Political violence and public health in Haiti.

In 1991, a violent military coup unseated Haiti’s first democratically elected government. An estimated 5000 people died, and hundreds of thousands more were displaced during the three years when military and paramilitary groups ruled the country. It was my privilege and responsibility to help provide basic medical services in central Haiti during those years. After constitutional rule was restored in 1994, it was possible to assess the effects of those events on our medical and public health efforts in the central plateau. We termed these years the “lost years,” since many of our efforts required a modicum of order and a functioning public health system in order to bear fruit. In the years since 1994, the nongovernmental organization Partners in Health has been able to forge strong public–private partnerships throughout central Haiti. During the past three years, for example, we have scaled up an integrated AIDS prevention and care project in this region. With support from the Global Fund to Fight AIDS, Tuberculosis, and Malaria, about 1000 patients with advanced human immunodeficiency virus disease are currently receiving supervised, communitybased care and treatment. Working in conjunction with underfunded public health clinics, we were witness to the reinvigoration of primary health care in many of the major towns in central Haiti. 1,2