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SANJAY GUPTA MD
How Haiti Recovers; Health Care Shuffle in Washington
Aired January 30, 2010 - 07:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, HOST: I'm Dr. Sanjay Gupta in Port-au-Prince, Haiti. We've been here for nearly three weeks and really looking at the challenges that still lie ahead.
Are there actually too many doctors at some of these hospitals and how will the doctors be distributed around the city and around the country? Organization is going to be key here.
Also, Christiane Amanpour is going to be my guest today. We're going to talk about how Haiti could possibly look going forward, and what's going to be needed to get there.
And finally, we met these two guys. Their twins, general surgeons and they are Haitians. They never left and they're making a huge difference.
You're watching SGMD.
GUPTA: And we are joined now by Christiane Amanpour.
First of all, thank you for being on the show. Great honor for me.
We've been talking a lot these past couple of weeks about what has happened here in Haiti and the lack of infrastructure. You know, I've been focusing on medical stuff. Hospitals were destroyed. And also, so many medical schools were destroyed as well.
Before this all happened even, it had one of the lowest physician-to- patient ratios in the country -- in the world. And people keep asking me, what is Haiti going to look like?
And I don't know the answer to that question. I mean, is it possible to rebuild?
CHRISTIANE AMANPOUR, CNN CHIEF INTERNATIONAL CORRESPONDENT: I believe so. And I think that this is a unique moment, because this earthquake, this disaster has so captured the world's imagination.
We're now hearing language from leaders that I do not remember hearing for years and years. In fact, quite the reverse -- we're hearing nation building. We're hearing long-term development. We're hearing Marshall Plan even. Which means that, hopefully, there's a real focus, a real concentration, a serious look at how to move this country forward. And there are pillars of an economy here that could be used to move it forward and to have it stand on their own two feet. They are rich in agriculture, or they could be, and tropical fruit. They are rich in the potential for tourism. They are rich in high of quality, low-wage workforce, particularly in the garment industry.
And over the last year or so, they've had this special U.S. legislation, which allows quota-free, duty-free imports from Haiti into the United States. This is huge. And it had begun to turn around before the earthquake struck.
GUPTA: This is a beautiful place. You know, just driving around. And, obviously, the other part of this island is Dominican Republic, which is a place that focuses on tourism quite a bit. Why has Haiti found itself in this position?
AMANPOUR: A lot of it has been leadership. It's true that in the Dominican Republic, they had military leadership for a long time, but they spent 30 years after that standing up governance, standing up the economy, standing up infrastructure. And so, today, they have a really thriving economy, plus a thriving tourist industry compared to this one, which is minuscule compared to it.
Here, the poverty has forced people to denude their land. They have simply cut down the forest. Why? Because they cook with charcoal. Why is that? Because they haven't been taught how to cook with something else.
I was told by an official here that they had a pilot program on how to cook with kerosene. In the Dominican Republic, people cook with kerosene and not charcoal. They don't cut down their forest just for basic cooking.
Here it was moving. They were educating people how to do that and then the funding dried up.
So these are the things that people have to look at: how to fund a reeducation process as well as a massive reconstruction process.
The prime minister here told me that it would take four years just to get Haiti back to where it was an hour before the earthquake struck.
GUPTA: Which wasn't in a very good place.
GUPTA: As you've been reporting all week, what -- I don't know how to ask this -- but what is the obligation of the United States or other countries to be doing all this? You said Marshall Plan.
AMANPOUR: Well, you know, Sanjay, you work in the field of human endeavor and you work in the field of human health. There is a massive injustice, a massive global injustice to having the world's richest nation sit on the doorstep of the world's poorest. And whether it's for moral reasons or pragmatic reasons, I think many are beginning to accept that the United States and the rest of the global community have a responsibility here. Pragmatic by that, I mean so that they don't have untold numbers of aliens, illegal aliens who want to get to the United States.
