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April 7, 2011

Haiti: Lessons Being Learned

More than a year after an earthquake devastated much of Haiti on January 12, 2010, the nation still struggles to deliver health care to its citizens. While strained, before the quake, to provide the usual array of services—child health care, reproductive health care, infectious disease prevention and treatment—Haiti faces new challenges in the wake of the disaster, further taxing the health ministry and providers.

In a conference at the Johns Hopkins Bloomberg School of Public Health, Jean Hugues Henrys, MD, dean of the School of Medicine, University of Notre Dame of Haiti, addressed the new and persistent challenges to Haiti’s health care system. The conference, “2010 Earthquake in Haiti: Public Health Interventions and Preparedness Lessons from Haitian Researchers,” took place on March 31, 2011.

Dr. Henrys described a pre-earthquake Haiti in which health care was provided by both traditional healers and by “official medicine,” which consisted of a mix of public and private institutions, operating as a collection of decentralized health microsystems.  Traditional, at-home, self-treatment tended to prevail over official medicine, and recent data show that 75 percent of Haitian women give birth at home, mostly with the help of midwives. Although infectious diseases such as HIV/AIDS and tuberculosis top the list of causes of death, Henrys said that, like most nations in the world, “Haiti was experiencing an epidemiological transition from infectious disease to chronic disease,” such as heart disease and diabetes.

Now, however, the ministries of health have a new target population. Amputees are first on the list of those with unaddressed and urgent health care needs. Those suffering from psychological trauma are also among some of the most vulnerable populations. The medical communities in Haiti, says Henrys, must adapt to incorporate more post-operative care for amputees, to provide mental health services, and to provide physical rehabilitation. Providers must also adjust to the challenges of providing care to patients who are still displaced and living in camps. Another challenge to the system is the “flooding of health care actors” that occurred after the earthquake. With thousands of new health care providers migrating to Haiti post-disaster, issues of governance have arisen in the health sectors.

To address the challenges, Henrys urges new modes of partnership between public and private providers.

Also presenting at the conference were several leaders in Haitian health care. Jeanne Marjorie Joseph, MD, addressed concerns and challenges in the mental health sector, as so many Haitians have been psychologically traumatized by the earthquake and its aftermath. Joseph is the coordinator at Unité de Recherche et d’Action Médicale (URAMEL), Centre de Psychotrauma d’Haiti.

Rachel Labbe-Coq, MD, MSc, presented a talk on lessons learned with regard to cholera; Labbe-Coq is the country director, International Training and Education Center for Health (I-TECH), Haiti. In addition, Edieu Louissant, MD, addressed the challenges and possible solutions for providing care to people living with HIV/AIDS (PLWHA)in Haiti after the earthquake; Louissant is a national evaluator at the Ministry of Health, Haiti.
 –Christine Grillo