Haiti After the Earthquake (18 page)

The presentations were scripted, but exchanges with senators and the global peanut gallery (such hearings are broadcast live on C-SPAN) were not. After the two other presenters (James Dobbins of the RAND Corporation and Dr. Rony François, former Secretary of Florida's Department of Health) had delivered their remarks, Senator Kerry guided the discussion. He first asked about food shortages. In the short term, it was hard to think of an alternative to the World Food Program's logistically robust food distributions. But almost none of the food it procured was locally grown. I was proud to be able to offer an example of local production: vitamin-enriched peanut butter had proven a miraculous treatment for childhood malnutrition while also creating jobs and stimulating local agriculture (simply by purchasing locally grown peanuts). It wasn't nuclear physics. Such investments could help diminish hunger, support local farmers, and build food-processing capacity in rural Haiti.
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Senator Ben Cardin of Maryland asked an important question: How might we learn from past mistakes in aid delivery? Most of those present wanted to correct the inefficiencies in the aid system. People in the audience, seated behind me, passed notes to me in the hopes that I might underscore important points. One such note was affixed to a news report from that morning, which announced that
the Haitian government had received significantly less than 1 percent of U.S. relief aid since the quake.
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Later we would learn that it was not only U.S. aid that bypassed the government: an estimated 0.3 percent of all Haitian quake relief went to the public sector.
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In fact, more went to the government of the Dominican Republic than to Haiti's government. The lion's share of every U.S. dollar spent on earthquake relief went to the U.S. military's efforts, which included search and rescue and logistic support needed, as we had learned, to save lives.
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But the military leadership we'd met in Haiti would be the first to say that relief is not the same as recovery.

Although it wasn't clear how best to make the leap from relief to recovery, I returned to Haiti torn between optimism (the goodwill in Montréal and in Washington felt real) and pessimism (we'd been saying the same things for well over a decade). One thing was certain: there was little knowledge, in Washington, of Haitian history or of the close links between the two oldest republics in the hemisphere. Most Haitians I've met argue that it's impossible to know the history of either country without knowing that of the other.
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But the powerful could afford not to know.

I hoped that a new infrastructure of transparency might grease the aid machinery's skids and improve performance on all sides. Colleagues in our tiny UN office were already tracking aid pledges and publishing disbursement rates (mostly shortfalls) online. It was our shared hope that this platform—the infrastructure in question—would help Haiti build back better and move us beyond rudimentary declarations of support to a focus on delivery. Otherwise, why have meetings a thousand miles away from those needing water, sanitation, medical care, solid homes, and decent jobs?

These were the questions on my mind when I headed back to Haiti after the Montréal meeting and the Senate testimony. Thirty days after the quake, we were once again preparing to receive President Clinton, who was coaching us on the transition to reconstruction. Claire Pierre had been working closely with the Minister of Health, Dr. Alex Larsen, who encouraged us to focus on rebuilding health infrastructure.
In one meeting, he asked us to rethink the hospital we'd been planning to build in Mirebalais since before the quake. “You need to set your sights higher,” he said. “The hospital needs to be a place that can train young doctors and nurses, but also one that can train allied health professionals—the people who run labs and pharmacies—and community health workers. It needs to be bigger, many times bigger, than what we agreed upon.” He planned to say as much to President Clinton, who would return to Haiti on February 11.

We were working with Clinton's team and the Office of the Special Envoy to plan this next visit. I suggested that Clinton should visit the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), a Cornell-affiliated NGO led by Dr. Bill Pape. Pape had been one of four physicians invited to the White House when, in 2003, the Bush administration contemplated the launch of its AIDS program. (The President's Emergency Plan for AIDS Relief, or PEPFAR, as it would be called, would prove to be the most ambitious global health program of the preceding decade.) I was there too, and had worked with Pape for almost twenty-five years. After the quake, he also began pressing me to focus on the health sector—not because we were physicians but because improving access to health care was, like improving education and sanitation, something everyone could agree on.

Pape's suggestion was fine by me. I wanted to focus on health to drown out the mounting clamor about everything from land tenure to urban planning. The challenges of rebuilding a single hospital were daunting enough; coordinating diverse interests to help the Haitians rebuild a health system would require energy and time and resources. Clinton knew I felt overwhelmed by our broad brief. He knew I felt out of place when it came to discussing rebuilding industry and roads and civil society, and that I wished to work in the arena I knew best.

During President Clinton's visit to GHESKIO on February 5, both Pape and Larsen suggested to him that my energies be focused on the health sector. Clinton made a joke of it: “Farmer, did you pay them to say this?” A moment later, an American nurse brought us an infant with a congenital heart defect. “This child needs surgery at once,” she
said to the President, who took the baby in his hands. He turned to me and said, “Okay, Paul, make sure this boy gets the care he needs. Can you do that?” I nodded. That was something I knew how to do.

