Dietitians Help Deliver Disaster Relief in Haiti — A Special Interview With Ellen Boldon, RD
By Sharon Palmer, RD
Haiti’s devastating earthquake has captured the hearts of people worldwide. About 200,000 people have lost their lives and 700,000 people have been displaced in the Port-au-Prince metropolitan area, according to U.S. Agency for International Development figures. During a natural disaster of this magnitude, many healthcare professionals—dietitians among them—join relief efforts volunteering their services. It’s easy to understand why food and nutrition professionals need to step up; much of the basic need boils down to providing food and clean water for a multitude of needy people. Since the earthquake, the United Nations World Food Program (WFP) and partners have provided emergency food assistance to approximately 1.7 million people, including approximately 950,000 people through a 16-site distribution system. The WFP and nongovernmental organization (NGO) partners are also distributing food to areas outside Port-au-Prince, including orphanages, hospitals, and spontaneous settlements.
Today’s Dietitian touched based with Ellen Boldon, RD, nutritionist at St. Boniface Haiti Foundation, on February 7 to get a better idea of how dietitians are doing their part in Haiti.
TD: What were your professional responsibilities prior to the disaster?
EB: I've been in Haiti for almost two years as a volunteer for St. Boniface Haiti Foundation, a small NGO providing healthcare services in Fond des Blancs, a remote mountainous area. I am responsible for all of our nutrition programs. We have five community-based programs: recuperation of malnourished children, child malnutrition prevention, pregnant and lactating women, HIV/AIDS, and tuberculosis. Some of these programs require only my oversight of the ration distributions, but the recuperation program is being reassessed and a new curriculum developed. An adjunct program to give a high-protein cereal ration in addition to the regular ration has been established. We are making this product on site using corn and beans.
I'm responsible for overseeing the receipt and storage of our food donations and am accountable to our donors. I provide consultation for nutrition concerns in our hospital and am also the administrator for our small elderly home. I also occasionally teach nutrition classes at our adult learning center.
TD: What were some of the nutritional concerns that you frequently observed among the Haitian population before the disaster?
EB: The incidence of hypertension and diabetes is pretty high here but there are very few people with weight issues of the excess kind. I am working in rural Haiti, which is very resource poor. Many people here live on less than $2 U.S. a day. They do tough, physical work and there is a high rate of food insecurity. Approximately 20% of the children in Haiti are moderately or severely underweight and 25% are stunted, but we suspect that these rates are a little higher in our region. Our hospital also has a stabilization unit for severe acute malnutrition and we see many children with kwashiorkor.
TD: How have you been involved with the disaster relief?
EB: L'Hopital St. Boniface is located about 65 miles southwest of Port-au-Prince. We experienced very little structural damage here, though the earthquake was felt quite strongly. Almost immediately, families in our villages started to receive their friends and relatives from Port-au-Prince. Our population has grown drastically and has put a strain on the few services available locally.
Because we are remote, we didn't initially receive a large influx of patients at the hospital. We started to finally receive post-op patients airlifted from the USNS Comfort last week. At this time, we are the only hospital in the country willing to receive spinal cord injuries.
The organization of disaster relief has been very difficult, chaotic, and we have been experiencing many problems getting supplies and food. We are also working with Unicef to scale up our recuperation program to reach more children in our outlying villages, hold emergency child mobile medical clinics, increase services for pregnant women, and scale up immunizations and micronutrition supplementation. There has been some food distribution locally from donations sent to our missionary neighbors. While we continue to wait for a supply of food from the large NGOs to do general distribution, we are happy that we do have food to continue our regular community programs.
TD: What is the need in terms of food and nutrition?
EB: At this time, almost four weeks have passed since the disaster. I've been monitoring the prices of the local staple foods at our weekly market. Prices have risen about 25%, a huge burden for those who have a difficult time affording food in the first place. We expect that the prices will continue to rise as stocks in the country deplete. Haiti relies heavily on imported food, and the port in Port-au-Prince cannot receive large containers as the wharves and equipment have been destroyed. There are no other ports in Haiti capable of receiving the large ships.
Locally, the millet harvest is coming in and this year it is a very poor yield, which will compound hunger problems in our zone, as this is a staple food. Longer term needs will be difficult to meet and the level of food insecurity will be very high. I suspect that Haiti will be in need of food donations for quite a while. Support and development of agricultural programs are even more desperately needed now for Haiti to become more self-sufficient.
