A State of Denial

Mudpie Factory--Cite Soleil
October 16, 2012
Photo by John Carroll

In 2007 I posted that people in Soleil were so hungry they were eating mudpies.

As people found out about this atrocity I think they were in disbelief. One commenter wrote that maybe the lady who makes the mudpies in Soleil should turn into a Mrs. Fields and export her mudpies to the States.

In 2012 people in Soleil are still eating mudpies.

Her "factory" is in the same location in an especially dangerous part of Soleil. And as you can see, as of an hour ago, she is still hard at work. She insists her dirt is special dirt from Hinche and she adds butter, salt, and water. I think you can see the rivulet of toxic filthy water running besides her.

She slops the concoction together and forms saucer-sized circular mudpies that harden quickly in the Soleil sun.

Denial is good for us when it comes to thinking about this. It could not be happening we tell ourselves. This can't be happening 90 minutes from Miami.

We need to make light of this.

We need to deny.

(Photo by John Carroll)

John A. Carroll, MD
www.haitianhearts.org

Reality Check in Cite Soleil

St. Catherine's Hospital
Cite Soleil
October 15, 2012
(Photo by John Carroll)

Asleep

Photo by John Carroll

Sorry, my dear, but we just didn’t care. You probably realize that by now.

You appeared with a tense, distended, and painful abdomen. For the previous four days you hadn’t been able to relieve yourself nor even sleep due to horrible visceral pain that distended lumens cause.

You winced as we poked and prodded your silent belly. And we used those big words as we concluded that you had a bowel obstruction.

Your eyes searched our eyes. You looked but we couldn’t. 

But what did we do with the gift of our knowledge about your condition? Our minds and hands could not be pushed into action for you.

My dear, you know why you got into this mess in the first place? It was us. We are corrupt. And we steal lives.

And people like you don’t count ESPECIALLY when you are sick. Your lives mean nothing to us. You knew that, right?

But you were generous and gave us one last chance at redemption.  Why did you think we would care now when you neared the end when we didn't care in the beginning?

Something for pain for you? Pain control for the poor? I don’t think so. No morphine, no dilaudid, no fentanyl patches for you. There aren't any here. You need to groan and roll slowly from side-to-side... waiting for sleep.

Well, your bed was empty this morning. Thank God. He took you. Your celestial discharge has happened and you got your wish for sleep. 

But make no mistakes...we don’t really care one way or the other.

You paid the big price for our corruption.

And we will too. 

(Photo by John Carroll)

John A. Carroll, MD
www.haitianhearts.org

Two Years of Cholera....by Crof

Please read this excellent summary of the two year anniversary of cholera in Haiti by Crof.

Tempered Happiness

St. Catherine's Hospital--Cite Soleil
Rehydration Room
October 12, 2012
(Photo by John Carroll)

The Haitian Public Health nurses (MSPP) working in this cramped tiny room tucked away on the second floor of St. Catherine's Hospital in Soleil save many little lives EACH day. With salt and sugar mixed in a bag of sterile water. And knowing where tiny collapsed veins course under the skin without being able to see or feel them they start tiny IVs.

This one year old was lying fairly lifeless with her eyes sunk and half closed two hours before this photo. She was one of a jillion babies and toddlers in Cite Soleil today with terrible vomiting and diarrhea. They finally get so weak they refuse the breast and they all seem to hate oral rehydration solution.

So with some history from the mother, the look of the child and the mother, the status of the child's lips and eyes, and your OWN gut reaction, you throw out all the clinical rules you once thought were important, and you start an IV on the patient.

And after just a little while they all wake up and look around.  And the blan doctors are all so happy, but the Haitian MSPP nurses take it all for granted. Because being this ill is taken for granted in Soleil.

And the prolonged assault by the army of sick babies never ends during the daylight. However, night time kills these babies in the arms of their mom in their shacks. The babes don't even whimper....they just slip away into the Light.

But you and I know they shouldn't have got sick in the first place. And so many more should have been treated today that didn't make it to the Rehydration Room.

In good Irish form our happy thoughts are tempered.


John A. Carroll, MD
www.haitianhearts.org

CITE SOLEIL

CITE SOLEIL
OCTOBER 10, 2012
(PHOTO BY JOHN CARROLL)

"My Dad is in Prison"

Zima
October 9, 2012
(Photo by John Carroll)

Dear Everyone/Anyone,

My name is Zima and I am two years old. As you can see, I don't feel well.

Full disclosure:  I did not really write this entire letter to you. An adult helped me. But believe me, if I were a few years older, I would agree with most of it.

So here goes.

I live in Beleko which is a neighborhood in Cite Soleil. It is infamous for the number of gang related violence during the last six years.

My family is very poor as is everyone in Beleko. I live with my mother and three siblings.

My dad has been in prison for the last two years in the penitentiary down town in Port-au-Prince. I don't know why he is there and each time my mom tries to visit him, she is turned away at the prison door. She says it is a bad place.

