Friday, March 16, 2007

Haitian Hearts to Monmouth

Haitian Hearts to Monmouth?
By Dr. John A. Carroll
January 31st, 2007
UPDATED: February 1, 2007 @ 2:10 am
From the Catholic Health World,
January 15, 2007:

“OSF Healthcare System, Peoria, IL, plans to buy Community Medical Center of Western Illinois, Monmouth, IL, by March and to rename it OSF Holy Family Medical Center.

“The Community Medical board members said they believe “OSF has the size, strength, and expertise to address the complexities of modern health care, to provide Community Medical with access to capital, and to assist Community Medical in responding to the pressures of current and future government and insurance reimbursement policies.”

The board members also noted that the mission of OSF is “very compatible” with that of Community Medical.

“Plans call for OSF to retain all of Community Medical’s employees, maintain the services the facility provides, look for ways to enhance those services, and invest in the campus. Upon completion of the deal, which is pending regulatory approval, OSF Holy Family will follow the Ethical and Religious Directives for Catholic Health Care Services.”

The Ethical and Religious Directives for Catholic Health Care Services were written by the National Conference of Catholic bishops and approved as the national code by the full body of bishops at its June 2001 general meeting.

The Ethical and Religious Directives state:

“Catholic health care expresses the healing ministry of Christ in a specific way within the local church. Here the diocesan bishop exercises responsibilities that are rooted in his office as pastor, teacher, and priest.

“…the diocesan bishop fosters the mission of Catholic health care in a way that promotes collaboration among health care leaders, providers, medical professionals, theologians, and other specialists.

The Ethical and Religious Directives first chapter is “The Social Responsibility of Catholic Health Care Services”. Many of the Directives come from the Bible:

”First, Catholic health care ministry is rooted in a commitment to promote and defend human dignity; this is the foundation of its concern to respect the sacredness of every human life from the moment of conception until death. The first right of the human person, the right to life, entails a right to the means for the proper development of life, such as adequate health care.

”Second, the biblical mandate to care for the poor requires us to express this in concrete action at all levels of Catholic health care. This mandate prompts us to work to ensure that our country’s health care delivery system provides adequate health care for the poor. In Catholic institutions, particular attention should be given to the health care needs of the poor, the uninsured, and the underinsured.

”Third, Catholic health care ministry seeks to contribute to the common good. The common good is realized when economic, political, and social conditions ensure protection for the fundamental rights of all individuals and enable all to fulfill their common purpose and reach their common goals.”

Based on the fact that OSF’s new medical center will adhere to the Ethical and Religious Directives, it appears that Haitian Hearts patients will be treated in Monmouth?

The View from Inside

The View from Inside
By Dr. John A. Carroll
January 31st, 2007
UPDATED: February 1, 2007 @ 2:03 am

It was 5 PM in Cite Soleil. The 15 month old baby boy had a good morning in the malnutrition program and mom just finished giving the baby his bath from the water in the big plastic bowl. They live in a one room shack with another family in this slum in Haiti.

Even though he only weighs 12 pounds, mom looked at him and could see that he is bigger. His arms and legs have a little meat on them now and his face has a more animated expression. He still won’t walk but he seems to move more.After his bath, which he seemed to like, she dried him off with a small blue towel and placed him on the bed in the room. Yes, her baby was getting bigger.

Mom was happy.

However, right after the bath, she heard gunshots close by and she immediately put the baby down on the floor. A bullet ripped threw her wall and she ran for the baby. She saw the flattened bullet that was buried in the blue towel.

When she ripped the towel off the baby, she expected the worse. But her baby boy just looked at her and smiled. He was not hurt. The wall and blue towel had somehow stopped the bullet.

Yesterday, I walked to the end of Cite Soleil. I wanted to see their home from the inside.

The end of Soleil is where the slum meets the ocean. It is also where the baby with the blue towel exists. People really don’t live here. They just exist and are viewed as subhuman forms of life that may have just crawled out of the brown Bay of Port-au-Prince. Most Haitians have never been here and have no plans of visiting.

Two UN tanks passed me as I walked and they turned down the last paved street to the left. This was where I turned also. The first tank went all the way down the street and the second tank waited on the corner. There were about 5 UN soldiers on each tank with their weapons aimed at the neighborhood houses and any gang members that may be hiding inside.

I stopped at the home of the baby. Two families live inside the one room. The front door is a sheet. The wall on the ocean side was made of concrete and the wall opposite to that seemed to be made of a heavy cardboard. Both walls are pockmarked with bullets that have been fired by gangs and the UN.

