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Archive for March, 2010

by Erica Gralla

Port-au-Prince, Haiti – Wednesday, Jarrod and I had the opportunity to visit Cange, where Partners in Health (PIH) began its first clinic. To convey just how inspiring that is, Mischa (who has a masters in public health) told us it was like visiting “Mecca” for public health. If you’ve never read Mountains Beyond Mountains, or heard of Paul Farmer, perhaps now is a good time to start.

Jarrod has been working with Partners in Health to examine their supply chain in Haiti, which was already stretched near its limit before the earthquake. Of course, the earthquake changed all that, as donations of money and medical goods poured in faster that PIH could handle them (though the money is never enough for the need in Haiti, it seems), and the supply chain expanded many-fold overnight. Katherine, PIH’s point person for all things logistics, came down to Haiti to assess the situation, lend assistance, and bring Jarrod and I on a logistics-oriented visit to Zanmi Lasante (the Kreyol name for Partners in Health).

My global health friends would perhaps have found our “tour” slightly disappointing – we saw mainly warehouses, boxes, and the storage rooms of pharmacies. For me, this is fascinating stuff – and it should be for you, as well! Because without a steady supply of pharmaceutical products and medical supplies, health systems stop functioning.

Our first stop was Saint Marc, a relatively recent addition to PIH’s network of clinics. The reason for our stop was a brand-new warehouse, built into the back corner of the clinic compound, with gleaming walls and high ceilings. An SUV was pulled up to the entrance, being loaded with boxes for a journey to another clinic. Inside, boxes were piled on boxes, since shelves had not yet been ordered, but the space did not feel particularly crowded (a good thing). Jarrod wanted to measure the warehouse, and since there was no tape measure, he used dollar bills and a camera to get the dimensions of the square floor tiles. This type of making do, ad-hoc creativity is a key element of many supply chains I’ve seen in developing countries. So we fit right in. We saw the paper-based system used to keep stock records, then headed back to the clinic to see the pharmacy. Drugs stocked in the warehouse are sent to the pharmacy weekly (or as needed) to be stored in plastic containers and dispensed to patients. Finally, we wandered the clinic compound a little, while we waited for the driver to pull up the car. Zanmi Lasante pays a lot of attention to landscaping and the environment of the clinic, and in Saint Marc the landscaping was very much in progress. The warehouse was recently constructed, another building was going up near the pharmacy, and trees were being started all over the compound.

Next, we visited the outpatient clinic in Saint Marc, a short drive away. Here we saw another pharmacy, but in this case (perhaps because the main warehouse was not on-site), the pharmacy back room doubled as warehouse. Boxes were stacked to the ceiling, though drugs were organized and accessible. Drugs are dispensed to patients through something like a barred window, though the “bars” are really a nicely worked artistic design.

Finally, we headed toward Cange, the original clinic now grown into a “Sociomedical Complex”, including a full-service hospital, plus blood bank, schools, and other social enterprises. The roads have apparently improved in recent years, and it wasn’t until the last stretch up the side of a mountain (overlooking the lake created by the big dam –  if you remember your Mountains Beyond Mountains) that we hit bumpy dirt road. I’ve heard from several people that “there’s Haiti, and then there’s Cange.” I don’t think I can judge the truth of this statement, since my experience of Haiti has mainly been shuttling between the US Embassy and the UN Log Base through a recently destroyed Port-au-Prince. Not exactly the standard Haiti. But I can see why it might be true. Much of Haiti appeared (to my eye) empty and barren, where Cange is covered in tall trees. There’s an atmosphere that I can’t quite put a name to, but it comes from the kids and adults and doctors and managers and everyone else you find in this ‘sociomedical complex’. The school, the hospital, the church, and the koi pond (!) beckoned, but our first stop was… the warehouse!

The “depot” has two floors, with pharmaceutical products stored in the climate-controlled rooms upstairs, and medical supplies downstairs. This warehouse felt distinctly more “seasoned” than the new one in Saint Marc, with a proven system of organization, yet a feeling of being strained almost to its limits. Nevertheless, it functioned well. Most supplies go through Cange, and are distributed from here to the other clinics. Boxes were piled to the ceilings around the outside of the warehouse, waiting for distribution to a clinic when needed, while unboxed medical supplies were stored on shelves for use in Cange. PIH uses an electronic medical records system to track stock. I attempted to learn about it from a very patient woman, using my one-and-a-half semesters of French. Katherine translated where necessary. This time, when Jarrod wanted to measure the warehouse dimensions, someone had a tape measure, so I followed him around writing down dimensions while the PIH staff looked on in bemusement (or, that’s what it seemed to me!).

