2010mar22 oas diaspora cnf combined health development recommendations and leiderman notes

7/31/2019 2010mar22 Oas Diaspora Cnf Combined Health Development Recommendations and Leiderman Notes

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HAITIAN DIASPORA FORUM:HAITIAN DIASPORA FORUM:CONTRIBUTING TO A STRATEGIC PLAN FOR RECONSTRUCTIONCONTRIBUTING TO A STRATEGIC PLAN FOR RECONSTRUCTION

AND DEVELOPMENT IN HAITIAND DEVELOPMENT IN HAITI11

OAS Headquarters, 17th Street & Constitution Avenue, NW, Washington, DC 20006OAS Headquarters, 17th Street & Constitution Avenue, NW, Washington, DC 20006March 21-23, 2010March 21-23, 2010

WORKSHOP 6: Recommendations on Health Development

Introduction

It is conservatively estimates that the approximately two million earthquake survivors who are either injured,displaced or both, will need at least three times the medical and health care services - some for the rest oftheir lives - as the remaining eight million or so who survived unharmed. This effectively means that Haitispre-earthquake capacity has to double. And to avoid excess deaths and debilitations, it has to double now,not later.

1 This Forum is co-organized by the OAS and the Haitian Diaspora organizations in coordination withthe Haitian Mission to the OAS with the support of the governments of the United States of Americaand Canada, as well as the WK Kellogg Foundation.

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It is also acknowledged that the environmental refugee population will continue to be uprooted, poorly-housed and under terrific stress for months if not years. This means they probably will be several timesmore vulnerable to secondary health problems, infections, accidents and mental illnesses than otherHaitians. The question marks suddenly become exclamations. The salient questions are:

1. Should Haitis medical and health care capacities be increased from pre-earthquake levels? If so, towhat levels? and for whom?

2. From where will the additional medical and health care workers come? in what categories andproportions? and who will train, assign and supervise them?

3. How will the expenses be paid for personnel, equipment, supplies, facilities, utilities, timely construction,operation and maintenance?

4. What modifications of usual care and access will have to be made to attend to the special needs of sucha large population of displaced persons?

5. In the cost-benefit analysis of investment in medical and health care for Haiti, what was the value of aHaitian life before the earthquake? what was it during the foreign response? what is it now? what should itbe in the future?

6. Is there a theory of social triage that is both ethical and cost-effective for medical and health care in Haitiover the next several years?

Population In Need

1. Earthquake victims: The earthquake has caused a development of new population of people,internally displaced persons. One out of every five Haitians are in this population. Their needsare specific and immediate. We will need to target specific interventions.

2. Women: Women are the majority of Haitian population. Most are in their mid twenties and aremarginalized within the Haitian population.

3. Children: Pediatric care in Haiti is in dire need of strengthening. Children are striving to surviveas mortality has increased

4. Elderly: Most elderly are taken care of by family members or neighbors and are at high risk ofdying with lack of proper health care

5. Laborers: Occupational health and safety is an important issue in Haiti

6. Persons with Chronic Diseases: maintaining continuous health of those with chronicdiseases such as hypertension, diabetes, etc.

7. Health Care Workers: are heavily exposed to diseases

8. Students: Medical, nursing, paramedical persons are in need of sustained support

HEALTH DEVELOPMENTThe following are recommended by the workshop and they are categorized according to the type ofprofessional groupings that will be involved. The above are the recipients the below include the personsresponsible for implementing the strategies.

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Preventative Medicine1. Promoting health education with a specific framework of social determinants of health

2. Education campaign focusing on infectious diseases such as TB, HIV, malaria, STIs, and watersanitation hygiene (WASH)- using media forum ie. television, radio, and oral animation, theatre

3. Health focus in the penitentiary, ensuring access for health of prisoners

4. Promotion of healthy lifestyle through sports

5. Implementing a follow up care system, funding existing rehap centers

6. Investing in sustainable health by focusing on the environmental effects pre/post earthquake onhealthcare in Haiti, (ie. measuring effectively the amount of toxins in the air and addressing thisissue in an effective way, resources toward environmental standards for Haitis air, promoting cleanair, replanting the trees to prevent continued deforestation of Haiti land mass)

7. Pour resources into health systems management

Human Resources1. Promoting a partnership between diaspora health care professionals and health care professionals

in Haiti to provide intense and modern technology training2. Support the existing development of small community health centers outside of the capital3. Investing in work force development, community workers and other mid level provider to build the

infrastructure and could be trained to be a mid level resource for the community4. Create incentives for specialist to work in the provinces thereby decentralizing special care services5. Investing in local Haitian organizations and contracting them directly

6. Suggest that we have a Haitian version of the relief ship to be docd at the seaport, Haitian docs,social workers, nurses, etc.. over a period of 5 years, while the health system is restructured

7. Investing in civil service humanitarian act for Haitians to return for two weeks to provide servicesand their jobs in the states remain secure

8. Use the medical students to work in the camps, psycotrauma, while the school gets rebuilt, theycan be used in public health, sanitation, etc in the camps

Emergency Preparedness

Investing in an adequate emergency system, ICU, CCU system and promoting partnerships betweenAmerican University Hospitals and the MOH

Advanced Clinical Education9. Funding towards building medical schools of excellence in partnership with the private/public

hospitals through:a. Rebuilding hospitals (public/private)b. Supporting clinical mentorship programs to build technical and practical capacity for the

many medical students who are no longer in schoolc. Partnering with the MOH, Notre Dame, Kiskea and public/private hospitals to build medical

continuum through clinical educationd. Maintenance of a medical residency and fellowship focusing on diseases that are endemic

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to Haiti and the Caribbean ( ie. Telemedicine where doctors can communicate withinternational community via internet and web for continued training and support of Haitiandocs in Haiti)

10. Fund a mini-fellowship in infectious diseases for local doctors. This activity will build capacity ofthe in-country physicians, and strengthen the skills of other members of the multi-disciplinary team,including the counselors and treatment support staff, and the technical staff (ie, pharmacists, labtechnicians). This training will provide an opportunity for continued clinical technical assistance thatwill be sustainable over time by Haitians

Womens Health11. Invest in family planning, womens reproductive health and child health organizations, health

centers in conjunction with MOH12. Partnering with private sector organizations

Performance Based Evaluations13. Create a performance based eval system through the MOH for local based organizations, hospitals

and international aid working in Haiti.

