Case study: Determinants of health—Recovery

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Headshot of Joanna Breems, MD, FACP · Clinical Assistant Professor
Joanna Breems
MD, FACP · Clinical Assistant Professor
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After recovering from a bio-prosthetic valve replacement, Jean Baptiste returns to rural Haiti.  ​

Doug and Sandy are grateful for your assistance. They ask you to travel with them for a one-week trip to Bon Samaritain, Haiti, where Jean Baptiste lives with his parents. You decide to go with them on the trip.   ​

Doug and Sandy have already received $100,000 in donations to be used to improve the health of people living in the region of Bon Samaritain. 

Before your trip, you read up a bit on Haiti.
Villages are shown as small dots. Jean Baptiste lives in one of the villages denoted as a green dot, about 2–3 hours' walk one way to the health center, where there are few resources, and many are outdated or non-functional.​
People living in rural Haiti are disadvantaged on multiple levels:
Typically there is no running water, electricity, toilets, no paved roads, emergency services, or basic health care such as safe childbirth or treatment for malaria.
The vast majority of people in Bon Samaritain
have no access to health care services. Very few people can access the one existing health center because of its location along the coast. For those who can access the health center, not much can be said about quality of care they receive because no one is measuring or evaluating this.
Financing of health services is very challenging
because the population is extremely poor and the government salary support for the six nurses and one Haitian physician is unreliable due to governmental mismanagement. This, in turn, affects the health center’s ability to purchase supplies and medications. Public health efforts are absent in this area.  

questions

The Regional Health Director for Bon Samaritain has presented your group with three health initiatives that he believes would be beneficial to the Region of Bon Samaritain. Which would you choose? Tap on each of the choices below to learn more details.

$100,000 will fund: Building a new (unfurnished) clinic up in the mountains near Jean’s village to provide an access point to those without any health care access.

$100,000 will fund: Starting vaccinations and high-dose Vitamin A with deworming campaigns to reach about 10,000 children throughout the whole region for the next five years. 

CHWs can also provide health education in the villages. 

While in some contexts, trained CHWs can treat some diseases, they will not be able to provide treatment in Bon Samaritan due to lack of funds for ongoing training.

$100,000 will fund: Undertaking a well-drilling effort to establish 10 groundwater wells throughout the region. 

Bon Samaritan is considered severely water deprived, and diarrhea is the #2 cause of child death (ages 1–5 years). 

What are your other ideas?

Return to Jean Baptiste's diagnosis

Continue to the next section (Cultural Determinants of Health)