Research News

Build Haiti back better

With the beginning of the spring rains, cholera is on the rise in Haiti once again.

Pioneering Haitian physician Jean William “Bill” Pape is determined to be ready. “The new vision is to build back better,” Pape said during this year’s Tennessee Global Health Forum hosted 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”), who in 1982 established GHESKIO, the world’s first HIV/AIDS treatment center, in the capital, Port-au-Prince, 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 15 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.

See a map of Port-au-Prince. Pan left to find Boulevard Harry Truman. The slum described in the story is across the boulevard from the “camp site” and “Hôpital Gheskio.”

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.”

Other speakers at the day-long forum included Brian Heuser, assistant professor in the Practice in International Educational and Public Policy at Vanderbilt’s Peabody College; William Paul, director of the Metro Nashville Public Health Department; and James Schorr, clinical professor of Management at Vanderbilt’s Owen Graduate School of Management.

Village children in Mozambique line up for a "taste test" of nutritionally fortified porridge. Photo by Claire Brown.
Village children in Mozambique line up for a "taste test" of nutritionally fortified porridge. Photo by Claire Brown.

Schorr discussed “social enterprises,” business models and market-based approaches especially created to address social problems. Non-profit organizations, for example, are diversifying away from total reliance on charity toward entrepreneurship in order to make their programs more sustainable. An example is New Path Nutrition, a non-profit venture established last year by two of his graduate students. They are trying to establish a locally owned enterprise in the rural Zambezia province of Mozambique to produce nutritionally fortified flour. The goal is to help improve nutrition while creating jobs.

Paul described efforts in Nashville to “change the environment” in ways that encourage healthier behaviors. With the help of a federal grant entitled “Communities Putting Prevention to Work,” the city has undertaken a number of projects, including integrating physical activity and healthy eating into Head Start classrooms and encouraging the establishment of fresh food markets in inner-city neighborhoods.

Heuser discussed the benefits of partnering public schools with public health programs through “health promoting schools,” for example. “Developing a healthy, educated and self-sufficient citizenry should be the first priority of every government,” he said.

Boat schools in Bangladesh. Photo courtesy of Brian Heuser.
Boat schools in Bangladesh. Photo courtesy of Brian Heuser.

“Look at these wonderful boats,” Heuser said as he flashed a photograph on the screen. “These are classrooms in Bangladesh . . . Within these boats they’re educating but they’re also doing health promotion.” This is a practical way to bring schools from village to village, and it meets the needs of students “in their particular social, economic and cultural contexts,” he added.

One of those contexts is environmental. The boat schools were created “around the idea that the world they live in is actually changing,” Heuser said. “These folks know . . . that climate change is going to affect them. Building schools on river banks is not sustainable.”