Ministry of Health Disaster in Haiti

Pediatric Cholera--Photo by John Carroll

Early today in pediatric clinic in Cite Soleil I had a young mother bring in her 10 month old baby boy. She told me that he started having diarrhea yesterday. He had ten white watery stools yesterday and five similar stools this morning. He is drinking some and nursing some but clinically appeared lethargic and moderately dehydrated.

It was an easy diagnosis. I thought this baby boy had cholera.

Most of my pediatric patients in the clinic actually do have diarrhea. But this baby's diarrhea was different and his clinical presentation was consistent with cholera.

So what should I do?

The population of Soleil is estimated to be in the hundreds of thousands. But no one knows for sure. And before cholera struck Haiti in 2010, Soleil had the usual horrible diseases of poverty. Now it has had cholera added to its "differential diagnosis" . And the experts from around the world say that cholera will return here in a few weeks when the rainy season starts.

Is this baby the harbinger of the next wave of cholera?

Working in Cite Soleil as a physician is challenging. We all know that the people from the slum are suffering and dying from stupid deaths everyday. This is no secret. And intervening to help them is not always straight forward.

Soleil should not have a monopoly on medical helplessness and hopelessness, but it sure seems to.

I first worked at St. Catherine’s Hospital in Soleil in 1987. I had the opportunity to work with Dr. Paul Blough, a retired OB-GYN doctor from Peoria, Illinois. Dr. Paul delivered over 10,000 babies at St. Catherine’s in the 1980's and 90's. He was in his 70’s and 80’s when he worked in Soleil and he gave excellent obstetric care. And so did the Haitian midwives that worked with him.

The Daughters of Charity, who are an order of St. Vincent de Paul Sisters in Soleil, worked at St. Catherine's during those years too. The hospital functioned and many patients were treated every day.

Doctors Without Borders, which responds to "hot zones" around the world, has been running the hospital since shortly after the 2010 Haitian earthquake. But they left the hospital three months ago because their contract with the Haitian government expired.

Doctors Without Borders had an army of medical people including public health experts that tracked cholera in the Soleil slum neighborhood-by-neighborhood and street-by-street. Cholera tents were erected at St. Catherine's Cholera Treatment Center (CTC). These tents were away from the other post earthquake tents that housed general medical patients. Thousands of cholera patients were treated and many lives were saved.

And inside the hospital that was not damaged by the earthquake, Doctors Without Borders offered a small emergency room, surgery department, internal medicine and pediatric wards, and an obstetric unit.  Many patients from Soleil were operated because the surgeons, anethesiologists, and surgical nurses were on site.

Entrance to St. Catherine's Hospital Cite Soleil

But all has changed. St. Catherine's is no longer bustling with activity like it should be in this huge destitute slum.

Ministre de la Sante Publique et de la Population (MSPP), which is the Haitian Ministry of Health, is in charge of St. Catherine's Hospital now. MSPP has government hospitals in each of Haiti's ten departments. However, they don't function well.

St. Catherine’s is in terrible condition now. It is staffed by a tiny handful of excellent Haitian doctors employed by MSPP, but the hospital has very few medical supplies.

And there is a new problem.

Patients are now charged five Haitian dollars (75 cents US) to have a check up. And if they need to be admitted to St. Catherine's they are charged two hundred Haitian dollars (25 dollars US) for a bed. Doctors Without Borders did not charge.

Patient's families have to provide the sheets for the bed and food for the patient. And family members bathe the patient and empty the bedpan.

Medical supplies and medication are provided by the hospital if they have them. But if they are not available, the patient's family has to try and buy them somewhere on the street which is frequently impossible to accomplish. (How would you buy 4-0 chromic sutures?)

So lack of money stops people from coming to St. Catherine's in Soleil in the first place.

The hospital has very few patients right now. With Soleil's population, there should be patients everywhere. The three stretcher Emergency Room is usually empty of patients and staff. It has one tall narrow cabinet with some medications to treat infectious diseases and hypertensive emergencies.

The General surgery ward at St. Catherine's is competely closed as are the operating rooms. There are no surgeons or anethesiologists.

The Obstetric ward is open and seemed to have the most patients of any inpatient unit. And C-sections can be done under a spinal...but only when a nurse anethetist and an obstetrician is present.

Internal Medicine Ward--St. Catherine's Hospital (Photo by John Carroll)

The Internal Medicine ward has a smattering of a few ill elderly people. There is no oxygen to give patients in respiratory distress and very few medications. It is very depressing to see the elderly lying about sick and in disarray.

The Pediatric ward has a few patients but they should have many more. There are many sick kids in Soleil. St. Catherine's has three Haitian pediatricians employed by MSPP that run an outpatient clinic at St. Catherine's for a few hours Monday-Friday.  And these same three physicians admit the sick babies who they think they can manage in the hospital with its meager supplies and technology.

Pediatric Ward, St. Catherine's Hospital (Photo by John Carroll)

So what does all this mean?

It means that St. Catherine's Hospital, run by MSPP, is offering very inferior care to hundreds of thousands of people from Soleil who become sick or who are injured.

How does this scenario play out on a day by day basis?

Let me give a couple of examples.

A few days ago while rounding in St. Catherine’s Internal Medicine ward, I spotted a sweet appearing old lady lying in a corner bed. Her name is Famia and she is 72 years old.
She had three interested family members seated near her by her bed. Famia was alert and had a very kind appearing grandmother type of face.

I asked her what was wrong. She said that she had been given a shot in her left buttock five days prior and develped a problem.

Famia rolled over and showed me her massively swollen and tender left gluteal area. Her buttock and thigh were red and warm to touch all the way to her mid thigh. There were ominious appearing purple patches of skin over the buttock. She obviously had a very infected buttock and and thigh and needed surgical debridement and antibiotics to have a chance at survival.

