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On the front lines: One doctor’s decades-long fight to heal Haiti

A devastating 2010 earthquake in Haiti created an unprecedented health crisis that led the U.S. to grant Haitians Temporary Protected Status. But with the Trump administration's plan to eliminate TPS, 60,000 Haitians living in the U.S. may be deported. NewsHour Weekend's Ivette Feliciano reports on one doctor's efforts to confront Haiti's health challenges amid a possible influx of deportees.

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  • Hari Sreenivasan:

    The current violence in Haiti is increasing, but for Haitians, life must go on even in the face of dangerous political protests and past natural disasters. Last month, NewsHour Weekend traveled to Haiti on the ninth anniversary of the 2010 earthquake. And in tonight's Signature Segment, NewsHour Weekend's Ivette Feliciano profiles Haiti's unique resilience through the experience of a doctor on the front lines of the country's ever-changing social crises and public health needs.

  • Ivette Feliciano:

    In the last three decades, the news out of Haiti has mostly been about political instability, deadly epidemics, and a devastating earthquake that took a quarter of a million lives, and left two million homeless.

    Yet in that time, the child mortality rate was cut in half. The country's HIV rate went down from 6.1% in 1993 to less than 2% today. And overall life expectancy has risen by about 10 years.

    Much of that success is thanks to the vision of a man who has been on the frontlines of every major health and social crisis in the country since the late 1970s, Dr. Jean William Pape.

  • Dr. Jean William Pape:

    Haiti is a country that needs help and if its son and daughters don't do it, nobody will do it.

  • Ivette Feliciano:

    Born and raised in Haiti, he graduated from what is now Weill Cornell Medicine in New York City in 1975, where he remains a professor of medicine.

    But he works in Haiti, where he returned in 1979. From the beginning, his work involved an immediate crisis. As an internist working at Haiti's state university hospital, he confronted an infantile diarrhea epidemic.

  • Dr. Jean William Pape:

    The mortality was staggering. It was 44%. That is for every 100 children admitted, 44 would die.

  • Ivette Feliciano:

    The children were dying of dehydration. To combat it, Dr. Pape developed an oral rehydration mixture, which he taught mothers at the hospital to prepare at home.

  • Dr. Jean William Pape:

    It worked so well that our mortality fell to less than one percent. Within one hour, that child who was dying was again back to life. So they said, you're doing so well, we have adult patients who present with diarrhea. Can you see them? And those turn out to be the first AIDS cases.

  • Ivette Feliciano:

    To battle Haiti's first AIDS cases, Pape teamed up with his mentor back at Cornell, Dr. Warren Johnson, and Haiti's Ministry of Health, to create GHESKIO, which is now the second oldest research institution in the world dedicated to the fight against AIDS.

    The French acronym means "the Haitian Group for the Study of Kaposi Sarcoma and Opportunistic Infections", as the term AIDS had not yet been coined.

  • Dr. Jean William Pape:

    People were dying within six months to a year. So it was scary because nobody knew how it was transmitted. And we knew that we were on something big.

  • Ivette Feliciano:

    AIDS was so prevalent in Haiti that a myth arose that being Haitian was a risk factor for the disease.

    But Pape and his team produced groundbreaking studies that helped disprove the widespread notion that Haitians were especially susceptible to AIDS. And early on, Haiti's Ministry of Health closed all commercial blood banking after Pape's team connected blood transfusions in Haiti to infections.

  • Dr. Jean William Pape:

    And I think this is the most single important measure we took early on to control the AIDS epidemic.

  • Ivette Feliciano:

    In the early 2000s, GHESKIO began providing life-saving antiretroviral medicine to Haitians for free, with support from the global fund and the U.S. President's Emergency Plan for AIDS Relief, or PEPFAR.

    Today, the World Health Organization implements GHESKIO's treatment guidelines for HIV in low-resource settings around the globe.

    But not long after GHESKIO's AIDS treatment took off, things literally came crashing down. The 2010 earthquake destroyed or badly damaged half of its buildings. Four staff members died, and nearly everyone lost a loved-one.

  • Dr. Jean William Pape:

    I must say the earthquake was the toughest blow that we had. And what encouraged me is that the next day, 60% of our staff was here. So i assembled them in a room. And i said, "look, we are the first black country to become independent. We've had major calamities before. We overcame them. And we will overcome this one.