TD: In what form are disaster victims receiving food and water?
EB: We will be receiving dry rations (rice, beans, cooking oil) for general distribution to families and foods like Supplementary Plumpy (a food supplement) and high-protein biscuits for the children. In other regions, they have been doing wet ration (cooked meal) feedings because of security issues involved with distribution. In Port-au-Prince, there have been general distributions of dry rations and to ensure the food gets to the most vulnerable—the children—the food is only being distributed to women.
There are many, many more people in need than are receiving food at this time, but every day relief organizations improve the number of those receiving supplies.
TD: What specific areas have dietitians helped with in the disaster relief?
EB: Unicef is facilitating a twice-weekly meeting of a nutrition cluster, which brings together all the NGOs doing nutrition work in Haiti and is held in accordance [with] and [with the] approval of MSPP, Haiti's ministry of health. The nutrition professionals include a few dietitians working for large and small NGOs from around the world. Most are working in the heavily damaged areas like Port-au-Prince and Leogane, but some are working rurally as I am. This networking has allowed us to share resources and [ensure] there isn't duplication of effort and coverage.
Dietitians are doing mostly organizational, procurement, and program development/supervisory work, but they are also working directly with victims. Haiti has long-established community health programs and very good local health professionals who have been trained to screen for malnutrition and to follow protocols for treatment, so in most cases dietitians would be working to assist and support the local staff.
One important area that we are working in is infant and young child feeding. During disasters, it is important to support and encourage breast-feeding mothers to continue. The use of infant formula is a very last resort because of the risk posed by unsanitary conditions and lack of clean water. Its use can increase the risk of illness and mortality. It is not uncommon for very well-meaning people to distribute infant formula inappropriately, which can discourage mothers from breast-feeding, thus putting their infants at risk.
I had the privilege to provide some training for the medics of the 82nd Airborne. They are working in the community and helping to assess overall needs in the camps and orphanages and then hooking other organizations up to address those needs. I taught them how to do a quick screen for malnutrition in children under 5 years, including measuring mid-upper-arm circumference and checking for bilateral edema.
Most of the hospitals in Port-au-Prince have been destroyed or damaged, so the medical care has been very basic, much of it provided in tents outdoors. At the best of times in Haiti, nutrition support beyond basic tube feeding is available at very few institutions. Most hospitals do not even feed their patients; instead, they rely on family members to provide food. The healthcare system in Haiti is severely underfunded and has received a tremendous blow.
TD: What is the current mood among disaster victims in Haiti?
EB: In Port-au-Prince, plans are under way to build more permanent shelters. The rainy season is approaching and close to 1 million people are living in tents or under plastic sheets tied to sticks. There is a desperate need for safe housing right now. There will be a second wave of disaster as disease spreads. While the government has been encouraging people to leave the city for the countryside, there are many who have nowhere else to go or do not want to leave their damaged homes and businesses. They are very hopeful that they can rebuild and resume their lives. We expect that the nutrition situation in the country will get worse before it gets better. Many of those who have left the city for the countryside, for places like Fond des Blancs, say that they will return to the city when there are opportunities for housing, education, and employment. No one knows how long that will take, but realistically it could be years.
TD: How can we, as dietitians in the United States, help the Haitians?
EB: I am so happy to know that many fellow dietitians have been moved to help. I love this beautiful, tragic country and am proud to call her my adopted home. The Haitian people are some of the most resilient in the world, are proud of their unique history, and determined to survive and prosper. There's a Haitian proverb that I've been hearing lately: depi tet poko koupe nou espere mete chapo, which translates literally to “since our head hasn’t been cut off yet, we can still hope to wear a hat.”
Haiti will need support and attention for several years. The scope of the damage here is so large it is difficult to grasp. I would suggest that people find an organization that they would like to support, either financially or with expertise, and make a long-term commitment. If you feel motivated to volunteer, ask those organizations if they could use your help. You may be surprised at what you end up doing.
— Sharon Palmer, RD, is a contributing editor at Today’s Dietitian and a freelance food and nutrition writer in southern California.
For more information about the St. Boniface Haiti Foundation, visit www.haitihealth.org.