Haiti, Sickle Cell Anemia, and Vaccination

Haiti is plagued by sickle cell anemia. The majority of Haitians are black. Sickle cell anemia is a disease that, for the most part, afflicts blacks.

I had never seen a child with a sickle cell crisis until I did my pediatric clerkship at Cook County Hospital in Chicago. I developed a new respect for this terrible disease.

Haiti's poor children, which is the vast majority of it's pediatric population, do well to receive the "first generation vaccinations". Very few obtain pneumococcal vaccine or Hemophilus influenza (Hib) vaccine. Both of these vaccines, when given to children in resource rich countries, dramatically decrease the incidence of invasive disease due to these organisms.

Children with sickle cell anemia succumb to invasive pneumococcal disease at a far greater rate than do children without sickle cell anemia.

Vaccine reduced bacterial illnesses in children who have sickle cell disease
by Kirsten H. Ellis
Infectious Diseases in Children Staff Writer

June 2007

Rates of invasive pneumococcal disease in children aged younger than 5 years with sickle cell disease decreased 93.4% after the pneumococcal conjugate vaccine was introduced in 2000, according to a new study published in Clinical Infectious Diseases.

Invasive pneumococcal disease is the leading cause of mortality among children with sickle cell disease. Compared with the general population, patients with sickle cell disease are between 30 and 600 times more likely to develop pneumococcal meningitis, bloodstream infection or other serious infections.

The researchers were not surprised by the decrease in invasive pneumococcal disease among vaccinated children with sickle cell disease, but were surprised by the magnitude of the reduction.

“That number says that the vaccine is doing well in a high risk population and is efficacious in preventing serotypes that are contained within the vaccine,” Natasha Halasa, MD, MPH, assistant professor of pediatric disease at Vanderbilt University School of Medicine and one of the study’s researchers, told Infectious Diseases in Children. “I was surprised that it was over 90% effective because there are other serotypes out there that are not covered by the seven-valent vaccine.”

The pneumococcal conjugate vaccine (PCV7, Prevnar, Wyeth) is recommended for all children aged younger than 2 years and for selected children aged 2 to 4 years with high risk conditions, including sickle cell disease.

Prior to the pneumococcal conjugate vaccine, children with sickle cell disease were given penicillin prophylaxis to thwart infections, which showed an 84% decrease of invasive pneumococcal disease, according to the findings of a prior study.

This vaccine is administered at routine checkup ages.

“Since all kids are supposed to get this vaccine at 2 months, 4 months, 6 months of age and then again at 12 months, children with sickle cell are now receiving this benefit at such an early age when the rates of pneumococcal disease are so high."

Sorry most Haitian children with sickle cell are not receiving this benefit.

A Byte Out of Poverty

Peoria Journal Star
Tuesday, June 19, 2007

"Humanity's greatest advances are not in its discoveries, but in how those discoveries are applied to reduce inequity. Whether through democracy, strong public education, quality health care, or broad economic opportunity, reducing inequity is the highest human achievement."

That's a pretty powerful quote. And this altruistic appeal originates not from a preacher or presidential candidate but from a software engineer named William Henry Gates III - better known as "Bill."

The Microsoft mogul recently addressed the graduating class of Harvard, the Ivy League school he famously quit to pursue his passion for computers. After accepting an honorary degree, Gates joked he was glad to finally get his diploma. But jokes aside, this commencement address transcended the usual fodder college grads hear. It was revelatory, honest, a humanitarian call to arms.

The 52-year-old Gates admitted he left campus in the mid-1970s "with no real awareness of the awful inequities in the world - the appalling disparities of health, and wealth, and opportunity that condemn millions of people to lives of despair." It took him "decades to find out" that others, especially in developing nations, were getting substandard schooling, enduring hunger or dying of treatable illnesses like malaria and measles - not of their own fault, but because both private and public sectors had failed them.

In revisiting his naivete, Gates urged not only graduates but also Harvard as an institution to "make market forces work better for the poor" and use "creative capitalism . . . so that more people can make a profit, or at least make a living." In addition, citizens should "press governments around the world to spend taxpayer money in ways that better reflect the values of the people who pay the taxes."

