Haiti After the Earthquake

by Paul Farmer

  Didi Bertrand Farmer has worked for the last ten years as a community organizer, an activist for the rights of women and girls, and a researcher in Paris, Haiti, and Rwanda. She currently serves as the Director of the Community Health Program for Partners In Health in Rwanda and leads the Haiti-Rwanda Commission, created after the 2010 earthquake to promote cultural exchanges between the two countries.

  Louise Ivers, M.D., is Chief of Mission for Partners In Health in Haiti. She is an Assistant Professor of Medicine at Harvard Medical School and an Associate Physician in the Division of Global Health Equity at Brigham and Women’s Hospital. Dr. Ivers implements health programs and is interested in improving the delivery of health care in resource poor settings, the provision of care to the rural and urban poor, as well as patient-oriented investigation that offers solutions to barriers to healthcare. She balances her time between management of PIH Haiti, direct clinical service, and operational research.

  Dubique Kobel, M.D., is a clinician working with Zanmi Lasante in Port-au-Prince. He attended medical school in Cuba. He and his wife, Dr. Nadège Kobel, have been providing health care to the residents of Parc Jean-Marie Vincent since the earthquake.

  Evan Lyon, M.D., has worked in Haiti since 1996, when he first lived in Port-au-Prince as a volunteer teacher. He has worked against health inequities as a clinician, teacher, activist, and scholar for more than a decade. Dr. Lyon completed his medical degree at Harvard Medical School in 2003 and internal medicine residency at Brigham and Women’s Hospital in 2007. He has been involved in many aspects of Partners in Health/Zanmi Lasante’s expansion in rural Haiti, including TB and HIV care, community health work, prisoner care, health education, and human rights documentation and advocacy. After the earthquake in January 2010, Dr. Lyon helped coordinate Partners In Health’s immediate relief efforts in support of the public General Hospital in downtown Port-au-Prince.

  Michèle Montas-Dominique is an award-winning journalist and the former news director of Radio Haiti Inter, a private radio station in Port-au-Prince where she began reporting in the early 1970s. She took the direction of the radio station in 2000 when her husband, well-known Haitian broadcast journalist Jean Dominique, was gunned down in front of it. In December 2002, Michele Montas’s bodyguard was killed with a bullet intended for her, and Radio Haiti Inter was closed two months later. During her third exile in New York, Montas worked as Spokesperson of the United Nations Secretary General, before returning to Haiti last January, one week before the earthquake. She is a Senior Adviser to the UN Secretary General’s Special Representative in Haiti.

  Joia S. Mukherjee, M.D., trained in Infectious Disease, Internal Medicine, and Pediatrics at the Massachusetts General Hospital and has an MPH from the Harvard School of Public Health. Since 2000, Dr. Mukherjee has served as the Medical Director of Partners In Health, an international medical charity with programs in the United States, Haiti, the Dominican Republic, Rwanda, Lesotho, Malawi, Burundi, Peru, Mexico, Guatemala, Russia, and Kazakhstan. As Medical Director, Joia coordinates and supports Partners In Health’s clinical team in their efforts to provide high-quality care to the poorest and most vulnerable. She is also an Associate Professor in the Department of Global Health and Social Medicine at Harvard Medical School and in the Division of Global Health Equity at the Brigham and Women’s Hospital. She teaches infectious disease, global health, and human rights to health professionals and students from around the world. Dr. Mukherjee’s research and scholarship are focused on generating a body of evidence to inform the development of health care delivery systems to address the enormous burden of disease in resource-poor settings. Dr. Mukherjee consults for the World Health Organization on health systems strengthening, human resources for health, and the treatment for HIV and drug resistant tuberculosis in developing countries.

  Naomi Rosenberg has been working for Partners In Health (PIH) since 2005 and is a second-year medical student at University of Pennsylvania School of Medicine. At PIH, she directed the Right to Health Care Program—a program that brings patients from Haiti and Rwanda to the United States and elsewhere for treatment not available in their home country. In January 2010, Naomi took a leave of absence from medical school to assist with work in Haiti and has been responsible for the transfer and care of fourteen critically ill people, who are currently living in the Philadelphia area. She also works to connect patients in Port-au-Prince to specialty care whether in Haiti or abroad.

