Introduction
Haiti was in the midst of the largest cholera outbreak in the world in 2011. The cholera bacteria had been introduced to Haiti from UN peacekeeping soldiers who were dumping their waste into a tributary of one of Haiti’s largest rivers. Many Haitians were becoming sick and dying within hours of becoming ill.
The Peoria Journal Star gave me the opportunity to blog on the Journal website about conditions inside a Cholera Treatment Center where I was working in central Haiti. During the last five years, I have posted more than 400 posts about Haiti covering a myriad of topics.
A good investigative journalist is much better than an amateur blogger like me. But I don’t have the luxury of putting the journalist in my doctor bag and carrying them to Haiti with me. I wish I did.
However, bloggers are frequently the ones who can break the story first and may not be restrained as much as conventional mainstream media. For example, in 2014 when chikungunya was attacking about everyone I knew in Haiti, it didn’t take too much for me to post about this nasty mosquito-borne virus.
I have divided this post into general topics and curated the content of Dispatches from Haiti with an explanation and link to relevant posts. (A few links are from other sources.)
My goal is to post as a person on the ground experiencing events first hand while trying to see the big picture also. I wanted Dispatches in Haiti to shine light on Haiti’s medical problems seen by me with the patient in front of me. (I don’t like to suffer alone.)
In tough situations our first inclination is self-protection which means keeping our lives, our jobs, our health insurance, and our place at the country club. We hesitate to criticize the powers that be even if we think the powers are wrong. And the problems stay hidden and covered up.
Finley Peter Dunne allegedly said that the job of a newspaper is “to comfort the afflicted and afflict the comfortable”. Dispatches from Haiti is sure not a newspaper, but I have tried to do what Mr. Dunne stated–in blog format.
Thanks for reading.
Haitian Hearts
Since 1995 Haitian Hearts has brought about 200 patients to the States for surgery. The majority of the surgeries have been pediatric heart surgery.
Haiti does not have more congenital heart disease than any other country. But it does have more rheumatic heart disease than developed countries due to untreated strep throat and poor living conditions.
How do we “find” these patients? How do we screen them and then bring them to the United States for surgery? What sort of challenges awaits along the path to surgery?
The narrative of Baby Ayiya explains some of the process. Poverty in the slum, illiteracy, violence and fatalism, and greed in the United States all play a big role determining whether Ayiya will have surgery or not. My goal is to help her without hurting her or her immediate family and that can be difficult.
Negotiating for her life on both sides of the Atlantic is what I have to do. I have to beg many different gatekeepers for Ayiya. This should not be necessary in 2016 but it is.
Should heart surgery be done in Haiti on a full-time basis? Of course. But the Haitian Government needs to provide the “proper medical infrastructure” to safely perform high-tech heart surgery. And as I type this in 2016, 70% of the Haitian population does not have access to full-time electricity to power their light bulb let alone power a cardiac bypass machine.
OSF-Saint Francis Medical Center and The Catholic Diocese of Peoria
In the 90’s OSF-SFMC in Peoria operating Haitian kids. In 2001, OSF and I parted ways after I wrote a letter to the Administrator Keith Steffen over my fear of overcrowding in the ER. OSF then dropped their support of Haitian Hearts.
Over the years Haitian Hearts donated over 1.1 million dollars to OSF-Children’s Hospital of Illinois for care of Haitian Hearts patients in Peoria. All the physicians involved did their work pro bono. In 2003 OSF refused to reaccept any Haitian Hearts patients who had been operated on in the past and were back in Haiti. Kids with congenital heart disease or rheumatic heart disease sometimes need a second operation years later. We have had a number of patients need repeat heart surgery and have lost at least three patients now because I could not get them reaccepted. (On the good side we have had MANY Haitian Hearts patients who were operated at OSF-SFMC, then rejected by OSF to return, who were accepted at other medical centers in the States and did well with repeat heart surgery. But these medical centers are very difficult to find.
One of the most depressing meetings I ever had was in 2003 with Bishop Daniel Jenky of The Catholic Diocese of Peoria. I was pleading for the lives of my Haitian kids. He showed great fear of OSF and would not go to bat for my sick Haitian kids.
Unfortunately, Bishop Jenky still protects OSF-Saint Francis Medical Center. He is afraid of the financial power of OSF in the Peoria area. The OSF Sisters lost control of their own hospital years ago and Bishop Jenky has thrown his support to our local powerful businessmen.
