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Haiti Update: Lambert Santé’s Director Honored with Award from the Ministry of Health

May 28, 2010 in Haiti by Kevin Connell | Comments closed

by Kevin Connell, RMF Program Director, Caribbean

Real Medicine has continued to push forward its strategy for healthcare in Haiti.  Our partnership with Lambert Santé has been building traction over the past few weeks.  The hospital has already hired 3 out of 4 new medical residents to join the core staff at the hospital and is working on hiring 4 nurses, which we expect to happen over the course of the next two weeks.

This critical increase in the rotating core medical personnel at the hospital will go to support 24 hour emergency care, continued post-operative care for earthquake-related injuries and general practice medicine.  The increase in manpower will begin to help replace what has been a steady but reduced flow of volunteers and ensure that the hospital always has someone available to handle cases, no matter when they should arrive.  Real Medicine plans to expand this program in the next few months as the hospital continues to transition away from disaster-related care.

The residents will train under Dr. Margaret Degand, the hospital’s Director, who was recently featured in the Port-au-Prince newspaper, Le Matin, as a leader and hero in the private Haitian community’s response to the health crisis.  Dr. Degand is a plastic surgeon by trade, who made the pivotal decision on January 12th to change her clinic into a hospital and begin offering a range of advanced care and treatment services to the surging patient population. 

Quickly becoming a go-to destination for fracture-repair (through what is called external fixation), reconstructive surgery and post-operative wound care, her small 14 bed facility rose to the challenge, treating more than 1200 patients since that first day and performing more than 820 surgeries.

Dr. Degand, who was a highly-regarded surgeon before the crisis, has recently earned praise for her efforts in post-earthquake healthcare delivery.  As noted in the article, she received an Honorary Certificate of Merit last month from the Haitian Ministry of Health for her efforts, an award which she has proudly hung over the hospital’s entryway.  Dr. Degand is quite proud of what she has been able to accomplish for the Haitian community in the past four months, and her success in responding to the need is only enhanced by her hope to help transform the quality of care given to the Haitian public permanently through continued partnerships with the international community and the Haitian government.

She works around the clock at that dream, often taking patients in for emergency treatment in the middle of the night or performing as many as 23 surgeries on the same patient to ensure best-practice results for everyone—regardless of their means.  Her hospital has relied on the generosity of the international medical community and Dr. Degand’s wide-network of friends in Europe, highly successful surgeons, anesthesiologists and other medical professionals, who continue to volunteer their valuable time to fly to Haiti and serve in her hospital.

However, the resources are not as available 4 months after the crisis as they were at the height of the crisis, and Dr. Maggie, like so many health directors at hospitals throughout Port-au-Prince, is anxious about the future.  She knows first-hand the need for restructuring in the healthcare system, which has been ravaged by the widespread destruction.  Since January 12th, private hospitals have stepped in to fill the void in available health infrastructure (due to the earthquake’s destruction) to meet the heightened need for treatment around the country.  However, many hospitals are straining to meet the public need without sufficient external support from the government or from international donors.  Some are even closing under the financial pressure, as was the case with RMF partner hospital, CDTI.

Dr. Degand sees the need to support public/private hospitals with funding not just as a short-term solution to save the country from a protracted health crisis, but as an opportunity to improve the quality of public healthcare in Haiti for good.  In the article from Le Matin, Dr. Degand says (translated from French):

“All these people who died must not be for nothing; we must ensure something comes out of it. Public health, good or bad, is too expensive in Haiti because of a lack of resources, unlike in the Dominican Republic where [even] the private medical sector is generally subsidized by the state or banks”.

Dr. Maggie believes that the outcome of the health crisis in port-earthquake Haiti should be the formation of a new public health system built in partnership with private hospitals and clinics to ensure quality healthcare for all, rich or poor.  At Real Medicine, we couldn’t agree more.

Read more about our partnership with Lambert Santé

Read more about Real Medicine in Haiti


Run for Haiti: your legs can save lives

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Haiti: Reacting to Sean Penn’s Testimony to the Senate Foreign Relations Committee

May 24, 2010 in Haiti by Kevin Connell | Comments closed

Sean Penn made a powerful point in his speech to the Senate Foreign Relations Committee on Wednesday in his update on the reconstruction efforts in Haiti.  He reported that the international community’s unprecedented support after January 12th has not made its way to the community fast enough, citing excessive caution at the hands of the decision-makers in writing the checks.  Mr. Penn said that the “bureaucracy of international aid is protecting people to death”, arguing that in trying to avoid the problems of aid to Haiti that have taken place in the past like corruption and aid-dependency, the international community is jeopardizing the current effort to save lives on the ground.

