March 3, 2011

Haiti’s recovery offers lessons at forum on global health

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Jean Pape, M.D., speaks about Haiti’s efforts to recover from last year’s devastating earthquake. (photo by Joe Howell)

Haiti’s recovery offers lessons at forum on global health

Haiti's cholera epidemic has slowed in recent weeks, but the death toll will likely rise again once the rainy season begins in late spring.

Jean Pape, M.D., who in 1982 established GHESKIO, the world's first HIV/AIDS treatment center, in the capital, Port-au-Prince, is determined to be ready.

“The new vision is to build back better,” Pape said during the third annual Tennessee Global Health Forum hosted last week by the Vanderbilt Institute for Global Health.

Since winning its independence in 1804 after a successful slave uprising, the former French colony has been saddled with enormous debt, a succession of dictators and economically crippling trade embargoes. And that was before last year's catastrophic earthquake, which killed, by some estimates, more than 300,000 people.

Even before Haitians could clear the rubble or bury their dead, they were hit with a cholera outbreak that so far has claimed more than 4,500 lives. The succession of calamities is almost too much to bear, especially for the poorest country in the Western Hemisphere.

Yet Pape (pronounced “Pop”) has taken each challenge in stride. After the walls of GHESKIO collapsed, he and his staff, many of whom lost their own homes, set up a makeshift camp on the center's grounds to house and care for several thousand survivors.

In the 13 months since the quake, GHESKIO has largely been rebuilt.

About 6,000 of the homeless were moved across Harry Truman Boulevard to a better organized and supplied tent city. A committee of residents is in charge of operations, including monitoring security and public health.

Now Pape is focused on the “City of God,” the adjacent, sprawling slum of 200,000 that seems to spill into Port-au-Prince Bay. “In here there are no toilets at all,” he said.

To head off the next wave of cholera, latrines and water stations have been installed and an army of community health workers has been trained.

“The best way to control the cholera epidemic is to make potable (drinking) water and latrines accessible to vulnerable populations,” he said.

That's just the beginning

“We need to incorporate health into a package of essential interventions … through the creation of what we call 'global health villages,'” Pape said. This is a new model of “integrative development” that coordinates traditional public health and nutrition programs with education, job creation, training and microcredit.

“We've learned that in the worst environment, health programs can work when there is collaboration between the private and public sector and donor support,” he continued. “Economic sanctions and embargoes do not work. They only make poor leaders richer and poor countries poorer.

“Haiti's problems are huge but they are not insurmountable.”