Monday, November 22, 2010

Desperate Needs

Soon after I arrived in Haiti to coordinate Direct Relief International’s cholera response efforts, I had a conversation with some doctors, nurses, and a pharmacist who had been working in country when the outbreak started. They told me that when they heard there was cholera in the country, they all felt a tinge of excitement. At first I chalked this up to some kind of strange humor that medical professionals have been known to have. I’ve worked with enough doctors and have enough paramedic friends to know that they can get strangely excited about seeing a new kind of illness or a particularly gruesome injury. So I assumed they were excited because they would now get to treat cholera patients; something they wouldn’t likely get do in the States. But when I began to question them, I found out that wasn’t the case at all.

As I have traveled throughout Haiti over the past ten months visiting hospitals and clinics, I’ve realized that resources in the country are extremely limited. Many medical facilities lack fundamental items such as latex gloves, generic antibiotics, and soap--not to mention surgical equipment, x-ray machines, and basic lab supplies.

On Tuesday I met with an aid organization called Management Sciences for Health (MSH) to discuss developing a maternal-child health program in the rural areas in Haiti. They asked Direct Relief to help raise the standard level of care in these rural clinics by donating supplies and equipment so that when there is a complication during childbirth, the mother and baby might have a chance for survival. (Currently Haiti has the highest maternal and infant mortality rates in the western hemisphere). I told them that we might not have the resources to donate high tech obstetric equipment to the 150 facilities they were talking about. However, they reminded me it’s not high tech obstetric equipment they need. In many of these clinics, there are no surgical instruments for the doctor to use to perform a cesarean section. Many don’t have birthing beds so mothers are required to lay on a piece of wood set on top of concrete blocks or tires during labor. What they were asking for was not high tech at all. To raise the standard of care in these places, all you need to do is provide an exam table, some basic instruments, a sterilizer, a bit of soap, and some gloves. These items would save lives.

After the earthquake in January, there were some very serious injuries that would have been difficult to deal with even in the most advanced medical facilities. Thousands of people needed amputations. Many were paralyzed. People were trapped under the rubble for days and required advanced care for long periods of time. Medical staff did amazing work but there were patients who had sustained such extreme injuries that they could not be saved.

But cholera is easy to treat. That’s why the medical staff was excited. They felt like they would really be able to save the lives of the people who contracted it and could easily stop the spread to other people. All that’s needed to contain the illness is access to clean water and soap. And if a person does get cholera, it can be treated in the early stages with a simple oral rehydration solution made with water, sugar, and salt. If it’s progressed to the later stages, all that’s required is a simple IV drip that a nurse can administer and possibly a few doses of a generic antibiotic—things you would find in any small clinic in the US.

Cholera is no longer a serious concern for most areas of the world. In fact, just this week officials announced that cholera has been confirmed in the Dominican Republic and in Florida—both were found in people who had traveled to Haiti. However, health officials aren’t concerned about it in these areas because when the population has access to soap and clean drinking water cholera does not become an issue.

In Haiti though, where there is not enough soap, water, IV solutions, or antibiotics to go around, there are now over 15,000 confirmed cholera cases, over 1,100 deaths, and it has spread from one department (equivalent to a county in the US) to all ten. And bio surveillance teams in Haiti say these numbers are probably 400% under reported due to the fact that the Center for Disease Control only counts cases that have been confirmed by lab tests. As I’ve mentioned, lab equipment in Haiti is largely non-existent outside of the private hospitals and those treatment centers that have sent their samples off for testing often receive inconclusive results due to problems with the sample.

Haiti has endured through years of terrible hurricanes, an HIV epidemic, and most recently of course the January 12th earthquake that’s been called the worst natural disaster in the western hemisphere. But cholera is different. Cholera should be easy. The medical staff I talked to made the same mistake I did when talking about upgrading the rural medical facilities to help save pregnant mothers. We assumed that the most basic things that we take for granted like having enough soap and water and being able to give birth on an exam table are available in Haiti. But often they are not. And they need all the help they can get.

