Sunday, September 12, 2010

Tetanus

 

This man underwent a leg amputation for an open fracture.

He did not receive tetanus toxoid or immunoglobulin.

When checked this man for the first time early in the week, he looked like this-- unable to open his mouth much and barely able to swallow liquids.

I started him on metronidazole and gave him a tetanus toxoid.

He continues to pull out his IV, but at the end of this week, he is now able to open his mouth and take water with a straw.

We will see what happens.

Lack of basics in Haiti is a big killer.
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Haiti's Rubble (Continued...)

Just 2 percent of quake debris in Haiti cleared
By TAMARA LUSH (AP) ­ Sept 11, 2010

PORT-AU-PRINCE, Haiti ‹ From the dusty rock mounds lining the streets to a
National Palace that looks like it's vomiting concrete from its core, rubble
is one of the most visible reminders of Haiti's devastating earthquake.

Rubble is everywhere in this capital city: cracked slabs, busted-up cinder
blocks, half-destroyed buildings that still spill bricks and pulverized
concrete onto the sidewalks. Some places look as though they have been
flipped upside down, or are sinking to the ground, or listing precariously
to one side.

By some estimates, the quake left about 33 million cubic yards of debris in
Port-au-Prince ‹ more than seven times the amount of concrete used to build
the Hoover Dam. So far, only about 2 percent has been cleared, which means
the city looks pretty much as it did a month after the Jan. 12 quake.

Government officials and outside aid groups say rubble removal is the
priority before Haiti can rebuild. But the reasons why so little has been
cleared are complex. And frustrating.

Heavy equipment has to be shipped in by sea. Dump trucks have difficulty
navigating narrow and mountainous dirt roads. An abysmal records system
makes it hard for the government to determine who owns a dilapidated
property. And there are few sites on which to dump the rubble, which often
contains human remains.

Also, no single person in the Haitian government has been declared in charge
of the rubble, prompting foreign nongovernmental organizations to take on
the task themselves. The groups are often forced to fight for a small pool
of available money and contracts ‹ which in turn means the work is done
piecemeal, with little coordination.

Projects funded by USAID and the U.S. Department of Defense have spent more
than $98.5 million to remove 1.2 million cubic yards of rubble.

"There's not a master plan," Eric Overvest, country director for the U.N.
Development Program, said with a sigh. "After the earthquake, the first
priority was clearing the roads. That was the easiest part."

Overvest said the Interim Haiti Recovery Commission ‹ created after the
earthquake to coordinate billions of dollars in aid ‹ has approved a $17
million plan to clear rubble from six neighborhoods in Port-au-Prince. The
neighborhoods have not yet been selected, however, and it's unclear when
debris will be removed from other areas.

Leslie Voltaire, a Haitian architect, urban planner and presidential
candidate, says his country needs a "rubble czar."

"Everybody is passing the blame on why things haven't happened yet," he
said. "There should be one person in charge. Resettlement has not even begun
yet, and it can't until the city has been cleared."

Voltaire maintains that there are enough crushers, dump trucks and other
heavy equipment for the job; others say that more machinery is needed. But
everyone agrees that recovery will take decades ‹ and the slower the rubble
removal, the longer the recovery.

Most Haitians are simply living with the rubble, working and walking around
it. After a while, the gray heaps and cockeyed buildings just blend into the
tattered background of the city.

"It will take many, many years to fix," Overvest acknowledged. "We can't
just go with wheelbarrows to remove it."

But that's exactly what some Haitians are doing: using shovels and
wheelbarrows to clear properties ‹ a Sisyphean task if there ever was one.

"Personally, I don't think Port-au-Prince will ever be cleared," said
47-year-old Yvon Clerisier, an artist working a temporary job clearing
rubble with a rusty shovel for a private homeowner. He wore torn jeans, a
sweaty T-shirt and sandals, and was covered in a fine dust.

Clerisier was one of a dozen men working in temperatures higher than 100
degrees Fahrenheit (38 Celsius). The property owner, Gregory Antoine, said
he paid the crew $1,200 for three weeks of work.

"People want to work," Antoine said. "If you get a good organization to put
people to work and give them direction, things will get done. But right now,
nothing is getting done."

It's not for lack of trying. The nonprofit organization CHF International
spent about $5 million of USAID money on heavy machinery and paying Haitians
to remove rubble from specific sites.

Dan Strode was the rubble-removal operations manager for CHF for three
months; some dubbed him "the rubble guy" because of his enthusiasm for the
job.

"Rubble isn't sexy," the Californian said. "And clearing it is not as simple
as people think."

Strode's big worry: that debris won't be cleared fast enough and that the
piles of rocks and garbage and dirt will be overtaken by tropical growth.

