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Doctor: Haiti Lacks Critical Health Infrastructure

New America Media, Interview, Dr. Erin Marcus Posted: Feb 13, 2010

Dr. Barth Green co-founded Project Medishare, which has worked in Haiti for two decades. He led the first team of U.S. physicians to Port-au-Prince after the earthquake and, together with the University of Miamis Global Institute, spearheaded the development of a 240-bed tent hospital that is now the countrys largest functioning urgent care hospital. His group is working with the U.S. government to establish Haitis first rehabilitation hospital. Green spoke with NAM contributor Erin N. Marcus on Feb. 5th.

Barth Green, M.D. aids critically injured patient Barth Green, M.D. aids a
critically injured patient.

How would you describe the countrys health infrastructure before the earthquake?

There are wonderful doctors and nurses in Haiti. But as far as a real health infrastructure, it didnt exist, because they didnt have the funding. They havent had the resources, the technology.

If you have a heart attack or stroke in Haiti, you die. There is not one angiogram machine in the whole country. Think about it - 10 million people, not one angiogram machine. They cant catheterize a patient. Its a totally different world, one hour from Miami.

What are Haitis most pressing health needs right now, and what are going to be its most pressing future health needs?

In three weeks, the rainy season begins, and theres no doubt were going to have epidemic issues with malaria and dengue.

TB and HIV - there were hundreds of thousands of patients under treatment. They cant get their medicines, theres no place to go.

Weve seen case after case of tetanus. Ive been a physician for 40 years, and Id never seen tetanus.

Weve got tens of thousands of people disabled from amputations, from paralysis, spinal injuries, brain injuries. (These) people need (physical) rehab and there isnt a good resource in Haiti now. There were small smatterings, but they were crushed.

Many aid workers have expressed concerns about a lack of coordination of the relief effort. Has this been your experience?

Right after the earthquake it was total chaos, it was a different world, but now were beginning to get our act together.

Its not well coordinated between the different divisions and agencies, but it will be shortly because theres a turnover plan. Theres organization about whos going to do what - thats good news.

What is your impression of the U.S. governments response to the quake? What would you advise the U.S. government to do?

No nation in the world has invested more money and more effort and more resources than the U.S. The United States is committed to Phase 2, which is not just resuscitation, not just CPR for Haiti, but reconstruction to get it a better way.

The downside is the left hand doesnt know what the right hand is doing. The DOD doesnt talk to HHS, which doesnt talk to USAID. Its just very frustrating.

Ill give you an example: There are 7,000 U.S. troops, heavily armed, on the ground there. We asked the U.S. government -- our government -- for some support, which would take about a total of 20 soldiers. They said no, theyre too busy. So we had to hire mercenaries to protect our camp. Is that right? I dont think so ... were serving as the triage for the U.S. (Navy hospital ship) Comfort and for the medivacs, theyre using us as a staging center.

Were lives lost as a result of the temporary hold on humanitarian flights out of Haiti?

I know they were lost. The question is, would these people have died?

(Before the earthquake), we had (performed) the first kidney transplant in Haiti. The poor gentleman got into problems with his graft. It was right in the middle of the embargo on flights, and he died in the hospital, right next to the airplane. If the airplane was flying, would he be alive? I think so.

Thats just one example. Theres no doubt that lives were lost, but lives are being lost every day there because of inadequate medical facilities and staff and organization.

What are long term solutions regarding the transportation of critically ill Haitian patients?

The worst thing to do would be to put them on planes and fly them all over the U.S. The nuclear family would disappear. Sometimes theres only one parent (and) if you take an adult to go with a child, the other children are orphans. If you take a husband whos the provider to go with his son, the family is without anything.

The best thing to do and the best practices are what were doing right now. Today as we speak, CT scanners, MRI scanners, anesthesia equipment, ICU equipment, fluoroscopy -- all this is being flown in, its being set up in temporary hospitals were going to put them in permanent structures. By treating them in Haiti, on the ground but with world class resources, youre giving (patients) the opportunity, short term, to have the best care possible. Long term, were going to leave every piece of this equipment and were beginning to train our Haitian colleagues so when we hand off these hospitals in the next couple of months, theyll be there forever. Were not rebuilding Haiti the way it was, were rebuilding a different Haiti.

What advice would you give an aid worker heading to Haiti, to prepare psychologically?

Theres nothing you can do to prepare for what youll see. Its life changing. I didnt see one doctor or nurse who hadnt cried and didnt cry at one time, no matter how old, big, macho, whatever.

Its really important for any for American going down there, or any foreign person, to step lightly. Remember these are a very proud, dignified people. I think a lot of things people do, especially in todays media world, are inappropriate. People are sending out blogs with their own agendas on the internet. I would ask them to treat (Haitian patients) as they would their own family, be respectful. The good news is that 99.9 % of the people who are working with us are there for the right reasons.

Related Articles:

Rising Seas and Extreme Weather: Communities in Harms Way Want U.S. to Act Now

Mission Haiti - Fear, Misinformation Hinder Aid

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