  Timothy T. Schwartz, Ph.D., has lived and worked on Hispaniola, the Caribbean island that Haiti shares with the Spanish speaking Dominican Republic, since 1990. Schwartz spent two years living in a Haitian fishing village, part of a dissertation project funded by the National Science Foundation, and three years living and working among peasant farmers. He has directed five major studies in rural Haiti for the German government, USAID, and multinational NGOs. Dr. Schwartz is the author of a book about the failing of charity and aid in Haiti called Travesty in Haiti and an academic treatise called Fewer Men, More Babies: Sex, Family and Fertility in Haiti.

  Jéhane Sedky joined the Office of the Special Envoy for Haiti in June 2009 as the Senior Advisor on Strategic Communications. Prior to her appointment, she served for two years as Senior Advisor to United Nations Assistant Secretary-General Kathleen Cravero. Previously, Ms. Sedky was Chief of Media Relations at UNICEF. When President Clinton’s UN Tsunami Office was created (in 2005), Ms. Sedky was appointed Strategic Communications Advisor. Ms. Sedky began her UN career as a Press Officer at UNICEF, where for five years she worked closely with Executive Director Carol Bellamy on media issues related to the protection of children and women. She has an undergraduate degree in International Relations from Tufts University and a graduate degree in International Human Rights Law and Political Science from the Graduate Institute of International Studies in Geneva. She has authored a book on children in armed conflict.

  ACKNOWLEDGMENTS

  I make two types of acknowledgments in closing this book. The first, to thank those who helped us to write or illustrate or edit the book, can be done in fairly short order. The second would necessarily include listing the thousands of friends, family, volunteers, and donors who gave us something more to describe than collapsed buildings and broken bodies. The long list (a modest way to thank those who helped us save lives) is still very incomplete, but can be found at http://www.pih.org/eqgratitude.

  These short thanks do not include those credited as writers or authors or editors, even though each contributed greatly to the book, while working behind the scenes: Peter Osnos, who encouraged me to write for him long before the earthquake; Lindsay Jones, our first editor at PublicAffairs; Lisa Kaufman and Christine Marra, senior editor and editorial production manager, respectively; and Susan Weinberg who, along with Peter, is seeking to make sure this book is widely read. Whether we’re writers, editors, or photographers (or the lone artist in the group), we share this gratitude to the A Team at PublicAffairs.

  In Haiti, the quake has left me more thankful than ever for the valiant health care professionals (doctors, nurses, social workers, and community health workers) of Partners In Health and Zanmi Lasante, and also for all those who work in communications, procurement, logistics, and finance. A few of them appear as characters in these pages, but hundreds more have worked long hours providing care in the quake’s aftermath, including a stubborn cholera epidemic and a dearth of services in the regions most affected by the quake. I hope I may be forgiven for singling out Ophelia Dahl, Ted Constan, Loune Viaud, Pa Frico, his daughter Marie-Flore Chipps (who, like most of our Haitian coworkers, faced heavy losses), Evan Lyon, Keith Joseph, Serena Koenig, Koji Nakashima, Kate Greene, Kim Cullen, Ali Lutz, Kathryn Kempton, Jon Lascher, Andrew Marx, Maxi Raymonville, Wesler Lambert, Fernet Léandre, Anany Gretchko Prosper, Patrick Ulysse, Leslie Tuttle, Sarah Marsh, Cate Oswald, Father Eddy Eustache, and Paul Zintl.

  In the Haitian Ministry of Health, in addition to those thanked in the text, I am grateful to Alex Larsen, G
abriel Thimothe, Ariel Henry, Claude Surena, and many others struggling in Haiti’s underfunded public health system, which includes the General Hospital and partners from Belladères to Saint-Marc.

