Monday, August 14, 2006

Ceftriaxone and the Purpose of Life:

“It’s not good when you see nine and ten-month-old babies with dirt under their fingernails,” says John of some of his patients. It means they are spending too much time on the ground in the filth. This isn’t a safe place for anyone, much less babies.

Some of these babies also have high fevers, brought on by various infections. Bacterial infections are treated with antibiotics. We brought 30 grams of ceftriaxone with us, a heavy duty, injectible antibiotic. This drug went generic last summer. Under the brand name, Rocephin, it cost $40 a gram. Now, it’s only $10 a gram in the United States and $33 U.S. a gram in Haiti, which is still much too expensive for the average poor Haitian.

John can usually get about two doses from each gram, depending on the size of the child. Many times he will have a nurse give one injection and have the mom and baby return the next day for another. Often after the first dose, the child will be much improved the next day. Three weeks into this trip, John has already administered about 30 injections.

Of course, the source of many of these infections is dirty water and other unsanitary conditions. Given that we aren’t eliminating the source of the infection, does our work seem pointless? No, and I’m going to let Dr. Francis Collins, who directed the Human Genome Project, one of the most scientifically significant projects ever, tell you why:

“I went to West Africa to work in a small mission hospital for a month. I went there in the midst of all sorts of other scientific endeavors. It was a bad time to leave, but I really wanted to do this. I went there with this image that I was going to make a profound difference in that situation. After a couple of weeks, I was really depressed. Here was a circumstance where all the patients I was trying to take care of had diseases that didn't have to be. They were the consequence of poor public health, of contaminated water, of inadequate nutrition. I knew I could pull some of these people back from death, but I knew they'd go right back out to that situation. My dreams of myself as the healer for this large population were lying in pieces on the floor.

“One morning I walked in to see a young farmer who we had treated the day before for tuberculosis, and he looked at me and he said, 'You know, I get the feeling that you're wondering why you're here.' He said, 'You came here for one reason. You came here for me, and that ought to be enough.' And that sticks in my mind -- more than any moment I think I have experienced in my life -- as truth. We should have our grand dreams, we should pursue them, that's what being human is all about, that's part of the nobility of our enterprise. But we should never forget that what really matters is what you do one-on-one with a single human being. Where you reach out and you try to help them make their life a little better. And if that's all you do, your whole life is to do that occasionally, then you have succeeded.”

John treated the child pictured above at the pediatric clinic at Grace Children's Hospital in Port-au-Prince.

Wednesday, August 09, 2006

Willy and the Will to Live

It has been 12 days since Willy had surgery. He remains in critical condition, though he is now responsive. He has had a number of challenges since the surgery: blood clots in his lungs, renal failure, a tear in his abdomen, and the always present risk of infection. Making it is a long shot. Like many sick Haitian children we have seen, though, Willy has a strong will to live, despite all the suffering he has endured. We see this time and time again in the children whose parents bring them to the clinic where John works. Even in the best of circumstances, these people’s lives are filled with misery. They live in mosquito-infested shacks with dirt floors and leaky tin roofs. They feel fortunate if they get one inadequate meal a day. They have to walk miles for water that may or may not be clean. There isn’t much to look forward to in terms of life improving for them or their children. And yet they want to live. Life is good. “Choose life,” says God in Deuteronomy, and the Haitians uniformly do.

This outlook accounts for the low suicide rate in Haiti. We have never heard of this happening. A 1989 study by the Dade County (Miami) Coroner’s office found that Hispanics, Native Americans, and Haitians have suicide rates of 13.9, 11, and 3.1 per 100,000 population per year respectively.

A posting on the Corbett list-serve, which carries notices and e-mails about all things Haitian, contends that Haiti is a breeding ground for terrorists with sympathies or links to Al-Qaeda. The author’s evidence isn’t very good, but I do think that terrorists can recruit people in places like Haiti, where poverty is so extreme. However, I think that even the most hardened, ideological Haitian would find the notion of suicide bombing crazy. They appreciate the old Cold War acronym MAD: Mutually Assured Destruction . Violence that results in one’s own death? How can that make any kind of sense?

And so they live each difficult miserable day, thanking God for the privilege and for the little gifts He sends them. Voluntarily checking out early is not an option. And if they get any chance to extend their lives though medical treatment, they are going to flight like fury to make it happen. That’s what Willy is doing now. Life is good even when it’s hard.

The picture accompanying this post is of Desir Dukens. Desir is a 16-year-old who lives in Port-au-Prince. He is in the advanced stages of rheumatic heart disease. Like Willy, Desir wants to live, as his blast of a smile demonstrates. But in a land of no heart surgery, the prognosis for Desir is not good.

Accommodations in Paradise:

Americans who come to work in Haiti generally stay in guest houses, hotels, or private residences. For a variety of reasons, we stay at a hotel in Port-au-Prince. John negotiates a monthly rate—about $42 a night—that is cheaper than the guest houses. These establishments charge between $25 and $30 a night, per person, though this usually includes two meals a day. The downside of guesthouses is that guests share a room with other travelers, so there is no control of bedtime or noise. There is no air conditioning. Only a couple bathrooms serve the guests. In some of the guesthouses, mosquitoes are ubiquitous. It would be difficult for us to stay in these accommodations for an extended period of time and impossible for John to ensure the security of his medical equipment.