In the critique, he referenced a slew of other problems that have directly arisen through those cautionary delays.  Among them, Mr. Penn mentioned the 5 fully-functional hospitals “in this city of ruins” that have had to close since the disaster because they ran out of money and couldn’t meet the sniff-test of donor agencies quick enough.  He also discussed the children who have been allowed to die of simple but deadly diseases, including a recent 15-year-old boy with Diphtheria, because of a lack in supply of basic medical treatments.

Mr. Penn’s argument resonated with me because I’ve experienced them directly.  We worked to raise emergency funding for our partner, CDTI Hospital, before it was forced to close in March.  Our efforts and those of the international community proved to be too little and too late to save the hospital, but for some reason it seems that the reconstruction effort in Haiti is slow to learn its lessons.  Organizations continue to draw up plans to fund the construction of new hospitals that will take years to build while more of the remaining facilities—already providing public healthcare each day—continue to run out of funding.  Finally, I watched first-hand as the boy that Mr. Penn talked about was turned away from our other partner hospital, Lambert Santé, despite the staffs best efforts, because they, like all the other facilities Sean’s team visited that day, lacked the available treatment.

The same frustrating lack of coordination that has plagued relief efforts in the initial weeks is still evident in these critical gaps in program funding and medical supplies, vaccinations and treatment distribution—holes that continue to claim lives while the decision-makers deliberate the best way to plug them.  While there is a strong argument to be made for exercising caution and thinking long-term, the international community should keep in mind that some problems—like ensuring basic healthcare in a city largely destroyed by a natural disaster—don’t wait for a convenient time to be fixed.

In his point on Wednesday, Mr. Penn was dead-on.  We can only hope that someone up in Washington was listening.

A transcript of the speech is available here.

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Sleeping Giant – Port-au-Prince, April 18, 2010

April 18, 2010 in Disaster Relief, Donate, Haiti by Kevin Connell | Comments closed

After a three-week hiatus from Haiti to help present Real Medicine’s strategy for the country to key contacts in Washington, including a Director on Obama’s executive committee at the White House, it’s been very strange being back on the ground in Port-au-Prince.

I’m not sure what has specifically changed.  The crush of relief workers, military personnel and patients is less pronounced but still ever-present.  There is still unbearably bad traffic in the mornings and afternoons on the major arteries, UN peacekeepers / Haitian police continue to prowl the streets and setting periodic roadblocks, and the massive tent communities continue to loom, sweeping through the city’s interior up into the suburbs.  But overall, things seem to have settled down into an eerie sort of aftermath calm—a grudging acceptance of the new baseline—where the original problems persist, but have been allowed to recede just below the surface.

One of the topics of discussion you hear everywhere is the concern over where and how the money donated for the reconstruction is being spent.  A recent article mentioned close to $10 billion in aid that has been pledged so far for the long term rebuilding and development of Haiti.  But if you are here on the ground, that money is hard to see.  The tent communities are now getting drenched each night in the inevitable nightly monsoon that happens at about 7pm.  These rains are expected to get much worse as the season progresses.

One tangible thing I have noticed is that much of the rubble that once clogged the streets downtown has been removed or neatly pushed into corners.  However, I do not see many trucks carrying wood or hear the sound of hammers, drills or saws in the distance.  Most people have yet to see the temporary housing structures being built that were so central to the reconstruction plan.  The UN had put together an elaborate strategy to carve out zones in each neighborhood to move the original residents of those neighborhoods back into while the surrounding buildings are rebuilt.  It seemed like a very sensible plan—preserve the social and familial networks while making room for the reconstruction.  However, like many of the plans for this country post-earthquake, we are still waiting to see them actualized.

As a somewhat-related side note, I just read a security brief from a friend in the business here that left me very concerned about the stability of Haiti in the near future.  The 4,000 criminals that escaped from jail when the national prison collapsed have reportedly been rebuilding their criminal organizations alongside the reconstruction efforts, and it’s feared that there may be a rise in rioting/crime on the horizon, particularly if the aid/reconstruction funding continues to go unseen.  One piece of news that was particularly startling was that some of these gangs actually have training camps in certain areas of the city where the work to prepare for kidnappings, robberies, etc.  With the 2 MSF employees kidnapped in March, it seems the stage may be set for more clashes between the relief efforts and the inner-city’s criminal element.

Despite these challenges, Real Medicine has continued to push forward with its plans to continue to build sustainable primary healthcare in the communities that need it the most.  We are currently discussing project plans with key partners in Haiti.  One of which involves being the implementing partner for a new primary health clinic in a neighborhood to the north end of the capital that has very little access to basic healthcare.  Our team has been performing due diligence on these partnerships, the proposed communities involved and the project itself to ensure that all three meet with our standard of expectation.   Funding remains a key concern for this and other projects, as we work to access the unprecedented amount of funding that was raised in the initial weeks after the disaster.

