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In Haiti, bad water, roads all adds up to poor health [The Virginian-Pilot, Norfolk, Va.]
[May 13, 2009]

In Haiti, bad water, roads all adds up to poor health [The Virginian-Pilot, Norfolk, Va.]

(Virginian-Pilot (Norfolk, VA) Via Acquire Media NewsEdge) May 13--BELLADÈRE, HAITI Dr. Ralph Ternier hears that the local Catholic church now has running water and sighs, a little envious.

The hospital in Belladère, Haiti, where he is the medical director, doesn't have water yet; it has to be bought and trucked in over treacherous mountain roads.

The 40-bed facility, which provides free care, wasn't big enough when built in the 1940s. Now it's even less adequate, as the population of this rural central plateau has more than doubled to 70,000. Ternier hates that he can't get chemo to every patient with cancer, that the pediatric ward doesn't have toys and that the world seems to think that for the desperately poor patients he serves, all this is good enough.

"We want to give good health care, not only basic care, but the best thing," he said. "We are trying to push the limits." The Haitian doctor will make his case Friday when global health experts convene at Norfolk State University at a conference sponsored by Physicians for Peace. The event, which is free and open to the public (registration is required at, also promises to be a reunion for the many churches and organizations in Hampton Roads who are trying to help out in Haiti.

Dave Plum of Virginia Beach and the Rev. Etienne Aristild of Baptiste, Haiti, will be there, listening. Plum is a civil engineer who designed a water pipeline now under construction in Baptiste, a mountain village where he's working with Aristild, the priest of the Catholic church that has a "twinning" relationship with the Church of the Holy Family in Virginia Beach.

A few years ago, a friend of Plum's asked him to come to Holy Family to "answer a few questions related to water," for the Virginia Beach church, which was considering digging a well for the village of Baptiste. That sparked, in 2006, the first of his several visits to Baptiste. There, he saw women and children making two-mile treks up steep mountain paths to a mountaintop spring, carrying back the multigallon containers on their heads.

He quickly saw a well wouldn't work.

"We needed to find a way where we could go around that mountain and use gravity flow," Plum said. "Make it sustainable." The Baptiste project shows how closely global health issues are interconnected. It's not just about vaccinations and setting broken bones -- it's about schools and roads and jobs, too.

"The first rule is to have good clean water," said Dr. Edward Lilly, a gastroenterologist and board member for Physicians for Peace who has done medical missions in Haiti about a dozen times. He gave the example of how contaminated water leads to infections causing chronic gastritis, which leads to stomach cancer, which is much more common in poor countries.

"You can prevent the cancer from developing if you just treat the gastritis," Lilly said. But to prevent the gastritis and a host of other things, you need basics beyond medicine. "If you have water and you have transportation, you can do all the other things." Haiti, by far the poorest country in the Western Hemisphere, has serious problems with both. Contaminated water is rife; many roads in rural areas haven't been paved since the 1940s, and look it. Nearly 80 percent of the people live on less than $2 a day, and more than 2/3 of the population is unemployed.

"Deprivation on this level, it's so hard for people in our world to understand," said Sarah Marsh, women's health coordinator in Haiti for Partners in Health , an international health care and social justice organization based in Boston. The group was founded by Dr. Paul Farmer, who will be the keynote speaker at Friday's conference and the commencement speaker at Eastern Virginia Medical School on Saturday.

There's no radiation treatment in Haiti for those with cancer. There's no MRI. There are only a couple of places to get a CT scan and they're too expensive for most people, Marsh said.

And there's a severe blood shortage, which is particularly dangerous because many Haitians have severe anemia from malnutrition, malaria and other causes.

Coordinating health care is a particular challenge in poor countries where services are often fragmented or scattered. The nonprofit Zanmi Lasante, Partners in Health's sister organization in Haiti, partners with the country's public ministry of health to have the broadest impact. Ternier, for example, works both for Zanmi Lasante as an HIV/tuberculosis program doctor and as a medical director for the ministry of health at the hospital in Belladère.

A partnership with Partners in Health to combat maternal mortality stemmed from Hampton Roads.

Next week, local doctors including Dr. Alfred Abuhamad, chair of the OB-GYN department at EVMS, will travel to Haiti to join Marsh and help train health professionals there on the use of ultrasound equipment that was donated by General Electric. It's the second such training in Haiti.

Abuhamad, who will speak on a technology panel Friday, said it's not as simple as just transplanting the machinery. With, at best, spotty electricity and dependence on generators in Haiti, they had to find ways to keep the ultrasounds working when the power cuts off.

Ternier will speak Friday on a panel titled "Challenges of Collaboration and Integration Within Existing Programs," but back home in Haiti, he'd really just like to have a new hospital. One at least double in size, with a nice big lab; a bright, cheery pediatric ward; and, of course, water that doesn't have to be trucked in.

"We have to try to lessen all the inequalities," he said. "It's the same thing as why this child has a tumor and has 10 doctors, why another one who is poor cannot have the same thing? It's always the same question." Nancy Young, (757) 222-5559,

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