Friday, December 31, 2010

Annus Horribilis for Haiti

No one who cares about Haiti can be too sorry to see 2010 end. I wrote an essay that was recently published in a local newspaper and I will share it here. Here's hoping that 2011 begins the resurrection for Haiti

My husband John Carroll and I are asked to give presentations on Haiti and the work that we do with our organization, Haitian Hearts. Haitian Hearts brings children and young adults from Haiti to the United States for heart surgery and also supports general medical care in Haiti. During the question and answer period after the presentation, we sometimes are asked, “Do they know about birth control?

I confess to feeling upset when I hear this question. I don’t like what the question implies: “It would be in those people’s best interest if their parents had used birth control, and they didn’t exist.” Despite their difficult circumstances, the Haitians themselves are glad they are alive, just as we who are more materially privileged and have less life-threatening problems are glad we exist. Upon hearing this question, I wish I had the magical ability to transport the person to Haiti. When you are sitting in front of a person who needs food, or medical care, or even a hug, their existence seems inevitable and good, just like yours and mine does.

When we think of people in an abstract way—as huge masses of the suffering, poor—we are more likely to draw conclusions that aren’t respectful of human dignity and the right to life. We view the people themselves as the problem and not the appalling conditions that exist in the world and that our sinfulness has helped create. This distancing is a form of denial.

The answer to the problem of poverty that kills is not birth control; it is living the Gospel, bringing the Kingdom of God to our world. Jesus personified it and preached it, and 2,000 years of Church tradition reinforce it. Perhaps Jesus’ strongest statement about how we are to treat the poor is in Matthew 25, where he links our care of those most in need to our salvation. Those who feed the poor, clothe the naked, care for the ill, visit the prisoner inherit the kingdom.

From the document, The Church in the Modern World, comes these challenging words: “. . . the right of having a share of earthly goods sufficient for oneself and one’s family belongs to everyone. The Fathers and Doctors of the Church held this opinion, teaching that men are obliged to come to the relief of the poor and to do so not merely out of their superfluous goods. If one is in extreme necessity, he has the right to procure for himself what he needs out of the riches of others. Since there are so many people prostrate with hunger in the world, this sacred council urges all, both individuals and governments, to remember the aphorism of the Fathers: ‘Feed the man dying of hunger, because if you have not fed him, you have killed him.’”

Before 2010, a good day in Haiti, particularly in Port-au-Prince, was already like the aftermath of a natural disaster. But this past year, the people of Haiti have borne an inconceivable level of suffering: a devastating earthquake that killed tens of thousands of people in a matter of seconds; seemingly permanent tent and tarp cities with all their problems of poor sanitation, lawlessness, and inadequate protection from the elements, including hurricanes; and as I write this, a deadly cholera outbreak that will likely kill thousands more people. The people of Haiti seem to be carrying the cross for the entire western hemisphere.

I don’t like typing that word thousands in the paragraph above—too many people gone and no names, faces, or stories with the number—so let me tell you about one bright spot: a four-year-old girl who survived for several days in a collapsed building destroyed by the earthquake, trapped next to her father who was dead. A relative brought her to a hospital where John was working and upon exam, he detected a heart murmur and sent her for an echocardiogram. She has a fixable heart problem, and we are searching for a hospital for her. So there is hope for her.
Faith, the faith of the Haitian people and our own faith, gives me hope. Poor Haitians who have so little materially have the greatest faith. They are constantly praising God and depending on Him. They show no self pity in the face of such painful, heartbreaking circumstances. When I get discouraged thinking about Haiti, I try to contemplate Jesus. God sent His only Son to walk among us and how did we treat him? How much darker can things get for us than God nailed to a cross? And yet, this was not the end and out of the Crucifixion came the Resurrection. I have faith that if we follow God’s great commands to love Him and each other, Haiti, too, will have a resurrection.

Sunday, December 12, 2010

Patient 142 Has Been Patient

We have many challenges in bringing patients from Haiti to the United States for medical care. From the moment John hears a not-so-innocent murmur as he listens to a child's heart, a process is set in motion, which if it is successful, results in the child coming to the United States for surgery.
In a normal situation--as if there was such a thing as normal in Haiti--John gives the family money and instructs them to take the child to a cardiologist for an echocardiogram. This test is recorded on a videocassette, which the family must bring back to John. Then if the child doesn't have a passport, one must be procured. The family is instructed to check in regularly with our Haitian helpers. All of this must be done in a country with roads that wouldn't be called roads elsewhere, where death trap transportation is the main mode of travel and by families with few resources, who are struggling just to live.
In the United States, we send the echocardiogram around to doctors who have expressed an interest. And we tap any connection we can think of to find a hospital that might be willing to accept a charity international case.
Once we get yes from a hospital and doctor, we look for a host family. Then we have to get through a whole lot of visa and travel paperwork that I won't bore you with describing right now. Really, it takes a series of miracles for us to get anyone out of Haiti and to the United States.
That is doubly, triply, quadruply the case for Widnerlande, pictured above. John first saw her in a clinic and sent her mom and her off for an echo when she was 18 months old. She is now seven. Some of the obstacles included: an echo that got lost in Haiti. inability to contact the family, who lives hours from Port-au-Prince (this always makes things more difficult as passports and visas can only be gotten in the capital), and lack of passport for Widnerlande until recently, to say nothing of the natural disasters that have hit Haiti--hurricanes and the earthquake that devastated the country. For weeks, we didn't even know if Widnerlande and her family were alive. And now cholera is blighting the land.
Despite all of this, we found a surgeon, a hospital, and a host family. Our Haitian helper assisted Widnerlande in getting a passport. All of the visa paperwork has been sent to the embassy. Widnerlande and her mother are in the capital and so is John to transport her to the United States, and we have someone in country to help get the visa. And so it appears that our--can I dare say?--last obstacle is the political violence in Haiti, which has shut down the airport and the embassy and made travel in Haiti dangerous. It will eventually end, and we have faith we will get the visa.
We thank Widnerlande for her patience.

Monday, December 06, 2010

The Price of Cholera

Meet Renaldo. I wish we could. He died this morning about an hour after this picture was taken. His mother is terribly sick with cholera and was too weak to even react when her son died.

Renaldo had been admitted to one of the Cholera Treatment Centers yesterday with diarrhea. The nurses said that he didn't look too badly. But he began vomiting this morning. Cholera can kill quickly.
God bless Renaldo and God help us.

Sunday, November 14, 2010

He Should Be Mad: "Haitian Government, Release Those Containers!"

After watching the weak 60 Minutes report on Haiti this evening, I feel validated in my opinion that Haiti's government doesn't know what it's doing and also an awful sense of deja vu. Part of the story focused on a man from South Africa with the 7th Adventist Church who is building housing in Haiti. His organization had shipped containers filled with building supplies to Haiti for 1,200 temporary houses. However, the 24 containers were sitting at the Haitian port where they had been for months, despite the South African having all the necessary documentation and a $6,000 check to pay the Haitian government for storage costs.

When the 60 Minutes correspondant Byron Pitts described this situation to the Haitian Prime Minister Jean-Max Bellerive, he agreed with the Pitts leading statement that obviously something had not been done properly or the containers would have been released. (Nice hard hitting reporting)

Shortly after the interview, the containers were released. The South African was told the containers had been missing a Haitian government seal. Yes, for months the containers filled with materials to build houses for people living in tarps were held up because they lacked a government seal. Why did Pitts not press Bellerive on what was either a lie or gross incompetence?

The old, missing seal story is a familiar one to us. After our son Luke's adoption was completed by the Haitian court, the papers had to make the rounds of many Haitian ministries for their seal. In one case, we were told the stamp was broken and they had to send to Germany for another stamp. I kid you not.

Wednesday, November 10, 2010

For Those Who Would Like To Become Haitian: Dual Citizenship

If you didn't have time to read the lengthy and thought-provoking article by Rene Bruemmer of the Montreal Gazette that I posted last week, here are some of the points that drew my attention.

"Political instability and poor governance [are] the most important drivers of failure from which all other negative consequences follow."