The baby’s mother told me they had recently moved to this location because there was too much shooting where they were before. I wondered if they had just come from Baghdad?

There was a small window on the south side and I could hear the UN tank slowly coming back up the street. I moved toward the window and quickly snapped this photo. I wasn’t thrilled with the idea of the UN troops seeing something silver slide out of a small window.

Just think if you looked out of your window in Peoria and saw a tank with five armed soldiers with their automatic weapons just a few feet away aimed at your house and your kids. How would that make you feel? Just think if they didn’t speak English and knew nothing of you or your family’s situation. Just think if you had no food or clean water, had no electricity, had no job, and you couldn’t read and write, and you had absolutely no where to run when the bullets start ripping through your walls.

That is exactly the situation in Soleil. Every day here is a challenge for food, water, and survival. Nothing is easy in Soleil especially for mothers who wrap their babies in blue towels.

September 20, 2007:

The baby pictured above survived the bullets in Soleil but died from a respiratory illness in the spring.


The Mission and Maxime

The Mission and Maxime
By Dr. John A. Carroll
January 29th, 2007

Maxime Petion was buried across the Illinois River on Saturday. His brother and his pastor from Haiti were able to attend as were hundreds of central Illinois people who knew or had heard of Maxime.

Our friend Maxime must be in Heaven now. His life in Haiti was very difficult for 21 years. But I think people that arrive in Heaven must forgive or they don’t get there. However, they don’t have to believe everything they read.

OSF Health Care Mission has a website that says the following:“OSF Health Care fulfills, through a service of love and compassion, a mission of caring and peace consistent with the needs of the Church and the people served. The love of Christ permeates its work as it strives to continue the healing ministry of Christ and His Church to the total person; to be love, mercy, inspiration, tenderness and compassion to those whose lives are entered.

“From this philosophy flow these values which permeate all of our endeavors:

1. Justice: Personal worth and dignity of every person we serve regardless of love, color, religion and ability to pay;
2. Compassion: Caring response to the physical, emotional, and spiritual needs of the people we serve;
3. Integrity: Decision-making based on Catholic Ethical principles and Catholic social teachings in every activity of the system.

The people that should assure these OSF values are respected failed Maxime miserably.

A nurse wrote a poem about Maxime and Jackson (another deceased Haitian Hearts patient that was included in the obituary):

“Thank you, Maxime, for lessons taught how to pause and enjoy the minutes, to be grateful, to breathe, and to sleep, and to laugh with beloved family and friends. As Jesus did, and Jackson and so many others, you have again taught us by example, a quiet persistent message, despite being wracked by pain and exhaustion, despite smashing into nightmares of inequity, injustice, man’s arrogance and fear. Faith. Hope. Love. My faith and hope have been, once again, healed by your life example, your love of life. Now is the moment, not tomorrow or next year. Thank you for the reminder Maxime. I will try, again, to make NOW count.”

“The religion Jesus gave to us is not a religion without risks.”
Fr. Gerard O’Rourkee

John A. Carroll, M.D.

Saint Anthony and the Dragons

Saint Anthony and the Dragons
By Dr. John A. Carroll
January 26th, 2007

Today I went back into Cite Soleil to work. I work with an order of Catholic Sisters who have a large pediatric clinic, a school with 600 kids, a malnutrition program, and a sewing class for hundreds of women from the slum. Only six sisters are present and live across the street from the clinic. Two Haitian pediatricians work in the clinic.

The front of the Sisters’ home is pock marked with bullet holes. Yesterday, Soleil, with 300,000 people was “closed” due to shooting between the UN (MINUSTAH) troops and the gangs.

The Haitian gangs are locally referred to as chimere which means dragon. These gangs have spearheaded the massive number of kidnappings during the past year in Haiti and many believe are part of the narcotic industry as well. They are extremely violent and carry automatic weapons that keep the Haitian police out of the slum. Jean-Claude, the driver that picked me up early today, grew up in Soleil, but has moved out due to the constant violence that puts the worst slum in the western hemisphere in a persistent state of conflict. However, he knows many of the gang players and works for the Sisters. He may have saved my life today.

Clinic was closed yesterday due to the shooting and was much lighter today because mothers are still afraid to venture out with their babies due to the recent violence. My guess is that 200 babies and kids showed up today for illnesses or vaccinations.

