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Countries most affected by disasters are often those with limited local capacity to respond. When local capacity is overwhelmed, international humanitarian response often provides needs-based emergency response. Despite global progress in education and the development of international humanitarian response standards, access to training and integration of local actors in response mechanisms remains limited. In May 2017, the Haiti Humanitarian Response Course (HHRC) was implemented in Mirebalais, Haiti to increase local capacity and allow for effective future engagement with international humanitarian actors in a country prone to disasters.
In collaboration with the Hôpital Universitaire de Mirebalais’ (HUM; Mirebalais, Haiti) Department of Medical Education and Emergency Medicine (EM) residency program, four physicians from the Division of Global Emergency Care and Humanitarian Studies at Brigham and Women’s Hospital (Boston, Massachusetts USA) facilitated the course, which included 53 local physicians and staff. Following 15 hours of online pre-course preparation, through didactics and practical small-group exercises, the course focused on key components of international humanitarian response, minimum standards for effective response, and the roles of key response players. The course was free to participants and taught in English and French.
The HHRC reduced the barriers often faced by local actors who seek training in international humanitarian response by offering free training in their own community. It presents a novel approach to narrow critical gaps in training local populations in international humanitarian response, especially in environments prone to crises and disasters. This approach can help local responders better access international humanitarian response mechanisms when the local response capacity is exhausted or overwhelmed.
The HHRC demonstrates a potential new model for humanitarian and disaster training and offers a model for similar programs in other disaster-prone countries. Ultimately, local capacity building could lead to more efficient resource utilization, improved knowledge sharing, and better disaster response.
Between 2010 and 2019 the international health care organization Partners In Health (PIH) and its sister organization Zanmi Lasante (ZL) mounted a long-term response to the 2010 Haiti earthquake, focused on mental health. Over that time, implementing a Theory of Change developed in 2012, the organization successfully developed a comprehensive, sustained community mental health system in Haiti's Central Plateau and Artibonite departments, directly serving a catchment area of 1.5 million people through multiple diagnosis-specific care pathways. The resulting ZL mental health system delivered 28 184 patient visits and served 6305 discrete patients at ZL facilities between January 2016 and September 2019. The experience of developing a system of mental health services in Haiti that currently provides ongoing care to thousands of people serves as a case study in major challenges involved in global mental health delivery. The essential components of the effort to develop and sustain this community mental health system are summarized.
This paper addresses the relative scholarly oversight of the history of public health in Haiti through a close examination of the colonial public health system constructed and operated by the United States (US) during its occupation of Haiti from 1915 to 1934. More than simply documenting a neglected aspect of Caribbean history, the paper offers the US occupation of Haiti as a remarkably clear example of a failed attempt to use a free public health service to cultivate a health conscientiousness among the Haitian citizenry through the aggressive treatment of highly visible ailments such as cataracts and yaws. I argue that the US occupation viewed the success of the Haitian Public Health Service as critical to the generation of a taxable, compliant and trusting citizenry that the colonial state could enter into a contract with. This idealistic programme envisioned by the US occupation was marred by financial mismanagement, racism, delusions of grandeur and contempt for Haitian physicians that resulted in the production of a far more precarious public health service and administrative state than the US occupation had hoped. By the time the Great Depression arrived in 1930 the Haitian Public Health Service was gutted and privatised, having successfully provided the majority of Haitians with free healthcare, yet failed to have persuaded them of the value of being governed by a centralised administrative state.
