Saturday, August 28, 2010

Haitian Hearts has 141st Patient Accepted in to the USA

When I was working in Haiti in July a very sick man came to clinic early one morning. He was in terrible congestive heart failure and arrived on the back of a little motor scooter.

He has been accepted into a medical center in the USA and will be arriving soon.

See Maria's blog for further details.

Wednesday, August 25, 2010

Haiti's Seaport...Corrupt and it Must Change

Posted on Sat, Jul. 17, 2010
Seaport, the engine of Haiti's recovery, is sputtering

PORT-AU-PRINCE -- The day the ground buckled, a $3.2 million crane crashed into the water off this country's main seaport, the pier crumbled and cracked containers spilled into the sea.

Six months later, the crane and containers remain in the water and two floating barges have temporarily replaced the pier.

The Port-au-Prince seaport, a main economic driver of Haiti's economy, is critical to the country's recovery from the worst natural disaster in the Western Hemisphere. But six months since the Jan. 12 catastrophic earthquake, the facility remains crippled.

The international community and aid groups complain bitterly that Haiti's government has failed to present a master plan to revive the port sector -- criticized as a pocket of government neglect, cronyism and fierce rivalries even before the disaster.

``The port is a broken asset,'' said Adrian van der Knaap, head of operations for World Food Program Haiti, one of the largest users of Haiti's ports.

``The island needs well-functioning ports. It can be much, much better than it is now.''

Samuel Perez, formerly U.S. military commander in charge of reopening the port, was more blunt.

``The Haitian government has to come to grips with how they are going to reconstruct that port,'' said Perez, who spent three months here. ``The port people are very, very satisfied with the fact they are making money hand over fist. . . .They are fleecing poor Haitians.''

Any long-term improvement in Haiti's economy depends on both repairing and reforming the country's ports system, including its underused and neglected ports.


Tackling the ports and their entire supply chain, including customs clearance, could be the litmus test for a 31-member reconstruction commission chaired by Haitian Prime Minister Jean-Max Bellerive and former U.S. President Bill Clinton.

``A lot of issues are going to come on the table as a real condition to invest in Haiti and the port is one of the first on the list,'' Bellerive told The Miami Herald. ``I don't see how we can dodge on that.''

But Haitian President René Préval's government, like Haitian governments since the main seaport was constructed in the 1970s, has refused to provide transparent and clear rules on how port facilities should operate, critics say.

The port -- located next to a sprawling seaside slum and congested downtown -- has come to symbolize the Haitian government's shortcomings:

Before the quake, the port was a cash cow, earning millions from a $310 wharfage tax on every 20-foot container brought into Haiti. But instead of investing the money in equipment and upgrades at all government ports, the money went to paying the salaries of hundreds of unnecessary and ghost employees, government officials said.

``The port became more of a social program rather than a commercial program,'' said Hughes Desgranges, senior advisor to the director general of the National Port Authority (APN), the government overseer. ``You have a port that can be the engine of the Haitian economy, but it's been badly steered.''

At the same time, the government discouraged the expansion of private ports in the capital and other seaside cities, cornering the shipping market for the Port-au-Prince port.

The few port improvements over the years have been modest at best: In a post-disaster report, the government conceded that the port's cranes were insufficient for major shipping, and the channel was never dredged, preventing large ships from docking.


Its flaws have made the port among the most expensive in the world for consumers and haulers. Although it falls under the auspices of APN, a cadre of shipping agents and terminal owners operate everything from the cranes to the warehouses. The port is also among the least efficient shipping hubs in the world, according to a recent survey by the International Finance Corporation, an arm of the World Bank. To complete shipment of a 20-foot container of dry goods to Haiti, it took an average of 33 days, the survey found, compared to 10 days to ship to the neighboring Dominican Republic's main port.

The same study estimates that the cost of port and terminal handling fees for Haiti is $700 for imports. In the Dominican Republic, it is $460.

The various costs and inefficiencies deter serious investments or job creation.

Since the quake, complaints have mounted. Prospective investors struggle with congestion. Increased costs include a $300 fee that port operators now charge to cover the leasing of barges for offloading cargo.

``It's scandalous,'' Mark Billingham, a frustrated British businessman, said about all the costs, after paying $32,000 to move his 78 containers onto land.

``The corruption is blatant, the bureaucracy and uncertainty, a terrible mix,'' he said.

Billingham said his company, Modular Construction, had planned to invest in Haiti, but the experience has soured him.

``We are going to do the best we can to build and sell some schools, recoup our money and say `Adios' to Haiti,'' he said.

Soon after the 7.0-magnitude earthquake rocked Haiti's capital and nearby cities, the country was forced to turn to the Dominican Republic to truck in life-saving aid.

With a government-estimated 300,000 dead, an equal number injured and surgeons forced to sterilized instruments with vodka, the port became critical to saving lives.

But the already unstable northern pier had crumbled into 1,476 feet of rubble under the sea, and the southern pier was badly damaged. Long-neglected provincial ports were either too small to handle the flood of containers, or the roads connecting them with the broken capital were themselves broken.

The international airport was also damaged, diverting flights.


With the U.S. military commander pressuring to get the main seaport operational, the southern pier was repaired and the decision was made to lease two 100- by 400-foot floating barges from Jacksonville-based Crowley Maritime Corp.

As the U.S. military's $22 million contract with Crowley came to an end on April 15, the maritime agents said they took over the contract at the request of APN.

``We could not allow container flow to stop. We had to accept those costs,'' said Geoffrey Handal, assistant general manager of ETS. J.B. Vital and a member of Association Maritime D'Haiti (AMARH), the 10 agencies and three terminal owners operating in the port.

In an interview with The Miami Herald, AMARH representatives said they've received a bum wrap.

``The port itself is efficient. It's once you get to the container yard and to customs and you have to deal with all of the paperwork,'' Handal said. ``Doing business in Haiti is frustrating whether you are importing or not, or using the port facilities or not.''

Still critics argue that the entire ports' supply chain has an image problem. Some in the international community suggest a true privatization model where APN's roles as operator and regulator are separated.

``You have a private sector that has made the investment but what has been lagging is the public sector's ability to either effectively help manage that process, or step back and ensure there is enough separation that allows them to regulate the port environment,'' said Anton Edmunds, who advises Caribbean businesses, and is familiar with the challenges of Haiti's ports.


In January, Bellerive asked the International Finance Corporation for an assessment of Haiti's port sector. He disagrees with the current model, he said, because while APN controls the monopoly and should be operator, it has relinquished that role to the private sector, while not allowing competition from non-government owned ports. ``I am not a port specialist, but I cannot accept ideologically that somebody tells me that they are against competition,'' he said. ``I cannot accept that.''

AMARH members say they support privatization, but the field must be level and transparent. The government, they argue, cannot simply shut them down without compensation after they've invested more than $70 million to keep its port facility afloat, at the government's behest.

Bellerive says all the government has is the monopoly. Still, doing away with it will not be easy, he concedes, even if ``there is a lot of political will.'' Any swift decision to change the status quo, could quickly trigger an internal crisis in a country prone to conflict.

``If you close the port for one week, it's going to be a major crisis inside Port-au-Prince because 80 percent of everything that is entering is going out through the port. The people who have a lot of interests, they know that we are afraid of that,'' he said.