After clinic was over, I wondered across a field that leads directly to St. Catherine’s Hospital, the only hospital in Cite Soleil. It is staffed by Medecins San Frontieres (Doctors Without Borders) and a few Haitian physicians.
The hospital is very small, but there were hundreds of people, walking in and out of the waiting area, carrying people into the tiny emergency department, and visiting patients in the small inpatient wards.

I took pictures and talked to multiple people that had been shot in the last couple of months in the slum. A 24 year old girl, who I have talked to in the past, was shot in her abdomen in November. The bullet pierced her uterus, killing her baby inside. She underwent abdominal surgery, had a hysterectomy and has a colostomy. She was very febrile today lying under a sheet and shaking. MINUSTAH shot her when she was out for a walk in November. (She is pictured above.)

In the same room was a 34 year old man that was shot in his home yesterday evening when he was preparing to take a bath from a bucket of water. His wife stated that MINUSTAH tanks fired into his home. He was hit in the right chest, left shoulder, and left leg. He had a right sided chest tube with dark blood draining into a bag on the floor. His wife said that it had been emptied a couple of times. He had no chest x ray done. Other than the chest tube, he only had an IV in his right arm.
I took a fair number of pictures on the wards and in the tiny ER.

Jean-Claude and I then walked out of the hospital and onto the street running in front of the hospital called Soleil 1. He went to the left to purchase a telephone card and I told him I was going to take a photo of tires burning in the middle of the street about 75 yards in the other direction. We agreed to meet at the same spot in a couple of minutes.

There were no cars and no tap-taps now because MINUSTAH was patrolling in their tanks and kids were hurrying home from school in their uniforms. Women were still selling their goods on the curbside but the activity had definitely slowed down from earlier this morning when we arrived.

The gang leaders have absolute control over their zone in the slum. Everyone in their area answers to them. Five people were shot the other day and their bodies burned by a gang. The people killed supposedly were giving out information about the location of the gang. The people in the slum are very scared.

As I headed up the street I could see that three large rubber tires were on fire. This is the Haitian way of stopping vehicles including UN tanks from entering a certain area. I took a picture from where I was but thought I could get a better picture if I walked a little closer. The flames and black smoke were filling the air.

As I got closer to the tires, a group of teenagers on the far corner, across the street and behind the tires, started yelling at me and rushed me. I stood still and they came up shouting not to take pictures and the oldest and biggest grabbed at my camera screaming at me. I didn’t let go and his hand slipped off my hand and the camera. I told him no. He started screaming at me again and grabbed at the camera again. This time I let it go.

Kids and teenagers in the slum are armed by the chimere they work for and I thought “my Canon or my life”. But it made me mad to give it up. They all ran across the street behind the burning tires and I saw the punk that took my camera open the screen and try and look at saved pictures as he hustled away. He returned to the fire and I thought for sure he tossed in the camera.

Everyone started running back down the street towards the hospital area. Black smoke was filling the air. People motioned for me to follow them. As I walked back to the corner where I had left Jean-Claude, I looked to my right and running down an alley directly towards me was group of young men carrying machine guns. The man in front had no shirt on.

Very bad thoughts went through my head as to what was going to happen then. So I just stopped again and waited. There was no where for me to go. What were they going to do?

They sprinted across the street just a few feet in front of me and headed down the street running by the hospital. They knew the UN tanks were coming soon and they were going to their base area a few blocks away. I was very happy the UN tanks had their attention.

It became fairly chaotic then with people moving quickly and looking over their shoulders for chimere and the UN. I waited just outside the entrance to the hospital. Looking across the field at the Sister’s clinic I could see two MINUSTAH tanks in tandem slowly moving down the street with their automatic weapons pointed in both directions. I did not know who to fear more, MINUSTAH or the chimere.

An old lady came out of the hospital entrance and started to head out from behind a wall where I was hiding. I pulled her back because she obviously was not aware of the problems lurking a hundred yards away. She smiled and seemed so vulnerable to this insanity as I led her back to the hospital entrance.

Jean-Claude showed up and I told him what happened. He seemed stunned and he knew he shouldn’t have left me, but I actually left him, and made the mistake. I told him I wanted to head back across the field to the Sisters thinking that may be the only safest haven right then. So we quickly walked across this open field and back into the clinic compound.

