Monday, January 23, 2012

Implementation of basic oral health care delivery systems in Haiti (Un)

Cap Haitien, Haiti

Bon jou, s'ak passe, salut.  There are many ways to greet someone in Haiti, a true mélange of cultures and opinions in one small but electric country.  Haiti has been a "hot topic" in a variety of forums- international media, politics, and of course inside the walls of the Brigham.  As a longtime Partners in Health fan and global health enthusiast, my goal is to investigate the process of implementing an oral health delivery system in Haiti that is sustainable, appropriate, and affordable to deliver.  Using the World Health Organization guidelines as set forth in the highly under-used Basic Package of Oral Care as our model, we hope to merge education and direct care in one program that integrates the local population but can be applied globally.  Additional aims of this directive are as follows:
Ensure that the oral health care provisions established are sustainable by training local Haitian nurses to be dental assistants.
Implement and utilize the Atraumatic Restorative Treatment method, which allows for restoration of dental decay in basic accomodations without electricity or water-dependent equipment.
Provide direct oral health care to Haitian residents including emergency relief, preventive care, and comprehensive dental services.
To establish a continuing education, referral, and teaching center for the North Haiti Dental Association (NHDA) doctors.
Vision and supplies were packed into checked luggage and I set forth to Port-au-Prince, a maze of rebuilding and tent cities slowly regenerating two years after the devastating 2010 earthquake complicated by lack of infrastructure and a cholera outbreak.
Port-au-Prince: Cholera public service announcement found on most public buildings in Haiti.  From the capital, we flew on a verified joyride to our site in Cap Haitien on a small 15-seater over the mountain ranges Massif du Nord and Montagne Noires.
Re-usable airline ticket to Cap Haitien.  The airport consisted of a one-room terminal.  The waiting room for the airport was outdoors.  We were transported to and from the airport in the bed of a pick-up truck, which was actually a delightful experience.
I was told by a local source that there are approximately 10,000 NGOs in Haiti, with a good portion operating in Cap Haitien, a large city nestled between mountains and sea in the northeast of Haiti.  We were de-briefed on our program and schedule of visiting several clinical sites in addition to various didactic lectures. 
From my time in Cap Haitien thus far, I have made a few observations about this dynamic culture.  One, there is a palpable charisma throughout the entire place that understandably attracts the international community.  Two, there are no trash receptacles to be found, and every type of disposable waste ends up on the street, in the ocean, or on the beach [picture below].  The grime on the streets is in stark contrast to the dignified manner and careful grooming of the Haitian people, best visualized in church, which is well-attended.  Religion is engrained in the core of the culture; when driving down the street one passes "Lord the Savior Auto Repair" and "Jesus Christ the Good Shepherd Barbershop."  Walking down the circus of dirt roads, you hear the roar of motorcycles narrowly dodging pedestrians, the smell of petrol and burning, and the coating of dust all synthesized together in a term my site mentor coined as "a potpourri of poverty."  However, I have seen such developmental potential in Haiti as we passed by miles of pristine beaches, leafy mountains, and quaint landscape ripe for economic opportunity.  The situation here is truly unlike any other that I have seen in previous global health experiences in Nicaragua, Bolivia, China, and Botswana.  I am both intrigued and energized to immerse myself in this clinical and educational experience.

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