Two years ago, the government did quietly clean out the port, cutting the workforce to 500 workers from about 2,000, Alcime Henry, head of port operations, said.

But little else has been done in way of reform.

Meanwhile, the debate over the future of Haiti's ports has become cast in a bitter battle between two powerful Haitian tycoons -- Edouard Baussan, who heads AMARH, and Gregory Mevs, whose family operates a private terminal and port just two miles from the main port.

``It is not a clash of personalities. It is about port policy, a level playing field, uniform application and respect by all of rules and regulations,'' AMARH said in a statement.

In March, the Mevs family announced a $70 million investment project with Miami-based Sante Shipping to redevelop their private Terminal Varreux, and tap into a growing transshipment market with the 2014 expansion of the Panama Canal.

The plan included building two deep-water jetties for container cargo at a cost of between $20 million and $25 million.


The announcement raised eyebrows in Haiti as some questioned whether the company had authority from APN to make such an investment. Under Haitian law, APN is the only one that can grant permission to develop a port, or allow one to receive containers, the more lucrative of the cargo.

Bellerive, who wrote a letter to the Mevs on Jan. 18 allowing for them to make infrastructure investments, says it's clear to him ``they have the authority.''

``I'm very optimistic that the executive branch and the government will respect their contractual obligation with Terminal Varreux,'' Mevs said. ``I know that this government is committed to turning an important page in Haiti's history.''

Mevs has long argued that the government port monopoly is unfair.

But others argue that inviting competition in a country that doesn't receive enough containers could hurt the government port.

``International and private investors are willing to put the money, and private investors should be allowed to compete,'' Mevs said. ``What's important is to build additional facilities, improve competition and service so that prices go down.''

Observers in the international community say Haiti has to get a handle on its ports sector. ``Haiti must become a better, easier and more attractive place to do business,'' said Tony Chan, deputy mission director for the U.S. Agency for International Development in Haiti. ``But in order for this to happen, all of the links of the country's major supply chains have to properly function.''

Herald staff writer Scott Hiaasen contributed to this report.

Tuesday, August 24, 2010

OSF's Keith Steffen and Long Waits in the Emergency Department

In today's Journal Star there is an article on long waits in the nation's emergency rooms.

Dr. Nick Jouriles, emergency medicine chief at Akron General Hospital in Ohio was quoted in the article:

"The longer people stay in the emergency department, the more likely they're going to have complications, deaths. If they are elderly, they're more likely to end up in the nursing home."

In 2001 I wrote Keith Steffen, CEO at OSF-SFMC in Peoria this letter.

The next day I was put on probation for six months and Keith referred to me as "a malignancy in the emergency department."

I think OSF-SFMC was keeping the hospital full of elective surgical cases to the detriment of my Emergency Room patients.

A few months later Mr. Streffen fired me, and in July, 2002 he cut all OSF funding of Haitian Hearts patients.

Tuesday, August 17, 2010

Will Saint Francis Really do this?

Will OSF allow Jenny to die?

How could OSF do this?

OSF has a shining brand new 300 million dollar medical building. But was this building worth it if the life of one Haitian is ignored?

If Jenny were in Peoria, we wouldn’t keep her invisible. If she asked for medical help, the Peoria community would try and help her. Jenny lives 90 minutes from Miami.

The best medical technology in Peoria should not be used in a discriminatory fashion. Will OSF allow Jenny to die in Haiti with no medical technology at all?


Photo by John Carroll

Examining patients in Haiti is a very humbling experience for me.

When I look at the patient sitting on the examination table in front of me I realize there is no difference between the two of us. We are the same being. He just happens to be in a worse way that particular day than I am. And deep inside I realize some day I will be in his position one way or another.

When one is strong and seemingly in control one can be mistaken and think that he will always be in control of himself and his environment. But that is just not true.

Someday we will all be Haitian-like. We will be looking into someone's eyes pleading for help for ourselves. Will the other person be kind and at least try and help some? When our day comes hopefully we will have some of the dignity that Hatiians display during their dark hours.

John A. Carroll, MD

See the abstract below about humility in medicine.

"The new professionalism movement in medical education takes seriously the old medical virtues. Perhaps the most difficult virtue to understand and practice is humility, which seems out of place in a medical culture characterized by arrogance, assertiveness, and a sense of entitlement. Counter cultural though it is, humility need not suggest weakness or lack of self confidence. On the contrary, humility requires toughness and emotional resilience. Humility in medicine manifests itself as unflinching self-awareness; empathic openness to others; and a keen appreciation of, and gratitude for, the privilege of caring for sick persons. Justified pride in medicine’s accomplishments should neither rule out nor diminish our humility as healers."

Jack Coulehan, MD, MPH
Annals of Internal Medicine Vol. 153 Number 3
August 3, 2010

Sunday, August 15, 2010

President Preval

Photo by John Carroll

Haitian quake shook leader to his core

'As a person I was paralyzed,' says President Rene Preval, recalling the suffering he saw. He's quiet for a politician, even humble; but his silence since the disaster enrages many.

By Joe Mozingo, Los Angeles Times

August 15, 2010

Reporting from Port-au-Prince, Haiti — Haitian President Rene Preval peers off and rubs his beard when he thinks about those 35 seconds when the earth convulsed.

Preval was feeding his 8-month-old granddaughter dinner in the courtyard of the presidential mansion. They were thrown to the ground as the house collapsed. Unable to reach anyone on the phone, Preval jumped on the back of a motorcycle taxi and directed the driver toward downtown. Wending through the rubble in the dark, he couldn't comprehend the scope of death and ruin.

"Pain made me speechless," he says during a two-hour interview in an office behind the half-collapsed National Palace. "As a person I was paralyzed."

In the days and weeks following the Jan. 12 earthquake, Haitians desperately wanted to hear from their leader. Soon they were furious at his silence.

"I was much criticized for not having spoken.... To say what? To the thousands of parents whose children were dead. To the hundreds of schoolchildren I was hearing scream, 'Come help me!' " He pauses and sighs. "I couldn't find the words to say to those people."

Preval, 67, a quiet former agronomist with a gap-toothed smile and silver beard that some Haitians suspect has magical powers, has always been an enigmatic figure. He concluded his first term as president, in 2001, with a prophetic warning of the chaos to come — "Swim to get out" — and retreated to a tiny home in the northern mountains to help peasants grow bamboo.

When he ran again in 2006, he barely campaigned and said almost nothing. Political observers were perplexed by his candidacy, because he never seemed to really like being president. He certainly never showed the thirst for power of any of his rivals or predecessors, and his return to the National Palace felt so casual as if to be almost accidental.

So did his success. Preval's government quietly settled a gang war that had paralyzed the capital, stopped a horrific spate of kidnappings, restored regular electricity, reformed a corrupt police force, and secured trade preferences from Washington. And despite being hit by two destructive hurricanes, Haiti experienced a semblance of political stability for the first time in decades.

The world didn't notice because, for once, Haiti was not in the news.

"He came in when the country was at war," says Michele Montas, a longtime journalist and now a special advisor to the head of the United Nations mission in Haiti. "He brought the opposition into the government. He tried to reassure the private sector. As a journalist in this country for 30 years, I've never seen a political figure as shrewd as Rene Preval.... Can you imagine a politician who gets to power and he didn't even campaign?

