Population & Family Health

Brian Hoyer MPH/MIA '09

Brian Hoyer (seated at right) with Haitian volunteer doctors from Organisation des Jeunes Progressistes Pour la Sante which runs mobile primary care clinics in Port-au-Prince

When did you graduate?
I finished in May 2009 with a dual degree from Popfam’s Forced Migration and Economic and Political Development at SIPA.

For my internship, in the summer of 2008 I went to the Szechuan province in China to work with the emergency response after the earthquake. I also worked in Pakistan in 2005 after the earthquake there with Americares.

Who do you work with now?

I’m now working as a consultant with Americares on this project. When I came here it was supposed to be 3 weeks but then after I arrived, it changed to 6 months.

I had worked for Americares full-time before I went for my MPH in their African Programs as well as in their Emergency Department. I’d never worked in Haiti before. Most of my background is in Africa.

The Port-au-Prince airport days after the earthquake

When did you arrive and what were your responsibilities?
I arrived on the 16th of January with a cargo plane full of basic essential medicines. It was literally our job to make sure that all of those got to the right place at the right time and in the right quantity. We had an airlift of close to $6 million in supplies that landed and parked in the grass in Port-au-Prince.

We slept next to the cargo and worked on the logistics to find trucks and forklifts. We were lucky and quickly set up a warehouse to begin distribution to 50 different institutions. Some of them received several shipments; some were really small groups that only got a few supplies.

Some of my favorite groups to work with are the small teams of Haitian doctors who have set up mobile clinics. These small groups fall outside of the big NGO system and the public hospital system, but they have a huge impact.

How’s your Creole?
Many coordinating meetings are still held in English, even though the government doesn’t like that. I speak very basic French and am just learning to speak Creole. I always move with Haitians who help me with translation. And I speak Spanish which is very helpful here. Somehow I find a way – though it’s not always perfect.

How have your responsibilities changed?
Our NGO’s mission is to provide emergency assistance and build capacity for the health system overall. My job as Emergency Response Manager includes developing and monitoring programs in public health both in Port-au-Prince and outside in the various departments of Haiti.

At first we were focused on immediate aid with material assistance. We’ve started to balance out the other way working on longer programs (2-3 years).

For example, this week we brought a team of bio-medical engineers to repair equipment and begin to train hospital technicians at four of the largest hospitals in Port-au-Prince  We also are working on a comprehensive national malaria control program, supporting the sole Haitian organization working to manage chronic disease mainly focused on diabetes, various reconstruction project including relocation of a tertiary level hospital which suffered tremendous damage but still is working out of flimsy tents, and providing material support to community and primary health programs in many of the 600 camps in Port-au-Prince. 

Restocking a neighborhood clinic

What are your impressions 2 months after the earthquake?
The situation is still extremely serious. Last night we had our first significant extended rain storm. It was a really heavy rain that flooded a lot of people. It takes a very bad living situation and made it worse. We, the humanitarian community, know it’s coming but are not prepared for it at all.

It’s still the acute phase – not trauma like the first month - but the level of medical needs is still very high.

On the brighter side, there have not been reports of outbreaks. There have been increases in reporting and confirmed cases of malaria, but we’re estimating that’s due to increased access to healthcare, reporting from foreign doctors, and increased awareness. You can’t necessarily trust surveillance figures compared to before the earthquake.

There is care available in Port-au-Prince.  A few weeks ago there were 90 different clinics providing free access to healthcare for many people. This presents a challenge for the private healthcare providers of the country, but in reality the need remains large. However, there are windows of possibility to improve the health system in Haiti in the long term.

What is it like working with the government?
Although there are many negative reports on the Ministry of Health, I just want to say, my experience has been mostly positive. There are still challenges.  For example, a few weeks ago we were meeting outside the Ministry of Public Health and Population [because the building was significantly damaged] with the deputy minister.

He was there with all of the files and chairs from the office. Then, just as we began to talk, we had to relocate because they want to demolish the building. So the minister stands up and we follow him to a gas station and put down a table there and had our meeting there in the middle of a gas station.

But it was very organized, he had all of his papers, and his questions and we met there. It’s true that they lost huge amounts of data – all of the training materials and records, but there still is a lot of capacity here and we just need to try to work with them.

Cash-for-Work program clearing a clinic site in Port-au-Prince

Can you give me a sense of what a “typical” day is for you?
I’m living in a very safe place in a compound. We have our meetings to plan which cars are going where and the logistics for the day. We’re usually leaving by 7:30 am and go to hospital visits early because it’s when you catch the most people to follow up on medicines that we’ve sent for or that have been ordered through our warehouse.

It takes a long time to get around Port-au-Prince which had terrible roads to start and now many are blocked with tents or rubble. Traffic is definitely the worst that I’ve ever been in – it can take a few hours just to get up the road.

We’re also trying to do assessments which is a tricky thing to do, because most people are over-assessed. At one point, there were 300-400 health NGOs alone working in Port-au-Prince and most were there for the first time.

We get tons of phone calls from groups asking for assistance, so there’s a lot of following up directly. And then you have to figure out how to hire local staff, keep your car running, implement security protocols, etc. And, for now, you have to be back inside the compound before dark.

I’m hoping things will become a little more settled and I can get a little more normal life. But right now, I’m living behind a compound wall which, to be honest, is very frustrating.

Overview of a camp in Port-au-Prince, Haiti

Given the level of destruction when you arrived, would you have expected more progress by now?
I definitely would have expected more progress. I don’t want to sound negative because there are a lot of good things happening. But six weeks ago we knew that we needed more latrines, and now we still need more latrines. So much of the shelter and sanitation needs are not being met yet.

There’s a lot of criticism that the established camps will turn into shantytowns - but the alternative is not clear. There’s massive migration out of the city, but some people may not be leaving because NGO’s are focusing too much on Port-au-Prince. The grand plan is to [focus on the whole country], but a lot of groups have not done that yet.

Is there anything that you think people should be aware of about Haiti now that it’s begun to recede from the headlines?

With the scale of the disaster, attention needs to stay here for years, not just months. Training programs and building up from a very poor health system - to do that is a huge challenge – and it takes a commitment of every group not to be here for 6 months but for 6 years. It takes smart locally informed projects that take into consideration politics, land, and how a family lives here.

Given what you are doing now, what was the most helpful class in preparing you for this experience?
I’ve actually been on courseworks quite a bit to grab resources here and there.  I even asked that my access not be cut off since it was due to!

Classes - Water and Sanitation in Complex Emergencies and Program Planning. At SIPA  - a class with Professor Elizabeth Lindenmyer gave a lot of information on Haiti that was helpful to go back to for political background.

The best part has to be the people I have met through Mailman.  For example, if I want to know something about an organization, chances are that someone from my Mailman School network works for them. Another alum here works for Merlin. When she needed something she let me know and we got it to her in a few hours which was a lot quicker than it would have happened otherwise. Even more than classes it’s the actual people.