Watching a child die in Haiti

I wrote this article for The Star-Ledger nearly a decade ago but the newspaper’s editors refused to print it because I went to Haiti on my own vacation time. I did that because I disagreed with the editors’ judgment that what was happening in Haiti at the time was unworthy of the newspaper’s attention. A modified version appeared in the now defunct New York Sun.  This article is dedicated to Maplewood’s Megan Coffee, a Star-Ledger Scholar–her twitter is #@doktecoffee— who, for no pay, has been operating a tuberculosis clinic in Port-au-Prince for more than three years. Her clinic needs your support. Please help her.

 

PORT-AU-PRINCE, Haiti–Marin Telemaque, in her party outfit with the pink pleated skirt, carried her baby two miles over a rocky dirt road to the clinic in Sibert. She dressed Laura in her white baptism dress.

“The baby is very sick,’’ said the sister who directed the clinic. She met Marin at its entrance. “You must see the doctor right away.’’

The nun, a Polish woman named Leila Cochla, knew the baby needed to be in front of the line of 200 mothers who brought  children that morning.

Laura, 10 months old, could not hold up her head. She was vomiting and very weak. Her glassy eyes rolled. Her tongue was swollen. She did not cry.

John Carroll, the American doctor from Peoria, had just arrived to start a week’s work. He had not yet put down his battered brown leather bag when two Haitian nurses entered his examining room. One held Laura. The mother followed. Under her white cloche hat, with the letters DKNY, the young woman looked confused and worried.

“This one first,’’ said one nurse to Carroll.

“What’s the problem?’’ asked the doctor in Creole. He is a big, muscular man who played small forward for the Bradley University basketball team. He is 50.

“She has been throwing up,’’ said Marin in Creole. “She is dizzy.”

“How long?”

“Five days.”

The doctor told the nurse to take off Laura’s dress. Marin took the dress and folded it carefully on her lap. The baby wore frilly pink panties. No diaper.

“Severely dehydrated,’’ the doctor said in English. “Shock. This is one sick baby. What a way to start a week.’’

A nurse gave Laura water in a cup, but it spilled from her lips. The baby was not strong enough to drink. Then Carroll used the tube of a syringe to draw electrolytes from a bottle and squirt them into her mouth. She could not suck at the plastic tube.

“She needs an IV,’’ Carroll told the nurses. He gave her a shot of antiobiotics and another of medicine to stop vomiting. The baby did not react to the prick of the needles. Children in the clinic hate needles. They call them “pikki-pikki.”

It was difficult to find veins in the pudgy baby, so an IV was inserted into her scalp. She was brought to the one examining room with a bed, laid  on some pillows, facing a  small, broken statue of the Virgin who looked down at Laura from a small plaque hanging on a nail on the stained white wall.

Carroll left a nurse to stay with Laura and he returned to his room to see other patients. Most  had dysentery or impetigo or parasites. One woman brought twins with tuberculosis. Another brought a baby boy with kwashiorkor, the African word given to the malnutrition that distended his belly and turned his hair straight and orange.

The nurse rushed in. “The IV came out,’’ she said.

When Carroll arrived, Laura’s head was bent impossibly back. She was having a seizure. The pillows were smeared with blood from the IV insertion.

“This baby is going to die,’’ Carroll said, gently pushing Laura’s head upright, laying her back down. Her breathing was loud and raspy.

He left the room and returned with a device called an inter-ossiary. He brought it from America. It permits IV fluids to be injected into blood-rich bone marrow, but its insertion is painful. Carroll stuck it in Laura’s knee. She did not cry. He ordered more antibiotics injected into the IV.

“Where’s her mother?’’ Carroll asked.

“Gone,’’ said the nurse. Sometimes, babies are abandoned, so nurses must watch mothers. This mother, the nurse said, went home because she was too upset to stand.

Carroll  raised Laura’s chin with his fingers to keep her airways open.  She didn’t like it. She cried a little, swung her arms, clenched her fists and curled up her knees.

“Good,” the doctor said. “Fight me! Fight me!”

The baby did fight, but, as soon as he stopped holding her chin, Laura’s arms fell to her sides  and her breathing became shallow. He did it again and again.

“The baby needs a ventilator,’’ he said. “She needs oxygen. That’s what would happen at home.’’ The clinic has no ventilator. No oxygen.

In America, Laura would be rushed to the hospital in an ambulance. But, in this country, even before the emergency that began a few months ago, even before the ouster of the president, almost nothing has worked. No ambulances are available.

“The best we could do is put the baby in the back of the van and take her.’’

But there is no van. Two days ago, while the driver Yvon was bringing Sister Leila  from the bank downtown, three men in a pickup forced them over on a road near the clinic, just beyond a bridge over a polluted stream. The bridge was built by American soldiers who brought back President Jean Bertrand Aristide to power in 1994, the last time Marines were in Haiti.

One man put a gun to Yvon’s head, told him to get out, then got in and took the wheel. Another poked a gun into the nun’s side, took her purse, and dragged her out. They took the van, turned it around, and headed toward Cite Soleil, the worst slum in the capital. They fired their guns in the air so no one would try to stop them.

These men are called les chimeres. Ghosts. Gangsters. American and French troops are trying to disarm them now. Aristide’s enemies say he armed les chimeres to be his personal army and they terrorized the people. Aristide’s friends say he didn’t give them the guns–they stole them. It doesn’t matter. The van is gone.

“She probably wouldn’t survive the trip anyway. Even if we had the van.’’

Besides, he said, the hospital was overwhelmed. She would die waiting for someone to see her.

Carroll stood by the baby’s side for two hours, holding her chin up. Gradually, the baby stopped fighting. Her cries grew weaker. “She’s giving up,’’ he said.

Then, Laura’s breathing stabilized. Carroll sat down. He said simply, “Maybe.”

She stopped breathing for a moment, then began again on her own. It went on like that for another hour. It is called Cheyne-Stokes respiration. The doctor watched.

“With this baby, her heart will go on beating, but her breathing will stop and then the heart, too. With an adult, the heart stops first, then the breathing.’’

Laura’s chest rose and fell, then stopped. Then rose and fell again.

“What you see on CNN is not the tragedy of Haiti,’’ said Carroll. “I don’t care how many men kill each other with guns or machetes. I don’t care about the politicians or the Marines. This baby is the tragedy of Haiti.’’

Laura’s breathing stopped and did not start again.

Carroll jumped from the metal folding chair, held her chest in large basketball player’s hands, pressing thumbs hard into her body, trying to squeeze her lungs into working. He turned her over and slapped her back, then kneaded her chest again.

“She’s going,’’ he said, but kept pressing his hands into her chest.

He said, “I’m sorry,” and stopped. Laura’s chest did not rise. Her arms extended straight out to her sides, her pudgy legs relaxed, toes pointing downward. Carroll wet his hands in the sink and made a cross on her forehead.

“No one will stick pikki-pikki in you anymore. And you will not have to go to the general hospital now. You will go to a better place.’’

Laura opened her eyes wide, raised her head, took one deep breath.

Then she died.