As an undergraduate at Duke University, Maxwell Kligerman stumbled into an amazing scientific opportunity. He spent the summer of 2009 collecting data on the availability of health-care facilities in Leogane, Haiti, a coastal city with a population of about 50,000 to support the work of Family Health Ministries, a non-profit founded by Duke reproductive endocrinologist David Walmer, MD.
With a guide, Kligerman walked every street in Leogane, tabulating the location and characteristics of even the most modest doctors' offices.
His tally was important for local residents and some global health scholars, but certainly not anything with worldwide relevance.
We still need to keep Haiti on our radar. It's been five years since the earthquake, but now is really the tipping point.
Then, on Jan. 12, 2010, the magnitude 7.0 Haitian earthquake struck, its epicenter just five miles from Leogane. Kligerman had unique, pre-earthquake data that could show the effects of the quake on local health-care opportunities. He could see what happened when the city experienced an influx of foreign aid and how the quake affected the trajectory of its development.
Taking advantage of his rare opportunity, Kligerman returned to Leogane in both 2011 and 2013, collecting information about the availability of health-care facilities.
Now, Kligerman is a third-year medical student at Stanford and recently published his findings in The American Journal of Tropical Medicine and Hygiene, in collaboration with Walmer and Stanford's Michele Barry, MD, senior associate dean for global health, and Eran Bendavid, MD, assistant professor of medicine.
He has a critical message for those interested in global health: "We still need to keep Leogane and Haiti on our radar. It's been five years since the earthquake, but now is really the tipping point."
Before the earthquake, Leogane had 25 health-care facilities, ranging from a small doctors' offices to large hospitals. Eleven of those buildings collapsed during the earthquake.
But soon, the international community swooped in, upping the number to 28. By 2013, Leogane had 34 healthcare facilities, many offering free care. Yet although the numbers look rosy, change is on the horizon.
Doctors without Borders, which operates the only full-service hospital, has announced plans to close the facility in 2015. That alone will dramatically reduce the availability of health care to Leogane residents, Kligerman said.
"There's a very serious transition going on where a lot of international aid funders are beginning the process of transitioning facilities to local providers or entirely withdrawing support," he said. "While this is ultimately the goal of any relief effort, it will be important to monitor the ongoing transition to ensure local institutions are able to take up the reins."
International aid agencies did a great job in Leogane, Kligerman told me. They came in when needed and provided care in a crisis. Some scholars had worried international aid might push out homegrown resources, but that wasn't the case in Leogane, he said.
"The aid community has made such meaningful contributions, we must go that final extra mile to ensure their efforts have the desired long-lasting impacts," Kligerman said.
He said the study can serve as a model on the effect of foreign aid on health-care resources following disasters and hopefully help improve future disaster responses.