Post-earthquake Haiti Research Articles

Symptoms of PTSD in a sample of female victims of sexual violence in post-earthquake Haiti

BackgroundGlobally, sexual violence (SV) impacts 25–33% of women, is often perpetrated by intimate partners and occurs even post-disasters. The 2010 Haiti earthquake occasioned a SV epidemic in Cité Soleil, where over 50% of females are reportedly victims of SV via non-intimate partners/strangers (NPSV). Little is known about the psychological effects of SV perpetrated by NPSV; even less in known about the biopsychosocial consequences of NPSV on women in Haiti. Yet, the World Health Organization recently called for research on NPSV, particularly in poor and disaster-affected countries. MethodsAs a first step in categorizing the consequences of NPSV on female victims in Haiti, we conducted 2 focus groups of 16 female residents of Cité Soleil who survived the earthquake and its aftershocks, along with ensuing hurricanes and cholera. ResultsParticipants reported rapes by strangers who intentionally “crush the uterus.” All endorsed criteria for PTSD, including enduring physiological, neurological and psychological symptoms: significant intrusive, avoidance, arousal, cognitive, mood changes, as well as significant distress/impairment in various areas of functioning; and all but one became pregnant from the experience. All denied substance use and other illness that is not associated with the sexual violence. LimitationsOur study was exploratory, targeting a small sample of women in one specific neighborhood and cannot be generalized to all SV victims in Haiti. ConclusionsFollowing earthquakes, there should be vigilance by public health officials and rescue teams for prevention of SV against women. Women who survive SV in Haiti should be provided access to trauma-informed care that addresses biological consequences of the SV, as well as biological, neurological and psychological sequelae.

Molecular epidemiology of Staphylococcus aureus in post-earthquake northern Haiti

Knowledge of nasal carriage is important in predicting staphylococcal infection, and no information exists regarding the endemicity of Staphylococcus aureus in Haiti. We performed a cross-sectional analysis of S. aureus nasal screening in an acute care, a subacute rehabilitation, and a community setting, with a brief medical and epidemiological history. PCR-positive S. aureus screening nasal cultures underwent molecular analysis for spa type, SCCmec type, and virulence genes (Panton-Valentine leukocidin (PVL), toxic shock syndrome toxin (TSST), and arginine catabolic mobile element (ACME)), and were evaluated for antibiotic susceptibility using commercial tests. Overall carriage rates of 8.4% methicillin-susceptible S. aureus (MSSA) and 2.8% methicillin-resistant S. aureus (MRSA) were identified, with a high rate of tetracycline resistance. TSST and PVL genes were identified in MSSA. MRSA isolates contained no virulence markers. Unique MSSA phenotypes (i.e., linezolid-resistant, vancomycin-sensitive/daptomycin non-susceptible) were identified, as were two PVL-positive ST152 MSSA colonization isolates, previously geographically limited to Africa. We found a low S. aureus carriage rate with complete vancomycin susceptibility and high tetracycline resistance, which has important public health implications with regard to treatment. Additionally, the finding of PVL-positive MSSA isolates, including the expansion of a previously described limited 'divergent' clone, ST152, warrants further evaluation.

Feasibility of the hydrogen sulfide test for the assessment of drinking water quality in post-earthquake Haiti.

In 2010, a magnitude 7.0 earthquake struck Haiti, severely damaging the drinking and wastewater infrastructure and leaving millions homeless. Compounding this problem, the introduction of Vibrio cholerae resulted in a massive cholera outbreak that infected over 700,000 people and threatened the safety of Haiti's drinking water. To mitigate this public health crisis, non-government organizations installed thousands of wells to provide communities with safe drinking water. However, despite increased access, Haiti currently lacks the monitoring capacity to assure the microbial safety of any of its water resources. For these reasons, this study was designed to assess the feasibility of using a simple, low-cost method to detect indicators of fecal contamination of drinking water that could be implemented at the community level. Water samples from 358 sources of drinking water in the Léogâne flood basin were screened with a commercially available hydrogen sulfide test and a standard membrane method for the enumeration of thermotolerant coliforms. When compared with the gold standard method, the hydrogen sulfide test had a sensitivity of 65% and a specificity of 93%. While the sensitivity of the assay increased at higher fecal coliform concentrations, it never exceeded 88%, even with fecal coliform concentrations greater than 100colony-forming units per 100ml. While its simplicity makes the hydrogen sulfide test attractive for assessing water quality in low-resource settings, the low sensitivity raises concerns about its use as the sole indicator of the presence or absence of fecal coliforms in individual or community water sources.