"If we don't clear it, what we will leave behind is something that is worse
than before," he said. "If you come back in a year, and the rubble hasn't
been cleared, it will be grown over, subject to landslides and unstable."

Strode, who coordinated the removal of nearly 290,000 cubic yards of
material in three months, said a major obstacle to demolishing buildings has
been the lack of property records, which either were destroyed in the quake
or never existed at all.

Without an owner's consent, it is difficult to remove debris, he said.
Another problem: Strode often received approval to demolish a building such
as a hospital or a school ‹ even when nearby homes were at risk.

"You cannot wantonly go in and demolish," he said. "There's a liability
issue."

Strode is no longer doing rubble removal. The grant money ran out, and has
not yet been renewed.

Another hurdle: dumping the debris.

While many private landowners and others are dumping the rubble in the
streets, canals or countryside, there's only one place in all of Haiti where
NGOs using U.S. money can take contaminated rubble: an approved and
environmentally surveyed site.

"Not all rubble is the same," said Michael Zamba, the spokesman for the Pan
American Development Foundation. "There's a lot of contaminated rubble with
human remains in it. It can't go in a standard landfill."

Zamba points out that before the earthquake, Haiti was the least-developed
country in the Western Hemisphere ‹ so it's not that surprising recovery is
slow.

"Haiti is a really expensive place to work: You have to ship in gas,
vehicles, people," he said. "But you clean up the rubble in a neighborhood,
and it transforms it. Life comes back."

Friday, September 10, 2010

Haiti Plus Diabetes Equals Bad

 

This is the left foot of a 54 year old lady who came to clinic today.

She lives in the mountains and she has uncontrolled diabetes. She has been vomiting for weeks and her glucose is greater than 500.

Diabetics can have sensory neuropathies and with poor glucose control they can develop diabetic foot ulcers, gangrene, and osteomyelits.

Her dressing change pictured above reveals some of the extent of her pathology.

The smell in the clinic was and is terrible as the dressing was removed...and she and her son live with this medical and social and economic tragedy everyday.

Her white blood cell count is 38 thousand (normal is 5-10 thousand) and I believe she is septic from the infection in her foot.

She is now on two antibiotics and if she survives sepsis, she will have a partial foot amputation.
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Thursday, September 09, 2010

Sickle Cell Anemia and Tap Tap Drivers

 

This 15 year old boy has sickle cell disease.

Both his parents are dead and he lives with his grandmother.

Two days ago he came to the hospital for fever and cough.

He took a tap tap up the mountain alone to the hospital and the tap tap driver stole 250 gourdes from this young man and quickly drove off.

I started him on antibiotics and he is holding a bottle of folic acid from my beautiful mom. Folic acid will help him form new blood cells while sickle cell disease destroys them.

He is a great kid.
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Wednesday, September 08, 2010

While the Politicians Argue....

 


While the politicians argue cancer of tongue goes untreated and spreads.

This 41 year old man cannot swallow food and barely can swallow water. Nothing definitive has been done for him since this mass started 11 months ago.

He is in chronic pain and his upper airway is compromised.

In 2010 don't human beings deserve better?
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Wednesday, September 01, 2010

Violence in Haiti

Posted on Wed, Sep. 01, 2010
Violence mars Haiti's recovery

BY TRENTON DANIEL
tdaniel@MiamiHerald.com

A trio of gunmen stormed a gated home in the well-to-do Pelerin neighborhood, shot dead a Sunrise man and kidnapped a 16-year-old relative. Gregoire-Ronald Chery, 56, died of a single shot to the head. Nadege Charlot, his cousin, continued to be held Tuesday as kidnappers demanded a $100,000 ransom.
Nadege's abduction on Friday was the latest in a string of kidnappings in the hillside neighborhoods above Port-au-Prince, and it is raising fears that more could follow this election season.

Almost eight months after the Jan. 12 earthquake killed an estimated 300,000 people, crime trends show an increase in kidnappings compared to this time last year. U.N. police have documented 68 abductions so far this year, compared to 51 a year ago.

The winner of the Nov. 28 presidential election will be faced with the task of sheltering 1.5 million people made homeless by the January earthquake and removing 20 million cubic meters of rubble -- and reducing the growing numbers of kidnappings.

A recent U.S. travel advisory noted that bandits have attacked travelers leaving the Port-au-Prince international airport, and that at least two U.S. citizens were killed in recent months. Five have been kidnapped.

Even relief workers have been targeted. In March, bandits abducted -- and released -- two staff members of Doctors Without Borders in Port-au-Prince. Two months later, kidnappers grabbed a British national from the Pan-American Development Foundation and his Haitian driver. The Brit was released. The driver was killed.

