Hemophilia in islands

Island of Dreams

Twalzan Beach, Mayreau Island

I had forgotten just how beautiful are the waters of the Caribbean. Flying overhead, from Bridgetown (Barbados) to Union Island (St. Vincent and the Grenadines), even the prolific and troublesome brown sargassum, which spread like a brown sea-snake for miles and miles in the turquoise-jeweled sea, could not stop my awe of this place of paradise.

This was my third trip in 22 years to the island of Mayreau, to visit Kishroy Forde, a young man with hemophilia. I first visited in 2001, when Kishroy was only 6, at the bequest of his mother. She had called me collect, after a tourist gave her a copy of my book, Raising a Child with Hemophilia. The tourist was a nurse, and Kishroy’s mom had told her she had two children with hemophilia. My number was in the book, and Kishroy’s mom called and begged—no, demanded— that I come and teach her how to infuse her son. At once I loved her attitude and agreed.

Kishroy, Laurie and Officer Owen

I convinced a nurse from Miami to accompany me, and together we took several flights and then a very low-in-the-water wooden outboard boat to the remote island of Mayreau. At that time it had no electricity, government, or medical care. My nurse friend taught Kishroy’s mother in one afternoon how to prepare and infuse factor while I took the children—Kishroy, his four-year-old brother Kishren and their two half-sisters—to the beach to keep them busy. When we returned, Kishroy received his first ever infusion of factor, which I had brough with me. I shipped them from time to time with factor.

A lot happened in the intervening years. Despite our donations of factor, little Kishren died of a GI bleed. Because on Mayreau, nothing happens fast. To get to a hospital, you have to find someone with a boat willing to take you there. And it’s a 30-minute, bumpy ride over choppy waves. The main hospital staff did not know much about hemophilia in those days. After his death, the mother left the family and moved to another island, leaving behind Kishroy, 11, now without his brother or mother. And last year, his best friend, and cousin, Tevin died, age 25, of a brain bleed in his sleep. This one hurt Kishroy the most.

Luckily, Kishroy has an exceptional father, Adolphus, who was a fisherman at the time. And an island full of relatives. I returned in 2014, to see the little boy I knew had grown to a young man now 6’3” tall! I stayed only for a couple of days, enough to give him more factor, some gifts and to see how he was. The island now had electricity, and a nurse who visited once a week.

Then, Save One Life stepped in to help. Kishroy received a sponsor: first, the Castaldo family of Illinois; then, John Parler of Florida. Both families have children with hemophilia. Kishroy also received a scholarship to attend post-high school training. He learned how to repair computers, and studied electrical engineering. This would alter his life.

I continued to donate factor when needed. Kishroy would call, text or WhatsApp me to request what he needed. I was impressed that he never asked for anything more than what he needed.

Mayreau Medical Center… and post office

The day finally came when I could get away post-Covid and return to see him. So I spent last week with Kishroy, now 28. I arrived by boat again, and he was on the dock to greet me. This time I was amazed at his growth—not in height, but in maturity. The little boy I knew has become a man, who still lives in a tiny island of only 450 people, but who has big dreams. In fact, Mayreau now seems to be a place of big dreams.

It’s hard to overestimate how strange it is to live on such a small island your entire life. I doubt Kishroy has ever been to a movie theater. He grew up with a house with a rain vat to collect fresh water, an outhouse, and no electricity until 2007. He is surrounded by family and neighbors, and knows every inch of the island. To go anywhere requires a boat. The sunsets are spectacular, the people unhurried and kind, the vibe very cool and serene. Crime? “Sometimes someone will have too much to drink and will need to be escorted home,” Kishroy shared. There are only three policemen on the island, and one is—of course—Kishroy’s cousin Owen. I joked to Kishroy that I would just assume that everyone we met was his cousin.

How do you dream and plan, when your life is so literally limited? And you have suffered not only such losses, but have a life-threatening blood disorder and no medical facility to help?

The new hardware store in progress

Kishroy may be one of the most self-reliant people you could meet. He not only can fix just about anything electrical, he can repair out board motors, knows plumbing, and does construction. His computer skills got him a job as Director of Operations for a new tourist spot on the island, in a location perfect for kite-surfing, which is huge here.