  • Ivette Feliciano:

    GHESKIO treated more than 3,000 trauma patients immediately after the disaster. It housed an additional 7,000 in a tent city for more than a year. Not a single person died during that time.

  • Dr. Jean William Pape:

    We had to do a number of things, continuing our mission of caring for patients with AIDS, tuberculosis and conducting the research. But we had people coming with the worst wounds you've ever seen.

  • Ivette Feliciano:

    In the aftermath of the earthquake and subsequent cholera outbreak, Pape and his team saw opportunities for innovation.

  • Dr. Jean William Pape:

    This is a perfect example of how architecture and health work together.

  • Ivette Feliciano:

    They partnered with local artisans and the U.S.-based non-profit architecture firm, Mass Design Group to rebuild. A state-of-the-art cholera treatment center includes an underground wastewater system. And since tuberculosis thrives where there is poor ventilation, the new TB treatment center forces hot air up and out of the building. As a precaution, staff and patients are still required to wear masks.

  • Dr. Jean William Pape:

    Everything has been calculated. The wall is not too high so that the wind can go through so that you have no chance of getting tuberculosis.

  • Ivette Feliciano:

    From the start, grants from a vast network of both local and international funders have been essential to the research and treatment GHESKIO provides. Deputy Director Dr. Marie-Marcelle Deschamps has been with Dr. Pape since the beginning. She says more than half of the staff are women.

  • Dr. Marie-Marcelle Deschamps:

    So we are the leaders. It's a holistic approach where you deal with denial. You deal with depression of the people, with their family issues, with their poverty. Name it. We have to find a solution.

  • Ivette Feliciano:

    GHESKIO has expanded into social work and education. It houses a primary school that serves 350 children. It also has vocational training, and special programs for women who have experienced physical abuse.

  • Rose Laure Jean:

    I came to GHESKIO because I was a sex worker and I was being mistreated. Groups of young men would rape and beat us. I found out I was pregnant and came in for a consultation. They taught me woodworking and now I have a profession.

  • Ivette Feliciano:

    But the main focus hasn't strayed from GHESKIO's initial mission to fight and prevent HIV and AIDS in Haiti. More than 30,000 HIV infected patients at GHESKIO are on effective treatment.

    At a daily "mothers club", HIV-infected women receive counseling to ensure they don't transmit HIV to their children. And there are workshops teaching people risk factors and symptoms of infectious diseases associated with HIV, such as tuberculosis and human papilloma virus.

  • Elizabeth Dumay:

    I am proud of the work that I do helping HIV infected patients because I myself am HIV positive.

  • Ivette Feliciano:

    All of this comes at no cost to 100,000 patients each year. That's especially important in Haiti, with close to 60% living under the poverty line.

  • Loudwige Saint-Julien:

    They respect people, I get my medication on time. If i don't come they call me on my phone.

  • Ivette Feliciano:

    Pape has received numerous awards, including a Clinton Global Citizen Award and a French Legion of Honor.

    Yet despite all of GHESKIO's success, Pape believes decades of stigma regarding Haiti's history of AIDS and poverty harms the country. And that stigma may soon begin to affect U.S. foreign aid to Haiti. In 2017, when referring to 15,000 new Haitian immigrants to the U.S., President Trump said quote "they all have AIDS." Early last year, Trump included Haiti in a group of quote "s-hole" countries, questioning why so many Haitians had ever been permitted to enter America. Several months later, the Trump administration announced its plans to rescind the Temporary Protected Status — or TPS –granted to Haiti after the 2010 earthquake.

    Immigration advocates challenged the decision in five pending federal lawsuits. If they lose, close to 60,000 Haitians in the U.S. could face deportation this summer.

  • Dr. Jean William Pape:

    It would be very bad because we already have a lot of unemployment. We have, as you know, no army. There's a small police– 15,000 for 11 million people. It would create more chaos. The greatest wealth of Haiti right now is Haitians overseas sending remittance back to the country.

  • Ivette Feliciano:

    While the future of TPS is in limbo, Pape and his team say they will continue to try to improve the lives of Haiti's most vulnerable populations.

  • Dr. Jean William Pape:

    With privilege, you have responsibility. And the biggest responsibility you have is for the poor people. They know we are for them, we are here with them, and we are one.

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