Following the January 12, 2010 earthquake in Haiti, Partners In Health (PIH) and our Haitian sister organization Zanmi Lasante (ZL) immediately began to both respond to immediate medical needs and plan for the long-term recovery and rebuilding of Haiti's public health system. Now, nearly 15 months after the earthquake, PIH/ZL's focus is on these long-term programs, including our community-based rehabilitative medicine program.
In general, patients have sustained one of four types of injuries: a closed fracture which will need follow-up x-rays and cast changes; an open fracture, which requires wound care in addition to typical fracture care; an amputated limb, which often requires additional surgical procedures for prosthesis fittings; or permanent neurological disabilities, which include spine fractures, spinal cord injuries or paralysis. No matter what the injury, these patients require specialized rehabilitation. Recovering from a fracture means not only learning how to walk with a crutch, but also retraining muscles, ligaments and tendons to walk again. Patients who have had limbs amputated or who have been permanently disabled will need occupational therapy to learn how to live with their disability, in addition to ongoing physical therapy to strengthen their muscles. Patients who underwent life-saving surgeries in the aftermath of the earthquake will require months, and in some cases years, of follow-up and aftercare.
PIH/ZL’s Community-Based Rehabilitative Medicine Program has two main components: Clinical Care and Community-Based Care. When an injured patient first comes to one of PIH/ZL's hospitals or clinics, they are seen by a clinician, who then refers appropriate patients to the rehabilitative team. A doctor of rehabilitative medicine handles all medical issues related to this disability. After a complete evaluation, the rehab doctor develops a care plan, 90% of which takes places outside of the hospital with PIH/ZL's team of community health workers. In cases of extreme injury, patients are reffered as inpatients to PIH/ZL's rehabilitation clinic (currently in Cange, while a state-of-the-art rehab center is being planned and constructed in St. Marc).
Back in the community, each patient is visited regularly by a home visit team, a three-member unit: a rehab doctor and/or nurse (for clinical support), a rehab technician (for physical and other rehab therapies), and a rehabilitation educator, who is a community health worker (CHW) who has been specially trained to tend to the needs of people with disabilities. Throughout this time, the patient's CHW visits him or her daily to monitor the patient’s state, providing in-home support and accompaniment throughout the healing process.
Thank you so much for your support of Partners In Health's earthquake relief and recovery programs. If you wish to continue supporting these types of programs, be sure to take advantage of the GlobalGiving Bonus Day on March 16! All donations made on 3/16 will be matched at 30% (up to $1,000 per donor)!
For video on our rehab program, click below:
When the earthquake struck Haiti on January 12, Zanmi Lasante was uniquely positioned both to provide emergency care and to help develop and implement plans for long-term reconstruction. ZL provided life-saving care to thousands of injured people, opened clinics to serve more than 100,000 people in four spontaneous settlement camps, and launched a $125-million plan to help rebuild Haiti's public health and health education systems.
Highlights from the response:
In the first hours after the earthquake, Zanmi Lasante took immediate action to provide emergency medical care to earthquake victims both in Port-au-Prince and at our facilities in the Central Plateau and Lower Artibonite. ZL medical and engineering staff arrived at the badly damaged general hospital in Port-au-Prince just after the quake, where they helped restore electricity, deployed volunteer surgical teams and urgently needed supplies, and worked with partners to get 12 operating rooms up and running around the clock.
As thousands of injured people fled the ruined capital, ZL opened up new emergency wards and brought in volunteer orthopedic teams to help perform emergency surgeries at four of our largest facilities in central Haiti. In the first four weeks after the earthquake, these facilities delivered life-saving medical care to 2,961 patients with earthquake-related injuries.
Just two weeks after the earthquake, ZL set up health clinics to serve over 100,000 displaced people living in four spontaneous settlement camps around Port-au-Prince. ZL's clinics provide comprehensive primary health care and social support services — including maternal and child health, reproductive care, HIV and TB testing, mental health care, and malnutrition treatment — to roughly 10,000 people each week.
Each clinic is staffed by a team of Haitian physicians, nurses, psychologists, pharmacists, and lab technicians. ZL also trained and hired local residents to serve as community health workers at each location, improving outreach into the settlements and providing jobs and income.