Famia's Infected Thigh (Photo by John Carroll)

However, Famia was receiving no IV, no antibiotics or pain meds, and there was no operating room or surgeon waiting to help her. Her leg was septic and she would be too if nothing was done very soon.


I told her that I would pray for her and slowly backed away from her bed not knowing what to do here in Soleil with more neglected slum pathology. Famia had impending death written on her forehead.

I walked to the pediatric ward with Famia on my mind. Prayer is most important, but is that all I could do. What about "works"? There had to be more that we could do here and right now.

And then it dawned on me...why not transfer her? I have a good friend who is a surgeon in private practice in Port-au-Prince, and her number was on my cell phone.

So I called her immediately and she was accepted over the phone right away. I rushed back to her bed, gave her family members the address to the private hospital and surgeon and some money for public transportation and they said they would take her.

Famia made it there and is being treated...I don’t know if she will survive, but her chances at survival in Soleil were zero. And none of this was necessary if St. Catherine's was functioning at a basic level like it should be. ( While posting this, I just received an e mail from the private hospital director stating that one of his surgeons is taking care of Famia and she is doing well.)

And on a bigger picture, what will the people of Soleil do when the rainy season starts and cholera starts infecting them again?

St. Catherine's is going to triage people with cholera AWAY from St. Catherine’s to CTC’s because they have no intention of treating cholera like Doctors Without Borders did during the last two years. Patients will be sent to the small CHAPI health center near the entrance of Soleil or to some other CTC somewhere in PAP run by NGO's. (Hopefully, Samaritan's Purse will reopen their 200 bed CTC in Soleil if necessary.)


And what about my baby in the clinic with cholera yesterday? The baby was still alert enough to take fluids by mouth, but with the weekend approaching, I told the mother that she needed to take her baby to a CTC in the neighborhood of Delmas so the baby could have an IV.

Mother listened but she politely refused.

She knew St. Catherine's is right across the street and could not understand why she could not take her baby there.  And she said she would get lost in the Delmas neighborhood and would not be able to find the CTC.

So I reluctantly gave here some packets of oral rehydration salt and some money for transportation to Delmas if she changed her mind.

It would be easy to blame this mother. But we can't especially under the inhumane living conditions in Soleil. There is no structure here except hob-nob attempts at daily survival.

And guess what? Many more mothers in Soleil think the same way that this mother thinks. They have no money for transportation out of the slum and they have more kids at home to worry about.  So they have to do their own triage and decide which of their kids go to school, which kids eat, and which ones get medical care. They have to pick which children will live and die.

I recently talked to an official for MSPP in downtown PAP. I specifically asked the official why things are so atrocious in MSPP run hospitals. The official said that there is not enough funds dedicated to MSPP for anywhere in Haiti, let alone Cite Soleil. The official said there is not the “governmental will” to allow MSPP hospitals to function at a higher level.

This leads us back to money again. Where is all the post earthquake billions of dollars of pledged money for Haiti?

I can sure tell you where it isn't. It is not at St. Catherine's Hospital in Cite Soleil.

Neonatal Intensive Care Unit--St. Catherine's Hospital, Cite Soleil (Photo by John Carroll)

John A. Carroll, MD
www.haitianhearts.org

Violence in Soleil--March 5, 2012 (Updated)

While entering Soleil yesterday morning (Monday, March 4, 2012) my driver Jean Claude and I  noticed hundreds if not thousands of young people walking in the streets. This seemed unusual and looked like a demonstration was just ending.

Jean Claude grew up in Soleil and always has his ear to the ground.  I asked him what was going on. He said he had no idea and pulled over on the main road.

Jean Claude stuck his head out the window and asked people walking by what was happening. We were told that there was a shooting of a man in Bois Neuf that morning. Bois Neuf is a section of Soleil just a few blocks away. The victim was taken to a hospital and was in critical condition. And the victim just happened to be a school director for a group of very popular schools in Soleil that provide education and hot meals for over 6,000 children every day.

The people from the slum were enraged with the shooting of this man and attempted to set shacks on fire in Bois Neuf where they thought the shooters could be. MINUSTAH stepped in at that point and stopped the place from going up in flames.

None of this sounded good.

Love--March 6, 2012--Photo by John Carroll

So we proceeded to the pediatric clinic in the back of Soleil and hundreds of patients were waiting like usual on a Monday morning.

The pathology in the clinic was the same. One of my little patients was a 10 month old baby girl named Love. She was brought to the clinic by a lady that is not her mother because her mother is "crazy" according to the caregiver.

Love had been sick for 15 days with fever, vomiting, and diarrhea. She lives in a tent.

The baby did appear quite ill--dehydrated, hot, and lethargic. Love needed to be admitted to St. Catherine's Hospital in Soleil which is only about 50 yards from our pediatric clinic.

However, because of the shooting of the school director earlier in the morning, St. Catherine's had sent home their entire staff of doctors and nurses and advised other doctors on their way not to come into the slum. So the patients in the hospital were on their own and I could not send Love to St. Catherine's for an IV and antibiotics.

So I told the caregiver that she needed to leave Soleil now and go to St. Damian's Hospital in Tabarre right away. And if she did not do this Love would probably die. The caregiver was excellent and agreed to leave right then for the Tabarre hospital.

The slum has so many problems with violence being one of them. Violence and fear closes things down and people like Love can die easier from stupid deaths.

(I will verify what is posted above and update with any additions or corrections as soon as possible.)
--------

Update:

Tuesday Night, March 6, 2012

I heard from very reliable sources that it was Jean Nelson who was shot and killed. Mr. Nelson was Fr. Tom Hagan's right hand man in Soleil and director of Hands Together Schools in Cite Soleil.
Another teacher was killed at the same time and Mr. Nelson's brother was shot but was not killed. I do not know the extent of his injuries.