Wednesday, November 17, 2010

60 Minutes

This is a really good story that aired Sunday on 60 Minutes. It touches on many of the issues that people are really frustrated with. Government says its a lack of money. NGOs say its the government interference or worse. And the international community is too nervous to make good on their commitments.

I've driven past those tents on the road to Carrefour many times and have distributed medicines in that tent city. We've also donated to that Partners in Health Hospital.

It's a bad sign that it takes seeing it on film to make me remember how bad it is down there. It has all started to become the new reality for people in Haiti and it's not hard to imagine a future where those tents and those camps just become the norm.

Monday, November 15, 2010

Dr. Charles

An hour and a half after leaving the crowded streets of Port au Prince, we arrived at the gates of the new Camejo Hospital in Leogane, a town only 20 miles outside the capital city where the January 12th earthquake was centered. After honking our car horn at the gate, an older man dressed in nurse scrubs and holding a machete opens the gate and waves us in. Like every time I pass through one of the large metal gates in Haiti, I have no idea what I’m going to find on the other side. In this case, what we see is a lush piece of land, two football fields in length, with a wooden building standing in front of a larger, mostly collapsed, concrete building. This is the site of the new Camejo Hospital that is being run by Doctor Joseph Charles and the Camejo Group, a group of Haitian doctors of various specialties.

Working in Haiti over the past ten months, I’ve constantly found myself wondering what the country looked like before the earthquake. Like so many other aid workers I’ve meet here, I had never been to Haiti prior to January of this year so I have no personal reference for the state of the country before “the twelfth,” as they say here. However, what I can do is compare what it looks like now to what I witnessed when I first arrived at the end of January. Unfortunately not much has changed. Although the rubble is finally beginning to be cleared from the streets, very few homes or businesses have been rebuilt and all of the tent camps that sprung up in the immediate aftermath remain. The cramped conditions of the tent cities are unsanitary, unsafe, and provide no real shelter from the brutal sun and constant rain. And as we all are well aware of now, these are the conditions where cholera thrives.

Depending on who you talk to, you’ll get a different answer for the reason behind the slow recovery effort. Some say the government is underequipped and unprepared to deal with a recovery effort of this size. Some say that the non-governmental organizations (NGOs), which have received most of the aid money that’s been given for Haiti thus far, are short-sighted and unable to work within the government’s reconstruction plan. And some say that the Haitian people have become so dependent on foreign aid (it’s said that Haiti has more aid groups per capita than any other nation) that they often rely on outsiders to help solve their problems for them instead of taking the initiative. Clearly, there are aspects of all three at play. But Dr. Joseph isn’t using any of these excuses – and he is going to prove that Haiti can be rebuilt better than it was before the earthquake.

Dr. Joseph is a Haitian surgeon and his wife Dr. Marie is a pediatrician, however between them they have about a dozen different medical degrees and certificates. Although he couldn’t tell me for sure, Dr. Joseph thinks there are probably only one or two other Haitian surgeons working in Leogane, a town of over 250,000 people. I first went to see their clinic back in February to see if Direct Relief could help supply them with medicines and supplies because there were almost no other medical facilities that survived the earthquake--although by that time numerous NGOs and foreign armies (including the US, Canadian, and Japanese) had come into town and set up field hospitals and clinics. When I arrived at the clinic, there were roughly 20 mothers with their babies waiting to see Dr. Marie and another handful of patients waiting to see Dr. Joseph. I remember feeling badly that I was taking their time away from their patients just to show me around their clinic.

Joseph and Marie were extremely grateful for the medical support that foreign groups were providing but they knew that in time, the foreigners would leave and it would be up to the Haitian people to figure out how to care for their own people. So shortly after the earthquake hit, Joseph and Marie’s son and daughter in law, Jodel and Sulfrance Charles, started an NGO called Renewal 4 Haiti in their hometown of Aurora, Colorado. They planned to raise funds to build a new surgical, referral hospital in Leogane. They already had the land, a parcel that was acquired from a patient who Dr. Joseph treated for free in 1988, but now there was a small wooden hospital on the site that the Canadian Army had built and operated out of when they were working in Leogane. Dr. Joseph let the Canadian Army use his land for free because they were helping the people in his town. In return, they left behind the brand new wooden building that was perfect for a temporary hospital because it is not made of concrete. People are wary of concrete in Haiti.

