Sixteen-year-old Florence was an orphan doing domestic work when the January 2010 earthquake hit Haiti. She moved with the family she worked for to a displacement camp, where her employer raped her. The rapist threatened to harm her even more if she told anyone, so she didn’t see a doctor. Besides, she didn’t have the money, the means, or the information she needed to get care. She discovered she was pregnant.

Months into her pregnancy, Florence decided to press charges. But the lack of a post-rape medical exam not only affected her health; it also prevented her from pursuing justice for this horrible crime.

In Haiti, the justice system relies on certificates from care practitioners after a post-rape examination as foundational evidence for prosecuting rape. Without this medical certificate, rape charges will not proceed successfully; and because significant numbers of rape victims cannot or do not seek medical attention following rape, many attackers are never charged or punished.

There are few instances in which the health and human rights of women and girls intersect in such an immediate way as after violence. Ending violence against women and girls, like that endured by Florence, is a public health imperative.

Sexual violence causes physical injury, disability, and even death. It can result in sexually transmitted disease, poor reproductive health, unwanted pregnancies, unsafe abortions, and depression. The public health community, including local and international health providers active in Haiti, needs to be prepared to handle the health and social consequences of violence against women, and to work to prevent this violence. Playing a role in successful prosecutions, including by issuing medical certificates after rape, is only one of many ways health professionals can take an active role in ending violence against women.

In Haiti, where I interviewed more than 120 women and girls about sexual violence and access to health care in 2010 and 2011, the government is doing little to inform the public about access to post-rape care, and few health providers are trained to address gender-based violence. Professional schools for doctors and nurses do not include instruction on treating gender-based violence as part of their core curricula or continuing learning programs. Doctors and nurses may not necessarily know how important medical certificates are for rape prosecutions. So even when girls like Florence are able to overcome obstacles in getting to a health facility, they may still not receive appropriate medical services, or the correctly completed medical certificate they need.

November 25 was the 30^th anniversary of the International Day for the Elimination of Violence Against Women. Over these 30 years, enormous gains have been made in some countries in passing laws against sexual and domestic violence and in developing guidelines for health providers to identify, treat, and refer victims of gender-based violence to appropriate services. In Haiti, these gains are just now starting to be made—slowly—with the criminalization of rape in 2005 and new legislation addressing violence against women being discussed.  But these gains mean little to women like Florence when the reality of seeking health services or justice is a far cry from the laws and guidelines.

Health professionals may not know that the women and girls they treat have experienced sexual violence and about the resulting trauma. Naomi, 25, didn’t tell anyone that a man had raped her, but she had an already-scheduled family planning appointment at a clinic shortly after. “I didn’t tell them I had been raped, because I was ashamed,” she told me.Unlike Florence, she had reached medical care—she was there in front of a health professional—and still Naomi slipped through the system.

Health professionals’ ability to recognize, treat, and work to prevent violence against women can have a significant impact on the human rights of women everywhere, and is especially critical in disaster or displacement situations with high risk of sexual violence, like Haiti.

In Haiti, and indeed in many other countries, public health authorities should take immediate steps to inform the public about where victims can go for post-rape care, as well as steps necessary for legal redress, such as obtaining medical certificates. Public health officials should work with medical and nursing schools to ensure that providers have proper training and the ability to recognize signs of violence if a patient is reluctant to speak.

Public health officials should also work with the many nongovernmental organizations operating in Haiti to make sure health professionals know what services are available for psychosocial support, legal assistance, or relocation to safe housing for women victims of violence. Without this, appropriate health care and legal redress will remain out of reach for women like Florence and Naomi.

_____________________________________________________________________________________________

Amanda Klasing is the Americas researcher for the Women’s Rights Division at Human Rights Watch and author of the organization’s report, “‘Nobody Remembers Us’: Failure to Protect Women’s and Girls’ Right to Health and Security in Post-Earthquake Haiti.”

For more information:

Human Rights Watch: ‘Nobody Remembers Us’: Failure to Protect Women’s and Girls’ Right to Health and Security in Post-Earthquake Haiti

The wealth of global response to Haiti’s January earthquake suggests a tremendous sense of global responsibility for a country whose current death toll is over 200,000. Now that Haiti is on the world’s central radar, how might those involved in rebuilding ensure that Haiti become a lasting center of global responsibility? That is, what’s the relationship between empathy for those affected by disaster and an engagement in transformation?

Certainly Haiti is in desperate need. Yet the discrepancy between the aid provided before 16:23 on Tuesday, January 12, 2010, and the outpouring of funds since then is hardly consistent with the constancy of need that Haiti has expressed for decades. Will Haiti remain a point of awareness for those who feel this recent increase in responsibility, or will it disappear back into the realm of public health experts and anthropology lectures at elite universities as it has so often before?

