The prime minster is quoted as saying, “The earthquake, tsunami and the nuclear incident have been the biggest crisis Japan has encountered in the 65 years since the end of the second world war. Police warn that [...]]]> The damage in Onagawa and other areas of Japan’s coast are unreal. They remind me of New Orleans after Katrina and Haiti when the quake hit. It’s sort of in between. The reality is, Japan is facing its greatest crisis since WWII.

The prime minster is quoted as saying, “The earthquake, tsunami and the nuclear incident have been the biggest crisis Japan has encountered in the 65 years since the end of the second world war. Police warn that the death toll could exceed 10,000 in Miyagi prefecture alone, and a UN agency reported that more than 1,600 people were confirmed dead. Most are thought to have drowned. I’m stunned.

Having spent time in Japan, it’s a country that I both love and admire. The people are great, and they deserve our support. I’m headed over. I leave on Tue at 6AM and arrive in Tokyo at 11:30 AM on Wed. I will keep everyone informed here and on Facebook.

James

MR. TONER: Thank you and good afternoon. And thanks once again for joining us. As many of you know, this is the third of three briefings that we’ve set up in advance of Wednesday’s one-year anniversary of the tragic earthquake that struck Haiti. This particular [...]]]> USAID Deputy Administrator Donald Steinberg, U.S. Global AIDS Coordinator Eric Goosby, Centers for Disease Control Director Thomas Frieden And USAID Haiti Mission Director Carleene Dei

Cholera is an intestinal infection caused by toxigenic Vibrio cholerae, group O-1 or O-139. Natural and man-made disasters which produce overcrowding, a scarcity of safe drinking water, improper elimination of human waste, and the contamination of food during or after its preparation are risk factors for the spread of the disease.

In areas where cholera has not been confirmed, a suspected case is defined as severe dehydration or death from acute watery diarrhea in a [...]]]> From: http://new.paho.org/disasters/index.php?option=com_content&task=view&id=543&Itemid=660

Cholera is an intestinal infection caused by toxigenic Vibrio cholerae, group O-1 or O-139. Natural and man-made disasters which produce overcrowding, a scarcity of safe drinking water, improper elimination of human waste, and the contamination of food during or after its preparation are risk factors for the spread of the disease.

Description

In areas where cholera has not been confirmed, a suspected case is defined as severe dehydration or death from acute watery diarrhea in a patient over 5 years of age.

In areas where an epidemic is under way, a suspected case of cholera is defined as acute watery diarrhea, with or without vomiting, in a patient over 5 years of age.

A confirmed case of cholera is defined as the laboratory-confirmed presence of V. cholerae 01 in any patient with diarrhea. Once the presence of the disease has been confirmed, it is unnecessary to examine specimens from all cases or contacts. Monitoring should include ongoing laboratory confirmation of a small proportion of cases.

It is important to adopt this definition. However, for clinical management of cases of acute watery diarrhea in an area in which an epidemic is under way, cholera should be suspected in all cases in patients aged 2 or older. It should be noted that in Central America, cholera primarily strikes adults, with 80% of the recorded cases representing individuals 5 years of age or older, while 80% of diarrheal diseases from other causes occur in children under 5.

There are more than 60 serogroups of Vibrio cholerae, but only the O1 serogroup causes cholera. V. cholerae occurs as two biotypes: classical and El Tor. Each biotype has two serotypes: Ogawa and Inaba. The El Tor biotype (first isolated in Egypt in 1905) is responsible for almost all the recent outbreaks of the disease, producing a greater proportion of asymptomatic infections than the classical biotype and surviving longer in the environment. This biotype can live in association with certain aquatic plants and animals, which makes water an important reservoir of the infection.

History of Cholera in the Region

The second cholera pandemic spanned the period 1826 to 1837. This was the first pandemic that ravaged England and Western Europe, causing thousands of deaths in early 1830. The epidemic spread to Canada, the United States, and Mexico in continental North America, to Guyana in South America, and to Cuba.

In January 1991 Vibrio cholerae 01 reached a town on the coast of Peru, trumpeting the arrival of the seventh cholera pandemic in Latin America. By the year 2000 the epidemic had spread to 21 of the 35 countries of the Region of the Americas, with Canada, Uruguay, and the Caribbean remaining free of the disease. Moreover, in 1999 Argentina, Bolivia, Chile, Costa Rica, French Guiana, Guyana, Paraguay, Panama, and Suriname did not report cases of the disease.

In the 19th and early 20th century cholera was a predominantly urban phenomenon with high case-fatality rates (30-50%). In contrast, the Latin American epidemic of the 1990s was rural, with lower case-fatality rates (around 2%). The disease is also becoming endemic, and an incipient seasonal epidemiological model can be observed.

