Upon reviewing the above video of Sebastian Walker’s incredible reports from Haiti starting just 24 hours after the earthquake in January 2010 through September 2011, it leaves one scratching his or her head about how best to engage as a non-profit organization trying to help. While there is an element of demonization that pervades Mr. Walker’s report about the lack of coordination, accountability, urgency and impact of the NGOs that work in Haiti, surely this generic classification cannot apply to all those organizations working to help the Haitian people. The numbers are stunning, to be sure: $2 billion in aid money over the past 18-24 months and Haitians are not much better off for it by any set of indicators.
Much has been written about this phenomenon so rather than conduct a literature review on the subject, I think about our own experience in Haiti thus far. Containers 2 Clinics, has created a reliable, safe haven for pregnant women and girls in the Delmas section of Port-au-Prince where they can receive comprehensive antenatal care at a small cost. Women have come to rely on us to provide the care they need in the absence of any other alternative in their catchment area. While it hasn’t been easy, we are providing a critical service for them amidst the chaos, corruption, and lack of accountable leadership that exists in Haiti.
Spending time in Haiti and even viewing Mr. Walker’s report can leave one with a sense of utter desperation and hopelessness about the apparent lack of progress in Haiti. But does that mean aid organizations should pack up and let Haitians fend for themselves? Given the countries colonial history, back-breaking national debt and exploitation by neighboring countries, is it any wonder that the Haitians, despite their best efforts, have not been able to get off their knees? Are we all not obligated to right the wrongs of the past, provide sufficient infrastructure, basic health care and education to allow market forces and social systems to develop naturally?
As with any country so heavily dependent on foreign aid, Haiti must develop confident, patient, autonomous and visionary leadership to shepherd the country through this evolution. But leadership development takes time, something most Haitians battling cholera, malnutrition, lack of shelter and staggering unemployment simply do not have. In the meantime, we cannot turn our backs on the Haitians when they so desperately want a better, more dignified, life for themselves and their children.
Despite the challenges of occasional pharmacy stock-outs, diagnostic equipment failures, and staff shortages, Containers 2 Clinics continues to deliver quality antenatal care to the women and children in central Port-au-Prince. And word is getting out. On a recent trip, it became clear that women are coming from farther and farther outside Port-au-Prince because they have heard that they can receive reliably-comprehensive care from the C2C clinic at Grace Children’s Hospital. So they queue up at 6am in order to be at the front of the triage line when the hospital gates open at 8am. But for them it is worth it to know that they won’t have to go elsewhere for consultation, diagnostic testing or medications. In fact, they repeatedly ask if they can deliver their babies in the clinic.
When I arrived on Monday, December 5th, it was my twelfth trip to Haiti. As C2C’s Director of Operations, I first came to Haiti just sixty days after the devastating January 2010 earthquake to work in partnership with AmeriCares to develop clinic sites in a country whose health system had reverted to chaos. C2C entered Haiti with one objective: to work in partnership with local institutions and to support their recovery efforts by providing focused, integrated maternal and child health services for Haiti’s most vulnerable people.
Douglas Hodgkins Photography
In March 2010, the Port-au-Prince airport was still in disarray: one runway was functional and visitors and aid workers entered the country through a temporary warehouse which functioned as both immigration center and logistics ground-zero. I was reminded of that first trip on Monday when I was processed swiftly and efficiently through immigration. The customs official welcomed me warmly to Haiti and I was handed a tourism brochure. What a difference nearly two years can make.
These days, we travel to the C2C clinic and partner sites on roads that are reasonably cleared of rubble. Hundreds of thousands of people are still living in IDP camps; the traffic is still congested beyond description; and Haitian people still struggle to meet their basic needs. But things have changed – not fast enough, but for the better. The influx of relief and aid organizations has thinned and streamlined its collective efforts.
Tori Stuart Photography
Despite hurricanes, cholera outbreaks, periods of civil unrest, and pharmaceutical shortages, the C2C clinic continues to do what it set out to do over a year ago: to provide women with high-quality health services. Over 9,000 women have been treated at the C2C clinic. Drs. Roche and Justin, physicians on-site daily at the C2C clinic, provide comprehensive pre-natal care to pregnant women. Our nurses triage patients upon arrival at the clinic and manage medical records, tracking the progress of each woman’s pregnancy. On average day at the C2C maternal health clinic, 40 women receive urgently needed care – a testament to our partner, Grace Children’s Hospital, whose staff has worked tirelessly to rebuild a 40-year old local health institution.