Many of the more than 300,000 people wounded by the earthquake suffered crush wounds, compound fractures, spinal injuries and other severe injuries that will require ongoing and specialized rehabilitation. Tens of thousands more were scarred emotionally by the loss of family members and friends, homes and livelihoods. To meet their needs, ZL more than doubled the size of our rehabilitative medicine and mental health teams. By the end of June, the physical therapy team had distributed 400 wheelchairs and was providing care to 50 people with amputations. The mental health and psychosocial support team had offered more than 4,200 support services in spontaneous settlements, including psycho-education, counseling, and individual and group therapy.
In partnership with the Haitian Ministry of Health, PIH/ZL is building a world-class, 320-bed teaching hospital in Mirebalais. The new hospital will train the next generation of Haitian doctors, nurses, and lab technicians, equipping them to take on the challenges of rebuilding and strengthening the Haitian health care system. When its doors open in late 2011, the Mirebalais hospital will be Haiti's largest public hospital outside Port-au-Prince. It will house clinical facilities not currently available in Haiti, including an intensive care unit and six operating rooms, and will contribute to the national goal of decentralizing services, including both clinical care and education for health professionals.
A cholera epidemic has broken out in the Lower Artibonite region of Haiti. As of Friday morning, October 22, more than 2,000 cases and 140 deaths had been reported. PIH has rushed clinical reinforcements and supplies to the region and has mounted a massive community education and mobilization campaign. Community health workers are fanning out throughout the area to distribute oral rehydration salts and soap and to warn people of the need to drink only clean or purified water and wash their hands frequently—the two keys to preventing further spread of the disease.
Starting on Tuesday evening, patients suffering from acute watery diarrhea began arriving at Hôpital Saint Nicolas in St. Marc, which PIH operates in partnership with the Haitian Ministry of Health. By Thursday evening the hospital in St. Marc was overflowing with over 500 patients, of whom 12 had died. Another 437 patients were taken in between 6:00 Thursday evening and 5:00 Friday morning. Other hospitals in the Lower Artibonite region—including PIH facilities in Petite Riviere and Verettes—also reported large numbers of patients with similar symptoms and high mortality rates.
Although the diagnosis of cholera was not confirmed until Friday morning, PIH, the Ministry of Health, and other partner organizations had already launched urgent treatment and prevention efforts. The most effective treatment for both cholera and other acute diarrheal diseases is oral rehydration; and prevention hinges on providing access to clean water.
Zanmi Lasante dispatched reinforcements for both the clinical and community outreach efforts from our team in Port au Prince and our facilities in the Central Plateau. And several longstanding partner organizations have rallied to support PIH and the Ministry of Health on both fronts. Operation Blessing, which has worked closely with PIH to provide clean water in settlements around Port-au-Prince, rushed to St. Marc to help. Two branches of Médecins Sans Frontières (MSF-Spain and MSF-Belgium) deployed clinical team reinforcements to St. Marc and Petite Riviere, where they are taking the lead in setting up systems to separate cholera cases from non-cholera cases.
Lack of access to clean water has long been a major threat to public health throughout Haiti. Zanmi Lasante has worked with partner organizations to combat the problem on many fronts:
As we work urgently to treat cholera patients and halt the epidemic before it can spread to the crowded settlements around Port au Prince, PIH will continue to emphasize that strengthening public infrastructure, especially the water supply, must be a top priority in post-earthquake reconstruction efforts.
SIX MONTH REPORT OVERVIEW
Six months have now passed since a devastating earthquake ripped through Haiti. Every day since January 12, 2010, Partners In Health (PIH) and our sister organization Zanmi Lasante (ZL) have been working to help Haiti's people build their lives and their country back better.
Although not yet fully funded, the Stand With Haiti Fund we established in March has provided PIH and ZL with the resources and the strategic vision to begin the process of building back better in Haiti through a combination of: strengthened clinical services at our existing health centers and hospitals as well as in new facilities; expanded social and economic support programs for the most vulnerable patients and community members where we work; and investments in long-term, strategic revitalization of the public health and medical education systems.