Risks for the Traveler

People who follow the usual tourist itineraries and observe food safety recommendations face practically no risk when visiting countries that have reported cases of cholera.

The 10 Most Frequently Asked Questions

Q. When we speak of cholera we often refer to it as a pandemic. What is a “pandemic”?

A pandemic is a disease that strikes the majority of the population in a large region, emerges simultaneously in different parts of the world, and is a long-term phenomenon.

Q. Is cholera as widespread and serious now as it used to be?

No. In the 19th century cholera was found in major cities, causing high case-fatality rates (30%-50%), while today the infection is often mild, self-limiting, or subclinical and is found in rural areas, with relatively low case-fatality rates (2%).

Q. What led to the changes in the model of the disease?

The following factors can be mentioned: (a) El Tor, a biotype of V. cholerae in circulation, which produces a greater proportion of asymptomatic cases than the classical biotype; (b) greater access to safe drinking water; (c) better excreta disposal systems; (d) health education, and (e) primary health care.

Q. Is it possible to contract V. cholerae through person-to-person contact?

It is possible, but this type of transmission is very rare.

Q. What are the main steps in managing a suspected case of cholera?

The main steps are: assess for dehydration, rehydrate with a solution of oral rehydration salts, observe the patient, replace missing fluids, administer oral antibiotics only to patients with serious dehydration, and feed the patient.

Q. Do we need a health system with a high level of complexity to treat cholera?

Fluids and simple electrolyte replacement therapy produce excellent results in the majority of cases. Serious cases may require antibiotics (doxycycline or tetracycline for adults; trimethoprim sulfamethoxazole for children). These interventions can be carried out at the primary level.

Q. Are travel and trade restrictions recommended in outbreaks of cholera?

No. Travel and trade restrictions between countries or between different areas of a country do not prevent the spread of cholera. Not only are they ineffective, they lead to the suppression of information on outbreaks of the disease. WHO modified its International Health Regulations in 1973 so that travelers would no longer be required to show a certificate of vaccination against cholera.

Q. Are vaccinations recommended for cholera control?

No. The traditional vaccine against cholera (based on whole, killed cells) is characterized by low levels of efficacy and high reactogenicity. Therefore, it is not recommended for the control of epidemics. The new vaccines might be considered, but with these, there is a rapid loss of protection, giving people a false sense of security. Resources should be channeled to the most useful control methods.

Q. How do we protect young children against cholera?

In infants under 6 months, breast-feeding protects against the disease. Careful preparation of formula and food with safe drinking water should protect infants who are not breast-fed.

Q. Is it mandatory to report cholera outbreaks?

Yes. The diseases listed as reportable by the International Health Regulations are cholera, yellow fever, and the plague. WHO publishes the data on cholera outbreaks in the Weekly Epidemiological Record; the CDC publishes its semiweekly “Health Information for International Travel” to inform the public about where cholera and yellow fever have been reported.

What to Do at the Institutional and Community Level

• Adopt long-term policies to ensure that all populations have access to adequate systems for excreta disposal and the provision of safe drinking water;

• Offer basic health services through primary health care systems. The majority of cholera cases respond well to simple therapies; Prescribe antibiotics only for cholera cases showing signs of severe dehydration;
• Monitor the susceptibility of V. cholerae to antibiotics;
• Maintain specificity in reports, employing the case definitions developed by PAHO/WHO;
• Update the epidemiological profile of areas with cholera or considered at risk for the disease;
• Offer periodic training to physicians and paramedical personnel for the clinical management of patients with acute diarrhea;
• Maintain a stock of essential emergency supplies, especially oral rehydration salts (ORS) and solution and appropriate antibiotics.
• Maintain a buffer stock of drugs at appropriate points in the drug administration system;
• Emphasize safe disposal of human excreta through health education;
• Construct sanitary systems for human waste disposal, suited to the local conditions.
• Promote community production of chlorine so that it can supply itself.

What to Do at the Personal Level

• Drink only safe water (tap water, boiled for a minute or more, or water that has been disinfected with chlorine or iodine tablets);
• Avoid raw food (except fruits or vegetables that can be peeled);
• Cook food until hot both inside and out and eat while still hot;
• Carefully wash and dry kitchen or serving utensils;
• Wash hands carefully with soap after using the toilet and before preparing or eating food or feeding children;
• In emergencies, while a better latrine is being constructed, a simple pit (0.3m x 0.3 m x 0.5 m) can be dug at least 30 meters from the well or other source of drinking water. Latrines should be located below the level of the water source. Avoid swampy ground.

