Haiti After the Earthquake (6 page)
Read Haiti After the Earthquake Online
Authors: Paul Farmer
From 2005 on, we continued to expand our work in the public hospitals across central Haiti, while some of us, including leadership from our Haiti team and Harvard Brigham colleagues, began setting up shop in southeastern Rwanda. We were first dispatched to a longabandoned hospital in an area of former national parklands where as many as 60 percent of the population had been displaced, at one point or another.
It was satisfying work. By the summer of 2008, it was easy to see the power of good public health governance when linked to funding and to decent implementation capacity. Working with the Rwandan Ministry of Health (which had also received support from the Global Fund) and the Clinton Foundation, Partners In Health recruited and
trained two thousand health workers, rehabbed a dozen clinics, rebuilt two hospitals, and broke ground on a third. (We'd been sent to three of the four districts in Rwanda that lacked any working district hospital; the country has thirty districts.) If the work remained on track, we would soon be serving as large a population in Rwanda as we served in Haiti, where the effort had taken two decades.
trained two thousand health workers, rehabbed a dozen clinics, rebuilt two hospitals, and broke ground on a third. (We'd been sent to three of the four districts in Rwanda that lacked any working district hospital; the country has thirty districts.) If the work remained on track, we would soon be serving as large a population in Rwanda as we served in Haiti, where the effort had taken two decades.
But Haiti exerted a hold over us all, and we felt it more sharply in times of trouble. The country had known plenty of troubles, even compared to Rwanda, and the situation was about to get worse. During these years, I flew between Haiti, Harvard, and Rwanda, and my family moved to Rwanda's famously spotless capital city of Kigali in 2006. Kigali was in many ways the mirror opposite of Port-au-Prince. Although Haiti's capital in 2007 was no longer being termed “the kidnapping capital of the world,” as it had the year before, progress there was slow.
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Haiti was disheveled and disorderly and unsafe. The de facto government had been replaced by one led by René Préval, Aristide's former prime minister, but his government was unable to find firm footing. In April 2008, a worldwide spike in food prices (which had almost nothing to do with Haitian policies and more to do with biofuels and U.S. and European agricultural subsidies) led to riots throughout Haiti; attacks on UN peacekeepers stationed there resulted in several deaths, most of them Haitian. Yet another government collapsed, and for months the country had no prime minister because the Haitian parliament refused to ratify the proposed successor, Michèle Pierre-Louis, an economist who had worked on education initiatives and headed up George Soros's foundation in Haiti.
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Haiti was disheveled and disorderly and unsafe. The de facto government had been replaced by one led by René Préval, Aristide's former prime minister, but his government was unable to find firm footing. In April 2008, a worldwide spike in food prices (which had almost nothing to do with Haitian policies and more to do with biofuels and U.S. and European agricultural subsidies) led to riots throughout Haiti; attacks on UN peacekeepers stationed there resulted in several deaths, most of them Haitian. Yet another government collapsed, and for months the country had no prime minister because the Haitian parliament refused to ratify the proposed successor, Michèle Pierre-Louis, an economist who had worked on education initiatives and headed up George Soros's foundation in Haiti.
The riots and political impasse had shaken the eight-thousand-strong UN establishment in Haiti. Leadership in the local UN offices and in New York pushed for a shift of focus, from peacekeeping and policing to what some called “human security”âdecent jobs, food security, education, access to clean water, and medical care. From Rwanda, where we'd experienced the effect of that country's commitment to development and human security, we cheered this shift.
Late August of 2008 found many of us in Rwanda, when, during a visit from President Clinton for the groundbreaking of a new hospital, we got more bad news from Haiti. Another hurricane (on the
heels of two before it) had struck northwest Haiti and Cuba with great loss of life in Haiti (but almost none in Cuba, which had evacuated more than a million citizens from harm's way).
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Haiti's third largest city, Gonaïves, was under several feet of water. I headed back there and, on September 6, hours after returning from the drowned city, drafted a letter to our supporters. I'll quote it at length because the sentiment that “Partners In Health is not a relief organization, but we'll do whatever we can to help” would prove relevant again only fifteen months later. So too would our understanding of the sharp limitations on Haitian officials who lacked the resources to respond to such circumstances. Here is the letter as it was posted:
heels of two before it) had struck northwest Haiti and Cuba with great loss of life in Haiti (but almost none in Cuba, which had evacuated more than a million citizens from harm's way).
