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6164: Hopital St Croix (fwd)

From: ange perrault <ange.perrault@mail.tju.edu>

>Date: Sun, 3 Dec 2000 22:55:30 -0800
>For those of you who have not seen this newswire article,
>This is the full text of the story written by Fiona Lloyd-Davies (you may
>have seen the truncated version), a BBC reporter who visited Leogane, Haiti
>during the first treatment cycle of the CDC-funded Hospital Ste. Croix,
>Haiti lymphatic filariasis elimination project that occurred in Oct/Nov
>year.  Over 108,000 people were treated in the plains and mountains through
>a magnificent effort by hospital staff, health workers, and community
>volunteers.  I apologize if I have left someone off but please feel free to
>pass on to other interested persons.
>Many, many thanks from Hospital Ste. Croix, CDC and Notre Dame for all your
>support in moving this program forward.
>The Herald (United Kingdom): Stopping the rot: Haiti is the poorest country
>in the west. It is also one of the most shambolic: even the forthcoming
>elections are in doubt. Yet for most people avoiding the most disabling
>disease in the world is the pressing issue of any day.  Source: The Herald
>(United Kingdom), November 18, 2000, Page 6 BY FIONA LLOYD-DAVIES Jean
>Sylven was washing cars as usual. As he bent down to rinse the sponge, he
>glanced from the bucket to his foot. His left foot seemed to have grown: it
>really was getting bigger. That was three years ago.  His wife left him,
>taking their daughter with her, one month after his foot started to swell.
>Now his leg and foot are three times their normal size, like a massive tree
>trunk with hardened bark skin. But what causes him the most pain is the
>smell of his rotting flesh. As the infection spread and the flesh on his
>foot started to die he was cast further and further out. 'She didn't want
>our daughter to see me anymore, to know who her father was,' he says,
>casting his eyes down his leg to the ballooned foot.  People running the
>small stores selling plantain fritters and knick-knacks in this market area
>of downtown Port-au-Prince don't want him anywhere near them. It's not hard
>to get him to move on: they just throw a bucket of water over him, and it
>does the trick. Jean is only 29.  Dr Jack Lafontant is in a hurry to leave
>Haiti's capital. He is returning to his hospital in Leogane to embark on a
>mission that was two years in the making. This is the first day of a drug
>distribution programme which he hopes will eradicate the second most
>disabling disease in the world: elephantiasis. For him this has become a
>crusade because so many people - more than 60% - in his area are infected.
>'Personally I think that it will be a big achievement for us to help our
>Haitian brothers and sisters who are very sick. We are like a team that is
>ready for a big game that we will win.'
>He is chief executive of the St Croix Mission Hospital about 30 miles from
>Port-au-Prince. It's only 7am but already men holding megaphones walk the
>dusty streets with urgent messages, and radios blast out now-familiar
>tunes. They are all focused on their mission which is to go out into the
>town and the plains armed with more than two million pills to give to the
>people of Leogane.
>But the stakes are high. The effects of this disease are dramatic. 'That
>disease can break a family because you know they cannot sleep in the same
>room, and that creates a lot of problems. The look of the legs is very,
>bad and the smell also is very, very bad and those people are excluded from
>the society.'
>Haiti is the poorest country in the western hemisphere and three-quarters
>the population, like Jean, are living below the poverty line - that is, on
>less than $1 a day. One-third of the Caribbean island of Hispaniola, Haiti
>teeters on the edge of chaos. It has no large reserves of natural
>a bit of oil but not enough to make up for the shortfall when Baby Doc
>Duvalier, the son of the dictator Papa Doc, left the country with millions
>of dollars in 1986.
>As a symptom of the state Haiti is in prior to the elections on November
>Jean's story is a startling example. He has no choice but to think only as
>far as his next meal - the lot of most Haitians.
>The country is in chaos: no roads, no sewage, only 20% get electricity, and
>that's only 2-5 hours a day. Can Aristide - the people's choice - really
>sort this out? The people say they are thirsty for Aristide like the corn
>thirsty for the rain but his man, Preval, has been running the country
>1996 and little has changed. Critics even think that Aristide has gone the
>way of all politicians in Haiti: corrupt.
>The May Senate elections in which Aristide's party, Fanmi Lavalas, won a
>majority have been denounced by the opposition and not been recognised by
>the OAS and US due to irregularities. While the people of Leogane queue for
>their drugs the Prime Minister announces an attempted coup after a tip-off
>from the Americans and six police chiefs are arrested, some as they attempt
>to cross the border into the Dominican Republic. Sources say there was talk
>of assasinations - of the current president, Preval, and Aristide.