``After Jan. 12, it looks like the good targets would be the NGOs,'' said Reginald Delva, the head of a security consulting firm. ``And I'm pretty sure they don't have ransoms planned into their budgets.''

Delva said about 30 private security firms work in Haiti, each with about 1,500 guards.

Kidnappings in Port-au-Prince are down significantly from record highs of previous years -- there were more than 800 in 2005. But the U.N. and others say they're concerned about the 33 percent uptick they've seen so far this year over the same time in 2009. Many say they suspect politicians are tapping gang leaders to instigate unrest and carry out kidnappings to collect money to hire street protesters during the election.

``I'm not afraid of gangs and insecurity,'' said Haitian National Police General Director Mario Andresol. ``I'm afraid of political turmoil. Anything can happen -- trouble on the streets, big riots, big demonstrations. This is when a government gets sent away.''

Rumors of an outbreak in violent demonstrations were abuzz in mid-August as prospective candidates and their supporters awaited the electoral council's announcement on who would make the final cut.

A delay in an announcement made some to wonder if the council was trying to avert the possibility of violence.

INSECURITY

Although the elections are the topic du jour, general insecurity is a close second.

On Jan. 12, about 4,000 prisoners escaped the national penitentiary. Police officials believe some of the escaped prisoners have organized into gangs in neighborhoods such as Martissant, just outside Port-au-Prince.

``These guys on the streets could create an insecurity situation,'' Andresol said. ``We're after them. We arrested them before. We'll arrest them again.''

The majority of the abductions have focused solely on Haitians, especially those living in Pelerin, Thomassin and other relatively affluent areas.

So far this year, 83 percent of the kidnappings have involved Haitians compared to 17 percent that involved foreigners, said André Leclerc, a spokesman for the U.N. policing unit.

Kidnappers may be following the affluent to their neighborhoods under the guise of holding everyday discussions and conducting business deals, said Frantz Lerebours, a Haitian police spokesman.

``Because the downtown area is broken, a lot of activity has gone up to Petionville,'' Lerebours said. ``Naturally, the criminals have followed.''

Kidnappings are not the only violent crime worrying police.

Chery, a Haitian fraud investigator with the U.S. Department of Homeland Security, was gunned down at his cousin's home in Petionville. Family members say the middle-class host family was targeted because there were relatives visiting from the United States.

On Aug. 3, a doctor and opposition leader was shot dead after bandits stole his necklace and tried to take his wallet. A colleague said the killing was politically motivated; police say the case is under investigation.

Other security concerns include a turf battle in the seaside slum of Cité Soleil that injured even bystanders -- including four children -- and protests that have demanded President René Préval's departure. In June, unknown gunmen fired shots outside his home.

And then there are rapes of women in some of the 1,300 camps scattered around the city. In the first two months after the quake, the Haitian grass-roots women's organization KOFAVIV documented 230 rapes. The medical humanitarian group Doctors Without Borders has treated more than 200 victims of sexual violence.

FRUSTRATION

Even as observers say kidnapping remains troublesome, they also say Haiti's ratio of crime to population is low compared to Mexico, Venezuela and Colombia. But observers also say they worry that the Caribbean nation could see a surge as the population grows frustrated with what they see as an unresponsive administration and inadequate relief effort from abroad.

``There are more violent places than Haiti,'' said Bruce Bagley, chair and professor of the University of Miami's Department of International Studies.

``But I would expect crime, gang-related activity, and kidnappings to continue to rise as people become increasingly disaffected with the government and the international response.''

Miami Herald staff writers Jim Wyss and Nadege Charles contributed to this report.

Corruption at Haiti's Wharf Continues

Corruption at Haitian Customs in Port-au-Prince is so bad. Not that the international community is immune to corruption, but Haiti needs to get their act together at the wharf in Port-au-Prince.

Officials at the wharf holding up containers for money need to go to jail.

See Lance Durban's comment below from the Bob Corbett list.


Lance Durban commenting on Ilio's sense of urgency...

I have no quibble with Ilio's post other than to note that the "time to get serious" in Haiti has been any time since the departure of J.C. Duvalier in 1986. Haiti has never gotten on track, and frankly I see no real evidence that it will get on track now.

Yesterday, I spent a good part of the day attempting, vainly, to get some urgently needed parts out of customs at the PAP airport... needed for samples so that our company could compete on a new contract. The customs official was far more concerned with blocking the release as a way of showing that he was indeed the boss than in helping our company, even though we import some 2000 lbs of air cargo thru his terminal each week which keeps over 500 Haitians employed. How can one begin to explain the bigger issues to anyone working in today's Haitian government?