So, stand this country up. The Obama administration has been working for the last year to try to do that. President Clinton, the former president, has been -- having a huge role in trying to get it up in terms of commerce, economy, and infrastructure.
There is potential here. If you look at the United Nations statistics, you can see all the indicators showing progress over the last several years, just before this earthquake struck. So, there was hope on the horizon. And one more time, it's been dashed by natural disaster.
GUPTA: Hurricanes last year, earthquake this year, the threat of hurricanes again this year. In India, you know, I'm Indian, people talk a lot about brain drain. People leaving the country and going to other countries, like the United States or Britain. If you have a lot of international aid and you don't allow Haiti to sort of develop on its own, could that be a problem? Could international aid...
AMANPOUR: It's a big problem. The whole poverty trap is about drowning in international aid. Without long-term development -- look, nation-building is not sexy. It's not like rubble rescues. It's not like air lifts. The press isn't there for nation-building.
But if you go back to post-World War II and you pull out the speech that George Marshall made that led to the rebuilding of Germany, to the rebuilding of Europe. He created -- the United States created a stable, strong, and peaceful Europe that exists to this day as an engine and as something that is not a threat to the rest of the world, as it was before the war.
This is the model. And I think leaders today have to decide: are they going to keep throwing good money after bad in just intermittent disaster focus? Or whether it's Afghanistan, whether it's Yemen, whether it's Haiti, are they going to take the bull by the horns and really invest in something that will stand -- that will enable them to stand on their own two feet. And that's what the Haitians want more than anything.
GUPTA: Fascinating questions. I learn something every time I get a chance to talk to you. Thanks so much.
AMANPOUR: Thank you.
GUPTA: Appreciate it.
Much more on the show coming up. This is something that surprised me. There may actually be too many doctors in some of the hospitals in Port-au-Prince. What is going on? What is the plan for those doctors?
And also, the president did talk about health care reform, or was it health insurance reform in the State of the Union? We're going to dive into that as well. Stay with the program.
GUPTA: You're looking at some of the most remarkable images we've seen here in Haiti.
This is a 16-year-old girl who was trapped for 15 days under the rubble. Rescuers say she was very dehydrated. She was very weak. But she's very much alive -- a remarkable story of survival.
And it got us thinking, how do people survive after incidents like this? As you might imagine, there are some things that can limit that. First of all, you have to have access to air. People who are trapped in areas where they don't have any access to the outside, they can't survive more than a few hours. In fact, some of these rescuers walking around with CO2 monitors, actually measuring CO2, carbon dioxide, to see if there's any evidence of life, any evidence of breathing.
Water comes next. People don't agree on exactly how long you can go without water, but certainly, 15 days is too long. This 16-year-old girl probably had access to some water.
And take a look at this woman. This is a woman I met when I was in Pakistan a few years ago. I am told that she may be the one of the longest known survivors in the world after a natural disaster. This was after the earthquake in Pakistan.
But she was trapped in her own home. She was able to move around, I understand, a little bit and had access to water from her kitchen, but she survived for 65 days. She weighed just about 24 kilograms or around 60 pounds when she was found.
That's how some of these stories of survival are going. And there are still some search and rescue teams out even today.
You know, as we look around Port-au-Prince and look at all these things that went right and went wrong, we know that in the beginning, there simply weren't enough doctors or nurses or medical supplies. But now, a couple of weeks later, in fact, in some places, there may be too many doctors at some hospitals.
How should those doctors be organized, how should they be coordinated, and what should they be doing for the rest of the city and for the rest of the country? Take a look.
GUPTA: We're in the lobby here at general hospital. And one of the things that you'll notice right away, I'll notice, is that things are definitely better here than they were even just a couple of days ago, lots of different equipment here. Gloves -- they didn't even have gloves to perform some of these operations here just a couple of days ago. All kinds of suture. One thing that's worth pointing out though, even in the midst of all this, they still have instruments like this. That's a Black and Decker drill. That's what they have to use to be able to perform these operations to actually put the pins into the legs.