"I really think he's misunderstood. But to some extent it's his own fault."

Haitians have long grumbled about Preval's inability or unwillingness to speak to the masses and pitch a vision of the future. But when the earthquake killed an estimated 230,000 people, displaced more than a million more and leveled whole swaths of the capital, what was once seen as a tolerable quirk in a humble man became a focal point of the nation's outrage.

Asked what Preval has done for the country, people in many parts of the capital grimace or swipe their hands in disgust, as if the answer is so obvious that the question itself is an outrage.

"Preval didn't do a damn thing," says Kerby Badio, 28, living in the sprawling tent camp outside the palace that Haitians call the White House. "He can't even get the palace fixed. If a country doesn't have a White House, it's not a nation."

Badio voted for Preval in 2006 because he thought he would make life better for the poor. But the president's seeming absence after the earthquake crystallized a feeling that he didn't empathize with their suffering.

"When a country goes through something like that, everyone looks for a president to say something. He didn't say anything for weeks. He was just riding around on his motorcycle," Badio said.

In nearby Fort National, residents were furious when the government razed homes to cut new road corridors. "We didn't know what was being done," says Victorin Richard, 22, whose little hut was among those cleared. "We thought they were building new houses. Now we hear it's a road. It's just going to be dust. They'll never finish it."

All of this has big political implications for the country's recovery in a presidential election year. Preval, who cannot run for reelection, founded a new platform, Unity, to maintain some political continuity when he departs. But his lack of popularity leaves the election wide open, with many people on the streets saying they'd vote for hip-hop singer Wyclef Jean.

Foreign aid groups and diplomats have complained that Preval has been indecisive and has failed to settle key issues of where to settle the displaced.

"We know that it is not an easy task," says Julie Schindall, a spokeswoman for the relief group Oxfam, which supplies clean water to the camps. But the people in the camps "are living on the edge. And they need to know what the future holds."

Still, longtime Haiti observers view this in context of the turmoil before. Mark Schneider, a senior vice president at the International Crisis Group, a nonprofit group devoted to resolving deadly conflicts, says Preval has done "a remarkable job, given the half-functioning government, given the level of malaise, unhappiness and corruption previously."

"People say they're looking for a father figure to say things are going to be OK," Schneider says. "And he just doesn't do that. The instinct in his gut is that if he doesn't see evidence that that's going to happen, he's not going to say it."

But Schneider acknowledges that Preval needs to better explain his plans to the public.

"There's frustration and uncertainty. People are asking, 'What's next?' "


Preval rode to power on the wings of his political mentor, the fiery slum priest-turned-president, Jean-Bertrand Aristide.

The two had become friends when Preval owned a bakery that supplied free bread to Aristide's church. When he succeeded Aristide as president in 1995, they had grown estranged, and Aristide was unwilling to give up his power, having his own loyalists embedded in the police and government and using street gangs to terrorize opponents.

The message of who really ruled was made clear when Preval and his then-wife found their dog dying of a machete blow — inside the National Palace.

His weak position hit its nadir in 2000 when his best friend, the crusading radio broadcaster Jean Dominique, was assassinated after accusing various Aristide acolytes of corruption and thuggery. Preval was devastated. He appointed a judge to investigate, but when Aristide succeeded him in 2001, the judge found his budget and security suddenly withdrawn, and fled to Miami.

Still, Preval's first term was noted for many improvements — new roads, schools, hospitals. He cleaned out many of the "zombie" employees on the government payrolls and investigated human rights abuses.

He has always said he prefers practical steps to sweeping ideology or rhetoric.

In person, Preval is nothing like the stiff, distant man in front of the microphone. He is open, humorous and human like few politicians, admitting his frailties and chatting without the salesman sheen. Walking with a reporter behind the National Palace, among roaming chickens and peacocks, he puts his arm around an elderly man with light eyes and white hair.

"He looks just like me," he says. The man smiles dutifully, clearly having heard this before.

He approaches another worker he knows and says, "He's on his way to an anti-Preval demonstration."

The man shakes his head, somewhat nervously, until Preval laughs and pats him on the back.

In the office, he ruminates on why his people seem to be turning against him. On the wall is a poster of Dominique, with the words "We Will Never Forget" in Creole.

Preval details a range of plans to build temporary shelters, followed by tall apartment buildings, to bring order to the teeming neighborhoods where houses were literally built on top of one another. He appointed a civil engineer to work with U.N. officials and relief organizations to settle land disputes and find suitable places for the people in the tent camps.

"If the people know that within five years there will be apartment buildings, they will go," he said.

But he knows he is in no position to promise them this. The election to replace him is scheduled for Nov. 28. The U.N. advisors working on the issue hadn't even heard of this apartment idea, and appeared to be waiting for his successor to grapple with long-term issues.

He hopes he can make some headway before his legacy is sealed by catastrophe.

"There was so much death, so much suffering, one has to find a person responsible for that. Since they can't accuse the one up there," he says, pointing up, "they are accusing the one in the palace. Sometimes you have the impression people are accusing you of actually causing the earthquake."
Copyright © 2010, Los Angeles Times

Nyoung at 5:25 AM August 15, 2010
Michele Montas is the widow of Jean Dominique. Dominique is described as having been Preval's "best friend" in this article. That should have been mentioned because it undermines its credibility to just have her presented as a neutral expert journalist. I don't know if the author just didn't know she was related or chose to withhold the information...It seems that the "quiet humble" Preval is on an orchestrated PR tour -- I've seen a couple of articles like this recently. Clearly, the situation in Haiti is the very definition of complexity and it's possible that nobody could have done better than Preval has...but well before the earthquake there was a widespread perception among the poor that Preval had deserted them and that should not be so easily discounted as merely being the result of his communication style. I suspect the Haitian poor are infinitely more misunderstood than Preval is.

huitzilopochtli88 at 1:44 AM August 15, 2010
The article appears to be skewed to portray Mr Preval as a victim and a hero.

However, was he not the man in charge when the country was told their seismic building standards were inferior and a moderate earthquake would cause buildings to collapse? He sat there doing nothing and ignored those warnings. If he were in charge in some countries and did nothing as he did, he would be cast out with a ceremonial sword and you can guess what the prime directive of that ceremonial sword would be intended for.

RJM Haiti at 9:59 PM August 14, 2010
Thank you. Finally a voice that recongnizes the HUMAN Rene Preval. How easy it is to expect our leaders to be super human. The night of that terrible earthquake Mr. Preval personally lost close workers and some of the brightest among his young government associates. Anyone who works in trauma and grief counseling understands that he could not reach out until he reached in and allowed some inner healing. Thank you also for giving credit to Mr. Preval for what he has done for Haiti since he is in office. Haiti, though far from perfect, really IS better for his having been president.

Saturday, August 14, 2010

US Congress Must Pressure Haiti

Photo by John Carroll

Congress must put pressure on Haiti

By Mark Weisbrot, August 14, 2010

WASHINGTON — The “international community” is in
charge of rebuilding Haiti, and one thing has
become clear: it is not interested in any kind of
democracy there, not even the low level of
“democracy” that it has committed to in Iraq or

Haiti’s provisional electoral commission has
decided, once again, that the country’s largest
political party, Fanmi Lavalas, will not be allowed to
participate in parliamentary elections scheduled for

This is the equivalent of excluding the Democratic
Party (actually something quite a bit larger) from U.S.
congressional elections in November.