>can happen here. The only thing that is certain is that elections bring
>instability and violence. The bodies are already piling up, four reports in
>a week and at least one shot in the head, lying in the middle on the main
>route leading south out of Port-au-Prince. No-one can be bothered to move
>the body, the cars just career around it making the traffic jams even
>At the pro-Aristide rallies people come out on to the streets, chanting his
>name and waving his poster. Some say 'it's Arisitide or violence'. But even
>the election is in question. At the time of going to press, President Rene
>Preval indicated that it may be postponed. You just don't know in Haiti.
>The tourist trade has been decimated by Aids scares, political instability
>and violent military coups. In the past 15 years there have been have been
>half a dozen governments and army dictatorships. There is little formal
>employment and no free health care worth knowing about. If you're ill in
>Haiti you need money and a family to nurse you.  Jean has neither. He lives
>in the street, but more often than not, in the road. So, like flotsam and
>jetsam, he drifts around the gutters of Port-au-Prince with the worst of
>rubbish. Hobbling about on his crutches with his only possession, a faded
>lime green sausage bag that contains a few bits of white rag he uses to
>bandage his foot. Rejected by his peers, he is part of the detritus of
>Haitian daily living, of the open sewers reeking an unforgettable stench
>that hangs in the air wherever you are in the city.  'I'm living in an
>unbelievable amount of misery here where you see me sitting, I don't have
>any place to sleep, if it rains I get wet,' he says.  'I sleep with the
>mosquitoes that are biting me, it's unbelievable misery.' Jean's story is
>typical and it's this that Dr Lafontant wants to stop dead in its tracks.
>is a practising doctor as well as running the hospital, but this project
>more important than having a lot of money in a bank'.  The mosquitoes that
>have become Jean's bedfellows are at the heart of the problem. They are the
>carriers of this disease known as lymphatic filariasis, which has two
>manifestations: elephantiasis, the swelling of the leg and foot known as
>'Gros Pied' in Creole or 'Big foot': and hydrocele, when the scrotum
>filled with fluid. Jean has both.  The cause is a microscopic worm which
>lives deep in the lymphatic system, gradually destroying it. At night these
>micro filarial worms come to the surface of the skin just as the mosquitoes
>come out for their human blood meals. As they bite one person infected with
>the worm, the mosquitoes become a carrier and take the worms to the next
>unsuspecting victim, infecting as they nibble another blood meal. It takes

>years of exposure to become infected, but in Haiti that may by your tenth
>birthday.  In other countries such as the United States, elephantiasis died
>a natural death as the country developed. Once drainage and sewage systems
>were built in the southern States in the 1920s and thirties, the areas of
>dirty water that mosquitoes breed in virtually disappeared. But Haiti is
>poorest country in the western hemisphere. Two-thirds of the population
>no access to clean water and a decent sewage system is simply not an
>What is an option is to stop the transmission of the disease. Kill the worm
>and the mosquito will no longer infect anyone.
>The numbers with the worm throughout Haiti have yet to be determined but
>what the doctors like Jack Lafontant know is that it's present in every
>department of the country. 'This is a disease of poor people and we have
>thousands of poor people in Haiti who cannot move, cannot work and it's
>horrible for them. You know, it's like hell for them.' Which is why the
>World Health Organisation has declared war on this disease and two years
>launched a worldwide campaign to eradicate it by 2020.  When studies
>revealed that such a lot of people were infected in Leogane, it seemed the
>perfect place for the pilot project. Working with Jack Lafontant are three
>doctors from the Center for Disease Control, an Atlanta-based American
>government-funded organisation. They are all equally passionate about this
>programme. Pat Lamy and Michael Beech have come out to oversee the drug
>distribution and proudly take us to the depot. It's as if we are entering
>Santa's grotto.
>A small house is now overflowing with boxes of drugs, paper cups, charts
>special packs that will go to each of the 100 distribution points that will
>be open from 9am. Two drugs are the key to bring about an end to this
>disease, Diethylcarbamazine (DEC) and Albendazole. SmithKline Beecham has
>donated the Albendazole and CDC paid for the other, a cheap drug costing
>less than one cent. By taking just a few doses of each, once a year for
>years, the worm will die, stopping transmission of the disease immediately.