While there are plans in the works to build a permanent hospital on the site, for now there is no rush. Dr. Joseph has capacity for 20 beds, and while we were there about half of them were filled. Two people had typhoid. One patient had malaria. But thankfully there were no cholera patients yet. Recently they built another room which will serve as the operating theater, and Direct Relief has provided them with the funds to outfit it. Because the site is on a major highway that connects Port au Prince to the Western departments, Dr. Joseph expects to see many patients who have been injured in traffic accidents.

We asked him how he expects to fund and sustain a hospital in Haiti. The majority of Haitian people cannot pay for medical services, even at a place like Camejo Hospital where the supplies and medications are often given away for free. “There are ways to do it,” he said with a smile. “If someone comes in for a surgery and he cannot pay, we ask the family what they can do to help. Maybe they can work around the hospital for a week.” “Another way,” he says, “is if we have ten patients and only two can pay, they help pay for the others.” We found out later that the man with the machete who opened the gate for us will be the first one to have surgery when the new surgical suite opens. He has a hydrocele (an accumulation of fluid in a body cavity) that needs to be removed and is working there now to pay for it.

If only donors and NGOs can do more to encourage and support these kinds of activities instead of thinking about how to spend their money in the short term, Haiti can harness the talents of people like Drs Joseph and Marie Charles and indeed rebuild better.

Friday, July 2, 2010

End of Another Trip

Once again I find myself sitting in a Florida airport contemplating the trip I've just returned from. This one-week trip absolutely flew by as compared to the past few where I've spent three weeks down there and usually had at least a bit of down time to process some the things that I'd been through and experienced.

First off, and on a totally different note, I should say that it's extremely unfortunate that Brazil just lost to the Netherlands 2-1 in the World Cup. Haitian people are completely obsessed with Brazilian football and the country has been in a fervor as they've been winning over their past games. It really seemed like it was one of the few things keeping many of those people upbeat. The first night we got there, we almost couldn't get to our house because of the parades and parties in the streets that thronged late into the evening. The past wins and future predictions were on everyone's lips and I'm sure the country feels like they've just suffered another huge letdown. It sounds strange to say but anyone who has experienced the World Cup outside of the Unites States will know what I mean.

Ok, back to my contemplation in the airport...

The big question on all of our minds during this trip now that we are nearing the 6 month anniversary of the earthquake was, "are things any better now than they were 5 months ago when we first got down there?" On the surface, it appears that they really are not. The tent cities seem to have grown even bigger since the last time I was there. Actually, a 'tent city' doesn't really describe it very well but I'm not sure what else to call it. Basically any open space the city has to offer, from the park in front of the collapsed presidential palace, to the median in the center of the highway, to ravines where the rain water flushes thru after any heavy rain, has turned into a place where people have either put up a tent or a tarp so they can have a place to sleep. For the first few months, there often weren't toilets or running water for these people to use so the hygiene was appalling. Typhoid has now broken out in many camps, as has outbreaks of scabies and TB. Violence and rapes are on the rise and families have taken to sleeping in shifts so they can keep watch for each other.

Six months on, the larger of these camps are much more organized and sanitary now because most of the larger tent camps have been taken over my at least one NGO that usually provides water, toilets, and possibly a health clinic. However, the fact remains that it has been 6 months and people are still living in appalling conditions.

Food provisions have been cut off so as to limit dependency yet there are almost no options for employment (aside from the "cash for work" programs for which the lucky few Haitians can earn $5 a day cleaning the streets, piling rubble, or cleaning the latrines in the camps). Schools are back in session but they are asking parents to pay for the 5 months that they weren't operating. And hospitals are functioning again yet many facilities are so poor that patients are required to not only buy their medicines and pay the doctor visit, but also buy the latex gloves the doctor uses to examine you with or the needle and syringe he uses to treat you with.