Mental Health14. Investing in mental health needs to be addressed especially since the earthquake, looking at

different mediums of therapy especially for children15. Creating a culturally sensitive model for mental health care

- - - - - - -

APPENDIX I

The following is material prepared for the conference by AMHE.

The Cost of Haitian Medial Services and Health Care, Facilities, Supplies and EducationAssociation of Haitian Physicians Abroad (AMHE) has been working to estimate the cost of medial healthservices for Haitians including those who were victims of the earthquake. AMHE estimates that Haitirequires at least a doubling of its medical and health care workforce to meet post-earthquake needs. From

where will they come? In what categories and proportions? And who will train, assign and supervise them?

AMHE believes that the workforce should predominantly come from within the national Haitian population.It also believes that roughly one out of every hundred Haitians is needed at some level of medical andhealth care services that have direct contact with patients, e.g. physicians, dentists, surgeons, nurses,nurse practitioners, technicians, dieticians, paramedics, and associated clerical and facilities maintenance,e.g. secretaries, custodians, engineers, etc. That means roughly 100,000 persons out of an adult workforceof approximately four to five million.

Starting with whatever pre- and post-earthquake information is available, AMHE proposes to conduct anational census of and search for actual and potential workers, their locations and current educationalstatus and employment experience. A national public relations campaign will publicize the goal of achievinga ratio of 1 per 100 for medical and health care services. A registry of existing and potential employees

will be created.

Assuming a workforce of 100,000 segmented into five earnings levels of US$3000 x 30,000 workers,US$5,000 x 30,000 workers, US$7000 x 20,000 workers, US$10,000 x 10,000 workers and US$12,000 x10,000 workers per year, the total payroll would be US$600 million per year. This would represent a yearlyworkforce investment of approximately US$60 per Haitian.

Given the dire living conditions, uncertain resettlement future and extremely high-risk exposure to injury andillness among Haitis environmental refugees - approximately 1,500,000 persons - AMHE would put firstpriority on recruiting a workforce specifically for this population. At the ratio of one per hundred, that would

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be approximately 15,000 workers. At the same ratio of categories as above, the payroll would be US$3000x 4,500 workers, US$5000 x 4,500 workers, US$7000 x 3000 workers, US$10,000 x 1,500 workers andUS$12,000 x 1,500 workers, or approximately US$90 million per year.

From news reports, Haitis medical and nursing schools were severely damaged or destroyed. Therefore,near-term, AMHE proposes a campaign of international lobbying and negotiations to place at least oneHaitian in every medical and nursing school abroad. Working with Haitian foreign embassies, consulatesand Diaspora members in destination countries, AMHE would create support groups to raise sufficient fundsfor students tuition, travel and living expenses.

Also near-term, AMHE proposes to expand its current program of advanced to provide intensive short-courses in Emergency Medical Techniques (EMT), Community Emergency Response Techniques (CERT)and Community Environmental Response Techniques (CERT2) at first to the 15,000 who would berecruited to work with displaced earthquake victims. With an average class size of fifteen and averageduration of five days per course, this would take a thousand complete cycles of instruction. If given on aweekly basis through the next year, this means twenty simultaneous sets of cycles. Assuming fourinstructors per course, 80-100 full-time instructors would be required. This is within AMHE/s recruitmentand coordinating capabilities, and instructors would be drawn from qualified people in Haiti and abroad.

Drawing on the payroll estimate of $600 million per year in Section IV and assuming that total costs for

medical and health services would be three times that, including capital investments, then a nationalprogram would be slightly less than US$2 billion annually in round numbers. This is approximately US$200per year per Haitian. Of this, US$250 million per year is needed for the millions who were injured anddisplaced by the earthquake. AMHE believes these are reasonable estimates, and from the point of view ofexpected public and private medical and health care providers, they begin to put a realistic value on Haitianlife.

From where will this money come? For comparison, annual remittances by Haitians living abroad havebeen in the billion dollars a year range. American government foreign aid to Haiti has been approximately ahalf-billion dollars annually, and this has been roughly matched by aid from other countries. In theimmediate earthquake response, the American military expended a quarter of a billion dollars to establish itpresence in the country, and other American government contracts amounted to almost a half-billiondollars. Hundreds of millions of dollars were quickly accumulated by public fund drives. The current United

Nations flash appeal for Haiti is for more than a billion dollars.

Before the earthquake, neither Haiti nor its foreign aid partners had a program to bring Haitis medical andhealth care system quickly up to world standards. The strategy was for incremental appropriations overdecades, supplemented by charitable contributions and foundation grants. Unfortunately, indices show thatHaitians continue to be greatly under-served and at risk for debilitating injuries, diseases and illnesses.Therefore the current funding strategy has not satisfied the need.

