A Wise Use of Medical Resources--2005
I ran across this article today. I know this article needs to go in the 2005 category, but I wanted to post it now. Precious articles like this one cannot be lost. jc
A wise use of medical resources?
Caring for sick Haitian children personalizes poverty of developing nationsSunday
April 24, 2005
BY MARIA KING CARROLL
We are standing on the second floor of the UNICAR hospital in Guatemala City at 7 a. m, listening to about 15 doctors discuss the children on the floor who have recently had heart surgery. A tall, trim man wearing a light blue suit and sporting a full head of neatly combed white hair leads the group from one child's bed to another, asking questions and making comments.
"This is like going on rounds with God," whispers my husband, Dr. John Carroll, the founder of Haitian Hearts, a program that brings Haitian children to the United States for heart surgery. In fact, Dr. Aldo Castaneda, our elegant leader, is one of the gods of pediatric cardiac surgery. We have ventured to Guatemala to see if his program might accept a Haitian child for surgery.
Fifty years ago, as a med student in Guatemala, Dr. Castaneda hooked up dogs to a prototype heart-lung machine to understand how it might be used to help people. It's difficult to operate on a beating heart. The heart-lung, or bypass, machine allows surgeons to stop the heart without killing the patient. Bypasses made open¬heart surgery possible.
After completing his residency and working at the University of Minnesota, Dr. Castaneda spent the bulk of his career at Boston Children's, where he headed the Department of Cardiovascular Surgery from 1972 to 1994. Our host in Guatemala, his young associate, Dr. Juan Leon-Wyss, tells us that most prominent among Dr. Castaneda's many surgical innovations is showing the world that it is not only possible but preferable to operate on newborns with congenital heart defects, rather than waiting until the children are older, as was the practice.
Despite these world-class accomplishments, Dr. Castaneda has saved what I believe is one of his most impressive achievements for his "retirement." He returned to Guatemala, a poor central American country of 14 million where there was no children's heart surgery, and started the Fundacion Aldo Castaneda. Through this foundation, he built the hospital, UNICAR, supplied it with state-of¬the art medical equipment and recruited staff.
In 1997, doctors performed the first pediatric heart surgery in Guatemala. Last year 373 surgeries were completed at UNICAR. The program is managing cases just as complex as those in medical centers in the United States. On rounds, we see three children with hypoplastic left heart syndrome, a condition where essentially the left half of the heart is missing. This severe defect requires three surgeries to correct.
We are so impressed with the level of medical care at UNICAR that Haitian Hearts donates money to pay for the surgery of a Guatemalan child whose family cannot afford it. Guatemala and Costa Rica are the only central American countries where pediatric heart surgery is performed.
After rounds, we gather in the conference room to review some echocardiograms of Haitian children. We show the group echoes of children with complex and simple defects. Watching these echoes sets Dr. Castaneda to musing.
"If you look at this from a public health point of view, given limited resources, we'd like to operate on children who we can cure, who can go on and have a good quality of life and a normal life span. But to view it less coldly, I know when the child is in front of you, it's different; you want to help that child."
Dr. Castaneda says they would like to operate on a Haitian child, but they are not able to do it for free. The team is interested in an 18-month-old girl who has ventricular septal defect, or a hole between the lower chambers of the heart. As heart defects go, VSDs are usually relatively easy to repair. For this surgery and the necessary medical care, the cost would be $6,000.
"You should know," says Dr. Casteneda, "that our success rates don't match the big programs in the U.S., like at Boston Children's, but we achieve rates as good as those at second-tier U.S. programs."
We all agree that this little girl would be a good candidate for surgery at UNICAR. Our next step is to arrange for the child and her mother to travel to Guatemala City, which will necessitate flying to Havana, Cuba, as there are no direct flights between Haiti and Guatemala.
Given the widespread health problems in developing countries, is the extensive cost and effort of providing Haitian children with heart surgery a good use of resources? After all, bringing individual children from Haiti to the United States or Guatemala does not alleviate Haiti's crippling poverty. What it more immediately does is help some children and their families.
In a broader sense, though, I think having these children in our communities helps "raise the voice of the poor," which economist Jeffrey Sachs states in his book "The End of Poverty" is one of the nine steps to exactly that goal.
Because of the power the United States wields, we need to be especially aware of the conditions of people in poor countries. We were in Haiti last November. Haitians were paying close attention to the U.S. presidential elections. Arguably, the U.S. president affects the lives of average Haitians more than the lives of average Americans.
The children we bring for surgery personalize the problems in developing countries. We hope people will want to help them and the millions they represent in places like Haiti. Children in developing countries, like all of us, deserve first-class medical care.
Individual stories can move people to action. For despite the moral calculus those in deprived countries are forced to use to determine who gets medical care, Dr. Casteneda says that sometimes even when the surgical risks for a child are high and the outcome uncertain, they have taken a leap.
"When we've seen the child, we've broken down and operated."