What Not to Do

• Do not eat mollusks, shellfish, or other fish or seafood from polluted waters, unless they are cooked thoroughly;
• Do not eat raw vegetables;
• Do not wash kitchen utensils or eat with water known to be contaminated;
• Do not bathe in water known to be contaminated;
• Do not mix raw food with cooked food;
• Do not drink milk that has not been pasteurized, unless it has been boiled adequately;
• Do not eat ice cream or use ice, unless it is from a safe source;
• Do not take antibiotics, unless prescribed by a health worker;
• Do not issue a quarantine in an effort to control the spread of cholera.

Note: The use of trademarks is to help with identification, but it does not represent an endorsement by the Pan American Health Organization (PAHO/WHO)

Suggested Readings

• “WHO Guidelines for cholera control”, Revised 1992 WHO/CDD/SER.80.4 REV 4 (1992) Orig. English. Spanish version: “Lineamientos para el control del cólera”.
• WHO “Guidance on formulation of national policy on the control of cholera” WHO/CDD/SER/92.16 REV.1 Original Spanish-English version: “Lineamientos de la OPS para formular una política nacional de control del cólera”.
• WHO “Diarrhea management training course: guidelines for conducting clinical training courses at health centers and small hospitals” Geneva, WHO, 1990 WHO/CDD/SER/90.2 (English only)
• WHO “Guide to simple sanitary measures for the control of enteric diseases”. Geneva, WHO, 1974 (English only)
• Manual for laboratory investigations of acute enteric infections. WHO/CDD/83.3 Geneva, WHO, 1987
• The treatment and prevention of acute diarrhea: practical guidelines. 2 ed. WHO, 1989 (Available in English, French, Portuguese, and Spanish)
• Manejo de los pacientes con cólera. WHO/CDD/SER/91.15 Rev. 1 (1992) Geneva, WHO, 1992
• CDC -Centers for Disease Control and Prevention “Health Information for International Travel” 1999-2000 DHHS, Atlanta, GA. On-line version.
• “Textbook of International Health” by Paul F. Basch (Chapter 1 – Historical Background) Department of Health Research and Policy, Stanford University School of Medicine. Oxford University Press (1990)
• La Investigación de las Dolencias Infecciosas en la Historia (Las seis primeras pandemias – pp 274-284) Arturo Romero B, MD Academia Colombiana de Ciencias Exactas, Físicas y Naturales. Colección Enrique Pérez Arbeláez, No. 12 Santafé de Bogotá, DC Colombia, 1997

It’s a statement you hear bantered around a lot by talking heads: “Haiti is the poorest country in the Western Hemisphere.” And yet, Haitians are, in large part, prevented from coming to the United States to try to escape that poverty.

A guy I know was conducting runs from Florida to Haiti and the DR, back and again, over and over again, right after the earthquake hit. He brought a ton of supplies [...]]]>

Drinking from a Water Hose. Not in Haiti.

It’s a statement you hear bantered around a lot by talking heads: “Haiti is the poorest country in the Western Hemisphere.” And yet, Haitians are, in large part, prevented from coming to the United States to try to escape that poverty.

A guy I know was conducting runs from Florida to Haiti and the DR, back and again, over and over again, right after the earthquake hit. He brought a ton of supplies in and a bunch of Haitians out on one of his flights. When he landed on this particular trip, he was held by ICE for “smuggling” Haitians into the country. Of course, he hadn’t intended to, because they had passports and visas stamped from the US Consulate in Port-au-Prince. Well, something went wrong and the they were turned away.

Listen, I’m not one for illegal immigration; I think it should be done properly. Though, in saying that, I can understand why someone might want to try their luck getting into the US. What I find interesting is, had they been Cubans, they would have likely qualified for political asylum. But because they’re not from an embargoed country, they are screwed.

Anyone coming to the US is doing so for one reason–to make a new life for themselves. Okay, in fairness, I’ll concede that there are small minorities of people who come here for nefarious reasons, such as terrorists, smugglers, and other criminals looking to either perpetrate more crime in our country, or to escape prosecution in theirs. But for the most part, the folks landing fresh off the boat or jumping over fences are doing so with good intentions. Again, I’m not for and do not support illegal immigration, all I’m saying is, let’s put it in perspective.

A garbage river in Haiti

My question is, why are we so diligent to return Haitians, but not Mexicans or others from the Americas who make their way across our border with Mexico? I find it strange that we will largely ignore people coming to work as migrant farmers and day laborers, who speak Spanish, and we’ll let in Cubans in once they land because they are considered political refugees (who also speak Spanish, ironically), but we’ll deport any Haitian who actually survives the 600 mile trip in shark infested waters, even if he is able to slap a wet, tired, and cold hand on the shore. In many respects, they should have the same status as Cubans, after all, for the last 30 years we’ve largely contributed to the political and economic violence that’s taken place in Haiti. All I’m saying is, why not be even handed? Why give Cuba special rights and not Haiti? Why even give them to Cuba in the first place? I’m just asking.

