were only able
to go so far until the road turned to dirt and holes and the driver
pulled over. We all got out at that point and lugged Jackson's suitcase
down slippery and steep dirt trails. These were the same hills and roads
that Nadia and her mom had carried Jackson on a chair to see us on
December 1,
2005 when he was too weak to walk. It did not seem humanly possible that
Jackson survived that trip.

I had been to Jackson's home five years ago and the surroundings all
started looking familiar. As we approached Jackson's home, approximately
25 of his neighbors were on a front porch of the home next to Jackson's
singing and praying very loudly over problems they were having.

Jackson's mom Rosette, older sister Claudette, and eight year old
brother were there to greet us on a small patch of dirt that serves as
their front yard. Rosette was not smiling but she gently hugged us. I
could hear her wheezing from her asthma. She is 44 years old but appears
quite a bit older.

She invited us in her little two room shack. We entered through the
front door, which is a piece of cloth, into a room about 12#12 feet. The
floor is cement and the walls are cinderblock and cement. The roof is
the usual Haitian corrugated metal roof with holes in it where we could
see dots of daylight above us. One light bulb hangs suspended from a
wire that is fed with borrowed electric current from the big electric
line close to their home.

An adjacent darker smaller room's walls are caving in and its roof is
leaking even worse than the main room. Rosette stores her second hand
clothes that she buys in a port city in this room and sells them on a
street corner near her home in La Boul. Nadia and her little brother
sleep in this room.

Jackson's bed was to our immediate left in the first room and they have
turned it into a little "shrine". The bed has a spread and small pillow.
A red covered Bible with "Jackson" scribbled on the side sat on the
pillow as did his fake Rolex looking watch and his picture album of all
the blans that helped him in the United States when he had his previous
heart surgeries. A ragged stuffed little cloth dog that must have been
Jackson's sat guard in the middle of the bed facing the pillow.

Rosette talked about how much she appreciated what we had done for
Jackson. She spoke of her life and that not much is left for her. She is
grateful for her children, especially Nadia, who seems like she can help
the most now that Jackson is gone.

Maria slowly unloaded Jackson's suitcase with his second hand clothes
that were still neat and folded. At this point, Rosette started to cry.
Maria removed a smooth heavy rock from the funeral that was engraved
"Jackson Jean-Baptiste Jesus Loves You". Rosette could not read the rock
because she is illiterate or the numerous notes from people in the
States. When I handed her the funeral pamphlet with Jackson's smiling
face on the cover, she barely looked at it and did not open it. His
sisters glanced at his obituary in the Peoria Journal Star, but could
not read the English.

Maria explained who gave which gifts and Rosette shook her head as if
she understood.

We gave her only a small portion of the money that was donated to her at
Jackson's funeral, so if she gets robbed, the thieves will get only a
small portion of the donation. We will disperse the rest to her in the
same quantities when we come in the future. Also, it would be nice if a
work team could be organized to build her a new home or patch the leaky
roof and repair the wall that is crumbling in the dark room.

Sister and Bishop Jenky, I am going to ask Rosette if she would like to
visit the United States so she can meet Jackson's host families in the
Peoria area, his doctors and nursing staff at OSF, and can see his grave
in Goodfield, Illinois.

I would like you to be able to meet her. She will thank you for all you
did for Jackson but will have some questions for you regarding Jackson's
demise in 2005.

She will probably ask you, Sister Judith Ann and Bishop Jenky, what your
understanding was regarding Catholic social teachings, the Bishops'
Ethical and Religious Directives regarding health care, and the OSF's
Sisters mission philosophy regarding her son. Rosette will want to see
the plans for the new 200 million dollar Children's Hospital of
Illinois, and may ask you why you would not accept 20,000 dollars for
Jackson's care in Peoria when he really needed your resources. She will
have specific questions for Keith and Paul, and will ask some ethical
questions of Joe and Gerry, I am sure. Doug, her legal questions will
probably be limited, but I am sure she would like to meet you anyway,
since you played such a large role in Jackson's life.