In addition, he is transforming a donated two-room dwelling near the main beach into a hardware store. He came up with a brilliant idea. Seeing the multi-millionaire yachts and catamarans that arrive each week for a quick stop, knowing the fishing industry and need for properly functioning outboard motors, Kishroy noticed that every time someone needed a repair, they had to plan a trip all the way to Union Island or the St. Vincent mainland. Time-consuming and aggravating. He realized that Mayreau needed its own hardware store. He began clearing out the dwelling and installing shelves, and hopes to open this year, and turn a profit in a few months.

See all the photos here

It would be easy for Kishroy to succumb to despair and depression over his losses and suffering, but he never complains. He turns hardship into action; difficulties into dreams; dreams into reality. He may live out his life on this small island, but he will be king of it. It’s quite a metaphor for those of us in America, who might think we have it tough. We have no idea. It takes a visit to Mayreau to put it into perspective. Dreams matter and dreams make the difference.

I left Kishroy with enough factor for about six months, thanks to all the donations we have recently received. He left me feeling incredibly proud of the man he has become, and humbled by his positive attitude and strength. I cannot wait to return—next year. Read the 2014 visit here.

Laurie and Kishroy in 2023, same spot!
Laurie with Kishroy (L) and Kishren (R) in 2001

Island Paradise or Prison?

After escaping a major snow storm that grounded 50% of flights at Logan, I boarded JetBlue to New York on Thursday, then Bridgetown, Barbados, and then my real destination, St. Vincent and the Grenadines (SVG), a nation composed of five main islands. I was last here
in 2001—13 long years ago—to meet the Fordes, a family with hemophilia on the remote island of Mayreau. It’s not easy to get to. After a one night stop over in Kingstown, the capital of SVG, and a meeting with the lovely Dr. Bhattarai Datta, a pediatrician who wants to start a hemophilia organization, I had a short flight, over to Union Island in a private plane, owned and piloted by Martin Jennett, a suntanned, charming and wry Scotsman who has lived here since the 1970s. He showed up in shorts and flip-flops, and said climb in! His Grumman American Tiger—which he says is “just my car”— is compact, cute, nimble and does the job, just like its owner. His gorgeous clipper Scaramouche was used in the Pirates of the Caribbean!

We were airborne at once and pierced the clouds. They billowed on my right, the sun heating them. On my left, islands and turquoise waters. Mayreau eventually appeared; we have to technically fly over it to get to Union Island, where there is a runway. From the air, Mayreau was splayed like a green starfish floating on the sea.

Seeing Kishroy for the first time in 13 years!

At Union Island, I met Glenroy, the captain of a boat which transfers the high school kids on Mayreau to Union every day! He introduced me on the dock to Nancy and husband Lorne, a couple from Nova Scotia, who were also heading to Mayreau. And on the docks is where I met up with Kishroy Forde, who I last saw in 2001, when he was only 6! He shyly walked around me, unsure if it was me, and said hi, and
I recognized him immediately. I gave him a hug, big
smile and we chatted. He is 6’2” now, a far cry from the skinny little boy that I put on my knee then.

Splayed like a green starfish: Mayreau

The ride over was nice, my hair was a disastrous mess, and I mostly listened to Nancy, who shared how she and Lorne had bought a house a few years ago as a winter retreat here, but who have been coming here for 20 years.
At Mayreau, Kishroy’s dad Adolphus met us at the dock. Dennis, owner of Dennis’s Hideaway, where I would be staying, had sent a driver to pick me up in the strangest truck ever. It looked like it was pieced together bit by bit from scrap metal from anything handy. It was amazing that it could run. There was no dash, just open wires; no steering column cover. Everything exposed and jerry rigged haphazardly. The door would shut only with a lot of outside assistance. You do whatever you must to keep going here.
Dennis’s Hideaway was written up recently in Outside Magazine as a place to try. It’s where I stayed 13 years ago and it’s pretty much the same. A bit rustic, but from my room, a great view of Mayreau Bay, and Kishroy’s house. It was nice to see Dennis again. He’s a bit grizzled, but still flashes a broad smile. I invited Nancy and Lorne, Kishroy and Aldolphus to dinner at Dennis’s that evening. We gathered at 7 pm first by the round, hardwood bar, where Dennis joined us. He told us stories about various visitors, and how one woman came back to stay a week, and asked if he recognized her. He said no. She said last time she had been there he had proposed marriage to her! We laughed. I said, “So you probably don’t remember me from 2001?” He paused and asked, “Did I propose to you too?” We all laughed again.
We called it a night at 9 pm; the mosquitoes were biting and their bites sting with impunity. They call these mosquitoes “noseeims,” as in “No see them.” Really.
Saturday February 8, 2014