Disability in post-earthquake Haiti: prevalence and inequality in access to services

Purpose: To assess the prevalence of disability and service needs in post-earthquake Haiti, and to compare the inclusion and living conditions of people with disabilities to those without disabilities. Methods: A population-based prevalence survey of disability was undertaken in 2012 in Port-au-Prince region, which was at the centre of the earthquake in 2010. Sixty clusters of 50 people aged 5 + years were selected with probability proportionate to size sampling and screened for disability (Washington Group short set questionnaire). A case-control study was undertaken, nested within the survey, matching cases to controls by age, gender and cluster. There was additional case finding to identify further children with disabilities. Information was collected on: socioeconomic status, education, livelihood, health, activities, participation and barriers. Results: The prevalence of disability was 4.1% (3.4–4.7%) across 3132 eligible individuals. The earthquake was the second leading cause of disability. Disability was more common with increasing age, but unrelated to poverty. Large gaps existed in access of services for people with disabilities. Adults with disabilities were less likely to be literate or work and more likely to visit health services than adults without disabilities. Children with disabilities were less likely to be currently enrolled at school compared to controls. Children and adults with disabilities reported more activity limitations and participation restriction. Conclusion: Further focus is needed to improve inclusion of people with disabilities in post-earthquake Haiti to ensure that their rights are fulfilled.Implications for RehabilitationAlmost one in six households in this region of Haiti included a person with a disability, and the earthquake was the second leading cause of disability.Fewer than half of people who reported needing medical rehabilitation had received this service.The leading reported barriers to the uptake of health services included financial constraints (50%) and difficulties with transport (40%).People with disabilities did not participate equally in education or employment and had poorer access to health care.

Participatory engineering for recovery in post-earthquake Haiti

Participatory engineering has been called for after major catastrophes, yet is often bypassed due to countervailing implementation of ‘quick fixes’. While immediate expert-driven solutions may be attractive, in the long-term they may be ineffective and inconsistent with the goals and capacities of local stakeholders. This article discusses the findings of National Science Foundation research by a team of three engineers and one social scientist who visited Haiti twice, four and seven months after the January 2010 earthquake, to investigate community participation in water and sanitation engineering processes in Léogâne. Methods included interviews with local inhabitants, water-sector actors, and government agencies; inspections of the engineering of the existing water and sanitation system; surveys of the affected population; and a participatory workshop to which numerous community-based organizations were invited. The research tests the potential for engineers to develop stakeholder-based participatory processes in a post-disaster context, which is hypothesized to produce better outcomes than traditional top-down authoritative planning processes. Focusing on the sanitation sector within a multi-stakeholder arena, the article analyzes the potential for various kinds of interactions amongst actors during unfolding decision-making processes at multiple scales, and assesses how each might contribute to better post-disaster engineering and ultimately more sustainable water and sanitation systems.

