By Nancy A. Kelly
Health Volunteers Overseas
Access to health care is fundamental to our quality of life and, for the world’s poorest, essential to the daily struggle for survival. Yet, three billion people live without basic health care services.
In all nations, human beings – physicians, nurses, dentists, physical therapists, and other professionals – are the foundation of health care systems. The delivery of services pivots on the availability of these trained professionals to provide care.
This foundation, however, is crumbling. Africa, alone, has a shortage of one million health providers. World-wide estimates indicate that 4 million additional health workers are needed to provide adequate coverage for an ever growing population. We are at a critical juncture in which the crisis of low numbers of health workers in high-need regions must be addressed to face the health challenges of this generation and the next.
For the past two decades, Health Volunteers Overseas (HVO) has worked to increase health care access in developing countries through clinical training and education programs in child health, primary care, trauma and rehabilitation, essential surgical care, oral health, infectious disease, nursing education and burn management. In more than 25 resource-poor nations, HVO trains, mentors and provides critical professional support to health care providers who care for the neediest populations in the most difficult of circumstances.
Our goal at HVO is not only to train new health care providers, but also to encourage and to sustain current health workers so that they can continue to practice in their home countries where their skills are most urgently needed. By increasing the total number of trained health workers in high need areas, we improve access to care and the health of the world’s poorest.
All of us have a role to play in improving global health by educating ourselves and others about the vast unmet needs, volunteering our time and expertise as health care providers, and supporting those who work to make a difference in the lives of others. By harnessing the power of a vital human resource — health care providers – we believe that it is possible to break the vicious cycle of poverty and illness endemic to developing nations.
Case in Point: Haiti
The earthquake that rocked Haiti on January 12 left a wide swath of destruction, with estimates of 230,000 deaths, over 200,000 injured, and more than a million left homeless. The disaster was compounded by the epicenter having been near the capital of Port-au-Prince, which left much of the government’s facilities and infrastructure in ruins. Similarly, the United Nations and NGOs, who would normally have a leadership role in a rescue/recovery operation, lost many of their staff members.
Into this void rushed many people willing to help on so many fronts – to rescue those trapped under buildings, bring supplies of food and water, save the lives of those who were injured, evacuate others for surgery or a better life, bury others, counsel the grieving. All came eager to help and, while much help was provided, the situation served to remind us that good intentions are not enough.
There are many myths that surround disaster assistance, whether natural or man-made.
As a result of the behaviors and attitudes around these myths, disaster assistance often becomes more difficult, despite everyone’s good intentions. Bearing in mind the reality of needs and the kinds of appropriate assistance available, plans are already underway for helping Haiti to rebuild.
The U.S. pledged $100 million in emergency aid. The United Nations and Haiti have developed a $700 million plan to start getting the country back on its feet. The plan calls for massive infrastructure repair, boosting national food production, and creating employment opportunities, all in the next 18 months. The agricultural sector is a cornerstone of the plan, as the country has suffered greatly from food shortages and deforestation.
The UN-Haiti plan also calls for decentralizing government services, as much of the population has left Port-au-Prince and fled to more rural areas. While facilities were lacking or non-existent prior to the earthquake, there will be an even greater need now.
This is particularly true in the health sector.
An assessment conducted by Handicapped International found that approximately 80-90% of hospital admissions after the earthquake were orthopaedic traumas. Fractures represented 51% of the cases they found, followed by amputations at 35%.
Most of the amputations were lower limb, and of those, the majority were above the knee. Their assessment found that 2,000-4,000 amputations could be estimated as a result of the earthquake (either as an initial life-saving measure or, later, as secondary complications set in.)
Rehabilitation services prior to the earthquake were extremely limited, so that will need to be an emphasis in the country’s recovery.
Another sobering finding from Handicapped International (HI) was that among those severely injured, the percentage was unusually high for those people of working age (18 – 59). HI reported that the age group represented 49% of Haiti’s population yet they noted 65% of those severely injured were from that age group.
This means that with so many injured among people in their prime working years, significant efforts will need to be made to return them to work, and to make new construction accessible.
With so much to be done, recovery for Haiti will be a long process.
However, in the midst of all the devastation and sorrow, there is hope for a brighter future. HVO Volunteer Denise English, PT, was training rehabilitation technicians at the Hôpital Albert Schweitzer (located 60 miles from Port-au-Prince) when the earthquake struck.
Upon her return, she wrote of this hope, “Infrastructure is being created. Groups are working in concert rather than isolation. Rehabilitation is now being pushed front and center.”
David Charles, the hospital’s Haitian Rehabilitation Services Manager wrote of their work, “The rehabilitation service of HAS is truly rare in that it is one of the few rehabilitation centers that provide therapy from the first day of hospitalization until the day of discharge, and in that it continues to accompany the patient beyond their release with a rehabilitation program that best suits their individual needs.” Haiti’s recovery will depend on such crucial services.
HVO will continue to keep abreast of the recovery plans for Haiti and will keep you informed of ways in which we can all be involved in a carefully planned approach, because good intentions are not enough.
About Nancy A. Kelly
Nancy Kelly has been the Executive Director of Health Volunteers Overseas since it was founded in 1986. Prior to that time, she worked for the National Council for International Health (now known as the Global Health Council) and served as a Maternal Child Health Worker with the US Peace Corps in the Republic of Korea. Ms. Kelly received her BA in Asian Studies from the University of Virginia and a Master of Health Science degree in Maternal and Child Health from the Johns Hopkins Bloomberg School of Public Health.
Ms. Kelly is a frequent speaker at meetings of professional associations on topics related to volunteer preparation, effective cross cultural communication, the role of education in capacity building and leadership in a cross cultural context. She has also written numerous articles on developing programs that effectively utilize the skills and expertise of volunteer short-term health care professionals, and how to identify an appropriate volunteer placement.
In addition to her responsibilities at Health Volunteers Overseas, Ms. Kelly serves on the Board of Directors of the US section of Handicap International and Global Impact, as well as on the Advisory Board of the Emory Spine Center for Outreach and Medical Education and on the Open Board of the International Society for Prosthetics and Orthotics. She also is a member of the Global Health Task Force of the US Summit and Initiative for Global Citizen Diplomacy.
In 1998 Ms. Kelly was inducted into Delta Omega (Alpha Chapter) Honorary Public Health Society in recognition of her role in the founding of Health Volunteers Overseas.