The long-term ramifications of the earthquake in Haiti, already the poorest country in the western hemisphere by a wide margin, are staggering. One month following the devastation, PIH began to move beyond the acute phase of response in order to formulate and execute medium and long-term plans for the rebuilding of lives and livelihoods, communities, and the public health system. Though we are sure our plans will continue to develop as the needs on the ground evolve, on February 12, 2010, PIH launched a Fund for Building Back Better in Haiti to support a three-year recovery and rebuilding plan with an initial budget of $125 million.
Below we have outlined the current projected activities and efforts that the Fund will support with the knowledge that the scope of our interventions, and therefore the size of the Fund, may grow in the months to come.
Medium-Term Activities (1-6 months)
1. Continue urgent medical and surgical care operations for earthquake survivors.
PIH/ZL will sustain our expanded volunteer deployment, logistics, warehousing and distribution system in support of the increased demand for medicines, medical and surgical supplies and equipment and the need for specialized surgical and medical teams to reinforce and help train our existing staff. These efforts will continue to serve patients in Port-au-Prince at the University Hospital (HUEH) and at PIH/ZL facilities in the Central Plateau and Artibonite Departments.
2. Sustain community-based care and mobile clinic outreach within Port-au-Prince.
PIH will operate mobile clinics serving between 80,000 and 100,000 displaced people within five or six communities in Port-au-Prince to provide comprehensive primary health care, reproductive health services, treatment of pediatric malnutrition, HIV testing and referrals, and disease treatment and prevention.
3. Provide assistance to displaced people and affected households in PIH/ZL's catchment area.
In collaboration with partner organizations and through our existing community-based social and economic support initiatives, PIH/ZL will help strengthen food & agriculture, housing, safe water, education, and income generation programs for the most vulnerable people in the areas we serve.
4. Build capacity for acute trauma counseling and overall mental health services within our sites.
With key partners, PIH/ZL is conducting an initial needs assessment at our sites and in the spontaneous camps. The assessment is particularly focused on identifying consultation psychiatry needs, developing a training plan for staff and community health workers, outlining additional medicine requirements, and defining key psychosocial support activities.
5. Support the social and economic needs of Zanmi Lasante's more than 4,000 staff.
Almost all our Haitian staff have lost family members in the earthquake and are taking in relatives who have nowhere to go. To ensure these front-line workers, the majority of whom are medical personnel and community health workers, can continue to perform their jobs over the long-term, PIH/ZL is distributing financial assistance to staff to help them with basics during this very difficult time.
Long-Term Initiatives (2-3 years)
1. Expand capacity for specialty clinical services needed to care for earthquake survivors.
PIH/ZL will develop new facility and community-based capacity for post-operative care, rehabilitation and physical therapy, and mental health services by forging strategic partnerships, recruiting additional expertise, and conducting extensive training. Surgical care will be greatly strengthened at all of our facilities in the Central Plateau and Artibonite, with higher-level surgery available at five hospitals and capacity for emergency obstetrical care available at all sites.
2. Strengthen our clinical operations and the public health system.
In partnership with the Haitian Ministry of Health, PIH/ZL will strengthen our network of community health workers as well as the clinical operations at 12-15 hospitals and health centers that provide comprehensive health care to our catchment area in the Central Plateau and Artibonite Departments, which together may grow from 1.2 million to 1.7 million people.
3. Build and renovate public health infrastructure.
Construction and renovation projects, in the form of new hospitals, training centers, pharmacy/warehousing buildings, surgical suites, outpatient clinics, and inpatient wards, will take place at six sites already identified.
4. Strengthen the public medical and nursing education system in Haiti.
A new hospital and teaching center will be constructed in the town of Mirebalais, which is estimated to serve roughly 450 patients per day. The Mirebalais facility will serve as one of Haiti's national teaching hospitals, with PIH/MSPP facilities in the Central Plateau and Artibonite serving as satellite teaching sites.
5. Expand PIH/ZL's programs for social support, community development, and poverty alleviation.
Roughly 2,000 additional community health workers will be hired and trained to work in tandem with mobile clinics, health centers, and hospitals to expand the reach of services.
On February 11, 2010, Dr. Paul Farmer articulated his view on the crisis and need in Haiti: "We are in uncharted territory here, and a certain humility about diagnoses, prescription, and prognosis is surely warranted...So what is to be done? ... Might addressing the acute needs of the displaced and injured afford us a chance to address the underlying chronic condition?" After some reflection, he summarized, "So the diagnosis is: natural disaster in a setting of great and longstanding privation... Haiti needs to build back better and stronger than before. This, then, should be the treatment plan."
While PIH/ZL's role in building back better is only a small piece of Haiti's overall plan, our vision of accompanying Haiti has resounding effects in the small country and beyond. As of February 12, 2010, we have raised roughly $57 million toward our $125 million plan to build back better. Our expectation is that $15 million will be spent before July 1, 2010, and an estimated $110 million in the two to three years that follow. We welcome and encourage both longstanding and new partners to contribute to the STAND WITH HAITI Fund as a way to engage in sustained, long-term recovery to rebuild lives, livelihoods, and communities.
With thousands of survivors needing amputations to save their lives following the January 12 earthquake, the PIH/Zanmi Lasante team has been increasingly concerned with how to help amputee patients literally get back on their feet.
