AMHE Newsletter # 369
- Dr. Maxime J. Coles
- 5 days ago
- 68 min read
Table of Content of the AMHE Newsletter # 369
1- Words of the Editor-in-Chief: The Opioid Crisis in the USA
2- Maxime J-M Coles MD : Osgood Schlatter Disease
3- Rony Jean Mary MD : HAITI : PROUESSES INTERNATIONALES, RETOMBÉES NATIONALES DE GRANDE ENVERGURE.
4- Reynald Altema MD : The Scandal
5- Requiem AMHE: Joseph Leon Paul MD, Emile Solages, Roger Germain MD, Christian Fresnel Larosilliere.
6- AMHE News, Resident-Program, Teaching and Medical Missions in Haiti, Emmanuel Francois MD and the AMHE Foundation at their 50th Anniversary Gala, AMHE Chapters, AMH, William "Bill" Pape MD.
7- Maxime J-M Coles MD: Heritage d'un pays sans gouvernance
8- Rony Jean Marie MD: CES PATHOLOGIES QUI SONT DU DOMAINE DE LA PSYCHIATRIE ET DE LA MÉDECINE GÉNÉRALE
9- Reynald Altema MD: Joey's Growth
10- Reynald Altema MD: Pith of the Situation
11- Franky Telemaque MD: Info Gazette Medicale and Info Chir
12- Coin des Lecteurs: "Dual Citizen", a new movie of Rachelle Salnave, Diverse News
13- Jean Serge Dorismond MD: L 'Amour va plus loin
14- Maxime J-M Coles MD : L'Impact d’un Malaise
Editorial Board
Maxime J-M Coles MD
Rony Jean Mary MD
Reynald Altema MD
Yasmine Titus Pompey MD
Fahimy Saoud MD
The Opioid Crisis in the USA
The Opioid crisis represents for me a reminder of the early 90’s when I moved from Meharry Medical School (Nashville TN) to join the Yale-New Haven group at Bridgeport Hospital, a designated Level One Trauma Unit, in Bridgeport CT, “absorbed” by the Yale-New Haven Group. Bridgeport Hospital took the new designation of “Bridgeport Yale Health System”.
Mainly, it becomes more practical for the state of Connecticut to divide their main hospitals into two main groups related to the two main medical schools. All hospitals in the North of the state (along the Merritt Parkway) received an affiliation with Harford Hospital and all hospitals in the South part of the state, (along I95), become part of the Yale New Haven System, rendering the Trauma system more functional while facilitating the EMT/ ambulance system to a better delivery of the injured patients.
The state of Connecticut became the envy of many other states in the New England area, defying other to achieve such cohesion while ”entering” the new era for Hospital designation to handle Polytraumatized patients. Bridgeport Hospital and St Vincent Hospital become respectively designated Level One and Level 2. Bridgeport Hospital was absorbed by Yale New Haven and was designated as a Level One Unit under the name of “Bridgeport Yale Health”.
As Chief of Orthopedic Trauma, I was responsible for the orthopedic clinics as well as the well-being of all polytraumatized patients admitted to the Hospital. I had a team of six physician-assistants and two technicians to support me in all activities and especially the clinics; also surgical and orthopedic residents were rotating from Yale New Haven. It was a very dynamic team and it was my responsibility to train the personnel to handle any poly-traumatized patients reaching the doors of our hospital. It was the place where I met most of the victims related to the Columbian Cartel Drug ring. A very active police squad from Hartford to Bridgeport was overseeing their traffic of drugs. We were simply the purveyor for care.
So many stories fit in with my 18 years of service at that institution, and this has been for me, an experience of a lifetime with an excellent team to support my efforts as well as a very cooperative staff of well-trained Orthopedic surgeons involved in all kinds of orthopedic specialties to support my efforts.
I enjoyed living in the town of Monroe CT, located 5 minutes North of Bridgeport CT and I also was allowed to build up a private practice. My Kids grew up there happy and attended their high school, and respected colleges. In my previous private practice experience following General Surgery and Orthopedic residencies at Howard University Hospital, I joined Meharry Medical school where I became Assistant-Professor and Chief of the Orthopedic Service at the Veterans Administration in Murfreesboro TN. Such were my previous experiences, rendering me ready to take over these important charges at Bridgeport Yale Health.
I found myself involved in a prestigious institution, rubbing shoulders to the biggest names in Orthopedics, participating in Grand rounds regularly with the residents and the orthopedic staff at Yale Hew Haven. In the gilded hallways of their university hospital, I met many famous orthopedists who became my peers and I enjoyed the illusion of being part of an elite in Medicine. Often, we will participate in combined grand rounds at Hartford Hospital.
The reality of things was much different because, behind this glamorous façade, I was running a very busy service , handling multiple spécialités clinics (Trauma, Hand, Pediatrics, Spine, Foot and ankle etc.), mainly a dumping ground for patients involved in the Columbian cartel drugs. A large town like Bridgeport with a mixed population allowed me to expand my skills in the treatment of a very diverse population.
From being a traumatologist, I become a sport medicine man involved in differents sport activities like football, soccer, baseball, Jai Ali, basketball etc. I dealt with neonate, children, adults and seniors, moreover the different gang members running the streets of Bridgeport. Often, such gang dealers were not older than 16, although they were part of an essential reseau for the distribution of the drugs. Many of them were also addicted or even seeking or trying to sell drugs during their visits in the hospital on the floor or in the clinics. So many different groups to control which demonstrated how one can realize the way I played an important role in the care of these underprivileged.
I performed under their eyes, and they understood that my presence was primordial in their community, while their health and well-being was my priority. They wanted me to know how I played an important role in their life and as such, I was imposing respect and I needed to be protected. Many of the groups would voice such need to protect their physician at any price. They felt the weight of my words when addressing them to control their temper, during different visits at our institution.
We treated them with respect, and they often offered me their “protection” in the clinics or in the town for being their physician at the clinics. Indeed, I became the man to go to for all the victims of a shoot-out. Often, one may find the need to tell us when a weekend may become agitated because of possible gun fights between different gangs. Then, we would expect many injured in the emergency room. It was their way to warn us and keep us ready for possible gunshot-wound injuries or fights between different groups.
The orthopedic team appeared to be well protected because we were told so many times that our backs were covered. To the point that we were the only physicians or physician-assistants comfortable enough to enjoy the privilege of going downtown Bridgeport after a late case and ordering a late-night sandwich.
The opioid crisis was different then or perhaps; I did not know enough to appreciate other involved in the distribution. What we knew that one gets injured searching for drugs or how much he/her spent in buying the package of drugs and at that time perhaps, we can at least guess what kind of opioid drug he was taking. Often, it was le “lord” punishing a young member because he used the drugs for personal reasons, in inflicting a gunshot wound. Once admitted, they would have proper screening with blood and urine tests.
A typical victim will come to the ER, dropped by a friend, usually in a car, but most of the time they will never reveal the name of the offender. Generally, a gunshot wound to the knee was considered as a punishment for a bad action in the group. It was the way the young were punished for deviating from their rules of law and a “leader” will shoot him at the knee level. This is the way many patients will present through the ER.
Prior to my arrival at the Bridgeport Yale Health institution, such patients were treated in a trans skeletal traction for six weeks and once sufficient callus was observed clinically or through radiographical studies, they would benefit from a spica cast application in the plaster Room. Then they will be discharged home to return to the Orthopedic clinic in six weeks for further follow-up care, then a removal of spica cast and application of a fracture brace will follow. It was the previous protocol.
I changed that routine, weeks after my arrival at Bridgeport Yale Health by using more aggressive medical care in the treatment of such fractures. After 48 hours of admission, through medical clearance, such patients would be booked into the operating room to benefit from a surgical treatment consisting in a closed reduction and a closed intramedullary rodding or with an open reduction and internal fixation with plate and screws, depending on the kind of wounds created by the velocity of the bullet. After surgical treatment, patients would be discharged in 72 hours.
Unfortunately, the gang leaders did not appreciate such treatment and with a so short hospital stay, they interpreted the punishment as not sufficient enough and as a result, they would re-visit the patient at home to punish him again with another gunshot wound to the other lower extremity. If the punishment needed to be more severe, they would go the chest or the head to make sure that the chances of survival were minimal.
Nowadays, talking about opioid crisis, it is not anymore counting the number of gunshot wounds we may have seen in our clinic but more counting about how many cases of overdoses, or hospitalizations with complications and even death, we have seen in our healthcare institutions. How different is the problem in our communities…
Drug addicts do manage their addiction, trying to be dependent on a physician in which they place their thrust while such physicians may fail at time to be the best remedy to their problem. Presenting at time, a poor remedy and facilitating the relapse of a drug user who may have had no other chance to manage his setbacks. It is not often that we hear this aspect of the life of the drug user. It is well known that opioids drug abusers may relapse or fail their treatment within a year. A study published in the Jama Psychiatry and Drug and Alcohol Dependence has shown that up to 90% of drug users seem to have failed their treatment in a year, especially at the renewal of their medications following hospitalization especially among the underprivileged population. One can’t believe anymore that this crisis is only seen as a crisis related to poverty or low-income patients.
In the wealthy, the problem is also rampant, but the approach is quite different, and the addiction thrives because patients carry their own prescriptions from their private physicians especially when they reside in influential neighborhoods. They have prescriptions for opioids or benzodiazepines, Adderall medications etc. to control appetite (GLP-1: Ozempic) or weight loss (phenetamine), insomnia or nervousness, headache or dry mouth… because they are MVP patients. It has been reported how such patients will show strong evidence of overdose or at least, risks of overdose.
We heard about celebrity death exposed to such “VIP Medicine habits”. Remember well how “propofol” was used in the death of Michael Jackson in 2009 when administered by his private physician or when Matthew Perry was found inert in 2023 following a lethal dose of “ketamine”. In fact, often, physicians refuse to manage patients dealing with opioids problems but have the tendency to refer them to an outpatient pain specialist.
Moreover, as surgeons, we may also encourage such addiction by our way of prescribing pain medication for comfort. We hesitate often in the choice and in the amount of pain medication just by thinking what an abuse of opioid medication can bring like problem for the one who uses them improperly. I recently saw the new movie on Michael Jackson, and I was really surprised to hear that the became addict only after such medications were provided to him by his private physician, following his burn injury while performing. I would recommend the movie to anybody who grew up following such a passionate singer and performer. The movie, really, gave me an other opinion of Michael Jackson.
Research has already shown that patient satisfaction is well related to opioid prescription and often, court cases have demonstrated the way patients claim how they were not well treated because they were deprived of the proper amount of medication to control their pain and discomfort. I remember well a lady who was seen regularly in the ER because of chronic dislocation of her shoulder but looking for more pain medication, she will pop out the shoulder in search of care. She studied the pattern of rotation of the medical staff in the ER and will present with recurrent symptoms once a new team of physicians rotates in the ER.
Physicians need to be protected from retaliation when one judges unethical or excessive some prescribing practices and tries to change the concept that the more you provide pain relief, the better way such patient is approached.
Opioid addiction is not just a crisis reaching the poor, it is seen also in all social classes especially in the higher and dominant classes. It does not discriminate against wealth or poverty, fame or shame, nor it help one in being more influent. The healthcare system will have to perform an introspection and look at the problem more closely or more life will continue to be destroyed.
Maxime J-M Coles MD
Boca Raton FL
Références :
1- Richard A Lawhern PHD : The Real Cause of America’s opioid crisis: Doctors are not to blame.
2- Matt McCord, MD and Brian Kleeper PHD: Ben Franklin’s timeless wisdom: a key to solving America Opioid Crisis.
3- Ronald A Zent, MD : How were we duped and what can we do about the opioid overdose crisis?
4- Amy Baxter MD : How enhanced Recovery After surgery solves our opioid problems.
5- Carlos N Hernandez-Torrez: Addiction in Medicine
Jessica Singh MD : Physician burnout: Finding peace in a broken health care system.
Osgood-Schlatter Disease
Osgood-Schlatter disease is often seen in growing adolescents because of chronic inflammation or irritation in an area located just below the knee joint, anteriorly, especially where the patellar tendon attaches to the tibia, proximally. Around 4% of people may be affected, more often the males to a 3:1 ratio, and the dominant lower extremity can be more affected or can be seen bilaterally in around 25% of adolescents.
