Thursday, July 7, 2011

Great Article about a Partner in Haiti

Hello Out There,

Since my wife and I had our baby boy Finley just three weeks ago I'm taking a couple months off from traveling to Haiti. However, I'm still working hard from home and wanted to share a great article I came across today.

It's about one of Direct Relief's largest recipients of aid since the quake. They are basically the only full-scale trauma and surgical hospital, have one of the only neo-natal ICUs, and now have one of the only CT scanners in the country. They also have a full-scale prosthetics/orthotics fabrication center on-site and are in the process of building a teaching hospital on-site. They provide free care to everyone who walks in and now are able to perform surgeries for hundreds of hydrocephalus children (which are by far the hardest thing for me to see) thanks to the CT scanner and rotating teams of neurosurgeons.

The article states that this model needs to be replicated throughout Haiti--and it's true. What they don't mention is that a great organization called Project Medishare is spending around $200,000 per month to keep it running and unfortunately that will likely not be able to continue forever. Running a hospital in Haiti (or anywhere) for a population of people who cannot pay is about the most expensive undertaking there is.

Nonetheless, this place is doing amazing work--not only in the immediate aftermath of the quake, but even now 19 months on.

Thursday, June 2, 2011


We arrived at the small medical clinic in Petit Trou de Nippes about five hours after we left Port au Prince that morning. The distance is only 75 miles but the unpaved roads, traffic, and small lakes and rivers we had to drive through to get there made the drive take quite a while. Halfway through the trip my Haitian colleague Catherine asked me if I felt like I was in a blender due to the jostling of the Land Cruiser we were driving in. We just pretended we were getting expensive lower back massages the whole way.

Like the other clinics I’ve visited on this trip, this is the only one serving the 25,000 people who live in the area. Unfortunately, this one currently does not have a doctor because he left for a training course in Port au Prince and they fear he’s not coming back due to the poor pay he’s receiving working at the small government clinic. So it’s currently being run by an extremely young but committed first year resident who just graduated from medical school last year. I asked her if she felt ready to be running a medical clinic just one year out of school. Before she answered yes, she hesitated and looked around at the two nurses, social worker, administrator, pharmacist, and lab technician who were sitting on the bench across from her waiting to hear what she’d say. It seemed like she wanted to reassure them that she could do it.

Like the doctor on the island of La Tortue who asked for a better boat to get his patients across the ocean to the larger hospital, the doctor at this clinic also asked for better transport. However, she wasn’t asking for it so she could send patients to other facilities, she was asking for it so they could have a way to get women into her clinic to deliver their babies. The only “ambulance” the clinic has is two broken down motorcycles and they said they wouldn’t want to transport pregnant women on motorcycles even if they were working. That made sense to me. Or I should say it made sense for a brief moment. They went on to say that pregnant women usually come in to deliver on horseback or are carried in a chair or lying down on a door carried by their neighbors like pallbearers.

At that moment, I flashed back the advice I received at the labor and delivery class my wife and I had attended a few weeks ago in preparation for our son’s birth. “Partners,” she said, “watch out for potholes when you’re driving to the hospital. They are a killer when you’re pregnant.”

There are some things about working in Haiti (and the developing world in general), that are consistently frustrating. Visiting this hospital reminded me of two of them.

Nearly 100 doctors and over a thousand nurses get their degrees every year in Haiti. However, because they are paid so little by the government to work in public facilities, most do not remain for long. It is not uncommon for a doctor to make $500USD a month while a nurse can make between $250 and $350 depending on her level of training. And these are pre-tax salaries. Imagine a doctor making $6,000 a year. It’s insulting. Therefore, most of them either leave the country or work for NGOs in Haiti who pay them a decent wage. So while plenty of doctors and nurses are trained every year, many rural areas are left without a way to care for their people.

