Haiti: How to Sustain Rebuilding Effort

By Stan Friedman

The leaders of World Relief International and Medical Teams International say making the decision to turn their attention toward sustainability is tough, but necessary, even though current needs remain great.

“I have a little debate going on in my head, and it’s an important debate,” says John O’Kelley, World Relief’s Haiti country director. “Just because something is not sustainable, does that mean it’s not important? The Good Samaritan didn’t pass the person on the side of the road and ask, “Is it sustainable to help this guy?”

The debate has consequences even for the people with whom O’Kelley works. “We are developing programs on big scales and that’s very important, but I also have staff that are living in tents,” he says. “I’ve got a guard who’s living in a Boy Scout tent with a hole in it, and he has a wife and three kids. I have to let my heart not get hardened.”

The other side of the debate reminds O’Kelley, who has been in the country roughly eight months, that “needs are still important, but if you want to focus on changing things, you have to focus on sustainability.

“Just meeting current needs is very hard because that’s a bottomless pit,” O’Kelley adds. “I can’t do all of that. It’s a fatiguing mental struggle, the mental dilemma. It’s always there. You can’t get rid of it. You’d like to get rid of it. So what do you do? It’s a constant tension.”

World Relief already is building churches and schools in Léogâne, the earthquake’s epicenter. Its buildings are designed to withstand earthquakes of 8.0 magnitude – the 2010 quake registered a 7 magnitude. The new buildings also can withstand hurricane-force winds.

In addition to construction, the organization is undertaking an ambitious agricultural program to teach farmers better production, increase the number of crops they can grow at the same time, and expand markets.

World Relief is careful not to engage in activities that lead to further dependence. Rather than just providing handouts, it pays people for labor such as removing rubble as part of their Cash for Work program.

Ted Steinhauer, MTI Country Director

Medical Teams International, a faith-based organization headquartered in Portland, Oregon, was ready to move from providing immediate care to focusing on development last year, but another crisis hit. “We had to put those plans on the back burner, and we got thrown into cholera on October 22,” says Ted Steinhauer, the organization’s country director.

With money supplied by Covenant World Relief and other sources, Medical Teams started two cholera clinics that saw 150 patients a day at the height of the outbreak. The clinics have treated more than 9,000 cholera patients, Steinhauer says. MTI supplied medical personnel to work alongside Haitians and provided Ringers Lactate, a solution used to rehydrate cholera patients.

Now that the crisis has subsided and the clinics are seeing just a handful of cholera patients, Medical Teams is once again putting its emphasis on three critical aspects of development: clinical care (general practice), training, and facilities.

Steinhauer is adamant, “Community health does not do any good if you do not have clinical care.”

The organization is working with the Union of Evangelical Baptists of Haiti to develop a long-term critical care program. “I’ve known them for a long time, and they do great work,” says Steinhauer, who has made Haiti his home for 30 years and led successful businesses and a local Christian school for many of them.

Although MTI has provided most of its services for free, health providers are recognizing the need to start charging for services. Patients at its new clinic in the tent city Canaan (pronounced Ka-non) have to pay a small fee.

“A hospital cannot live on donations,” Steinhauer says. “If it depends only on donations, then it’s going to close. It can have donations, but its operating expenses have got to be covered by its patients or it will not stand.”

Providing service for free leads to people not taking responsibility for their health – and puts other clinics out of business, says Steinhauer. But, he adds, no one will be turned away if they lack the ability to pay.

Offering clinical care will mean improving the training of nurses and technicians. “You cannot have good clinical care without trained nurses and technicians. Training and education has to be at the top of our list if we are truly getting involved in long-term sustainable relief,” Steinhauer says. “You cannot sustain anything if it is just foreigners running it.”

Haitian doctors and nurses went through a crash course at the two clinics operated in northwest Haiti during the cholera outbreak. Foreign doctors provided the lead in treating patients, but the clinics are now functioning with Haitian staff. Medical Teams is developing a program to train nurses and lab technicians in the region.

Nursing schools in Haiti are basic and graduates need a lot more training, Steinhauer says. “We have discovered that the most efficient way is to pick out the best graduates that have the most aptitude. Then we bring in nurse teams and they learn very, very well from doing. Haitian nurses can put an intravenous feed in a rock.”

Medical Teams plans on training enough nurses and technicians in the next five years to expand the clinics and support them with an entirely Haitian staff. “The objective is that ultimately we would only bring in a medical team if specialists were needed,” Steinhauer says.

MTI has implemented case and facilities management practices in all partner hospitals and clinics. That training has included teaching treatment protocols – cholera hadn’t been seen in Haiti in 60 years – and how to provide follow-up care, as well as how to best set up the cholera wards and sanitation practices.

Improving and starting better facilities also will be essential. “Historically, developing nations have good doctors, but what they don’t have is good facilities,” Steinhauer explains.

Covenant World Relief just approved a grant to make the clinic in Canaan a permanent facility that will have more space and supply equipment. What is now little more than an open-air pavilion will be enclosed.

Steinhauer says the witness of faith-based organizations is essential to the future medical and spiritual health of Haiti. “In Haiti, the public hospitals are terrible because there is so much politics,” he explains. “If it weren’t for faith-based organizations, there would be no health care here. We minister through healthcare because our responsibility is to show how kingdom principles work.”

Helping Haiti recover will take decades, says David Husby, director of Covenant World Relief. He understands that some people have been skeptical about the possibility of Haiti ever changing. They cite corruption and lack of funding.

“It’s not just corruption,” he says. “That’s a kind of a scapegoat thing where people want to blame it on corrupt leaders. The disaster itself set the poorest country in the western hemisphere way back. To think that we can go in there in a short time and transform Haiti is wrong. It’s not going to happen.”

But Husby also believes a better future is possible. “I am optimistic that with time and patience – and with Haitians taking the lead – real transformation will take place.”

A conversation O’Kelley had with his 14-year-old daughter, Amanda Rose, revealed the kind of faith he hopes other people will hold onto as they look to Haiti’s future. The O’Kelleys moved to Haiti less than a year ago, and Rose has struggled to fit in both at the school she attends and in her new neighborhood.

“She’s an amazing young lady,” O’Kelley said. “She is not necessarily having a great time, and we discussed how long we would watch her suffer, because we wanted to let her know she’s so important that we would go home if we had to. She said, ‘Go home? You gotta be kidding. This is a God thing. God can help us.’ ”

To read earlier stories, click on the links below:

• Haiti: From the Reporter’s Notebook
• Haiti: How Detroit Helped Prepare Caregivers
• Haiti: Fighting the Deadly Scourge – Cholera
• Haiti: Two Stories – Two Miracles
• Haiti: Just Take One Step At A Time
• Haiti: Getting Help Often A Challenge
• Haiti: Living Each Day – A Miracle
• Hope, Changed Lives Focus of Special Haiti Series