Haiti After the Earthquake Page 6

  This new, human-security-based approach had been long agreed upon but never really implemented. In espousing this approach—security will follow investments in basic social services and freedom from want—I was only trying to be honest. I’d long before concluded that jobs and such services, along with full political participation of the poor, were the best (and perhaps only) way to lessen violence and discord in the places we’d worked. But this was not an agenda I could push forward alone. The incoming UN development coordinator, Kim Bolduc, a Canadian born in Vietnam who had barely survived the destruction of UN headquarters in Iraq, shared this view. On a preliminary visit to Haiti, Bolduc had pushed to redirect the UN’s focus toward sustainable and equitable development.

  After letting the UN leadership know that I had Clinton’s blessing to focus on health, education, and food security, even as we both promised to be cheerleaders for any and all decent (meaning pro-poor) development projects, I invited my new UN colleagues to visit our sites. “Come up to our hospitals and clinics,” I suggested, “and you will see that basic services are what Haitians are asking for and can themselves, with accompaniment and support, provide. And President Clinton will help bring in private investors to support large projects and small ones, including those that help Haiti’s farmers and artisans and market vendors.” Saying this sort of thing wasn’t innovative, but implementing it would have been—at least in Haiti.

  With Harvard’s support, I began commuting between there, Haiti, and Rwanda. My new rank meant not only checking in with Mr. Annabi and others on each trip but also a great deal of time spent “interfacing with the international community.” Listening to complaints was a big part of the job, and we heard from everyone: UN development experts seeking more resources to fund their projects rather than peacekeeping and military efforts; representatives of influential governments with bilateral development projects in Haiti; leaders of the Haitian government, who rightly deplored the scant support they received to monitor all (and implement many) of the health, education, and sanitation services; NGOs, large and small, which complained about the UN and the Haitian officials and took ill any critique of their efforts; and the business élite, who told us that government rules and regulations were not to their liking.

  But if anyone had real cause for complaint, it was—and still is—the Haitian people themselves, so long excluded from any meaningful discussion of their fate.21 To a list of grievances spanning at least two centuries, they added the inability of state and nonstate providers to ensure basic succor to those in great need, in spite of the large presence of humanitarians and NGOs. These sentiments—these complaints—have been the constant companions of almost everyone working in Haiti to deliver such services.

  The failure to provide basic services—health care, education, water, sanitation—had reached a parlous state. In the fall of 2009, the Ministry of Education estimated that half of all school-age children were not in school, and that many of those who were in school attended what the Haitians call lekol bolèt—“lottery schools,” so-called because, pedagogically, you take your chances there. The great majority of schools, maybe 90 percent, were private and relied on families’ ability to pay tuition. President Clinton was convinced that if all children were in school and had at least one decent meal there, the stain of child servitude, referred to in Haiti as the restavèk system, would be dealt a serious blow.22 The Haitians with whom we spoke agreed in principle, but finding the resources to make school fees, uniforms, books, and lunches available, and to improve the quality of education by training teachers, proved difficult. Although everyone seemed to agree on the diagnosis, and many on the treatment plan, failure to deliver led to another round of recrimination and blame. Similar discord was heard whether the topic was health care, access to potable water, clean energy, or ports and customs—the entire range of topics we were supposed to be addressing.

