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OO RUEHWEB

DE RUEHPU #0086/01 0260257
ZNR UUUUU ZZH
O 260256Z JAN 10
FM AMEMBASSY PORT AU PRINCE
TO RUCNDT/USMISSION USUN NEW YORK IMMEDIATE 0061
RUEHC/SECSTATE WASHDC IMMEDIATE 0256
RUEHGV/USMISSION GENEVA IMMEDIATE
INFO RHMFISS/HQ USSOUTHCOM MIAMI FL IMMEDIATE
RHMFISS/JOINT STAFF WASHINGTON DC IMMEDIATE
RUEHDG/AMEMBASSY SANTO DOMINGO IMMEDIATE
RUEKJCS/SECDEF WASHINGTON DC IMMEDIATE
RUEHPU/AMEMBASSY PORT AU PRINCE

UNCLAS PORT AU PRINCE 000086 
 
AIDAC 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: EAID ECON PGOV PINR PREL PREF HA
SUBJECT: HAITI POST-EARTHQUAKE USAID/DART HEALTH OVERVIEW 
 
REF: PORT A 0054; PORT A 0058; PORT A 0060 
 
¶1.  (U) Summary.  As the number of patients requiring specialized 
medical assistance declines USAID's Disaster Assistance Response 
Team (USAID/DART) staff report that the current emphasis on 
earthquake-related trauma surgery and injuries has begun to shift 
to basic primary care, surveillance, and disease prevention.  The 
Pan-American Health Organization (PAHO) and U.N. Health Cluster 
report 150 operating health facilities in Port-au-Prince, including 
48 facilities with surgical capacity.  Existing health facilities 
and supplies have been augmented by a robust international 
response, including the deployment of U.S. medical response teams 
and the provision of USAID-funded medicines and equipment.  End 
summary. 
 
 
 
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TRAUMA NEEDS AND CURRENT CAPACITY 
 
--------------------------------- 
 
 
 
¶2.  As of January 23, approximately 20,000 injured people require 
medical assistance, according to the U.N. Health Cluster.  Of the 
total, approximately 1,000 patients require specialized care.  At 
the same time, PAHO reported the presence of a total of 150 
operating health facilities in Port-au-Prince, including 48 
facilities with surgical capacity - 36 fixed facilities and 12 
field hospitals.  An additional two floating hospitals with 
helicopter transport capacity -the USNS COMFORT and a Mexican 
hospital ship - and approximately 11 mobile clinics are currently 
operational in the capital, according to USAID/DART staff. 
 
 
 
¶3.  U.S. Department of Health and Human Services' (HHS) medical 
response teams are also providing medical care in Haiti at several 
locations, conducting consultations with more than 1,000 patients a 
day, many with acute medical problems, representing a total of more 
than 10,000 consultations as of January 25.  HHS deployed five 
Disaster Medical Assistance Teams (DMAT) and an International 
Medical Surgical Response Team (IMSuRT) on January 20.  Each DMAT 
team has 35 members, representing a total of 175 medical staff, 
while the IMSuRT is comprised of 48 staff.  DMAT teams have been 
deployed to multiple affected locations, including spontaneous 
settlement sites of displaced populations in Gheskio and the 
Petion-Ville club.  In addition to conducting surgical procedures 
for earthquake-affected populations, the IMSuRT currently in Haiti 
plans to donate its significant cache of surgical equipment and 
supplies to USAID upon departure. 
 
 
 
¶4.  USAID/Dominican Republic (USAID/DR) has reprogrammed USD 1 
million in health resources to provide three Dominican public 
hospitals near the Haiti border crossing at Jiman???? with 
medications 
and supplies. 
 
 
 
¶5.  USAID/DART staff note the enhancement of U.N. Health Cluster 
coordination and information sharing capacity as a result of the 
arrival and support of USAID and the U.S. Centers of Disease 
Control (CDC) staff.  In addition, USAID/DART staff highlight the 
value of the recent establishment of U.N. Health sub-clusters for 
hospitals, mobile health teams, assessments, reproductive health, 
and drug supply and management in strengthening the targeting of 
response efforts. 
 
