Three Years Later

This is likely to be my last post about Haiti for a while.  I’m certainly no expert, nor does my week there in January qualify me as such.  But I had the opportunity several weeks ago to attend a lecture at Harvard – Haiti three years after the earthquake.  The lecture was hosted by the Harvard Haitian Alliance, the Harvard Undergraduate Global Health Forum, and the Tufts Pan-African Alliance.  The panel of distinguished guests included Jonathan Katz – journalist for the Associated Press and author, Dr Rishi Rattan – Advocacy Chair for Physicians for Haiti, Patrick Sylvain – writer and photographer, and Nancy Dorsinville – Policy Advisor in the Office of the UN Special Envoy to Haiti.  In the course of the lecture, the panelists brought up some remarkable points about Haitian healthcare and governance.  Here is my take.

Paul Farmer once characterized the problems plaguing a post-earthquake Haiti as “acute on chronic” – bad on top of already terrible.  The world’s response (read: US, UK, France, Canada) has been to support the Haitian government to the tune of providing over 60% of the country’s budget.  Those have proven to be some powerful purse-strings, likely to influence even the most resolute of politicians to succumb to powerful donors’ wishes and agenda.

However, American politics of late has clearly demonstrated its blatant inability to compromise and solve our nation’s acute problems of budget negotiations, debt ceilings, and the economy, let alone the chronic issues around spending, taxes, debt, education, human rights, violence, and homelessness.  The American medical and health care system, in particular, has been trying to conquer chronic disease in the United States for years while barely managing to contain acute illness among our own citizens.  This approach therefore proves entirely problematic when trying to introduce an “American” system in Haiti to “eradicate” poverty, illiteracy, crime, and disease.  This approach only begs the question, what hope is there for eliminating cholera in Haiti under such a system?

Policy makers devising a “solution” for Haiti will never succeed if that solution continues to be made by international “experts” without consultation of the Haitian majority.  For example, the “expert” opinion on how to eradicate cholera in Haiti, largely supported by the UN, is to employ vaccinations and antibiotics to treat cholera.  However, eradicating cholera is much easier than vaccines and antibiotics.  Removing the source by providing clean water and sanitary facilities is a far simpler and sustainable solution, and one that every day Haitians would much rather have.  Yet with the UN holding the purse strings, Haiti’s response has been to comply.

Point blank, the Haitian State must operate for Haitians – and more importantly be allowed to operate for Haitians – despite the possibility that it may do so poorly or inadequately.  There will undoubtedly be mistakes and failures, but just as a child must be allowed to get back on the bike and try again, so too must the Haitian government be allowed to learn from its own errors without foreign intervention preventing those errors from occurring in the first place.  At the very least, those mistakes for once would be entirely Haitian.  In the United States, we purport to believe in a government of the people, by the people, and for the people.  The lingering question then remains… why is this not okay for Haiti?

Filed under: Haiti, medicine, politics Tagged: health policy and management, opinion

Posted in Haiti

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