I have heard my mom say that there are thousands of men like my dad there being held without charges. She has no money to get him a lawyer. The inmate's cells are so crowded the men sleep standing up. I worry about my dad. I hope he is still alive.

Please watch this video when you have time. It is short.

My mom took me to the pediatric clinic today in Soleil. I am just not doing well.

First of all I weigh twenty pounds and am two years old. I don't even want to eat at this point. And my mom doesn't have much to give me in the first place. My legs have swollen in the last several months because I don't have enough protein in my diet. Therefore, fluid seeps out of the blood vessels into the tissues of my legs. They hurt. The university people call me an "apathetic kwash". I don't know what that means and I don't really care.

I also have diarrhea all the time. I am passing mucous, blood, and my mom says I have white worms too. We don't have clean water to drink and many toddlers in Beleko are just like me. We are chronically sick and many of us die before we even go to school.

For some reason I have a fever and a cough and the doctor just told my mom I may have pneumonia.

I am going to be admitted to St. Catherine's Hospital in a few minutes.  I knew I shouldn't have come here in the first place. Someone will need to watch my brothers and sisters at home because my mom has to be with me 24/7 at the hospital because the MSPP nurses can't do everything. At least they don't charge pediatric patients like me.

Well, gotta go.

Thanks for reading this. Please pray for me and my family and especially my dad.

Love,

Zima

-------------

John A. Carroll, MD
www.haitianhearts.org

Respect for Life in the Slum--Updated October 8, 2012

Respect for Life Baby in Soleil
October 8, 2012
(Photo by John Carroll)

You may remember the little baby in trouble on Friday afternoon.

Well here she is today (Monday) with no oxygen requirements. She is breathing easy on her own. This is good because there are no ventilators at St. Catherine's Hospital in Soleil.

The baby is getting intravenous antibiotics ampicillin and gentamicin. She is not out of the woods but  she stands a chance.
------------

St. Catherine's is being repainted. It looks better than a few weeks ago.

This hospital is run by the Haitian government. But you know what? It needs to be torn down. The people deserve much more than this.

Just think if it were demolished and rebuilt in the middle of this horrible fetid slum. Just imagine a nice big hospital in this place that could provide basics for hundreds of thousands of people.

It could be a great teaching hospital because the pathology of hundreds of thousands of people nearby would keep it busy and full all of the time. The amount of heart disease, infectious disease, and trauma is incredible here. And most importantly the people of the slum would benefit.

Haitian medical staff have to be paid fairly. They work very hard and CARE for each other. The Haitian government needs to do the same.

Hold UN Accountable in Haiti

Hold the UN accountable for Haiti’s cholera epidemic 

By Myrtha Désulmé, Stabroek News (Guyana), Oct 1, 2012
http://www.stabroeknews.com/2012/features/in-the-diaspora/10/01/hold-the-un-accountable-for-haitis-cholera-epidemic/ 

Myrtha Désulmé is President of the Haiti-Jamaica Society and the Caribbean Representative of the Haitian Diaspora Federation 

On 24 August, Tropical Storm Isaac pummelled Haiti, resulting in floods, mudslides, and storm surges; downed trees and power lines. The storm threatened the lives of millions, particularly the more than 400,000 homeless Haitians, still living in flimsy tents, exposed to the elements like sitting ducks, two-and-half years after the January 2010 earthquake. Painful images of tent-dwellers bracing against fierce winds, with a background of flying tents containing all of their worldly possessions, were streamed on CNN between news of another US shooting incident, and the joys of Australian river rafting. 

Adding to the crisis was the fear of an ensuing surge of the cholera epidemic introduced into Haiti by the UN forces. The initial death toll from TS Isaac is reportedly at twenty-four, but this number could spike due to the potential increase in cholera cases. 

On 21 October, 2010, ten months after the greatest natural disaster of the modern age, cholera exploded in the Artibonite region along Haiti’s central river system, quickly spreading to other areas. Haiti went from never having had a cholera outbreak in recorded history, to now having, based on the Pan-American Health Organization (PAHO), “one of the largest cholera epidemics in modern history”, which has killed more than 7,585 Haitians, and infected over 594,198 to date. 

According to Duke University Professor Deborah Jenson, who has written extensively on Haiti, research of 19th century newspapers, and sea merchants’ journals, reveals that while cholera raged in the United States and much of the Caribbean, it always failed to take root in Haiti. When it first arrived in the Americas in 1832, Haitian President Boyer immediately announced public health measures to prevent the invasion of cholera. 

In 1892 President Hippolyte again published protocols to prevent the introduction of a Euro-American infection.  It is in fact this Euro-American epidemic which led to the development of sanitary sewer systems in Europe and America. 

Numerous independent DNA tests and epidemiological studies, including those of the UN itself, have established that Nepalese troops to the UN peacekeeping mission in Haiti (MINUSTAH) brought the vibrio cholerae bacteria to Haiti.  Geneticists have precisely matched the epidemic strain in Haiti to a particularly virulent, deadly cholera strain found in Nepal in the summer of 2010, just before the troops were deployed. 

Although Nepal has endemic cholera, the UN did not test or treat the Nepalese peacekeepers for cholera prior to their deployment.  In Haiti, they lived on a base with a haphazard and inadequate sewage system, and recklessly dumped all waste into an unfenced pit.  It was easily foreseeable that human faeces containing cholera bacteria could contaminate a tributary, which runs just meters from the base into the Artibonite River, travelling downstream to infect the Haitian families who drink, bathe, play, and wash laundry in the river. 

Three of the brave souls who have taken on the UN Leviathan are Attorneys Marguerite Laurent of the Haitian Lawyers Leadership Network (HLLN), Mario Joseph of the Bureau des Avocats Internationaux (BAI), and Brian Concannon of the Institute for Justice & Democracy in Haiti (IJDH). 

On 3 November, 2011, BAI and IJDH filed a lawsuit on behalf of 5,000 cholera victims. The case demands that the UN provide the only long-term solution, which is the comprehensive clean water and sanitation infrastructure necessary to control the epidemic. Cholera is generally easily treatable with oral rehydration solutions.  But for those who lack access to clean water and medical care, it can kill in a matter of hours. Medical treatment, vaccinations, and chlorine tablets are saving some lives for now, but cholera immunity lasts only a few years, while the cholera bacteria will remain in Haiti indefinitely.  The water and sanitation infrastructure will not only eradicate cholera, it will reduce all water-borne diseases in Haiti, which kill thousands every year. 

Incredibly, the UN initially denied responsibility on the premise that a “confluence of factors”, including Haiti’s weak sanitation and health infrastructure, were the real reasons for the outbreak. This preposterous, and legally invalid defence, is akin to starting a fire in a dry field, and blaming the wind for the spread of the fire. Before the outbreak, Haiti was widely known to be one of the most water insecure countries in the world, and after the devastating earthquake of January 2010, experts warned that outbreaks of water-borne diseases, especially cholera, would have disastrous effects. Haiti’s fragile conditions created a heightened responsibility for the UN to exercise care in its operations. Yet the UN failed to take simple measures that would have prevented the outbreak, like testing of its soldiers known to come from a cholera-endemic region, proper management and disposal of waste, and immediate corrective action.  By any legal code, the UN is legally responsible, because their carelessness directly caused foreseeable harm to victims. 

The victims of cholera filed complaints directly with the UN’s internal claims unit. MINUSTAH’s operations in Haiti are governed by a Status of Forces Agreement (SOFA), which affords the UN and MINUSTAH broad immunities from civil or criminal prosecution in Haitian courts. To balance this immunity, the SOFA requires the establishment of an independent Standing Claims Commission, to hear claims and compensate victims, who have been injured in the course of UN operations. Despite this requirement, no commission has been established during the eight years MINUSTAH has operated in Haiti.  In fact, there has never been a Standing Claims Commission established in over 60 years of UN peacekeeping, even though these commissions are a standard feature of most SOFAs. 

Momentum has been building, to pressure the UN to respond justly to the epidemic. In January, ABC News published an article entitled: UN Soldiers Brought Deadly Superbug to Americas. 

In March, President Bill Clinton, UN Special Envoy for Haiti, publicly affirmed that UN peacekeepers were the “proximate cause” of the cholera epidemic.  Hundreds of Haitians marched from the UN’s base to the Haitian parliament, demanding justice for cholera victims. The New York Times ran a front-page story confirming the UN’s responsibility in bringing cholera to Haiti, and exposing its failure to respond accordingly.  After a visit to Haiti by the UN Security Council, the missions of the U.S., France, and Pakistan, declared to the Security Council that the UN must do “whatever is necessary to make this situation right”. 

In April, The Economist published a scathing piece calling on the U.N. to accept responsibility for its wrongdoings in Haiti.  In May, Nigel Fischer, UN Humanitarian Coordinator in Haiti, acknowledged that the UN’s current efforts were “patchwork, Band-aid work,” and that “the long-term solution was investment in improved drinking water sources and waste management.” 

The U.S. Centers for Disease Control and Prevention (CDC), and prominent French epidemiologists have published studies confirming the source of the disease; while Washington Post editorials, TransAfrica Forum, Human Rights groups, and faith-based organizations, like the Church World Service, have called for the UN and the international community to take responsibility swiftly in ending the epidemic. 

On 17 July, US Representative John Conyers, Jr. (D-Mich.), and 103 other Members of Congress sent a letter to Susan Rice, U.S. Ambassador to the United Nations, applauding her call for UN accountability, and asking her to urge the organisation to take a leading role in addressing the cholera crisis in Haiti, which according to the Haitian Government, infects 600 new victims every day. 

The Congressmen wrote: “As cholera was brought to Haiti due to the actions of the UN, we believe that it is imperative for the UN to now act decisively to eliminate this deadly disease from Haiti…. A failure to act will not only lead to countless more deaths: it will undermine the crucial effort to reconstruct Haiti.” 

