Posted By: John P. Howe, III, M.D. on August 3, 2010

Labels: Haiti , Health Care Education, Health Systems Strengthening, Humanitarian Aid

In late May, Dr. Louis Sullivan, former Secretary of the U.S. Department of Health and Human Services and current Project HOPE Board member, and Dr. Ruben Pamies, Dean for Graduate Studies at the University of Nebraska Medical Center, asked to meet with me in Washington. They expressed a deep concern for the next generation of Haitian physicians and nurses, in light of the damage suffered by the medical and nursing schools in Port-au-Prince.

They asked Project HOPE to join in assessing the current capacity of Haiti’s health professions education – in the context of the future need for health care in the country. Two days ago, we visited the medical school, Universite D'Etat D'Haiti, which has been largely reduced to rubble. Today, we went to the site of a former nursing school on the grounds of the teaching hospital, Hopital Universite D'Etat D'Haiti, also known as General Hospital. What we saw was breathtaking. The nursing school building had been leveled – now replaced by UNICEF tents. Hundreds of nursing students lost their lives, when the school collapsed.

General Hospital, which long served as the “safety net” hospital for the poor of Port-au-Prince, is a shadow of its former self. What was once an 800-bed facility was reduced to a 300-bed capacity. Major buildings (general surgery clinic, inpatient women’s internal medicine, outpatient clinics and pediatrics) are shuttered. In the face of this, the need for urgent care continues on.

Nick Lobel-Weiss, Executive Director of Global Emergency Relief based in New York City, and secunded to the General Hospital, gave a most compelling example. A twenty-nine year-old woman with active tuberculosis, now in her 29th week of pregnancy, was in the midst of being transferred from the teaching hospital to the Adventist Hospital in the Diquini neighborhood of Port-au-Prince, which had been spared from major earthquake damage.

We met Dr. Megan Coffee, an infectious disease fellow from the University of California, San Francisco. She arrived in Port-au-Prince in late January -- and has been involved in round-the-clock care of critically ill patients since then. She told us of the high prevalence of post-partum, dilated myocardiopathy, not often seen in the U.S. These patients can present with an admitting diagnosis of tuberculosis when, in fact, their chest X-ray findings are those of heart failure. Here at General Hospital, earlier today, a 22-year-old woman was found sitting bolt upright gasping for air, due to this underlying heart problem.

Later in our visit, the director of pharmacy shared her gratitude for the medicines and medical supplies, donated by HOPE. She cited IV fluids from B. Braun and lidocaine from Hospira. We were later joined by two of the Haitian biomedical engineers who helped prepare HOPE’s assessment of medical equipment, requested by the Minister of Health after the earthquake, at six of the largest hospitals in Port-au-Prince.

Dr. Sullivan and Pamies are right – health professions education is at risk here in Haiti. Its future supply of physicians and nurses, and hence the future of country’s health care, is in question. While the focus of recent months has been on the acute crisis (post-earthquake trauma) and more recently, the quiet crisis (tuberculosis and diabetes), the unseen crisis (health professions education) is now at hand. The right prescription for returning Haiti to an adequate supply of physicians and nurses needs to be written as soon as possible. The health of Haitians, now and in the future, will be the beneficiary.

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