tent structures built close together stretch across the distance, filling the photo frame

Overhauling Haiti

By Christine Grillo

Months after the January 12 earthquake razed Haiti’s capital of Port-au-Prince and claimed 230,000 lives, Haitians and others involved in recovery efforts are faced with the question of how best to rebuild, or even where to start. Johns Hopkins Public Health associate editor Christine Grillo posed three questions about Haiti’s future to a disaster response expert who provided emergency medical care in Haiti, a student who was in Haiti during the earthquake, and a Haitian-born and -raised faculty member.



How Will Haiti Survive Future Disasters?

The best way to be prepared for disasters is to have a strong government and infrastructure that includes a health and emergency care system. Even before the earthquake Haiti didn’t have those things. The Haitian government has been weak for decades, and it has a great dearth of resources. So the country exists in a chronic, low-grade disaster state with very poor health, public health and economic indicators. To make matters worse, it has frequent natural disasters—hurricanes, and now earthquakes—which further prevent development.

The most important thing Haiti needs is a stronger, more reliable government and the funding to rebuild its infrastructure. Unfortunately, both seem pretty unlikely. Without these fundamental changes, the lives of the Haitian people will not improve.

How the world chooses to approach Haiti is a difficult dilemma. No one, including the U.S., wants to take over the management of the government; but the government has been unstable for years. The world has to provide some political and economic stability to allow infrastructure to be built.

From a health care and public health perspective, there are also fundamental infrastructure needs that must be addressed. Some experts have predicted that Haiti will rely on health care from other countries and agencies for years. Many nurses, physicians and public health workers died in the earthquake. The nursing school at the University Hospital collapsed and killed the entire annual class of nurses. There is now the great need to rebuild the physical infrastructure for health care, but also rebuild its intellectual capital through training and schools.

Despite years of aid and billions of dollars in the last decades, Haiti remains the least developed nation in the Western Hemisphere. Unfortunately, corruption has been a great contributor to this. Haiti is ranked as one of the most corrupt countries in the world. This has led to terrible hospitals, dirt roads, a weak power grid and unemployment of greater than 40 percent. But the people I met there were strong and kind and resourceful despite the devastation and overwhelming personal loss. Once again, the country needs a political solution. My big hope is that because of the devastating nature of the event, Haiti and the world will wake up and finally make some of the critical decisions that need to be made.

Thomas Kirsch, MD, MPH ’87, is an associate professor in the Department of Emergency Medicine at the Johns Hopkins School of Medicine and the Bloomberg School’s Department of International Health; co-director of the Center for Refugee and Disaster Response; and the Johns Hopkins Disaster Response team leader in Port-au-Prince.

Where Will Haitians Be Educated?

As a Johns Hopkins student, I have been listening attentively to the ongoing discussions about the role that Hopkins and other universities might play in the rebuilding of Haiti. Essentially, every institution of higher learning in Haiti has been flattened. In a situation like this, Port-au-Prince’s university students are already asking, where will they continue their education?

An important question we must ask on a broader level is, Who will lead Haiti out of this disaster with no schools—literally no buildings—left to train and educate future leaders? Even before the earthquake, graduate students dealt with crowded classrooms and few opportunities. But with many schools still indefinitely closed, rising Haitian physicians, accountants and business leaders have little hope for continuing their schooling.

Institutions like Hopkins have much to offer. Much as Tulane’s students were accepted at universities across the nation after Hurricane Katrina, schools of public health might save spaces or scholarships for Haitian students. While Haiti overflows with innumerable NGOs, few U.S. institutions of higher education have satellite or partner institutions in Haiti. Any involvement could not be timelier.

Haiti’s reaction to the earthquake is a testament to the fact that Haitians will move on, survive this tragedy and sustain themselves. My fervent hope is that the Haiti that emerges will display real economic, human rights and public health progress.

Jane Andrews, an MPH student, was researching iodine deficiency in Département of Artibonite when the earthquake hit. Soon after the quake, she and three fellow MPH students rushed to Port-au-Prince to help with relief efforts.

Rebuild a City or Build a Nation?

After the quake, my brother and his family had to leave Port-au-Prince. They moved back to our hometown of Gros-Morne, Département of Artibonite. Like them, thousands of families in Port-au-Prince are moving out of the city and migrating to other smaller cities and towns across Haiti.

The towns are trying to handle the influx of people, but there are almost no existing services in these small towns and cities. Gros-Morne never had electricity, except for a very brief time when electric power was provided intermittently to less than half of the population for a few hours at night.

When the earthquake hit, approximately 2 million people were living in Port-au-Prince. It’s extremely overcrowded—but people move to the capital because it’s the only place in Haiti with basic services and jobs. The medical school is there, and the agriculture school is there. In Haiti, if you want your child to be somebody, you have to move to Port-au-Prince. But give me a break—if Port-au-Prince breaks, the whole country is broken. And that’s what happened. People are leaving the city now; it makes no sense to bring them back.

In my opinion, we should not rush into rebuilding Port-au-Prince. Instead, let’s build up the towns across the nation. Let’s build roads; right now, everything is so expensive in Haiti because the roads are so bad. We need a rail system. Let’s build airports somewhere other than Port-au-Prince. Let’s build homes and infrastructure. Let’s break the vicious cycle.

Let’s build a nation.

Born and raised in Haiti, Pierre K. Alexandre, PhD, MPH, MS, is an economist and associate professor in the Department of Mental Health. He has a background in economics, public health, environmental sciences and agriculture.