Haiti After the Earthquake (28 page)

While in Rwanda, I thought long and hard about that country's recovery from the genocide and about other recoveries of recent history. Bold rebuilding plans always include major public works projects. Haiti needed them, too. There were innumerable public-works jobs imaginable, from reforestation and rubble removal to building schools that were safe and well-supplied. Haitians needed a real health system, which would require massive investment in new clinics and hospitals, staff to run them, and health insurance—yes, “the public option.” (Only three hundred thousand families in Haiti had private insurance.) These tasks were indivisible, as FDR noted at the outset of the Depression: “Public health . . . is a responsibility of the state as [is] the duty to promote general welfare. The state educates its children. Why not keep them well?”
²⁷

Job creation and improved health and educational services, with greater investment in the public sector, should have been a big part of the recovery plan. The Interim Haiti Recovery Commission needed to be swift and nimble; the rules of the road for development assistance needed to be rewritten, not to favor contractors and middlemen and trauma vultures, but to favor the victims of the quake. By summer, shovel-ready projects that could create tens of thousands of jobs (or perhaps more) were available. But most people were living in poverty without reliable jobs. Haiti's
ti machann
(“market women”), for example, seldom had access to capital or financial services and had been working against an undertow of unfair trade policies. But they were as entrepreneurial as anyone.

Projects of all sorts could be green-lighted by the recovery commission, but they would move sluggishly if the funds seeped in slowly or if strangling strictures were placed on their disbursal. The commission didn't even have its own project money. In the face of urgent need, were we well served by the fetishization of process that retarded the flow of capital into the hands of poor families?

Americans with long memories knew it was possible to move forward with a sense of urgency. During the Depression, job creation and improved services—from health care to education to rural electrification—were the focus of great efforts and significant enthusiasm. Roosevelt, then the governor of New York, called for “workfare”
and welfare through the Temporary Emergency Relief Administration. This call was made on August 28, 1931, and the program was up and running by winter.
²⁸

Later, these lessons were brought to scale through many other programs, including the Civil Works Administration, which created millions of jobs and moved billions of dollars into both the public sector and the hands of the previously unemployed. Many civil works programs—dams, municipal water systems, public power plants, roads, reforestations, communications infrastructure, even blazing the Appalachian Trail—were completed in part because of the Civil Works Administration and other civilian jobs programs.

Certainly Haiti's need was no less great than that faced by the States during the Depression.
²⁹
A better functioning tax base would have been handy. (The Haitian version of the IRS had never functioned well and, like the Ministries of Health and Education, had been destroyed in the quake.) But in principle, other capital was available: the world had responded generously, and now it was incumbent upon us to move these resources into the hands of the Haitian people. It was not a matter of choosing between public and private sectors, but of focusing resource distribution on the poor and displaced by providing basic services and by launching substantial job creation efforts. Only an infectious failure of imagination would slow such projects down or smother them in their cradles.

In Rwanda, I thought about the many meetings I'd attended since the quake. Some were less mind-numbing than others. Meetings involving President Clinton tended to be engaging because he always had good ideas and tried to boost morale. Other meetings seemed promising as well. On June 7, I was the lone American invited to a tripartite health summit between Haiti, Cuba, and Brazil. When I was informed by Claire Pierre that the meeting was to be held in the Hotel Montana, where Walt Ratterman and Mario Pagenel and so many others had died, I thought there had been a mistake. The Montana was down. But Claire would know; her mother had lived in an apartment there, which had been leveled. “Yes,” she said. “That's where the meetings will be held. Some of the conference rooms under the hotel are intact.”

On top of a hill overlooking the city and the bay and also the Central Plateau, the hotel grounds were an eerie perch. The building was little more than a pile of plaster and concrete and twisted steel. One of the owners limped over toward us. (She had been badly injured, I knew, and had lost one of her grandsons along with most of her guests.) She led us to a lower terrace under which lay, undamaged, a subterranean meeting room. The tripartite mission (Haiti-Cuba-Brazil) would meet there, she said. “And I have something for you,” she told Claire. “Some things I found in the rubble.”

When we emerged for a coffee break (and a break from translating between doctors speaking in French, Creole, Portuguese, and Spanish), the Montana owner gave Claire her sister's wedding album. “I found this in what used to be your mother's apartment.” The album was water-stained and warped, but the pictures were mostly undamaged. It was one of the only times that I saw preternaturally cheerful Claire tear up. She hugged the album to her chest. “And for you, doctor,” continued the owner, “I found this.” She handed me a waterlogged report of the health status of the Haitian people. Probably the work of some consultants who had stayed at the Montana, it was still wet and in worse shape than the photo album. I took it gratefully, and we returned downstairs to join the Babel of physicians from across Latin America, as they asked how a proper health system might emerge from the wreckage.

To those in the camps, and to many of my colleagues, the summer was one of lowered expectations. If help was on the way, it was travelling slowly and in the form of discrete projects visible to some but not to all. At least we knew the teaching hospital in Mirebalais—by far the most ambitious project we'd ever taken on—was moving forward. Many others labored mightily to improve conditions in one way or another. But projects without perceived national reach were not cheered by those untouched by them. As the rains fell, weeds appeared and began to cover some of the uncleared rubble. It was a summer of great discontent.

