A Sobering Meeting With the WHO

25 May, 2010

Ever since I arrived in Haiti I’d wondered how the medical efforts of all the NGOs and Haitian hospitals were being coordinated. After spending the morning seeing patients at a clinic at the Ste. Croix “tent hospital” I found out.

The wall of the Ste Croix Hospital
 SOS: 180 Dead

We were invited to go to the biweekly meeting of the Léogâne area WHO “health cluster.” It was held in a big tent on the grounds of the regional UN headquarters. The big UN site was bordered by cinder block walls topped with several layers of razor wire. Very serious looking UN soldiers from Sri Lanka wearing blue helmets, combat fatigues, and machine guns stood at the entrance. We exchanged our IDs for UN badges and walked through the compound. The grounds were filled with tents of various sizes and little pre-fab offices. A row of white satellite dishes pointed up to the sky like huge, gaping mouths. We found the tent, and settled in on folding chairs arranged in a rough circle. There were 10 or 15 other people.

The head of the Léogâne Health Cluster, a Haitian physician and new WHO employee, welcomed everyone and took a quick poll which established that more people spoke English than French. So the meeting was conducted in English. He began by apologizing for the absence of the representative of the Haitian Health Ministry, who was supposed to be conducting the meeting. (The next day he told me that he’d called the man daily over the previous few days to remind him, most recently at 11 am that morning for the 3 pm meeting. When he called the representative afterwards to see why he hadn’t shown up the man said something like, “Oh, sorry, I guess I forgot.”)

We learned that about half the medical NGOs registered in Léogâne were represented at the meeting; the other half were unaccounted for. Furthermore, it was estimated that no more than half the NGOs working in the area had registered with the WHO at all--maybe they weren’t even aware of the existence of the Health Cluster. It didn’t take a rocket scientist to figure out that under these circumstances, meaningful coordination of health care resources wasn’t going to happen. The truth is, each NGO was operating semi-autonomously.

The WHO doctor summarized the current state of play: The seasonal rains were just starting, making it impossible to run mobile clinics in some remote locations. Not a single facility was providing dental care in all of Léogâne. Virtually none of the NGO field hospitals, and almost none of the few standing Haitian hospitals had working laboratories, and the very few that did were charging for their services. Many patients who had had emergency surgery for fractures following the earthquake had not achieved satisfactory bone union and would need new surgery for internal fixation. But the nearest facility able to provide this surgery was many miles away and waiting lists were very long. In fact, there was only a single X-ray machine in the entire region, operated by the Japanese Red Cross. They could only accept emergency cases.

Then each NGO gave an update on its activities. Some were focused exclusively on reproductive health and domestic violence, others on childhood nutrition, still others on lymphatic filariasis. Several doing mobile clinics had already run out of key medicines.

The WHO doctor summarized the combined epidemiology report based on information supplied by some of the NGOs. Unfortunately, he said, he had data for only five medical categories—several key diagnoses such as sexually transmitted diseases and PTSD could not be collected. Why? Because WHO was not allowed to change the collection forms without the approval of the Health Ministry. He had sent the Ministry a proposed revised epidemiology form many weeks ago but they hadn’t yet approved it. Not surprisingly, the current statistics were not particularly useful—almost 60% of the cases fell in the category, “Other.”

He also repeated a previous request that NGOs conducting mobile clinics provide the GPS coordinates of each of their sites so that a map could be constructed that would reveal both unnecessary overlap and gaps in coverage. To date almost no one had complied, and at this meeting not a single NGO could supply the requested information.

Copies of an undated and unsigned letter from the Ministry of Health were passed out which ordered all medical NGOs to register with the Ministry or leave Haiti within 30 days. Several NGOs reported trying to meet all the requirements of the letter, but said it was virtually impossible because the relevant office was often closed, and even when it was open, when they went to  register they were told to come back in a month. As I understood it, most NGOs were in fact operating without having satisfied the Health Ministry’s requirements. Nevertheless, it seemed unlikely that they would be kicked out of Haiti, if for no other reason than bureaucratic inertia. It also emerged that the government had recently imposed an import tax on many items being brought into the country by health-related NGOs, such as computers and medical equipment. The tax specifically included medicines that were to be distributed without charge.

Finally, plans were announced for a big health fair to be held on Haitian Mothers’ Day. The theme was pregnancy prevention--there would be talks on birth control, and lots of condoms would be distributed. Though the plans were presented very seriously, I chose to think that the organizers recognized the irony of holding a pregnancy prevention fair on Mothers’ Day. I had to find something to laugh about!