Haiti: Putting the Pieces Back to Together

Haiti is now at a critical point with respects to its socioeconomic, political and health conditions. Each of these aspects are intricately woven with one another, as in many nations, however the nature of Haiti's situation is so dependent on the successful resilience of each of these factors. There is optimism for Haiti's reemergence from decades of anguish, and I witnessed tangible progress from the field during my week-long medical mission organized jointly by The George Washington University School of Medicine and Project Medishare.

Project Medishare, founded in 1994 by Dr. Barth Green and Dr. Arthur Fournier, is a non-profit organization dedicated to improving the health of the Haitian people by reestablishing the health infrastructure in several communities. Through the generous support of Ariel Foundation International I was able to spend time treating patients in the rural Central Plateau region of Haiti, working alongside a team of GW physicians and medical students, Haitians physicians and Project Medishare trained Haitian healthcare agents. We worked primarily in the village of Thomonde, with frequent treks to remote hillside communities and a site visit of Zanmi Lasante in the village of Conge, which is a clinic of Partners in Health (PIH), a nonprofit organization founded by Dr. Paul Farmer. Our team also had the opportunity to visit with Dr. Raul Rafael from the Haitian Ministry of Health, and discussed how we can play a more involved role.

The flight from Miami to the island nation of Haiti is only 90 minutes, yet Haiti is the one of the poorest nations in the world. As a native of Nigeria-living there for 8 years- and having traveled extensively throughout parts of rural China, Vietnam, Thailand, and Brazil, I thought I had seen poverty and elements of suffering; however my time in the impoverished village of Thomonde allowed me to experience abject poverty.

Our plane landed in the overpopulated capital of Port-au Prince, which is dotted with rundown buildings, open sewers, and peasants suffering the wounds of civil strife and oppression. However, there are moments in the city were one can sense hope expressed by the brightly colored tapstaps (public buses exquisitely decorated with Creole sayings) that zip through the streets overflowing with lively passengers and the vibrant music echoing for the side streets.

Once we left Port-au-Prince, the pavement ends abruptly. Cutting through the denuded jagged mountains of the Central Plateau, it took approximately 4 hours by Jeep to get to Thomonde. En route, we passed several Nepalese United Nations (U.N.) forces that were stationed along the road. The U.N. forces were called in to contain and capture Rebel leaders (who we also had to pass and searched our vehicle) that had taken hold of nearby mountain villages.

Due to Project Medishare's excellent reputation with the community, we were provided access to the Mayor of Thomonde's guesthouse for lodging purposes during our stay. There were about 3 persons to a room and we slept on mattresses that were on the ground. The open-aired ventilated guesthouse was luxurious compared to the rest of the village's small shanty houses with corrugated ceilings that housed in where in the range of 5 to 10 people.

I visited one of the Catholic churches in the center of Thomonde during my first day and struck by fervor of the churchgoers and the similarities between Catholic masses in Nigeria. The church was packed, standing room only, with children smartly dressed in brilliant white and blue uniforms.

Spending 8 hours everyday treating villagers, during our health fairs that we held in the local churches, was the critical learning component of my time in Haiti. Although our GW team was stationed in Thomonde, we worked in mobile clinics throughout the central plateau, such as nearby Marmont and as far away as Bin Touribe and Wanna and, over a course of five days, we saw about 1,217 patients. I took dozens of blood-pressures, monitoring for cardiovascular abnormalities. I personally witnessed numerous cases of high-blood pressure and several patients had to be rushed to the nearby hospital for attendance. Moreover, I encountered patients that suffered from: anemia, hypertension, scabies, tuberculosis, malaria, hookworm, and water-borne diarrhea, HIV/AIDS, on a daily basis. All of the above-mentioned diseases occur at an alarming rate in Haiti, and several of them are being complicated by the development of drug resistance which arises from varying factors such as misinformation about how and when to take drugs, noncompliance with instructions, lack of medication, etc.

With regards to HIV/AIDS, Haiti is the country most affected by the AIDS pandemic, outside of the African continent, with an estimated 6.1% of the adult population being HIV positive, with numbers as high as 14% in certain urban areas. In Thomonde, the village where we spent most of our time, its estimated that 5-10% of the residents of are HIV positive, and over 50% of these people living with HIV are women. To address these alarming statistics Project Medishare has developed a Project C.A.R. E. (Creating Access Rapidly and Effectively). Project C.A.R.E. is charged with providing HIV and Sexually Transmitted Infections (STI) prevention training in the province of Thomonde and neighboring communities.

The successful work that non-profits such as Project Medishare and Partners in Health (PIH) having been undertaking for several years now in Haiti, has provided the communities with a renewed sense of hope and optimism. Still, there is so much that needs to been done, and the developed world and the Haitian government need to start taking more of a leadership role in addressing these health and healthcare disparities. Organizations such as United States Pharmacopeia (USP), and the Clinton Foundation could also take steps to assist the Haitian government in obtaining more generic drugs, and setting up drug quality standards and quality assurance programs, to ensure that the quality of the drugs that are taken by patients are of the highest standards and this could aid in curbing the development of drug resistant diseases.

Please visit these well deserving websites to see how you can assist the Haitian people:

• Haiti Innovation (www.haitiinnovation.org)

• Project Medishare (www.projectmedishare.org)

• Partners In Health (www.pih.org)

• The George Washington University Medical Center International Medicine Programs (www.gwumc.edu/imp)

The author, Kenechi G. Ejebe, is a second year medical student at The George Washington University School of Medicine in Washington, DC.

This text was originally published by the Ariel Consulting Group of Washington, DC in their August 2005 newsletter. Visit them by clicking here.