Partners In Health Haiti Earthquake Recovery

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On December 4, 2012, PBS NewsHour featured a story on Partners In Health's ongoing earthquake recovery efforts in Haiti.  Below, please find a transcript of the program as well as a link to the video. 

Long After Earthquake, Haiti Still Feels Devastating Effects of Cholera Epidemic

FRED DE SAM LAZARO: The 2010 earthquake that devastated Haiti may still loom large in Americans' memory, but, in Haiti itself, that was at least three disasters ago, before Hurricanes Tomas last year, Isaac in August, and recently Sandy.

Each storm brought a grim reminder of yet one more ever-present disaster: the deadly cholera epidemic that started 10 months after the quake.

At the cholera ward of Saint Luc's Hospital just outside the capital, Port-au-Prince, Dr. Jackinson Davilmar says since Hurricane Sandy admissions have doubled from 20 to 40 patients each day.

DR. JACKINSON DAVILMAR, Saint Luc Medical Center (through translator): Most of the new cases are coming from further up the hill in places like Petionville where we had not seen them before. I'm not positive, but perhaps the wells there have been contaminated.

FRED DE SAM LAZARO: Experts believe cholera was brought here by U.N. peacekeepers at the time, a battalion from Nepal. Untreated sewage from this base flowed into a tributary of the ArtiboniteRiver, the major source of water for both washing and drinking.

Cholera is spread by fecal-oral contact. Two years on, 200,000 patients have been sickened, 7,500 have died from the extreme diarrhea and fluid loss. Each flood brings more contaminated water, more cases.

The epidemic prompted massive relief efforts and public campaigns on the streets and in classrooms promoting hygiene and sanitation. Fatalities have dropped from 10 percent of cases early on to about 1 percent.

Still, 600 people have died from cholera this year, many in remote areas, even those unaffected by floods. There's now plenty of awareness of cholera in Haiti. The biggest challenge for people today is distance.

As the epidemic subsided over the last few months, many treatment centers have been closed in the remote areas. So, getting to places that remain open is a huge challenge. It can take hours. And that delay can be fatal.

Sentiment Joseph, a 27-year-old mother of three, will likely recover, having made it in time to get prompt antibiotics and rehydration therapy. Her husband wasn't so lucky. He died a week earlier in their home less than an hour away by motorcycle.

SENTIMENT JOSEPH, Cholera survivor (through translator): He took ill around midnight. There was no one to care for the children, no means to bring him in. We didn't have the money to hire a motorcycle.

FRED DE SAM LAZARO: Across this spartan treatment center run by the Boston-based charity Partners in Health, other challenges were apparent from patient stories.

MAN (through translator): We don't have hygienic facilities. We treat our water, but don't have a formal latrine.

MAN (through translator): I was staying in my sister's home, and I'm not sure she treated the water.

MAN (through translator): There are 14 people living in our house. And it's very expensive to treat the water for so many people. And our only latrine was destroyed in a road-building project. So, we don't have that.

FRED DE SAM LAZARO: Cholera, not seen in Haiti for almost a century since 2010, is likely to remain for some time, says Partners in Health physician David Walton.

DR. DAVID WALTON, Partners in Health: Cholera endemic to the region, to the country is the last thing that they needed. Permanent solutions need to be put in play to be able to really stem the tide of this epidemic that is still ongoing.

FRED DE SAM LAZARO: He says cholera's persistence is a proxy for a much larger rebuilding effort that's fallen short, one that should have provided far more access to clean water and sanitation.

DR. DAVID WALTON: On a scale of A. through F., it's a D.

FRED DE SAM LAZARO: At least 360,000 people remain in crowded tent camps, he notes. Other people have rebuilt in poor neighborhoods destroyed in the quake, like this one in the hilly suburb of Petionville.

Water had to be carried in. And there are few toilets, so there's a threat of cholera.

James Sanvil lives in the U.S., but was visiting family here.

