Monday, March 12, 2007

OSF's Anonymous Apologists

OSF’s Anonymous Apologists
Author: Dr. John A. Carroll

Haitian proverb: Woch nan do pa konen doule woch nan soley. (The rock in the water does not know the pain of the rock in the sun.)

Dear PeoProud, Knight in Dragonland, and Eyebrows Mcgee,

Your comments the last couple of days after “Kidnapped” attempt to detract from the main issue which is clearly patient abandonment at OSF. Even though your comments are anonymous, they reveal a significant amount.

I would like to respond to some of your ideas regarding this important topic.
Peo Proud, I don’t think you do understand the “Catholic charity and mission issue” at OSF or you wouldn’t be asking the questions that you are. Haitian Hearts does work with many hospitals around the country. Please understand that Peoria’s physicians and nurses understand the Haitian children’s hearts better than any other health care providers in the country. They would love to see these kids return to Peoria. Not only is it the correct moral and ethical decision to make, it is the best medical decision to make for the kids.

Peo Proud, if you had open heart surgery done in Peoria, really trusted your cardiologist and surgeon, and needed repeat surgery, would you want to be told to go to Medical Center X somewhere, work with a new set of physicians, and let them split your chest open? And what if you could pay for your surgery, and your physicians wanted to take care of you, and your family wanted to take care of you, and OSF’s lawyer told you that OSF would not accept you, how would you feel? Would that make you happy?

Now, Knight. Do you mind if I call you Doctor Knight?

Dr. Knight, I don’t blame you for remaining anonymous. You should stay anonymous in Peoria if you know what is good for you. But don’t break your arm patting yourself on the back as a “bleeding heart”. You still have a ways to go.
Dr. Knight, you comment, “The simple answer is that money should go where the need is greatest and where it can benefit the most people”. Do you really believe what you are writing?

Let’s say, for example, you go to your office tomorrow and it is chucked full of people, like Eyebrows Mcgee, suffering the heartbreak of sinusitis, viral tonsillitis, bronchitis, Type II diabetes secondary to morbid obesity, and end stage emphysema thanks to too many Lucky Strikes. As you know, most of these illnesses don’t need to be treated or could have been prevented.

So, Dr. Knight, according to you, it sounds like you will announce to your full waiting room that everyone should go home and take an aspirin because “…money should go where the need is greatest.” Many of your patients obviously don’t meet your criteria. I don’t think Eyebrows, and other folks like Eyebrows, would be happy with you and you wouldn’t make a nice living if you did that.

The bottom line is that you are going to treat everyone that shows up that day with advice, medication or whatever. You are going to do your best. However, if health care dollars were allocated with the criteria as you suggest, you wouldn’t be treating many people in central Illinois.

Dr. Knight, if a Haitian Hearts child showed up in your waiting room, I bet you would treat him or her with their congenital heart disease. I doubt you would refuse them care like OSF does.

The fun part about working in Haiti is that I get to treat malaria, tuberculosis, typhoid, pneumonia and meningitis every day. These illnesses cost pennies to treat.

But I just can’t make the leap in logic that just because a Haitian child has a hole in their heart, they are “too expensive to treat”. When is a person “too expensive to treat”? When is a child anywhere “too expensive to treat”? I don’t buy that at all. And neither does the any child’s mother. Know what I mean?

Eyebrows, you commented that people have “politely” asked me questions in their comments. When you called me an “ass”, is that your way of being polite? You also talked about hospital administrators and St. Thomas Aquinas in adjacent sentences regarding allocation of the health care dollar. That made me a little nervous too.

Eyebrows, you state that “in the real world in which we live and function, resources are limited.” I ask you for whom are they limited? For you in Peoria or the people here in Haiti? That is the scary part of this concept for people like you. The resources exist, we just don’t use them equitably.

You have used the mesmerizing lexicon of “limited health care resources”. Also, you must know that less than 10% of the world’s health research budget is spent on combating conditions that account for 90% of the global burden of disease like malaria, tuberculosis, and AIDS which scourge Haiti too. Does this seem like a good thing to you?

Eyebrows, you pit the poor against the poor by asking, “Should OSF turn its limited charitable time and dollars to Peorians who can’t afford their heart surgeries, or to Haitians?”

Please don’t call me an “ass” again, but my answer to your question is “yes”. Both groups of people should get their heart surgery.

The Millennium Development Goals, set by the United Nations Millennium Summit in 2000, is a set of goals to be accomplished by the year 2015. The goals include:

Maria on December 21st, 2006
Dear Eyebrows McGee,

I don’t agree with your assumption that there is not enough to go around so that everyone’s basic needs are met.

Here’s some info from an article in the September 2003 issue of Pediatrics entitled: “Inequity in Child Health as a Global Issue”.

“Half of the world’s population, 3 billion people, lives on less than US $1.30 per day. The world’s 225 richest people have a combined wealth equivalent to the annual income of the poorest 2.5 billion people, nearly half of the world’s population.”
Included is a table that lists The World’s Priorities (Annual Expenditures). We spend $6 billion per year for basic education for all but spend $8 billion per year for cosmetics in the US. We spend $9 billion per year for water and sanitation for all but spend $11 billion per year for ice cream in Europe and $12 billion for perfumes in Europe and the US. We spend $13 billion per year for basic health and nutrition for all but spend $17 billion for pet foods in Europe and the US.