Gates should know something about values. The man who tops Forbes' billionaires list has, along with wife Melinda, thrown himself into philanthropy. His foundation, with an endowment of $33 billion, has given millions in grants to fund the kind of "teach a man to fish" initiatives he referenced in his speech: college scholarships, public school curriculum support, access to vaccines and, of course, money to bridge the digital divide. Like Warren Buffett, another billionaire benefactor, Gates seems to have realized money is only as good as the man who makes it, and that wealth and position can motivate others - politicians, businesses, the media - to pay attention to those less fortunate.

In his late middle age, the world's richest man has dedicated his time to the world's poorest people. Ironic, yes, but nicely so. Would that those of us mere mortals with more modest means but equally generous spirit follow suit.



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My comment:

The PJS editorial states, “…Gates seems to have realized that money is only as good as the man who makes it, and that wealth and position can motivate others—politicians, businesses, the media—to pay attention to those less fortunate.”

Why isn’t the Journal Star “paying attention” to those less fortunate that have lived right here in Peoria? I wonder what the Journal Star thinks of OSF’s refusal to take care of Haitian Hearts patients that have been treated at OSF in the past and now need further heart surgery to stay alive.

Haitians kids are dying because of OSF’s refusal to care for their patients. Gates’ cry for reducing inequity as the “highest human achievement” generates no action in Peoria for Haitians, only written words.

The Cuban Experience

“It is increasingly rare for many of us to believe that people can be poor, but honest; poor, but deserving of respect. Poverty is no longer blamed on anyone but the poor themselves. Contempt for the poor has become virtue.”

John Cardinal O’Connor
Archbishop of New York

After working a fair number of years in Haiti, I think that Haiti’s medical problems are solvable. All problems in Haiti are solvable, but this post regards how adopting certain aspects of Cuba's health system could help Haiti and, quite possibly, improve the lives of certain poor populations in the United States.

The International Journal of Epidemiology published an article in August, 2006: “Health in Cuba”. It is written by Richard Cooper, Joan Kennelly, and Pedro Ordunez-Garcia.

The authors write that no matter what one believes about the politics of Cuba, there is a lesson to be learned regarding Cuba’s health care system. And with just a little water separating Cuba from Haiti, my very small mind asks, why can’t Haiti adopt some of Cuba’s life saving public health measures?

The article reports that the word needs to disseminate that Cuba has done something very worthwhile regarding health care.

The abstract of the paper states:

“The poorer countries of the world continue to struggle with an enormous health burden from diseases that we have long had the capacity to eliminate. Similarly, the health systems of some countries, rich and poor alike, are fragmented and inefficient, leaving many population groups underserved and often without health care access entirely.

"Cuba represents an important alternative example where modest infrastructure investments combined with a well developed public health strategy have generated health status measures comparable with those of industrialized countries. Areas of success include control of infectious diseases, reduction in infant mortality, establishment of a research and biotechnology industry, and progress in control of chronic diseases, among others.

"If the Cuban experience were generalized to other poor and middle income countries, human health would be transformed. Given current political alignments, however, the major public health advances in Cuba, and the underlying strategy that has guided its health gains, have been systematically ignored.”

The authors are saying that the biomedical literature in English has been almost entirely silent on the Cuban health experience and Cuban health revolution since 1959. They think that an open discussion should take place on the potential lessons to be learned from the Cuban medical experience because the “raison d’etre of the health sciences is the discovery of new knowledge and the use of that knowledge to improve health”.

In 1991 the Soviet Union withdrew economic support for Cuba. The authors refer to this as an “abrupt economic disruption”. However, they noted, “The impact on health indices was relatively modest and short-lived, however, further demonstrating that economic measures alone are poor predictors of physical well-being within a society. One potential explanation of this anomalous pattern may be the relative absence of extreme poverty, which is the most powerful economic correlate of ill health and can confound the effect of average Gross National Product (GNP). Cuba has a high degree of income equality and lacks the marginalized slum populations of most of Latin America, although the growing dependence of the tourist economy and, to a lesser extent, foreign remittances has widened the income distribution”.

Regarding the infant mortality rate, the article reports, “Since 2002 Cuba has had the second lowest infant mortality in the Americas, 20% below the US rate for all ethnic groups and just below the rate for US whites... Thirty-five per cent of the Cuban population is black or mulatto, yet the infant mortality rate are less than half of what is observed in the US black.”

“In terms of child survival, a ‘continuum of care’ that provides for the pre-conceptional health of women, prenatal care, skilled birth attendants, and a comprehensive well-baby program can quickly reduce infant mortality to levels approaching the biological minimum. Many observers will regard these propositions as reasonable, yet hopelessly too ambitious for the poorer nations of the world, It must be recognized, however, that these principles have been successfully implemented in Cuba at a cost well within the reach of most middle-income countries.”

