Teams poll Haitians to learn what they need after earthquake
Sunday, January 31, 2010
PORT-AU-PRINCE, HAITI -- How do you find out what the Haitian people really need now, nearly three weeks after the earthquake? You ask them.
Three-person teams, each including at least one member who speaks Creole and French, are fanning out to 152 sites across the country this week, asking a long series of questions to "key informants." When they are done, they hope to have a clearer picture of the food, shelter, water, sanitation and health-sector needs of the Haitian population.
That's the intent of a week-long project run by the U.N. Office for the Coordination of Humanitarian Affairs, the World Health Organization and the U.S. Centers for Disease Control and Prevention.
It is an experiment in another way, too. The data are being collected on hand-held computers (PDAs) as well as on paper forms marked with pencils.
Much as truth is the first casualty of war, reliable information is one of the early casualties of natural disasters. Until fairly recently, disaster responders relied on their senses, and their common sense, to identify problems. The notion of measuring what you could see was viewed as an academic and slightly effete response to things such as earthquakes, hurricanes and tsunamis.
That view has changed.
The "evidence-based" paradigm slowly remaking medicine has crept into disaster medicine, too. So has the drive to make this field, like much of the rest of medical care, more democratic and responsive to the consumer and less paternalistic and responsive to the expert.
It is true, though, that time is of the essence, even a few weeks after a disaster such as this. Methodological rigor has to wrestle with the need to get things done.
The survey this week didn't ask questions of a random sample of Haitians in the way that a medical trial would. That would have been a huge and time-consuming undertaking. Instead, it sought out individuals expected to know what was happening to the people in their area: mayors, village directors, health officials. The places weren't chosen randomly either. The designers chose fairly evenly spaced sampling sites, with extra ones in the heavily damaged Port-au-Prince area.
There is also the matter of what to ask. Too little, and it's worthless. Too much, and it tries the patience of interviewer and informant. "This is a not-so-rapid rapid assessment," Carl Kincade, a CDC epidemiologist, said as he fluttered the 10-page questionnaire while waiting in the mid-morning heat for interviewers at a dusty lot in a centrally located neighborhood.
One of the teams went to Kenscoff, an administrative district of six villages south of Port-au-Prince. Reaching it took an hour of steady uphill driving. Part of the way, the road traveled the edge of a gorge-like valley, with lush terraced fields on its slopes. The destination was a village called Nouvelle Tourraine.
Relatively speaking, Nouvelle Tourraine was spared. Of its 7,981 residents, one person died in the earthquake and one was injured. Two Catholic churches and 64 houses were destroyed; nine other houses were damaged.