Another day and another opportunity to learn more about disaster relief, the Haitian people, and the organizations that support this country’s journey back from devastation.

C2C’s partner organization, Americares is providing essential medical and health supplies to dozens of organizations (hospitals, clinics, orphanages) that Haitian citizens are counting on to receive treatment and care. The pharmaceutical supply chain in Haiti, like so many systems, was crippled by the earthquake and the provision of medicine and supplies is this environment is an urgent responsibility that Americares’ experienced field staff is fulfilling in an able and timely manner. Drawing on decades of experience, Americares has the know-how, the commitment to local partnerships, and the dedicated staff to fill this critical gap. Three Americares staff members are on the ground here in Port-au-Prince and are coordinating shipments of supplies into the country and then to health facilities in need. They are generous, experienced and well-networked in Haiti and they’ve been able to help C2C to identify potential partnerships and sites for C2C deployment in the coming months. Check out the extraordinary work of Americares at www.americares.org.

The utility of C2C’s model to a disaster relief environment has become especially salient. Firstly, so many critical facilities have been destroyed or damaged and there simply isn’t a structure from which medical personnel can provide services. But in a more nuanced way, C2C’s model is uniquely suited to disaster relief. Tens of thousands of IDPs (internally displaced persons) are without homes, access to food, water, and healthcare. In the immediate aftermath of the quake, improvised IDP camps were established and tents were distributed. While this served the immediate need, there are now camps all over Port-au-Prince. The one we visited yesterday (formerly the site of the Petionville Golf Club) currently has 70,000 people. The difficulty of providing services of any kind to these populations is that government and relief agencies alike are reluctant to make permanent the itinerant community. By building a health center, the community will become more and more fixed at these camp sites and it’s not a long-term solution. Temporary facilities are more appropriate but, unfortunately, with the hurricane and rainy season on the horizon, tented structures won’t withstand the inclement weather. Enter the C2C modular solution. C2C’s units are “semi-permanent” – stable and durable enough to provide the highest quality of care, but ultimately very able to be moved as the need changes.

Today, Kathleen and I met with two important – and very different – organizations: Canape Vert Hospital and Management Sciences for Health. Canape Vert is a private hospital; arguably, one of the best hospitals in Haiti. After the earthquake, Canape Vert immediately began providing free services. Thier hospital was damaged but is functional. A new maternity wing was destroyed and 15 of 47 patient rooms are no longer safe for occupancy. The management board of Canape Vert Hospital is eager to pursue a hybrid approach to health services: to provide high quality care, at a price, to people who can afford it, and to provide the same quality of care for free to people who cannot. Without any revenue for two months, Canape Vert is an unenviable position: they need to go back to charging for service, but they want to retain a mechanism by which indigent patients can receive care. They believe firmly that the quality of care should be equal for both populations, but the financial challenges of making this happen are enormous. The prospect of a hospital like Canape Vert closing its doors would be a terrible loss for Haiti. While their target population isn’t the poorest of the poor, the have a great sense of social responsibility, they maintain the highest standards possible in this environment and, ultimately, they represent progress and a sound future for healthcare in Haiti.

Management Sciences for Health (MSH) has been working in Haiti for years and their over-100 staff members are all Haitian nationals, with the exception of one person. MSH works hand-in-hand with the Haitian Ministry of Health. They did so before the earthquake and they continue to support dozens of MoH services and systems after. Indeed, they’ve ramped up their programming and they are providing urgent support to public sector employees – the Ministry of Health offices were completely destroyed on January 12^th. MSH presently supports 147 clinics all over Haiti. There are a number of sites that would be especially appropriate for C2C’s clinic, because the facility was destroyed. We were encouraged and impressed by MSH’s tremendous efforts, their firm commitment to building local capacity, and their deep partnership with the Haitian government.

Our work here this week is to evaluate potential sites for C2C’s prototype clinic – but the need is staggering. C2C’s model is especially well-positioned to meet this need. We will not lack for deployment sites or for meaningful partnerships with local organizations to operationalize the C2C clinic upon arrival in May. The coming months for C2C will see the opening of the clinic doors, but our task is to scale to multiple clinics, to meet a growing need, and to hone our operational model in a sustainable way.

Downtown Port-au-Prince

The C2C assessment team arrived in Port-au-Prince yesterday and we’ve spent the first full day in-country traveling to the towns of Petit Goave and Petit Guinee – 60 kilometers south-west of Port-au-Prince. International relief teams and NGOs are conducting major health and infrastructure interventions in this area, as it was closest to the epicenter of January’s earthquake.

The scene along the roadways is sobering. Collapsed buildings are intermittent: along a single stretch of road, every other building might have completely collapsed while others remain standing without even a crack in the façade – the result of inadequate building materials. Cement structures that may have appeared strong and well-maintained pancaked down into piles of rubble. The remaining rubble has been scavenged for steel scrap. Surprisingly, market life is vibrant; vendors are selling their wares, fruits and vegetables, and cooked food along the roadsides, oftentimes directly in front of collapsed buildings.

Tent Housing for IDPs

Tent cities have sprung up by the hundreds – mostly informal settlements, with tents provided by aid agencies and intermittent services. Two months after the earthquake, some tent cities with thousands of people are only now receiving sanitation facilities. Garbage collection is non-existent and clean, safe water is in short supply.

Juxtaposed with this ruin are the beautiful, expansive blooms of bougainvillea; colorfully painted “tap-taps”, or taxis, transporting people through gridlock traffic. It’s incredibly difficult to tell what aspects of the deprivation existed long before the earthquake, or what troubles were simply exacerbated. Hundreds of people are at work in streets, clearing rubble, helping to make the roadways passable. These people are benefiting from “cash for work” programs administered by USAID and UNDP. The demolition of structurally compromised buildings and the clearing of tons of rubble will be a years long endeavor for Haiti. In the meantime, most people whose homes withstood the quake still won’t risk going inside; they’re sleeping in makeshift tents on the sidewalks for fear of aftershocks.

Waiting to see a doctor in Petit Guinee

In Petit Guinee, we visited an improvised health center converted out of a local, open-air bar literally steps from the ocean. For now, the facility is serving its function: medical personnel from the International Medical Corps (IMC) are providing primary health care, nutrition counseling, and psychosocial support. Women and children are lined up by the dozen, awaiting consultation in small “rooms” divided by hanging blankets. For now, IMC is providing critical health services, but with the hurricane and rainy season just weeks away, their placement on the coast will be untenable. They are looking to move the clinic inland and to increase their capacity to treat patients. Presently seeing approximately 100 people per day, the needs are exceeding the supply of services.

IMC’s services extend throughout Port-au-Prince and along the southern coast. We are eager to visit additional IMC sites later this week. Tomorrow, we will meet with field staff from Save the Children to learn more about their expansive operations.