World Humanitarian Day

As we celebrate the second annual World Humanitarian Day, our attention at Project HOPE naturally turns to the many volunteers and staff who have made relief efforts possible in places such as Haiti.

When the earthquake struck Haiti, doctors and nurses put aside their hospital duties, their private practices, their family vacations, to respond to this acute crisis.

The brief spotlight that shined on Haiti in the weeks after the tragedy exposed immense critical need, but it also reminded us of the country’s chronic, more “quiet” condition. If January 12th was the date that sent the country to the emergency room, then now is the time when Haiti’s caregivers must decide how to treat the chronic secondary condition diagnosed in the process.

This condition is seen in the thousands of amputees now in need of rehabilitation, as well as the widespread tuberculosis prevalent in the mountain regions and HIV in the valley populations, and in the young women dying in childbirth for lack of medical care.

The situation is serious. The very pipeline of future Haitian doctors and nurses is in peril. Hundreds of nursing students lost their lives when the nursing school, on the grounds of the country’s only public teaching hospital, collapsed. The nearby medical school was also largely reduced to rubble. And the hospital itself, which long served as the “safety net” hospital for the poor of Port-au-Prince, is now operating at less than 50 percent capacity, with many of its major facilities closed.

The prescription?

It will not be found in the well intentioned but "stand alone" efforts. Carlene Dei, USAID country director for Haiti, estimates that there are over 9,000 NGOs now working in the country, 80 percent of which are not collaborating with the U.S. Embassy and other NGOs. There must be a “whole community” effort if there is to be progress.

The effort must involve Haitian doctors, nurses and other health care workers. Hôpital Albert Schweitzer in Deschappelles, Haiti, embraces the philosophy of increasing and expanding local capacity and has become one of the two leading centers for trauma-related surgical amputations and subsequent rehabilitation in Haiti—a shining example for the rest of the country to follow. To continue to be able to move forward in this way, the pipeline of future doctors and nurses must be repaired.

Just recently, I witnessed an outstanding response to the current "quiet crisis," now happening in Haiti. I saw the sailors of the USS Iwo Jima and volunteer doctors and nurses from non-governmental organizations, including Project HOPE, working side-by-side with their Haitian counterparts, engaged in treating those in medical need in Port-au-Paix, a city on the country's north coast.

It was a model of the "whole of community" approach to care that the ship's Commodore, Captain Tom Negus likened to the process of weaving a tapestry—integrating professionals from an array of specialties with the local needs of the patients.

All of these individuals, as well as those working behind the scene, making a difference in the lives of those in need, deserve our heartfelt salute on this day.

Photos by Project HOPE PAOs Astrid Riecken, Allison Shelley, and Eric Campbell

Haitian Doctors and Nurses: The Next Generation

In late May, Dr. Louis Sullivan, former Secretary of the U.S. Department of Health and Human Services and current Project HOPE Board member, and Dr. Ruben Pamies, Dean for Graduate Studies at the University of Nebraska Medical Center, asked to meet with me in Washington. They expressed a deep concern for the next generation of Haitian physicians and nurses, in light of the damage suffered by the medical and nursing schools in Port-au-Prince.

They asked Project HOPE to join in assessing the current capacity of Haiti’s health professions education – in the context of the future need for health care in the country. Two days ago, we visited the medical school, Universite D'Etat D'Haiti, which has been largely reduced to rubble. Today, we went to the site of a former nursing school on the grounds of the teaching hospital, Hopital Universite D'Etat D'Haiti, also known as General Hospital. What we saw was breathtaking. The nursing school building had been leveled – now replaced by UNICEF tents. Hundreds of nursing students lost their lives, when the school collapsed.

General Hospital, which long served as the “safety net” hospital for the poor of Port-au-Prince, is a shadow of its former self. What was once an 800-bed facility was reduced to a 300-bed capacity. Major buildings (general surgery clinic, inpatient women’s internal medicine, outpatient clinics and pediatrics) are shuttered. In the face of this, the need for urgent care continues on.

Nick Lobel-Weiss, Executive Director of Global Emergency Relief based in New York City, and secunded to the General Hospital, gave a most compelling example. A twenty-nine year-old woman with active tuberculosis, now in her 29th week of pregnancy, was in the midst of being transferred from the teaching hospital to the Adventist Hospital in the Diquini neighborhood of Port-au-Prince, which had been spared from major earthquake damage.

We met Dr. Megan Coffee, an infectious disease fellow from the University of California, San Francisco. She arrived in Port-au-Prince in late January -- and has been involved in round-the-clock care of critically ill patients since then. She told us of the high prevalence of post-partum, dilated myocardiopathy, not often seen in the U.S. These patients can present with an admitting diagnosis of tuberculosis when, in fact, their chest X-ray findings are those of heart failure. Here at General Hospital, earlier today, a 22-year-old woman was found sitting bolt upright gasping for air, due to this underlying heart problem.

