Should a 20-year-old girl look like this? Her body appears to be swollen with fluid. The only way for her to breathe efficiently is to sit up and lean against a wall. And the only way she can sleep during the past five days is by sitting up. This photo was sent to me a few minutes ago by her father in Haiti who is humbly begging for her life. Should it be this way? I have known her for years and remember her holding a Barbie doll when she first became ill. This was before her two heart surgeries.
And now in 2026 shouldn’t she be a normal young person planning her fall semester at a university and looking forward to her life? Which way do we send her and her dad from her quiet little village on the ocean through the gangs which encircle the capital? What will their asking price be today? How does she stay alive in the back of a pick-up truck with many other miserable people in 100 degree heat over some of the worst roads in the world? And if she arrives, how do we make a diagnosis and orchestrate a treatment plan in the middle of extreme dysfunction at every level? Where is the medical algorithm for this? Which book? How do we factor in a lack of functioning hospitals, a lack of money, a lack of security, a lack of everything? And finally, what do we do about this besides whisper, “I am sorry”? Is that good enough to placate our moral injury? God have mercy.
—
John A. Carroll, MD
www.haitianhearts.org
johnacarroll.substack.com
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