by Dr. Alexandre Carvalho, Reynolds Fellow
As another month comes to an end, the situation in Haiti improved but still a lot as to happen before the population can return to their normal lives. The country is still in a harsh situation, and the rainy season starts this April. How are things down there? What are the immediate and long term needs? What are the next steps? With those questions in mind, our group (Public Health Action Group) led by me and Erika Pozo, went to Haiti during this Spring break to find that much had changed and new challenges had arisen.
We stayed with a local church group in a very poor neighborhood of Carrefour, SW of Port-Au-Prince. They run an elementary school (Ã‰cole Le Bon Samaritan) that was damaged but not collapsed during the earthquake. The school is now closed waiting for an structural assessment of its foundations, so that it can retunr to its normal activities safely. The school is led by the amazing Rev. Jean Millien and his wife Mona Millien; by renting physical space and with the help of generous donations and medical volunteers from Connecticut, the Milliens opened a small clinic that provides basic care to the surrounding population. Their small clinic, when staffed by health professionals, cares for an immense number of people that would have nowhere to go: Haiti does not have a Universal Health Care system, and medical services and medications are expensive and out of the reality for the majority of the population that lives with less than a dollar per day.
While working as a medical volunteer with them, it became clear that the needs shifted to a more primary health care pattern: the complaints were basically fevers, diarrhea, skin infections, vaginal discharges, parasite infestations, anxiety disorder, headaches, malnutrition, and so forth. Clearly a different scenario from the immediate aftermath of the event. But even though our humanitarian work is much needed, in the way the current relief efforts are being carried out, they won't suture the wound, or even worse, they won't prevent future injuries from happening. And here is where the wake-up call is ringing but still not waking up anyone in the mainstream disaster relief establishment: where is the capacity-bulding mentality? Where is the vision for the future?
In Haiti right now, all the healthcare efforts carried out by the "big orgs" (like WHO/PAHO, UNICEF, USAID, etc) are centered primarily on Port-Au-Prince and have a focus on the big Tent Cities. The other relief NGO's such as the Red Cross and Doctors Without Borders are tackling the medium encampments. The remaining displaced are settled on small and micro tent communities that house around 10-50 families each, and their health needs are desperately not met. As you walk around the streets, take a car and drive around the country, or even use google maps, the amount of those small groupings is on the thousands.
Things need to be done in a different way, and from the start. We need to take the example of the Milliens to the rest of Haiti and other scenarios where natural or war catastrophes happen. A multilateral fund that will be used to set small primary health care clinics on interested local church groups or grassroots organizations, with local management and leadership, as well as a stipend for local programs. Start with health education, outbreak surveillance, census of the people in the vicinities. Provide medical, safe water and nutritional services; be the frontline that will be connected to the larger relief work and give headquarters an online input and output advanced station. Furthermore, by providing community organizing skills to local leaders, leverage organized people to pressure governments for services; later, use that same dynamo to set the stage for small entrepreneurial businesses supported by microfinance mechanisms. Do all of this paying the local people that are without jobs and that had their lives disrupted by the tragedy.
This model would provide the roots for power for individuals to really change their conditions in the long run, and not just wait for chance to smile or frown; health promotion and disaster prevention indeed, helping local people to grow wings and resurrect from the ashes.