Nevin was cleaning out his office this week, after three years as the HAS Director of Finance and Administration, and he discovered a faded book entitled The Health of Haiti 1928-1929, written by Capt. Kent Melhorn, USN, who was the Director General, National Public Health Service of Haiti. How did an American Navy Captain happen to prepare such a book?
For almost 20 years in the early 20th century (1915-1934), Haiti was occupied by the US marines, in order to protect US business interests and to bring stability to a fractious political environment. One of the contributions of the US military was the strengthening of the Haitian medial infrastructure. Many of the large hospitals of Haiti’s cities were built or expanded during that period. Annual reports described scientific meetings of the Haitian Medical Society, listed the construction and renovation projects, and identified the currently-diagnosed illnesses.
Not surprisingly, many of the illnesses which plague Haiti today were present in the 1920’s, including tuberculosis (300 cases), malaria (11,000 cases), and treponematosis (78,000 cases). Embedded in the book’s charts and statistics is a reference to a total of 23 cases of cholera, indicating that the current scourge of cholera has historical antecedents in Haiti.
The occupation was marked by a series of wars with cacos, labeled as insurgents, who wanted to restore their precious independence, and ended only when the US could no longer afford to sustain a major military presence on the island. What it left behind was a national health system, with a formal approach to epidemiological surveillance, and a focus in sanitation and the prevention of disease.
Today, the CDC research team has returned to HAS from its sheltering sojourn at the Embassy during hurricane Tomas. They carry on the tradition of clinical research established by Capt. Melhorn and his colleagues, supported not by marines but by topographic maps, GPS handhelds, and a team of local translators and enumerators from the HAS staff and neighbors.
The number of new admissions increased sharply after the passage of Tomas, to a high of 24 new patients on Monday, with a modest decline overnight yesterday. The next week will be instructive to us as we monitor these new admissions, and where they come from, as well as their gender and age. In the meantime, our community-based staff continues the information campaign; the HTRIP team, which supports a number of community groups in the high mountains, has provided cholera prevention messages in its educational sessions for new planters of the tree plots, including messages about hygiene in these water-deficient areas.