A Baton Rouge physician who’s about to visit Haiti for the second time since the January 2010 earthquake, says the role of some volunteer physicians is becoming more mentor than primary doctor.

With the influx of free care provided by medical teams from around the world, Haitian physicians are being hurt financially, said Dr. Robert H. Krupkin, an emergency room physician.

Krupkin, 61, went to Haiti last year for eight days under the auspices of the Jewish Healthcare International mission. Krupkin will return to Haiti Monday with JHI.

“There was a health-care system in Haiti before the earthquake,” Krupkin said. “Not a great one, but there was one.”

Other Baton Rouge physicians, health-care professionals and churches have worked in Haiti since the earthquake.

Of the $483 million donated for Haitian relief through the American Red Cross, almost $300,000 has come from Baton Rouge, said Nancy Malone of the Red Cross’ Louisiana Capital Area Chapter.

“Haitian doctors tell us, ‘We want you to be our partners,’” Krupkin said. “We were taking their patients. This next mission I’ll be more of a mentor. The Haitian doctors will do the surgery. We’ll scrub with them and teach them technique.”

Eighteen months after the earthquake, the International Organization for Migration estimates that 634,000 people live in displacement camps.

“We drove through the tarp city in Port-au-Prince,” Krupkin said. “It stretches as far as you can see.”

Much of Port-au-Prince, the earthquake’s epicenter, was leveled.

The government placed the death toll at 316,000, though other estimates place deaths attributed to the earthquake at between 200,000 to 250,000.

Earthquake damage estimates, from sources outside the Haitian government, range from $8 billion to $14 billion.

Though pledges from international donors exceed $5 billion, only about $1.5 billion has been spent, according to GiveWell, an independent, nonprofit charity evaluator. For more information, see http://www.givewell.org.

Money raised and pledged amounts to 80 percent of Haiti’s gross domestic product, according to GiveWell.

Haiti’s reputation for corruption presents a challenge when it comes to getting money where it’s needed, Krupkin said.

The Clinton Bush Haiti Fund, a relief effort that grew out of the friendship of former presidents Bill Clinton and George W. Bush, has a good approach, Krupkin said. Clinton and former President George H.W. Bush have worked together, as well, on tsunami and hurricane relief.

The Clinton Bush Haiti Fund makes direct grants rather than funneling money through the government. Krupkin said a planned allied health-care school in Port-au-Prince is an example of how the fund works.

Baton Rouge orthopedic surgeon Craig Greene, 36, who’s been to Haiti twice since the earthquake, said, “We shouldn’t give them hundreds of millions of dollars but (instead) build them a hospital.

“In an ideal world, you let the local doctors come to the United States to train for six months and go back,” Greene said. “It’s not saying we know it all. We’re blessed with medical knowledge and want to share it.”

According to information at http://www.clintonbushhaitifund.org, the fund doesn’t have a set expiration date but is meant to have a finite existence.

The fund, according to the website, is meant as a bridge from the 18-month emergency period to a reconstruction period of 10 years. The fund had received $54 million in donations as of May 15, 2011.

There is a shift now from triage to “what can we do to help you?” said Greene.

“In the initial response after the earthquake, I don’t think the local doctors cared where the help was coming from,” he said.

“If they feel threatened by U.S. doctors helping, we may want to shift the emphasis from patient care to (American) physicians being a resource for local (Haitian) physicians,” Greene said. “As you transition to the long term, it’s important to have partnerships.”

The Lancet, an international medical journal, poses the question of how many Haitians could afford private care before the earthquake.

“Would a patient who can afford to go to a private clinic, with air conditioning and immediate consultation, go instead to a Doctors Without Borders clinic in a hot, crowded tent in a dangerous part of town?” asks Doctors Without Borders head of mission Stefano Zannini in an interview in The Lancet.

As Krupkin was leaving Haiti last fall, he tried to arrange cancer treatment for a teenager.The girl was to be treated by a Haitian pediatric oncologist following a protocol supervised by doctors at St. Jude Children’s Hospital.

“Sadly, after leaving Haiti and despite the efforts of people inside and outside of medicine in Haiti and the U.S., a decision was made to not treat this child, and she died approximately six weeks after I left Haiti,” Krupkin said.