A Sociological Counter-reading of Marie Chauvet as an “Outsider-Within”: Paradoxes in the Construction of Haitian Women in Love, Anger, Madness

As a sociologist trained to analyze social reality in search of ways to transform it, I am always puzzled by the way literary scholars portray Marie Chauvet, to use the trope of Patricia Hill Collins, as an outsiderwithin.1 Such a situation of dual identity is created through engagement with one's position within a community as well as exclusion or strangeness from that community. To use an anthropological idiom, Chauvet could be considered as a writer reflexive of her own social reality. Indeed, many literary scholars define Chauvet's work as a critique of both the political system of the Duvalierist regime of 1957-1987 and the discriminatory practices of the Haitian oligarchy, the elite to which generations of Chauvet's family, including herself, belonged by birth and/or through marriage. That tradition of social critique has been a hallmark in Haitian literature starting with the Indigenist school of the nineteenth century and continuing in the works ofjacques Roumain and Jacques Stephen Alexis, the two most successful male Haitian writers of the twentieth century. Yet for many, Chauvet is unique because, as Joan Dayan states, Never before had a Haitian woman dared not only to question the nationalist assumptions of Francois Duvalier and the noiriste celebration of'black essence' but also to take on the burden of writing in a culture that had simultaneously praised and silenced women.2This praise of Chauvet, which comes from many corners, is paradoxically not based on her own political engagement. Rather, her association with some form of radicalism is based on the of her literary works. For example, the well-known Haitian American writer, Edwidge Danticat, honoring Chauvet as one of the three giants of Haitian literature, claims that Chauvet seems to be speaking to us . . . from the grave in assessing and criticizing the current sociopolitical conditions of life in contemporary Haiti.3 Another Haitian American writer, Myriam Chancy, in a provocative article titled Exile and Resistance: History as a Revolutionary Act, also claims that Chauvet's work-like that of the Jamaican writer Michelle Cliff-focus [es] on the role of women and how politically conscious women negotiate their sexual oppression within social and class constraints.4 For Chancy, both writers present in their work the possibilities for resistance as represented by women through history. Such resistance is revelatory of women's efforts to free themselves of prescribed social roles as breeders, mothers, nannies, and laborers.Celebrations of the revolutionary and transformative nature of Chauvet's work contribute to a process of myth-making. Literary scholars such as Hellen Lee-Keller argue not only that Chauvet criticized despotism and racialized social hierarchies but also that the reason her book was banned was that she questioned and condemned the patriarchal and elitist structure of Haitian society. Lee-Keller further states that Chauvet uses the trope of madness as her primary strategy for navigating the political sphere, thus creating an alternative future vision for women's roles in Haiti.5 Likewise, Elizabeth Walcott-Hackshaw speaks about the boldness and perspective of Chauvet's work, stating that the writer courageously exposed the politics of Duvalier's terrorizing regime and that her work moves beyond Haitian reality and the Haitian border. Chauvet's use of the first-person narrative, she claims, seemed to say what others stifled.6 Another literary critic, Melissa Sande, uses Chauvet's work as the framework for her analysis of gender and literature in post-earthquake Haiti.7 Lastly, although Kaiama Glover acknowledges Chauvet5 s absence from-and, most likely, her refusal to participate in-any form of organized politics of Black radicalism or of women's struggles, she finds a redemptive explanation.8 She claims that Chauvet was literally punished, removed from the pantheon, excluded, silenced partly because of her political decision to be nonaligned. …

Traumatic Encounters: Negotiating Humanitarian Testimony in Post-earthquake Haiti