  Practicing medicine in settings as different as Haiti and the urban United States taught me that scarcity (real and perceived) of resources was at the root of most of the discord. The team in the OSE—the Office of the Special Envoy—was committed to building back better in several senses. One was of course building or rebuilding infrastructure (from bridges to roads) and farmlands damaged by the storms. But we also had aspirations to build the development machinery back better. One of the books I gave to my new coworkers was a scathing indictment of development assistance, Travesty in Haiti, by anthropologist Tim Schwartz. I suspected it had won him few friends, but the book taught me a lot. His description of several abandoned windmills in the northwest could serve as a parable of foreign aid in Haiti:The wind generators stand like monuments atop a hill overlooking the city of Baie-de-Sol, the capital city of the province. They are the first thing one sees approaching the city, five majestic windmills, each one capable of producing fifty thousand kilowatts of energy. But they are useless, vandals having long ago ripped out their electrical guts. I had difficulty learning about them. No one could remember when they were installed. Government officials reported knowing nothing about them.... From missionaries I was able to learn that an unremembered foreign aid organization had installed the wind generators in the early 1990s, and that U.S. military personnel had tried to fix them during the occupation. That is all I got. But it was enough because it is the typical story regarding development all over Haiti: “it is broken, can’t be fixed, and nobody knows anything else about it.” And that was the whole point. To me the wind generators epitomized foreign aid. Their guts ripped out, never having functioned for longer than a blan [foreigner] sat watching and caring for them.23

  We agreed that it was our duty to learn why foreign aid had failed, and to engage in goodwill efforts to improve it. Another of the duties of our small UN office (fewer than a dozen people, including volunteers) was to track pledges of development aid and see if they really ended up in Haiti. This process, which was directed by a hardworking and savvy young Australian on loan from UNICEF, Katherine Gilbert, marked the first time that one could check whether or not promised capital was moving. President Clinton also reached out to governments and agencies slow to keep their pledges, prodding diplomatically. These two interventions—a real-time window onto pledges and the courtly chivvying of the Special Envoy—led sometimes to more recriminations (including official letters of complaint from sovereign nations protesting that they had, in fact, fulfilled their pledges) but also started to speed up disbursement of some of the money. But this did not mean effective implementation, as Schwartz’s windmills suggested.

  Because many of the implementers were nongovernmental organizations, we also sought to develop a registry of NGOs working in Haiti. Nancy Dorsinville and Abbey Gardner, two longtime colleagues and friends who’d come with me to the UN, took on this project, promising to produce an online platform by the end of 2009. Although we found thousands of NGOs, we had no way to assess the quality or even the goals of their efforts. Sometimes we weren’t sure organizations were still in existence. (Official records had not been updated in years.) Most importantly, despite the fact that the NGOs with the largest budgets (those funded by the United States and other bilateral and multilateral donors) were providing services for which the government was responsible, government officials had no way to monitor or coordinate their work.

  We knew from experience that after the money arrived, if it did, issues of implementation would take over. Delivery of quality services and coordination of nonstate providers were the biggest challenges in health care efforts, certainly. For example, Partners In Health and Zanmi Lasante had recently built the Ministry of Health a small community hospital, our tenth together, for only $700,000, and thereby created another two hundred permanent jobs. But such projects seemed too modest to those looking at the big picture, and critics—they were too numerous to count in all Haiti endeavors—could always dismiss any one project as either irrelevant or unsustainable.

  Sometimes the small picture augured well for the bigger one, which invariabl
y included, in development jargon, both implementation and integration of efforts across diverse sectors: social services, energy policy, governance, economic growth. It wasn’t hard to point to regions needing improvement in all sectors—across Haiti but especially in isolated, rural areas. Part of my role as Deputy Special Envoy was to focus attention outside the “Republic of Port-au-Prince,” where all development meetings took place. Again, this idea was hardly innovative—integrated rural development is one of the great clichés in such circles—but implementation itself was innovation. “GSD,” as Clinton liked to say: get stuff done.

  Some of the UN leadership in Haiti, along with a few friends of Clinton, visited central Haiti together in the fall of 2009. On one excursion to the town of Boucan Carré, isolated by a river that often flooded, we visited a rehabilitated public hospital covered with solar panels placed by locals working with Walt Ratterman. (He, along with the Solar Electric Light Fund, had solarized clinical facilities with us in Rwanda, Burundi, and Lesotho.) There was nowhere Ratterman wouldn’t go to promote clean, renewable energy, and how he got those panels across the river was something I planned to ask him. He was all about GSD.