>Everything has been planned with military precision. Each health point has
>team of people who will record names, hand out chlorinated water, count the
>pills, and even someone to check the mouths of the kids, just to make sure
>they really have swallowed the pills - eight of the DEC and one of the
>In a country that believes in spirits or fetishes, and where voodoo is the
>defining religion, a key to the success of the programme has been to break
>down traditional attitudes towards the disease. Everyone here has seen
>someone with 'big foot' but it has only been through education that they
>know the true cause. According to local voodoo tradition, it's the magic
>powder that causes 'gros pied'. If you step in it, they say your feet will
>swell out of all proportion. It's the magic.
>'I used to be very afraid,' says Jackie Louis Charles, the physiotherapist
>at the St Croix Hospital's specialist clinic for elephantiasis. He has
>one sufferer, Maurice, who has had two very enlarged feet all his life.
>'When I was a child, going to school I would never walk anywhere Maurice
>been. Not until after it rained.' Jackie has been working at the St Croix
>Hospital Hope Clinic ever since it opened in 1995 and has treated more than
>600 people. 'At first it was very hard,' he says, 'but I felt I must do
>Devoted to his patients, he has seen the results of careful physiotherapy
>and massage on once-infected over-swollen limbs. With patients who are no
>longer infected he has even stopped using gloves, throwing off the final
>remnants of childhood fear and cultural prejudice.  Maurice, just one of
>many elephantiasis patients who still come regularly to see him for
>treatment, now leads a normal life as a small-businessman, setting up a
>chicken stall opposite the main gates of the hospital. But the Hope clinic
>is one in a million. Funded by the American CDC it can offer a free service
>and free drugs to those who can't afford to pay. This is not the case at
>State Hospital in Port-au-Prince.  Jean has been persuaded to try his
>chances at the hospital. He doesn't hold out much hope - he has been down
>this route before when the disease started.  When he noticed his foot
>getting bigger he went to the doctor. But the doctor misdiagnosed his
>condition, telling him it was 'coldness'.  It made sense to Jean at the
>time. As he was working barefoot in cold water, washing cars everyday,
>it was the cause of the problem.  The medicine from the doctor was useless
>and when his foot continued to get bigger his wife walked out. He has been
>on the streets ever since. Then the bumps started and his whole body
>in front of his eyes. 'If I touch a part of my leg, I'll then touch some
>other part of my body and it just seems to spread. I'll continue on this
>until I die, I guess.' As with his previous visits to hospital, the doctors
>don't seem to know much about the disease. Their diagnosis and advice is
>damaging, too. Like the doctor he saw when his foot started growing, even
>here, these recently qualified interns think he has contracted the disease
>from walking barefoot in water, unaware elephantiasis is transmitted by
>mosquito. It was because of this that Jean thought water was causing the
>problem and so made sure water never got near his now acutely infected
>He hasn't washed it in three years.  There's no doubt the smell puts the
>doctors off. They don't want to touch him and barely disguise their
>repulsion. But the deciding factor is that he has no money and no family to
>care for him in hospital. We, 'les blancs', as anyone foreign is known in
>Haiti, therefore become his temporary family and pay the Pounds 3 admission
>fee. Congealing blood stains the formica top where you hand over the money,
>and a clerk carefully writes Jean's name down in a ledger. The young
>don't want to give their names to a journalist. 'You understand,' they say,
>wearing their most professional, caring smiles, 'that we want to do
>everything we can for these people, but there is nothing we can do for
>Nevertheless, Jean is given a prescription and we join the queue over the
>road at the pharmacy to buy a syringe, antibiotics and a sedative. But we
>don't stay the night with him, and he is left on a bare trolley to fend for
>himself in casualty. He is pushed behind a wall, out of sight, but the
>ensures he's not out of mind. This is the first time he has slept under
>cover in three years.
>In Leogane the distribution programme is well under way and people are
>queuing for the pills. The preparation has been extensive. In the past few
>months community meetings have been held and up to 40,000 people have come
>to hear why they should take the drugs and what they will do for them. One
>thousand people have been trained to help over this four-day period, when
>the drugs will be given out free. The adverts are still buzzing round the
>airwaves: men stride around with megaphones, shouting from trucks.  'People
>of Leogane, are your ears trumpets? St Croix hospital will give medicine
>filariasis to everyone, to prevent big feet,' say the broadcasts.
>Jack Lafontant is confident that there will be a good turnout. 'In Leogane
>everybody is motivated because they know that they have the disease, a lot
>of people have the disease, their family has the disease and so it was not
>very difficult to advertise the project. All the signs are that he's right.
