Shehzad Noorani

Overhauling Haiti

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.