  In Boucan Carré, one obstacle to getting stuff done was the challenge of getting there during the rainy season. We’d been talking about building a bridge there for years, but Partners In Health didn’t have the expertise or resources to do so; the Haitian Ministry of Public Works was chronically starved of funds and expertise, too. In my UN role, I learned that the Brazilians had both military engineers and a robust bridge in a warehouse somewhere, and started importuning Mr. Annabi and the Brazilian force commander to help span the river at a place locals called fonlanfè—“hell’s deep.” Several people had died trying to ford the river, including two pregnant women the previous year, and we’d recently lost an ambulance there to a flash flood. With this coalition, I thought, we could surely build a proper bridge before the next rainy season. The Ministry of Public Works liked the idea, and so did the Brazilians, and so did Clinton. Denis OʹBrien, an Irish cell phone magnate with deep affection for Haiti, said he’d pay for the labor and the little stretch of land necessary.

  The people of Boucan Carré were also thrilled with the idea, as were the doctors and nurses there, including one of our protégés, Dr. Mario Pagenel, who had helped launch our efforts in Boucan Carré. Also pleased were all those who’d been stranded on the wrong side of the river when they needed the care we could offer in other, larger facilities. But getting the bridge up required a lot of paperwork, many meetings and calls, and then more paperwork. (One UN formality required that the Haitian government promise that no one involved in the project be harmed. The Brazilian general, as impatient with paperwork as anyone, scoffed at that stipulation, adding, with sarcasm, “I think we can take care of ourselves with the dangerous Haitians out there.”) I pestered Mr. Annabi by phone and e-mail, begging him to make it happen; I begged the Haitian government, too. Each party (excepting OʹBrien and the inhabitants of Boucan Carré) referred to certain forms that needed to be signed and approved. Just when we were starting to get discouraged about this fetishization of process, the Prime Minister (who also believed in the project) signed the last forms, Annabi gave the go-ahead, and a team of Brazilian engineers, a few Irish and American volunteers, and hundreds of Haitians pulled together to erect the bridge in a matter of days.

  This remarkable project, as modest as it might seem to engineers, was a reminder that even patchwork coalitions could complete important, lifesaving work.24 Ophelia Dahl described the bridge in a speech in the fall of 2009, a few days after it was completed:One of the areas in which we work is a commune called Boucan Carré, which has a clinic but is cut off for much of the year by a river, a river aptly named fonlanfè (or fond d’enfer—deep hell). This river has swept away patients who were forced to try to cross it to get help; it has gobbled up jeeps and an ambulance and even cattle being herded across to get to market. Many who have worked there said we must get a bridge. A bridge to cross deep hell to make sure that patients have access to the road so that they don’t bleed to death hoping that the waters recede. You’ll never get a proper bridge built in Haiti, said many. You need heavy equipment and the coordination of the government. You won’t cut through impenetrable red tape, you’ll need resources and engineers and soil experts, and it’ll never happen.

  Six years ago, we started in earnest to bring together groups who could help us, and we went down many a blind alley. We turned to engineering firms here, and when they saw what would be involved, they turned us down. But over time we found new partners: a cell phone corporation, a foundation. We had an engineer from the U.S. raise money and relocate to the village to move things forward. We enlisted a general, the chief of the UN forces, the Haitian government, and even President Clinton had a large role in bringing others into the enterprise. Our colleagues in Haiti added this to their list of jobs: Patrice [Névil], Louise [Ivers], Loune [Viaud], and many others. After six years and many false starts, Haitians were employed to help with the construction and, last week, we got word and pictures that the bridge was finished. It is a strong and handsome structure made more beautiful by its function; not just to provide access across the river but to save lives and transform a community. Together we can build extraordinary public-private partnerships and bring new people together to do whatever it takes to change the way the world works. Of course the bridge is an obvious metaphor for what we do, but so are the waters of hell. And I say if we can build a bridge over hell together, think what we can do for the mortal world.25

  Getting that bridge up made me believe that our small UN office—which was about nothing so much as building bridges—could get stuff done and on a larger scale. It was modest as a project but potent as a symbol, as were the glittering solar panels atop the Boucan Carré hospital. I wanted others to see that such projects could be accomplished in rural Haiti.