OSF built the Milestone Project in the mid-2000’s, which cost hundreds of millions of dollars. They valued this endeavor more than saving Haitian lives. Bricks and mortar were more important to OSF than young Haitians. And when Haitians die in Haiti it doesn’t make the news or embarrasses OSF in any way. It is quiet and who cares besides the patient’s own family? And which Haitian family living in the slum embedded with green sewage and pigs will hire a malpractice lawyer? This attitude by OSF goes against the philosophy of the OSF Sisters and the teachings of Catholic Church regarding Catholic hospitals and serving the poor.
The dangerous policy that OSF adopted when they denied my Haitian kids medical care is not only dangerous for my patients but is harmful to the entire Peoria medical community. See this post from 2014.
I wrote quite a few of these posts over they years essentially begging OSF’s administration to remove their embargo against, not only my Haitian Hearts patients, but OSF’s very own patients. I never heard from anyone over the years except Sister Judith Ann who is CEO of OSF HealthCare. Several years ago I wrote her and asked her to remove OSF’s blocking Haitian patients from returning to OSF. She wrote me back but did not remove the embargo. I am sure she feels terrible about this embargo but has been counseled that she should not remove it because to remove it would admit that it exists. Admitting mistakes is something that big businesses like OSF aren’t inclined to do.
Pope Francis writes about the culture of indifference that desensitizes us to the suffering of others.
Jackson Jean-Baptiste was a Haitian Hearts patient. He needed repeat heart surgery at OSF, but he too was denied. Jackson died. Here is a post regarding Jackson. We still keep in contact with Jackson’s mom and his sister Nadia.
Should OSF be sued for negligence? Other hospitals in the United States, and Canada, and Cuba, and the Dominican Republic and Guatemala DON’T want these Haitian patients who have already been operated at OSF. They are not virgin cases and can be tough because they have been operated once. I know because I have tried these countries. Other medical centers believe and have told me they feel these Haitian patients are OSF’s responsibility. And they are of course–not only from a medical standpoint but from a moral standpoint as well.
In summary, regarding OSF and The Catholic Diocese of Peoria, I feel sorry for these large Catholic institutions, but I feel worse for my Haitian patients. Both OSF and The Diocese have made a big mistake that have negatively affected the lives of many Haitian Hearts patients. This will not be a proud chapter in the history of a Catholic medical center founded on moral principles stressing Catholic social justice. Other Catholic medical centers around the world are guilty of similar (not the same) behavior neglecting international patients. But that doesn’t excuse OSF and the Diocese. In the future, people will not believe that this was allowed to happen in 2016.
Cholera
As mentioned above, since 2010 Haiti has had the largest and most deadly outbreak of cholera in the world. Cholera is a dreaded disease which has attacked the world (including the United States) with distinct epidemics over the centuries.
Cholera is a historic disease also. Even before it was known what caused cholera (a bacteria), a young English general practitioner, Thomas Latta, MD, wrote a series of letters to the Lancet describing how he used intravenous fluid in the 1830’s to resuscitate patients near death during a cholera outbreak. This was the first recorded use of intravenous fluid solution for human treatment.
And the discipline of Public Health started a few decades later when Dr. John Snow identified a cholera outbreak to a neighborhood around the handle of a water pump in England. He didn’t know cholera was caused by a bacteria then, but he knew the epidemic was somehow related to the pump.
In medical school and during residency I never dreamed that I would see a case of cholera. But during the past five years I have had the opportunity to work in numerous Cholera Treatment Centers all over Haiti. (Cholera initially started in central Haiti but spread to all 10 departments in Haiti as well as foreign countries including the United States.)
Understanding how cholera makes people sick and how to treat cholera is not rocket science. Delivery of care to poor people in Haiti is the hard part.
Just recently, for the first time in six years, the UN Secretary-General Ban Ki-moon acknowledged that the UN played a role in the initial outbreak. Cholera has now infected a million people (probably a COUPLE OF MILLION if anyone was REALLY counting) and killed 10,000. The UN asked for 2 billion dollars for help eradicating this disease…but very little has been collected which assures that cholera will still infect and kill many more Haitians. Preventative methods to avoid cholera are decreasing and Cholera Treatment Centers are closing due to lack of funding. Amazingly during the first six months of 2016 there have been 25,000 cases of cholera in Haiti. (Over two hundred patients have died through July 2016–again, probably underestimated.)
Here are a few posts about my experiences with cholera during the last six years.
Cholera in Haiti: Many Questions with Few Answers
The lady in the wheelbarrow in Cite Soleil.
A sign in Haiti.
Cholera and blame in rural Haiti.
The Cholera Treatment Center at Hospital Albert Schweitzer in the summer of 2011 was very busy. We were seeing 300 new cholera patients each day and admitting quite a few of them to the tents for IV hydration. It was not unusual to be surrounded by five or six patients who were semiconscious as we put IV’s in them as fast as possible and flooded them with fluids. This post is my last one from Schweitzer.
