Haiti

Project Objectives:

Continue funding to allow permanent free clinic at Lambert Santé Surgical Clinic, a facility which since the January 2010 earthquake has never stopped providing much needed care to public patients. Through utilization of monthly funds provided by RMF, this free clinic has continued offering quality healthcare to patients in need of primary, secondary and tertiary care, offering :
• Primary care services (general, pediatric and trauma consults)
• Emergency care
• Maternal/child healthcare
• Secondary and tertiary care for medical &surgical conditions, prosthetic-fitting, rehabilitation and counseling for amputees
 

Develop a Consortium providing Public Healthcare utilizing local private facilities through a Public / Private Partnership leveraging economies of scale, existing facilities core competencies and expertise, which includes now:
• Plan development and execution while securing funding for operational, program and staffing costs
• Management Support, Coordination and Oversight of target activities
• Coordination and partnership development with other healthcare providers
• Develop partnerships with medical and nursing schools
• Develop Supplier relationships to support consortium w/quality products & services at reduced cost

Summary of RMF-sponsored activities carried out during the reporting period under each project objective (note any changes from original plans):

The overall healthcare situation in Haiti, apart from the effects of the regressing cholera epidemic has been better during this past 4 month period. But this system is still a much disorganized one with little or no knowledge on current and actual health offers (specific information of services offered and available) and their location. These facilities are sparsely distributed and evolving individually, for the better part.
This becomes especially true when in need of emergency care at night or during a holiday, when save a few locations, little or no comprehensive emergency and critical care is currently available.

The Cholera response to the outbreak has registered significant improvement during the past 2 months (lethality ratio falling and multiple health actors vigorously involved in the effort to treat and control the disease are more and more getting involved in general primary care again while decreasing the numbers and locations of operational CTU, and CTCs (respectively 188 and 100 in early February).
And although better, the overall water supply and sanitary procedures available remains rudimentary at best, this is particularly the case in the camps where lesser and lesser adequate conditions are being observed.

Another problem which seems to affect IDP camps is eviction threats (already under way in some camps). The first February OCHA humanitarian bulletin documents 169 camps affected by this phenomenon as about 74% of IDP’s are leaving on privately owned land and as time passes the landowners are questioning the possibility for them to regain these lands.
Most of these evictions or relocations in some cases are undertaken without a clear plan for or sometimes no housing at all. For example the Pétion-Ville mayor has started late January a relocation program with allocation of funds (20,000 gourdes/ per family) from available city hall funds, which has permitted little clearing of some of the 3 major IDP locations of this town, i.e. the 2 public squares (Saint Pierre and Boyer and also the soccer field Sainte Therese). While welcomed by some, mostly the ones with partially damage houses, this procedure while recommendable offers little or no prospect for a family without a habitation.

Epidemiologic surveillance remains vigilant still and the response to new cases still organized and efficient and as the lack of a proper human excreta disposal system and subsequent disposal sites are hampering the efforts toward control of Cholera progression, other aspects of healthcare are reclaiming their place during cluster meetings and definition of objectives.
At the last meeting in early February where post-earthquake work was officially being resumed, a comprehensive evaluation of current and future healthcare building and reconstruction projects has been presented by the IHRC, which +first mandate of 18 months is closing in, more and more concerns are becoming apparent that the initial phase of the Healthcare rebuilding will be lengthy and difficult. Of the 156 reconstructions projects identified in the Healthcare sector, only 56 are envisioned to be probably completed by October 2011, not taking in stride multiple obstacles and delays.

• 11 of them of a total of 66 are financed but not started yet
• 23 of them of a total of 43 are currently being developed
• 22 are actually completed, but consist more of consolidation of already in place facilities and implantation of small clinics

The MoH is targeting a significant improvement of healthcare delivery by October 2011 with the construction of 10 hospitals and 30 clinics, launching new constructions for 20 more hospitals and 30 clinics while relying in fact on funds for 10 hospitals and 15 clinics.

Amongst their immediate plans are found:

• Implantation of an emergency room in all functioning public hospitals,
• Development of an national Ambulance service,
• Education of better educated and trained healthcare agents to penetrate and touch the communities
• Establishing guideline for a more organized and need oriented educational program which should be, when available, followed by all partners in their activities.

A. LAMBERT SANTÉ Surgical Center (RMF Partner clinic and surgical center) activities:

1) RMF is continuing to co-finance the activities of the free clinic at this facility which continues to provide basic primary care services 24/7 but also secondary and tertiary care for surgical patients in need of specialized procedures.

2) The Surgical clinic with the same funds continues to insure salaries for three Medical Residents and three nurses, involved respectively regular nightly and holidays medical coverage and day to day care of hospitalized and surgical patients at the facility.

3) Few surgical procedures falling under RMF’s tutelage were performed during this time because Lambert Santé’s owner and Medical Director, Dr. Degand in regard to her involvement with other organizations, has recently started two programs with another of her significant partners, ALIMA:

• A clinical study of ostemyelitis incidence and particularities as a complication of post disasters limb fractures such as the January 12 earthquake, which required them to collect many post surgical patients from surrounding facilities to be evaluated and operated on.
• A cardio-thoracic surgery program launched successfully with the treatment of 9 patients during the month of February.
• Such a program should surely represent another core competency of our Consortium project, when it becomes active.

Number served/number of direct project beneficiaries (for example, average number treated per day or month and if possible, per health condition).

From October 2010 to February 2011, solely with RMF funding, the free clinic was able to see and treat 477 patients (with an average 119.25 a month for the duration), these treatments consisted grossly of:

• 196 emergency cases (minor surgeries, trauma, etc.)
• 278 outpatients visits (general, pediatrics, internal medicine visits)
• 3 major surgery cases (amongst them a cleft palate and a neglected elbow fracture)

Wound care and trauma related injuries represented around 41% of all consults during this period (decreasing proportion from last report) as the needs of the population are shifting significantly towards medical issues, representing about 58% of all consults.