Haiti After the Earthquake Read online

  Table of Contents

  Title Page

  Dedication

  Epigraph

  NÈG MAWON

  Haiti

  WRITING ABOUT SUFFERING

  Chapter 1. - THE CATASTROPHE

  Chapter 2. - PRAXIS AND POLICY

  Chapter 3. - JANUARY 12 AND THE AFTERMATH

  Chapter 4. - A HISTORY OF THE PRESENT ILLNESS

  Chapter 5. - INTO THE CAMPS

  Chapter 6. - FROM RELIEF TO RECONSTRUCTION

  Chapter 7. - RECONSTRUCTION IN THE TIME OF CHOLERA

  Chapter 8. - LOOKING FORWARD WHILE LOOKING BACK

  EPILOGUE - January 12, 2011

  Other Voices

  LÒT BÒ DLO, THE OTHER SIDE OF THE WATER

  SIM PA RELE (IF I DON’T SHOUT)

  The voices of the voiceless

  Listening to the voices

  The focus groups

  Fok sa change/It has to change

  A key word: participation

  One priority: decentralization

  “Envestisman nan moun”/Investment in people

  Choosing where to live

  A crisis of confidence

  What aid?

  Solidarity

  Dreaming of a new country…

  GOUDOU GOUDOU

  MOTHERS AND DAUGHTERS OF HAITI

  I. Rediscovering Haiti: December 2008–January 2009

  II. Bringing Haiti to Rwanda: January 2010

  III. The Plight of Women and Girls in Haiti: June 2010

  IV. Lessons from Rwanda: March 2011

  HUMANITARIAN AID, IMPARTIALITY, AND DIRTY BOOTS

  LOPITAL JENERAL STRUGGLES TO SURVIVE

  DOCTORS IN TENTS

  THOSE WHO SURVIVED

  FIRST WE NEED TAXIS

  THE OFFICIAL

  BUILDING BACK BETTER

  Tracking international assistance

  Changing the way not-for-profits work in Haiti

  Increasing the level of commitment to budget support

  NOTES

  ACRONYMS AND INITIALISMS

  CONTRIBUTORS

  Acknowledgements

  INDEX

  Copyright Page

  To Al and Diane Kaneb,

  and all those who stand with the Haitian people

  Then Jesus cried out again in a loud voice and breathed his last.

  At that moment, the curtain of the temple was torn in two,

  from top to bottom. The earth quaked, and the rocks were split.

  The centurions and those with him who were keeping watch of Jesus,

  saw the earthquake and what took place and they were terrified ...

  —Matthew 27:50–52, 54, Palm Sunday Liturgy

  The dead are always looking down on us, they say.

  While we are putting on our shoes or making a sandwich,

  they are looking down through the glass bottom boats of heaven

  as they row themselves slowly through eternity.

  They watch the tops of our heads moving below on earth,

  and when we lie down in a field or on a couch,

  drugged perhaps by the hum of a long afternoon,

  they think we are looking back at them,

  which makes them lift their oars and fall silent and wait,

  like parents, for us to close our eyes.

  —The Dead, Billy Collins

  NÈG MAWON

  Haiti was founded by a righteous revolution in 1804 and became the first black republic. It was the first country to break the chains of slavery, the first to force Emperor Napoleon to retreat, and the only to aid Simón Bolívar in his struggle to liberate the indigenous people and slaves of Latin America from their colonial oppressors. Tragically, this history of liberty and self-determination has drawn two centuries of political and economic ire from powerful countries resulting in policies which have served to impoverish the people of Haiti.

  Feared by Thomas Jefferson for their successful uprising; extorted by France in 1825 for 150 million francs to compensate the loss of the Empire’s “property”—both slaves and land—(a debt the Haitian people completed paying, with interest, more than a century later); occupied by the U.S. military between 1915 and 1934 to stifle European influence in the Western Hemisphere; and disrespected in their quest for democracy by an unrelenting series of dictators and coup d’états backed by Western countries: the free people of Haiti have been continually re-shackled politically and economically.

  In the wake of the January 12, 2010, earthquake, Haiti’s history of unrelenting struggle for justice is its greatest resource. This history, as Haitians remind us, is what makes Haiti mighty: mighty without material wealth, without natural resources, without arable land, without arms.

  Amidst the rubble of the houses, buildings, and schools, and in front of the once grand National Palace, stands Nèg Mawon—the symbol of Haiti. Nèg Mawon at once embodies the marooned man, the runaway slave, and the free man. He symbolizes the complex history of the Haitian people: stolen from Africa, marooned on an island and liberated through a brave and radical revolution. Shackles broken, machete in hand, the free man does not hide; rather he blows a conch to gather others to fight for the freedom and dignity of all people. For the self-evident truth—that all men are created equal. Nèg Mawon is the indefatigable spirit of Haiti’s people, a people profoundly and proudly woven to their history.

