Tuesday, May 25, 2010

CUBAN-TRAINED DOCTORS IN HAITI FOR THE LONG HAUL

CUBAN-TRAINED DOCTORS IN HAITI FOR THE LONG HAUL 

Story and Photos by Conner Gorry

When the earthquake hit Haiti on the sunny afternoon of Jan.12, Cuban doctors serving throughout the country’s health system were among the first responders. Within 24 hours, these health professionals were joined by Cuban specialists trained in disaster response and epidemic prevention. Members of Cuba’s Henry Reeve Emergency Medical Contingent, many of these volunteers had served in post-disaster situations in Pakistan, Indonesia, China and elsewhere. 

A confluence of factors – the scope and location of the earthquake, the number of victims, the tenor of the destruction, and its disproportionate impact on vulnerable populations including pregnant women and children – make the Haitian scenario more complex than those in which the Henry Reeve Contingent has previously served. Innovation, combined with a targeted scaling up, was clearly needed. Enter doctors trained at Havana’s Latin American Medical School (ELAM).

“When I saw the images, I knew I had to help. Even before they asked for volunteers, I was ready to go to Haiti,” Dr. Carlson George, an ELAM alum, told me on the eve of his departure for Port-au-Prince on Feb. 11. Today, there are more than 700 ELAM-trained doctors and students from 27 countries providing free primary care, vaccinations, rehabilitation and other specialized services alongside Cuban colleagues as members of the Henry Reeve Contingent – now numbering 1,452.

THINKING GLOBALLY, ACTING LOCALLY

Cuban-Haitian health cooperation, initiated in 1998, has been marked by its collaborative approach, involving Haitian stakeholders in program design, implementation and evaluation. The earthquake response upholds this tradition: more than half of the ELAM-trained professionals in the Contingent are Haitian. This includes residents, family doctors, and 5th-year medical students.

The presence of Haitian doctors and medical students is critical to the Contingent’s efficacy. Not only do they serve as translators – essential to any relief effort in this French and Creole speaking country – but they bring indispensable cultural competencies to health services provision. The importance of understanding the culture of health here cannot be understated: in Haiti, a country where 71 percent of the population lived in poverty before the quake, the public health system is financed by patient fees – everything from gloves to anesthesia must be paid for before treatment. Not surprisingly, this means most people have limited experience with formal health care services since they can’t afford to see a doctor (or go broke trying). Haitian members of the Contingent not only understand these realities, they’ve lived them, so they’re careful to explain to patients – in Creole – that Cuban services are free, plus basic health promotion and prevention concepts like how vaccines work and the importance of breast feeding. Sometimes, however, the health education gap looms large: many surgeons, like Costa Rican orthopedic surgeon resident Dr. Douglas Valverde, explained how difficult it is to convince patients of the necessity of amputation, with some ultimately refusing the procedure.

As the emergency phase formally draws to a close (and the rains arrive), most international medical relief teams are scaling back their Haitian efforts. Unfortunately, the health picture remains dire, taking onnew urgency with increased risk for malaria, typhoid, leptospirosis, and meningococcal meningitis projected through June. After nearly 12 years of health cooperation with Haiti – through hurricanes, flooding, social unrest, and now a catastrophic earthquake – Cuba has favored engagement over withdrawal. The strategy continues: Cuban members of the Henry Reeve Contingent were given the opportunity to transition into the Comprehensive Health Program, making its standard two-year commitment, while ELAM doctors were given the option of remaining between three months and two years. “I’ve committed to stay here a year. The Haitian people need us,” Dr. Sindy Gómez from El Salvador told me. Those committing to stay beyond the emergency phase have been posted to 20 community hospitals and 39 health clinics throughout the country.

When I asked Dr. Patrick Dely, a Haitian doctor currently serving in Port-au-Prince how he sees Haiti’s future, he took several moments to respond. “This earthquake makes me want to work harder, fight harder for change,” he told me. “People talk about the reconstruction of Haiti, but for me Haiti was never constructed. We have to talk about construction.” In hospitals and health posts throughout Haiti, Cuban-trained doctors are dedicating themselves to that construction, helping rebuild the health system one patient, family and community at a time.


 

 Conner Gorry is senior editor of the MEDICC Review. This report is the result of Conner Gorry’s month-long assignment covering the Henry Reeve Contingent in Haiti. For more, see MEDICC Field Notes.