So far there are no indications that the Obama
administration, which has — to put it mildly — e
normous influence over the government of Haiti,
has any objections. It had supported the last
elections in April 2009 that also excluded Fanmi
Lavalas, even though the exclusion led to a boycott
of 90 percent of voters.

To follow the historical thread, Fanmi Lavalas is
headed by Jean-Bertrand Aristide, who became Haiti’
s first democratically elected president in 1990. He
was overthrown by the military seven months later,
in a violent coup that had a lot of Washington’s
fingerprints on it.

President Clinton restored Aristide three years later,
but Aristide offended Washington by, among other
things, getting rid of Haiti’s brutal army — which
was not so much a military force as an instrument of
political violence on behalf of Haiti’s ruling elite.

Paul Farmer of Harvard Medical School was Bill
Clinton’s deputy special envoy at the United
Nations. His “Partners in Health” has nearly 5,000
people in Haiti. Testifying in late July at a
congressional briefing, he described what
happened after Aristide and his party were elected
for a second time, in 2000:

“Beginning in 2000, the U.S. administration sought .
.. to block bilateral and multilateral aid to Haiti,
having an objection to the policies and views of the
administration of Jean-Bertrand Aristide, elected by
over 90 percent of the vote. ... Choking off
assistance for development and for the provision of
basic services also choked off oxygen to the
government, which was the intention all along: to
dislodge the Aristide administration.”

It was the second Bush administration that finally
overthrew Aristide for the second time — in the
coup of March 2004.

But as Farmer notes, the process was initiated under
the Clinton administration in 2000. And the Obama
administration is currently supporting efforts to
prevent Aristide from returning to his country, a
violation of Haiti’s constitution.

If only Washington were a tenth as good at
rebuilding Haiti as it was at destroying the country
before the earthquake. But six months after the
catastrophe, less than 2 percent of the 1.6 million
homeless have homes.

Hundreds of thousands have nothing at all; and 80
percent of the homeless that do have shelter are
living under tarps where the ground under them
turns to mud when it rains.

And less than 2.9 percent of all aid money has gone
to the Haitian government, which makes
reconstruction nearly impossible. With a hundred
thousand children wounded from the earthquake,
Advertisement public hospitals are closing.

The land that is needed for shelter is owned by rich
Haitians, who have other plans. The Haitian
government has the authority to take this land, with
compensation. The international community can
make this happen.

It’s time for members of the U.S. Congress to step up
to the plate and change our foreign policy toward
Haiti, as they did after the 1991 military coup.
Congress can make sure that the aid flows to where
it is needed, that land and shelter are available, and
that Haitians are allowed to elect their own

After all that Washington has done to punish Haiti,
this is the least they can do.

Mark Weisbrot is co-director of the Center for
Economic and Policy Research. Readers may write
to him at CEPR, 1611 Connecticut Avenue NW, Suite
400, Washington, D.C. 20009-1052; Web site: www.

Rebuilding Haiti

Rebuilding Haiti Requires New State-Building Strategy

(Rand Corp. report – Friday, August 13)

Haiti's future prosperity and peace depend on its ability to build a more resilient state, one capable of providing public services like education and health care as well as responding effectively to natural disasters, according to a new study from the RAND Corporation.

Even before a 7.0 magnitude earthquake battered the Caribbean country in January, its state institutions were riddled with weaknesses in human resources, organization, procedures and policies. Now, with the international community having pledged nearly $10 billion in aid, priorities need to be set and state building should be at the forefront of earthquake recovery efforts, according to RAND researchers.

“Many studies have identified Haiti's most-pressing problems, but what haven't been focused on are the state institutions themselves: how to make them stronger and more resilient,” said James Dobbins, a co-author of the study and a senior fellow at the RAND Corporation, a nonprofit research organization. “Haiti will remain vulnerable to natural disasters, political turbulence, and civil unrest until it develops effective institutions.”

The RAND study finds that most plans and proposals for rebuilding Haiti are too broad in scope, too ambitious in their objective, and fail to set priorities or lay out a sequence for introducing changes. The study identifies the main challenges to a better government and proposes a realistic set of actions. Specifically, it recommends the Haitian state and international donors focus on public administration, justice, security, economic policy, infrastructure, education and health care.

In preparing the report, RAND researchers spoke to representatives of the Haitian government, international organizations, key donor agencies, people in the Haitian private sector, foreign investors and nonprofit organizations that work in Haiti. Dobbins, director of RAND's International Security and Defense Policy Center, previously served as the Clinton administration's special envoy to Haiti.

Haiti is the poorest country in the Western Hemisphere, with a per-capita income less than a quarter of the average for Latin America and the Caribbean. The country has no coherent public education or health care system, its judicial system is a shambles and the state has created a hostile environment for business, according to researchers.

Nevertheless, the situation is not hopeless. Following a change of government in 2004, Haiti enjoyed five consecutive years of economic growth and made tentative progress toward better governance. With the right institutions and incentives, the country can not only recover from the earthquake that killed more than 300,000 people, but embark on a period of improved public security, social well-being and sustained economic growth, according to the study.
“State-building may not have the same appeal to international donors as erecting new buildings, but it's got to be done if Haiti is to successfully rebuild itself,” said Keith Crane, a study co-author and a senior economist at RAND. “International donors have poured billions into Haiti, but they have not focused on creating sustainable institutions to provide a payoff from those investments. For example, roads have been constructed, but until recently donors failed to ensure that the Haitian state would maintain those roads. Donors have invested in new power plants, but some power plants have ceased operations because not enough money was charged and collected to pay for fuel.”
Identifying the state's core functions — with a focus on those that promote security, stability, and economic growth — should be the first step of any state-building strategy, researchers say. Next, Haiti needs to establish what actions are top priority, and create a set of deadlines and responsibilities.
Laurel Miller, co-author of the study and a senior policy analyst with RAND, identifies judicial and corrections reform as critical. She recommends that the Haitian government and the United Nations continue to maintain an international military and police force in Haiti for at least the next five years, while reforms to judicial and penal systems are put in place.
The study also recommends:
· International donors should work with the Haitian government to create a modern civil service replete with job descriptions, pre-determined qualifications for positions and a competitive process for recruitment, hiring and promotion.
· To make reconstruction possible, the Haitian government and the donor community should make rubble removal the most important priority. The Haitian government should make immediate arrangements for depositing rubble; the international community should provide funds and equipment as quickly as possible.
· To accelerate economic growth, the Haitian government should quickly eliminate unnecessary procedures involved in registering businesses and property, and reduce the cost and length of time needed for those actions.
· The Haitian state should focus on monitoring and regulating the delivery of education and health services, not providing those services itself.
· Major donors — including the United States — should submit all project and program concepts to the Interim Haiti Recovery Commission for coordination, to achieve more coherence among the various reconstruction and reform programs.
The study, “Building a More Resilient Haitian State,” can be found at

Wednesday, August 04, 2010

Relief Efforts in Haiti: Good or Bad?

Photo by John Carroll

Posted on Sat, Jul. 31, 2010
Haiti relief efforts: Doing good, or doing harm?

