PORT-AU-PRINCE -- 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 but healthcare 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 healthcare turnaround for the most destitute of Haiti’s poor.
For the past year, a small army of community healthcare workers has quietly ventured beyond the clinic’s front gate to confront some of the stumbling blocks that have long made providing quality healthcare 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 clean-ups 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, its shallow bay waters filled with trash 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, which forced fleeing residents to set up a tent city in the clinic’s 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 smart phones. 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,” he said.
Paul Farmer, chair 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 Boston-based Partners In Health/Zanmi Lasante nonprofit medical organization provided the cholera vaccination to Haitians living in the Central Plateau, where the disease started.
“Anyone who exposes him or herself as a nurse or physician to a lot of patients living in poverty gets an earful about social conditions,” Farmer said.
As a result, addressing transportation, food, electricity and housing issues become important in struggling communities such as Village of God.
On a recent morning, as workers from GHESKIO toured the Village, some of its 10,000 residents chatted about the transformation. The tension that normally welcomed visitors has been replaced with pride, and an overwhelming sense of accomplishment.
“This is a zone that used to be very dirty. They have motivated us,” said Gabriel Mizo, 46, a block leader inside the community. “GHESKIO’s doctors have brought a lot of hope.”
Then someone shouts: “There is no more cholera here.”
Crime persists, however. Earlier this month, Haiti National Police launched a surprise raid, arresting 17 gang members including a top leader.
But much of the activities in the village these days center around the work of clinic staff. Throughout the community, there are several oral re-hydration points for those who contract cholera. Specialized buckets of portable water, created in the clinic’s lab, are also provided to families. Even the water provided 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 clean-up 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 school children pour out of one of the few multi-story structures. Almost all of the students have been vaccinated against cholera by GHESKIO’s teams - as well as against several common childhood diseases through an unrelated Ministry of Health campaign.
“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.”