ARI SHAPIRO, Host:
And now we return to Haiti, where people are just beginning to put their lives back together after the catastrophic earthquake there. Some banks and stores have reopened. People are searching for jobs and there is food for sale in some markets. Medical needs are just beginning to move beyond broken bones and amputations to more long term health issues. NPR's Joanne Silberner reports that there is some hope and a lot of work ahead.
JOANNE SILBERNER: Ron Waldman has seen a lot of human misery following disasters, but says Haiti's the worst he's seen. Waldman worked in Indonesia after the tsunami in 2004. He's worked in numerous refugee camps in places like Somalia.
He's the medical coordinator of the relief effort for the U.S. government and he got to Port-au-Prince last Saturday. There is some good news. People with crush injuries, with terrible bone fractures are finally getting care. But now, two and a half weeks after the quake, they need post-op care. Speaking by phone from Port-au-Prince, Waldman says that's a problem.
WALDMAN: The problem is that the surgical wards can discharge people in 10 or 50 or 100 per day, each day - but the postoperative care takes much longer.
SILBERNER: And there's no space at the busy hospitals. An Emergency Field Hospital run by the U.S. government sent several patients out for post-op care at local hospitals, only to see the patients come back. Wendy Batson says some who suffered simple bone fractures that didn't break the skin have been told to come back later. Batson heads the U.S. division of a nonprofit called Handicap International. It helps people with physical disabilities.
WENDY BATSON: We're not out of the woods yet, and the mobile teams who are working the neighborhoods are still finding people who clearly have the kinds of infections that require getting them into the medical care system, such as it is, as soon as possible.
SILBERNER: And many of those infections will likely end in amputation, as many have already. That's because untreated gangrene can kill a person in a day. Batson's group estimates that there will be 4,000 amputees in Haiti.
BATSON: I think we can help all 4,000. But I think it's going to be an enormous piece of work. So, nor do I think it's going to be fast.
SILBERNER: Prosthetic devices can't be used right away - the stump has to heal. They've been helping people with stretching exercises to keep the muscles working for the month or so before a temporary prosthesis can be used. And they've begun plans for a factory in Haiti, to manufacture prosthetics. The challenge, says Batson, there's no local health care system to support them.
BATSON: That, of course, is what's been so absolutely cruel about where this earthquake hit. Even in poor countries like Pakistan, there are backup medical systems within reach, and that there's just not in Haiti.
SILBERNER: New problems are going to show up in Haiti because people are crowding together in parks, in makeshift, roofless tents, says Ron Waldman.
WALDMAN: Obviously, accompanying those things is the threat of communicable diseases, particularly diarrheal diseases. Lack of shelter raises the risk of pneumonia. The aggregation of the population raises the risk of outbreaks of measles and other communicable diseases.
SILBERNER: But even before the quake hit, Haiti was struggling with two major infectious diseases: HIV and tuberculosis.
WALDMAN: My understanding is that the tuberculosis sanatorium, where there was obviously high concentration of cases, was destroyed. And I know that the penitentiary was destroyed, and that was another area where there were quite a few tuberculosis patients as well.
SILBERNER: There are some programs aimed at helping TB patients, but the patients are hard to find. As for the second disease, HIV/AIDS, there's some hope here. A partially destroyed clinic that was distributing antiretroviral drugs to 12,000 patients has managed to hang on. Jean Marc DeMatteus is with Gheskio clinic. He says they've been able to reach 80 percent of their HIV patients. Last week, outside what remains of the clinic, DeMatteus said now is a key time for action - not just distributing the drugs, but raising money.
JEAN MARC DEMATTEUS: We are well aware that in two months, three months, these kind of things tend to fade from the headlines. And we want to see if we can raise as much money now, so that three to four months from now, we can be really tackling the massive issues that we're going to need to be tackling.
SILBERNER: That is creating a health system in Haiti where there wasn't much of one before.
Joanne Silberner, NPR News.
SHAPIRO: At npr.org you can see an audio slide show about an Haitian-American doctor who is interested in Haiti's long-term challenges.