If a similar event struck even one American city — a hypothetical transformation in 12 hours, in which time all basic health indicators, poverty levels, and living conditions become identical to a portion of the population on the outskirts of Port-au-Prince in 2008 — gross national income per capita would drop US$43,000. Infant mortality would jump 857%. Three percent more people would have AIDS, and TB rates would increase by 1,344 %. Unimaginable? Yet even these changes would fail to convey the years that Haiti has lived as one of the most impoverished nations of the world. A history of discord and poverty has combined to create an unshakable stigma that shrouds any association with the country. With this comes outside prejudice, and from prejudice the extensive debilitating components of social suffering. An earthquake with a magnitude of 7.0 hitting the country’s capital city is only the tip of the iceberg. Haiti needs the world to extend a hand not only in the coming months, but the coming decades.

Psychological factors make it so easy for us to forget, and sometimes hard to empathize with, suffering. Perhaps by acknowledging our psychological default setting we can improve everyday awareness of global suffering and increase long term action.

There are two primary limitations to comprehending the suffering of others. The first is internal: we are naturally programmed to feel more sympathy towards individuals than groups. Several studies have been done tracking gross donation quantities based on the picture that accompanied a campaign. Those pictures with a single child staring with longing into the camera resulted in considerably more money than the simple addition of one more child to the picture. Human empathy is simply not hardwired to deal with numbers and vast areas of suffering. A death count of 105 seems not much different from 103, yet when a report states that two were dead, we care. Indeed it appears that the fewer the number, the easier it is for onlookers to develop collective empathy. The second limitation is that of language: there are many instances when a limited vocabulary cannot convey the intense emotion that accompanies a tragedy; and increasingly in the medical world, there is an absence of jargon to fully explain the subtleties of suffering. Reading of one’s suffering, in short, can limit our ability to fully comprehend its depths.

Of course, some possess a greater ability to empathize than others, and empathy measures are inevitably generalizations. But taking human nature into account and applying it to a sustainable support strategy could perhaps keep Haiti on the radar. As the world marches on in the coming months and years, it is important that we not only remember Haiti, but also that we actively fight against the natural processes that makes us forget.

For more opinion on this subject see: http://www.nytimes.com/2010/01/14/opinion/14thu1.html

http://www.washingtonpost.com/wp-dyn/content/article/2010/02/01/AR2010020103183.html

http://www.nytimes.com/2009/07/09/opinion/09kristof.html?_r=2

For the empathy study cited see: http://pluto.mscc.huji.ac.il/~msiritov/KogutRitovIdentified.pdf

For up to date info on Haiti see:
http://topics.nytimes.com/top/news/international/countriesandterritories/haiti/index.html?scp=3&sq=haiti%20death%20toll&st=cse

Graffiti from a wall in Haiti. Photo by Arlan Fuller, FXB Center for Health and Human Rights

Click here shortly before 8:00 pm to participate.

More information on the webcast from Stand With Haiti, the Partners In Health blog covering their work in Haiti, including earthquake relief efforts:

Join PIH physician Dr. Evan Lyon for a presentation on his recent trip to Haiti and a live Q&A.

Tuesday, February 16, 8:00 pm EST

Dr. Evan Lyon has been a volunteer physician with Partners In Health/Zanmi Lasante for over a decade. He participated in PIH’s initial response to the earthquake on January 12, 2010 — just over one month ago. Since that time, the official death toll has reached 230,000 and continues to climb. At least 1.5 million are out of their homes — many have migrated back to the countryside. Those who remain in and around Port-au-Prince occupy makeshift refugee centers.

Dr. Lyon will speak about his two weeks at the University General Hospital (HUEH) in Port-au-Prince where PIH has helped coordinate efforts to bring this — the largest hospital in Haiti and its only public teaching hospital — back into a functional facility. After a brief presentation, he will answer your questions about the progress of Partners In Health so far, and the challenges that lie ahead.

We encourage students and teachers of all levels to join the discussion. To submit questions before the presentation, please email sdhr@dartmouth.edu. You may also submit questions during the presentation, via the live chat window found next to the livestream video. When submitting a question, please state your name and your school or location.

Please join us for this special presentation by visiting this webpage at 8:00 pm EST on Tuesday, February 16.

Suggested background reading:

“Haiti: A Creditor, not a Debtor” by Naomi Klein
http://www.thenation.com/doc/20100301/klein

“‘Break Hearts Open’ in Haiti” by Evan Lyon:
http://english.aljazeera.net/focus/haitiearthquake/2010/02/20102272125725938.html

“Fault Lines: The Politics of Rebuilding in Haiti”
Video: http://tinyurl.com/ydz7z7p

A transcript of this segment can be found here.

Dr. Lyon was also interviewed yesterday on Here and Now.

