Haiti After the Earthquake (40 page)

Housing.
In either scenario, safe and affordable shelter will be another of the weighty matters that continue to preoccupy those living in Haiti. It was understood shortly after the quake that people could
be pulled out of the camps by opportunity or pushed out by force. In the optimistic scenario, in which pull forces predominate, massive investments in housing stock have been made in well-chosen sites throughout the country. Such housing units were planned and built, complete with basic services—clean water, modern sanitation, and of course health care and education—and with proximity to a growing number of jobs in the formal economy (which boosts tax receipts) and, for farmers, to processing plants, warehouses, and customers for their produce. By 2015, the number of people in camps has been reduced by two-thirds, and large planned communities are taking final form in half of Haiti's departments. A dozen smaller developments, the fruit of participatory community planning, are underway in the other half. The rate of home ownership has risen steeply, and many poor families can now hope to avoid informal settlements and slums without sanitation, electricity, water, and roads.

In version two, push forces have dominated: sharp clashes between landowners and the displaced continue. Haiti's police are called to forcibly remove more than one hundred thousand “squatters” (less than ten percent of the million and more in camps) and violence leads to scores of deaths. Multinational troops are called in on the side of the landowners, and in 2015 Haiti is again declared an unsafe destination by many other countries (some of them with far higher rates of violence in their own cities but less vulnerable to travel bans). Those forcibly removed find themselves in equally grim settings, and resentment toward the police and other representatives of the state reaches an apogee. For many of the displaced, the concept of the rule of law lacks all legitimacy because law has been used so many times against them and almost never for them. The class divide in Haiti has deepened further, both in terms of economic disparities and in terms of the loss of shared purpose. Social capital has been squandered.

In a pessimistic view, the year 2015 also brings a steady drumbeat from the development community, foreign and homegrown: in an effort to avoid creating dependency upon such extravagancies as food and water, the argument was made that basic service provision to those living in camps needs to be cut back. This policy was recognized
by most camp dwellers as an effort to push them out by making the camps uninhabitable. Cholera and other waterborne diseases, only recently brought under control, returned with a vengeance, not only in the camps but across the country. These diseases brought great suffering and death and also lower profits for farmers in cholera-endemic areas, whose products are spurned on local and international markets because of misguided fears about transmission.
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Health and education.
As early as 2009, it was clear that two-thirds of medical care and more than 80 percent of primary and secondary education were delivered in the private sector—a fact linked, in the eyes of many, to poor health indices and low rates of literacy. What will the next five years bring?

Well before 2015, the public hospital in Mirebalais will have been completed and launched. This will come to pass in either scenario, I dare say. But in the brighter scenario, it came to fill a better role not simply as a teaching and referral hospital but also as a source of care for the large number of families coming to central Haiti to work in schools and healthcare institutions as well as in agricultural regions opened up by better roads, improved irrigation, and ready access to credit. Nonstate providers (from NGOs to religious groups) continue to furnish many of these services but are now doing so in a more coordinated manner, one that builds local capacity by training workers and by moving resources to where they are needed most. The medical center in Mirebalais, drawing on educators from North America and Cuba and the Haitian diaspora, has been training not only doctors and nurses but also a broad range of allied health professionals able to strengthen health systems throughout the country.

The cholera epidemic was brought to heel in 2012 after a coalition of Haitian and international players fought for ramped-up vaccine production in India, leading to the world's first cholera-vaccine stockpile. The vaccination campaign was linked to renewed efforts to make safe water and modern sanitation widely available across the country. Haitians were at the center of this effort, as they had been years before in the delivery of integrated AIDS prevention and care that halved the size of epidemic in Haiti. Cholera treatment centers closed as the number of new cases dwindled to a few a day; patients
were expertly treated in the public-private health centers and hospitals in each department.

In this optimistic scenario, building back better has been applied to both infrastructure and human capital. The long-term development plan, Haiti's version of Vision 2020, led to a policy known as
Investir dans l'humain
—“investing in people.” The renaissance in public education opened up primary and secondary education to all and helped prepare young Haitians for full participation in the governance of an increasingly decentralized economy and the global knowledge economy. The
restavèk
problem has diminished as all children are finally accorded a chance to go to a good school, regardless of their parents' ability to pay school fees. Each year, the quality of pedagogy has improved as more teachers are trained and retrained—and as their salaries rise.

In a pessimistic version of events, 2015 marks the fifth year of a cholera epidemic that won't be leaving Haiti anytime soon. Several hundred thousand Haitians have fallen ill with the disease; international experts were never able to agree on the need to deploy cholera vaccine and more aggressive treatment. Thousands of small water projects lessened the number of cases, but the hybrid El Tor strand is now endemic in Haiti and across the Caribbean. (Cuba and Jamaica were largely spared due to aggressive prevention measures.) The occasional case in Florida or New York has led to scapegoating of Haitians and calls for more aggressive responses to the disease in Haiti. But too few robust programs were implemented, and the lack of ready access to potable water and modern sanitation meant that, in 2015, scattered outbreaks of cholera again occurred in each of Haiti's departments. Dithering about the role of cholera vaccine and proper management of these cases in such resource-poor settings continues in meetings, and in meetings about meetings.