The IJDH/BAI lawsuit aims to compel the UN to spend $750 million – 1.2 billion on comprehensive water and sanitation infrastructure, which would improve Haiti for decades.  By comparison, MINUSTAH’s operating budget in Haiti for one year is around $800 million, and only half of the $5.33 billion pledged for earthquake recovery has been disbursed. With nearly half-a-million homeless earthquake victims in sprawling tent camps, exposed to disease, eviction, arson, and violence, the Red Cross, whose core mission is humanitarian assistance during emergencies, is planning to build a hotel on a property it purchased for $10.5 million of funds collected in the name of suffering Haitians, while the Clinton-Bush Haiti Fund made a $2 million equity investment in the 5-star Royal Oasis hotel. 

If the lawsuit is successful, the clean water and sanitation infrastructure will save between 50,000  – 70,000 lives over the next ten years, by eradicating cholera, and all other water-borne diseases. 

On 4 June, 7 months after the filing of the lawsuit, a “Regional Coalition on Water and Sanitation for the Elimination of Cholera in the Island of Hispaniola”, was launched by UN agencies, World Health Organization (WHO), and UNICEF, in collaboration with the Pan-American Health Organization (PAHO), the Centers for Disease Control and Prevention (CDC), the Spanish Agency for International Development Cooperation (AECID), and the Inter-American Association of Sanitary and Environmental Engineering (AIDIS). The Coalition pledged to support efforts by the governments of Haiti and the Dominican Republic “to harmonize and streamline international assistance and investments in water and sanitation infrastructure aimed at eliminating cholera from the island”.  On 18 September, CARICOM joined the Coalition. 

But four months after its launch, the Coalition has done nothing to save lives or eliminate cholera, and does not even have any funding in place. It is merely “urging governments and international organizations to support their efforts”. While the UN, which has the funds and the legal obligation to right its wrongs, is not responding. Some believe that the Coalition is just a smokescreen, to take the pressure off the UN, which is simulating a response, without setting the precedent of accepting liability. 

In the words of Betsey Chace, a finance volunteer with IJDH, “… fair treatment of Haiti by the international community [is] the only thing that will enable Haiti to break the cycle of extreme vulnerability to disasters.  There is little natural about a death toll in the [hundreds] of thousands from an earthquake of 7.0 magnitude, or massive loss of life from heavy rainfall. These unnatural disasters result from political, environmental, and economic conditions, that will improve only when Haitians are supported rather than thwarted in building a system of laws, rights, and accountability, that are the foundation of a just and safe society.” 

On 28 July 2010, the UN General Assembly adopted a Resolution recognising access to clean water and sanitation as a human right essential to human dignity, and to the realisation of all other human rights.  We urge the entire Caribbean family to remain vigilant, to ensure that the basic human rights of the Haitian people are upheld, and that the UN returns to its core mission, of fighting infectious diseases, not spreading them.

 (This article was posted on the Roger Annis website CHAN.)

Everyone Counts in the Slum

Everyone Counts, October 5, 2012
(Photo by John Carroll)

Do four pound babies in one of the worst slums in the world really count?

It seems they do.

This precious little girl was born on Friday morning but was having trouble breathing by mid-afternoon.

So the nurses in the OB Ward wrapped up this baby, handed her to her sore sixteen year old mom, and told her to go to Pediatrics.

Mom carried the baby alone as she ambled over to Peds which was in a different building about twenty yards away.

A Peds nurse unwrapped the baby and pronounced the baby dead. She was cyanotic and not breathing or moving.

Another "health care provider" grabbed the baby and administered "bouche-a-bouche" (mouth-to-mouth) resuscitation.

The young mom watched showing no emotion whatsoever.

The little baby with no name started to breathe and move and she turned pink. And parents in the Pediatric Ward stretched their necks and watched from their own baby's miserable cribs.

A tiny nasal prongs was taped into the newborn's nostrils and attached to a huge five foot paint-peeling oxygen tank near by. Three liters of oxygen streamed into her airway.

A tiny bore nasogastric tube was passed and the baby's abdomen was decompressed to help her diaphragm work easier.  A 24 gauge IV was placed on one attempt into the back of her right hand. Sugar water dripped in.

The baby opened her left eye and looked around.

Her respirations were fast but her color was good and pink.

Throughout this effort, the Haitian nurses and doctor talked like usual, even joked, but no one screamed or yelled or went crazy. There was definite respect for this little life on the edge.

Life is important in the slum.


John A. Carroll, MD
www.haitianhearts.org

                                                                                            

                                                                                                                                 

Cholera in Haiti

Cholera in Haiti & the United Nations - IJDH.ORG from New Media Advocacy Project on Vimeo.

A Broken Heart in a Cholera Treatment Center

Luckner

In June of 2011 I was notified by a physician friend of mine, Dr. Jen in Port-au-Prince, that she had a young patient named Luckner with a serious heart problem. She wanted to know if I would examine him and evaluate him as a candidate for heart surgery through Haitian Hearts.