To satisfy the need, AMHE proposes that Haiti and its foreign aid partners create a specific medical andhealth services fund. To use a relevant and verifiable benchmark, the level of funding would be equal to thelevel of Haitian Diaspora remittances. This will motivate the Diaspora to maintain high levels of personal aid

food, clothing, shelter - to friends and families back home while challenging multilateral donors to likewiseat the sectoral level - medical services and health care - across the entire population. The fund would be

managed by a board of trustees who members will be foreign donors, Haitian Diaspora remitters, HaitisMinistry of Health and private Haitian citizens. For this effort, AMHE proposes to develop the ground rulesand recruit the initial board of trustees.

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APPENDIX II

THE RESPONSIBILITIES OF FOREIGN DONORS TO HAITIANS ABROAD FOR EARTHQUAKERECOVERY

This is material prepared by the Haitian Resource Development Foundation (HRDF) for the OASconference. HRDF has worked in Haiti for more than twenty years providing medical health services andtraining.

From the point of view of Haitians living abroad, the past two months have been dj vu all over again.Incipient stereotyping, unfairness and exclusion of Haitians Abroad from earthquake response policies,

priorities, decisions, contracting, monitoring, quality control and evaluation are reminiscent of racialprejudice and civil rights struggles fifty years ago.

DISASTERS, DIASPORA AND THE MARCH OF HISTORY

1. Disasters - Civilization, no matter how advanced, is vulnerable to disasters. The result has been aterrible toll in lives and property, especially in the so-called underdeveloped parts of the world.

2. Where does humanitarianism come from? - In the big picture, the most valuable product of civilization

is the Family of Man. This is an overarching and unifying concept. It is multi-racial, multi-cultural, andmulti-skilled, and shares a distinct humanitarian trait that compels people to help each other in times oftrouble.

3. Mutual Aid Looking more closely, within this trait is embedded in the principle of mutual aid. Todaysdisaster responders may suddenly become tomorrows disasters victims and, conversely, todays disastersurvivors may be needed to respond to someone elses disaster tomorrow. Thus, there are good reasonsfor everyone to a) prepare for disasters, b) be willing to respond, and c) maintain sufficient resources at theircommand. This is the principle of mutual aid.

During disasters, the expectation and need for help on the one hand, and the ability to offer it on the other,is often strongest among those who share occupations, nationalities, culture, religion or types of suffering.

And in the Haitian and Chilean earthquakes, of course, a huge number of teams of all kinds have crossed

international borders in the same spirit of mutual aid. They fully expect that someday, Haitians may cometo their rescue.

4. What about the Diaspora? - There is also mutual aid among national, cultural and ethnic Diaspora,such as Haitian-Americans, living outside their countries of origin. In general, Diaspora members haveimproved their lives and have become critical to the survival of poorer friends and families back home. Inthis regard, the United Nations High Level Dialog on Migration and International Development recognizedDiaspora populations as economic life savers because their remittances rival the size of foreign aid itself.Further, Diaspora

a) Remind host countries that there is a world beyond their borders,b) Help interpret the meaning of events occurring in their homelands, andc) Help countries learn how to adapt to each others strengths and weaknesses, needs and trends.

This kind of information and understanding is valuable and probably cannot be acquired any other way. So,wise democracies would best regard their Diaspora as valuable human resource. Diaspora participation ininternational disaster response is a good case in point.

5. Haitian Diaspora Resources Three hundred years ago, Haitis African forebears became anintermingled population among indigenous and colonials in the Caribbean and the Americas. As history willhave it, many chose to leave or were forced to flee. Today, hundreds of thousands of bright and successfulHaitians live abroad, mostly in the United States. They are a significant portion of Haitian human resourcesin the world.

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Because of its accumulated but seldom acknowledged talent, some view the Haitian Diaspora as a kind ofdisembodied brain. It grows more intelligent with every emigrant student, graduate or professional wholeaves the country. And among them are almost certainly some who anticipated the earthquake, advisedagainst shoddy construction on dangerous land, and who could have mitigated the disaster given theauthority and sufficient resources.

Haiti can either borrow or transplant this intelligence. If borrowed, it would be for functional purposes -advisors, teachers, doctors, farmers, foresters, designers, etc. If transplanted, it would be for structuralpurposes - voters, land-owners, elected and appointed officials, etc. Either acquisition would benefit thecountry, especially now.

INTRODUCING THE HAITIAN RESOURCE DEVELOPMENT FOUNDATION (HRDF)

1. More that twenty years of distinguished service- HRDF is a Haitian-American organization that alsohas active partnerships with European agencies, municipalities and citizen organizations. HRDFsdirectors, staff, teachers, trainers and advisors have been both Haitian and non-Haitian. So in this way, it isintermingled in the world, the same as the Diaspora and the whole Haitian population at large.

As an organization, HRDF maintains the capability to scale up to meet increased needs.

A month ago, the Haitian Resource Development Foundation decided its earthquake response program.HRDF believes that Haitis most valuable assets are its people. Therefore, the welfare, resettlement andemployment of the displaced - HRDF considers them environmental refugees - plus access to naturalresources for food and shelter, are pre-eminent. HRDF has been seeking contributions, contracts andpartners to carry out this program.

2. Interdisciplinary and Intercultural Teams - No matter how large the pool of first responders in theworld, the severity of the earthquake effect has forced everyone to make a big decision - either scale up orget out of the way. This is reflected in the government of Haiti requests for long term rotations of doctors,engineers, inspectors and such rather than for short fly-in and fly-out sorties typical of the first weeksresponse. It is probably a wise decision, and HRDF concurs. But this puts much more emphasis on theneed for team orientation, accommodations, supply lines, sustaining funds plus support of a distinctlyHaitian nature. This includes a variety of services, including translation, interpretation, negotiation,

mobilization, intervention, monitoring and evaluation. This implies interdisciplinary and intercultural teamsand contracts.

