A Global Perspective on Health Care

    • October 10, 2011

On January 12, 2010, a magnitude seven earthquake struck Haiti, killing hundreds of thousands of people and injuring or leaving homeless millions more. Faced with a health care crisis complicated by deep poverty and long-term unrest, the country worked in atypical and less than ideal conditions to save lives and stave off epidemics caused by the crumbling infrastructure.

Despite the best efforts of Haitian health professionals and international aid workers, a cholera outbreak quickly spread, exacerbated by a lack of clean drinking water and effective waste management. The waterborne pathogen causes an infection of the small intestines, resulting in diarrhea and vomiting that causes severe dehydration that is often fatal if not treated immediately and effectively. Since October 2010, cholera has affected more than 100,000 people in Haiti and caused more than 3,000 deaths.

For Haitian-American Sidney Coupet, DO, MPH, a Robert Wood Johnson Foundation (RWJF) Clinical Scholar (2011-2013), the turmoil only strengthened his commitment to help his parents' country.

Coupet is the founder and executive director of Doctors United for Haiti, a group he started in 2006 to support Haiti's health care system and improve the quality of care. The group sends physicians, surgeons and other health professionals to the country to work side-by-side with their Haitian counterparts in a continuing education and training model. "We're not a typical organization in that we don't function in a unilateral fashion," Coupet says. "We're there from the beginning to get the natives involved in their care, to build accountability with Haitian doctors."

The cholera outbreak brought new urgency to Coupet's efforts. "I know people directly affected by the cholera outbreak," he explains. And as a health care provider, "I felt driven to respond to the situation in ways that I know I can contribute."

Coupet began researching a variety of effective interventions for a cholera outbreak in the hope that, if there was a second outbreak, health officials would be prepared to treat and contain it. He partnered in this work with Reza Nassiri, DSc, who serves on the board of directors of Doctors United for Haiti and is the director of the Institute of International Health at Michigan State University.

Their comprehensive findings were published in The DO, a magazine for osteopathic physicians. The paper lays out a series of interventions that can be effective in managing cholera, including specific details like what intravenous fluids to use, how soon oral rehydration can be administered, and acceptable antibiotics that shorten the duration of illness.

In the paper, Coupet and Nassiri also discussed prevention and containment of the infection. A safe water and food supply, improved sanitation and health education through mass media can contain infection and prevent reoccurrences. A cholera vaccine, although widely opposed in Haiti, is important to consider, they wrote.

They also encourage partnership programs like Doctors United for Haiti. "To reduce morbidity and mortality rates associated with cholera in Haiti, a strong and sustainable partnership needs to be established between the health care sector and the environmental and civil agencies," the paper says. "This comprehensive interventional plan needs to be implemented through a health professional partnering program in which health care volunteers provide support and work with Haitian health care professionals. … This comprehensive approach will enhance the health care organizational structure and health care delivery efficiency in the likelihood of another cholera epidemic in Haiti."

Global Health Care

"I believe we're living in a global society now," Coupet says. "Health care is no longer a national agenda, it's a global agenda." Haiti is only 700 miles away from the United States, he points out. "I think we're affected by some of the situations that happen there. Being aware of the situation, being able to constructively provide inputs for their policy-makers, can impact us when we start thinking about U.S. policy decisions."

That perspective has shaped his research as an RWJF Clinical Scholar, where he is the first osteopathic physician selected for the prestigious program. Coupet's research is focused on whether completing a rotation in another country will influence physicians' style of practice or encourage them to work in underserved communities. He will begin with physicians working in Haiti because of his connections to the country, but he hopes to also study other developing countries.

"The Clinical Scholars program is providing me with the skills to really contribute to society as a whole, and the skills I've gained so far just within a few months have given me the opportunity to publish this paper and to adopt a global, more systemic approach," he says. "I believe the skills I'm learning are going to continue to help me improve and contribute to society, here in the United States and in my parents' native country."