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An American Doctor Among Haiti's Poor
February 2003

by Michael Deibert.

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This article was produced with the collaboration and financial support of Fogarty Center - National Institutes of Health (NIH), USA and the GHESKIO Centres in the scope of the project "Strengthening the capacity of journalists in the Caribbean and Central American region to report on HIV/AIDS: Focus on Haiti." This project is being implemented by the Communication Centre on AIDS (CECOSIDA) and the Panos Institute.

In the children's ward of the Zanmi Lasante health center, set among the rolling mountains of Haiti's rural Plateau Central region in the village of Cange, Dr. Paul Farmer is prescribing oxygen and medicines for a sick teenage boy.

The boy is gasping for air, in the throes of multidrug resistant tuberculosis. Emaciated and weak, his eyes are alive with fear. "He's in respiratory distress," says Farmer. "We need to keep him breathing."

Outside, the building in a small courtyard, over 100 people, some from as far afield as the remote southern city of Les Cayes, some 90 miles (145 km) away, stand waiting with their various afflictions, hoping to be seen.

Two elderly peasant men in broad-brimmed straw hats, a tiny elderly woman bent double by tuberculosis and an otherwise healthy-looking man who is HIV-positive wait for a chance to be treated at the hospital by the man Haitians have come to call simply "Polo."

Farmer, a Harvard-educated physician who hails from rural central Florida and also holds a PhD in anthropology, first came to Haiti in 1981 after working with immigrant Haitian farm workers in Florida and the Carolinas. He said he was shocked that anyone would choose to work in such desperate conditions, which often appeared to him to be little better than slavery. "Have you ever been to Haiti?" the immigrants would reply to him.

Farmer kept coming back to Haiti after that first trip. Working through the Partners in Health network, he formed the Clinique Bon Sauveur with local priest Father Fritz Lafontant in 1985. It was the first step in creating what has over time become the most sophisticated and medical operation in the entire country.

The existing health complex (Zanmi Lasante means "Partners in Health" in Haitian Creole) was founded on land that had been occupied by squatters displaced by the construction of Haiti's Peligre hydroelectric dam in 1956, and has become a frontline in Haiti's struggle against endemic maladies such as tuberculosis and malaria, as well as the more recent scourge of AIDS.

For many, it serves an example of what wisely spent aid funds can do for this impoverished Caribbean nation of 8 million. The center's ambulatory clinic often sees over 300 patients and its optical clinic over 90 in a single day.

It is an example sorely needed in a country where, according to figures provided by the World Food Program (WFP), three-fourths of the populace lives below the poverty line and 4.5 percent are suffering from acute malnutrition.

According to Haiti's Ministry of Health, 4.5 percent of the population -- some 360,000 people -- have been infected with HIV, the virus that causes AIDS.

Haitians' health problems have been compounded by another seemingly chronic Haitian affliction: political instability. Jean-Bertrand Aristide, a former Roman Catholic priest who began his second term as Haiti's president in February 2001, has been locked in a dispute with the main opposition over the results of elections in 2000 that has stalled as much as $500 million in international aid. The conflict has flared violently in recent months, with protests, riots and strikes gripping all parts of the country.

"His mother died of AIDS," Farmer says, putting his hand on the shoulder of a small shyly smiling boy named Charlemagne who had run up to greet him as he walks through the compound. "He had TB himself, but we think he'll be fine now."

Another child of 10 or 11 runs up to Farmer and, laughing, pulls up his t-shirt to reveal a deep scar running the length of his abdomen. The child had undergone open-heart surgery at Cange, attended to by a team of American and Haitian physicians after suffering rheumatic heart disease that damaged his heart valves. The operation saved his life. "Everything's alright now," the boy says, beaming. "Thank God for Dr. Farmer."

At the clinic, Farmer is supervising the construction of a new respiratory unit complete with high-power fans to circulate the air better and ultraviolet lights that work to kill the organism which causes tuberculosis.

The unit will be the first of its kind in Haiti, and will contain 10 rooms for the worst TB cases. Cange has already become a national referral center treatment of the disease. Zanmi Lasante will also be sharing in $2 million of a $67 million award secured by Haiti's Health Minister, Henri Claude Voltaire, last May from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The award will be used in an integrative approach with Haiti's already existing health infrastructure and not for the clinic solely.

"It's not Cange per se that will receive funding from the Global Fund but rather a number of institutions throughout the entire department, in which there are scores of partners and potential partners," Farmer says. "Our group is also trying to reinforce public health infrastructures, (and) the project won't work if we can't help rebuild the public health system."

Though Farmer also maintains clinics in Lima, Peru and Russia, Cange has served as the 43-year old's base for most of the last 20 years.

His home, at the end of a deeply forested path next to the clinic, is a modest, two-room building painted in the bright pastel colors of the Haitian peasant shacks that surround it. A computer rests on a desk and books line the walls.

As Farmer emerges from another meeting, a beautiful teenage girl comes up and kisses him on the cheek. The girl, it turns out, is a teenage sex worker who has recently discovered that she is also HIV-positive. Sexually abused by a policeman at a young age, the staff at Cange is working diligently to save her from the ravages her sickness can bring. In celebration, she has decided to go to school, for the first time in her life.

"I know my letters," she says, opening her purse to reveal dog-eared copies of books on Creole grammar and Haitian history. "Even if I can't read yet."

"All of these lessons you see in these cases here are about inequalities of power, the vast and unfettered power of the rich world, and the sharply constrained power of the poor," says Farmer. "Health care and education need to be considered basic rights, because without them, this work is doomed and so are hundreds of millions of lives."

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