Haiti’s Medicine Man
After a massive magnitude-7.0 earthquake devastated Haiti in January 2010, more than 350 medical nongovernmental organizations poured into the country.
The immediate global response was to help the 300,000 injured, who suffered primarily fractures, infections, and head trauma, according to the Centers for Disease Control and Prevention. Severe injuries often required surgery or amputation.
“When you were in the hospitals after the earthquake, you saw amputated arms, legs—it became personal. I was there, experiencing it. It’s not just on TV,” said Malek Sbih, MBA ’05. Sbih is a medicines and technology adviser for the Pan American Health Organization (PAHO), the World Health Organization’s regional office for the Americas and the Caribbean.
As the Washington, DC-based department’s point man for Haiti and a liaison between PAHO, the US Agency for International Development (USAID), and the Haitian Ministry of Health, Sbih traveled to Haiti at least eight times in the first 18 months following the earthquake, sometimes for more than a month at a time.
There, he assessed the medical and supply needs of organizations, doctors, and their patients and attempted to meet them, collaborating closely with the Haitian government, NGOs, and health-care providers. Some volunteers had little experience working in a situation like Haiti’s, so Sbih and the staff helped them determine the supplies they needed.
After the earthquake, those 350 NGOs, each with different methods, aimed to house Haiti’s homeless, feed the hungry, heal the injured, and treat the sick. But to do so required medicines, supplies, and basic organization.
That meant transporting supplies from Haiti’s capital, Port-au-Prince, to the country’s 10 departments (Haiti’s equivalent of states), driving over dirt roads full of potholes and roads that disappeared in the rain. In a nation the size of Maryland, helicopters were needed to reach departments that seemed so far away because they were cut off by impassable roads.
It also meant having to navigate the bureaucracy of the government and the roughly 10,000 NGOs with a presence in the country—all of which worked on separate, small projects, with varying objectives ranging from health care to shelter to feeding the hungry.
A February 2011 Washington Post article summarized the situation: “The effectiveness of the NGOs is now being questioned, by the groups themselves, and especially by Haitian leaders who complain that NGOs have become a parallel government hobbled by poor coordination, high turnover and a lack of transparency.”
In October 2010, the situation in Haiti worsened: cholera arrived.
Efforts to stem the epidemic—which killed almost 4,000 people—hinged on finding doses of medicine that were scattered across the country and managed by separate NGOs. Simply put, the amount of medicine needed was determined by how much medicine was actually in the country.
A virulent infection carried by contaminated water, cholera can kill within hours through severe dehydration and diarrhea. It is treated primarily through rehydration. Serious cases require antibiotics, considered an easy treatment in the US.
“Cholera is very easy to treat with the right supplies,” Sbih, who also has a medical degree, explained earnestly. “Very easy to treat. We had medicines everywhere, but we didn’t know how many.”
Without knowing exactly how many cholera medicines were in Haiti, PAHO had difficulty ascertaining how many supplies to purchase—possibly jeopardizing lives with a lack of supplies.
“We were trying to centralize everything and to know how much medicine we had to treat cholera in the country,” Sbih said.
So he and his team in Washington established a website that would offer a snapshot of all medicines and supplies in the country. Members of each NGO log in to the site every week and enter their inventory into the database.
The site not only allows Sbih and his colleagues to know what medicines and supplies are available, it also helps the agency forecast the quantities it will need in the future.
“We’re pretty proud of this because finally we now know how many medicines we have for cholera in the country,” he said.
In late November 2010, Haiti’s principal pharmaceutical agency, the Programme on Essential Medicines and Supplies (PROMESS), distributed more than 87 tons of essential medicines and supplies to help the victims of cholera. Since then, the agency has distributed over 100 tons of new cholera supplies.
Between October 2010 and January 2011, about 200,000 people were treated for cholera, costing $2 million in medicines and supplies. Of those 200,000 cases, 70,000 were severe, and potentially deadly if untreated.
On the ground, Sbih supported PROMESS, which is managed by PAHO. He also promoted the Strategic Fund, PAHO’s program through which member states can purchase public health supplies. Through the fund, Latin American and Caribbean countries have access to inexpensive, quality medicines and technical support to help them forecast their needs.
In the first three weeks after the earthquake, $3 million in medicines and medical supplies arrived in Haiti. Medical professionals and NGOs from Port-au-Prince and beyond come to PROMESS’s warehouses, collecting for free the medicines and supplies they need to distribute throughout Haiti.
Generally, PROMESS itself does not actively distribute medicines and supplies; rather, it fills request orders and makes sure the 13 warehouses operated by the Haitian government have sufficient supplies.
But in Haiti after the quake, there was no coordination between NGOs, efforts were duplicated, and some medicines dispensed for free by PROMESS were sold on the street, Sbih said.
So he met with Haiti’s minister of health to establish registration procedures for all organizations wishing to use PROMESS. By filling out a simple one-page statement of intent, organizations could then freely access and distribute PROMESS medicines.
Sbih has witnessed the country’s devastation and the roadblocks to its recovery firsthand.
Some of the warehouses were inoperable when he arrived right after the quake, and many can only be reached by helicopter, as the roads from the capital to the departments are often impassable.
“We were sleeping outside in a small tent,” he said of his first trip to the country. “It was very difficult to help the people.”
Those early days in Haiti were busy and emotionally intense. Everyone did everything, distributing medicines, cleaning warehouses, staying up all hours, Sbih recalled.
To support Haitian authorities in coordinating the international health relief efforts, PAHO/WHO established the Haiti Health Cluster. The Health Cluster brings together more than 400 registered health partners working in the country, forms working groups on different health topics, and publishes a bulletin every two weeks on health issues in Haiti, including cholera updates. Sbih chairs the Health Cluster’s subgroup on medicines and medical supplies, where group members discuss the concerns they face in the field.
And in late April, Sbih may have placed his last order for cholera medicines. The requisition was a “just in case” order, he said, as the number of cholera cases in the country are decreasing.
Since the quake, Sbih has seen improved coordination between PROMESS, the Haitian Ministry of Health, and NGOs. He hopes to further improve that coordination in the future, establishing PROMESS as the sole supplier to the warehouses across the country that receives the program’s medicines and supplies.
“We never know how much they need,” he said. “We’d like to tie with USAID and set up a network with warehouses and PROMESS.”
For now, he is waiting for the recent transfer of power from Haiti’s former president René Préval to newly inaugurated president Michel Martelly to smooth over before continuing with the project.
UN special envoy for Haiti and former US president Bill Clinton has also been keeping a close watch on the transfer of power and the country’s recovery efforts, playing a key role in Haiti’s reconstruction. Sbih worked with representatives from the Interim Haiti Recovery Commission, co-chaired by Clinton, on the ground in the immediate aftermath of the earthquake.
“Before this disaster, Haiti had the best chance in my lifetime to fulfill its potential as a country, to basically escape the chains of the past 200 years,” Clinton wrote in a January 2010 Time piece. “I still believe that if we rally around them now and support them in the right way, the Haitian people can reclaim their destiny.”