IntroductionImages of destruction and suffering relayed by survivors, journalists, and aid workers were essential to connecting the world to the January 12, 2010, earthquake in Haiti and to generating the global expressions of solidarity that followed. Yet these attempts to bear witness to the catastrophe in Haiti for viewers at home often reinforced the distance between Haiti and the West. Despite their authors' stated compassion for and solidarity with the Haitian people, such accounts detached the crisis from its historical and political contexts to insert Haiti into what Michel-Rolph Trouillot calls the savage slot, a temporary stand-in for the global South, until the international media moved its catastrophe caravan on to the next disaster.1 Buried under this deluge of reports and survival accounts trying to make sense of the disaster, Haiti seemed beset once again by a shroud of otherness as the island quickly disappeared behind a mirage of images.2 As the immediate response to the earthquake reveals, testimony is a fundamental cog of the humanitarian machine that is important for publicizing causes, shaping perceptions, and mobilizing solidarities; as a result, it is also a fragile terrain of cross-cultural encounters fraught with the politics of writing or speaking for others.Five years after the 2010 earthquake, my objective in this article is to return to a number of long-form testimonies published in the immediate wake of the catastrophe to examine how these narratives grapple with the ethical, political, and ideological implications of representing the pain of others for audiences in Europe and North America. In their accounts of the disaster, US humanitarian filmmaker Gerard Straub, Haitian Canadian author and newly elected member of the French Academy Dany Laferriere, and Haitian writer Yanick Lahens all marshal a journalistic realism in their efforts to document and bear witness to this traumatic upheaval. These three authors also share a sustained concern for the production, circulation, and consumption of images of the disaster in the international public sphere. Though they are not humanitarian aid workers, Laferriere and Lahens relay representations of Haitian trauma into the same international public sphere wherein foreign humanitarians and journalists projected their own. Like Straub, Laferriere and Lahens also position their narratives as necessary rejoinders to deformations of Haitian history and culture that permeated many popular mainstream accounts of the disaster including, but not limited to, CNN's voyeuristic coverage as well as the heavily condemned remarks by Pat Robertson about Haiti's pact with the devil or David Brooks about its progress-resistant culture.3 The portraits of postquake Haiti that emerge from such testimonies bear witness to the reactions of the individuals and communities enmeshed in the catastrophe and the international humanitarian response to it.Humanitarianism, whether as disaster response or in the form of development, remains an important economic, political, and social interface that mediates power relations between the global North and South. In recent decades critics have denounced Western humanitarianism as a tool for the spread of neoliberal globalization, the opening of new markets, and the privatization of even greater swaths of Southern economies.4 However, in mainstream views of humanitarianism, Mark Schuller argues, the 2010 Haiti earthquake is particularly significant because it sparked the emergence of a short-lived discourse critical of humanitarian organizations in light of the grossly mismanaged recovery.5 The accounts by Straub, Laferriere, and Lahens that are at the center of my analysis actively participate in the emergent, yet fleeting, discourse that Schuller highlights. Combining foreign, diasporic, and national viewpoints with regard to Haiti, their narratives think critically about global NorthSouth relations in the humanitarian context. …

A New Pastoralism?: Nature and Community in Lyonel Trouillot’s La Belle amour humaine

A New Pastoralism?Nature and Community in Lyonel Trouillot’s La Belle amour humaine Martin Munro For many Haitian authors, the earthquake of 2010 shook not just the physical space of Haiti but also its cultural and social foundations—indeed, everything. This idea is suggested, for example, in the title of Dany Laferrière’s first postdisaster book, Tout bouge autour de moi (Everything moves around me).1 The image the title evokes is of the author standing at the center of a still shifting world, shaken and alone. One gets the sense that he wants to resist being redirected, thrown off the singular literary and intellectual path that he has carefully shaped for himself for over a quarter of a century. He says that he had decided when sleeping out on the tennis court at the Hotel Karibe not to let the earthquake “shake up” his agenda.2 Now is not the time for tears, he says, but to “continue on our path.” He does not accept the idea of a “year zero” for the Haitian people or that the collective memory can be easily erased.3 The earthquake is part of the historical journey that stretches back to Africa. Nothing could change that journey, he says; “we continue.”4 The vocabulary and imagery he uses suggest a continued forward movement; one must continue to walk down these paths, without standing still or looking back. This contrasts to some degree with Edwidge Danticat’s idea of a radical break with the past and of the post-earthquake period as a new epoch in Haitian history. In Create Dangerously: The Immigrant Artist at Work, Danticat writes that there was to be no turning back from the moment of the earthquake, no comforting recollections of familiar places. These memories now belonged to a previous Haiti that “no longer exists, the Haiti of before the earthquake.”5 Reading Laferrière’s 2009 chronicle of return to Haiti, L’Énigme du retour, she finds it to be already like a “historical novel.” The cultural and creative stakes have also been radically changed for Danticat, as in post-earthquake Haiti the practices of reading and writing “will never be the same.” Everything has changed, including artists like herself, who find that their muse has been “irreparably altered.”6 [End Page 20] Many of the earliest post-earthquake works of Haitian writing were chronicles. For example, Laferrière’s Tout bouge autour de moi and Rodney Saint-Éloi’s Haïti, kenbe la! were attempts to record the authors’ thoughts and observations in the largely neutral style of the chronicler. There is analysis and they do offer reflections on broader issues, but formally these works remain in great part standard chronicles, recording events in a largely chronological manner; in this sense they remain faithful to the event itself. Fidelity to the truth seemed to be a primary motivation for many authors. One was left to wonder, however, what the role of fiction might be in the post-earthquake period. Does the drive for truth and the need to bear witness necessarily exclude fiction and render it a sign of vanity, a luxury almost?7 Fiction in a sense was a victim of the earthquake. One wondered at the time how long it must itself stay buried under the rubble and, when it was finally pulled free from the ruins, what condition it would be in. Would it have retained its force and vitality, or would it have to start anew, its memory either erased or forever traumatized by the event? What was the point of writing fiction after January 12, 2010? This article begins to address these questions through close analysis of Lyonel Trouillot’s first post-earthquake novel, La Belle amour humaine. This book suggests that the author agrees with Laferrière’s idea that the Haitian writer must not be diverted from his or her literary path, and that the earthquake itself does not—must not—become the primary point of reference for Haitian literature. To do so, the work implies, would be to fall into a trap, whereby the creative freedom of the author is limited and forever circumscribed by the events...