I agreed to do this but I was located in central Haiti about three hours north of Port-au-Prince. I was working at a Cholera Treatment Center at Albert Schweitzer Hospital. I asked Dr. Jen if Luckner could come up to Schweitzer and I would examine him. She said he would make the trip.

At the Cholera Treatment Center we had a tiny admit room. Hundreds of sick patients were coming every day with cholera. We put IV's in the sickest cholera patients in this room and sometimes we would have six or seven very ill patients in shock slumped in their chairs or lying unconscious on cots. Sometimes the patients were even slumped against each other in these close quarters.

One day a young man showed up. Even though I had never seen him I thought he had to be Luckner. He looked too strong and healthy to be a sick with cholera.

The young man was  Luckner and he looked scared. He was scared to be around so many deathly ill appearing cholera patients. I could tell he wanted to leave the Cholera Treatment Center as fast as possible.

I examined him quickly and could hear the loud murmur coming from his leaky aortic valve.

I assured Luckner that we would help him as much as we could and that he could head back to Port-au-Prince. He seemed to be a perfect candidate for repair or replacement of his aortic valve.

So I e mailed Dr. Jen and explained to her that Haitian Hearts would do what we could to get Luckner admitted into a US medical center for heart surgery.

I sent Luckner's history and physical and his echocardiogram to Dr. Bryan Foy a heart surgeon in Illinois who has operated many Haitian Hearts patients in the past. Dr. Foy reviewed the echo and agreed that Luckner needed surgery.

Dr. Foy operates out of a number of medical centers in northern Illinois. Edward Hospital in Naperville is one of them and they accepted Luckner for surgery.

During the past year Dr. Jen and her group of friends in Port-au-Prince were able to obtain a medical visa for Luckner. And they brought him to Naperville about one month ago. He is with a wonderful host family there.

And guess what? Dr. Foy operated on Luckner several hours ago and replaced his leaky aortic valve. (As I post this Luckner is in stable condition in ICU.)

This fortunate 25 year old man just received a new lease on life. My thanks to EVERYONE for all their help with Luckner during the last year.


John A. Carroll, MD
www.haitianhearts.org

Fear of Engagement

As it turns out, there is no reason to fear engagement. We are not destroyed when patients suffer or die, but rather deepened, becoming better able to open ourselves to the complex lives of the distressed and infirm next time around. Over time, there comes a natural but mysterious adjustment toward equanimity, in which we can hold onto both worlds, that of safety and that of danger, simultaneously, without calamity.

David Watts, M.D.
New England Journal of Medicine
September 27, 2012

"I Can't Do My Work Anymore"

Photo by John Carroll-September 18, 2012

This sweet little lady is 78 years old.

She is in the middle of six months of outpatient treatment for tuberculosis and she is doing pretty well.

However, she told me that she can't get her house work done anymore. She smiled, shook her head, and said she has a hard time doing her wash by hand.

House Call in Hell

We are One Body

Photo by John Carroll

Quoting St. Paul, Dorothy Day wrote: “We are all members one of another, knowing that when ‘the health of one member suffers, the health of the whole body is lowered.’ ”

Forget the Haitian National Palace

Haitian National Palace
(Photo by John Carroll, September 15, 2012)

One of the most beautiful and elegant buildings in the Americas was destroyed in less than a minute on January 12, 2010. The Haitian earthquake crumpled the Haitian National Palace. The quake also destroyed almost all of the other Haitian ministry buildings in downtown Port-au-Prince.  

The Palace had been built using American engineers when the US occupied Haiti from 1915-1934.

This edifice was twice as large as our White House and it represented Haitian politics, ruthless dictators, and failed presidents. Many Haitians considered it a “den of corruption”.

Sean Penn and his charity recently volunteered to knock down the vestiges of the Palace. During the last several weeks Penn used 98% Haitian labor, some American engineers, and big Caterpillar equipment. The sagging cupulos and most of the building are now at gound level.  

The street in front of the Palace is blocked off to traffic and a green mesh has been placed interlacing through the fence surrounding the Palace. The final destruction of this edifice was shrouded by the mesh and semi-hidden from the public.

And now Haitian President Michael Martelly states that he does not know where the funding is going to come from to build a new Palace.

Why build a new Palace?

I can promise you that people are dying just a few blocks away for very stupid reasons. Watching sick three-year olds, thirteen-year olds, young men, and skeletalized old ladies gasping for their last few breaths is horrid. Are their lives not more important than another opulent political building?

Port-au-Prince is morass of misery and not fit for humans. The millions of dollars needed to reconstruct another Palace should be used instead to improve the basics that poor humans require to live with a little dignity. Millions of people in Port-au-Prince are living moment-to-moment, breath-to-breath.

Photo by John Carroll

President Martelly, forget the symbolism. Please attend to the living.

The Haitian National Palace is history. Let it be.  

