Haitian Baby Boy with Cholera and Hope--April 2015

Baby Boy--April 2015 (Photo by John Carroll)

Several mornings ago a young mother carried her 12 month old baby boy into the pediatric clinic in Cite Soleil. (I will refer to him as “Baby Boy”). The mom and Baby Boy had been triaged to a wooden bench surrounded by about 25 other very pathetic slum babies and mothers who had made it that far in the process. However, one glance at Baby Boy was all one needed to know he was sick and that he needed to be evaluated right away. His eyes were sunk, his lips were dry, and except for quiet respirations, he wasn’t moving.

His mother stated that she recently had him in the only functioning Cholera Treatment Center (CTC) in Soleil for four days in a hospital called St.Luc’s which is about a mile from our pediatric clinic. However, she took him out of the CTC several days prior because she did not really think he had cholera. She took him back to her squalid shack in the neighborhood adjacent to St. Luc’s. However, his white watery stools continued over the last several days and he was harder to wake up and so she decided to bring him to our pediatric clinic.

There has been much cholera in Haiti already this year. From Crof’s blog:

From January 1 to March 31, 2015, the Ministry of Public Health and Population (MSPP) reported 11,414 suspected cases of cholera and 105 deaths, including 3,037 in March.

These figures represent more than three times those recorded in the same period last year when 3,772 cases and 28 deaths had been reported.

They are also slightly above those recorded in the same period in 2012 when the epidemic was at its peak (10,832 cases and 61 deaths).

The metropolitan region of Port-au-Prince is the most affected, recording more than half of the 11.721 cases (52%).

The health community fears the figure of 27,753 cases recorded in 2014 will be surpassed, already estimating at least 28,000, new cases in 2015.

After a quick exam of Baby Boy we wrote out a referral note to the CTC at St. Luc’s and advised mom to return to the CTC with the baby right away or he would die. (This CTC is the only one functioning in all of Cite Soleil. Doctors Without Borders left a couple of years ago and the Haitian Ministry of Public Health and Population (MSPP) doesn’t care enough about Soleil to staff a cholera clinic now.) But we could also tell by the look in the mother’s eyes that she did not believe or want to admit that Baby Boy had cholera. Haitians are horrified of cholera and they do not want to be stigmatized as dirty people or unfit mothers who cannot care for or protect their little ones.

Many thoughts rushed through my head. Would this mother take her dying baby boy back to the CTC where she had just left? Would the CTC even accept the baby back due to the fact that the mother left “against medical advice” already? I didn’t have high hopes for Baby Boy as the mother left with him lying limp in her arms. I felt worse about this scenario than I usually do when I send other gravely ill babies to other hospitals. I felt very guilty to be honest.

The next day I worked in pediatric clinic as usual and saw the usual potpourri of Haitian slum babies who had everything from severe malnutrition to pneumonia. Our malnutrition center is currently closed due to the fact that the Daughters of Charity, who run the clinic, have been robbed so often during the last 12 months. Recently I have sent three of my most severe malnourished babies to another well-known malnutrition center in the Delmas area of Port, only to have them rejected and returned to me because they were “not malnourished enough”.

By the next day I decided that I needed to follow-up on Baby Boy. So after clinic was over I walked the mile towards the ocean to the back part of Soleil towards St. Luc’s and the CTC. It was incredibly hot in Soleil and the streets were full of people doing everything you can imagine. It is a very alive place in so many ways. A UN truck with about six soldiers was calmly patrolling the area and a new Haitian National Police station with its clean white surrounding walls was located just a few blocks from the wharf. (The UN troops from Nepal are believed to be responsible for introducing cholera to Haiti in October 2010. See this post on UN accountability.) Laughing school kids walked by me in groups of two or three and an occasional motorcycle would speed by carrying three or four school kids nestled together behind the driver.

UN troops in Haiti–April, 2015 (Photo by John Carroll)

As I walked along the streets I was fairly convinced that I would not find Baby Boy or his mother. There are hundreds of thousands of people in Soleil and I just did not think the odds were good that the mother even took Baby Boy back to the CTC at St Luc’s. I thought Baby Boy was probably already buried in a nearby pauper’s field.

Cite Soleil (Photo by John Carroll)

Cite Soleil (Photo by John Carroll)

I walked across a little bridge running over green water filled with pigs and plastic and styrofoam debris slowly heading out to the ocean. As I turned north I could see the hospital on a flat field several hundred yards in front of me. The scene there is so desolate and desperate. It is dirt and garbage and pigs and sun and dust and wind. And there was sadness gripping my heart as I tried to get my mind around this. I still haven’t “evolved” after over thirty years here in Haiti. Even though I have been to this hospital during the last several years, I thought that the view around me was what a hospital with a CTC placed in the middle of Hell would look like.

When I arrived at the gate the security guard pointed down the walkway to the CTC. I washed my hands in water mixed with Clorox and entered the CTC. The nurse showed me the six adult cholera patients lying on cots inside. They all appeared to be alive..some more than others. However, much to my dismay, there were no babies inside. As I started to ask the nurse if she remembered Baby Boy, she calmly pointed to a lady who had slipped in the door and was standing next to me. I looked to my right to see the smiling mother of Baby Boy. She pointed outside, just behind the tank where I had washed my hands a few minutes earlier, and told me Baby Boy was right there. I quickly followed her a few steps out the door and there was Baby Boy under a green mesh awning and he looked much better. She picked him up and he looked around like all was ok. He didn’t look real happy but he was indeed alive. He had been successfully hydrated during the previous 48 hours at the CTC and brought back to life.

Baby Boy at the Cholera Treatment Center in Soleil –April, 2015 (Photo by John Carroll)

But the story quickly got a little more complicated. After I praised the mother for bringing Baby Boy back to the CTC, she told me that this was the first time he had been here. She told us in the clinic two days before that he had been in the CTC for four days. Now I was really confused. So I walked back to the nurse’s station and the nurse pulled his chart. Baby Boy had in fact been hospitalized at the CTC there a few days before for two days before mom took him out.

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 Baby Boy.

So I was very happy Baby Boy was still with us and she was too. (My guilt level, that all Irish people seem to somewhat enjoy and be sustained by, had diminished some.) The nurse in the CTC was indifferent. She never used the word cholera once. She did not appear heartless in any fashion but she has seen many good and bad medical outcomes in this hell and needs to pace herself.

I also thought that if a near-death Baby Boy can be kept alive here in Soleil with the seeming infinite number of barriers working against him, almost anything is possible.

“What you must realize about a hopeless situation is that it’s just a situation — you are supplying the hopelessness.” (Tweet posted by Robert Brault.)

John A. Carroll, MD
www.haitianhearts.org

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