Social Foundations for a Community-Based Public Health Cholera Campaign in Borgne, Haiti

By Mazzeo, John; Chierici, Rose-Marie | Human Organization, Winter 2013 | Go to article overview

Social Foundations for a Community-Based Public Health Cholera Campaign in Borgne, Haiti


Mazzeo, John, Chierici, Rose-Marie, Human Organization


The rapid and widespread progression of cholera in rural Haiti can be attributed to a "perfect storm" of conditions, including the widespread use of unprotected water sources, rudimentary sanitation, the lack of means to afford simple necessities, and the near absence of basic health services to treat the sick. Accessibility of essential health care and reliable sources of clean water in remote areas of rural Haiti are fundamental barriers to addressing acute public health emergencies, including the ongoing cholera epidemic. This article explores the notion that positive health outcomes for hard to reach populations can be achieved through community mobilization. The gwoupman peyizan (peasant movement) in Borgne has established an extensive, capillary-like social network that served as a model for the mobilization of volunteers in the fight against the cholera epidemic. This case study from Borgne, Haiti describes the role of Alyans Santé Borgne (ASB) in coordinating community mobilization efforts against the epidemic. It suggests that the treatment of cholera and other infectious diseases requires a model of care delivery that efficiently brings resources to remote areas and recognizes the value of existing models of social organization in this process.

Key words: Haiti, cholera, social activism, public health, community development

. ,.[T]he arrangements of a society become most visible when they are challenged by crisis

- Wolf 1990:593

Adjusting his beret, Leon, the leader of Koodinasyon Gwoupman Peyisan Borgne (Peasant Organization Committee of Borgne or KGPB), looks around the crowded meeting hall in Tibouk where the group gathers for its weekly meeting. Then, Toc... Toc... Toe... He begins to tap his finger on the table...rhythmically, purposefully. Sitting along the wall, delegates representing communities from the seven rural districts of the Commune of Borgne in northern Haiti stop talking and settle down on their benches. Leon, seated behind a long table flanked by his assistants, also peasant leaders, takes a last look at the agenda for the day and opens his notebook. The rhythmic tapping continues until he has everyone's attention then gradually shifts to a familiar beat, and, as one, the crowd stands to begin the group's anthem.

It is an impressive performance, and Leon is an impressive figure. He is a strong man, around 45 years old, sinewy, and stocky; his hands are those of one who works the land-rough and broad. He is intense and focused; he has the eyes of a hawk that take in everything around him. The men and women in the room are farmers and members of gwoupman peyisan (peasant groups). They are the voice of the peasantry, the backbone of rural Haiti, and a powerful social and political movement representing the interests of small farmers. We, the authors of this article, are guests of the group at this meeting, invited to talk about development projects of particular interest to KGPB such as a tree nursery and mobile clinics designed to bring health services to hard to reach localities in the area.

Our group started the trek from the town of Borgne while the morning mist still hung over the valley and the sun was barely rising. It is a tough but gorgeous two hour walk on a rocky road-barely a path really-that climbs rapidly then rushes down steep mountains and crosses the river Estere as it meanders north to reach the Caribbean Sea. Alongside the road are lakou (extended family compounds) and small garden plots where farmers till the land with machetes and hoes. Women walk hurriedly down hills balancing baskets heaped with produce on their heads, children play with toys built from empty plastic containers, and goats scamper on rocks. One could say that people are poor here-few families can afford to send their kids to school or even feed them one meal a day-and that development has bypassed this remote comer of the world. Aside from cultivating small gardens and selling goods at roadside stands or marketplaces, there are no other local ways to generate income. …

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