John A. Carroll, MD
www.haitianhearts.org

AIDS/TB Treatment in Haiti at GHESKIO

In post-quake Haiti, rebuilt AIDS clinic treats more patients

 

By Anastasia Moloney, Reuters Alertnet, September 5, 2012

http://www.trust.org/alertnet/news/feature-in-post-quake-haiti-rebuilt-aids-clinic-treats-more-patients/

 

PORT-AU-PRINCE (AlertNet) - Tucked away in the Haitian capital is one of the world's leading AIDS treatment and research centres. A clean, tightly-run clinic provides an oasis of calm and order in stark contrast to the crowded, rubbish-strewn streets outside its guarded gates in downtown Port-au-Prince.

 

Set up 30 years ago, the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections - or GHESKIO - suffered $10 million-worth of damage in the massive earthquake that rattled Haiti in January 2010. The disaster destroyed parts of a clinic, a hospital for tuberculosis (TB) patients and research laboratories across GHESKIO's several sites. And, it has taken until now for the centre to get back on track.

 

"We have almost rebuilt everything. We have caught up with lost time," GHESKIO Director, Dr Jean William Pape told AlertNet in an interview at the centre's headquarters, near the grassy grounds that served as a makeshift field hospital in the aftermath of the quake. "We are also seeing more patients now than pre-quake times," he added.

 

Ground-breaking research

 

Over the decades, tens of thousands of Haitians living with TB and HIV/AIDS have relied on GHESKIO for free, life-saving treatment.

 

With the help of Haiti's ministry of health and Cornell University in the United States, Pape set up GHESKIO in 1982. He and other Haitian doctors had observed an increase in the number of adults in the Caribbean country mysteriously falling ill and dying from previously treatable diseases such as diarrhoea and Kaposi's sarcoma - a rare type of cancer that can affect the skin and internal organs.

 

These observations were published a year later in a seminal study that described AIDS before the acronym even existed. As such, GHESKIO was the first institution in the world exclusively dedicated to fighting HIV/AIDS.

 

"The word AIDS then did not exist. It was coined much later," Pape said. "We published in the New England Journal of Medicine the first cases of AIDS in a developing country. Our patients presented either with Kaposi's sarcoma or opportunistic infections," the Haitian-born doctor explained. "Ninety percent were males and about half had tuberculosis. We had a feeling that this was going to be important."

 

GHESKIO went on to publish more ground-breaking research, including a paper dispelling an early theory that Haitians were more at risk of catching the AIDS virus than other populations. "I think what unified us most was the fact that the world almost was against us early on. AIDS then was known as the 'four H' disease - homosexuals, heroin addicts, haemophiliacs, and the fourth H being the Haitians," Pape said. "This was a huge mistake. We published data that shows Haitians had the same risk factors as anybody else," said the U.S.-educated doctor, who is also a professor at Cornell University?s Weill Medical College in New York.

 

In 1996, GHESKIO's research also helped show that AIDS could be transmitted through heterosexual contact. "When we reported the rapid shift from a homosexual population to the heterosexual population nobody seemed to believe it could occur so quickly. But it did," Pape said.

 

More recently in 2010, following GHESKIO's clinical research on antiretroviral therapy for HIV patients, the World Health Organisation changed its guidelines on its treatment protocol for HIV patients.

 

Key care provider

 

Today, GHESKIO provides around 500 TB patients free treatment every year, making it the largest provider of TB care in the Caribbean nation. It also gives free HIV/AIDS services to around 140,000 children and adults every year, including counselling, HIV testing, antiretroviral therapy and nutritional supplements. Despite GHESKIO's reach, HIV treatment coverage in Haiti reaches less than half of those in need, according to UNAIDS.

 

GHESKIO's focus on preventing mother-to-child transmission of HIV, ensuring a safe blood supply, and AIDS prevention campaigns - including raising awareness about safe sex and condom use - have all helped to lower Haiti's HIV prevalence rates. Today, 2.2 percent of Haiti's adult population is living with HIV, down from 6.2 percent in 1993, Pape said.

 

"You are not going to die anymore"

 

Providing HIV patients with free antiretroviral drugs is one thing. However, making sure patients take the cocktail of powerful antibiotics over a course of six months or more when they are supposed to, and correctly, is quite another challenge.

 

It's a problem Pape and his team are constantly striving to solve. When a patient fails to pick up drugs or misses a medical appointment at the clinic, says Pape, GHESKIO's electronic records system alerts a field worker to visit the patient's home. Patients can also ring a hotline and speak to a doctor. Also, every TB and HIV patient is given an extra two-week supply of medication, an initiative that helped save lives in the chaos following the earthquake.

 

"In Haiti, there have always been problems of some kind, so we had to develop a contingency plan," Pape said, referring to the nation's troubled history of social unrest and political upheaval.

 

But perhaps more importantly, patients are given hope. "It's team work," Pape said. "The counsellor, lab technician, field worker and nurse, all of them are involved in indicating to the patient - 'First of all, you are not going to die any more. Now you can think about living and about finding some work. Give us a little time, give us two to three weeks of taking your medicine daily and we'll change your life'."