JAMES SANVIL, Haiti: There is no water, no way for them to get water down here, because there's no water came, like, down here.

FRED DE SAM LAZARO: Kevin Fussell is one of many small providers who have tried to bring relief. He's a Georgia physician who started a charity to provide safe drinking water.

His group installed clean water facilities into six schools in the central Haitian town of Mirebalais before running out of donated funds.

He says they'd like to put in many more, but have had no luck applying for funds the U.N. has for water projects.

DR. KEVIN FUSSELL, World Water Relief: They're basically trying to come up wore water solutions for an entire country. And we're working in a very small region. And they're looking for bigger global solutions.

My problem with that thinking is that three years later somebody is still thinking about global solutions, when we have real problems right here. And nothing is being done.

FRED DE SAM LAZARO: That's a complaint that's widely heard. In water and sanitation projects or anything else, there's little to show for the billions in aid that came in or was pledged to Haiti, says human rights activist Antonil Mortime.

ANTONIL MORTIME, Human Rights activist (through translator): I have talked to people in the tent camps. If you look at Cite Soleil, you can see that the situation is actually worse.

There's no change with education, with infrastructure or health care. Corruption, poverty and hunger haven't decreased.

FRED DE SAM LAZARO: Nigel Fisher, head of the U.N.'s large Haiti mission here, acknowledges the slow pace, but says there has been some progress on the massive rebuilding task, a much smaller number of tent dwellings since last year, for example.

NIGEL FISHER, Deputy special representative of the U.N. Secretary-General: If Haiti were a glass, and it's gone from being 10 percent full to 15 percent full, let's recognize that without in any way diminishing the fact that you have still got 85 percent of the glass full.

FRED DE SAM LAZARO: But Fisher says many of the problems were endemic to Haiti long before the earthquake.

NIGEL FISHER: What we're seeing is people who are in camps because of entrenched poverty. Many of these people were hidden before in slums. They're now in the open in camps.

And that is a function of underdevelopment. It's a function of weak governance. It's a function of lack of alternatives, and which these people faced before.

FRED DE SAM LAZARO: He says one of the biggest problems is that Haiti's government, crippled by the quake and a corrupt reputation, hasn't been able to lay down national priorities for the rebuilding.

That's largely been led by foreign non-government organizations, at least 10,000 of them, everything from small church groups to the large international agencies. NGOs have received more than 90 percent of all aid dollars.

DR. DAVID WALTON: The amount of redundancy with the more than 10,000 NGOs that the U.N. special envoy's office has estimated exist Haiti just leaves one wondering where all the money has gone.

And, frankly, if you look at, as they have done, where all the money has gone, hardly any of it has gone to strengthen the government.

FRED DE SAM LAZARO: Partners in Health, which has been in Haiti for 25 years, is trying to restore what it says is the appropriate role for the government.

DR. DAVID WALTON: So, 60 percent of our beds have medical gas. They also have electrical receptacles and data capacity.

FRED DE SAM LAZARO: The group raised $22 million to build a 300-bed state-of-the-art teaching hospital in central Haiti. However, it then partnered with Haiti's Ministry of Health to design and run it. It will turn over the hospital to the government in 10 years.

Dr. Walton says Haiti can never be rebuilt unless it has a strong, accountable government.

DR. DAVID WALTON: It would be so much easier for us to run it the way we wanted to run it and not coordinate with anybody but ourselves, because, hey, we're really smart, or at least we think we are.

FRED DE SAM LAZARO: And you are the guys with the money.

DR. DAVID WALTON: We are the guys with the money. And, again, NGOs don't guarantee the right of health to citizens of any country. But the government does. And we see ourselves as supporting the government.

FRED DE SAM LAZARO: President Michel Martelly cut the ribbon on the new hospital, vowing his administration will do better.

International donors, who have withheld half the $5 billion they pledged to rebuild Haiti, will closely watch how projects like this hospital fare.