The chimere were located only one and one-half blocks from our clinic. Jean-Claude and another guy said “let’s go talk with them about your camera”. I agreed. I wanted that camera back and MINUSTAH was gone for the time being. I couldn’t believe I was going to go talk to heavily armed chimere about a camera. Was I compounding one mistake with another?

We walked one half block and turned to the left. About one block up the side street was a group of about twenty people. My stethoscope was still draped across my neck and I had a surgical scrub top on because of Haiti’s sun. In my right hand was my beat up duffle bag with my medical instruments. It has made many trips to Haiti and looks like it should remain in the slum. I had about 300 dollars in my shirt pocket that I use to buy x rays for patients in the clinic.

We stopped at the group and the lead chimere, called "commander", was a guy about 25 years old, very cocky appearing, and carrying what appeared to be a hunting rifle with a scope. (I don’t know guns.) He was the “commander” speaking for the gang leader who was hidden deep in the maze of the slum.

I explained in Creole that I wanted my camera back, and who I was, and that I had been coming to Soleil for 20 years. He laughed and said he could care less if I “was the President”. He kept his rifle pointed at the ground. About 20-30 people gathered around us very quickly. I told him I was taking pictures of patients in the clinic and the hospital and when I took a picture of burning tires in the street, a group of thugs ripped off my camera. He told me that I shouldn’t have taken any pictures because I am a doctor, not a journalist. He said my camera was destroyed.

When MINUSTAH is not shooting into the slum from their tanks they are taking pictures of everybody on the street that looks like gang members. MINUSTAH tries to kill or capture them and then turn them over to the Haitian National Police. The chimere were afraid I had their pictures and would turn their pictures over to MINUSTAH. I also knew that a free lance photographer was shot and killed by gang members yesterday for taking photos of them.

I had told myself in the past that if I ever got taken by chimere, I would tell them they were in control and that I could do nothing. But I would not and could not show any fear.

As I was speaking to the “commander”, more and more people gathered. I was standing next to Jean-Claude. I felt someone tugging at my right pant leg but I didn’t want to look around away from the chimere leader. I told him he was in control and that I couldn’t do anything. Someone tugged again and I looked around. It was a 30 year old appearing guy who asked me if I had money in my pocket and was taunting me. I thought it was time to leave at that point.

I put my hand on the armed chimere’s shoulder and told him I knew all their lives were terrible in Soleil. He said nothing.

Jean-Claude and I turned around and the guy that had been pulling at my pants said, “Get out of here”. The crowd of people laughed. We walked down the street and did not look back. I held my breath until we turned the corner.

I entered the clinic again and the Sisters gave me some grapefruit juice and I explained to them what happened. They assured me that I would get my camera back. I prayed to St. Anthony, the patron saint of lost things and lost causes. Soleil is lost.

I had no way home out of the slum at that point anyway so I sat and prayed and talked to the Sisters. The clinic was empty except for three sisters and a couple of people bringing in boxes of medical supplies.

Some representatives of the gang came to the clinic about an hour later. They said they had my camera and would sell it back to me for $1,000 US. I didn’t want it back that bad. They came down to $700 dollars but I said I would give them $100 dollars, and that was it.

I counted out the Haitian money in my pocket that equaled $100 US. But as I was doing this, I thought they may try and take me, and my camera would not be all that important any longer.

I stuck the money in my pocket and three chimere came quickly into the clinic. Two were tall and one was short. They had no masks on. Kidnapping is the slum’s biggest industry now and it is a community effort. And the Haitian police don’t come close. I didn’t really have much bargaining power at that point other than the Sisters and Jean-Claude. And some of the chimere’s kids attend the Sisters’ school and come to clinic for their medical care.

The shortest chimere fumbled inside his pocket and pulled out my camera. We grabbed it from him and I handed them the money.

The big chimere then said to me in no uncertain terms to erase the pictures on the digital camera. I told him to wait. I upload pictures to my computer every night just in case something like this would happen. I turned on the camera, which was not damaged, and started to erase as the chimere watched every move I was making. He was nervous. The word “BUSY” came up on the screen and the chimere asked me what that meant. I told him the pictures were being deleted and he saw the little bar was moving across the screen. This made him happy and he and the other two chimere hurried out of the clinic, afraid that MINUSTAH would come down the street again trying to kill them.

When I saw them go through the door, I stopped the deletion of the pictures. I was able to save most of the pictures I had taken today. None were of the chimere.

I thanked St. Anthony in the clinic when they left without me.