After our warehouse visit, we got to see the rest of the complex. The hospital is extremely impressive, with two operating rooms, staffed at the moment by a team from the US. We saw women making “Plumpy Nut”, a peanut-based supplemental feeding product aimed at children. We saw the blood bank, patient rooms, an art center run by a woman from North Carolina, and the Friendship House, where guests can stay. Finally, the last stop on our tour: the koi pond! Along the way, we met a number of fascinating and dedicated people who contribute in very different ways to making Zanmi Lasante in general and Cange in particular as amazing as they are.

Our last stop was a PIH agricultural warehouse, which is currently housing some overflow medical goods (donations after the earthquake overwhelmed the dedicated medical warehouses). Finally, we drove back to the hotel. It had been a long, hot day, and we dropped our things off in our rooms, loaded up on bug spray, and headed back to the outdoor tables by the pool, ready for a cold beer. Or so we thought. Katherine asked for one brand, and they didn’t have any. She asked for another, then another, and finally any beer at all. They didn’t have any. At all! They had Bailey’s and vodka and whiskey, but no beer. (And in places where one should be suspicious of ice, beer is really the way to go.) We ordered cokes and lamented. Until, twenty minutes later, someone from another table got up, walked behind the bar, opened the fridge, and pulled out a can that looked suspiciously like beer.  We waited to confirm our suspicions; ten minutes later, again. Was the restaurant hiding beer from us? Had they brought their own beer? Was there some sort of misunderstanding? Was this some sort of test, to see whether we wanted beer badly enough to take it ourselves? The suspense was too much. We had to ask. Impolite to say the least, we walked over to the beer-laden table and inquired. Turned out they had brought it themselves. They were also a team from University of Georgia, with a bit of overlap in interests. We exchanged business cards, and they offered us beer. Mission accomplished! (And a good thing too, since we met some interesting people!)

The following morning, we drove back to Port-au-Prince, down a beautiful paved road (it wasn’t always this way). Our last stop was the PIH warehouse in Port-au-Prince, which they acquired just for the earthquake. It’s not a long-term solution, but at the moment it is piled high with all things useful and mysterious. Donations (of goods) after an earthquake are more often useful than not, but sometimes people donate what they have without thinking of what PIH might actually need. This can be a problem if there is limited storage space and limited capacity to look through the donations and understand their use. There were piles of pain relievers and beds and bottled water, but also an entire wall of expired medicines and mysterious surgical equipment no one had the skills to understand. They planned to have a surgeon from the US come down to the warehouse for two full days to sort through the surgical equipment and figure out what might be useful and what to discard.

PIH faces an interesting challenge here. They are generally a health care organization, which has ramped up (amazingly well) to deal with a major emergency in Haiti. How will they manage the assets (donations, warehouses, people) they have acquired for the earthquake when things return to “normal”?

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By Erica Gralla

Port-au-Prince, Haiti – Today was a day of contrasting locations. As usual, I awoke in a khaki-colored army tent, on an army cot with an army mosquito net zipped around me. My hair, washed last night, was nowhere near dry in the humidity here. I stopped at the bathrooms next to the pool, already starting to feel the oncoming heat of the day. When I reached the heavy Embassy doors, I braced myself for the blast of cold air. Usually it’s a welcome change, but mornings (and evenings) here are just perfect weather. Only in the morning and the evening do I remember that I’m in the Caribbean, practically next door to beautiful beach resorts. It’s pretty easy to forget, here.

