On January 12, 2010, a 7.0 magnitude earthquake struck southern Haiti. It virtually leveled the capital city of Port au Prince, and in a matter of an instant, 316,000 people lost their lives. For those of us working in Borgne, it was an emotionally devastating event on many levels. Numerous people across the commune lost family members who lived in the southern part of the country. Friends we worked with both in the Ministry of Health and in USAID perished when the Ministry of Health and the Hotel Montana collapsed. Hundreds of doctors and professionals with deep knowledge of the country’s health system and its needs were lost. It was a painful day.
The H.O.P.E./ASB hospital became part of the extraordinary global humanitarian response to this tragedy. Dr. Thony and his team established the hospital as a national tertiary site for treating the injured. A team of volunteers from the Spiritus Christi church, in Rochester, NY, flew down to help our friends in Borgne build a temporary shelter at the hospital—a shelter that was soon full with both the injured and displaced. H.O.P.E raised thousands of dollars to purchase medicines and other medical supplies, and arranged for shipment of needed equipment from the U.S. to Borgne. People in Borgne prepared meals and opened their homes to people impacted by the quake. Despite the devastation and the extraordinary sense of loss, there was also a spirit of comraderie and compassion—a sense of community on a global scale. Sean Penn and Anderson Cooper were highly visible celebrities who both championed and dramatized the response. The world felt like it had come together in Haiti. There was hope.
Within a matter of weeks the celebrities had left. The news cycle shifted to bombings in Uganda, and Spain’s victory over Netherlands in the World Cup. Haiti was no longer on the front page. Hordes of international NGO’s had descended on the country. White Toyota Land Cruisers carried their banners along with their European and American experts to the far reaches of the country. Along with their spread came cholera. Cholera is a disease that is easy to treat in places with potable water, sanitary sewers and access to health care. Haiti is not one of those places. The first cases were reported in October of 2010 and within a matter of 10 days a small outbreak in the Artibonite (the first ever in Haiti) had spread across the country.
I was with Dr. Thony Voltaire, H.O.P.E./ASB medical director, when we first heard of how rapidly cholera was spreading. We were in Port au Prince trying to buy an ambulance and on our drive down from Borgne he had predicted that it would be only a matter of days before cholera would spread across the country. As soon as he heard where it had spread, Dr. Thony was desperate to get back to Borgne. He knew that this waterborne killer would quickly reach the commune. He knew the mountainous geography and network of rivers would swiftly spread it to people who could not easily reach the care they needed. He knew the lack of sanitary sewers and untreated water were a recipe for disaster. He knew the work that lay ahead to prepare the response.
Dr. Voltaire, who is normally cool and calm in the face of crisis, was anxious and agitated, desperately needing to return to Borgne. We hurried our efforts to finalize purchase of the ambulance and left as soon as possible on the 12 hour drive from Port Au Prince back to Borgne. Dr. Thony drove the ambulance and we spoke very little as we drove over the mountains through the dark to get home. I could feel his mind racing with concern. I could see the tension in his face and hands as he held the wheel and drove breakneck over potholed roads. By the time we had arrived back to the hospital, the first cases of cholera were reported in Tibouk. The next morning, I woke early, around 5:00, in preparation to return to the U.S. Dr. Thony had left at 3:30 for Tibouk with a team from the hospital. The next crisis of Haiti was unfolding.
As with the earthquake, H.O.P.E./ASB coordinated hundreds of volunteers in immediate response to the outbreak. Working in tandem with a team from Medicines Sans Frontieres (Doctors Without Borders), we established a cholera treatment center at the hospital in Fond Lagrange, and a cholera treatment unit at an abandoned clinic in Tibouk. Partnering with the American Red Cross, H.O.P.E/ASB created a water and sanitation team (the precursor to our S.E.E. Team) who engaged the community in participatory cholera prevention and sanitation programs. This team set up and stocked 21 oral rehydration posts across the mountains and at the junctions of major pathways leading to the two treatment facilities; they collected critical health surveillance data, and educated people about protecting water sources. Community volunteers in Borgne retrofitted thousands of plastic water buckets with lids and spigots (at a cost of just over $2) and our water and sanitation team trained people on how to safely collect and treat water in these incredibly low-cost and simple but effective systems. The grassroots response led by Dr. Voltaire and the H.O.P.E./ASB team was rapid, comprehensive, and very successful.
In time, the cholera epidemic in Haiti shifted from crisis to an endemic fact of everyday life. Since the beginning of the outbreak, more than 800,000 people were infected and more than 9,500 people have died from the disease. The response in Borgne was widely recognized as one of the most successful in the country. Our mortality rate was approximately one-third of the rate found in comparable rural areas. The community had once again joined hands to confront a life threatening challenge. More importantly, behaviors changed. People were more careful about where they got their water and how they treated it. We constructed or rebuilt more than 30 latrines across the commune and people were more aware of the adverse effects of open defecation.
As happens with every crisis, the legions of international NGO’s packed their bags and left. They were off to the next funding opportunity and the next crisis. Our team in Borgne remains—steadfast and true to their mission to ensure the well-being of their commune and the people who live there. COVID has presented a new challenge, but this time the world is preoccupied with its own fragility and uncertainty. Dr. Thony and his team have done what they always do—respond with intelligence and passion to the situation as best they can. They have built quarantine spaces; protected the staff with personal protective equipment; and, launched a commune wide education campaign on COVID prevention.
In each of these cases—earthquake, cholera, COVID-19— I am reminded what makes our model and our team uniquely successful. We don’t leave Haiti when the latest crisis is over. We don’t leave because it is where we live and where our friends live. We stay and learn and adapt and innovate. We are not chasing funding in order to move on to the next global crisis because the crisis is never really over. The every-day health challenges of a remote poor rural community in Haiti are crises enough. Typhoid, tuberculosis, parasitic infection, malnutrition, and all manner of chronic disease remain even if they don’t make the news. We remain too. I have come to realize that Dr. Thony rises every morning by 4:00, not just in times of Cholera. He is out of bed and on his way to Tibouk, or conducting rounds in the hospital, before the rooster crows. As with cholera, he knows that ensuring the health of his community requires daily vigilance, creativity, quick action, and a long-term commitment to making meaningful change. We are fortunate to walk with such a special person in such an extraordinary community.