 

Pape is now overseeing the building of a new hospital for GHESKIO's TB patients, set to finish in May 2013, after its TB hospital was destroyed in the earthquake.

 

While GHESKIO is rebuilding, though, Haiti in general is still struggling to recover from the earthquake. "The country has not yet rebuilt. It's going to take some time before the country as a whole can catch up," Pape said.

 

"But we are a resilient nation, a resilient people and I think that we will be able to go back and do better than what we were doing before the earthquake," he said.

 

Mennonite Central Comittee on MINUSTAH

Cite Soleil
Photo by John Carroll

On Letterhead of Mennonite Central Committee, United Nations Liason Office

August 29, 2012

(Posted to CHAN website, including original letter attachment in pdf format.)

Dear Security Council Representative,

Mennonite Central Committee Haiti (MCC Haiti) is a disaster relief, development and peace organization. MCC Haiti has been serving in Haiti, alongside Haitians, in the area of agriculture, human rights, health and education for over 50 years. We have consistently engaged with local communities in peace programming in Haiti and have seen first-hand the impact of the United Nations Stabilization Mission in Haiti (MINUSTAH) forces in the country. We are writing this letter in light of the upcoming decision-making process regarding the MINUSTAH mission, and the extension of its mandate.
This position statement, along with all of our advocacy work, is informed by Haitian civil society; we have engaged in extensive conversations with our advocacy partners and the positions herein reflect those dialogues. As co-signers on this letter, Plateforme des Organisations Haitiennes des Droits Humains (POHDH), Réseau National de Défense des Droits Humains (RNDDH), and the Plateforme Haïtienne de Plaidoyer pour un Développement Alternatif (PAPDA) all attest that the following information represents their position on MINUSTAH and the importance of the recommendations presented here.
According to paragraph seven of Security Council resolution 1542, the directives of MINUSTAH are to: ensure a secure and stable environment, protect the rule of law, support the constitutional and political process, encourage free and fair elections, promote and protect human rights, particularly those of women & children, and ensure accountability and redress.1 In the eight years of MINUSTAH’s presence, there has been little evidence to prove that this mandate has been effectively carried out. Rather, the presence of MINUSTAH forces has undermined peace efforts throughout the country, with the troops themselves engaging in grave human rights abuses.
Accountability for Human Rights Violations:
According to the United Nations Conduct and Discipline Unit, 758 allegations of misconduct have been reported in the past five years; 217 of which were categorized as sexual exploitation and abuse.2 Out of the 217 reported cases since 2007, 58 remain classified as “pending”.3 This 27% rate of uninvestigated sexual exploitation and abuse cases does not amount to the zero-tolerance policy indicated in the MINUSTAH mandate.
Just in the year since the last renewal of the MINUSTAH mandate, there have been several examples of abuses of authority within MINUSTAH including the torture of three Haitians in Cite Soliel by Brazilian troops on December 13, the kidnapping and rape of the minor Roody Jean by two Pakistani soldiers on January 20th, and the beating of students in Lycée Capois de Limonade on January 31.4
Negligence:
There is sufficient proof indicating that the cholera epidemic, introduced to Haiti in October 2010, was the result of inadequate sanitation procedures on the part of MINUSTAH forces. This has resulted in the death of more than 7,0005 and the infection of over 525,000.6 The Haitian Rural Code, (Art. 297), states that human waste should not be disposed of in or near rivers, springs, ponds, or reservoirs. The Haitian Penal Code addresses cases of carelessness and neglect in this respect and according to the Civil Code (Art.1168, 1169.1170) compensation must be provided to victims and their dependents affected by the negligent acts.
The Pan American Health Organization estimates the cost of water and sanitation systems, sufficient to eradicate cholera, to fall between $800 million to $1.1 billion.7 It is the responsibility of the United Nations to make reparations for these losses and further, do all it can to bring an end to the epidemic, including the financing of necessary infrastructure.
Insufficient Security Threat:
Article 39 of the UN Charter applies directly to countries that pose an imminent threat to peace. While the Security Council determined the existence of such a threat to peace in Haiti in 2004, the factors that led to that decision are no longer valid. Haiti has not experienced any systematic violence or wide-spread conflict in over five years while other countries such as Somalia, Syria, and Colombia, where conflict undermines both national and international security, do not have a peacekeeping force. Out of the 22 countries in the Caribbean, Haiti was ranked fifth from last in homicide rates in 2011.8 Brazil, Paraguay, and Ecuador, as well as several other countries that contribute military personnel to the MINUSTAH mission, had much higher homicide rates in their own countries. Haiti is now under the leadership of a stable government with its executive, legislative, and judicial branches secured. This government must be given the opportunity to lead its own people, without the influence of a foreign military body.
Sovereignty:
