A version of Jim’s article “Why Haiti (still) Matters” was published in the Newark area Star-Ledger, January 27 issue.   Jim Morgan (below) is the co-founder of the Lamp for Haiti.  January 12th was the third anniversary of the Haiti earthquake.  The media has highlighted the slow and uneven use of international aid dollars since then, but Jim is not interested in submitting to pessimism.

Read it here: http://blog.nj.com/njv_guest_blog/2013/01/why_nj_should_care_about_haiti.html.

The three year anniversary of the Haitian earthquake is upon us, and Haiti still matters.

I have been asked several times in the past month the same question.  “What happened to all the billions of dollars sent to Haiti?”

I don’t pretend to  be able to answer that question on a broad scale, but I have personally witnessed exactly the types of good results that the American people would hope that their donations had gone to – providing direct lifesaving assistance to the poorest of the poor, in their hour of need. To be sure housing must be addressed more completely and expediently.   Recovery is far from finished, or even in full swing, but there is cause for more than naïve optimism. Let’s start with the literally thousands of lives saved by rescuers and disaster personnel who sprang into action following the earthquake in 2010. While less dramatic, important and effective strides are being made today by Haitians and Americans and other nationals.  For example, as bad as life was in the tent encampments, and still is, that there were not rampant typhoid epidemics or huge spikes in drug resistant TB is a public health accomplishment that ought to be touted as an example of a successful collaboration of the Haitian Ministry of Health and the international community.  The Ministry of Health in Haiti today is a much stronger institution than it was in 2009.

Drs. Paul Farmer and Jim Yong Kim, (Dr Kim is now head of the World Bank) have successfully implemented a model of healthcare in the developing world that has become prototype.  The organization they helped to found, Partners in Health, has demonstrated decisively,  on multiple continents, that  by working with the local government in helping to develop the public health sector, using local talent and paying fair wages,  quality lifesaving healthcare with sustainability can be delivered.   A new teaching hospital that will train tomorrow’s doctors and nurses in Haiti is one byproduct of such collaboration.

Our organization, Lamp for Haiti, works in a dangerous and very poor slum called Cite Soleil. Taking a page from the PIH book we utilize local talent, including Haitian doctors and nurses, and work in collaboration with Ministry of Health. We see about 200-300 patients each week, providing them with quality free primary and urgent care.  Many of our patients thank us each week for our presence and lifesaving work, made possible because of outside donors’ support in conjunction with skilled and intrepid Haitian staff.

A recent piece by Deborah Sontag in the New York Times sheds critical and much needed light on how recovery funds have been spent – or not spent – in Haiti following the January 2010 earthquake.  While the article is important as a means of public oversight of a vast project, I fear it misses contextual points.  First, recovery is expensive and often slow but it can yield results with flexibility, patience and persistence.   Consider that CNN’s  Adam Lashinsky reported a full two years after Katrina that the Lower Ninth Ward “…still looks as if a powerful bomb had struck.”   But America continued to believe in the Gulf, and it continues to recover today.

Katrina recovery in government funding cost over 140 billion dollars. Recovery from the tsunami in Japan has been estimated to cost 300 billion dollars. Governor Cuomo has asked the federal government for almost 42 billion dollars for New York State alone following Hurricane Sandy.

Haiti has about $7.5 billion to work with to recuperate from one of the worst natural disasters in recorded history. Haiti is among the poorest countries on the earth.  On that day in 2010, Haiti was devastated by a magnitude 7.0 earthquake at a relatively shallow depth of 8 miles. (A shallower earthquake sends more force to the surface, inflicting greater damage. Compare Haiti to Chile’s most recent earthquake with a magnitude 8.8 but occurring at a depth of 22 miles. This greater depth contributed a substantial degree of protection from surface damage.) The Haitian disaster left over two hundred thousand dead and perhaps 1.5 million more people  “displaced”, a euphemism for newly homeless.