Development and validation of a Haitian Creole screening instrument for depression.

Developing mental health care capacity in postearthquake Haiti is hampered by the lack of assessments that include culturally bound idioms Haitians use when discussing emotional distress. The current paper describes a novel emic-etic approach to developing a depression screening for Partners in Health/Zanmi Lasante. In Study 1 Haitian key informants were asked to classify symptoms and describe categories within a pool of symptoms of common mental disorders. Study 2 tested the symptom set that best approximated depression in a sample of depressed and not depressed Haitians in order to select items for the screening tool. The resulting 13-item instrument produced scores with high internal reliability that were sensitive to culturally informed diagnoses, and interpretations with construct and concurrent validity (vis-à-vis functional impairment). Discussion focuses on the appropriate use of this tool and integrating emic perspectives into developing psychological assessments globally. The screening tool is provided as an Appendix.

Water-related infrastructure in a region of post-earthquake Haiti: high levels of fecal contamination and need for ongoing monitoring.

We inventoried non-surface water sources in the Leogane and Gressier region of Haiti (approximately 270 km2) in 2012 and 2013 and screened water from 345 sites for fecal coliforms and Vibrio cholerae. An international organization/non-governmental organization responsible for construction could be identified for only 56% of water points evaluated. Sixteen percent of water points were non-functional at any given time; 37% had evidence of fecal contamination, with spatial clustering of contaminated sites. Among improved water sources (76% of sites), 24.6% had fecal coliforms versus 80.9% in unimproved sources. Fecal contamination levels increased significantly from 36% to 51% immediately after the passage of Tropical Storm Sandy in October of 2012, with a return to 34% contamination in March of 2013. Long-term sustainability of potable water delivery at a regional scale requires ongoing assessment of water quality, functionality, and development of community-based management schemes supported by a national plan for the management of potable water.

Air quality in developing world disaster and conflict zones — The case of post-earthquake Haiti

Data on air quality are remarkably limited in the poorest of the world's countries. This is especially true for post-conflict and disaster zones, where international relief efforts focus largely on more salient public health challenges such as water and sanitation, infectious diseases, and housing. Using post-earthquake Haiti as the example case, this commentary explores air quality challenges in the developing world, highlighting concerns related to infrastructure damage from post-conflict and disaster settings. We contend that there is a growing and presently unmet need for further research and attention from the global health community to address these issues.

