Lessons Learned and Suggestions: Working with the Citizens in Haiti

Doctors Tom and Carol Ritter have been donating their services to the people of Haiti for the past several years. On his blog posting from Haiti 24 January, Tom offers lessons learned, and suggestions for response in Haiti:

1. Utilize local "organic" organizations that have been created out of the chaos of this disaster and praise them for what they have done right, under these impossible circumstances. Help them by asking them what they need to improve the crude but somewhat effective systems they already put in place, and resist the temptation to replace it quickly with a Western model.

2. Move patients down to the appropriate level of care with a person they trust. The idea is that when patients are moved, a Haitian nurse and/or trusted family member should evaluate the new location for safety, etc., in order to prevent them from feeling even more isolated and displaced.

3. Let everyone blow off steam once in a while - both from the patient and family side as well as providers. Note: The Haitians believe if they lose their temper once in awhile, it helps them calm down to get things done rather than keeping it inside and staying frustrated.

4. We need to stop wasting, to reuse resources and recycle, because Haitians believe strongly that wasting anything is sinful and they do not respect those who do waste. Be culturally sensitive, as you already are. Again, this is what we have heard from the front lines in taking care of a displaced population.

5. Develop an adequate registration mechanism. Earlier methods of registration during the initial phases of the disaster, although very imperfect, still should be incorporated into the newer systems as they evolve, and labeled as primitive in the field assessments and registration.

6. Recognize that electricity is very expensive and find better ways to minimize waste. Excess use of electricity at relief centers takes electricity away from local Dominicans which might lead to resentment and anger from the local population.

7. Dr. Marc Pinard is most concerned with the fact that his regular Haitian and Dominican patients have been suffering without his care, and need the same access to our facilities as those other trauma patients from the earthquake and disaster areas. He was hesitant to open his clinic for this reason, but opened it purely on a humanitarian basis and should be recognized for this role. Marc is also recognized as a Mother Teresa-like figure who has trained all over the world. He could practice anywhere, but he chose to return to serve the people along the border shared by both countries. He also suffers with his own medical issues, but put the needs of his patients before his own.

8. Develop better communication mechanisms for Haitians. Their main frustration is that they still don't know whether loved ones are still alive, suffering, displaced, dying or dead. Therefore, utilize all and any means to improve their communication with one another. For example, give them phone cards and/or cell phones with the right country codes to call others. Contrary to popular misconception, many of the patients we saw had e-mail addresses and need some form of access to the internet at the hospitals and throughout Haiti as well as the border areas, such as churches, stores, etc. A conference on this concept has already been convened on yesterday in Washington DC. For details, contact Tom Ritter.

9. We realize there is a desperate need to depopulate Port au Prince, but do it in a way that does not frighten or dehumanize their homes. They need to know when they return - if they return - it will be to a better place, not worse. Perhaps even have different ideas developed to show them as an example how it may look when they return. Every Haitian we have spoken with has conveyed fears that their home will become a place where garbage is dumped and bodies are buried, as has always happened in the past. Significant reassurance needs to be used to help them overcome these fears if Haiti is to be rebuilt correctly again.
10. Give Haitians the means to make their own food to their own tastes, cooked using their own methods and own ingredients, i.e. rice, beans, goat and chicken. This will also free up your own scarce resources to be used elsewhere while simultaneously empowering the victims of the disaster. Although efforts have been made to provide adequate food and nutrition under difficult if not impossible circumstances, the food that is served is perceived as somewhat less in quality than what an animal is fed, and could be counterproductive.

11. Develop a job corps for Haitians run by Haitians with Haitian management and focus. In other words, they need cash but want to earn it themselves by rebuilding both their own country and internal dignity and self worth.

12. Ask the local communities in Haiti who have helped in the past, and work those relationships (i.e. IMA, Partners in Health via Paul Farmer, Remote Area Medical, Friends of Haiti Green Bay) - both secular and religious, medical and non. These relationships are important because they know who the community leaders are, who often are not the most obvious or official leaders. Possibly ask technology experts like Bill Gates to help develop a Google map to educate people about the already existing infrastructure in those villages so that they can better help those populations. Not all villages have the same access to outside help, and not all outsiders access the same leaders within the different villages. Centralizing this via the internet and modern techology will simplify and advance this.

13. Ask people about their own priority list, not what is perceived by outsiders as their need. You have a priority list - and so do the Haitians. We need to ask them up front what their needs and priorities are.

14. We are nothing without good translators. We need translators fluent in Spanish, English, and Creole. Treat them like the precious resource they are by praising, paying and respecting them as one of the most important members of your team. Without them you are blind, deaf, and dumb, and will not enact any of the wonderful ideas that you have already developed. That said, pay them what is acceptable so as not to poison the well from which we all draw upon with a potential devastation of their economy.

15. How do we develop better relationships and communication with a central command and all those involved? We need facile, easy and reproduceable communications.

To read the entire blog go to: Carol and Tom in Haiti:
Stories from Doctors Tom and Carol Ritter doing relief work in Haiti