Is rural health care in Haiti sexy? Right now, the world cares because of an uncanny combination of natural disasters (earthquake and hurricane) and a severe cholera epidemic.

For three days now, our small group from Jewish Healthcare International and Houston Haiti Relief Initiative have examined what is truly sexy about rural healthcare in Haiti. Namely, people doing whatever they can to help their neighbors live today and tomorrow a little better. Not too worried about next year if we can make progress next month.

Our Haitian “team” (Jewish Healthcare International, Houston Haiti Relief Initiative & Project Medishare)

Today, our group of five volunteers, Dr’s “Steve, Rich, Paul, Manesha, and Adam” worked again for hours in a small rural clinic closed to the outside world for 4 months of the rainy season and accessible only by foot or four wheel drive vehicle the rest of the time. In the Savane plate clinic, we saw patients with broken bones poorly healed, strokes not fully treated, little dentition, poor access to care and even worse continuity of care.  With the leadership of our dedicated community host, Medishare, we put a needed, effective and meaningful band aid on a wound.

The disease itself needs long term solutions.  Yes to economic development, yes to roads, yes to collaborations, yes to more money and resources. The work on the ground may seem as slow as the oh my gosh really awful traffic right now in Port-au-Prince, but rebirth appears everywhere out of the rubble and destruction.  Don’t believe in only doom and gloom on CNN. Believe in new energy, ideas and relationships.

Today, our group of five shares preliminary thoughts of how two small U.S. NGO’s can work with two or more large and successful Hatian NGO’s and the government to make small gains, particularly for rural Hatians.

Some ideas:
Dr. Paul– primary care missions to rural areas with training and teaching; mobile eye care program and glasses; improved access to specialists on regional basis.

Dr. Steve– special needs like improved pharmaceuticals, improvements in surgical subspecialty equipment; training programs to improve local capacity; more funding to rural care.

Dr. Rich– improvements in family planning; prenatal care and obstetrics, focused specialty and subspecialty teams for training and delivery; meet needs expressed by rural NGO like Project Medishare.

Dr. Adam– Keep it simple and meet expressed needs; improve systems to increase access and continuity of care; training to increase capacity; several small continous quality improvement ideas; all volunteers to learn some creole.

Dr. Manesha– training for midwives and prenatal providers; delivery kits for home births; greater accessibilty to regional centers for high risk obstetrics; improved prenatal nutrition.

Some of these ideas may resonate with existing Hatian NGO’s and the government. Some may not. All require our commitment to sustainable change.

Your thoughts? Come visit Haiti, send and spend some money, create your own sexy stories, and make your own small contributions.  If you’re lucky like us, you will work with a great Haitian and volunteer team and make many new friends.

I just finished a 12 hour day here in Haiti, up on the Central Plateau in Thomonde. Near Hinche, a regional city of 100,000, Thomonde is a rural community of several thousand. Our headquarters for two days, we are escorted around by two exceedingly dedicated, talented, brave, and smart representatives of Project Medishare, Marie and Laurene.  One is lucky to have such partners that instill hope in every breath despite hardships that make most of us tremble. When 2-3% of Haiti’s population was killed by the earthquake (and everyone in the whole country was affected), and society could have crumbled like concrete buildings, the only way visitors, like the doctors with me from Jewish Healthcare International, avoid despair is to surround ourselves with talented Haitian community health workers and expose ourselves to native hospitality.

Today’s lessons, like the school we saw at a health clinic in one of the more remote areas of Haiti, called Boucantiste, come from what we clinicians learned long ago: poverty breeds disease. HIV disease, TB, cholera, malaria, malnutrition, etc., cannot be solved without profound economic development and support. That is why it was so heartening to see Medishares working to build an Akimil plant (a bean/rice food supplement with fortified vitamins) about to be finished next to a new rural training center. Throw in sustainable farming on site, and we truly have a yummy long-term mix. I hope some of you who gave me money to give out will like the small amount I am leaving for this purpose.

Next up, on the way to Boucantiste, you learn the meaning of the word “rural”, people living in the country. A 75 minute convoy of two vehicles, the mobile health van and the personnel, over small canyons, rivers, up and over and across and down pretty steep cliffs, feeling bumps and cracks in the road with every four wheel drive spin, with scenery as beautiful as any found anywhere, but almost no people or homes visible, arriving suddenly at a one room church and an open air covering for the school, where the monthly health clinic is held. Monthly, except for the four months of rainy season, when no cars can pass, and of course no people can get to the city. All is still except for the 100 schoolchildren singing “Maria, Maria” to the instructions of their two teachers.

Inside the church, at least 150 people are lined up on three walls to see providers: a wall for pregnant and breastfeeding women, a wall for the dozens of children, and a wall for adult males and females.  Dividing up quickly and taking our cue from the one Haitian nurse practitioner and intern on-site for the day, we dive right in, with interpreters, and a mobile pharmacy with a fairly effective though limited formulary. Several thousand dollars of samples we brought do prove helpful in some cases. Severe hypertension, severe arthritis, reflux and ulcers, iron deficiency, worms, urinary tract infection, eye infections, hernia, headaches, rashes and contusions, from those who had traveled 1-2 hours on foot to the church. Two cases of goiter and hyperthyroidism, one almost certain congenital heart disease in a 5 month old not thriving. We help, reassure, treat, and recognize that a paved road to these rural areas is more potent a pill than any we can deliver.

On to Hinche to see regional hospital, over 100 beds, orderly treatment of multidrug resistant TB (must stay at site for a year), HIV, peds, ob, post-partum, surgery, and unfortunately, cholera. Another make-shift cholera camp set up at the front entrance. Yesterday, all had hope the disease might wane. Today, 50 new cases on top of 50 in treatment. 100 now in a tent hospital. Several died again because they got there too late. Heroic Ministry of Health administration and Partners in Health clinicians making a difference. Medishare, our host, providing supplies, training, and additional personnel.

Riding back to Thomonde, the conversation turns to happiness and hope. What does it take to be happy in the world? Certainly food, housing and health at a minimum. What about hope? Marie tells us that Haitians are hopeful–they believe that tomorrow will be better, that they can’t complain about themselves if others are worse. Hope from Haiti is a blessing for all of us, despite the overwhelming suffering.

Tomorrow, I will blog about several ideas our group has to support the amazing, sophisticated and remarkably successful partnerships that have existed for many years on the ground but can always benefit from additional resources.