From San Francisco to Port-au-Prince

We collected at SFO, ready for a 10 day trip to Haiti, to join a group from Harvard for a Global Health Bootcamp. Despite some typical airport delays, missed flights, and sprinting through the airport, our fearless program directors navigated our safe and timely arrival in the newly rebuilt airport of Port Au Prince.

The ride from the airport was filled with stories of the 2010 earthquake and its devastation, and Sri and Phuoc’s experiences witnessing and navigating the chaos and providing medical care. From the road, it there looked to be some signs of recovery. The airport was entirely new. You could no longer simply drive onto the runway. The military presence was gone. Brick-making and other signs of construction lined sections of the road from the airport, and a tent city that had been erected to house the earthquake victims, and had become home to many for the prolonged recovery had nearly totally been dismantled.

So what are we doing in Haiti? We’re spending our time learning from the fine folks of Partners in Health (PIH), aka Zanmi Lasante (ZL) (in Creole), a Boston-based NGO that has been working in Haiti for the last 30 years, founded on core values of social justice, their mission is to improve the health of the underserved Haitian community. Over this time, their primary focus of providing healthcare has expanded to address the underlying determinants of that health as well.

The first stop in our introduction was Zanmi Beni (http://www.zbchildren.org/), an orphanage for some fifty children, most with special needs, that were homeless or displaced after the earthquake. A main building and land was purchased and developed into a lovely space with playground, physical therapy, music therapy, and school. While none of the children are up for adoption, that have recruited people to be new parents to the children and have recreated a style of family support.

We were taken to the back of Zanmi Beni, we were introduced to a project by Operation Blessing (http://www.ob.org/_where/haiti/) where they were developing a large scale tilapia fish farm. Aiming to address the protein deficiencies in the country, the NGO has set up an industrial fish farm employs locals learning how to raise, breed, and make a sustainable business out of providing fish to their community.

From Port Au Prince, we headed by van up the now paved road, courtesy of the UN earthquake relief, to Cange, the initial site of ZL. We pulled up to ZL, a castle-like complex, set on a hill. Its walls were retaining walls, built elegantly into the hillside, its gardens, restored tropical forests enshrouded the dormitories and clinic buildings. Situated on a hill, the van bumped up the driveway and we piled out to settle into our newly built accommodations for the week and then gathered in a dining room, large and sparsely decorated with huge windows overlooking a verdant valley.

Our introductions were exciting. The room percolated with the energy of like-minded passionate people, most us were, likely me, at the beginning of a career in global health, and some who have worked for decades Haiti or other sites in their struggles for equity. We were a multidisciplinary roundtable of residents and fellows in internal medicine, pediatrics and psychiatry, a group of engineers working on the water supply system, an economist, mental health workers, and some of the leadership of PIH.

With a quick recap of ZL history by Joia Mukherjee and Paul Farmer, Joia pointed out that our being here was a time for the leadership to share more than the model of ZL, but the vision of health and social justice that had sustained them through the years. The core tenet is the belief in social equity; that a poor person’s life matters as much as a rich person’s. The drive to develop this equity has framed the work they’ve done over the years starting with the premise that healthcare is a human right. Their model emphasizes a multifaceted approach. So often in global health, prevention is pitted against secondary care. Paul pointed out that that is a fallacy, and in fact you need to have both to make effective gains in development. As such their work addresses coordinated hospital, clinic, and community based care. They have directed program funds towards consolidating user fees to eliminate barriers to accessing care, establishing access to essential drugs, capacitating staff by paying them more than standard wage, and hiring an army of community healthcare workers.

Amidst their stories and lessons, Joia identified what she believes are the two main principles in developing global health as a human right; engaging the community and engaging and reinforcing the government. As they have grown their organization, they are working to scale their model in collaboration with the public sector to address the underlying issues such as poverty, education, and nutrition.

While the projects I’ve seen today in some ways seem disparate, I am struck by the clarity of the ZL vision and the way in which it seems that every aspect of the program is a direct reflection of their core values. Like spokes in a wheel, they radiate from the same core: Health is a human right. In addressing health care, they are addressing the impediments to health: Malnutrition by promoting fish farming, barriers to accessing care by creating a charge free multilevel health system, environmental health by planting trees, and healing a fracture in the community by developing an orphanage that restores the community spirit. Each project is a spoke and together they generate a more stable wheel.

Alexandra Stanculescu, MD – UCSF Global Health – Hospital Medicine Fellow