Violence in the Slum (UPDATE 2–September 10, 2015)

Maudlin--September 2015 (Photo by John Carroll)

I posted on John-Wood here and here.

Manes, my motorcycle chauffeur, and I left the Delmas area of Port-au-Prince mid-morning today. He had spoken on my phone with Maudlin and she told him where to stop at a familiar street with a busy market in Sarthe. (Manes lives in Sarthe also).

We headed north on Route National One. The traffic was insane as usual. 

As we stuttered along I thought that I would find a very sick John-Wood and wondered what I would do with him. I would probably need to take him to some hospital but I had already sent him to two hospitals in the last three days and they failed him.  I decided that Foyer Saint Camille would be the answer in LaPlaine. It is a hospital founded by Italian Catholic Priests of the Camillien order.  Maria and I have worked there on and off over the last 10 years in their Cholera Treatment Center in late 2010 and the Emergency Department this year.  

Manes turned left onto a side road teaming with people at the market. He called Maudlin again and she said she would meet us there. It was too difficult or her to explain where she lived in that confusing maze of humanity. 

A few minutes later she nonchalantly showed up like she was out for a Sunday stroll. Maudlin and I walked back down the crowded street as Manes slowly tooled alongside of us on his moto.

After about a block we turned left onto a large field that looked like a garbage heap that had been crushed down. Naked kids and pigs and sun and misery were absolutely everywhere. Shacks were erected in no particular fashion and were made of cinderblock, tarp, wood, metal toll, and cardboard.

John-Wood’s Neighborhood (Photo by John Carroll)

As we approached  adults strained to see what was going on in with the strangers walking in their area.  About fifty yards later Maudlin pointed at a shack on the right that was hers.

She led me into a narrow passageway that led to her door. As I looked down at the entrance of the passage there was a little yellow Haitian Ti Malice (Buerre de Cuisine) bucket filled with human excrement which was surrounded by hundreds of swarming flies. I brushed by it separating the cloud of flies.  Maudlin was obviously embarrassed and picked up the bucket and headed back outside to dump it.  I continued walking.

A few feet later about five kids surrounded the front door of her shack which was made of cinderblock and plywood. I entered the room. My guess  this room was 10 feet wide by 20 feet long. Maudlin, John-Wood, his two brothers aged 4 and 10 years old and their father live in this room.

John-Wood (Photo by John Carroll–September 10, 2015)

Lying on the only bed to my left was precious John-Wood. He appeared alert but wasn’t moving much. He made good eye contact as usual. His axillary temperature was 101.5 and his heart beat was 180/minute. His eyes were sunk and his lungs still sounded junky. But he wasn’t cold and his capillary refill was still brisk. I thought at worst he could have warm shock and sepsis…impossible to tell.

Maudlin had returned by then and told me he had four loose stools this morning and that she had no oral rehydration solution or any medication so all she could give him was her breast. I watched him take her breast but he would only feed for a couple of minutes before he ran out of energy. He was weak and breathing fast and sucking was just too hard for him.

By then the heat inside her room had soaked my scrubs and sweat was pouring off me from every sweat gland that I own. At one point, very transiently, I went blank due to the heat and couldn’t think or process anything. 

I told Maudlin that John-Wood needed to go to the hospital. And then I tried to pull a fast one. I suggested that we go blitzing into Soleil to St. Catherine’s Hospital on Manes’ moto and get John-Wood  hooked up to an IV to save his life. I knew that there was one nurse there who is excellent at IV’s even when one can see no veins. Maybe she had got to work today and would be there. Soleil was very close and we could be there very quickly.  

Maudlin calmly replied that “Soleil is hot today” which meant they are shooting but that she would go outside and ask the men in her lakou about trying to enter Soleil for the second time today.  She had tried earlier this morning but was turned back by the shooting. 

I sat on the edge of John-Wood’s bed and stared at him. And he stared back but he didn’t move much.  The heat was intense. I couldn’t imagine how much fluid this little guy was losing from insensible water loss due to the heat in the shack. But I knew we needed to move right away.  And I prayed that God would provide an answer. 

Maudlin returned with Manes very quickly and they both said that they would not go into Soleil with the baby. Too big a risk from the warring gangs. My heart sank and I turned my head and stared again at John-Wood. 