Building roads, school, and hospitals is relatively easy compared to maintaining and running them. The latter takes an educated bureaucracy to manage the never ending tasks associated with governing and running institutions.

Sixteen thousand civil servants were killed in the earthquake, more than 20% of the country's public administration workforce. There is joke in Haiti that those killed were the most dedicated employees as they not only bothered to show up for work, but were still there late in the afternoon when the earthquake hit.

Powerful elites limit institutions because the institutions usurp the elite's power. Instead the elites create patronage networks, based on loyalty to the elites.

Eighty percent of Haiti's college graduates flee their homeland "for the brighter future of elsewhere."

Non-governmental organizations (NGOs) provide 75% of the health care in Haiti.

One of Bruemmer theses is that Haiti needs educated bureaucrats who can help run the state. He believes that some of the money pledged to help Haiti should go for this purpose. He acknowledges that the process of building institutions takes years or even decades.

Haiti needs an influx of educated people to help build these institutions. One could argue that Haiti has that in the many NGO's and the UN which have a presence in Haiti, but given their huge presence, the successes seem minimal. As well meaning as all these outsiders are, they remain, to some extent outsiders. A lack of experienced, educated, committed Haitians exists. What to do?

As I pondered this question, a thought popped into my mind: What about dual citizenship? What if the United States, Canada, and France, with Haiti's permission, allowed their citizens to have dual citizenship with Haiti? These three countries come to mind because of their historical relationships with Haiti and also because of the large numbers of Haitians who live in these countries, particularly the U.S. and Canada. People of Haitian descent or others who have a connection to Haiti--perhaps those who have adopted children--might be interested in becoming citizens of Haiti and more fully participating in the building of the country if they could retain their current citizenship.

I realize this idea is a little half baked, and I will explore its pros and cons in further posts. But things must change in Haiti, or as Bruemmer says, the tragedies of the present will join the tragedies of the past that are"waiting in the wings to hobble the future."

Tuesday, November 02, 2010

Cholera Update

I know that in my last post I said that the next post--this post--would be about the problems of a (non) functioning government in Haiti. But in the meantime, the AP ran an article about the source of the cholera in Haiti. I won't reprint the entire article, but here are some excerpts:

A cholera outbreak that has killed more than 300 people in Haiti matches strains commonly found in South Asia, the U.S. Centers for Disease Control and Prevention said Monday.

The finding intensifies scrutiny on a U.N. base above a tributary to the Artibonite River that is home to a contingent of recently arrived peacekeepers from Nepal, a South Asian country where cholera is endemic and which saw outbreaks this summer.

The Associated Press found questionable sanitation conditions in an unannounced visit to the base last week and an exclusive tour of the facility given by peacekeepers Sunday. The U.N. defends its sanitation practices and has repeatedly denied it was a source of the infection. The peacekeeping mission said officials were looking into the matter Monday following the announcement.

The AP visited the base last Wednesday to follow up on a statement by the mission that its sanitation measures met U.S. and U.N. standards. The area between the base and the river reeked of human waste. Several pipes were leaking, including a broken plastic pipe emitting a foul-smelling black liquid near what the soldiers identified as latrines. The dump site for the waste was a few hundred yards (meters) away in shallow, shovel-dug pits, next to several homes. Neighbors said the pits often overflow and run to the river, and they stopped drinking from the river and sought fresh water uphill.

Okay, so we don't know for certain if the cholera came from the UN forces. But it seems like this is a likely possibility. One of the mysteries of the outbreak is where the bacteria came from as cholera is not endemic to Haiti. We now have at least a hypothesis.

So if the cholera is coming from the troops, it would mean that the UN forces who are in Haiti as peacekeepers. to protect Haitians-though many living there would say that the UN troops make Haiti a more dangerous place--have spread a deadly disease because they did not properly dispose of their waste. The deadliness overwhelms the irony.

Monday, November 01, 2010

How Do You Have a Country Without a Functioning Government?

The title of my post is a questions that has perplexed me for sometime. In my opinion, one of Haiti's main problems is that it doesn't have a competent, functioning government. This was true before the earthquake and it is even more painfully true now.

I read the article below from the Montreal Gazette on the Corbett listserv. It articulates this problem in much detail. The article is lengthy, but worth the read. In my next post, I'll offer some thoughts on Haiti's lack of governance.

Haiti civil service in ruins
Montreal Gazette By Rene Bruemmer, October 27, 2010

How do you fix a failed state? How can the world help a nation in wretched disrepair, unable to feed, educate, employ or heal the majority of its people, become self-sufficient and capable of giving its citizens decent lives?

The short answer, according to one school of thought gaining currency in international development circles, is bureaucrats. Train and hire lots and lots of bureaucrats. And use them to bolster and maintain the institutions that manage the endless day-to-day needs of providing potable water, health care, schooling, land titles, policing and justice.

Foreign governments and NGOs can build all the roads, hospitals and schools they want in Haiti, Andrew S. Natsios, the former administrator of the U.S. Agency for International Aid, said in an interview with The Gazette. But without a functioning public service in place to manage them, those roads, hospitals and schools are doomed to fail.

"Clearly, port facilities, roads, bridges, schools, health clinics and water systems (which were already crumbling before the earthquake) must be rebuilt," Natsios said in his testimony before the U.S. Senate's Foreign Relations Committee Hearing on Haiti last May. "But, if that is the extent of our reconstruction efforts, then Haiti will simply revert to its failed state status and whatever is reconstructed will begin to crumble over time without institutions to ensure maintenance."

The magnitude of the tragedy surrounding January's earthquake, which killed more than 230,000 people and left 1.3 million homeless, is in many ways due to Haiti's lack of institutions -a man-made tragedy. Buildings were poorly constructed with shoddy materials on unstable land, with no government system to inspect them, no legal system to punish builders, no insurance system to allow citizens to bury and rebuild. A similar magnitude quake in Chile that occurred six weeks after Haiti's resulted in just 500 deaths, due in large part to Chile's push to build earthquake resistant buildings. Chile is considered among Latin America's best-governed countries.

The problem, Natsios said, is that while rebuilding roads and schools is relatively easy, creating institutions -a functioning ministry of health, for example -is complex, costly and can take decades. It is also risky, as Haiti's political instability could destroy much of the work done, as it has in the past. Humanitarian food aid and health care make up the majority of
foreign assistance to Haiti. Compared with handing out bags of rice to the starving or building a hospital, the work that goes into building institutions -educating workers, bettering management systems, improving transparency to limit corruption, developing clear hiring and promotion practices based on merit -is not very visible. The benefits can also be hard
to quantify. All of these elements make it difficult for the political leaders of foreign nations, who have to justify their expenses to their taxpayers and voters, to invest heavily in institution building.

But as Haiti slowly rebuilds after the earthquake, development experts warn that reconstructing infrastructure without addressing the country's governance issues could be akin to throwing the money into a bottomless pit. In Haiti in the Balance: Why Foreign Aid Has Failed and What We Can Do About It, author Terry Buss notes that unlike many failed states, Haiti has received billions of dollars in foreign support, along with the aid of
thousands of non-governmental organizations (NGOs) and the presence of UN security troops. International governments and organizations gave more than $5 billion in foreign aid between 1990 and 2005, yet the standard of living in Haiti dropped in that period.

"Aid shortcomings likely originated because donors collectively fail to deal with political instability and poor governance as the most important drivers of failure, from which all other negative consequences would follow," Buss wrote.

Businesses, Buss noted, do not invest in failed states, buy their exports, or start companies there. Without investment and jobs, there is little tax revenue with which to pay for civil servants to run the state. It is a vicious circle.

In the absence of institutions, NGOs have moved in to fill the void -well-intentioned, for the most part, but also a crutch the Haitian government has come to rely on, at the expense of creating its own civil service networks that could oversee the needs of the whole populace. NGOs provide 75 per cent of health care in Haiti.

The problem has become even more dire today. The earthquake killed 16,000 civil servants, more than 20 per cent of the country's total public administration workforce. (A cynical Haitian joke grounded in truth notes that those who were killed were the good civil servants -the ones who actually showed up to work, or bothered to stay until 4:53 p.m., when the
earthquake struck).

