by Paul Farmer
29 Kathie Klarreich. “Haiti’s Working Better.” Miami Herald: December 8, 2009. Available: http://www.haitiinnovation.org/en/2009/12/09/haitis-workingbetter-piti-piti (accessed April 15, 2011).
30 See, for example, J. Frenk et al. “Comprehensive Reform to Improve Health System Performance in Mexico.” Lancet 368 (October 2006): 1524–1534; J. Frenk “Bridging the Divide: Global Lessons from Evidence-Based Health Policy in Mexico.” Lancet 368 (2006): 954–961.
31 Bolduc survived the August 19, 2003, truck bombing of the UN headquarters in Baghdad. The explosion killed seventeen UN staff, including Sergio Vieira de Mello, the chief envoy to Iraq, and injured more than one hundred others. “Truck Bomb Kills Chief U.N. Envoy to Iraq.” CNN (August 20, 2003). Available: http://edition.cnn.com/2003/WORLD/meast/08/19/sprj.irq.main/index.html. See also Samantha Power’s stirring book on this topic, Chasing the Flame: Sergio Vieira de Mello and the Fight to Save the World (New York: Penguin, 2008), which explores the perils, moral and logistic, of such missions.
Chapter 3
1 David Halberstam. The Best and the Brightest (New York: Ballantine Books, 1992).
2 The church-run Collège La Promesse in Pétionville collapsed on November 7, 2008, killing ninety-two students and teachers and injuring one hundred fifty or more. Like most buildings in Port-au-Prince, the school had been self-built by the property owner without the help of engineers or any sort of building code. See “Death Toll Rises to 92 in School Collapse in Haiti.” New York Times (November 8, 2008). Available: http://www.nytimes.com/2008/11/09/world/americas/09haiti.html (accessed April 15, 2011).
3 Pierre-Louis was voted out of office by the Senate by simple majority, after serving for little more than a year. In public fora, her opponents complained that her response to the 2008 hurricane season had been slow and inept. But others suspected that her ousting had more to do with the threat she may have posed to her superior, although Pierre-Louis had never expressed any intention of running for president. For example, Mario Joseph, a human rights lawyer, suggested that “Préval was threatened by the growing power and connections of Pierre-Louis, particularly after the visits of Bill Clinton. She was becoming the darling of the donors, who called her capable, and I think he felt she was getting too big for her britches.” See Joseph Guyler Delva. “Haiti President Designates Economist to Be Premier.” Reuters (October 29, 2009). Available: http://in.reuters.com/article/2009/10/30/haiti-primeminister-idINN3039324720091030; Joseph quoted in Kim Ives. “Haitian Prime Minister Ousted by Senate.” Pacific Free Press (November 5, 2009). Available: http://www.pacificfreepress.com/news/1/4999-haitian-prime-minister-ousted-by-senate.html (accessed April 15, 2011).
4 “Former President Clinton on Haiti.” Real Clear Politics: January 13, 2010. Available: http://www.realclearpolitics.com/articles/2010/01/13/interview_with_fmr_president_clinton_on_haiti_99900.html (accessed April 15, 2011).
5 Ibid.
6 Louise Ivers. “A Doctor’s Story.” Irish Times: January 18, 2010. http://www.irishtimes.com/newspaper/world/2010/0118/1224262564631.html (accessed April 15, 2011).
7 The interview was broadcast on CBS’s 60 Minutes on January 17, 2010. Available: http://www.cbsnews.com/video/watch/?id=6108550n&tag=api (accessed April 15, 2011).
8 For an extended discussion of the challenges of coordinating humanitarian aid efforts in general and after the earthquake in Haiti, see Chapter 7, “Reconstruction in the Time of Cholera” and passim, frankly, because that is what this book is about. For an account of these issues in the press, see Patricia Zengerle and Jackie Frank. “Haiti Needs Better Coordination.” Reuters (Jan 27, 2010) Available: http://www.reuters.com/article/2010/01/27/us-quake-haiti-idUSTRE60O29A20100127 (accessed April 15, 2011).
9 Dean Lorich, Soumitra Eachempati, David Helfet. “Doctors: Haiti Medical Situation Shameful.” CNN, January 25, 2010. Available: http://articles.cnn.com/2010-01-25/opinion/doctors.haiti.hardships_1_haiti-trauma-surgeons-medical-supplies?_s=PM:OPINION (accessed April 15, 2011).
10 P. Farmer. “Gram-Negative Sepsis of Uncertain Etiology.” New England Journal of Medicine 340, 11 (1999): 869–876; See also Paul Farmer. “Haiti, l’embargo et la typhoide.” Le Monde Diplomatique (July 2003): 26–27.