Cite Soleil
Sometimes I feel like closing my eyes in Cite Soleil. I don’t really want to see everything. There is so much we need to do if we have our eyes open. And that little voice inside never lets up.
The paragraph below from the April 5, 2012 New England Journal of Medicine makes me think of Haitian children in the same way as the world did two hundred years ago–
“For centuries, the cumulative weight of experience fostered the conclusion that childhood deaths were inevitable. Many families, even those of plentiful means, lost half or more of their children. Seemingly nothing could be done — medically, politically, or economically — save to let nature take its course. Indeed, the mind of the public had changed little since the 2nd century, when the emperor Marcus Aurelius wrote, “One man prays, `How I may not lose my little child’, but you must pray, `How I may not be afraid to lose him’” (Meditations 9.40).
Cite Soleil is a large slum in Port-au-Prince that I have posted about frequently. This slum has been in existence for about forty years after people from the Haitian countryside flocked to Port looking for salaried jobs in the formal work sector. i.e. sewing t-shirts and making baseballs for Rawlings. But they never made it out of the slum and it is a pretty bad place now.
Soleil is ignored by the government regarding providing essential services like running water, reliable electricity, health care, etc. However, right now there is a truce between the gangs, most likely a “purchased peace” of some sort where the gangs are paid not to shoot at each other right now.
I work in a pediatric clinic in the back part of the slum. In my opinion a physician is one of the least important people in Soleil. People who fight for social justice to improve the slum’s infrastructure do much more good.
When we talk about poverty it is easy to forget that poverty in the Soleil slum is more than just going to bed hungry. There are many things that contribute to and sustain poverty.
Violence is one of those “things”. Gary Haugen’s book “The Locust Effect: Why the End of Poverty Requires the End of Violence” delves into great detail the enormous toll that violence reaps on the poor of every society.
Hagen explains the types of violence the poor feel every day which paralyzes them and helps keep them poor. They usually do not have the help of the local police and quite often the police work against them.
This seems to be the case in Soleil.
Haugen writes:
“But, the world overwhelmingly does not know that endemic to being poor is a vulnerability to violence or the way violence is, right now, catastrophically crushing the global poor. As a result, the world is not getting busy trying to stop it. And, in a perfect tragedy, the failure to address that violence is actually devastating much of the other things good people are seeking to do to assist them.
“In the lives of the poor, violence has the power to destroy everything— and is unstopped by our other responses to their poverty.”
My patients in Soleil come from broken families. Their family members are scattered all about. Some are working in the province or in the Dominican. And some never returned after the earthquake in 2010.
I have also noticed that poverty seems to bring on blank looks by my patient’s mothers. Some mothers seem almost crazy. They talk too much. Or they don’t talk at all. They don’t seem to think straight–at least that is my take. Many mothers seem to lack emotion when they tell me about the plight of their sick child on their lap. It is something that I can’t understand well or maybe don’t want to understand well.
Sarah from Soleil.
I posted this about my conversation with a certain mother:
“Why was the mom’s ability has a “history-giver” so garbled and changing all of the time? I have taken other histories similar to this one in the slum so maybe I should not have been confused. My thoughts and “psychobabble” to explain this are that when people like this young mom live in one of the worst places on the planet and every day is just another day to try to survive, their processing and delivery of information can be less than precise. I would say that a combination of poverty, culture, local neighborhood pressure, lack of education, fatalism, lack of concept of time (every-day-is-the-same), constant profound problems, and very little support “makes” these women give the answers they give. I also believe she can survive in Soleil much longer than I ever could. Her defense systems are always kicked in somehow to keep her functioning to the highest degree for herself and for her baby.”
Also, poverty begets fatalism. Nothing seems like it will change. Babies live or babies die. You get shot or you don’t. You are hungry or you are not.
Suffering in Soleil.
Just across the street from our pediatric clinic is St. Catherine’s Hospital. It is a state-run hospital and is so dysfunctional and overpriced hardly anyone goes there.
However, I remember St. Catherine’s in the 80’s and 90’s when it did function. I remember Dr. Paul Blough from Peoria delivering over 10,000 babies at St. Catherine’s over a 10-year time span.
St. Catherine’s could be a wonderful teaching hospital for Haitian medical students, Haitian medical residents, and for foreign medical resident physicians to experience “international medicine”. And just think what this infusion of physicians and nurses and some technology could do for the people of the slum.
At present, Soleil lacks the proper medical infrastructure to care for 300,000 people. Or even for 300 people.
