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Rebuilding Health Care System Major Hurdle for Haiti

Ray Suarez reports on how Haitian and international medical teams are wrestling over whether to discharge earthquake victims who have been treated, but don't have homes where they could continue their recovery.

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    When the buildings came crashing down, the patients came rushing in. And two weeks on, the living are scattered in hospitals on both sides of the Haitian-Dominican border. Many have badly damaged bodies, many in hospital beds have nowhere else too go. But, after the initial trauma, Haiti is now turning a corner.

    DR. DAVID WALTON, Partners in Health: The major challenge now is post-op care and what we would call in the medical profession discharge planning. How do you discharge a patient and assure quality care when they are homeless? And how do you make sure that infections don't develop? How do you assure that bandages are changed for amputees or wounds that have been debrided?

    And I would say this — this phase is the most difficult phase, because, all the groups are here right now, but, soon, many of the groups — not all the groups, but many of the groups are going to pull out.


    Dr. David Walton is American. He's spent most of his adult life caring for the people of Haiti. Eight months of the year, he works for Partners in Health, an American medical NGO, its mission, assist Haitian doctors and nurses and an overburdened ministry of health by helping create, not impose, solutions.

    Its expertise here has proven vital and has uniquely positioned it to help rebuild Haiti's shattered health system. Now a small army of volunteers has arrived as varied as the colors on their backs, Norwegian Red Cross, EMTs from Brooklyn, International Medical Corps, to name a few, all working under the watchful eye of the 82nd Airborne Division of the U.S. Army.

    Walton stressed that he works for General Hospital's director, Dr. Alix Lassegue, who took me through the darkened streets of his hospital's complex to juvenile wards, where exhausted amputees lie awake in stifling heat. I asked him when there will be room for these patients indoors. He says there already is.

    This building has been inspected by engineers, and they have decided that it's perfectly usable and occupiable. And the patients, after the aftershocks, are too nervous to be treated inside, so they are out here in these tents.

    That's just one of a mountain of challenges for Dr. Lassegue. Many of his staff died. Others are scattered, attending to injured and dead family members in the ruins of their homes. He's providing care for a patient population that is also largely homeless, and he can hardly send amputees to live on the sidewalk in front of the ruins of their homes.

    DR. ALIX LASSEGUE, medical director, General Hospital: The government is on the way to set up some tent village where we could have discharge persons.


    Frightened patients, a doctor shortage when the volunteers go home, nowhere to send the recovering. It's monumental, really.

    But this building is a constant reminder to all at the hospital of what this country has lost. Up to 150 second-year nursing students at this, Haiti's only public teaching hospital, were killed when the building where they trained collapsed. The recovery has only begun, and the smell of human remains stings the air.

    But Haiti's medical challenges and Partners in Health's role in the response range far from Port-au-Prince. Thousands of injured headed out of the capital to other parts of Haiti, many taking the bone-jarring two-plus-hour trip up rutted roads, through Haiti's beautiful and poverty-stricken Central Plateau, to one of the only places they could get help in those terrible first days, the 25 year-old Zanmi Lasante medical complex in Cange.

    Earthquake victims poured in from the capital, tripling the patient load at the small hospital, and overwhelming a place more accustomed to dealing with HIV and tuberculosis than with challenging surgical patients.

    They filled the hospital wards, then filled up the church with the suffering — 100 doctors and 400 to 500 nurses showed up. The remote clinic shot 1,150 X-rays in their first week.

    Dr. Maxy Raymondville is an obstetrician and gynecologist with Partners in Health.


    We lost all of the communications with Port-au-Prince. The cell phones, they are not working. And I say, well, we are in trouble. And, quickly, trucks bring patients here. We don't know how they reached here. For some reason, we started like 20. The emergency room was packed, 40, 50. In less than two days, there was more than 150 lying everywhere.


    The Haitian Episcopal priest who founded this operation, Father Fritz Lafontant, brought prayers and song to the quake victims packing his little hospital. Quietly singing along was a young seminarian, Ben-Jean Falot. The 29-year-old had just finished making a presentation at a seminar when the quake began. He was trapped in the rubble for 18 hours, and lost his right arm.


    We had just finished the seminar, and I was going to another seminar when the earthquake hit and the house fell down.


    Ben-Jean was right-handed, and told me he hadn't thought much about his life ahead with one arm. He just thanked God he was alive.

    That transitional problem, what to do with the recovering but no longer seriously ill, is even more challenging here in Cange, far, far from where these patients live, or used to live.


    They don't have anyplace to go. I keep talking to everyone, asking, where are you living in Port-au-Prince? What's happening during the earthquake? They say, I don't have any home.

    I said, OK, you need to think about discharge. And some of them, they will need follow up. We don't know exactly how we are going to deal with that.


    All the doctors we spoke with want to remind you of one thing. This is not a crisis that will be over in a week or a month. Port-au-Prince's pulverized health infrastructure, and the lives of its most ill patients will take years to fix.

    And Dr. Lassegue says, while he's grateful for outside help, he wants to tell donors that the solutions and the new health systems will have to be run by Haitians, for Haitians, even if they're funded from outside.


    We know we need help, but this is our plan. This is our vision of Haiti in 25 years to come. So, help us. I may follow your advice, but don't tell me, do this or do that because it's your vision. I may be wrong. You may be wrong also. So, let's discuss that. But don't forget, it's my country. It's not yours.


    He knows, most of the new help will go home eventually, but he doesn't want Haiti totally on its own when that happens.

    While General Hospital copes, the crisis is far from over. It's well understood that many of the injured remain out in Port-au-Prince's neighborhoods and beyond. So, aid organizations like the International Medical Corps are sending teams out into the makeshift camps day after day, pushing back against the country's unfolding medical crisis one person at a time.