I’m not a humanitarian worker, one that walks around the camps teaching people how to set tents up efficiently and trains local community workers on how to promote washing your hands and drinking treated water. I’m not a doctor, not a teacher, and will be of little use to determine where it is safe to rebuild houses. And to be honest you won’t find much in my blog that you can’t read in the newspapers, in Haitian cooking websites, or blogs of other people dealing with the challenges of living in low-income countries. So am I useful, here in Haiti?
I do believe that as part of IDA, I am working to make a positive contribution through improved access to quality medicines. It’s not the only thing that matters, but it definitely matters. There are different channels through which public hospitals or humanitarian projects in Haiti can buy medicines: there’s a central medical store, there’s the private market, and some also import directly. I’ve heard enough pharmacists or heads of health projects tell me, ‘Yes, buying medicine through supply channel A is more expensive than through supply channel B, but when channel B is empty, we still need the medicine, so we’re going to buy from channel A, as much as we can!’ This tells me there’s a role for IDA – our mission is to make medicines available that are both affordable and of high quality, precisely so this pharmacist can fill his pharmacy with what he needs.
Of course I’m just one person, but, at the risk of sounding super corny, 160 ‘one persons’ of us make realizing our mission possible. My little role for these few months is to link the field to our headquarters. When I tell one pharmacist here that shipping from the port of Rotterdam to the port of Port-au-Prince takes 29 days, with a possible 2 to 3 weeks delay because of transit which we can’t control, and that based on his order details, this means we can ship in 3½ months, including time for him to get the goods out of customs once they arrive here, I’m not going to be the one processing his order, picking it from our shelves, ordering the missing ones from manufacturers, booking the shipping line, loading it into a container… It’s the whole IDA team, plus the manufacturers and the shipping line and the customs officials and everyone else, who actually get the goods delivered. Yet when I tell him 3½ months, as we sit at a table with supply chain diagrams and an Excel sheet of medicines, I feel personally responsible for these months, I want to go back to Amsterdam or to the manufacturers and load their medicines into my bag and not let them go until they are in his hospital! (Which would be a highly inefficient supply chain..)
Another pharmacist of a large organization here told me how IDA coincidentally delivered his last annual shipment just days before the January 12th earthquake, and how their response would have been a lot worse without it. I can hear the emotion in his voice as he tells me this, and explains that now it is important that the next order arrives for New Year’s, are as right after New Year’s there is always a peak in patient visits.
I visualize the steps necessary for his order to reach Haiti in December, the long chain of hands typing and calling and clicking and packing and carrying and checking, almost like in the terrible first scene of Lord of War when a bullet is manufactured, packed, shipped, is picked up, loaded into a gun, and ends up in someone’s forehead. A bit of a bloody comparison, I concede, especially as medicines should be doing the opposite.
Then at the other end, I imagine the waiting rooms. I have visited a few hospitals here in Haiti, and pass through waiting rooms of others on my way to the pharmacies, but I mainly know waiting rooms from Burkina Faso, where two years ago I conducted interviews in over 30 health centers as an intern for the World Food Programme. There, in the Sahel region, the waiting rooms (and, once, patient rooms too) often extended to the simple outside, along the wall of the health center or under a tree. The hospitals I have seen here so far luckily are better equipped. Of course, after the earthquake, entire operations were taking place outside. Because the building had collapsed, because it was too full, or because people were afraid to get back inside. Things have improved dramatically since then.
Waiting rooms smells like disinfectant, and, to be honest, like sick people. This is normal of course. People are waiting, with their children, with a bandaged foot. Some can barely support themselves against the wall, some are hooked on IV. You can sometimes hear painful moments in the operation or delivery rooms – I’ve shuddered hearing a little boy scream his lungs out in pain during circumcision, and saw a little baby bundled in a blanket on a bed after hearing his mother groan through contractions and his birth. There is family to help those who can’t make it alone. It’s really important – in the main hospital in Dori (Burkina Faso) for example, unless it’s an emergency, the nurse or doctor will prescribe a medicine, whose prescription you bring to the pharmacy, which then writes the price down, which you bring to the cashier to pay, and then head back to the pharmacy to collect the medicine, each time waiting in line again. You don’t want to be doing this while in pain, and you can’t when you don’t have the energy to rise from your bed, a shadow of a body struggling to survive.
All of this I remember and imagine, as the pharmacist tells me there is a peak in patients after New Year’s. On one side, the long supply chain, on the other, patients in a waiting room. Some of it may sound a little gruesome, but the few peeks I’ve gotten are far softer than the simple reality nurses, doctors, and patients themselves go through. It’s a world where many lives are saved and wounds healed, but also with a lot of tough pain and loss. The little white and coloured pills, the bottles of iodine and swathes of cotton, the thin needles and transparent IV bags, they are not just details here.
So do I make a difference? We are ants in the cross-continental chain that gets the medicines and medical supplies to the patients. Ants are small and not much good alone, but they can also carry 10 to 50 times their weight (according to WikiAnswers). IDA supplies medicine for some 90 million people a year. That’s a lot of times our weight for 160 people, but it’s worthless without nurses and doctors and ships and trucks and pharmacists and stock keepers and good policy, etc. And to the pharmacist sitting across me, it’s worth a lot less if his stock arrives after the patient peak. I better get my ant to work!