The condition was named after an orthopedic surgeon Robert Bayley Osgood (1873-1956) and a Swiss surgeon Carl B Schlatter (1864-1934), both described the disease independently in 1903.
Often seen during the growth spurts when muscles, bones and tendons or other structures are changing rapidly. Additional stresses on bones, muscles from different physical activities in children involved in sport like jumping and running, place the knee at risk for this common condition. Although less active children are not spared from such disease.
Generally, rest, ice and anti-inflammatories can be sufficient to control the pain and discomfort while stretching and strengthening exercises may control the pain and facilitate a return to daily activities.
Osgood-Schlatter disease causes pain at the tibial tubercle (bony bump) where the patellar tendon attaches to the proximal tibia (shinbone).
The end of the long bones (epiphysis) in any growing children has special areas allowing such bones to grow called “growth plates”, representing an agglomeration of specialized cartilage cells, in a state of constant multiplication until a child reaches the fully growing age. Then the growth plate disappears (fuses) and gives place to a more mature bone, seen mainly at the end of adolescence.
Some other growth plates serve as attachment sites to tendons like the Patellar tendon or the Achilles tendon. Around the knee, the bony bump felt in front and below the joint is called “tibial tubercle”, covering the proximal end of the tibia. Such growth plates are better known as an “apophysis”. The anterior thigh muscles (Quadriceps) form a large tendon distally, called the “Patellar tendon” which attaches to the tibial tubercle, exercising a pulling force to extend the knee joint.
This is generally with repetitive flexion/extension motions, mixed with a constant traction in a growing child that such an irritation (inflammation) of the growth plate can be seen. Often, it may result in a bump or a prominence located in front of the knee, occasionally tender to palpation and percussion of the proximal tibial apophysis. This is the most common anterior knee pain encountered in childhood, and such may call is at time, growing pain or overuse injury.
Another similar insertion over a growth plate (apophysis) is seen around the ankle when the Achilles tendon attaches to the apophysis provided by the calcaneus bone. This disease is known as Sever’s disease. Other apophyses like the greater tuberosity of the femur or the humerus attach also muscles or tendons… etc. and can create similar problems.
My older son is a Basketball coach and recently his young players underwent intensive training and conditioning exercises to the point that many players experienced fatigue and pain following multiple activities to improve their conditioning and jumping abilities. Some experienced pain and discomfort at the palpation of their tibial apophysis necessitating a period of rest with ice application to the knee. I wonder why such new players are being pushed so much to improve their skills. I was told that is the way basketball and other sports are becoming so competitive. I then stood on my corner and waited for more to develop such anterior knee pain.
Clinically, one can observe an enlarged or swollen tubercle, exhibiting pain with running, jumping and even squatting activities in different sports like basketball, volleyball etc. One or both knees can be involved in the process although one may become more symptomatic than the other. Seen more often in boys than girls and in some studies, the right side was more commonly involved in the disease. Pain at palpation or at percussion of the tibial tubercle with possible swelling, or redness, and tightness of the quadriceps muscles should orient the examiner toward the diagnosis. Walking, jumping, kneeling and even squatting may also increase the symptoms of pain.
Such clinical findings may confirm the diagnostic of Osgood Schlatter’s disease. Although radiographic studies may not be necessary to make the diagnosis, it can be warranted when there may be a differential diagnosis or a reason to rule out any fracture at the level of the apophysis.
One must remember that the patellar tendon complex is stronger than the cartilage at the apophysis. So, any hard tug or hard pull on the tendon can easily cause a fracture of proximal tibial tuberosity. Activities such as running, jumping, pivoting or cutting in sports like football, basketball, soccer etc. can cause such a strong and fast contraction of the muscle. Instantly, then, the player will experience sudden pain and discomfort enabling him to bear weight on the lower extremity.
Tender and enlarged tubercule, painful to palpation.
A small fracture at the proximal tibial apophysis
The treatment for Osgood Schlatter disease shoots at reducing pain and swelling of the knee. Nowadays, there is so much pressure on young kids to perform in sport activities that often, you will find them playing on such extremity and minimizing the pain. One side or both may be involved in the process. Typically, the young child will limp and experience pain even at rest then, it becomes necessary to limit the sport activities for a certain period, generally 10 days to two weeks.
It has been suggested that the disease may be more often seen in boys than girls simply because of a higher rate of participation in sport from 3:1 to 7:1. Others have even suggested a higher incidence in children suffering of ADHD because of their increase in stress on tibial tuberosity.
Often, I would encourage a stretching and strengthening program of exercises while they may apply ice over the tubercle. I have seen kids insist on continuing their sport activities and often, we do not have too much control since they may prefer at time, not to report the discomfort to continue playing. Persisting activities on a painful knee may not cause long-term damage but it is necessary to help the family understand that such injury will not cause damage to the knee in a long range.
In 10 days, they should enjoy a return to full activity, but parents and players should have a clear understanding that such pain can be recurrent until the growth plate closes following the growth spurt around the age 14 for the girls and 16 for the boys. Surgery is rarely recommended.
The prominence of the tubercle may increase in size by demonstrating a large bump. Occasionally one will continue to have pain at palpation and percussion of the tubercle despite all conservative treatments, and I have examined patients who requested to have the bump removed, not understanding that the patellar tendon was inserted on this spot.
We discussed stretching exercises above to prevent or relieve the symptoms in working out Quadriceps and Hamstring muscles with the addition of anti-inflammatory medications as well as the application of Ice and Cold packs for a faster return to activities, but more, some have even used a Patellar tendon strap which may unload some tension of the patellar tendon over the tibial tubercle.
A tibial tubercle fracture is occasionally seen in adolescents, near the end of the growth spurt. Such fracture can be confirmed with a plain radiograph, and treatment may be conservative or operative. Such fracture represents less than 1% of all pediatric fractures, more often encountered in boys than girls approaching their maturity between the ages of 12 and 15.
Such fracture is the result of an excentric contraction during jumping or during a forced flexion during an eccentric contraction. Occasionally in 4% of cases, a compartment syndrome can be also diagnosed, or meniscal tears especially may be seen with specially, the avulsion fracture (type III).
One will have to remember that the proximal tibia is formed by two ossification centers : the proximal tibia physis (primary) and a secondary center of ossification (tibial tubercle apophysis) allowing the insertion of the patellar tendon, The proximal tibial physis closes posteriorly first and then anteriorly as well as proximally to distally rendering the secondary center (apophysis) at greater risk of fracture in older children near maturity.
The extensor mechanism exerts greater force at the secondary ossification center while the blood supply is assured by the recurrent anterior tibial and this vessel is responsible for any possible compartment syndrome which may be seen at time. Based on the level of the fractures and their displacement and according to the Ogden classification, tibial tubercle fractures can be seen at the secondary ossification center at the insertion of the patellar tendon (type I), propagating between the ossification centers (Type II), extending posteriorly to the primary center (Type III) or to the entire physis (Type IV) or finally to a sleeve avulsion of the extensor mechanism from the secondary ossification to the primary center.
Ogden Classification of tibial tuberosity fractures
Ogden Type I apophyseal fracture of proximal tibia
Clinically, with a history of long-standing Osgood Schlatter disease and a sudden onset of pain, following jumping or sprinting activities, with an inability to bear weight on the injured extremity, we could observe knee swelling and a large hemarthrosis, especially with type III Ogden injury is appreciated.
Such individuals will experience an inability to do straight leg raise with pain at palpation of the tibial tubercle, bony crepitation and because of bleeding there may be a high risk for an “anterior compartment syndrome” especially if firmness over the anterior soft tissues is appreciated. It will be important to monitor the neurovascular status.
CT scans and perhaps MRI studies may be needed to determine any fracture extension to the knee joint. Ultrasonography has been used in the early stages to detect soft tissue or cartilage swelling.
Any minimally displaced can be treated conservatively in a long leg cast or a brace for 6 weeks but many type II to V fractures with intra-articular involvement will need a CT scan evaluation to decide if a surgical treatment is necessary to restore the joint surface or if soft tissue repair is expected, included meniscus.
Ogden IV displaced fracture through the auricular surface
An open reduction and internal fixation with or without an arthrotomy for a displaced apophysis fracture is performed through a midline incision, allowing an evaluation of the fracture site and the removal of any interposed periosteum or other soft tissue. After the obtention of anatomical reduction, my preference goes generally to 2 cannulated screws (4.0) for a stable fixation but if we are dealing with a very young patient, smaller screws or even K-wires can be used as well.
The menisci should be inspected to rule out any tears and allow proper repairs. I like to encourage the range of motion following a short period of immobilization, but such patients should be in a non-weight bearing brace or in a long leg cast for six weeks. Fractures of the tibial apophysis should heal well and a return to sport activities may be expected in the 3 to 4 months and even earlier after rehabilitation.
Ogden type 3 tibial tubercule fracture
Intra-articular fractures of the apophysis of the proximal tibia may present with long term complications like leg length discrepancy, growth arrest anteriorly or posteriorly leading to a decrease in the tibial slope and imposing a genu recurvatum which can lead to pain, instability and a higher risk of degenerative arthritis. Finally, patellar tendon avulsion has been described as a complication of Osgood Schlatter end should be kept in mind for the one neglecting th symptoms of pain in continuing their competitive efforts.
The most common complication following any surgical repair is certainly stiffness or even bursitis due to the presence of any prominent screws in the subcutaneous tissue. They can be easily resolved with their removal. Finally, there should be a low incidence of leg length discrepancy, depending on the age of the patient. The closer a patient is to maturity, the lesser chances of having a leg length discrepancy.
It is always a challenge to treat such fractures, especially when the displaced one involves the articular surface or is associated to meniscal tears. They do have a high rate of union, and one should be familiar with their complications. I wish this article will provide to our residents and young Attending, a better comprehension to deal with a proximal tibial apophysis fracture especially around the growing age of an adolescent.
Maxime J-M Coles MD
Boca Raton FL
References:
1- Peck, DM (June 1995). “Apophyseal injuries in the young athlete”. American Family Physician. 51 (8): 1891-5, 1897-1898.
2- C Corbi F, Matas S, Alvarez-Herms J, Sitko S, Baiget E, Reverter-Masia J, Lopez-Laval I (2022). “Osgood-Schlatter Disease: Appearance, Diagnosis and Treatment: A Narrative Review”. Healthcare: 10 (6):1011.
3- Bloom J (2004). “What is the best treatment for Osgood Schlatter disease?”. Journal of Family Medicine. 53 (2)L 153-156.
4- Haber, Daniel B., Tepolt, Frances ; Michael P. ; Kalish, Leslie : Kocher, Mininder S. (2018-07-27). « Tibial Tubercle Fracture in Children and Adolescents” . Orthopedic Journal of Sport Medicine. 6.
5- Guler, Ferhat; Kose, Ozkan; Koparan, Cem; Turan, Adil; Arik, Hasan Onur (September 2013). “Is there a relationship between attention deficit/ hyperactivity disorder and Osgood-Schlatter disease?”. Archives of Orthopedic and Trauma Surgery. 133 (9): 1303-1307.
6- Vergara-Amador E, Davalos Herrera D, Moreno LA : Radiographics features of the Development of the Anterior tibial tuberosity. Radiologia 2016:58;294-300.
7- Bowers KD, Jr. Patellar tendon avulsion as a complication of Osgood Schlatter’s disease. Am J Sports Med/ 1981; 9:356-359.
HAITI : PROUESSES INTERNATIONALES, RETOMBÉES NATIONALES DE GRANDE ENVERGURE.
CES JEUNES QUI FONT NOTRE FIERTÉ.
1)Hailey Baptiste à Madrid
2)Gessica Geneus au festival de Cannes avec son film “Marie Madeleine”
3)Milenchy Carthousia Pierre à UQUAM
4)Melchie Dumornay à LYON, France
5)Abigail Alexandre à Paris
6)Ariana Milagros Lafond au TOGO
En ce mois de mai qui consacre l’arrivée des temps chauds de l’été, je voudrais avoir une pensée spéciale pour ces jeunes de mon pays ces beautés d’Haiti, ces femmes aux talents variés qui ont levé bien haut les couleurs nationales partout où elles ont porté leurs pas au cours des six précédents mois. Pour un pays comme le nôtre qui est souvent mal représenté sur la scène internationale et dont on ne parle souvent qu’en termes de misère, de corruption et de famine, il est réconfortant de lire dans les grandes manchettes internationales des propos élogieux à l’égard d’Haïti et de son peuple.