Let me explain my thoughts here. If we are going to give special dispensation to illegal immigrants who are able to touch land, like Cubans, it’s because there’s some special mitigating factor. With Cuba, it’s political. So if you make the trip and you get past the Coast Guard, you can then get that special status under the law. Well, here’s why Haitians should get it too.

When I was down there, I was told that there is over 80 percent unemployment. That seems to be the consensus wherever you look. What does that translate to on the ground? No shelter, limited clothing, no soap, no food, and no clean water. Think about it. That’s nuts. That means one out of every 10 Haitians has no way to earn a living and no way to take care of their children. And we thought 12 percent was bad in the United States. Make no mistake about it, this isn’t by accident–Haiti’s unemployment and poverty didn’t happen by chance; the situation in Haiti is the direct result of it’s history as a slave colony.

After Haiti kicked France’s ass in 1804, the world got pissed off. Wait, let me state that properly–white people in power revolted at the idea of a black republic. Yes, it’s true. They are in the position they are in, because of the French, with the help of the United Kingdom and the United States. That’s right, we helped cause it. We’ll be damned if some slave country is going to be successful. So we put our collective feet down on their collective necks. If you don’t think I’m being fair, then ask yourself why France, under the rule of King Charles X demanded a payment of about $500,000,000 from the new country before it would lift an economic embargo that it orchestrated after it ran from Haiti with it’s wounded tail between it’s legs.

Haitians fill containers from a dirty river

The United States isn’t innocent here either. Our forefathers, also slave owners, played a massive role in isolating Haiti after it won (fair and square) it’s freedom. For example, Haiti wasn’t invited to attend the Western Hemisphere Panama Conference in 1825, and, as a nation, we refused to even recognize Haiti as an independent nation until 1862. Go figure, when we were fighting over, among other things, the morality of slavery in our own country.

Now, I’ll be the first to tell you that Haiti is also Haiti’s worst enemy. Culturally, morally, legally, politically, economically, and every other way–Haiti is in trouble. That’s not to say there aren’t fantastic things about Haiti and the Haitians, if there weren’t, I’d not be writing this article right now. But in the absence of true leadership, people will accept whomever steps up to the plate. And plenty of wanna be presidents, emperors, dukes, and dumb asses lined up to take a stab and the country, and each other.

Then in 1915, they got us, erm, I mean they got U.S.–in the form of a military occupation that lasted until 1934. And actully, there was some stability. We tend to bring a bit of that through force when we arrive. The problem is, when we left, so did our promises to help support the country. Wait, that sounds familiar. Where have I heard of that happening before… Well, at any rate, they tried to keep things together and then they got the Duvalier family tree from hell  from and their kleptocracy from 1959 to 198, and then a series of violent junta regimes after that.

We played a major roll in financing instability. A great example is when we helped Haiti set up SIN (Service d’Intelligence National), the national intelligence agency for Haiti. I know, could the name get any better? The CIA funded SIN to help counter drug smuggling (a sin, if you will), but before we knew it, SIN began selling drugs. Go figure. Just like us to send millions in cash without making sure the people spending it are kept accountable.

And so it went for years. One bad thing after another from arrests of high level politicians, to rapes, to mass-murders, and so on–until it seemed the entire planet had finally had enough and sent in UN troops after the rebellion in 2004. Of course, UN “peace keepers” have also been accused of atrocities too–go do research on Sun City (Cite Soleil)–and Haitian police have summarily executed citizens in the streets. If you don’t think that’s true, I can show you a video that would shock your conscious that happened downtown days after the earthquake. But that’s for another article.

What bugs me the most is, over the last 30 years the United States has beat the living tar out of Haiti through economic sanctions, double standards, aid embargoes, and the like. In 2000, while we were fighting about who won the presidency here, we were punishing Haiti because when Aristide won overwhelmingly. What did we do, we blocked aid and funding. For the record, you want to know who suffers when that happens? Average people. Normal people. Jean Claude on the street trying to take care of his family–not the guys in power. For goodness sake.

The National Security Strategy of the United States of America says we promote “freedom and the development of democratic institutions” and “support those who struggle non-violently for it, ensuring that nations moving toward democracy are rewarded for the steps they take”. I call bullshit. I can’t think of a better place in the world where that sentiment could possibly ring more hollow. Now, compare that to Cuba.

