Haiti

CROSS-CULTURAL COLLABORATION

Overview
After the 2010 Haiti earthquake, Dartmouth College and Dartmouth-Hitchcock Medical Center (DHMC) sent six Geisel-DHMC teams to Haiti to provide medical care and supplies to those affected by the disaster. Dartmouth’s relief efforts included 60 healthcare professionals, 8 donated planes, 40 tons of donated medical supplies, and $1.5 million in donations from 1,300 people and 45 organizations.

Since then, the initiatives and projects in Haiti that Dartmouth faculty and students are involved in continue to grow and diversify as we encourage interdisciplinary, collaborative solutions to the challenges of health care delivery, education, and community development facing the people of Haiti. The following is an overview of Dartmouth’s achievements in Haiti since the earthquake and its plans for future engagement.

Major Achievements
• Over 50 Dartmouth undergraduate and graduate students have worked with Haitian partner organizations on research and service projects since June 2011
• Dartmouth Infectious Disease and International Health team awarded 5-year PEPFAR grant to improve HIV care and treatment in Les Cayes, Haiti (October 2011)
• Held $300 House Design Symposium on Dartmouth’s campus (January 2012)
• Acquired funding to begin Affordable Housing Prototype Construction in Haiti (January 2013)
• High-level Haitian Government delegates, NGO leaders, Dr. Jim Kim convened at Porter Foundation Symposium (February 2013)

32 Dartmouth and DHMC faculty and staff have worked in Haiti, in addition to 60 first responders part of Haiti Earthquake Response
• Provided technical assistance in health care delivery, development, housing; direct patient care; training and education; clinical research; quality improvement 

51 Dartmouth undergraduate and graduate students have worked in Haiti
• Participated in water and sanitation projects, business and microfinance initiatives, engineering projects, clinical research, monitoring and evaluation, medical education, community health projects, global health clinical electives

Porter Symposium: “Haiti and Dartmouth at the Crossroads” – February 20-22, 2013
“Haiti and Dartmouth at the Crossroads” was a three-day conference that brought together 63 experts across disciplines, including Haitian government representatives, NGO leaders, and individuals from the private sector and academia, along with representatives from Dartmouth and other US and Canadian academic institutions. The symposium’s goal was to have working groups propose and implement collaborative, sustainable solutions to Haiti’s crises in three key areas: education, economic development, and health care. In each area, the working groups developed and refined at least one project proposal that had been endorsed by the Haitian government prior to the meeting.  The selected project(s) in each area had to be implementable and able to show results within the short term (1-3 years).

In the area of health care, the selected project was a National Critical Care, Trauma, and Rehabilitation Network, which intends to encompass a nationwide comprehensive network of hospitals, and pre-hospital services with training and education that would address the unmet needs of the major causes of death in Haiti today. With expertise in trauma care and emergency preparedness, DHMC can play an important role in helping bolster care and training at the department-level health facilities across the country. DHMC faculty and house staff in Emergency Medicine, Trauma, and Orthopedic Surgery would be especially important in assessing the current level of trauma care management in each department in Haiti and helping to set priorities for improving such care.

The selected projects in the areas of education and economic development included Economic Development at Le Port de Nippes, a National Institute of Studies and Educational Research (INERE), an Institute for Environmental Sciences in the Martissant Park, and a national network of Resource Centers.

Since the February meeting, progress has been made in refining each project. A follow-up meeting took place in Port-au-Prince in late April to prepare a submission for a planning grant to the World Bank to further develop these initiatives.

Click on the following links, to hear World Bank President Kim’s feedback on the projects selected in health care, economic development, and education.


$300 House Project
In the fall of 2010, Professor Vijay Govindarajan and Christian Sarkar developed the $300 House concept and began a blog to develop a dialogue to discuss proposed solutions for very low-cost housing for the poorest populations in the world, those who are not currently served by any conventional housing programs. Tuck First-Year Project students teams and students in Professor Jack Wilson’s Studio Art 65 course, Architecture I took on the challenge of examining the $300 House idea in Haiti.

$300 House Design Competition
In Spring 2011, over 300 designs were submitted to an open, crowd-sourced, design competition for the $300 House Project and six winning teams attend the Prototype Design workshop in Hanover with the goal of integrating the best aspects of their ideas into a single prototype house for (1) a rural setting and (2) a densely populated urban slums. Critical to the success of the meeting was the presence and input of Haitian leaders into the prototype design and eventually the local communities’ reception of the prototypes built on site in Haiti. Two designs were selected for the prototype construction in rural and urban sites in Haiti. A Dartmouth team of students and faculty visited Fond des Blancs with St. Boniface Haiti Foundation during Spring Break 2012 to solicit community feedback on the designs and project implementation. The designs were refined after the trip and in January 2013, Dartmouth acquired seed money to begin the prototype construction in Haiti.

To learn more, check out a short video on the $300 House Initiative.

