PORT-AU-PRINCE, Haiti — For years, the low-lying slum along the bay and the AIDS clinic across the street lived in separate worlds, a one-way relationship where the sick shuffled out of the slum, but health-care providers didn’t dare go in.
Then Haiti’s massive Jan. 12, 2010, earthquake and subsequent cholera outbreak crumbled the barriers.
“We didn’t ask for any of it,” Dr. Jean William Pape, founder of GHESKIO, Haiti’s leading HIV/AIDS clinic and research center, said about the disasters. “But now we got them. What are we going to do with them?”
For all the devastation and death both catastrophes unleashed, they also stirred hope of a health-care turnaround for the most destitute of Haiti’s poor.
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For the past year, a small army of community health-care workers has quietly ventured beyond the clinic’s front gate to confront some of the stumbling blocks that have long made providing quality health care in the developing world challenging.
On any given day inside Port-au-Prince’s slum-by-the-bay, T-shirt clad health workers and physicians can be seen handing out buckets of chlorinated water and other cholera treatment, supervising community cleanups and stepping into humble homes to deliver primary care.
The intense focus on Haiti’s slums come as an increasing number of Haitians leave tent cities for crowded ghettos, triggering fears of a deepening public-health catastrophe in a country where people already contract tuberculosis at a higher rate than anywhere in the hemisphere except for Peru, and many children never make it to their third birthday because of any number of illnesses, including 21 waterborne diseases.
It also comes in a country with one of the hemisphere’s highest rates of HIV, the genesis for the founding of GHESKIO, the Haitian Group for the Study of Kaposi’s sarcoma and Opportunistic Infections.
But the current mission has little to do with AIDS treatment. Rather, the focus is on improving the lives of the poor in a nation where clean water and sanitation are luxuries, and where the government is struggling to raise $2.2 billion to eradicate a cholera epidemic that has claimed 8,048 lives and sickened 650,218, according to Haiti’s Health Ministry.
“When I look at old Paris, old Rome, those were all slums that they improved. So why can’t we improve these slums?” Pape said. “If you provide them with the tools, they’ll get there.”
Twenty years ago, Pape could look out across a busy Harry Truman Boulevard and see the pristine blue ocean hugging Port-au-Prince’s bay. Today, the ocean is murky and its shallow bay waters were filled with trash in order to create the Village of God and various communities of ramshackle concrete-block shanties that make up the City of the Eternal.
It’s a place where gangs and disease run rampant, where the rain brings down topsoil and human waste, and where residents are more likely to go to the bathroom in plastic bags than outhouses.
But treating disease inside the slums, a refuge of warring gangs and kidnappers, has long been a challenge — even for the clinic.
“My staff was very reluctant,” Pape said. “This is a very dangerous area where people are killed all of the time.”
The first opportunity came with the quake, when fleeing residents set up a tent city in the clinic parking lot. Then cholera hit.
“We used to have 14 to 15 cholera victims a day,” Dr. Mireille Peck, a GHESKIO physician and head of its community program, said on a stroll through the Village of God.
A year ago February, the clinic, with government support, started a door-to-door cholera-vaccination campaign using smartphones. It went even further, teaming with residents to enter homes to conduct a health survey and treat victims.
That relationship made the clinic’s staff realize the residents were their neighbors, Pape said:
“My staff is happy they did it. They realized these are real people who have needs like everybody else, which is to send their kids to school and hope for a better life.”
Paul Farmer, chairman of Harvard Medical School’s Department of Global Health and Social Medicine, said, “Haiti’s progress depends on inclusion, and inclusion depends on some basic services.”
“You can’t do good medicine for poor people without having some strategies to address their poverty,” said Farmer, whose Partners In Health/Zanmi Lasante nonprofit medical organization provided the cholera vaccination to Haitians living in the Central Plateau, where the disease started.
Much of the activity in the Village of God these days centers on the work of clinic staff. Throughout the community, there are several oral rehydration points for those who contract cholera.
Specialized buckets of potable water, created in the clinic’s lab, are also provided to families. Even the water sold by private providers has improved, thanks to negotiations by the clinic’s doctors.
On a tour of the village, Peck notes the visuals that are also feeding the sense of pride. Lots once strewn with garbage are clean, and canals normally infested with mosquitoes have been reduced to puddles.
“You don’t see how it is clean?” she said, stopping in front of a group of women who were employed in a clinic-run community cleanup program that closed in November after funds dried up. “They are still sweeping because they have taken ownership of the project.”
A few yards away, giggling schoolchildren pour out of one of the few multi-story structures. Almost all of the students have been vaccinated against cholera by GHESKIO’s teams.
“If today we have these children sitting here and they are healthy, after God, we have to thank Dr. Peck and the people at GHESKIO,” said Pastor Jean Samson Charles, the school’s director. “They have stood alongside us and fought for us to allow us to be here today.”