Project Medishare: a volunteer program in international health at the University of Miami.

Most U.S. medical schools have programs in international health, but there is a need to find ways to make students (particularly those with little clinical experience) more effective volunteers in international settings. The Department of Family Medicine at the University of Miami School of Medicine developed a program to help prepare students for international work and to ensure that the work they do makes a difference. Over the past four years, this program, Project Medishare, has sent groups of students to Haiti to conduct health fairs. Students prepare all year for their voluntary trips, which take place during the spring and summer breaks; they learn about Haiti's history, culture, language, and health problems. They also raise funds and donations of medicine and supplies. The health fairs, which are one-day events in orphanages and villages, emphasize patient education and preventive medicine. The success of the fairs is evaluated using testimonials from Haitian officials and patients, students' journals, and data collected by the students. Factors critical to Project Medishare's success include (1) having a "critical mass" of culturally and linguistically competent students and faculty; (2) collaboration with local authorities and providers; (3) advance preparation; and (4) using lessons learned from each event to improve the next.

The health care delivery crisis in Haiti.

BACKGROUND AND OBJECTIVES: This article documents the history, politics, and economics that have contributed to a health care delivery crisis in Haiti and why family medicine will be crucial for the recovery of Haiti's health care. Since the United Nations intervention, there has been some improvement in health conditions. However, the embargo and political turmoil left little infrastructure on which to build. Developing family medicine, one of the priorities of the Ministry of Health, will reverse traditional forces that favor emigration and specialization and will provide the country with well-trained physicians who can treat most of the common health problems of Haiti. These common preventable and treatable problems are now contributing to short life expectancy and high infant mortality. While the ultimate responsibility for Haiti's health rests with Haitian health professionals, the country has an immediate need for international humanitarian assistance, particularly for general medical care.

PIP: With its 7 million people inhabiting an area the size of the state of New Jersey and with average annual per capita income of $225, Haiti is the poorest and most densely populated country in the Western Hemisphere. 85% of children in rural Haiti have clinical evidence of malnutrition, the infant mortality rate is 94/1000 live births, the maternal mortality rate is 4.5/1000 live births, life expectancy is 55 years, and there are rapidly growing rates of tuberculosis, malaria, and AIDS. Much of Haiti's health crisis is tied to the country's recent troubled political and economic past. That past has disrupted Haiti's health infrastructure to such an extent that Haitian people routinely suffer with, and often die from, readily preventable and treatable illnesses. Haiti's health care infrastructure cannot be rebuilt without humanitarian support and technical assistance from the international community. The authors explain the history, politics, and economics which have contributed to the health care delivery crisis in Haiti and why family medicine will be crucial for the recovery of the country's health care. The development of family medicine will check certain elements which favor emigration and specialization, and will provide the country with well-trained physicians who can treat most common health problems in the country.