Haiti: Before and After the Earthquake

Vincent DeGennaro, MD, MPH

Goals• History of Haiti

• Health and economic indicators

• My personal experiences in Haiti

• Short term and long term goals

• Donate to Project Medishare or Partners in Health

A Brief History of Haiti

• Christopher Columbus landed on Ayiti in 1492

• Haiti became known as the "Pearl of the Antilles” – By the 1780s, Haiti produced about 40 %

of all the sugar and 60 % of all the coffee consumed in Europe

• Children of whites and their concubines were free people and could own property, including slaves

Viva la Revolution!• 1791 The slave revolt begins in Northern Haiti• 1799 Fighting the British, French, and mulatto

land owners, rebel slaves capture all of Haiti and all Hispaniola by 1801

• 1802 Napoleon invades and recaptures Haiti• 1804 United by France’s brutality, all

indigenous oust French army• All whites evacuate and remaining 4,000 are

slaughtered as retribution

A New Nation is Born

• France, England, and USA enacted embargo and forced Haiti to pay 90 million gold francs which took until 1947

• Haiti occupied the DR from 1822 to 1844• Ruled by series of dictators until 1915 when

US occupied Haiti until 1934– Rewrote the constitution to allow foreign

ownership of land– Owned Haitian national bank until 1947

Modern Haiti

• “Papa Doc” ruled from 1957 to 1971– His government killed 30,000 people and drove away

Haiti’s intellectuals

• 19 year old “Baby Doc” lived as a playboy and drove Haiti into debt

• Jean-Bertrand Aristide elected and overthrown in 1991 and over 40,000 Haitians fled by boat

• US Marines reinstate Aristide in 1994• In 1996, Haiti had its first peaceful transition

between two democratically elected leaders• Aristide was overthrown and “evacuated” by US in

2005• UN peacekeepers arrive and oversee election of

Rene Preval

Health Demographics

Haiti USAMaternal Mortality Rate

680 deaths/ 100,000 live births 11 deaths/ 100,000 live births

Birth Rate 29.1 births/1,000 population 13.82 births/1,000 population

Infant Mortality Rate

57 deaths/ 1,000 live births (37th) 11.6 deaths/1,000 live births

Under Five Mortality Rate

72 deaths/ 1,000 live births (48th) 7.6 deaths/ 1,000 live births

Life Expectancy 55 years 78.11 years

Economic Indicators

• GDP per capita: $1,300 (203rd)• 80% live below poverty line• Half the population earns $60 or

less per year. • The total expenditure on health per

person is $54 per yearSources: CIA Factbook 2009, WHO Country Fact Sheet, UNICEF State of the World’s Children

My prior experiences in Haiti

The “Pearl of the Antilles”

Life in Rural Haiti

Port au Prince 2006

Port au Prince 2006

Transit in Port au Prince

Project Medishare/UM Hospital

Early “OR’s”

Medical Record Keeping

Tour of Port au Prince

US Embassy

L’Hopital Communitaire Haitien

Skull Laceration

Draining a breast abscess

Closed Dislocated First and Second Digit

Baby with facial nerve palsy

Ortho injuries

Pediatrics

OB/GYN

Pharmacy

After the “aftershock”

Before………….and after

Partnerships

Portuguese BombeirosKorean EMTFrench Mountain Rescue EMT/MD’sHungarian EMTsSwiss Nurses/EMTsAustralian Nurses/EMTsIsraeli MDs/NursesCuban MDsUSAJamaican ArmyUN Peacekeepers from Bolivia, Chile, Argentina, NepalHaitian MDs

NursesEMTsAdministratorsTranslators

What now?

• Short term: Weeks

– Address immediate medical needs

– Food and water distribution

– Sanitation and hygiene

– Restore government to power

– Demolition of buildings

• Medium term: Months

– Permanent shelter for rainy/hurricane season

– Rebuild governmental capacity

– Rebuild public health infrastructure for basic health needs

– Long term access to food, water, sanitation

Long term: Years• Rebuild schools,

hospitals, government buildings

• Peaceful transition of government

• Developing industry, agriculture, transportation sectors

• Education• Training and retaining of

national intellectual capacity

• Elimination of extreme poverty

How will the US respond?

• When to leave?

• How to transition control of government?

• Healing

– Micro or macro?

• Rebuilding infrastructure

– How to design buildings? Where to build?

• "I am at my core optimistic about the possibilities before us and the potential of our support to help rescue and transform our poorest neighbor. The response from citizens of the US to the recent events in Haiti has been overwhelming and encouraging. There is the promise of solidarity by our leadership to make long-term commitments to the kinds of investments needed in Haiti—and to fulfilling them. For two centuries, the Haitian people have struggled for basic human and economic rights, the right to health care, the right to education, the right to work, the right to dignity and independence. These goals, which Haitians share with people all over the world, should direct our policies of aid and rebuilding.“– Paul Farmer, 1/29/10 in testimony to US Senate Foreign Relations

Committee

Please give:

Partners in Health www.pih.org

Project Medishare for Haitiwww.projectmedishare.org