Most of the ministry buildings, with their tax receipts and property titles and legal records, were destroyed in the quake. Most of the government ministers were killed.

Ten months after the earthquake, Philippe Mathieu, the country's former agriculture minister and now the Haiti director for the Quebec branch of international aid organization Oxfam, is still living in a tent beside his home. Repairs are needed to secure his house, but repairs are slow in coming, even for a former agriculture minister.

Asked how a lack of public service institutions has affected his country, he offers this example: In his district of upper Delmas in Port-au-Prince, there are now about 60 tent camps for the homeless. Some house as many as 600 people, yet many camps have not reported any cases of diarrhea for months. Camp residents have organized themselves to ensure water delivered
to the cisterns is treated regularly with chlorine, and tested to make sure it is free of bacteria and hasn't been over chlorinated.

"People realize this, that the water is better than before the earthquake," Mathieu said. He is part of a group trying to get clean water to the entire district. Except they can't because many of the pipes are broken, leaking water out and letting filth in, and the pumping capacity isn't strong enough to get the water up to the higher regions in hilly Port-au-Prince. The
organizing committee can't find the plans for the aqueduct system to tell them where the pipes are located -either because the records were destroyed in the quake, or because they never existed in the first place.

"Before the earthquake, water was purchased -people had to pay for it. . . . All countries get treated water. Why can we not do this in Haiti? You see the government has no global idea of how to manage the country.

"As a Haitian, this is what bothers me -there are no real plans. It's like all Haitians have the capacity to think, but they think only for themselves.

"We will never get the people out of the camps and back to their homes because they won't have water -the conditions will be worse than in the camps."

The hardships of the average Haitian's life are difficult to fathom for residents of comfortable nations like Canada. Three-quarters of the population lives on less than $2 a day, and more than half live in extreme poverty on less than $1 a day, Buss notes. Half the population of 9 million has no access to potable water, and 90 per cent don't have electricity. Half the population can't read, and less than one quarter of rural children go to school.

Two examples of the impact of the lack of public administration on the lives of Haitians: Eighty per cent of the schools are private so many Haitians can't afford to go, and they're of "dismal quality anyway," Buss writes. And only 24 per cent of pregnancies are attended by a trained health professional -most Haitian women give birth outside of a hospital or clinic,
without medical help, reports the International Monetary Fund.

According to the UN Development Program, Haiti ranks at 154th out of 177 countries on its Human Development Index, which measures life expectancy, education and standard of living. Every country below Haiti is in sub-Saharan Africa, and "Haiti ranks at the average of all sub-Saharan African countries," Buss notes. The nations of the Caribbean and Latin America, Haiti's geographical cousins, rank much higher.

How Haiti came to this miserable state of governance is the stuff of tragic history, foreign interventionism and chronic political instability. The only slave colony to win its independence from its colonial rulers through armed revolt, Haiti became an international pariah after becoming a free nation in 1804. It was forced to pay the equivalent of $22 billion in reparations to France for that country's "losses" in revenue from its slave-operated coffee
and sugar plantations, a debt that was only cleared in 1947 after more than a century of payments and hobbles the country's development to this day. It was the victim of numerous economic blockades by foreign powers trying to control its lucrative export trade, especially by the United States, which did not want Haiti's example inciting slave revolutions on its own

Meanwhile, the Haitian revolution gave rise to two distinct populations: a small urban elite and a Creole-speaking majority of subsistence farmers. "The mercantile elite and thus the state derived their income from taxing the export of the peasant surplus, via custom houses," says the CDA Collaborative Learning Projects, a Massachusetts-based non-profit research centre. "The structure of this economic division . . . gave shape to the extractive, predatory nature of the state that has lasted into the present."

The state itself was volatile, with its leaders more intent on preserving power and fighting with parliament than ensuring the well-being of its citizens, especially those living in rural regions. Of its 55 elected presidents since 1806, Buss writes, only nine completed their full term -the rest were overthrown, killed or died in office. Such instability does not
lend itself to the creation of a stable, well-functioning public administration.

What was created, as is the case in most developing nations, was a patrimonial state -"a state in which the power of the government and even the private sector is in the hands of an elite that uses the levers of economic and political power to retain control," said Natsios, the former administrator of USAID, the United States government's main agency for providing international assistance, and now a professor of foreign policy at Georgetown University in Washington. "I don't mean necessarily repressive control. Through patronage jobs, contracts, monopolistic control of the economy -they develop patronage networks."

Government ministries, Natsios said, don't necessarily do ministry work. "The government hires people who are part of networks, sort of like tribal chiefs, and they have followers and you basically give the followers paid jobs. They don't necessarily show up or have
qualifications, but they remain loyal to the regime.

"That is characteristic of a lot of poor countries, but Haiti is the most thoroughly patrimonial state in Latin America."

A World Bank study found that 30 per cent of civil service workers were phantom employees. One ministry had 10,000 employees, only about half of whom were ever at work.

"People think it's corruption," Natsios said. "It's not corruption ‹ people are using the system as a glue that holds the society together."

That being said, corruption is endemic -Transparency International ranked Haiti as among the fifth most corrupt countries in the world in 2004, 2005 and 2006.

Natsios refers to the recent book Violence and Social Orders, written by Nobel-prize winning economist Douglass North as well as John Wallis and Barry Weingast, in which the authors say it is the density of institutions that distinguishes rich from poor nations. Countries like America and Canada have groups that administer public service, keep public order, ensure the
rule of law and build a market economy. Organizations, the authors note, keep governments and societies in check by controlling conflicting interests of various groups in an impersonal manner, maintaining public accountability and transparency, and on the economic side "ensure open entry and competition in many markets, free movements of goods and individuals," and use the creation of institutions to promote opportunities, protect property
rights and control violence. Free markets spur the economy and aid political stability, the authors write, which in turn allows governments to provide services.

More traditional societies, like Haiti, have powerful elites that limit these types of institutions because they impede their power -instead, they create patronage networks through the government to restrict economy to their own class and hand out public service jobs to their own supporters to keep them loyal. In these societies, it is who you know that counts, whereas
in institutionalized societies, it is largely impartial bureaucracies that make decisions based on impersonal regulations, equal to all.

In Haiti, public service is not a popular profession, due mainly to low wages, especially compared with what could be earned in the private sector. There's a lack of skilled people to fill the jobs, anyway -80 per cent of Haiti's college graduates flee their homelands for the brighter future of elsewhere. Less than one per cent of Haiti's population is employed in the public sector, as compared with two per cent in Africa and more than seven per cent in many developed nations. The lack translates into gridlock in all areas, including economic -a World Bank study found that the average time to start a new business was 25 days in the most developed countries, 75 days in Latin America, and more than a year in Haiti. It was also relatively much more expensive.

"Without formal institutions capable of providing the enforcement mechanisms necessary to decrease risk and uncertainty, businesses will not pursue economic opportunities," Natsios said. "Thus any effort to build new institutions must incorporate private sector development; it cannot solely target the Haitian state in a vacuum."

Without a proper public sector, the IMF notes, Haiti is even unable to properly manage the money that is flowing in from donors.

How then, do you fix a broken public sector? One way is to ensure a good portion of the $11 billion in aid promised to Haiti is earmarked for civil service reform, creating jobs and helping to institute an incentive and accountability program that would reward and motivate its employees. Natsios urges incentives for Haiti's vast educated diaspora, numbering more than 2 million in the United States and Canada alone, to be allowed to return, if only temporarily, to help its country rebuild. He also called on the U.S. government to reinstate a university scholarship program that used to bring 18,000 students a year to American schools to be trained, with the proviso that they had to return to their homelands to work and rebuild.

There are signs of hope. In the decade before the earthquake, Haiti made efforts to improve its governance issues, saw a decrease in gang violence and lawlessness and experienced five straight years of economic growth. After the earthquake, Haiti's government presented its Action Plan for National Recovery and Development of Haiti, which focused heavily on
improving governance and decentralizing services, giving powers to smaller, provincial governments spread throughout the country, instead of concentrating them all in the capital, Port-au-Prince.