The cartographic dimensions of humanitarianism: Mapping refugee spaces in post-earthquake Haiti

This article examines the post-earthquake politics of space via the literal and cultural mapping of internally displaced persons in Haiti to consider the cartographic dimensions of humanitarian biopower. I begin by analyzing OpenStreetMap Haiti, an online collaborative cartographic project, which mapped Haiti’s roads and refugee camps after the earthquake by using high-resolution satellite imagery, global positioning system technologies, and aerial photographs—much of which is derived from US military data—in order to facilitate “humanitarian” efforts on the ground. I contend that the visual text produced by OpenStreetMap Haiti, which functions as a map to locate and situate refugees, represents a particular form of humanitarian biopower. In the second half of this article, I analyze a 2012 work of comics journalism titled Tents beyond Tents, which offers a critique of humanitarian “aid” from the perspective of Haitians who occupy the internally displaced persons camps created after the earthquake. I consider how the comic functions as a cartographic project, or cartoon mapping, through depictions of the spaces of the refugee camps in and around Port-au-Prince.

Blurred lines: accountability and responsibility in post-earthquake Haiti

Allegations that International Non-Governmental Organizations (INGOs) are not accountable to the populations they assist have followed several humanitarian operations, and the 2010 Haiti Earthquake was no exception. In response, initiatives such as the Humanitarian Accountability Partnership guided agencies’ efforts to become more accountable. Results of mechanisms implemented by two INGOs showed that although conditions were created for people to raise concerns, the ability of Haitians to obtain a response from the agencies was limited. The research found that while in principle agencies have the best interests of affected populations as their aim, fragmentation and power asymmetries within the humanitarian sector create conditions wherein agencies define the limits of what they are responsible for and, consequently, what they can be held accountable for. This literature review shows that without agencies’ recognition of the responsibility that comes with power, no initiatives will enhance a more coherent vision to improving their accountability.

Global health and transfusion medicine: education and training in developing countries

Education and training in transfusion medicine have improved over the past decade in developing countries but are still generally deficient for the purpose of maintaining the safety of the global blood supply. In 2009, the World Health Organization global database on blood safety indicated that only 72% of countries in the world were able to meet their training needs necessary for maintaining the safety of their local blood supply. Educational approaches in transfusion medicine vary widely between continents and world regions. In this article, we summarize a session on global health education and training in developing countries that took place at the 2012 AABB conference. The panel consisted of transfusion representatives from South America (Brazil), Asia (China), Africa (South Africa), and the Caribbean (Curaçao), as well as a description of capacitation issues in postearthquake Haiti and the pivotal role of the US President's Emergency Plan for AIDS Relief (PEPFAR) in transfusion training and education in Africa. We present here summaries of each of these panel presentations.