Meanwhile, rescue operations continue at full speed — medical personnel, military forces, and other aid workers and peacekeepers have arrived in droves in Haiti over the past week. There has been bottleneck at the airport in terms of receiving and distributing goods, due mainly to capacity, security, and communications issues. The provision of surgical services, food, water, shelter, and medical supplies has been mobilized as quickly as possible; nothing seems efficient enough, though, considering the sheer size and immediacy of the demand.

Dr. Evan Lyon, a Partners In Health clinician currently in Haiti, executive editor of Health and Human Rights: An International Journal, and co-founder of the OpenForum blog, shares his experiences on the ground in Haiti. His communications have been published on the Partners In Health website, and we share his latest update below.

Click here to read more of Dr. Lyon’s experience in Haiti.

Click here to hear the January 16 “Radio Rounds” interview with Dr. Lyon.

[Editor’s Note: The following note from Dr. Lyon is reposted from the Partners In Health website.]

01/19/2010

Dr. Evan Lyon has been on the ground working at the general hospital in Port-au-Prince since Saturday [January 16]. He’s working with a partnership between PIH and the Haitian Ministry of Health to coordinate restoring services at the hospital.

For many years, PIH’s sister organization Zanmi Lasante (“Partners In Health” in Haitian Creole) has been one of the largest and most attractive training sites for graduating medical students. The majority of our doctors and nurses, pharmacists, and lab technicians, have trained at the general hospital in Port-au-Prince, Hôpital de l’Université d’état d’Haiti (HUEH). Until less than a decade ago, all doctors trained in Haiti graduated from the national medical school and received training at the general hospital. Zanmi Lasante has been honored to host many of the top graduates of the national university in their first year out of medical training for a year of social service. Zanmi Lasante’s finest medical staff are among these graduates, who are now leading Partners in Health’s efforts to respond to the disaster.

The general hospital sustained massive damage; at least 50 percent of the campus cannot be used. Many buildings are destroyed. All are cracked. Only some are safe to work in. The adjacent nursing school was completely destroyed–we are working in its in the dusty shadow, where the bodies of many, many second year nursing students remain trapped in the rubble. It will be weeks or months until the rubble is cleared. The smell of death is everywhere. Many of the dead are our sisters and brothers in health, who had worked alongside us to relieve suffering.

Today we worked to get the university hospital on its feet again.  Dr. Lassegue, the hospital’s director, and his staff are leading efforts to care for the injured.  Partners In Health is working closely with the hospital to provide care and to help organize relief efforts from international aid agencies from around the world.  Surgeons had been operating with daylight and flashlights but electricity is now restored. Seven operating rooms are now performing surgeries.  An estimated 1000 patients have already been assessed and are awaiting surgery on the campus. People are lying on mats on the ground, in shade where it can be found, under sheets strung from the trees.

Inpatient wards are coming together. We hope to increase to ten operating rooms in the next 48 hours, with 24-hour service now that the electricity has been restored. The hospital must stand again.

As I left the hospital compound this evening, I saw the lights of a large front-end loader working near the morgue. Three dump trucks were at the ready. Where thousands upon thousands of bodies had lain just days ago, only 40-50 bodies remained. Swollen, alone, pushed to the side of the pavement slippery with blood and body fluids.

As I walked past the morgue and the largest pile of bodies, I noticed that one was wearing a Zanmi Lasante t-shirt. I cannot begin to understand why this small detail made a scene of unspeakable sadness even sadder.

- Evan Lyon

A number of international aid efforts have already been mobilized. The US government, the US Coast Guard, the US Agency for International Development (USAID), and Haitian communities in the US have organized a range of support efforts. International aid agencies such as Oxfam, the International Red Cross, the British Red Cross, and Médecins Sans Frontières, among other agencies, have also announced their emergency assistance support. Haiti has recently been able to operationalize its airport to receive resources.

Boston-based Partners in Health has worked on health and development in Haiti for over two decades, and the organization has set up an emergency field hospital and has sent out various communications about the tumultuous event. Executive Director Ophelia Dahl writes, “In an urgent email from Port-au-Prince, Louise Ivers, our clinical director in Haiti, appealed for assistance from her colleagues in the Central Plateau: ‘Port-au-Prince is devastated, lot of deaths. SOS. SOS… Temporary field hospital by us at UNDP needs supplies, pain meds, bandages. Please help us.’” You can help Partners in Health and earthquake victims by making a contribution, as explained on the PIH website.

The US State Department has set up the following number for US citizens seeking information about family members in Haiti: 1-888-407-4747.

For the latest developments in Haiti, see the following news and information web links:

PIH Updates

US Department of State

ReliefWeb

BBC News

CNN International

Al Jazeera’s The Americas Blog

USA Today

Oxfam