Haiti and the international community have set up the Interim Haiti Recovery Commission (IHRC) to oversee allocation and spending of all donations over $500,000 and deal with administrative issues like issuing permits to build hospitals and schools, as well as carry out economic development projects. Included among more than $1.7 billion in projects approved by the IHRC in August for new roads, housing and agriculture, was $25 million to go toward
a project to help the government provide services and increase transparency and reduce corruption.

In Montreal earlier this month for a conference to promote business ties between her countryand Quebec, Haitian Commerce and Industry Minister Josseline Colimon Fethiere said the government is aware of its shortcomings, and trying to address them. The government has created lists of its remaining employees, those who were not killed or fled the country, and
continues to employ and pay them as long as they show up to work. Training programs are planned, as are improved computer systems. And the time to start a new business in Haiti has been reduced to six weeks, she pledged.

"What we're doing is trying to rebuild the structure," she said. "We're making steps in the right direction."

Now all Haiti needs, in theory, is the political stability to maintain the progress. But the ability of the country to host fair presidential elections Nov. 28 is already being put in doubt. Haiti's electoral commission has excluded 15 candidates without giving a reason, and blocked the Lavalas Party, popular with rural voters, from running. In addition, the names of at
least 230,000 dead have to be purged from the voter roles and 1.3 million homeless need to be re-registered, Newsweek reported.

In Haiti, the tragedies of the past are ever present, waiting in the wings to hobble its future.

Wednesday, October 27, 2010

Mass Production of Mud Cookies. Really.

Maybe you've heard of mud cookies before. If you have, you probably try not to think about it. We have a couple sitting on top the piano in our living room. They are a reality check. They are a perspective check.

Here's the reality: people are so hungry in Haiti they will resort to eating mud cookies to fill their stomachs. In Cite Soleil, John came upon a place where, as you can see in the pictures above, they mass produce mud cookies. The woman who makes them say that the dirt comes from Hinche, a town of 50,000 in central Haiti. We haven't been able to discover why the dirt from Hinche is special. The woman making the cookies said that pregnant women eat the mud cookies.
It is really difficult to think about people eating mud cookies. Sometimes when we've shown people in the United States our mud cookies, we get blank faces in response, as if they can't or don't want to acknowledge the reality of what the mud cookie means. It does put one's own problems into perspective. To some, it may seem cruelly unnecessary to show people the mud cookies when it doesn't seem as if there is anything they can directly do about the conditions that cause people to eat mud cookies. But you never know when an experience like this will change a person's life. And at the least, as Dr. Albert Schweitzer says, the encounter may encourage people to "Think occasionally of the suffering of which you spare yourself the sight."

Tuesday, October 26, 2010

Cholera: A Terrible Disease

"We found Radha lying on a thin blanket in her hut. Her body was twisted into a knot of pain. Her hair was wet, saturated with sweat, as was the pink sari she wore. The smell in the hut was terrible. . . (her) mother was trying to keep her clean, but Radha's fever rendered her incoherent and incontinent. She vomited again violently as we watched, and that provoked a new dribble of diarrhea. . . what kills people who are contaminated with the cholera bacterium is dehydration . . The word cholera comes from the Greek word kholera, meaning diarrhea. The diarrhea of the cholera sickness has a singularly vile smell, and you never get used to it."

I shuddered when I read the above passage, just a few months ago, from the novel Shantaram by Gregory David Roberts. The novel is based on Roberts' experiences in India. I remarked to John how horrible cholera sounds and he confirmed that it is.
Cholera hasn't occurred much in Haiti. Back in 1990 when I went to the country for the first time, the health department recommended many vaccinations (typhoid fever, hepatitis) for travel to Haiti but not cholera, though the vaccination was suggested for travel to other parts of the world. (Note: if I read the literature properly, for the last several years, cholera vaccinations have not been recommended for travelers going anywhere).

Things have changed in the last few days and now Haiti is battling this terrible scourge. Cholera can kill in hours. The loss of fluids causes extreme dehydration, which leads to dangerous electrolyte imbalances.

The treatment for cholera is Oral Rehydration Therapy (ORT), a solution of sugar, salt, and other minerals dissolved in water that is administered to patients to keep them from getting dehydrated. In time, the bacteria works its way out of the patient's system.

We hope and pray that the cholera is contained and does not spread to the camps or other places in Port-au-Prince.

Monday, October 18, 2010

Valses to Voodoo

This past Friday we attended a piano concert at Bradley University's Dingledine Music Center. Pianist Joshua Russell played pieces composed by Haitian pianist and composer Ludovic Lamothe, pictured above.
The concert was a revelation. I didn't know that Haiti had a tradition of classical music. The music was energetic and full of surprises. Russell, who teaches at Bradley and who has taught music in Haiti and did his doctoral dissertation on Lamothe, described hearing a recording of Lamothe's playing as life changing. He said that even though the compositions were all written, Lamothe sounded as if he was inprovising, playing with a captivating freedom. Russell has recently released a CD of Lamothe's music called Valses to Voodoo.
In Lamothe's compositions, one can hear the influences of Haitian folk music, the rhythms of voodou drums, Latin American rhythms, and the music of Frederic Chopin. Lamothe was sometimes referred to as the black Chopin.
It's impossible to convey the magic of music in words, but if you want to learn more about Joshua Russell's interpretation of Lamothe's music, check out his website.

Wednesday, September 29, 2010

Big Problems; Little Solutions

The illnesses and injuries that John saw in patients on his most recent trip to Haiti were staggering. One woman's foot was literally rotting off her leg due to untreated diabetes. Because there was no anesthestist available, the woman had to wait a week for surgery. So instead of having her foot amputated, she had to have her leg amputated below the knee because the gangrene had spread.

The left side of one man's face was swollen to unbelievable proportions because of untreated tongue cancer that had spread to his jaw and neck. All John could do was give him pain medication.

One man had lockjaw from tetanus. His family would bring him liquid food that they were able to feed him.

A 30-year-old man fell out of a tree and broke his back. The staff was trying to figure out the best way to tell him that he would never walk again.

A married woman was trying to come to terms with the fact that both she and her husband tested positive for HIV.

Delayed treatment, lack of prevention, a hazardous envirnoment, lack of adequate medical care--these are some of the reasons that people are so ill. It can be overwhelming to learn about, so much so that we can throw up our hands and say, "It's beyond me."

But that attitude ensures that things will stay the same. I want to challenge everyone reading this to do one small thing to help Haiti. Think about what that could be.

Sunday, September 26, 2010

Haiti and Murphy's Law

This past Friday just after 3:30 pm, John received an e-mail from our friend Frandy in Haiti. It was short and in its entirety read:

A big wind is hitting Port-au-Prince this afternoon.I wished i could take pictures but i had to run in order to protect myself.Please pray for Haiti!

We didn't know exactly what to make of this e-mail. A big wind? There were no hurricanes heading toward Haiti. However, we found out just how big of a wind over the next couple of days. This from a contributor to Bob Corbett's list:

We've just gone through an hour of the worst Wind and rain storm I've
encountered in my 13 years here. It was worse than any hurricane I;ve gone
through. I kept thinking it was like a typhoon - it was so strong and very
frightening.I was sure all the trees would come down with the force. It was just awful. There's still thunder around but the rain and the wind have calmed down now.
I'm trying to find out something on the Radio. A friend rang me from Jacmel
and he said he had heard that there was a problem in Delmas so this is why
he called. He said people were saying the "earth had turned" - not an
earthquake, but "terre viré". He said people said that many people had died,
but I don't know if this is true.What I can say is, I don't know how the tent people have survived this, if indeed it is throughout PauP and not just in Delmas.

We're still finding out how many "tent people" died, but according to one report, the freakish storm destroyed or damaged at least 8,000 tents.

Let's do more than just pray for Haiti.

Saturday, September 11, 2010

See No Evil

When we are in Haiti, we take a lot of pictures and use them in our blogs. Some of the pictures are of people who are suffering terribly due to illness or injury. We sometimes send these pictures to people in efforts to find medical care in the U.S. for people who are beyond the help of Haiti's meager system. Such is the case with the man pictured above who likely has cancer of the tongue and has received no treatment for it. All John can do for him is medicate his pain. Sometimes we send pictures to show people the kinds of problems that people in Haiti have. We also give presentations at home and we use the pictures to illustrate the difficulties of life in Haiti. Sometimes, as with the picture above, these pictures are hard to look at.

