A visit to Haiti, and the biggest hellraiser I know

Last month, Melinda and I took the kids on a vacation during their mid-winter break—and managed to get in a quick visit to Haiti, where we caught up with one of the heroes of global health, Paul Farmer.

If I had to list ten amazing people I’ve had the honor of meeting, there’s no question Paul would be right up there (Nelson Mandela would be at the top). I don’t have enough space in this post to do justice to what a special person he is, so if you want the full story, I’d suggest the book Mountains Beyond Mountains, by Tracy Kidder, which tells the whole story. Paul co-founded Partners in Health (PIH), which helps run medical clinics at 12 sites in Haiti, providing phenomenal levels of care—dealing with everything from ophthalmology to women’s health to HIV and TB. They reach more than a million people and employ thousands of Haitians. PIH also runs clinics and hospitals in several other countries, including Rwanda and Russia.

I don’t know anyone who does a better job than Paul of calling attention to the cause of global health. He’s not a scold—he really draws people in and gets them excited about the work. He chose to work not only in Haiti, but in some of most remote regions within Haiti. The poorest places in one of the poorest countries anywhere. He’s driven by a strong sense of justice. As he says, “The idea that some lives matter less is the root of all that's wrong with the world.” Short of meeting Paul in person, you can get a good sense of his passion from his book To Repair the World, a collection of speeches where his moral vision really shines through. If you really want to dig in to the details, Reimagining Global Health: An Introduction is a good place to start—it’s based on a course he co-taught at Harvard.

Melinda and I have met Paul in various places (including a discussion Melinda had with him for WIRED last December), but we hadn’t visited him in Haiti for nine years. I had read a lot about the earthquake that devastated the country in 2010 and was eager to see how things had progressed. Plus, just being around Paul is an inspiration in itself.

We started our day in Cange, a town in the Central Plateau of Haiti where PIH has a clinic. When we arrived, a small student orchestra was performing a song that I later learned was from Pirates of the Caribbean. At least judging from what we saw, life in Cange has improved since the last time Melinda and I were there. The health clinic has a lot more space now, and the local school has expanded too. While it used to take four hours over bumpy roads to get there from Port-Au-Prince, you can now make the trip in less than 90 minutes, thanks to a road that the European Union helped pay for.

I’ve met a lot of doctors working in poor communities. Sometimes they’re reluctant to get too attached to their patients, because the emotional toll would be so high. But not Paul. As we made our way through the clinic, he seemed to draw more energy from everyone he met—stopping to offer clinical advice to a nurse or a word of encouragement to a patient. I got the feeling he would have been happy to spend the day just roaming the halls and caring for people.

After Cange, we drove about 15 minutes to see a factory that makes a kind of fortified peanut butter for undernourished children. Abbott Laboratories helped fund the factory, and it is quite fancy. They have huge propane tanks to run heaters and big generators to power the machines inside. The peanuts are grown by 200 local farmers who trained at the facility. We watched as the nuts were roasted, shelled, and ground, and then mixed up with other ingredients to make the paste. A machine pours it into big 1 kg jars that will be distributed to families. There’s even a lab with technicians who test the paste for contaminants.

Next we drove into the city of Mirebalais to see the new hospital run by PIH and the Haitian government. I was blown away. The hospital opened last summer and was built using money donated after the 2010 earthquake (people who were injured in the quake still need ongoing treatment). As you can see from the video here, they spared no expense to make it a first-class facility. There’s a machine for performing CAT scans. There’s a sophisticated system for keeping medical records. The staff can send digital images to Harvard and get input from specialists there. They have modern incubators for premature infants. The hospital gets electricity from an enormous solar array (plus a diesel generator at night).

As we pulled up to the hospital, I noticed a bunch of kiosks set up out front. They weren’t part of the hospital, but they were a natural outgrowth of it. Every day several hundred people come to the hospital for care, but the staff can’t deal with them all at once. Local entrepreneurs have created this impromptu market where they sell food and other items to the waiting patients.

Inside, we met some of the patients and staff. One of our daughters is thinking about becoming a doctor, so she peppered Paul with questions as we walked around. We all visited the ward for premature infants. Later, on the flight out of Haiti, the kids told me how moving it was. They had never seen anything like that before.

In another ward, Paul introduced me to one boy who had had cholera, and another whose appendix had burst. For a lot of Haitians, those conditions would almost certainly have killed them. But thanks to the great care they got here, both boys were well on their way to being cured.

Overall we had a great visit. I saw real evidence of progress. Of course, Haiti has a long way to go: It remains quite poor. And I worry about how the projects I saw will generate enough revenue and enough generosity from donors so they can maintain such great facilities. Operations and maintenance—whether for a CAT scanner or a peanut processor—takes funding and technical expertise. I left Haiti wanting to learn more about how countries at various levels of wealth are able to build strong health care systems, especially for primary care.

But even understanding all the challenges, I felt hopeful about the opportunity for more Haitians to improve their lives. You know you’ve had a good trip if you can visit a country as poor as Haiti and leave feeling optimistic about its future.