Look to Haiti’s neighbor to the north and you find free education, free health care, and poverty–compared to us. But compared to Haiti, Cuba’s the bomb. What has democracy bought Haiti so far? Death, destruction, incredible poverty even by Cuba’s standards, lawlessness, sickness, and water that would gag a maggot.

Look, I’m all for democracy. But I also believe in social equality, human rights, feeding the hungry, and healing the sick. What’s does the evidence tell us about our policies towards Haiti and Cuba respectively? Well, it says that we’ll let Cuban’s have a free ride once they land ashore–if they make it–because we’re fighting against communism, and therefore they deserve our support. But Haitian’s can kiss are butt, because they’ve already got a democracy. Right now, all it means to be free in Haiti is to have the opportunity to die poor, hungry, sick, and uneducated. Sounds peachy.

Until the governments of the world get their act together, develop long-term education and health programs, establish a stable infrastructure, and support the right people to get into power, average people like me and you will need to put our boots on the ground there to help out other average people who welcome it.

Here’s what you and I can do to help. Tell others. Raise funds. Get off our couches and do something, anything. Call our congressman and tell them we need to help. And get them the things they need — and it’s not Starbucks, McDonalds, Internet access, or the newest 4G cell phone on the market—it’s things like clean water. You know, that stuff you and I can get it right from our tap, but instead, we buy it bottled from a tap somewhere else. Man, I remember being a kid and drinking right from the hose; I remember that rubbery taste. Now, I buy water. Really? I’ve decided to pinch pennies now, drink tap water, and use the savings to help Haiti.

That may seem useless, but it isn’t. One person can make a difference. Haiti’s water poverty index is, get this, 147 out of 147. That is, Haiti has the worst water in the world–and contaminated water is, without a doubt, the number one killer of Haitian children. The country has one of the worst infant and maternal mortality rates in the world, and over a third of all kids who manage to make it to their first birthday, show signs of malnutrition, severely stunted growth, and infectious diseases. They need water. We can help them get that by bringing in filtration systems, teaching them how to keep things clean, by investing in water plants, and so on.

That’s just one example of what we can do. What will YOU do today?

By Monika Kalra Varma — she is the Acting Director of the RFK Memorial Center for Human Rights and has worked extensively on advocacy and legal actions related to the United Nations, the Organization of American States and other donor states’ obligations to human rights within Haiti.

http://jurist.law.pitt.edu/forumy/2006/12/human-rights-is-not-just-charity-in.php

Human Rights Day is not only a day to commemorate the UN’s Universal Declaration of Human Rights, but a day to [...]]]>

Human Rights in Haiti

By Monika Kalra Varma — she is the Acting Director of the RFK Memorial Center for Human Rights and has worked extensively on advocacy and legal actions related to the United Nations, the Organization of American States and other donor states’ obligations to human rights within Haiti.

http://jurist.law.pitt.edu/forumy/2006/12/human-rights-is-not-just-charity-in.php

Human Rights Day is not only a day to commemorate the UN’s Universal Declaration of Human Rights, but a day to look towards what challenges lie ahead for realizing human rights in even the world’s most difficult of situations. There is perhaps no greater challenge in the Western Hemisphere than Haiti, nor a greater opportunity.

Haiti as a country has a tremendous commitment to human rights, one that we in the United States have a difficult time even recognizing. This includes the right to health, “the right of every citizen to decent housing, education, food and social security.” Haiti, the most impoverished nation in our hemisphere, accepts these greater responsibilities despite not yet having the resources to fulfill its obligations.

So what does a government that takes on such responsibilities do when it has no resources? It reaches out to its friends in the international community to help it grow and provide for its people. In 2004, countries around the world did just that – they pledged just over $1 billion to Haiti through the Interim Cooperation Framework, a plan to help the Haitian state develop the sustainable institutions and infrastructure necessary to provide access to health care, education and other human rights. The framework called for funds to be used in a way that empowers the government with the capacity to do its job better over time.

Donors met again last week to check on their progress. The Haitian government was commended for “sound fiscal policies” by international leaders including the U.S. Assistant Secretary of State for Western Hemisphere Affairs.

The international community’s performance report was less than positive. Haitian Prime Minister Jacques Edouard Alexis said that 99% of this money had not actually been disbursed. He expressed his hopes for funds to be channeled to Haitian ministries so they could strengthen their own systems to successfully carrying such work on into the future – exactly as the plan had called for.