Hands Together has over 6,000 children in their schools and feeding programs in Cite Soleil.

Apparently 15 men were involved in the shooting in Bois Neuf early yesterday morning.

Mr. Nelson was also director of Boukman Radio Station in Cite Soleil. He had lost both his wife and child during the 2010 earthquake.

The pediatric clinic today was only one quarter full by my count. Three of our doctors did not come to work today because of the violence in Soleil. Another man was shot in Bois Neuf today...I don't know his outcome.

St. Catherine's Hospital, right across the field from our pediatric clinic was essentially devoid of medical staff again today.

We know who died form the terrible shooting yesterday but we don't know the many others who MAY have died because they could not venture out into the streets to get to the clinic or to St. Catherine's Hospital today.

A manifestation is planned for Soleil in the morning in honor of Mr. Nelson.

Lost Her Daughter from Cholera in Soleil

Photo by John Carroll--February 25, 2012

Cite Soleil

Photo by John Carroll--February 25, 2012

Cite Soleil

Photo by John Carroll--February 25, 2012

These men in Soleil were working like this to make a few cents today while the Haitian Prime Minister was resigning a few miles away.

Que lastima!!

Deconstruction of a Haitian Heart

Beth


Teledjol is a Haitian word which means gossip or rumor mill. It is the way news is spread in Haiti. Facebook is here too but teledjol is still king.

When Haitian Hearts comes to Haiti it doesn’t take long before we are seeing patients with heart problems.

The other day a polite 16 year old girl showed up with a “heart problem”. I will call her Beth.

Beth came with her mother who does laundry at a hotel in Port-au-Prince. Mother makes 5 dollars per day and she commutes a long ways via public transportation.

Beth lives in downtown Port-au-Prince with her mother and siblings in a place called Carrefour Feuilles.

Beth told me that in October, 2011 she became short of breath and started coughing up blood. She was hospitalized in LaPlaine for ten days and got better. Her doctor told her she had a heart problem and started her on a strong diuretic (furosemide).

However, Beth told me that she is still short of breath with exertion. She takes her furosemide daily, but she does not know the dose and only had a couple of pills left in a crumpled tiny baggy.

At the appointment with me Beth did bring her chest x-ray and an echocardiogram. Both had been done last fall when she was sick.

I like to talk with patients and examine them before I look at their test results. I want to make my diagnosis with just the history and physical and quantitate a pre-test probability of disease BEFORE I look at test results. Test results can lead physicians astray because tests frequently "lie" and test results need to be combined with the patients exam to arrive at a proper diagnosis.

Beth appeared calm and not short of breath. Her oxygen level (pulse oximeter) was 98%. Her skin was warm and dry.

However, Beth’s blood pressure was bothersome. It was 132/50 in her right arm. That sounds good, but there is too much of a gap between the top (systolic) and bottom (diastolic) number. And in Haiti that frequently means that her aortic valve is not competent. In other words, her aortic valve may be leaking which allows blood to flow in the reverse fashion when the heart is resting between beats. This allows too much blood to flood her main pumping chamber (left ventricle) with blood which can hurt the chamber over time because of volume overload.

Her neck did not reveal any distended neck veins. This was good because it means that the venous return of blood was entering the heart unobstructed-- not blocked from a totally failing heart.

Beth’s heart exam revealed a heart that was slightly enlarged. And sure enough, listening along the left border of her sternum revealed a high-pitched decrescendo murmur during diastole..which meant that her aortic valve is leaking.

Inching the stethoscope out to the apex of her heart below her left breast revealed another murmur. It was loud, medium pitched, and radiated to her left armpit. This told me that her mitral valve was also leaking.

In Haiti these findings mean that Beth most likely had at least two bad heart valves from rheumatic fever that she unknowingly acquired as a child.  (Rheumatic fever is caused by strep throat that is never treated with penicillin. The body’s immune system attacks the strep bacteria and can attack the heart valves at the same time.)

So I peeked at her chest x-ray. It showed a slightly enlarged heart (not too bad) and a big left atrium (not too good). This meant that her mitral valve was indeed leaky and maybe tight (stenotic) too. The good news about her chest x-ray was that her lung fields are clear...no fluid in the lungs.

Her echocardiogram, which cost her mother $80 US here in Port-au-Prince,  showed both her aortic valve and mitral valves to be diseased and leaky, but the function of her heart muscle is good. The left ventricle is beating well because the heart muscle has not been damaged to the point where it is stretched so much that it can't contract efficiently.

So what now?

Beth needs heart surgery. And she needs it sooner rather than later. She does not have the cardiac cachexia brought about by a severely weak heart...yet. She can still withstand the organized assault of heart surgery.

Haiti is in shambles. Her heart surgery cannot be safely done here.

So I told Beth and her mother to start working on obtaining her Haitian passport and Haitian Hearts would start looking for a medical center to accept her.

I also started her on other medications to help her heart beat stronger, diurese more fluid, penicillin to prevent further rheumatic fever, and an aspirin to keep her blood thin so she does not form a blood clot in her distended left atrium and have a stroke.

And all of this was caused because she lacked basic health care. No treatment for a sore throat when she was a kid.

John A. Carroll, MD
www.haitianhearts.org

MINUSTAH in Soleil

Photo by John Carroll--February 17, 2012

St. Catherine's Hospital--Cite Soleil

Photo by John Carroll--February 17, 2012

Hanging Out in Soleil

Photo by John Carroll--February 17, 2012

Karnival in Soleil

Photo by John Carroll--February 18, 2012

Why We Bring Haitians to the States for Heart Surgery

Photo by John Carroll--February 18, 2012

This is the Internal Medicine Department at St. Catherine Laboure Hospital in Cite Soleil. Doctors Without Borders quit staffing the hospital in December, 2011. MSPP (Ministry of Public Health) in Haiti is now in charge.