We'd received patients like this boy, named Héros, for years at our facilities in central Haiti. Most were cared for in Cange, but some ended up, as he later did, in Harvard's affiliate hospitals. Héros needed open-heart surgery (if less urgently than averred), a procedure that wasn't yet possible in Haiti. That was one of the reasons we were taking the Minister of Health's recommendations about Mirebalais seriously: Haiti needed at least one state-of-the-art hospital. In the interim, there was the hospital in Cange—far from state-of-the-art but still a decent place to practice medicine. I was anxious to return. It was one month after the quake, and I still didn't feel as if I'd been home.

Returning to Cange would lessen my persistent anxiety regarding friends and others still unaccounted for—an anxiety all of us shared. Most had found their way onto grim lists: dead, injured, safe. But for weeks, some few remained unaccounted for, and families kept on hoping against hope. Little by little, and often late at night, I whittled my own list: my brother-in-law injured; a number of colleagues dead; most of my nearest and dearest safe. Nonetheless, I counted close to fifty colleagues and friends who had lost their lives in the space of a minute.

My colleagues and patients, almost all of them Haitian, were safe because the network of hospitals and clinics we'd built up over the years was well outside the quake zone. I wanted to get back to Cange, although I wasn't much needed there: my coworkers had their hands full since day two when the first waves of injured survivors began arriving from the capital. They had sent many doctors and nurses to help out in the burgeoning camps in Port-au-Prince. (Haitian physicians working with Partners In Health in rural Rwanda, Malawi, Lesotho, and Burundi also returned to the capital to pitch in.) But in the chaos of the broken city, I thought more and more about getting back to Cange, if only for a couple of days, to see
friends and family. My sister-in-law, a nurse-anesthetist in Cange, was in the OR almost around-the-clock, but I knew we'd find time to catch up.

I was also anxious to see Father Fritz and Yolande “Mamito” Lafontant, the elderly couple who had been like surrogate parents to me since 1983. Although their house was damaged and their daughter's home destroyed, they'd survived the quake because they too were in central Haiti. Many of their friends were not so fortunate. Their lives beyond Cange had been focused on Haiti's Episcopal Church, which had been battered by the quake: Saint Trinity Cathedral, with its famous murals, had been leveled, as had the diocesan offices and the convent. The bishop's wife was badly injured and had taken refuge in Cange; she needed to get to the
Comfort
and perhaps, my colleagues thought, to the United States. I hoped to be helpful on that score. It was a relief to make rounds in a hospital that was clean and orderly and busy. Mostly, however, I wanted to spend a night in my own house.

The drive to Cange used to take well over three hours, even though it's less than fifty miles from Port-au-Prince. The road had recently been repaved, and had cut the time, and the jolts and aches, in half. I convinced Claire Pierre to go with me. We hadn't yet left the quake zone, and had seen few neighborhoods, or even vistas, without fallen buildings and debris. But the wreckage became less frequent as we drove north, disappearing altogether a few miles outside the city.

What didn't disappear were the spontaneous settlements. By the beginning of February, they stretched into the empty plain—almost a desert in the dry season—between the city and the mountain chain separating it from the Central Plateau. Some of these camps boasted proper tents; others were crafted mostly of tarps, plastic, and tin; none were very orderly. Alongside the road leading across the plain were groups of people carrying tools and materials to build more camps. With no trees or water, but many cacti, this wide-open space looked more like a bit of arid west Texas than a tropical island. It was hard to imagine how anyone encamped there would get by for even a few days. And more refugees were coming, we'd heard.

We traveled over the first mountain range and into the lower Central Plateau, which had more trees. There too we saw the beginnings of new settlements—“IDP camps” in UN argot because they were peopled by internally displaced persons—and wondered if those pitching them were originally from these parts or simply seeking refuge from the chaos and aftershocks of the city. We didn't stop in Mirebalais, the lower plateau's chief town, although we'd promised to meet with the mayor about our plans to rebuild their hospital—a project spearheaded by Dr. David Walton and a Boston contractor, Jim Ansara, who had been in Haiti on and off since the quake. If we were to proceed in keeping with the wishes of local and national authorities, we needed to go back to the drawing board on the proposed hospital, because some of our partners—the Health Ministry, the medical and nursing schools, and the General Hospital—were in shambles or ruins. Although David and Jim had asked me to stop by the proposed construction site, I was too anxious to get home. We reached Cange by late afternoon.