Rubble removal throughout the city is almost non existent, and since the government has been so slow to provide any help or guidance on rebuilding people's homes, people have begun to do it on their own using whatever wood, concrete, and bent rebar they can find.

So yes, things are still quite bad and it's both appalling and tragic that the government remains basically silent in the aftermath of this tragedy when they possibly could have galvanized the support of the entire world to rebuild Port au Prince and encourage decentralization by upgrading the infrastructure of the outlying cities. As it is, the opposite is occurring. People who initially left the city to live with family or friends around the country are now moving back into this city that was built for 500,000 that now hosts over 2 million people and counting. It seems that no matter how bad the outlook is in Port au Prince, prospects for jobs outside the city are worse.

However, despite all of this, I truly don't leave Haiti discouraged. To be quite honest, I don't think you can expect that after the largest natural disaster in the Western Hemisphere in the poorest country in the same region that things will be better, or even back to normal, within 6 months. I'm fairly certain that some people in New Orleans were still living in asbestos filled FEMA trailers years after Katrina hit and it took almost four years to start clearing out and rebuilding the Lower 9th Ward. It might be overly optimistic to think that Haiti, with the host of problems the country was already facing, should be able to move people back into their homes in that amount of time.

And at the risk of sounding like a broken record, I've gotten to meet and spend time with some incredible and dedicated Haitian people who are absolutely committed to lifting their country up from it's current state. These doctors, politicians, philanthropists, and activists have not given up on their people or their hopes for a better Haiti. They are frustrated by the Haitian leadership and by the soaring budgets of many of the large international NGOs in Haiti who are not focused on sustainability or empowering the Haitian people. But they are encouraged by the sad fact that as a result of this event, many of their hospitals are now better equipped, their schools are being rebuilt better, and the world may actually remain focused on Haiti for years to come.

Sunday, June 27, 2010

Sacramento Bee Article

Hello out there,

I'm heading back to Haiti today for a week to visit sites and start putting together a six-month post earthquake assessment. I'll try to send out a couple notes while I'm there but in the meantime, here's an article that I wrote for the Sacramento Bee, my new hometown paper, that was published today.

Monday, May 17, 2010

Violence in Haiti

During the past four months that I’ve spent in Haiti, I’ve gotten lots of questions from friends and family (mostly from my loving and worried mother) about how safe it is for her child to be staying in the outskirts of Cite Soleil in Port au Prince. And I’ve had a difficult time answering that question. It turns out; Haiti is a hard country to stereotype.

Haiti has long been declared the poorest and most violent country in the Western Hemisphere; with Cite Soleil the largest and most dangerous slum in this country. Cite Soleil borders the city of Port au Prince on Route 9, which is next door to where my colleagues and I have been staying over the past four months. However, during the time we’ve been down here, we never been attacked or really even felt threatened in any way. We’ve seen some fairly violent fights break out at food distributions and gas lines. We’ve driven behind a truck filled with food that got hijacked by young men who jumped inside the trailer (unbeknownst to the driver) and emptied all the food to their friends waiting in the street. True, we are rarely greeted with smiling faces as we drive past the newly erected shanty towns on our way to our apartment. And yes, people do get quite upset when you take a picture while driving past in a speeding car. But how can you blame them? They are living in the poorest city in the western hemisphere; have just been through the worst natural disaster for the area in history; are aware of the $1 billion has been raised on their behalf yet are still living in tents (if they’re lucky) without any hopes for immediate improvement.