For many ordinary Haitians, the goal, as one health worker put it, is to make it to the end of each day alive.


Mirebalais University Hospital
Mirebalais University Hospital

Haiti Program Highlights, 2012

The purpose of this report is to provide a general update on the progress of Partners In Health's ongoing work in Haiti since the earthquake in January of 2010. Thanks to your generous support, Partners In Health has raised over $140,000.00 via globalgiving for our Haiti Earthquake Recovery project. We extend our deepest gratitude, on behalf of all of our patients and colleagues, for your commitment to and belief in helping poor people access quality health care. 

Partners In Health and our Haitian sister organization, Zanmi Lasante (“Partners In Health” in Creole, or ZL) provide medical care at 15 health centers and hospitals across Haiti’s rural Central Plateau and Lower Artibonite regions. As well as improving access to care, PIH/ZL is dedicated to raising the standard of care in rural Haiti by introducing new diagnostics and treatment regiments for both common and complex illnesses. 

Hôpital Universitaire de Mirebalais (Mirebalais University Hospital)

Haiti has long been the heart of PIH’s work, and today PIH/ZL is the largest healthcare provider in Haiti. By investing in public health infrastructure and the local workforce, PIH and ZL are rebuilding the health system in rural Haiti and ensuring the long-term sustainability of our efforts. In 2010, PIH/ZL conceived of Mirebalais University Hospital (HUM) in response to an urgent request from the Haitian Ministry of Health following the destruction of the national referral and teaching hospital in Port-au-Prince in the January 2010 earthquake. Beyond delivering life-saving care to a poor and underserved population of 3.3 million in Mirebalais and central Haiti, HUM will allow us to embark on an ambitious strategy to develop the capacity of Haitian clinicians (doctors, nurses, and specialists) to provide care.

As of July, hospital construction is fully complete, and the hospital will open at partial capacity in spring 2013. Additional specialty services will be rolled out over the following two years. Upon opening, HUM will offer the following services:

  • Community health services, including vaccinations, treatment for malnutrition, and preventative care
  • Outpatient services, including TB/HIV, general adult and pediatric care, and non-communicable diseases
  • Women’s health services, including family planning, reproductive health and comprehensive emergency obstetric care
  • Inpatient care, including internal medicine, pediatrics, and intensive care
  • Surgical care, including Caesarean sections and emergency surgeries
  • Emergency medical services
  • Advanced diagnostics, including digital radiology, ultrasonography and computed tomography
  • Mental health services
  • Laboratory and pharmacy

As a national teaching hospital, HUM is designed both to provide a new standard of healthcare in the public sector and to take a leading role in training and retaining an expanded workforce of well-trained and highly motivated doctors, nurses, and other health professionals.

Cholera prevention and treatment

The cholera epidemic had affected 553,270 people and killed 7,238 nationwide between October 2010 and June 2012. From January 2011 to May 2012, PIH/ZL treated 70,582 suspected cases of cholera at our facilities, 56,506 of whom were hospitalized, and 282 of whom died. Nationwide in Haiti, the case fatality for cholera is 1.3%; at PIH/ZL facilities it is 0.4%. After a year of fighting the outbreak with treatment, we added an additional tool to our arsenal: in April, PIH/ZL launched a pilot cholera vaccination campaign which reached nearly 50,000 people with the two-dose vaccine. Though these achievements are substantial, we are additionally buoyed by the international attention we were able to draw to the epidemic and ultimately the World Health Organization’s recommendation that a stockpile of vaccines be available in Haiti

Cancer care

Building upon PIH’s existing health programs and partnership with the Haitian Ministry of Health, PIH/ZL launched the first comprehensive and integrated breast cancer program in Haiti’s Central Plateau and Artibonite Departments. Currently our breast cancer program is based out of Cange. When the Mirebalais National Teaching Hospital begins operating at full capacity, the program and clinical team will transfer there.

