ARTICLE - REBUILDING HEALTH CARE

(Wall Street Journal) By MIRIAM JORDAN - CAYES JACMEL, HAITI

Word traveled fast after the devastating Jan. 12 earthquake that good, free medical care was available at this little hospital in southern Haiti. By 4 a.m. each day, patients start lining up at the Centre Medical Emanuel.

"People come from the mountains, hours and days away," says Elaine Kang, a family doctor from New York volunteering here with U.S.-based Team Ange, which has been sending in medical teams and supplies. Recently, however, short of surgeons, Dr. Kang had to turn away patients.

Now that the need for urgent care has subsided and this island nation has faded from headlines, fewer foreign health professionals are flocking here. Groups that dispatch medical teams are attracting fewer donations from Europeans and Americans. "This is a concern we had: The minute Haiti went off the news, people would forget about it," Dr. Kang says.

Haiti officials now are tasked with rebuilding a health-care system of their own. An assessment prepared by foreign experts for the U.N., World Bank and Haiti government, which was reviewed by The Wall Street Journal, calls for a system that guarantees universal access to primary care, quality services and essential medication.

It recommends "massive investment" in training for Haitian medical professionals and decentralization of care, which has been concentrated in the capital while neglecting the rest of the country.

Thousands of international medical teams rushed to Haiti initially. Doctors and nurses, lugging life-saving supplies, hitched rides with private pilots or took circuitous routes to get here. They performed thousands of life-saving surgeries, even in makeshift field hospitals.

In the wake of the emergency, access to health care for many Haitians has never been better. But hospitals where foreign medical volunteers had been treating mainly quake victims are also packed with patients suffering from diabetes, AIDS, cancer and other ailments, in addition to those requiring follow-up care for quake injuries. "The big question is, what will happen when the foreign medical aid groups leave," says Nyka Alexander, a spokeswoman for the World Health Organization.

Ariel Henry, chief of staff for Haiti's Health Ministry, said the country is "open to all contributions" as long as local health personnel benefit from the partnership and the health-care system is strengthened overall. Dr. Henry said many medical teams initially had arrived without gaining clearance from local authorities. That phenomenon, while well-intentioned, has since led to coordination problems.

The health ministry is still in shambles; more than half of medical professionals are living in tents. Doctors without Borders, the nonprofit medical group, runs at least 500 of the 1,600 hospital beds in Port-au-Prince. The capital's General Hospital has more foreign than local medical staff.

"Outside medical organizations are now the backbone of Haitian medical care," says Dana Van Alphen, regional adviser for disaster management at the Pan American Health Organization who has been involved in discussions with a Haitian presidential health commission.

"It's a very difficult situation, but we have to start somewhere," says Dr. Van Alphen, adding that the quake provides the "opportunity" to start anew. Haiti will be seeking a massive injection of funds from wealthy countries. The report for the U.N., to be released at a donor conference in New York on March 31, puts the cost at upward of $750 million over the next five years.

On average, Haitians subsist on less than $1 a day. But 70% of respondents to a WHO-commissioned survey in Port-au-Prince said they pay for medical care. It is one reason many Haitians only visit a hospital when their condition is life-threatening, health experts say.

Rudimentary public clinics and hospitals lack basic equipment and a stable work force. Port-au-Prince's university teaching hospital, General Hospital, doesn't have its own ambulance or CT scan. Many Haitian staff are owed several months of wages, and therefore don't show up for work.

"I am yet to see one attending Haitian physician in the emergency room," says Gabriel Novelo, a Mexican doctor with International Medical Corps, a Santa Monica, Calif.-based volunteer group whose doctors and nurses are staffing General Hospital.

Dr. Novelo, who is coordinating IMC's operations, says the group hopes to see "transitional" care in place before it quits the country. That would include pairing Haitian medical personnel with foreign staff for training; transferring functional control of hospitals and clinics to locals and establishing a primary health-care program.

"We are committed to staying as long as we can," said Dr. Novelo. But he added, "The minute we run out of funding, we leave. There is no way around that."