  Harvard Medical School and its affiliated hospitals have allowed me, Louise Ivers, Joia Mukherjee, Claire Pierre, David Walton, and many others to serve as volunteers in Haiti before and after the quake, and my gratitude to these institutions—for helping universities and academic medical centers to build a “there there” in global health—knows no bounds. President Drew Faust and Dean Jeffrey Flier share our vision of global health, as do Ophelia Dahl and Jim Yong Kim and partners, including Wes Edens, Mala Gaonkar, Bill and Daisy Helman, Dan and Annette Nova, and Stephen and Liz Kahn. At the Department of Global Health and Social Medicine, my thanks go to Emily Bahnsen, Zoe Agoos, Matt Basilico, Luke Messac, and Jen Puccetti, and also to academic colleagues, including Anne Becker and David Jones and Arthur Kleinman, who covered for me and others in teaching, clinical, and administrative duties in the weeks after the quake. Thanks, too, to Deans Rick Mills and David Golan, and to several of my medical students, who are listed below. At Brigham and Women’s Hospital, thanks go to Howard Hiatt, Joe Rhatigan, Jenni Watson, Susan Radlinski, to the Global Health Equity residents, and to all the doctors and nurses, named and unnamed, who traveled to Haiti after the quake; we are all indebted to the hospital’s leadership, especially Joe Loscalzo and Betsy Nabel, for making such pragmatic solidarity possible. At Partners Healthcare, my deepest debt is to Gary Gottlieb, also of Partners In Health, but many others came up with cash, supplies, transportation, and, especially, skilled medical personnel. I am thankful to many at Children’s Hospital, but especially to John Meara and so many other surgeons (and anesthesiologists and surgical nurses) from all Harvard teaching hospitals. You did us proud.

  Most of the UN leadership with whom President Clinton and I worked the most closely perished in the quake, but members of our OSE team were spared and continued working: Nancy Dorsinville, John Harding, Ricardo Sanchez-Sosa. Other UN officials rotated in and out of Haiti, but brevity of service was not always a marker of impact. I’m grateful to Dr. Garry Conille for his hard work and leadership, and to Katherine Gilbert for her innovations in tracking aid and also aid effectiveness. Our collective thanks go to Gabrielle Apollon, Lee Bailey, Carolina de Borbon Parma, Jennie Weiss Block, Anne Frotscher, Abbey Gardner, Kirsten Gelsdorf, Treena Huang, Hardin Lang, Francesca Lubrano di Giunno, Habila Maiga, Joel Malebranche, Violeta Maximova, Gregory Milne, Paula Montes, Lenore Price, Maria Concepcion del Rosario, Jéhane Sedky, and Anke Strauss. In addition, I’d like to offer a special thanks to Aaron Charlop-Powers, whose mother, a friend to our work, died in an accident shortly after the quake; Aaron continued his efforts in and behalf of Haiti.

  Some of our friends and colleagues at the Clinton Foundation and in President Clinton’s office are named in the previous pages, but I’d like to thank in particular the tireless Laura Graham and also Hannah Richert, Doug Band, Ami Desai, and Jon Davidson. Many have spent long hours responding to the cholera outbreak, but I can’t help but thank Mark Rosenberg in particular for his vision in drafting the consensus statement.

  In Rwanda, where we have worked (and been sheltered) for some years, we are grateful to leaders at the national, provincial, and district levels for their support of our efforts and for their warm welcome of Haitian officials and students interested in learning how Rwandans have “built back better” since the genocide. I would be remiss not to single out two individuals: Dr. Agnès Binagwaho, who has advised and shepherded our work in Rwanda from the beginning, and Anne Sosin, who has helped Didi bring the Haiti-Rwanda Commission into being. On a personal note, it was easier for Didi and me to work in the quake zone knowing that our children were in a safe place, which is precisely how our family thought—and still thinks—of Rwanda. I am deeply grateful for our oldest daughter Catherine’s discerning contribution to this book. Her efforts have been felt in our work in Haiti and Rwanda too. I can only hope this testament will help our other children (Elizabeth, Charles-Sebastien, Rick Ryan, and Richard) understand our long absences.