Later in our visit, the director of pharmacy shared her gratitude for the medicines and medical supplies, donated by HOPE. She cited IV fluids from B. Braun and lidocaine from Hospira. We were later joined by two of the Haitian biomedical engineers who helped prepare HOPE’s assessment of medical equipment, requested by the Minister of Health after the earthquake, at six of the largest hospitals in Port-au-Prince.

Dr. Sullivan and Pamies are right – health professions education is at risk here in Haiti. Its future supply of physicians and nurses, and hence the future of country’s health care, is in question. While the focus of recent months has been on the acute crisis (post-earthquake trauma) and more recently, the quiet crisis (tuberculosis and diabetes), the unseen crisis (health professions education) is now at hand. The right prescription for returning Haiti to an adequate supply of physicians and nurses needs to be written as soon as possible. The health of Haitians, now and in the future, will be the beneficiary.

HOPE's Legacy Lives On

On the USNS Iwo Jima, three miles off the white sand coast of Port-au-Paix in northern Haiti, the berths are filled with doctors and nurses, engineers and electricians from the U.S. and countries around the world, now engaged in the Navy mission Continuing Promise.

Its mission—to train U.S. personnel, military and civilian, for humanitarian assistance and disaster relief—is the twentieth for Project HOPE and the Navy. What began with the tsunami, and 210 Project HOPE medical staff on the USNS Mercy, continues to this day aboard the Iwo Jima, where four separate Project HOPE rotations of volunteer doctors and nurses will be involved in its entire four-month deployment in Latin America.

The waters of the Caribbean are too deep for the ship to drop anchor at its current location, so it slowly moves in a square pattern at two knots – an appropriate metaphor for its always-in-motion schedule, one which will include eight countries, with visits of about ten days each.

Mission Commander, Captain Tom Negus, told us that this is the best experience of his Navy career, as he brings together people to deal with the most challenging of issues facing the region. Negus likened the process to weaving a tapestry—integrating professionals from a wide array of disciplines with the needs of the community.

From 5:00am to 7:00pm, seven days a week, the men and women of the Iwo Jima, including volunteers from HOPE and those of other non-governmental organizations, are reaching out to Haitians in need -- on the ship and on shore. These settings include clinics offering medicine and surgery, as well as operating rooms for eye and general surgery. Each day, over 600 men, women and children are the beneficiaries.

Earlier today, HOPE volunteer and internist Mike Polifka, now in his seventh Navy/HOPE rotation, cared for a young woman with swelling in her right leg. In the U.S., this finding might have been confused with venous insufficiency, swelling related to inadequate return of blood to the heart. Not so in Haiti, thanks to Dr. Polifka. He made the diagnosis of elephantiasis (filariasis) -- an infection involving the lymphatic system rarely seen in the U.S. The antibiotics that he prescribed will improve her life dramatically.

Port-au-Paix Mayor Charles Guillet Salvador came to the clinic this afternoon -- to personally thank Dr. Polifka and his Navy and HOPE colleagues. He spoke, in grateful terms, of the profound impact that the Iwo Jima is having on the people of Port-au-Paix. When the ship leaves in a week, they will have a different view, positive at that, of America.

All of this is in perfect keeping with the proud traditions of the first ship on which HOPE volunteers served: namely, the Consolation, a Navy hospital ship, painted white and renamed the SS HOPE in 1960. Its legacy lives on, here in Haiti, on the Iwo Jima.

Intersection of Interests

For many weeks after the January 12th earthquake, the daily sound of chopper blades filled the quiet town of Milot, Haiti, as a 40-bed hospital swelled to serve 600 patients during helicopter airlifts to the Hopital Sacre Couer.

Sacre Couer has served the community of Milot, with a population of 35,000, since 1977, with additional referrals coming from Cap Haitian, the second largest city in Haiti. The hospital--whose specialty services, from complicated deliveries to neurosurgery, are renowned--has earned its place in history for its response to the first major earthquake to hit the country in many generations. And Project HOPE was at the heart of this effort.

Many of the earthquake-affected patients were transferred from the USNS Comfort where rotations of HOPE volunteer doctors and nurses were hard at work. They were admitted to the hospital where they benefited from the best of HOPE’s corporate partnerships.

For example, in the neonatal unit, dehydrated infants received Hospira fluids. In the intensive care unit, the sickest of patients were monitored by Siemens equipment. In the operating room, patients underwent surgery with the latest in cardiac monitoring from Philips. And throughout the hospital complex, patients and staff alike enjoyed clean water made possible by a solar-powered purification system from DynGlobal.

As I have mentioned in recent postings, I believe that in the direst of tragedies, the best outcomes are those made possible by not one but many heroes. In Haiti, these heroes were on the Comfort with its Navy and Project HOPE doctors and nurses, among the U.S. Marines making around the clock airlifts, within the staff at Sacre Couer, and found in the generosity of U.S.-based health care corporations. Each of these heroes joined HOPE in putting a face on America’s humanity.