Fellowship Site: Haiti

The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) is a non-governmental organization working in close partnership with the Haitian Ministry of Health, dedicated to providing clinical service, research, and training in HIV/AIDS.

The GHESKIO Center is housed in four government buildings in Port au Prince and integrates patient services, health research, and training in HIV/AIDS and inter-related diseases including sexually transmitted diseases, and tuberculosis.

GHESKIO was founded in 1982 by a group of eight Haitian health professionals with a primary goal of understanding the epidemiology of the HIV epidemic in Haiti. It has been under the leadership of Dr. Jean Pape since its inception. GHESKIO operates a clinical center in Port au Prince that provides free HIV voluntary counseling and testing, AIDS care, tuberculosis treatment, reproductive health services, and management of sexually transmitted diseases. The Haitian Government has designated GHESKIO a "Public Utility", a status reserved for institutions which are "essential to the welfare of the Haitian people", such as the Haitian Red Cross.

Haiti is the poorest country in the Western Hemisphere and a developing country with a per capita income of $480/year according to the World Bank. Haiti occupies the western third of the island of Hispaniola in the Caribbean Sea, sharing the island with the Dominican Republic. Haiti's population is 8.5 million people. The country spends annually $8 per capita on health care and has only 2.5 physicians per 10,000 people. The life expectancy at birth is 51 years. Haiti has a generalized HIV epidemic with an estimated 3% of the adult population HIV-infected. Haiti has also has the highest tuberculosis rates in the hemisphere with >250 cases/100,000 population.

GHESKIO has collaborated with Cornell University since 1982 and with Vanderbilt University since 1992. GHESKIO is a prime example of the mutual benefits derived from sustained training that is focused in Haiti but continues to draw heavily from the expertise available through U.S. collaborators. The GHESKIO-Cornell-Vanderbilt research and training collaboration has received 25 years of uninterrupted NIH support including an NIH MERIT award in 1992 (1990-2002; PI Johnson).

GHESKIO, Cornell, and Vanderbilt are partners in multiple ongoing NIH research and training programs in Haiti and the Caribbean, including:

1. an NIAID-funded Clinical Trials Unit at GHESKIO, with involvement in the HVTN and the ACTG
2. a Fogarty AIDS International Training and Research Program (AITRP)
3. a Fogarty Clinical, Operational, Health Services Research Training Award (ICOHRTA)
4. an NIAID Comprehensive International Program for Research on AIDS (CIPRA)
5. the NIAID-funded Caribbean, Central America, South America network for improving data management (CCASAnet)
6. the Office of AIDS Research (OAR) supported Trans Caribbean HIV AIDS Initiative (TCHARI)

In 2003, GHESKIO was asked by the Haitian Government to expand its model of clinical services to 32 private and public hospitals throughout the country as a part of the Network for Comprehensive Care of AIDS and Tuberculosis (Figure 1). These sites provide HIV counseling and testing, and TB and AIDS care which is integrated into existing primary care services. GHESKIO provides training, supervision, administrative support, and quality control for all HIV/AIDS and TB clinical services provided at these 32 sites.

GHESKIO was founded in 1982 by a group of eight Haitian academics, clinicians and public health professionals GHESKIO documented the first cases of AIDS from a developing country in 1983 in the New England Journal of Medicine. Since this time, GHESKIO has created an internationally recognized center of excellence. The GHESKIO Center conducts clinical and operational research on HIV/AIDS and provides training to Haitian investigators and health personnel. GHESKIO, in partnership with the Haitian Ministry of Health seeks to define HIV/AIDS prevention and treatment models for Haiti through the conduct of research, and then expand these models to the national level through training.

GHESKIO has an executive board of five members and 115 employees. GHESKIO has 15 physician investigators and 3 senior laboratory investigators. The GHESKIO Center has served as the Haitian Government's research and training center for HIV/AIDS for twenty years.

The NIH-funded clinical research includes the following projects:

1. HIV Vaccine Trials Network (HIVTN)
2. Clinical Trials of Antiretroviral Therapy
3. Studies of Informed Consent in Haiti
4. Prevention and Therapy of Tuberculosis
5. AIDS in Women and Children
6. Evaluation of Rapid Syphilis Diagnostics for the Elimination of Congenital Syphilis in Haiti
7. Molecular Epidemiology of Drug Resistant Tuberculosis
8. Targeted Evaluations of AIDS Treatment in Haiti
9. Dental Research
10. HPV Cancer Research

More Project Details from the NIH/CRISP database

With support of the Fogarty International Center, GHESKIO, Cornell, Vanderbilt, and Quisqueya University have created an MPH program in Haiti. The MPH degree is conferred by Quisqueya University, which is a private university with undergraduate and graduate degree programs. Quisqueya Medical College is located adjacent to GHESKIO in Port au Prince. Dr Kyss Jean Mary, Dean of Quisqueya Medical School, is on the training advisory board of GHESKIO, and Dr Pape is Co-Director of the MPH program with Dr Jean Mary.