Contrast that to the Dominican Republic, where my current Haitian partner had invested in a business some 20 years and received a special "Foreign Investor's Card" that got him instant access to high-level assistance in key ministries. (He still carries the card, no doubt as a pleasant memory of that warm welcome).

Let me offer a prediction on the upcoming election... if it comes off at all. None of the candidates will ignite much excitement and the resulting vote will yield no overwhelming winner. The losers will all claim to have been cheated (and perhaps will have been), so any winner will have to make accomodations just to be inaugurated. The necessary change will not happen and the status quo will prevail... until, social pressures create the next inevitable explosion.

The possibility of some dramatic change with massive popular support was why I was at least receptive to a Wyclef Jean candidacy. Granted, this would have required a CEP able to see beyond the legalisms that they used to bar this outsider. But, it's back to the question at the end of paragraph 2 above, namely: How could one seriously expect the CEP to understand the larger picture?

Of course, Wyclef would be a huge gamble, but one does need to break eggs to make an omelette! If Wyclef is truly interested in effecting change in Haiti, I would suggest a different tactic than the one he appears to be taking. Rather...

Interview in depth all of the candidates, Wyclef, and find (1) the one that you can work best with, one who is hopefully also (2) the one you feel is best able to lead Haiti out of the wilderness. Back this individual and campaign vigorously for him/her, recognizing that your support can help swing the contest. Post election, you should establish residency in Haiti and roll up your sleeves. (As Sean Penn is demonstrating this month, you can work in Haiti while "moonlighting" on your Hollywood job. Indeed, the latter is important in support of the former). As others have pointed out, 5 years is not a very long time, and by 2015 you would have not only a better understanding of what Haiti needs, but more importantly, a better idea of how to move the ball in the right direction. Uh, and good luck.

Lance Durban

Saturday, August 28, 2010

Haitian Hearts has 141st Patient Accepted in to the USA

When I was working in Haiti in July a very sick man came to clinic early one morning. He was in terrible congestive heart failure and arrived on the back of a little motor scooter.

He has been accepted into a medical center in the USA and will be arriving soon.

See Maria's blog for further details.

Wednesday, August 25, 2010

Haiti's Seaport...Corrupt and it Must Change

Posted on Sat, Jul. 17, 2010
Seaport, the engine of Haiti's recovery, is sputtering
BY JACQUELINE CHARLES
jcharles@MiamiHerald.com

PORT-AU-PRINCE -- The day the ground buckled, a $3.2 million crane crashed into the water off this country's main seaport, the pier crumbled and cracked containers spilled into the sea.

Six months later, the crane and containers remain in the water and two floating barges have temporarily replaced the pier.

The Port-au-Prince seaport, a main economic driver of Haiti's economy, is critical to the country's recovery from the worst natural disaster in the Western Hemisphere. But six months since the Jan. 12 catastrophic earthquake, the facility remains crippled.

The international community and aid groups complain bitterly that Haiti's government has failed to present a master plan to revive the port sector -- criticized as a pocket of government neglect, cronyism and fierce rivalries even before the disaster.

``The port is a broken asset,'' said Adrian van der Knaap, head of operations for World Food Program Haiti, one of the largest users of Haiti's ports.

``The island needs well-functioning ports. It can be much, much better than it is now.''

Samuel Perez, formerly U.S. military commander in charge of reopening the port, was more blunt.

``The Haitian government has to come to grips with how they are going to reconstruct that port,'' said Perez, who spent three months here. ``The port people are very, very satisfied with the fact they are making money hand over fist. . . .They are fleecing poor Haitians.''

Any long-term improvement in Haiti's economy depends on both repairing and reforming the country's ports system, including its underused and neglected ports.

ULTIMATE CHALLENGE

Tackling the ports and their entire supply chain, including customs clearance, could be the litmus test for a 31-member reconstruction commission chaired by Haitian Prime Minister Jean-Max Bellerive and former U.S. President Bill Clinton.

``A lot of issues are going to come on the table as a real condition to invest in Haiti and the port is one of the first on the list,'' Bellerive told The Miami Herald. ``I don't see how we can dodge on that.''

But Haitian President René Préval's government, like Haitian governments since the main seaport was constructed in the 1970s, has refused to provide transparent and clear rules on how port facilities should operate, critics say.

The port -- located next to a sprawling seaside slum and congested downtown -- has come to symbolize the Haitian government's shortcomings:

Before the quake, the port was a cash cow, earning millions from a $310 wharfage tax on every 20-foot container brought into Haiti. But instead of investing the money in equipment and upgrades at all government ports, the money went to paying the salaries of hundreds of unnecessary and ghost employees, government officials said.

``The port became more of a social program rather than a commercial program,'' said Hughes Desgranges, senior advisor to the director general of the National Port Authority (APN), the government overseer. ``You have a port that can be the engine of the Haitian economy, but it's been badly steered.''

