Wednesday, August 17, 2011

Frustration Following Earthquake

"The frustration of many volunteers and disaster relief experts (who arrived following the January 12th earthquake) was rooted in their inability to find a system capable of effectively using their resources and good will. 'We were unprepared for what we saw in Haiti-the vast amount of human devastation, the complete lack of medical infrastructure, the lack of support from the Haitian medical community, the lack of organization on the ground,' wrote three New York surgeons after a mission to the quake zone. They first showed up at the General Hospital [in Port-au-Prince (where my colleagues had directed them)] but felt that their efforts to help were futile: 'This facility could not nearly accommodate our equipment nor our expertise to treat the volume of injuries we saw.' A number of visiting medical teams felt similar frustrations well before they packed and left. They had encountered, for the first time, the profound weakness of the underdeveloped public hospitals that should have been the frontline in the fight to save lives after the quake. From day one, friction grew between teams with much-needed skills and those, mostly Haitian, who had for years tried to keep such facilities from collapsing.

Most of the friction did not stem from cultural barriers. Some of the complaints came from Haitian-American professionals who spoke Creole and French just fine. (Many were happy to question, in those languages, the competence of their fellow Haitian professionals. It was a combustible mix, and a conversation to which non-Haitians contributed at their own peril.) These were, rather, structural problems. The urban public health delivery system, long weakened, was now all but destroyed. Beyond saving lives, the medical practitioners faced a choice between giving up on the public system and seeking to rebuild it. It was for this reason we sought to direct expertise, skills, and goodwill towards the public-sector institutions still standing.

These frustrations were not new. In previous decades, we had encountered the same deficits and dysfunction while trying to provide health care to Haiti's poor. We learned early on about the friction between the diaspora and the Haitians we worked with-those who had never left. But such friction was not a given, nor did it prevent young Haitian-Americans from providing some of the best, most patient care in the days after the earthquake. Natasha Archer, a young Haitian-American resident physician from Harvard, was one of the many volunteers based at the General Hospital. One night, after a long day of service, she wrote about lifesaving work of a makeshift surgical team from Haiti, Boston, New York and New Jersey. When a young girl presented with a rigid abdomen late one evening, and an x-ray suggested a perforated small intestine, she was immediately taken to the OR. The cause was likely typhoid. Natasha warned, correctly, that a lack of proper sanitation would lead to more such cases- and other waterborne illness.

I had reviewed the scant literature on typhoid in Haiti a decade before (it revealed the same high prevalence) and came to the same conclusion. I'd issued the same warnings. A few years before the earthquake, Haiti was declared the most water-insecure country in the hemisphere. After the temblor, sanitary conditions only magnified the threat of waterborne pathogens, including cholera- the most dreaded consequence of disaster and displacement. This was, again, what doctors termed an acute-on-chronic problem: one that should have been dealt with long ago, and one crying out for attention in the weeks after the quake. The good news was that, with proper surgical care, this girl's life could be saved, and it was. Young doctors like Natasha were often the glue that held together people from what seemed like different worlds, people with the best of intentions."

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