However, while we didn’t ever experience it firsthand, we have heard many stories of kidnappings and shootings during our time here. There was a well-publicized case of the two Medicines sans Frontiers workers who were kidnapped (and later released) upon leaving their clinic. And we also heard from a colleague at St. Damien’s Children’s Hospital that two U.S. aid workers were shot outside their facility near the U.S. Embassy earlier this month, although I have yet to find any documentation of it. And many of the NGOs that we work with in Haiti wouldn’t even venture over to our office/apartment off Route 9 because of the violence and widespread reports of shootings and robberies during the Aristide years five years ago. Indeed, a couple Haitian citizents who had come from the states to work with us for a short time were unwilling to even come with us to our office.

I’m sure that Haiti can be and has been a violent place over the years but I’m always puzzled by these accounts because I just have not seen it during my time here. I’ve seen small acts of aggression due to unimaginable desperation. But those acts pale in comparison to my interactions with some of the kindest people I’ve ever met in my life. In fact, on the same day I heard that the two people were shot outside the Embassy, a Haitian man I didn’t even know literally gave me the shirt off his back because I said I liked it.

Like I said, it’s a hard country to stereotype.

Friday, May 14, 2010

Where does the Money go?

The Chronicle of Philanthropy announced yesterday that over $1.1 billion has been donated to support relief efforts in Haiti. The largest recipients include the American Red Cross ($444 million), Catholic Relief Services ($135.7 million) and Oxfam International (over $100 million). This outpouring of generosity on the part of the world community is unprecedented and should be applauded and (hopefully) repeated. And for the most part, from what is possible to observe in Haiti, these organizations have been good stewards of this money, doing as much as they can as efficiently as possible to assist those who have been affected by the earthquake.

However, all of this money that has been raised on behalf of the Haitian people begs the question of whether or how the Haitian people will actually benefit from it. Of course, the money is being spent on Haitians' behalf by the NGOs that received it, but that's different from allowing them to spend it themselves. How much do their voices count in allocating this money or even giving it to them to empower their communities, rebuild their schools and hospitals, or provide education to their children? How much of the money will actually remain in Haiti for the decades that it will take to rebuild?

A few months ago, the students at the University of California at Santa Barbara held a fundraiser for Haiti and decided to donate the $25,000 they raised to Direct Relief International, the organization I work for that has been providing medication and medical supplies to hospitals in Haiti since 1964.

Among the speakers that evening was Professor Claudine Michel, a dynamic accomplished member of the Haitian Diaspora who edits the only peer-reviewed Journal of Haitian Studies in the world. Another speaker was Dr. Nadege Cilatandre, also Haitian, a brilliant young scholar who engaged in post-doc studies as a University of California post-doc Fellow. Nadege provided a rich retrospective on Haitian history and also showed the 600 attendees photographs of a community center, complete with a library and computer lab, in Carrefour-Feuilles that she personally had helped create with small-scale contributions and volunteer labor though Haiti Soleil, a small nonprofit she had established. The center was destroyed in the earthquake but the staff had self-organized and begun providing emergency help to the families and community that it serves. They lost nearly everything, spent what little financial cushion existed to help pull the community together, and continue doing this work as the months tick by.

Direct Relief’s CEO, Thomas Tighe, was at the meeting too. He told me he afterwards he was both humbled and puzzled after hearing these presentations that the funds collected from UCSB’s students would come to Direct Relief instead of Haiti Soleil to rebuild the library. But it gave him the idea to have Direct Relief serve as a conduit for channeling funds to well run, local, Haitian-run NGOs that have been working in their communities for many years and simply do not have access to funds that the international NGO community has.
The hallmark of Direct Relief’s approach is that we look for the local leaders who invariably do all the important work where the rubber hits the road. We look for the people who are plugged in, deeply committed, very smart, and with credibility and trust earned over many years. In any community (think of who you’d want to hear from in a local emergency in your own town) these are the people whose ear to the ground and ability to make things happen is essential.