I will obtain her travel visa and Haitian Hearts will purchase her
ticket and travel to and from Peoria with her. You don't have to worry
about these details.

Please let me know when a good date would be when we could all get
together with Rosette so open and honest communication, a central OSF
mission statement, can occur. She lost her son. She deserves this, don't
you think?

Sincerely,

John Carroll

PS Would you please circulate this to the people at the top if their e
mail addresses don't appear? Thank you.

The Scandal of Poor People's Disease

The Scandal of Poor People’s Disease

On the Opinion page of the New York Times several days ago, there was an article entitled “The Scandal of the Poor People’s Disease” by Tina Rosenberg. Rosenberg’s idea is that if you have to get sick, it is better to become ill with a disease that infects the rich too. That way more research is done, more medications are registered and used, more lobbying is done for your plight, and you may be helped. For example, due to strong lobbying groups in the US, HIV became a very hot topic quickly which led to very serious research and the development of medications that have extended the lives of many people with the HIV virus all over the world. If the developed world did not have AIDS, this research most likely would not have been done.

Tuberculosis infects one-third of the world’s population. You read that correctly. Two billion people are infected. Not all have the disease, but many are infected and are at risk of developing active TB. In the decade of the 90’s tuberculosis killed more people worldwide than in any decade in human history.

In Haiti, my wife and I spend much of the year working in a pediatric TB clinic. Haiti is full of tuberculosis and it hits children especially hard. Children’s immune systems just do not fight TB well enough and infection can turn into full blown tuberculosis. Fifty percent of children with active TB who are not diagnosed or treated with medications for the disease are dead in 5 years.

There are 8,000,000 new cases of tuberculosis infection each year around the world. Tuberculosis kills 5,000 people EACH day. While there has been a cure for TB for 50 years, virulent new forms of the disease have arisen. Despite this, there have been no new registered drugs for TB in 40 years. The vaccination for TB is 80 years old. As Rosenberg states, TB is an ancient disease and the cure is outdated. What she means is a disease of this magnitude has been targeted by very little research and attempts to control it--until AIDS came along and infected the wealthy nations.

When AIDS became common in the US and Europe, AIDS victims frequently became infected with TB because their immune systems were damaged. AIDS patients around the frequently die from TB. Therefore, public health systems were resurrected in the US and TB was made much more of a priority. As a result, the US has an all time lowest number of TB cases in the nation’s history.

TB attacks the invisible poor people around the world. In the US we have children who are too obese for the car seats that are manufactured. The children my wife and I see each day are too small to sit in these car seats. But they don’t need car seats here because the parents don’t have cars. TB attacks these kids and makes them even smaller.

The Haitian Cook and St. Augustine

The Haitian Cook and St. Augustine

When Jackson Jean-Baptiste was with Maria and me during the month of December, he was really sick. However, many people here got to know him as much as Jackson would allow. People became attached to him in some way probably due to his fragile condition. He was very thin, spoke softly and deliberately, and walked slowly. But his mind worked very well.

Maria and I got to know him quite well. He told us about his mother’s life. She travels 12 hours once a week to a southern coastal city in Haiti to buy used clothes and sell them on the street near Jackson’s home. She makes the round trip in one day.

His father worked in a quarry. One day, when Jackson was just a boy, while his father was hanging from the side of the cliff by a rope, an enemy of his in the neighborhood, cut the rope with his machete. Jackson’s father plunged to his death suffering a massive head injury. Jackson told us the story impassively. When I asked him if he knew where the man lived that cut the rope, he replied “yes”. Nothing was ever done to bring the man to justice. Jackson seemed to accept that. He couldn’t do anything about it anyway. He was poor.