Because breast cancer is not yet a widely recognized disease in Haiti, most patients with cancer present in very advanced stages, necessitating some combination of mastectomy, chemotherapy, and/or palliative care. For women whose cancer results are positive, ZL provides chemotherapy and surgery (mastectomies, quandrantectomies, and lumpectomies) in Cange. Our current caseload includes 10 patients that are on active chemotherapy for breast cancer, and an additional 30-40 patients receiving Tamoxifen alone.

To encourage a greater awareness of breast cancer in our catchment area, our staff also coordinate extensive education initiatives at the community and clinical levels. Community awareness events held on World Cancer Day and International Women’s Day shared information about breast cancer with a broad audience. Community health workers, who frequently visit patients in their homes, also receive information on breast cancer to pass along to their patients. We have already seen an increase in caseload as a result of these community outreach efforts, and expect that trend to continue as breast cancer awareness in our catchment area increases.

Rehabilitative medicine

Following the January 2010 earthquake, PIH/ZL marshaled the resources of academic and medical partners to treat the thousands of victims who lost limbs and mobility in the tragic event. We have since built upon this emergency response to develop and implement a community-based model of rehabilitative medicine that continues to provide care to earthquake survivors as well as a number of other patients who have suffered strokes or other catastrophic illnesses that have resulted in limited mobility.

Patients who have been injured or ill are evaluated and referred to the rehabilitation team where they are comprehensively managed by an interdisciplinary group of professionals, which includes physical medicine and rehab physicians, therapists, rehab technicians and rehab educators. Awareness and sensitivity to each patient’s unique socioeconomic needs, personal goals, and social support is paramount in the formation of a plan that ultimately facilitates maximal community reintegration. Community-based rehabilitation and long-term accompaniment by specialized community health workers called Rehab Educators account for a significant portion of the clinical care delivered and is essential in combating harmful stigma and maximizing quality of life and reintegration.

Currently, rehabilitative medicine is offered through PIH/ZL’s two largest hospitals: L’Hopital Bon Sauveur in Cange and L’Hopital Saint Nicolas in St. Marc. During FY12, PIH/ZL supported two rehab technicians, six rehab educators, and one administrative assistant who carried out 455 new consultations and 1,520 inpatient, outpatient, and community-based patient visits.

These clinical care initiatives continue to revolutionize the treatment course following catastrophic illness or injury and address the harmful notions of stigma around disability. It is through the demonstration of what is truly possible that we practice daily disability advocacy. As a ward full of onlookers stands in amazement as someone takes their first steps after injury or a community realizes what a profound impact a ramp can have on individual autonomy and access, it is apparent that this work makes an impact beyond the clinic doors. In 2013, PIH/ZL will expand rehabilitative medicine to Mirebalais University Hospital, which will include inpatient, outpatient, and community-based service delivery as well as an emphasis on clinical rotations for medical residents. 

Cholera vaccine distribution
Cholera vaccine distribution

"When the 2010 Haiti earthquake crumbled the country's largest public nursing school, killing more than 100 students and faculty, we envisioned a country with a new generation of inspired nurses. With our partner, Regis College, we are facilitating a three-year master's degree to reinforce nursing education in Haiti for years to come." -Sheila Davis, DNP, ANP-BC, FAAN, Director of Global Nursing, Partners In Health

On June 27, 2012, The MetroWest Daily News published the following article, detailing the grant awarded to Regis College intended to tackle the nursing education shortage in Haiti:

The Clinton Bush Haiti Fund has announced a nearly half-million dollar grant to Regis College to educate faculty at six Haitian nursing schools.

The $462,800 grant was made to Regis’ Haiti Project to assist in providing 24 Haitian educators with master’s degrees in nursing. These nurses, in turn, will be able to pass that education along to 1,650 students each year.

The program has a multiplier effect on Haiti by sustaining nursing jobs, promoting health care standards, and transforming the health sector, all while filling a need for skilled Haitian health workers.