The Embassy is beautiful, with a big open area reaching up through the whole building, and a café on the ground floor. The walls are white, with red wood accents, and big colorful artwork on the walls. Each morning I walk up the stairs and into our “fishbowl” of an office (a converted training room). The air conditioning, the fishbowl windows, and the PCs make it feel a bit like MIT, which is good for productivity but perhaps less so for context. We can watch people walking by – it’s a random selection of army personnel in camo, well-dressed regular embassy staff, USAID in their matching khaki polos, and random others like us in boots and t-shirts. We have access to a large-format printer, so we have maps all over the walls and the slides from a briefing tacked across the windows with scotch tape. Our tents don’t really keep the rain out, so most of us have left our luggage against the walls or under the tables in the office. We also have a box of water bottles and a couple boxes of MREs. It’s getting a little crowded.

At 11am, we headed over to the UN Log Base for the assessments working group. The UN base is an adventure of a different sort. You enter down a long road with two checkpoints, where they check vaguely whether you have some sort of official-looking badge (twice for extra security) and then wave you on. Most of the action (for us, anyway) is over by the exit, where the UNICEF and WFP offices are. We headed in that direction, grabbed our laptops and notebooks, and went to find the meeting area. We were directed to a large tent with sides of netting, a floor of wooden boards, and a random selection of folding chairs. It was hot. We all fanned ourselves with whatever paper we had on hand and waited for the meeting to start. We heard from four different groups conducting assessments. At the embassy, we can meet over laptops around a table. In this tent, we had no table (not for such a big group, anyway). When someone wanted to present something, there were two options. IOM dumped a big poster-size map on the floor in the middle of our circle of chairs, and we all peered down at it. WFP passed around several paper copies of maps and reports for us to look at. And it worked just fine. The UN base has such a different feel from the embassy. No US Army, and people from everywhere, dressed every which way. As Jarrod wrote earlier, all the work is done either in big tents or tiny pre-fabs, with struggling air conditioners and folding chairs and three people crammed in a tiny space. And it works! We went to the UN restaurant for lunch (burgers!). It’s open air but with a roof and shade over half of the tables. You wait in a line to order your drinks (first), then your food (second) and pay (third). The order, apparently, is very important, as I was informed on my first visit. They hand you a slip of paper, and you take it over to the proper station. A grill for burgers and a kitchen for everything else. You hand it to someone and eventually your food materializes. Despite the heat, it’s a nice place to recharge.

After lunch, we piled into the car for the third location of the day – the Digicel building downtown. Dr. Louise Ivers has office space there. The drive was sobering, since the destruction is much greater in the downtown area. There are lots of buildings leaning at crazy angles, and more that look more like dust with chunks of cinderblocks. But the one that sticks with me the most was a building where the walls had collapsed and the floors had simply collapsed on one another, looking like a stack of pancakes. It’s too easy to imagine what happened there.

The Digicel building is tall, at least ten stories, made of glass and metal. It stands alone, taller than anything else around, in the middle of a big parking lot with a high wall around it. We walked in and the guard told us to head up to the seventh floor. The elevators had red “danger” tape across them, so we took the stairs. The floor tiles had red ‘x’s marked all over them, there were cracks on the walls, and there were people working on most of the floors. We joked about what the red x’s might mean, but at every floor we could look out and see all the collapsed buildings around us. Definitely didn’t instill much confidence as we climbed to the middle of a tall building. The earthquake was suddenly a bit more real. Digicel is a major cell phone company here, and its offices are nice – cubicles like anywhere in America. But it was ghostly quiet, just a few people in a giant empty space. Our meeting was in one of the wall offices. We met Dr. Ivers, and went over plans for the questionnaire.

We stopped at the UN base on our way back, to get ideas for our assessment methodology from WFP, then headed back to the Embassy. We had dinner with the Colonel in charge of our project, at a restaurant across from the Embassy. The food was extremely slow in arriving, and after at least half an hour they returned to say they did not have “lambi” and would we accept something else. It took them half an hour to realize this? Someone tried to ask for a free beer in compensation but apparently, they didn’t understand (or did they really…?). But the conversation was good, the beer had arrived, and the weather was perfect (the table was outside) so the time passed quickly. Everyone eventually received their orders, mostly meat-or-fish-or-shelfish in “sauce creole” with “bananes”, or fried plantains, and rice. After dinner, we made the short walk back to the Embassy and into our air-conditioned, tiled and carpeted home away from home.