From Masisi to Activists: Same-Sex Relations and the Haitian Polity

From Masisi to Activists: Same-Sex Relations and the Haitian Polity Thérèse Migraine-George While the inextricable connection between democracy and human rights has been well documented, it is also no coincidence that countries enjoying a high degree of socioeconomic stability and political liberalism are generally striving to achieve gender equality and, in some cases, have even legalized same-sex relationships. Indeed, the public ways in which bodies are represented, shaped, and disciplined undergird a complex interplay of social, political, and cultural ideologies that, in turn, reflect on the civic health of a nation or a community. Drawing on Michel Foucault and Julia Kristeva among others, Judith Butler notably shows that the constitution of bodily margins and boundaries through which sexual others are both produced and “abjected” is based on an arbitrary yet regulatory differentiation between the “inner” and “outer.” This distinction undergirds homophobia as well as racism. As she puts it, “The boundary of the body as well as the distinction between internal and external is established through the ejection and transvaluation of something originally part of identity into a defiling otherness.”1 Moreover, the strategies used by sexual minorities to become more visible in the civic space, to move from the outer social margins to the inner public realm, significantly point toward the mechanisms of inclusion and exclusion that operate in any society, in regard not only to its sexual minorities but to disenfranchised groups in general. The margin, whether ethnic or sexual, is therefore a critical vantage point to observe the central functioning of power. In the context of Haiti, the status of people who engage in same-sex relations and the ways in which some organizations have recently begun to advocate more vocally for their rights are particularly significant in relation to ongoing efforts to build a sustainable democracy and to counter the pervasive anomy of the civic space. Although the integration of different sexual behaviors within Haitian Vodou has been highlighted, particularly in the 2002 documentary Of Men and Gods, people engaging in same-sex relations in Haiti are subjected to various forms of harassment [End Page 8] and stigmatization. Homophobia in post-earthquake Haiti has been further reinforced by the popular belief that Masisi—a derogatory term used to designate “effeminate” men in Haitian Kreyòl—provoke divine punishment in the form of natural disasters. It is within such a discriminatory context that a “gay rights” movement has recently emerged in Haiti.2 In May 2012, an “LGBT Congress,” which attracted over three hundred people and many nongovernmental organizations, took place in Port-au-Prince to mark the International Day against Homophobia and Transphobia. In the words of one participating organization, Housing Works: The 2010 earthquake further devastated the poorest nation in the Western Hemisphere, so issues of basic survival can seem to trump the need for other kinds of advocacy. But the work for cultural and national acceptance of LGBT people in Haiti remains a struggle, and this conference is proof that the rebuilding of Haiti means houses, hospitals and schools, and social justice for marginalized groups within the country.3 One newly formed organization, Kouraj, also participated in the May 2012 Congress. On its website, the organization presents itself as “a group of masisi activists, created to politicize other homosexuals and transgender persons in Haiti regarding their fundamental human rights.”4 Interestingly, Kouraj decided to break away from the acronym LGBT in favor of the name “M Movement.” This is based on the Kreyòl terms Masisi, Madivin, Makomer, and Mix, which, the organization explains on its website, more accurately reflect the complex reality of same-sex practices in Haiti while resisting Western-imposed gender and sexual norms.5 This essay argues that the civic space that the “M community” is trying to carve out for itself constitutes a laboratory for the democratization of Haitian society. In its efforts to achieve social justice, the movement follows the communitarian spirit of both Haiti’s Vodou tradition and its revolutionary past, while opposing masculinist forms of centralized government, divisive social prejudices, and Western hegemonic discourses. Although the M community experiences a specific form of ostracization, its struggle for legitimacy reflects a much...

Médecins Sans Frontières Experience in Orthopedic Surgery in Postearthquake Haiti in 2010

During January 2010, a 7.0 magnitude earthquake struck Haiti, resulting in death and destruction for hundreds of thousands of people. This study describes the types of orthopedic procedures performed, the options for patient follow-up, and limitations in obtaining outcomes data in an emergency setting. There is not a large body of data that describes larger orthopedic cohorts, especially those focusing on internal fixation surgeries in resource-poor settings in postdisaster regions. This article describes 248 injuries and over 300 procedures carried out in the Médecins Sans Frontières-Orthopedic Centre Paris orthopedic program. Surgeries described in this report were limited to orthopedic procedures carried out under general anesthesia for all surgical patients. Exclusion factors included simple fracture reduction, debridement, dressing changes, and removal of hardware. This data was collected using both prospective and retrospective methods; prospective inpatient data were collected using a data collection form designed promptly after the earthquake and retrospective data collection was performed in October 2010. Of the 264 fractures, 204 were fractures of the major long bones (humerus, radius, femur, tibia). Of these 204 fractures of the major long bones, 34 (16.7%) were upper limb fractures and 170 (83.3%) were lower limb fractures. This cohort demonstrated a large number of open fractures of the lower limb and closed fractures of the upper limb. Fractures were treated according to their location and type. Of the 194 long bone fractures, the most common intervention was external fixation (36.5%) followed by traction (16.7%), nailing (15.1%), amputation (14.6%), and plating (9.9%). The number of fractures described in this report represents one of the larger orthopedic cohorts of patients treated in a single center in the aftermath of the 2010 earthquake in Haiti. The emergent surgical care described was carried out in difficult conditions, both in the hospital and the greater community. While outcome and complication data were limited, the proportion of patients attending follow-up most likely exceeded expectations and may reflect the importance of the rehabilitation center. This data demonstrates the ability of surgical teams to perform highly-specialized surgeries in a disaster zone, and also reiterates the need for access to essential and emergency surgical programs, which are an essential part of public health in low- and medium-resource settings.