The entire earthquake event was and is tragic.  I still experience unwanted, intrusive memories of a particular young man, about 22 years old who was lying on a gurney in a preoperative ward at St Damien Hospital. The air was dense with death, a result of gangrenous limbs and slowly fading persons awaiting amputations , those limbs which only hours before had carried them to their children’s’ schools or had waved good-bye to husbands and wives,  or had flagged down a Tap-Tap  to bring them to work.  Now the young man with a mangled right arm and severely crushed left leg – the crushed bones in the calf felt like sand and small stones in a leather sack – was lying on his back pleading with me through a steady stream of tears… “Please Doctor James. Don’t let me die. I can’t die. You understand?  I just graduated from university and I have a job and I am to be married. You are married, right Doctor James? You understand me? Please don’t let me die.”

I told him I wouldn’t let him die, but he did, sometime during that night from overwhelming infection.

As an internist and palliative care physician, I have seen scores of families through the process of dying.   As an Emergency Physician in lower Manhattan on September 11, 2001, and again in Port- Au- Prince after the 2010 earth quake, and again when cholera swept Haitian tent cities in 2011, bearing witness to death has sadly become a part of my professional experience.   Yet while this death was as tragic to me as any I have experienced, it has also inspired me; it has given me focus.  We cannot allow ourselves to become numb to such stories. They are real, and when we allow them to move us, they lift us up as individuals and as a nation, spurring us to act.

The second bit of context relates to geography.  It takes just under 4 hours to travel from JFK to Port-au-Prince.  The proximity of Haiti to the US means that the problems, particularly infectious diseases, on that island will not stay isolated there, and they are far more likely to find their way to America than diseases from more remote parts of the world. Bacteria cannot read, and they don’t respect international rules or territorial lines.  We would be wise to robustly bolster our efforts at supporting public health in places like Haiti, where such measures can have a significant impact on lowering the risk of the spread of disease in this country.

Finally, the concept of fairness is perhaps the greatest reason we ought to continue to be actively interested in Haiti. Americans inherently seem to understand fairness. Imperfect in our attempts to do so, we continually strive to level the playing field, as evidenced by  UN data on recovery and reconstruction following the 2010 earthquake, showing that fully one-third of funding came from the US. Fairness as it pertains to Haiti demands that we continue to care. As for me, I don’t give in to the naysayers who tell me that things will never improve, or that whatever resources sent there are squandered.  I suggest instead that they look into some of the positive work that is being done there, and I encourage them to stay involved.

Haiti still matters. Reconstruction in Haiti must continue, and surely housing needs to be addresses at a substantially more robust pace. But we can’t give up.  We can’t give in to frustration. We must stay involved as individuals and as a nation. It’s good for Haiti, and it’s good for us.

By James Morgan MD (from the Fall newsletter)

For most of my adult life, a common refrain that I have heard is “we are living in difficult times”.  I suspect that throughout the ages, there has been a tendency to say that the current epoch is more difficult than the ones preceding it.  And yet what often shapes our common knowledge of those eras is  not so much the difficulties faced but the responses, the human responses, sometimes right on the mark but just as often a little off-center.   Mother Teresa comes to mind as one who faced certainly overwhelming odds in addressing poverty. But rather than feel hopelessly paralyzed  she put one foot in front of the other, and tirelessly cared for those that even the inanimate gutters of the dirt and cobblestone streets seemed to have rejected. She would go on to start an order of nuns providing care to the most marginalized persons of the globe. (She started two homes in Port-au-Prince which operate there fully today!)

The earthquake in Haiti, that furious and terrible 40 seconds, seconds of horror that would for some bring years of misery, was in January 2010, almost three years ago.  The country in the immediate aftermath was a cracked shell of the shell it had been just before the tranbleman tè. It was, in a word, teetering.  People living there and people all over the globe, people just like you who care about souls they have never met and never will meet, people who have families and jobs and debt, and parents who are aging and grandchildren who are sick, who themselves have health problems, these people – you are among them – reached out a hand and said “grab hold. I can help. I can’t do it all, but I can help.” And it is because of your solidarity, real and pragmatic and soulful, I am convinced, the country did not teeter over the edge into absolute despair. There is progress. I bet Mother Teresa would be proud of your path.

Lamp’s Health Center is now staffed with full time professionals and support personnel.  Our primary and urgent care setting allows people to see one of our two physicians,  Dr Jude Dorsainvil and Dr Barrère Hyppolite who provide respectful and quality healthcare. Our laboratory allows for testing for common diseases of poverty and the tropics, like malaria and typhoid,  as well as basic serologies that serve to screen for illnesses such as diabetes and kidney disease. Our pharmacy has benefitted from donations from individuals and larger organizations, for example AmeriCares and Catholic Medical Mission Board, and allows our doctors to appropriately treat those conditions, and then to see the patient  back in follow-up weeks or months later.