Including this dying lady, there are four adult patients in the tiny internal medicine unit. St. Catherine's is the only hospital for hundreds of thousands of people in Soleil.

Patient "154" Arrives in USA Today for Heart Surgery

Haitian Hearts patient number 154 arrives today for heart surgery.

Many thanks to his family in Port-au-Prince for never giving up on him and to Miss Ginny and Miss Amy for supporting him through some tough times.

More later.

Impunity in Port-au-Prince

February 8, 2012

(Photo by John Carroll)

Impunity in Port-au-Prince

By AMY WILENTZ

Port-au-Prince, Haiti

IT has been painful to watch as Jean-Claude Duvalier, who inherited the brutal dictatorship that once ruled Haiti, swanks around the hot spots of Port-au-Prince, flanked by the dregs of his regime — including former members of the dreaded secret police, the Tontons Macoute — as if he were just another member of the capital’s thoughtless, partying elite.

Since his return in 2011 from a 25-year exile, Mr. Duvalier — Baby Doc — has managed to insert himself into semi-polite society, even finagling a seat near the new president, Michel Martelly, at the memorial ceremony for the victims of the 2010 earthquake. The president has filled many positions in his government with former Duvalier officials and their relatives. In short, he is rehabilitating Mr. Duvalier — and along with him, the extrajudicial code he and his father, François Duvalier, governed by. Last month, Mr. Martelly proposed a blanket pardon of Baby Doc — who has been accused of corruption and human rights abuses — telling The Associated Press, “I do believe that we need that reconciliation in Haiti.”

A day later, after a cry of indignation from Haitian and international groups, he claimed he had been misunderstood. But it turned out his pardon wasn’t even necessary. On Jan. 30, the investigating judge on the case recommended that all human rights charges against Mr. Duvalier be dropped and that he be tried instead in a lesser court on charges of financial malfeasance. Amnesty International called the investigation “a sham.”

It is the continuation of Haiti’s tradition of impunity (the veiled meaning of “reconciliation”) that has led directly to the convulsed, inconclusive and violent gyrations the country has made in its attempt to move toward democracy since the overthrow of Baby Doc. Haiti will not achieve real democracy if its justice system remains unwilling to condemn the crimes of the past, punish the perpetrators and make it clear that such abuses will not be tolerated in the future.

In nearly 30 years of power, the Duvalier regimes offered impunity for their operatives. The army and the Tontons Macoute committed gross violations of human rights, including arbitrary arrest, prolonged incarceration without trial, starvation and torture of political prisoners and the persecution and killings of their associates and families.

The violence persisted after Baby Doc fell. While he and his family fled to France aboard a United States cargo plane, crowds wielding rocks and machetes destroyed the homes of known Duvalierists and hunted down and killed dozens of Tontons Macoute.

They did this, a Haitian friend once explained to me, because they knew the courts could not or would not bring the Tontons Macoute to justice. These killings were mostly revenge murders — score settling — and no one in the crowds was jailed or prosecuted for them.

While the country was ostensibly laying the groundwork for democracy, known perpetrators of human rights abuses were only occasionally arrested. Most were promptly released; many escaped. Few have been brought to trial, and even fewer convicted.

In 1987, elections were aborted when a mob of former Tontons Macoute descended on a polling place and slaughtered 34 voters. More were killed in other polling places. It took nine years for Claude Raymond, the former head of Baby Doc’s army and the suspected mastermind of those attacks — if one can use such a term — to be arrested. (In that time, he even presented himself as a candidate for president, though he was excluded from participating in the elections.) He was never tried and died in prison in 2000.

In 1991, Haiti’s first fairly elected president, Jean-Bertrand Aristide, was ousted from office, and in 1994, at least 23 of his supporters were killed by paramilitary forces in Raboteau, a shantytown on the western coast. In 2000, after Mr. Aristide returned to power, 16 of the perpetrators were arrested and found guilty. But after he was overthrown and exiled for a second time, Haiti’s supreme court overturned 15 of those convictions. Only one person connected to the attacks has been incarcerated; he was tried and convicted — of mortgage fraud — in New York. Another person tried in absentia had his Florida lottery winnings garnished and distributed to victims of the massacre.

Today, besides a few bright points — like the conviction last month of eight police officers for killing prisoners after the earthquake — impunity remains the country’s fallback position. It has made a functioning justice system, and therefore democracy, impossible.

That’s why Mr. Duvalier must be prosecuted for his crimes against humanity. If they are dismissed, it will send a cheering message to past and future perpetrators of similar abuses. If he is tried and convicted, those who have relied upon impunity will know that they, too, risk a turn in the dock.

The Haitian people want justice, and the international community must support them. Two days ago, on the 26th anniversary of the overthrow of Baby Doc, a small but vocal crowd of his regime’s victims protested in front of the Palais de Justice. They painted the words “Aba impinite” — down with impunity — in blue spray paint on the court’s white wall.

Amy Wilentz is the author of “The Rainy Season: Haiti Since Duvalier.”

Haitians in the Dominican Republic

You need to watch this video.

(Photo by John Carroll)

Posts from Pestel

Please see these posts from the Peoria Journal Star website and Crof's blog H5N1.

Where did the Aid Go?

Read this article from Salon.

Haiti Outrage

Read this article.

Frederick Douglass

As Frederick Douglass noted, “It is easier to build strong children than to repair broken men.”

Hope this Article is Wrong

I hope this article is wrong.

Haitians Flee to Brazil Looking for Work and Life

See this article in the Times.

Homicide Rate in Haiti Less than Peoria

Photo by John Carroll

See this article from CHAN website---

Homicide Rate Study Challenges Mainstream Portrait of a ‘Violent’ Haiti

By Roger Annis

Published in Haiti Liberte, Jan 4, 2012

The 2011 Global Study on Homicide by the UN Office on Drugs and Crime (UNODP) has published its world survey for 2011. Its published figures on homicide rates place Haiti very low in comparison to the other countries of the Caribbean and Latin America.

