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Baby Boy (Photo by John Carroll)

blogs.pjstar.com - by John A. Carroll, MD -  www.haitianhearts.org - February 13, 2014

. . So what happened here? Didn’t you hear that things are going much better in Haiti now? I read it in the news. . .

We won’t be able to go to Soleil tomorrow. Too much shooting. Gangs against gangs and then the police come and shoot too. My driver Djongo does not play. He grew up in Soleil.

That is what Djongo told me a few weeks ago. But the next morning I talked him into taking me into Soleil anyway.

There were no gunshots that fine morning as we coursed through the Soleil streets near the general market where MINUSTAH and the Haitian police are located. Everything seemed normal. But the general pediatric clinic in the back of Soleil was only one-quarter full and the starving-baby clinic was one-half full. My guess was that the mothers were too afraid to navigate the streets of the slum with their babies and toddlers. So they stayed closer to home. Food and illness and immunizations came in second to the threat of bullets.

And since January 1, six weeks ago, the Haitian Hospital next to the pediatric clinic is now charging 100 Haitian dollars for a bed and 200 Haitian dollars for oxygen if you need it. And 50 Haitian dollars will buy you an IV and rehydration fluid that will save your baby’s life. And a treatment of a first degree burn is cheaper than treatment of a third degree burn.

These obscene charges keep many moms and babies away from the Haitian Hospital now. They don’t even come to the outside outpatient clinic at the Hospital now because of prohibitory charges that we would buy a Big Gulp with. Only eight babies were in the almost empty run down rooms of the pediatric department. There should be hundreds of babies filling these rooms getting treatment for the ubiquitous stupid slum illnesses. Unless the stupid illnesses were prevented in the first place…

However, that morning at 11 AM an impassive appearing sixteen year old girl calmly carried her newborn baby boy to the pediatric ward after paying eight Haitian dollars (one US dollar) for his dossier. Baby Boy was nine hours old. He had no real name quite yet. Mom said she lives in Sarthe which is a huge neighborhood which buttresses Soleil. Unable to say how long she was in labor, she delivered Baby Boy at 3 AM that morning with the help of a local midwife. But because of “absence de cri” and the fact that he didn’t move much or take her breast, she thought it best to hand carry him herself to the Haitian Hospital located deep in Soleil.

This young mom said that she had only two pre-natal checkups during her nine month pregnancy and yes she could feel the baby move during her entire pregnancy. She was prescribed some sort of medication at one of her check ups but she didn’t know what it was or what it was for and she couldn’t pay for it anyway. And she works for “some lady” and did not want to ask her for money.

Baby Boy arrived at the hospital with shallow irregular breathing. His cord was tied with a dirty piece of cloth. And when he was not convulsing he stared straight ahead. He weighed 3.1 kg (about 6.5 pounds). Baby Boy would blink when I blew on his eyelashes but all I could see was death stamped on his face.

So a tiny IV was started by the excellent Haitian nurse and Baby Boy was given the usual and customary antibiotics to cover for neonatal sepsis. And labs were drawn from an artery near his wrist. The blood from the artery should have been a nice happy red but it was evil appearing and dark indicating low oxygen. (There is no ABG machine in the Hospital so you check “partial pressure of oxygen” with your eyes. Pulse oximeter, you ask? None available.)

So from time to time we bagged Baby Boy by hand with a bag hooked up to nothing except room air. He had constant seizures that were treated with phenobarbital and diazepam. His lab work of course never returned. And we had no ventilator to help him breathe and no medication to support his blood pressure.

So Baby Boy hung on for about 36 hours like this and then mercifully died. His body was wrapped in the usual and customary fashion in a towel secured by string and carried to the Hospital morgue. Mother has no money to bury him.

So what happened here? Didn’t you hear that things are going much better in Haiti now? I read it in the news.

In French, Baby Boy succumbed from “Souffrance Foetale Aigue”. Wow. Doesn’t that sound like a professional diagnosis? Word for word translation is “Acute Fetal Suffering”, which is exactly what Baby Boy experienced. In English, his medical diagnosis would be “Acute Fetal Insufficiency”. And this means that while his sixteen year old mom was delivering him on the floor of her shack with the help of the neighborhood midwife, Baby Boy’s brain did not get enough oxygen for one of many possible reasons. Maybe his cord was wrapped around his neck. Maybe her placenta ruptured or maybe her contractions cut off essential blood flow to Baby Boy’s perfectly formed little in-utero brain. In his case I think he could have easily been saved with proper prenatal checkups and follow up, fetal monitoring, and if necessary a forceps delivery or C- section for a complicated delivery.

But you can forget everything written above. It is all bafflegab because it is NOT really getting to the ultimate problem.

Baby Boy’s REAL diagnosis should be “Souffrance Sociale” which means Social Suffering. Our liberal academics would call this “structural violence”. Who can disagree? Baby Boy sure seemed to suffer from this observer’s eyes. And it seemed violent to me. Meaningful social structures in Haiti just do not exist for the majority of the population. When Soleil has shootings that scare everyone, lacks clean water, has food insecurity (i.e. starvation), has green water and muck floating in canals, lacks education, lacks jobs, lacks preventative medicine, lacks emergency medical services, lacks a functioning Hospital, and lacks almost everything except big French words, then we have many hidden Baby Boy’s out there in the slum.

The Haitian government has to solve this problem. Human beings should not be existing like this. The government needs to better the lives of the people that elected them by improving the infrastructure and by creating social support systems that really function.

If the political will was there, this would be much easier to do than we think.

John A. Carroll, MD
www.haitianhearts.org

http://blogs.pjstar.com/haiti/2014/02/13/social-suffering-in-soleil/