Health and sartorial elegance in Haiti
Antje Neubert, senior research fellow at the Centre for Paediatric Pharmacy Research, School of Pharmacy, University of London, describes working with a German non-governmental organisation in Haiti, after the earthquake in January 2010
See other Christmas miscellany articles
The engines of the American Airlines aeroplane roared and slowly we gained speed. For the last time I saw the blue and grey huts in between the green of the trees before they became almost invisible, like little dots as the plane hovered above the sea.
I was leaving Haiti, half laughing, half crying, after my first mission with Pharmacists without Borders, a German non-governmental organisation dedicated to improving the supply of medicines to developing countries.
Its partner organisation, Landsaid, has run a mobile clinic in Haiti since February 2010 and, for three weeks, I was its pharmacist. In addition, the team was made up of a German doctor, a Haitian doctor, three nurses (two of them from Haiti) and two translators.
I arrived on 26 July in Port au Prince, where I was warmly welcomed by the team already there and by temperatures of nearly 40C. For the first few days I worked with Maria, the pharmacist whom I was to replace, and benefited from her long-standing experience working in developing countries. She provided me with a comprehensive introduction to my responsibilities within the mobile clinic team and we also discussed various local clinical problems.
The daily routine of the mobile clinic was well established; after all, I was working with the eighth Landsaid team and the 18th member of Pharmacist without Borders in Haiti. From Monday to Saturday we worked in the Villam Beta camp and at a health point at Cazeau on alternate days.
Villam Beta is one of the camps developed after the earthquake on 12 January 2010. There are more than 1,000 such camps in Haiti and a total of 1.5 million people live in them. About 5,000 people were living in Villam Beta but numbers are rising.
The health point at Cazeau is a former seminary that was destroyed by the earthquake — four priests were buried under the debris. The patients coming to Cazeau do not live in camps but, on my way there every other day, I could see that their living conditions were similar to those in the camps.
Every morning we arrived at around 9am and a crowd of all ages would be expecting us. Everyone would wait patiently until we finished unloading our boxes and we were able to start the clinic. There were some guards who helped us, and by doing so, they could earn a little money so at least they could buy some food.
About half of the patients were children; the youngest I met was just six days old. I can report, fortunately, that the number of patients decreased over the time I was there and levelled off to about 50 a day. Our German doctor had worked in developing countries on many occasions, particularly after natural disasters. He knew a great deal about the common clinical conditions so he was able to diagnose and start treatment quickly.
The young paediatrician from Haiti, however, was less experienced and required some support with drugs and dosing, so it was important for me to check the prescriptions on the patients’ health cards and question prescribing where necessary. I soon found that the best way to do this was to prepare an alternative proposal for the prescription, which I would carefully suggest because he did not cope well with criticism.
Since the choice of drugs was limited and we did not want to buy new medicines unnecessarily, every evening I discussed with the German physician how to use our stock most effectively. I was surprised how treatment recommendations differ across countries. For instance, drugs such as metoclopramide, which in Germany are contraindicated in children, are given with a dose recommendation in the BNF or World Health Organization guidelines.
It was possible to order medicines via wholesalers, but this was time-consuming and expensive so I tried to limit these orders as much as possible. Also, not everything in the wholesalers’ catalogues was available. Nevertheless, I visited Promess, one of the largest drug wholesalers in Port au Prince and was surprised by the large size of the depot and how well organised it was.
Our most urgent requirement was for paediatric antibiotic suspensions. Dosing in children, especially for the very small ones, was a particular challenge and often, while splitting tablets, I would long for at least some of the choice of formulations we have in Europe.
The most frequent conditions I saw were worm infestations, infections, particularly of the lungs and urinary tract, and small wounds and abscesses. Malaria was common. There was also an increasing number of patients with high blood pressure and diabetes.
However, because treatment for these chronic diseases is long-term and Landsaid would withdraw the mobile clinic by the end of September — the provision of health care after this was unclear (eg, who would prescribe and finance the blood pressure drugs) — treatment was not initiated for these patients.
This will not be the only unsolved problem when NGOs start gradually to withdraw their help from Haiti. For instance, NGOs also ensure there is sufficient drinking water in the camps and work with camp management to look after the latrines. This is important to ensure minimum hygienic conditions are met and to avoid the outbreak of epidemics.
Waste disposal site
More than nine months after the earthquake, 98 per cent of the destroyed buildings had not been rebuilt. When I was there in July, people were living surrounded by rubbish and debris and, despite the material and financial help from all over the world, I felt as if I were working on a waste disposal site.
It will be difficult for the country to rise by itself. Corruption is common. Prices for daily goods increased significantly after the earthquake and are similar to those in London, if not higher — on one occasion, a market trader seriously wanted to sell me a pineapple for five US dollars.
It was also disheartening that not everybody put their heart in the recovery effort. We were there voluntarily, taking annual leave to do so, but some citizens who were paid for their work would often only do the absolute minimum. It was an unpleasant reality.
But there were also shining examples, such as the nurse who helped me in the pharmacy. Patiently, she would explain to the patients in Creole how to take the medicines. She was accurate and reliable, and she kept smiling, even in stressful situations. Some of the guards who helped us to load and unload our van each day were enthusiastic and warmed my heart.
And, of course, there were all the children, who would get so excited if I took a picture of them on my digital camera and showed it to them. A special memory was when one day a little boy came over and proudly showed me the car that he had made from an empty plastic bottle. It even had side mirrors and a windscreen and made me wonder why we need games consoles.
Despite all the debris, broken buildings and camps it was apparent that there were many hair and beauty salons in the area. Haitians pay a lot of attention to their appearance and personal hygiene. Although living in a tent, most of the time we saw them in the clinic they were well dressed with newly washed clothes and neatly done hair.
This mission was a great experience. Using my knowledge as a pharmacist in a place where it is urgently needed, I felt I really made a difference and I got to know the country and its people.
At no point did I really feel scared (apart from the morning a large bird spider paid me a visit). The members of the team I worked with were pleasant both to work and live with — sharing fruit salad soon became a daily ritual.
It did not bother me that we had to get water from a well and that often there was no electricity — at least I was staying in a house that protected us from the rain, which is so much more than most of the Haitian people have.
Currently there are as many as 400 NGOs in Haiti, all providing medical aid which requires substantial organisational efforts. Pharmacists without Borders and Landsaid have done a good job in organising. I now know how much our expertise is needed there and can only recommend this type of work to anyone who wants to experience pharmacy from a different angle.
I hope the country will be able to get rid of the rubbish and the debris so in future the beauty of it will not only be seen in the clothing of its people.
Haiti rise again!
LandsAid is still present in Haiti working on a long-term prosthesis project.
Further information about LandsAid, including how to make a donation
Citation: The Pharmaceutical Journal URI: 11052438
Recommended from Pharmaceutical Press