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08-13-13
This is Herve Gilbert of Haiti Connection Network. Welcome to our special
edition today, dedicated to a hot topic of the news in Haiti and in the
diaspora.
Since the
untimely death of Judge Jean Serge Joseph in Haiti occurred under suspicious
circumstances, there is an outcry in Haiti or a "hodgepodge" that forced
even the parliament, institution dealing almost exclusively with legislation to
participate in the investigation of the death ...
Therefore, three commissions of inquiry have since been set up in Haiti on this case and
then the transfer of the remains of the Canadian-Haitian citizen judge, to
Quebec Canada for autopsy before burial ...
According to
the latest news we received this week about the results of the autopsy made in
Canada, it appears that Judge Jean Serge Joseph succumbed to intracerebral or
intraparenchymal hemorrhage. So we called on a doctor to help us see more
clearly in this case.
We have with
us on the telephone Dr. Carl Gilbert, surgeon practicing in the United States
for years, journalist and writer well versed in Haitian affairs. He will help
us clarify certain aspects of this story.
Good evening
Dr. Gilbert!
HG: First,
Dr. Gilbert, you are a practicing physician here in the United States for
years, Before getting into the core of the subject, I'd like you to tell us a
bit about your professional experience and what is your specialty as a
physician.
DCG: as you
said before, before getting deep on the
subject, I would like to express my condolences to the family of Judge Jean
Serge Joseph ... struck by this sudden death... and thank you for invitating
me.
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| Dr Carl Gilbert 08-12-13 |
Indeed, I am
a practicing general surgeon ... I have been practicing for many years in the United states.
I am a specialist in surgery ... as defined and certified by the American Board
of Surgery ... I have a remarkable private clientele in the city of Little
Rock, Arkansas. As you stated earlier, I am also a writer ... and a trained journalist and I've also worked with you closely on other Haiti Connection Network programs of which I am the general manager.
HG: So, as a
specialist in general surgery, your scope of care on the human body is very
diverse. You care ... or you have a deep enough knowledge of ..... pathologies
or diseases of the skin and soft tissues, certain diseases of the head and
neck, endocrine glands, thorax, all What other abdominal organs ... (esophagus,
stomach, intestines, liver, gallbladder and biliary tract, pancreas and
spleen), help me ... What else .... and arteries and veins etc. .... is not it?
 |
| Dr. Gilbert and Dr. Midi during surgery (left to right) |
DCG:
Absolutely ... General surgery deals with these diseases ... but on a more or
less regular basis according to the interest of the surgeon or his sub-specialty
and advanced training, I'd say ...
HG: And
then, Dr. Gilbert, what is your interest??
DCG: Well,
my interest is the abdominal cancer surgery or not, some tumor of the soft
tissue, cancer or not, the wounds of the skin .... I mean, certain vascular procedures
, and then I practice a laparoscopic surgery which is
actually closed intervention techniques approaches with cameras compared to
open surgery techniques ...
H.G: Thank
you Dr. Gilbert! Now let's begin to the subject of our conversation of the day:
You are well
aware that the news of the death of Judge Jean Serge Joseph that continues to make
headlines from Haiti since July 14,
2013?
D.C.G: Absolutely, I've heard ...
D.C.G: Absolutely, I've heard ...
HG: It is a
death for which rumors have alleged the possibility of poisoning by members of the
current government in Haiti .... And sources close to the family of the judge
according to the notes I'm looking at here had even told the press that the
autopsy conducted in Canada had confirmed the theory of poisoning. But ...
Canadian coroner's office would later corroborate physicians Mevs hospital,
that the judge had died of a cerebral intraparenchymal hemorrhage.
Will you
clarify this term for the listeners? How to define this medical jargon?
DCG: This is
a bleeding that occurs within the brain substance.
HG: At a
press conference after the death of the judge, the doctors from the hospital Mevs
said that when Judge Joseph arrived, he was already in a critical condition and
beyond cure. These doctors knew the cause of death was a stroke before an autopsy
have been performed. Is this possible?
DCG:Yes,
it's possible ?
Dr. Gilbert, we will now play an audio clip of the first declaration of a Physician at the Bernard Mevs Hospital in Port-au-Prince a few hours after Judge Joseph was pronounced dead. This recording is a little distorted but I hope you will be able to hear it. Be patient with us.
Dr. Gilbert, we will now play an audio clip of the first declaration of a Physician at the Bernard Mevs Hospital in Port-au-Prince a few hours after Judge Joseph was pronounced dead. This recording is a little distorted but I hope you will be able to hear it. Be patient with us.
H.G Stay
tuned! listeners of Radio Haiti Connection! We have with us on the line,
Dr. Gilbert who is discussing with us the tragic death of Judge Jean Serge Joseph. We
just listened to sound bites of a press conference given by doctors at Mevs
Hospital.
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| Catscan - Med |
Let me
do a rundown of that press conference
which the sound of the audio was a little altered. In my opinion, the physician who was giving
the press conference was a little hesitant in his statements. There was some
uncertainty when he said he wanted to wait for the autopsy results to decide,
he made mention of stroke, of cva... What is your impression?
