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…global health should not only mean acknowledging how power imbalances result in universal health woes, but also taking the steps to give back power.
When Christopher Columbus established a Spanish colony in Hispaniola in the late 15th century, the encounter between Europeans settlers and the native Taino populations led to devastating spread of diseases. Colonization and recent occupations of Haiti largely contributed to the prosperity of Western powers. This has carried major health consequences and policies that stain current global health organizations and practices. The cholera epidemic in Haiti could not be a better example. What would decolonizing global health mean for Haitians?
Around the 16th and 17th centuries, the field of tropical medicine was born, out of fear for European colonizers’ health in the ruthless epidemic and climatic conditions of Asian, African and American colonies. Yellow fever affected French generals Leclerc and Rochambeau in Saint-Domingue and the former succumbed to it. To this day, the World Health Organization still uses the label of tropical diseases to denote all diseases that occur solely, or principally, in the tropics such as malaria, dengue and yellow fever (even though, in many instances, these diseases could have been eliminated from the tropics if these countries had the means to). Tropical medicine developed through the 19th and 20th centuries, with a significant development in terms of scientific knowledge, especially marked by the birth of epidemiology and population health around 1854 while cholera was rampant in Europe. The American Rockefeller foundation then played an important role by coupling philanthropy with technical expertise, foreign policy, and protection of American interest (Patricia Josefina Lopez, 2014). Mary Agnes Palilonis of Wake Forest University relates that the Rockefeller foundation heavily invested in training of personnel to treat tropical diseases in Latin America and the Caribbean.
When the US occupied Haiti in 1915, the marines turned to the Rockefeller foundation to finance a network of rural clinics and other health infrastructures, to protect the American soldiers from tropical diseases. Cap-Haitien’s Justinien hospice was transformed into a hospital in 1920 and a laboratory was built to test prisoners and gendarmes for malaria. Such efforts led to the first sanitary studies of tropical medicine in Haiti, determining rates of malaria and parasite intestinal infections (Ary Bordes, 1980). As Palilonis puts it: “The scientific advancements coming from universities of Western countries were largely used as tools to protect colonists from tropical diseases and to control and civilize native populations.” But as the US occupation of Haiti ended in 1934, the Rockefeller foundation ceased its financing of Haiti’s health, leading to a massive slow in the development of health programs.
In the second part of the 19th through the 20th century, as trade among countries blossomed and the world became more connected, infectious diseases like cholera also spread in Europe, America and the Caribbean. International cooperation gave birth to multiple health agencies including the Pan-American Sanitary Bureau, between the US and its trade partners in Central and South America, which later became the Pan-American Health Organization (PAHO). One could conclude that the main motivation of these efforts was to protect commerce and money, not necessarily the threat that these diseases posed to the Haitian people, or any impoverished people .
After the foundation of the World Health Organization and several important Non-Governmental Organizations, international health took a new turn, putting its emphasis on global pandemics such as HIV/AIDS, food insecurity, maternal mortality, etc. During this era, Haiti had been falling into a cycle of political and economic turmoil fueled by exploitative neoliberal policies, foreign political and military interventions, and natural disasters, contributing to putting the healthcare system and the whole country on its knees. However, NGOs and development projects thrived, especially after the 2010 earthquake.
When cholera came with the United Nations peacekeeping forces which had been in Haiti since 2004, the UN resisted recognizing its implication in the genesis of the health catastrophe which claimed close to 10,000 Haitian lives. The story of cholera in Haiti, as the fragmented stories of health interventions there, sounds as if we were still in the early days of global health, as if Haitians were the ones the rest of the world had to be saved or protected from.
In this increasingly connected world, keeping the mentality inherited from colonialism only costs more lives.
In this increasingly connected world, keeping the mentality inherited from colonialism only costs more lives. It shouldn’t be this way, especially during the current pandemic of coronavirus disease which will, I presume, have a violent grip on the country. Does Haiti have the means to use the drastic strategies to prevent one more catastrophe? Of course not. A pandemic-ready healthcare system cannot be built in such short timing in a country that has long been depleted of its resources.
The question of decolonizing global health has been raised broadly recently, through academic forums and online discussions. In a recent Twitter thread, Harvard’s Dr. Louise Ivers affirmed: “I worry that decolonizing will become a [topic] for big health institutions but not realized in actions…” To begin with, the very idea of global health should not only mean acknowledging how power imbalances fueled by exploitative policies result in universal health woes, but also taking the steps to give back power.
The problems with Haiti’s healthcare system began at its foundation. The solutions cannot happen overnight, but the beginning steps include valorization of our language, knowledge, history and culture. As the Haitian saying goes, “Kreyòl pale, kreyòl konprann.” This saying signifies that conversation and therefore cooperation can’t happen without a deep understanding of each other’s roots and backgrounds, how we got to the place we are today. Decolonizing global health also entails giving access to empowering spaces of conversations, be it academic conferences, biomedical journals or university cursus. Ultimately, it can be materialized through new economic policies that allow autonomy and sustainability of Haitian institutions responsible for protecting Haitian lives. As we continue to face the threat of global pandemics of infectious diseases, the time is always right to strive for solidarity and social justice.
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