Three years after catastrophic earthquake, Haiti remains stricken with poverty, disease

Three years ago this month, Lora Iannotti, PhD, assistant professor at the Brown School at Washington University in St. Louis, was working in the seaside town of Leogane, Haiti — 18 miles west of the capital Port-au-Prince — helping teach local officials how to improve the health of Haitian children.

Iannotti was in Port-au-Prince on Jan. 12, 2010. On that day, Leogane, the very town she had been active in, became the epicenter of a catastrophic earthquake. She survived, but Haiti was devastated; an estimated 3 million were affected by the earthquake in a country already known as the poorest in the Western hemisphere.Despite an immediate influx of aid — the United States and other countries generously pledged $4.58 billion and have committed over $1 billion to the reconstruction effort — support for the country has come to a halt. Even worse, says Iannotti, who has been to Haiti 10 times since the earthquake, are that impediments remain in the way of progress that could exist.

“One in four children in Haiti are chronically undernourished, placing them at higher risk for infectious disease morbidity and mortality, growth faltering, and cognitive impairment,” Iannotti says. “Yet the Copenhagen Consensus 2012, authored by four Nobel Laureates and other esteemed economists, ranked bundled micronutrient interventions to fight hunger and improve education as the highest return-yielding strategy for policy-makers and philanthropists.”

That’s not happening, says Iannotti, who has been working in Haiti since 1990. “Haiti is literally aching for public health expertise, yet not one public health degree program exists anywhere in the country — neither undergraduate nor graduate. Teaching hospitals seem to have more donor appeal and have attracted external funding; legions of doctors come and go in the country, too, with their Band-aid treatment services, but preventative action and investments are minimal.

“If the U.S. considers its own history, it was only the introduction of public health initiatives — vaccination campaigns, water and sanitation improvements, and better nutrition — that turned the tide of infectious disease last century.”

Iannotti says most of the nearly $1 billion reconstruction aid resources have been allocated to humanitarian relief assistance and infrastructure development.

“A small fraction of funds went to primary health care and education,” Iannotti says. “USAID boasts of such accomplishments as refurbished classrooms and provision of teaching and learning kits. In a country where the literacy rate is 62 percent, a half-million children do not attend school, and 75 percent of teachers lack adequate training, this is entirely inadequate.

“University enrollment in Haiti is less than 1 percent. Where is the sense in colorful new school buildings stocked with pencils and notebooks without trained teachers and healthy students?”

Ten months after the earthquake, a cholera epidemic ravaged the nation further and escalated again with the onset of the rainy season in 2012. But this situation should astonish no one, Iannotti says.

“Haitians, especially young Haitians, have been dying from diarrhea for decades,” she says. “The abysmal water quality and nonexistent sanitation systems are the obvious cause for this, in combination with a silent but lethal problem sometimes referred to as ‘hidden hunger.’

“Haitians, like many poor populations globally, lack critical nutrients in their largely monotonous diet. Zinc, for example, found more readily in ‘luxury’ foods, is necessary in the recovery from diarrheal infections,” she says.

Haiti is not without hope. “A cadre of nurses and community health workers are ripe for public health learning, but lack the opportunity in Haiti and face logistical obstacles to leave the country for even a workshop.

“It is utterly wrong to assume development and good health cannot happen for Haiti,” she says. “Talented young Haitians are quietly, and all too patiently, waiting for their chance to try. Let’s not stand in the way.”