The original mandate for MINUSTAH was a directive to provide security and the facilitation of a peaceful transition to a stable Haiti. However, the objectives and goals of the 2008 benchmarks, created assumedly as a method for measuring steps toward withdrawal, deviate from the original intent of the mandate just four years earlier, adding economic and social components to the MINUSTAH mandate.
These benchmarks could easily be used to justify the prolonged presence of this unpopular force by claiming that sufficient economic and social indicators have not yet been achieved.
Post-earthquake reconstruction in Haiti remains largely incomplete, including 390,000 people still living in tent camps, more than 500,000 people infected by cholera, and 49% adult literacy rate.9 These problems facing Haiti are not of a military nature, rather are economic factors that require holistic solutions and the strong leadership of the Haitian government.
Conclusion:
In two years since the earthquake, the MINUSTAH mission has cost the international community a total of $1,556,461,550.10 This comes in addition to their contribution of approximately 10,000 troops and police forces each year. This money was spent during long periods of global economic downturns, the application of budget cuts by many member states of the United Nations, and falling rates of employment for their affected citizens.
For eight years, MINUSTAH has reaffirmed their commitment to Haiti’s sovereignty, independence and territorial integrity. The recognition of these fundamental aspects of statehood are essential components in ensuring peace and security in Haiti. In September 20, 2011, the Haitian Senate adopted a resolution, stating that MINUSTAH troops must withdraw from Haiti; this is a clear indicator of the lack of local support. The dignity and rights of Haitians must be acknowledged.
We contend that the prolonged presence of MINUSTAH armed forces in Haiti is misguided, ill-timed, and out-dated for the nature of needs currently facing Haiti in the context of reconstruction. We recommend that the Security Council respect the sovereignty of Haiti and pass a resolution calling for the accelerated withdrawal of all MINUSTAH personnel from Haiti, working in close collaboration with the Haitian government to realize this objective. Further, we recommend that:
1. due to MINUSTAH’s stated desire to improve the living conditions of concerned populations,11 previously slated funding for military activity be reallocated to the development of water and sanitation infrastructure, and managed by other UN agencies.
2. the Security Council ensure that each member country investigate all allegations of human rights violations brought against their respective troops where impunity within MINUSTAH has not been addressed.
3. the SOFA agreement be respected, by establishing a Standing Claims Commission to hear cases against MINUSTAH, operating even after MINUSTAH has exited from Haiti.
4. MINUSTAH claim responsibility for the loss of life that occurred as a result of the cholera epidemic and pay reparations to the families of the victims that were infected or died as a result of the disease.
Sincerely,
Plateforme des Organisations Haitiennes des Droits Humains (POHDH)
Antonal Mortime, Executive Secretary
Réseau National de Défense des Droits Humains (RNDDH)
Pierre Esperance, Executive Director
Plateforme Haïtienne de Plaidoyer pour un Développement Alternatif (PAPDA)
Camille Chalmers, Executive Director
Mennonite Central Committee Haiti (MCC Haiti)
Mbugua & Kristen Chege, Policy Analysts & Advocacy Coordinators
Notes:
1. UN Security Council Resolution 1542; Adopted by the Security Council at its 4961st meeting, on 30 April 2004 (paragraph 17).
2. http://cdu.unlb.org/Statistics/StatusofInvestigationsSexualExploitationandAbuse.aspx
3. Id
4. RNDDH. Situation Générale des Droits Humains dans le pays au cours de la première année de présidence de Michel Joseph Martelly. June 14, 2012
5. H5N1 http://crofsblogs.typepad.com/h5n1/2012/05/haiti-7182-cholera-deaths-as-of-may-20.html
6. Partners in Health http://www.pih.org/pages/cholera/
7. http://new.paho.org/blogs/haiti/?p=2182
8. UNODC Global Study on Homicide, 2011 (page 93)
9. UNICEF, At a Glance: Haiti: http://www.unicef.org/infobycountry/haiti_statistics.html
10. http://www.cepr.net/index.php/blogs/relief-and-reconstruction-watch/minustah-by-the-numbers
11. UN Security Council Resolution 2012; Adopted by the Security Council at its 6631st meeting, on 14 October 2011 (paragraph 13)
Mennonite Central Committee
United Nations Liason Office
777 United Nations Plaza
New York, NY  10017
(See also the October 2011 submission on MINUSTAH to the United Nations Universal Periodic Review that was co-signed by the Mennonite Central Committee.)

Mindless Menace of Violence

“Our lives on this planet are too short and the work to be done too great

to let this spirit flourish any longer in our land.

Of course, we cannot vanish it with a program nor with a resolution.

But we can perhaps remember, if only for a time,

that those who live with us are our brothers and sisters;

that they share with us the same short moment of life;

that they seek, as do we, nothing but the chance

to live out our lives in purpose and in happiness,

winning what satisfaction and fulfillment we can.

Surely this bond of a common fate, this bond of a common goal,

can begin to teach us something.

Surely we can learn, at least, to look at those around us as fellow man;

and surely we can begin to work a little harder

to bind up the wounds among us and

to become in our hearts brothers and sisters, compatriots once again.”

Robert F. Kennedy      ( 1925 – 1968 )