before and after
Traveling to Haiti in December 2009, weeks before the earthquake, exposed me to healthcare in a low-resource area.
Hospitals ran without support staff and with only the most fundamental of supplies. I saw fractures being set without pain medication and sometimes without even an x-ray. Why? The answer is simply that the patients couldn’t afford it.
One woman came in with symptoms of congestive heart failure. She was short of breath and had significant swelling and pain in her legs. A resident doctor on duty evaluated her for free, a service provided by the state. But the healthcare coverage stopped there unless the woman or her family had the means to buy the treatment right there on the spot.
In this case they did. A family member went to buy diuretics, a needle, a syringe, gloves, gauze, and tape from the pharmacy across the street. They came back with the supplies in a brown paper bag, and the doctor administered the medications. This bare-bones supply system of sorts was commonplace at many hospitals across Haiti.
There are an estimated 25 physicians and 11 nurses for every 100,000 Haitians. This makes them a valuable asset to the country. (By comparison, its neighbor the Dominican Republic has more than 185 physicians and 180 nurses for every 100,000 residents, according to the World Health Organization).
When the magnitude of “something vs. nothing” is so powerful, their every act of care makes a great difference. In the days following the earthquake in January 2010, knowing that these strong and dedicated Haitian doctors were on the ground working hard as they always did was a central part of me personally coping with the tragedy.
Returning to Haiti two years later (over the recent winter break) showed me once again the effects of chronic endemic poverty. The common pediatric illnesses requiring hospitalization included malnutrition to the point of kwashiorkor, and gastroenteritis to the point of severe dehydration. In the outpatient setting, it was again and again cases of abdominal parasites and ringworm.
Parents often said they couldn’t afford to buy treated water or age-appropriate formula. Across the board, healthy children were still under-weight and under-height compared to international norms, stunted by their living situations.
During the most recent trip, we were fortunate to shadow and precept at St. Nicholas, a hospital in financial partnership with Partners in Health. They had many basic medical supplies and medicines in stock, free for patients. This made a world of difference.
One evening our group met at the home of Dr. Kerling Israel, a young Haitian physician who has trained both in her home country as well as in the U.S. and now works for Partners in Health in Saint Marc. We asked her what she felt Haiti’s health system needed most.
She answered thoughtfully and carefully: two things.
The first, she said, was medical supplies; the plastics, the instruments, the medicines that are simply nowhere to be found. The second is investment in sustainable operations. One example is her current work to build permanent partnerships between Family Practice Residency programs in the U.S. and the Residency training programs in Haiti. This exchange of faculty and residents benefits all involved and strengthens the future health infrastructure.
I witnessed the effects of chronic endemic poverty both before and after the earthquake, and the subsequent international aid response. In most ways not much has changed, but at least we’re getting closer to understanding and solving the long-term solutions. Many people, inside Haiti and out, are taking the first steps to raise the standard of care where it is needed most.