PORT-AU-PRINCE -- In the weeks and months of desperation that came after the January quake in Haiti, hundreds of do-gooders -- from emergency doctors and disaster specialists to animal lovers, movie stars, and even clowns -- have poured into the flattened capital.
More than six months later, Haitians say the outpouring of charity in the relief effort from organizations both big and small was welcomed. It was critical to helping save lives and feeding the hungry.

Under debate, though, is who is best qualified to respond to natural disasters. Now, as Haiti enters the height of the hurricane season and its potential for flash floods and landslides, that question takes on more urgency. Last Tuesday, the precarious situation became evident once again when two children died after rain caused a wall to collapse on top of their tarp home in one of the 1,000-plus camps that still house many left homeless by the earthquake.

Small groups argue that their nimbleness allows them to move much more swiftly to the location of a disaster than some large, more established humanitarian groups. They count common sense and eagerness to pitch in as their best assets, and some of them have spent years here.

Global health experts counter that while the relief efforts of grass-roots charities are appreciated, sometimes these groups lack experience and get in the way.

``There's a lot of good that can be done, but there's also a great deal of harm that can be done,'' said Jeff Wright, a disaster response specialist with World Vision, a Christian humanitarian organization. ``Who should respond are those with competence.''

Wright and other public health professionals found some do-gooder groups seeking to help -- only to find they hampered urgent relief efforts and sometimes competed with Haitians for scarce resources.

As aid workers try to shelter and relocate 1.5 million displaced people, nongovernmental organizations, or NGOs, also have come under fire for working at cross purposes. A property owner in the city of Delmas, for example, wanted to evict several hundred squatters, but NGOs kept delivering aid to the site -- not exactly an incentive for people to pack up.


One disaster response expert recalls how after Katrina, New Orleans received a flurry of do-gooders -- not all of whom were qualified to assist.

``People showed up in New Orleans, saying, `I'm a doctor, I have a stethoscope around my neck.' It was unclear if they really were,'' said Irwin Redlener, a physician and director of the National Center for Disaster Preparedness at Columbia University's Mailman School of Public Health. ``It was a free-for-all. One can only imagine what happens unfettered in places like Haiti.''

The compulsion to help quake-battered Haiti was immense. Many opened their wallets, but others opted to fly in on private planes and drive in from the neighboring Dominican Republic.

Haiti's proximity to the United States influenced many to come, experts say. Few natural disasters in recent years have generated such intense interest.

Some of that has to do with the magnitude of the disaster: An estimated 300,000 people were killed, and the world responded.

Americans donated more than $1 billion, and 120 countries have pledged more than $9 billion to help rebuild.

Much of the donated money supplied critical services in the immediate aftermath of the temblor, but it also supported foreign NGOs, some of which undermined local institutions by diverting resources from their coffers. The lion's share of aid has long steered clear of the Haitian government because of a history of graft.

The donations to NGOs ``made for certain that the Haitian institutions -- and some of them were very good -- ended up being without any capital,'' said Jocelyn McCalla, senior advisor to the Haitian special envoy to the United Nations. ``The Haitian medical facilities could not compete with the NGOs because of their foreign base. They had to lay off their staff.''


Right after the quake, so many flights with aid workers tried to land at the severely damaged airport that they were locked in holding patterns over the capital; others were directed to the Dominican Republic or sent back home.

Animal lovers from the Humane Society International swooped in. So did Clowns Without Borders. And as Haiti transitioned from an emergency phase to a reconstruction effort, college spring breakers and pest control exterminators joined the fold. First-timers were plentiful.

NGO-rented SUVs still knot traffic in Port-au-Prince's already too few streets.

The U.S. State Department's most recent travel advisory, issued on June 24, ``strongly'' urged U.S. citizens not to visit Haiti. But it also took into consideration the downside of too much benevolence.

``Those wishing to assist in Haiti relief efforts should be aware that despite their good intentions, travel to Haiti will increase the burden on a system already struggling to support those in need on the ground,'' the statement said.

Thomas Kirsch, a Johns Hopkins emergency physician, noted how young Scientology ``Volunteer Ministers'' did little to create job opportunities for Haitians.

``Rather than have college kids from California come down, it would be better to hire a bunch of Haitians to hand out bottled water,'' said Kirsch, who led a team of doctors and nurses to Haiti shortly after the quake. ``All that does is undercut the local population.''

One Scientologist volunteer who traveled to Haiti said her colleagues' work was more substantial than merely distributing water. Besides, she added, the desperation in Haiti was great, as was the demand for help.

``Our feeling is you can't have too many volunteers,'' said the Rev. Susan Taylor, national director of the Churches of Scientology disaster response. ``Millions of people need help, and there are so many volunteers. You can't just throw money at a situation. You need people.''


Public health experts note that many people arrived in Haiti wanting to help but needed help themselves. Wright, of World Vision, said several groups of volunteers showed up ill-prepared.

``They hadn't thought about where they would stay or how they would get a ride from the airport,'' said Wright, who made two post-quake trips to Haiti and has worked in disasters since 1991. ``They needed help helping. They themselves became victims.''

Though the United Nations also took a serious hit and lost high-ranking officials who worked in Haiti in the quake, it drew widespread criticism for its slow response in coordinating relief efforts.

The American Red Cross also took a drubbing over the whereabouts of millions of dollars in aid after the agency's efforts weren't apparent to some on the ground in Haiti. The Red Cross responded by saying it has shifted tactics to a three- to five-year recovery plan. Rather than using the money to distribute bottled water, for example, the group plans to fund water sanitation programs.

But other ad hoc groups wanted immediacy. Hours after the quake, Dirk DeSouza of Miami Beach found himself stirred by the ghastly images. Though he had never visited Haiti, he urged his circle of Facebook friends and their friends to drop off food, water and medical supplies at a triangle-shaped lot in South Beach.

After sorting the goods, DeSouza and his pals shipped them off to Port-au-Prince on donated aircraft. They named themselves 1st and Alton for the lot on which they gathered donations and dubbed their Facebook-driven response ``Flashmob relief.''

``It's wholesale misery going on down there,'' DeSouza said. ``When you see somebody dying on the side of the road, when you see somebody in need of water, you don't need to be seasoned.''

Miami Herald Caribbean correspondent Jacqueline Charles contributed to this report.


Tuesday, August 03, 2010

Haitian Adoptions

Photo by John Carroll/July 28, 2010
Beautiful Haitian of thirty seven babies, toddlers, and children in an orphanage in the capital going nowhere quickly. How sad and how bad.

My wife Maria and I adopted a Haitian toddler several years ago. It took 20 months of agonizing paperwork (done by Maria). The bureaucracy on both sides of the water was terrible. (We had to be fingerprinted three times by the US government. And our adoption documents sat in various Haitian ministries for months at a time...just needing one director's signature.)

It has not been uncommon during the past twenty years to walk down the street in Port-au-Prince and be offered a baby/child to adopt by a desperate adult caregiver. In fact that happened frequently. And still does post earthquake. (We were offered a baby who was born in July by the parents...but the offer was made to us in May.)

Haitian parents love their kids, they just can't feed and educate them. So there are hundreds of thousands of orphans in Haiti.

Haiti just went through the biggest natural disaster ever recorded. In history. Ever.

Were mistakes made with hustling over 1,100 kids out of Haiti to be adopted AFTER the earthquake? Probably.

