PHILADELPHIA—Paul Farmer is used to uphill battles. After decades working to fight HIV/AIDS and tuberculosis in impoverished areas of Haiti, the seemingly tireless doctor and anthropologist is now struggling to reassemble a health strategy for the country after last year's earthquake and subsequent cholera outbreak.
For Farmer, co-founder of the nonprofit organization Partners In Health (and the subject of Tracy Kidder's book Mountains beyond Mountains), the key is to rebuild primary health clinics—not just create treatment centers, Farmer said this week at the American Society of Tropical Medicine and Hygiene's annual meeting here. These basic buildings cost hundreds of thousands of dollars to retrofit, but once they're up and running and staffed with health workers, they can take advantage of medical experts internationally via simple Internet connections and partnerships with world-class institutions, such as Massachusetts General Hospital. Such clinics can see thousands of locals who previously had little or no access to medical care, which increases the odds of diagnosing chronic conditions, such as HIV/AIDS and tuberculosis earlier, and of keeping people well enough so they are less vulnerable to disease in the first place.
Although the earthquake shed new light on the country's health challenges, it was not a singular cause of them. "Haiti's problems are not acute, they're chronic," Farmer said. "They did not have the surgical capacity before the earthquake and certainly did not have it afterward," he said. Not only were many of the nation's hospitals and clinics destroyed in the quake, but much of the human health resources were lost, too. "When the nursing school collapsed, it was full of students," he said. "A lot of them died—and so did their teachers."
As of November—nearly two years after the earthquake—some 550,000 Haitians were still living in temporary camps (just less than half of the 1.3 million peak). Even before the event, Farmer noted, Haiti was the most water-insecure countries in the region. So establishing basic infrastructure that it has been lacking for decades, such as improved water supply, would help boost overall health and decrease the risk that cholera will return with the rainy season.
And Farmer sees it as a "clear example of international responsibility" to help. Within less than a year, cholera became the most common killer of young adults in Haiti, and "many Haitians regard this as an introduced problem," he said.
Cholera has been a disease of the tropics, but it and other diseases common in equatorial regions, often referred to as neglected tropical diseases, aren't "about latitude only," he said. "All diseases that affect the poor are neglected diseases."
He finds hope for Haiti in other countries that are on the path to a better health infrastructure, such as Rwanda in Africa. "If Rwanda can crawl back from the genocide," he thinks Haiti has more than a fighting chance.