According to the study, Haiti's homicide rate in 2010 was 6.9 per 100,000 population. That compares to Jamaica(highest rate in the Caribbean) at 52, Trinidad at 35, the Bahamas at 28 and neighbouring Dominican Republic at 24. The rate for the U.S. colonies of Puerto Rico and U.S. Virgin Islands (2007 statistics) is 26 and 39, respectively.

The highest murder rates in the world are in Honduras (82), El Salvador (66), Belize (42) and Guatemala (41), all of which are U.S. client states. (By comparison, Nicaragua's rate is 13, Mexico's is 20 and Brazil's is 23 (2009 figures)). Haiti's rate is only marginally higher than the U.S., which is 5.

The UN report does not contain figures for Haiti for the two years of illegal, foreign-appointed government in 2004 and 2005. But during the four years of elected government from 2000 to 2004, the annual rate was high, between 15 and 20. These were the violent years in which paramilitary forces assaulted ordinary Haitians and governing institutions in the destabilizing prelude to the overthrow of the government of Jean Bertrand Aristide in February 2004.

The Global Study on Homicide brings together global, regional, national and sub-national homicide data in one publication. While not necessarily indicative of overall, relative crime figures in each country, it is perhaps the closest that is readily available. Homicide is a very specific, illegal act, the "crime of crimes" that is easily quantified. Other violent crime statistics compiled by the UNODP have two great disadvantages. One, the reporting from countries by the organization is incomplete. Two, definitions and measurements of the different categories of violent crime vary from country to country, as does the capacity to record them.

'Violence' as justification for military occupation

The foreign military intervention that facilitated the overthrow of Aristide in 2004 and became institutionalized through the UN Security Council military force called MINUSTAH has always justified its actions by saying that foreign soldiers are needed to save Haitians from themselves. Officials of the United Nations in Haiti as well as the embassies of the U.S., Canada and Europe never cease to claim that Haiti is permanently threatened with descent into chaos and violence.

International media typically chimes in with its own versions of this fable. Yet, the homicide figures for Haiti fly completely in the face of these claims.

This double speak deliberately confuses and conflates the so-called violence of legitimate protest demanding social and political rights, including measures of self-defence, with the violence of the wealthy elite of Haiti and its backers in the U.S., Canada and Europe as they conspire to keep Haiti poor and keep poor Haitians marginalized in their own country. Thus was the ‘violence’ of the 2000-2004 destabilization period and coup d’etat presented.

Since the earthquake, reporting of popular protests against the ongoing military occupation of MINUSTAH or the slow pace of earthquake aid and reconstruction often suggests, subtly or more brazenly, that descent into chaos constantly looms.

Contemporary media presentations of Haiti sometimes remind the reader of Haitian history of news reporting in the 19th century or early 20^th century when naked colonialism still ruled in the colonies or ‘spheres of influence’ of the U.S. and Europe. Newspapers of that era regularly warned of inevitable violence and pillaging by Black people against any and all social order should they succeed in attaining their freedom.

The reported homicide rate for Haiti raises an obvious question: If the rates of crime and violence in Haiti are exponentially lower than neighbouring countries, why, exactly, is a seemingly permanent UN military occupation force of 13,000 foreign soldiers and police in the country in the first place?

Where did the Money Go?

Photo by John Carroll
Cite Soleil

Great article in Counterpunch by Bill Quigley.

Haiti--The Aftershocks of History

(Photo by John Carroll)

Last month this little man was my patient in a pathetic cholera tent in Robillard, Haiti.

Like most elderly Haitians when I asked him his age he could not give a definite answer. He did say that he was born during the United States Occupation of Haiti. So that means he was born somewhere between 1915--1934. So he is between 77 and 96 years old. My guess is that he is 93 years old, give or take a couple of years.

He was never married and has no children. He lives in a little ti kay in Robillard and is assisted as necessary by an elderly niece.

He was a farmer most of his life. And he sold livestock and produce.

When he was admitted to the tent, he was quite ill--dehydrated with vomiting and diarrhea. He was very weak and spent most of his day on the wooden cot with his niece attending to him. He would look around, but that is about all he did.

So we tanked him up with IV fluids and held our breath. Cholera is hard on old people.

As they days went by, he became stronger and began to stand at his cot side. And even though he was very hard of hearing, he wanted to be heard. So he would give little speeches in the tent to the amusement of the other cholera patients and families.

One day I asked him what he thought of the Americans occupying his country many decades ago. He said it was good because "if it weren't for Americans, we (Haitians) would not have clothes on our backs".

His philosophy is somewhat different than the article below which describes Haiti's painful history.

(We discharged this man from the tent after his vomiting and diarrhea stopped and he was eating and drinking. He left the tent with his little tree-branch-cane, happily talking, with his niece at his side.)

jc


Haiti--The Aftershocks of History
by Adam Hochschild


As a French possession, it was once the most lucrative colony on earth, producing nearly one-third of the world’s sugar and more than half its coffee. All, of course, with the labor of slaves. And slavery in the Caribbean was particularly harsh: tropical diseases were rife, there was no winter respite from 12-hour workdays under the broiling sun, and the planters preferred to replenish their labor force by working their slaves to death over a decade or two and then buying new ones.

In 1791, what today is Haiti became the scene of the largest slave revolt in history. Over the next 13 years, the rebels fought off three successive attempts to re-enslave them. The first was by local planters and French soldiers, aided by arms from the United States, whose president and secretary of state, George Washington and Thomas Jefferson, were both slave owners horrified by the uprising. The second was by the British, at war with France and eager for fertile sugar land and slaves to work it. And finally, after he took power, Napoleon tried to recapture the territory as a French colony and restore slavery.

