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.