Last night, the cook approached me near the kitchen. He is a very black man with a kind face and nice smile. He told me that Jackson’s death had “hurt his (the cook’s) chest”. I told him I felt very sad too. The cook just shrugged his shoulders and looked at me with his very expressive eyes. He said, “Doctors are not God. You did all you could for him and God did the rest.” But the cook did not know, and will never know, our riches at home and why we should have helped God with Jackson. We simply did not do our part in Peoria.

The Haitian cook, who works very hard for very little salary, gave us more support regarding Jackson’s death than did any member of the Leaders of the Catholic Medical Center in Peoria that rejected Jackson during his days of suffering and misery when something could have been done. The Catholic Diocese Hierarchy had no supportive words either regarding Jackson as we buried him near Peoria.

Yet, this poor Haitian cook told me how hurt he was that Jackson died. Jackson’s death meant more to this poor man than all the rich men I know at home. A Haitian had lost another Haitian brother. Rich men lose stocks, jobs, money, homes, and objects. The death of Jackson meant nothing to the rich at home.

Saint Augustine wrote:

Let us by our prayers add the wings of piety to our alms deeds and fasting so that they may fly more readily to God. Moreover, the Christian soul understands how far removed he should be from theft of another’s goods when he realizes that failure to share his surplus with the needy is like theft. The Lord says: “Give, and it shall be given to you; forgive, and you shall be forgiven.” (Cf. Luke 6:37,38)

The Clinic—March 31, 2006

While Maria and I were in Haiti in December, ’05 we didn’t work in Sister Lila’s clinic because the travel would have been too dangerous. Car jacking and kidnappings occurred daily. There were 120 reported kidnappings in December, but only six reported in March. The Haitians that we talk to say the amount of violence has decreased due to the presidential elections that were successfully held on February 7.

When Yvon the driver picked us up today, we were happy to see him. He has been working for sister for years and is very dependable. On airport road, about one mile from where we stay, were concrete road blocks and we pulled over when motioned to do so by UN forces holding carbines. They just asked to see our vehicle's registration papers and were very polite. The soldiers appeared calm talking to the people that walked by. We were gone in two minutes. We saw about 6 white UN tanks on the way to and from the clinic.

Clinic went very well today. Friday is pediatric day and the census was down some (probably about 100 kids) due to the rains at night which fill the puddles in the dirt road and make it very difficult for public transportation to make it down the road.

On the way home, Yvon took a shortcut through Cite Soleil. We went down a new boulevard named after a young man killed by United Nations forces in the last few months. Everything in the slum looked normal to me except the buildings with their walls pockmarked by holes from bullets over the last several years. Gangs and UN forces had fought it out many times.

It was amazing traveling through this slum that is the home to an estimated 200,000 people that had been walled off from the rest of the world for months before the elections. Now kids played on the sidewalks and ladies sold their wares on the street corners as usual. Yvon had a big smile on his face as he drove through…Preval had won and Soleil was quiet for now. Haitians love tranquility.

The Haitian Orphanage

The Haitian Orphanage—-March 30, 2006

Yesterday Maria and I visited an orphanage here in PAP. There are 90 children in the orphanage which has two buildings located about one block apart. The “new” building has had 3 hours of electricity since the Haitian presidential elections on February 7, 2006. It has no generator yet, so kerosene lamps are used at night for light. This building is the home for approximately 50 toddlers and babies. The other building has the older children.

A young mother came to the gate three days ago. She explained that she just delivered her own baby, cut the cord herself, and swaddled up the baby in a towel. The young mom explained that she has no means to care for the newborn. The manager of the orphanage accepted this baby boy who appears perfect. He just was created and has no marks on him, no impetigo, no hair loss from the unrelenting fungal infections that destroy Haitian kids scalps. He survived his delivery without a Lamaze class, a midwife, a doctor, or anyone except his young mom who did all the right things. He has not been put down yet in the Haitian dirt with its plethora of microbes waiting to attack. And he has avoided the mosquito with it’s malarial parasite and virus which causes dengue fever. Most importantly, he doesn’t yet know he has been abandonded by his birth mom who did the right thing….