But, as we’ve learned over many years (and is clear to me again after the past several months in Haiti), these great local leaders are often so busy doing great work for the people in poverty areas that they they’re invisible to individual donors and the large funding streams. For whatever reasons, funding tends to find its way only to large groups steeped in the arcane bureaucracies of government funding or have world-class, rapid-response marketing that can galvanize attention and resources when a high-profile emergency occurs and people are inspired to give.
Since then, Direct Relief has allocated an initial $500,000 from the Haiti contributions received to serve as a ‘community grant fund’ that offers local groups the ability to access grants for up to $25,000. So far, we’ve received over 40 requests and have provided $125,000 to five local groups to: begin rebuilding the library and community center in Carrerfour-Feuilles, keep free medical services open at a community hospital for three more months, re-open a medical clinic in Delmas, provide psychosocial support to youths who have left Port au Prince for the northern district, and start a feeding and therapeutic support program in the devastated Carrefour-Feuilles area. Those funds will be spent in, and reinvested in Haiti, directly. We’re hoping that our support, and listing these groups on our website, may give them some profile and help them attract other resources, including directly from others who might learn about them in this way.

All of these groups that we are fortunate enough to be able to provide grants to have been working in Haiti long before many of the rest of us came in to help and have a great sense of what their communities need. No one has a bigger stake in making sure these resources make a difference. We just don’t always think to give them the resources to do it.

Wednesday, May 5, 2010

Meeting a Supreme Master

I'm spending the week traveling with Claudine Michele, a professor of Haitian studies at UCSB and the editor of the only scholarly Haitian journal in the U.S. She and former student named Nico Pascal a have come to Haiti to help Direct Relief select Haitian NGOs to fund. As I've mentioned in the past we have established a $500,000 community grant fund to let Haitian groups who have been working here long before the earthquake get access to the money that has been raised for their country. So far we've selected five groups and are hoping to fund at least 15 more.

So after picking Claudine and Nico up from the airport, we drove an hour north to Mirebalais to visit a K-6 school modeled after the Montessori system. The place was like a paradise. It was peaceful, serene, and best of all, every single kid had a smile on their face. It is something that you do not see very often in Port au Prince and it was extremely refreshing.

From there we drove to Gressier, about 3 hours SW, to visit with Max Beauvoir Haiti's high priest of the voodoo religion. It was an honor to meet this man as I've read a lot about him and his work as I've tried to gobble up all the information I can about the voodoo religion. The man is a personal friend of Bill Clinton, has met Ban Ki-moon, fled the country during Aristide's rule, and got voodoo recognized as an official religion in the states. I could have spent all day listening to him speak but unfortunately, believe it or not, some Scientoligists showed up to speak to him about opening up a medical clinic across the street from his house.

Essentially, Mr. Beauvoir is concerned that the earthquake will erase the voodoo culture in Haiti because it knocked down some of the main temples in the country and nobody is paying to rebuild them. He says most of the churches will get rebuilt but nobody wants to pay to fix the temples and the majority of Haitians who practice the religion aren't wealthy people. It's a tough situation. Clearly these places of worship should be preserved but there aren't many NGOs are going to want to get behind a project like this.

Again, another aspect of this earthquake that you'd never think about but has fairly devastating consequences for the history and culture of Haiti. For me, it was an honor to meet a man who has dedicated his life to preserving it.

Tuesday, April 27, 2010

What a Day!

Yesterday, the CEO of Direct Relief International, Thomas Tighe, arrived into Haiti with his 16 year-old son Travis. I don't know whether it was just good timing or kismet, or just fantastic (Plandrew-ing) but in the first five hours of his arrival, we had met with the Minister of Health for Haiti, Paul Farmer of Partners in Health, and the head of health services for USAID Haiti. Because his arrival coincided with a large meeting of ministry and health care officials who were discussing the interim plan for health care in Haiti, we were able to get them all down together at one time to discuss ways we can assist the country recover from the damaging health-related effects of the earthquake. They were all grateful to hear what we've done and we have plans to meet with the head of pharmaceutical services tomorrow to discuss what medicines are needed and how we can best communicate and deliver the products we are bringing into the country.
And to top it all off, Paul Farmer, who I've never met, recognized my name from a Huffington Post blog I wrote about Partners in Health. He said that although he never reads blogs because of all the bad information that circulates out there, he really thought my post on the long-term health services in Haiti had captured the nuances that many people miss. And to show his sincerity, he personally signed and sent me a copy of his new book.
It feels like Direct Relief is genuinely starting to get some traction in this country and people are beginning to take notice of who we are and what we're doing.

