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phanages had sequestered these children in separate rooms away from the healthy children. Most were wasted, as they could not feed themselves and required forced feedings, which were difficult for their matant (literally “my aunt”), the Haitian women providing care, to perform. Their limbs were spastic, their comprehension was minimal and, regardless of their physical age, their functional level was a year or less. I attributed their condition to birth complications–lack of oxygen, maternal hemorrhage, or prolonged labor.

I had a small but enthusiastic team—Russ, Parul, and Rob, all first-year students, plus my sister-in-law, Nancy, a pediatrician from Cape Cod. The discussion focused on the visual problems of four of the children.

“Dr. F., four of these children have cataracts. Why is that?”

“Great question, Rob. Usually, we see cataracts only in old folks.” Actually, I was dumbfounded by this finding. “Perhaps it’s a tropical medicine thing. We’ll need to research it when we get back.”

“Did they [the children with cataracts] have any other findings?” asked Nancy.

“Yeah,” volunteered Russ. “There was not one of them that was normal. Kind of funny-looking.”

A long pause ensued.

“Congenital rubella. Perhaps they have congenital rubella,” Nancy speculated.

My sister-in-law had provided us with a brilliant insight. Rubella (German measles) is a benign viral infection that causes a few days of mild fever and rash, unless one happens to be infected early in pregnancy. In that case the virus can cause cataracts, deafness, retardation, abnormally small heads, and heart defects in the fetus.

Nancy’s insight awoke me from the fatigue of a day in which we saw 300 children. This was really important. We’d missed it on the first pass because no one in the United States ever sees congenital rubella any more. It’s easily preventable with immunization. Haiti, however, was the only country in the hemisphere that did not immunize against rubella.

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