I have spent the last three weeks working in the Hospitalito in Santiago Atitlan, Guatemala. Santiago Atitlan is a city of 50,000 people, located on beautiful Lake Atitlan, surrounded by three towering volcanoes. The hospital consists of a four bed ED, two labor and delivery rooms with two beds in each, three inpatient rooms, and an operating room. The two upper levels are currently under construction, but will greatly increase the capacity of the hospital. The staff consists of mainly volunteer physicians and local nurses and technicians. The main language spoken by the patients is Tz'utujil, which is then translated by the nurses to Spanish for the physicians. Patients came to the hospital from towns all around the lake and surrounding area. They often arrived via Tuc-Tuc (motorcycle-taxi), but sometimes walked, were carried by family members, or arrived by Bomberos (volunteer firefighters without medical training or resources).
I have been back in the United States for a week and a half now. Coming home from Guatemala during the holiday season is a strange transition. I couldn't help but look at all of the (admittedly exciting) products and services being offered, and think "oh, that money for that completely useless thing could pay for 'x' children's medicine, or food." I have been trying to adjust to life in the US, and accept the differences between life here and the poverty in places like Xela, trying to enjoy the luxury but maintain the perspective. In the midst of all of this enjoyment, I am reminding myself periodically that too much acceptance of this sort of disparity leads to complacency, which only further harms people.

Note: Senator Frist  sits on the board of the Clinton Bush Haiti Fund.

Helping Haiti not just survive but thrive

By Gary Edson

The stakes are high as Haitians struggle to resolve disputes over the accuracy of preliminary vote tallies from the November 28 national election. Haiti's next president and its parliament must be able to lead the nation from catastrophe to prosperity.  But it is equally important that the international community helps Haiti's new leadership establish an environment in which the nation can thrive.

Amid this latest crisis and the persisting pains for millions of earthquake victims, the approaching one-year anniversary of the January 12 disaster is a reminder of all that must still be done.  The world must redouble the efforts of the past year to tend to the many remaining urgent needs. At the same time, we must not lose sight of a need just as critical: creating the building blocks for long-term, vigorous economic expansion and job growth — the only real path to a stronger and better Haiti.

Indeed, the goal of the donor community should be to put itself out of the Haiti aid business. To do that, we need to be laser-focused on helping Haitians create and build their own livelihoods.  There are no straight lines from pain to promise in this equation, but Haiti has one important thing on its side: despite the devastation, the Haitian people are ready to write a positive new chapter in their country's troubled history.  We must help them do so by promoting job growth and economic opportunity— and then by getting out of the way.

As Paul Farmer, Partners In Health's founder and United Nations Deputy Special Envoy to Haiti said in a recent Foreign Policy column: "Haiti has 9.8 million people, and at least half were unemployed even before the earthquake. If we focused our efforts on the singular task of getting them jobs -- even if we did nothing else -- Haiti's reconstruction could be a success."

This is the focus that former Presidents Bill Clinton and George W. Bush have given the Clinton Bush Haiti Fund.  Since we began independent operations in May 2010, we have dedicated ourselves to making targeted, thoughtful grants and investments in four areas that are at the foundation of viable economic growth:

 

  • Restarting, expanding and creating new small businesses, in which women play a large role;
  • Supporting a transition from an underground economy to a formal one;
  • Bolstering job creation, particularly jobs providing direct social benefits; and
  • Empowering people, especially women and youth, with life skills and job training to embrace economic opportunity.

 

For example, in July the Clinton Bush Haiti Fund announced a $245,000 grant to INDEPCO, Haiti's largest network of garment micro-entrepreneurs, which provided an injection of capital that will enable 1,000 workers to complete 40,000 school uniforms.

In late November, the Fund, announced a $5.68 million partnership with MasterCard Foundation, YouthBuild International, and the Haitian NGO IDEJEN to support construction job training for at-risk young people. We've also just announced a grant to Architecture for Humanity in support of the Haitian Rebuilding Center in Port-au-Prince, which will provide design support and technical expertise to Haitian construction firms.

To date, the Fund has raised $52 million, of which nearly $20 million has been committed to organizations that support our mission of economic growth and empowerment. We seek to empower and catalyze — letting Haitians lead the way and promoting projects with ripple-effect potential.

We also have addressed selected humanitarian needs, playing a "gap-filling" role.  For instance, the Clinton Bush Haiti Fund responded to the recent cholera outbreak by redirecting a portion of a recently announced $1 million grant to GHESKIO, a 28-year-old Haitian healthcare organization, to its cholera treatment centers in Port-au-Prince.