I wonder if there was a real clinical evaluation of the patient's arrival. Why he did not mention the results of the cat scan if they had one ... So ... ambiguity or speculation ... What do you think Dr. Gilbert?
I wonder if there was a real clinical evaluation of the patient's arrival. Why he did not mention the results of the cat scan if they had one ... So ... ambiguity or speculation ... What do you think Dr. Gilbert?
DCG: First, I
must tell you that we are not here to criticize anyone, as not having been on
the scene, it is difficult to say exactly what was done or not for the patient.
H.G: I want to interject here, Dr. Gilbert... according to the audio of the conference, the patient arrived at 3 am, he wasn't seen by a doctor until 7 am, 4 hours later. And he died up until 8:00 pm... That gives us a lapsed time of 18 hours since his admission to the hospital.
And then there was talk of massive cerebral hemorrhage. ... We must then ask ourselves what has been done to stop the bleeding .... Dr. Gilbert you have the floor again ...
And then there was talk of massive cerebral hemorrhage. ... We must then ask ourselves what has been done to stop the bleeding .... Dr. Gilbert you have the floor again ...
DCG: Haiti
is not the United States where an ambulance ride from a private house to a hospital can takes an average of 10,
11, 12 minutes. In a secluded area, there is a medical helicopter that can
transfer a patient to a hospital in 30 minutes ...
However, with that said, we must adopt a scientific approach to the problem:
Someone gets
sick and his family and doctors believe he has a cerebro-vascular accident.
Immediately, the patient must, in addition to solutions, receive upon arrival
to the hospital, a brain scan or a MRI which is the acronym for magnetic
resonance imaging to detect, as well as the scanner an intracerebral hemorrhage at
an early stage.
HG: Listeners of Radio Haiti Connection, you're listening to our special edition on our discussion regarding the tragic death of the Judge.
HG: Listeners of Radio Haiti Connection, you're listening to our special edition on our discussion regarding the tragic death of the Judge.
Dr. Gilbert,
Can you explain what can cause a "massive stroke"?
DCG: Like
any bleeding that occurs in the human body or animal body, brain hemorrhage is
caused by a ruptured blood vessel, artery or vein in the brain.
This rupture
can happen because of different causes:Of these
cases, we have:
Hypertension
badly or poorly treated
vascular
malformations that can be called in medical jargon cavernoms, arteriovenous
malformations, aneurysms.
As another
cause of intracerebral hemorrhage we have cerebral venous thrombosis or
thrombophlebitis that produces blood clots and block the cerebral veins.
if a patient
has a brain tumor, it may be complicated by intraparenchymal or intracerebral
bleeding.
HG: But the
autopsy could detect a tumor to the judge, is that it?
D.C.G: Yes
indeed, it is usually the function of the autopsy to tell us exactly what
caused the bleeding.
In most
cases, intracerebral hemorrhage are prone to happen in persons taking
anticoagulants or anti platelet meds.
I must
mention here: there is quite an elevated number of people or patients now under
treatment of anticaoagulants. These drugs are
products that are prescribed by doctors to thin the blood ... and to prevent the formation of blood clots, which in medicine we call embolism in patients.
If a patient
is receiving anticoagulant he may suffer from bleeding as a side effect. This
bleeding can be in the intestines, kidneys, brain or any other organ of the
human body.
HG: Dr.
Gilbert ,apart from anticoagulants are there any other products that can cause
hémorrhage in the brain?
DCG-There
are aspirin, ibuprofen and all drugs in the same family as aspirin, the vitamie
E. And there are many other known or unknown subtances that are in the
environment, including plants in our pharmacies and hospitals, etc.. which can
cause bleeding.
In the
United States we are told that the incidence of intracerebral hemorrhage is 16,
17 or 18% .... Fortunately there are test to determine if the rate of
anticoagulant medication is too elevated or not ...We will therefore be able to
adjust the dose.
So in
summary: A quick brain scan is essential to guide treatment. And as I
said earlier, the magnetic resonance imaging is another test that must be done
quickly.
Some centers
will also do a angiogram if the doctor thinks the patient may be suffering of
a vacsulaire mallformation such as
aneurysm...
H.G: Dr.
Gilbert! Suppose someone is experiencing anger or psychological pressure, the stress of this
anger or anxiety ... can it also cause "massive stroke."?
DCG: I can
say without fear of contradiction that in some cases the stress may cause
rupture of blood vessels.
Stress,
Hervé is an important factor in the cause of an illness or disease. I'm no
psychologist but I recalls well my studies in medical school.
When the
body is faced with a stressful situation, it pumps adrenalin, this biochemical
substance which then causes a chain reaction in the nervous system or brain. The
heart begins to beat faster, the size of the blood vessels of the body changes,
it is as if the body is preparing to face scary or emotional event.