Part of me is happy with the delays, recalling that the ~$9B was given to this country’s development over the last decade had yielded a corresponding drop in GDP of 25%.  Clearly, we need to be careful with our aid and development budgets.  But then I think about those people living under sheets amidst the monsoon-like rain we had tonight—so bad that it was difficult to drive through the runoff on the road.  And I wonder what all this time is really adding to the decision-making—shouldn’t the risk/reward of a development project be clear enough after 8 weeks of review and analysis?  It leaves me wondering if that money will make it to the efforts on the ground after all.  Until then, the development community (Real Medicine included) will continue to hurry-up and wait for continued progress in Haiti.  I only hope that the locals living out in the mud can do the same.


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Haiti’s Looming Healthcare Transition

March 12, 2010 in Haiti by Kevin Connell | 1 comment

Joshua hasn’t always had this much attention.  He was found after the earthquake hit by some rescue workers who were searching through the rubble for survivors.  Joshua was significantly dehydrated, malnourished and bleeding profusely from deep lacerations to his arm.  In the aftermath of the biggest earthquake to strike Haiti in more than a century, he had been left alone to fend for himself in the dust and rubble. 

Somewhere between eight and ten years old (no one is sure), Joshua is non-verbal and struggles from the debilitating effects of Cerebral Palsy.  He has clearly never received treatment for the disorder, which has especially stunted in his development.  Yet when you look at him, Joshua stares right back into your eyes, offering facial expressions and hand gestures that tell you he understands much more about what is happening than he can convey. 

Some weeks after abandoning him in the quake’s aftermath, Joshua’s mother learned of his new home at CDTI.  She has dropped by a couple times since the quake to try and remove him from the hospital before his wound treatment has been completed.  Joshua’s mother uses him to make a living, dragging him with her on the streets as a token of helplessness to use to beg for money.  To her, she once told the hospital staff, he is nothing more than a dog. 

Ironically, the Jan 12th earthquake brought about the most loving and committed family Joshua has ever had.  Ever since some of the staff members, including Julie “Jitterbug” (nickname) Pearce, brought him in for emergency treatment at Sacred Heart, Joshua has been the heart and soul of the hospital.  Nurses give him pats and high-fives as they walk by; doctors offer him candy after his checkups; his days living in the tents at the hospital have been so great to him that Joshua is rarely seen without a huge smile on his face. 

As beautiful as his story of rebounding from disaster sounds, Joshua nevertheless underscores a huge problem facing Haiti.  With the emergency phase of relief interventions over, the healthcare in-country is now at a critical transition point where the private hospitals and clinics that opened their doors to the earthquake victims in the initial days of the disaster are now running out of funds.  Their contributions for the past two months are no longer sustainable and without external support, each one of these novel public/private operations—critical in filling the dearth of healthcare facilities in Haiti—will have to close. 

Staffing is the clearest example of the shifting needs.  The volunteers who are coming for 2+ week assignments are fewer, and holes are becoming increasingly apparent in the hospitals’ available human resources to handle the increased patient loads from the ongoing health crisis.  The initial emergency that connected their separate worlds has now abated, leaving behind large long-term healthcare challenges that have to be addressed by more permanent solutions on the ground.  There is little or no clarity about where patients at many private hospitals would go, should the doors close to this option. 

We saw this most clearly with our physical therapist, Mel Hoffman’s, departure.  On her final day, she made the rounds to the thirty or so patients she had befriended in her daily physical therapy sessions saying goodbye.  Spending the entire afternoon, Mel finally came to Joshua’s bedside.  After spending some time with him, she gave him a long hug and slowly turned to leave.  Before Mel had taken three steps away, Joshua was screaming and crying hysterically.  Any doubts I had had about his ability to understand the circumstances around him were dispelled at that moment.  It was clear that he knew exactly what was happening.  With a heavy heart, Mel went back, picked him up and rocked him for ten minutes while he cried, wetting himself in the process. 

Joshua Cries

Eventually she handed Joshua over to another one of the staff, stood up and walked away for good, but it was clear that neither she nor Joshua would ever be the same.  Two worlds, brought together for a short while by a common hope were sliding apart once again by their uncontrollable fates.

Mel Hands Over Joshua

Much like Joshua, Haiti is in transition, reluctantly being handed over to those who will have to care for its long-term development.  Indeed, despite the contributions of so many from around the world, healthcare in Haiti will inevitably have to become Haitian once more.  But the international community needs to do more to ensure that this transition takes place effectively and responsibly.  Haiti can’t afford to be left behind again.

Despite the questions that remain for Haiti’s future, the strength of its people remains resolute, shown most clearly by Joshua.  As Mel hugged him one last time before walking out of Sacred Heart and back to her life in the United States, I watched as tears ran uncontrollably down her face and Joshua, the child with little hope for a normal life in the future, wiped them away. 

Mel & Joshua Say Goodbye

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