But are mistakes being made now by slowing Haitian adoptions? Yes, definitely, with many Haitian kids suffering in every fashion you can imagine.

See article below.

August 3, 2010

After Haiti Quake, Adoption Chaos

BAXTER, Minn. — Beechestore and Rosecarline, two Haitian teenagers in the throes of puberty, were not supposed to be adopted.

At the end of last year, American authorities denied the petition of a couple here, Marc and Teresa Stroot, to adopt the brother and sister after their biological father opposed relinquishing custody.

Reluctantly, Mr. and Mrs. Stroot, a special-needs teaching assistant and a sales executive with four children of their own, decided to move on.

Then on Jan. 12, a devastating earthquake toppled Haiti’s capital and set off an international adoption bonanza in which some safeguards meant to protect children were ignored.

Leading the way was the Obama administration, which responded to the crisis, and to the pleas of prospective adoptive parents and the lawmakers assisting them, by lifting visa requirements for children in the process of being adopted by Americans.

Although initially planned as a short-term, small-scale evacuation, the rescue effort quickly evolved into a baby lift unlike anything since the Vietnam War. It went on for months; fell briefly under the cloud of scandal involving 10 Baptist missionaries who improperly took custody of 33 children; ignited tensions between the United States and child protection organizations; and swept up about 1,150 Haitian children, more than were adopted by American families in the previous three years, according to interviews with government officials, adoption agencies and child advocacy groups.

Among the first to get out of Haiti were Beechestore and Rosecarline. “It’s definitely a miracle,” Mrs. Stroot said of their arrival here, “because this wasn’t going to happen.”

Under a sparingly used immigration program, called humanitarian parole, adoptions were expedited regardless of whether children were in peril, and without the screening required to make sure they had not been improperly separated from their relatives or placed in homes that could not adequately care for them.

Some Haitian orphanages were nearly emptied, even though they had not been affected by the quake or licensed to handle adoptions. Children were released without legal documents showing they were orphans and without regard for evidence suggesting fraud. In at least one case, two siblings were evacuated even though American authorities had determined through DNA tests that the man who had given them to an orphanage was not a relative.

“I feel a weird sense of survivor’s guilt,” said Dawn Shelton of Minnesota, who hopes to adopt the siblings. “So many people died in Haiti, and I was able to get the life I’ve wanted.”

In other cases, children were given to families who had not been screened or to families who no longer wanted them.

The results are playing out across the country. At least 12 children, brought here without being formally matched with new families, have spent months in a Pennsylvania juvenile care center while Red Cross officials try to determine their fate. An unknown number of children whose prospective parents have backed out of their adoptions are in foster care. While the authorities said they knew of only a handful of such cases, adoption agents said they had heard about as many as 20, including that of an 8-year-old girl who was bounced from an orphanage in Haiti to a home in Ithaca, N.Y., to a juvenile care center in Queens after the psychologist who had petitioned to adopt her decided she could not raise a young child.

Dozens of children, approaching the age of 16 or older, are too old to win legal permanent status as adoptees, prompting lawmakers in Congress to consider raising the age limit to 18.

Meanwhile, other children face years of legal limbo because they have arrived with so little proof of who they are, how they got here and why they have been placed for adoption that state courts are balking at completing their adoptions.

One Kansas lawyer said he satisfied a judge’s questions about whether the Haitian boy his clients had adopted was an orphan by broadcasting announcements on Haitian radio stations over two days, urging any relatives of the child to come forward if they wanted to claim him.

Another couple seeking to adopt, Daniel and Jess McKee of Mansfield, Pa., said Owen, 3, who can dribble a basketball better than children twice his age, arrived from Haiti with an invalid birth certificate — it shows him as 4 — a letter in French signed by a Haitian mayor that declared him an orphan, and stacks of handwritten medical records from his time in a Haitian orphanage.

Their prospective daughter, Emersyn, also 3, came with no documents at all.

“As things stand,” Mrs. McKee said, “I’m basically going to show up in court and tell a judge, ‘These kids are who I say they are,’ and hope that he takes my word for it, because if he asks me to prove it, I can’t.”

Later, she added, “I guess the government said, ‘Let’s just get the kids out of Haiti, and we’ll worry about the details later.’ ”

Decisions Made in Haste

Administration officials defended the humanitarian parole program, saying it had strict limits and several levels of scrutiny, including reviews of adoption petitions by the State Department and the Department of Homeland Security in Washington and Port-au-Prince, the Haitian capital.

But they also acknowledged that the administration’s priority was getting children out of harm’s way, not the safeguards the United States is obligated to enforce under international law.

Matt Chandler, a spokesman at the Department of Homeland Security, said the evacuations were done in the best interests of children who faced “an uncertain and likely dangerous situation that could worsen by the day, if not by the hour.”

Whitney Reitz, who oversaw the parole program at the Department of Homeland Security, acknowledged that the decisions were hastily made.

“We did something so fast,” Ms. Reitz said at a conference in New York in March. “We did something that normally takes a couple of years and that we normally do with excruciating care and delay. There’s so much time for deliberation in the way the program normally goes, and we condensed all that into a matter of days.”

There is no evidence to suggest that the evacuations were driven by anything other than the best of intentions. And with untold numbers of unaccompanied children in Haiti, the hemisphere’s poorest country, left fending for themselves or languishing in institutions, it is not hard to make the case that those who were evacuated are better off than they would have been in the hemisphere’s poorest country.

Many now live in the kind of quiet, scenic towns depicted in Norman Rockwell paintings. They are enrolled in school for the first time. They have grown inches, gotten eyeglasses and had their cavities filled.

And they are learning what it feels like to have a mother and father wake them up every morning and tuck them into bed every night.

But child protection advocates like Marlène Hofstetter at Terre des Hommes, an international child advocacy organization, contend that those ends do not justify the means. Rushing children out of familiar environments in a crisis can worsen their trauma, she said. Expediting adoptions in countries like Haiti — where it is not uncommon for people to turn children over to orphanages for money — violates children’s rights and leaves them at risk of trafficking, she added.

“I’m certain that one day these children are going to ask questions about what happened to them,” Ms. Hofstetter said. “I’m not sure that telling them their lifestyles were better in the United States is going to be a satisfactory answer.”

Even though the humanitarian parole program has officially ended, it remains a source of tensions between American-run orphanages in Haiti and international child protection organizations.

The advocates, led by Unicef, have refused to place children who have lost their parents or been separated from them in some foreign-run orphanages, fearing they would be improperly put into the adoption pipeline before they had the chance to be reunited with surviving relatives.

And the pro-adoption groups, led by the Joint Council on International Children’s Services, accuse the advocates of using endless, often unsuccessful, attempts to locate the children’s biological relatives to deny tens of thousands of needy Haitian orphans the opportunity to be placed in loving homes.

“Unicef’s idea is to house children in tents, and tell them that maybe in five years their relatives will be found,” said Dixie Bickel, who has run a Haitian orphanage called God’s Littlest Angels for more than two decades. “What kind of plan is that?”

Washington Feels Pressure

Concerns about child trafficking led China, after its 2008 earthquake, and Indonesia, after the 2004 tsunami, to suspend all international adoptions, despite intense pressure by pro-adoption groups in the United States, according to Chuck Johnson at the National Council for Adoption.

