Long-term commitment, not just short-term response, needed in Haiti

Issue: April 10, 2010

ByRichard L. Lindstrom, MD

Richard L. Lindstrom

The continuing suffering and tragedy caused by the earthquake in Haiti is, to me, yet another example of how fragile health care infrastructure and human life are in the poorer countries of the world.

Haiti represents the poorest country in the Western Hemisphere, and 50 mostly underequipped ophthalmologists care for a population of 9 million. That is one ophthalmologist per 180,000 people as compared with one per 18,000 people in the U.S. In some areas of sub-Saharan Africa, there is only one ophthalmologist per 1 million people, so Haiti is not the least well-served country in the world, but it is the least well-served country close to home.

Even in the best of times, quality care for many is impossible in the face of such an enormous lack of trained personnel, not to mention the lack of infrastructure, equipment and even medication. It is appropriate that a crisis the magnitude of that suffered in Haiti is followed by an enormous emergency response that is global in scope. The response of multiple governments, the military, organized ophthalmology and thousands of volunteers demonstrates that in the face of crisis, humankind can and usually does respond with urgency and compassion. This, of course, is appropriate and to be applauded.

Still, having traveled the world for decades, both to treat patients in impoverished countries and to help teach the dedicated ophthalmologists who have committed their careers to treat the less fortunate, as I age, I find myself with a growing sense of despair at how difficult it is to sustain the support those less fortunate desperately need from those who are more blessed. Soon there will be another crisis in another part of the world, be it tsunami, earthquake, flood or drought, and the world’s attention will be diverted from Haiti. The crushing cycle of poverty, famine and disease will almost certainly recur, and most will forget the needs of Haiti as they rush to respond to the next catastrophe. While one must remain optimistic, the current difficult economic times worldwide make me believe that the sustained economic support a country such as Haiti will need to rebuild and improve its eye care delivery system is far from certain.

I have seen the power of a long-term commitment of one country’s medical professionals to another work magic in countries such as Nepal, where amazing advances in the quality of eye care have been achieved over the past decade. The magic formula was not a massive short-term response to a crisis, but the willingness of a critical mass of ophthalmologists to make a long-term commitment and go back over and over and over again to the same country. This is what is needed in Haiti.

It is a classic teaching to think globally but act locally. Haiti is the most disadvantaged country close to the U.S. It is a small enough country that a concerted effort by its neighbors, including (and especially) the U.S., could make a major difference. If as few as 100 of the 18,000 U.S. ophthalmologists committed to make an annual trip to Haiti for the next decade, they could do for this small country what our colleagues in Australia and New Zealand have done for Nepal.

I am encouraged to see the Pan-American Association of Ophthalmology, the American Academy of Ophthalmology, the U.S. military, leading educational institutions such as Bascom Palmer and many of my colleagues engaged in the current humanitarian effort in Haiti. It would be wonderful if this effort could be sustained, resulting in a major improvement in the quality and quantity of eye care available to this country’s citizens by 2020. It takes leadership and commitment, and between the organizations currently engaged, both are ample and available. I am willing to help, and I know many of my U.S. colleagues are as well. I deeply hope a leader committed to this vision steps forward, and if one does, working together we can make a long-term and permanent difference.