But I would say that by far the thing that makes you feel the worst, is that most of the things they are requesting can be provided with a relatively very small amount of money and yet they’ve been dealing with these problems for years. The doctor on the island of I’le a Vache asked if we could fix the leaky roof in his exam room so when it rained he and his patients wouldn’t get wet anymore. The doctor on the island of La Tortue needed $1,000 to dig a well so he could put running water in his hospital. The doctor in Petite Trou de Nippes said her dream would be to have an actual ambulance but she’d be happy if they could have some gurneys or stretchers so women wouldn’t have to be carried in on doors. The medical director of Beraca Hospital wants a sterilizer so they wouldn’t have to disinfect their instruments in a pot of boiling water on the stovetop anymore. The nurse on I’le a Vache needs a raise from $300 a month to $350 a month because her parents spent all their money to send her to school and now she’s responsible for taking care of her three siblings. And the administrator in Nippes, who was extremely proud to show me the professional patient records and filing system he keeps on all the patients who come in, said he needed a new desk because the one he’s using is just a piece of plywood sitting on top of two oil drums. For some reason, that one made me feel the worst. This guy was working for almost no pay (and often goes months without even getting a paycheck) yet was very proud of his work. The least you could do is give him a desk.

You could raise enough money from a bake sale to solve most of these problems. In fact, the Haitian doctor I was travelling with who had been working in the states for the last 30 years promised to personally pay the $1,000 for the well because of the thought of working in a hospital without running water was unbearable to him.

I take some comfort from the fact that I work for an organization that can help respond to most, if not all, of these requests. However at the same time I know we’re just scratching the surface. There are thousands of health facilities all over Haiti that need wells dug, leaky roofs fixed, and new desks for their administrators.

Friday, May 27, 2011

Travelling North

As I continue to travel around this country, I become more amazed and saddened that things actually seem to be more desperate once you leave Port au Prince. I came here to respond to the earthquake in Port au Prince but didn't imagine that things might actually be worse elsewhere.

Yesterday afternoon my colleagues and took the thirty minute flight from Port au Prince to Port de Paix in the far Northwest of the country. (A driver picked us up at the airport after driving up from the capital the day before and said it took him eight hours to get there due to the poor roads). We came to the north to visit two more hospitals in order to upgrade the conditions of their maternity wards and encourage more women to come to the hospital for pre-natal visits and delivery. As we drove down the long, bumpy and muddy road from the airport to the hospital I was struck by the fact that this town seemed to be the poorest I’d seen in Haiti. There were almost no other cars on the road (as compared to the constant traffic in Port au Prince) and the houses and roads looked to be in even worse shape than those in the capital. However, when we arrived at Beraca Hospital were greeted with a hot lunch of chicken, fish, plantains, rice and beans and a team of doctors and nurses who were eager to hear what we had come to offer.

Once again, I was struck by the eagerness and commitment of this medical staff to their jobs despite the fact that many of them had not been paid in months, their pharmacy had almost run out of stocks, and their sterilizer had broken so they had resorted to sterilizing their instruments in a pot of boiling water. This particular hospital had been funded by missionaries since it opened but funding has stopped and they haven’t received any outside support in over 10 years. Since they are not a government hospital, they do not receive any funding from the Ministry and thus have to rely on patient fees to support the hospital. That is almost unheard of in Haiti because it is simply not a model that can work here. Many patients cannot afford to pay for basic care. For example, ever since this hospital raised their fees for deliveries to 1,000GDS (roughly $25 USD), they only do 30 deliveries a month compared to the 100 they did before. So instead, the women have to deliver at home with the assistance of a matron who is often untrained and ill equipped to handle anything outside of a normal, perfectly smooth delivery.

This morning we left Port de Paix to head for La Tortue on a small boat with an outboard motor (that broke two times during the journey) and a purple velvet curtain attached to a PVC pipe that they used as a sail and boom. (The resourcefulness of Haitian people never ceases to amaze me).

When we reached the island of La Tortue I thought I might be at the end of the earth. This is an island of 40,000 people but only has 10 cars and a couple tiny boats to get supplies across. The steepness and bumpiness of the unpaved roads is astounding. A couple of times I thought for sure the Land Cruiser transporting us was going to tip over backwards due to the incline. And now, it’s 7pm and I’m sitting on the balcony of the only guesthouse in town overlooking the whole island that stretches nearly 50km long and 7km wide and there are no lights on as far as you can see in any direction. Indeed, the hospital we visited today only has power for 6 hours per day using a generator, does not have running water, and has to send patients to the hospital in Port de Paix (in that same velvet sail boat that takes nearly an hour—not to mention the trek to get to the water) if there is an emergency.