At least on the surface, people's responses to disturbing pictures fall into one of a few categories: shock and sadness; apathy (what can I do about these problems that have been around as long as human beings themselves); anger (either at the situation or at us for showing them the pictures); or a non-response (perhaps this is a form of overwhelm).

With our 24 hour media beaming images of the latest disaster into our living rooms round the clock it's not surprising that people can become jaded. We're all busy with important things and having our attention grabbed however momentarily by a picture like the one above isn't a pleasant experience. For myself, though, and despite the much greater exposure we have to the world's suffering than we did even 25 years ago, I find seeing pictures like this a necessary experience. For despite my access to information, it's too easy for me to forget.

As I was pondering the above issues earlier in the week, I came across a bumper sticker with the following wisdom:

Think occasionally of the suffering of which you spare yourself the sight.-Albert Schweitzer

So at least for today, we are not spared.

Monday, August 23, 2010

A Grateful Family

Poor people with heart problems in Haiti are in a lot of trouble. Most of the time, they die deaths that could be avoided with surgery that we in the United States take as our birthright if we need it. Once in awhile, though, a miracle occurs, and a patient is accepted for medical care in the United States or another country. I call it a miracle, and given the rarity of the situation, it is. But it takes a lot of hard work on the part of my husband John. Through his efforts, a man with a serious heart problem was accepted for medical care in Florida. As you can read from his nephew's letter below, Haitian people have a great capacity for gratitude and a beautiful manner of expressing it, even in another language.

Dear doctor,

May God Bless you and your family for longer! doctor me and all my family we're very happy that God sent you on our way just to help us with this great problem.Beleive me we haven't enough words to show you franckly our joys for that.In more ,say to you only "Thank you"it's too light.Cause you merit more.So,as we know God has eyes open on everything we do good or bad.Of there,we hope deeper of our heart he will reward you not only for today.But for all the rest of your life.And why not of generation in generation.

In fact doctor,as i said to you we had an appointment yesterday to the american consulate.thanks to the lord they gave to my uncle the visas for a short time,three months.then we are grateful toward jesus for that.Cause he's done the main thing for us.And then ,after all things you did also,i see it's not good to keep on calling you:dear doctor, dear doctor... it could be better to consider you as a member in our family.cause the job that you've just done for our family seems like the job of a cousin,a brother a father and so on.For all things, i decide to pray for you and write you every time i get chance to do it just to get informed about you.Of all my heart you're a good one. . .

Don't forget to let the other doctor to know how much we were so happy when he did accept to write the American consulate a kind of letter to help my uncle found the visas.We need to think your wife also doctor.Cause,we saw her determination to help us to succeed too.Please say "hi" to her for us.

Doctor,as a good one. stay like that,don't be changed.Cause God has a plan for you too.Beleive in that,there will be a day you will feel it.Yeah! you deserve that!!!!!!



Friday, July 02, 2010

Some Thoughts from the Ground in Haiti

Here is an excellent guest post from my husband John. It describes what we saw in Haiti on our recent trip and some thoughts about it.

My wife Maria and I worked in Haiti during part of the months of May and June. We stayed in a guesthouse-orphanage just outside of Port-au-Prince.

A lady named Yolande lived right across the street from us.

Yolande is 78 years old and lives under a blue tarpaulin which encloses a small pup tent inside.

During the earthquake on January 12 her shack, which was located several miles away, was so damaged that she had to move out. Yolande suffered some leg injuries at the time of the quake and still has one lower leg wrapped in a rag. But Yolande smiled and told me that her legs were "much better".

One afternoon shortly after we arrived, I entered an opening in Yolande's blue tarp. The stifling heat, humidity, mosquitoes, and flies were overwhelming.

The tarp was fastened to thin wooden poles and tied above with shoe laces and other fragments of cloth.

Yolande's family brings her rice and vegetables when they can and she cooks in a metal bowl over pieces of charcoal.

I found Yolande to be a practical and pleasant woman. She did not complain about her living arrangements and even said that Americans are the most charitable people in the world. I sure did not feel that way right then as I hurried out from under the tarp so I could get a breath of cooler air in the street.

During this time of the year in Haiti, the rain comes in torrents in the late afternoon or evening, and now this rain seeps through Yolande's tarp and leaks into her tent. So on top of roasting, Yolande and her family are wet much of the time too.

These hardships are not isolated to Yolande.

Haiti has an estimated 9 million people with one third of the population living in the capital, Port-au-Prince. In this city there are over one thousand tent cities, and an estimated 1.5 million people are still homeless five months after the quake. Many people told me that they are simply too afraid to move back inside of their houses. If their houses are still standing, the walls may have been fissure (cracked) and people fear they will collapse on top of them.

Several miles from us downtown Port-au-Prince looks like a nuclear bomb struck it. The once beautiful Haitian National Palace is collapsed and the majority of nearby Haitian government ministry buildings downtown were destroyed in the 47 second earthquake. Haiti's tax building is pancaked just across from the Palace with its director's body and many employees still inside under tons of concrete.

A densely populated tent city now sits in front of the vacant Palace in Port-au-Prince's largest square called Champs de Mars. A young man who identified himself as Carlos told me some of their problems after I walked through his section of the tent city. Carlos seemed fatalistic and did not see any end in sight to their misery.

Rape is common in Port-au-Prince's tent cities and seldom gets reported. Poor women in tent cities have no rights.

Fountains and small decorative pools in Champs de Mar have turned into large toilets filled with stagnant sewage. Kids play nearby with their family's tent abutting these toxic cesspools. Sewage drainage and treatment facilities are more or less nonexistent.

In the chaotic months following the quake, millions of dollars flowed into Haiti from generous people all over the world. (One out of two American households gave to the Haitian relief efforts.)

And five billion more dollars from the international community has been pledged to Haiti over the next two years. Bill Clinton who is UN Special Envoy to Haiti. Recently Mr. Clinton along with Haitian officials have been in charge of the Interim Haiti Reconstruction Commission. One of the objectives of this Commission is to allocate these funds to ensure that the money is used in a transparent fashion for Haiti's post earthquake reconstruction.

Mr. Clinton and Haiti's Prime Minister Belleriviere announced the Commission's first approved spending projects:

- $45 million from Brazil and Norway in direct funds for the Haitian government, closing a quarter of its estimated $170 million budget shortfall.

- $1 million from the Clinton Foundation for buildings that can be used as storm shelters in the quake-ravaged towns of Leogane and Jacmel, which are often in the path of Atlantic hurricanes.

- A $20 million fund to provide loans to small- and medium-sized Haitian businesses.

But despite international pledges of some $5 billion over two years at the United Nations donors' conference for Haiti in March, only a fraction has actually been delivered - just $40 million from Brazil.

Even though other pledges are supposed to be delivered soon, I spoke to no Haitians during our entire time in Haiti who trusts that the money will be spent properly. People that I spoke with don't really trust Mr. Clinton any more than they do their own fragmented and dysfunctional government. Many are very angry with Haitian President Preval for his perceived lack of leadership and poor communication through Haiti's largest crisis in its history. They also feel he is cuddling up to international powers for business interests that will exclude the majority of poor Haitians.

And why should 9 million poor Haitians trust any one? They and their ancestors have been on the short end of the stick since Haiti was founded as a Republic more than 200 years ago. The corrupt Haitian state is considered to be a fact of life... not unlike corrupt Illinois politics.

So what do "we" do with hundreds of thousands of displaced and homeless Haitian people? Although Haitians are a tough lot, they are not as resilient as our defense mechanisms would like us to believe. And on top of this earthquake which was "biblical" in size, the U.S. National Oceanic and Atmospheric Administration has predicted a terrible tropical storm season coming Haiti's way in several months.

But so far (as of this writing) the Haitian government has relocated only about 7,000 vulnerable people to two safer camps. The relocation is slow because the crippled government doesn't have enough money to complete a job that includes not just setting up new tents, but providing work, schools and services.