  When I arrived in Haiti on Thursday, January 14, 2010, I asked my friend who was driving, “Koté Nèg Mawon”—where is the free man? “Li la” he said—he is here. And as we rounded the corner behind Champs Mars, the plaza in front of the devastated palace where thousands had already made their homes—and remain today—there, rising from the dust of the still trembling earth, stood the statue of Nèg Mawon. I was drawn by the image out of the car and as I stood, weeping, an old woman put her arm around me; she too was crying. I said, “Nèg Mawon toujou kanpé!!”—the free man is still standing!! And she replied, powerfully, “Cheri, Nèg Mawon p’ap jamn krazé”—my dear, the free man will never be broken. It is with this surety that we must stand with Haiti, a country whose spirit and people will never be broken, and work in solidarity toward the future the Haitian people deserve.

  —Joia S. Mukherjee

  Haiti

  after the earthquake

  WRITING ABOUT SUFFERING

  Some years ago, after two decades of witnessing and writing about epidemic disease and violence of all types, I set out to write a book based on some lectures about violence and medicine that I’d given at the University of Rochester. The title of the book was going to be Swords of Sorrow, from a Gospel line (Luke 2:35): Mary learns that her soul will be pierced by a “sword of sorrow” because she is willing to be a vessel of grace. I liked the alliteration. But I never finished that book. What was the point, I worried, of writing another book about the suffering caused by war and genocide and other misfortunes natural and unnatural?

  I thought again about that truncated project shortly after an earthquake struck Haiti’s capital city on January 12, 2010. Preliminary estimates of the dead ran to six figures. The immediacy of rescue and relief soon gave way to a series of questions about the dimensions of what had happened, about why Haiti had been particularly vulnerable to such a disaster, and about how to respond to the unfolding “humanitarian crisis” (to use the jargon of the day). Suffering is never just pure suffering; it occurs in a particular place and time. My book would have examined histories of suffering in Haiti, Guatemala, and Rwanda—Haiti being the place that has taught me the most.

  Knowledge of Haiti might not help a trauma surgeon attend to broken bodies pulled from the rubble. But deep familiarity with the place helped frame answers to some of the
questions posed above and also helped guide actions in the aftermath of the quake and during the reconstruction that would follow. The relevant knowledge needed to be historically deep (because the damage caused by the quake and the responses to it were rooted in Haitian history) and geographically broad (because Haiti had for centuries been caught up in a transnational economic and political web, a condition very much on display before and after the quake). This may sound academic. I didn’t want to write a dispassionate study of the Haitian earthquake. Instead, I wanted to offer an account of a difficult time; to bear witness.

  Bearing witness surely has a certain value, especially if it is linked to goodwill efforts to prevent unnecessary suffering caused by war or disease or insufficient preparation for natural disasters. Documentation by eyewitnesses can serve to inform people who are not on the scene but are in a position to help or hinder subsequent interventions. But was it appropriate for a physician, an American at that, to speak for the victims? Many in academia would argue vehemently that only the victims could speak for themselves, and that anyone who presumed to speak on their behalf would rob them of their agency. However, this is not always true: as far as the earthquake goes, the chief victims’ voices were stilled forever. Seeking to “echo and amplify” (to paraphrase Haiti’s former President Jean-Bertrand Aristide) the voices of those we encountered as well as those silenced was and remains our principal interest in writing about violence of all sorts.

  I use we and our here because, a few months after the quake, a small group of friends and coworkers decided to put together an account of that terrible time. We’ve done our best to offer an honest rendering, even though no one had stopped to take notes amidst the maelstrom. It is also our desire to broadcast the voices of those most affected.

  This book faces the same problems I encountered in writing Swords of Sorrow. In addition to clichéd (and overly academic) concerns about voice and representation, serious challenges are involved in seeking to write and complete a book in a few months. These challenges are heightened by publishing such a book in English because the primary victims of the quake do not speak English (or speak it less well than they do other languages).

  We’ve tried to address these challenges in the structure of this book, which includes my own account along with a series of brief essays, photographs, and one drawing by friends, family, and coworkers. I describe the aftermath of the earthquake as experienced by a physician working alongside colleagues in Port-au-Prince and central Haiti both immediately after the quake and in subsequent months. I double back to revisit my personal history in Haiti, and that of Partners In Health and its Haitian sister organization, Zanmi Lasante, over the past twenty-five years.

  This quarter-century has been, for us, one of satisfying growth in spite of disappointments and the dashing of many of the hopes awakened by the fall of the Duvalier dictatorship in 1986. If this book has a central metaphor, it’s one taken from clinical medicine: the earthquake can be understood as an “acute-on-chronic” event. It was devastating because a history of adverse social conditions and extreme ecological fragility primed Port-au-Prince for massive loss of life and destruction when the ground began shaking on January 12. For this reason, the account is not linear but rather follows clinical logic: it explores the acute-on-chronic disaster that occurred on January 12 and its origins in Haiti’s troubled history.

  A sound account of the quake must go deep into Haiti’s history to illuminate what caused the chronic disabilities, engendered over five centuries by transnational social and economic forces with deep roots in the colonial enterprise. Haiti was born of resistance to this enterprise, and therein lies both the strength and disability of the new polity—the reactive and reticulated pattern of growth registered in the nineteenth century and in the past one, when Haiti became anchored more formally in the “American hemisphere” through a nineteen-year military occupation by its oldest neighbor. When the U.S. Marines withdrew in 1934, they left a superficial calm and a social class that relied heavily on the army as the arbiter of political transitions.

