Original Church in Cange
Father Fritz Lafontant
A brief history of the Cange Haiti and Partners in Health:
The village of Cange, on Haiti’s Central Plateau, is submerged by a dam on
the Artibonite River. Designed and funded largely by U.S. and international
agencies, the dam is intended to promote agribusiness and to supply the
capital city of Port-Au-Prince, many hours distant, with electrical power.
Residents of Cange, all subsistence farmers, receive little or no
compensation for their homes and land, moving up to the barren hillside as
Father Fritz and Yolande Lafontant establish a primary school for the
children of the Cange area. Many of their students do not reach
adulthood–infectious diseases killed almost one-quarter of all children.
The Lafontant’s and their colleagues are joined by Paul Farmer, just accepted
to Harvard Medical School, and 18-year-old Ophelia Dahl.
Working with local partners, they establish a community-based health project
in Cange. Confronted with many illnesses no longer covered in the U.S.
medical school curriculum, Farmer is forced to supplement his Harvard
education with infectious-disease textbooks and do-it-yourself guides.
With the support of the Episcopal Church in Haiti and the United States, and
from Boston businessman Tom White, the Clinique Bon Sauveur is established
The first case of AIDS on the Central Plateau is identified by health
workers based in Cange. The disease becomes prevalent among the region’s
poorest residents, many returning from work as servants in the city.
Partners In Health (PIH) is founded by Farmer, White, Dahl, Harvard Medical
School student Jim Yong Kim, and their friend Todd McCormack. Its primary
goal is to support activities in Central Haiti, including a clinic, a
training program for community-health workers, and a mobile unit to screen
residents of area villages for preventable diseases. A number of schools are
established as well. Aided by PIH funds, the Lafontant’s and other local
residents establish partner organization Zanmi Lasante, Creole for “Partners
In Haiti, PIH and Zanmi Lasante launch a novel, community-based TB treatment
and control program that increases cure rates from about 50 to 100 percent.
A new generation of Haitian-American health activists begins working with
PIH through the “Haitian Teens Confront AIDS” program (HTCA) in Cambridge,
Massachusetts. Meanwhile, in the southern Mexican state of Chiapas, PIH
forms a partnership with health activists from the region’s indigenous
peasant communities struggling against both violence and preventable
diseases. Many of the ill are refugees from the genocidal war in neighboring
Proje Sante Fanm, the first women’s health clinic in Central Haiti, is
founded in Cange. Five thousand women are evaluated in the first year of
For his work with PIH, Paul Farmer is honored with a MacArthur Award. He
uses the entire $250,000 prize to establish the Institute for Health and
Social Justice (IHSJ). The IHSJ launches a number of applied research
projects investigating links between social and economic inequalities and
poor health outcomes. Jim Kim assumes the role of PIH Executive Director.
In Haiti, both the clinic and the community-health program are expanded. HIV
replaces TB as a leading infectious cause of death in certain regions. The
first cases of multidrug-resistant tuberculosis (MDR-TB) are treated in
At the urging of PIH board member Father Jack Roussin of the Society of St.
James, PIH teams up with poor residents of Carabayllo, a shantytown district
on the outskirts of Lima, Peru. Following the community-based model
developed in Haiti, PIH and partner organization Socios En Salud (Spanish
for “Partners In Health”) conduct a “community diagnosis” in Carabayllo,
discovering persistent barriers impeding residents’ access to health care.
Together, they begin working to fill in those gaps, training community
residents as health outreach workers, and developing health interventions
targeted to community members’ needs. An initial survey of Carabayllo and
environs turns up an outbreak of tuberculosis that does not respond to
standard antibiotic therapy. More than one hundred people are sick with
these strains of MDR-TB–they had been declared “incurable” by local and
PIH teams up with Maria Contreras, a community activist based in the
Roxbury, Massachusetts neighborhood of Egleston Square. Like many urban
neighborhoods in the U.S., Egleston Square–located ten minutes away from
the Harvard Medical School campus–suffers from high levels of poverty and
disease. Maria and PIH staff begin to train a team of neighborhood
activists, dubbed the “Soldiers of Health,” to detect and treat other
residents’ preventable health problems. In Peru, meanwhile, PIH and Socios
En Salud begin a joint project to treat MDR-TB patients in Carabayllo. Most
of them begin immediately to show improvement, despite their supposedly
“incurable” condition. Community residents are trained to deliver the
complex drug therapies, including up to seven different antibiotics, in
patients’ homes. Back in the U.S., the Institute for Health and Social
Justice publishes its first book, Women, Poverty, and AIDS, which is awarded
the Eileen Basker Prize from the American Anthropological Association.
In Haiti, Zanmi Lasante is by now treating almost 35,000 patients annually.
