Dr. Barth Green co-founded Project Medishare, which has worked in Haiti for two decades. He led the first team of U.S. physicians to Port-au-Prince after the earthquake and, together with the University of Miami’s Global Institute, spearheaded the development of a 240-bed tent hospital that is now the country’s largest functioning urgent care hospital. His group is working with the U.S. government to establish Haiti’s first rehabilitation hospital. Green spoke with Erin N. Marcus on Feb. 5th.

How would you describe the country’s health infrastructure before the earthquake?

There are wonderful doctors and nurses in Haiti. But as far as a real health infrastructure, it didn’t exist, because they didn’t have the funding. They haven’t had the resources, the technology.

If you have a heart attack or stroke in Haiti, you die. There is not one angiogram machine in the whole country. Think about it – 10 million people, not one angiogram machine. They can’t catheterize a patient. It’s a totally different world, one hour from Miami.

What are Haiti’s most pressing health needs right now, and what are going to be its most pressing future health needs?

In three weeks, the rainy season begins, and there’s no doubt we’re going to have epidemic issues with malaria and dengue.

TB and HIV – there were hundreds of thousands of patients under treatment. They can’t get their medicines, there’s no place to go.

We’ve seen case after case of tetanus. I’ve been a physician for 40 years, and I’d never seen tetanus.

We’ve got tens of thousands of people disabled from amputations, from paralysis, spinal injuries, brain injuries. (These) people need (physical) rehab and there isn’t a good resource in Haiti now. There were small smatterings, but they were crushed.

Many aid workers have expressed concerns about a lack of coordination of the relief effort. Has this been your experience?

Right after the earthquake it was total chaos, it was a different world, but now we’re beginning to get our act together.

It’s not well coordinated between the different divisions and agencies, but it will be shortly because there’s a turnover plan. There’s organization about who’s going to do what – that’s good news.

What is your impression of the U.S. government’s response to the quake? What would you advise the U.S. government to do?

No nation in the world has invested more money and more effort and more resources than the U.S. The United States is committed to Phase 2, which is not just resuscitation, not just CPR for Haiti, but reconstruction to get it a better way.

The downside is the left hand doesn’t know what the right hand is doing. The DOD doesn’t talk to HHS, which doesn’t talk to USAID. It’s just very frustrating.

I’ll give you an example: There are 7,000 U.S. troops, heavily armed, on the ground there. We asked the U.S. government — our government — for some support, which would take about a total of 20 soldiers. They said no, they’re too busy. So we had to hire mercenaries to protect our camp. Is that right? I don’t think so … we’re serving as the triage for the U.S. (Navy hospital ship) Comfort and for the medivacs, they’re using us as a staging center.

Were lives lost as a result of the temporary hold on humanitarian flights out of Haiti?

I know they were lost. The question is, would these people have died?

(Before the earthquake), we had (performed) the first kidney transplant in Haiti. The poor gentleman got into problems with his graft. It was right in the middle of the embargo on flights, and he died in the hospital, right next to the airplane. If the airplane was flying, would he be alive? I think so.

That’s just one example. There’s no doubt that lives were lost, but lives are being lost every day there because of inadequate medical facilities and staff and organization.

What are long term solutions regarding the transportation of critically ill Haitian patients?

The worst thing to do would be to put them on planes and fly them all over the U.S. The nuclear family would disappear. Sometimes there’s only one parent (and) if you take an adult to go with a child, the other children are orphans. If you take a husband who’s the provider to go with his son, the family is without anything.

The best thing to do and the best practices are what we’re doing right now. Today as we speak, CT scanners, MRI scanners, anesthesia equipment, ICU equipment, fluoroscopy — all this is being flown in, it’s being set up in temporary hospitals … we’re going to put them in permanent structures. By treating them in Haiti, on the ground but with world class resources, you’re giving (patients) the opportunity, short term, to have the best care possible. Long term, we’re going to leave every piece of this equipment and we’re beginning to train our Haitian colleagues so when we hand off these hospitals in the next couple of months, they’ll be there forever. We’re not rebuilding Haiti the way it was, we’re rebuilding a different Haiti.

What advice would you give an aid worker heading to Haiti, to prepare psychologically?

There’s nothing you can do to prepare for what you’ll see. It’s life changing. I didn’t see one doctor or nurse who hadn’t cried and didn’t cry at one time, no matter how old, big, macho, whatever.

It’s really important for any for American going down there, or any foreign person, to step lightly. Remember these are a very proud, dignified people. I think a lot of things people do, especially in today’s media world, are inappropriate. People are sending out blogs with their own agendas on the internet. I would ask them to treat (Haitian patients) as they would their own family, be respectful. The good news is that 99.9 % of the people who are working with us are there for the right reasons.

Erin Marcus is an internal medicine physician and writes at New America Media.

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