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Glowing

By Dr. Jarrod Goentzel

We returned to the restaurant at the UN Logistics Base for dinner last night.  There is something nice about relaxing with people from different organizations all playing distinct roles in the effort here. Tonight my eye kept wandering to a guy sitting alone with his computer at the table next to us in my line of site.  Fair skinned with a scraggly beard and tussled hair, he looked to be in his mid-30s.  Staring deeply into his computer, he caught my eye when he suddenly leaned forward and stuck his tongue out and smiled.  He then bobbed side to side and smiled again.  Clearly the wifi signal was strong enough for him to have a skype video connection with his kid(s) back home.  And the glow of the computer screen on his face under the starry sky of the open air restaurant matched the glowing expression on his face.

As a father of two boys, ages 5 and 1, I can completely understand making silly gestures at a computer screen.  And it made me really miss my own wife and boys.  It also added a deeper level of respect that I have for these aid workers and soldiers toiling for weeks on end while their families are far away.

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Haitian Standard Time

By Dr. Jarrod Goentzel

Port-au-Prince, Haiti – I arrived in Port au Prince today on a 2 hour flight using a large plane typically allocated to a lucrative international route.  Maybe it is a way for the airline to utilize its fleet during the offseason for European travel.  But I would like to think that it is due to the increased demand for people wanting to come help in the recovery effort.  Perhaps the airport still has limited landing slots due to the single taxiway from the runway to the tarmac (one key bottleneck in supply for the initial response) and they need to use larger jets to accommodate all the passengers.  Indeed, the plane was full of a wide variety of passengers, some wearing suits and some wearing matching T-Shirts to identify their service project.

After an afternoon of settling in to the tent and doing a little work, we went to dinner at the UN logistics base.  The former MINUSTAH training facilities, located adjacent to the airport, have been supplemented by myriad prefabs each with a tiny air conditioner and several UN workers crammed inside.  UNICEF set up several large tents with tables of PCs set up in rows.  Other tents have a circle of chairs for coordination meetings.  There is no central map to guide you and many of the prefabs are labeled simply with an 8.5×11 sheet of paper stating its functional but critical role like “WFP LOGISTICS” in Arial 32pt font.

A hub in this vast compound is an open air restaurant on the second floor of a building with a grill and deep fryer.  They mix a few local specials with comfort food and fries.  The place seems to be a respite of relaxation after a day laboring away at a computer screen in your prefab, yet short of a festive environment that I might have expected on a Saturday night. Then I realized that while I had traveled in on the first day of my weekend, there is no weeks end to the work here.  The needs do not wait to conform to a five day workweek.  The US set its clocks forward last night for Daylight Savings and Haiti stayed on Standard Time.  But there is nothing “standard” about the time many people are laboring here.

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Meet Team Boston

The MIT Haiti Data Project Team is now officially known as Team Boston.  We had a bit of trouble coming up with a name (“What’s in a name? That which we call a rose/By any other name would smell as sweet.” — Romeo and Juliet, II, ii, 1-2), debating between college names, colors, and Creole words — but then we decided to settle on a geographical name to indicate where our work is coming from as well as to recognize all the people from the Boston area who are volunteering their time to work on this project.

As mentioned in the Haiti Data Project post, the core of the team consists of 3 advisers and 8 students. We would like to introduce ourselves a bit more, and following are a few words from each of the students explaining our background and motivation for joining the project:

Jason Andrews

I am focusing my time at Fletcher on humanitarian studies with a special interest in disaster management.  I have also begun constructing my thesis, which is looking at ways humanitarian agencies can decrease the 72 hour response time by using tech such as remote sensing, improved organizational structure, and perhaps (with your guidance) improvements in the supply chain structure.

My other activities aside from my classes include involvement in the Ushahidi team at Fletcher and a Disaster Assistance Team member for the Boston Red Cross. However, these activities are not that time consuming and are very flexible, which will allow for the MIT project to be my first priority.

Keith Berkoben

Received a Bachelor of Science in Engineering Sciences (biomedical), Harvard ’04 (thesis: “An interactive wireless teaching solution”), after which he worked for 5 years at a start-up developing IT systems for home monitoring of chronically ill patients.  Over the past two years he have become involved in international development, particularly related to technology training and utilization at the local level.  During these two years making two trips to Afghanistan to seed the deployment of a community wireless network and train locals to extend it.  This network continues to grow.

Why this project?