  Historians often claim that their discipline reveals the significance of current social processes, and they are right: the decades preceding the quake set the stage not only for what occurred during the acute event but also for the challenge of reconstruction. Following a brief review of Haitian history—which is, necessarily, a review of the history of the New World—we return to the challenge of reconstruction after the temblor of 2010. In the years before it, we saw that Haiti had become a veritable “Republic of NGOs,” home to a proliferation of goodwill that did little or nothing to strengthen the public sector. Thus did clinics sprout up without much aid to the health system; thus did schools arise by the hundreds even as the Ministry of Education faltered; thus did water projects appear even as water security (like food security) was enfeebled.

  This was the situation pre-quake, as described in this book. Efforts to rebuild after the quake needed to draw on the sudden attention of the world and the generous promises and pledges to craft a new way of doing business that did not further weaken the Haitian government. It’s hard to imagine public health without a public sector, and the same could be said for public education and public works. And so this book recounts efforts to stand up a “recovery commission” to address the dysfunctional system of humanitarian aid that, good intentions aside, has become another obstacle to Haiti’s recovery and sovereignty.

  It’s the argument of this book that rebuilding capacity—public or private—in Haiti requires sound analysis of what, exactly, has gone so wrong in the previous four decades. To accomplish this—what doctors call diagnosis and prescription—we’ve had to abandon anxieties about representation and about intruding in the text both as narrators and as characters. Every account is personal. Most of those who contributed to the relief efforts described here are not included (though we’ve tried to thank some of them in the acknowledgments). We’ve also sought to focus on the shortcomings of the quake response, rather than the victories.

  In academic circles, few rewards are given for this sort of candor, or for failing to include all the key actors on the scene. But knowing that a quarter of a million voices were silenced on a single night and that more recent problems (such as cholera) are part of the same tragedy encourages us to offer these personal and place-specific narratives.

  Whether these narratives are termed “history’s first draft” or simple first-person accounts, they constitute our collective effort to recount and account: to recount what happened before it slips from our memories and to account for what placed Haiti, a country we all love, at such extreme risk well before January 12, 2010.

  This book, with all its limitations, is offered as a humble tribute to those who perished that day, to those who live on with their injuries, visible and invisible, and to those who continue to stand with the Haitian people. Among them are the tens of thousands who responded to the suffering caused or worsened by the earthquake, including those who supported, quietly and from afar, the imperfect efforts described in these pages.

  1.

  THE CATASTROPHE

  On January 13, the day after an earthquake struck Haiti’s capital, I finally got through to Dr. Alix Lassègue, the medical director of Port-au-Prince’s largest hospital and a longtime friend. The hospital’s real name is l’Hôpital de l’Université d’Etat d’Haïti, but most people call it the General Hospital. I began trying to reach Lassègue a couple of hours after the quake. His cell phone number, like all the other numbers I tried, led to a recorded message or an ominous buzz. From what we knew at the time, the hospital was smack in the middle of the quake zone. The facility sat among a dozen government buildings, including the medical and nursing schools, and we could see from live reports that most of those buildings had collapsed—during business and school hours. It was clear that our work as health providers in Haiti would be changed forever.

  So now what? It was hard to know how to prioritize anxieties, and as a d
octor, I thought immediately of the General Hospital. It wasn’t hard to imagine the enormity of need in this struggling public facility which had, in the best of times, too many patients, too few staff, and far too few resources. After dozens of tries, it was almost a shock when I connected to Lassègue on a colleague’s cell phone.

  “What do you most need?” I asked.

  Lassègue would hear this question again and again over the next weeks and months, usually with scant practical outcome, but this was early in the game—less than twenty-four hours after the quake. Of course he needed just about everything, including electricity, supplies, salaries, and medications; the hospital had been scrambling for all these even before the quake. He gave me a long and fairly specific list. He needed materials and labor to repair the damaged parts of the hospital, and engineers able to assess the structural integrity of the buildings still standing. He needed help trying to save the lives of those still trapped under collapsed buildings abutting the hospital grounds, including not only the nursing school next door—“a total loss, I fear, and all in it”—and nearby federal buildings, but also houses, businesses, and schools. “It’s much worse than we thought,” Lassègue said. “Just managing proper disposal of the bodies is overwhelming us.” He needed help moving casualties out of the courtyards and into the morgue but couldn’t do that because the power was down. (“Why move bodies into the morgue,” he asked, “without means of preserving them?”) I didn’t say much during the call because I’d never contemplated such problems.

  Lassègue kept talking. “What I need most,” he concluded, “are surgical teams—surgeons and anesthesiologists and nurses and post-op care and medications. And generators.” It was a relief to hear these specific requests, because they were needs we could address. I promised to get the word out and to join him as soon as I could, but our connection was lost and I’m not sure he heard the last bit.