First of all, should the tent cities continue to exist? Are they good enough?

No. These places are inhuman and horrible. Lack of food and water, lack of security, and the rain are a few reasons.

And the rain is quickly bringing more problems.

Malaria and typhoid fever were everyday occurrences in the area of the city where I was working. Stagnant dirty puddles of water are everywhere and are good breeding grounds for mosquitoes who will carry disease. I saw a teen-aged boy scooping up water in his hands drinking from a puddle in the road. Medical and public health interventions will not help the majority of Haitians unless their dangerous living environment is changed.

Also, heavy rains tempt unstable hillsides to unleash their mud. And serious flooding and mudslides could endanger not only Haitians but relief workers also.

Port-au-Prince, before the earthquake could have accommodated 300,000 people, not three million people. There has been decades of urban decay. This city is doomed right now unless a paradigm shift in thinking takes place.

We need to be honest and understand that many people are dying now and are still going to die no matter what is done. I saw children starving in front of me. I often wondered what good was my stethoscope in times like this.

So what needs to happen? What interventions will minimize the final death count? How can Haiti's problems be prioritized and triaged appropriately? What can be done to give some dignity to the life of over one million displaced Haitians? How do we stop the violence aimed at Haitian society's unfortunate losers?

Haitians tell me they want jobs. Who would have thought?

Jobs earn them money to repair their lives and their family's lives. Jobs allow one parent to stay at home during the day and take care of their babies and toddlers. Kids suffer alot mentally and physically when they are alone or being watched by a neighbor who is already swamped with problems. Children are literally down in the dirt and sewage and their chances for survival diminish without a parent home.

Mother's can breastfeed if they are home. And when mother's breastfeed, they save money because they do not need to purchase milk. And if they purchase powdered milk, they may accidentally prepare it with dirty water which can sicken their children.

With the billions of dollars that hopefully will come to Haiti, big firms with heavy equipment should be hired. Skillful urban planners from all over the world need to work with the Haitian government.

And most importantly poor Haitians need to be hired.

Hundreds of thousands of young, strong Haitian men and women that live in the capital would jump at the chance for a job. Hire them and pay them fairly so they can feed their families while they make a new and better Haiti. The billions of dollars of international pledges need to go for displaced Haitians while they perform the back breaking reconstruction of Haiti.

Pay Haitians in tent cities to repair or rebuild their own homes--the structures where they were living pre earthquake. Or pay the man that rents the home to these people. And these homes need to be earthquake proof homes using Western building codes. Earthquakes don't kill people, bad buildings do.

The huge mounds of rubble on the Port-au-Prince streets needs to be cleared so the streets can be navigated by cars and big equipment. The traffic jams in the capital now slow progress for everyone.

Many people have returned to their neighborhoods after inspections found their homes safe, but often return to the tent camps when word of aid distribution spreads. So food and water distribution needs to be local--- brought to people in their neighborhoods as their homes are rebuilt.

Port-au-Prince needs to be decentralized. The earthquake negatively influenced 80% of Haiti's economy because PAP was and is the hub of the country. Now the hub is critically ill. The capital is built over fault lines and this all could happen again. Three million miserable people living on top of each other need to be spread back out to Haiti's provinces.

But for people to move to the Haitian countryside or smaller cities outside of PAP, there has to be jobs, family members with adequate housing that can accept their homeless relatives, and some basic services like schools, roads, water, electricity, and medical care.

Trees need to be planted and gardens started in these communities. Listening to Haitian grass roots organizations and the Haitian farmer is very important. These people know what they need to stay alive.

The local Haitian community in the province needs to be involved in all decision points.

For­eign aid that flowed into Haiti after the quake has hurt the Haitian farmers. Most of the peo­ple in Haiti's central plateau (L'Artibonite) earn their liv­ing by grow­ing and sell­ing rice, Haiti’s sta­ple food. But the influx of for­eign food aid has meant that many Haitians can now get rice for free. As a result, the price of rice grown in Haiti has plummeted and the Haitian farmer finds himself in more trouble.

Several months ago even Mr. Clinton was quoted as saying, "...we made a devil's bargain" when he was President. He publicly apologized for forcing Haiti to drop tariffs on imported, subsidized US rice. His policy hurt Haitian rice farming and, as reported by Kim Ives, "seriously damaged Haiti's ability to be self sufficient".

And let us not forget that Haiti, believe it or not, is in the digital age. The Haitian people in the countryside have cell phones and access to the Internet. Many Haitians are adept at using both. This means that they still communicate with Haitian relatives, the diaspora, overseas.

Haiti's diaspora has sent back billions of dollars over the past few decades to needy Haitian relatives, but this obviously has not been enough. The diaspora need to physically come back to Haiti and revitalize Haiti's industrial sector. But they won't come back and invest in Haiti unless than can do so safely. Most diaspora tell me they fear for their personal safety in Haiti. Security everywhere needs to be improved. And the economic climate for joint business ventures, to stimulate Haiti's diaspora to invest in Haiti, has to be improved by the Haitian government.

In conclusion, Haiti was a severely damaged country before the January earthquake and is even more damaged now.

Haitians are a beautiful and wonderful people, but they are not as "resilient" as we would like to believe.

Yolande, the little old tent lady who lived near us, should not be living like this. If Yolande were your grandmother, you wouldn't refer to her as "resilient" as she suffers the Haitian heat and mosquitoes, would you?

The huge international monetary pledges need to be allocated in a transparent fashion to help these neediest Haitians.

Wednesday, June 23, 2010

Driving in Haiti--or even being driven--is nothing if not a adventure. The poor condition of the roads and the vehicles--and poor is a nice word to describe them--makes the strap hanging down from the car ceiling by the window, not just for decorative purposes. The holes and rocks in the road, the lack of driving patterns and lanes, the road-clogging number of cars trying to get someplace in a hurry all combine to make driving challenging at the least and dangerous at the worst.

Drivers in Haiti have to have the reflexes and judgment of expert video game players as negotiating the roads of Haiti, particularly Port-au-Prince, is like being in a real-life video game. More trucks than not have cracked wind shields. They belch black smoke, their interiors are stripped of all but the necessities (and seatbelts aren't considered necessities), and often there are empty beer cans rolling around on the floor.

We were fortunate on our most recent trip to have a fine driver, Jean Claude. He drives for the sisters who run the clinic in Cite Soleil. Besides being a good driver, Jean Claude, like most Haitian drivers, has to know how to keep his truck running. I can't even guess how many miles it has on it, and one Haitian mile has to be about the equivalent of 100 U.S. miles. Jean Claude faithfully and cheerfully got us where we needed to go, and we are grateful to him.
Jean Claude is pictured above with his truck, outside our guest house.

Monday, June 21, 2010

Earthquake Stories

It's been remarkable to hear people's stories about where they were when the earthquake hit. Our friend L was driving home from work. As his vehicle bounced over the rutted roads, he thought, "I need to slow down." He braked but his car continued to rock back and forth. He wondered if he had a flat tire until he looked up and saw the telephone wires swaying wildly. Earthquake. When it was finished, in less than a minute, he continued his drive to his home, part way up the mountain, having no idea of the devastation.

L's wife, who teaches at a school, was home and worried about him. Their cell phones and television were out, and they didn't find out about the extent of the damage until much later. Even until today, there is no cable television in Haiti. It apparently ended with the earthquake.

L was lucky in that his factory wasn't damaged much. Donations from his business associates abroad flooded in, and he and his co-owner divided up the money between his 500 plus employees. One of his employees, Nadia, is the sister of Jackson Jean-Baptiste, a Haitian Hearts patient who died in 2006. L often gives her a ride to and from work.

When we went to supper with L and his wife, he told us about how for fun he had an American Idol-type talent competition among the workers in his factory. He was impressed with some of the singing and dancing talent and would like to have them perform at restaurants, like the one we were at.

L's wife, N, worked at the Union School, a private, American-style, college prep, English language school with grades pre-K through 12. Fortunately, the quake occurred after regular school hours and those who were still on the premises managed to get out safely. Before the earthquake, the school had an enrollment of 300 plus; months after the earthquake when the school started up again, there were only 35 students, as many left for the United States or other countries.

