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Restoration, return, and rivers: How history drove Haiti toward undernutrition

Written by Evelyn Lukanen, B.A. candidate in Intercultural Studies: Cross-Cultural Healthcare and Cultural Anthropology at Biola University and participant in the 2023 Institute for Public Health Summer Research Program

Fishing boats in Port Salut, Haiti. Photo: Claudia Altamimi, Unsplash

During my involvement in the Institute for Public Health Summer Research Diversity Program in Cardiovascular Disease & Hematology (RADIANCE) track, I attended a presentation by Joe Steensma, EdD, MPH, MA, professor of environmental health at WashU’s Brown School. In the presentation called, “From Pearl of the Antilles to Peril in the Antilles.” In the presentation, Steensma proposed this study question: Why are children in Haiti not gaining weight? 

This introduction takes an unexpected turn beginning with the French Empire. According to UNICEF, Haiti was an agricultural powerhouse that once supplied 40% of the empire’s resources however today, nearly 59% of the population exists below the poverty line. A series of interacting systems stemming from a 200-year-old economic catastrophe, held the key to modern children’s crises.

Desperate to keep Haiti, Napoleon Bonaparte sold the Louisiana Purchase in 1803 primarrily to fund the war against the anti-slavery Indigenous Army, which included slaves and free men alike. After losing to Haiti at the Battle of Vert󠆌ières, France demanded Haitians pay extensive reparations in return for independence. Decades of toppling hierarchy between agricultural land owning, investing and converting would erode 70% of Haiti’s topsoil below water. Degraded soil structure can result in a poor infiltration rate of rain into aquifers which then disrupts water exchange between aquifers and rivers. As water sources are affected, scarcity, overfishing, and economic burden contribute to the “tragedy of the commons.” With agriculture and fishing collapsing, people turned to deforestation to sell charcoal. Deforestation of trees and mangroves further destroys land and aquatic ecosystems, hastening hardship. However, by using charcoal, Haiti can refrain from dependency on international energy supply.  

Charcoal has become one of Haiti’s most important crops with nearly all of Haiti now relying on it. A reduction in charcoal sales or production would alter Haiti’s way of life and economic stability. Burning charcoal for cooking releases carbon monoxide (CO) along with other toxins into the atmosphere. CO binds to hemoglobin in the blood, forming carboxyhemoglobin, which can reduce oxygen distribution. As children take deeper breaths to intake more oxygen, hypoxia (insufficient oxygen within tissues) forces the digestive system to shut down so oxygenated blood can supply other essential organs. Unlike previous study hypotheses, pathogens were not to blame for diarrhea and poor weight gain in many children. Hypoxia from CO exposure is. This study identified one cause of undernourishment in children, but an overall solution remains necessary. 

Professor Steensma’s answer was, “Let me fix one river.” Restoring one river could recover a damaged ecosystem, returning stability to the people who depend on it. Environmental and economic stability would encourage a spread of restoration to recoup community wellness.

I have learned that health is an interdisciplinary field interacting with the environment, economics and history. Throughout his presentation, Steensma inspired us to use education as a launch pad, not a limit. This has helped me actualize an impact on health care through nontraditional yet effective fields. His advocacy reminds me to look beyond the focus of a traditional career path to the wide world of opportunity where we can involve ourselves in wellness solutions.