Five years of progress

Author: Dr. Vincent DeGennaro Jr. ’02

I stepped off the medical transport helicopter to transfer a critically ill patient from a rural hospital to a high acuity urban hospital. We discussed the case with the emergency room doctors, loaded him onto the gurney and took off for a brief flight to the city where he would receive the intensive medical care he desperately needed. A simple transfer that is routine for people in the United States used to be anything but routine in Haiti — until now.

The patient came to University Hospital of Mirebalais, where Haitian doctors training to be emergency medicine specialists with Partners in Health cared for him for the first 24 hours. His condition deteriorated until he was too ill to travel 90 minutes via mountainous roads to the Project Medishare hospital. Haiti Air Ambulance, the first publicly available emergency medical helicopter in any low-income country in the world, transferred him by air. He arrived at the hospital in Port-au-Prince, where a staff of Haitians and expatriates gave him care on a par with any community hospital in the United States. These simple improvements to what is perceived to be an ailing healthcare system are only the start of the story, a new chapter in Haiti.

Saturday marked the five-year anniversary of the devastating earthquake that killed 220,000 people. But Haiti is much more than the sum of the natural disasters and political unrest that has plagued the nation for the last few decades. As a doctor working in Haiti immediately after the earthquake, I’ve witnessed the incredible advances in the healthcare system and beyond since January 2010. A national cancer treatment program, spearheaded by the Ministry of Health and Project Medishare launches on the anniversary of the earthquake, will permit access to cancer care in every geographic region in the country. Three hospitals have been built, and the national hospital in Port-au-Prince, badly damaged in the earthquake, is finally getting a complete renovation.

The narrative on Haiti must be adapted to reflect the situation on the ground. Bold changes are happening every day. Android tablets, sold around $100 to the growing middle class of several developing countries, are being manufactured en masse in Haiti by the company Surtab. Gourmet coffee, sisal and vetiver crop exports are growing each year. Tourism to Haiti is growing dramatically, many visitors coming to enjoy the island’s beauty and history.

Haiti’s governments have certainly had their share of problems, but gone are the days of the military dictatorships, replaced by a burgeoning (albeit fragile) tradition of democracy. The current political gridlock dominating the news out of Haiti is no worse than the U.S. election debacle of 2000 or the government shutdown of last fall. Understanding Haiti’s political problems requires a re-examination of our own historical contribution, from a decades long delay in recognizing the first black republic’s independence to 20 years of brutal U.S. occupation to countless coup d’états encouraged or supported by previous U.S. administrations.

Examining the failure of the international community to help post-earthquake Haiti is necessary to encourage new forms of financing. The Duvalier dictatorships from the late 1950s to the 1980s grossly mismanaged aid, but most of what was given by the United States was simply a blank check to stave of communism. The end of the Cold War and 20 years of trustworthy and democratically elected Haitian administrations hasn’t convinced the world to re-examine direct aid to the government for specific projects, where meeting benchmarks triggers the next round of funding. Of the $13 billion pledged by all donors in 2010, as of 2013 about half had been spent in Haiti, and, according to The Guardian, 94 percent to the United Nations, international nonprofits or straight back to the donor governments. Less than 1 percent of all funds donated to Haiti after the earthquake went to the Haitian government. The international community’s failure is evident in the tens of thousands still living in tents, the newly created slums just outside the city, and the introduction of a cholera epidemic that has killed thousands.

Looking forward, business is growing rapidly in Haiti, with an annual economic growth rate of 4.3 percent. In the last two years, four new luxury hotels have opened in Port-au-Prince. Caracol is a new industrial park constructed in partnership with USAID that has brought more than 5,000 jobs to Haiti. The international telecommunications company Digicel has connected the country by building a cellular and data network.

Haiti’s government has also made tremendous strides when given the chance. However, the project-specific aid for the new hospitals was more costly than necessary and didn’t employ local construction firms because the principal donors — United States, Canada and Japan — favored contracts with nonprofits and multilateral institutions such as the United Nations. Throughout the country, construction and road repair has become a national priority, funded largely by Venezuela’s loans. Haiti’s first overpass will open later this year, smoothing the intersection of two major boulevards in downtown Port-au-Prince.

Each stakeholder has a part to play in reframing the narrative of Haiti. The international media needs to stop polarizing the narrative so the stories are either related to death, destruction or simple advances and hope narratives. Haiti deserves a balanced and objective news narrative that doesn’t simply reinforce these two sides of the coin but provides genuine analysis and information. The U.S. government must treat Haiti as an equal partner on the international stage. All donor governments must extend their generosity to the Haitian people by recognizing the sovereignty and capacities of the elected government, and reconsider simply financing business and nonprofits that come from their home countries. The Haitian government needs to bury the politics of the past, the winner takes all narrative that has existed since independence.

As we carried the patient out of the hospital in Mirebalais on a stretcher, hundreds of people watched from the hospital grounds and the surrounding hills. Two hospitals, a medical helicopter and dozens of healthcare workers united to try to save one man’s life. The immense effort and expense for a single human being is nothing new; it’s only new to Haiti. His journey demonstrates that the systems in place are improving and that the involvement of the Haitian government is no longer a suggestion but a necessity for success. A new day has dawned and a new story is being told. Haiti is not the moribund country perpetually trying to catch up, nor are the small advances going to be the savior of Haiti. The incremental successes should be acknowledged and serve as examples to push us all to redouble our efforts.

Vincent DeGennaro is an internal medicine doctor and a global public health specialist at the University of Florida’s Division of Infectious Diseases and Global Medicine and works half time in Haiti with the nonprofit Project Medishare. See his An American Doctor in Haiti blogs.