To summarize the state of knowledge of the Endangered Antillean manatee Trichechus manatus manatus in Hispaniola, which comprises the Dominican Republic and Haiti, I reviewed documentary archives from pre-Columbian times to 2013. Manatees were historically abundant in Hispaniola but were hunted for centuries for their meat and other body parts for diverse uses. By the end of the 19th century manatees had become relatively rare around the island. Nevertheless, manatees remain widespread along the coast and occasionally occupy freshwater habitats in the Dominican Republic. In Haiti recent manatee sightings were restricted to two coastal areas. Currently, the manatee population of Hispaniola is perceived to be declining. The most commonly reported threats to the species include hunting, entanglement in fishing gear, boat strikes and disturbance by boat traffic, pollution, and habitat degradation and destruction. In the Dominican Republic longstanding national laws and international agreements protect the species and its habitat, and past conservation actions have raised public awareness about the status of the manatee. In Haiti knowledge of manatees is extremely limited and the species is not legally protected. I propose country-specific and binational recommendations to improve the contemporary conservation of manatees in the Dominican Republic and Haiti.
Argues that despite hopes of sweeping change, Clinton ended up running a traditional, Cold War–style foreign policy. He used Cold War institutions like NATO, and acted to contain Russian power in the Balkans. Examines attempts to apply a Clinton Doctrine and its successes and failures. Argues that Clinton's interventions advanced a trend of wars of Muslim liberation.
While the cholera outbreak in Haiti still claims victims every month, it is also the backdrop of one of the biggest legal battles the UN has been engaged in – one for the recognition of harm caused and for reparations for victims of cholera. Having used its immunity to disengage from the issue, the UN finally changed its stance in December 2016 and apologized for the organization’s role in the cholera outbreak. This article analyses the role of the elected members of the Security Council – alongside other key stakeholders – in contributing to the UN’s change of policy. Based on privileged access to a number of actors in this politico-legal fight, this article argues that elected members of the Security Council have played a crucial role in pushing the UN to ‘do the right thing’. This article, along with other contributions to this special issue, sheds a different light on the practices inside the Security Council, demonstrating that elected members are far from being powerless, as most of the literature on the subject tends to assume. They can successfully play a significant role inside the organization when the right conditions permit them to play this role.
In 2010, an important earthquake devastated Haiti and caused thousands of deaths. In a social context where women are particularly vulnerable, this cross-sectional study examined the associations between sexual assaults experienced by women before the earthquake, the earthquake exposure, the traumatic consequences, and their satisfaction of social support received.
A total of 660 women aged 18 to 86 completed questionnaires assessing exposure to the earthquake, sexual assault victimization, peritraumatic distress, Posttraumatic stress disorder (PTSD), depression, and social support. A moderated moderation model was computed to examine associations between exposure to the earthquake, sexual assault, social support, and traumatic consequences.
Results showed that 31.06% of women were victims of sexual assault before the earthquake. They presented higher prevalence of peritraumatic distress, PTSD, and depression symptoms, compared to non-victims. The moderated-moderation model showed that sexual assault and exposure to the earthquake were positively associated with traumatic consequences (respectively, B = 0.560, p < 0.001; B = 0.196, p < 0.001), while social support was negatively associated with them (B = −0.095, p < 0.05). Results showed a triple interaction: women victim of sexual assault who were satisfied with received social support are less likely to develop traumatic consequences after being exposed to the earthquake(B = −0.141, p < 0.01).
By demonstrating the role of sexual assault in the development of mental health problems after the Haitian earthquake, this study shows the importance for clinicians to investigate interpersonal trauma experienced before or following natural disasters among survivors. Results also indicate the key role of family and communities to help survivors build resilience and coping strategies with their social support.
Drawing on never-before-utilized archival and oral sources, “Making Peasants Chèf” contends that decades of peasant marginalization from political power created the social and political conditions for the rise of the infamous tonton makout militia under the dictator François Duvalier. After coming to power in 1957, Duvalier militarized and rearmed peasants in exchange for their loyalty. Thousands of previously ostracized peasants enlisted in the dreaded makout militia to access status and political power. This explains why the peasant-based militia formed an arm of state repression. With the support of an armed peasantry, Duvalier successfully repressed the political opposition, allowing the regime to stay in power for almost three decades.
