Korean Toddler gets new Trachea at OSF-CHOI...OSF's Haitian Patients Refused Care

Toddler youngest in world to get lab-made windpipe in Peoria operation shar.es/lpMUZ via @sharethis
— John A. Carroll (@haitianhearts) April 30, 2013

Illness as a Moral Experience

Looking at medicine this way reinforced my belief that the structure and demands of medical schools and hospitals create obstacles to caregiving. How to revivify caregiving in medicine became the issue. Teaching about illness experiences remains important. Yet the moral–emotional core of those experiences deserves greater primacy — as does the social suffering that affects everyone, but especially marginalized people already injured by poverty, isolation, and other forms of structural violence.

Another orienting issue is the lived relationship between patient (and family) and clinician. Here the anthropological model of exchange based in reciprocity can counterbalance the market model's infiltration into even the most intimate parts of health care. The anthropological perspective suggests that care resembles gift exchange between individuals whose relationship to each other really matters. Stories and meanings are exchanged, but also the raw experience of responsibility and emotional sensibility. Over time, caregiving changes the moral life of both caregiver and care receiver. Ultimately, caregiving is about doing good for others, and doing good in the world, as naive as it may sound, is what medicine is really about. That's what draws people to its practice, even if it's also about technology, biomedical science, and markets. That moral core of medicine may seem abstract, until you see health professionals passionately struggling to be useful, compassionate, responsive, and responsible while working with the indifference of bureaucratic rules, the cold counting and costing of institutional audits, and hard-to-balance personal demands on their time and concern.

Modern medical practice's greatest challenge may be finding a way to keep caregiving central to health care. That way will turn on structural and economic developments, technologies, and therapeutic models, but also on the importance that professionals ascribe to patients' deep experience and to such enduring moral practices of caring as the laying on of hands, the expression of kindness, the enactment of decency, and the commitment to presence — being there for those who need them. This is the embodied wisdom medical students need to learn and we all must remember. It is the lesson for the art of living and the art of medical practice that emerges from my 40 years of rethinking and reliving this subject.

Arthur Kleinman, M.D.

New England Journal of Medicine 2013; 368: 1376-1377

Infrastructure

Haiti's Infrastructure
(Photo by John Carroll---April 7, 2013)

I just love the word "infrastructure". We all love to talk about Haiti's infrastructure.

Merriam-Webster defines infrastructure as: The underlying foundation or basic framework (as of a system or organization).

The infrastructure in the picture above is in LaPlaine. This depicts Haiti's infrastructure pretty well.

And this infrastructure looked like this before the earthquake of 2012. Nothing has changed about this infrastructure except possibly the cow.

Haitians raise their families in this infrastructure. And they watch their babies die due to the infrastructure.

Haitians don't like infrastructure so much.  It is not just an academic discussion or exercise for them.

LaPlaine---April 7, 2013

John A. Carroll, MD
www.haitianhearts.org

She Makes Me A Slave (Addendum)

Willgesta
(Photo by John Carroll--April 6, 2013)

Mom speaks fast. No one usually listens. She needs her say.

Willgesta is 11 months old and was born at home. She has been sick for two months.

The spaces between her tiny ribs suck in with each breath. But she fights like a tiger. 

Please give her the breast, her cry is bad.

I have been to five hospitals and clinics and doctors.

No one does anything for her.

Receipts she has paid spill onto the table from a black garbage sack.

They say she has a hole in her heart. Her echo report is in Cange, of course.

Her weight has gone down and she has fevers and sweats.

Yes, she may have tuberculosis, but please fix her heart.

No, she has no passport.

I have six other children and they are "mal mange".

But she makes me a slave...I can’t let her cry.

I've called you many times but you don't answer.

I will bring you some limes.

Will you just take her and fix her heart?

(Addendum 4/7/2013: Willgesta was admitted to the best children's hospital in Port-au-Prince yesterday afternoon.)

John A. Carroll, MD

www.haitianhearts.org

Haitian Woman

Haitian Woman
(Photo by John Carroll)

Hope Keeps Us Alive

Marie-Claude
(Photo by John Carroll, April 1, 2013)

Hope Keeps Us Alive....blogs.pjstar.com/haiti/2013/04/…
— John A. Carroll (@haitianhearts) April 6, 2013

Best Western Hotel Grand Opening in Haiti

Ismael
(Photo by John Carroll--April 4, 2013)

Something not adding up here...blogs.pjstar.com/haiti/2013/04/…
— John A. Carroll (@haitianhearts) April 5, 2013

Beauty in Soleil

Photo by John Carroll (April 3, 2013)

The "worst slum in the western hemisphere" is filled with people like this.

