After the Shock

Writer: 
June 1, 2010
Ties that bind: Dzau with Partners In Health staff members at Cange pediatric clinic


Ties that bind: Dzau with Partners In Health staff members at Cange pediatric clinic. Credit: Ian Greenwald

On March 2, Victor J. Dzau, chancellor for health affairs and CEO of Duke University Health System, made his first visit to Haiti. A close friend and former colleague of Paul Farmer ‘82, Dzau had gone to support fourteen Duke medical volunteers deployed to assist the Partners in Health staff in Cange.

But he had also gone to assess the situation on the ground—and to determine how Duke Medicine could best help Haiti in the months ahead. He came away, he said, inspired by the “incredible spirit of the patients and aid workers,” but also staggered by Haiti’s enormous needs.

“The facilities in Port-au-Prince were destroyed, and the huge demand for emergency surgery and follow-up care spilled over into rural areas,” Dzau told me, explaining how the country’s health inequalities had exacerbated the effects of the earthquake. “Those rural areas lacked the manpower and the resources to respond, so the crisis put a tremendous burden on the country as a whole.”

One strong measure of a national public-health system is its ability to protect people from what are known as vaccine-preventable diseases (VPD). With a mere 43 percent of its population immunized against VPDs, Haiti lags far behind the rest of the region, putting earthquake victims at elevated risk of infection.

Take tetanus, said Dzau. “Most people have not been vaccinated for it, and now we’re seeing an increase in cases in people who have undergone surgery. They’re discharged from the clinic and return home. But ‘home’ is a tent or tenement, with no clean water or sanitation.”

As the Duke team attended to Haiti’s acute medical needs, Dzau and Farmer met with government officials and senior health-care leaders to discuss the country’s long-term challenges, among them educating Haiti’s future doctors and nurses. “Here the Haitians were very clear,” said Dzau. “They plan to work with McGill University to develop a curriculum tailored to the country’s particular needs. I think our job will be to support them with resources, but not to try to reinvent the system.”

Nurse anaesthetist Lee Freeman with young patient

Nurse anaesthetist Lee Freeman with young patient. Credit: Ian Greenwald

On the day I talked to Dzau, representatives of 138 donor countries assembled at U.N. headquarters in New York, where they pledged to “build back Haiti better” with $5.3 billion in funding over the next two years. Still, said Dzau, aid alone can’t solve Haiti’s problems. “The real problem that I see at this point in time is a lack of coordination and a lack of authority. There are a lot of NGOs there, and there’s confusion about what different groups are doing. Going forward, it has to be coordinated; it can’t be many individual do-gooders doing their own thing.”

No less important, he said, is the willingness of donor countries to work with the Haitian government. “The government has always had limited resources. But many of the donations, as well as funding from the U.S. government, are going to NGOs, not the government,” he said. “That is a real problem. So the question is, how can academic institutions like Duke help to find the funding to enable the government to do its job?”

On April 5, the third Duke Medicine volunteer team arrived in Haiti to assist the Partners In Health staff in both Cange and Port-au-Prince.  And while a formal Duke-PIH partnership has yet to be established, Dzau says there is strong interest on both sides in forging longer-term ties. “There is a great deal to be done down the road, including rebuilding the medical and nursing schools.”

For now, he says, Duke Medicine is committed to maintaining its support for PIH  “We’re sending medical teams every month for the next six months,” he said, adding that even as surgeries taper off, Haiti’s medical needs remain immense. Dzau pointed out that all members of the Duke teams volunteered to work in Haiti, and that Duke Medicine is covering their expenses, which are considerable. “We felt that this was best. These are all people who want to be there, and they’re working day and night for as long as they’re on the ground.”