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Haiti's third largest city, Gonaïves, was under several feet of water. I headed back there and, on September 6, hours after returning from the drowned city, drafted a letter to our supporters. I'll quote it at length because the sentiment that “Partners In Health is not a relief organization, but we'll do whatever we can to help” would prove relevant again only fifteen months later. So too would our understanding of the sharp limitations on Haitian officials who lacked the resources to respond to such circumstances. Here is the letter as it was posted:
I am writing from Mirebalais, the place where our organization was born, having just returned from Gonaïvesâperhaps the city hit hardest by Hurricane Hanna, which, hard on the heels of Fay and Gustav, drenched the deforested mountains of Haiti and led to massive flooding and mudslides in northern and central Haiti. A friend of mine said this morning: “I am 61 years old, born and raised in Hinche. I have never seen it under water.” Gonaïves, with 300,000 souls, is in far worse shape, as you'll see from the other pictures I append. The floodwaters in Hinche are dropping, but as of 5 P.M. last night, when we left Gonaïves, the city was still under water. And hurricanes Ike and Josephine are heading this way as I write.
Everyone copied on this note has already heard, most probably directly from PIH, about these storms and their impact on Haiti. I apologize for writing again and for asking my own colleagues and friends to consider sending more resourcesâwe need food, water, clothes, and, especially, cash (which can be converted into all of the above)âso that Zanmi Lasante, and thus all of us, can do our part to save lives and preserve human dignity.
The need is of course enormous. After twenty-five years spent working in Haiti and having grown up in Florida, I can honestly say that I have never seen anything as painful as what I just witnessed in Gonaïvesâexcept in that very same city, four years ago. Again, you know that 2004 was an especially brutal year, and those who work with Partners In Health know why: the coup in Haiti and what would
become Hurricane Jeanne. Everyone knows that Katrina killed 1,500 in New Orleans and on the Gulf Coast, but very few outside of our circles know that what was then Tropical Storm Jeanne, which did not even make landfall in Haiti, killed an estimated 2,000 in Gonaïves alone....
become Hurricane Jeanne. Everyone knows that Katrina killed 1,500 in New Orleans and on the Gulf Coast, but very few outside of our circles know that what was then Tropical Storm Jeanne, which did not even make landfall in Haiti, killed an estimated 2,000 in Gonaïves alone....
We're faced with another round of death and obliteration. Haiti's naked mountains promise many more unnatural disasters. We know that a massive reforestation program and public works to keep cities safer are what's needed in the medium and long term. But there's a lot we can do in the short term to help out with disaster relief.
None of us regard Partners In Health as a disaster-relief organization. Together, we've built Partners In Healthâmeaning the network of locally directed organizations working in ten countriesâto serve a different cause. We wanted to attack poverty and inequality and bring the fruits of modernityâhealth care, education, et ceteraâto people marginalized by adverse social forces. It seemed likely, as reports came in this week, that many other institutions and organizations would be far better able to respond to the aftereffects of storms and floods. I'd been told, as the American Airlines flight passed over flooded Gonaïves, that the city was cut off from outside help, but even as I heard this, I knew that our own colleagues were there, volunteering what meager resources we had on hand, and a few hours later I was there, too. I was hoping that we'd find that the city was receiving the expert attention of organizations trained to do disaster relief. So imagine my surprise, yesterday, when I discovered that very little in the way of help had reached Gonaïves or the other flooded towns along the coast.
Although it's not true that Gonaïves cannot be reached by vehicle, it is true that the city center is still under water, and that the road into the city is well and truly flooded. Between Pont Sondéâthe only way to the coast (since the major bridge between Port-au-Prince and Gonaïves is out, as is that to the north)âand the flooded city, we saw not a single first-aid station or proper temporary shelter. We saw, rather, people stranded on the tops of their houses or wading through waist-deep water; we saw thousands in an on-foot exodus south towards Saint-Marc.
We saw a couple of UN tanks rolling through the muddy water over these streets, some Cuban doctors, and two Red Cross vehicles (one of them stuck in mud at least 10 miles from the city), and heard and saw helicopters overhead. But for the most part the streets were full of debris, upside-down vehicles, and dazed residents looking to get out before the next rains. Our friend Deo from Burundi was there and said it reminded him of nothing so much as what he'd seen there, and in Rwanda, at the time of the genocide in 1994âlong lines of people carrying little more than their children, goats, and balancing sodden bags and suitcases on their heads.
A speedy, determined relief effort could save the lives of tens of thousands of Haitians in Gonaïves and all along the flooded coast. The people of that city and others have been stranded without food or water or shelter for three days and it's simply not true that they cannot be reached. When I called to say as much to friends working with the U.S. government and with disaster-relief organizations based in Port-au-Prince, it became clear that, as of yesterday, there's not a lot of accurate information leaving Gonaïves, although estimates of hundreds of deaths are not hyperbolic. We had no cell phone coverage there and had to wait until last night to call people in Port-au-Prince. One sympathetic American friend, following up on our distress calls about a lack of relief, told me this morning the retort she'd heard from an expert employed by a UN-affiliated health organization: “Three days without water is nothing. People in southern Haiti affected by Gustav went ten days without water.”