What does “proper medical infrastructure” mean? The basic definition would be modern hospitals with a constant supply of electricity that powers lights and supports ventilators and bypass machines, provides clean water that actually comes out of faucets, a constant flow and turnover of medical supplies, and the support needed to keep the technology functioning and not lying in a dusty heap in a corner somewhere.
And if this “culture of a modern hospital” is created here, then all hospitals in Haiti could improve and perform much better than they do now taking care of common diseases and common surgical procedures.
Paul Farmer proved years ago that treating “untreatable” TB and HIV in Haiti was not only possible but by doing so it actually improved the general health of people in the local “catchment areas” who suffered from the usual commonplace diseases such as pneumonia, diarrhea, hypertension, and pregnancy-induced illnesses.
I am convinced that the medical infrastructure in Soleil will not improve until the Haitian politicians want it to.
Haitian Pornography
See this post.
“Death in Haiti can be cruel, raw, and often devastatingly premature. There is often no explanation, no sympathy, and no peace, especially for the poor. Death’s ubiquity, however, does not mean that it deserves any less attention or thought.”
Watching a child die in Haiti.
Not once in 35 years have I seen as shot of morphine given for broken legs, severe burns, or pain from cancer. Haitians’ lives are painful and they often die in pain.
Pain relief in Haiti–a short story.
Diane and the police chief from Illinois.
—————
Earthquake–2010
On January 10, 2012, at 4:53 PM Haiti’s ground began to shake. And after about 47 seconds several hundred thousand Haitians were crushed to death. Many women were indoors huddled around little black and white tv sets watching a popular Dominican soap opera when their roofs collapsed on them and their neighbors.
Haiti’s most powerful Catholic prelate fell to his death from a seminary balcony as the earthquake crushed his cathedral nearby.
Bodies were scooped up for days like pieces of heavy debris, thrown in dump trucks, and buried in a pauper’s field named “little of nothing”.
And I learned that earthquakes don’t really kill people, bad buildings do.
After the earthquake, 13 billion dollars of money was pledged to Haiti from all over the world. However, pledged money does not mean money given. And money that was given was given to whom? And for what?
I learned from the catastrophic earthquake that earthquakes do not kill people, but bad buildings do.
Haitians refer to the earthquake as goudougoudou — that’s the affectionate name that Haitians have given the disaster. Many told me that they never saw their loved ones again. They never came back from downtown Port-au-Prince.
A pediatrician who I practice with in Port lost her daughter who was a student in the national nursing school when it collapsed during the quake. She showed no emotion when she explained this to me.
Have we learned anything?
The international community pledged between 9 and 13 billion dollars to help Haiti after the quake. Very little of this money actually made it to the people who needed it the most. And a whole industry of literature appeared during the past five years questioning the earthquake aid that never made it.
Is Haiti much different now than before the earthquake? I don’t see it but my world is fairly myopic as I make it from the Delmas area of Port to Soleil each day. But I can say for certain, that I sure don’t see billions of dollars worth of improvement.
———-
Haitian Politics
When I speak with Haitians about politics and politicians they usually just say that they “don’t get involved.” They don’t believe that politics and government will help them or their families.
However, this is not to say that Haitian’s don’t follow local and international politics very closely. They know exactly what is happening in the US government, who is a Democrat and who is a Republican. They know who John Kerry is and who Donald Trump is and what they believe.
I was able to walk to a voting booth on a Sunday morning in 2010 and posted about it here and here. Less than 20% of the eligible voters in Haiti actually voted. The United States was heavily involved in that election and President Michael Martelly, with our help and blessing, became the anointed one.
During this convoluted election Port-au-Prince shut down for a few days. Tires were burnt in the streets. I was working in a Cholera Treatment Center in Port and taking a motorcycle to work in the mornings. Their were not many vehicles on the streets. Instead of going home at night, I stayed in a call room near the CTC which had working wi-fi and so I was able to blog about the disaster occurring in front of my eyes.
Our CTC ran low on IV fluids for out cholera patients because the delivery of the fluids was down due to the danger of being on the streets. So we had to divvy up the fluids the best we could between people who were dying for lack of fluid. I do remember one sweet old man who died for lack of IV fluids. Haitian politics killed him. Repeated calls to aid organizations did eventually bring some needed IV solution.
The last five years under Martelly was kind of embarrassing also. Due to a political impasse between President Martelly and the Haitian legislature there have been no parliamentary elections during the last four years of his presidency. Martelly ruled by decree since early 2015. The government just didn’t work. Urgent issues of reconstruction and reconciliation were not addressed leaving the country in even worse political dysfunction.
