I have seen something else under the sun: The race is not to the swift or the battle to the strong, nor does food come to the wise or wealth to the brilliant or favor to the learned; but time and chance happen to them all.          King Solomon, Ecclesiastes 9:11      

The infant mortality rate in Haiti appalled me. Only one of five infants survived to age five. Almost one third of the infants died of tetanus (lockjaw), a totally preventable disease. In fact, never before or since have I seen a case of tetanus in the United States. In Haiti, tetanus was as common as the flu. I began analyzing factors that contributed to such a high incidence of tetanus in these babies.  

Soon after arriving on Ile de la Gonave, I delivered a healthy boy in the hospital. I felt that the more sterile environment would prevent this child from contracting tetanus. He and his mother were discharged from the hospital as healthy as any mother and child I had ever delivered in the States. About ten days later, however, this mother brought her baby to the hospital with a high fever, convulsing, and in morbid condition. I started an IV and antibiotics to no avail; the baby died of tetanus. I quizzed the mother as to what happened after they went home: What did she feed the baby? How did she bathe him? She said she breast fed the baby and bathed him in rain water (which was certainly superior to river water). But then her story unfolded.  

After leaving the hospital, she took her baby to the local witch doctor (medicine man), which was her custom and the prevailing tradition of all women after giving birth. He prepared his concoction of mud, water, and herbs and packed it on the baby's umbilical cord. This ritual was supposed to help the umbilical cord fall off without bleeding, to confer special healing powers to the baby, and help prevent umbilical hernias, common among Haitian babies. I immediately knew the source of the tetanus. No doubt the mud from which the medicine man made his concoction was teeming with tetanus bacteria. Laying this deadly paste on the umbilical cord of a newborn, made it almost inevitable that the baby would become infected with tetanus. What more could I do? This baby was delivered in our clinic with the most up-to-date medicine and sterile techniques available in Haiti. The mother was counseled on proper care of the baby, which I am sure she respected, yet the power of tradition and ancient beliefs could not be changed so easily.  

I did not dare to publicly denounce the medicine man for fear he would place a hex on me. I wasn't worried that the hex would harm me but that it could turn the people against me. I was a stranger in his land, and who was I to question the wisdom of his ancient medical practices? That night I had trouble sleeping, racking my brain for a solution. I tossed and turned and eventually began dreaming about the dilemma. Suddenly, I woke up with an idea that I felt would work. I don't claim I am clairvoyant, yet over the years I have found the answers to some very perplexing problems in dreams. I call them "educational dreams." Perhaps, while we sleep, our subconscious is freed of the logical barriers that hinder creative thinking while we're awake. In my heart, I knew the Spirit of God gave me the answer.  

 I sat straight up and remembered the 12 giant crates of Emko foam I had inherited in Puerto Rico (see "Why did I ask for 12 Boxes of Emko Foam?"). What if I could persuade the medicine man to substitute Emko foam for the mud/herb concoction he was packing on every baby's umbilicus? If I could do that, I would not have to teach him about the germ theory or convince him that his treatment was actually killing babies, but the end result would be just as good. I had brought eight cans of Emko to help some of the women who really wanted and needed birth control, even though providing birth control was strictly forbidden by Haiti's government. I could hardly wait for morning. I had a confidence and peace in my heart that my plan would work.  

When the clinic nurse arrived, I asked her to introduce me to the medicine man. She was uncomfortable with my request as she tried to dissuade me in several ways, but I insisted. I knew my encounter would take the utmost in diplomacy so I briefed the nurse on our mission. It took about 15 minutes walking along little dirt paths to reach our destination on the outskirts of the village. We arrived at a fairly attractive whitewashed mud hut with a thatched roof and a neat yard that indicated elevated social status. When I met the medicine man my fears were alleviated. He was friendly, had a broad smile, and seemed genuinely pleased to meet me. I thought, What a rare and wonderful moment; A modern medical doctor meeting with an ancient tribal medicine man. It was as if I had stepped out of a time machine into the Stone Age.  

I felt no disdain toward this man because of his primitiveness or ignorance, but a certain awe that he was carrying on a long tradition of the healing arts, some of which definitely had merit. I was sure there were things he could teach me. Doubtless, someday history will consider my modern medicine equally primitive. It was only a matter of time and circumstances that made the difference between the ways we practiced medicine. I did not need to be introduced. He knew who I was, although I had never met him. Word of my presence was known to almost everyone on the island and I am sure to the medicine man my arrival was perceived as intimidation to his authority and a threat to his income. 

The witch doctor was a short ebony man with tiny sparkling eyes and thin white hair covered by a straw hat. A few badly decayed teeth added character to his smile. I looked around at the tools of his trade. Baskets filled with different roots, bark, leaves, and herbs lined the walls. Matchbox-size packets filled with herbal substances were tied to strings his patients wore around their necks. He braided his own rope and string from a pile of hemp in the corner. He also used the hemp for medicine. I saw very few finished goods because, unlike a modern apothecary, the medicine man customized his concoctions as people came in. An assortment of animals, chickens, cats, and dogs, lived around the cottage, some running in and out of his open door.  

