Haiti Update: Building Back Better?

In the days following the devastating earthquake that rocked Haiti on January 12, 2010 there were so many urgent needs to respond to: rescue and recovery; tending to the injured; burying the dead; and finding shelter for the more than one million newly homeless.

Health officials also had to consider longer-term concerns such as rebuilding hospitals and institutions as well as the looming threat of infectious diseases like cholera or malaria brought on by a city of displaced people living in tents with questionable access to clean water and sanitation. But there was a hint of guarded optimism that the unprecedented level of aid pouring into the country might enable Haiti to tend to its wounded population and rebuild better than before.

Brian Hoyer, Mailman School alumnus ('09) and director of AmeriCares Haiti, receives an emergency shipment of cholera treatment supplies.

Twelve months later, Haiti is a country struggling to rebuild. Cholera is no longer a threat but a reality, having taken an estimated 3,600 lives and requiring continuing emergency supply shipments like the one pictured which touched down in Port-au-Prince earlier in January bringing medicines to AmeriCares Haiti.

Mailman School faculty and alumni who have worked in Haiti over the past year have seen some glimpses of the country moving forward, but have also witnessed an absence of leadership and inertia that cause some to worry that Haiti’s best chance for a brighter future is slipping away.

Building Back Better

“Rebuilding to pre-earthquake status has never been a real option in my mind given that Haiti was in a health emergency well before January 12, 2010.” – Brian Hoyer, ’09, Country Director, AmeriCares Haiti

It would be an understatement to say that Haiti pre-earthquake had its share of problems. In 2009, the United Nations Human Development Index ranked Haiti 149th out of 182 countries finding more than half of its citizens living on less than $1 a day. It is a country where only 26% of births are attended by skilled health personnel and where life expectancy is only 62 compared to a regional average of 76. (WHO)

And then the earthquake struck.

As news spread of the enormity of the quake’s damage, the hundreds of thousands dead, and the scale of human suffering, there was an outpouring of relief from all parts of the globe. With the world’s attention and money flowing into the country, some thought this might be the opportunity for the Haitian government, in collaboration with international aid groups and the private sector, to rethink and rebuild institutions, infrastructure, and processes – to build back better.

But today, the government is still weak and the reconstruction commission not as active as people had hoped. Port-au-Prince remains the focus of most aid efforts, leaving the countryside mostly outside of the rebuilding conversation. Compounding the issue is the lack of jobs and job training which furthers civil unrest.

Richard Garfield, DrPH, RN, professor at Columbia School of Nursing and Mailman School’s Program on Forced Migration, worked on the earthquake response to support the U.S. Centers for Disease Control, the United Nations, and the Haitian government. “There’s very little private sector – a fundamental problem as there are no jobs,” notes Dr. Garfield. “There are very few people in government – [and within government alone] there’s a great need for organizational governance, training and jobs to make the reconstruction work.”

Mailman alumnus Brian Hoyer, who has worked with AmeriCares Haiti since the disaster, adds, “A long-term commitment is needed to make lasting changes in Haiti, and even the non-profit humanitarian sector should do whatever possible to help create jobs.”

Small Steps

In the meantime, groups take heart from the small inroads that have been made. Dr. Garfield travels to Haiti regularly on behalf of Columbia’s School of Nursing and the Mailman School of Public Health. He is intent on reactivating the main school of nursing in Port-Au-Prince which enrolls approximately 300 students.

“The school started again in September, but it has a long way to go as it’s working out of tents and with the old curriculum,” mentions Dr. Garfield. “We’re working to develop internet capacity, create libraries so students can function in the modern ways, use international volunteer faculty, and create primary care rotations offsite - as opposed to working in hospitals which is what they did in the past.” Garfield notes that given the destruction of so many hospitals, these students will more likely be working in community health, outside of hospitals, where the major needs and opportunities lie.

“With over 50 local partners, we have supported the only Haitian organization working to care for diabetics and cardio patients,” explains Hoyer of AmeriCares Haiti. “Assisting them to expand coverage in some of the poorer zones of Port-au-Prince and elsewhere in the country—estimated to have 300,000 diabetics.”

Being so close to the United States has its advantages for Haiti – drawing a number of individuals and institutions wanting to help. But with so many disparate groups working on different projects, it’s sometimes hard to assess the impact.

Dr. Garfield notes, “People tend to talk about what they’re doing as if they’re big things, but the small things are not insignificant. It’s hard to know if it all works up to much, but Haiti would be worse off without it.”

Photo: In Port-au-Prince, Brian Hoyer of AmeriCares Haiti receives urgent supplies for cholera treatment and prevention on January 8, 2011.