During the fall of 2015, I posted here and here about the Haitian elections. This time the United States contributed 33 million dollars to the Haitian electoral process and the final vote was called fraudulent. The Haitian people took to the streets in early 2016 to show their disgust and President Martelly stepped down on February 7. However, due to the rigged elections and the power of the people, a new president was not installed. A provisional government with an interim president (President Privet) was installed.
A new presidential election is now scheduled for October 9, 2016. And the United States states it is not contributing money this time.
Chikungunya and Zika
The cholera epidemic in Haiti seemingly was not enough for Haiti. Apparently Haiti needed to suffer more from infectious diseases that no one had ever heard of. During the last five years two new mosquito borne diseases have occurred in Haiti–chikungunya and Zika. Both are viruses carried by the nasty mosquito vector and both have made thousands of Haitians very ill.
Chikungunya strikes Haiti in 2014.
Haiti’s virus of the year in 2016 is Zika. It is a cousin to the dengue and chikungunya viruses.
Experts tell us that blood which was drawn three years ago in Haiti has been tested and has shown Zika virus. So Haiti has had the virus for at least three years and so is not as new as most of us think.
Dr. Louise Ivers of Partners in Health has called Zika the “silent epidemic” in Haiti. The majority of people with Zika don’t know they have it, epidemiological data in Haiti is not always trustworthy, the Haitian resident physician strike just ended and so identification of cases may be underreported, and the test for Zika is too expensive for most people to afford to prove they do (or do not) have the disease. As of this writing, Haiti has reported 3,000 cases, while the Dominican Republic has reported 5,000 cases. (These numbers make no sense to me.)
Zika is linked to microcephaly and mental retardation, Guillain-Barré Syndrome, and inflammatory eye conditions. And even when babies appear normal at birth, Zika can still attack and injure their central nervous system as they grow older. This is a very scary germ and another epidemiologic crisis in Haiti.
Until Haiti can control its poor sanitation and control the mosquito, vector-borne diseases such as these Zika, dengue, and chikungunya will continue to run through the Haitian population until sufficient immunity is acquired.
I examined this baby in clinic in August, 2016 in Cite Soleil.
——–
Border Refugees (2015–2016)
In Haiti nothing is at it seems. And this would include the refugee crisis on the Haitian-Dominician border.
During the last couple of years hundreds of thousands of Dominicans of Haitian descent were stripped of citizenship and forced to prove they were born in the Dominican Republic. And hundreds of thousands of people of undocumented immigrants were forced to register with the Domincian government. Legal paperwork in the Dominican is very hard and expensive for poor people to obtain. As a result residents born to immigrant parents dating back 80 years were not entitled to citizenship. Hundreds of thousands of people in the Dominican were recently made stateless. Many could not find legal remedy and were scared for their lives and left for the border on foot. A number of these people told me that they were threatened with another Trujillo massacre if they stayed in the Dominican Republic.
As most of us know nothing is as simple as it seems. Most things are not usually black or white. There is some gray. The same is true of the relationship between Haiti and the Dominican Republic which occupy the same island in the Caribbean.
But I want to be clear about something. There is a grave human rights violation occurring on the Haitian-Dominican border right now. People I have visited in the refugee camps in 2015 and 2016 just outside of Anse-a-Pitres, Haiti are being treated like animals. Many of these folks have told me that no one cares about them. And they are right. Neither Dominican nor Haitian governments want these people.
Their essential rights to protection, food, water, and medical care are not being upheld. They are held captive to their daily need to survive. They are not viable members of any society except their camp society where they exist day-to-day.
This is an unfortunate man-made disaster and has been created on both sides of the Haitian-Dominican border. Both Dominican and Haitian authorities are guilty of serious human rights violations. And the deaths and the misery of the people imprisoned in these camps are on their shoulders.
I have posted on these camps located in south-eastern Haiti here, here, and here.
“Since the middle of June 2015, more than 60,000 Haitians and Dominicans of Haitian descent have fled the Dominican Republic under the threat of deportation. The exodus is in large part the consequence of a 2013 ruling by the Dominican Constitutional Court that effectively stripped some 200,000 Dominicans of Haitian descent of their citizenship, thereby creating the largest stateless population in the Western Hemisphere.” (foreign affairs.com)
During my conversations with many individuals in these camps I asked them, “What can anyone do for you?” Their answer was: “Give me a piece of land where I can grow crops to feed my family.” They would gladly use their hoe and their pick ax and their back muscles to make this happen.
These folks were not living an easy life during their decades in the Dominican. They worked very hard in the fields and as domestics for Dominican families. And If their lives would have been better in Haiti, they wouldn’t have left in the first place. (Many of these deportees have lived in the Dominican for decades…without “proper papers”.)