  Less than a month later, I crossed the bridge with one of Clinton’s closest friends, Rolando Gonzalez-Bunster (who runs a large Latin American energy company and donated a big generator to the General Hospital right after the quake). We were again part of a large UN convoy and protected by UN security, which amused my Haitian coworkers. They’d welcomed me to Boucan Carré many times, but never with such an entourage. Thinking of patients lost to flash floods, and even of our ambulance, I crossed the river in what most would consider the correct way: safely, a dozen feet above the rushing water. As I held back tears, I told our first-time guests about the two women who’d died in childbirth stranded on the wrong side of the river. I was pretty sure they were unimpressed by the engineering—why the fuss over such a simple bridge?—but the Brazilian general and my coworkers, Haitian and American and Irish, understood why I was so moved.

  But it was not to be a simple visit: as ever in Haiti, more drama awaited us. A few hundred meters past the bridge, on the rutted and muddy road to Boucan Carré, our convoy was blocked by an overturned UN truck that had scattered large sacks of food (none of it locally grown). We got out, planning to walk the rest of the way on foot, when some Haitian colleagues came to take us to the hospital. The main attraction for me was the fact that the hospital was by then almost entirely solar powered. Walt Ratterman wasn’t there, but the director of his Solar Electric Light Fund explained the system to Clinton’s friends and the UN visitors.

  The hospital was busy. My Haitian colleagues (and a few students from Harvard Medical School) showed us the facility, which had been built by reclaiming an abandoned building, erected many years ago as part of a failed development project. Right next to the hospital was a bank run by Fonkoze, a Haitian microfinance group offering financial services to poor women. The guests were also shown an ingenious charcoal-briquette maker that used sugar cane waste rather than trees, and the beginnings of a tilapia hatchery we’d started near the bridge.26 All I had to do was listen, but I couldn’t help thinking about the promise of decent implementation and of the proper integra
tion of efforts in health care, small businesses, pro-poor financial services, cleaner fuels, and better infrastructure. We were hoping that Rolando Gonzalez-Bunster and other guests would invest heavily in similar efforts across Haiti. It was a pretty impressive show and they said as much.

  The overturned truck was still obstructing the road on the way back. As we walked around it, the head of UN security (guarding me, ostensibly) asked anxiously if we could find a doctor. “I’m a doctor,” I replied with a mix of amusement and irritation: he was surrounded by medics, as Louise Ivers and David Walton were there, too. (My colleagues smirked a bit each time I was addressed as “sir” or “ambassador.”) The UN employees pointed to a woman in labor on the side of the road, carried there by family members on a homemade stretcher; they were trying to reach the hospital in Boucan Carré on foot. Louise and I examined her as discreetly as we could: She was in arrested labor and needed immediate attention in a hospital where, if necessary, she could have a Cesarean section. She needed modern obstetrics.

  We asked the head of UN security to take her not to Boucan Carré, but back over the bridge to the nearest Partners In Health affiliate—the hospital we’d just built for the Ministry of Health for $700,000. Thanks to the bridge, it was now only twenty-five minutes away. Off they went, with Dr. Walton in tow. We assured Rolando, whose birthday we celebrated over lunch in Mirebalais, that the baby would be born safely, attended by a nurse-midwife and an obstetrician. And two hours later, Walton joined us in Mirebalais with the good news: a healthy baby boy had been born into good care.27 I gave silent thanks not only to the Haitian doctors and nurses but to Mr. Annabi and the engineers who built the bridge. Due to the partnership, the woman had been transported over deep hell to the safety of a proper hospital—and thus to a fate far different from that reserved for the two women and their unborn babies the previous year.