A mixed-methods assessment of the experiences of lay mental health workers in postearthquake Haiti.

A mixed-methodological study conducted in the aftermath of the 2010 Haiti earthquake assessed experiences of 8 lay mental health workers (earthquake survivors themselves) implementing a psychosocial intervention for residents of camps for displaced people in Port-au-Prince. Quantitative results revealed decreased posttraumatic stress disorder symptoms, consistently high compassion satisfaction, low burnout, moderate secondary trauma, and high levels of posttraumatic growth measured over 18 months. Qualitative accounts from lay mental health workers revealed enhanced sense of self-worth, purpose, social connection, and satisfaction associated with helping others. Results support the viability of utilizing local lay disaster survivors as implementers of psychosocial intervention.

Development and Use of a Comprehensive Humanitarian Assessment Tool in Post-earthquake Haiti

This paper describes a comprehensive humanitarian assessment tool designed and used following the January 2010 Haiti earthquake. The tool was developed under Joint Task Force – Haiti coordination using indicators of humanitarian needs to support decision making by the United States Government, agencies of the United Nations, and various non-governmental organizations. A set of questions and data collection methodology were developed by a collaborative process involving a broad segment of the Haiti humanitarian relief community and used to conduct surveys in internally displaced person settlements and surrounding communities for a four-month period starting on 15 March 2010. Key considerations in the development of the assessment tool and data collection methodology, representative analysis results, and observations from the operational use of the tool for decision making are reported. The paper concludes with lessons learned and recommendations for design and use of similar tools in the future.

The Role of Education for Democracy in Linking Social Justice to the ‘Built’ Environment: The Case of Post-Earthquake Haiti

The manner in which the built environment is constructed has a tremendous effect on the degree to which health, wealth and social outcomes are distributed within a society. This is particularly evident when a crisis of the natural environment affects the built environment, as was the case after the Haitian earthquake of 2010. Understanding the consequences of the earthquake as socially precipitated rather than a natural occurrence requires a paradigm shift, a project for educational policy, pedagogy and epistemology. In particular, education for democracy in its broadest sense can serve to re-align thinking towards understanding the connection between the built environment and social justice. In this article the authors present their research with teacher-education candidates and the candidates' perspectives and experiences of education for democracy at a Canadian university. In relating these perspectives to the possibilities for contextualizing the aftermath of the earthquake in Haiti, the authors propose educational policy solutions that highlight a thick democracy, social justice, the role of context and history, and a more concrete connection with public health.

Exploring Unintended Social Side Effects of Tent Distribution Practices in Post-Earthquake Haiti

The January 2010 earthquake devastated Haiti’s social, economic and health infrastructure, leaving 2 million persons—one-fifth of Haiti’s population—homeless. Internally displaced persons relocated to camps, where human rights remain compromised due to increased poverty, reduced security, and limited access to sanitation and clean water. This article draws on findings from 3 focus groups conducted with internally displaced young women and 3 focus groups with internally displaced young men (aged 18–24) in Leogane, Haiti to explore post-earthquake tent distribution practices. Focus group findings highlighted that community members were not engaged in developing tent distribution strategies. Practices that distributed tents to both children and parents, and linked food and tent distribution, inadvertently contributed to “chaos”, vulnerability to violence and family network breakdown. Moving forward we recommend tent distribution strategies in disaster contexts engage with community members, separate food and tent distribution, and support agency and strategies of self-protection among displaced persons.