Joanna Kotcher Medical Coordinator in Ethiopia Kebri Dehar

Scottish-based Joanna Kotcher has had an extensive career.  Among her roles she has worked as a Medical Co-ordinator for Doctors of the World and other non-governmental organisations, also as a nurse, a writer and as a consultant. Originally from the USA Joanna is one of our in the field volunteers and has worked as a Medical Co-ordinator for about 13 years primarily in refugee camps and conflict situations to set up programmes and help implement changes to strategies that bring long awaited medical aid to disrupted areas.

Doctors Of the World had started work in 2007 in the Somali region of Ethioipa to provide primary health care in rural communities but was halted and was restarted in Kebri Dehar, a large town in the same region from 2008-2010. Joanna worked there from February to June 2010.

"I wanted to volunteer with Doctors of the World (DOW) as it combines work on human rights (specifically international humanitarian law and rights), medicine, and conflict. I can’t think of any other profession I would rather be in."

After arriving in Kebri Dehar , only military convoys, road work vehicles and some civil service cars were permitted to travel in the region. I was also struck by the limited amount, variety and quality of food available.

The DOW project during my mission was mainly hospital based with technical support, training, donation of drugs and supplies to surgery and maternal health. This included emergency services in obstetrics and operating theatre. Toward the end of my mission, we developed the next project plan which included time spent preparing various strategies, how to store blood donated for transfusions during power cuts, or how to organise the  pharmacy so that drugs are properly monitored. My ‘hands on’ days were spent on the hospital wards with members of our team, assisting in surgery, training staff, and seeing patients with the team. I have a specialisation in trauma (wound) care, surgery, and other conflict-related medical and psychological areas such gender based violence.

Following our return to the rural sites near town in May, we met with the elders of the community, local authorities, and village health workers that had not seen any humanitarian organisations for quite some time. Many of the village health posts had not been fully operative since 2008. The most pressing medical needs in this region were infectious diseases such as pneumonia, diarrheal diseases related to sanitation, and malaria.”

Six Months after the earthquake that shook Haiti, help is still desperatly needed.

12th July 2010

                    © Stéphanie Lelong

Six months after the earthquake, as the hurricane season begins, the timing for Haiti's reconstruction remains critical. Doctors of the World calls for the funds promised by the international community to be used to provide a truly equitable healthcare system

Our work has helped to limit the effect of the disaster on health, but the living conditions for the 1.3 million disaster victims in Port-au-Prince and the surrounding region are extremely difficult.

For many, the daily situation is not improving but getting worse as food distribution comes to an end. We still have our teams in Haiti and with the emergency phase over we continue to work to ease the desperate situation the Haitians face caused by epidemics and malnutrition. However, to date, only a few hundred million dollars of the $10 billion pledged has actually been paid by various countries and donors. It is high time that these promises were kept; things need to move faster.

The $10 billion dollars in aid pledged by the international community at a conference in New York in March would provide for and allow the implementation of a health care system which is more equitable in terms of cost and carried out in the poorest and least accessible districts. The clinics set up by us in the emergency context could then make a permanent commitment to providing a new quality of health care for the poorest Haitians.

Our actions have helped limit the effects of the disaster on health.

There has been no spread of contagious diseases. There have been few cases of malaria and typhoid diagnosed. There has been mass vaccination of children and infants. We have also tracked and managed cases of moderate or severe malnutrition. We have also made it possible for thousands of Haitians to have their first real access to care. Before the earthquake, more than 60% of the population had no access to care. Today, 5,000 free medical consultations are conducted each week by our teams in 10 clinics in tents set up in the poorest districts. Sadly, it remains difficult to refer a patient for treatment at a hospital and transfers between hospital services are very complicated.

Six months after the earthquake hit, the psychological effects are still felt, the Haitians are still suffering. People are having trouble overcoming the trauma, as Dr Emanuela explains:

"Every morning people come to see me for imaginery illnesses, there seems to be nothing wrong but if you ask questions they say they can'ty sleep, can't eat, that they are constantly reliving the 52 seconds during the earthquake."

For this reason psychological support must continue beyong the emergency phase. Mental health support must be fully integrated into the Haitian healthcare reconstruction plan.

We aren't just working in the capital Port-au-Prince; here is a recap of our international network projects across the country:

In Port au Prince

Doctors of the World is active in 10 locations in Port au Prince: St Michel, Carrefour Feuille, Cité Georges, Canapé Vert, Automeca, Delmas, Solino, Saint-Marc, Miron and the Mahotière, covering a population of about 123,000 people. The teams provide primary health care, reproductive health (antenatal, postnatal, family planning, gynaecology), detection of malnutrition, immunization and psychosocial activities. Since the beginning of the emergency, more than 71,000 primary health care consultations have been provided.