Monday, April 26, 2010

Getting Ahead in Haiti

A few days ago, my colleague and I were scheduled to drive up to Hospital Albert Schweitzer to assess their medical supply needs and determine what more we could supply them from our medical supply inventory. Unfortunately, as we soon found out, we wouldn’t be able to make the three hour drive to Deshapelles because our car was out of gas and our local staff member had been unable to purchase gasoline for pretty much the entire week before we arrived. When he was able to get fuel, it was only after waiting in line at the pumps from noon until 5:30pm because he didn’t want to risk purchasing it from the street vendors who often mix it with water. So unfortunately, we had to cancel the trip and turn it into a work-from-home day. We are now on constant alert for gas stations carrying fuel so we don’t get stuck again.

But a gas shortage in Haiti doesn’t just mean fewer cars on the streets. It means that houses, hospitals, schools, and businesses can’t run their generators to keep their lights on or the equipment running. Now that many hospitals in Port au Prince are working out of tents using generator-powered equipment, a fuel shortage can have devastating consequences.

And a gas shortage cripples businesses as well. The warehouse we rent as a storage and distribution site for medical supplies is actually in a factory where they process and bag clean drinking water and make huge blocks of ice so people can have cold drinks. A lot of people do not own ice makers, but even if they did, they would also need constant electricity for the units to function. So this business distributes bags of water and blocks of ice get via truck to local vendors who sell them on the streets. And a gas shortage means that they cannot make clean drinking water.

The barrier for entry for businesses in Haiti is extremely high, and this is a huge contributing factor for the high unemployment rate.Things we completely take for granted in the US are not so in Haiti. To open a business, you not only have to provide your own security, but you also have to ensure that you have your own constant fuel supply (or, rather, a reliable source electricity, like solar.) The entrepreneur-owner of this water and ice factory spent eight years lining up all the necessary pieces, and when he finally did open, he had 10,000 people come in to apply for 500 jobs.

People want to work; they just don’t have the opportunity to. A fuel shortage affects every step in the commercial processes of manufacturing, distribution, and sales. And a fuel shortage doesn’t inspire much confidence for entrepreneurs here, who, like everywhere else drive economic activity.

Wednesday, April 21, 2010

Haitian Hospitals in a Catch-22

Since the devastating earthquake on January 12th, hospital services in Haiti have been provided to patients for free. No matter what your status or ability to pay, for three months after the earthquake you could feel certain that you could see a doctor and (hopefully acquire medications) for free. This was a fantastic service and was a great idea because it enabled the poor to have access to the health care services that they often go without.
However, the free service in many facilities has now ended because these hospitals have only been guaranteed reimbursement for their services until April 12th. Many hospitals are now struggling with what to do next.
If they begin charging people to see the doctor, the majority of Haitian people will not be able to afford it. Thus, the follow-up treatment that is so essential for people who are newly handicapped and people with chronic conditions will go untreated. However, if they do not charge, many hospitals will be forced to shut their doors. In fact, one of the premier hospitals in the country, Hospital Sacre Coeur (CDTI), recently shut its doors because they sustained a great deal of damage to the hospital building and had to spend so much of their own money treating patients for free while (still) waiting for the reimbursement monies. Like any other business, a hospital must have income to finance their operations. Even the non-profit hospitals, of which there are many fantastic ones in Haiti, have to generate income somehow to pay the staff and the buy the diesel for the generator.
However, there is another devastating aspect of this story. As we all know, there was an incredible number of doctors and nurses who came to Haiti in the aftermath of the quake to assist in these facilities and the work they have done in the past three months has saved countless lives. It has been easy for these medical personnel to work in any of the hospitals and clinics in the area because everyone was providing services for free. These overseas medical personnel don’t want to make the patients pay for services they are providing out of the goodness of their hearts. However, now that some hospitals are beginning to charge again, these doctors and nurses are avoiding those facilities that are forced to take fees. These hospitals are now losing the expertise of the overseas medical personnel who do not want to work in a place that is charging the patients for the work they are doing for free.
Unfortunately there is no easy solution to this problem. The health care system in Haiti has been set up as a fee-for-service model. To change that now would take a lot of money that Haiti does not currently have. Unfortunately, if it doesn’t change, the hospitals will have to begin charging patients, overseas medical personnel will not want to work in these facilities, and the Haitian people will suffer as a result.
An efficient, self-sustaining and self-financing system for health care is very attractive but also very hard to achieve. Even the United States, the richest country in the history of the world, is trying to figure out how to do it. Significant resources have been donated for Haiti in recognition of the immense scale of loss and much of these resources have been used in part to subsidize the most basic goods and services (including health care) that people need but simply do not have the ability to pay for. Pulling this subsidy out now, three months after the worst disaster in the Western Hemisphere seems too abrupt. If there was a gradual lessening, rather than a complete elimination of the subsidy, perhaps there would be time for the market forces to kick in without kicking out all the people who lost everything.