Ill-armed, barefoot and hungry, the rebels fought against huge odds: Britain dispatched an armada of 218 ships to the Caribbean, and its troops battled for five years before withdrawing; Napoleon sent the largest force that had ever set sail from France, losing more than 50,000 soldiers and 18 generals to combat and disease.

The former slaves lost even more lives defeating these invasions, and no country came to their aid. This blood-soaked period also included a horrific civil war, periods of near famine, and the massacre or flight into exile of most educated people and skilled workers of any color. By the time Haiti declared independence in 1804, many of its fields, towns and sugar mills were in ruins and its population shrunken by more than half. The Haitian Revolution, as it is known today, was a great inspiration to slaves still in bondage throughout the Americas, but it was devastating to the country itself.

For a gripping narrative of that period, there are few better places to turn than “Avengers of the New World: The Story of the Haitian Revolution,” by Laurent Dubois, a Duke University scholar of the French Caribbean. Now Dubois has brought Haiti’s story up to the present in an equally well-written new book, “Haiti: The Aftershocks of History,” which is enriched by his careful attention to what Haitian intellectuals have had to say about their country over the last two centuries.

The history is a tale of much misery, shot through with flashes of hope and bravery. Both the United States and the colonial powers in Europe were profoundly threatened by the specter of slaves who had successfully battled for their freedom; the United States didn’t even recognize Haiti for over 50 years. Still worse, France in 1825 insisted that Haiti pay compensation for the plantations taken from French owners. In case the Haitians did not agree, French warships lay offshore. The sum the French demanded was so big that a dozen years later, paying off this exorbitant ransom, and paying the interest on loans taken out for that purpose, was consuming 30 percent of Haiti’s national budget. The ruinous cycle of debt continued into the next century.

Seldom, however, can outsiders be blamed for all a country’s troubles. More disastrous than foreign interference was that Haiti’s birth was such a violent one. Democracy is a fragile, slow-growing plant to begin with, and the early Haitians had experienced none of it, not as subjects of the African kingdoms where many of them were born, not as slaves and not as soldiers under draconian military discipline for over a decade of desperate war. In Haiti’s succession of constitutions over its first hundred years, the president sometimes held his post for life, and it’s no surprise that one leader began calling himself king and another emperor. Furthermore, the revolution itself had seemed to show that any change in government could take place only through military force. As Dubois sums it up: “The only way for an outsider to take power — one that would be used again and again over the course of the 19th century — was to raise an army and march on the capital.”

Brute force still ruled in the next century, climaxing in the three-decade reign of the Duvaliers, father and son. Their militia, the dreaded Tontons Macoute, spread terror on a scale exceeding anything before, murdering as many as 60,000 people. François (Papa Doc) Duvalier banned any civic organization that could threaten his control, even the Boy Scouts.

The family’s close ties with the United States were immortalized by a famous photograph of Papa Doc and the presidential envoy Nelson Rockefeller waving from the balcony of Haiti’s National Palace. During the cold war, a strongman like Duvalier, no matter how brutal, could usually count on American support as long as he was vocally anti-Communist. Father and son understood this well and shrewdly used that knowledge to retain power, as did petty tyrants across Latin America, Africa and Asia.

Deep American meddling in Haiti did not end with the cold war. Dubois, however, devotes only a few pages to the quarter-century since Jean-Claude (Baby Doc) Duvalier was overthrown, and doesn’t really tell us what he thinks about the controversial progressive Jean-Bertrand Aristide and the degree to which the United States played a role in his ouster as Haiti’s president in 2004. In an otherwise authoritative history, this is a disappointing omission.

Part of this book does feel chillingly up to date, however: its account of the United States Marine occupation of Haiti for some two decades starting in 1915. The occupation was accompanied by high-flown declarations of benevolence, but the real motive was to solidify American control of the economy and to replace a constitution that prevented foreigners from owning land. The Marines’ near-total ignorance of local languages and culture sounds all too much like more recent expeditions. American officials declared, accurately enough, that the Haitian government was in bad shape and needed reform.

But as the troops on the ground discovered, like their counterparts in Iraq and Afghanistan, no one likes to be reformed at the point of a foreigner’s gun. “We were not welcome,” wrote one private Dubois quotes. “We could feel it as distinctly as we could smell the rot along the gutters.” The Americans soon found themselves fighting off waves of rebellion against their rule. United States troops burned entire villages accused of sheltering insurgents and ruthlessly executed captured rebels or — does this sound familiar? — men who might have been rebels; often there was no way to distinguish them from local farmers.

When they finally pulled out, the Marines did leave some roads, clinics and schools behind them. But the occupation’s death toll, humiliation and theft of resources, Dubois makes clear, loom far larger in Haitian memory. Even with the best of intentions, which the Marines certainly didn’t have in 1915, nation-building is no easy job. Administered less arrogantly and in cooperation with Haitians themselves, aid from abroad can sometimes help, as with the work of the estimable, Creole-speaking Dr. Paul Farmer and his Partners in Health program, which brings health care to the poorest rural areas and helps train Haitian medical workers. But the real freeing of Haiti from the burdens of its past — a task now made immeasurably greater by the catastrophic earthquake of 2010 — can be done only by Haitians themselves.

(Photo by John Carroll)

Adam Hochschild is the author of seven books, most recently “To End All Wars: A Story of Loyalty and Rebellion, 1914-1918.”

Rural Haiti and Road to Recovery

(Photo by John Carroll)

A Quake-Scarred Nation Tries a Rural Road to Recovery

By RANDAL C. ARCHIBOLD
New York Times, Dec 26, 2011
http://www.nytimes.com/2011/12/25/world/americas/in-countryside-stricken-haiti-seeks-both-food-and-rebirth.html?_r=1&ref=randalcarchibold

(Please note the comment appended to this article that I reproduce from the Corbett mail list.--RA)

(This article was posted by Roger Annis of CHAN.)

