Haiti Case Study - The Department of Global Health and Social ...

Figure 3: Graph of Fatalities reported versus days since incident
5. The first step occurred immediately, during the actual earthquake (i.e. those caught in
collapsing building who were crushed instantly); the second step occurred later 117 when open
wounds became infected, untreated compound fractures became gangrenous, tetanus set in,
untreated crush injuries caused renal failure, etc. These delayed fatalities, caused by
earthquake-related injuries but leading to death several weeks after the disaster, were the
result of delayed access to health-care facilities.
6. Lack of secondary and tertiary care capacity made patient triage and the setting of
priorities for care the most important drivers in handling patients. Delays in care could lead
to worse patient conditions and thus tougher medical challenges than would have been
present with timely intervention, especially in those portions of the population suffering from
anaemia (caused by malaria), from drug resistant tuberculosis, or from malnutrition whose
underlying poor health status exacerbated their earthquake-related injuries.
7. Immediately following the earthquake, many people with relatively minor (i.e. non-life
threatening) injuries overwhelmed secondary care infrastructures, preventing their
specialized capabilities from being used appropriately, while primary care facilities were
overwhelmed by patients with injuries too complex to be handled. In some instances,
primary care facilities’ only option was to treat patients urgently despite scarcity of tools and
medical staff expertise 118 . Other patients were lucky enough to be transferred to a suitable
facility, but arranging these transfers was a distraction for medical staff, which lost precious
time for addressing acute care needs.
8. A longer-term challenge came from financial arrangements for externally provided
health care: would Haitians have to pay directly for the care they received or would it be
provided to them free of charge? Before the earthquake, most services offered by MSPP
required user payment. 119 As a result, many Haitians had difficulties accessing public health
since most of them live on two dollars or less per day. After the earthquake, a wide range of
NGOs and other international actors, with total funds which far exceeded the MSPP
budget 120 , were able to offer many free medical services. This “shift of power” from state to
externally provided health services undermined the national health system.
9. Responders needed to incorporate the system of temporary medical treatment facilities
established by numerous civilian and military actors into an effective care network with
existing medical treatment facilities. This was needed to both meet the immediate medical
needs of the population and promote reconstruction and development of Haiti's medical care
network to meet local needs long-term.
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