Over the past 26 weeks, our efforts have saved lives through emergency critical care and surgical services; helped seriously injured patients regain mobility; resettled abandoned and disabled children into a safe group home; comforted communities in need of spiritual and emotional solace; and provided strategic planning assistance to Port-au-Prince's General Hospital (HUEH) as well as the Haitian Ministry of Health (MOH) leadership.
Hundreds of thousands of earthquake survivors across the Central Plateau and Artibonite Valley regions as well as in four large settlements of displaced people in Port-au-Prince have benefitted from the generosity of all those who supported and continue to give to PIH's Stand With Haiti Fund. This report summarizes what you have helped make possible since that terrible afternoon in January. For more detailed information and multimedia content, please visit www.standwithhaiti.org/six-months.
We have been able to respond to the disaster and embark on the work of building back better thanks to the extraordinary generosity and solidarity of individuals, organizations, and institutions who through June 30 had contributed a total of $85 million, including a substantial sum designated specifically for long-term rebuilding and strengthening Haiti's public health system.
Of that amount, we have expended $26.6 million to date. The table below (see link: PIH Six-Month Report: Overview) presents a summary of how that money has been spent and the graph provides a projection of how we intend to use the remaining $98.4 million of our planned $125 million fund over the next two years. These projections are consistent with the general parameters outlined when the Stand with Haiti Fund was established. They have been and will continue to be refined and adjusted regularly based on our understanding of shifting needs and priorities.
Our work is far from over. The rubble has yet to be fully cleared. More than a million people are still living under tents, tarps, and makeshift shelters in crowded encampments, with limited access to food, water, sanitation, schools, jobs, and social services. Many people are still in pain, hungry, and desperate.
But with over 25 years experience and a local staff of nearly 5,000 people working through an expanding network of public hospitals and health centers, we're committed to continuing to provide quality health care to those who need it most and striving to bring long-term strategic improvements to Haiti's public health and medical education systems. To do this, we will use the same values and approach that have guided our work for many years: solidarity with the Haitian people and the communities in which they live; partnership with the government of Haiti and other institutions and organizations; and a comprehensive vision of what is comprised by health care.
PBS NewsHour recently interviewed Father Eddy Eustache, a priest and psychologist who serves as Director of Mental Health and Psychosocial Services for Zanmi Lasante, PIH's sister organization in Haiti. Below is an excerpt from the interview. Read the full piece at the link below:
Q: What are the most common mental health challenges you are seeing in Haiti at this point?
A: Almost four months after the earthquake we are seeing people having various kinds of emotional distress responses. These include difficulty sleeping, heart palpitations, somatic complaints, and significant sadness, worry and anxiety. Some of these can be seen as normal reactions to a highly abnormal situation. However, the level of distress for many is severe. We also see people who have developed psychotic reactions, and other more acute mental health problems, since the earthquake.
One major challenge is a general lack of services in Haiti to address significant mental health problems. Haiti had few mental health professionals, and limited organized mental health services prior to the earthquake. There was not a clear understanding of the prevalence of mental health problems in Haiti prior to the earthquake, but we can expect that the mental health dimensions of the earthquake, overlaid on the pre-existing issue of poverty, will have significant ramifications for mental health. Our hope is to further develop the services needed to assist with such problems, in a culturally appropriate way, for the long-term.
Q: How are mental health workers trying to address the needs?
A: Interventions are needed that respect people's capacity to recover from such an event, that do not pathologize normative responses to such a terrible circumstance, that do not risk harm to individuals, that have some evidence for their efficacy, and that are appropriate to the Haitian context.
At Zanmi Lasante [Partners in Health] we have expanded our team to 17 psychologists from three prior to the earthquake, and to more than 50 staff focused exclusively on mental health and psychosocial services. We have been working ... to provide communal opportunities for mourning, to develop community-based supportive interventions in collaboration with schools and churches, and we have expanded basic clinical services.
This has included training of doctors and nurses in management of acute mental health problems, and planning for expansion of the system of care to include community health workers attuned to mental health, and development of effective referral networks to providers.
Read the full interview at the link below:
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