With over 900 organizations involved in the aid response, efficient communication is an imperative.  Keith aims to examine inter-agency communication in the crisis response, and learn how it could be improved.  What is the role of IT in modern crisis response?  Can we coordinate in the cloud?  Keith hopes to include his work on this project as a component of his masters’ thesis.

Rahul Kar

I am a mechanical engineer by profession currently researching technology transitions in the aviation industry to reduce emissions. I use System Dynamics in my research and wanted to volunteer my experience with SD for this project. I hope to help the team in whatever little way possible in that regard. Emergency response is new territory for me.

Emily Keane

I’m a first year Fletcher student focusing in humanitarian assistance and public & NGO management. I’m also currently interning for The Boston Consortium on Gender, Security, and Human Rights researching the gender implications of disarmament, demobilization, and reintegration on women in post-conflict settings. Before Fletcher I worked in international development and public health, with a focus on reproductive health and was a Peace Corps volunteer in Madagascar. I volunteered to be on this team because it matches my academic and professional interests in management of humanitarian aid delivery. I’m extremely interested in analyzing how current systems and structures affect aid distribution.

Marlon Roberts

I am currently an MBA candidate at the MIT Sloan School of Management. In my prior work, I was an algorithm developer for a defense contractor, focusing mainly on computer vision algorithms for unattended ground sensors. At MIT Sloan, I have performed project work in several of my classes, and plan to eventually transition into a role as a consultant.

I volunteered to join this team for multiple reasons. This project tackles a major problem and would give me an opportunity to:

* Leverage my background in data mining

* Participate on a project in the Caribbean, a region I led a series of MIT Sloan consulting projects to in March 2009.

Adrian Rodriguez

I am a second year technology and policy masters student with a research focus on corporate social responsibility. Prior to coming to MIT, I worked at IBM in Research Triangle Park, NC on server virtualization and cloud computing. My background is in Computer Engineering, with a degree from the University of Miami. I’m originally from Miami, FL and would like to contribute my technical skills to data assessment.

An Vu

I am a graduate student pursuing a dual degree in Technology and Policy (TPP) and Nuclear Engineering.  I spent the first half of the life in France and the other half in Texas.  Growing up, I spoke French (which I hope will help me understand Creole somewhat…) and Vietnamese, and then I learned English when I moved to the US.  My love of learning languages led me to study Spanish as well.  I joined this project for two main reasons:

1) The needs in Haiti are urgent.  The results of this project can benefit thousands of people, and though the task may be daunting, I want to help in the best way I can — and as an engineer, that means data analysis.

2) From my project in G-Lab: Global Health Delivery, one main problem I tackled was the lack of assessment of the delivery of necessary – often life-saving – goods in humanitarian organizations. I hope to apply the knowledge and skills I learned from my experience in G-Lab towards this project.

Ashley Zohn

I’m a dual degree MIT Sloan/Harvard Kennedy School MBA/MPA.  I have a background in emergency preparedness and disaster management from working in Disaster Planning and Preparedness at the American Red Cross of Massachusetts Bay and at the State of Florida Division of Emergency Management.  I volunteer for the team for two main reasons.  First, I had been seeking a way to help with the relief effort in Haiti.  Second, after learning about the project, I feel as though it will be very useful for my professional development to see how the skills I’m learning in school apply directly to the field.

Meeting Dr. Marc Zissman

We had our first meeting with our project leader and main contact in Haiti, Dr. Marc Zissman on March 3, 2010.  From the discussion with him, our team was able to gain a better understanding of the goal and the scope of our project. As the Joint Task Force (JTF) rolls out the survey to determine the supply needs in Haiti, Dr. Zissman hopes that as our team “comes in without a horse in the race”, we will be able to assess the data about the supply and needs in Haiti with a fresh outlook and present the information in way that will be useful to key decision makers on the ground (i.e. U.S. generals).

Dr. Zissman raised the following key questions about the situation in Haiti:

  • How does the supply compare to need?
  • Where, when, and how should we best apply our limited resources?
  • What are the humanitarian needs of the earthquake victims? How are they changing vs. time and location?
  • Can a Common Operating Picture help achieve unity of effort in the absence of unity of command?
  • Is a DoD-enabled supply necessary?