So the resources are there.

I think some of the challenges are getting people: to acknowledge and care about the problem of poverty; realize that the resources do exist, and (the hardest part), to make personal sacrifices to alleviate the poverty.

As you pointed out, each individual’s resources are limited. I think all of the examples you listed are worthy causes. I think people who want to make contributions make decisions based on their experiences and knowledge. I don’t think there are right or wrong answers here. Some considerations people take into account are: severity of suffering, how well their money will be used, proximity of the cause.

I will make a case for Haitian Hearts, but I don’t want to do this by denigrating other causes.

First of all, why Haiti? Haiti is the poorest country in the western hemisphere, 600 miles from Florida. If you read the history, an arguable conclusion is that the United States contributed to this distinction, from not recognizing Haiti when it was founded to “escorting” President Aristide out of the country a couple of years ago with a lot of not-so-nice stuff in between. So severity of the poverty, proximity to the U.S., and past crimes by the U.S. are three reasons that I think Haiti is a worthy place for you to focus your charity dollars.

Why children with heart problems? John has been going to Haiti for more than 25 years. Haitian Hearts grew out of his general medical work there. He kept coming across children who either had congenital heart problems or rheumatic heart disease. In 1995, he brought his first patient to Peoria. Many medical centers around the country, including OSF, have international programs, so the infrastructure, so to speak, exists to help these children. BTW, when HH was based at OSF it wasn’t an entirely charity endeavor. HH volunteers raised more than $1 million, which went directly to the Children’s Hospital of Illinois to offset medical costs.

The biggest reason to contribute to HH is to save the life of the child. I have to speak more from the heart now, but hopefully we make decisions with our brains and our hearts. There is something so cool about seeing a child who couldn’t walk or play, who was gasping for breath get up after recovering from surgery and get to be a kid and get to have a future. There is something so cool about bringing hi tech, cardiac surgery to a poor Haitian child. I was privileged to witness one of these open heart surgeries and it is an absolute miracle that doctors can cut open a person’s chest, hook them up to a bypass machine, stop the heart, fix the problem, and restart the heart. It is practically routine now in the U.S., but I tell you, it’s a miracle. I think it’s reasonable to suggest that U.S. medical centers share some of this technology and expertise with children from Third World countries.
One of the questions you asked was something along the lines of, “Why should I help Haitians whom I don’t know?” This is where John and I and others involved in HH have an advantage: we do know these Haitians and their families. And this also is one of the benefits of the program. HH introduces these children to communities around the country. When these children are here, they personalize the developing world and all of its problems; it’s not some abstraction anymore. I believe that hosting and getting to know these children has been a life changing experience for people. Many of our HH host families continue to have relationships with these children and their families and also are involved in Haiti in other ways. There’s no denying that if you have an emotional attachment to a person, you’re more likely to want to help them. We help our own children first, then our neighbor’s children, etc. Bill Gates has said that if the children from the developing world lived next door to us, we would not allow them to suffer the way they do. Well, for a few months, these children do live next door to Americans.

As far as John’s credibility, I can tell you (and other people who know him can vouch for it), he lives a very frugal life, by any American standards, much less by the standards most doctors live. This doesn’t seem to be a big sacrifice for him, and it has allowed him to dedicate thousands and thousands of his own dollars to HH. He has paid for many of the children’s plane tickets and also even a couple of surgeries. It has also allowed him to spend months each year working in Haiti. John takes no salary from HH. So, the founder of the program is fiscally conservative and is very concerned with how HH funds are spent.

There is mercy work and there is justice work. Mercy work responds to an immediate need, while justice work corrects the situation that leads to the problem. Digging wells to provide clean water so that children don’t get typhoid and other diseases is justice work. Providing them with heart surgery is mercy work. Both kinds of work are important. Correct me if I’m wrong, but it seems like there is an implication that it’s somehow wrong or irresponsible for a child in Haiti to have heart surgery when so many other children suffer from more easily treatable diseases. But perhaps it’s wrong or irresponsible for a person to buy a $30,000 vehicle when a $15,000 one will do just as well. The extra $15,000 could then be spent on either wells or heart surgery. I am probably not making this argument very eloquently, so I would recommend the book “Mountains Beyond Mountains”, by Tracy Kidder, a biography of Dr. Paul Farmer, a physician who works in Haiti, Rwanda, Peru, and the prisons of Russia. He is someone who has changed reality by helping to drive down the price of HIV-AIDS meds. Towards the end of the book, some of his associates fly a Haitian child who is sick with cancer to Boston for treatment. Dr. Farmer has interesting things to say about this case that apply to HH.

Coincidentally, as I type these words on the evening of 12/21, Maxime Petion, a HH patient, is flying to Cleveland where he will be assessed for surgery. We are grateful to Cleveland Clinic for accepting Maxime. John and I both have blogs that focus on Haiti: John’s is and mine is You might find it interesting to check out them out. Besides being a great physician, John also takes great pictures, and those accompany our oh-so-incisive posts.
I hope based on the foregoing that you might consider giving some of your $20 to Haitian Hearts.

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