About an hour northwest of Port-au-Prince, Haiti, lies the village of Do Digue. It’s not on many maps, and roads in the region are few. As with all of Haiti, described by Oxfam as “one of the most unequal societies in the world,” it is a place of extreme poverty, little infrastructure, and devastation brought by an earthquake and hurricane within six years of each other. It’s early June, and working alongside the locals one will find Gifford Health Care’s Dr. Josh White and volunteers with Community Health Initiative (CHI) Haiti, a nonprofit White co-founded to not only improve health care in the region but also empower the community with self-directed projects for a healthier, more equitable future.
But don’t call the organization a charity.
“Our core values are accompaniment and solidarity,” said White. “We don’t assume we know better, and we don’t consider ourselves a charity. We have a strict no-handout rule. We attempt to help people create better lives for themselves.”
In keeping with those values, CHI charges a nominal fee for a visit to one of its five medical clinics and two surgical units (the fee is waived if it’s determined the patient can’t afford it); employs Haitians, including Haitian doctors; and partners with the local community on projects ranging from latrine– and road-building to recycling, to water treatment systems.
The water project is the result of CHI’s goal to reduce diarrheal rates in the region. The organization partnered with Deep Springs International to distribute its point-of-use chlorinating system, Gadyen Dlo, which means “water guardian” in Haitian Creole. CHI purchases 5-gallon water-treatment buckets—each with a spigot on the bottom but no handle, to discourage using for other purposes—which they distribute to households, again for a nominal fee to reflect CHI’s values of partnership and solidarity. CHI also employs local people to provide education and ongoing monitoring to ensure buckets work properly. Recent numbers published by CHI show a reduction of diarrheal rates from 40 percent to about 2 percent.
A Pledge to Do Better
White, hospital division medical director at Gifford, has volunteered in Haiti since 2004 with a friend from medical school, Chris Buresh. After seeing the bad often outweigh the good on poorly organized group trips sponsored by various nonprofits—with no preparation, little to no training, and no one tracking patient information and measuring outcomes—the two committed to do things differently and established CHI in 2012.
“On those trips we saw, at best, a lot of ineffective care provided and, at worst, it caused harm,” White said. “There was no preparation or training. We learned on the fly, which is not a good way to do it.”
“No one was measuring the impact of work, no one was tracking patient information, and so there was no way of effectively treating someone with a chronic condition,” he said. “We would give out pills for high blood pressure, for example, but there’d be no follow-up. We didn’t know if it worked. There are a lot of assumptions that people believe. Unless you track rates, you don’t know.” In the case of one patient, he said, “We learned she had run out of her pills, her blood pressure had skyrocketed, and she’d had a stroke.”
CHI volunteers, by contrast, become well versed in a 90-page training document defining protocols, and spend hours walking through protocols with staff on site before providing care. Then, “all CHI providers work together in one area,” White said, “so they can lean over and ask questions.”
And CHI has its own electronic medical record (EMR) system. “Evidence-based data collection is key,” said White. “You may be hurting people if you are not measuring outcomes.”
In Haiti, White and CHI providers treat patients of all ages for a wide range of conditions and illnesses, from those familiar to us in the United States, such as heart disease and diabetes, to tropical diseases like malaria.
“A lot of what we see is the result of a lack of care,” White said. “For example, someone who’s had a heart attack but never had any treatment.”
They commonly see fungal issues, given the heat and humidity, and cases of constant eye irritation and carbon monoxide poisoning. “Many cook over an open, coal-fueled fire in an enclosed space no bigger than an outhouse,” said White, explaining the frequent cause of the latter.
CHI providers also treat a great number of pregnant women, he said, and two of CHI’s recent successes are its Helping Babies Breathe program, which has cut the infant mortality rate in the region by 71 percent, and a birth control project. While birth control projects are not unique among nonprofits operating in Haiti, unlike most others, CHI prioritizes education and clinical studies to measure effectiveness.
“Some women are not using the pill correctly, because they haven’t been educated,” said White on the dangers of providing medication without follow-up. “Some think the pill attacks sperm, kills sperm. If they are not having sex and there is no sperm, they believe the pill will attack the woman. So they have more sex than they might have, believing it to be necessary, and resulting in an increase of sexually transmitted diseases.”
Community health outreach is another focal point for CHI, which employs about six full-time community health staff, each responsible for a catchment area of about 100 households.
Advice for Volunteers
White travels to Haiti several times a year, often to manage administrative matters but also as the lead doctor on week-long trips with a team of volunteers from across the U.S. He facilitated such a trip in early June and has plans to lead another volunteer team in June 2019. In addition to healthcare providers, anyone can volunteer.
“Anyone who wants to come is encouraged,” said White. “They can help in the pharmacy or assist in triage, taking blood pressures. We make an effort, though, not to have volunteers do jobs that we can employ local people to do.” On his last trip, CHI employed three Haitian doctors.
While White’s team saw 1,700 patients on their last trip, he is hesitant to talk about numbers.
“Numbers tell you nothing about quality of care,” White said. “We would rather take care of 300 patients really well than 500 really poorly. For me, the key piece is, did the patient in front of you get better? When you focus on numbers, you risk cutting quality.”
White offers this advice to individuals considering volunteering with CHI or another organization: “Research the organization you are going to go with. Look for organizations that are involved in data collection, research, measuring efficacy—if they don’t track what they do, they are probably not helping.”
And beware groups that are “slinging pills,” he advises, and those that take action without proper research. “You can’t just go down there and start doing things,” he said, citing an example where another organization meant well in paying nurses the same wage they’d be paid in the U.S., “but undermined the local economy, caused other doctors and nurses to stop working, and made the situation worse.”
There are a few other points White would like potential volunteers to know about Haiti: the country is safe—“if you can handle yourself in a mid-size city in the U.S., you’ll be fine”—and the people are happy. Despite the poverty, despite the public health crisis, White sees joy.
“The resilience of people is amazing,” he said. “They get up at 4 in the morning to walk several hours to the clinic, where they may have to wait for eight hours before being seen, yet they’ll still be happy and pleasant. Volunteers can learn a whole lot in Haiti. You bring a whole lot more back with you than you brought.”
White refers to comments from people on social media and elsewhere, wondering about the “why” behind recent celebrity suicides given their apparent success.
“Fame and wealth don’t lead to happiness. People in Haiti have very little material wealth, but they are happy. They are not morose, not sad. You can learn a whole lot by going down there.”
White, who lives on a farm in Barnard with wife Kim and their two children, Corrine, 7, and Broder, 10, plans to one day take the entire family to Haiti. Kim has been before, and “the kids are begging to go down,” he said. “When they are older, and don’t need eyes on them all the time.”
CHI works with 300-400 volunteers each year. They come from across the U.S., from Vermont to California and throughout the Midwest.
In addition to volunteers, monetary donations are critical for CHI. The average team spends $5,000-$7,000 on medications in a week. Medical supplies and other items are typically not needed, White said, as often they can’t be used. CHI providers determine what is needed to deliver care using World Health Organization guidelines and evidence-based data.
Over the years, a number of Gifford Health Care staff members have volunteered with CHI, and Gifford has donated supplies based on specific CHI requests.
For more information about CHI Haiti, including outcomes and ways to give, visit chihaiti.org.
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