11 In 2002, Haiti was ranked 147 out of 147 countries on the Water Poverty Index, and 101 out of 122 countries for water quality—dead last in the hemisphere in both studies. See P. Lawrence et al. “The Water Poverty Index: An International Comparison.” Keele Economic Research Papers (2002); D. C. Esty and P. K. Cornelius, eds. Environmental Performance Measurement: Global Report 2001–2002 (2002). Comparison chart available at http://www.unesco.org/bpi/wwdr/WWDR_chart2_eng.pdf (accessed April 15, 2011); see also Farmer. “Political Violence and Public Health in Haiti.”
12 For more on the role of universities during the earthquake response, see Andrea Fuller. “American Universities Rush to Front Lines in Haiti.” Chronicle of Higher Education: January 21, 2010. Available: http://chronicle.com/article/American-Universities-Rush-to/63692/ (accessed April 15, 2011).
13 Paul Farmer, Louise Ivers, and Claire Pierre. “Tales from the Front.” Miami Herald (January 23, 2010). Available: http://www.haitispecialenvoy.org/press/op-eds/drs-farmer-ivers-pierre-tales-from-the-front/ (accessed April 15, 2011).
14 See Peter Baker and Joseph Berger. “U.S. to Resume Airlift of Injured Haitians.” New York Times: January 31, 2010. Available: http://www.nytimes.com/2010/02/01/world/americas/01airlift.html (accessed April 15, 2011); Alex Lantier. “U.S. Halts Military Flights to Evacuate Haiti Earthquake Victims.” WSWS.org: February 1, 2010. http://www.wsws.org/articles/2010/feb2010/hait-f01.shtml (accessed April 15, 2011).
15 Farmer. AIDS and Accusation: Haiti and the Geography of Blame.
16 We also discussed his visit to Rwanda earlier that month, which was meant to improve Franco-Rwandan relations. The diplomatic relationship between the two countries had been strained since the genocide and was severed by Kigali in 2006, when a French judge issued arrest warrants for a number of top aides to Paul Kagame, the current Rwandan president, on the grounds that they were somehow involved in the downing of Rwandan dictator Juvenal Habyarimana’s plane on April 6, 1994—the event marking the start of the hundred-day genocide. Most observers didn’t find the evidence against the Kagame aides to be credible. Kouchner’s trip to Kigali aimed at a return to amicable relations, including the resuscitation of cultural exchanges and development assistance. Franco-Rwandan relations would be strengthened further a month later with President Nicholas Sarkozy’s visit on February 24; Sarkozy allowed that the French government had made “grave errors of judgment” during the genocide. For news coverage of Kouchner’s visit to Rwanda, see “Rwanda and France Pledge to Boost Ties after Three-Year Freeze.” RFI (January 7, 2010). Available: http://www.rfi.fr/actuen/articles/121/article_6426.asp (accessed April 15, 2011). For coverage of Sarkozy’s trip, see Anjan Sundaram. “On Visit to Rwanda, Sarkozy Admits ‘Grave Errors’ in 1994 Genocide,” New York Times (February 25, 2010). Available: http://www.nytimes.com/2010/02/26/world/europe/26france.html (accessed April 15, 2011).
17 Peter Walker. “Haiti Can Lead Earthquake Relief Effort.” Guardian (January 25, 2010). Available: http://www.guardian.co.uk/world/2010/jan/25/haiti-earthquake-relief-effort-summit (accessed April 15, 2011).
18 Quoted in Rob Gilles. “Haiti Conference: Nations Call for Haitian Government to Lead Rebuilding,” Huffington Post: (January 26, 2010). Available: http://www.huffingtonpost.com/2010/01/26/haiti-conference-nations_n_436495.html (accessed April 15, 2011).
19 Quoted in Marc Lacey and Ginger Thompson. “Agreement on Effort to Help Haiti Rebuild,” New York Times: January 25, 2010. Available: http://www.nytimes.com/2010/01/26/world/americas/26haiti.html (accessed April 15, 2011).
20 Christine Welter. “Montreal Hosts Haiti Reconstruction Conference,” Suite 101: January 26, 2010. Available: http://www.suite101.com/content/montrealhosts-haiti-reconstruction-conference-a194024 (accessed April 15, 2011
).