I have had a number of young mothers in Haiti bring in their newborns that they delivered alone at home lying on their dirt floor. One mother told me that when her newborn cried immediately after delivery, the neighbor man next door heard the baby’s cry, and rushed over and cut the baby’s cord. This neighbor man could be considered a concerned person, but hardly a “skilled birth attendant”, which almost all Cuban mothers have during labor. This scenario in Haiti is absurd and wrong and could and should be fixed.

I think the real problem is fear. How much will the gran mange in Haiti have to give up for the vast poor underclass in Haiti can live like humans? How much will the well-to-do in the United States have to give up for our poor health care statistics to improve? Probably very little. And all social classes in Haiti and the United States would live stronger and more productive lives if the slightest amount of compassion, energy, and action were directed for the benefit of the poor.

The Cuban story regarding improving the health of its population needs to get out and be implemented in resource rich and resource poor countries whose people suffer from health care inequalities.

Luke--Part 2

Luke underwent his tests yesterday at OSF in Peoria.

The tests reveal that he has a large kidney stone in his right kidney that will need to be removed so that it does not obstruct and further injure his kidney.

The stone probably formed due his severe malnutrition several years ago in Haiti with infection possibly playing a role.

The medical care that he received yesterday from the nurses and physicians was excellent.

Luke spent approximately 30-40 minutes in the operating room where the procedure and xrays were obtained. No surgery was performed. He entered the operating room at about 9 AM and was discharged to home at 11:10 AM.

OSF's charges for the above are $9,500. The physicians charges are not included.

I asked OSF for an itemized bill so we can see how this breaks down. Will post the bill when I receive it.

Haitian has Heart Surgery at Provena St. Joseph

Marie Amazan, a 24 year old Haitian Hearts patient, received two new heart valves at Provena St. Joseph Medical Center in Joliet, Illinois. See Press Release. Provena St. Joseph provided their medical center pro bono as they did for four previous Haitian Hearts patients.

Dr. Bryan Foy performed the delicate heart surgery and Dr. Kinder placed a permanent pacemaker. All physicians involved in Marie's care provided their services at no charge.

Marie is from Carefour Feuilles in Port-au-Prince. She lives in a crowded two room house on the side of a steep hill. Many family members live with her. She has six older sisters and no brothers. Her father is dead.

Her family does not eat everyday due to the poverty of Haiti and her neighborhood can be dangerous with the gang and political violence that plagues much of Port-au-Prince.

Marie has been unable to do much for many years due to congestive heart failure. She could mop the floor and make her bed, but that was about it.

This week, Marie was discharged from the hospital and is improving everyday. A Cardiovascular Intensive Care nurse, Anita, has been supervising Marie's outpatient medical care and transportation since discharge from the hospital.

Marie was given a chance by Provena St. Joseph and its physicians and nursing staff. Haitian Hearts cannot thank all of you enough.
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See ABC News story.

See more about Marie's recovery as reported in Chicago at ABC News.

Haiti and Cuba--So Close, Yet So Far

Haiti and Cuba are separated by 90 miles of water. Their geographic proximity is close, but the health of their people could hardly be further apart.

Under President Aristide, Haiti and Cuba developed strong ties with considerable benefit for Haiti’s people who suffer from chronic substandard medical care. During the past decade Cuba sent over 500 members of a “medical brigade” bringing different levels of medical care to 75% of the Haitian population.

I have spoken to a number of Cuban physicians over the past 7 years. They work under austere conditions in rural Haiti and many work in urban hospitals in Haiti’s larger cities. The challenges are great, but the Cuban physicians seem to be quite flexible.

When I asked a female Cuban physician if she missed her family in Cuba she replied that the “Haitian people are my family”. I asked another excellent Cuban physician, if he enjoyed being in Haiti. He responded yes that he did and that he could "buy jeans on the street corner in Port-au-Prince". Haiti offers mixed blessings for all foreign physicians that work there.

It has been my experience that the Haitian people trust the Cuban medical professionals in their country. Many of my Haitian patients have been seen and examined by Cuban physicians. The Haitian people believe that the Cuban medical professionals are doing the very best they can for them.

I have seen statistics regarding the influence of Cuban physicians. I do not know where the statistics have originated or whether they are valid, but they are very optimistic.

