Living Dangerously

We're a few weeks away from the second anniversary of the January 10, 2010 earthquake. As far as healthcare is concerned, have we moved forward or backwards? Besides a modern hospital being built in Mirebalais, nothing has really changed. Some will cite dealing with the Cholera epidemics during the past year as the reason for such lack of progress. Yes, many resources dedicated to infrastructures have been shifting to the Cholera campaign. But the reality is there, begging for change. Patient, such as Yolene presented below, can't wait for long.
Yolene, a 36-year old woman, pregnant with her fifth child has been given a long list of prenatal lab tests to do. She looks at the script with sadness, knowing there's no way her partner would have money to pay for the tests. Six months later, when it comes the time for her to deliver her baby, she’d probably stay home, hoping for the best outcome. But if the baby turns or descends the wrong way or is huge, or if any other unforeseen complications occur, she may have to become part of the statistics on infant or maternal mortality.
There are thousands of Yolene in Haiti. For them each pregnancy is like a curse from the devil, on a financial standpoint. Who should pay for their prenatal, perinatal, and postnatal care? If they need a C-section, who should pick up the tab?
Henry has been living with Diabetes for almost a decade now. He drives a tap tap (re-arranged pickup truck where people seat on top of each other), when it’s available. The few gourdes (Haiti’s currency) that remain in his pocket, after paying for usage fees and fuel, can barely buy his medications (Glucophage and Glyburide) and food for his family of four. Many times he has to go without his meds or seeing a physician.
Thousands of Henry, living with chronic diseases, mostly Hypertension and Diabetes, face the same challenge: continuing care and daily medications. Who should help Henry pay for his medications?

Current Status

Today we're a few weeks away from the second anniversary of the January 12, 2010 earthquake that has devastated many of the western cities and towns of Haiti. Though most streets are now free of rubles, the apocalyptic image offered by the capital city, for example, is the same. You just have to take a trip to downtown Port-au-Prince to see the makeshift tents on Champ-de-Mars Park, the collapsed presidential palace, the ruins of the governmental offices, and the abandoned buildings of the business center. All surrounded by the stench of decomposed trash and portable toilets. Through it all, people have to make a living there, raise their kids, build a business, learn a trade, stay healthy, dream for a better Haiti. All of us living in Haiti face the same challenges. Yes, challenges, because that's what everything is in there, even the most basic necessities, such as food, water, lodging, and healthcare.

Food. Expensive, sometimes unavailable. Foods for the rich in the markets at Petion-Ville and grocery stores. Foods for the poor on roadsides, everywhere. Upscale restaurants, clean and safe. Roadside "chen janbe" (dog-crossed), dirty and germ-infested.

Water. Expensive, mostly unavailable. Clean water, free of water-borne diseases (such as Cholera), is bottled, thus expensive to most Haitians.

Lodging. The tent cities here and there say it all. Decent houses and apartments are available, but expensive. The affluence of international workers in the towns outside of Port-au-Prince has hiked the cost of housing.

Healthcare. Well, that's going to be the bulk of our discussions. So many challenges, but so many opportunities to do better. The volunteers and ONGs have saved the days after the earthquake. The response was massive. Quality care was free, thus accessible to all. High-skilled medical volunteers, many of them experts in their fields or heads of departments, came to contribute. For a while, as far as healthcare is concerned, it was heaven.  However, that could not last forever, of course. Months after months, ONGs are ending their activities or scheduling to do so in three or six months. Workers, clinical and supporting, enamored by decent paychecks are left grappling with the prospect of unemployment. The few institutions left behind, those that were there before the quake, have to push patients away--they mosatly accept complicated cases. Private hospitals that were put on the brink of bankruptcy are regaining their patients, those who can pay. But those who cannot pay face the same challenges they had before the quake: getting timely quality care.