Thursday, March 25, 2010

Huffington Post

Hi out there,

Check out The Huffington Post's new blogger!

Mine is the one directly above Sienna Miller's post...

Friday, March 19, 2010

Another Airlift

Every so often something happens down here that makes you think that some of the coordination effort between the UN, aid organizations, and the government is actually working. The UN has the tremendously difficult task of trying to coordinate and oversee the over 900 foreign NGOs in the area to avoid duplication and ensure that everyone in the earthquake-affected area is receiving aid. As you can imagine, this often looks a lot like herding cats (or maybe even wind).

NGOs are autonomous agencies and have their own ideas on what they want to accomplish and how they want to accomplish it. However, one of the bright spots in this whole effort is the UN logistics cluster that provides supply-chain and transportation support to groups like us who are providing essential medicines and supplies to hospitals and clinics so that patients can receive the kind of care they deserve.

Like many other organizations currently working in Haiti, we are primarily focused on distributing these medical supplies to the earthquake affected areas of Port au Prince and Leogane. However, medical facilities all over the country are now over-burdened by the thousands of Haitians who have relocated from these areas to go live with family and friends.

The effects on the outlying health facilities are intense. They are receiving additional patients into their already tenuous medical system (511,405 people as of February 17th) but generally not receiving any of the aid that the hospitals in affected areas are. Indeed, after meeting with the WHO last week I found out that they too are focusing their medical relief efforts specifically in these few cities.

So we have made a concerted effort to try and get medical relief supplies to hospitals and clinics distributed throughout the rest of the country. However as anyone who has been to Haiti can attest, the roads are in tough shape and the traffic within Port au Prince can turn a one kilometer drive into a two hour sweaty standstill. So when we heard that the UN was offering helicopters to move humanitarian cargo to areas that could not easily be reached by roads, and that the service was actually being underutilized, we thought it was too good to be true.

So after receiving a request of medicine from an organization called the Haiti Hospital Appeal, who are supporting the influx of patients (many of whom are amputees and quadriplegics who have come off the USS Comfort) at the Baptist hospital in Cap Morin, we loaded up a truck with two tons of antibiotics, oral rehydration, and pain medication for children and brought them to the UN airfield to fill up the Mi-8 chopper. The entire flight and unloading time was only two hours (as compared to the roughly 20 it would have taken by road) and before we knew it we were back at the airfield and they were packing it up for the next trip.

After spending six weeks down in Haiti, I’ve realized the most important part of effective aid delivery is planning and coordination. Planning your route so you don’t sit in the traffic. Planning what services you are going to provide so you don’t dump any useless items on the recipients. Coordinating your efforts with other NGOs to ensure that all the facilities here are being looked after. And in this case, utilizing the coordination efforts of others so that the support for Haitian people can stretch far and wide.