Globe staff photo/John Tlumacki
Drawing on 27 years of helping patients in Haiti, Dr. Paul Farmer today suggested a treatment plan for post-earthquake Haiti that could turn the devastation into an opportunity.
In his first public forum since the Jan. 12 quake, Farmer challenged an overflow audience at Harvard Medical School to work with Haitians to attack the impoverishment that made the suffering from the disaster far worse than it needed to be.
"Might addressing the acute needs of the displaced and injured afford us a chance to address the underlying chronic condition?" he asked.
Invoking medical metaphors, Farmer described Haiti as an "acute-on-chronic affliction -- evident, at last, to the entire world." He said post-quake Haiti was "an already bad problem rendered immeasurably worse by the gravest natural disaster to befall this part of the world in centuries."
Farmer, the co-founder of the Boston-based non-profit Partners in Health and also deputy United Nations envoy to Haiti, stopped short of offering a specific treatment plan. He said that is the job of the Haitian people. "How often in medicine have we learned that plans for patients must be, if they are to succeed, made with patients?"
But he said institutions in Boston and beyond now have a rare opportunity to not only help Haiti treat its immediate wounds, but also to help generate the longer-term development that Haiti desperately needs.
Farmer cited several specific challenges for research institutions and the hordes of non-governmental organizations working in Haiti before and since the quake.
For example, he said doctors are now seeing cases of tetanus that are "a reminder of the chronic failure to inoculate with an effective, safe vaccine that costs pennies." He said that Dr. Natasha Archer, a Haitian-American physician from Brigham and Women's Hospital, was part of a team that confronted an emergency surgery case probably caused by typhoid.
"Natasha warned, correctly, that a lack of proper sanitation in the coming days and weeks and months would lead to more such cases," Farmer said, "and I was thinking, with some shame, that a decade before I had reviewed the scant literature on typhoid in Haiti, which revealed the same high burden of the disease and came to the same conclusion."
Farmer also pointed to the crisis of clean water in a country that, one year before the quake, was declared the most "water-insecure" nation in this hemisphere.
The biggest challenge is to get people working, he said, and some aid groups have begun implementing "cash-for-work" programs. These have generated about 35,000 jobs, he said -- far short of the 500,000 paying jobs that are needed. "This is the only way to move resources from the self-described donor nations to the survivors who are able-bodied and anxious to work."
Apart from testifying before Congress soon after the quake, Farmer has had few opportunities to assess publicly what happened in Haiti and what needs to be done. It was also his first trip back to Boston since the quake.
Farmer first worked in Haiti when he was a Harvard medical student in 1983, and he co-founded Partners in Health in 1987. The non-profit employs about 4,000 people in Haiti, more than half of them community health workers who have built a network of services reaching villages across the central plateau. When the quake hit, Partners in Health became the go-to international group for coordinating the emergency medical response.
In part because of Farmer's personal prominence as a crusader for better health care in Haiti and 10 other countries, Partners in Health has attracted worldwide attention and has raised more than $52 million for earthquake relief and longer-term rebuilding.
Harvard President Drew G. Faust opened the meeting by acknowledging the contributions from across Harvard to the relief effort. She asked those who had done volunteer work in Haiti since the quake to stand up, and more than a dozen people in the hall rose to their feet to applause.
She also recognized Farmer's critical role, as co-founder of Partners in Health as well as chairman of the medical school's Department of Global Health and Social Medicine and chief of the global health equity unit at Brigham and Women's Hospital.
Faust told Farmer: "You were there with an understanding of the context, the culture, and the history that would enable you to be focused and effective amid the chaos all around you, and to bring order out of that chaos."
But in his address, Farmer acknowledged the risks of overstating any doctor's role. Although he saluted the heroism in Haiti of doctors, nurses, and citizens, he said, "What we need are teams, and above all, systems to deliver services effectively."
Farmer said he was reluctant to offer a prognosis on Haiti's future. Instead, he cited the opinion of two young Haitians he met who answered an old man's plaint that "Haiti is finished." The two young people answered, "No, Haiti will never be finished," Farmer said. "Haiti's is not a terminal illness."
James F. Smith writes about Boston's global ties. His blog is at boston.com/worldlyboston. His email is email@example.com.
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