Governance.
Haiti, increasingly vulnerable to hurricanes, also faces other kinds of storms: 2010 was an election year. Political discord continues to roil Haiti, as it must when so many are excluded from full participation. By 2015, the country has a new president and a new legislature. Their legitimacy in the eyes of the Haitian people, surely more important in principle than their legitimacy in
the eyes of a vaguely defined international community, will depend on the manner of their advent to public office.

In version one, increasingly unlikely, there is continuity with the popular movement that grew in the late 1980s, and 2011 will have marked the third time in Haiti's long history that power is transferred peacefully from one civilian and elected government to another. In this optimistic (if improbable) vision, continuity with 1990—the Great Rupture with autocratic or military rule—is clear. At every level of government, from the capital to the ten departments to all of Haiti's towns and villages, there is a growing consensus regarding a sound plan for sustainable development. Continuity with the other great moment of Haitian history—the fight against slavery and for independence—is palpable, as people are engaged in their own development and in a shared vision of fundamental freedoms, including freedom from want and servitude. The watchword of this participatory democracy comes from the former slave Toussaint Louverture, whose famous line upon being captured by Napoleon's forces is known by every Haitian child lucky enough to be in school: “In overthrowing me, you have done no more than cut down the trunk of the tree of black liberty in Saint-Domingue. It will spring back from the roots, for they are numerous and deep.”

In version two, willed or unintentional exclusion of the popular movement, having led to low voter turnout, leads to a government with scant legitimacy in the eyes of the majority. Without genuinely participatory government, sustainable development will be difficult in Haiti. “Participatory” does not mean the fetishization of some superficial process contracted out to a consulting group charged with interviewing “the community” about how it feels about one or another plan for breaking the cycle of poverty, storm, disease, and cronyism. Nor does it mean a ceremony involving ballot boxes and candidates flown in to greet the populace after having charmed alien donors. “Participatory” means, rather, a transfer of at least some resources from rich to poor. This is a transnational process, and it means a historical reckoning with what has happened to Haiti's once abundant resources, including those taken from the Haitian people over three centuries of coerced labor, unequal development, local
misrule, gunboat diplomacy, military occupation, dictatorships family and military, and persistent attempts to undermine the popular movement.

When Franklin Delano Roosevelt wrote of the four freedoms, “freedom from want” was central to his platform. That speech was delivered in 1941, but the same concern for human security—housing and food security, education, and jobs—led to his election amid the economic disaster of 1932 and to his reelections in 1936 and 1940. Roosevelt's audience did not anticipate that the Four Freedoms (freedom of expression, freedom of worship, freedom from want, freedom from fear) might once again become the Two Freedoms under subsequent American administrations. Haitians have long known that rights are worth fighting for and more than words on paper. In the past three decades, as in the late eighteenth century, they have been seeking both formal and substantive rights: as the saying goes,
san pè nan vant, pa gen pè nan tèt
—“when we live with hunger, we will not live in peace.” Until the basic needs of the Haitian majority are met—food and shelter, education and health care, jobs that promote dignity—there will be scant peace in Haiti.
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This was true before the quake, and it remains so after.

I
t's hard to know
where to end an account like this one, but the one-year anniversary of the earthquake seems as good a time as any. We've all been forced to think hard about the past year, and to consider the next steps. Discussions are underway about the future of the Office of the Special Envoy (this decision will be up to President Clinton and the UN), about the rebuilding of the health system (this discussion should be the purview of the Ministry of Health but remains subject to the will of the donors, who control so much of the funding), and about reconstruction (this should be in accordance with a national plan, endorsed by those most affected, although this goal remains elusive).

The one-year anniversary also meant, for me and for thousands of coworkers, difficult decisions for Partners In Health and Zanmi Lasante. So much changed with the quake: one day, we were heavily concentrated in rural regions and working to provide health and social services across central and lower-Artibonite Haiti. Within a week or so, we were struggling to provide basic services in four camps in the heart of the city, including sprawling Parc Jean-Marie Vincent.

We were all ending a year of incalculable loss and facing one of great uncertainty, sure to be deepened by the upcoming runoff elections for president and then another season of rains and hurricanes. The death of Tom White, a founder of Partners In Health and the first to invest in our endeavor—“to make a preferential option for
the poor in health care”—closed out our own year of loss. I was once again en route between Rwanda and Haiti when Ophelia Dahl gave me the news of Tom's death. I headed back to Boston immediately. Tom's widow, Lois, asked me to give the eulogy during his funeral on January 11, one day before the anniversary of the quake. Somehow these sad anniversaries were all jumbled together for me: in speaking about Tom in a packed Jesuit church at Boston College, I was speaking about Haiti, too.

The service drew a big delegation from Haiti, including Father Fritz. There were mourners from a dozen countries: a map of his generosity. Mapping or measuring largesse is hard, quite apart from personal loss. How do you measure compassion and goodness? As fond as Tom was of precision, his stock in trade as a builder, he was deeply mistrustful of confident answers to this question. Long before he knew success in business, Tom was asking hard questions about how to live in a world in which it was simply not possible to be free of anxiety. For someone who loved numbers and worked closely with engineers to build sturdy bridges and tunnels and buildings, he was always the first to admit there was no unfailing algebra of decency, no geometry of the heart or calculus of compassion. If I may paraphrase Tom's son Peter, Tom's determination to realize
eudaimonia
—human flourishing—had inspired all those gathered, as I noted in my eulogy: