Wrap up on Haiti

11 Feb 2010 Wrap up on Haiti

I’ve returned to something approximating a normal routine after the trip to Haiti. I’ll admit to the usual disappointment that “everything,” didn’t change. By no means did we fix the country, or even come close (not that such was ever our intent). As on previous trips, we helped a few individuals who needed help. Most of the trip was about touching people who are sleeping in the streets and vacant lots near their ruined homes and workplaces. Perhaps 10% of our patients received direct medical help for immediate medical problems. The other 1350 (give or take) at least got to interact with three separate people who touched them and listened to their stories. They got to sit in the shade for a few hours. They got clean water if they wanted it and emergency food if they needed it. They left with a couple of bags of over the counter medications that might help with aches and pains, congestion, and getting to sleep.

It was the best we could do.

The most popular question I’ve gotten, when people hear that I went, was “how is it?” Here’s what I say: It’s bad. It’s very bad. The city is ruined. Many streets look normal until you realize that you’re looking at 2nd floors that are resting on the ground. The people are still hungry. One mark of this disaster will be a population with a sizable proportion of amputees. I expect many buildings to be rebuilt with an eye to handicapped access. Another mark will be years of psychological issues. We took to calling it “Earthquake Survivor Syndrome.” A constellation of symptoms – inability to sleep, sour stomach, headaches, body pain, night terrors, and so on. All perfectly reasonable reactions to having your home destroyed, relatives killed, and sleeping on the ground for weeks with no end in sight.

The challenge for Haiti in the next decade will be to leverage the disaster, horrible as it was, into an opportunity. Haiti remains the poorest nation in our hemisphere. It’s perhaps an hour by air from Miami. As I’ve been saying to people over the past four years – this situation is in our backyard.

At some point in the not too distant future, the flavor of the aid that we provide will need to change. Usually, my group charges a nominal fee for clinic visits. Not much – and certainly nowhere near enough to cover our expenses – but charging prevents us from undercutting local care providers. If we always gave away free care, people would simply wait for the free doctors rather than keeping local doctors employed. We want to wind up as a supplement to local capability – not a replacement. Similarly, when we build a school or a clinic – we are very careful to build a Haitian team who are responsible for it – and then provide the resources they need in order to take the lead on construction and operation.

Obviously, on this trip, everything was free. But sometime soon, outright aid needs to become partnership instead. Managing that transition will be a challenge for everyone. This is the difference between the Partners in Health approach, and (for example) the Doctors Without Borders. The latter roll in with team after team of highly trained doctors and staff – but then they roll out again. PiH stays to build capability from the bottom up.

What can we do that would help the most? I honestly do not know.

I do want to give shout-outs to some groups I saw working down there:

* We saw some really high grade shelters and tents provided by Rotary International, Canada, and Coleman. I’m sure that a lot of other groups provided shelters, but those three were everywhere.

* The Dominican Red Cross were everywhere.

* “Save the Children” had truck after truck of supplies rumbling around town.

* The US armed forces were omnipresent – and we heard a rumor that these men and women were volunteering their non-deployment time (i.e: time that they could have been working at a US base and living with their families) to serve in Haiti.

* And of course, Partners in Health.

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