“All of us who work with Haiti know,” said Regis College President Antoinette M. Hays, PhD, RN, of Wayland, “that collaboration from inside – from the Haitian Ministry of Health and Haitian universities – is the best kind of collaboration. That is what this Regis international nursing faculty partnership is all about as it educates the educators in nursing in Haiti.”

Clinton Bush Haiti Fund board member Sen. William H. Frist, also a thoracic surgeon, said, “Haiti is in dire need of indigenous health workers who are committed to their local communities. Long-term health and economic results can only be achieved by partnering with Haitians to build the health training and service programs that they own, operate in, and use.”

The Clinton Bush Haiti Fund was formed after the January 2010 earthquake in Haiti when President Obama asked former President Bill Clinton and George W. Bush to lead a fundraising effort to help Haiti build back better.

“The Clinton Bush Haiti Fund’s support of our work is a dream come true,” said Nancy White Street, ScD, RN, director of the Regis College Haiti Project. “Thinking back to 2007 when we first traveled to Haiti to complete our on-site needs assessment of nursing in Haiti, and all that we have accomplished and overcome since that time, it is quite extraordinary. I always knew we were doing something very special. Although we were a small team, our spirit and conviction were mighty.”

The Haiti Project emerged last year after three years of planning and development. It has evolved with the collaboration of Partners In Health, a Boston-based nonprofit organization dedicated to providing quality health care to populations devastated by poverty and disease since 1987.

Initial funding for Regis’ Haiti Project included funding from an anonymous donor to Partners In Health and generous support from the Ansara Family Fund at the Boston Foundation.

In keeping with the theme of “Building Haiti Back Better,” the Regis College Haiti Project is an “educate the educator” model that is building constructive pathways for nursing education to help build the human infrastructure of Haiti’s health system. The project supports a sequencing of some classes in Haiti, some online, and some during summer residencies on the Regis campus.

Read more:

On April 8, Jon Lascher, PIH’s Haiti Program Manager, updated viewers on Haiti’s cholera epidemic during a live interview on MSNBC’s The Melissa Harris-Perry Show:

Haitian cholera epidemic in wake of earthquake devastation 

Just months after a devastating earthquake hit Haiti in 2010, an outbreak of Cholera followed, claiming the lives of thousands. Haitian American blogger Alice Backer, former AP correspondent Jonathan Katz, and Jon Lascher from Partners In Health, join Melissa Harris-Perry in discussing the source of the epidemic and the potential dangers brought by the upcoming rainy season in Haiti.

Please take a minute to view the video here.


“If this was happening here in America, if this was our families in America, we wouldn’t stand for it,” said Lascher. “Cholera is still present… it has started raining already. We’ve had a period of time where cases started going down during the dry season and so we’ve had time to prepare…to do the right thing… But not enough has happened.”

During last year’s rainy season, the number of new cholera infections in Haiti tripled.  

“It spread so quickly because people don’t have access to basic rights like water, sanitation, hygiene, and health care,” continued Lascher. “It needs to be a comprehensive approach to treating and preventing cholera so that we can make sure that there aren’t 7,000 more deaths this year. We need to make sure we’ve learned from past mistakes.” 

As part of this comprehensive approach, PIH is working with the Haitian government and the Haitian NGO GHESKIO to launch a cholera vaccination campaign that will target 100,000 highly vulnerable people and prove that the two-dose vaccine can be delivered effectively in both a Port-au-Prince slum and an isolated, rural community.

Lascher concluded by saying, “We deserve to do better, Haitians deserve better.”

Since the outbreak began in October 2010, more than 7,000 people have died, and at least 531,000 Haitians – roughly 5 percent of the nation’s population – have become sick.

Lascher was joined on the program by Haitian American blogger Alice Backer and former AP correspondent Jonathan Katz.

Learn more about PIH's cholera efforts in Haiti.