21 To those eager to level corruption charges against the Haitian government, I would push on two fronts. First, it’s not very helpful to criticize a government such as Haiti’s in a vacuum. A sound analysis situates Haitian politics and bureaucratic performance in a broader context, historical and geographical. Few years in Haiti’s history are unmarked by foreign intervention or meddling of some kind. What we know about democracy in Haiti is this: whenever a popular leader (elected by significant margins) is given a chance to hold office, he will, as surely as night follows day, soon face embargoes and bad press and possibly worse. No one would deny that the current government has certain inveterate weaknesses, but perhaps it’s time to let Haitian democracy run its course, to let the Haitian civil services grow and take root. Second, to avoid corruption, public institutions—from the line ministries to facilities such as the General Hospital—need an infrastructure of transparency: modern bookkeeping, electronic disbursement of payroll, performance-based financing, effective communications technology. For the last two decades, the Haitian state has been starved of resources. Long accustomed to paltry tax revenues, embargoes intended to pressure the governments in the direction of foreign business interests emptied the meager federal coffers. Instead, money flowed to NGOs, which wittingly or unwittingly weakened the public sector. By the close of the millennium, the Republic of NGOs had undermined the Republic of Haiti’s capability to fulfill its government mandate. In these conditions, corruption charges sometimes seem misplaced.
22 Lacey and Thompson. “Agreement on Effort to Help Haiti Rebuild.”
23 Amy Wilentz, who has written extensively about recent Haitian political history, made the point that Préval’s leadership style was a welcome break from a history of “strongman” politics she connects with Duvalierism. Préval’s administration, “while certainly not incandescent,” she writes, “had a calming influence on the roiling tide of Haitian politics.... The quiet president, operating behind the scenes with the international community, instead of strutting before the foreign press and claiming he’ll fix everything, is perhaps at this moment not such a bad leader for Haitian democracy, after all.” See Amy Wilentz. “The Dechoukaj This Time.” New York Times, February 7, 2010. Available: http://www.nytimes.com/2010/02/07/opinion/07wilentz.html?_r=1&adxnnl=1&pagewanted=all&adxnnlx=1292446954-gjxDURsrw0KQhLo4k/EZpw (accessed April 15, 2011). Wilentz’s perspective is a helpful counterweight to the heavy doses of criticism laid on Préval and his administration after the quake. But it is not an exaggeration to say that the government’s efforts often have been anemic at best.
24 Jonathan Demme’s 2003 documentary The Agronomist follows Jean Dominique’s and Michèle Montas’s struggle to make Radio Haiti-Inter a mouthpiece of the people.
25 Régine Chassagne. “I Let Out a Cry, as if I Had Just Heard that Everybody I Love Had Died.” Irish Times: January 17, 2010.
26 For more about their organization, Kanpe, see http://www.kanpe.org/home.html (accessed April 15, 2011).
27 There were many such stories from the early days after the earthquake. Some aid workers were stuck en route to Haiti; others had trouble leaving. See, for example, Alan McDowell. “Aid Workers Face Logistical Problems.” National Post (January 14, 2010). Available: http://www.nationalpost.com/news/story.html?id=2442757.
28 The full text of President Obama’s speech is available here: http://abcnews.go.com/Politics/State_of_the_Union/state-of-the-union-2010-president-obamaspeech-transcript/story?id=9678572 (accessed April 15, 2011).
29 The full text of the 2003 testimonial is available here: http://foreign. senate.gov /imo/media/doc/FarmerTestimony030715.pdf (accessed April 15, 2011).
30 For evidence on this score, see Tracy Kidder’s piece in the Nation, “The Trials of Haiti” (October 27, 2003). Available: http://www.thenation.com/archive/trials-haiti .
31 Paul Farmer, Joseph P. Kennedy, and Jeffrey Sachs. “U.S. Owes Aristide a Fair Chance to Govern.” Boston Globe (June 30, 2001), Sect. A:15; P. Farmer, M. C. Smith Fawzi, and P. Nevil. “Unjust Embargo of Aid for Haiti.” Lancet 361 (2003): 420–423.
32 Full coverage of the hearing is available here: http://www.cspan.org/Watch/Media/2010/01/28/HP/A/28965/Senate+Foreign+Relations+Cmte+Hearing+on+Haiti+Relief.aspx (accessed April 15, 2011).