 
 
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USNS COMFORT 
 
------------ 
 
 
 
¶6.  On January 20, the hospital ship USNS COMFORT arrived in Haiti 
with 1,000 hospital beds and medical supplies to augment in-country 
capacity to treat the increased caseload of casualties resulting 
from the earthquake.  The hospital has 10 operating rooms, 24 
surgeons, and 130 nursing staff on board.  Patients are primarily 
being transferred from University Hospital and other Government of 
Haiti (GoH) hospitals in Port-au-Prince.  As of 1300 hours local 
time on January 23, medical staff aboard the USNS COMFORT had 
treated 1,427 patients and performed more than 93 surgeries, 
according to the U.S. Department of Defense (DoD). 
 
 
 
¶7.  The USNS COMFORT currently has approximately 350 patients on 
board and is expected to reach maximum capacity within the next 48 
hours.  The ship has a capacity of 1,000 beds which includes 
patients as well as one accompanying family member, resulting in an 
actual patient capacity of approximately 500 patients.  The U.N. 
Health Cluster is working to identify additional stabilization 
locations to relocate treated patients for post-operative care in 
order to make more space available to accommodate additional 
incoming patients. 
 
 
 
¶8.  The GoH Ministry of Health (MoH) and PAHO have identified 
potential post-operative care sites at Eliazar Germain in 
Petionville, St. Jude Hospital in Delmas, and Delmas 48, which are 
currently being assessed.  However, the combined capacity of these 
facilities may be inadequate to handle the projected flow of 
patients.  The DoD is in the process of deploying a self-sufficient 
emergency medical facility (EMF) with a potential 250-bed capacity. 
However, due to  transportation and set-up times, the EMF unit 
would likely not be operational for another 14 days.  A short-term 
solution is required and USAID and HHS are currently evaluating the 
potential purchase of a federal medical station (FMS) from the 
CDC's Division of Strategic National Stockpile.  Each FMS provides 
beds, supplies, and medicines for 250 patients.  The FMS could be 
set up in three to four days but would require additional support, 
such as staff, tents, generators, and water and sanitation 
services. 
 
 
 
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GOH EMERGENCY MEDICAL SERVICES STRATEGY 
 
--------------------------------------- 
 
 
 
¶9.  Developed in collaboration with PAHO, the GoH  emergency 
medical services strategy is comprised of three parts, including 
support for mobile health teams targeting displacement sites; 
permanent health facilities that serve as first referral facilities 
located at main displacement sites; and hospitals and field 
hospitals identified by the MoH. 
 
 
 
-------------------------------- 
 
SUPPORT TO DISPLACED POPULATIONS 
 
-------------------------------- 
 
 
 
¶10.  To facilitate appropriate targeting of health services at the 
estimated more than 600 spontaneous settlement sites accommodating 
displaced earthquake-affected populations in and around 
Port-au-Prince, U.N. and relief organizations are assessing and 
mapping sites to identify gaps and service needs.  Population 
estimates of settlement sites range form GoH reports of 609,000 to 
International Committee of the Red Cross estimates of 1 million 
people. 
 
¶11.  Current MoH strategy plans to support 16 health facilities in 
proximity to the largest settlement sites and utilize mobile health 
teams to reach other areas of need.  USAID/DART staff caution that 
current plans for mobile team service provision may be overly 
ambitious, citing the inclusion of HIV/AIDS patient treatment and 
routine immunization provision which would require cold chain 
facilities.  USAID/DART staff note that an initial focus on basic 
health services may be more effective with the potential to expand 
services where feasible at a later date.  In addition, USAID/DART 
staff note that plans for settlement sites and displaced population 
movement remain fluid.  An estimated 235,000 displaced persons have 
departed Port-au-Prince for other departments in Haiti, according 
to the GoH.  In these areas, increased medical staffing and 
supplies may be needed to meet the increased number of patients. 
 