What saved me (and my camera) was my association with the Sisters and the good amount of work that these six Sisters do in the worst slum one can imagine. The gang members are hungry and they know if they venture outside of their zone or Cite Soleil, they will be killed by another gang or by MINUSTAH. They have no future but now. The one hundred dollars will buy them some home made rum, marijuana, and more bullets.

An hour later, on the way home, the streets in Soleil were calm again like nothing had happened. The tires that burned were tiny little black spots on Soleil 1. The sky was blue, the sun was shining, and all appeared good.

I asked Jean-Claude if the chimere said anything about kidnapping me. He smiled and said yes that they had referred to me as “big money”, due to the fact that I am from the United States. He also told me they thought that I was “C.I.A.” and that I may have been photographing them. He assured them that I was not and that I worked for the Sisters in their clinic.

So Jean-Claude, the Sisters, and St. Anthony all pulled together and I got another break. The poor people in Soleil usually do not.

Tomorrow, I’ll go back and try it again.

John A. Carroll, MD

Haiti on the Brink

Haiti on the Brink
By Dr. John A. Carroll
January 25th, 2007

Each Wednesday our mobile medical team piles into a nice new truck that has URGENCE brightly painted on the front. We work in two slums in Port-au-Prince. The first slum is called La Saline and the second is Cite Soleil. Both slums are on the water front. Cite Soleil is known for its gang warfare with the UN troops and miserable poverty. La Saline is known for its miserable poverty.

The population of these slums is guessed at around 300,000. Port-au-Prince has a population of approximately 2,000,000.

There were five of us in the truck today as we coursed through a slum called Pele. We stopped at a house in Pele and filled the back of the truck with medication in large picnic coolers that we hand carry into the slum when the streets become too narrow to continue in the truck. As usual, Pele’s streets were full of pedestrians this morning. However, as we approached Route 1, which runs by Cite Soleil, five United Nations tanks were positioned up and down this street and an a UN soldier stood in front of our vehicle, put his hand up, and motioned for us to stop.

There are almost 9,000 UN troops in Haiti now. The UN has been here since July, 2004. The UN commander in Haiti is Brazilian as are the majority of the troops.The UN had been shooting inside Cite Soleil early this morning and now had the entire slum entrance and exit blocked off with their white tanks that menacingly sat on Route 1.

UN troops had traded gunfire with armed gangs while the UN was taking control of an abandoned school that the gangs had used to fire upon UN troops. The UN is doing all they can to kill gang members and take over their bases, so that Soleil can be turned over to the Haitian National Police.

Route National 1, which is usually fairly busy, was empty of traffic. Pedestrians and their bags and wheelbarrows, were searched before they could continue walking past the slum. The white UN tanks and their machine guns were aimed directly into the slum.

We have a clinic about one mile inside Cite Soleil. We work here in the afternoons after finishing clinic in La Saline. It didn’t appear we were going to be able to enter Soleil in the afternoon or even head down Route 1 towards La Saline.

The UN soldiers had patches on their soldiers from Bolivia and from Peru. I got out of our vehicle and told them we were a medical team headed for La Saline and we needed to be allowed to pass.

In Haiti, I have found out that everything is possible.

The UN soldier in charge was very polite and had another soldier search the back of our vehicle to see what we had in the containers. The commander called a mile down the road to let the other soldiers know that we were going to be allowed to use the road. He told us we could proceed down Route 1.

A large crowd of people stood on the corner and watched our interaction. I felt bad for them because I am sure some of them live inside the fetid slum of Soleil which is currently full of tragedy and most likely many had family members trapped inside.

A UN soldier took a picture of us as I took a picture of him.

We headed down Route 1 and our driver, who is very well versed in local slum politics, told me that the gangs from Soleil probably had escaped and would be in La Saline where we were headed. There are no UN soldiers in La Saline and the Haitian police will not go into either slum because the gangs have bigger guns than they do. Our goal was to triage the sickest patients from the clinic in La Saline to different hospitals and hand out bags of rice to mothers with children.

La Saline looked as fine as La Saline can look when we arrived. We heard no gunshots and everything looked normal.

The clinic was full, so we ran a full clinic. We sent two very ill pediatric patients to the hospital that supports us. The big problem was an 18 year old girl lying on an army cot on the dirt floor in the middle of the clinic. The other patients stared at her from their wooden benches.

She was very weak and said that she had vaginal bleeding for nine days and couldn’t stand due to weakness since she had lost so much blood.