Cholera is a disease of poverty and, like so many of the challenges Haitians face, the symptom of a much larger problem. It threatens lives, but also the island's ability to prosper. That's why we are remaining focused on the difficult but critical work of growing economic opportunity. In the coming weeks we will announce additional grants and investments, including financing for Haitian artisan exports and support for emergency medical training.

In the months since January 12, and for so many years before, the story of Haiti has been one of aid. The Clinton Bush Haiti Fund supports initiatives that will write very different stories — of Haitian mangoes sweetening Coca Cola beverages; of Haitian artisans producing crafts for Macy's; and of Haitian youth emerging from the shadows to obtain skills and jobs. These will be stories of the new Haiti: Haitians producing and exporting to thrive, rather than depending on aid to survive; stories not just of help, but of hope.

Gary Edson is CEO of the Clinton Bush Haiti Fund and former senior advisor on security and economic affairs to President George W. Bush. He co-led the development of the President's Emergency Plan for AIDS Relief (PEPFAR), and also led the effort that established the Millennium Challenge Corporation to combat global poverty.

 

 

As I am nearing the end of my time in Guatemala, I have been wrapping up all of the projects I have been working on here. Cody Bowers has been writing about the Oral Rehydration Solution (ORS) project, so I will let him update about that in a different blog. The project that has been taking most of my time here is the creation and implementation of protocol for the screening and treatment of malnutrition.
I have put my faith in my education and dedicated myself to continuing the effort of supporting people's health with the knowledge imparted to me over the past two years. Doubts certainly cross my mind as I question if what I am doing is effective, right or even necessary, whereas other times my faith is supported by the curative effects of medicine. There are nuances to the body which we cannot control, but we must rely on continued research to improve best practice techniques. Despite occasional skepticism and my desire to permit my body to heal without medicine, I will take cold and flu medication just to reassure myself that I support the practice that I preach. The advancement of science has helped us prolong life and alleviate illness, but occasionally signals are left unnoticed or the wrong test is ordered, despite the good intentions and full payment of diligence. Sometimes medicine can't control everything it encounters and last week entailed two very difficult patient cases who were both attended to properly, but something was missed.
One of the interesting things about being in Xela is the high volume of foreigners living and working here. Xela is rather well known for its Spanish language schools, which draw people from around the world. In addition to the linguistic draw, Guatemala is filled with NGOs, and there seems to be an especially high concentration in this area.
Primeros Pasos is a clinic that charges $0.62 cents for a pediatric consultation and $3.75 for an adult to see a provider. Any medicine in the pharmacy is free with the cost of admission and some remedial laboratory work is included in the nominal fee as well. The clinic is constantly receiving miscellaneous grants and substantial financial support from Inter-American Health Alliance (IAHA) to pay the salaries of the few employees that run the place and then volunteers take care of the rest. Lauren and I noticed two issues at the clinic that we felt we could address to cut costs and improve patient care. She moved directly into improving malnutrition treatment protocol and wrote an entire study that is waiting approval. We also have found that the clinic is frequently without oral rehydration salts (ORS) used as treatment for people, but especially children, with diarrhea. Lauren and I were frustrated by the absence of ORS packets in the pharmacy, which led us to create a project to expand care at Primeros Pasos. Finding the perfect recipe for ORS and buying 100 pound bags of salt and sugar is our immediate goal.
I write to you today a little more optimistic than my last post on the developing disaster in Haiti. I will be keeping on top of the situation there and encourage you to stop by to read updates on my personal website, BillFrist.com. This weekend, I urgently emailed around the medical community, searching for desperately needed supplies for Haiti's ongoing cholera outbreak. From starting with nothing Saturday morning, we now will have a massive bulk shipment of Ringers Lactate and IV sets arrive this week in Haiti, be distributed that afternoon to 8 facilities by evening. Impressive response on short notice.
As the cholera outbreak continues to ravage through Haiti, killing hundreds and inciting terror and riots throughout the country, I'm afraid I may have more bad news. It has come to my attention today that the cholera outbreak is being vastly underreported and underestimated. My sources on the ground in Haiti have estimated that the current epidemic is up to 400% worse than the official numbers reflect. Considering that the official numbers already state a toll of 1,110 dead and another 18,000 sick, the scope of this savage outbreak is shocking.

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