The orphanage is staffed by Haitian “nannies” who feed the children, bathe them, wipe their noses, change their diapers, and wash their clothes. Last month, in February, a pregnant lady fell in PAP and went into premature labor. She delivered a 1.2 kg baby girl who was put in a neonatal unit in a community hospital. The baby had a gestational age of 6.5 months. Well, the baby ran up an $800 dollar bill and the mother, of course, could not pay it. The hospital told the mother that if she did not pay the bill, they would put her baby up for adoption. The mother showed up at the door of the orphanage and explained the situation to the managers. The managers talked to the administrator of the hospital who cut the bill in half. The orphanage managers then paid $400 dollars to get the baby, gave it back to the mother, and the mother is working off the bill each day as a nanny in the orphanage. She brings the 2 month old baby girl with her to the orphanage. She is very happy to have her baby who is gaining weight and to retain her dignity by working for the people that saved her baby from adoption.

This building also houses a boy and a girl from the province who were sent into the capital with heart murmurs. Both children are 5 years old. The little girl has a hemoglobin of 6 and the little boy’s hemoglobin is 5. The children walk slowly like shy poor little Haitian kids always walk. Neither say anything and do not appear afraid.

Both of their murmurs are probably innocent flow murmurs because the blood is so thin and non viscous. Also, their hearts are somewhat enlarged from malnutrition and anemia, and that stretches the valves, so the valves can be leaky and create a murmur too. They are so anemic because they lack enough iron in their diets and have worms in their intestines. Both like the meals at their new home and take their iron supplements.

Not having enough to eat in 2006 really is immoral. The median annual income in Miami-Dade County per family is $35,900. The average income in Haiti per person each year is estimated to be about $200. (Median and average are not the same, but one can see the gross inequality between US and Haitian people, even if the units are different.)

Letter to Cardiologist

Peoria’s Medical Mafia

Letter to Cardiologist for Jackson
Date: 26 Dec 2005 16:05:37 -0000From: “Realname”
Subject: Jackson

Dear Doug,
Hope you had a good Christmas.
Doug, through some fairly miraculous circumstances during the last coupleof days, Jean-Baptiste was accepted into Cleveland Clinic. (They areasking for no fees.) They wrote the letters immediately and Maria and Iwill apply for his visa to travel tomorrow. We have alot to do tomorrowmorning but if all goes well, sans kidnapping, we will get on an AA flightat 3 PM tomorrow for Cleveland. (There have been dozens of kidnappings inthe last 2 months here with white Americans as prime targets.)
Jackson is doing some better. I added spironolactone to his meds and heseemed to start to mobilized some of his ascites and feels better. Hebreathes well at rest and I have only seen him really dyspneic once ortwice. His heart still sounds terrible of course. His liver remainspulsatile and big.
We wish we were bringing Jackson to you. You know the faith I have inyou. I never received a response from OSF since my pleading with them forJackson started in May. Unfortunately, even with YOU advocating forJackson to the “committee”, I had no faith that they would accept him evenfor 20,000 dollars. The events that occurred while you were gone forseveral years, diminished my faith in CHOI to a very, very low level. Iknow we all see from where we stand, but some incredible events occuredwhich does not instill much confidence in the business leaders at OSF orCHOI. Jackson is the third Haitian Hearts patient OSF has rejected in thelast one and one half years—Willie (we offered full charges for hisfailed pacemaker generator–he was syncopal and in heart failure when Iexamined him in Haiti in Feb, 04 with a heart rate that did not go above60), Faustina (we offered 10,000 dollars…fortunately, she has beenaccepted as well for no charge, and will be leaving Haiti in a week forher mitral stenosis), and Jackson. All 3 kids were/are in terrible shapeand OSF-CHOI was going to let them die in Haiti. This is so wrong. As Isaid, I want you and the other docs at CHOI and the nursing staff to takecare of these kids, but the administrative team at OSF is so incompetentand uncaring about these Haitian Hearts patients, I don’t ever see CHOIbecoming what it really could with them running the show. You areemblematic of what a childrens hospital should be about. They are not. Istill love OSF because OSF is not the administrative team and corporate.It is the people that give the care at the bedside, in my opinion. Thereare 5,000 good employees that work at OSF.
Doug, there will be other Haitian Hearts patients that need valvereplacements. I know of three right now. I will approach OSF the same wayand hope that the current administrators are gone and replaced withadministrators that agree with the hippocratic (sp?) oath and good medicalethics. My hope is that doctors and nurses in Peoria really publicallyquestion the administrative team at OSF and say that patient abandonmentlike this must stop.
Thanks for reviewing all the echoes over all of the years and giving thesekids and all kids your best, Doug.
John

