Even before a devastating earthquake destroyed lives, flattened buildings, and left more than a million people homeless in Haiti four years ago, the country’s health prognosis was critical. Poverty and disease ruled, and the number of medical practitioners was in short supply.
Then, when the 7.0-magnitude quake crushed Haiti on Jan. 12, 2010, leaving roughly 230,000 dead and 1.5 million homeless, life for the poorest country in the Western Hemisphere was worsened.
One day after the quake struck, a group of Boston-area doctors formed Physicians for Haiti to help rebuild the country’s crippled medical training and education systems, much like efforts to reconstruct roads and buildings.
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Now as the world looks to Haiti on the fourth anniversary of the quake, leaders of the program emphasized that much more work needs to be done.
“We are just scratching the surface,’’ said Dr. Zadok Sacks, cofounder of the Haiti program and a physician at both Brigham and Women’s and Boston Children’s hospitals.
Dr. Michelle Morse, the group’s other co-leader, said the program aims to build a long-term and sustainable structure in Haiti. But the challenges remain severe.
“We’re still seeing really serious health outcomes that need to be treated,’’ said Morse in a phone interview from Haiti. “We still have a cholera epidemic, so there is much that needs to be done.”
As Haiti tries to move past the widespread devastation, its people remain in need of food, homes, and jobs. Billions of dollars in promised aid from foreign countries and humanitarian organizations have not trickled down, partly because of worries about Haiti’s political infighting and corruption, according to Associated Press reports.
On Saturday, Prime Minister Laurent Lamothe sounded a hopeful tone in his progress report to the country, saying that fewer people are living in settlement camps and that thousands of new houses are being built.
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In Boston, where some churches are planning to use Sunday services to mark the quake’s anniversary, Haitian-Americans and immigrants are also hopeful.
“It’s a sad anniversary, but we don’t want to make it a sad time,’’ said the Rev. Jean Jeune, whose First Christian Church Source of Grace in Mattapan will hold two services marking the quake. “We are going to celebrate life.”
The Rev. Jacques Dady Jean, a Mattapan pastor, said Haiti is in a better position today than it was before the earthquake in terms of job creation, infrastructure, and business investment.
“Haiti was forgotten before the earthquake; now the earthquake has put Haiti back on the world map,’’ he said. “Although we will never forget the lives that we lost, we are trying to get the most out of the tragedy for the people left behind.”
After Sacks and Morse helped bring the local doctors together to help Haiti, Morse said she worked at Haiti’s general hospital in Port-au-Prince for about two months. It was functioning at low capacity, with volunteers working into the night, numerous cases of tetanus, and patients with limbs that were not healing. In the middle of all the chaos, hospital staff went on strike protesting conditions there, recalled Morse.
“The general hospital still has its challenges, but it has come a long way,’’ she said. “The medical training facilities were severely damaged after the quake, and most have not been replaced. The general hospital has not been rebuilt.”
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Planned construction on a new section of the hospital has not happened, she added.
Despite those challenges, Physicians for Haiti moves forward, Morse said.
The program connects physicians in Haiti with doctors in the United States, giving them resources, training, and information.
Its visiting professors program holds conferences in Haiti and it offers a social medicine course each summer. In addition, it launched a pilot effort at Mirebalais University Hospital to hold interactive training sessions that focus on skills critical to being an educator. So far, 500 medical practitioners in Haiti — doctors, nurses, students — have participated in the program.
Sacks said that while so much attention to Haiti has centered on the problems, it is important to note the efforts that are working.
“There is truly a remarkable group of professionals in Haiti,’’ said Sacks. “They are doing the work day in and day out to provide the best health care they can, and they do it without a lot of the tools that we have.”
Material from the Associated Press was used in this report. Meghan E. Irons can be reached at meghan.irons@globe.com. Follow her on Twitter @meghanirons.