It's been a month since one of the modern era's deadliest earthquakes struck Haiti on January 12th. As Haitians mark this milestone with three days of mourning, remembering the 200,000-plus who perished, international relief groups who rushed to help the stricken and tend the injured also pause briefly to take stock.
We can see that much has been accomplished during the past four weeks, but significant challenges remain.
Our hope is that the suffering that today overwhelms Haiti can be a catalyst to generate the kind of powerful, yet focused extended international commitment needed to tackle a debilitating health care crisis that for decades has stunted development in the Western hemisphere's poorest nation.
It is a crisis that, despite the best previous efforts from groups including the World Health Organization/Pan American health Organization and respected non-government relief groups, has left Haiti with a set of public health indicators on a par with Afghanistan and Somalia.
The first step in the international response is already well underway: to bring emergency relief to ease the immediate suffering. My organization, International Medical Corps, is one of scores of government and non-government agencies deploying skilled health professionals to treat the injured and provide lifesaving health care.
As one component of our own response, we leveraged our partnership with this country's largest health care union, the Service Employees International Union (SEIU), to dispatch teams of Creole-speaking nurses to help the Haitian relief effort. In addition, we turned to our network of thousands of health professionals at the major universities and hospitals, including Stanford, UCLA, Columbia, Johns Hopkins, Northwestern and Rush.
From our work in earlier natural disasters, including the 2004 tsunami and major earthquakes in Pakistan and Indonesia, we know that performing to a high standard in the early phase is crucial for longer-term success. Haiti has its own experienced and dedicated health professionals, but for now, doctors, nurses and other specialists arriving as part of the international relief effort are needed to help tackle this daunting health care burden.
Once they have stabilized their personal lives, Haitian health care specialists should lead an intense effort that includes their international counterparts to conclude the emergency phase and lay the groundwork for a more robust, responsive health care system capable of addressing the nation's endemic public health challenges. As former President Bill Clinton, the United Nations special envoy for Haiti, put it, the task is "building Haiti back better".
As Clinton notes, a good beginning has been achieved in recent years to spur Haiti's development. But there is still much to do. The extraordinary level of public attention now focused on Haiti, coupled with a genuine desire to help, offer a window of opportunity to build on what has been achieved by existing international assistance.
Health indicators tell their own story of need. Haiti has the highest HIV/AIDS infection rate in the Western hemisphere and while U.S. funds from the President's Emergency Plan for AIDS Relief (PEPFAR)--which topped $100 million in 2008--have helped reduce infection rates in some areas, more assistance is needed. According to the World Food Program, nearly 10% of Haitian children under 5 years old suffer acute under-nutrition, while far higher numbers of pregnant women and children under 5 are affected by anemia. These health issues affect both individuals' health and well-being and, on a larger scale, national development.
But whatever the international community does to help ease Haiti's long-standing health crisis, success requires the broader involvement of the Haitian government and local communities. And that is the real challenge.
Our own experience has taught us that the most effective, sustainable development programs are crafted and implemented with the active participation of the local community and in close coordination with the regional and national health system. The importance of training health care personnel and building the capacity of local institutions to make up for so much that has been lost is also essential. Nothing less than an internal and external renewal of purpose is needed if the people of Haiti are to benefit from the unprecedented--but almost certainly, brief--level of political will among countries in the hemisphere to help their most vulnerable neighbor in this, its hour of greatest need.
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"It is striking that there has been virtually no mention in the media of the fact that Cuba had several hundred health personnel on the ground before any other country," said David Sanders, a professor of public health from Western Cape University in South Africa.
Before the earthquake struck, 344 Cuban health professionals were already present in Haiti, providing primary care and obstetrical services as well as operating to restore the sight of Haitians blinded by eye diseases.
Havana has also sent 400,000 tetanus vaccines for the wounded.
However, in reporting on the international aid effort, Western media have generally not ranked Cuba high on the list of donor nations but Cuba sent 350 doctors, including 280 young Haitian doctors who graduated from Cuba. The final figure accounts for a combined total of 930 health professionals in all Cuban medical teams making it the largest medical contingent on the ground.
They reported on a "hospital" where mothers and their newborns were being returned to the streets within hours of birth.
Even in the hospital these women and there babies were on the ground on cardboard covered with some fabric.
Then they followed up on the little girl Dr Gupta operated on on the hospital ship Comfort. She was released from the hospital.
She was dazed because she didn't remember the earthquake and her mother and sister were killed and her house destroyed. She, too, had a shelter made of old sheets.
Dr. Gupta said how difficult recovery is for her or anyone released from the hospital to return to these circumstances.
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