Faulkner’s tragic masterpiece is, in essence, a novel of encounter, one in which different, even irreconcilable worlds collide most explicitly through their opposed understanding of race. New Orleans, in this novel, represents the radically cosmopolitan, a loose and ever-changing mix of Spain and France, Virginia and Kentucky, Haiti and Cuba, as well as many ethnicities and nationalities of Africa. In contrast, the world of Mississippi is organized according to the brutal simplicity of only two kinds of people: white masters and black slaves. Out of this conflict between New Orleans and Mississippi, Faulkner showcases the potential of New Orleans to lead the United States toward a progressive racial politics.
This chapter examines the migration of nearly 200,000 Caribbean immigrants – from Jamaica, Haiti, Puerto Rico, Barbados, Grenada, Aruba, and Curaçao – to Cuba in the 1920s and early 1930s. Jamaicans and Haitians, more than others, were perceived as threats to Cuban culture and national security, and between 1925 and 1933 the Gerardo Machado government encouraged the expulsion of Antillean workers and the nationalization of labor. Caribbean immigrants played a surprisingly important role in the organization of workers in the sugar industry and had a significant role in the sugar worker mobilizations of the early 1930s that culminated in the 1933 Revolution. The young Cuban Communist Party made great efforts to recruit and address Haitian and Jamaican workers, and West Indian immigrants were strikingly visible in labor agitation and resistance as well as in the strikes and mill occupations that accompanied the Revolution of 1933.
To investigate the social and living conditions of households in Haiti before and after the 2010 earthquake and to determine the prevalence of emotional and physical abuse of children aged 2 to 14 in households after the earthquake.
Nationally representative samples of Haitian households from the 2005/2006 and 2012 phases of the Demographic and Health Surveys were used. Descriptive data were summarized with frequencies and measures of central tendency. Chi-squared and independent t tests were used to compare pre-earthquake and post-earthquake data. Basic mapping was used to explore patterns of child abuse in relation to proximity to the epicenter.
Comparison of pre-earthquake and post-earthquake data showed noteworthy improvements in the education attainment of the household head and possession of mobile phones after the earthquake. The prevalence of emotional, physical, and severe physical abuse in 2012 was estimated to be 78.5%, 77.0%, and 15.4%, respectively. Mapping revealed no conclusive patterns between the proximity of each region to the epicenter and the prevalence of the different forms of abuse. However, the prevalence of severe physical abuse was notably higher in settlement camps (25.0%) than it was in Haiti overall (15.4%).
The high prevalence of child abuse in Haiti highlights an urgent need for interventions aimed at reducing occurrences of household child abuse.
Given the frequency of natural hazards in Haiti, disaster risk reduction is crucial. However, evidence suggests that many people exposed to prior disasters do not engage in disaster preparedness, even when they receive training and have adequate resources. This may be partially explained by a link between mental health symptoms and preparedness; however, these components are typically not integrated in intervention.
The current study assesses effectiveness of an integrated mental health and disaster preparedness intervention. This group-based model was tested in three earthquake-exposed and flood-prone communities (N = 480), across three time points, using a randomized controlled trial design. The 3-day community-based intervention was culturally-adapted, facilitated by trained Haitian lay mental health workers, and focused on enhancing disaster preparedness, reducing mental health symptoms, and fostering community cohesion.
Consistent with hypotheses, the intervention increased disaster preparedness, reduced symptoms associated with depression, post-traumatic stress disorder, anxiety, and functional impairment, and increased peer-based help-giving and help-seeking. Mediation models indicated support for the underlying theoretical model, such that the effect of the intervention on preparedness was mediated by mental health, and that effects on mental health were likewise mediated by preparedness.
The community-based mental health-integrated disaster preparedness intervention is effective in improving mental health and preparedness among community members in Haiti vulnerable to natural hazards. This brief intervention has the potential to be scaled up for use with other communities vulnerable to earthquakes, seasonal flooding, and other natural hazards.