Our hotel room has a little refrigerator, air conditioning, and constant power, thanks to a generator. We have wireless in our room and our own bathroom. The bed sheets are changed every other day and the floors and bathroom are cleaned. The door locks, so our stuff is safe. It’s no four star place, more like one or two—but it’s cool, comfortable, and safe. The hotel overall is more secure than guesthouses, with a gate and a guard. U.N. forces and other armed people also dine here frequently. A couple of the owners run around with beefy-looking handguns tucked in their back pockets. People have been kidnapped outside of guesthouses and a guard was killed inside one of them. I don’t pretend to think that hotels are immune from violence, but they do seem safer and are definitely more comfortable. Our hotel has a pool—of questionable cleanliness—and an open air restaurant, where we often have breakfast and supper. With the refrig in the room, we are able to keep soda, beer, cheese—all the essentials— on hand and make at least one of our daily meals.

Despite the advantages of the hotel and its relative economy, John feels guilty about bunking here. The whole notion of staying in a hotel seems too plush to him. Until about two years ago, he lodged in guest houses. But for all the above mentioned reasons, he started patronizing hotels, first at a place on Delmas 19. Unfortunately, that part of town was becoming increasingly dangerous—we heard nearby gunfire daily—plus the hotel wasn’t well run. After the maids picked up our dirty towels, we couldn’t get new ones until the towels they picked up were washed and had dried in the sun Why the owners didn’t invest in a dryer, I don’t know, but it was emblematic of the way they treated their help. It was also difficult to understand as occupancy at the hotel was very low. Were towels really so scarce?

So about a year in half ago, we started staying in our current accommodations. This hotel is nicer than the first one we stayed in and also cheaper. Plus, it’s within walking distance of the clinic where John works and not far from the airport. We are some of their best customers, especially now, since people are staying away from Haiti due to the kidnappings. But from time to time, John will go over the math again, as if to reassure himself that staying here really is a better deal. I tell him he can just blame it on me. “I’m married now, and my high maintenance wife insists we stay in hotels.” I wouldn’t care.

In a country where obscene poverty surrounds us, it may seem petty to focus on these details. Last week, a 14-month-old baby girl John had been following, died. He escorted the hysterical mother home. She is from out of town but is staying in a slum called Cité Jeremie. From where we are staying, we could throw rocks and hit the tin roofs of this shantytown. Her accomodations were partially constructed of garbage (see above). People sleep in dirt that turns to mud when the rain comes through their leaky roofs. There is no air movements and mosquitoes swarm through the fetid shadows.

Given that these are the living arrangements of millions of Haitians, we should feel guilty about where we stay. An attorney friend of ours who is very active in social justice work at home and in Haiti occasionally stays at the same place here in Port-au-Prince. The last time we saw him here after he had eaten a good meal and gotten a good night’s sleep he commented on his need for nice accommodations, “I’m a candy ass.” We all are, compared to the poor of the world.

Wednesday, August 02, 2006

A Pizza Party:

On Sunday we went to a pizza party. Our friend Mary, who works at the Missionaries of Charity—Mother Teresa’s sisters—home for the dying in Bel Air, invited some children from the Sisters’ home for children who are sick to the guest house where she stays for pizza and ice cream after Mass. She invited us as well.

About 11:30, Mary and her visiting friend Dee, drove to the children’s home and picked up about 15 kids whom the Sisters had selected to attend the party. These youngsters ranged in age from about four to ten. Some of the children are sick and some are living at the home because their parents cannot afford to take care of them. I asked Mary about one little boy about six who had a bloated abdomen and almost no waist. “He has AIDS,” she told me. A four-year-old boy was blind, though this did not keep him from scarfing down his share of Dominoes Pizza. Yes, there is a Dominoes in Port-au-Prince, two actually. It is the only American fast food chain I have ever heard of in Haiti. An 8-year-old girl was deaf and mute.

All of the kids were still dressed in their church clothes: frilly pink dresses for the girls, yellow shirts and dark pants for the boys. They nibbled on appetizers of cheese curls. Pretty soon the doorbell rang, just like at home, and Mary walked in with eight boxes of pepperoni pizza. The kids got as much pizza as they could eat along with Coke and Couronne cola, a sickly sweet yellow-orange fruit soda.

A 3-year-old boy we have a special interest in sat next to a 9-year-old girl, who shared her soda pop with him. This boy is used to swiping food off other children’s plates, so the sharing is a revelation. Not to have to compete with other children for food and attention: Mon Dieu! What a world! John sat next to the blind boy. “He was very interested in the pizza,” John said. “He had no problem locating it and eating it.”

Mary told us a story about a handsome 8-year-old boy at the party. He came to live with the Sisters because he was sick, but after he was better, his parents did not return for him, which is frequently the case. The Sisters had found an adoptive family for the boy, but he didn’t want to be adopted; he wanted to live with his mom and dad. A staff member and the boy went to the boy’s town to search for his family. They searched and they searched, but couldn’t locate them. The staff member said, “We can’t find them. We have to go back to the Sisters’” The boy said, “Let’s look for a little while longer.” Heartbreaking.

The kids burned off their lunch by running laps around the house in a giggling herd with the 3-year-old leading the way. The older girls would haul him up the five stairs on either side of the house. It was like watching the running of the bulls in Spain: an exuberant stampede of childhood joy. No one was smiling more broadly then the 3-year-old. What fun to play with the children!

We have come to know up close how much potential these children have. The smarts and athleticism and creativity and spunk and personality they possess stand out in bold relief against the depravity of their environment. These children are descended from some of the toughest people on earth: those who defeated Napoleon and established the first republic via a slave rebellion. We can see in all these children gifts that their environment doesn’t always nurture or allow them to exercise. It’s a loss for the kids but also a loss for the world because we need them.

After the running around, Mary served vanilla, strawberry, and chocolate ice cream, as much as everyone wanted. It was the end of a very good party.

The young man in the picture wasn't at the pizza party, but he too, has a lot of potential.