“You can't have public health without a public health system. We just don't want to be part of a mindless competition for resources. We want to build back capacity in the system.”
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We've taken on the major health problems of the poorest - tuberculosis, maternal mortality, AIDS, malaria - in four countries. We've scored some victories in the sense that we've cured or treated thousands and changed the discourse about what is possible.
The biggest public health challenge is rebuilding health systems. In other words, if you look at cholera or maternal mortality or tuberculosis in Haiti, they're major problems in Haiti, but the biggest problem is rebuilding systems.
If any country was a mine-shaft canary for the reintroduction of cholera, it was Haiti - and we knew it. And in retrospect, more should have been done to prepare for cholera... which can spread like wildfire in Haiti... This was a big rebuke to all of us working in public health and health care in Haiti.
Haiti is always talking about decentralization and nothing has been so obvious, perhaps a weakness, as the centralized nature of Haitian society as being revealed by the earthquake. I mean, they lost all these medical training programs because they didn't have them anywhere else.