For years, money has flowed directly through NGOs to carry out projects in Haiti, bypassing the government. Although some NGOs like Zamni Lasante, run by 2002 RFK Human Rights Award winner Loune Viaud, do work with the Haitian government, most do not. In many cases, the international community acts as an enabler, offering a quick fix instead of partnering with the Haitian government to build long term solutions. This approach takes an already weak public infrastructure and brings it to near collapse. Without the resources and infrastructure to implement its plans, the government has no ability to improve the public health situation. It is easy to point to concerns of corruption or the government’s inabilities as reasons not to fulfill pledges or to sidestep the government, but the consequences of not improving the government’s capability to eventually sustain itself infringes on Haitians’ human rights.

Although there is no obligation to assist Haiti, many countries did come together to pledge their support after many years of questionable intervention in Haiti. Once a country does choose to intervene, it bears a responsibility to the Haitian people. This line of thinking breaks from human rights’ traditional focus on a country’s obligations only extending to its own people. That paradigm fails to explain situations where wealthy donor countries have a greater impact on human rights situations than the government of a weaker host country, yet enact policies to the detriment of individual rights. There is a legal basis for obligations applying outside of one’s own borders that must be more closely examined and adhered to.

The $1 billion that the international community patted itself on the back for giving is not charity. Once a nation makes this kind of a pledge, it must actually follow through with its commitments and use the funds in a way that, at minimum, does not undermine the Haitian government’s ability to do its own job and help its own people. Under the current system, Haiti can not fully develop its own capacity and the country and its people are forced to rely on international donors and NGOs who may or may not deliver on their promises on into the future to meet Haiti’s human rights commitments.

The Interim Cooperation Framework could empower Haiti to develop internally and fulfill its responsibilities, though donor states have all but ignored it. The Haitian government is currently finalizing its Poverty Reduction Strategy, a new framework utilizing the same sustainable philosophy for donor support that intends to do just that – reduce poverty. The government developed a carefully thought out strategy to move forward. The difficulty is in getting the international community to support its plans.

Bypassing the government completely is at best wholly patronizing and at worst a direct violation of donor countries’ human rights obligations. As we celebrate human rights today, we should begin expanding our understanding of rights because in places like Haiti, the old way of thinking in only enabling further rights abuses.

Editor’s Note: Check out this site — http://ijdh.org/

Hesperian, a publisher in Oakland, CA collaborated with Medical Education Cooperation with Cuba (MEDICC) to produce an English edition of their Health For All Medical Glossary, originally published by MEDICC Review in Spanish, French and Creole. Developed for the Haitian graduates of Cuba’s Latin American Medical School in Cuba; the glossary assists these committed young doctors on their return [...]]]> Wanted to share this project with anyone who practices medicine in the field. It’s a great resources.

Hesperian, a publisher in Oakland, CA collaborated with Medical Education Cooperation with Cuba (MEDICC) to produce an English edition of their Health For All Medical Glossary, originally published by MEDICC Review in Spanish, French and Creole. Developed for the Haitian graduates of Cuba’s Latin American Medical School in Cuba; the glossary assists these committed young doctors on their return to Haiti–since they learned medicine in Spanish, speak with their patients in Creole, and compose clinical records in French.

Crazy.

Download the glossary as a PDF organized alphabetically by:

• Español
• Kreyòl
• Français
• English

I have copies of each on my thumb drive so I can access it on a laptop of hand held when I’m in the field. I’m seriously thinking about making a derivative work out of it for BOTG volunteers in the form of a printed field manual. Will let everyone know if I do that. Would take me a few weeks to lay it out, but I think it’s a worthy project.

I’m not saying there aren’t any, but of those who are qualified, and I use that term rather loosely, they are [...]]]> I read a great article by Kevin Edmonds called “The Undermining of Haitian Health Care: Setting the Stage for Disaster” that really made me think. He rightly pointed out, and I totally noticed while I provided emergency and primary medical care to the Haitians, is there is a serious lack of medically trained locals to care for their own people.

I’m not saying there aren’t any, but of those who are qualified, and I use that term rather loosely, they are mostly trained elsewhere. I actually rode into Haiti from the Dominican Republic with a Haitian medical student, who is in this final year at a school in Santo Domingo. I’m not sure if he’s even planing on returning to Haiti, as his wife and family live in New York. One of the doctors I worked with once I got into country, also trained in the DR, is currently in Miami working on passing the USMLE. He may not return either. After all, what’s the point?

There are medical schools in Haiti, but they are almost as scarce as clean water, and few Haitians can afford to attend them anyway. The medical school at the University of Tabarre in Port-au-Prince was the first ever to provide free tuition to students, which is a huge thing. While it withstood the earthquake on January 12, it’s not withstood the many man-made disasters that have occurred in its very short history.

