These kinds of cruel triage decisions are commonplace in Haiti and existed long before the earthquake struck on January 12th. The poorest country in the Western Hemisphere has never had an effective public health system. Thousands of non-governmental organizations (ngos) - by some counts more than 10,000 - are trying to plug holes in the ship.
What's really needed is a new ship.
So far there's been no significant spending on rebuilding because there's nobody to spend it. The best hope is effective action by the Interim Haiti Recovery Commission co-chaired by President Bill Clinton and Haitian Prime Minister Jean-Max Bellerive. The Haitian parliament is still in the process of approving this commission, which will help allocate donor funds and oversee reconstruction.
Meanwhile, the clock is ticking in a major way. The rainy season has already arrived. With it will come an increase in problems such as malaria, dysentery, and lung infections. Malnutrition, disease, and stress - all exacerbated by the earthquake - are a particular threat to pregnant women and their offspring. And, of course, the generally miserable conditions present on January 11th not only persist but are significantly worse.
Where do ngos fit in? The Haitian people are desperate for relief today. They need the basics: food, clean water, housing, and medical care. In the absence of an effective government response, ngos have been stepping up. One Haitian man living in a tent told me that "the foreigners are helping us more than the government." There is no question that the activities of ngos need to be coordinated; too many people are doing their own thing. But until a strong, effective central authority arises, the ngos will continue to fulfill a crucial role.
A powerful example is Partners in Health (PIH), an ngo that has been helping Haitians for over twenty years. On April 5th, I visited the largest tent camp in Haiti: Parc Jean Marie Vincent. It houses almost 50,000 people displaced by the earthquake. PIH has set up a small clinic right inside the camp. Every worker I met was Haitian. Ten doctors see a total of 400-500 patients a day. Physicians, nurses, and other health professionals arrive first thing in the morning and don't leave until the last patient is seen. A rudimentary lab tests patients for pregnancy and illnesses like malaria, HIV, syphilis, and urinary infections. There's a small pharmacy. Family planning, psychological counseling, and social services are all provided. There are definite logistical challenges, such as maintaining enough supplies given the limited storage space. And the doctors and nurses told me they could use more of pretty much everything (space, health professionals, medications, lab equipment, supplies). But I couldn't help marveling over the small miracle PIH has created in the midst of a nightmare.
Back to the mission in the north of Haiti. After some very tense moments, a healthy baby girl was delivered and the premature baby boy survived the temporary lack of supplemental oxygen. And I left Haiti wondering whether the country will ever reach the point where the fate of its children doesn't rely on the roll of the dice.