L & N opened their home to medical teams from the United States. For them, life has now largely returned to normal.

Wednesday, June 16, 2010

Through A Mirror Dimly

We talk to all kinds of different people when we're in Haiti, and we hear different opinions of what the problems and solutions are. One of the last nights we were in Port-au-Prince, we went out to eat with an American couple who have been in Haiti for more than 30 years and raised two children there. The man, L, owns a manufacturing business, and the woman, N, is a teacher.

We had dinner in a restaurant. Our friends had to fight a lot of Saturday night traffic on Delmas to pick us up, so we didn’t sit down to eat until about 8 pm. We asked the couple what they thought the solution was to the tent cities. We agreed that it is a difficult problem to solve. L has met with one of the camp leaders to offer employment to some of the people living in camps who qualify.

We heard from another man who runs a business and offered to help one of his employees who lives in a tent get back into a house that his employee didn't want to leave the tent because he didn't have to pay rent and he and his family received free food and medical care. Going along with this, L said that a man who sells water reported that his sales are up, despite free water being available. They decided that some people have more money to spend because, again, they aren't having to pay rent. As we think about this, we have to take into account how terribly inferior housing conditions were for the Haitians before the earthquake for them to view living in tents as not that big of a step down.

This reminds me of a statement that John made earlier in the trip. We were walking along the partially destroyed street of Delmas 31 when we heard, "Clank! Clank! Clank!" the sound of metal on metal. It was a man, whom we've dubbed the "clanking man." Prior to the earthquake, he lived in a tent below a bridge and fashioned items out of scrap metal. After the earthquake, same thing. Back then, we went into his tent and it was hot and mosquito-ridden. As we walked by him this time, John said, "You know who was affected least by the earthquake? Clanking man." His life was so awful already ("We are living in misery," he told us before) that it could hardly get worse.

But it has. A good day in Haiti, particularly Port-au-Prince, before the earthquake, was like a natural disaster. It is imperative that we understand how bad things are now that they have had a most devastating one. Hundreds of thousands of people are living in tents, which won't last long and will be inadequate when hard rains come. Poor sanitation and people living on top of each other create conditions that can breed epidemics.

I can't imagine what the environment inside the tent is like at night. We spent our last night in Port-au-Prince in a guest house. The heat and humidity were stifling, suffocating. During the night, I didn't think I was going to be able to take it, I was so uncomfortable. And then I thought about all the people sleeping, or trying to, zipped up in the tents, and I was ashamed of myself.

Sunday, June 13, 2010

A Haitian Bus Ride

The day before yesterday, we travelled by bus from Les Cayes back to Port-au-Prince. We decided to take the bus instead of fly back because it is cheaper and we would be able to see some beautiful coastline scenery.

Departure times in Haiti are a moving target. First, our bus was going to leave at 4 am, then at 3 am and finally at 2:30 am. As John says, if you can't take a joke, don't blame Haiti. A group of hardworking gentlemen from Grand Rapids, Michigan had to get to the PAP airport to catch their flight, and they chartered the bus to take them. These men had been doing construction projects at the hospital near our guest house in Cite Lumiere. There was room for us on the bus, though, and we decided to go with them, rather than try to catch a bus later in the day when the traffic would be worse. We wouldn't be able to see the scenery but we would arrive in PAP early in the day. Plus we heard the driver of the 2:30 bus was good, nothing to be taken lightly in the challenging driving conditions of Haiti.

The bus was able to go fast on the smooth road, lightly trafficked road (at this hour) leading out of Les Cayes. As we left the coast line and crossed the southern peninsula, the sun was rising and we began driving through some towns as we approached PAP. Even at 5:30 am on a Sat. morning, the streets and towns were filled with people and vehicles. Haiti is on the same time as the midwest, giving them early morning light.

As the traffic picked up, our bus began passing other vehicles. We had one scary moment in the passing lane when we were barrelling toward a truck and it didn't seem as if we had time to get over. "Yikes!" I said right before our bus driver pulled back into the right lane ahead of the truck we were passing, avoiding an accident by the hair of his chinney-chin-chin. "I can't believe there aren't bodies all over the road," muttered the man next to me.

We drove through what was left of Leogane, the epicenter of the earthquake. Lots of tent cities. Carrefour, a sprawling suburb of Port-au-Prince was in bad shape. Carrefour is an oceanside town that then goes up the mountains. In between the ocean and the mountain is a flat, fairly narrow piece of land. It seemed as if all of the rubble from the earthquake had been swept into this flat area and was competing for space with all of the people, markets, and structures that didn't collapse. It is a jumbled mess.

We arrived at the airport and got a ride to Gertrude's guest house, where he headed out on another adventure. More in the next post.

Saturday, June 12, 2010

Digging Up Haitian History

Since John's last trip to Les Cayes, he had been wanting me to meet a German man, Johannes, who lives in the area and knows a lot about Haitian history. As you will see, in fact, he and his wife Luise are living on top of it.

We met them at their home just up the hill from our guest house. Johannes and Luise have been living in Haiti since 1975. Since then, Johannes has learned a lot about Haitian history. He explained to us the difference between the two native groups who populated Haiti before Christopher Columbus arrived. The Tainos, the majority group, were originally from Brazil and were peaceful. The more aggressive Arawks, who came from the northern islands of South America, like Guyana, would send attacking parties to fight the Tainos, and, according to Johannes, also practiced cannibalism.

Johannes then brought out some of the pottery and other artifacts that he has found on his property.

The dirt holds layers of history: the lower you go, the more ancient the history. He has also found bottles and other things that the French brought over. Johannes held out a part of a bone and said, "Here's just a little piece of someone's body that tells how they died." It was a vertebrae with part of a iron rod through it.

The Haitian Revolution, which started in the 1790s was a bloody war. "It was based on dishonesty," said Johannes. The French told the slaves that if they helped them defeat the Spanish, who were attacking from the east side of the island and the English, who were attacking from the sea, that the French would give the slaves their freedom. Napoleon reneged on the deal, though, and things got ugly. With its massive production of coffee, sugar, and other products, he thought Haiti, the richest French colony and one of the richest colonies in the world, was too valuable of a colony to lose. When the Haitian slaves defeated Napoleon's troups, the first and only black republic started by freed slaves was born.
The picture at the top of this post is a view from Johannes' backyard. After breakfast, we went outside and Johannes showed us a wall of dirt where he began picking out little pieces of property. It's amazing what history we are living on top of!

Friday, June 11, 2010

Of Amputees and Assumptions

For most of our week at the guest house near Les Cayes, a couple of guys from the United States have also been residents. One of them Peter, a recent high school graduate, was born in Haiti, but grew up in Florida. He was assisting Derek, a doctor and the other resident, with translating in a clinic where they were working. Peter's father is from this area, as his some of his family.

One evening, I was sitting at the desk in our room typing, I heard the front door slam. When I got up to look in the living room I saw it was Peter along with a man who didn't have any arms. "Wow, that guy really suffered in the earthquake," I thought as I ran through a list of everything he wouldn't be able to do: feed himself, get dressed, write, or even give someone a hug

Later in the evening, I asked Peter if the man he was with was one of his patients. Peter looked puzzled, so I continued. "The man who didn't have any arms."

"Oh," said Peter. "That was my dad."

Wow, talk about false assumptions.

We found out that Peter's dad lost his arms in a sugar cane auger when he was 13. One arm got trapped and he instinctively went for it with his other arm and it was trapped. He lost both of his arms right below his shoulders.

This was a reminder to me that Haiti was a dangerous place with numerous people who lost limbs BEFORE the earthquake. Now this awful natural disaster may have created 100,000 or more amputees.
Because the need for prosthetic limbs has always been great in Haiti, the hospital in Cite Lumieure, down the road from where we are staying, has a prosthetic unit that is pictured at the top of the page. It has been extra busy lately as teams from the United States and other countries fly to Haiti to make and fit prosthetics for people who need them.
This week we saw a young woman, whose leg was amputated well above the knee, receive her prosthetic limb. One of the woman on the team explained that it is much more difficult to learn to use an artificial limb when the loss of limb occurred above the knee. We watched this young woman walk gingerly back and forth across the room, getting used to the way the prosthetic bent.