One report from The Guardian, (March 17, 2004) states, “ In the areas (of Haiti) covered by Cuban doctors, the mortality rate for infants under 12 months dropped from 80 to 28 per 1000 live births, and that for children under five, from 159 to 39 per 1000 live births. The maternal mortality rate dropped from 523 to 259 deaths per 100,000 live births. More than 370,000 Haitians—80% of them children—have been vaccinated by the Cuban teams.”

The Guardian continued to report, “Cuba established a School of Medicine in Haiti, staffed by Cuban professors, to train Haitians to continue the work begun by the Cuban medical teams. At the time of the coup, 247 young Haitians were studying there. Another 372 are studying medicine as scholarship students in Cuba.”

Below are statistics comparing Haiti and Cuba:

1. Prevalence of Tuberculosis--
Cuba: 14/100,000
Haiti: 392/100,000 (Haiti ranks worse than Sudan, Pakistan, Mongolia, North Korea, Russia, and Romania.)

2. Infant Mortality Rate--
Cuba: 7/100,000
Haiti: 80/100,000

3. Access to Safe Water--
Cuba: 91% of population
Haiti: 58% of population

4. Maternal Mortality Rate--
Cuba: 33/100,000
Haiti: 523/100,000

5. Adult Illiteracy--
Cuba: 3% of population
Haiti: 47% of population

Luke

My wife and I adopted a Haitian boy last year. We named him Luke and we think he is about four years old. We brought him to the United States in February, 2007.

This post will be added to as the days and weeks roll by regarding Luke's medical saga at OSF in Peoria.

Several months ago Luke developed a medical problem. He has gross hematuria which means he is passing blood in his urine.

We did some blood tests at a local lab that is run by a lady named Joyce Harmon. After Joyce would take Luke's blood, she would kiss him, to help melt away his pain and trauma that he felt he did not deserve. Joyce charges very little for her blood tests and her lab is more a labor of love than a way for her to make any real money.

Other than the blood in his urine, Luke's blood tests were normal.

At that point, we decided to do a sonogram of Luke's kidneys. The sonogram was done at OSF in Peoria and OSF charged us $700.00 dollars for this test. The radiology group read his sono for no fee.

The sono revealed that Luke has kidney stones in his right kidney with an obstruction somewhere in his collecting system.

Several weeks later, Luke had his appointment with a pediatric urologist in Peoria who is very competent and we trust.

More tests were ordered.

On June 7, 2007 we received a letter from OSF-SFMC that stated, "As a service to you we have verified your insurance coverage; however, verification of benefits is not a guarantee of payment by your insurance company that all services rendered will be covered. Based upon this verification, your estimate/deposit for this visit will be $875.00 due upon registratiion. Your payment options are credit card, cash, or personal check."

What the above means, is that OSF-SFMC wants their money as soon as possible. The $875.00 is for a lasix radionuclide scan of Luke's kidney. Like the kidney sonography bill of $700.00, these bills are not covered by our insurance and do not come off our deductible.

So I spoke with the pediatric urology office and we cancelled the lasix radionuclide scan.

On Friday, June 15, Luke is scheduled to have a cystoscopy with retrograde pyelograms performed under a general anesthesia as an outpatient at OSF.

Patient Accounts at OSF called my wife today and stated that OSF charges for the cystoscopy will be $4,598.00 and the charges for the retrograde pyelogram (squirting some dye up the ureters during the cystoscopy), will be $4,903.00. These tests should take between 30-45 minutes in the operating room.

The pediatric urology fees and anesthesiology fees are unknown at this time.

After we meet our deductible of $2,500.00 and add $1,000.00 more, Blue Cross/Blue Shield will cover the rest...we think. OSF advised my wife today to bring $1,600.00 cash on Friday morning at 7 AM to get things started off on the right foot for OSF, the Catholic medical center with a "commitment to life".

OSF's Commitment to Life?

My wife was being cared for by an OSF health care provider last fall. E-mails between the OSF provider and my wife were blocked. They could not communicate with each other over medical issues while we were in Haiti.

The OSF provider was stunned to realize this especially when we did a “test run” to see if we received each other’s e-mails. No e-mails were received by either party when sent through the OSF account.

What can this OSF provider do? Nothing if this individual wants to keep her job.

It seems that both my wife’s account and my account to OSF and from OSF employees to us have been blocked by OSF. Dr. Gerry McShane indicated this as I posted in the past. Dr. McShane told me last spring that he was not receiving my e-mails.