For example, when humanitarian teams of the United States Southern Command have come to Haiti overthe years, they wisely used HRDFs senior staff along with those of other Haitian-American organizations.The roles of Diaspora team members have been to a) help assess and select communities, b) introduceand link SOUTHCOMs professionals to Haitian professionals and local populations, and c) work side byside with them. HRDF has worked in a similar fashion with the French on a variety of communitydevelopment, environmental protection and education projects. With all these kinds of partnerships, HRDFreceives full responsibility and funds for their implementation.

AFFIRMATIVE ACTION FOR HAITIAN DIASPORA ORGANIZATIONS

1. Culture, Motives and Opportunities - HRDF may be considered highly evolved among professionalDiaspora organizations, but it is not alone. There are hundreds, and they are a distinct class of NGOs intheir shared culture, motives and opportunities. They work in and for Haitians years before, then during andafter disasters. HRDF believes that these attributes Haitian culture, motives and opportunities - areessential. Therefore, HRDF believes that great benefits come when the Diaspora organizations work intandem with Haitians, mutually defining goals and objectives, expending money and materials, monitoringeffectiveness and coalescing operations. Too often, donors and contractors ignore, forget or do not requirethis important working relationship. The results are typical of what we now see in Haitis earthquake zone -inefficiency, chaos and paralysis. This needs to be remedied.

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2. Foreign Contracts - To HRDF, these above terms of engagement are missing from foreign governmentcontracts in Haiti, not just since the earthquake but over many years. Since January 12, hundreds ofmillions of dollars have been spent in just two months. A review of published contracts gives the impressionthat recipients are frequently non-competing, favored companies, or semi-public, religious, professional orother non-profit organizations that have little or no particular historical interest, concern or experience inworking alongside Haitians. They are contractors pure and simple. As more and more reports emerge fromHaiti, HRDF is seeing this as a typical, wasteful and prejudicial practice. And from the view of manyHaitian-American organizations, it amounts to unfairness of humanitarian rights at the international level,reminiscent are reminiscent of racial prejudice and civil rights struggles fifty years ago in the United States.Without a doubt, Haitian Diaspora companies and organizations with appropriate experience andcredentials should share the foreign donors contracts for relief work in Haiti.

5. American Contracts - Where American government contracts for Haitian earthquake relief and recoveryare concerned, all of them are paid for by American tax money. Thus, every citizen rightfully expects that:

- Access to and use of money will be subject to law, not to someones personal discretion,- Requests for, justification, allocation and cost-benefit analysis of funding is a matter of public interest, andtherefore should be transparent,- The basis for access to funds will be open, competitive and on the merits of the applicants and theirproposals. Exceptions for extenuating circumstances should be strictly limited.

Further, Haitian-Americans in particular ought to rightfully expect that:

- Government contracts will acknowledge the Haitian Diasporas three special attributes for work in theircountry of origin, namely shared culture, motivation and opportunity. The government should find directand unambiguous ways to make the most of these attributes to increase success.- Especially in the case of contracts for Haiti, something akin to the philosophy and practice of AffirmativeAction is necessary to give the Haitian Diaspora minority a fair share of work and to use the aid money tohelp unify them with Haitians back home.- Plentiful contracts in the range of up to five million dollars each should be available to match thecapabilities of most Haitian-American NGOs or companies. Monster contracts in the tens or hundreds ofmillions of dollar range should be subdivided and individually competed for.- Haitian-Americans companies and organizations with relevant capabilities should not be, as in the past,

referred to major recipients to beg for subcontracts.- Regardless of their size and experience, the American government ought to be actively recruiting bonafideHaitian-American companies, professionals, and NGOs for work during this momentous tragedy. This is theprecise time and opportunity when small companies and organizations likes these could grow and maturewhile helping their country of origin.

HRDFWeston, FloridaMarch 18, 2010HRDF Dispatch 14

22mar10ORGANIZATION OF AMERICAN STATES HAITIAN DIASPORA FORUMNOTES FROM WORKSHIP SIX: SOCIAL DEVELOPMENTStuart M. Leiderman [email protected]

uncorrected

Landreau: the maginitude. there are best practices. in La, the fazilure of the flood control system, neworleans, 5000,,000, the system failed. it wastn just a hurricane, a big flod insued. we couldnet survive

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that. when levees broke, too hundred and fifty thousands homes destoryed. up to ten feet. we can learnfrom those horrific catasttrophes. first, the people of Haiti are one of the first for Katrina. so were here tohelp Haiti. the good news, despite suffering, the dynamics of how to take opportunity of thie sterrible horrificdisastern how to build better and stronger. exap;mle, new orleans schools ere among the worsst. how, webruilng a new public school system. one of the thngs that seems apparent to me about Haiti, loking forardto going for in two wks. now, can only go members of congress, three hours at a time. on the tarmac. yest,we have not gone to Haiti. we have to go and get the scale of it in our minds. we have to go in a helicopterto see the extent of destruction, etc. the point, with your help and good feedback and communication,perhaps members of congress can help build a better child welfare system, empowers women, among allthe issues. the idea is trying to service chilldren in and of familiels, giving them the tools to do it. I havesome specific ideas. I want to share with you, our louissiana delegation. two. you can gujild back afterdisaster, after you finish crying, we can build something that can last, perhaps so much better. two, wehenwe thing about women, children and families, so that the foundation we lay down, childrens, rights, familyrights, promoste communication, at the end of the day, every child connected to a family. we dont yet haveit right in the U.S., were trying. as we think about a new system for Haiti, put our best systems forward. myoffice is open to you. I do serve on the app;ropriatioens committee, where, who, when it gets funded. giveme your idesas and Ill do the best I can.

chairwoman. I am tasked with education and child development. the future depends on it. today, rangingfrom literacy, schols, welfare, etc. we will look at childredn from infancy to theunivesity system. the

process, I will need two volunteers, take notes,etc. att he end of the session dto the world bank nextweek.