Her exam showed that her sclera were very pale, she had a fast heart rate, and a bounding, dynamic pulse consistent with blood loss.

So when clinic was over, she was drug to our truck and loaded in back. We headed out of La Saline. I had a plan for her and hoped it would work.

Last weekend my wife and I visited a three story building that was turned into a high risk maternity hospital in PAP. It is staffed by Medecins Sans Frontiers with a skeleton crew of physicians and nurses. Last month 1,200 deliveries were done at this hospital including 200 C-sections. There is an incredibly high number of women with toxemia of pregnancy admitted. The maternal mortality rate in Haiti is one of the very highest in the world.

So I asked our driver to go this maternity hospital with our young anemic lady hoping they would accept her. Women in all sorts of obstetric conditions were literally everywhere— filling every hallway, bed, and stretcher. Many were in labor about to deliver and crying out with their contractions. No epidurals are done here. Some women deliver on the street in front of the hospital. And these are the fortunate Haitian women who do not deliver at home alone or with a midwife from the village.

We drug and carried our girl in and a quick sonogram revealed that she did not appear pregnant or appear like she had an ectopic pregnancy. However, her hemoglobin returned at 4.6 which is about one-third of what it should be. Her sister, who accompanied us, went to the lab to donate her blood.

An excellent German MSF doctor asked me if I would accept a 7 lb. baby boy who was born an hour ago. His 20 year old mother went into labor last night but arrived only an hour before she delivered. Her water had broken hours before. And the little guy was in respiratory distress and had to have some temporary CPR after he was delivered.

We climbed the narrow steps to the second floor to check him out. This newborn was definitely in respiratory distress and his lungs sounded terrible. He was on oxygen by prongs leading into the nose. He still hadn’t cried and wasn’t moving. However, his vitals were reasonable aside from his rapid respirations.

I accepted the baby because if I didn’t they were going to send the baby to the public hospital in Port-au-Prince which really doesn’t function well, and the staff is frequently on strike. Port-au-Prince offers no great alternatives for babies like this and accepting him was the only thing we could do.

The hospital had no portable oxygen to send with us. So we gave him two injections of antibiotics to cover him for infection that he may have acquired perinatally, wrapped him in a towel, and took off his oxygen.

We went down the steps quickly and I hoped he would keep breathing. We pushed through the crowd on the sidewalk, climbed up into the vehicle and went tearing across this nutty city with no traffic lights or stop signs that anyone respects. The trip took one half hour and the baby actually started moving his legs as we neared the pediatric hospital. In the ED, he pinked up with oxygen, opened his eyes, and looked around.

When civil disorder is great in a country, and there is no meaningful infrastructure, and Spanish and Portuguese speaking soldiers are trying to kill Creole speaking Haitian gangs in the kidnapping industry, innocent people are injured in everyway. They are locked in their slums and their mothers are lucky to get to any hospital to deliver their babies. Everybody suffers and everyone is pushed to the brink including one hour old baby boys.

John A. Carroll, M.D.

Thursday, March 15, 2007

The Thirteenth Day of Christmas

The Thirteenth Day of Christmas
January 22nd, 2007
by Dr. John A. Carroll

Father Rick Frechette is a Passionist Catholic priest and physician in Haiti that I have the opportunity to work with on a weekly basis. Father’s article is incredible and describes the Haitian slum (Cite Soleil), the bullets that fly between UN and the kidnapping gangs but strike innocent people, and social injustice that devours the body of a woman.

Pictured above is Estherline in clinic last Wednesday. She is the 19 year old girl who was shot in her left shoulder and chest by the UN helicopter while she slept. Her face says it all as UN tanks patrolled the street just a few feet away in Cite Soleil.
The Thirteenth Day of Christmas

The number thirteen can cast a shadow of unease. It represents a kind of thin place, through which evil and harm can slip suddenly into ones life and reap havoc. Christmas cannot be exempt, at least on this side of heaven, from the contradictions crafted by the Prince of Darkness. These twelve days of Christmas had some pretty strong contradictions in them, at least in my very small corner of the world. Feel free to delete them and get on with your life. I wish I could.

“Peacekeepers”, who walk around only with drawn guns, seem to be missing the point. “Gang leaders”, who claim to be revolutionaries for a better world via kidnapping and killing, are equally unenlightened (to say the least). But they fire real bullets at each other, heavy weapons at that, and the real bullets shear real flesh.