Catholic Bioethics Seminar--February, 2006

On Saturday, February 4, 2006, a Catholic Bioethics Seminar was held at St. Sharbel’s Church in Peoria, Il. The key note speakers were Father Michael Bliss, Dr. Gerald McShane, and Joe Piccione.

Father Bliss is OSF’s chaplain and a member of the ethics committee at OSF. Dr. McShane is employed at OSF Corporate and is Chair of OSF Ethics Committee. Joe Piccione is the OSF Corporate Ethicist, a lawyer, and philosopher.

Father Bliss gave the first talk. His comments included that “medical ethics is doing good for people in a good way”, “we need to recognize the patient’s dignity and realize the greatest good for the patient”, and that oral contraceptives can, at times, “bring about death”. Father held up a pamphlet describing the ethical and religious directives of the bishops and stated it was very good and easy to read. I happened to have my own copy with me at the seminar.

When Father was done speaking, he asked if there were any questions from the audience. I raised my hand and stated that Haitian Hearts had buried a patient one week prior who had been refused by OSF, and I wanted to know why and how we can avoid this “problem” in the future. Well, Father Bliss would have none of this and cut me off mid question and stated that he would not answer my questions and had no comments. I told him that I thought it was his responsibility to tell the public why OSF had abandoned this young Haitian man (Jackson Jean-Baptiste). He said “no further comment” and that Bishop Jenky had dealt with this problem in the past. That was it. He obviously did not want the crowd to hear my questions or comments and what was he going to say that could possibly defend OSF’s actions and went against the ethical directives of the US bishops. He was in a losing position and knew it.

The next speaker was Dr. McShane. He gave a talk on doctor-patient relationships and said that this relationship is fundamental. He had a nice but very simple handout. Compassion and caring is key. He referred to himself as a good physician. His handout referred to the emotional, physical, and spiritual needs of the patient. His handout went on and on. Dr. McShane’s voice was shaky and nervous. He stated half way through his speech that “John Carroll will probably have some questions for me”.

When Dr. McShane was done with his pitch, he asked if there were questions and looked at me. I again raised my hand and told him that his words were beautiful but that OSF had acted the opposite with regards to my dead Haitian patient and I wanted to know why. To my surprise, Dr. McShane stated that he would not answer my question regarding the deceased Haitian that was refused care at OSF. He told the crowd that I was bringing up this topic “every six months”. Dr. McShane is paid a huge salary by OSF Corporate to give these talks and he is very grateful for the generosity of the Sisters.