At the same time, the government discouraged the expansion of private ports in the capital and other seaside cities, cornering the shipping market for the Port-au-Prince port.

The few port improvements over the years have been modest at best: In a post-disaster report, the government conceded that the port's cranes were insufficient for major shipping, and the channel was never dredged, preventing large ships from docking.

COSTLY, INEFFICIENT

Its flaws have made the port among the most expensive in the world for consumers and haulers. Although it falls under the auspices of APN, a cadre of shipping agents and terminal owners operate everything from the cranes to the warehouses. The port is also among the least efficient shipping hubs in the world, according to a recent survey by the International Finance Corporation, an arm of the World Bank. To complete shipment of a 20-foot container of dry goods to Haiti, it took an average of 33 days, the survey found, compared to 10 days to ship to the neighboring Dominican Republic's main port.

The same study estimates that the cost of port and terminal handling fees for Haiti is $700 for imports. In the Dominican Republic, it is $460.

The various costs and inefficiencies deter serious investments or job creation.

Since the quake, complaints have mounted. Prospective investors struggle with congestion. Increased costs include a $300 fee that port operators now charge to cover the leasing of barges for offloading cargo.

``It's scandalous,'' Mark Billingham, a frustrated British businessman, said about all the costs, after paying $32,000 to move his 78 containers onto land.

``The corruption is blatant, the bureaucracy and uncertainty, a terrible mix,'' he said.

Billingham said his company, Modular Construction, had planned to invest in Haiti, but the experience has soured him.

``We are going to do the best we can to build and sell some schools, recoup our money and say `Adios' to Haiti,'' he said.

Soon after the 7.0-magnitude earthquake rocked Haiti's capital and nearby cities, the country was forced to turn to the Dominican Republic to truck in life-saving aid.

With a government-estimated 300,000 dead, an equal number injured and surgeons forced to sterilized instruments with vodka, the port became critical to saving lives.

But the already unstable northern pier had crumbled into 1,476 feet of rubble under the sea, and the southern pier was badly damaged. Long-neglected provincial ports were either too small to handle the flood of containers, or the roads connecting them with the broken capital were themselves broken.

The international airport was also damaged, diverting flights.

AN IMAGE PROBLEM

With the U.S. military commander pressuring to get the main seaport operational, the southern pier was repaired and the decision was made to lease two 100- by 400-foot floating barges from Jacksonville-based Crowley Maritime Corp.

As the U.S. military's $22 million contract with Crowley came to an end on April 15, the maritime agents said they took over the contract at the request of APN.

``We could not allow container flow to stop. We had to accept those costs,'' said Geoffrey Handal, assistant general manager of ETS. J.B. Vital and a member of Association Maritime D'Haiti (AMARH), the 10 agencies and three terminal owners operating in the port.

In an interview with The Miami Herald, AMARH representatives said they've received a bum wrap.

``The port itself is efficient. It's once you get to the container yard and to customs and you have to deal with all of the paperwork,'' Handal said. ``Doing business in Haiti is frustrating whether you are importing or not, or using the port facilities or not.''

Still critics argue that the entire ports' supply chain has an image problem. Some in the international community suggest a true privatization model where APN's roles as operator and regulator are separated.

``You have a private sector that has made the investment but what has been lagging is the public sector's ability to either effectively help manage that process, or step back and ensure there is enough separation that allows them to regulate the port environment,'' said Anton Edmunds, who advises Caribbean businesses, and is familiar with the challenges of Haiti's ports.

$70 MILLION INVESTMENT

In January, Bellerive asked the International Finance Corporation for an assessment of Haiti's port sector. He disagrees with the current model, he said, because while APN controls the monopoly and should be operator, it has relinquished that role to the private sector, while not allowing competition from non-government owned ports. ``I am not a port specialist, but I cannot accept ideologically that somebody tells me that they are against competition,'' he said. ``I cannot accept that.''

AMARH members say they support privatization, but the field must be level and transparent. The government, they argue, cannot simply shut them down without compensation after they've invested more than $70 million to keep its port facility afloat, at the government's behest.

Bellerive says all the government has is the monopoly. Still, doing away with it will not be easy, he concedes, even if ``there is a lot of political will.'' Any swift decision to change the status quo, could quickly trigger an internal crisis in a country prone to conflict.

``If you close the port for one week, it's going to be a major crisis inside Port-au-Prince because 80 percent of everything that is entering is going out through the port. The people who have a lot of interests, they know that we are afraid of that,'' he said.

Two years ago, the government did quietly clean out the port, cutting the workforce to 500 workers from about 2,000, Alcime Henry, head of port operations, said.