Julia Harrington Reddy, a senior legal officer with Open Society Justice Initiative, described the Dominican Republic’s court ruling and treatment of Dominican Haitians as a “civil genocide.”
“It’s really going as far as you can go without killing them,” Reddy said. “You essentially make people disappear… In this case, although no one is going out to shoot these people, in a systematic way, taking away their nationality is a way of extinguishing all of their rights and effectively extinguishing them as a social and political force.” (USA Today)
But I would go further. I think we are in fact killing them. We are killing them through neglect. I heard of five who had died due to the camp situations and, just as importantly, I have looked into the eyes of these people and can see they are slowly losing their “force”.
So who are these folks in the camps? Are they really people?
Adriana (above) is a 32-year-old lady who told me that she and her six kids and husband have lived in the camp since mid-June. They have no legal papers. I asked her if she was beaten or physically hurt in any way in the Dominican. She said that she had not been physically hurt in any way, but she had heard that if Haitians did not leave the Dominican soon, they would be killed. So she and her husband determined it was time to go.
This man above is 61 years old and told me he lived in the Dominican Republic for 29 years. When I talked to him the other day he was holding his head in pain. The heat and sun are relentless and a little boy right next to him was loudly scraping a few grains of white rice with a metal spoon from the bottom of a big steel bowl. The noise which toxic and was making this man’s headache worse. And so he yelled at the boy to be quiet. A neighbor lady a few feet away joined in and threw a stick at the little boy who happily hopped away with his bowl.
This gentleman told me he has a brother two hours up the mountain from the camp in Thiotte but they have no room for him or his family. So he is stuck in hell holding his head. (Many Haitians left Haiti decades ago and have no one to come back to. Their village may have been flooded or their original blood families have left their village for one reason or another and are lost to the refugees.)
This man, with the blue hat above, lived and worked in the Dominican for 37 years. He is 47 years old now. (I blotted out his face.) He has no legal papers either. He told me that he sneaks back and forth across the border EACH day from the camp to work in the Dominican fields for a little cash and then sneaks back to the camp at night. He said he is very afraid to do this but he has little choice.
Other camp members run back across border in the morning and cut limbs off of trees on the Dominican side and carry them back to the Haitian side where they turn them into charcoal to sell for a few cents. (They would not need to cut down Dominican tree limbs if there were any tree limbs left in Haiti to cut down.)
Who are the kids in the refugee camps?
Estafanie above is nine years old. He father is Dominican and her mother is Haitian. Both of her parents are in the DR. She left the camp today on the back of a motorcycle with the Bien-Etre Sociale worker with a big smile on her face. She will be placed with a Haitian family.
The nine-year-old child above is Yolanda and she is 9 years old. Apparently about four months ago she developed a distended painful abdomen. It sounded like a bowel obstruction to me. Somehow her mother had the child checked by the Haitian MSPP doctor (Haitian government doctor) in Anse-a-Pitres. He saw that she was critically ill and wrote a letter which allowed both of them to re-enter the Dominican Republic even though her mother did not have “proper papers”. (Mother told me she has lived for 27 years in the Dominican.)
Yolanda’s mother also said that she paid for a Dominican ambulance to take her daughter five hours to the Dominican capital of Santo Domingo where the surgeons operated on her abdomen. They created a colostomy and she and Yolanda arrived back in the camp three days ago. She has no material for her colostomy except a piece of fabric she wraps around it.
Yolanda’s mother also told me this morning that she paid 340 dollars US for her daughter’s surgery and her hospitalization in Santo Domingo. (I highly doubt this.) She said she made the money buying and selling things along the border. The child’s next appointment is November 10 when they will attempt to “hook her back up”. Her mother says she has no idea how she will pay for this.
(We were able to move Yolanda to Port-au-Prince where she had successful abdominal surgery which reconnected her large intestine.)
The above little one is Jean-Wendy and was feeding himself alone in Park Cadot 1–one of the refugee camps outside of Anse-a-Pitres. When he felt that he dropped one kernel of rice he moved his bowel to make sure he caught it. He is blind and deaf and was alone. A man sitting a ways a way from him said he was his father but when I asked his name, the man did not know.
Several months later we were able to have Jean-Wendy evaluated for his hearing and vision in Santo Domingo. Unfortunately, nothing can be done for either his eyes or ears at the moment. But he and his mom and siblings are out of the camp and spending time in both Pedernales and Anse-a-Pitres.
These children are obviously being neglected by both Dominican and Haitian authorities.