I have sent e mails to OSF Corporate and to OSF's Administrative team and legal counsel pleading for the lives of Haitian Heart's children to allow them to return to OSF for further care.

I do not believe that Dr. McShane and others want other members of Corporate or any OSF employee seeing the content of my electronic communication.

Our four year old son will soon have surgery at OSF. Will the e-mails continue to be blocked by OSF regarding my son’s medical care too? The physician who will operate our son works out of OSF-Children’s Hospital of Illinois.

The Value Statements at OSF are being ignored. Statement number four, “Collaboration with each other, with physicians, and with other providers to deliver comprehensive, integrated and quality health care. Statement number seven, “Open and honest communication to foster trust relationships among ourselves and with those we serve.”

OSF’s hypocrisy regarding its Value Statements is not ethical and could indeed be dangerous.

Milestone for Generosity?

A Milestone for Generosity
Friday, June 8, 2007

OSF Saint Francis Medical Center's plan to improve care for its youngest patients seems to have touched the community. Donations are pouring in by the millions.

First came CEFCU, which in February pledged $1 million toward a new pediatric emergency department for the Children's Hospital of Illinois.

In April came $500,000 from Lynn and Susan McPheeters to help fund construction of the hospital's neonatal intensive care unit. Lynn McPheeters, whose daughters were born at St. Francis, is a former president of the hospital's foundation council.

Then RLI Corp. founder Jerry Stephens and his wife, Helen, donated $5 million for the neonatal ICU. Stephens told reporters he had long admired the standard of care at St. Francis. He also revealed that his only brother had died from spinal meningitis and he hoped to spare other families such grief.

All of this generosity is remarkable, especially since OSF isn't running a public campaign for its "Milestone Project" - a $234 million, eight-story building going up at its Downtown campus. In addition to the Children's Hospital, that building will have ground-floor space for Peoria's St. Jude cancer clinic affiliate, to be named after longtime St. Jude crusader and former Peoria Mayor Jim Maloof.

Perhaps local folks just have a soft spot for children, whom nobody wants to see suffer from treatable diseases.

Perhaps it's because Peorians feel that OSF's project, along with a $350 million makeover of Methodist Medical Center, will solidify the city's reputation as downstate's premier medical community. Or perhaps it's simply because people recognize that extraordinary beneficence has a way of paying its own, intangible rewards.



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There are 4 comments:

John A. Carroll, MD – Peoria, Illinois
June 09, 2007 - 22:49
Subject: Peoria's Medical Mafia

The Journal Star editorial reports the millions of dollars given to OSF from people in the area. Their generosity is inspiring.

However, will the funds be put to the best possible use by OSF? Will OSF Corporate and OSF-SFMC Administration follow the founding Sisters mission philosophy?

Probably not.

Haitian Hearts donated over 1.1 million dollars to Children’s Hospital of Illinois over the years for inpatient care for Haitian children. Our patients that were operated at OSF several years ago have been rejected at OSF for repeat heart surgery with full and partial charges offered for their care. Two have died. More will die soon unless OSF follows their mission statements.

There is significant fear in the Peoria community by individuals and institutions. To criticize OSF in a public forum with one’s name attached is not what people usually want to do. An individual contributor to OSF, one that OSF has privately courted for years, implied to me that she feared for her medical safety if she was publicly critical of OSF. (She has chronic medical problems.) This individual has strong reservations about OSF’s current leadership but is afraid to say so. Her fear really says something significant about OSF and would sadden the Sisters.

Also, the Journal Star and the Catholic Post have not reported OSF’s negligence of dying Haitian children and the obscene discrimination leveled against these children. The coverage of OSF’s 500 million dollar expansion and creation of jobs for the Peoria area has been more important to these two newspapers for reasons that are apparent to anyone who lives in central Illinois.

John A. Carroll, MD

Woodford Pundit
June 08, 2007 - 17:36
Subject: All right . . .
Now that we've vented our hatred . . .

Cudos to JMD
June 08, 2007 - 09:49
Subject:
The good sisters of the third order are the crookedest bunch of "well you know what" that ever predatated in the business world.

They do NO charity. They will demand others "share the wealth" as they refer to it. If you cannot tell I know what nuns are REALLY like.

jmd
June 08, 2007 - 08:42
Subject:
If they really cared about patient care - they would drop their vastly inflated pricing schedule.