Joe ?Bernadel: 70 percent of students this year will fail? we want to work with haiti to reinforce thesystme of Haiti education, the state system. I will ask people to give references to the documents they cite.

RachelPiere: social worker at chavre, d.c. five years working in child welfare, awhat in d.c. can be used toimprove child welfare in Haiti. glad there is a component in this. should be at the core of reconstruction.several clauses in haitian constitution, children shouldhave equal access to educatdion, health, etc. aswe go forward, we need to understand that preserving families and keeping them together, giving mothersalternatifesvery improratant in looking forward to sustainab le haiti.

Duval, educator. new york. producctx of bilingual education in U.S. past twenty years, bilingual

educatdion for Haitian childresn, and the success rate. later, looking at eecuatdion ystems in Haiti, and thequality of educators serving that population. hoping to share ideas lokiing at access for the children, Imeana equitable access for all, I mean excellence, and rigoroous educatdion for all, contributing the thedevelopment and construction of Haiti. later, some ideas and key points from the mininster of educatdion ofHaiti and short- longterms goals.

chair: okay, panel, questions later.

Joe Bernadel. there is no single movement for reaching educatdion goals. there is a tremendous amojnt ofissues to be considered. but I have to say to you as the Unesco re;port Educatdion for Ak it did not startwith the earthquake. we are apreciated of the acdditional look because of the eathquake. but we talkingabout those who are marginalizedeach country has different ways to meet them, in the light of theresources available. it is not the lack of desire or knowledge or awareness of example, sometimes the

resources are simply not available, time, hman resources and money. in terms of time, haiti has a situationis that we have to address right nowthe conditon of five to sic hundred thousand chilcresn. in terms ofresources, we have sets of conditions..the need to have a national standared tdhat starts a somethinginstitute in Haiti right now. the second is what is going to be the language from now on. third. where willthe monney comme from? I would like us to concentrate among the three topics.

woman: in french I would need two rapp;orters for the workshop. this is the

Hillary:woman, works for interamerican commission at oas. we want wommens matters to be taken intoaccount in oas res;ponse. my first experience, from five years ago. relating to security. women in the

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nhaitiainational p;olice. two issues to think aboutviolence against women, haiti in p;articular, but all overthe wlrd. also, participation of women in Haiti. it really makes a difference for their participation in thevarious sectors.

Leonie, Lamby: social justice and grassroots develoiment . my experiece inextricablyl linked to womenspaticipation. their own vision of what they want the country to be. in addition to p;ort-au-prince, nationally,womens roles, violenceagainst women, health and inteconnectedness between health and education, ,access to water, etc. al I;nvolved in womens issues. so Lamby, particularly rural haitians, theyare about60 percent of the countrys populations.

chairwomman: OAS guildelines, please pick up copies.

Dr. Josephh pierre-paul cadet, first vp haitian american physicians abroad: thank you for being here thisafternoon, a great cause, thank you fory our commitment. presen tingtthe speakers for this afternoonssession.on health. Dr. aJean Claude de ..

Dr. Jen Claude. unfortunately after this horrible earthqualke, we know it is immportant to get togethyerand find a collective vision. we hae health care problems, mixed in with educaitdon problems, we are

talkilng about a poulationsixty to seventy percent of Haitian children donth ave access to school. afterthe earthquake, parents lost anything, all their assets, they dont have money for tuitionj. we have a millionfive hundred thousand uprototed, they are living in terrible conditions, like malaria, no access to water, thereare other diseases, we have to find a way. the third element is that we have to look long term and try tosolve them

Mayo . PAHO: paho is the specialilzed agency in health and welfare of oas, and affiliated with who.

Gail Christopher: health and welfare, kellog foundation. were committed to being a partner with haiti forthe long term. imp;ortant to take a long view, multi decade. as for health, we take a social determinantdsaproach to health.l in this case, racism, it has to be looked at head on..not just after the quake but before.in cluding thestructural racism, because it is imprtant to ownership, empowerment and healilng.

afternoon session

Cadet: reading his questionsdecentralization of health care facilitiesfeasibility of technology, etc., andfairness. what kind of help would come from for example the private sector. etc.

Dr(woman). Mart: whats been missing is looking at links between health and social behavior. ex.highest hiv in caribbean...I'e noticed we ahavenot been successful in a campaign to motivate healthbehavior. so while other countries have mds and nurses to help resolve situations, we really need tointegrate a framework from social sciences. an example is h1n1 around the worldhad to incoporatesocial sciences, and has to account for low literacy.

french speaker: prevention is the key. santiary..two pathologies. tuberculosis and hiv. we need schoolingand commnity education for that, radio, television, we need the media to help us. I can help with that. weneed to use our human resourcessome training, etc. then we need to get in touch with s ponsoringorganizationsthen we can get physicians from all ocrners of the world. we need to create emergencyservices. the diaspora has a res;onsibility to establish partnerships with the hospitals of universitiesinternational professional speakers bureau.

mnichelle Karshan: I think its imp;ortant to include the health of prisoners, and identify its diseases andinfections, because high mortality rate within the prisons.