In 2012, C2C will integrate two programming additions to our service delivery: community health education and ultrasound technology. Health education services will focus on preventive care on important topics like: healthy pre-natal and post-natal practices, proper breastfeeding and infant care techniques, HIV/AIDS prevention education, and sanitation and hygiene. By introducing ultrasound technology, our pre-natal patients will be better served by identifying dangerous obstetric complications early and identifying solutions to ensure safe delivery.
C2C is working to grow its clinic presence in Haiti and to expand our ability to more reach women and children, to help keep families healthy, and to support local institutions to grow their capacity to serve patients in the year ahead.
Secretary Clinton with USAID Administrator Rajiv Shah
Last week, C2C participated in the final round of the Saving Lives at Birth: A Grand Challenge for Development grant (www.savinglivesatbirth.net) in Washington DC. More than 600 applicants submitted proposals to the RFA issued by a consortium of USAID, The Bill and Melinda Gates Foundation, Norwegian Ministry of Foreign Affairs, World Bank and Grand Challenges Canada. C2C was selected as one of the 77 finalists to participate in the Development Exchange, a three-day event in Washington where finalists could network and share their ideas with one another as well as speak with the final evaluation team about their innovations. Our Director of Partnerships and Development, Jessica Thompson Somol, and Founder/President, Elizabeth Sheehan, met with hundreds of key opinion leaders and other organizations in the development arena, including representatives from the Gates Foundation, Grand Challenges Canada, representatives from corporate social responsibility programs, politicians and media.
Christy Turlington Burns
The event provided C2C with tremendous exposure and publicity. The forum was open to the public for part of the time and many people walked through the booths learning about some of the new cutting-edge innovations being proposed to save the lives of mothers and infants at the time of birth. The C2C team is looking forward to following up with the many valuable connections made in Washington to advance its model, exploit possible funding options and expand the exposure this event afforded C2C’s work in Haiti and its upcoming deployment to Namibia. Unfortunately C2C was not awarded one of the 19 seed grants but the team remains optimistic about other funding opportunities based on some of the reactions and feedback it received. On the last day, we were treated to keynote speeches from Secretary Hillary Rodham Clinton, Christy Turlington Burns from Every Mother Counts, Kevin Starr from the Mulago Foundation and others. It was a terrific three days and we were proud to be there!
Shipping-Container Clinics Could Be the
Future of Mobile Hospitals
About 42 million
shipping containers moved through American ports last year, and one
organization had a bright idea for repurposing these ubiquitous steel boxes:
Make them into mobile clinics that could be shipped around the world to
developing countries in need of better access to healthcare or to disaster
zones where brick-and-mortar hospitals have been damaged.
By
Chris Sweeney
When a magnitude 7.0
earthquake rocked Haiti last year,
80 percent of the buildings at Grace Children’s Hospital in the capital,
Port-au-Prince, toppled. Grace’s inpatient ward, which provided care to more
than 300 children each year with tuberculosis, HIV and other ailments, was
condemned and demolished. As much of Haiti’s critical infrastructure crumbled
after the disaster, the hospital pushed on by stringing up tarps outdoors and
salvaging old cribs and beds so it could continue helping patients, including
those sickened by cholera, the first outbreak in the nation in decades
Around the same time the quake hit, a Massachusetts-based organization called
Containers2Clinics (C2C) and its partners were busy overhauling two 8 x 20-foot
shipping containers into a maternal-care clinic. Founded in 2008, the nonprofit
was based on the idea that these easy-to-move industrial containers could take
on a new life as boxy hospitals-on-the-go, boosting healthcare access in remote
areas of developing nations, particularly for children and women. The prototype
container-turned-clinic was slated to go to Bani in the Dominican Republic. But
when C2C learned about the destruction at Grace Children’s, the company made a
course correction and sent that first clinic to Haiti, where it helped Grace
care for thousands of patients.
Given shipping containers’ reputation for sturdiness and longevity–not to
mention their sheer ubiquity–it’s not surprising that eco-minded engineers and
designers have been transforming the utilitarian steel boxes into all sorts of
spaces, including DIY wet labs and cozy vacation homes. Crews battling forest
fires have hauled them into the field as makeshift bunks. Retrofitted
containers are increasingly proving useful in disaster relief; they have also
have caught the attention of agencies such as FEMA and the Red Cross.