On January 10, 2012, the Chicago Tribune published the following article, written by Dawn Turner Trice:

Though world stood still, things moving forward in Haiti

This was the email Dr. Evan Lyon sent Jan. 17, 2010, five days after Haiti's devastating earthquake:

drove past the main central park in (Port-au-Prince) where at least 50K people must be sleeping and it was almost silent.

people cooking, talking, some singing and crying.

people are kind, calm, generous to us and others. even with hundreds lying on the ground, open fractures, massive injuries of all kinds.

there are few dead bodies on the street.

stench is everywhere.

the city is changed forever

Thursday is the second anniversary of the earthquake, and Lyon returned to Haiti last week to check on patients he hopes to bring back to this country for care, to help launch a new residency program for Haitian doctors, and to mark the anniversary.

Lyon, 40, is a Harvard-trained physician and assistant professor of medicine at the University of Chicago. He's also the medical director of the Right to Health Care Program for the international medical and social services organization Partners in Health.

When he arrived in Port-au-Prince last Friday, he headed to a hospital in Carrefour, the neighborhood that was near the epicenter of the earthquake. He was on his way to meet a 20-year-old woman whose bone cancer had metastasized.

Lyon had been working with the woman's doctors from his office in Chicago since last fall and they had asked him to explain to her why she was no longer a candidate for treatment in the United States, as her condition was terminal.

Although the woman's cancer had nothing to do with the earthquake, she and her mother had been living in a tent since the disaster.

"I'll be checking in with other patients who will be able to come to the States for care," said Lyon. "But unfortunately, this young woman isn't one of them."

On the way to the hospital, he said, the first thing that struck him was how quiet the streets of Port-au-Prince were. And that's a big difference even since September, the last time he was in the capital.

"We drove through the downtown in the middle of the city near the presidential palace and there's a massive refugee camp" around the site, said Lyon. "There are about 15,000 people in that part of town. But things are eerily quiet and it almost felt better when more was happening in the streets and there was more activity."

Tens of thousands of people lost their lives in the earthquake, and about 1.5 million were displaced. About 500,000 still live in temporary housing, according to Partners In Health.

Lyon said that though most of the residents have moved out of the capital and into long-term settlement camps, he fears that some people may not have immediate access to health care or other services.

"There's been more engagement, more work and, in some ways, more progress over the last two years than in years before," he told me. "But it still doesn't come close to meeting the size of the need."

As he rode through the city, he said that though the main roads have been cleared of debris and makeshift tents, none of the buildings housing the ministries of health and interior or the Supreme Court have been rebuilt. The landscape has gaping holes and, for miles, bears little resemblance to the Haiti he remembers back when he first arrived in 1996 as a music teacher.

Much work remains in Haiti, including stemming a cholera epidemic that began in October 2010, and continues with about 600 new cases a day. Lyon has been working with a human rights organization that's investigating the cause of the epidemic, which, as of Dec. 25, had killed at least 7,001 Haitians, according to the Haitian Ministry of Health.

Despite all of this, there are signs of hope.

Lyon said one example is a new residency program that was launched this week at a hospital Partners In Health runs with its Haitian sister organization Zanmi Lasante in St. Marc, about 50 miles north of Port-au-Prince.

"Of all the work that needs to be done here, this is entirely optimistic," Lyon said.

He said the program will teach Haitian doctors how to be family practice physicians.

As part of the program, Lyon and other physicians will conduct classes over the Internet and travel to Haiti to teach. The University of Chicago also will start a one- to two-year fellowship in which trained doctors will work and teach in Haiti for about six months a year.

"Two years after the complete destruction of the main hospital and medical school, we're making progress, although it never feels fast enough," he said. "Within a year, a new national teaching hospital (built by Partners in Health and Haiti's Ministry of Health) will open. It's a nice way to think about the anniversary. Despite the many challenges ahead, we're moving forward."

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Map of Partners In Health Haiti Earthquake Recovery