Comment cela a-t-il donc pu être possible.?
Eh bien, c’est à la faveur d’une vague de percées fulgurantes de jeunes talents de chez nous qui, sur la scène internationale, semblent être décidés, à vendre une meilleure image de ce que nous représentons ou de qui nous sommes vraiment.
Loin de sombrer dans le défaitisme et la merde qui semblent être les seuls images ou repas à gaver à tout bout de champs, ces jeunes se démarquent des schémas traditionnels et sont en train de nous tracer une autre voie.
Tout a commencé avec la sélection de football haïtienne qui obtint sa qualification au mondial le 18 novembre dernier, jour mémorable de la bataille de Vertieres. Pour une équipe qui n’a pu jouer aucun de ses matchs à domicile depuis de nombreuses années, et qui a bravé toutes les adversités qu’une telle situation a dû entraîner, il faut reconnaître que seule la fierté d’être Haïtiens, des sentiments patriotiques à toutes épreuves et le désir de servir leur pays auraient pu porter l’équipe à atteindre un tel sommet sur le plan international.
Vint ensuite l’exploit de Ariana Milagros Lafond qui secoua le pays, et nous mit tous au pas lorsqu’elle remporta le prix de meilleure tiktokeuse de l’année au Togo, “house of challenge“
Pays situé en Afrique de l‘Ouest, entre le Benin et le Ghana, vers la fin du mois de Mars de cette année.
Ce qu’il fallait voir dans son parcours, c’est bien moins son badge de Tiktokeuse ou d’influenceuse, que la façon dont elle a pu galvaniser des fans de partout, nationaux et étrangers, derrière une cause par laquelle elle paraissait elle- même toute dépassée. On sentait dans sa voix cette fierté de porter les couleurs nationales, alors que ses épaules transpiraient de frustration, semblaient s’écrouler sous le poids immense des échecs et péripéties qui sont au quotidien le sort de tout un peuple, et ne finissent guère de nous accabler et de nous terrasser.
Suite au succès d’Ariana, arriva la performance hors pair d’Abigail Alexandre devenue la détentrice du prix “Eloquencia” de grande oratrice et de débatteuse organisé à Paris chaque année . Elle a suivi à la lettre les concepts fondamentaux du ternaire : Logos-Ethos -Pathos et a su prouver qu’il suffisait de montrer la voie à n’importe quel Haïtien ou Haïtienne pour qu’il s’y engage résolument et finisse par dépasser son mentor. D’ailleurs, c’était en trainant les batteries et les canons de leurs maîtres blancs que nos héros avaient pu s’initier au maniement des armes, apprendre l’art de la guerre avant de finir par chasser leurs bourreaux de la terre Saint-Dominguoise pour en devenir les vrais maîtres.
Au Canada c’était pareil, c’est une jeune Haitienne du nom de Milenchy Carthousia Pierre qui vient tout juste de remporter le premier prix de “ l’écriture et de la meilleure thèse “ à l’université de Montréal (UQUAM)pour l’année 2026.
Elle n’a que 21 ans et elle est étudiante en sociologie.
Le thème était “Mon pays”. Et là, elle avait pu placer Haiti sur un piédestal jamais connu au paravant.
Laissant l’Afrique et l’Amérique et retournant une fois de plus en Europe, il y a eu trois évènements majeurs au cours desquels Haïti était encore à l’honneur. D’abord c’est la jeune Hailey Baptiste, d’origine Haïtienne, qui a détrôné Aryna Sabalenka, la meilleure joueuse de tennis mondial, en quart de finale, par 2-1 sets à Madrid, en Espagne.
Ses parents qui auraient sacrifié, dit-on , toutes leurs épargnes pour la propulser au-devant de la scène, sont originaires d’Haiti et habitent dans le Maryland. Sa vie privée n’est pas très connue du public.
Vint aussitôt et presqu’au même moment la prouesse de Gessica Généus dans la présentation de son film “Marie Madeleine “ au festival de Cannes considéré comme le plus prestigieux festival de film au monde. Dans ce film, elle présente Haïti et les Haïtiens sous leurs vrais visages, dans toute leur authenticité : dans leur laideur et leur beauté tout aussi bien dans leur tendresse et leur radicalité…
On sait que les œuvres cinématographiques sont choisies selon des critères stricts de qualité artistique, de date de production récente , et d’avant- première mondiale exigée.
Les comités de présélection, composés de professionnels du cinéma (critiques littéraires, journalistes et autres ) visionnent des milliers de courts et longs métrages et font une recommandation au délégué général qui prend la décision finale. Le choix est collégial et souverain.
Gessica a expliqué dans une interview qu’elle a toujours cherché à demeurer elle-même. Elle dit aussi chercher à s’approprier qui elle est vraiment, au lieu de se laisser définir par autrui. (Voir son Interview sur YouTube ….
(Google information sur le festival de cinéma de Cannes)
Que dire enfin de notre superbe et talentueuse Melchie Dumornay qui postule désormais le ballon d’or européen, catégorie féminine, après avoir reçu le trophée de meilleure joueuse de France, elle qui joue à Olympique Lyonnais en France , et qui nous représente avec brio?
Elle était magnanime, humble et modeste en décrochant ce prix qu’elle a d’ailleurs dédié à ses coéquipières, à ses fans et à Haiti son pays.
Félicitations Melchie
Pendant trop longtemps, nous avons aidé les autres à chanter nos malheurs, à nous présenter sous des jours sombres. Nous semblions vouloir exporter notre misère aux autres pour nous attirer une quelconque sympathie de leur part, une assistance externe qui n‘a servi qu’à enrichir un petit groupe de nationaux et de donateurs étrangers. Ces derniers, les donateurs, ont toujours pu rentrer chez eux avec la grosse part de l’assistance qu’ils fournissent, au point de dire de cette aide que c’était presque et toujours une forme d’assistance déguisée aux assistants eux-mêmes.
Alors il était grand temps de changer le narratif et de projeter une autre vision de nous-mêmes.
Haïti a désormais le vent en poupe.
A travers leurs exploits, c’est l’histoire de tout un peuple que ces jeunes talents sont en train de réécrire. En même temps que nous les applaudissons, nous ne devrions pas oublier que réussir n’est jamais un hasard ; c’est un construit et un défi. C’est toujours le résultat d’un effort, d’une discipline appliquée à un travail de longue haleine.
Tandis qu’ils sont en train de faire honneur à la nation, ils nous rappellent que c’est la somme des efforts individuels , la cohésion qui s’en dégage, à partir d’une politique savamment mise en place qui seuls, peuvent transformer ces élans patriotiques de courte durée en gains pérennes et solides.
Ces jeunes, ce sont les héros de notre temps Ils sont donc des modèles à émuler par tous et par chacun d’entre nous.
Nous en prenons donc l’occasion pour souhaiter un parcours exceptionnel à l’équipe nationale qui va nous représenter sous peu aux joutes “footballistiques “de l’été 2026.
Grace à eux nous sommes de retour sur la scène internationale après une éclipse de plus de cinquante années.
Rony Jean-Mary, M.D
Coral Springs, Florida
Le 18 Mai 2026
THE SCANDAL
Valentine’s Day, 1989. A thud heard ’round the world jolted the quiet bedroom community of Wyandanch in Long Island, NY. The reason? A bounced check for the Ebenezer Baptist Church's electric bill was returned in the mail. Sister Karen’s jaw slackened when she opened the envelope. This was unheard of. As head of the church's finance committee, she ensured all bills were paid on time. Support for this place of worship was a given in this tight-knit group of parishioners; weekly tithings were robust and had not budged.
Six months into the tenure of a new pastor, a nifty but annoying buffeting of the ho-hum of this institution was in full display. The newcomer—young and single—came across as ambitious and quickly moved into new territory, talking about making some surgical changes. In a culture that prized tradition, this was tantamount to bruising some feelings. He wanted to move too fast—mess with tried-and-true methods that had served the institution well—and apply new ways, all in the name of grooming a new generation for the passing of the baton. Good idea, but a gauche delivery yielding smoldering unease.
The concept of tradition was steep. Ebenezer was an enclave where the faithful came to fulfill a spiritual need through worship and to satisfy a social appetite through fellowship. A strict classification of roles gave adherents a sense of belonging and the ego-buffing shine of appreciation, no small matter for blue-collar workers who may not have that satisfaction elsewhere. Some of the elders were grumbling about his stewardship style. He didn’t seem to care for the opinions of the old but reliable foot soldiers. He was sowing dissension among natural allies and fostering the kind of self-inflicted wounds that fester and boomerang to haunt sooner or later. His credentials were stellar. He had gone to great schools, was eloquent, and could keep the flock spellbound from the bully pulpit. But his hubris seemed to get the better of his judgment at times, and his cockiness bordered on arrogance.
He shocked many parishioners when he commented on the menu served during fellowship sessions. That tradition of feasting—so dear to folks who considered that community like their home—was not his to tinker with. His off-handed remark of “fattening farm” didn’t sit well, especially since he was trying to convince the flock of the benefits of cutting back on calories. Collard greens with ham hock, macaroni and cheese, trotters, biscuit, corn muffin, fried fish and chicken, oxtail—the works—followed by sweet potato pie or hot peach cobbler with ice cream, not to mention different varieties of cakes, were the norm. Yet there had never been a plate filled with food that he hadn’t liked; his tone, far more than his choice of words or intent, rubbed the wrong way.
These were not fatal flaws and could be forgiven—or forgotten—with deft apologies and stroking of egos. What was not so easy to accept was his frolicking with the young set and playing favoritism. Worse, he let them get involved in the church's financial affairs, bypassing the hierarchy. That was how Albertine, a striking young single woman, came to hold access to the reverend’s emergency credit card. Obviously, some type of hanky-panky was going on. Sister Karen had always held the opinion that among consenting adults, what happens in their privacy is no one else’s business. The red line was mixing business with pleasure—mixing the church’s tithings with personal pleasure. Her uncle had helped start the church and had instilled in her a love and devotion to it; such a connection was too strong to let a Johnny-come-lately mess it up. Back on Valentine’s Day, the reverend was AWOL for hours on end. Sister Karen sent multiple emergency pages without any response. By her reckoning, the balance in the checking account should always be well padded with an excess of 5G to avoid such a mishap—and she didn’t care for the smell of this rat.
Sounded like Reverend Isaiah Albertson, Jr.—who always liked to preach against sinning—was in the middle of sinning himself. To avoid any interruption of service, Sister Karen went to the bank and paid the bill from her checking account, planning to be reimbursed later. She was hoping the reverend’s reputation wouldn’t be ruined, that morale wouldn’t be affected, and— worse yet—that trust would not erode. Where was he? What was he doing? He couldn’t respond to any message sent to him—he was in the middle of his own closet full of skeletons. A teetotaler, he became inebriated soon after a couple of glasses of whiskey. Albertine had convinced him to leave his religious frocks behind and spend a night of romping by taking her to a casino in Atlantic City. Of course, breaking one rule opened the door to other infractions. She discovered a man unable to hold his liquor, but she was determined to have fun no matter what. She helped him to bed, took money and credit cards from his wallet, and went on a gambling spree—soon hooked on the adrenaline, with inhibition washing away. Exuberance led to depletion of the limits on the cards.
Hours later, he was dealing with a hangover of the worst kind: vomiting, dueling with a searing headache. Albertine first noticed the messages from Sister Karen and dutifully ignored them. When he finally saw them and panicked, she sneered, “Are you the captain of the ship or a tamed sheep?” While he gave the impression from the pulpit of being the top dog, in private with this young belle, the tail was wagging the dog. Reverend Albertson was wallowing in mud. Albertine kept the party going—ordering room service and picking the priciest items. He wasn’t feeling well, and he had to listen to her tart tongue. His wallet was empty, and he couldn’t cover the hotel bill after her spree. Instead of a good time, he was fiddling with the misery of a perfect storm. Far from home, far from his norm, far from his bank account. Instead of solace to help him lick his wounds, he was receiving flagellation. “What kind of man are you without money? You ain’t got no money, you just ain’t no good!” This volley from a pouting Albertine drove him to the edge, the edge of his sanity, of despair, and of his existence. What happened next was never fully explained. By morning, the reverend and Albertine were found in a wrecked vehicle that had struck a pillar—an abrupt, violent end to a night that had already spiraled beyond control.
