title: The livelihoods of Haitian health-care providers after the january 2010 earthquake: a pilot study of the economic and quality-of-life impact of emergency relief.
abstract: BACKGROUND
  An effective international response to a disaster requires cooperation and coordination with the existing infrastructure. In some cases, however, international relief efforts can compete with the local work force and affect the balance of health-care systems already in place. This study seeks to evaluate the impact of the international humanitarian response to the 12 January 2010 earthquake on Haitian health-care providers (HHP).
  
  
  METHODS
  Fifty-nine HHPs were surveyed in August of 2010 using a modified World Health Organization Quality of Life-Brief questionnaire (WHOQoL-B) that included questions on respondents' workload before the earthquake, immediately after, and presently. The study population consisted of physicians, nurses, and technicians at public hospitals, non-governmental organization (NGO) clinics, and private offices in Port-au-Prince, Haiti.
  
  
  RESULTS
  Following the earthquake, public hospital and NGO providers reported a significant increase in their workload (15 of 17 and 22 of 26 respondents, respectively). Conversely, 12 of 16 private providers reported a significant decrease in workload (p < 0.0001). Although all groups reported working a similar number of hours prior to the earthquake (average 40 h/week), they reported working significantly different amounts following the earthquake. Public hospital and NGO providers averaged more than 50 h/week, and private providers averaged just over 33 h/week of employment (p < 0.001).Health-care providers working at public hospitals and NGOs, however, had significantly lower scores on the WHOQoL-B when answering questions about their environment (p < 0.001), and in open-ended responses often commented about the lack of potable water and poor access to toilets. Providers from all groups expressed dissatisfaction with the scope and quality of care provided at public hospitals and NGO clinics, as well as disappointment with the reduction in patient volume at private practices.
  
  
  CONCLUSIONS
  The emergency medical response to the January 2010 earthquake in Haiti had the unintended consequence of poorly distributing work among HHPs. To create a robust health-care system in the long term while meeting short-term needs, humanitarian responses should seek to better integrate existing systems and involve local providers in the design and implementation of an emergency program.
authors.affiliation: North Shore University Hospital/Long Island Jewish Medical Center, Department of Emergency Medicine, 300 Community Drive, Manhasset, NY 11030, USA. jrohini@gmail.com.
authors.forename: Rohini J
authors.initials: RJ
authors.lastname: Haar
authors.forename: Sassan
authors.initials: S
authors.lastname: Naderi
authors.forename: John R
authors.initials: JR
authors.lastname: Acerra
authors.forename: Maxwell
authors.initials: M
authors.lastname: Mathias
authors.forename: Kumar
authors.initials: K
authors.lastname: Alagappan