Today the doctor told us about a woman who came to deliver her baby at the hospital but he could not deliver the placenta no matter what he tried. So he sent her down the incredibly steep and bumpy road in the Land Cruiser and across the ocean in the velvet boat in order to be seen at the public hospital in Port de Paix. However, since this woman did not have the $30 for the procedure, they would not see her. So she waited outside the hospital for 4 days, meanwhile becoming infected, until finally her family was able to gather the money to get the hospital to perform the procedure.

This is an island where the hospital used to be the premier facility in the Caribbean and people traveled from all over the Caribbean to come for treatment. Today, I met the doctor at that same hospital on this same island and his first request was for a better boat so he could get patients away from his hospital and across the ocean to a different one.

This is an island where Napoleon’s sister once lived. Today, her house has been reduced to the foundation because the stones have been used to build dozens of other houses around the island by people who don’t have any other resources to use.

The sheer neglect of these areas over the past few decades has led to an astoundingly fast and extreme fall from decency.

Friday, April 15, 2011

Giving Birth in Haiti

Halfway through my trip to Haiti this week, my wife sent me an email saying that if our baby was born today, he would have a 90% chance of survival. I found that incredible given that Melissa literally just entered the third trimester last week. Obviously we hope that the baby will cook for the full 40 weeks and we won’t have to worry about an early delivery; but it is actually quite comforting to know that if he had to come out now for some reason, he’d probably be just fine.

The day she happened to send me that message I was visiting a hospital we’re supporting in a town called Marchand Dessalines, named after one of Haiti’s first leaders after independence, about two and a half hours north of Port au Prince in the mountains of the Artibonite. I learned from Dr. Fequirere, the young Haitian OB/GYN who works at the hospital, that if a child is born in Haiti at the start of the third trimester, there would be practically no chance of survival.

Haiti has the highest maternal and infant mortality rate in all of Latin America and the Caribbean. Pregnancy and its complications have become the leading cause of death and disabilities among women of childbearing age. Out of every 100,000 births, 630 women die giving birth. Roughly 77% of Haitian mothers give birth at home and nearly 100 babies out of 1,000 (10%) die during the first year after birth. The thought of my wife giving birth inside what’s become the typical home in Haiti, a battered tent or tarp help up by 4 sticks without any running water or sanitation, makes me queasy.

In this year after the earthquake, Direct Relief has been focusing on addressing the immediate medical needs of the population. We’ve supplied wound dressings, sutures, and wheelchairs after the earthquake; IV solutions, oral rehydration, and antibiotics after the cholera outbreak; and bleach, soap, shampoo, and toothpaste to address the poor hygienic conditions in the camps. However, now 15 months after the earthquake and 7 months since the outbreak of cholera, we’re taking a step back to look at the ongoing and ever-present medical issues facing the country. And the one that jumps out and takes your breath away is the number of women and babies who die unnecessarily every year in Haiti due to complications with childbirth.

The doctor at the hospital in Marchand Dessalines told me that day that they deliver roughly 80 babies per month, 10 of whom will die. While this hospital has 5 well-trained doctors, 18 nurses, and an anesthesiologist, they lack the material resources to save these babies. There is no blood bank in the hospital. Often times they do not have the medications needed to treat the women. And they do not have any incubators, let alone a neo-natal intensive care unit, to deal with premature deliveries. In fact, the doctor told me that they have to refer these pre-term labor cases to a hospital over an hour away. The road between the hospitals is impossibly bumpy and winding, and the woman is transported in the back of a truck. Imagine your wife or mother or daughter or sister having to endure that journey.

