The earthquake in Haiti was a wake-up call to the world, drawing attention to this little island nation. The Haitian population in the US never managed to secure enough political power to turn our government's eye to the plight of what is known as the poorest country in the Western Hemisphere. Instead, it took an earthquake.
To get a sense of how ill-equipped years of world neglect has left Haiti to cope with this crisis, it helps to know some statistics about the country and its medical situation.
According to the UN, the population of Haiti was 10 million in 2009. Haiti is 27,750 square miles or slightly smaller than the state of Maryland. Thanks to many other excellent diaries on Daily Kos recently, we understand how deforestation and shoddy construction due to Haiti's enduring poverty contributed to the serious effects of the earthquake.
Haiti has never had sufficient medical resources for its population in normal times, let alone during a catastrophe. According to the WHO's World Health Statistics 2009, as of 2003, Haiti had 1,949 physicians or 3 per 10,000 people. In comparison, the United States--which also has a physician shortage--has 730,801 physicians overall, or 26 per 10,000 people. That is twice the global average of 13 per 10,000 people.
Unlike the United States, which makes up for its shortage by an increasing reliance on nursing staff (2,669,603 overall, 94 per 10,000), Haiti has only 834 nurses, or 1 per 10,000 people.
(Note: Some of these figures add up strangely, but the WHO relied on different sources to compile different pieces of data.)
Prior to the earthquake, Haiti was said to have 30 hospitals and approximately 13 beds per 10,000 people compared with 31 beds per 10,000 people in the United States. Like many hospitals in underdeveloped areas of the world, Haitian families are often responsible for providing bedding, food, and medications from an outside pharmacy for hospitalized loved ones.
After the earthquake, the capital Port-Au-Prince was serving at least 250,000 injured people using 18 hospitals and emergency field hospitals.
The US also dispatched a Navy hospital ship, which has 800 doctors, 1,000 beds, and 6 to 11 operating rooms. Many operations, however, are being performed outdoors. As a result of crush injuries from falling debris, physicians are performing approximately 70 amputations daily. Here is an account from Dr Evan Lyon, Haiti:
We’ve been operating for 2 or 3 days now but in improvised operating rooms without proper anesthesia. We’ve been forced to do amputations with a hack saw bought from the hardware store.
For the last few hours we’ve begun to have electricity. Until then we’ve been operating by day light and by flash light. I’m looking at a courtyard with more than a thousand people that need urgent surgery to potentially save their lives.
Very soon there’s going to be now a generation of people with amputations and so we need crutches, we will need wheelchairs, we’ll need other ways to help people move--if they survive--to help them get on with their lives.
In 2008, Haiti's gross domestic product (GDP) was $11.53 billion, according to the CIA World Factbook. More than two-thirds of the population are unemployed and 80% live below the poverty line. The gross national income per capita for Haiti in 2008 was an estimated $660. The estimated per capita total expenditure on health in Haiti was $42 in 2006 compared with $6,719 per capita in the United States.
Haiti has had difficulty keeping skilled professionals in the country, including physicians and nurses. In 2007, James Dwyer writing for the Hastings Center, reported that Haiti had lost 35% of physicians who graduated from medical school in Haiti.
With the country having a literacy rate topping 50% and a life expectancy of 59 years for men and 64 years for women, as well as endemic poverty, it is difficult for Haiti to train and keep medical personnel.
Some countries and organizations have tried to improve the situation in recent years. Cuba has trained hundreds of Haitian doctors, and Medecins Sans Frontieres has been working to train nurse anesthetists for the past 10 years:
From 1998 to 2008, 24 students graduated. Nineteen (79%) continue to work as NAs in Haiti and 5 (21%) have emigrated. In 2008, NAs were critical in providing anesthesia during a post-hurricane emergency where they performed 330 procedures. Mortality was 0.3% and not associated with lack of anesthesiologist supervision. The completion rate of this training program was high and the majority of graduates continue to work as nurse anesthetists in Haiti.
No doubt these anesthetists have been sorely needed. According to a CNN interview with a Haitian-American nurse volunteering in Haiti at the moment, pediatric medical supplies are also sorely needed. She said she has one bottle of hand sanitizer to help prevent infection and when that runs out, nothing. While a lot of medical supplies have been donated, much of it is designed for adults; pediatric needles and oxygen masks especially are in short supply.
In addition to medical needs for earthquake victims, Haiti's citizens have many other important medical needs. Haiti has a national HIV rate of 2.2% (UNAIDS), and a high mortality rate for children under 5, which the UN puts at approximately 85 per 1,000 births. They also have a rate of cervical cancer that is 12 times the rate in the US, and half of all cancer deaths in Haitian women are from cervical cancer.
The main reason Haiti does not have higher overall rates of cancer, cardiovascular disease, and diabetes is that only 3% of their population has survived to the age of 65. Nearly 38% of Haiti's population is under the age of 14. Compare this to the United States, where only 20% of the population is under the age of 14. Having such a large juvenile population complicates efforts to recover from a major disaster.
The earthquake has left 2 million homeless and 200,000 dead. Likely, some of Haiti's scarce medical personnel are among the dead. Aftershocks continue to plague the city. There have been several already, and USGS scientists say they could continue for years to come:
Their initial probability estimates for the next 30 days are that there is a 3 percent chance of a magnitude 7 or greater quake, a 25 percent chance of a magnitude 6 or greater quake and a 90 percent chance of a magnitude 5 or greater quake.
If ample money is not poured into rebuilding quality edifices in Haiti, then the country will remain at risk for a similar disaster in the future. Haiti will need to establish a building code and regulate where people can build, something not done previously. To date, at least $1 billion has been pledged. It will take billions more and years to rebuild Haiti, yet according to USAID, the Tsunami experience suggests that the "rush for aid in Haiti [will] last no longer than three months." It is very important that our memories of the earthquake and its effect on Haiti persist even when the footage fades from the television screen and the magazine covers.
Before the earthquake, Haiti was barely a blip on the radar of most people--something thought of only when those heartwrenching commercials came on to talk about the starving orphans. This is what left Haiti so ill-prepared to cope with the current situation and what lies ahead. After the news crews leave, hundreds of thousands of Haitians (including thousands of new amputees) will need to rebuild their lives, and they're going to need our help.
UPDATE:
Fellow Kossack Vc2 has a diary with information on how you can help contribute to relief for Haitians. Kossacks have already sponsored more than 101 boxes going to Haiti!