Partnership with Haitian Education Leadership Program (HELP)
HELP is the largest scholarship granting organization in Haiti. Since the earthquake, five high-achieving Haitian university students have studied at Dartmouth during the Summer term. We hope to continue the visiting student program annually and connect Haitian students to Dartmouth-affiliated projects in Haiti. Additionally, we are exploring ways to develop a true “exchange” in which Dartmouth students can spend time learning alongside HELP students in Haiti. For example, we are hoping to incorporate medical students in HELP with DHMC/Geisel faculty’s ongoing research in Haiti. Learn more here.

Tele-Medical Education – Weekly Online Lecture Series for Haitian physicians, nurses, residents
Dartmouth College, McGill University, Université de Montreal, and the Haiti Medical Education Project provide continuing medical and nursing education through weekly online video lectures for Haitian physicians, nurses, social service residents, medical students and others from seven total sites in Haiti. To date, over 80 medical lectures have been given. Recently, a nursing weekly lecture series launched and Dartmouth began a joint internal medicine resident’s reports with Haitian residents in Port-au-Prince.

For more information on Geisel’s tele-medical education efforts in Haiti and for opportunities to become involved, contact Geisel Associate Professor of Medicine, Brian Remillard.
Learn more here.

GHESKIO in Port-au-Prince, Haiti
GHESKIO is a Haitian non-profit organization founded over 30 years ago to combat the spread of infectious disease, primarily HIV/AIDS, through research, training, and treatment programs. Through the ongoing work of Peter Wright, MD with GHESKIO, Geisel medical students and DHMC faculty and staff have participated in research and clinical work at the Port-au-Prince site over the years, with an emphasis on cholera prevention, HIV care, and TB control. Following the earthquake of January 2010, GHESKIO has expanded its efforts, becoming involved in community development and education for the area surrounding their Port-au-Prince campus including the nearby slum area of Cite de Dieu. Dartmouth has engaged business, engineering, and architecture students to support these efforts. A particular emphasis in the past year has been learn as much as possible from the patterns of illness in cholera patients presenting to the Cholera Treatment Center and to help with cholera vaccination program led by GHESKIO that vaccinated 50,000 people  in the urban slums surrounding GHESKIO.

GHESKIO in Les Cayes, Haiti
In October 2011, Dartmouth was awarded a five-year PEPFAR subgrant to partner with GHESKIO and work at Hopital Immacule Conception in Les Cayes, Haiti on HIV care and treatment initiatives. The DHMC Infectious Disease and International Health team, led by Peter Wright,  Jodie Dionne-Odom and Elizabeth Talbot, has already made inroads in terms of improved HIV testing rates, better linkage and retention in care, prevention of mother to child transmission, and tuberculosis infection control. They regularly bring “Subject Matter Experts” from various DHMC sections to support their ongoing work.  For example, DHMC Pediatric Radiologist Therese Vaccaro conducted a radiology training for physicians in Les Cayes to better diagnosis TB in April 2013. There are increasing opportunities for Dartmouth graduate students and DHMC residents to participate in research initiatives in Les Cayes.

St. Boniface Haiti Foundation
The St. Boniface Haiti Foundation (SBHF), located in the rural and mountainous Sud Department, is the only source of healthcare for over 250,000 people in rural Haiti. St. Boniface Hospital (SBH) in Fond des Blancs is the center of all treatment programs.

Led by the Dartmouth Center for Health Care Delivery Science, Dartmouth has worked with SBHF to provide technical expertise in health care delivery while also increasing its engagement in community development initiatives like affordable housing and water and sanitation. In 2011, St. Boniface hosted a Geisel medical student during an international clinical elective. Other projects have included a supply-chain management review for the hospital conducted by two Geisel-Tuck MD/MBA students, a study of St. Boniface’s community health worker network by two TDI MPH students, and an ongoing mobile health initiative to improve communication and education of community health workers initially launched by a DHMC family medicine resident. In the near future, we plan to connect DHMC residents in the Leadership Preventive Medicine Residency with SBHF to develop and monitor hospital performance indicators.

Partners in Health in Haiti
Dartmouth has been invited to have a teaching role in the brand new, state-of-the-art, 300-bed, Hopital Universitaire de Mirebalais that was completed by Partners In Health and Haitian Ministry of Health in 2012. In the future, DHMC/Geisel faculty and staff will have opportunities to support the teaching and training of Haitian health care professionals, medical students, and residents. Most recently, DHMC lab technicians have been invited to provide training to Haitian lab technicians at the new hospital. 

Dartmouth’s engagement at the departmental-level hospital St. Therese in Hinche continues to develop, as there remains a dire need to maintain an adequate level of functionality, along with opportunities to strengthen education and training for Haitian health care providers and trainees. In November 2012, a needs assessment visit took place to assess the current state of the hospital and what is needed to bring it up to a level of adequate functioning so that visiting faculty and students from Dartmouth and other institutions can be of help. Most recently, an ultrasound training led by DHMC’s Robert Harris was conducted for physicians at the hospital.