 
 
¶12.  USAID/DART staff report that a multi-sectoral rapid assessment 
of spontaneous settlement areas, led by he U.N. Office for the 
Coordination of Humanitarian Affairs (OCHA) and comprised of 24 
three-person teams, is scheduled to begin on January 25.  Teams 
will utilize a modified initial rapid assessment (IRA) tool to 
collect basic information pertaining to population and health, 
nutrition, water, sanitation, security, and shelter conditions at 
settlement sites in Port-au-Prince and other areas outside the 
capital.  USAID/DART staff note that the information compiled from 
the assessment pertaining to the number and location of available 
health facilities and water distribution points is critical to 
identify gaps in coverage and inform appropriate response measures. 
 
 
 
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MEDICAL SUPPLIES 
 
---------------- 
 
 
 
¶13.  Despite the availability of medical supplies through the 
PAHO-supported MoH warehouse PROMESS, inadequate messaging and 
supply tracking challenges have hindered the efficiency of 
distribution efforts.  International relief agencies with 
independent transport capabilities may pick up medicines at the 
warehouse immediately, while local relief agencies require MoH 
concurrence.  To communicate the availability of medicines and the 
process for accessing supplies, the MoH has initiated radio message 
broadcasts to inform local clinics, hospitals, and relief agencies, 
in addition to posting a message on the InterAction website to 
alert international NGOs.  In addition, USAID/Haiti has contracted 
Management Sciences for Health to visit hospitals and clinics to 
assess medicine shortages and link the health facilities to the MoH 
warehouse.  USAID/DART staff note that this may increase the need 
for medicines as more facilities and agencies begin to access 
PROMESS. 
 
 
 
¶14.  Inadequate tracking and monitoring of warehouse and pipeline 
medicine supplies have also created significant limitations in the 
ability to accurately forecast short and medium-term needs. 
Additional United States Government (USG) pharmacists are assisting 
with system tracking and management to address the issue.  USAID is 
also evaluating the possibility of providing additional support to 
PROMESS. 
 
 
 
¶15.  In addition, to MoH medicine supplies through PROMESS, 
USAID/OFDA has ordered four U.N. World Health Organization (WHO) 
health kits capable of supporting 10,000 individuals for a 
three-month period at the request of USAID/Haiti and PAHO.  This is 
in addition to five USAID/OFDA-provided WHO health kits consigned 
to PAHO at the onset of the disaster.  USAID/DART staff note that 
the USAID/OFDA-funded health kits should provide an adequate buffer 
stock for fixed health posts and mobile health clinics.  Future 
requests for WHO kits should be dependent on improved 
accountability of existing kits and drug supplies. 
 
------------------------------ 
 
SURVEILLANCE AND PUBLIC HEALTH 
 
------------------------------ 
 
 
 
¶16.  To date, WHO reports no outbreaks of communicable diseases, 
including measles, rubella, and diarrheal disease, despite 
difficult public health conditions.  However, the earthquake has 
disrupted vaccination services and conditions have contributed to 
increase population vulnerability.  In response, the U.N. Health 
Cluster has reported plans to increase immunization activities for 
measles and diphtheria, pertussis, and tetanus (DPT).  In addition, 
the U.N. Health Cluster plans to establish epidemiological 
surveillance mechanisms at 51 health facilities on January 26 to 
monitor health conditions and disease outbreaks to facilitate a 
rapid response to potential outbreaks. 
 
 
 
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LOOKING AHEAD 
 
------------- 
 
 
 
¶17.   As the focus of response efforts shift from emergency trauma 
interventions to basic primary care, surveillance, and disease 
prevention, USAID/DART staff emphasize the need to support mobile 
health teams to reach the significant number of displaced persons 
concentrated at spontaneous settlement sites in Port-au-Prince and 
other departments in Haiti, as well as existing health facilities 
in high-density settlement locations.  USAID/DART staff also 
highlight the need to incorporate disease surveillance and 
nutrition surveys into health service interventions and note the 
need for flexible response programming capable of adjusting to 
evolving displacement strategies, including potential GoH plans to 
relocate displaced persons.  In addition, USAID/DART staff note the 
continuing need to identify available facilities to provide 
post-operative care for individuals injured in the earthquake. 
USAID/DART staff will continue to monitor health conditions and 
coordinate with USAID/Haiti, the GoH, and U.N. and relief 
organization partners to address health needs. 
MERTEN