HAITI NEEDS CONTINUED SUPPORT FROM FOREIGN HEALTH PROFESSIONALS

Sunday morning services at Ebenezer Baptist Church in Atlanta, Georgia, across the road from the original edifice where Martin Luther King Jr. preached. Photo by Melanie Stetson Freeman/The Christian Science Monitor. Printed with permission of Getty Images.

Haiti's fragile health care system collapsed—along with the rest of Port au Prince—after a massive earthquake struck the island nation on January 12, 2010. Although health care resources were severely limited before the earthquake, the lack of human resources may now be Haiti's largest obstacle to providing basic care, particularly to its impoverished capital city of 3 million people, where the quake was centered. Large numbers of foreign health professionals are needed to supplement Haiti's health care worker shortage in the short term, and massive training of native health care workers is essential to improving long-term community health, as demonstrated by Perry et al.¹

Prior to the earthquake, Haiti spent US $82 per person per year on health care, and that dearth of funding was apparent in the lack of medicines, facilities, and personnel available for use.² The staff of Port au Prince General Hospital were not paid from November 2009 through May 2010, a common occurrence. In addition, there were less than 2000 doctors in all of Haiti in 2005, putting the country's ratio at 3 doctors and 1 nurse per 10 000 Haitians, far less than the World Health Organization's target of 23 health professionals per 10 000 persons.² Seven percent of Port au Prince's population perished in the earthquake; that total likely included many health care professionals, further deflating the ratio.

Training a new cadre of health care workers will take many years; for the foreseeable future, however, the current health care system must contend with increased morbidity from earthquake-related sequelae. Studies have demonstrated an increase in all-cause mortality in the post-Hurricane Katrina Gulf Coast region compared with years prior.³ Disasters in developing countries that are accompanied by poor living conditions spread cholera, dysentery, tetanus, and malaria outbreaks. The rainy season in Haiti could mean as many as 60 000 additional malaria cases if the seasonal peak approaches the rural prevalence of 3% in Port au Prince's 1.5 million homeless persons.⁴ The cholera epidemic is further evidence of the non-existent public health system and serves as another reminder of the need for more medical assistance. In addition, the long-term morbidity for the 350 000 Haitian victims of traumatic injury may mean increased mortality rates for up to 40 years.⁵

There are several models of temporary personnel supplementation of Haiti's health care system currently in use. At some nonprofits, there are waiting lists of literally thousands of health care professionals in queue to serve the Haitian people, assuring medium-term sustainability. Combining this type of supplementation with the training of indigenous health care workers offers both sustainability and capacity building. Solutions that rely on the aid of foreign health professionals, however, must first guarantee full employment for all Haitian health care workers. Once the entire native work force is working, foreign health professionals can fill in the large gaps in care. If all foreign health professionals and nonprofits were to go home today, the native work force would be simply too small in number to address the scope of the problem both now and in the future.