<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<HTML><HEAD>
<META http-equiv=Content-Type content="text/html; charset=US-ASCII">
<META content="MSHTML 6.00.6001.18385" name=GENERATOR></HEAD>
<BODY id=role_body style="FONT-SIZE: 10pt; COLOR: #000000; FONT-FAMILY: Arial" bottomMargin=7 leftMargin=7 topMargin=7 rightMargin=7><FONT id=role_document face=Arial color=#000000 size=2><FONT id=role_document face=Arial color=#000000 size=2>
<DIV>What should be the future of Haiti's health system? How can outsiders
help?</DIV>
<DIV> </DIV>
<DIV>Two and a half months since the Haiti earthquake, health professionals are
still addressing urgent needs, but also thinking more and more about the
long-term future of the health sector in Haiti. Even before the earthquake,
health services were not strong. Might now be a time to think about and plan for
a stronger, more sustainable health system in Haiti? What directions
do Haitians want to go? How can outsiders best help?</DIV>
<DIV> </DIV>
<DIV>Various ideas are being put forward. One CCIH member long involved in
Haiti, IMA World Health, <A href="http://www.imaworldhealth.org">www.imaworldhealth.org</A>, has been
exploring interest in a decentralized health system that would involve NGOs and
FBOs as well as government, borrowing from IMA experience in countries such as
D.R. Congo and Sudan. </DIV>
<DIV> </DIV>
<DIV>If you have ideas or opinions about the best way forward, feel free to
share them with this listserv community by sending a message to <A href="mailto:haiti@ccih.org">haiti@ccih.org</A></DIV>
<DIV> </DIV>
<DIV>And read this article below from the Washington Post which asks this
question as well, and points out that in some ways, all the well meaning
foreigners providing free health services may actually be making things worse
for the longer-term future of Haiti's health system.</DIV>
<DIV> </DIV>
<DIV> </DIV>
<DIV><FONT size=4><STRONG>Steady supply of medical services begins to pressure
Haiti's doctors</STRONG></FONT></DIV>
<DIV> </DIV>
<DIV>By Lois Romano, Washington Post Staff Writer, Thursday, March 25, 2010; A12
</DIV>
<DIV> </DIV>
<DIV>Jerry and Marlon Bitar are prominent Haitian surgeons, identical twins who
have done everything together for all of their 48 years. They both studied
medicine in France, returned to Haiti in 2000 to take over a clinic serving
low-income patients, and built a separate private practice that has given them
national prominence and paid the bills. </DIV>
<DIV> </DIV>
<DIV>In the weeks following the deadly Jan. 12 earthquake, they worked 18-hour
days side by side, performing 900 surgeries and amputations free of charge
between both of them. And now, their lives are defined by the same split
reality: "before the earthquake" and "after the earthquake." </DIV>
<DIV> </DIV>
<DIV>Sitting in their cramped office, the brothers tell the story of most
Haitian medical providers and hospitals. Since the earthquake, Haiti has been
awash with doctors from all over the world providing the kind of top-notch care
rarely experienced in this chronically poor country. It has been a gift of epic
proportions, the Bitars say, in a place burdened with disorganized health care,
and high rates of HIV and tuberculosis. </DIV>
<DIV> </DIV>
<DIV>But as the immediate crisis starts to wane, more and more patients with
maladies unrelated to the earthquake are turning to international health-care
teams led by the World Health Organization, raising concerns about Haiti's
ability to care for its own once the relief teams pull out and need for
rehabilitation and long-term care grows. </DIV>
<DIV> </DIV>
<DIV>The Bitars ask what appears to be a simple question: How can the country's
medical structure be rebuilt when hundreds of humanitarian teams are still
providing health care for free? The surgeons say they have no income -- not from
the poor and not from their private practice. For one, 700,000 people are now
homeless with no access to funds. For another, the hospitals, the Bitars and
others say, are finding it hard to compete with the visitors. With no end in
sight, some of the nation's doctors have already left, and others are
considering leaving. </DIV>
<DIV> </DIV>
<DIV>"We have not been able to make payroll for two months," Jerry Bitar said.
</DIV>
<DIV> </DIV>
<DIV>Marlon added: "I am very worried that many of our good doctors will leave.