In Cité Soleil

We set up three mobile clinics in 16 displaced persons camps and we support the Choscal hospital. Since January, more than 21,000 patient consultations and 4,800 psychosocial counselling sessions have been provided and more than 18,000 people have been immunized. Meanwhile, individual and group interviews, community and prevention activities have been offered: adults have already held 75 discussion groups and 725 workshops have welcomed Cité Soleil children. 20,000 people have also participated in educational and health risk awareness activities and 90,000 condoms have been distributed.

In Sonapi

We ran a clinic in the Sonapi camp that saw 200 patients per day, and two clinics in the Croix de Bouquettes and the Lycée Jacques Premier camps. This facility closed in June.

            © Stéphanie Lelong

In Carrefour Feuille

We ran a clinic which provided nearly 300 consultations per week: healthcare and maternal-child health, health education, immunizations etc. This closed in June.

In Petit Goâve

At Hôpital Notre Dame of Petit Goâve we have been supporting maternity and paediatric units through a sexual and reproductive health programme which includes: healthcare personnel (gynaecologists, midwives, healthcare assistants) training and capacity building, providing medicines, modern medical equipment and gynaecology equipment, reconstructing buildings and assistinh in antenatal preparation for childbirth.

In addition, we have six dispensaries in the remote region of Petit Goâve to ensure the most isolated people are cared for, particularly children under five years of age and pregnant women. Our programme focussed on: family planning, antenatal and postnatal consultations, health education, family planning, training of staff etc.

In Grand and Petit Goâve, we are providing a primary healthcare and nutrition programme as well as supporting four dispensaries located in rural areas of Grand Goâve and in Petit and Grand Goâve. We also giving support for different levels of acute severe malnutrition. Between January and May, 714 children were registered at this centre. Meanwhile, advocacy and prevention are offered to communities, particularly focussing on maternal and child health.

In Grande Anse

With the influx of new comers to the area after the earthquake, Doctors of the World France strengthened its existing programme and currently offers free treatment at 12 health centres in the region. Since February, these centres have provided an average of 8,730 consultations per month; nearly three times more than in the months before the earthquake. All services provided are free to all. We had more than 2,000 consultations for children under five years old. Furthermore, in order to relieve the dispensaries and reach isolated populations, two mobile clinics visit the most remote areas. On average 630 consultations are provided per week; 16% of the patients are displaced persons. Finally, special attention is given to screening and treatment for malnutrition.

Our work would simply not be possible without your support. Thank you for helping us to react quickly in a crisis and care for the most vulnerable.

Fred, Haiti - 6 months on, the reconstruction of Haiti continues

Fred Costa arrived in Haiti to help with the clear up operation after the devastating earthquake hit the country in January.  Fred has been working as a Logistician in Haiti for the past 4 months for Doctors of the World (DOW). 

Fred is part of a team of more than 450 people working in Haiti, comprising of national and international staff.  DOW is providing health care in clinics and hospitals around the capital Port-au-Prince as well as in the towns and surrounding areas of Petit Goave and Grand Goave.

Here Fred shares his experiences:

The city of Port-au-Prince is still pretty much the same as when I got here. There is a lot of rubble.  Many buildings which were destroyed remain as they were when I arrived.  There are now thousands and thousands of makeshift shelters and tents too.

  

Pictures of Port-au-Prince.

A lot of the Haitians don’t have a house or any access to water but they always look well–presented at work - clean, tidy and shaved. They always have a smile and can have a laugh and a joke. They are always so polite and respectful too.  

 












No matter what, they always believe in better days, in a better life, in a better country, and a better tomorrow.  They believe this so that gives me the extra strength to work every day a bit better than before in order to give them the best I have.

Fred and the carpenters building a medical clinic in Miron - Port-au-Prince.

Half of my time is spent solving problems as a Logistician.  This role is largely spent building, fixing and maintaining everything so our operations can run smoothly.  

  

One of our mobile clinics in St Marc - Carrefour.

If a generator breaks down or if a clinic is at risk of being flooded I am on hand to fix these things.  The other half of my time is spent working on how to expand our programme by calculating the budget and working out what things need to be bought to continue our work efficiently.  The work is very intense.  It is fulfilling to feel that what I am doing here helps and will provide a better life for the Haitians.  I am realistic though – due to the incredible devastation caused by the earthquake, providing that better life will be difficult to achieve. 

Fred and the Logistics team.

No matter how much of a bad time they have endured, the Haitians always see a better future.  I will finish my mission here in August.  I am starting to miss this place even before I have left it.  It seems to me that life in Europe is more complicated.  People have more problems there and they are not happy.   But in Europe we have everything yet here in Haiti they don’t have anything. 

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