Over 70 people are involved in this project, and Dr. Zissman pointed out a few key players, notably Dr. Louise Ivers who is heading the Partners in Health (PIH) efforts in Haiti and was described as “she is like Mother Theresa” in regards to all the amazing and selfless work she has done.  Read the article “‘I can’t sleep at night because of the things that I see” [http://harvardscience.harvard.edu/medicine-health/articles/louise-ivers-i-can-t-sleep-night-because-things-i-see-0] to learn more about Dr. Ivers. Dr. Zissman also highly praised the CDC Scientists (“these CDC people are the best”), who recently released a draft summary of the results from the Initial Rapid Assessment (IRA) in Haiti.

Dr. Zissman gave us quick tips on how to present to the U.S. military — particularly to generals who will be the main audience for the presentation of our data analysis.  When giving presentations, we should start with a BLUF — Bottom Line Up Front — slide where we lay out what we need/want/would most like to convey.  Generals only have time to look at one slide of information, so we have to make sure that whatever we put on the slide will be relevant and, most importantly, of interest.  Each general has a type of slide he likes to look at, and we should learn from previous presentations and talk to the people who usually brief the generals as to how the information should be presented to make the most impact.  Colonels have a bit more time and are able to look at longer documents (2-3 pages) or presentations with a few slides that include pictures and key bullet points.  Bottom line: present the information as clearly and concisely as possible. After all, time is money.

Defining Our Tasks and Deliverables

Our team met for a 2-hr long session to determine exactly what we aim to achieve.  Our 3 main goals are:

  • Examine conclusions that can be drawn from the data and create ways to present the data to key decision makers
  • Develop a system dynamics model to represent the major levels which describe the relief effort in Haiti
  • Analyze whether the data being collected is appropriate and sufficient for determining optimal resource allocation

Over the course of the project, we will provide a template that can be used to inform resource allocation decisions. This will include the following:

  • Dashboard – The dashboard will be used to present assessment findings to JTF-HAITI, USSOUTHCOM, JCS (Joint Chiefs of Staff), and UN leadership.
  • System Dynamics Model – The model will take the form of a conventional software package such as VENSIM
  • White Papers – The White Papers will cover issues related to Food, WASH (Water, Sanitation & Hygiene), Shelter and Health in Haiti
  • Project Report – The report will detail our project findings

Each member on our team was assigned a specific task, and the focus at the moment is to finish updating the White Papers.  Starting on Monday, data from the new survey is expected to “flow in en masse” (quote from Dr. Zissman), and our data team is ready to get to work!

Rain

It has been raining continuously in Boston over the past 2 days, and our thoughts are invariably turned to Haiti and the prospect of the rainy season.  Haiti’s rainy season could start as early as this month and is expected to peak in May; hence providing adequate shelter for all the people who have lost their homes in the earthquake has been an urgent priority. Reports indicate that an estimated 1.3 million people have rendered homeless, and about half have received “emergency shelter materials” such as tarpaulins, tents, ropes, timber, and toolkits.  The need for shelter cannot be stressed enough, as seen from the testimony of a woman in Haiti:

Andreanes Theodore lost her husband in the earthquake and now lives in La Piste with her children aged 2, 6, 7 and 8. She said: “We couldn’t sleep at night when it rained. We would be awake the whole night, just waiting for the sun to come up. Now the Red Cross has given us sheeting we slept well last night, even though it rained.”

– British Red Cross, Race to give shelter to Haiti’s homeless reaches halfway, 12 March 2010

Yet these emergency shelters will not be enough once the hurricane season arrives in the summer.  As of now, it is unclear what exactly is being done to prepare for the hurricane season, especially since half of the people homeless in Haiti still do not have any sort of shelter. However, the shelter concerns have been in the forefront of everybody’s mind…  As we in Boston listen to the rain pounding against our glass windows, we can only begin to fathom the disaster that will occur as hurricanes hit Haiti this summer… (If anyone wants to join in an anti-rain-dance to ward off the hurricanes, please leave a comment!)

Red Cross Progress Report

Yesterday (March 12, 2010), the American Red Cross released a two-month progress report on the aid efforts in Haiti.  Some of the Red Cross actions include “spending or allocating $106.4 million […] and providing relief items for 400,000 people.”  You can read the detailed report on the American Red Cross website here.

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