In Haiti, building people, not things: Porter
Dr. Paul Farmer, who has saved hundreds of thousands of Haitian lives, talks about the rebuilding process and why he’s “not cynical at all.”
By hero, I mean Farmer has saved hundreds of thousands of Haitian lives over the past 28 years, both personally and through the “social medicine” organization Partners In Health, which he co-founded there.
He’s also been a huge champion of the country’s poor — pointing out repeatedly, in books and articles, how the world’s powers (notably the U.S., Canada and France) and the aid industry have bled the country dry and then blamed it for its weakened state.
Finally, he spent 2.5 years as the United Nation’s deputy special envoy for Haiti.
In Canadian terms, Farmer would be Terry Fox, Jack Layton and Naomi Klein all rolled up into one tall, very sunburned (he’s allergic to sunscreen) person.
He was here accepting a $1-million cheque from the Slaight Family Foundation to launch Haiti’s first emergency medicine training program.
That made him particularly happy. But, in general, I expected him to be cynical and depressed about the state of development in Haiti, five years after the devastating earthquake. Last month, I reread his 2011 book Haiti After The Earthquake on the flight to Port-au-Prince. In it, he uses the five-year anniversary as a meaningful milepost in the country’s development.
“Let’s say the date is now January 12, 2015,” he wrote. “What has happened to the rubble, the camps, the promised efforts to rebuild?”
His answer was two distinct scenarios. The first is gloriously hopeful. The country has harnessed the tsunami of aid to build social safety nets unknown there since Columbus hit a rock just offshore in 1492. There are new social houses, new free schools, solar panels and a wind turbine farm, and “more than two million Haitians have participated in public-works projects, bringing unemployment below 50 per cent for the first time in decades.”
The second scenario is depressingly bleak. The camps for the internally displaced are still bursting, few jobs have been created, cholera is endemic, people are still starving ...
“Did I really not give a third way?” he said, reaching for my copy of his book. “Clearly, the first scenario has not come to pass.”
Farmer had been firmly in the optimist camp, believing the tragedy would offer a new start for the country.
What went wrong?
“The whole reason this didn’t work is structural. (The aid model) is not designed to strengthen Haitian institutions, or transfer resources to Haiti. There was lots of talk about that, but structurally things are not set up that way. It’s set up as a contracting system, and the biggest contractors are American. So you shouldn’t ask ‘what went wrong.’ It went right. It was set up to work this way,” he says.
“For things to go right, the rules of the road have to be rewritten.”
The model he gives is his own — the university hospital of Mirebalais, built by Partners in Health 60 kilometres outside of Port-au-Prince and opened two years ago.
I visited the hospital last year and was stunned. It seemed like something you’d find in rural Canada, not rural Haiti: a pharmacy stocked with expensive chemotherapy drugs (a first for a public hospital there), a gleaming new $700,000 CT scanner (the first in a public hospital), three operating rooms with full-time trauma surgeons (also, sadly, a first).
I met a 57-year-old HIV patient being treated for tetanus — a deadly disease. The hospital had undoubtedly saved his life for $1.15 — the price of a hospital card (another first in a large public hospital.)
Farmer is right to be proud of the end product. But it’s the process he’s talking about.
First, the hospital was built with the prompting of the Haitian government. It is a public hospital, and the government now delivers $8 million (U.S.) in its operating costs.
But, more notably, it was built with Haitian labour, trained on-site by American volunteers.
One thing I often hear from foreign businessmen in Haiti is that it’s very difficult to find local expertise. Some 85 per cent of the country’s university graduates have traditionally emigrated elsewhere. The firms that do exist are small — they can’t produce the quantity for mega building projects.
When Jim Ansara, in charge of the PIH’s hospital construction, started looking for locals to wire the new facility, that’s what he found: no expertise. Instead of hiring an American firm, he eventually convinced members of Boston’s International Brotherhood of Electrical Workers (an electrical union) to volunteer in Haiti, wiring the new hospital buildings and training local Haitians as they did so.
They worked the same model for plumbing, masonry, carpentry, building maintenance, metal work.
“I’d be lying to you if I said it was smooth,” Ansara says. But, in the end, 185 volunteer professionals trained an estimated 550 Haitian workers with advanced, technical skills that are, clearly, in high demand in Haiti. Two of the newly trained electricians are now wiring another PIH hospital, according to Ansara.
“The mosaic artists we trained all have full-time work now,” Farmer says.
It is more complicated than hiring an American firm to do everything, top to bottom. But, even hospitals won’t save lives without trained people working in them. In the end, development should focus on building people, not things.
Farmer is taking the model to Liberia and Sierra Leone, where PIH is planning to build public hospitals. Ebola highlighted the weak health systems in those countries, just as the earthquake did in Haiti.
The legacy of Haiti’s earthquake, he says, is “aid needs to be done differently.”
“We have to keep trying to do it,” he says. “I’m not cynical at all. Cynicism is a dead end. These things are doable — we’re not driving a Range Rover to Mars.”