New America Media, Question & Answer, Erin Marcus
You last visited Haiti in late June. What happened during that trip?
I went as a private citizen and visited with Haitian physician friends and my colleagues from school, many of whom had lost family members. I visited them at the general hospital and private offices. In most cases, their offices were empty and patients weren’t coming, because they could go to the [foreign] NGO clinics for free. Therefore the Haitian physicians couldn’t compete.
What are the biggest health problems in the country at this time?
The two biggest issues are access to care and affordability. Even prior to the earthquake, there weren’t enough Haitian physicians to cover the entire territory. After the earthquake, the problem was exacerbated. Patients aren’t able to get to a physician, and when they get there they aren’t able to pay for the care.
A couple of additional challenges are the rehabilitation of amputees, and the mental health challenges. A lot of people were traumatized and have post-traumatic stress disorder. There are also people with underlying mental health conditions such as depression that have been exacerbated. We don’t have enough mental health professionals in Haiti to address these issues.
Are there any health problems that the public health community did not anticipate?
I think they were anticipating major epidemics that didn’t occur, such as cholera and emerging infections. Fortunately, we were able to avoid them, but since I’m not practicing in Haiti, I can’t say I have all the information on that.
What are health services in Haiti like today? Where are people going to get their medical care?
Obviously, there’s less access to care than existed prior to the earthquake. A lot of the hospitals crumbled, a lot of providers’ offices were damaged, a lot of providers died. There are fewer providers providing care. Right now many people are going to their previous providers and dispensaries, but these have been supplemented by the makeshift hospitals that the NGOs set up after the earthquake. Some areas, particularly the rural areas, still lack health care, and people still need to travel long distances in the back of a car, on the back of a donkey, or on a cart to access health care.
What are the challenges that Haitian health professionals are facing at this time?
From the standpoint of the Haitian doctors, they have a dilemma. Although they understand that there aren’t enough Haitian health care providers, they feel there is unfair competition from the health care providers from abroad who provide care for free. They can’t compete with them, and the government can’t compete with them. Yes, they understand that people need care and the NGOs are providing a service that’s needed, but they would prefer that there be some grant support to the Haitian health care workers, who can provide culturally sensitive care at a much lower cost, and reach more people. It would also help reinvigorate the economy in Haiti. There are a lot of Haitian doctors who are unemployed or underemployed, and have no source of income.
What are the specific needs of Haitian health professionals now?
They need to rebuild whatever situation they had before the earthquake, and they would appreciate it if the international community provided some financial support, at least on a short-term basis, to help them rebuild the health system. The foreign physicians aren’t going to stay in Haiti for the long term. There is a need for support for the health care institutions in Haiti to allow them to provide care in their local communities, and for help rebuilding the local health care infrastructure.
How did your organization react immediately after the earthquake?
Our first priority was to find ways for our members to travel to Haiti in order to assist with the emergency medical response. Since we did not have the resources to organize flights to Haiti, we relied on the logistical support of other major organizations. We had a list of medical volunteers ready to travel to Haiti at a moment's notice, but it was difficult to find flights.
It was very frustrating. We had a lot of people who were eager to go, but Haitian physicians weren’t on the priority list.
How has your organization’s mission changed since the earthquake?
Before the earthquake, we focused on providing assistance to the general hospital in Haiti and academic support, such as lectures and exchange programs to do training in the States. These are on hold, since the medical schools have been destroyed. Our new strategy is to identify local Haitian health care institutions that have specific programs serving Haitian people and provide funds, whether it is for physician salaries or supplies. Our other focus is to help to rebuild the academic health care institutions in Haiti.
What did you think of the media coverage after the earthquake? Has it been balanced?
We are grateful to the media in general for providing extended coverage of the earthquake aftermath and for keeping the focus on Haiti for a long time. Concerning the emergency medical response, the media put the spotlight almost exclusively on American and other foreign medical teams, largely ignoring the contribution of local Haitian physicians, or physicians of Haitian descent who traveled to Haiti from the U.S. or Canada. They treated lots of patients and contributed significantly to the relief effort, and it wasn’t reported.
Dr. Erin Marcus is associate professor of clinical medicine at the University of Miami Miller School of Medicine. A Doctor's Word is supported by a grant from the Ford Foundation.