  Finally, writing requires protected time and protected spaces, and these were very hard for me to find. My deepest gratitude goes to Jennie Block, who insisted on both; Jon Weigel, who did more than anyone else to help me finish my part of this volume; Maryse Penette-Kedar, who offered me safe haven within the quake zone, Todd and Anne McCormack, who as ever provided safe haven in Boston; and my brother Jeff, who not only helped me carve out a few days to write but also read parts of the book and discussed most of it. Writing also requires editors of the more informal sort: friends who read drafts or just listened to arguments. This past year, Claire Pierre and Louise Ivers, much mentioned in this book, and also Jean-Renold Réjouit, Abbey Gardner, and Cassia Holstein, helped me to understand things about the quake and about development assistance that I might not otherwise have grasped. As ever, and for almost thirty-five years, Haun Saussy has helped me to understand and better describe complex events.

  2010–2011 has been a grim season of loss. In addition to those lost on January 12, we all miss Tom White, Yolande “Mamito” Lafontant, Patricia Neal, Alix Chipps, Joan Kleinman, and many others. The dedication page allows me to thank Al and Diane Kaneb, who, like Tom, have supported our efforts unstintingly and generously for long years. Love is good, but unconditional love is better, and it’s for this reason I dedicate this volume to two friends who are still very much with us, and still standing with Haiti.

  The longer (though necessarily incomplete) list of friends, family, volunteers, and donors who contributed in countless ways to our efforts after the earthquake can be found at http://www.pih.org/eqgratitude.

  INDEX

  Abe, Valentin

  accompaniment

  Action Plan for National Recovery and Development of Haiti

  acute-on-chronic

  events

  problems

  Adams, Jody

  Africa, AIDS

  Aristides in

  Darfur and

  displaced persons time in “temporary” settlements

  Haitian students and

  health policy and

  tuberculosis

  See also specific countries

  Agoos, Zoe

  agriculture in Haiti

  after earthquake

  Clinton apology on

  deforestation and

  international trade policies and

  Nation essay (Farmer) and

  nature and

  problems overview

  U.S. agricultural subsidies effects

  vitamin-enriched peanut butter

  Aiding Violence (Uvin)

  AIDS

  Bill Clinton’s programs

  direct service and

  first UN General Assembly on

  policy and

  President’s Emergency Plan for AIDS Relief

  social response and

  Vienna International AIDS Conference

  See also Global Fund to Fight AIDS, Tuberculosis, and Malaria; specific organizations

  AIDS and Accusation (Farmer)

  AIDS/Haiti

  meeting (January 12)

  National AIDS program

  Partners In Health programs

  See also Global Fund to Fight AIDS, Tuberculosis, and Malaria; specific organizations

  “America’s Top Chef” fundraiser

  Anacaona, Taino Queen

  Andrews, Jason

  Anglade, Dominique

  Annabi, Hédi

  background

  earthquake and

  UN Haiti team and

  Annan, Kofi

  Ansara, Jim

  Antelope’s Strategy, The: Living in Rwanda After the Genocide (Hatzfeld)

  Apollon, Gabrielle

  Arcade Fire band

  Archer, Natasha

  background

  earthquake and

  Arias, Oscar
>
  Aristide, Father Jean-Bertrand

  1990 elections/1991 coup

  after coup

  background

  Bush administrations and

  democratic elections and

  forced exile

  French debt and

  medical school and

  return to Haiti

  second presidential election/term

  words/ideas of

  Aristide, Lady Mildred

  AIDS programs and

  coup/exile and

  Aristide Foundation

  Arrupe, Father Pedro

  Associated Press articles

  ATD Quart Monde

  Augustin, Josué

  Bahnsen, Emily

  Bailey, Lee

  Balch, Emily Greene

  Ban Ki-moon

  Bill Clinton and

  donors’ conference (2010)

  International Donors’ Conference (2009)

  Montas-Dominique and

  UN emergency session day after earthquake

  Band, Doug

  Barnett, George

  Basilico, Matt

  Bayona, Jaime

  bearing witness to suffering

  See also earthquake accounts

  Becker, Anne