[CCIH-Haiti] What should be the future of Haiti's health system? How can outsiders help?

[MartinRS at aol.com]

What should be the future of Haiti's health system? How can outsiders  help?
 
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?
 
Various ideas are being put forward. One CCIH member long involved in  
Haiti, IMA World Health, _www.imaworldhealth.org_ 
(http://www.imaworldhealth.org) , 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. 
 
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 
_haiti at ccih.org_ (mailto:haiti at ccih.org) 
 
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.
 
 
Steady supply of medical services begins to pressure  Haiti's doctors
 
By Lois Romano, Washington Post Staff Writer, Thursday, March 25, 2010; A12 
 
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. 
 
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." 
 
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. 
 
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. 
 
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. 
 
"We have not been able to make payroll for two months," Jerry Bitar said. 
 
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." 
 
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. 
 
"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." 
 
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. 
 
"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. 
 
The Bitars concede that they are overwhelmed with the new needs thrust upon 
 them, and that current resources are not enough to meet demands. 
 
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. 
 
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. 
 
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. 
 
"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." 
 
Added Jerry: "Before, they would beg us to go home early after surgery. Now 
 they are crying to stay here." 
 
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. 
 
"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. 
 
"What's the point of saving a life," Butin asked, "if she is going to just  
sit there for the rest of her life?" 
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