Crawford Killian:
“Child health and our human responsibility are formalized by the UN Convention on the Rights of the Child, adopted in 1989 and ratified globally thereafter. The Lancet Series on child maltreatment examined the Convention and highlighted six provisions, including “special protection measures, such as for refugee children, those in the juvenile justice system, and those belonging to a minority group”
So what do I think is the answer to this deportee problem in Haiti?
I usually deal with patient problems one-on-one. I don’t feel totally comfortable trying to discern what to do with 1,400 people in camps in Anse-a-Pitres or with 60,000 refugees up and down the Haitian-Dominican border. Many expert opinions are needed. And implementation of good plans need to happen.
Here is what I would do:
I would boycott tourism in the Dominican Republic until the Dominican Republic quits deporting these black people of Haitian descent. Many people are leaving voluntarily because they are not keen on being killed in the Dominican if they stay.
I would quit funding the Haitian government so they can have 33 million dollar elections that are a sham and not supported by the vast majority of Haitians. The people in the camps, in Soleil, and in the rural provinces know that the Haitian government will do nothing for them. Ever.
I would not flood these camps up and down the border with doctors and nurses flown in from everywhere on earth. Too much money and time would be spent without adequate return. (Providing potable water is much more important. If cholera struck here, it would be very bad news.)
I would close the camps here in Anse-a-Pitres. The old ladies would leave first and the women and children would follow. The man who owns the land where the camps sit wants his land back. He should get his cactus, rocks, and dirt back as soon as possible.
Where would the refugees go? The refugees would be adopted into Haitian homes. The Haitian Catholic Church supported by Caritas Internationalis and many other Catholic organizations from around the world would provide the finances. And each Haitian home would be given a certain amount of money each month to care for these displaced people. These host families would provide shelter, treated water, food, and protection. The kids would go to school. Please remember that Paul Farmer gave his Haitian tuberculosis patients money to come to his clinic to get their tuberculosis medication. And they did it and many survived their tuberculosis. That didn’t seem like rocket science to me, but it sure worked. As usual money speaks.
If any other countries wanted to step up and accept these folks, that would be just fine. (Many of these refugees already speak Spanish.) How about Cuba? How about Venezuela? How about Mexico? How about many countries in Central America? How about the United States/Canada? (John Kerry just announced that the US will accept 85,000 refugees in 2016. How about a few from Anse-a-Pitres?) Would some people refuse to leave the camps? Sure. Some are working on their papers right now so they can go back to the Dominican legally. That is fine if they want to stay as long as the landowner does not pitch them out. ——–
Since I wrote the above in 2015, with the help of aid organizations, many people in the camps were given a small amount of money and moved to homes in the interior of Haiti. I do not know if they are better now than they were in the camps. I do know that refugees told me that they were afraid to leave the border because that is all they knew and they were afraid to venture too far into the interior of Haiti.
And this year, in 2016, thousands more people have left the Dominican Republic for the border camps.
Haitian doctors and nurses on the Haitian-Dominican border complained that they do not have enough IV fluid to treat their cholera patients. And their patients are dying.
When people in refugee camps are not recognized as even existing by the Haitian government, then no action is taken to help these refugees. And the Dominican government could care less about the tens of thousands of people in the border camps unless diseases from these wretched sites spread back to the Dominican Republic.
“Each physician is a moral agent with specific duties and accountability to individual patients, no single physician can be expected to fulfill the full complement of obligations belonging to the medical profession as a moral community.” (Annals of Internal Medicine, 15 December 2015)
When I look at this refugee crisis it is clear that the authorities do not want the refugees to get any meaningful medical care. In the camps I wondered what my role should be. I strongly believed that the authorities didn’t want the camps to be “too good” for fear of attracting more people. The MSPP clinic in Anse-a-Pitres was woefully understaffed and understocked even with basic medication and IV fluid. A baby from the camps died in the river bed one night from cholera as her parents were attempting to flee with her to the hospital across the border in Pedernales.
The UN in Haiti
The UN peacekeeping forces (MINSUSTAH) have been in Haiti since 2004. Some Haitians are happy to have them in Haiti and some are not. I think that the Haitians who are happy for their presence think that they keep the gangs at bay in the slums of Port. But I think the gangs are quiet now due to the fact that they are being paid to keep the peace for the time being.
Many Haitians want MINUSTAH to leave Haiti. They have been guilty of physical abuse of Haitians and also accidentally started the Cholera outbreak in Haiti in 2010. It has been the largest cholera outbreak in the world killing 10,000 Haitians and infecting one million. (Probably both numbers are underestimates.) Cholera has sickened 25,000 Haitians during the first half of this year.
Just recently the UN finally admitted that they played a role in the outbreak of cholera in Haiti. Four years ago the UN asked for 2 billion dollars for help eradicating this disease…but very little has been collected which assures that cholera will still infect and kill many more Haitians.