We are especially proud of our own Ms Moza Flaure Alcius, RN, who next month will complete a one year training program to become a nurse midwife.  Lamp sponsored her enrollment in this excellent schooling, run by Midwives for Haiti, located in the country’s Central Plateau. Ms Flaure will be the driving force behind our women’s center, slated to launch January 2013. She is  guided by Anjali Gupta, MD, a physician in New Jersey, as well as Board member Dr Dulaurier Jacques, a Haitian OB-Gyn physician.

We continue to provide our services, including medications and supplies and labs testing,  at no cost to the patient.  This is an issue that has been visited and revisited, and we always come to the same conclusion that people will not choose health care when they cannot buy food.  Until the economic climate improves in Cite Soleil – the typical resident there gets by on about 50cents per day,  in a country where one gallon of gas is about eight US  dollars –we believe that we have no other option.

In what is certainly a good sign, we are growing out of our current space.  The coming year will see us either expand locally or move to a nearby spot where we can build. When we do , of course we will maximize our use of local labor and skills as we are able.

These are difficult times, especially if one lives in a slum in Haiti, under a leaky tin roof. And yet this project, the work of the community and staff of Lamp, and of our supporters should give one pause for hope. Most of you reading this have heard at one time or another that Haiti has made no progress in these past three years.  I disagree with that, at least in some arenas. (With regards to the public sector it is true that thousands of people are still living in ragtag tents today. However  the Ministry of Health is a much stronger bureaucracy than it was before 2010, and has played a key role in helping to address major public health issues like cholera. There are certainly many other like examples. ) Many nongovernmental organizations like Lamp for Haiti, Partners in Health and St Damien’s hospital have made tremendous inroads.

At Lamp , as in each of our lives, we  effect change where we stand. This model of quality care in one of the poorest slums on the planet, of showing compassion and solidarity by providing not just throwaways but quality, solid meaningful care, by and for Haitians, this is something of which we ought to be proud.  Let’s celebrate that and keep up the effort.  Thanks for your continued support and confidence in this important work.

On behalf of those whom we work with and for, a resounding Thank you! for your generosity in material, finances and spirit.  We are making a difference.

Since the earthquake of January 2010, we have refocused our mission to prioritize that which provides direct patient care, and related services. In short we want to keep our strengths strong and we are doing just that.

Some accomplishments to highlight…

Nurse training

Ms Flaure, one of our top nurses, is presently receiving advanced training in Hinche about 37 miles north of  Port-au-Prince in the country’s central plateau region. The program is run by an organization called Midwives for Haiti (http://www.midwivesforhaiti.org/). She will return to work for us in December and will manage the women’s program.

Expanded hours

While previously we were able to see patients three days per week, we now are open five. Under the direction of Dr Barrere Hyppolite and Mr. Benoit Florestal, the facility is operating in a manner consistent with our goal of being about Haiti, run by Haitians.

Laboratory

Our laboratory has been inspected by the Ministry of Health, and we passed with flying colors. We perform basic serologies, blood counts, blood and sputum smears (for malaria, TB and other tropical illnesses). Miss Aline, our certified lab techinician, keeps the lab in top shape.

Pharmacy Expansion

Our pharmacy provides medications to patients at no charge. Periodically we revisit the notion of patients paying a small stipend for the meds. The reality is that when patients need to pay, they forgo treatment. Most people get by on about 50 cents daily in the area where we work.

Leadership

Perhaps more than anything, the leadership now in Lamp for Haiti has taken a huge step forward. Dr Barrere Hyppolite and Mr Benoit Florestal together set the tone for professionalism as they work each day, often under extreme circumstances, to ensure that patients are receiving quality health care.

Partnerships

We have partnered with several organizations providing health care and related services in Haiti. Among them are Americares and Pure Water for the World.  We provide logistics support at Cardinal Stepinac orphanage in Bon Repos, located about 30minutes outside of Port-au-Prince.