But retrofitting an old, dirty steel box into a sanitary mobile clinic requires
innovative design, precise fabrication and a fondness for using every last
square inch of a tight space. To make it happen, C2C turned to Anshen + Allen
Architects and to Stack Design Build, a construction service firm adept at
retrofitting containers. The firm’s portfolio includes the aptly named Box
Office, a three-story complex in Rhode Island made from 32 recycled shipping
containers that, among other things, serves as Stack Design Build’s
headquarters. “We got a layout of the two shipping containers, and some
very basic schematics and plans,” Andrew Keating, principal and co-founder
of Stack Design Build, says.
Shipping containers aren’t the most forgiving material to work with–space is
limited and incorrect cuts are costly. And because mobility is the clinics’ key
feature, the building specs had to stay within the “ISO
Envelope”–precise dimensions set by the International Standards
Organization that allow containers to be neatly and securely stacked for
shipping. So before putting plasma cutter to steel and busting out the welders,
Keating and colleagues plotted out every detail, down to the angle of the exam
tables. “When it comes time to take tool in hand and make a cut in a
shipping container, there’s no hesitation,” he says.
To make an entire clinic fit into two shipping containers, the first had to
include two exam rooms, similar to a doctor’s office. The second container
needed to be a small pharmacy and laboratory, equipped with a refrigerator,
microscopes and basic diagnostic equipment. The original sketches Keating
received didn’t include mechanical space, so his team needed to create a place
within the already tight confines for basic electric and plumbing systems. The
solution: Build a small partition near the far end, just in front of the
shipping container’s front door, and then sandwich the mechanical guts of the
clinic into that space. This setup ensured easy access for maintenance without
interrupting the flow of the clinic; doctors and patients enter and exit
through doors cut in the middle of the containers.
Making room for the electronics was only half the challenge. Because C2C
intends to send these clinics to remote locations, Keating built the electrical
system to handle irregular power flows and pull power from a variety of
sources. “I think the electrical system is one of the best parts of the
prototype. We came up with a system that would allow the clinic to be powered
from absolutely any source available–local grid power, any kind of generator,
or any nearby house panel,” Keating says. “The proto was shipped with
this long heavy-duty cable that extends from the clinic to whatever the power
source is going to be, and some twist-lock connectors that could plug into
anything.”
The specs for the prototype called for no air conditioner, either, and Stack
Design Build was acutely aware that a steel box sitting in the Haitian sun
would heat up quickly. To keep the clinic cool, Keating’s team applied a 2-inch
layer of closed-cell spray-foam insulation before putting up easy-to-clean
walls made from fiberglass reinforced panels. The team also added through-wall
fans powered by photovoltaic panels and passive ventilation to keep the air
moving. Keating and company applied a few coats of highly reflective white
paint and built a custom canopy.
The operational C2C prototype arrived in Port-au-Prince at the end of 2010.
Kathleen Flemming, C2C programming director, says Grace Children’s Hospital’s
staff has used the shipping-container clinic to care for nearly 4500 patients
in the roughly eight months since then. Patients receive primary and preventive
services, including vaccinations, pre- and postnatal care, infectious disease
testing and treatment, and nutrition counseling.
With its first mobile clinic a success in Haiti, C2C is scaling up. The
organization is scouting locations and securing partners for future clinics. To
increase production, C2C has begun working with Allied Container Systems, one
of the largest providers of prefabricated containers in the world. Lee Hayes, a
project manager at Allied who oversees the C2C work, says the second clinic
will be similar to the prototype, though there will be a few tweaks, including
air conditioners.
Allied is scheduled to finish its first container clinic for C2C in the coming
months, which will go to Haiti. But Hayes says demand for retrofitted
containers is growing across the board. Allied–a major supplier of containers
for the military–has been approached about retrofitted operating rooms and even
large-scale housing developments. And though C2C is focused on bolstering
healthcare infrastructure in developing nations, and not necessarily disaster
relief, its work with Grace Children’s Hospital shows that container clinics
can quickly go where they’re needed.
Considering that more than 42 million containers moved through U.S. ports last
year, the raw material is available. And we certainly know how to move them.
A recent article in the New York Times offers a much altered story of death and destruction vis-à-vis the 2010 earthquake in Port-au-Prince. Here it is, by the numbers:
The report said as many as 895,000 people moved into camps after the earthquake, not the 1.5 million estimated by the International Organization for Migration, an intergovernmental organization. At most, an estimated 375,000 people remain displaced, with a maximum of 66,620 living in camps…contrary to the migration organization’s tally of more than 600,000 people living in camps.
