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Lecture Spotlights Health Care Inequity Close to Home

March 21, 2009 — Why should someone in Philadelphia have better access to health care than someone in Charlotte Amalie?
Dr. David Walton thinks there is no reason at all.
If you think health care is a human right, there is no reason for this inequality, according to Walton, the featured speaker for the Alfred O. Heath Distinguished Lecture Series at the University of the Virgin Islands Friday evening. The lecture was broadcast to a St. Croix campus from the St. Thomas campus.
A Harvard-educated physician who spends much of his time treating the poorest of the poor, Walton wants people to think about why everyone should not have the same access to health care regardless of their location or their ability to pay for it.
Walton's work with the organization Partners in Health takes him to Haiti's central plateau, where PIH has established one of nine health care centers in nine different countries, places where those who used to go untreated now have better access to care than in some areas of the United States.
Walton, 31, believes that the difference PIH is making is through providing access to care to everyone, and that everyone has a part in remediating unequal access to health care.
"You cannot have a system where the abject poor have to pay," Walton said. "The key [to success in Haiti] was making health care free.… Poor people get better too."
The centers provide care to people with a variety of illnesses and injuries. Many in Haiti used to die, not because their illnesses were untreatable, but because they did not have the access to the care that they needed. Interestingly, the top 10 causes of death in Haiti bear a resemblance to the top 10 causes of death in the U.S. — in the pre-antibiotic era, because of the lack of access to medical care.
Haiti's dire conditions can even be observed from space. Walton showed a satellite photo of the island of Hispaniola, where the border is clearly distinguishable — the Dominican Republic side is green, and the Haitian side is brown from the nearly complete deforestation of the countryside.
In addition, last years' hurricanes displaced some 900,000 people – 10 percent of the population. Malnutrition is endemic, tuberculosis is diagnosed daily, tetanus is a regular problem, and even cutaneous anthrax is common, though these illnesses cost only pennies to treat, Walton said.
People still die even from diseases as simple as diarrhea in Haiti, Walton explained.
But now, even diseases that are thought to be very costly to treat, like diabetes, typhoid, AIDS and HIV are being treated by Partners In Health centers in Haiti. When pharmaceuticals from well-known companies proved too expensive, the company contacted pharmaceutical companies in India that could make the same drugs for one-hundredth of the price.
With a budget of only $6 million and 6,000 employees, PIH staffs the local hospital with local doctors. This local participation is critical for the longevity of the organization, and its ability to continue to provide care to the population.
Community health care workers, who in Haiti are called "Accompagnateurs" play a vital part in Partners for Health's success. These workers, based in Haiti's rural areas, ensure that patients in remote areas are taking their medications every day and taking them properly. These workers are paid a stipend.
During 2007-2008 Partners in Health had 1.7 million patient encounters with a basic package of primary, prenatal care, vaccines, medicine and access to modern obstetrics.
"Women's health is an important barometer," Walton said. "Safe motherhood is one of a variety of basic health care indicators."
In Haiti, 670 of 100,000 women die in childbirth, compared with U.S. statistics with only six of 100,000 women, according to Walton.
Walton found his calling after attending a lecture by one of Partners in Health's founders, Dr. Paul Farmer. Walton became Farmer's research assistant and at the end of the term, Farmer rewarded Walton with a trip to Haiti.
"It was like in a cartoon where the character has a light go on over his head," Walton said.
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