PAPAYE, Haiti — For months after the earthquake that struck the capital, Manel Laurore pulled shattered bodies from his neighbors’ homes, hunkered in fetid refugee camps and scrounged for food and water. Today, his main worries are when his bean, corn and plantain crops will come in.

“I will never go back to Port-au-Prince,” said Mr. Laurore, 32, a former shopkeeper who was sifting soil to plant a tomato garden, referring to the capital. “It left a strong pain inside. Here the work is hard, but you live in total peace.”

His work, on a 15-acre cooperative farm in Papaye, represents a small but promising success for an ambitious program being promoted by aid workers, government officials and international donors: saving the country by developing the countryside.

When the earthquake leveled Port-au-Prince on Jan. 12, 2010, planners and visionaries here and abroad looked past the rubble and saw an opportunity to fix the structural problems that have kept Haiti stuck in poverty and instability. An idea that won early support was to shrink the overcrowded, underemployed, violence-ridden capital and revive the desiccated, disused farmland that had long been unable to feed the country.

“Decentralization is a critical cornerstone supporting my vision for a new Haiti,” President Michel Martelly told potential investors last month. “We want to strengthen and empower our rural communities and create new ones.” But the vision has run up against Haitian reality: myriad economic and infrastructure deficiencies, the lack of credible opportunity in rural areas and the fading of international interest and funds.

Reviving rural Haiti would wean the country off an overreliance on imported food while creating jobs in the countryside, helping to discourage mass migration to urban sinkholes like Port-au-Prince. Before the quake, nearly a quarter of the population lived in the capital, where two-thirds of the labor force had no formal jobs and overcrowding was considered a major contributor to the quake’s estimated death toll of 300,000.

Tens of thousands of people fled Port-au-Prince for rural areas immediately after the quake, but most have since returned, American and Haitian government officials said, finding little opportunity and food to be scarce. “We need to reverse the trend of people in rural areas moving to the city,” said Ari Toubo Ibrahim, the Haiti representative for the United Nations Food and Agriculture Organization. The organization says it believes that, with enough training and support, about a tenth of the 600,000 people still in earthquake camps could ultimately move to the countryside.

New factories are also part of the plan. A South Korean-run industrial park in the north, partly financed by the United States, is expected to open next year, providing at least 20,000 jobs. But experts say agriculture is the nation’s biggest need.

Farming has declined to 25 percent of the economy today from 40 percent a decade ago, making Haiti more dependent on imported food. Today, the government says, 52 percent of the food Haitians eat comes from abroad, compared with 20 percent a few decades ago. The decline in farming dates primarily to the mid-1980s, when the government encouraged urbanization, and it worsened under a trade embargo during political turmoil in the 1990s. When trade restrictions loosened, the market was flooded with cheap, foreign staples like American rice, Dominican poultry and milk, in powdered form, from as far away as Europe.

A series of storms in 2008 further wiped out farms, and riots over the soaring cost of food, owing to fluctuations in the world market, led lawmakers to oust the prime minister.

Recently, though, there have been signs of a potential turnaround. This month, the World Bank approved $50 million for agriculture projects. “When agriculture grows, gross domestic product grows,” said Diego Arias, an agriculture economist who analyzes Haiti at the World Bank.

Signature Haitian products like mangoes, coffee and cocoa are getting a burst of overseas attention, and BioTek, a Florida company, is awaiting approval from the new government on a long-awaited public-private plan to revive Haiti’s last remaining sugar mill, in Léogâne, one of the areas hit hardest by the quake.

Haitian specialty coffee is in demand in restaurants in New York, Miami and other American cities, and the Inter-American Development Bank, Nestlé and Colombia’s National Federation of Coffee Growers have announced a $3 million effort to help 10,000 coffee farmers replant trees on denuded hills and increase production for both home consumption and export.

The American grocery chain Whole Foods has been selling a variety of mango indigenous to Haiti, and Lèt Agogo, a Haitian organization whose Haitian Creole name means Milk Aplenty, has stepped up a program to give cows and training to farmers and to process the milk into a sweetened drink that Haitian schoolchildren commonly consume.

Taiwanese agronomists have expanded a program to help rice farmers increase their yields, though imported rice, much of it from the United States, is still far cheaper in markets than Haitian-grown rice.

But the challenges are staggering, and most concern money. Irrigation is lacking, and poorly constructed ports and roads disrupt the delivery of produce to domestic and international markets. Government efforts ground to a virtual halt for months last year after a political crisis swirled around a botched election.

Foreign aid has slowed to a trickle. Only 43 percent of the $4.59 billion promised has been received and disbursed, according to the United Nations. The Interim Haiti Recovery Commission, the body created to coordinate and prioritize aid, closed in October when its mandate expired, with little sign that it will be renewed. The panel, led by former President Bill Clinton, was set up to provide some assurance to international donors, wary of channeling aid to a historically corrupt Haitian government, that their money would be well spent. Its departure raises questions about whether the remaining pledges will ever be fulfilled.

Haiti’s five-year agriculture plan developed after the quake has received only about half of its nearly $800 million budget. Haitian officials say the government actually needs $1 billion to $2 billion to carry out the plan. The new agriculture minister, Hébert Docteur, said he hoped to carry out the program with whatever resources he had to help struggling farmers. “Too often they are trying with hand tools to get something from the land, but it is not nearly enough,” he said.

The United States has opened several training centers that aim to instruct hundreds of farmers in rudimentary practices often taken for granted in other countries.

Wansy Jean Poix, 36, a sorghum and corn farmer in La Tramblay, near Port-au-Prince, said he was accustomed to planting by simply tossing seeds on a large patch of ground. Now he plants in rows, to maximize the use of the land. “We increased production so there is more for ourselves and to sell on market,” he said.