In fact, in a heavy holiday gunfire exchange in Cite Soleil, between peacekeepers and builders of a better world, a young girl took a bullet into the part of her that was “with child”. An emergency Cesarean delivered a baby that was dead from a gunshot injury, and the mother still is fighting for her own life. Imagine, shot to death in your mothers womb. The young mother still lies before me in my mind, and I witness her life struggle.

The Book of Revelations speaks of a dragon, as big as a third of the sky, whose tail sweeps the very stars away in fury, and who waits eagerly at the side of the pregnant one to devour the fruit of her womb.

A fairy tale? I doubt it. And our Church knows that it is no fairy tale, too. Our liturgy shows us blood (red vestments) three times during Christmas week: the feasts of St Stephen, the Holy Innocents and Thomas Becket. The contradiction to Christmas lives on.

Up the rusty spiral steps, to four more children who got too close to bullets. While asleep on their simple mats, a “peacekeeper helicopter” fired shots, long before dawn’s light, hoping to hit the builders of a better world in the dark. Blood soaked mats, the tin roof riddled with bullet holes, with one hole the size of a giant fist. The oldest girl is just 19 years old. Her left shoulder has a gaping wound. She cannot speak from terror. She is still in critical condition. The three younger girls have “lesser wounds”: one to the head, one to the arm, one to the leg. They all have major wounds to the soul. Did anyone notice?

The peacekeepers deny they shot from the air. The only other explanation is that the four young sisters fired rounds at each other in their sleep, and then shot holes through the roof, and then their guns vanished in thin air. Nowadays, “truth” is whatever the strongest say happened. Maybe it has always been so. Please pray for them. Especially the oldest, whose name is Estherline.

On the ninth day of Christmas I met Madame Noel, literally, Mrs. Christmas. I didn’t so much meet her as find her on the street, slouched up against a wall, half dead, mouth open and full of flies.

We jumped from the truck and picked her up. The stench hit us like a brick wall, and was unmistakable. It was the rotting flesh of cancer. Mrs. Christmas was about 70 years old, and was at the very end of savage, untreated breast cancer. Untreated? Yes. She is a sufferer of cancer in a country with almost non existent access to health care for the poor. In fact, it would be hard for a poor person to find even a daily vitamin.

As we lifted her into the truck, gagging, with the images from Cite Soleil also fresh in my mind, a passerby patted me on the back and said, “Happy New Year, Father.” You have got to be kidding. How happiness could have anything to do with all this was utterly beyond me. But I thanked him, smiled, and wished him the same, not realizing the power of the grace present in the timing of his greeting.

Madame Noel never spoke except to say her name. To any question we asked, she would whisper, “Madame Edeline Noel.” She seemed to be in a shock similar to that of Estherline, wondering if she was really there, if this was really happening to her. I was completely upside down and feeling lost for the two days that we cared for her. In such situations you feel compassion for what you also abhor. You want to embrace, and you want to run. And your body puts its own brakes on: if you go to near, you wretch unceasingly. And it is not lost on Mrs.Christmas that she is the cause of your wretching.

I can understand now the scene in the life of St Francis where, terrified, he kissed the leper. It was the absolutely courageous and merciful act to bridge the huge gap of such moments, so full of contradiction, I will spare you a detailed description of the wound which spanned her entire chest, and totally destroyed it.

When finally and mercifully she died, I prayed over her lifeless body. “May the angels lead you into paradise, may the martyrs rush to welcome you on your way….” As I prayed, I was thankfully given the grace of feeling tremendous satisfaction, and felt myself turning right side up again, and reoriented. There she lay, and that was how she died: in a clean bed, with clean sheets, with clean dressing on her terrible wound, a strong perfume against the stench, IV fluids to keep her from dehydrating, morphine to lessen her agony, and a poinsettia that one of the boys from the orphanage had put on a table next to her bed.

Also, she had us as friends: comforting words, daily prayers and the last sacrament. This beat by far the death she faced on a shabby street in a filthy slum. The passerby was right. Grace will break eagerly into the new year, even if only to give a somewhat happier ending to a disaster, and will wander the earth seeking those willing to give her a chance to do so.

Now we are in our third day trying to release Jayelle from her kidnappers. She is three years old. Her mother is sick with worry and unable to eat or sleep. We spent the feast of the Three Kings trying to release her from criminals who see her only as a cheap trinket that might bring big money, and who promise to give us her head on a platter if we do not comply with their impossible demands. We live in a world where heads have been delivered on platters, with no metaphors involved.