Their was a panel discussion that followed and a question was asked regarding birth control pills being prescribed by a Catholic medical center. Dr. McShane stated that it would be “sinful” to use the pill as an oral contraceptive. Joe Piccione shook his head yes. I asked, at that point, why Joe Piccione had come to Peoria in 1993 to help establish a protocol so OSF physicians and the OSF Health Plan could offer oral contraceptives and sterilization. I had the newspaper article in my hand that described what Piccione and our previous bishop and the OSF Sisters had developed last decade regarding oral contraceptives and sterilization. Piccione tried to defend his actions and stated that Bishop Meyers agreed with him as does Bishop Jenky and actually Pope Benedict would be in agreement with OSF’s stand on birth control pills and their allocation. Piccione was really reaching when he said that the Pope would be in agreement. I asked Joe if it was about money and he replied “no”, however, I held up the PJS article where he was quoted about the need for oral contraceptives if OSF was to stay competitive in the health care field. Joe seemed to be at conflict with his statements a decade before. At that point the priest who was moderator became quite angry with me and told me that I could not ask any more questions. This poor priest is a parish priest at St. Sharbel’s and probably was worried that OSF would be upset with him if the speakers were made to look too hypocritical.

So that was that. The bioethics seminar was very elementary and misleading to the public and some of the crowd went away confused. I am also sure that most people there would have sided with the ethicists because my questions and comments were pointing out things that the crowd wouldn’t think were possible at OSF with the Bishop and even the Pope supporting, Good people, like the crowd at St. Sharbel’s, want to believe that their Catholic leaders are leading them in the correct moral direction. This is such a shame and emblematic of the horrible situation in which the Catholic Church in the US finds itself today.

Father Jean-Juste Released

Fr. Gerry Released!
-----Original Message-----From: BrianhaitiSent: Sun, 29 Jan 2006 12:18:51 PM Eastern Standard TimeSubject: Fr. Gerry Released!Fr. Gerry Released!January 29, Noon ETWe have great news: Political prisoner Fr. Gerard-Jean-Juste, "Fr. Gerry" is right now on a plane in the air from Port-au-Prince to Miami. A cancer center in Florida has agreed to treat his leukemia, so he will get immediate attention for the cancer, as well as for the pneumonia he contracted this week.Fr. Gerry was granted a provisional release, which requires him to return to Haiti after the treatment to face the charges still pending against him. The current charges against him are as baseless as the other charges which have been dismissed. Fr. Gerry's lawyers at the Bureau des Avocats Internationaux (BAI) have filed an appeal, asking for the charges to be dismissed. The appeals court can rule on the appeal without Fr. Gerry's presence, so it is possible that the case will be dismissed without requiring him to return to court. If he is forced to return to court, the BAI lawyers will continue to fight the charges.In the meantime, Fr. Gerry will be relatively safe, and will have his leukemia treated. Doctors who have examined him are hopeful that his disease is at a stage where it can be successfully treated, but they cannot be certain without more tests.Today's victory proves the Haitian proverb, "men anpil, chay pa lou-: many hands makes the load light. This mobilization has been by far the strongest and most persistent Haiti advocacy effort in the ten years that I have been involved in Haiti work. Everyone who called, faxed, wrote or emailed Haitian and US officials, everyone who signed a petition, everyone who forwarded information about Fr. Gerry to their church, their friends, and their family, should be proud. Close to a dozen human rights groups, over 50 members of the US Congress, and hundreds of religious, political and human rights leaders from all over the world joined together to make this moment possible.Together we demonstrated that the world does care, that justice is possible, and that collective action does work. No small accomplishment.Fr. Gerry said in a letter from prison on Friday: "understand that I wish you all to extendyour support not only to me but to as many political prisoners as possible wherever on planet earth. Probably, you are aware that there are quite a number of political prisoners around the world. Think of them and keep them in your heart.. I am very grateful to Amnesty International and to all of you for helping fight for the human rights of all political prisoners, here in Haiti and across the world. Let's keep the momentum on for justice, peace, love, and sharing to prevail all over the world as God wants it."Today we should all take the time to pat ourselves on the back. But tomorrow we need to get back to work, to help the political prisoners that Fr. Gerry left behind in Haiti.Peace, BrianBrian Concannon Jr., Esq.DirectorInstitute for Justice & Democracy in HaitiPO Box 745Joseph, OR 97846541-432-0597http://www.ijdh.org/Brian@IJDH.ORG