HELPING DIRECT RELIEF INTERNATIONAL HELP THE PEOPLE IN HAITI


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.

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.