A Haitian Solution for Public Infrastructure to Eliminate Diarrheal Disease

It is undeniable that Haiti needs -- and deserves -- a functional and dignified solution that provides the major tools to combat diarrheal disease -- clean water, primary healthcare, and clean waste. This is not a Haitian problem: It is a global one.
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The Haitian government faces the monumental task of developing sanitation and water infrastructure in a city the size of Manhattan, (a task that would undoubtedly cause any administration to balk). In response the Haitian government has developed a National Plan for the Elimination of Cholera." The $2.2 billion dollar plan has not begun to be implemented, is underfunded and is projected to take a minimum of 20 years.

But what many don't know is that diarrheal disease, even prior to the cholera outbreak, was the leading cause of child mortality and the second leading cause of overall deaths in Haiti. More than a health and nutrition issue, diarrheal disease is the manifestation of an inadequately built environment -- the failure of waste and water infrastructure systems to provide populations with adequate sanitation and drinking water.

In fact, Haiti is the only country where sanitation access decreased in the last decade; absorbing both the earthquake damages and consequent rapid population displacement and urbanization poses additional system-wide stress. Today, only 28 percent of Haitians have access to improved sanitation, and only 40 percent have access to clean drinking water.

It is undeniable that Haiti needs -- and deserves -- a functional and dignified solution that provides the major tools to combat diarrheal disease -- clean water, primary healthcare, and clean waste. This is not a Haitian problem: It is a global one, seen across developing economies in Southeast Asia and Africa. But piped, clean water and subterranean wastewater infrastructure is a 19-century solution that today is often financially insurmountable in the near term for many countries facing 21-century challenges: disease outbreak, natural disaster recovery, massive informal cities or post-conflict reconstruction.

Last month leaders, experts and innovators from around the globe gathered in New York for the annual meeting of the Clinton Global Initiative (CGI). The Clintons have clearly harnessed the power of proximity -- leveraging the convening of major players across sectors to make commitments that propose solutions to problems currently thwarting economic and social progress in areas of scarcity.

MASS Design Group first began working in Haiti following the 2010 earthquake on a tuberculosis hospital with Les Centres GHESKIO, a Haitian-born leading institution in healthcare service delivery. Following the cholera outbreak, the inability of temporary tent treatment facilities to meet demand and endure the outbreak was ominous, so we teamed up again. This fall, MASS and GHESKIO are finalizing construction of Port-au-Prince's first permanent diarrheal disease treatment center that does three things in one facility:

  1. Provides dignified and holistic care to cholera patients;
  2. distributes chlorine tablets to purify water for drinking;
  3. and perhaps most importantly, decontaminates waste on-site to stop the bacteria's spread.

This has become a model that could be adapted to address health, water and waste needs throughout the city via a decentralized, accessible and affordable system. MASS's CGI commitment is to research, develop and design a system that follow through on that opportunity to create a well-designed system of centers and community based nodes across Port-au-Prince. Water and sanitation services will dovetail with existing healthcare facilities and smaller scale community kiosks will be distributed within communities. This is healthcare unpackaged -- circumventing the traditional Western reverence for labyrinthine and state-of-the-art facilities and pushing care services and facilities within the immediate proximity of the people they are meant to serve. In turn, these Health and Hydration Centers would address the broader determinants of health that render poorer communities disadvantaged and less likely to develop economically.

Building on the groundbreaking research GHESKIO, Partners in Health and others are doing, the commitment outlines an immersive research phase to determine areas of highest need, and will then pilot the centers there with a consequent expansion across metropolitan Port-au-Prince. If implemented effectively, this model would potentially increase access to sanitation from 28 percent to 75 percent by 2020, providing a bridging solution sooner and at a fraction of the cost.

GHESKIO and MASS have begun the actualization process, and will now convene a team of partners to develop and optimize the model's three services with an informed knowledge of how best to seamlessly integrate the centers into the daily routines and spaces of communities. This is the potential of partnership and the real take-away of this year's annual meeting, and the outcome will depend on -- as President Clinton said so eloquently in his opening plenary -- our capacity to "overcome our differences and unite our strengths."

Murphy and Ricks co-founded MASS Design Group, a nonprofit architecture firm based in Boston, MA and Kigali, Rwanda. Besides Haiti, MASS is currently working in Rwanda, Liberia, Uganda, and the Democratic Republic of the Congo, among others. MASS seeks to improve health and foster dignity through architecture in the communities where they operate, and works integrally with those communities to leverage local materials and labor. For further information on MASS, please visit here.

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