After January’s quake, Haiti, though, was hardly able to stand on its own feet, much less push back, Haitian officials acknowledged. Orphanage directors with political connections in Washington said they saw an opportunity to turn the tragedy into a miracle. Some issued urgent pleas, saying that the children in their care had had been left without shelter, and that the orphanages’ limited stocks of food and water made them prime targets for looting.

In the United States, adoptive parents contacted anyone they knew who might have money, private planes and political connections to help them get children out of Haiti. Evangelical Christian churches, which have increasingly taken up orphan care as a tenet of their faith, were also mobilized. Before long, legislators and administration officials were getting calls from constituents.

Senator Mary L. Landrieu, a Louisiana Democrat and adoptive mother, has been a champion of the cause and pushed administration officials to help bring Haitian children here after the quake. “I wouldn’t be the least bit surprised if there are some errors that were made,” Senator Landrieu said in an interview about the rescue effort, “but you want to err on the side of keeping children safe.”

On Jan. 18, less than a week after the earthquake hit, the secretary of homeland security, Janet Napolitano, announced that the United States would lift visa requirements for those orphans whose adoptions had already been approved by Haitian authorities and those who had been matched with prospective parents in the United States.

The requirements were written so broadly, adoption experts said, that almost any child in an orphanage could qualify as long as there were e-mails, letters or photographs showing that the child had some connection to a family in the United States. And by the time Ms. Napolitano announced the program, military flights filled with children were already in the air.

“The standard of proof was very low,” said Kathleen Strottman, executive director of the Congressional Coalition on Adoption Institute, a nonprofit group that is a leading voice on American adoption policy. “That’s why the administration ended the program as quickly as they did,” she added, “because they worried the longer it was open, the more opportunities they would give people to manufacture evidence.”

Obstacles to Adoption Vanish

Over the next several weeks, orphanages big and small were nearly emptied, whether or not they had been affected by the earthquake.

The staff at Children of the Promise, about 90 miles from Haiti’s capital, barely felt the temblor. But 39 of the 50 children there were approved for humanitarian parole, even though none of them had been affected by the disaster and the orphanage had not yet received the proper license to place children.

Rosemika, 2; Alex, 1; and Roselinda, 1, offer a look at the typical humanitarian parole case. Rosemika’s mother died before the quake. The other two children were given up for adoption because their parents could not provide for them.

Jenny and Jamie Groen, a missionary couple from Minnesota who were volunteering at the orphanage, had fallen in love with the children and decided to adopt them.

Under normal circumstances the couple would have had to get special permission from Haiti’s president to adopt because they are both 28, and the government requires at least one of the prospective parents to be older than 35.

After the quake, Prime Minister Jean-Max Bellerive summarily signed off on their adoption — as he did with all humanitarian parole petitions submitted to him by the United States — without checking the Groens’ qualifications.

Meanwhile, the couple rushed back to the United States for the background checks and home study their own country required for them to take children into their care. And they submitted e-mails, photographs and a Dec. 2 newspaper clipping to prove that their commitment to adopt the children predated the earthquake.

During a recent visit to the orphanage in Haiti, surrounded by peasant hovels and sugar-cane fields, Ms. Groen, now pregnant, said she and her husband were still trying to absorb how quickly they were going from an empty nest to a full one.

It has been a whirlwind for the children’s biological relatives as well. The girls’ relatives still regularly visit the orphanage. “That’s the thing that’s so different about Haiti,” Ms. Groen said. “It’s not full of unwanted children. It’s full of children whose families are too poor to provide for them.”

That appeared to be the predicament shared by Beechestore, 14, and Rosecarline, 13, who are going through all the turmoil of adolescence, exacerbated by a confusing legal tug of war.

In the spring of 2008, their biological father had told the American authorities that he had placed the children for adoption only because he thought they would be educated in the United States and then returned to Haiti. Once he understood the implications of adoption, he refused to give them up.

In November 2009, American authorities formally notified the Stroots that their adoption petition had been denied.

By then, the Stroots were spent — emotionally and financially. The effort to adopt the children had taken four years and $40,000. Rather than appeal, the Minnesota couple decided it would be best for everyone to end their efforts.

Then the earthquake hit. Homeland Security, which earlier had denied visas to the children, reversed course without consulting the children’s biological father or the Stroots. “One day, we’re being told we can’t have the kids,” Mrs. Stroot said. “The next minute, we’re getting a call telling us we need to get them winter coats. It was crazy.”

In late July, a Minnesota judge awarded the Stroots legal custody of the children. Neither the previous denial nor the views of the children’s biological father were mentioned during the proceeding, the Stroots said.

Since then, the newly expanded family has moved on to more mundane matters, like dentist appointments, vaccinations and back-to-school shopping.

“God got done in 10 days,” Mr. Stroot said, “something human beings couldn’t do in years.”

Erin Siegal contributed reporting from Oakland, Calif. Barclay Walsh contributed research from Washington.

Haitians Attempting to Escape the Inferno of Haiti

Photo by John Carroll

Coast Guard intercepts 323 migrants from Haiti

MIAMI (Reuters) - The U.S. Coast Guard repatriated 323 Haitian migrants on Monday after intercepting them aboard two overloaded sailboats in Bahamian waters, northwest of Haiti's northern coast, a Coast Guard officer said.

The operations since Friday were the largest interceptions at sea of would-be migrants from the poor Caribbean state since it was devastated by an earthquake on January 12 that wrecked the capital Port-au-Prince and killed up to 300,000 people.

Attempts by Haitians to reach the United States illegally in small unseaworthy boats had appeared to drop off following the earthquake, both because of the impact of the disaster and because of the presence of U.S. military warships supporting a huge international relief effort during several months.

But the latest interceptions indicated U.S.-bound migration attempts by Haitians might be picking up momentum again.

"The Coast Guard continues to station cutters and aircraft off the coast of Haiti to deter illegal migration and to interdict and rescue those who attempt to depart on these unsafe vessels and dangerous voyages," Captain Steven Banks, chief of enforcement of the Seventh Coast Guard District, said in a statement.

The Coast Guard Cutter Legare stopped an overloaded 40-foot (12 meter) sail freighter carrying 164 Haitian migrants about eight miles south of Great Inagua, Bahamas on Friday.

Two days later, the same cutter intercepted another sail freighter carrying 159 Haitians about 33 miles west of Great Inagua.

More than six months after Haiti's crippling earthquake, described by some experts as one of the most destructive natural disasters in modern history, the United Nations says the massive relief operation it is heading has made progress.

But at least 1.5 million quake victims are still living in vulnerable tent and tarpaulin camps across Port-au-Prince, and aid workers fear that unless more secure shelter and housing is provided there is a risk of another humanitarian disaster as the hurricane season enters its peak period in August.

(Reporting by Pascal Fletcher; editing by Chris Wilson)

© Copyright 2010, Reuters

Catholics and Fear of Church Hierarchy in Peoria

Peoria Journal Star

Forum: Catholics shouldn't be afraid to challenge church hierarchy

Posted Jul 31, 2010 @ 10:45 PM

With the sale of Resurrection Church in LaSalle, plus the demolition of St. Benedict's in Ladd and the loss of attendance in the four suspended churches in our area, it is time to challenge the church's hierarchy.