With the support of the Haitian, Cuban, and Taiwanese governments, Tabarre opened the doors to its medical school in 2003. And you know what, people really thought there was change in the air. Given that over 90% percent of Haiti’s doctors work in the capital, with the remaining two-thirds are in rural areas, this was an important development that promised to reverse the tide of declining medical care in the small Caribbean country– if not to at least beat it back 1/60 of a step.

You may not know this, but Haiti has one of the worst doctor-to-patient ratios in the world–period. It’s bad. It’s worse than student to teacher ratios in Newark. The country was that way before the school opened, that way after the school opened, and it still is today. There is approximately one doctor to every 10,000 patients in cities or built up areas, and around one to every 20,000 people in outlaying rural areas. Quite honestly, having a free medical school promised to be a major milestone for Haiti. But like most of the promises made in Haiti and to the Haitians, it didn’t last.

When Aristide was overthrown in an almost bloodless coup d’état, so was the school. About a month after it opened, education stopped and the United States Marine Corps and the United Nations moved into the building. What’s crazy is, it didn’t open back up until 2009, and only then as a very pale imitation of what it had previously been. You can’t help but wonder, “WTF? Really?” Not a single student from the original intake returned to Tabarre, but instead many transferred to ELAM, the Latin American Medical School in Cuba.

What’s interesting, is those students are far from the first to go to Cuba. One of the doctors I worked with in Delmas was trained there, and he’s a superb surgeon. I had always heard the school was top notch, but you never know for sure until you work side-by-side with someone it produced. Being in the thick of it is where speculation, conjecture, and politics goes right out the window. The fact is, ELAM is an exceptional medical school, and if I were younger, I would apply to attend there myself. I think it would be a fantastic learning experience. Heck, I’d go to any medical school that would give me a scholarship to attend, after all, it’s money that generally keeps people out anyway–not a lack of aptitude.

I’m really impressed with Cuba. Think what you may about Castro and the country since the 60s, they’ve graciously sent doctors to Haiti regularly since 1998–and I admire and respect that. After the earthquake, a bunch of Cuban doctors linked up with a bunch of Haitian doctors that trained at ELAM, and they all made a difference in people’s lives. Keep in mind, at the time of the Tabarre’s opening, there were less than 2,000 Haitian doctors in the entire country. In a nation with so few physicians to provide needed medical care to the Haitian people, the school was truly an important project.

When I got there just after the earthquake, I was pleasantly surprised to find out that many of the students who left after the school was shut down in 2004, had came back to work with others to provide care. I heard about it from one of the doctors I worked with. Within a few days, the population around the school had swelled to over 10,000 people looking for help. But very little help came, despite being so close to the airport where American forces paved the way for thousands of planes to bring in critically needed supplies. I know, I was in and out of the airport every day and brought back supplies to our clinic. But that”s Haiti for you — millions of dollars of aid comes in, and it disappears before it can make it 400 feet.

So where does that leave Tabarre? Buggered. Still. And where does that leave Haiti? Same position. Haiti needs a thriving and productive medical school–now. Becoming a doctor isn’t a two-week course; the sooner you start teaching, the sooner people can get out there and practice. Without a school, the country is medically crippled.

Haiti has plenty of natural disasters like hurricanes, earthquakes, landslides, and floods, so the need for qualified emergency care rises each year and thousands die when it could have been prevented. The need for even basic primary care for millions, is equally obvious. Especially now given that the homeless rate is around 2.5 million or so. But it just seems like there are people, especially foreign interests, ready and willing to keep Haiti in the stone age. While natural disasters can temporarily cripple the nation, men seem hell bent on crippling it for generations.

My goal is to build one. Yes, it’s an ambitious, almost crazy goal–but it’s doable. You dream it, then you do it. That’s how all good things happen in life. And that’s how we’ll build a teaching hospital someday in Haiti. We’ll start small and build big. There’s someone out there, somewhere, who has the money and contacts to make it happen. Who want’s their name on the building? How about the Bill and Malinda Gates Teaching Hospital in Delmas? Or, maybe the Richard Branson (isn’t one of his kids in medical school?) Teaching Hospital? Come on folks, somebody needs to step up here. Let’s do this.

Note: Go read Kevin’s work here: https://nacla.org/node/6427. It laid the foundation and structure for this post here. If you’re interested in more information like this, contact us.

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Original Link: http://www.npr.org/templates/story/story.php?storyId=130412089&ft=1&f=1001

by The Associated Press

A refugee-advocacy group said Thursday that more than 70 percent of camps in Haiti, home to an estimated 1.3 million earthquake victims, lack proper international management nearly nine months after the disaster, leaving them at increased risk of sexual and gang violence, hunger and forced eviction.