So, it's by no means perfect. But if you look around here and take a look at all the operations that are going on, this is better than it was three days ago.
But here's something I didn't expect. They actually think there may be too many doctors. Doctors stepping over one another, lack of organization, people watching what's happening and come flooding down into an area like this.
We're about to go into this meeting, where they're actually getting all the chiefs in the various departments together to try and coordinate this, so they can try to be as efficient as possible.
UNIDENTIFIED MALE: I think all of the groups are well-staffed. The issue is coordinating the staffs...
UNIDENTIFIED FEMALE: And coordinating...
UNIDENTIFIED MALE: ... so they're not repeating or overlapping.
UNIDENTIFIED FEMALE: Yes.
GUPTA (voice-over): So that means some of these doctors may be sent to other hospitals, where they are short surgeons.
UNIDENTIFIED MALE: First in the area where we think all the sick patients are, and then have a way to go through, sweep the campus once a day and look for patients who are sick.
GUPTA (on camera): If you're even curious how they set up an operating theater or a whole system in the middle of an earthquake, you're looking at it over here. Literally writing on the wall. Here's OR1, here's OR2, there's the triage area, they got post-op over here and here, pre-op areas over here.
They actually separated this by the Haitian doctors, the native doctors (INAUDIBLE) Mt. Sinai over, the Swiss operating over here. That's how it works. Lots of maps, lots of coordination going on.
But one thing I want to point out and I think this is really important. We are still talking about Port-au-Prince, which is over here. We now know that so much -- there's been a lot of impact in other areas as well, such as Leogane. And the plan now is to start taking some of those medical capabilities and moving to some of the outlying areas.
GUPTA: You know, so many of you have emailed here at the show, asking how you can help and it's been a remarkable outpouring. I can tell you, having been on the ground for nearly three weeks now, that in some places, there certainly are too many doctors, for example, the general hospital here in Port-au-Prince. But in other places, there's still not enough. If you leave Port-au-Prince and go into some of the other areas that were hit hard by this earthquake, they haven't seen enough medical infrastructure as of yet. And really, in all places, there's still not enough nurses, the real workforces of any hospital, both for acute nursing care and chronic nursing care.
Think about the rehabilitation that's going into taking care of so many amputees, not to mention the prosthetics as well. These are going to be some of the challenges in the months ahead.
I could tell you that if you are thinking about coming down, as so many people are, you may want to think about whether that trip should be in a month or even a couple of months from now. The need is going to be just as great.
But thanks again for all of those e-mails. We're reading them and hopefully getting back to you as well.
Back home, obviously, a lot of discussion about health care reform. The president discussed it straight on in the State of the Union address. But is Congress listening? What's going to happen in the next several days and weeks?
We'll take a look at these brothers. They're heroes. They really are. The Bitar brothers, general surgeons who stayed and stayed open for business literally after this earthquake struck. We're going to take a look at the impact that they're making.
Stay with the show.
GUPTA: Welcome back to SGMD.
If you watched the State of the Union this past week, you know that President Obama reaffirmed his commitment to health care reform. But what does that really mean? And do these stalled bills in Congress really have a chance of gaining some momentum?
For that, we turn to senior White House correspondent, Ed Henry -- Ed.
ED HENRY, CNN SR. WHITE HOUSE CORRESPONDENT: Sanjay, you're absolutely right. The president reaffirmed his commitment in that State of the Union address to get a health care bill done. He was very candid about saying he had made some political miscalculations, that he's got to do a better job of explaining this debate to the American people, and he vowed he's not going to quit this effort to get a bill done this year, before those midterm elections.
But the problem is: he never got specific in that speech about how he's going to get it done. And that's simply because there's no easy path right now to get it through Capitol Hill, especially after that special election victory of Republican Scott Brown in Massachusetts that broke the supermajority that Democrats had in the Senate.