Kishroy with his father, Adolphus

Kishroy showed up at 8 am or so, and we took it slow that morning. First, to his house, to unload gifts. He has an islander’s walk, shuffling and unhurried, saying hello to everyone. We walked about 20 paces, took a left behind a little bar, and hiked the worn path, matted with leaves, lined with some trash but maintained by goats tied to posts. Some mixed breed dogs pranced out to announce my arrival, followed by pups. Once Kishroy put them at ease, they baptized me with their tongues, tails wagging so hard their torsos were shaken from side to side.
The simple wood slat home has deteriorated a bit, and most definitely lacks a woman’s touch—Kishroy’s mother left the family years ago. There is an outhouse and a rain vat. Kishroy shows me his Spartan room, and given
that this may be his home for life, I vow to get him a bedspread and matching curtains next time I come. His cousin Tevin is with him. We unload the gifts: a Bible, pens, books (like Fantastic Voyage, about scientists shrunken to travel through the blood stream), a waterproof expedition watch for him and his father, and wallets. Neither had a wallet.
Kishroy was delighted. And even more with the factor that next was retrieved!

Spartan bedroom

Kishroy is going to get a passport so we can try to get him medical attention for his elbow, which does not bend beyond 90°. I’m not sure what can be done, but we need to
at least find the answer and learn his options. But he needs to go to the States for this.
Next we take a walk. Behind his house are his uncle’s houses. Adolphus, his father, is

Kishroy’s home

one of seven sons: Claude, Samuel, John, then Adolphus, Job, “Nomo” (not his real name, but nicknamed such because his mother declared that after that baby there would be “no mo’.”) and Alvin (apparently her plan failed!). It’s clear that Kishroy, despite the risk of living on an island that just got electricity within the last 7 years, and is accessible only by boat, with no medical care, is surrounded by a tight-knit and plentiful family. In that way, he is richer than a lot of people I know.

One school house for all ages

We stroll up to the schoolhouse, where about 70 children all sit in one room. And the Roman Catholic Church, quite pretty and well-maintained, where almost everyone goes
to church. Then we hike around the perimeter of the island, admiring the sun sparkling on the sea, and the various shades of blue. We eventually end up at Nancy and Lorne’s cottage, and they invite us in, despite all the yard work they are in the midst of. A few minutes turns into 90, and we eat lunch and I listen to how Nancy sat with various elder women on the island to capture their stories for a book she authored. She gives me a copy, and one for John, Kishroy’s sponsor. I can’t wait to read this. She has I think for the first time preserved a piece of history of Mayreau.

Lorne and Nancy

After lunch we head for the beach, and climb on the dock, where some young boys are fishing. We need gas, and the guys load up the boat with empty containers. While we wait, Kishroy opens up a bit. I ask about his father’s fishing; how often? Where?
“He goes away sometimes for a day, sometimes for t’ree weeks,” he says simply. You miss him.
“Yes…” And adds softly and suddenly, “I miss my brother, too.”

Home made boat

 I was hoping we could somehow speak about this, but island culture is very different than our North American bare-all culture. Tragedies are not spoken about much. Kishroy’s little brother Kishren died of a GI bleed quite a few years ago. I had noticed his pictures that I took of him from 2001 set on the one piece of furniture in
the living room.
“I know you do,” I replied. “I miss him too. He was a good boy.” And talk turned to who was Kishroy’s best friend now? “Antonio,” and Kishroy smiles. I would meet him later that day.

Stunning Caribbean Sea

The boat was ready, so we gingerly stepped in, balancing dock to rocking dugout; I started doing the splits with one foot on the boat and one on the dock as the boat suddenly drifted away. Thankfully Tevin grabs me and kept me from plunging in!