The months passed by in a blur—more meetings, yes, but also a frenetic push to get money and projects moving. It was during that summer that a group of us decided to pull this book together. We hoped it might lend clarity to the debates about reconstruction, and that it might serve as an account, however partial, of those first six months. But to write a book, or even a few chapters, required time alone. I hoped to find such time during a giant AIDS conference in Vienna in the third week of July. These meetings, which took place every two years, gathered twenty thousand people and were quite a spectacle. Although meetinged-out, I'd promised Clinton and some Haitian colleagues, including Dr. Pape and Father Eddy Eustache, that I would be there. Vienna was not a city I knew, but I'd imagined a tranquil week in a leafy city, when half my time could be spent writing. (Cassia Holstein promised to meet me there for this reason.)

We arrived in the middle of a heat wave, hotter than any I'd endured in Haiti or Africa, and there was a good deal less tranquility and writing than hoped for. President Clinton gave the meeting's plenary address, speaking of Haiti. The net movement, he said, was forward and positive. A few of us gave a presentation about medical care in Haiti after the quake. I was eager to hear Dr. Pape's opinions and projections. (GHESKIOʹs clinics and labs, which he had founded two decades previously, were smack in the middle of the quake zone.) He predicted that although Haiti's AIDS epidemic remained “under good control,” the conditions in the camps, including the one abutting GHESKIOʹs downtown campus that we'd visited with Clinton in February, were ripe not only for epidemics of waterborne disease but for a rise in tuberculosis. Some of us, Pape included, remained worried about the introduction of cholera and other pathogens unknown to Haiti—as AIDS had been unknown a few decades before.

As in all such conferences, the most interesting conversations occurred
dans les coulisses.
Several of us met to discuss the Global Fund's grants to Haiti. The last real meeting on the topic had started at 4:00 P.M. on January 12, and the problems with the upper-level management of Haiti's AIDS programs remained largely unaddressed. It was also in Vienna that the Minister of Health in Lesotho, who had
once worked with the Clinton Foundation, reiterated a promise to take in some Haitian students at their university. (The Rwandan government had done the same.) Didi agreed to spearhead that effort after her troubling visit to Parc Jean-Marie Vincent earlier that month.

One of my only celebratory breaks that summer was the July 31 wedding of Chelsea Clinton and Marc Mezvinsky. Chelsea and Marc had traveled to Haiti together shortly after the quake, and since then, Chelsea had been back to the camps, including Parc Jean-Marie Vincent. A student of public health, she had warned us of cholera and other waterborne pathogens. But on that day, we raised none of these topics. We tried to avoid saying the words “Haiti” and “earthquake” altogether. (It was a reminder that there might be other topics of conversation.) It was there, in a lovely town in upstate New York, that I finally started working on this book. The day after the wedding, to encourage myself to write—to stop and think and write—I made a brief pilgrimage to the graves of Franklin Delano and Eleanor Roosevelt.

Within a week, the proud father of the bride and I were back in Haiti, where it was almost as hot as the Austrian capital. Clinton arrived in Port-au-Prince on August 5 to help launch the newly baptized Interim Haiti Recovery Commission. As had been the case from the beginning, disagreements about the commission's role bubbled just under the surface. Some representatives of the development enterprise were resentful—why stand up a body like this, they asked, if there were existing bodies?—but most were worn out and ready to acknowledge that something new was needed. The diplomatic community was also in large part bound by the strictures of that world to at least feign enthusiasm for the commission. The Haitian politicians were, as ever, split—some denouncing the commission as a failure even before it met for the first time and others, including members of the Préval administration, obliged to be supportive. Many of the behind-the-scenes meetings were devoted to making the commission nimble, transparent, and strong without weakening the line ministries (the government agencies in charge of health, education,
agriculture, et cetera). By this late date, most NGOs and aid groups allowed that efforts to bypass the line ministries had worsened Haiti's governance and fueled the overall lack of coordination. But how to repair this error while also speeding up reconstruction?

Claire Pierre was asked to head up the health sector of the commission. Could she be seconded by Harvard (and her hospital) to lead this small team? If anyone had the patience and competence for such a thankless posting, it was Claire. We were in full support, if she was willing to risk it. She was.

The next morning, Clinton traveled to Darbonne Sugar Mill in Léogâne, the town nearest to the epicenter of the quake. The only operational sugar mill in all of Haiti, Darbonne was always in the throes of closure because its output was as meager as its profit. Clinton was investigating whether investments in the mill might generate jobs and help stimulate biofuel production. We also came to see how Léogâne was faring: what had happened to schools and health centers, and what were the conditions like in its spontaneous settlements? I had worked in Léogâne's hospital as a medical student but had not been back in several years. (Léogâne was also the hometown of Edwidge Danticat, a friend and contributor to this volume.)