Ten 2-week intensive courses are offered in Haiti and taught jointly by Haitian, Cornell, and Vanderbilt faculty. MPH candidates conduct a research project mentored by a US and Haitian faculty member. An electronic medical library at Quisqueya allows all trainees, including Fogarty Scholars, full access to the Cornell University Medical Library. Because courses are offered in intensive blocks, candidates can continue to work in Haiti between courses. US and Haitian Fogarty Scholars benefit from the academic environment, can attend the MPH courses at no cost, and have full access to the visiting faculty from Cornell and other U.S. universities.

Housing Availability:
U.S. students live in a 3-bedroom apartment rented by Cornell University. Visiting FICRS Scholars are provided a room at no charge. The apartment is in a closed compound with security. There are ~30 other townhouse style apartments in the same compound rented by Haitian families, staff from other non-profit organizations, and foreign embassies. The compound includes a yard, a pool and tennis courts. The apartment has electricity with a back-up generator and internet. The apartment is ~ 20 minutes drive from GHESKIO. GHESKIO provides a 4-wheel vehicle with driver to transport students to and from the apartment to GHESKIO every day. The vehicle and driver are also available to the students on weekends for shopping and social functions.

Health Issues and Immunizations Needed for this Site:
See the Centers for Disease Control and Prevention Web site and The Yellow Book: Health Information for International Travel.

The FICRS program mandates that all Scholars see a physician prior to their assignment abroad. The site will require a formal letter from your physician stating that you have received the necessary immunizations prior to the start of your fellowship (hepatitis A, typhoid, meningococcus).

All students coming to Haiti should attend a travel clinic before departure. The Cornell apartment is five minutes drive from the Canape Vert Hospital, which is the best private hospital in Haiti where most staff from GHESKIO admit their own family when hospitalization is needed. The proximity to Miami (< 2 hours) and frequent flights (3 daily) would facilitate medical evacuation, though this has never been required.

Safety and Danger Issues:
GHESKIO has operated in Port au Prince for 26 years and has learned to deal with political and social instability in Haiti. The clinics have never shut down, and research projects have always continued. GHESKIO staff take great care to assure the safety of visiting students. The apartment and car are provided at no cost so that students have safe living and transportation.

GHESKIO is well connected to the Haitian community and foreign embassies and is well informed of political and social situations. GHESKIO is a "public utility" and as such has close contacts with the Haitian Government. GHESKIO also has a community advisory board with members from all social groups in Haiti. GHESKIO has close ties to the US and French Embassies. Therefore, when there are political and social problems in Haiti, GHESKIO leadership remain well informed. GHESKIO has developed a phone-chain system so that if political, social, or weather problems arise, then all GHESKIO employees and visitors can be 15 quickly notified by cell phone. In these cases, visitors are told to stay at the apartment for the day until further information is available.

GHESKIO has never evacuated foreign visitors in its 26 years. Nonetheless, Port au Prince is an hour and a half flight from Miami, and there are three flights daily. Port au Prince is 20 minutes flight from the Dominican Republic and there are two flights daily. We are a two hour drive from the Dominican Republic.

We tell all prospective students interested in coming to Haiti that their social lives will be limited and they cannot travel freely around the country. Students interested in a care-free backpacking adventure should not come to Haiti. Students interested in working hard at a very dynamic research center will thrive.

Visit the U.S. State Department Web site for additional information.

Language Requirements Other than English:
All professional staff members at GHESKIO speak English. Haitian Creole is helpful; it is spoken by everyone in the country including staff and patients. Creole courses are available to visitors. Creole is a relatively simple language to learn, especially for those with a background in a romance language. In addition, proficiency in French would be helpful but is not necessary.

What is it like to live in Haiti?
In the view of the program staff, Haitians are a wonderful people and the country has a rich culture and a 200-year history of independence. Haiti is also one of the world's most resource-poor countries and is beset with social-political turmoil. Many of the conveniences that are taken for granted in the U.S. may not be available in Haiti.