The humanitarian hospitals, they don't ask for any money. Yesterday, I went to
one and saw two of my private-paying patients getting treatment there." </DIV>
<DIV> </DIV>
<DIV>Indisputably, international organizations are carrying the Haitian
health-care system today -- and will continue into the indefinite future. Many
Haitian health-care providers were among the 230,000 killed in the earthquake,
and others have not shown up for work, dealing with their own losses. The
nursing school at the University Hospital collapsed during exams and killed
essentially an entire first-year class of nursing students. </DIV>
<DIV> </DIV>
<DIV>"It is a very difficult situation," said Thomas D. Kirsch, a professor at
the Johns Hopkins medical school and an expert in developing-world health issues
who was recently in Haiti. "If these organizations pulled out, the system would
be worse than ever, and as long as there is free care available, that's where
the Haitians will go and the Haitian doctors will have no business. . . . There
must be a well-planned transition period to subsidize the Haitian health-care
system, have [nongovernmental organizations] work directly with Haitian
providers, and to train sufficient providers and nurses to be able to meet the
population's needs." </DIV>
<DIV> </DIV>
<DIV>Nyka Alexander, a spokeswoman for the World Heath Organization, said that
"the international community working in health will not leave before a system is
in place, and this is precisely what we are working on . . . to build an
accessible system better than what was here before the earthquake." One part of
the plan, she said, was suggested by locals: Build mobile clinics so people
don't have to rely on emergency rooms. </DIV>
<DIV> </DIV>
<DIV>"It's going to require strong leadership from the Ministry of Health to
develop new policies, training and better pay," said Dana Van Alphen, a doctor
handling disaster management in Haiti with the Pan American Health Organization.
</DIV>
<DIV> </DIV>
<DIV>The Bitars concede that they are overwhelmed with the new needs thrust upon
them, and that current resources are not enough to meet demands. </DIV>
<DIV> </DIV>
<DIV>Down a narrow side street cluttered with rubble and garbage, behind an
elegant tall gate, sits the Bitars' oasis of yellow, low-slung buildings, hardly
touched by the earthquake. The inside of the Bernard Mevs Clinic tells another
story. A dozen tents used as hospital rooms dwarf the courtyard because the
patients refused to stay indoors, terrified of another earthquake. Adding to
their load, several HIV and AIDS facilities were destroyed, and the doctors
faced an additional 500 patients at their door, desperate to keep up with their
medication. </DIV>
<DIV> </DIV>
<DIV>The Bitars say they have enough HIV and AIDS medication, donated by the
Gheskio Center, and some additional support from Food for the Poor, both
nonprofit groups. Beyond that, the brothers say, they have received supplies
they don't need -- arthritis medication -- but are low on such basics as
sutures. </DIV>
<DIV> </DIV>
<DIV>Many of the patients have been there since the earthquake. A beautiful
13-year-old girl with an amputated leg glumly learns to push herself around in a
wheelchair. A 58-year-old man who was pulled from rubble sat for nearly two
months before a volunteer physical therapist pushed him to take some small steps
this week. A 39-year-old woman whose house collapsed on her and whose neighbors
amputated her arm to save her life sits day after day in her tent. When she was
brought to the hospital, the doctors amputated her leg as well. </DIV>
<DIV> </DIV>
<DIV>"Our biggest challenge is the next step: Where do these people go to
recover?" Marlon Bitar said. "Before the earthquake, we did a surgery, they
would leave, go home or stay with a member of their family. Many have lost their
homes and families. Now they are our responsibility." </DIV>
<DIV> </DIV>
<DIV>Added Jerry: "Before, they would beg us to go home early after surgery. Now
they are crying to stay here." </DIV>
<DIV> </DIV>
<DIV>Last week, a group of occupational therapists from the AFYA Foundation in
New York arrived unexpectedly. They had airlifted medical supplies and
equipment, such as syringes, IV bags, tents, mattresses and blankets. They
showed up at the Bitars' clinic and started to train the nurses in physical and
occupational therapy. </DIV>
<DIV> </DIV>
<DIV>"I am half a woman," Coreus Aieula told Danielle Butin, an occupational
therapist who founded the group and who showed Aieula how to put on a bra with
one hand. </DIV>
<DIV> </DIV>
<DIV>"What's the point of saving a life," Butin asked, "if she is going to just
sit there for the rest of her life?" </DIV></FONT></FONT></BODY></HTML>