Following up on yesterday’s meeting with MSH, we met today with Dr. Georges Dubuche, MSH’s Senior Techinical Advisor. Georges brought us to two of their clinics in Port-au-Prince with immediate need for replacement facilities. Of course, immediate need implies severe damage, and the first step is to get MOH permission to hire a demolition crew.
Georges estimates that it will take 1000 trucks 1000 days to clear the rubble in the city, and I’m not convinced that’s hyperbolic. A word on disaster preparedness, which I found interesting: based on historical records, the last earthquake felt in the Port-au-Prince area along the Enriguillo-Plaintain Garden fault was in 1770. At that time, Haiti was still a French colony, and in developing the city after the earthquake, Louis XVI mandated that all buildings were to be constructed of wood (as opposed to concrete blocks). If you look around Haiti today, many of these wooden buildings are still standing. Louis was on to something. 
Thirty-two coups and the economy-draining amortization of what in today’s USD would be 21.8 billion in debt to France (which, curiously, the US took to finance the Louisiana Purchase) later, what wasn’t burned (figurative) by politics, was challenged by hurricanes. With the extreme winds and rains, city planners returned to concrete as a primary building material and paid little attention to old building codes. New building norms were set and no one paid much attention to tectonic plates, which was fine…until more than 200 years of built up stress and energy in the earth brought many [concrete] buildings to ground – and with them much of the relative stability the country enjoyed in the last year/two years. Time to rethink building codes. Shipping containers, anyone?
This doesn’t read like very linear thinking, so let’s loop back: I learned all this driving around with Georges. MSH is an impressive organization, a talented and knowledgeable all-local staff with a wealth of contextual knowledge and a commitment to partnership with and capacity building in the public sector. C2C deeply admires and aspires to the bar they’ve set.
MSH’s approach to clinical programming is an “integrated package of primary health.” Interestingly, a few years ago, USAID encouraged quite the opposite: either you did TB or reproductive health or nutrition or sanitation or malaria, etc. MSH recognized the need to integrate these services in a central community-oriented location; rather than working off the expectation that folks would mobilize between locations for their many needs, MSH clinics offer all the primary care a patient needs in one facility.
They keep both electronic and paper records of community outreach and clinical visits. With two doctors, three nurses, six auxiliary nurses (responsible for the health education and home visits), a full lab, and a radio and bullhorn-disseminated public relations campaign, MSH clinics are quite comprehensive in their planning, scope, reach and reporting. They set the bar for clinic-level health delivery, and C2C and the MSH team will be in close touch in the weeks ahead.
YIKES, it just started to downpour. There are so, so many people in tents…
