“Football is the opera of the people” -Stafford Heginbotham

Finally, a happy affliction has struck Haiti: World Cup Fever. Since the tournament began last week, Haitians have something to celebrate and they’re doing it with unreserved joy. One and half million people are still living in camps or on the streets, 5 months after the devastating 7.0 magnitude struck Haiti in January. But soccer is bringing people together; cheerful shouting can be heard across Port-au-Prince when the games are broadcast three times each day at 6:30am, 9:30am, and 1:30pm.

Haitians are, by and large, supporting the Brazilian team. It’s hard to miss the thousands of yellow and green Brazilian flags decorating every corner of Port-au-Prince: hanging from the twisted balconies of fallen buildings, decorating cars and utility poles. Across a wide stretch of Port-au-Prince’s central road, Rue de Delmas, fans have gathered thousands of yellow and green plastic bottles and have strung them, criss-crossed, across Delmas like Christmas lights. The Haitian government has teamed up with groups like FimAid International to erect huge viewing screens in the refugee camps. For a little while, at least, displaced Haitians will have the World Cup games to share with each other as a distraction from the grind of daily life.

And in addition to soccer, there’s hockey. Grace Children’s Hospital, where the prototype C2C clinic will arrive on Tuesday, June 22^nd, received a special visit several weeks ago from Canadian NHL player, George Laraque. Of Haitian descent, Laraque lifted the spirits of children awaiting treatment at Grace by bringing hockey sticks and playing a demonstration game. It’s wonderful to see that sports, even in the worst of circumstances, can bring a measure of joy to Haitians.

Across campus at Grace Children’s Hospital, workmen have begun land preparation for the C2C clinic. A cash-for-work program has hired 20 local people to level the land on the northwest corner of Grace’s campus, in anticipation of the delivery of C2C’s container clinic.

Stay tuned in the coming days for more progress on-site at Grace, the installation of the C2C clinic, and soccer dispatches from Haiti.

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…

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.