BY MARIA KING CARROLL
We are standing on the second floor of the UNICAR hospital in Guatemala City at 7 a. m, listening to about 15 doctors discuss the children on the floor who have recently had heart surgery. A tall, trim man wearing a light blue suit and sporting a full head of neatly combed white hair leads the group from one child's bed to another, asking questions and making comments.
"This is like going on rounds with God," whispers my husband, Dr. John Carroll, the founder of Haitian Hearts, a program that brings Haitian children to the United States for heart surgery. In fact, Dr. Aldo Castaneda, our elegant leader, is one of the gods of pediatric cardiac surgery. We have ventured to Guatemala to see if his program might accept a Haitian child for surgery.
Fifty years ago, as a med student in Guatemala, Dr. Castaneda hooked up dogs to a prototype heart-lung machine to understand how it might be used to help people. It's difficult to operate on a beating heart. The heart-lung, or bypass, machine allows surgeons to stop the heart without killing the patient. Bypasses made open¬heart surgery possible.
After completing his residency and working at the University of Minnesota, Dr. Castaneda spent the bulk of his career at Boston Children's, where he headed the Department of Cardiovascular Surgery from 1972 to 1994. Our host in Guatemala, his young associate, Dr. Juan Leon-Wyss, tells us that most prominent among Dr. Castaneda's many surgical innovations is showing the world that it is not only possible but preferable to operate on newborns with congenital heart defects, rather than waiting until the children are older, as was the practice.
Despite these world-class accomplishments, Dr. Castaneda has saved what I believe is one of his most impressive achievements for his "retirement." He returned to Guatemala, a poor central American country of 14 million where there was no children's heart surgery, and started the Fundacion Aldo Castaneda. Through this foundation, he built the hospital, UNICAR, supplied it with state-of¬the art medical equipment and recruited staff.
In 1997, doctors performed the first pediatric heart surgery in Guatemala. Last year 373 surgeries were completed at UNICAR. The program is managing cases just as complex as those in medical centers in the United States. On rounds, we see three children with hypoplastic left heart syndrome, a condition where essentially the left half of the heart is missing. This severe defect requires three surgeries to correct.
We are so impressed with the level of medical care at UNICAR that Haitian Hearts donates money to pay for the surgery of a Guatemalan child whose family cannot afford it. Guatemala and Costa Rica are the only central American countries where pediatric heart surgery is performed.
After rounds, we gather in the conference room to review some echocardiograms of Haitian children. We show the group echoes of children with complex and simple defects. Watching these echoes sets Dr. Castaneda to musing.
"If you look at this from a public health point of view, given limited resources, we'd like to operate on children who we can cure, who can go on and have a good quality of life and a normal life span. But to view it less coldly, I know when the child is in front of you, it's different; you want to help that child."
Dr. Castaneda says they would like to operate on a Haitian child, but they are not able to do it for free. The team is interested in an 18-month-old girl who has ventricular septal defect, or a hole between the lower chambers of the heart. As heart defects go, VSDs are usually relatively easy to repair. For this surgery and the necessary medical care, the cost would be $6,000.
"You should know," says Dr. Casteneda, "that our success rates don't match the big programs in the U.S., like at Boston Children's, but we achieve rates as good as those at second-tier U.S. programs."
We all agree that this little girl would be a good candidate for surgery at UNICAR. Our next step is to arrange for the child and her mother to travel to Guatemala City, which will necessitate flying to Havana, Cuba, as there are no direct flights between Haiti and Guatemala.
Given the widespread health problems in developing countries, is the extensive cost and effort of providing Haitian children with heart surgery a good use of resources? After all, bringing individual children from Haiti to the United States or Guatemala does not alleviate Haiti's crippling poverty. What it more immediately does is help some children and their families.
In a broader sense, though, I think having these children in our communities helps "raise the voice of the poor," which economist Jeffrey Sachs states in his book "The End of Poverty" is one of the nine steps to exactly that goal.
Because of the power the United States wields, we need to be especially aware of the conditions of people in poor countries. We were in Haiti last November. Haitians were paying close attention to the U.S. presidential elections. Arguably, the U.S. president affects the lives of average Haitians more than the lives of average Americans.
The children we bring for surgery personalize the problems in developing countries. We hope people will want to help them and the millions they represent in places like Haiti. Children in developing countries, like all of us, deserve first-class medical care.
Individual stories can move people to action. For despite the moral calculus those in deprived countries are forced to use to determine who gets medical care, Dr. Casteneda says that sometimes even when the surgical risks for a child are high and the outcome uncertain, they have taken a leap.
"When we've seen the child, we've broken down and operated."
------
Maria King Carroll lives in Peoria and spends part of the year working in Haiti. Her husband, Dr. John Carroll, founded the Haitian Hearts program in Peoria in 1995 and continues to run it.
Maria King Carroll lives in Peoria and spends part of the year working in Haiti. Her husband, Dr. John Carroll, founded the Haitian Hearts program in Peoria in 1995 and continues to run it.
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