****
What happened was a cautionary tale against rushing into a close relationship without knowing a person well enough. The violent end of the night, unfortunately, was not the end of Reverend Albertson’s life’s indignities. Sister Karen, on whose shoulders everything financial falls, had to call an emergency meeting with available senior members of the Board. She laid out the known facts: the disappearing funds, the pastor's prolonged absence, and the grim news about his car accident. “A couple of us need to go down and find out the truth.” In addition to the funds not being available, she needed to worry about the liability for the health care costs. Since it was a car accident, the car insurance ought to cover the expenses. She wasn’t sure if his health insurance was still active because the due date is close to that of the electricity bill.
The optic of the reverend frolicking with a young member of the congregation was not in keeping with the Christian tenets that he had taken an oath to follow and to preach to the flock. Last was his health condition. Was he going to make it and leave a normal life? What about the young companion? The same pedestrian concerns about the pastor also pertained to her. Her parents attended the church occasionally and were the fickle among the fervent. Word had it they were more of a nondenominational bent. For this tragedy, that mattered not. A young life was on the line. Sister Karen headed for the hospital.
The scene in the ICU was gross. The reverend had a tube in the head. He also had one in the mouth and was attached to a breathing machine, and another one on the right chest. He was half-conscious but alert enough to recognize her and shed some tears. His companion was in better physical shape but not in the mood to talk to senior members of the church. She was alert all right, but when they came, she kept her eyes closed and feigned sleep. She wanted to avoid a scene because she would have given them some choice words, like “Mind your own business and leave me the f…alone.” Since the distance from Wyandanch to Atlantic City was well over 100 miles, the visiting delegation decided to stay for a couple of days in hopes of gathering some solid facts.
Being a young person, the reverend recovered quickly. Within days, he had only a chest tube. He was more than willing to remove the load he had on his chest and gave the following confession: I have sinned, and I am now paying the price for it. Forgive my transgression. I will pay back every dime that I owe the church. Pray for my soul.
Admission of sin and request for forgiveness go to the core of the faith and a long way in the hearts of the visitors. Yet each one needed to ask, how did a well-seasoned man fall for a trap so easily? Well-seasoned is an assumption to begin with. The fact of the matter was that he was new to matters of male-female relationships. At the same time, Albertine was a femme fatale. Such a character is well portrayed in Oscar Brown Jr’s song, Hazel’s Hips. She knew she had the looks; she flaunted them so she can hook an inexperienced prey or a fella that dropped his guards. Her parents had sent her to school at Spellman where she learned the art. Quite a few of her classmates there used the technique to sway the men from close by Atlantic University and Morehouse College. It was a game she enjoyed. Finding a sugar daddy was a pastime. The pastor was a young inexperienced male, a book rat, who had had few female relationships and had difficulty distinguishing vested flattery from genuine interest. Albertine gilded the lily and then dropped him like a rag doll. When the rubber met the road, his cockiness melted under the pavement’s heat.
Sure enough, when Albertine recovered, thank goodness she didn’t have serious injuries, she sued the reverend for reckless driving, endangering her life, and inducement. She forgot that when she upbraided him about his lack of funds on his credit card, she did so in public, and it was well documented that she was a player at the casino who used his credit card. After his insurance company settled for health care costs and some additional payment, she said with a straight face, “A girl has to do what she has got to do to make some money.” Say anything, sign any document, make up any scenario, all in the spirit of cupidity. The reverend’s fate was still being debated at the church.
His full confession to the Board members went thusly: “I dropped my guard, and for a moment, I forgot that my role as a shepherd was to protect and lead the flock. I allowed myself to be manipulated by an attractive member of the congregation, and I transgressed. She was clever and offered carnal pleasure, and I fell for it. Whenever she would complain about not having enough money and being stressed, I allowed her to use the church-issued credit card. My worst sin was to let her convince me to take her to Atlantic City to have fun at the casinos. I did it, but I should have known better. No excuse on my part. I had to rely on my brother to pay my hotel bill when I had no funds left. She cursed me about being an invalid without money, and that curve ball was so lethal that I tried to end it all. These are the unadulterated facts. I officially apologize. I repent for my sin. This is a big lesson in humility that I am learning. I will abide by any decision that you reach.”
It was a raucous debate. The fact that he spoke the truth did count but his prior statements and behavior that had rubbed folks the wrong way came back to the surface. It became a political matter: who would have the final say? A young pastor that comes in and wants to make wholesale changes and got burned by playing with fire wasn’t exactly what the members wanted. The final decision was a parting of ways with a face-saving solution: He would relocate to be closer to his family and continue his recovery from a terrible accident. He also received a three-month severance pay. Albertine was never to be seen and heard from again.
Reynald Altéma, MD
Palm City FL
Dear Joseph Leon Paul MD,
Losing such a friend brings a deeply unique sorrow, when mourning a healer who has spent his life, caring for others in a quiet grace, has also chosen to move back in his quiet Jacmel, Haiti, with the souvenirs of a physician who cared for each of his patients.
Your mission on earth is over, Joseph Leon Paul and through my voice, the AMHE would like to express its sincere condolences to your wife and children, to the families and friends affected by your depart.
Que la terre te soit legere, mon cher ami et Bon Voyage.
Maxime J-M Coles MD., FICS, FRCS, FAANOS-C.
AMHE Newsletter
We recommend to your prayers the soul of Emile Solages, who passed away on April 9, 2026, in Port-au-Prince, Haiti. For 60 years, he was the devoted companion of his wife, Bernadette, until her passing. He was a father not only to his four children but also to his three brothers, countless nephews and nieces, and extended family members whom he helped raise. His life exemplified the joy of sharing and the humility of service.
The Funeral Mass occurred on Saturday, May 2, at 10:00 a.m. at Saint Marc Catholic Church on South Flamingo Road in Southwest Ranches, FloridaThe family thanks you for your prayers, love and support during this time...
Dear Anthony,
I was fortunate enough to have a dad in my life. I wouldn’t trade him nor I would erase the moments we shared together in this world. As I witness today, the mission of Emile Solages, on earth, is over and you will have to transmit to the new generations the lessons learned from his wisdom.
He will always be on your side at any moment. Often, you may hear his voice or see him smile or chat with you, but while looking at the empty chair where he used sit and lecture you, I can guaranty that the souvenirs of lessons taught, will remain indelible. Dad is not gone, Tony, he will be always with you.
I wish to express my sincerest condolences to you, Florence and the children, to the Solages Family and close friends, personally and in the name of the entire AMHE Family.
May Your Dad Emile Solages have a safe voyage to his eternal residence and may he rest in peace.
Maxime J-M Coles MD., FICS, FRCS, FAANOS-C.
AMHE Newsletter
La AMHE rejoint la communaute medicale en Haiti et la AMH pour deplorer la perte brutale de notre confrere Dr Roger Germain. Nos condoleances les plus emues vont a sa famille et a ses amis proches. Puisse son ame se reposer en paix alors qu'il fait ce long voyage vers sa demeure eternelle.
Maxime J-M Coles MD
AMHE
Dear Laro,
Perdre un fils, le jour de sa graduation, est toute une epreuve pour laquelle il ne sera pas facile de trouver assez de mots de recomfort pour apaiser la peine d'un pere ou d'une mere et de toute une famille. Sa mission sur terre est terminee et son Createur l'a appelle a ses cotes.
Recois les condoleances emues tant au nom de la AMHE, qu'en mon nom personnel et partage les avec ta femme et ta petite famille de meme qu'avec les parents et amis affliges par son depart.
Que la terre lui soit legere et Bon voyage, Christian Fresnel, vers ta demeure eternelle.
Maxime J-M Coles MD
AMHE Newsletter Editor-in-Chief
Congratulations to William "Bill" Pape MD, for this lifetime achievement Award, honoring his leadership in the world of Medicine and his dedication to patient care. We are certainly, at the AMHE, thrilled to hear about such recognition, as the IAS President's Award.
It is a testament also to his unwavering commitment to medical research. William Pape MD continues to inspire all of us in the community and in the country of Haiti. Congratulations Bill and long life to GHESKIO.
Maxime COLES MD, FICS, FRCS, FAANOS-C.
Past AMHE President, AMHE Board Member
AMHE Newsletter Editor-in-Chief
A Thank You Note from The Chairman of The AMHE Foundation
Last Memorial Day weekend, the AMHE Foundation had a weekend of celebration dubbed the 50 th Anniversary Gala to celebrate the 50th anniversary of the Foundation at the Grand Hyatt Hotel in Washington, DC.
The weekend started with cocktail hour on Friday night, followed by several scientific lectures divided into CME granting activities and non-CME activities during Saturday day, followed by the formal black-tie gala at night.
On Sunday there was the closing brunch with more lectures on the lighter side. The affair was well received by everybody who attended. It was challenging work for the whole executive committee of the Foundation to put it together, but we were happy that everybody in attendance was satisfied.
The physicians who attended the CME granting scientific lectures, or their invitees and guests who attended the non-CME lectures had a treat. Everybody was in harmony to say that it was one of the best weekends that they had in their lives.
As Chairman of the Board of the Foundation, I want to thank everybody who had worked hard to make this weekend the success that it had been. I will thank first all the members of the executive committee starting by Doctor Yves Manigat the President, Doctor Louis Joseph Auguste, the Vice President, the secretaries Dr. Serge Bontemps and Dr Rita Bellevue, the treasurer Doctor Daniel Faustin, the members at large Doctor Ernst Garcon and Dr Rodrigue Charles. Special thank you note is to go also to Doctor Eric Jerome who put together the whole CME-granting scientific activities that apparently every attendant had loved and enjoyed.
Of course we should not forget Doctor Michael Bruno, the Executive Director of AMHE and of the AMHE Foundation who was the glue, keeping all the activities together.
We also should not forget to give our special thanks to Doctor Henry Ford, Dean of the University of Miami Miller school of Medicine, who delivered a magistral lecture to open the lecture series on Saturday Morning, the ambassador of Haiti in Washington DC, Mr. Lionel Delatour, who spent a brief time with us at the gala before being called to duty by his superiors in Port-au-Prince. A special thank you note is to go to Mr. Kwame Raoul, Attorney General of the State of Illinois, who delivered a vibrant keynote speech recalling his own father, the late Dr Janin Raoul who literally incorporated the Foundation 50 years ago and was the initial Chairman of the Board.
Finally, we want to thank all of those who came and participated in the activities, the AMHE
members and their guests, who were lecturers and attendees at the scientific meetings. Every attendant seems to be satisfied.
To terminate, I had asked Dr Martine Accilien, a physician from Illinois who attended the 50th Anniversary Fundraiser Gala, the permission to share with everybody her opinion as a sample of the kind of feedback we received from the attendees.
Emmanuel Francois MD
Chair AMHE Foundation
PS: The following is Dr Accilien’s writing...
“ Being present in rooms filled with living legends and learning from them was not only
a “once-in-a-lifetime” opportunity, but also an absolute honor and privilege. This past weekend in Washington, DC , the ground “shook” with medical giants, and our neurons “shook” with clinical pearls, all while we celebrated the selfless efforts of the Association of Haitian Physicians Abroad, translated in French as Association des Médecins Haïtiens Vivant à l’Etranger (AMHE), in support of healthcare in our motherland, Haiti .
After lectures led by many talented presenters, especially Dr. Henri Ford, who separated conjoined twins in Haiti, and Dr. Biassou, who shared her research on detecting illnesses simply through our voices using AI, to name a few—a dancing gala followed, where the famous band “Strings” performed some of their most popular songs . We were also honored by the presence of Illinois Attorney General Mr. Kwame Raoul and his wife, Dr. Lisa Moore!
To top it all off, experiencing Memorial Day weekend in Washington, DC was truly a treat .
Thank you, God, for the opportunity to travel , to learn , to dance, to make new friends, and to seize the day every day despite it all! A special
Thank you to GOAT Dr. Emmanuel Francois and his team for putting together such a special event!
Carpe Diem “
Martine Accilien Schultheis MD, AAFP
Family Physician, OSF Healthcare
Heritage d’un pays sans gouvernance
Adossé à sa moto, un jeune homme de chez nous, au visage grincheux, fait la garde. La cendre au bout de sa cigarette semble trembler alors qu’il veille d’un clin d’œil sur un perimetre, a la croisée des chemins. Il se tient à son poste d’observation, en maitre incontesté. C’est une sentinelle qui ne fait pas de quartiers. Il contrôler les allentours, d’un regard inquisiteur et combien infaillible.
