By Nyka Alexander

Nothing compares to the rhythm and energy of a work week at the PAHO/WHO representative office in post-earthquake Haiti. Even under ideal conditions, this office faced huge challenges in trying to meet the health needs of the Haitian population. Whether they were facilitating distribution of pharmaceuticals to distant hospitals, or providing technical guidance on nutrition, the staff of over 50 worked tirelessly to improve health conditions. Since the earthquake, the staff has expanded, incorporating health experts from around the world to help rebuild the health system. As each week begins, the PAHO/WHO team begin work with their counterparts at other agencies and within the Ministry of Health to help tackle the country's health problems.

Mario Voltaire speaks to Civil Defense officials tracking the arrival of donations at the port.


A key function of PAHO/WHO after the earthquake is deployment of specialists whose knowledge applies directly to disaster response. Two such specialists are Mario Voltaire and Victor Martinez. Their expertise is in SUMA - a software system developed by PAHO to help manage the distribution of goods received in an emergency situation. On a cloudless Monday morning, Mario and Victor are working to ensure information on supplies arriving from ports, airports, land crossings and warehouses is integrated and tracked using the SUMA system. "We do something nobody else does," says Victor. "We build local capacity to operate and control the country's own supplies." In the early days after the earthquake, before transportation systems were in place, the SUMA team would walk from the UN base to the airport several times a day, several kilometres each way, to ensure they were getting the most updated information at that point of entry. The SUMA system ensures accountability, transparency, and efficiency from response through recovery. 

Dr Dana van Alphen chairing the
Health Cluster meeting in port-au-Prince.


For the first month after the earthquake, the UN Health Cluster met every day to coordinate response activities. As post-disaster life became more routine in March, the Health Cluster held their meetings every Tuesday afternoon at the base that houses the United Nations Stabilization Mission in Haiti (MINUSTAH). As in most workplaces, this meeting was an important aspect of management and decision making for the PAHO/WHO office. However, unlike in most workplaces, the PAHO/WHO-led meeting is held in a large outdoor tent that frequently hums with the sound of passing helicopters. The passion and diverse personalities present at each cluster meeting also make it a particularly lively and engaging environment.

The meetings are structured to set priority needs, and to help all health responders coordinate activities and resources. The Health Cluster helps members answer questions such as which NGOs have ambulance capacity to spare or what health facility is accepting transfers of newborn babies with complications.

PAHO/WHO staff also participate in cluster meetings on other health-related issues such as water and sanitation, mental health, rehabilitation for the disabled, and gender-based violence. Similarly, meetings are held in Leogane and Jacmel, where PAHO/WHO has representatives coordinating the health response.

Sherley Pontius, PROMESS pharmacist, inspects
an order before releasing it to the client.

PROMESS covers 3,500 square meters, storing essential medicines for distribution across Haiti.

A family waits outside a clinic in a temporary settlement. Clinics such as this one report cases of potentially dangerous diseases.

Children watch as a Spanish Navy
helicopter takes off


The PAHO/WHO office was damaged in the earthquake, so staff have been moved into temporary structures on the grounds of the PROMESS warehouse. Established in 1992, PROMESS is the Programme for Essential Medicines, which PAHO/WHO supports. It provides essential medication to Haiti's public health institutions, not-for-profit private health care centres, and those run by non-governmental organizations. During office hours, orders are filled by a dedicated team of local and international pharmacists and warehouse workers. PROMESS played a prominent role immediately after the earthquake when it helped to re-establish the distribution of medicines to damaged health centres. It continues to organize and distribute  donated medicines.


On any given day, PAHO/WHO epidemiologists may be called to join a team investigating reports of illness in the temporary settlements of people displaced by the earthquake. A network of 52 sentinel sites report cases from a pre-defined list of diseases. Ranging from acute watery diarrhoea (potentially cholera) to suspected malaria and measles, these unusual diseases have the potential to spread rapidly. The team provides treatment to the patient and their family if necessary and takes samples for testing at the National Laboratory. The team always includes a member from PAHO/WHO and or the US Centers for Disease Control, Haiti's Ministry of Health, and the national laboratory and epidemiology department. Dr Mung is PAHO/WHO's epidemiologist who joins the team. In a typical week, they will investigate a dozen or so cases, sometimes more. Dr. Mung says training is an important part of the work, to ensure that the international doctors who have come in to support know how to identify diseases that may not be typical in their home country. 


One of the important functions of the PAHO/WHO Haiti office is to support the national vaccination program. This was suspended during the initial response to the earthquake, but is gradually getting up and running again. Some the first vaccination programs to be administered after the quake were in temporary settlements. Several international partners have joined in the effort, such as the Spanish Navy (or Armada) which has been instrumental in distributing vaccines to remote locations that cannot easily be reached overland. To pick up the vaccines, a helicopter lands in a field across the road from PROMESS. Three Spanish sailors jump out with their guns ready. They spread out around the helicopter creating a safe perimeter. The show of force seems incongruous in this quiet, sparsely populated part of town with only children as spectators. But it is explained that when the helicopter landed for the delivery the previous week, excited children came running, dangerously close to the swooping blades. 


Saturday provides the opportunity for a visit to remote areas. A helicopter is arranged through United Nations Humanitarian Air Service, and an itinerary is planned covering three locations in the north of the country: Port-de-Paix, Cap Haitien and Fort Liberté. The head of the PAHO/WHO office, Dr Henriette Chamouillet, is joined by several members of her team as well as the Minister of Health, Dr Alex Larsson. Staffers are eager to assess the response in the field, to meet their counterparts and to offer their support.

During the visit to hospitals in Port-de-Paix Christian Morales asks about the capacity of the generators. Often the capacity is too low to sustain services overnight, or to ensure the smooth running of equipment in the operating theatre. At a stop in Fort Liberté, pharmacist Sophie Laroche checks in with the clinic's pharmacist to see how the supplies are maintained or if there are any needs. She is impressed with how organized the dispensary is. "It is one of the best we have ever seen. This is not a rich clinic, but they manage well. We know that the donations they receive will be well used." PAHO/WHO subsequently supported the clinic with additional donations of medications, a paediatric consultation table and a birthing table.