But little else has been done in way of reform.

Meanwhile, the debate over the future of Haiti's ports has become cast in a bitter battle between two powerful Haitian tycoons -- Edouard Baussan, who heads AMARH, and Gregory Mevs, whose family operates a private terminal and port just two miles from the main port.

``It is not a clash of personalities. It is about port policy, a level playing field, uniform application and respect by all of rules and regulations,'' AMARH said in a statement.

In March, the Mevs family announced a $70 million investment project with Miami-based Sante Shipping to redevelop their private Terminal Varreux, and tap into a growing transshipment market with the 2014 expansion of the Panama Canal.

The plan included building two deep-water jetties for container cargo at a cost of between $20 million and $25 million.

RAISED EYEBROWS

The announcement raised eyebrows in Haiti as some questioned whether the company had authority from APN to make such an investment. Under Haitian law, APN is the only one that can grant permission to develop a port, or allow one to receive containers, the more lucrative of the cargo.

Bellerive, who wrote a letter to the Mevs on Jan. 18 allowing for them to make infrastructure investments, says it's clear to him ``they have the authority.''

``I'm very optimistic that the executive branch and the government will respect their contractual obligation with Terminal Varreux,'' Mevs said. ``I know that this government is committed to turning an important page in Haiti's history.''

Mevs has long argued that the government port monopoly is unfair.

But others argue that inviting competition in a country that doesn't receive enough containers could hurt the government port.

``International and private investors are willing to put the money, and private investors should be allowed to compete,'' Mevs said. ``What's important is to build additional facilities, improve competition and service so that prices go down.''

Observers in the international community say Haiti has to get a handle on its ports sector. ``Haiti must become a better, easier and more attractive place to do business,'' said Tony Chan, deputy mission director for the U.S. Agency for International Development in Haiti. ``But in order for this to happen, all of the links of the country's major supply chains have to properly function.''

Herald staff writer Scott Hiaasen contributed to this report.

Tuesday, August 24, 2010

OSF's Keith Steffen and Long Waits in the Emergency Department

In today's Journal Star there is an article on long waits in the nation's emergency rooms.

Dr. Nick Jouriles, emergency medicine chief at Akron General Hospital in Ohio was quoted in the article:

"The longer people stay in the emergency department, the more likely they're going to have complications, deaths. If they are elderly, they're more likely to end up in the nursing home."

In 2001 I wrote Keith Steffen, CEO at OSF-SFMC in Peoria this letter.

The next day I was put on probation for six months and Keith referred to me as "a malignancy in the emergency department."

I think OSF-SFMC was keeping the hospital full of elective surgical cases to the detriment of my Emergency Room patients.

A few months later Mr. Streffen fired me, and in July, 2002 he cut all OSF funding of Haitian Hearts patients.

Tuesday, August 17, 2010

Will Saint Francis Really do this?



Will OSF allow Jenny to die?

How could OSF do this?

OSF has a shining brand new 300 million dollar medical building. But was this building worth it if the life of one Haitian is ignored?

If Jenny were in Peoria, we wouldn’t keep her invisible. If she asked for medical help, the Peoria community would try and help her. Jenny lives 90 minutes from Miami.

The best medical technology in Peoria should not be used in a discriminatory fashion. Will OSF allow Jenny to die in Haiti with no medical technology at all?

Humility



Photo by John Carroll


Examining patients in Haiti is a very humbling experience for me.

When I look at the patient sitting on the examination table in front of me I realize there is no difference between the two of us. We are the same being. He just happens to be in a worse way that particular day than I am. And deep inside I realize some day I will be in his position one way or another.

When one is strong and seemingly in control one can be mistaken and think that he will always be in control of himself and his environment. But that is just not true.

Someday we will all be Haitian-like. We will be looking into someone's eyes pleading for help for ourselves. Will the other person be kind and at least try and help some? When our day comes hopefully we will have some of the dignity that Hatiians display during their dark hours.

John A. Carroll, MD
------------

See the abstract below about humility in medicine.


"The new professionalism movement in medical education takes seriously the old medical virtues. Perhaps the most difficult virtue to understand and practice is humility, which seems out of place in a medical culture characterized by arrogance, assertiveness, and a sense of entitlement. Counter cultural though it is, humility need not suggest weakness or lack of self confidence. On the contrary, humility requires toughness and emotional resilience. Humility in medicine manifests itself as unflinching self-awareness; empathic openness to others; and a keen appreciation of, and gratitude for, the privilege of caring for sick persons. Justified pride in medicine’s accomplishments should neither rule out nor diminish our humility as healers."