No human can go ten days without water. Food, perhaps. But not water. So we can expect that the people you see in these photographs, which I took by borrowing the digital camera of a Zanmi Lasante employee from Gonaïves (whose family, like all those you see, lost everything), are at great risk of falling ill with water-borne illnesses. There is also a lot of dead livestock floating down the streets of the city. The stench is overwhelming.
We are familiar with a lot of the Haitian officials charged with responding to this tragedy, which is, agreed, widespread. They showed up in Gonaïves: the district health commissioner, who is from the city and felt lucky to have avoided drowning; the coordinator of the government's
disaster response; nurses and doctors we've known over the years. They are doing the best they can with scant supplies. They are tired, thirsty themselves, hoarse-throated. Even Haiti's newly appointed Prime Minister, on her first day on the job, showed up this morning in Mirebalais, keeping a promise she made many months ago, long before she was directly involved in politics. She now has to install a new government, perhaps this afternoon, and respond to multiple disasters at once. These people, who are trying to help their fellow Haitians, deserve our help.
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disaster response; nurses and doctors we've known over the years. They are doing the best they can with scant supplies. They are tired, thirsty themselves, hoarse-throated. Even Haiti's newly appointed Prime Minister, on her first day on the job, showed up this morning in Mirebalais, keeping a promise she made many months ago, long before she was directly involved in politics. She now has to install a new government, perhaps this afternoon, and respond to multiple disasters at once. These people, who are trying to help their fellow Haitians, deserve our help.
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I wrote this letter a few hours before Ike, the fourth storm, hit Haiti. Pierre-Louis' first official visit was to the shabby Mirebalais hospital, which sat in a place everyone called
lòt bò latem
â“on the other side of the river.” The bridge connecting the town center to the hospital was also the span that connected central Haiti to the coast. A modest bit of infrastructure, the bridge was nonetheless a key artery. (Although there's no reason that the new prime minister would pause to make such an observation any more than might any of those accustomed to crossing it.) But that night, as Hurricane Ike drenched central Haiti's deforested mountains, a flash flood hit a UN base (home to a battalion of Nepalese peacekeepers) and swept scores of empty cargo containers into the river. The containersâwith “UN” marked in huge black lettersâstruck the Mirebalais bridge with enough force to bring it down, and the Central Plateau was cut off from the coast for months. The only way to reach the hospital was in dugout canoes.
lòt bò latem
â“on the other side of the river.” The bridge connecting the town center to the hospital was also the span that connected central Haiti to the coast. A modest bit of infrastructure, the bridge was nonetheless a key artery. (Although there's no reason that the new prime minister would pause to make such an observation any more than might any of those accustomed to crossing it.) But that night, as Hurricane Ike drenched central Haiti's deforested mountains, a flash flood hit a UN base (home to a battalion of Nepalese peacekeepers) and swept scores of empty cargo containers into the river. The containersâwith “UN” marked in huge black lettersâstruck the Mirebalais bridge with enough force to bring it down, and the Central Plateau was cut off from the coast for months. The only way to reach the hospital was in dugout canoes.
This letter became Partners In Health's first online appeal. (The generous response to this letter would later be dwarfed by the heartening response to our appeals after the earthquake.) After returning to Harvard, I forwarded the Gonaïves letter to a number of current and former U.S. government officials. We heard back from several of them, including President Clinton, who called within hours of receiving the appeal. He underlined the need to link palliation of sufferingâdisaster reliefâwith strategy and longer-term investments to grow Haiti's economy. To paraphrase his comments: “What can I do to help? We have to provide relief, but we need to focus on the
big picture: Haitians need more and better jobs, and perhaps some of them could be in reforestation and public works, like during the American Depression.” Clinton called as I was about to begin a lecture at Harvard Medical School, and I thought, once again, about how disparate were the worlds we spanned: Haiti and Harvard, New York and rural Rwanda.
big picture: Haitians need more and better jobs, and perhaps some of them could be in reforestation and public works, like during the American Depression.” Clinton called as I was about to begin a lecture at Harvard Medical School, and I thought, once again, about how disparate were the worlds we spanned: Haiti and Harvard, New York and rural Rwanda.
Clinton had been in northern Rwanda for a hospital's groundbreaking. But while there (with his daughter Chelsea), it seemed he spent more time talking about Haiti than he did about our medical work in Africa. (By then, we were working together not only in Rwanda but also in Malawi and Lesotho.) After the hurricanes, we made plans to meet in Haiti and to travel to Gonaïves together within the next month or two.
With food riots, storms, the collapse of a shoddily built school full of kids,
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and an entire city and some of Haiti's most fertile regions under water (which led, in part, to widespread hunger across the country), 2008 seemed apocalyptic. Few imagined that something much worse was in store.
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and an entire city and some of Haiti's most fertile regions under water (which led, in part, to widespread hunger across the country), 2008 seemed apocalyptic. Few imagined that something much worse was in store.
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