HAITI POST-EARTHQUAKE USAID/DART HEALTH OVERVIEW

UNCLAS PORT AU PRINCE 000086

AIDAC
SIPDIS

E.O. 12958: N/A
TAGS: EAID ECON PGOV PINR PREL PREF HA
SUBJECT: HAITI POST-EARTHQUAKE USAID/DART HEALTH OVERVIEW

REF: PORT A 0054; PORT A 0058; PORT A 0060


1. (U) Summary. As the number of patients requiring specialized
medical assistance declines USAID's Disaster Assistance Response
Team (USAID/DART) staff report that the current emphasis on
earthquake-related trauma surgery and injuries has begun to shift
to basic primary care, surveillance, and disease prevention. The
Pan-American Health Organization (PAHO) and U.N. Health Cluster
report 150 operating health facilities in Port-au-Prince, including
48 facilities with surgical capacity. Existing health facilities
and supplies have been augmented by a robust international
response, including the deployment of U.S. medical response teams
and the provision of USAID-funded medicines and equipment. End
summary.



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TRAUMA NEEDS AND CURRENT CAPACITY

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2. As of January 23, approximately 20,000 injured people require
medical assistance, according to the U.N. Health Cluster. Of the
total, approximately 1,000 patients require specialized care. At
the same time, PAHO reported the presence of a total of 150
operating health facilities in Port-au-Prince, including 48
facilities with surgical capacity - 36 fixed facilities and 12
field hospitals. An additional two floating hospitals with
helicopter transport capacity -the USNS COMFORT and a Mexican
hospital ship - and approximately 11 mobile clinics are currently
operational in the capital, according to USAID/DART staff.




3. U.S. Department of Health and Human Services' (HHS) medical
response teams are also providing medical care in Haiti at several
locations, conducting consultations with more than 1,000 patients a
day, many with acute medical problems, representing a total of more
than 10,000 consultations as of January 25. HHS deployed five
Disaster Medical Assistance Teams (DMAT) and an International
Medical Surgical Response Team (IMSuRT) on January 20. Each DMAT
team has 35 members, representing a total of 175 medical staff,
while the IMSuRT is comprised of 48 staff. DMAT teams have been
deployed to multiple affected locations, including spontaneous
settlement sites of displaced populations in Gheskio and the
Petion-Ville club. In addition to conducting surgical procedures
for earthquake-affected populations, the IMSuRT currently in Haiti
plans to donate its significant cache of surgical equipment and
supplies to USAID upon departure.




4. USAID/Dominican Republic (USAID/DR) has reprogrammed USD 1
million in health resources to provide three Dominican public
hospitals near the Haiti border crossing at Jiman???? with
medications
and supplies.




5. USAID/DART staff note the enhancement of U.N. Health Cluster
coordination and information sharing capacity as a result of the
arrival and support of USAID and the U.S. Centers of Disease
Control (CDC) staff. In addition, USAID/DART staff highlight the
value of the recent establishment of U.N. Health sub-clusters for
hospitals, mobile health teams, assessments, reproductive health,
and drug supply and management in strengthening the targeting of
response efforts.



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USNS COMFORT

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6. On January 20, the hospital ship USNS COMFORT arrived in Haiti
with 1,000 hospital beds and medical supplies to augment in-country
capacity to treat the increased caseload of casualties resulting
from the earthquake. The hospital has 10 operating rooms, 24
surgeons, and 130 nursing staff on board. Patients are primarily
being transferred from University Hospital and other Government of
Haiti (GoH) hospitals in Port-au-Prince. As of 1300 hours local
time on January 23, medical staff aboard the USNS COMFORT had
treated 1,427 patients and performed more than 93 surgeries,
according to the U.S. Department of Defense (DoD).




7. The USNS COMFORT currently has approximately 350 patients on
board and is expected to reach maximum capacity within the next 48
hours. The ship has a capacity of 1,000 beds which includes
patients as well as one accompanying family member, resulting in an
actual patient capacity of approximately 500 patients. The U.N.
Health Cluster is working to identify additional stabilization
locations to relocate treated patients for post-operative care in
order to make more space available to accommodate additional
incoming patients.




8. The GoH Ministry of Health (MoH) and PAHO have identified
potential post-operative care sites at Eliazar Germain in
Petionville, St. Jude Hospital in Delmas, and Delmas 48, which are
currently being assessed. However, the combined capacity of these
facilities may be inadequate to handle the projected flow of
patients. The DoD is in the process of deploying a self-sufficient
emergency medical facility (EMF) with a potential 250-bed capacity.
However, due to transportation and set-up times, the EMF unit
would likely not be operational for another 14 days. A short-term
solution is required and USAID and HHS are currently evaluating the
potential purchase of a federal medical station (FMS) from the
CDC's Division of Strategic National Stockpile. Each FMS provides
beds, supplies, and medicines for 250 patients. The FMS could be
set up in three to four days but would require additional support,
such as staff, tents, generators, and water and sanitation
services.



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GOH EMERGENCY MEDICAL SERVICES STRATEGY

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9. Developed in collaboration with PAHO, the GoH emergency
medical services strategy is comprised of three parts, including
support for mobile health teams targeting displacement sites;
permanent health facilities that serve as first referral facilities
located at main displacement sites; and hospitals and field
hospitals identified by the MoH.



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SUPPORT TO DISPLACED POPULATIONS

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10. To facilitate appropriate targeting of health services at the
estimated more than 600 spontaneous settlement sites accommodating
displaced earthquake-affected populations in and around
Port-au-Prince, U.N. and relief organizations are assessing and
mapping sites to identify gaps and service needs. Population
estimates of settlement sites range form GoH reports of 609,000 to
International Committee of the Red Cross estimates of 1 million
people.


11. Current MoH strategy plans to support 16 health facilities in
proximity to the largest settlement sites and utilize mobile health
teams to reach other areas of need. USAID/DART staff caution that
current plans for mobile team service provision may be overly
ambitious, citing the inclusion of HIV/AIDS patient treatment and
routine immunization provision which would require cold chain
facilities. USAID/DART staff note that an initial focus on basic
health services may be more effective with the potential to expand
services where feasible at a later date. In addition, USAID/DART
staff note that plans for settlement sites and displaced population
movement remain fluid. An estimated 235,000 displaced persons have
departed Port-au-Prince for other departments in Haiti, according
to the GoH. In these areas, increased medical staffing and
supplies may be needed to meet the increased number of patients.




12. USAID/DART staff report that a multi-sectoral rapid assessment
of spontaneous settlement areas, led by he U.N. Office for the
Coordination of Humanitarian Affairs (OCHA) and comprised of 24
three-person teams, is scheduled to begin on January 25. Teams
will utilize a modified initial rapid assessment (IRA) tool to
collect basic information pertaining to population and health,
nutrition, water, sanitation, security, and shelter conditions at
settlement sites in Port-au-Prince and other areas outside the
capital. USAID/DART staff note that the information compiled from
the assessment pertaining to the number and location of available
health facilities and water distribution points is critical to
identify gaps in coverage and inform appropriate response measures.



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MEDICAL SUPPLIES

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13. Despite the availability of medical supplies through the
PAHO-supported MoH warehouse PROMESS, inadequate messaging and
supply tracking challenges have hindered the efficiency of
distribution efforts. International relief agencies with
independent transport capabilities may pick up medicines at the
warehouse immediately, while local relief agencies require MoH
concurrence. To communicate the availability of medicines and the
process for accessing supplies, the MoH has initiated radio message
broadcasts to inform local clinics, hospitals, and relief agencies,
in addition to posting a message on the InterAction website to
alert international NGOs. In addition, USAID/Haiti has contracted
Management Sciences for Health to visit hospitals and clinics to
assess medicine shortages and link the health facilities to the MoH
warehouse. USAID/DART staff note that this may increase the need
for medicines as more facilities and agencies begin to access
PROMESS.




14. Inadequate tracking and monitoring of warehouse and pipeline
medicine supplies have also created significant limitations in the
ability to accurately forecast short and medium-term needs.
Additional United States Government (USG) pharmacists are assisting
with system tracking and management to address the issue. USAID is
also evaluating the possibility of providing additional support to
PROMESS.




15. In addition, to MoH medicine supplies through PROMESS,
USAID/OFDA has ordered four U.N. World Health Organization (WHO)
health kits capable of supporting 10,000 individuals for a
three-month period at the request of USAID/Haiti and PAHO. This is
in addition to five USAID/OFDA-provided WHO health kits consigned
to PAHO at the onset of the disaster. USAID/DART staff note that
the USAID/OFDA-funded health kits should provide an adequate buffer
stock for fixed health posts and mobile health clinics. Future
requests for WHO kits should be dependent on improved
accountability of existing kits and drug supplies.

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SURVEILLANCE AND PUBLIC HEALTH

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16. To date, WHO reports no outbreaks of communicable diseases,
including measles, rubella, and diarrheal disease, despite
difficult public health conditions. However, the earthquake has
disrupted vaccination services and conditions have contributed to
increase population vulnerability. In response, the U.N. Health
Cluster has reported plans to increase immunization activities for
measles and diphtheria, pertussis, and tetanus (DPT). In addition,
the U.N. Health Cluster plans to establish epidemiological
surveillance mechanisms at 51 health facilities on January 26 to
monitor health conditions and disease outbreaks to facilitate a
rapid response to potential outbreaks.



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LOOKING AHEAD

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17. As the focus of response efforts shift from emergency trauma
interventions to basic primary care, surveillance, and disease
prevention, USAID/DART staff emphasize the need to support mobile
health teams to reach the significant number of displaced persons
concentrated at spontaneous settlement sites in Port-au-Prince and
other departments in Haiti, as well as existing health facilities
in high-density settlement locations. USAID/DART staff also
highlight the need to incorporate disease surveillance and
nutrition surveys into health service interventions and note the
need for flexible response programming capable of adjusting to
evolving displacement strategies, including potential GoH plans to
relocate displaced persons. In addition, USAID/DART staff note the
continuing need to identify available facilities to provide
post-operative care for individuals injured in the earthquake.
USAID/DART staff will continue to monitor health conditions and
coordinate with USAID/Haiti, the GoH, and U.N. and relief
organization partners to address health needs.
MERTEN