Making prosthetics isn't a quick process; it involves making casts of legs. A kiln, pictured below, is used. The team made eight prosthetics this past week. They will also see the patients for adjustments as they get used to their new legs.
Hopefully, like Peter's dad, who has gone on to earn two degrees and raise a wonderful family, these people who have had such loss, can go on to lead productive lives.

Wednesday, June 09, 2010

Haitian Resilience?

I subscribe to the Bob Corbett list serve about Haiti. Recently on the Corbett site was a link to an interview of Michele Montas, a Haitian journalist and former spokesperson for UN Secretary General Kofi Ban Ki-moon by journalist Alice Speri. Here is an excerpt:

You talked about Haitian resilience. What does that mean really? What are some examples? Can that still happen?

It is happening. It has been happening since the quake. The day after the quake, when you had kids from the slums going into the university and getting students out of the rubble. There was no international assistance there, it was Haitians helping Haitians. It was people with their bare hands getting other people out of danger. The way people have bounced back… The way we have had for instance, life coming back to the streets, street sellers being back selling vegetables, selling rice, different things… The informal sector bounced back in an incredible way. Resilience is the Haitian’s way of accepting conditions. In any country of the world you would have what you had in Chile, you would have people looting, people just reacting violently. Haitians were incredibly disciplined after what happened. And I think it is something which is linked to Haitian experience, within the last two centuries. It’s something which is linked to a long history of resistance first and way after that facing incredible conditions of life.
I think this is true. In our work in Haiti and in spending time with our Haitian Hearts patients, who are so sick and then usually come through major surgery in good fashion, we have seen this resilience. We also see it in our seven-year-old son. John often reminds us that it was Luke's ancestors who more than 200 years ago defeated Napoleon's troops. Haitians are tough and resilient.

Then, also recently, the following anonymous comment was posted on the Corbett list.

I have never posted due to the fact I live and work here as a private individual and have done for many years. I employ people and would not want to jeopardise mine or my friends' livelihoods by offending the wrong people with my subversive thoughts about reality, dignity and decency.

Anyway, my point -

The thing that troubles me is that I keep reading how resilient Haitians are.

Well the truth is that they are just like anybody else - they are upset and badly shaken by events like anybody would be. It is almost as if one has to worry less about Haitians in peril because
they can handle more stress than your average human being. Almost an excuse not to afford them the concern that one would an American, Frenchman, Paraguayan or whatever.

This is wrong.

I also agree with this comment. There is something self-serving, especially now, about focusing on the resilience of Haitians. If we think they are so tough, perhaps it gives us a pass on doing our part to help them. You know, "Oh, they're Haitians. They're tough. They'll be alright. Yes, I know they are missing limbs and family members, but they are used to things like this and it doesn't bother them as much as if it happened to, well, me." In some ways emphasizing Haitian resilience is dehumanizing.

If we want to speak of the Haitians' resilience, let's speak of admiring it, of it inspiring us to act, to show our own toughness in responding to a catastrophe of huge magnitude.

I'm sure the little girl pictured above is resilient. She is one of the children living at Gertrude's orphanage.

You Can Always Pray

Yesterday, John taught a clinical lesson at the Missionaries of Charity compound to the nurse practitioner students. One hundred or so children live here some temporarily and some permanently. One of the sisters was holding a three-year-old who was understandable sad: she came to the sisters after the earthquake and no one knows anything about her family. She must feel so incomplete and empty, as if an important part of her is missing.

I described the Missionaries of Charity to a couple of people in Haiti as the Marines of Catholic nuns: they can only go home once every ten years; they are never seen eating or drinking; and they wear these habits that I hardly see how they keep from passing out in. It is hot and humid in Haiti now; it seems like 30 seconds after you take a shower, you need another one and this is without wearing a couple of layers of head to toe clothing. Despite these hardships (or perhaps because of them?) the sisters are productive and do very difficult work caring for the poorest of the poor.
On our way home, our hostess Beth Newton asked me what I thought of the Sisters' place. I said that I had been to their building in Port-au-Prince, but, still, it was a shock to see so many children without parents. On the wall of the building, sayings from Mother Teresa, the founder of the order, are painted in Haitian Kreyol including, "Every child is precious and a gift from God." I wish the world's priorities reflected this truth. As we go about our busy days, it's never a waste to offer up a prayer for the abandoned children of the world.

Two Haitis

"There are two Haitis: Port-au-Prince and everything else," is a statement we hear a lot. Flying into Les Cayes, one of the passengers on the plane said, "I tell everyone that Port-au-Prince is not the real Haiti." As someone who has spent most of her time in Haiti in the capital, I had to agree that at least from the air, the Les Cayes area looked much different than Port-au-Prince. It was shockingly green, for one. And then on the ground, there aren't as many people around. Many of the roads in Les Cayes are much better than those in PAP.
The above photograph is from the balcony of the home of our friends, Tim and Joan Reinhold. They are Christian missionaries who live 10 months of the year in Haiti. They, with a lot of Haitian help, built their beautiful home by hand, which is how so many things are done in Haiti. Tim and Joan help put roofs on school and churches throughout the southern peninsula of Haiti. Teams from different Apostolic Christian churches in the United States come and aid them in their mission. Their accomplishments are very impressive.
After the earthquake, many of the Port-au-Princians headed to the provinces where they had family or friends they could stay with. But after a few months, it was time to return home, which in many cases was now a tent. The lives of the people in the provinces aren't exactly easy on a regular day and they couldn't continue to support their extended families any longer.
We have heard Gertrude's suggestion several times by our American friends in Les Cayes: that hopefully Haiti will become more decentralized after the earthquake with Port-au-Prince not having such a stranglehold on all the government functions. If there was more infrastructure and commerce in the rest of the country, people could find employment outside Port-au-Prince and the terrible crowding in the city would decrease. And then, maybe, we would speak of one Haiti instead of two.

Tuesday, June 08, 2010

A Teaching Stint in Les Cayes

One of the reasons that we are in Haiti now is because John was asked to teach at a school for nurse practitioners. This is his second stint teaching at the school in Les Cayes. Yesterday, he lectured on pediatric appendicitis and shock. Today, we will go to a clinic run by the Missionaries of Charity, and John will give the students a clinical lesson with the pediatric patients.

The students are very motivated. They work full time and then come to class in the late afternoon. Yesterday, they had taken a pharmacology exam prior to John's class. They paid close attention during John's lecture and took lots of notes. It helps that John can teach in Haitian Creole.

The nursing classes are held at a business/technology school downtown, next to the new Coast Guard building that is being constructed. Here is the view from campus:

Yes, that is a cow grazing by the ocean. A new pier is also being constructed and many of our American friends hope that container ships will be able to dock and unload at Les Cayes. Many people have told us that they hope one of the responses to the earthquake is that governmental control and functions are decentralized from Port-au-Prince, making functioning throughout the rest of the country more effective and efficient. We will see.

Monday, June 07, 2010

Tent City, Haiti

Almost six months out from the earthquake, the most noticeable change to my eye is the tents: they are everywhere, some places in huge camps, sometimes in small groups, and occasionally there will be a lone canvas pitched off by itself. The tents are in industrial areas, on private property, on government property. They are often found where houses were once located. There are even tents in the medians of roads.

This is not to say that other effects of the earthquake aren't obvious. Rubble is strewn everywhere, more than usual. Half completed buildings hang in ruins. Certain parts of the city were damaged more than others: the Delmas section of Port-au-Prince appears to have been particularly hard hit, A portion of the road Delmas 31 was destroyed and we had to hike down through a steep gully and cross a dirty stream to make our way down the street. The inpatient unit at Grace Children's Hospital on Delmas 31, a special place to us, is not functioning and tents serve as the outpatient clinics.
One of our Haitian Hearts patients, Jenny G., pictured below, is standing next to the car she slept in the first two months after the earthquake and the tent that served as her bedroom after this.

So it is the tents that may be the most ubiquitous symbol of the earthquake.