Jack Coulehan, MD, MPH
Annals of Internal Medicine Vol. 153 Number 3
August 3, 2010

Sunday, August 15, 2010

President Preval



Photo by John Carroll


Haitian quake shook leader to his core

'As a person I was paralyzed,' says President Rene Preval, recalling the suffering he saw. He's quiet for a politician, even humble; but his silence since the disaster enrages many.


By Joe Mozingo, Los Angeles Times

August 15, 2010

Reporting from Port-au-Prince, Haiti — Haitian President Rene Preval peers off and rubs his beard when he thinks about those 35 seconds when the earth convulsed.

Preval was feeding his 8-month-old granddaughter dinner in the courtyard of the presidential mansion. They were thrown to the ground as the house collapsed. Unable to reach anyone on the phone, Preval jumped on the back of a motorcycle taxi and directed the driver toward downtown. Wending through the rubble in the dark, he couldn't comprehend the scope of death and ruin.

"Pain made me speechless," he says during a two-hour interview in an office behind the half-collapsed National Palace. "As a person I was paralyzed."


In the days and weeks following the Jan. 12 earthquake, Haitians desperately wanted to hear from their leader. Soon they were furious at his silence.

"I was much criticized for not having spoken.... To say what? To the thousands of parents whose children were dead. To the hundreds of schoolchildren I was hearing scream, 'Come help me!' " He pauses and sighs. "I couldn't find the words to say to those people."

Preval, 67, a quiet former agronomist with a gap-toothed smile and silver beard that some Haitians suspect has magical powers, has always been an enigmatic figure. He concluded his first term as president, in 2001, with a prophetic warning of the chaos to come — "Swim to get out" — and retreated to a tiny home in the northern mountains to help peasants grow bamboo.

When he ran again in 2006, he barely campaigned and said almost nothing. Political observers were perplexed by his candidacy, because he never seemed to really like being president. He certainly never showed the thirst for power of any of his rivals or predecessors, and his return to the National Palace felt so casual as if to be almost accidental.

So did his success. Preval's government quietly settled a gang war that had paralyzed the capital, stopped a horrific spate of kidnappings, restored regular electricity, reformed a corrupt police force, and secured trade preferences from Washington. And despite being hit by two destructive hurricanes, Haiti experienced a semblance of political stability for the first time in decades.

The world didn't notice because, for once, Haiti was not in the news.

"He came in when the country was at war," says Michele Montas, a longtime journalist and now a special advisor to the head of the United Nations mission in Haiti. "He brought the opposition into the government. He tried to reassure the private sector. As a journalist in this country for 30 years, I've never seen a political figure as shrewd as Rene Preval.... Can you imagine a politician who gets to power and he didn't even campaign?

"I really think he's misunderstood. But to some extent it's his own fault."

Haitians have long grumbled about Preval's inability or unwillingness to speak to the masses and pitch a vision of the future. But when the earthquake killed an estimated 230,000 people, displaced more than a million more and leveled whole swaths of the capital, what was once seen as a tolerable quirk in a humble man became a focal point of the nation's outrage.

Asked what Preval has done for the country, people in many parts of the capital grimace or swipe their hands in disgust, as if the answer is so obvious that the question itself is an outrage.

"Preval didn't do a damn thing," says Kerby Badio, 28, living in the sprawling tent camp outside the palace that Haitians call the White House. "He can't even get the palace fixed. If a country doesn't have a White House, it's not a nation."

Badio voted for Preval in 2006 because he thought he would make life better for the poor. But the president's seeming absence after the earthquake crystallized a feeling that he didn't empathize with their suffering.

"When a country goes through something like that, everyone looks for a president to say something. He didn't say anything for weeks. He was just riding around on his motorcycle," Badio said.

In nearby Fort National, residents were furious when the government razed homes to cut new road corridors. "We didn't know what was being done," says Victorin Richard, 22, whose little hut was among those cleared. "We thought they were building new houses. Now we hear it's a road. It's just going to be dust. They'll never finish it."

All of this has big political implications for the country's recovery in a presidential election year. Preval, who cannot run for reelection, founded a new platform, Unity, to maintain some political continuity when he departs. But his lack of popularity leaves the election wide open, with many people on the streets saying they'd vote for hip-hop singer Wyclef Jean.

Foreign aid groups and diplomats have complained that Preval has been indecisive and has failed to settle key issues of where to settle the displaced.

"We know that it is not an easy task," says Julie Schindall, a spokeswoman for the relief group Oxfam, which supplies clean water to the camps. But the people in the camps "are living on the edge. And they need to know what the future holds."

Still, longtime Haiti observers view this in context of the turmoil before. Mark Schneider, a senior vice president at the International Crisis Group, a nonprofit group devoted to resolving deadly conflicts, says Preval has done "a remarkable job, given the half-functioning government, given the level of malaise, unhappiness and corruption previously."