We have little authority in church governance. We must challenge this clerical pyramid that is secretive and above scrutiny. We must take a stand for accountability in overseeing the complexities of church finances and all church functions.

We want a diocese, monastery or abbey to be like that of a poor workman who is not sure if tomorrow he will find work or bread. We want them to be filled with those who with all their being share their suffering with those they preach to.

We no longer want a diocese, monastery or abbey whose leaders concern themselves with their own survival and security, free from fear, care or anxiety, while the parishioners are uneasy about what the future holds in their Catholic community. It is easy to speak of spiritual poverty, to fill one's mouth with pious words based on scriptural readings, and yet lack for nothing.

It is time, the parishioners take back the churches they paid for, furnished and repaired. It is time for the laity to handle church operations and let the priests be responsible only for what is sacred.

We have too many priests who live comfortably while parishioners struggle for their church's survival. This has to stop. There are few priests who emulate the poor Nazarene and the humble Jesus.

We need a crusade to recover "Christianity" from the clerical elite. This must come about in order to ensure our Catholic faith.

Carlo Olivero


Monday, August 02, 2010

A Lesson for U.S. Health Care

Photo by John Carroll
Les Cayes, Haiti
July, 2010

In Haiti, a Lesson for U.S. Health Care


In February, a month after Haiti’s earthquake, I went down to Port-au-Prince as part of a team that was helping to reactivate cardiac care in the city’s public hospital. For several months since, I have observed how the earthquake and its aftermath profoundly changed Haiti’s health care system. Over that time, I have come to the unorthodox conclusion that Haiti’s tragic experience may show us a way to improve health care in the United States.

Let me explain. The sudden availability in Haiti of free high-quality care from foreign doctors put enormous competitive pressure on the private local doctors, who had already been working under difficult conditions. Watching this situation unfold, I found myself wondering if the same would happen to private medical services back in the United States were our government to suddenly provide high-quality, low-cost health care.

Haiti, with the worst health care record in the Western Hemisphere — the infant mortality rate is nine times that of the United States and the maternal mortality rate is 50 times as high — was ill prepared to help disaster victims. For the public hospital in Port-au-Prince, earthquake damage only made things worse. Into this vacuum surged hundreds of international doctors and nongovernmental health care organizations.

In the beginning, of course, those with immediate injuries were treated first. But even after the earthquake victims had been taken care of, lines more than a quarter-mile long still formed at the hospital entrance. There were mothers carrying babies with swollen bellies, prematurely old men and women with waterlogged legs and labored breathing, people with painful sores and lots of people coughing. These were Haitians who’d had no access to medical care in a long time and who suddenly saw hope in a hospital full of foreign doctors eager to help at no charge.

This humanitarian aid came with a downside though: it caused many of Haiti’s local private clinics to lose business. One such clinic is Michel Théard’s cardiac practice, near the public hospital where I worked. Before the earthquake and during the immediate aftermath, Dr. Théard did echocardiograms (ultrasound images of the beating heart) for cardiac patients, because the public hospital lacks the equipment to do them. His ultrasound pictures, and those done by other private Haitian cardiologists, often at charity rates, enabled us to diagnose many conditions for patients in the public hospital.

But because Dr. Théard, and the private hospital with which he is affiliated, cannot compete with free foreign doctors, there is a danger that he will no longer be able to stay in business and provide echocardiograms for the poor.

There are many other services that only private doctors provide in Haiti, because the public hospitals are so poorly financed. The rudimentary intensive care unit at the public hospital has no heart monitors, oxygen sensors or any other kind of modern medical equipment. The only thing “intensive” about the I.C.U. is that a health care worker (doctor, nurse or nurse-anesthetist) is present at all times. A CT scanner donated to the hospital in the early ’90s lies rusting outside one of the buildings, sad evidence of the public medical system’s failure to provide adequate care.

Patients who can afford it get specialized procedures like CT scans and echocardiograms at private clinics and then return to the public hospitals for free care. This is also the case for many medicines: family members buy them at a pharmacy and bring them back to be kept under the patient’s hospital pillow for dispensing at the prescribed times.

Perversely, by shoring up the capacity of the normally dysfunctional public health system during this crisis, the foreign doctors may be further damaging Haiti’s fragile medical sector. Once they leave, who will be left with the will and the capital to adequately care for Haitians?

What may be needed, some have suggested, is for key nongovernmental organizations now offering health care in Haiti to work alongside the government’s Ministry of Health to rebuild destroyed facilities and to better train Haitian doctors and other providers. If the organizations could also cooperate financially by directing some of their budget into accounts run jointly with Haiti’s Ministry of Health, the government could reimburse providers like Dr. Théard for their work, thus removing competition between the foreign doctors and local private doctors. In time, as the Haitian government took control of health care delivery and education, the nongovernmental organizations would fade from the scene.

HAITI’S crisis — and its possible solution — provides a mirror for understanding our own difficulties delivering good health care in the United States. After all, it was a similar tension between private and public medical care that made it impossible for Congress, in passing reform legislation this year, to create a single-payer public health system. Many private health-care organizations — primarily for-profit insurance companies — strenuously resisted it, fearing that if the government suddenly provided high-quality, low-cost care for a significant part of the population, they would lose profits or go out of business. Worries about competition between public and private medicine, in other words, are universal.

It is clear that the American health care system functions at a much higher level than its Haitian counterpart does, but that’s mostly a matter of national wealth. Our healthier economy has allowed us to have a relatively viable private-sector health care system, though there remains tremendous disparity from one economic class to another in infant and maternal mortality and access to basic care. And now, because the growing cost of our health care system is unsustainable, we are faced with the need to consider an alternative.

The Haitian situation also suggests a solution — a way to provide health care for all in the United States without destroying our private medical sector. (This, by the way, was always President Obama’s goal, no matter how the right tried to defame his proposals.)

A public-private partnership like the one contemplated for Haiti could be created here. The government, through the Centers for Medicare and Medicaid Services, could team up with health care systems that provide high-quality care to people of all income levels — Kaiser-Permanente, in California, comes to mind, as does the Mayo Clinic network; the Geisinger Health System, in Pennsylvania; Partners HealthCare, in Boston; and Intermountain Healthcare, in Utah — to provide a public option. Private doctors could be paid for the work they did for the new public entity. People who did not want to join such a health plan could remain with their current private insurers.

Health care systems wishing to be part of the new partnership would have to demonstrate competence as well as fiscal responsibility. Those that did not provide good care at a reasonable price might fail, but in the long run the system could serve the broadest cross section of America, and it could do so without undermining private doctors — or at least not those who are motivated by care itself rather than by mere profit.

Although it is unrealistic to expect Congress to rewrite the health care law to allow for this proposal, there is room within the law for a state or regional pilot project to experiment with public-private medical partnerships.

Dr. Théard’s clinic in Port-au-Prince has not yet closed, but he tells me it is now fighting for its life, with little or no money for salaries, equipment or rent. “We are still open but without any help from any sector,” he said in an e-mail last week. “Equipment needs repair, buildings need repair and we are doing the best we can.”

Haiti’s need to fix its health care system is, if anything, more urgent than ours. But its best solution, a public-private partnership, is one that could easily work for America, too.

James Wilentz is a cardiologist at the Lenox Hill Heart and Vascular Institute.