Bringing life into the world should not be a death sentence in 2011. As I know now, we have the technology and knowhow to treat babies who are born three months (or more) early. The eight hospitals we’ve selected throughout the country (that all have trained doctors, nurses, and midwives), will ideally become “centers of excellence” in Haiti with new equipment and supplies we’ll provide them to save more lives and encourage more women to come in for pre-natal care. My wife Melissa has now had nearly a dozen hospital visits and will double that by the time this baby is born; yet over 50% of women in Haiti don’t ever see a doctor before they give birth—partially because of the state of the medical facilities.

Sometimes it takes a personal experience, or just the ability to place yourself in someone else’s shoes, to relate to these issues that affect so many people on our planet. In fact, I think one of the biggest problems we face today is many people’s inability to walk a mile in another’s shoes. (Think healthcare for the poor and elderly, welfare for those who cannot find jobs, and the state we’re leaving our planet for our grandchildren. But that’s a topic for a totally different blog.) I remember when I broke my first major bone and couldn’t walk for over three months; I discovered a newfound respect for people with physical disabilities.

And now that I have a pregnant wife, a baby on the way, and know what we can do with complicated pregnancies in the United States, I’m shocked by what the majority of women in Haiti have to go through just to bring a new life into the world. But we’re doing what we can to help change that for the nearly 1 million women in Haiti who receive care at these facilities.

Friday, January 14, 2011

Working Together

Once again, I'm blown away by the coordination effort that groups in Haiti are pulling off. Now it's in response to the cholera epidemic and not immediate earthquake response, but it's still happening nonetheless.

Direct Relief brought in an unprecedented amount of supplies to respond to the cholera outbreak thanks to the support of corporate donors who make these essential supplies. However, we were then stuck with the challenge of figuring out how to deliver these supplies to the over 100 hospitals and clinics we support in Haiti. Many of them are dozens of hours away along bumpy, unpaved roads and some of the clinics are actually on the islands off the coast of Haiti. Getting the supplies to these areas would require a huge logistical effort and would be extremely costly.

However, out of no where, we were put in contact with a group from Germany who provide helicopter ambulance transports for patients in the rural areas who need to get to a larger, more sophisticated hospital. Well with a sickness like cholera, patients don't necessarily need to be transported--they just need to receive immediate oral re-hydration and possibly an IV and antibiotics. So this group has been generously providing their helicopter for groups like DRI to use to get these supplies out to the rural areas where the people are being treated.

This past week we've made a number of deliveries and hope we can continue to do so in the future as this saves crucial time (and money).

So thanks to German Help One for providing this valuable service!

Monday, January 10, 2011

One Year Later

I was talking to a reporter friend from a local paper last night who had been with me one year ago when I came to Haiti to help respond to the earthquake that killed nearly 250,000 people and left over 1 million people displaced. He asked me if things had improved since he was here last January. It’s the obvious question to ask as we approach the one year mark of the quake — and it’s one I ask myself every time I leave my home in Sacramento and arrive in Haiti (I’m now on my eighth trip) — but it still gave me pause. It is such a difficult question to fully answer.

Luckily I lost my phone signal soon after he asked the question so I had more time to think about it. What I decided to eventually tell him is if you look at the recovery effort at a macro level you’re going to get discouraged and assume the effort has failed. But if you spend some time in Haiti and squint your eyes a bit, you’ll see some amazing progress that has been made and you might meet a large number of people whose lives have actually improved.

On the surface, things look to be as bad as they were in the days immediately following the earthquake. Very little of the rubble that suffocates the city has been removed and the only homes that have been rebuilt are those owned by the very wealthy. The tent camps are ever present and have not gotten smaller. In fact, the first things you notice as you drive away from the airport are the huge tent cities that seem to grow every time you see them. The tents and tarps that the people are living under are completely exposed and there is no privacy to speak of. Bathing, cooking, and washing are done out in the open. Often times families of up to eight people share the same tent and have to rotate sleeping hours because there is not enough space on the bed or floor to allow everyone to sleep at the same time.

To add to the dire living conditions, there is a constant threat of post-election rioting. The riots are not only violent but they also end up blocking the city’s streets and cutting off essential services like water distribution and sewage removal.