La chaussée de béton est fracassée tout au long de la rue principale. C'est une voie à peine passante, qui lui permet d’aborder à l’improviste, toute prochaine victime et de s’imposer pour mieux collecter ses devises. Le pays que nous a légué nos ancêtres est devenu méconnaissable. Des quartiers, si achalandés il y a quelques mois de cela, maintenant, complètement désertés alors que des animaux du pâturage trouvent encore la joie à se balader et à patauger dans la boue.
Au loin, la fumée s’élève d’un immense tas de gravats, à l’emplacement même d’une Ecole primaire qui faisait la fierté du petit village. Beaucoup ont fui les lieux pour aller résider ailleurs, alors que d’autres n’ont trouvé nulle part où se réfugier. Tout le monde subit le courroux de ces jeunes déchainés accusant une société de les avoir négligés ou délaissés depuis si longtemps. Ils refusent de s’enrôler dans nos écoles et préfèrent prendre la clef des champs. C’est une nouvelle "révolution" que de tout détruire pour ramener notre pays à l’état d’une jungle ?. C’est le libertinage moderne.
Un professeur s’étonne d’être encore vivante après tous les abus dont elle a été l’Object. Elle a quand même, survécu aux viols répétés et aux bastonnades d’un groupe de voyous qui a su la faire taire en l’empêchant de se défendre. Maintenant, elle contemple la désolation complète de ce petit coin de terre ou elle avait dedié tant d’amour. Comme professeur de sciences, elle a vu les rêves de toute une vie, s’envoler pour toujours, sans aucun espoir de les faire revivre.
Un jeune adolescent assis sur les rebords d’un puits, attend avec impatience une occasion pour se mettre une miette sous les dents et de se procurer de quoi faire survivre sa petite famille. Plus loin, un long tunnel près du lycée, mène à un labyrinthe qui débouche sur une petite rivière. Tant d’immondices s’y sont accumules… et, pourtant les plus jeunes s’y sentent en sécurité et en profitent pour jouer au football ou au basketball ou à la marelle. Plus personne ne regarde le ciel constelle, à la recherche d’une étoile filante, en signe de bon augure car la mort les tiraille de partout. Personne ne s’aventure au dehors, après le coucher du soleil puisque c’est la mort qui les guette. Notre pays est devenu un enfer sur terre.
Dans le village avoisinant, beaucoup ont été abattu en pleine rue et récemment, une mère allaitant son bebe en bas âge, s’est vu agressée alors qu’un de ces voyous lui rappait des mains, son nourrisson. Comment peut on imaginer qu’un individu, en toute conscience aurait pu montrer un tel manque de respect a la vie humaine, en s’accaparant du bebe de quelques mois dans les bras d’une propre mère, pour doucement le déposer sur un feu ardent. Quel carnage ! C’est du pur sadisme… un acte de barbarie extrême que nous avons revu assez souvent dans l’histoire partisane de notre pays.
Peut-on vraiment analyser l’état mental d’un tel individu ? … Ce n’est certainement pas une "révolution". Nos psychiatres devront trouver un propre nom pour celui qui commet un acte aussi odieux. L’histoire se doit de les juger sévèrement car ce sont des criminels et des apatrides. Nul ne peut faire exception.
Les hôpitaux ont été pillés et dilapides par ces gangs assoiffes, les appareils à diagnostiquer, démolis en pièces et avec raison, aucun médecin qui se respecte, ne s’aventure à se porter volontaire pour prodiguer des soins même bénévoles aux blesses qui souffrent énormément. Des plaies par balles fraiches ou infectées, des plaies pénétrantes et des patients a la dérive. Les hôpitaux et les centres de Sante ferment aussi leurs portes, incapable de prodiguer des soins a une population harassée et abusée. Le personnage hospitalier peut du jour au lendemain, devenir de prochaines victimes alors que les patients souffrent énormément de cette situation. Combien de personnages hospitaliers ont perdu la vie alors qu’ils travaillaient comme de bons samaritains ?
La liste peut est longue car nul n’est épargné : enfants ou vieillards, handicapés… Ce n’est pas une guerre ou plutôt, c'est un champ de bataille ou la vie perd toute valeur humaine. Un médecin obstétricien est arrache à ses bureaux et séquestre pendant des semaines avec une demande de rançons. Un chirurgien Orthopédiste est capture au volant de sa voiture alors qu’il s’apprêtait à se rendre à l’hôpital pour délivrer des soins a un traumatisé.
Une jeune pédiatre est séquestrée alors que son mari la conduisait à l’hôpital. Elle est violentée sans respect des valeurs humaines. Un autre médecin généraliste est enlevé en ses bureaux, abusée et violée et son corps nu est délaissé aux rebords d’une route isolée, sans vie, une ou deux semaines plus tard. Il est temps peut être de se ressaisir et de crier justice pour tous ceux qui ont peri ou continue à souffrir dans ce pays qui nous a vu naitre. C’est un carnage dans une absence de respect pour la vie humaine.
Une police incapable d’assumer la protection de ses citoyens et surtout des policiers travaillant tantôt dans la peur de ne pas y laisser leur propre vie, au point de changer de camp pour bénéficier de meilleures conditions. Une armée a peine reconstituée ou même réformée après de longues années sabbatiques, n’est que le reflet de cette force militaire qui nous a vu grandir. Des soldats mal equipes dont les armes n’arrivent pas à rivaliser avec la sophistication du matériel utilise par ces groupes armes.
Il n’y a que la pagaille partout ou l’on essaie de se frayer un chemin à travers la capitale de Port au Prince ou dans la plupart des villes de nos provinces. Des postes d’observation sous le contrôle de bandits, orchestrant le va-et-vient des passants affames et alarmes. Hélas ! Ils en profitent pour les dépouiller du peu qui leur reste à survivre. Notre pays n’est que le reflet de ces belles années qui nous ont permis de bénéficier d’une instruction et d’un savoir vivre.
L’international nous impose des solutions qui n’aboutissent à rien, une force militaire formée de soldats étrangers Kenyans qui ne connait pas le terrain et qui n’a pas su se montrer à la hauteur de ces bandits qui terrorisent la population. D’ailleurs, ils craignent même pour leur propre vie et essayent d’éviter toute action ou confrontation. Ils sont bien cases a l'emplacement de notre aéroport international, l’utilisant comme un "bunker" et recevant toutes les attentions de l’extérieur..., mais il semble que même leur bagage militaire pourrait être inferieur a la force de frappe de nos bandits.
Notre pays ne produit pas d’armes et l’on devra se demander leur provenance. Les gouvernements se succèdent et n’arrivent pas à trouver une solution qui nous rendrait tous, fiers d’être ce que nos aïeux, jadis avait rêvé pour nous: "Un peuple a substance, digne d’avoir osé en premier, briser les chaines de l’esclavage". De nouvelles équipes se succèdent à la direction du pays. Puisse ce Dieu de Misericorde leur donner la vision pour clarifier notre horizon obscur.
Le potentiel est présent parmi nous car comme Haitiens, nous avons brillé à travers le monde sans pour autant respecter les lois dans notre propre pays, une fois que nous refoulions le sol. Combien de nous avons excelle en littérature, en science ou au sport, a l'etranger ? Certes, nous avons été façonnes d’une terre argileuse spéciale par ces dieux, qu’ils proviennent des Arawak, ou du Dahomey, du Congo ou de la Méditerranée, de l’Europe ou de partout. Ceci nous a permis de surmonter les abus commis contre nous depuis des siècles, de par notre résilience, en nous permettant d’affronter toutes discriminations à chaque fois qu’elles se présentaient.
Haiti renaitra de ses cendres...
Maxime J-M Coles MD
Boca Ration FL
CES PATHOLOGIES QUI SONT DU DOMAINE DE LA PSYCHIATRIE ET DE LA MÉDECINE GÉNÉRALE,
Dans un récent article du Newsletter, nous avions fait mention de nombreux symptômes à connotation psychiatrique, et qui avaient pourtant beaucoup à voir ou à faire avec la médecine générale. Nous avions aussi expliqué qu’il fallait rechercher les causes organiques qui pouvaient être responsables de ces comportements anormaux apparaissant de manière soudaine, intempestive chez un sujet quelconque. Nous avions cité la confusion, l’hallucination, l’agitation, l’euphorie, la dépression, les troubles de mémoire, l’insomnie entre autres symptômes qui peuvent être d’origine médicale. Ce qui est important à présent, c’est de comprendre que même après qu’un diagnostic médical a été établi de manière certaine, il fallait avoir les yeux rivés sur des symptômes psychiatriques qui peuvent se manifester à tout moment.
Au nombre des pathologies à facettes médico-psychiatriques, nous relèverons les suivantes qui bénéficieront d'une attention toute particulière dans la suite de notre exposé.:
1) LA PORPHYRIE INTERMITTENTE AIGUË.C’est une maladie génétique due à une absence de l’enzyme porphobilinogène désaminase dans La chaine de production de l'hème, substance très importante dans le maintien de l’énergie corporelle. Elle est caractérisée par des douleurs abdominales aiguës et des symptômes psychiatriques tels la dépression, l’anxiété, la confusion, des vomissements, de la paralysie, ct. L’absence de cet enzyme empêche la conversion de porphobilinogène en hème avec comme conséquence une accumulation des précurseurs tels que le porphobilinogène et la porphyrine. C’est l’accumulation de ces précurseurs qui serait responsable de l’attaque abdominale aiguë.
Certaines conditions peuvent exiger un surplus de production d'hème dans le corps. C’est le cas où l’individu est en proie à des situations stressantes et où il cherche à compenser le manque d’énergie dont il a besoin. Dans les cas de porphyrie intermittente aigue, la conduite à tenir est la suivante:
a) évitez les benzodiazépines tels le clonazépam et le chlordiazépoxide. b)évitez les antiépileptiques tels le topamax et la carbamazépine
c) évitez les anti-depressants comme la phénelzine (M.A.O.I) et la venlafaxine.
d) évitez les somnifères tels le trazodone et le ramelteon
e) évitez les antipsychotiques tels le Geodon et le seroquel.
f ) considérez également dans cette liste les médicaments qui sont des inducteurs du Cytochrome P450 et qui peuvent réduire le taux de l'enzyme porphobilinogène ddésaminase.
Ce sont: les barbituriques, les antiépileptiques, le stress, les changements hormonaux dûs au cycle menstruel, la cigarette et les diètes pauvres en calories.À noter que les meilleurs médicaments à utiliser sont l’amitriptyline, l'halopéridol, le prolixin, le lithium, le Prozac , le Gabapentine, le lorazépam ect pour les symptômes psychiatriques.
TRAITEMENT:
Le traitement consiste à réduire l’accumulation de porphyrine et de porphobilinogène de la manière suivante:a).-Administrer de l'hème , et réduire par ainsi (via negative feedback) l’accumulation des précurseurs de l'hème. b).-Infusion de solutés à base de glucose 5-10% pour apporter de l’énergie au corps c).-Fournir une diète riche en carbohydrate à l'individu.À noter que les symptômes psychiatriques peuvent persister longtemps après que les troubles médicaux ont cessé.Et le diagnostic se fera en mesurant le taux de porphobilinogène dans l’urine. Toute valeur supérieure à 6 mg/L dans l’urine est considérée positive.
2) La deuxième pathologie à considérer est le LUPUS ÉRYTHÉMATEUX.C’est une maladie inflammatoire auto-immune affectant plusieurs organes du corps en même temps. Caractérisé par une alternance de périodes d’exacerbation et de rémission , il est souvent rencontré chez les femmes en âge de reproduction et atteint jusqu’à 1.5 million de personnes aux EUA. Il se manifeste par des plaques érythémateuses au niveau de la peau, particulièrement de la face, du crâne et des oreilles , et s’accompagne de fièvre, de fatigue, d’inflammation musculaire et de douleurs articulaires. Les lésions au niveau de la face ont un aspect particulier en 'ailes de papillon" avec la base des lésions pointée vers l’extérieur et le sommet dirigé vers la racine du nez des deux côtés. Le lupus s’accompagne de troubles de l’humeur ou troubles affectifs, de délire, de confusion, d’hallucinations.