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Non-Governmental Organizations in Haiti–The Hole in My Roof
In 1995 Haitian Hearts brought our first child to the United States for heart surgery. His name is Abdon and he was seven years old and suffered from Tetralogy du Fallot. This is the most common congenital heart disease which causes babies to be blue. There are four things wrong with the heart, and if not repaired, most kids don’t make it out of their teenage years.
Abdon and his family lived in southern Haiti and their front door was a piece of cloth. In Haiti when I was explaining the surgery that we were planning to Abdon’s father, he listened patiently. I went over the risks and benefits of the surgery. When I was done I asked him to sign the consent form if he agreed. He agreed and put his X mark on the signature line. When I asked him if he had any questions, he asked me if we could fix the hole in the roof of his house.
I learned from this interaction and many others that I needed to stay focused on my main goals in Haiti. The needs are so great that one can get distracted very easily and we can head off on tangents that have nothing to do with one’s expertise.
Since the earthquake in 2010, Non-Governmental Organizations (NGOs) in Haiti have been taking a lot of heat. Haitian Hearts would be considered an NGO.
NGOs function with the idea that they can help the Haitian people. And many do help the Haitian people. Babies are rocked and fed. Wells are dug. Hearts are operated and fixed. Much good work is done.
However, I think we NGO’s can overstep our boundaries. Our modest goals should be “not to hurt and hopefully help”. All NGO’s should register with the Haitian Government. In return, I would hope that the Haitian government would help the NGOs navigate through Haiti and enhance our efforts.
And NGOs are accused of not creating situations that are sustainable. And there is some merit to this criticism. But even if some actions are not sustainable, they frequently help the person or village in front of them for the short-term. If no harm is done, is that bad?
But maybe we do harm when we don’t realize it. I remember a multimillionaire American saying to me 30 years ago in Haiti, “I think we are creating a community of beggars.” And when I visit that village today, the adults there are still begging as they did as children three decades ago.
NGO’s in Haiti need to communicate better with each other and not be competing with each other for resources. There are websites designed to help NGOs know what is happening. I can’t stand it when people waste time and money duplicating efforts. And Facebook has a medical page where people working in Haiti encounter patients with medical problems and ask questions and look for resources to help that patient. This is excellent.
According to Paul Farmer, NGOs don’t confer rights for a population. The right to health care and the right to clean water, etc can be moved forward by people like us, but we are not in the business of conferring rights. The Haitian government needs to confer rights. Without basic rights like water, food, security, roads, health care, education, Haitian’s don’t have much hope for a decent future.
For an excellent academic and easy-to-read book regarding providing aid to the developing world, see Augusta Dwyer’s book Anatomy of Giving.
Haitian Physician Strike–2016
Young Haitian resident physicians work in Haiti’s public hospitals. Port-au-Prince has two large public hospitals and Cap Haitien has one. There are multiple other smaller public hospitals throughout Haiti. Without the incredible labor of resident physicians these hospitals cannot stay open.
On March 28, 2015 approximately 450 resident physicians went on strike paralyzing the public hospitals everywhere in Haiti. I published this post of an interview with a striking doctor and this post when the strike ended in August.
It was the longest strike by resident Haitian physicians ever. And I am sure it cost people their lives. And even though residents are now back at work in the hospitals, much needs to be done to make these hospitals fit for patients (and for young physicians). This responsibility is the Haitian government’s and 10 million people are waiting.
Restavek (Child Slave)
Restavek is the creole word meaning “stay with” and refers to the hundreds of thousands of kids who are from Haiti’s poor class who have moved into middle and upper-class Haitian homes to work. They are not treated well and you can google the word and see the extent of the problem.
Micki Morency wrote this wonderful article about one of our Haitian Hearts patients who was a restavek and needed heart surgery.
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Reentry
I frequently have my own little problems after returning home from Haiti. I have tried to explain them here with this post.
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Conclusion
Being able to post about profound experiences in downstream Haiti hopefully informs people of Haiti’s challenges.
It is also therapeutic for me to be able to scribble my thoughts down and not suffer alone as I witness the reality of Haiti from a place where nothing is as it seems.
I will end with this from Dr. Albert Schweitzer’s autobiography–“Out of My Life and Thought”:
“One can save one’s life as a human being, along with one’s professional existence, if one seizes every opportunity, however unassuming, to act humanly towards those who need another human being. In this way we serve both the spiritual and the good. Nothing can keep us from this second job of direct human service. So many opportunities are missed because we let them pass by.”
John A. Carroll, MD
www.haitianhearts.org