A very fast speedboat ride, crashing through the mild waves and dousing us with salty water, to get to a neighboring island about 30 minutes away to get the cheapest gas around: about $7 US a gallon! Everything on an island that must be imported is expensive, and almost everything must be imported. We finally pull up; my hair looks ghastly, my sunglasses are salty and coated but what a great ride!

Salt Whistle Bay, Mayreau

After we load up with an amazing amount of gas (must have been 50 gallons or more), just sitting in the boat at our feet we head out again. I realize we don’t have life jackets, or a radio, or much of anything safety wise, and now have a boatload of gasoline. Yikes.
We tour for the next 90 minutes all around the islands and cays. We see in the distance the small island where Pirates of the Caribbean was filmed. We see pretty green turtles poke their heads out of the water, staring at us with dull eyes. The water is a startling, pure turquoise, like a liquid gem. The sun beats down in us, despite the breeze and wind, and I am soon sizzling red.
We head back and in minutes are back at Mayreau Bay. I head up to Dennis’s to change. We later meet up at Kishroy’s house. En route in the dark, we spy Nancy and Lorne on the street and say our goodbyes and hugs. Maybe it’s the atmosphere, or being on such a remote and sparsely populated place that makes you need to get along, but you feel closer to people here. Nancy told me only last year for the first time did the island finally get a policeman. A vet comes to the island once a week (there is a problem with too many dogs); a nurse also comes once or twice.
If you get really sick at night, you must take a boat to get to Union, and the facilities there are a bit scary. Martin simply says, “Get to Martinique if you need medical attention.” And I am sure that’s not just a ploy to hire his
aircraft.

Kishroy (L) and Kishren, 2001

Unknown to me, Adolphus has been fishing since the early morning, and returns with succulent lobsters for dinner. He is a man of few words; but I know when I am being thanked. I also note that lobsters are his main source of income; to give away two is a sacrifice. And I note further that Adolphus has given me an entire lobster; Kishroy gets the tail of the second, where the sweet meat is of course, leaving Adolphus the head and chest, where there is virtually no meat. I am always struck by the true class some of the humblest people exhibit, and which is so lacking in many of the well-to-do.

We pop open some champagne and toast ourselves. And I split the lobster tail and share with Adolphus. A grand meal, a way to say thanks for all those who sponsor Kishroy (first the Castaldo family years ago, and now John Parler) and for those who donate factor. We are all keeping him alive and well. In his slight, faint voice, accented with the British lilt of the islands, he says, “T’anks for the factor and the sponsorship.” Nothing more need be said.

Some parts of Mayreau are poorer than others

We walk back in the darkness, skirting frisky dogs and a random goat, listening to the blaring and pounding of the karaoke bars nearby, stars above, ocean surf ever present, and say good bye at the gate of Dennis’s Hideaway. What a difference 24 hours makes. What a difference shared lives make. What a privilege to be here.

La Vida Hemofilia: A Visit to Puerto Rico

I have a strong affection for Puerto Rico and its hemophilia community. I first visited in 1998 after speaking with a young mom, Yoli, who called me to ask about her out of pocket costs, which were extraordinary. The timing was good, as I was beginning to wonder about the state of care there. All our newsletters to the Puerto Rican hemophilia foundation were returned, and there was no phone. Yoli did a bit of investigating and learned the nonprofit had become defunct. With a little more discussion, she decided to revive the nonprofit, and the new Asociación Puertoriqueña de Hemofilia (APH) was born.

Yoli and her husband Rene worked hard to build the new association up from the dust. And they did a fabulous job. Soon they had money for camps, scholarships and travel. They upgraded the only factor product on the island to a more advanced product. Things were going very well!

Then Yoli left to come to the US (mainland, that is; Puerto Rico is part of the US as a possession). Another young parent and lawyer, Johnny Marquez, took over the helm a few years back. Like Yoli, he has a son with hemophilia. I had stepped back so far I kind of lost track of what was happening there, and decided that the dead of winter, with one of the snowiest winters in history, was a good time to make a social call.