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I want to suggest considering healthcare and workforceto build up the economic and incomeopp;ortunities for haitiansmid level providers could be trained to be a mid level recourse for thecommunity.

woman: physician in montreal, have been withI also worked with diff orgs in ahtiai after the earthquake. Iam totally in agreement withwhat dr. mark justsaid, ahd ther eis an enormous deathrate for children andmothers as well. a tremendous problem, peole died at 27 and leave27 children behind. so we have to havesome kind of population control, not forcing, but to change behavior. in order to limit this problem. thatsonly a little bit of and for 12 million, its too much. then I would like to join Dr. Lefranche, because inmontreal congress, we were talking about the different universities and hospitals, except on ly three or foursuccesses, in these towns of 200,000 people. only a few health clinics because the government didnt havethe means to pay the purposes. there are not enough specialists, we as diaspora cannot changeeverythning. the different realization of health care 95 ercent of the specialists are in port au prince. sothere are places with specialists in departments, and anothyer portion of the coutry that has none. we cannot only work in port au prince but in the different departmenets.

Martin Dannenburg: on first visit to d.r., someone selling tourism in ;ponta cayeu, there were a hundredselected for medical class and he was 1010 on a list. I would suggest doingverious things including findingthe funds to expand medical schools to 150 to 200, instead of 100. as for prisons, mid leveltechnicians,you hae to expand them when you have ahuge problem in any field. we can t just depend on a few doctors

who are there. I would seggest sending known technicians out to help older people or the elderly.

Aldy Castor:

dea\ja vu all over again. not the firs time of telling what happened to haiti. we have had the adisory group,etc. last year in August, we had the same things in Miami. we hashed all the things. we come herebecause there is some funding given. iln last two minths, 2 billion for haiti, the concep;t is for haitianamerican, very few only four million I think has gone to HA organiations. Dr. Cadet is acting for investmentin the dias;pora. what should it do. wihthing the Associateion Haitian Phy Aborad, and hrdf, we have beendoing all this trainilng, emt, certd, intevention, urgery, but the only p;roblem we have is that we dont haveaccess to funding. we dont have to has, the res;ponsibitlity of the donors toward the ha and the dias;porabecausewe dont get our fair share, reminiscent of the sdeiscrimination of the civil years rights rera. weneed affirmative action for ha to have its fair share. so we ask to put in the record that we haitian amer

organizations should have fifteen ercent of the contract that is going for reconstruction of haiti. when youlook at the contracts, mega, one hundred million dollars, no has in the. we have to beg for sbucontracts.so this is where we have to go with the problem.

Leonie Hermantin: whenever I travelto haiti, I see multiple, howare organization work conducted? waysto help for example a nurse to be trained, we can go to a website or elsewhere to rovide ma contribution tomaintain doctors, nurses, medcial staff, within smaller communities and communes.

Micaile enviale, hirsh med center nurse: I suggest that we hafe a haitian version of the relief ship similar toComfort, four missions per year, one month each, Haitian ministery staff to overseee the function, over fiveyears. another solution is to have a helath insurance fund for the donors for the next five yars. again healthministry and diasp;ora working together. then, insufficientd staff, about a meeting with congress tomorrow,suggest an ACT mission whereAmerians can go to haitifor two weeks at a time

modeator:

Dr. Mark: adding to dr. castors recommendation. the concept of affirmative actxion. prior to theearthquake, many NGOs prior to it, but do not include haitian nationals. then they rotate out. so, for them,can we have a quota system on their contracts.. we need to maintain the knowledged e base in ourcommunity.

Sandra. I think my proposal merges education and health. on of the areas to look at are the natural healthsolutions that are in haiti and existed for decades, but theres no instituation that looks at it closely that

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haitians have used for decades. then form other communities all those countries use their naturalremediesbecause they actually get paid for that. thank

man in back. represented bmr and the health haitieconomic leverage project. main goal is to build in haitibecause we are talking about haiti

interpt

woman: survivors of earthquake. there are trauma, from families, to stay in haiti. lets look at many typesof therapy for children. prlbems of brainm devleopment. group and play therapy.

James: a couple of points about numbgers of doctors trianede in haiti, buit there are over three hudnredcoming out of the faculty and another hundred from Cuba. where are these doctors? ths money couldbeused to doctors from haiti, there are reasonsis the doctor free.

Margaret: talking about using the students who are recommend somehting about university of Haiti, theycan bring their help t the health services. they can be supp;orted financially.

shirly from hapc in south florida: suggestion on focus on followup care, an issue that people are leavingthe facilities.

woman: haiti needs telemediine, where doctors can commnicate with the other doctors, internet, web, withadequaqte

Dr. Prous comments, etc.

woman commmenter: all suggestions are im;portnat, workforce is important, the mmental healthinfrastructure is critical an dhas a way of getting g overlooked. need to assure accsss to mental health, not

just clinical but outreach.

Prou: a coule of ideas iteresting, to supp;ort the creation of a health fund. theres an ongoing initiative

financed by canada and others tring to inusre mother and child health care and was very successful.already decided to scale up on that initiative, to build social protectixon and health scheme for Haitians, anda lot of involvement in the rivate sector as well because there are not so many public services. theworkforcestake advantage of what is already available. even before the earthquake, peole haventreceived their salaires for several months.

Cadet: Tdhank you for your comments. next moderatorMarybell.

