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#310: Bringing lifesaving machines to an impoverished land (fwd)


Bringing lifesaving machines to an impoverished land 
Sunday, August 15, 1999

For more information on Renal Care International, call Yveline
Jean-Claude at (212) 746-1574.

A 50-ish gray-haired writer is seated in the first reclining vinyl
chair. A grandmother who loves to cook and travel is in the next. A
66-year-old woman with an amputated leg is farther across the room. A
retired nurse, in  her 70s, sits near her.For at least three hours a
day, three times a week, the writer, grandmother,amputee, and nurse come
to The Rogosin Institute in upper Manhattan and  hook up to kidney
dialysis machines that cleanse toxic substances from their  blood.
 To an outsider, the procedure might seem depressing. But to Dr. Yveline
 Jean-Claude, a 36-year-old kidney specialist, the machines are an
exciting gift  of life. The Teaneck resident is working hard to bring
them to the  impoverished residents of her native Haiti.  Her mission
began four years ago, when she learned that nearly 100 Haitian   
children, who had taken a tainted medication, died from kidney problems.
"They went into acute renal failure," Jean-Claude said. "If you can
support a   person through the acute phase, they can live. But nowhere
in Haiti was there dialysis."  The Harvard-educated nephrologist hadn't
been in Haiti since she was 5, and  she and her family fled from the
brutal and repressive Duvalier regime. She knew she would be attempting
to set up a medical unit in the poorest  nation in the Western
hemisphere, a nation with a barely functioning  government, sparse clean
water, spotty electric service, and scarce jobs. About all that's
plentiful are hunger and crime.

 Still, Jean-Claude pressed on.

 "Whenever people from Haiti get together, they often talk about how bad
 things are," Jean-Claude said from her office at The Rogosin Institute,
where  she is associate director of hemodialysis. "They send money back,
but the  most important resource Haiti needs is people. We need to go
back and bring what we've learned abroad." Jean-Claude has long yearned
to return some of her good fortune to her  homeland. After fleeing
Haiti, her parents, who were college professors,  reared her and three
sisters in the African nation of Chad until Jean-Claude  was about 15.
When civil warfare shook the French-speaking republic, the family fled
to the United States, settling in Brooklyn. As the petite young woman
grew up and entered the medical profession and  became more familiar
with her Haitian roots, her desire to aid those still  struggling only
deepened. Saving lives with dialysis, a critical but expensive
technology, was the one thing she had to offer. The avoidable deaths of
the children prompted her to  approach other colleagues of Haitian
descent.In late 1996, Antonio Joseph, a New York City nephrologist in
private  practice, along with Camille Romain and Martine Denizard, who
both work  with Jean-Claude at The Rogosin Institute, eagerly joined her
in forming the nonprofit group, Renal Care International. By October the
group hopes to have an eight-station dialysis center up and running in
the Haitian capital of Port-au-Prince. The government-funded State     
University Hospital of Haiti has remodeled a 2,500-square-foot wing to
accommodate it. The Rogosin Institute has donated used machines (new
ones cost about $15,000 each) and allowed Haitian doctors, nurses, and
technicians to train in its facilities. The American Association of the
Sovereign Military Order of  Malta, a religious charity that supports a
hospital in rural Haiti, has committed to grants of more than $50,000.
>From conception, though, it has been a rocky road."One of the biggest
challenges I have faced is to address the question of why bring dialysis
to a country that has so many other needs," Jean-Claude says.          
"It's hard to give good medical care when you're missing things [such
as] clean   water and sanitation. But if everybody has a wait-and-see
attitude, we'd never contribute anything."  Renal Care International
members traveled to Haiti in November 1996 to meet with the government
health minister and the director of the State University Hospital. The
Haitian officials were ecstatic to hear of Renal Care's plans and made
enthusiastic promises to help bring them to life. "The next thing I
heard there was political upheaval," Jean-Claude recalled. "People had
been replaced. There was a general strike in 1997. Medical  students and
interns and residents were protesting. Everything was closed. ...       
We couldn't keep track of what was going on." When the political
situation stabilized, a new group was in charge, but it enthusiastically
supported the project. Meteyer, who has worked to set up the fledging
nephrology division in Haiti and recently completed a six-week refresher
course in dialysis at The Rogosin  Institute, has hundreds of special
reasons for his doggedness.He carries fresh memories of the many
patients he has lost because of a lack of dialysis. When he talks of
them, his voice fills with despair. "There was a young man. He was 18,"
Meteyer began explaining in French. "I liked himvery much."The young man
loved soccer, like most youths in Haiti. He had hoped to study   to
become a computer analyst. But the kid's dreams evaporated like morning
 dew when the doctor delivered the crushing news that his kidney was so
 damaged that no medication or technology on the island could save him.
The young man's name was added to a depressing roll, that of hundreds of
 patients who die needlessly every year because Haiti doesn't have
dialysis. Most never even see a doctor because there is only one per
12,000 people, versus one for every 600 people in America. Those who do
get a doctor's attention are often afflicted by high blood  pressure,
which can be caused by a diet rich in salt, or diabetes. Because so     
many of the island's 6 million people have no refrigerators, they salt
their meat  and fish to preserve it. The result is an epidemic of
hypertension, which  damages kidneys. Others, such as the 18-year old,
contract kidney diseases from unknown origins. Then there are those,
like a 44-year-old mother of three, who suffered   renal failure during
pregnancy. Most Haitians are counseled to change their diets, but with
an average per  capita income of $400 a year, they don't have many
choices about what to   eat. And medications, such as sodium polystyrene
sulfonate, which can extend  the life of kidneys, are expensive and
scarce. So each month when six new patients at Meteyer's hospital reach
end-stage  renal failure, it is nothing less than a death sentence. The
end usually comes in  less than six weeks.It's why Jean-Claude's group
has been so determined to get the clinic up and going, even if only a
few patients can be treated initially. They still need at least $40,000
to purchase a generator for power and a  water treatment system, and
thousands more to stock dialysis solutions. Once   the clinic is
operating at full strength for about 18 hours a day, 64 Haitians will   
be able to attach themselves to the life-preserving machines. Jacque
Charlier, a writer who lives in Harlem, gets dialysis at The Rogosin    
Institute while awaiting a kidney transplant.  "This is something the
[Haitian government] should be doing. But here you  have an individual,
a private citizen who is doing it, and that's fantastic," Charlier said.
Despite all the obstacles that Jean-Claude's group has run up against,
she too hopes their example will ignite others. "On my bad days, I
certainly wonder what will be the next challenge," she says. "But
knowing what I know about Haiti, I felt compelled to do it. We hope it
will be a model for others in other areas to go back and give back,