Washington-based Refugees International said researchers visiting [...]]]>

Ramon Espinosa/Associated Press. A girl ties her hair next to her tent in a camp for earthquake survivors in Port-au-Prince, Haiti, last month.

Original Link: http://www.npr.org/templates/story/story.php?storyId=130412089&ft=1&f=1001

by The Associated Press

A refugee-advocacy group said Thursday that more than 70 percent of camps in Haiti, home to an estimated 1.3 million earthquake victims, lack proper international management nearly nine months after the disaster, leaving them at increased risk of sexual and gang violence, hunger and forced eviction.

Washington-based Refugees International said researchers visiting Haiti found that few of the roughly 1,300 camps they studied had International Organization for Migration-appointed officials to turn to for help and protection and are unable to communicate or coordinate with the international humanitarian community.

“The people of Haiti are still living in a state of emergency, with a humanitarian response that appears paralyzed,” the Refugees International report said. “Gang leaders or land owners are intimidating the displaced. Sexual, domestic, and gang violence in and around the camps is rising.”

The Jan. 12 earthquake, which killed up to 300,000 people, left millions homeless and little progress has been made to find the vast majority permanent shelter. A recent AP investigation found that one reason more than a million Haitians are still homeless amid piles of rubble is that not a cent of the $1.15 billion the U.S. promised for rebuilding has arrived.

“Action is urgently needed to protect the basic human rights of people displaced by the earthquake,” Refugees International said.

It criticized the International Organization for Migration, which is responsible for coordination and management of the camps in Haiti, and the United Nations operations in the country for not giving priority to actions to protect quake victims.

Refugees International’s President Michel Gabaudan said the organization can do “far more” to put managers in the camps, coordinate assistance, and help protect people. The report noted that the International Organization for Migration has about 700 staff in Haiti, but only three are protection officers.

The report called for the U.N. refugee agency, the UNHCR, which has decades of experience protecting the rights of displaced people and in coordinating camps, to co-lead protection activities in Haiti with the U.N. human rights agency. It also called on the U.N. to appoint a full-time humanitarian coordinator and increase police patrols “with officers that are properly trained, equipped, and have Creole translators.”

U.N. spokesman Martin Nesirky said Secretary-General Ban Ki-moon is aware of the report but had no immediate comments.

“It’s obviously highlighting very important matters including protection, especially of women, and that’s been a major concern of everybody right from the start,” he said. “We obviously share this concerns and we also want to see increased protection, particularly when it comes to sexual violence.”

As of Sept. 15, Nesirky said, 559 U.N. police officers were permanently present in six of the largest camps along with 640 U.N. military personnel. In addition, there are five mobile police units and another 704 military personnel carrying out mobile patrols at all times, he said.

Refugees International said “effective camp management and security patrols would also reduce risks of violence against women.”

It said some local women who established groups in the camps to carry out their own patrols and teach self-defense have received death threats.

It said local agencies working on gender-based violence in the camps reported that they had received three times the number of reports of sexual violence than pre-quake. The teenage pregnancy rate in the camps is also extremely high, Refugees International said, and medical agencies reported receiving large numbers of failed “street abortions,” some from girls as young as 10 years old. The organization said is also received reports “of women and girls forced to exchange sex for food, especially since the general food distributions stopped in April.

“In the absence of camp managers, self-appointed camp committees have sprung up,” Melanie Teff, one of the report’s co-authors, said in a statement. “In some cases, these are beneficial. But in others, these committees are made up of gang members, presenting themselves to aid workers as camp committees and intimidating camp residents.”

“I was told of a case where a woman went to take her trash out and a group of armed men raped her and bit off her tongue,” Teff said.

The lovely woman on the left hand an incredibly nasty crush injury to her hand when the earthquake hit and her home began to collapse. We saw her pretty much every single day at the clinic to clean the wound and dress it. We gave her what antibiotics we could, and always fed her. In many cases, the meal patients got from us was the only time they ate. It’s heartbreaking.

She and her son [...]]]>

A patient who later past away

The lovely woman on the left hand an incredibly nasty crush injury to her hand when the earthquake hit and her home began to collapse. We saw her pretty much every single day at the clinic to clean the wound and dress it. We gave her what antibiotics we could, and always fed her. In many cases, the meal patients got from us was the only time they ate. It’s heartbreaking.

She and her son (seen feeding her in the photo) came by dutifully on our orders for weeks, and she began to get better. Then she stopped coming. It seems that the trip she had to take to meet us became a burden on her family, and so they took her to another clinic who didn’t clean the wound or provide her antibiotics.

I was told that several weeks after I left Haiti, she passed away.