DURHAM — Much has changed in the four-plus months since the Haitian earthquake - regrettably, not all for the better. As an infectious disease specialist working on behalf of Duke Medicine, I traveled to Haiti in February and again in April. I found the contrasts between my two visits both starkly impressive and unsettling. I hope we are not seeing a repeat of the troubling history that long has haunted Haiti.
Thankfully, there is increasing evidence that Port-au-Prince is beginning to recover. Micro industries spring up daily in the many crammed tent cities - hairdressers, small shops, food stalls. Efforts to clean roadways and begin to demolish unstable buildings are afoot.
Yet the sight of the broken Presidential Palace, surrounded by bulldozers and slowly being razed, remains a solemn testimony to the destruction and the imprint the earthquake will leave on the nation's psyche.
Given the symbolic and emotional scars, it's all the more alarming that the international medical presence helping to support the local recovery is growing increasingly scant, even as infectious diseases such as malaria, dengue and typhoid are increasingly present, abetted by both heavy rains and poor disease control in the tent cities.
Though sanitation and potable water delivery have improved (although they remain far from ideal), rats and mosquitoes continue to dance through the night alongside the impoverished and homeless, transmitting their diseases. The smell of pestilence lingers.
Meanwhile, securing logistic channels, staffing and funding remains a great challenge.
The dilemma of how to offer long-term support to tens of thousands of people living in tents or in makeshift squatter camps is arguably the largest issue. Of particular concern is the fact that the number of support groups in the country continues to fall. University Hospital in Port-au-Prince, where the Duke Medicine team was stationed during my April visit, went from having dozens of donor organizations assisting their recovery to essentially only two or three.
Admittedly, the patient population has changed. No longer are earthquake victims presenting with trauma, fractures and crush injuries. Instead, typical developing-world medicine now dominates, albeit superimposed onto a city struggling to get back on its feet.
As the nightly tropical storms become more prolific, infectious diseases will be increasingly common. Sewage facilities, fresh water, electricity and supplies of food and medicines remain scant - or unaffordable - to those who need them most. Common problems such as HIV, heart failure and tuberculosis are becoming more complicated with the disintegration of chronic health care services in the aftermath of the quake.
This is not the time for emergency relief services to simply leave along with the camera crews, and for the rest of the world to once again turn its back. That would be a terrible case of history repeating for Haiti. A transition from emergency care to a longer term, sustainable response is desperately needed.
Haitians remain profoundly resilient and every day express their willingness to be a part of and lead their recovery. It should be our simple mandate to continue to do everything we can to facilitate this.
During a night shift, a friend e-mailed me a poem relevant to his own Haitian experience. "Invictus," by William Ernest Henley, contains the lines, "Under the bludgeonings of chance/my head is bloody but unbowed."
I cannot better describe the ongoing pride and hope that I saw every day in Haiti. As part of the international community, I believe we are morally mandated not to desert Haiti on this occasion.
Cameron Wolfe, M.D., is with the Division of Infectious Diseases in the Department of Medicine at Duke University Medical Center.