And then Maudlin said in her sweet voice, “How about St. Camille?”

I couldn’t believe that she would even know of St. Camille because it is about an hour north. And poor people like her are usually stuck in their little slums inside big slums.  St. Camille had been my first choice.  I knew God was helping us. 

I stood up quickly and said let’s go. Maudlin went outside and bought one diaper for her baby and changed it quickly. We left her two other boys surrounded by about five neighbor kids to fend for themselves and we headed towards Manes’ motorcycle.

Manes and Maudlin (Photo by John Carroll)

Manes and Maudlin got on first with Maudlin holding John-Wood in the white towel. I plopped on the back of the seat as a man was asking me for money and patting his stomach.

We headed out of Maudlin’s neighborhood and onto Route National One and went north. The road seemed like the road to hell. I knew I was endangering John-Wood and Maudlin. But there wasn’t any other choice. 

The traffic and heat and exhaust and chaos were overwhelming. My knees were abducted around the back of Maudlin because it would have been too easy to squeeze the baby with my thighs if I wasn’t careful. I wanted him to be able to get a full breath every breath.  I could feel John-Wood occasionally kicking his feet tapping the inner portion of my left knee which was a good sign.

John-Wood on Moto (Photo by John Carroll)

However, I usually ride with my knees tucked together and my elbows in because rear view mirrors and fast-moving other flying objects come so close to us on these streets. 

Then it happened. Manes wasn’t going fast but he swerved to the left as a tap-tap was coming up on my left shoulder. Manes did not see the tap-tap. My left knee struck the cowcatcher on the front of the tap-tap. This did get my attention. I looked down and saw spots of blood collecting on my scrubs over my left knee. Manes cursed and Maudlin just kept holding John-Wood. I stripped up my pant leg as we continued to jerk along and saw a very superficial abrasion. 

As we moved along John-Wood kept tapping my knee just  letting me know he was all right.  All was as good as it could be.

Rue Marin (Photo by John Carroll)

 After about 30 minutes of this hell in 100 degree heat, we arrived at Rue Marin and tried to turn east. However an 18 wheel  semi was trying to do the same thing and could barely move. We were stuck about 10 minutes there as Manes tried to safely wedge us into a narrow corridor between the semi and rows of motorcycles. We finally made it and moved forward down Rue Marin towards Hospital St. Camille.

About 15 minutes later we arrived at the hospital and Maudlin, still carrying the very resilient John-Wood, easily descended from the moto, while I basically fell off it. Hospital security let us into the courtyard and we casually walked to the Emergency Room.  

Amazingly, a doctor in the ER who I have worked with quite a bit, was on duty. He ushered us in and I gave him John-Wood’s history. He looked at John-Wood, briefly examined him, and said the magic words, “We will keep him.”

Over the course of the next four hours I made about 9 stops at different offices where I would speak with people through a hole in the brick wall. The pharmacy, admitting, and the cashier were all happy to take  Haitian Hearts money as we purchased an angiocath, tubing, buretrol, IV fluids, antibiotics, and labs for little John-Wood. 

The expert ER nurse slid a little yellow angiocath into the back of John-Wood’s right hand. He made a little noise with the needle stick but that was better than no noise. I always want to hear sick babies cry. 

John-Wood cooling out at Hopital Saint Camille…(Photo by John Carroll)

After a bolus of fluid John-Wood looked right and left much more and then decided to go to sleep with a cold compress on his forehead. I gave Maudlin 40 more US dollars and told her to only spend this for John-Wood’s hospital care. 

The ER doctor told me he would keep John-Wood overnight in the ER and then transfer him to a pediatric bed when one opened up on the ward. 

In total, we spent about 75 dollars US on John-Wood. All of this should have been done several days ago at much less cost in Cite Soleil.  Free universal care is so important for a place like Haiti.

The nice ER doctor gave me a ride home since he lives close by here in Delmas. On the way home as I looked out the window I kept wondering how many other salvageable babies are out there who just can’t get out of the slum and through the mean streets and the dysfunctional Haitian medical system.

John A. Carroll, MD

www.haitianhearts.org