On the feast of the Kings, rather then receiving the gifts that would show her dignity, Jayelle was instead stolen from her bed, in the presence of tied and gagged parents, and has become a dispensable object to be bartered for. On the feast of the Kings, also called Epiphany (which means “before your face”, or “right there in front of you”) we are supposed to be witnessing God’s glory made present, and not hell’s cynical fury.

These kidnappings are harder and harder to manage, they are completely out of control, and now involve children- some of whom have been killed. The family already gave their life savings and did not get the child in return. Then they called us to help. So far, we are failing to secure her release, and today is our last chance. But I think we will succeed. Even if we do, the poor family can hardly relocate to another and safer country, but will have to continue living in this same insecure world. And if we don’t succeed……..I shudder to think.

Do you remember “A Christmas Carol” by Charles Dickens? Do you remember that Scrooge stood before the ghost of Christmas Present, who opened its cloak and showed two wretched and trembling children? Do you remember their names? They made Scrooge tremble, and they broke his hard heart- so that the real spirit of Christmas could burst into it through the cracks and possess it.

The story I am telling you now is very much Christmas Present. My pen opens the cloak, to me as well as to you. We are not ghosts. It cannot be too late so save humanity, which Christmas reveals to us as also divine.

It is not only Dickens who reaffirms the gospel message. The most striking Christmas card I got this year quotes a Mozarabic text from 9th century Spain. It says that at Christmas we should not pray for Christ to be born again somewhere else, but rather that the Godhead be grafted into our hearts, here and now. Christ can be conceived in our hearts if we have unquestioning faith, and can abide in us if we keep our spirit free from corruption. Then we will live “overshadowed by the Most High”, and be quickened by this power all our days. It’s about having the right heart.

Thomas Merton helps us see with more clarity still. He says that when life and death have the same value, which usually means they are both cheap and worth nothing, it is death that spreads like wildfire and dominates over life. This is the contradiction to Christmas.

When life is precious, and death is abhorred- except when it comes at its proper time and represents the fulfillment of life- that is when life spreads like wildfire and dominates over death. This is the conversion of heart that Christmas should represent. Let’s pray that it does.

The twelve days of Christmas are over now. The tree lights are off, and the wreaths taken down. Ignorance and Want still huddle under the mantle of the spirit of the present age. Will you and I dare to be father and mother to them, on the thirteen day of Christmas?

“Happy New Year, Father.”

Yes, I believe it can be. If………….

Fr Richard Frechette
January 7, 2007

OSF's Expansion Continues

OSF’s Expansion Continues
January 22nd, 2007
by Dr. John A. Carroll

I noticed in the Journal Star today that OSF is working on “two smaller expansion endeavors”. The two projects include a $2 million dollar hangar for LifeFlight and a $15 million dollar medical building.

“It is part of our dedication and commitment to having facilities that can take us into the next decades,” said spokesman Chris Lofgren. “It positions us to provide appropriate level of services for decades to come.”

Being transported by air when one is sick or injured makes good intuitive sense. However, in Rosen’s Emergency Medicine, 6th edition, the following paragraphs describe their view of Air Medical Transport (AMT):

“Traditional research in air medical care has identified what can be done in the AMT setting. Work has shifted the focus from simple observational studies to measurement of the value of the interventions. The most basic consideration is if AMT makes a difference to patient care. Older, subjective studies show a benefit to AMT in only 10% to 20% of patients flown.

Where AMT appears beneficial, the advantage seems related to the provision of on-site advanced life support care rather than to a unique advantage of the helicopter. AMT has long been assumed to save additional lives in trauma; however, it is now recognized that improvements in outcomes are more likely related to the provision of on-site ALS care within a comprehensive trauma system rather than to the aircraft itself. Studies have challenged the benefit of AMT in interfacility transports in urban areas. Although the speed of the aircraft is undoubtedly greater than that of any ground vehicles, small gains in transport time may be offset by higher costs without significant changes in patient outcome.

It is interesting to see that highly skilled care at the scene with advanced life support seems to be the crucial issue rather than the “unique advantage of the helicopter”.

Remember, the Peoria Fire Department (PFD) can’t give advanced life support or transport the patient. Seems to me that OSF, with their deep pockets, could help the PFD advance their status to advanced life support so immediate on-site care could be given to the patient. According to Rosen, that is key to improving patient outcomes…not building $2,000,000 helicopter hangars.

John A. Carroll, M.D.