And of course, now there is cholera. Roughly 12,000 people per week have contracted cholera since it broke out in late October and over 3,000 have died. There is not enough IV fluid or oral rehydration solution in the country to treat everyone properly. To make a complicated situation worse, there is a great deal of misunderstanding amongst the local population regarding how it is spread. Locals often do everything they can to keep the cholera treatment centers out of their towns because they fear these centers will bring the deadly disease into their communities. Reports of violence against NGO workers and UN troops have been on the rise and in the rural areas there have been lynching’s of people who are rumored to have brought the sickness. One aid worker I talked to encountered a barricade in the road comprised of dead bodies warning the international community to keep out.

In a disaster of this magnitude it is easy to look at these large glaring problems and say that nothing has been done and that money raised has been wasted. In an ideal recovery situation, nobody would be still living under a tent and everyone would be back in their homes. But it is unrealistic to think that such a feat could be accomplished within a year. Over a million people back inside newly rebuilt homes within a year? No one can realistically say that should have happened by now. More people died in Haiti after January 12th than all the natural disasters that have occurred in the U.S. combined. It’s hard to even fathom the scale and scope of the destruction. Ninety-nine percent of all government buildings were destroyed and many of the government workers inside them were killed. How do you rebuild a country in these circumstances? What does success look like in this situation?

I would argue that on a micro level there has been a tremendous amount of success. Vital health services are available to segments of the population that lacked them before. The lives of many have changed for the better during the past year and should be taken into account when judging the overall results of the recovery effort.

Before the earthquake, the only organization providing services for the handicapped and amputees in Haiti was a small organization called Healing Hands for Haiti. There are now at least eight other organizations throughout the country that are providing these services, and Healing Hands has dramatically increased its ability to serve patients. In the past year, the Healing Hands team has fit over 900 patients with new prosthetics or orthotics and performed nearly 5,000 rehabilitation sessions for these patients. That’s more than any similar company in the U.S. would ever do in one year.

A year ago Hospital Bernard Mews in Port au Prince was a standard private hospital that could provide a limited number of surgeries and procedures for their paying patients. As a result of the support they’ve received over the past year from Project Medishare, they are now a state of the art facility with multiple sterile surgical theaters and an infant and pediatric intensive care unit. And the hospital can now provide all of its services free of charge. Thousands of people have now been served by this hospital that previously would not have been able to walk through the gates.

And Direct Relief International’s own $750,000 community grant program alone has given over 1,000 students the opportunity to go to school and receive lunch for free, provided care for 500 orphans (many of whom have special needs), trained community health workers to work in an area where there previously wasn’t any access to health care, rebuilt a library, and set up a community arts center for 150 children who were affected by the earthquake. We’ve set up seed banks for 4,000 farmers in the North, offered pre-natal care and safe deliveries to pregnant mothers in Jacmel, brought psychosocial support to the residents of Thomassin, and supplied funding for a hospital in Leogane to rebuild their surgical suite. We’ve been able to do this by tapping into the local talent and expertise of Haitian people who are working to rebuild their country. And Direct Relief is just one of the over 12,000 NGOs working in Haiti. And all of them are also doing amazing things.

And perhaps most importantly, it seems that people are beginning to invest in Haiti and provide the desperately needed jobs so that people can begin to fend for themselves. We rent a warehouse space inside a local factory run by two Haitian businessmen and since we arrived here last year, three private companies — a lumber company, a plastics company, and company making fiberglass domes —have moved in and are now employing hundreds of people. And the owner has told me he has investment plans from other companies for the rest of the 30 acres he owns.

It’s easy to come here and say that things have not improved in Haiti and that the aid is not working. But had aid groups not responded in the immediate aftermath of the quake a much greater number of people would have died. Fewer would now have access to healthcare, schooling, and water. Of course more needs to be done and done better. But I think the people who have been fitted for new limbs at Healing Hands, the patients who have received life-saving surgical procedures at Hospital Bernard Mews, and the kids who are now getting to go to school would say that at least some things have improved.