Le diagnostic se fait par la détection d’un niveau d’anticorps anti-nucléaire d’au moins 1:80. Mais le test tout à fait spécifique au diagnostic de lupus est la présence d’anticorps anti ADN à double brin (double Strand ADN) qui traduit la présence de la pathologie dans le noyau de la cellule. Le traitement consiste en l’utilisation de fortes doses de glucocorticoïdes et de cyclophosphamide. Dans les cas où la condition s’avère réfractaire au traitement , on a recours à de la plasmaphérèse. On peut utiliser des antidépresseurs des antipsychotiques et des stabilisateurs de l’humeur pour le traitement des symptômes psychiatriques qui généralement disparaissent au bout de huit semaines mais qui peuvent aller jusqu’à 24 mois.
3) LA MALADIE DE LYME OU LYME BORRÉLIOSE. C'est une pathologie transmise par la piqûre d’un tic qui inocule dans le corps une bactérie type spirochète du nom de Borrelia Burgdorferi. On en recense près de 30. 000 nouveaux cas de Lyme borréliose dans les régions Nord-est et mid-Atlantic, depuis la Virginia jusqu’à Maine et au-delà. Elle est endémique, également dans la région Nord-centre du Wisconsin et du Minnesota, ainsi qu’au Nord de la Californie. Le tic est fréquent dans les arbustes et les endroits truffés d’herbe, et la maladie est fréquente chez les gens vivant en plein air. Une paralysie faciale est aussi observée deux à trois semaines après s'être fait piquer par le tic. La pathologie à ses débuts est caractérisée par une lésion cutanée qui s'étend tout autour de la piqûre créant un aspect en "œil de boeuf "(bulls eye), et peut s'accompagner de paralysie faciale ou (Bell's Palsy) apparaissant deux à trois semaines après l'infection. Il se dénote également de la confusion, un manque d’appétit et de la fatigue qui peuvent faire penser à des symptômes psychiatriques comme la dépression par exemple.À un stade plus avancé de la maladie, ce qu’on observe surtout, ce sont des battements cardiaques irréguliers, des “douleurs neuropathiques ”des épisodes dyspnéiques , des tremblements qui peuvent être assimilés à de l’anxiété .
Le traitement est à base d'antibiotiques tels l'amoxicilline et la Doxycycline par voie orale. Dans les cas réfractaires, on peut utiliser des antibiotiques par voie intraveineuse. considérez à utiliser des anxiolytiques et des antidepressants si les symptômes psychiatriques persistent des mois après le traitement, ce qui arrive dans (10% des cas). Le diagnostic se fait par la détection d'anticorps anti Borrelia Burgdorferi dans le sérum de l'individu suivi d'une confirmation de la présence de protéines type Borrelia burgdorferi par le Western blot test.
4) ENCÉPHALITES DUES AUX ANTICORPS anti-NMDA RÉCEPTEURS. (TÉRATOME OVARIEN)Avant de parler des anticorps anti-NMDA, il apparaît juste de parler des récepteurs NMDA dont le nom scientifique est le (N-methyl-D’aspartate) récepteur. Ce récepteur est particulièrement présent au niveau du système nerveux central où il joue un role crucial dans la neuroplasticité, la formation de la mémoire et l'acquisition de nouvelles informations. Il facilite les échanges à base de calcium et de glutamate ayant lieu dans les neurones.
L'Activation du NMDA récepteur est unique en ce sens qu’elle requiert l’association du glutamate avec un autre aminoacide telle la glycine ou le D- sérine qui sont des co- agonistes pour qu’il soit activé. Cette activation est cependant bloquée par l’ion Magnésium Mg(2+) même après l’accouplement du glutamate aux co-agonistes précitées jusqu’à ce que la dépolarisation soit complète. Lorsque ces deux conditions sont remplies.(accouplement et dépolarisation) , le Channel s’ouvre et le flux de calcium peut alors avoir lieu, enclenchant le processus de mémorisation et d’apprentissage.> En raison de son influence considérable sur le fonctionnement du cerveau, toute irrégularité d ‘hypo ou d'hyper fonctionnement du NMDA récepteur peut conduire à des troubles mentaux de toutes sortes .Tandis que l'hypo fonctionnement conduit À la psychose et à l’hébétude , d'hyperfonctionnement par contre peut engendrer de l'excitotoxicité par trop d’influx de calcium dans la cellule et à la mort cellulaire. Cette théorie explique en partie les maladies d’Alzheimer et de Huntington.
Dans l’encéphalite due à des anticorps anti-NMDA récepteurs, il y a souvent un prodrome de symptômes viraux qui progressent rapidement en troubles psychiatriques. Chez les femmes, souvent un tératome ovarien est mis en cause. Mais la pathologie se rencontre chez les deux sexes qui vous arrivent dans un tableau d’agitation , de confusion, d’hallucinations, de catatonie, d’insomnie et de mania. Des pressions artérielles élevées sont alors observées ainsi que des variations du rythme cardiaque qui sont potentiellement fatales, et pour lesquelles le sujet doit être admis en soins intensifs le plus rapidement possible.
Malgré la difficulté que cela implique , en raison de l’état agité du patient, il est préférable de rechercher les anticorps anti-NMDA récepteurs dans le liquide cérébrospinal au lieu de les analyser à partir du Sérum de l‘individu. Car, la sensibilité du test est grandement améliorée avec le liquide cérébrospinal surtout si la personne avait déjà été sous traitement immunosuppresseur ou sous plasmaphérèse. La présence d’anticorps anti- IG g dans le liquide cérébro-spinal est pathognomonique de la condition.Le traitement consiste en un prompt “SLE administration” par voie veineuse d’une thérapie immunosuppressive à base d’immunoglobulines, dé glucocorticoïdes et de plasmaphérèse.
Si un tératome est observé, il faut l’enlever aussitôt.L’emploi d’antipsychotiques ne s’est pas révélé efficace. les benzodiazépines peuvent être une arme à double tranchant. Car, tandis qu’elles aident à traiter la catatonie, ils peuvent aussi aggraver la confusion chez le patient. La rémission complète des symptômes psychiatriques peut prendre des mois, voire des années.
5) LES TUMEURS NEURO-ENDOCRINIENNES.Un autre groupe de maladies médicales très impliqué dans les pathologies mentales, et qui se manifeste généralement par des troubles endocriniens est celui communément taxé de “Tumeurs neuro endocriniennes.”Ce sont des cancers solides et malins puisant leur origine dans les tissus endocriniens responsables de la production de certains neurotransmetteurs ou de certaines hormones. Elles sont surtout localisées au niveau des glandes surrénales, de la glande thyroïdienne et du pancréas.Ces tumeurs sécrètent leurs substances qui sont métaboliquement actives, directement dans le sang.
Ce sont des adénocarcinomes et des phéochromocytomes, produisant respectivement du cortisol, de la thyroxine et les catécholamines.Il existe une autre tumeur qui prend sa source au niveau du tractus intestinal et du poumon , et qui sécrète beaucoup de sérotonine en déviant le tryptophane et le niacin vers une plus large production de sérotonine . Cette tumeur est responsable du syndrome carcinoïde et s’accompagne d’une déficience en Niacin observée chez ces derniers patients.
Notons que dans les cas d'adénocarcinome de la thyroïde et des glandes surrénales, ou encore de phéochromocytome localisation médullaire au niveau des glandes surrénales, les symptômes observés sont les suivants.: Anxiété, insomnie, tachycardie, sueurs, tremblements, troubles respiratoires…etc.
Alors que dans les cas de surproduction de sérotonine conduisant au syndrome carcinoïde, nous observons des symptômes tels que : diarrhée, difficultés respiratoires , Tachycardie et flushing (ou rougeur et sensation de chaleur) au niveau de la face et du haut thorax, douleurs abdominales, toux et perte de poids.Le diagnostic se fait en mesurant le taux de 5-hydroxyindole acétique acide (5-HIAA)un dérivé de la sérotonine dans l’urine du patient sur une durée de 24h. Toute valeur supérieure à 25 mg est considérée très élevée.Valeur normale (2-9 mg) Des tests d’imagerie médicale tels le CT scan, le MRI, ou le PET scan sont ensuite utilisés pour localiser la tumeur en question. En termes de traitement, le résultat dépendra du type cancer , de la modalité thérapeutique qui est appliquée, et de la localisation du cancer. La résection de la tumeur donne les meilleurs résultats possibles, en à peu près huit semaines .
La chimiothérapie peut faire attendre jusqu’à une année avant d’observer la moindre réponse. Parfois , la chimiothérapie conduit tout simplement à contrôler les symptômes au lieu d’une cure définitive.
6) LA SYPHILLIS. -Enfin, la dernière maladie que nous allons considérer dans cette série de pathologies médicales capables de “ Singer “ des troubles mentaux, c’est la syphilis. Elle est capable de se présenter sous des formes variées d’où son nom de "grande imitatrice". Elle est causée par une bactérie ayant pour nom le Treponema pallidum. Son cours comprend trois phases distinctes: Le premier stade est caractérisé par l’apparition 10-90 jours après le contact sexuel d’une lésion ou chancre au niveau de la bouche ou des organes génitaux. En général, la période d’incubation est de 21 jours. Cependant il est recommandé d’attendre jusqu’à trois mois pour une fiabilité du test. Le chancre est généralement induré, de forme ronde et indolore.
Au deuxième stade, le chancre disparaît et les organes du corps vont être la cible privilégiée. Des lésions cutanées sous forme de taches rosaces ou noirâtres commencent à faire irruption sur le corps de l’individu Dans 50% des cas, ces lésions vont être perçues au niveau de la palme des mains et de la plante des pieds. Des plaques muqueuses sont observées au niveau des lèvres et de la bouche. L'œil peut être atteint causant des uvéites et des troubles de la vision. .La personne peut présenter un tableau de méningite avec des raideurs au niveau du cou accompagnées de migraines et de vertiges. Le cœur et les gros vaisseaux peuvent être atteints conduisant à des AVC et à des crises d’épilepsie. L’aorte et la valve aortique sont particulièrement touchées. Le foie , le cerveau, le muscle cardiaque lui-même, aucun organe ne semble être épargné par l’infection.
D’autres symptômes incluant la fatigue, la fièvre et l’inflammation des glandes lymphatiques peuvent aussi être observés. Enfin, arrivent la phase latente et la phase tertiaire de la syphilis. Au cours de cette phase latente, l’infection rentre dans un moment d’inactivité qui peut durer de nombreuses années. Le patient ne présente aucun trouble extérieur de la maladie. Sans traitement cependant, près de 30% des patients vont passer à la phase tertiaire de la syphilis où le spirochète envahit le système nerveux central , forçant le patient à présenter des signes de parésie, d’ataxie, de troubles de mémoire,, de psychose, d’épilepsie, de dépression et de troubles de l’humeur.
Le pronostic est très sombre une fois que ce stade est atteint et la personne bascule de l’apathie à l’irritabilité, de la dépression à l’anxiété et à l’agitation. Il faut donc considérer un VDRL ou un RPR pour tout patient nouvellement admis en psychiatrie. Si le titre est supérieur à 1:4, confirmez avec un F-tab Absorption test. Les populations à hauts risques tels les travailleurs sexuels, les homosexuels et bisexuels, les utilisateurs de drogues intraveineuses devraient subir un test de dépistage à la syphilis .De même , les personnes âgées présentant soudainement avec de la psychose et des troubles affectifs devraient faire penser à de la syphilis. Le traitement consiste à utiliser de la PNC G IM en une seule dose pour les stades de de syphilis primaire, secondaire et latente à ses débuts ..Dans les cas de syphilis latente avancée et de syphilis tertiaire considérez trois doses de PNC G IM à une semaine d’intervalle.Pour la Neurosyphilis, considérez la PNCG IV pendant 12-14 jours. Là fièvre peut survenir au cours des 24- 48h du début du traitement, c’est le Jarisch-Herxheimer syndrome. Si le patient est allergique à de la pénicilline, considérez la doxycycline par voie orale pendant 28 jours (100mg BlD). En cas de grossesse et d’allergie à la pénicilline, évitez la doxycycline et considérez de préférence le ceftriaxone IV, une aminoglycoside de 3e génération.