In fact, the body put up protective biochemical elements to fight the stress. But these same products can be harmful to brain cells and also blood vessels. In summary, to answer the question, stress especially acute stress can cause an outbreak of hypertension, at home we said "tansyon an monte" - and this pressure rise can cause ruptures of blood vessels in the organs, including the brain.
In fact, the body put up protective biochemical elements to fight the stress. But these same products can be harmful to brain cells and also blood vessels. In summary, to answer the question, stress especially acute stress can cause an outbreak of hypertension, at home we said "tansyon an monte" - and this pressure rise can cause ruptures of blood vessels in the organs, including the brain.
HG: Dr.
Gilbert can you please tell us about the treatment of intracerebral
hemorrhage or intraparenchymatous bleeding
as the autopsy revealed... we listen:
DCG: The
treatment starts with emergency care and general measures of resuscitation.
I'll will classify treatment into three categories: medical treatment, surgical treatment
and endovascular procedures.
1) Medical treatment with general resuscitative measures is supportive treatment. If the patient suffers from high blood pressure the number should be kept low enough to prevent the worsening of the bleeding.
1) Medical treatment with general resuscitative measures is supportive treatment. If the patient suffers from high blood pressure the number should be kept low enough to prevent the worsening of the bleeding.
All
anticoagulant therapies should be stopped or antagonized by the administration of
antidotes. The patient is connected to a respirator if not breathing properly.
Recourse to assisted ventilation is frequent or almost constant if the bleeding
is of infratentorial location, hypertension in the brain must be corrected by
implantation of brain catheters that will allow the brain to breathe so to speak.
Specific treatments for stopping the bleeding or prevent the reoccurrence of bleeding is evaluated with promising results when performed within three hours after the onset of clinical signs. It involves the intravenous injection of recombinant factor VII.
Specific treatments for stopping the bleeding or prevent the reoccurrence of bleeding is evaluated with promising results when performed within three hours after the onset of clinical signs. It involves the intravenous injection of recombinant factor VII.
2) The
surgical treatment may be considered in case of a progressive worsening of the
clinical picture, especially in young patients. The ventricular drainage or
flooding may be done in some cases, but
mortality remains high ...
HG: You say
that the surgery can be done in case of worsening of the clinical stage ... and in
the case of the judge?
DCG: Yes, early surgical evacuation of the hemorrhage is suggested in some cases, but many times we are not sure of the benefits ...
DCG: Yes, early surgical evacuation of the hemorrhage is suggested in some cases, but many times we are not sure of the benefits ...
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| Image during a stereotactic surgery |
A less
aggressive option, consisting of a stereotactic surgery consisting of the
injection of a fibrinolytic drug in the hematoma, allowing the breakdown of the clots so their suction
and drainage can be done, this procedure is being tested with promising
results.
In the case
of the judge I cannot comment as I previously stated, because I was not on the scene... The
neurosurgical treatment of aneurysms, arteriovenous malformations or cavernomas
depends on their location by angiography ( they must be accessible to surgery).
Finally, cerebellar hematoma can be evaluated in an emergency when causing
compression and life-threatening conditions.
3)
Endovascular
It consists
of a cerebral endovascular embolization of aneurysms, arteriovenous
malformations or dural fistulas. It is most often proposed as first-line
treatment of ruptured intracranial aneurysms. It is then used coils (small
clusters) platinum to seal the aneurysm sac. Embolization of arteriovenous
malformation nest by hyper selective micro-catheters can be made in most cases using special
adhesives.
HG: Finally,
I have this question for you: What can we learn from this tragic event and how
to remedy this in a country like Haiti.
DCG- It's a great question. I think the lessons to learn are from a medical and legal standpoint.
From a medical point of view, emergency care must be improved and delays in the delivery of care should be shortened, transportation of patients from one point to another within the country should be improved. When I was writing my health topics in the columns of a local newspaper in Haiti, I had even called for a rapid transport of people by medical helicopter (med-evac) from primary health centers to centers secondary tertiaries.
HG: This is an excellent recommendation Dr. Gilbert because imagine if someone gets sick in Jeremie, it would take 12 hours of travel to get to a well-equipped hospital and find a doctor who specializes in a critical case. Our Haiti, is it really in the 21st century ... We have a country without anything while health is the first priority. Every hospital needs to have a personal trauma 24/24. What do you think?
D.C.G: Well said Hervé ... 
To complete my answer to your question, there are other lessons from this event from a legal standpoint, in my opinion. Let me state that if the circumstances are suspicious about the death of a person, the embalming of the body should not be done before a autopsy by a qualified forensic pathologist has taken place in a brief delay. Otherwise doubts will persist about the actual cause of death in a country where there is a deficiency of advanced and modern labs and where traditional beliefs and rumors prevail easily over facts!
HG: Thank you for this interview Dr. Gilbert ; it was informative indeed.
That's it! Dear listeners of Radio Haiti Connection! This concludes our interview with Dr. Gilbert who has been very enlightening . This is Herve Gilbert from the studios of Radio Haiti in Florida Thank you for your loyal listening.
Thank you again Dr. Gilbert and thank you all for listening.
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