= = = = = = =

woman: social services and chld welfare, the problams of orphans, 570,973 children without parents,approx. 6 percent of population. we wold like to see the deinstitutionnalization of orphans, back intofamilies, so would like to seeand extended family being incoporated, then third, for those available foradopteion to be adopted inside the country. then outside, among Haitians. so preference there. we wouldalso like that Haiti signs the Hague convention of protectxion of children, and adoptio, to protect themagainst traffikiking.

as to issues of youth, I believe that, we shold really look at the 15-24 years olds because a lot of them are

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no longer able tobe in orphanae. about 83 perent of them are now. vulnerable to exploitation, needvocational program,s lifes ckills, etc.. specific recommendations, I thinkj that the United Staets child welfarecan be a system that can be repreoduced in hati. to reintegrate into communities, employment and mentalhealth services.have some foster care model. a atinoal internet database to register all children,etc. anew social work training program. finaly, that the serices ofcchildren shojuld be centralized with the haitiangovernment and contracted with ngos. need registries and followup by ngos so they know exacctly what isoffered and how it goes. the children of haiti is the problem of the government . so ngos registered andworking by permissinng.

Sandra: after january 12, the landscape has changed in the country. 4000 out of 5000 schools in theaffected region has have collapsedthe rest not determinedsch ools, o2000 students have been displacedas a result of the aearthquaketheir schools undeermined. about 80 percent of the universities impacted,and half of the students impactede. also lost teachers and administerators. about two hundredadministratdors lost. what we know for sure is hat this is of urgency. and every minute counts for kids,many who are sleeping in the streets. again, loking at what we are dealing with, although many schools areprivage, wmoen spend a lot of their money sending kids to school. as we plan for haitian schools, we haveto plan with what kids come with, not just what they lack. looking at other countreis, with technology, wecan moe forward at rapid rate. so lookikng at an adequately funded educatdion is of first order. looking atcurrriculum standards. tteachers standards.

moderator: decentralize school system. creation of teachers in stitute. higher wages, tecnoology andscience,

mr. joinj. sociologists. I want to talk about justice and working in gujadaloup. whaqt is the stragegy forecvelopmnet in Haiti. we see that the fate rests on the responsblity of the gobvernment. its not very srong.I think that the international aid souldhep the governmenet.the strength of the instituiono is necessary.multiply the schools. up too now, only half of the children have schools. the schools need to also beconstructed in the villages. villages have no access to schools, they have to go two hours to the mountains.

mr. fleury: here for the canadian haitians. my recommendation is back to 1917 an educaitdon fund to buildbilingual schools in all the villages of haiti. and how to train children who have handicaps, mental andphysical. the second part is to develop.e-learning programs.

mr. in the schools, nothing works right now. we need immediate constuction of different kinds of schools.we need to help the familieswith all kinds of financing. 89 to 90 percent of schools are private. so help thepublic schools. lets look at the programs, most ofit is made up by private schools. so we need a publiccurriculum. need to finance the universities.

a professor in haiti: try to leapfrogging education in haiti. second, we shojld think of technology basededucatdion. in myh opinion thats theonly way to reduce the gap. also, to allocate in the budget, money forlong distance education.

man: having so many amputees. need so many to be trained. second third, souragee i.e. oveagedkids. we need a parallel system..

joe bernadel: announced the creation of a multinational trust fund to be acted on March 31. just receivedthe information that the diasp;ora is only given a seat as observer. so we have a resolution to resistthiswe want two membgers on the trust fund. otherwise, this is all for nothing. a hand vote: weresupp;orting this unanimously.

man: louis elias, in educaitdon in haitit he past ten years. were on la gonave. not much going on in theprovinces for the kids. I supp;ort the professor? on ovecoming problems with the older students (in eachgrade). also need special educatdion. decentralizing the educatdion system isimp;ortant. were working asa partner with the public schools. we started with two schools, now with 19 and 6000 students.

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woman: joyci beni? we have to supp;ort a large program for literacy. we need some structures, video,radio and media and educational mateials to use.

woman: on the 31 march. this is going to be a pledging session. since last april, I was part of the pledignggroup.of approxx 4000 million, only 72 ? fuilled. we haveto do advocacy, lobbying. otherwise we arewasting our time with all these recommendations.

woman: deal with the gap that exists in the age level, what? use technology. self-identdify. a lack of selfimage, how do haitians fit in the world. get information from all the experts.

woman: fair is fair. a mechanism to help the government where it registers the investments andencouragtes us to return that investment. we have been educated in haiti.we all are in debt, and we willcreate the mechanism to create edcuatdion in haiti.

jacques.: bujilding

woman: evaluate people who want to open schools in haiti. create a teachers certificationn program.database for those in the education field. pgms for elderly and illiterate.

gerald germain: all the recommendations here can be regrouped. peopleIm sure that .early

education, I think that we need, workshops about education.whatever,

woman:

woman: a univesity of the west indies in haiti. if diasp;ora want to help, partner with american universitiesand . aid shoujld be conditdioned on Haitia proving their brick and mortar production of schools.

woman:

wisnerm winn: an educatdor: all this s impressive, I knew that when were talking about the earthquake, allthis meansrural schools, we have to start at the smallest schools.

man: any student who comes here shoujld apply to the united colored students fund.

woman: need to establish priorities. what could be achieved by the funding. abiliityto track who promisesfunding, who

michelle karshan: recommend that the government of haiti have a strong inspector generals office, so thatthe schools are free the publiic ones, and others.

woman: dallas: declare haiti an illiteracy zone. creole be made the official language. increasepubliicschools. online clases. we have to restore

me: childrend running in the streets amidst the expensive suvs conditdin foreign aid on haitian offers tocorect the priorities.

woman:

joe bernadel: encouraging, recommending therebuilding of the language innstitutes, to decide on thelanguage of instrxuction. we are also requriing and recommending that the curriculum be based onscienced, educadtion and techonnlogy. recommend creation of national science technology etc. office, andcreation of a university of technolgy in each department or each region. haiti wants to segment the countryintoo south, central and north regional authorities. educatdationjal vocatdional training schools, ..recommend a second chance educatdion optdion, so they are not just drifing around. students in thestreets need to be in school. a national institute for teachers, to etc. for a better haiti.