Conclusion:
Comme on l’a observé au cours des six pathologies explorées ci- contre , la cloison est souvent poreuse entre les maladies et les symptômes médicaux d’un côté, et ceux relevant de la psychiatrie pure, de l’autre côté. Bien d’autres pathologies comme la maladie de Wilson , l’hypovitaminose D, l'épilepsie pourraient aussi être inclus dans cette étude .Il y a même un jeu de balancier qui semble osciller de tous côtés dans ce grand quadrant que sont en fait, les sciences médicales. En partant des symptômes dans un premier temps pour aboutir , dans un second temps , à des maladies clairement définies où les deux branches se rejoignent et se complètent , nous avions cherché à prouver que plus on se met à écouter les patients , sans les classer en pathologies distinctes, mieux on leur rend service , et mieux on avance vers une compréhension intégrale et intelligente de notre rôle en tant que médecins et en tant que gardiens des vies de nos semblables..
Rony Jean-Mary, M.D
Coral Springs, Florida
Le 25 MAI 2026
References;
1) Medical conditions with psychiatric manifestations; Medline plus.Gov2)Medical mimics of psychiatric disorders;Carlat Publishing https;//the carlatreport.com3) NMDA RECEPTORS: How It Works. Unique Activation: h glutamate and co-agonist (either glycine or D-serine) tVoltage Gate: Even when bound, the channel is typically blocked by a magnesium ((Mg^{2+}\)) ion. This magnesium block is only relieved when the neuron is sufficiently electrically depolarized. Calcium Influx: Once both conditions are met, the channel opens, allowing calcium (\(Ca^{2+}\)) ions to flood into the cell, which triggers the biochemical pathways necessary for learning and memory. [1, 2, 3, 4, 5]
Clinical Relevance Wikipedia.National Institutes of Health (.gov): Therapeutic potential of N-methyl-D-aspartate receptor ...Stages of syphilis: primary and secondary stages ; Chancre followed by Mucous patches resembling “snail trails” can be seen in the mouth Ocular neurosyphilis can affect any part of the eye but most commonly presents as uveitis.Syphilitic meningitis can occur and produces stiff neck, headache, and vertigo; it can also lead to stroke and seizures. Other symptoms include fatigue, fever, and swollen lymph glands.Latent and tertiary stagesWithout treatment, the infection moves into a latent stage that can last for years, during which patients are free of any outward symptoms. Many people stay in this latent stage indefinitely, but if left untreated, about 30% go on to the tertiary stage.* The tertiary stage involves invasion of the spirochete into the central nervous system and can present with general paresis (eg, memory loss, mood changes, psychosis, seizures, dementia); it has a very poor prognosis. Irritability, depression, anxiety, apathy, and agitation are common.4)Why does an acute attack happen in AIP ? The bottle neck and the backup theory from the American porphyria foundation. Porphyria foundation .org.
JOEY’S GROWTH
Reynald Altéma, MD Joey Peters had the kind of upbringing that can warp a life paradoxically for the wrong reason: he was an only child raised by a parent who could not—or would not—deny him anything. He lost his father so early that not even a shadow of memory remained. In adolescence, he learned the family tragedy: his father had taken his own life, driven there by a misery rooted in marriage and, it seemed, by years of mental illness and depression. His mother, Martha, answered that loss with a vow. Her only child would be so steeped in love that he would never feel the absence that had hollowed out her own life. But abundance, even of tenderness, can become its own form of damage. A child raised without limits or necessary correction will grow with the wrong set of values. Joey was such a child.
He knew his mother would excuse almost anything. From that certainty grew entitlement, neediness, and the habit of receiving without ever learning the grace of return. His social instincts remained stunted because he never absorbed the quiet reciprocity on which ordinary affection depends. In time, every friendship spoiled. Whenever he failed to get his way, he concluded not that he had erred, but that others had failed to appreciate him. Friendless, he drifted into dim, airless days and a sullen depression.
He was an unremarkable student. He disliked team sports because the very idea of a shared effort meant little to him; his attention bent back toward himself by instinct. He was forever announcing some ailment, real or imagined—headaches, palpitations, stress, abdominal pains— and his mother, true to form, was alarmed by every complaint. The doctor’s office became a second home. At school, and later at work, people called him many things: mama’s boy, weakling, wuss, and, most often, selfish. Sooner or later, someone would call him a brat. He heard the word so often it began to land like a blow; whenever it reached him, something inside him tightened and fell still. Despite repeated visits to psychiatrists, neither he nor his mother would admit the obvious: he needed to grow up, loosen himself from her hold, and learn to inhabit a world that did not revolve around him.
His mother was useless in this regard. She could imagine no circumstance in which Joey might be wrong. If Joey said it, she received it as gospel. His mother was a socialite with a wide orbit of connections. She was an attractive woman and had never lacked admirers. From her, Joey inherited his looks, definitely her vanity, and lack of wits. After earning an associate degree in business, he stepped into a managerial position at a large insurance company through her influence. Yet for all his advantages, he soon became known as a lousy date. He was so self-absorbed that he did not know how to offer a compliment or puff up a woman’s ego by making her feel noticed. Conversation with him always began and ended with his bragging; a date with him was a plain bore. Unsurprisingly, no woman agreed to a second outing. He did not understand that affection requires attention, or that other people carry inner lives as urgent as his own. To sustain appearances, he often hired escorts for social functions. The gossip that followed attached the word playboy to his name, and those who knew him better could not miss the irony. His life changed on an ordinary Saturday morning when he met a wealthy widow ten years younger than his mother, though youthful enough in appearance to seem twenty years younger still. They crossed paths at a FedEx, where he had gone to overnight documents to a client. She was on her way to the gym, wearing tights that accentuated her curves. She was struggling with a heavy package. “Do you have a pen I can borrow?” she asked, smiling. “By all means, and let me help you with this burden,” he responded with a broad smile, handing her a pen and lifting the package for her as well. At once, he felt an unfamiliar fluttering through him. Thankful and a bit flattered, “Gee, thanks. So nice of you. Mind me offering you a cup of coffee?” There was a pastry shop in the same plaza. “My name is Edith. What’s yours?” she said. From the beginning she controlled the rhythm of the exchange. She did not let him settle into his usual monologue. Instead, she drew him out with question after question. “Aren’t you going to ask me anything? I won’t tell you unless you ask.” In that moment, Joey had met, perhaps for the first time, a woman who might tutor him on growing up. She quickly figured out what his problem in life was. “Joey, you need to grow up.
You can’t go on being your mother’s boy and making excuses. I can help you, but I won’t play your mother’s role. I’m not here to spoil you, and I won’t hold back when you need criticism.”
Edith startled Joey with her candor; he was unused to hearing such unvarnished truth from an older adult. At the same time, he felt powerfully drawn to her. She shared his mother’s silhouette, but not her mind. Whatever lay at the root of the attraction, a delayed Oedipus complex or whatnot, it joined reverence to desire. For her part, Edith saw in the young man not a lost cause but a diamond in the rough. If truth be told, she was discreet in her attachments, though she had long preferred younger companions. Well-read and intellectually flexible, she could pass without strain from levity to the sublime.
Over the following weeks, their conversations accomplished more for Joey than years of therapy had managed. She was mature, poised, and handsome in spirit as well as in person, and her wealth lent her the calm authority of someone unafraid to speak plainly. She did not soften her criticism merely to spare him discomfort. Yet she also knew how to reward growth. “Yes, I like young, handsome men. But I have no use for boys. With me, you either follow the rules or hit the road.” Such severity was often followed by a gentle persuasion: “Plato and Aristotle reflected on the forces that drive us, the meaning of life, and the ways we might improve our condition. Their learning sessions often ripened into something more intimate. We can do the same.” She delighted in the discipline of the mind and cherished the carnal exploration that followed it. One gave rise to the other, always in that order. To Joey, it felt like instruction braided with affection.
The sessions did, in fact, transform him. Joey learned quickly that whining had no place there. Nor could he afford to miss the quieter clues of another person’s needs: her playing classical music when menstrual cramps left her in pain, her darkening the room when a migraine seized her. Otherwise, he had to learn at last to tune himself to someone other than himself. To overlook such signals was, in Edith’s eyes, a failure of attention and therefore of character, and not worthy of physical contact. In this figurative boot camp, Joey slowly began to understand that caring begins with noticing. As often happens between lovers, the arrangement outgrew its original terms and gathered a life of its own.
The tutor became as invested as the student. Their conversations, once instructional, deepened into genuine exchanges of feeling, thought, and secrets. One confession, in particular, revealed the evolution of the relationship: “I once got sick and was admitted to the hospital with abdominal pain and diarrhea. A CT scan showed signs of colitis. After a battery of tests, the doctor told me I needed to go on a BRAT diet. I was offended because I thought he was calling me a brat. You have no idea how many times people have called me that. Only by reading the instruction sheet did I learn it had nothing to do with the insult. It stands for bananas, rice, applesauce, and toast. You can imagine how foolish I felt.” They laughed together. Then he said, “Talking like this does me a lot of good. But tell me, has anything ever happened in your life that truly hurt you?”
Edith’s eyes grew misty. “We all have our own dramas. I lost my husband to cancer, and a year later, I lost my daughter in a car accident on the night of her high school graduation. I thought I would lose my mind, and I spent a long time in therapy. You have no idea what losing loved ones can do to a person.” Joey learned the answer six months later, when his mother died of colon cancer. Grief entered him with such force that it seemed to dim the very face of the world. Color thinned; daylight lost its warmth; he felt an almost animal urge to withdraw from life and burrow into sorrow.
It was as if a new consign came into existence: “Let joy be in fetters and allow sadness to run amok.” Yet his change was already underway. The old reflex to complain had yielded, however imperfectly, to a new capacity for endurance and reflection with Edith’s help and presence. She grieved along with him and shared her previous successful coping methods. That hard-won growth sustained him again a year later, when Edith, his influential tutor in affection, discipline, and loss, was killed in a car accident. He sank into deep depression, but he did not break. He endured, and in enduring, became stronger.
Reynald Altéma, MD
Palm City FL
Pith of the situation
Moses Osborn was sitting on the chair in the examining room, fidgeting, alternately shaking his right and left leg, waiting for a verdict he didn’t care to hear or address. Yet it was a matter over which he had no choice. He had received enough badgering from his mother and his wife. One would pick up where the other left off. How he allowed them to convince him to have a prostate biopsy was the cost of a truce in a war of attrition. As a married man, he learned to make concessions for harmony by ceding ground on certain matters. On this subject, he had no chance of winning because the stakes were too high and there existed too many antecedents in the family.
Nonetheless, his stubbornness was not without well-founded reason. Up close, he saw the suffering of his 2 older brothers and his dad a few decades before, and he wanted no part of this misery. The misery lay in knowing the diagnosis, not being able to do a damn thing about the outcome, and yet going through treatments that sometimes felt worse than the disease. Against this argument, which amounted to heresy according to his loved ones, his only chance of salvation, as it were, rested not only on praying but on seeking medical care, the sooner, the better. Like seeking care even before any symptoms develop. “Don’t be like your dad, go and get checked. At least now there is a simple blood test.” That was the refrain leveled at him by his mom, an octogenarian still lucid with a sharp memory. Not surprisingly, his wife, Rosa, insisted on being present to hear the news. During the wait, she kept fiddling with the rosary and reciting Hail Marys with her eyes closed, posed like a figure in a forlorn poster.
Yes, as a literate man, he was quite aware of the alarming statistic that befalls his brethren from Jamaica: the highest rate of prostate cancer in the New World and perhaps in the world for reasons unknown. He needed to look no further for the evidence. His father died of complications of it, unable to pass his urine, then passing clots of blood in his urine with excruciating pain. That was bad enough; the worst part was the bone pain he started having all day long.
A vicious word he wished didn’t exist explained the phenomenon. It is called metastasis. Such a nasty concept. It made him feel nauseated whenever he thought about it. As a result, he decided he had no control over the disease and didn’t want to think about it, and would just as soon resign himself to death under hospice care rather than be a guinea pig that would endure painful procedures. His oldest brother wouldn’t stay out of a doctor’s office, careful as he was to pay attention to any minor symptom. At age 47, just like his father, he came down with the condition. He was among the first cohort of patients to undergo the newest technique, heralded as a great innovation, called “robotic surgery.” It sounded as though after the surgery, he had turned into a robot, losing any capacity for intimacy and gaining plenty of propensity for leaking his urine. The most vexing part was that he didn’t survive long after that. His brother had become embittered because his quality of life had turned inside out; instead of finding improvement through treatment, a jinx had taken up residence, as if welcomed on a red carpet.