The Clinique Bon Sauveur complex includes a women’s clinic, a pediatric-care
facility, an operating room, and a dormitory annex to the village school. At
Harvard Medical School’s Department of Social Medicine, the Program in
Infectious Disease and Social Change (PIDSC) is founded to serve as an
academic arm of PIH. Meanwhile, as MDR-TB patients in Lima continue to
receive treatment from PIH and Socios En Salud, a World Health Organization
study finds that MDR-TB has become widespread in over thirty “hot spots”
around the world. Most patients, the WHO reports, are receiving no effective
therapy and are spreading their deadly illness to family members, neighbors
The first group of MDR-TB patients in Carabayllo “graduates” from the
two-year course of treatment. Partners In Health and the Program in
Infectious Disease and Social Change at Harvard Medical School (PIDSC)
invite international health experts to Boston to discuss clinical findings
from the PIH-Socios En Salud project. In light of these results, the World
Health Organization changes its recommendations for treating drug-resistant
tuberculosis. With sponsorship from the Open Society Institute, PIH and
PIDSC staff help to develop international standards for treating MDR-TB in
The Zanmi Lasante sociomedical complex is treating over 50,000 patients
annually. A new MDR-TB treatment facility is built with funding from PIH
founder Thomas J. White, and the Haitian Ministry of Health designates it as
the primary referral site for the entire country. Zanmi Lasante and PIH also
begin an “HIV Equity Initiative” which provides AIDS sufferers in the region
with antiretroviral therapy. Back in Boston, in collaboration with Harvard
Medical School and the Soros Foundation, PIH staff publish a groundbreaking
study on the global impact of MDR-TB. The report highlights the importance
of community-based care in treating this and other “emerging infectious
diseases.” Paul Farmer and Jim Yong Kim, along with other PIH staff, are
active in World Health Organization efforts to establish pilot MDR-TB
treatment programs, and to organize drug-procurement systems.
The Bill & Melinda Gates Foundation announces a grant through the Program in
Infectious Disease and Harvard Medical School to fund MDR-TB research and
treatment efforts in Peru, and the former Soviet Union. Within five
years–working with the WHO, the U.S. Centers for Disease Control and
Prevention and Peruvian health authorities–PIH and Socios En Salud will use
these funds to expand their community-based treatment program to cover all
of Peru, while training health personnel from other countries with high
rates of MDR-TB. By this means, the methods first developed by PIH in the
squatter settlements of central Haiti will become standard in poor
communities all over the world.
History from the partners in Health web site www.pih.org
As you can see, Cange Haiti is a complex community. Cange is one of the poorest regions of Haiti, because of the hydroelectric Dam on the lake bordering the region. This project flooded the main fertile area of the valley and pushed the people of the area up onto rocky hillsides with very little farmable land. It has been the combined vision of Father Lafontant and Dr. Paul Farmer that has driven what has become one of the premier social, economic; medical complexes in a third world country.
Inside the 2 story church in Cange
Prior to this project, health care in this region was available for the wealthy. All hospitals in the region were cash only, pay before you enter. It did not matter how severe your medical need was; if you could not pay, you did not get any medical attention. The clinic that is in Cange now, is a sliding scale fee clinic. The less money you have, the less you have to pay to get medical services.
Child being treating in hospital for burns received from falling into a cooking fire
Over the last 15 years, this complex has grown at an almost unbelievable rate. The complex now has a two story church, a two floor hospital with an operating room (which is planned to be expanded to 2 operating rooms and a critical care area for post operative care), a dental clinic, a women’s health clinic, a model family planning clinic, a model Tuberculosis treatment facility, an eye clinic, a 450 student school, a preschool program designed to prevent malnutrition in preschool children, and many other buildings to provide support to these services.
Entrance to Clinic Complex
Preschool children coming for meal
Women working in sewing center
The water project for the region is a technological marvel. Before the water project, the people of Cange had to walk 1/2 mile to a VERY steep hill, and down the hill to a fresh water spring near the lake. Then they had to carry this water back up to there homes. A group of engineers from Greenville, South Carolina, led by Pierce Williams, designed a system to cap the spring and run the water down the mountainside through smaller and smaller pipes to create high pressure water supply. This high pressure water drives a pump which pumps the fresh water to a large underground cistern above the village which acts like a water tower to feed water to eight water stations throughout the village.
Pump Station for the water project
Water station in village
The current project underway at the village is the building of a school in Bas (lower) Cange. The children of the village have to cross 2 streams and go up the water project hill and then walk about a half a mile to get to school each day. Many of the children do not go to school because the trip is too strenuous for them. Several local churches here in the upstate including Holy Trinity Lutheran Church have raised over $75,000 to build a school for this village and provide them with operating funds for the first year. This will be an ongoing project to continue to provide the operating funds for this school.
Children from Bas Cange who will attend new school
A prototype school building
(the new school will look very similar to this building)
A check for $18,000.00 for school operational expenses presented to
Father & Mrs. Fritz Lafontant and their daughter Marie Flore Chipps at the
Episcopal convention in Greenville on 10/26/02
Our current project is to continue support for the village of Bois Joli. In the fall of 2004, we funded the building of a 6 room school for students grades K through 5th grade. The school now has 6 teachers and has over 400 students. Other recent projects in the region that we have help with include the building of a 3rd floor on the main school in Cange which now houses grades 9-12. They have also built a dorm for families on the main compound.
The next project we would like to undertake is the building of a church/community center and the development of an agricultural center to grow their own food for the village of Bois Joli. We will need to raise approximately $60,000.00 for this project.
If you are interested in donating money to help the people of Cange, please contact Holy Trinity Lutheran Church at firstname.lastname@example.org or call the church at (864) 224-4220.
The current situation in Cange is very bad. Partners in health had to withdraw their funding for the village. They only have a few clinics running and all the funding for the schools is gone.
There is also some local political turmoil stemming from the retirement of Father Lafontant. The local people are currently refusing our help, but without our funding the schools will be closed.
Stay tuned for more updates.