First of all, there's very little appetite among House Democrats to pass the Senate legislation. They're upset about the fact that it doesn't have a public option. They're upset that it has a tax on those so-called "Cadillac" plans. They're worried that's going to affect labor unions in particular.
Secondly, the other path the president could take is using this little-known budget device known as reconciliation to kind of jam it through the Senate with a simple majority instead of a supermajority. But conservative Democrats in the Senate are coming out now saying, they don't think that's the right way to go. That it could look like a power grab.
And I've gotten some inside information about a conference call that the White House had the day after the State of the Union with some advocates of health reform. I'm told that senior White House officials were very optimistic, insisting -- look, this effort is basically on the two-yard line, and it's closer to getting into the end zone than seven previous presidents ever got, and they believe they're still going to get it done.
But I'm told that on this call, one of the reform advocates said, look, allies of the White House are getting extremely nervous that the president's redoubling of his efforts in this speech to focus on jobs and the economy, and essentially put health care on the backburner is really going to stunt any momentum on health reform that the Democrats had just weeks ago before that special election.
And so, I think right now, the prospects for health reform are in pretty rough shape -- Sanjay.
GUPTA: All right, thanks.
You know, we're really dedicated to this issue here on SGMD. Health care, what it means to you, and what's going to happen with all this. Next week, we're going to convene a roundtable to really dive into this topic and hopefully present things in a way that maybe you've never heard before, in plain English. We're dedicated to this.
We're staying in Haiti, next, though, and talking about something that I've felt myself many times over the past couple of weeks, aftershocks, more than 50 of them in the nearly three weeks that we've been here. What is the emotional toll on people who are still living outside and what does it mean for them in the months ahead?
Stay with the program.
GUPTA: You're looking at the images that are playing out again and again, in the minds of Haitian people. There are images that are tough to look at and leaving a lot of people sort of searching for answers and searching for solutions as well. We focus a lot on physical injuries but what of the emotional injuries that are opened up again and again?
GUPTA (voice-over): Rumor of a big wave sends thousands running to higher ground. Many of them leaving behind the only possessions they recovered after the quake. These injured survivors beg doctors to leave them outside. They're too frightened to be inside.
DAVID WALTON, PARTNERS IN HEALTH: The Army Corps of Engineer has been here three times and has cleared several of these buildings. But every time there's an aftershock, all of our sick patients run outside. You know, there's so much trauma, both psychological and physical, no one wants to stay inside and patients refuse to go into any buildings.
GUPTA (on camera): And here's a good example of exactly what we're talking about. This is a standing house but there's nobody living inside. It is hard to over-estimate the impact of all of these aftershocks on someone's psyche. They're so frightened. They don't want to be in there. They're worried that their house could come tumbling down.
So instead, they live like this. They live in these tents, makeshift tents because they simply want to be outside and they think it's safe.
How scared were you?
UNIDENTIFIED MALE: "Very scared."
GUPTA: It's been around two weeks now since the earthquake. Are you still scared?
UNIDENTIFIED FEMALE: Yes, because from time to time they strike again, and I'm very stressed and my heart is beating.
GUPTA (voice-over): She says there's no one to help and she has nightmares of another quake.
(on camera): How many people like you are there? I mean, how many people in Port-au-Prince are going through what you're going through?
UNIDENTIFIED MALE: Most of the people.
GUPTA: It is difficult to diagnose post-traumatic stress disorder less than a month after the quake, but we do know a few things. First of all, it is worse in people who have some sort of pre-existing mental illness. People who have endured the most trauma, or seen the most horrific images, best advice to them, try and be with family and also, turn to your faith if you can.
It is difficult, even the churches have been destroyed. (voice-over): So, what does work? Access to the basic necessities again -- clean water, food, and even what might be considered perks, pillows, blankets, some sort of routine. No doubt, all of this is tough, and it is dangerous to generalize. But there is also some simple evidence that it can work.
Today, this young boy built a kite out of a paper plate. Despite the odds, he gets it flying, bringing a smile to his face and ours for just a moment.