"People say they're looking for a father figure to say things are going to be OK," Schneider says. "And he just doesn't do that. The instinct in his gut is that if he doesn't see evidence that that's going to happen, he's not going to say it."

But Schneider acknowledges that Preval needs to better explain his plans to the public.

"There's frustration and uncertainty. People are asking, 'What's next?' "

*

Preval rode to power on the wings of his political mentor, the fiery slum priest-turned-president, Jean-Bertrand Aristide.

The two had become friends when Preval owned a bakery that supplied free bread to Aristide's church. When he succeeded Aristide as president in 1995, they had grown estranged, and Aristide was unwilling to give up his power, having his own loyalists embedded in the police and government and using street gangs to terrorize opponents.

The message of who really ruled was made clear when Preval and his then-wife found their dog dying of a machete blow — inside the National Palace.

His weak position hit its nadir in 2000 when his best friend, the crusading radio broadcaster Jean Dominique, was assassinated after accusing various Aristide acolytes of corruption and thuggery. Preval was devastated. He appointed a judge to investigate, but when Aristide succeeded him in 2001, the judge found his budget and security suddenly withdrawn, and fled to Miami.

Still, Preval's first term was noted for many improvements — new roads, schools, hospitals. He cleaned out many of the "zombie" employees on the government payrolls and investigated human rights abuses.

He has always said he prefers practical steps to sweeping ideology or rhetoric.

In person, Preval is nothing like the stiff, distant man in front of the microphone. He is open, humorous and human like few politicians, admitting his frailties and chatting without the salesman sheen. Walking with a reporter behind the National Palace, among roaming chickens and peacocks, he puts his arm around an elderly man with light eyes and white hair.

"He looks just like me," he says. The man smiles dutifully, clearly having heard this before.

He approaches another worker he knows and says, "He's on his way to an anti-Preval demonstration."

The man shakes his head, somewhat nervously, until Preval laughs and pats him on the back.

In the office, he ruminates on why his people seem to be turning against him. On the wall is a poster of Dominique, with the words "We Will Never Forget" in Creole.

Preval details a range of plans to build temporary shelters, followed by tall apartment buildings, to bring order to the teeming neighborhoods where houses were literally built on top of one another. He appointed a civil engineer to work with U.N. officials and relief organizations to settle land disputes and find suitable places for the people in the tent camps.

"If the people know that within five years there will be apartment buildings, they will go," he said.

But he knows he is in no position to promise them this. The election to replace him is scheduled for Nov. 28. The U.N. advisors working on the issue hadn't even heard of this apartment idea, and appeared to be waiting for his successor to grapple with long-term issues.

He hopes he can make some headway before his legacy is sealed by catastrophe.

"There was so much death, so much suffering, one has to find a person responsible for that. Since they can't accuse the one up there," he says, pointing up, "they are accusing the one in the palace. Sometimes you have the impression people are accusing you of actually causing the earthquake."

joe.mozingo@latimes.com
Copyright © 2010, Los Angeles Times



Nyoung at 5:25 AM August 15, 2010
Michele Montas is the widow of Jean Dominique. Dominique is described as having been Preval's "best friend" in this article. That should have been mentioned because it undermines its credibility to just have her presented as a neutral expert journalist. I don't know if the author just didn't know she was related or chose to withhold the information...It seems that the "quiet humble" Preval is on an orchestrated PR tour -- I've seen a couple of articles like this recently. Clearly, the situation in Haiti is the very definition of complexity and it's possible that nobody could have done better than Preval has...but well before the earthquake there was a widespread perception among the poor that Preval had deserted them and that should not be so easily discounted as merely being the result of his communication style. I suspect the Haitian poor are infinitely more misunderstood than Preval is.

huitzilopochtli88 at 1:44 AM August 15, 2010
The article appears to be skewed to portray Mr Preval as a victim and a hero.

However, was he not the man in charge when the country was told their seismic building standards were inferior and a moderate earthquake would cause buildings to collapse? He sat there doing nothing and ignored those warnings. If he were in charge in some countries and did nothing as he did, he would be cast out with a ceremonial sword and you can guess what the prime directive of that ceremonial sword would be intended for.

RJM Haiti at 9:59 PM August 14, 2010
Thank you. Finally a voice that recongnizes the HUMAN Rene Preval. How easy it is to expect our leaders to be super human. The night of that terrible earthquake Mr. Preval personally lost close workers and some of the brightest among his young government associates. Anyone who works in trauma and grief counseling understands that he could not reach out until he reached in and allowed some inner healing. Thank you also for giving credit to Mr. Preval for what he has done for Haiti since he is in office. Haiti, though far from perfect, really IS better for his having been president.