33 The Foreign Assistance Act was signed into law by President John F. Kennedy in 1961. A product of Cold War politics, its stated goal was to win “hearts and minds” in developing countries declaring intentions to adopt socialist or communist tactics. Cold War mentalities still influence the U.S. foreign aid strategy. For example, Jeff Sachs notes that only one of the five operational goals outlined by the U.S. Agency for International Development (USAID) contributes to long-term development (“promoting transformational development”). The other four (“supporting strategic sites, strengthening fragile states, providing humanitarian relief, and addressing global challenges such as the HIV/AIDS epidemic and climate change”) are important components of foreign policy but do too little to take on poverty and economic development. Sachs tracks the meager $2.8 billion (out of $16 billion total) that went to transformational development. “The entire sum,” he writes, “went to technical cooperation: payments made primarily to U.S. entities—consultants from government agencies or nongovernmental organizations (NGOs)—for assignments in recipient nations. These missions may be useful, but the expenditures are not long-term investments in local clinics, schools, power plants, sanitation, or other infrastructure.” Further, the benefits of the aid that is disbursed are tempered by high overhead and policies promoting U.S. interests: food aid comes most often in the form of grain shipments—great for subsidized American agribusiness and perhaps less so for local farmers—and almost half the money for food aid goes to transportation costs, instead of food (see Jeffrey Sachs. “The Development Challenge.” Foreign Affairs 84, no. 2, pp. 78–79). In addition to its Cold War legacies, U.S. foreign aid struggles under the weight of great bureaucratic inefficiencies. Aid disbursement, for example, is splintered into eighteen institutions within the State Department and the U.S. Agency for International Development alone, and an additional twenty or more government institutions also have aid programs. Stewart Patrick of the Center for Global Development has called for a new cabinet-level agency that would centralize foreign assistance for international development under one roof. See Stewart Patrick. “U.S. Aid Reform: Will It Fix What Is Broken?” (September 2006), available: http://www.cgdev.org/content/publications/detail/10497 (accessed April 15, 2011). All these problems have led a growing number of government officials, development practitioners, and academics to endorse far-reaching reform of the Foreign Assistance Act. The Bush Administration proposed reform legislation in 2006, which has since been shelved. Oxfam America and ActionAid have both proposed more substantial reforms. See also “New Day, New Way” (June 1, 2008), a proposal made by a coalition of development and foreign affairs practitioners and policymakers known as the Modernizing Foreign Assistance Network. The report is available at: http://modernizingforeignassistance.net /documents/newdaynewway.pdf (accessed April 15, 2011).
34 The history of Haitian debt runs deep: after independence, the French claimed a debt of 150 million francs for property—including slaves—lost during the Haitian Revolution (see p. 127 and n. 14). In 2008, the government of Haiti owed almost $2 billion in foreign debt, half of which was canceled after a donor conference in June 2009. G9 countries announced the cancellation of the remaining half in February 2010, as part of the earthquake relief effort. See “G7 Nations Pledge Debt Relief for Quake-Hit Haiti.” BBC (February 7, 2010). Available: http://news.bbc.co.uk/2/hi/8502567.stm (accessed April 15, 2011).
35 Increasing evidence points toward the value of cash transfers, especially those targeted at women, at strengthening families and spurring grassroots development. See, for example, Joseph Hanlon, David Hulme, and Armando Barrientos. Just Give Money to the Poor: The Development Revolution from the Global South (West Hartford
: Kumarian Press, 2010).
36 Transcript available: http://www.haitispecialenvoy.org/press/transcripts/testimony-of-dr-paul-farmer-to-the-us-senate-committee-on-foreign-relations/ (accessed April 15, 2011).
37 The full text of the 2003 testimonial is available here: http://foreign.senate.gov /imo/media/doc/FarmerTestimony030715.pdf (accessed April 15, 2011).
38 For more on Partners In Health’s efforts to manufacture vitamin-enriched peanut butter as a ready-to-use therapeutic food, see Andrew Rice’s long exposé “The Peanut Solution” in the New York Times Magazine (September 2, 2010). Available: http://www.nytimes.com/2010/09/05/magazine/05plumpy-t.html?pagewanted=all (accessed April 15, 2011). As the article notes, producing such vitamin-enriched peanut butter led to legal threats from a company that claimed exclusive rights to the product. But can you patent peanut butter?
39 Yesica Fisch and Martha Mendoza. “Haiti Government Gets 1 Penny of U.S. Quake Aid Dollar.” Associated Press (January 27, 2010). Available: http://www.usatoday.com/news/world/2010-01-27-Haiti-aid_N.htm (accessed April 15, 2011).
40 Our colleagues at the Office of the Special Envoy have been militant about tracking these numbers. The most recent report on relief and reconstruction financing is available here: http://s3.amazonaws.com /haiti_production/assets/22/1._Overall_financing_key_facts_FINAL_6_original.pdf(accessed April 15, 2011).
41 Jonathan Katz, “Billions for Haiti, A Criticism for Every Dollar,” Associated Press (March 5, 2010). Sources compiled from USAID and the United Nations. Available: http://www.informationclearinghouse.info/haitiaid.jpg (accessed April 15, 2011).