John A. Carroll, MD
www.haitianhearts.org

Holy Saturday Night in Haiti

Sleeping with Mitral Stenosis in Port-au-Prince
(Photo by John Carroll, March 30, 2013)

This is how Marie has been trying to sleep for months. She cannot lie down because she cannot breathe.

Her exam today revealed a very tight mitral valve. The tissue is scarred down and does not let blood normally drain into her left ventricle which is her main pumping chamber. And fluid ends up in her lungs which has caused her right ventricle to become overloaded. And this causes fluid to engorge her liver and causes her abdomen to be painful.

And untreated strep throat caused all of this when Marie was 12 years old and she developed rheumatic fever.

And what really caused most of this is being poor.

What needs to be done?

Marie is on four types of heart medicine which is stopping her from tipping all the way over.  But the "cure" for Marie is heart surgery to replace her mitral valve.


John A. Carroll, MD
www.haitianhearts.com

Good Friday in Haiti

It is very early Good Friday morning.

Marie just texted me: "Dr mwn pa kapab respire bien ni donmi" ("Doctor I cannot breathe well or sleep.")

Jesus actual cause of death as He hung on His cross was suffocation. Marie is having fluid from her heart backing up into her lungs, which floods her alveoli and impairs oxygen transfer. Marie is suffocating on her cross like our Lord did on His.

Jesus could text no one. Marie can.

Jesus had to die. Marie doesn't.

Our response hasn't changed much in two thousand years.


John A. Carroll, MD
www.haitianhearts.org

Sent Home

I sent Marie to a hospital in Port-au-Prince very early yesterday morning. I spoke with one of the hospital doctors on the phone and told him Marie's medical history. He told me that she would be evaluated but that they had no open inpatient beds for her.

Marie called me before noon and was despondent. She said the hospital did nothing for her and she was headed home on a tap tap. She said that "...if I lie down, I will die."

I asked Marie if she could go to the General Hospital in Port-au-Prince right then. She said their staff is on strike.

And OSF remains quiet about Marie in Peoria.

What to do now?

Giving

Short video from the New York Times. Could be a satire of all of us who are trying to "help" Haiti.

Archbishop Wenski and Pope Francis

Archbishop Wenski has always been a strong supporter of Haiti. Here are his words on our new pope.

"They are going to let me die..."

Early this morning Marie texted me: "They are going to let me die, Doctor Carroll."

I quickly called her on Skype. She does not sound good. Marie cannot breathe well or sleep well. She seems to be dying of congestive heart failure due to her mitral valve which has been destroyed.

I have e mailed multiple people in the States and in Haiti requesting help for Marie. She needs to be hospitalized for oxygen and aggressive diuresis. And then she needs valve replacement.

@micheljmartelly Please help young lady with heart problem. She was operated in Illinois...needs help today..Marie at 47735075. Thx.
— John A. Carroll (@haitianhearts) March 26, 2013

OSF, Please Follow Your Philosophy

Please, OSF, follow your Mission Philosophy....blogs.pjstar.com/haiti/2013/03/…
— John A. Carroll (@haitianhearts) March 25, 2013

Haiti's Cholera Crisis

Haiti's cholera crisis bit.ly/10n3NrI
— John A. Carroll (@haitianhearts) March 21, 2013

Sounds Like Peoria to Me

Lyons: U.S. patients the victims of health care profiteers shar.es/ezQUa via @sharethis
— John A. Carroll (@haitianhearts) March 20, 2013

Pope Francis

Clearly defining his vision of his own role, he quoted from scriptural texts to say that as Bishop of Rome, he was endowed with “a certain power.”

But he went on: “Let us never forget that authentic power is service and that the pope too, when exercising power, must enter ever more fully into that service which has its radiant culmination on the Cross.”

“He must be inspired by the lowly, concrete and faithful service which marked St. Joseph and, like him, he must open his arms to protect all of God’s people and embrace with tender affection the whole of humanity, especially the poorest, the weakest, the least important, those whom Matthew lists in the final judgment on love: the hungry, the thirsty, the stranger, the naked, the sick and those in prison.”

New York Times--19 March 2013

Social Sin

"We live in the most unequal part of the world, which has grown the most yet reduced misery the least. The unjust distribution of goods persists, creating a situation of social sin that cries out to Heaven and limits the possibilities of a fuller life for so many of our brothers."

Cardinal Jorge Mario Bergoglio
2007

Deplorable

Haiti: Deplorable Conditions for Cholera Patients@msf_usa shar.es/epBwG via @sharethis
— John A. Carroll (@haitianhearts) March 12, 2013