Zoraida Rosado and I headed to San Juan on Wednesday, in between huge snowstorms in New England. Puerto Rico is often called the Shining Star of the Caribbean, renown for its pristine beaches and water, lovely climate and friendly people. While English is spoken, not everyone speaks it. I wondered if this created a barrier to hemophilia care since so much is available in English.

On Friday night we met socially with families and the executive team of the APH. Johnny and wife Tammie opened their home for everyone. We had a lovely time and Johnny filled us in on how things work in Puerto Rico.

First, there are about 180 people estimated to have hemophilia, and about 125 of these are registered. Though a small island, many people live far outside the capital, making it hard for them to come in to get care at the main hospitals. And despite being a US possession, medical care is definitely offered more like a socialist country. The government has a budget for factor, opens a “tender,” and pharmaceutical manufacturers offer bids on their products. Usually the government goes with the lowest bids per unit of factor. With a limited budget, the government typically selects plasma-derived products, as they are able to buy more product within the budget limits.

Just recently, a recombinant was selected. One of the moms I spoke with was a bit frustrated that she must go to the hospital each time her baby has a bleed. She is already to start to learn home infusion, but the hospital didn’t want to offer this. So she bought factor herself, out of pocket! I can’t imagine that happening on the mainland.

Overall, the children looked great, well cared for and very happy. We brought some of our books in Spanish, and hope to send more materials.

Insurance reform will also impact Puerto Rico, but how we just don’t know yet. I’ve invited Johnny to come to one of our Pulse on the Road seminars, so he can learn more and bring back information to our very warm and hospitable Latin friends on the beautiful island of Puerto Rico.

Thanks to Johnny and Tammie, and everyone who made our stay so pleasant!

Book I Just Read
The Imperial Cruise by James Bradley
In 1905 President Theodore Roosevelt sent a large political delegation, including Secretary of War William Taft, and his own daughter, the outspoken and rebellious Alice, on a cruise aboard the Manchuria to Japan, Korea and Hawaii to pave the way for better foreign relations. What was unknown to the public, and deliberately kept secret from Congress, thus breaking the Constitutional law, was that Taft and Teddy made secret alliances with the Japanese against Korean and China that left an open door to the Japanese to later invade these countries, and, Bradley postulates, lead to the attack on Pearl Harbor. The history he presents is not new, but Bradley makes much of TR’s racism, a topic most would like not to discuss. TR was just a product of his time, some might say. A fair point.

The topic of breaking the Constitution is excellent; Bradley’s depictions of what our country did to the Filipinos are searing; our military’s actions are unforgivable. You will be shocked if you have never heard this history before. He is to be applauded for reminding us that America has had (and still has) imperialistic motives. But the book is very hard to read, not because it is too scholarly or bogged down in minutia of history (it’s light on all that, if anything), but because of the vendetta Bradley apparently has against the Roosevelts. Bradley seriously damages his credibility as an author by using quotations grossly out of context and cherry-picking vignettes from TR’s life to paint a caricature of a man, instead of fairly raising the questions of his racism, nationalism and motives. He refers constantly to “Big Bill” (the 300+ pound Taft), “Princess” Alice and “Big Stick Teddy,” almost in a sneering, snarky way. Not just once, but over and over and over. You wonder when the editors checked out. Bradley also seems to have a vendetta against Christians; he correctly points out that Christian missionaries started the opium trade in China, making so many businessmen (and reverends) in America rich, but created a product Bradley refers to, again over and over and over, as “Jesus-opium.” And that’s only one example of his seemingly anti-Christian tirade. You find yourself wincing, and wishing Bradley would grow up a bit, as a man and as a writer. I felt that I was reading a weak term paper from a college student at times (too many times). He also jumps to historical conclusions, while missing key information in his theories and hypotheses. Most disappointing, coming from the author of Flags of Our Father, later a Clint Eastwood movie. Maybe, just as he repeatedly accused TR, Bradley has become slave to publicity, and needed to kick the readers’ hornet’s nest to get some media attention. He didn’t have to; the story of what happened in 1905 doesn’t need any flourish. It’s a sad chapter in our history. But there are probably better books to read on the subject than this one. Two stars.

ADVERTISEMENT
HemaBlog Archives
Categories