Dr. Paul’s prescriptions for Haiti’s ills

Reviewed by Roger Annis

From Tuesday’s Globe and Mail
Published Monday, Jul. 25, 2011 6:00PM EDT

Paul Farmer has written an essential book for understanding the country that was shattered by the earthquake of Jan. 12, 2010.

The stark drama of the days and weeks that followed goudo goudo (the neologism whose vocalization, Haitians say, most closely resembles the sound of those frightening moments when the earth shifted) is dramatically captured in his personal account of rushing to the country to join Haitian and international medical colleagues in treating earthquake victims. Thirteen of his colleagues and family members, as well as other writers, also recount their experiences and observations in the form of short essays and a powerful foreword to the book.

Haiti After the Earthquake, by Paul Farmer; Public Affairs, 429 pages, $30

Haiti After the Earthquake, by Paul Farmer; Public Affairs, 429 pages, $30

The uniqueness of Farmer’s written contribution to this new stage of Haiti’s history is the piercing historic and social/political dimensions he offers to the reader. He brings to its pages a deep examination of Haiti’s vulnerability to the devastating blow it suffered and the sharp shift in policies and practices now required if the country is to move forward. In so doing, he offers insights into why, 18 months later, the relief and reconstruction effort is bogged down.

“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 over the past four decades,” he writes in the opening pages.

Farmer has long been a sharp critic of the role of foreign governments and agencies in Haiti, most particularly the U.S. government. His 1995 The Uses of Haiti is a valuable primer on the country’s history.

As a Harvard University medical graduate, Farmer was a co-founder of the renowned global health agency Partners In Health. Haiti was the country of PIH’s beginnings, in the mid-1980s. The agency, alongside its Haitian partners, Zanmi Lasante and the Health Ministry, has blossomed into one of the country’s largest health providers, serving more than one million people in Haiti’s Central Plateau and Lower Artibonite regions and, since 2010, tens of thousands in the earthquake zone, including the largest displaced-persons camp in Port au Prince.

In Haiti, PIH has pioneered new and successful approaches to the treatment of HIV/AIDS, drug-resistant tuberculosis and a host of other poverty-related diseases, falsely considered intractable by some in global health circles.

“Doctor Paul,” as PIH’s patients fondly refer to him, titles one chapter of the new book A History of the Present Illness. It traces the long history of destructive, foreign intervention. Elsewhere, he describes how the embargo of development aid to Haiti’s government imposed by the United States (and Europe and Canada) after the 2000 election prevented the building of water-treatment facilities in the very region of the country where cholera was inadvertently (but negligently, all the same) introduced in October, 2010. (Joia Mukherjee, medical director of Partners In Health, who pens the foreword to Haiti After the Earthquake, wrote a scathing commentary on this precise story at the time the epidemic struck.)

Again at the outset of the book, Farmer describes the oft-misguided “proliferation of goodwill” directed at Haiti over the decades that has produced such poor results. “Thus did clinics sprout up without much aid to the public-health system; thus did schools arise by the hundreds even as the Ministry of Education faltered; thus did water projects proliferate even as water security (like food security) became enfeebled.”

His central prescription for righting Haiti’s woes is the fostering of strong national government and public institutions, financed by a national taxation system and assisted by foreign aid that develops Haitian capacity, rather than undermining it or serving intervention.

If there is one piece of the Haiti puzzle absent from the book that warrants attention, it is the Security Council military and police mission in Haiti known as MINUSTAH, now into its eighth year. Serious questions need to be asked about the legal basis of its presence as well as its exorbitant cost, amounting to many hundreds of millions of dollars a year.

Farmer’s engagement in Haiti took a turn in August, 2009, when he accepted an appointment as deputy special envoy on Haiti to the United Nations from the secretary-general’s special envoy on Haiti, former U.S. president Bill Clinton. There were those who worried that his critical voice on Haiti could be blunted in exchange for the greater policy influence he could presumably exercise in the new role. Thankfully, his voice is as sharp and perceptive as ever.

Roger Annis is a co-ordinator in Vancouver of the Canada Haiti Action Network. He just returned from directing a four-member, 10-day fact-finding mission to Haiti.


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