At least 20 candles were burning in front of small voodoo dolls lying upon a table. Toothpick-sized wooden spikes pierced various parts of these dolls, including their heads, chests, and abdomens. Bowls of colored sand and bottles filled with mixtures of blood and feathers lined the shelves on the wall. These compounds produced unusual odors which gave his home a medicinal smell that distinguished it from his neighbors. I began to quiz him on how he treated stomach ache. Without hesitating he took a plant out of a basket and showed me how he smashed its roots between two rocks making a paste to be placed on the stomach. It seems that everyone is interested in talking about their area of expertise.  

I told him that I had brought him a gift from Puerto Rico. I took the cap off the spray can of Emko foam and squeezed the top. His eyes bugged opened as the white foam streamed from the nozzle. He had never seen anything like it. I let him touch the cool foam and let him push the nozzle. He smelled and tasted the cream and rolled it around on his fingertips. He was like a kid with a new toy as he kept pressing the nozzle and watching the foam ooze out. He smeared some more on his hands and his face. I told him that the purpose of the foam was to squirt it on a newborn baby's umbilical cord and that he must use the foam instead of mud or it would not work. I asked him if he thought he could use this foam in the treatment of his babies. He nodded his head with a big smile, eager to get his hands on this new-found device. I told him to try it out and see if he liked the way it worked and if he did, I would bring him some more. Not wishing to be outdone by my generosity, he brewed a cup of herbal tea. He assured me it would give me long life. (So far it has worked.)  

I left the medicine man's house with a warm feeling that at least I had a shot at changing his devastating umbilical cord treatment. My hopes were realized when the medicine man came to my house the following day asking for more Emko foam. He said he had already used it on two babies, but I suspected he was using it on a lot of other things or he'd have plenty left. With his new "miracle" treatment, he had a significant edge on his competition. He would be a hard act to follow. I gave him my remaining seven cans of Emko foam and advised him to use them sparingly because once they ran out, there was no more for now. I promised I would bring more Emko foam on my next trip.  

Over the next weeks and months, hospital personnel reported a dramatic decrease in the number of babies coming to the hospital with tetanus. There used to be two or three a week, but they only saw two during the following month and those were from far away. My only worry was how to maintain a supply of Emko foam for the medicine man. For now, Emko was preventing tetanus. I knew the FDA would not approve the drug for that treatment, but it was working beautifully. In fact, I never saw “tetanus prevention” listed as an off-label use for any drug.  

(Excerpt from my book, “I Smuggled Drugs for God.")

LARRY J. MILLER, M.D. is a board-certified emergency medicine physician, recognized internationally as an industry leader, researcher, instructor, and successful businessman. Dr. Miller practiced Emergency Medicine at the Baptist Health System Hospitals in San Antonio for 31 years, where he treated more than 130,000 emergency patients. He was chairman of the Emergency Departments of the 5 Baptist hospitals for more than 15 years and Medical Director for 10 EMS agencies in South Texas for more than 30 years. Dr. Miller was the founder, CEO and Chairman of the Board of Vidacare Corporation, and the developer of the EZ-IO. Dr. Miller was granted more than 144 patents for Vidacare technology and received FDA clearance for 18 indications.

Dr. Miller taught intraosseous physiology to medical schools around the world, directed intraosseous research at the University of Texas Health Science Center, human clinical trials at 5 universities, and published over 27 research papers. He received the Innovation of the Year Award from the Wall Street Journal in 2008 for his development and commercialization of the EZ-IO, which has been credited with saving the lives of more than 4 million patients world-wide. He also received the Medical Device Innovation of the Year award from the Wall Street Journal in 2012 for his invention of OnControl for cancer biopsy. In December of 2010 Dr. Miller carried out an extensive humanitarian campaign in Haiti help to save lives from the ravishes of Cholera. More than 10,000 people died from this deadly disease, mostly of dehydration because medical personnel could not start an intravenous (IV) line. He worked with Project Hope, Physicians Without Boarders, and Samaritan’s Purse to teach the locals how to give IV fluids through the EZ-IO, enabling them to successfully save the lives of thousands of patients.

He and his team developed Vidacare Corporation into one of the most successful medical device startups in the past 15 years, selling the company to Teleflex for $300 Million. Dr. Miller received the Humanitarian of the Year Award from the University of Michigan in 2017 for his work in Haiti and development of the EZ-IO. He is the author of 3 books about Emergency Medicine, Missionary Medicine, and Suicide. He serves as medical director for Health Hero America and Acacia Medical Mission in South Texas, where he actively treats patients. He serves on the BODs of several medical device companies and the Advisory Board for the University of Michigan Medical School. For the past 9 years he and his wife, Monica, have served as medical missionaries in El Salvador, caring for some of the poorest people on earth.