A partnership with Hôpital Albert Schweitzer (HAS) is starting to fit these patients with prosthetic devices. With a well-stocked factory in partnership with prosthetics manufacturer Hanger, HAS has already begun accepting patients referred by PIH/ZL from the Central Plateau and Artibonite regions.
In early March, the PIH/ZL team brought three patients with lower extremity amputations to HAS for their prosthetic fitting. Staff noted the immediate change in the women as soon as they received their new legs--they were each able to stand up and walk with the aid of parallel bars, and quickly left behind their fears, prejudices, and doubts with each determined step. PIH/ZL staff also report that the three women are now able to walk as well as kick soccer balls - and next up on their agenda is dancing.
These three women are just a few of the patients who have undergone procedures at our hospitals and will be receiving prosthetic care through this partnership. Thank you for enabling this work!
PIH had more than 100 doctors, 600 nurses, and a total of 4,000 Haitian employees on the ground in Haiti working from 12 existing PIH medical facilities in Haiti before the earthquake struck on January 12th.
• PIH quickly established field hospitals in Port-au-Prince, helping set up 20 operating rooms, 12 of which were able to function around the clock.
• PIH established a comprehensive triage and relief transfer system to move patients back and forth from Port-au-Prince to PIH sites in the Central Plateau and Lower Artibonite Valley.
• PIH is evacuating patients in critical condition to hospitals in the United States and Dominican Republic as well as to the U.S.N.S. Comfort.
• PIH has sent 66 plane loads with more than 235 medical volunteers – orthopedic surgeons, anesthesiologists, surgical nurses and other medical professionals – and roughly 100,000 lbs of medical supplies to support the large network of PIH’s local health care providers already working in Haiti.
• The long-term ramifications in Haiti are going to be significant and far-reaching with a new, large group of vulnerable and displaced people. PIH has the experience and commitment to Stand With Haiti for many years to come.
Looking ahead, PIH’s efforts will be spent in three core areas:
1) supporting the public sector’s ability to provide health care;
2) mobilizing people at the grassroots level to participate in the health care system; and
3) addressing the mid- and long-term health, social, and economic ramifications of the resettlement of tens of thousands of people from Port-au-Prince to areas where PIH works.
Dr. Paul Farmer, PIH co-Founder and United Nations Deputy Special Envoy for Haiti, recently testified at the “Haiti: From Rescue to Reconstruction” hearing of the U.S. Senate Foreign Relations Committee.
"I am at my core optimistic about the possibilities before us and the potential of our support to help rescue and transform our poorest neighbor," stated Paul in his submitted testimony. "The response from citizens of the United States to the recent events in Haiti has been overwhelming and encouraging. There is the promise of solidarity by our leadership to make long-term commitments to the kinds of investments needed in Haiti—and to fulfilling them."
"For two centuries, the Haitian people have struggled for basic human and economic rights, the right to health care, the right to education, the right to work, the right to dignity and independence,"he continued. "These goals, which Haitians share with people all over the world, should direct our policies of aid and rebuilding."
Read and watch the complete testimony at the link below:
Sent on January 17, 2010, 3:34AM, General Hospital in Port-au-Prince (HUEH) by Dr. Evan Lyon of Partners In Health:
can't get through much now but beyond the horror, one very striking reality is that things are totally peaceful. we circulated in PAP in the middle of everything until just now. everywhere. no UN. no police. no US marines and no violence or chaos or anything. just people helping each other. drove past the main central park in PAP where at least 50K people must be sleeping and it was almost silent.
people cooking, talking, some singing and crying. people are kind, calm, generous to us and others. even with hundreds lying on the ground, open fractures, massive injuries of all kinds.
there are few dead bodies on the street. stench is everywhere. the city is changed forever.
we had a late day opportunity to evacuate 4 patients to the US. these may be the first haitian nationals allowed to leave for the US. but martinique has taken over 200. the DR has taken many many more. so we circulated in PAP looking for urgent cases. found hundreds but picked up the 4 to get out, hopefully to philadelphia. open fractures, gangrene, one 4 year old boy with a leg broken in 3 places, a minor head wound, and now 4 days of sleeping outside with IV fluid and maybe some pain meds. probably none.
at the airport, we drove onto the tarmac to meet the air ambulance. surrounded by marines and UN, massive weapons. a humvee with a gunner turret at the top drove by. the noise from the large transport planes was deafening. us citizens and haitian american citizens leaving by the hundreds on US planes. and our small team of haitian and american docs evacuating a drop in the bucket. my ears are still ringing from the noise of it all.
in contrast, port au prince is silent. no current. no car traffic. people sleeping in the streets but little else. beside the impossible weight and tragedy of this city completely devastated, one lasting impression was the stillness of the city. in shock, tragically sad, but quiet. so good to get away from the airport.
sleeping tonight in the house of a dear PIH friend and doctor. attending to neighbors here and able to rest. safety and the work is with our sisters and brothers in this beautiful, proud, and strong nation.
the safest and best way to be here and help is with our colleagues and friends. wonderful to be in the city, away from the airplanes, and working shoulder to shoulder with people we know and love and will continue work with to mourn, assist, and rebuild this special country.
in the photo you see the first time operating of any kind possible at the main general and academic center.
for press / outreach strategy, we might highlight the generosity and getting it done kindness of the air ambulance team. they also left us all the supplies they had on board - water, meds, IV material, blankets, food.
goodnight everyone. love. evan.
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