The amount of rubble that must be cleared…[is approximated by the report ] at 3.7 million cubic meters, not the 20 million to 25 million originally estimated by the Army Corps of Engineers or the 10 million the United Nations reported this year.
…the report’s most incendiary figure: an estimated quake death toll of 46,000 to 85,000 people. The Haitian government announced in January that 316,000 had been killed; in the initial weeks after the quake, it said about 230,000 had died.
How does this make us feel about data collection? What sampling and analysis mechanisms were used? How can they be improved? Perhaps most importantly, how will this effect the rest of the aid (63% of the pledged $4.6bil)? Will countries reduce their commitments? So many questions!
This is an excerpt from an article in the Huffington Post today:
One of the many results of technological advancement is that nonprofits can no longer ignore the world outside their doors. Nor can they realistically expect to survive if they are unwilling or unable to embrace the developments around them…
I don’t know how profound this is; I’m not sure that non-profits have necessarily had their heads in the sand, historically, but I think there is evidence that suggests that organizations that maximize social networking and new media outlets to associate their brands with something more impactful and novel (an updated way of solving an old problem; maternal mortality, e.g.) are more successful than those that do not. This is to say nothing of the actual program work – it’s all about presentation. And, ideally, with this new emphasis on public presentation comes more transparency and accountability. We (the philanthropic public) start asking harder questions if we don’t find the information in the public realm; requests that “successful” programs are predicated on data, for example. This results in more transparency that then helps weed the lesser out from the superior solutions to social problems.
C2C was asked to present at a conference of Fulbright scholars from the developing world – all studying at universities in the US – on the intersection between innovations in science and technology and global health issues. There were about 80 scholars in attendance and two other panelists in addition to me:
Dr. Bill Rodriguez founded Daktari Diagnostics, which is creating low-cost, durable field equipment for CD4 tests (which measure the load of HIV disease-fighting cells in blood; it’s the leading test for assessing HIV stage and prognosis). Prior to starting Daktari, Dr. Rodriguez returned to Harvard (where he’d been on faculty and started research programs in global health policy and global health diagnostics) and helped launch the Global Health Delivery Project. He has served as a consultant to the World Health Organization and the Bill & Melinda Gates Foundation on global HIV and tuberculosis treatment, has been an advisor to more than a dozen national governments, and served as a member of the WHO’s global HIV guidelines committee.
Jennifer Staples-Clark founded Unite For Sight while a sophomore at Yale University in fall 2000. With Jennifer’s leadership and vision as Chief Executive Officer, Unite For Sight is now a leading global health delivery organization that provides cost-effective care to the world’s poorest people. By investing human and financial resources into the social ventures of eye clinics in developing countries, Unite For Sight has provided eye care to more than 1.2 million people living in extreme poverty, including more than 42,000 sight-restoring surgeries.
These are heavyweights in the “technological solutions applied to health problems” space, and it was a great honor for me to be speaking alongside them. That’s an environment that most charges me – a space where a group of highly motivated and creative people get together to discuss new ways of tackling old problems.
One thing I talked about yesterday that C2C hasn’t discussed previously is the idea of the Three Delays, which I offer as reasons for the gap between known essential care treatments and the women and children who are dying for lack of access to them.
1) The delay in deciding to seek care, which speaks to a lack of education in the patient population.
2) The delay in reaching care, which suggests a lack of adequate infrastructure, specifically that infrastructure is not proximal to the needy populations.
3) The delay in accessing quality care, which points to an inadequacy of clinical training and/or diagnostic and pharmaceutical resources.
C2C seeks to tackle all three of these delays with our bifurcated model of facility (infrastructure, #2) and program support to local partners (education and resources, #s 1 and 3).
Another thing I discussed in yesterday’s presentation were reasons beyond “we know what works” for focusing health services on women and children. Specifically, that it’s good business (the return on investment is high: money spent on primary health ed and services now returns exponential savings in healthcare costs to health systems later) and good foreign economic policy (10 of the 15 largest importers of US goods and services are graduates of US foreign aid programs, and women in the developing world make up the largest emerging market this planet has ever seen). I find these arguments extremely compelling. It’s not an entirely emotional investment; rather, a sound economic move.
I’m returning to the Fulbright conference tomorrow to participate on a judging panel as teams of students present interventions based on case studies of global epidemics (HIV), natural disasters (cyclones), and localized disease outbreaks (cholera). I’m looking forward to more dynamic and thoughtful discussion!
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