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Sandra: right on point. I supp;ort a strong. publisly funded pulbic education for all. leveragingtechnolgoy and improvinng standards. making sure that the curriculum is culturally relevant. we talk aboutsuccsss, that can only be with an accountable system certification. I want to be sure, that we really payattention to those who are working in haiti for many yearsto make sure that all our children have a qualityeducatdion.

expert woman: child protection laws.child traffickking. I hope the donors will look at it. encouragediasp;ora to adopt haitian orphans. need social work programsfriendly visitorswe can train women forthat. and many small groups have continued to fundraise, maybe to adopt a school or somewhere else.lease rep;ort instances of child abuse.

Joel Romulus: [email protected] haitian foundation of new jersey too many of the unmivesities arein Port-au-Prince. this draws too many to the cpapital. it would be better to have branches of the centraluniversities in the departments. it would also help students stay in touchwiththeir families. with goodtechnology, they could be linked with the central faculty, libraries, we need some international teachers toevaluate this and to introduce students to the rest of agree. we could get some american universities toget involved iln this a two years program of exchange for Haitian students.

= = = = = = =

workshop womens affairs

leonie hermantin: womens agricultural competency is important.

ms marks: increase in assaults on women. shes been working on systems building. women need physicaland disease testing. we actually do not know whqata women and girls are bing raped, or the environment.

so a victims of violence registry to create a profile of perpetrators. take dna t be sed in courts for trials. thewhole story of yourng girls hasnt been told, analyzed.

hilary: womens leadership, only 4% of legislators. I dont think haitian women can afford to let men tocontinue to speak for them.

woman: theres a book: Women Dont Ask --- but we need to put a dollar value on it, how much will itcost?

man: have to emphasize educationa man needs to be reeducadted and a woman has to put a higherprice.

gertie phia, haitian renewal alliance: we are about culture and media in haitireinforce the national

television in creating programs for edcuatdion and health.

woman: we have to change the laws in haiti. for example, we know that women live under a regime, therewere some changes that tdook place, bukt right now a bill admitted to make men resp;onsibile we have tochange discrimination in divorce, health, needs to be a court where she can defend themselves. womnenneed to have access to credit

dr ms mack: the cost of recommendation for surveillance systems. we should model on,for example, CDC.

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moderator: to recommend that there will be at least one woman representative to the donors conferece atthe UN.

woman from montreal: to have a protection plan. we need to inrease their capacit, microcredit, ways tofinance microenterprises so that thtey can develop and help

man: some practical recommendations to solve problems with the media. the initiatives are disorganized.my recommendation is to try to organie and to have ;point of coordination for linking the diasporaorganizations with the haitian government. as to education, try to identify the human resources availableand link between universities

man: in order to value the role of women, there should be salaries for that. regarding dna, this shold besystematic. its cheap. mack: they do that.

me: condition foreign aid by appending the international conventions. also, women applying forgovernmnet land, lease it for asylum purposes, agriculture, etec.

woman: in the refugee camps, women need somewhere to go. they need to have a space for it, to haveaccess to doctors and others, so that there will be a change of law, and a means to punish the men who

commit these atrocities. in every region of the country, there should be social centers where women andmen can go for training, culture, i.e. haitian centers for stories, movies, lectures and to get training onvarious aspects of life.

woman: I am a lawyer, criminal law, do they actually , will they lodge complaints.

woman: recommendation for ngos in haiti distributing food, prepackaged, who can get together with peoplewho are making and selling real food

woman: rape victims, power crime, so empower

mack: the three women who died in the earthquake, need to support their organizations. help the structuresthat exist.

woman: education to the teachers so they can identify young children who are being abusedto make thechildren be comfortable coming to someone for help.

mack: to develop rehabilitation programs for women victimsthey can also be skills building.

man: a way to share the roles with women.

man: children grow upnever hit a children in school.

woman: an important recommendation to the health ministrywomens health services, especially in rurualareas.

moderator. reinforce programs for women in haiti

hilary: on women reporting rapes they are uncomfortable. husbands retribution is common. so notadvisable to report crimes, except where there are women in the police and penal systems.

Leonie: women should not be discouraged. they need strong womens organizations. in an area nearGonaives, prssures to deal with the rapists.

moderator: what would make the most immediate impadt on society?

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man: in a nutshell, we have to change the frame of mindmen, women, children. education.

woman:

leonie: the bottom line is profit.

mack: the disempowerment of haitian men because there has been no economy, explains aggression, etc.so male mental health.

woman: what would be a concrete recommendation? they need a minimum wage.

woman: may want to recommend that at least a certain percentage of foreign aid goes to help women.

woman: recommend two dollars per hour minimumwage.

hilary: the importance of womens leadership. extremely important that we monitor the aid going into Haiti.how much for womens needs?

leonie: aid was not getting to women, especially not rural women. focuson those midsized and smallsizedorganizations.

Stuart Leiderman [email protected]

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2010mar22 oas diaspora cnf combined health development recommendations and leiderman notes

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