Non-communicable disease diagnosis frequently relies on biochemical measurements but laboratory infrastructure in low-income settings is often insufficient and distances to clinics may be vast. We present a model for point of care (POC) epidemiology as used in our study of chronic disease in the Haiti Health Study, in rural and urban Haiti. Point of care testing (POCT) of creatinine, cholesterol, and hemoglobin A1c as well as physical measurements of weight, height, and waist circumference allowed for diagnosis of diabetes, chronic kidney disease, dyslipidemias, and obesity. Methods and troubleshooting techniques for the data collection of this study are presented. We discuss our method of community-health worker (CHW) training, community engagement, study design, and field data collection. We also discuss the machines used and our quality control across CHWs and across geographical regions. Pitfalls tended to include equipment malfunction, transportation issues, and cultural differences. May this paper provide information for those attempting to perform similar diagnostic and screening studies using POCT in resource poor settings.
This article develops an International Practice Theory (IPT) approach to United Nations peace operations through the study of the UN Stabilization Mission in Haiti (MINUSTAH). MINUSTAH saw the introduction of new practices within the context of a UN peace operation, namely the use of joint military-police forces to conduct offensive action against armed groups that were labelled as ‘gangs’. While more objectivist problem-solving approaches would argue that the UN mission was simply adapting to the situation on the ground, an IPT lens reveals that there was considerable struggle to integrate these new practices within the repertoire of peacekeeping. The article argues for the benefits of applying an IPT lens to peace operations while proposing to develop theoretical and methodological approaches that have been less prominent in IPT. Theoretically, it posits that IPT can better articulate practice and discourse by paying more attention to what actors say about what they do.
Before 1492, European feudal practices racialized subjects in order to dispossess, enslave and colonize them. Enslavement of different peoples was a centuries old custom authorized by the law of nations and fundamental to the economies of empire. Manumission, though exceptional, helped to sustain slavery because it created an expectation of freedom, despite the fact that the freed received punitive consequences. In the sixteenth century, as European empires searched for cheaper and more abundant sources of labour with which to exploit their colonies, the Atlantic slave trade grew exponentially as slaves became equated with racialized subjects.
This article presents the case of Haiti as an example of continued imperial practices sustained by racial capitalism and the law of nations. In 1789, half a million slaves overthrew their French masters from the colony of Saint Domingue. After decades of defeating recolonization efforts and the loss of almost half their population and resources, Haitian leaders believed their declared independence of 1804 was insufficient, so in 1825 they reluctantly accepted recognition by France while being forced to pay an onerous indemnity debt. Though Haiti was manumitted through the promise of a debt payment, at the same time the new state was re-enslaved as France's commercial colony. The indemnity debt had consequences for Haiti well into the current century, as today Haiti is one of the poorest and most dependent nations in the world.
The study uses interval regression to investigate factors affecting farmers’ willingness to pay for soil testing services in Northern Haiti. The model reveals that factors such as the type of crops grown, group membership, farmers’ educational level, access to credit, gender, contact with extension services or any institution, type of soils, income level, participation in soil testing program and farm size affect the amount to be paid for soil testing services. These results imply that the training module on soil testing and financial support in form of subsidies or access to credit should be provided to farmers.
In October 2010, the Haitian Ministry of Public Health and Population (MSPP; Port au Prince, Haiti) reported a cholera epidemic caused by contamination of the Artibonite River by a United Nation Stabilization Mission camp. Interventional studies of the subsequent responses, including a descriptive Methods section and systematic approach, may be useful in facilitating comparisons and applying lessons learned to future outbreaks. The purpose of this study was to examine publicly available documents relating to the 2010 cholera outbreak to answer: (1) What information is publicly available on interventional studies conducted during the epidemic, and what was/were the impact(s)? and (2) Can the interventions be compared, and what lessons can be learned from their comparison?
A PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA) search was conducted using the parameters “Haiti” and “cholera.” Studies were categorized as “interventional research,” “epidemiological research,” or “other.” A distinction was made between studies and narrative reports. The PubMed search yielded 171 papers, 59 (34.0%) of which were epidemiological and 12 (7.0%) were interventional studies. The remaining 100 papers (59.0%) comprised largely of narrative, anecdotal descriptions. An expanded examination of publications by the World Health Organization (WHO; Geneva, Switzerland), the Center for Research in the Epidemiology of Disasters (CRED; Brussels, Belgium), United States Agency for International Development (USAID; Washington, DC USA)-Development Experience Clearinghouse (DEC), and US National Library of Medicine’s (NLM; Bethesda, Maryland USA) Disaster Literature databases yielded no additional interventional studies. The unstructured formats and differing levels of detail prohibited comparisons between interventions, even between those with a similar approach. Only two (17.0%) interventional studies included any impact data, although neither commented whether the intervention improved health or reduced incidence or mortality related to cholera. Agreed frameworks for guiding responses and subsequent reporting are needed to ensure reports contain sufficient detail to draw conclusions for the definition of best practices and for the design of future interventions.
MillerJ, BirnbaumML. Characterization of Interventional Studies of the Cholera Epidemic in Haiti. Prehosp Disaster Med. 2018;33(2):176–181.
Haiti remains the poorest country in the Americas and one of the poorest in the world. Children in Haiti face many health concerns, some of which were exacerbated by the 2010 earthquake. This systematic review summarizes published research conducted since the 2010 earthquake, focusing on health outcomes for children in Haiti, including physical, psychological, and socioeconomic well-being.
A literature search was conducted identifying articles published from January 2010 through May 2016 related to pediatric health outcomes in Haiti. Two reviewers screened articles independently. Included research articles described at least one physical health, psychological health, or socioeconomic outcome among children less than 18 years of age in Haiti since the January 2010 earthquake.
Fifty-eight full-length research articles were reviewed, covering infectious diseases (non-cholera [N=12] and cholera [N=7]), nutrition (N=11), traumatic injuries (N=11), mental health (N=9), anemia (N=4), abuse and violence (N=5), and other topics (N=3). Many children were injured in the 2010 earthquake, and care of their injuries is described in the literature. Infectious diseases were a significant cause of morbidity and mortality among children following the earthquake, with cholera being one of the most important etiologies. The literature also revealed that large numbers of children in Haiti have significant symptoms of posttraumatic stress disorder (PTSD), peri-traumatic stress, depression, and anxiety, and that food insecurity and malnutrition continue to be important issues.
Future health programs in Haiti should focus on provision of clean water, sanitation, and other measures to prevent infectious diseases. Mental health programming and services for children also appear to be greatly needed, and food insecurity/malnutrition must be addressed if children are to lead healthy, productive lives. Given the burden of injury after the 2010 earthquake, further research on long-term disabilities among children in Haiti is needed.
DubeA, MoffattM, DavisonC, BartelsS. Health Outcomes for Children in Haiti Since the 2010 Earthquake: A Systematic Review. Prehosp Disaster Med. 2018;33(1):77–88.
To evaluate resilience and frequency of behavioral symptoms in Haitian children internationally adopted before and after the earthquake of January 12, 2010.
We conducted a retrospective quantitative study in 40 Haitian children. Families were also asked to participate in a qualitative study (individual interview at 18-24 months after the earthquake) and to complete State-Trait Anxiety Inventory (STAI) and STAI for children (STAI-C) questionnaires.
Demographic and clinical characteristics were similar in the group who experienced the earthquake (n=22) and in the group who did not (n=18). The families of 30 adoptees were interviewed. There was no statistical difference between the two groups for the STAI (P=0.53) and STAI-C (P=0.75) or for the frequency of behavioral problems. Plenary adoption was pronounced for 84.6% and 33.3% of the children adopted in the pre- and post-earthquake group, respectively (P=0.02). Children rarely talked about the experience of the earthquake, which, by contrast, was a stressful experience for the adoptive families.
Haitian children adopted after the earthquake did not express more stress or behavioral problems than those adopted before it. However, the possibility of a resurgence of mental disorders after age 10 should be borne in mind. (Disaster Med Public Health Preparedness. 2018;12:450–454)