GUPTA: You know, there are some clues as to how Haiti may progress over the next year. For example, if you look back at the tsunami, you get an idea of just how many people suffered from things like anxiety, severe depression, or post-traumatic stress.
But two thirds of people after the tsunami had one of those diagnoses. And I imagine the numbers are going to be very similar over here. So, it really speaks to the urge for psychological counseling, psychological intervention and probably a lot of that starting very soon.
There are people who are making an impact right now and here are two of them. They're twins, twin surgeons. And they stayed open for business after the earthquake trying to help people -- like this little girl -- and many, many others.
Stay with us.
GUPTA (voice-over): It doesn't take long to see the remarkable impact these two doctors are having here in Haiti.
Haitian surgeons, Jerry and Marlon Bitar. Yes, they're twins.
(on camera): So who's who?
You got the mole on the side.
UNIDENTIFIED MALE: Right.
GUPTA: So, that's the only difference?
(voice-over): To this community, they're also heroes. Why? Because when the earthquake hit, they stayed open for business.
(on camera): A lot of people left, or they want to leave because of how bad things have become. Do you want to leave?
MARLON BITAR, HAITIAN SURGEON: My answer is no way. No way, because it's my first time I feel the country really need us. And when we help, we forget the earthquake. GUPTA: How about you? Do you ever think about leaving?
JERRY BITAR, SURGEON: Negative.
GUPTA (voice-over): For more than two weeks, we went with them on their journey, tirelessly care for patient after patient, maxing out their hospital beds to care for those patients around the clock.
(on camera): One of the big challenges of operations like this is adequate pain control. As you can see, she's obviously having some pain. They're going to do an operation where they actually close the skin over where she had her amputation.
The medication there, that's all local pain medication to try and help, but it's tough.
How do you keep doing it? I mean, emotionally, it must be so hard, all the things that you've seen since the earthquake.
MARLON BITAR: It was very hard, hard. I think it was the end of the world.
GUPTA: Are you optimistic that Haiti can come out from something like this?
MARLON BITAR: That is why we're rear. We are very, very optimistic. I think it will be a bad thing or a good thing. We have to rebuild this country.
GUPTA: You think that's going to happen?
MARLON BITAR: Yes.
JERRY BITAR: Yes.
GUPTA: No doubt?
MARLON BITAR: No doubt.
JERRY BITAR: No, no. I think that we have to begin again.
GUPTA (voice-over): Now, running a clinic where all the patients are so sick and none of them can pay, well, it's not easy. On this day, they're trying to figure out how to make ends meet.
(on camera): You've had to take care of patients that can't pay you. It's been over two weeks now. How do -- how do you guys stay afloat? How can you pay your bills?
JERRY BITAR: It's my headache. And we're proud to have Haitian (ph) brothers, patient, family that have problem.
GUPTA: A lot of people are calling you guys "heroes." Are you heroes?
MARLON BITAR: We are heroes. Everybody in this country alive can be heroes, too, because everybody help.
GUPTA: Well, in many ways, they are reluctant heroes but heroes nonetheless and there are many of them down here. So many of the doctors and nurses and health care professionals have rushed down to Haiti, into Port-au-Prince, after seeing the images on television or hearing the stories. A lot of times, they were told that there wouldn't -- there won't be anything they could do. But they didn't take that as an answer, in fact, they made a huge impact on so many people's lives here and so many people are live today that otherwise wouldn't have been because of them.
And also the children around here, so resilient. I met this 15-day- old baby just a couple of days after being here. My wife pointed out to me that she has now lived more of her life as a quake survivor and has not (ph). The resilience that that child is going to develop as a result of what she's been through is remarkable and in many ways, inspiring.
CNN is committed to this. We're going to stay on the story. And you're going to see us here many times over the years to come, most likely.
But for now, I'm Dr. Sanjay Gupta, reporting to you from Port-au- Prince, Haiti.
More news on CNN starts right now.