>In Buissonniere, a rural health point a few miles outside of town, the wind
>drifts through the banana palms, momentarily breaking the stillness of the
>hot morning.
>Paul Jolies, one of a hundred local community health agents, is in charge
>here and is very happy with the way things are going. Two hours after
>opening their doors he reckons about 150 people have come. 'We expected
>and definitely more will come, this is just the beginning,' he says.  Part
>of his job has been to give out information. 'We've done a lot of work in
>getting people to understand what is happening over these few days of
>distribution. I think as the days go by we'll see a lot more understanding
>of the gravity of the disease as well as the cause it can have in your
>Odolfo Rosme heard about the distribution from a man with a megaphone and
>has walked from his garden job to come and take the pills. This point was
>the most convenient for him: 'I've come to take the medicine for the
>sickness,' he says. 'I'm not sure if I have it or not, but anyway I'm going
>to drink the medicine to make sure.' His wife and children will go to the
>one near their house: this one saved him going all the way home.  Like
>Odolfo, no-one has any fears about taking the pills, including the kids.
>They know all about the disease and the effects of the drugs. 'It' ll kill
>the worms,' they say, giggling, 'but also make our head hurt and give us a
>fever.' One critical part of the distribution programme is the reaction
>people may have to the drugs. If they are infected with the worm it can
>them sick, with vomiting and fever, and men may even get swollen genitals.
>At the moment no-one seems to be put off by it, so keen are they to do
>something to help the community.
>Suzanne Street is a volunteer who takes it very seriously. 'I've come to
>render a service to the community, they researched the problem and found
>there is a sickness, so everyone put their heads and their hands together
>make sure we can wipe it out.' But Dat Guelia, a volunteer at another
>Croix des Paix, is prepared for the worst. 'The pills haven't had any
>on people so far, but there will be a lot coming back.' If the drug
>programme had happened three years ago, Jean wouldn't be in the situation
>is now. The hospital said they needed the trolley and threw him out into
>hospital car park at dawn. 'It was because I didn't have anyone with me at
>the hospital last night, so they looked at me like a bum and they put me
>on the streets,' he says. Jean's only chance is to be transferred to
>Leogane, to the Hope Clinic. The hospital administrator is persuaded to
>him to Leogane in one of their private ambulances. The presence of 'les
>blancs' is a persuasive factor, but at least it means that this
>'inconvenient' patient is out of their hair. Jean struggles into the
>ambulance as the driver, despite holding a box of latex gloves, just
>watches. No-one will come near him, no-one will lend a hand. As he heaves
>himself in, the driver puts a mask over his face, and the humiliation is
>Later in St Croix hospital, Jack Lafontant agrees to admit Jean to the
>hospital. They know he has no money and no family. His is the worst case
>they've ever seen. Jackie washes and cleans his leg and foot and he is
>antibiotics to try and halt the infections. They will keep him in there for
>a month or more, so severe is his condition, but Jack Lafontant is
>they can help him. 'We can teach him how to clean well his legs, we can
>treat the infection, and also to do physiotherapy of the legs that
>facilitates the circulation of the lymphatic vessels. The results are very
>interesting because a large number of our patients present a decrease of
>volume of the legs and in that way they can move more easy and the society
>accepts them more.'
>It has taken two weeks for the smell to start to wane. By the first
>afternoon the other patients in the ward were complaining, but the Hope
>Clinic has kept its promise and continues to help Jean. More than 70,000
>people came to take their pills - that's half the population - and the
>campaign is moving into the mountains to reach the other half. 'We've hit
>our target,' says a jubilant Jack Lafontant.
>But there are still many people out of reach. Eddie is a musician about 31
>years old and has just moved into an apartment in Port-au-Prince. His foot
>is getting bigger every day. 'I know it's a fetish,' he says. 'I know it's
>magic, I know it's the poison'. But the real poison here in Haiti is the
>Copyright (c) 2000 Financial Times Ltd. and all respective publishers
>Received by NewsEdge Insight: 11/20/2000 14:23:02
>Marie-Nirva and Jack Guy LAFONTANT
>Returning Address : stecroix@Qmail.com
>Telephone (509) 511-5884
>Telephone Port-au-Prince's office (509) 244-3983
>Fax (509)244-7505
>Address: Hopital Sainte Croix
>                C/O Lynx Air P.O.Box 407139
>                Ft lauderdale Fl 33340

Ange Ronel Perrault, PhD.