His other brother met a fate not much different from either of theirs. He was 49 when he couldn’t pass his urine one day and ended up in the ER. Despite numerous interventions, he couldn’t stop becoming sicker by the month. Within 2 years, he was no longer among the living. So far, all of them have suffered quite a bit before dying. Hence, he saw no saving grace from seeking help or having anything done. He had celebrated his fiftieth anniversary a few months before. It occurred to him that his borrowed time was ticking. A few months later, he started having some difficulty expelling his urine. At first, he hid that from everybody, or he thought that no one else noticed it. Living with a mother who had lost a husband and two sons to this dreadful disease, it was foolish of him to think that he could outsmart her or his wife, whom his mother had trained to look for signs of this calamity. He constantly had to negotiate his way between the pull of his proud ego and the push from his loved ones. Naturally, they were talking to each other and exchanging opinions about their suspicions. “Mommy, come and see Moses passing blood in his urine!” Caught red-handed, he had no off-ramp; hence, he conceded defeat. His mother’s sad face with tears and his wife’s gloomy mien were too much to bear. He knew the narrative far too well. He knew what would happen next.
“So, doc, tell me, what’s the pith of the situation?” he said to the urologist when he entered the room, using his favorite expression for his right-to-the-point approach. He had girded himself for the worst news. He had already imagined the hardship weeks ahead of him and the near end of any good quality of life as he had known it. “The pith of the situation is that you dodged the bullet. You don’t have cancer, but your prostate is quite enlarged.” He and his wife exchanged looks, he was not quite believing the words just spoken. “No cancer? How can that be?” “A miracle just happened. Me and Mom were praying on this and doing long fasts. The Lord answered our prayers!” said his wife with effusive joy. Not wanting to show doubt—a sign of disrespect to a professional—and at the same time keeping his pent-up desire to celebrate in check, Moses didn’t know quite how to react to this unexpected outcome. “No cancer” normally was synonymous with “Jump for joy.” Premature jump for joy, unfortunately, can be followed by “Crying the blues.” This was a denouement that he didn’t want to consider. He distinctly remembered such a whiplash when his brother underwent robotic surgery. The feel-good endorphins dissipated so quickly as to be forgotten. The weeping lasted so long as to become the only memory of the experience.
Just as he was winnowing out the tawdry ruminations from optimistic dreams, the doctor stated in a neutral tone, “Dodging the bullet but not out of the woods.” That was close to killjoy. He went on to explain the advantages of taking a pill that would shrink the size of the gland and reduce the risk of cancer forming. Fair enough, he thought, but before claiming Alleluia, “One caveat, though. Occasionally, it may cause some erectile dysfunction.” That was a cold shower on a wintry day or an arctic wind blowing on a summer day at the beach. That elephant in the room, once brought to the fore, elicited different reactions from wife and husband. “That would be a small price to pay for his good health,” her facial expression implied. “Hell no, I can’t have that. My brothers suffered from that due to the treatment, and they felt miserable,” his mien left no doubt where he stood on this issue. “How soon can he start taking it?” she hesitantly asked, ignoring his negative reaction. That was the nail in the coffin. Erectile dysfunction, incontinence, and difficulty urinating were a triad he was always afraid of. The air felt heavy; the tension remained. Sensing the discomfort, the doctor added, “Of course, that is not to say that this always occurs when one takes this medication. It’s just a conversation that needs to take place. I can be proactive and give a prescription for Viagra to counter this effect if it happens.” That deft intervention worked like salt on ice. Dark clouds were clearing, ceding the space to hopeful rays of sunlight.
“Moving forward, doc, what will be the pith of my life?” Moses asked this question while accepting the prescription. The urologist lowered his head, taking the question in and carefully measuring his words: “The results were a pleasant surprise considering your family history. We must keep an eye on the condition's progression. We ought not to get our foot off the pedal.” In search of the pith of his life, he received a somewhat pithy answer, leaving open the possibility of doomsday ahead.
Moses knew he was at a crossroads. Hoping it was just a simple bump in the road was out of the question. He even wondered, for an instant, whether the biopsy result was accurate. What left no doubt in his mind was that he had an issue that he tried his best to ignore, but that was squarely a part of the pith of his existence. That was worrisome. Did he just obtain a reprieve by achieving a Pyrrhic victory? Or was it a new lease on life after a close call? He left the doctor’s office with the same concerns he had brought in. No closure came. Still in a state of betwixt-and-between, he went home with his wife.
A eureka moment occurred during the ride. “Darling, suppose we adopt a child?” Strange as this may sound, they both had agreed not to bring any child into this world to have a similar destiny as his own dad’s (aggressive prostate cancer) or her mother’s (aggressive breast cancer). The idea of adoption never crossed their minds. Now it seemed to make sense: going from empty nesters to parents raising a child when he was in the throes of a difficult phase of his own. Taking care of and being responsible for a little one could have psychological benefits, he thought. He adopted a five-year-old orphan, a girl who filled his heart with joy. The matter of prostate cancer was always a cause for trepidation and associated with conflicted sentiments. Ten years later, the inevitable happened. His PSA began to climb, and under duress from both his daughter and Rosa, he went along and had a biopsy. The path report was unequivocal: cancer with a low (Gleason) score. He was sixty. When offered several options, he chose watchful waiting, knowing full well the pitfalls of such a decision.
As luck would have it, fifteen years later, he was still alive when he sustained a massive heart attack, called the “widow maker” because it involved his left main coronary artery. That descriptive terminology aptly summarized what happened to him.
Reynald Altéma, MD
Palm City FL
Coin des Lecteurs
A little laugh…
Dr. Coles,
Cheers! Here's a joke for you to start it off right:
A mechanic was removing a cylinder head from the motor of a Harley when a heart surgeon walked into his shop. As the surgeon was waiting for the service manager to look at his bike, the mechanic called to him: "Hey Doc, can I ask you a question?" The surgeon, a bit surprised, walked over to the mechanic working on the motorcycle.
The mechanic wiped his hands on a rag and asked, "Doc, look at this engine. Like you, I can open it up, take valves out, fix 'em, put in new parts and when I finish this will work just like a new one. So why do I earn a pittance and you get the really big money, when we are doing basically the same work?"
Can you guess the answer?
The surgeon smiled, leaned over, and whispered to the mechanic: “Try doing it while the engine is still running”.
AMHE Newsletter from Doximity
Good morning Dr. Turenne:
THis is to inform you that yesterday morning we shipped a barrel to Justinine containing among many other things 2 EKG machines, EKG tracing paper, LMA tubes, lots of angiocaths, suture material, epidural and spinal anesthesia trays etc, The EKG machines were donated by Drs. Dufresne and Thelusmond, while the anesthesia tools were provided by Dr. Ketty Jules Elysee. I hope there will not be too much delay at customs and that these supplies will help caring for the population in need in Cap-Haitien. The full list is attached to this emali.
Once again, thank you for the good work that you are doing and we hope to be able to resume our yearly visit to the Hospital.
Louis Joseph Auguste, MD, MPH, FACS.
Surgical Oncology/General Surgery
Clinical Professor of Surgery
À l’AMHE
Au Dr Auguste Louis
Au Dr Emmanuel François
Chers confrères,
Par la présente, je tiens à vous adresser, au nom du collège des chirurgiens formateurs, des résidents du Service de Chirurgie de l’Hôpital Universitaire Justinien, ainsi qu’en mon nom propre, nos plus sincères remerciements.Nous accusons réception du kit Starlink que vous avez généreusement mis à notre disposition. Cet équipement moderne constitue un apport considérable pour notre service, en facilitant l’accès à l’information scientifique et en contribuant à l’amélioration continue de la formation et des pratiques chirurgicales.Ce geste témoigne de votre engagement envers le renforcement des capacités médicales et marque, sans nul doute, le début d’une collaboration étroite, durable et fructueuse entre nos deux institutions.Nous vous prions d’agréer, chers confrères, l’expression de nos salutations les plus distinguées.
Dr Enioth BRIGHT
Chargé de formation
Dr Émile Damas
Chef de service Chirurgie
Justinien Hospital, Cap Haiti
L’Haïtien ! Comme un jackpot dans un casino, les Haïtiens brillent partout et dans tous les domaines. Ils sont devenus des rois au sommet des montagnes. Soulevant les plus grands trophées, dans le cinéma, nous débarquons à Cannes comme si c’était notre cour privée, sans aucun complexe ni sentiment d’infériorité avec simplicité et élégance Dans la musique, certains des plus grands succès et des rythmes les plus vibrants viennent de chez nous. Dans le sport, nos talents se qualifient pour les phases finales des plus grandes compétitions mondiales. Dans le basketball, des joueurs d’origine haïtienne évoluent au plus haut niveau et atteignent les finales des compétitions internationales les plus prestigieuses. Dans les réseaux professionnels, dans le domaine médical, dans les arts plastiques, les arts martiaux, la cuisine, la littérature ou encore le tennis, les Haïtiens se distinguent avec éclat. En cuisine, c’est la reconnaissance internationale. En littérature, ce sont les plus grandes distinctions et décorations. En tennis, nous atteignons un niveau que nous n’avions encore jamais connu. Les planètes semblent s’aligner pour nous laisser passer malgré les difficultés. Les filles et les fils du pays brillent de mille feux. C’est extraordinaire. C’est exceptionnel. C’est tellement beau ! Et réconfortant. C’est l’oxygène en plein air et pourtant, tant de talents demeurent encore inconnus, prêts à éclore au grand jour. L’Haïtien talentueux existe dans tous les domaines. C’est l’ère de l’abondance. La récolte a été bonne, et elle continuera de l’être encore et encore, parce que la semence était propre, profonde et authentique. C’est l’air du temps. C’est un printemps haïtien. C’est l’Haïtien dans sa dimension la plus profonde, dans son élévation la plus haute, avançant vers les sommets du monde avec dignité, puissance et lumière.
Jean Yves Hakime .
Video de Radio Solidarite et les infirmieres d'Haiti dans un panel de discussion...
L' Amour va plus loin
Dieu nous prête un de ses enfants chéris souvent
Mais ce n’est pas pour le faire notre, longtemps
Car une fois ladite « mission accomplie »
Il rappelle son bel ange et nous le ravit.
Nous avons vu le ciel venir te réclamer
Avec les larmes aux yeux et le coeur endeuille
Nous te voyons partir sans pouvoir te garder.
En nous, ta mémoire continue d’exister,
Ton coeur ne s’arrête jamais de nous aimer
Ni ta jolie bouche, ni ta voix de chanter,
L’amour se moque des lois de la pesanteur
Il ne connait, ni danger, ni peur, ni frayeur
La distance et le temps sont : illusions et leurres.
Si la-haut doit être ta nouvelle maison
Nous resterons toujours en constance liaison.
L’amour va plus loin que frontières et horizons
Et se méfie toujours des lois de la raison.
Il se plait à rythmer les cœurs au diapason.
L’amour transforme les pleurs en gerbe de fleurs
Et les complaintes amères en bonheur.
Jean Serge Dorismond MD
Pembrooke Pines FL
L'impact d’un malaise
J’ai ressenti ma jeunesse déferler à mes pieds,
Quand sur un lit d’hôpital, deux opérations,
M’ont force à questionner toutes raisons d’exister,
Sans pour autant me faire plier sous la maladie.
J’entends encore le vent de la nuit soupirer,
Caressant mes oreilles d’un doux refrain,
Emportant au loin, les maux de mon cœur,
Rêvant encore dans un tourbillon du bonheur.
Nous perdons l’ardeur qui nous échafaudait
Alors que l’harmonie nous berçait,
Une fois sur le perron à l’Ecole de Medecine,
Entoure de camarades de promotion.
Les mots du doyen revenaient à l’oreille
Soupirant dans une tendre cohésion,
Ce leitmotiv de « Juillet c’est demain »
Qui nous motivait à se distinguer.
Mon être s’est affaiblit et a gémi en douceur
Pour mieux rebondir en sursaut,
Dans une vague harmonie du renouveau.
Et le Tout-puissant a su m’épargner la vie.
Maxime J-M Coles MD
Boca Raton FL
April 2026
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