Sunday, April 11, 2010
Since I have returned from Haiti, folks often asked me, what is the single greatest need. My answer is always, unequivically, infrastructure. Like the bones of a body or the steel beam skeleton of a building, infrastructure is what you hang everything else on. Haiti lacks a public healthcare infrastructure from what I observed. This is why I fear there will be many more deaths to come. With the advent of the rainy season, standing water means disease, and in the tent cities, disease will spread like wild fire. Public health requires a preemptive strike such as immunizing against possible communicable diseases. Secondarily, you enact measures to control the spread of diseases that are not preventable, such as treating disease as it occurs. Third, you can teach prevention, such as teaching the public to cover their coughs, not share cups and glasses, wearing masks, etc. I see these kinds of public health teaching and public awareness campaigns as very difficult for a country that can't even keep electricity going throughout the day. Public health is built on a healthy infrastructure of rapid public communication with common goals and mission. Just the fact that so many countries have swooped in to help without a Haitian bureacracy to oversee it, betrays a lack of organization. I saw very little structure to the relief effort. My experience at Diquini Hospital was a prime example. On my last day, with the two American OBs, they sought to impose structure. I numbered all the beds and all the charts at their request. But the Haitian nurse saw it all as a nuisance. She had her own order, and it had nothing to do with ours. There is no consistancy in place to ensure that the 'order' we imposed on the unit will remain. When we left, it most likely went away as well. That is what Haiti needs, an imposed authoritative systemic order for delivering healthcare to a population that continues to have chronic healthcare needs apart from the acute ones imposed by the earthquake. A woman should not have to have her yeast infection treated at a temporary tent clinic. There should be a healthcare structure for that. How does Haiti acquire this public health infrastructure? Well that's another post entirely.