The experimental farm in Papaye, three hours from the capital, at once demonstrates the promise and the pitfalls that face the effort to expand farming beyond the hardiest takers. The village was created last summer by Mouvman Peyizan Papay, one of the country’s largest peasant organizations, working with the Presbyterian and Unitarian Universalist Churches in the United States and other organizations. Together, they plan to build four more such farms in the central region.

The 10 families here grow their own food and have begun planting crops like corn and plantains to sell. Though the houses lack electricity, they are roomier than those many of them left in Port-au-Prince. But the project has relied on substantial help to get off the ground. The total cost for the five villages will be $1.6 million, almost all of it from churches and nongovernmental organizations.

The United Nations is studying the project, but it is unclear how well it could be duplicated. Similar villages have been proposed elsewhere, but beyond the money, city dwellers have to believe that it is worth the effort to move their families to spend hours in the hot sun, hoeing and planting. “If they have water, technical assistance and credit they can survive,” said Chavannes Jean-Baptiste, executive director of Mouvman Peyizan Papay.

Emmanuel Jean Pierre, 30, already has found that subsistence farming is not enough for him and has set up a small side business charging cellphones in the village using a solar battery he acquired in Port-au-Prince. He complains of the back-breaking work and misses the energy of the city, the parties, the friends. But with work scarce there and his small grocery business destroyed in the quake, for now, he said, he will stick it out here.

“If I saw a big change in economic opportunity in Port-au-Prince I would probably go back,” he said. “But I would rather stay here all my life.”

(Photo above by John Carroll)

Comment from the Corbett mail list, Dec 29:I thought this was a very good article. But I would like to know why reporters and also the State Dept. keep on saying that there is a shortage of food!! What they really mean is that there is a shortage of MONEY TO BUY THE FOOD. But that is not the same as a shortage of food. Everywhere you go, marchands are on the street selling fruit and vegetables.

It gives a very bad idea of how Haiti is. I'm particularly incensed when I read the State Dept. saying there's a serious shortage of food and water!!! Who writes this stuff? They've obviously not been in Haiti!! We're never going to get visitors coming in if they think they're going to starve!!

The Haitian Woman---Central Pillar of Haitian Society

Photo by John Carroll
December, 2011


Haitian Peasant Women as 'Poto Mitan'--Central Pillar: An Interview With Idèrle Brénus Gerbier

Interview by Alexis Erkert, Other Worlds, Dec 20, 2011

Idèrle Brénus Gerbier has worked with many peasant organizations in support of women rights’ and food sovereignty. She is a member of the Haitian National Network for Food Security and Sovereignty (RENHASSA), campaign coordinator for Food Sovereignty in Haiti, advisor of the National Confederation of Peasant Women (KONAFAP), and organizer for the Haitian Social Forum for Food Sovereignty.

In Haiti, peasant women play a special role in the home and in agriculture. We consider peasant women as the poto mitan, central pillar, of economic activities.

When neoliberal structural adjustment programs are imposed on the Haitian government, like they have been for 20 years, they affect our peasant women. They require that the state implement fundamentally anti-peasant programs that threaten to destroy the whole peasant sector. They mean the Haitian government doesn’t adequately fund our agriculture and has left the small farmers unable to compete [with cheaper imported goods] in the local market. Many farmers are forced to abandon agriculture to go work in factories or other activities, in the cities or in the Dominican Republic. And when a man leaves the rural community, the whole responsibility falls on the back of his wife.

The Haitian society is essentially macho, and the Haitian politicians and international interests oppress Haiti’s own children. Farmers become victims again and again and women are always held back. But these women continue to support their country.

Our goal is to achieve respect for the rights of Haitian women. Despite their position as poto mitan, as the main carriers of the national economy, rural Haitian women always suffer in our society. Most of these women have no direct access to agricultural lands and income is strictly controlled by men, despite their role in agriculture.

Many rural residents are forced to give away the children they love because they don’t have the financial capacity to keep their children at home and send them to school. The majority of these children become the slaves of women living in Port-au-Prince and in other cities. If women farmers could earn income from their hard work, they’d be able to keep their children at home.

The majority of the women working in the informal economy in the city come from the countryside. Many rural residents lost their lives because they were at the heart of the earthquake looking for employment in Port-au-Prince, working for pennies at a factory or selling bottled water in the streets. The earthquake increased the responsibilities that were already too heavy for these poor women.

I’ll repeat over and over that these women who lost their lives, their children, their husbands, and other loved ones in Port-au-Prince, lost them mainly because of lack of infrastructure resulting from the neoliberal policies in the country. But they’ll never be discouraged. They’ll always be involved in all kinds of constructive activities and keep supporting their country. After the earthquake, they went to Port-au-Prince searching for their children and ended up offering help to others who were in need. In the cities and in the countryside, these women work without rest.

We need to advance the struggle of women by redefining the concept of feminism in Haiti. To do this we have to reshuffle the cards and reduce the differences between our urban and peasant women. Right now there are two kinds of women: women with a capital W and women with a small w. Even within the women’s struggle, there are a lot of contemptible practices that have yet to be overcome. Most of the urban well-off women look down upon the poor countryside women, calling them tèt mare, wrapped head, because of the kerchiefs rural women often wear on their heads. The rich and educated town women forget that the poor peasant women make up the core of the rural communities that constitute the greatest part of the country. It’s not fair that a small minority have the privilege of monopolizing almost all of the society’s resources and wealth.

Peasant women are always present in all activities to win human rights, respect for life, and food sovereignty. October 15 was declared “Day of the Haitian Peasant Woman,” but unfortunately this day has never been commemorated. We have to recognize and appreciate women farmers for their significant socio-economic worth. We have to give them the compensation they deserve and support their efforts. We need to increase their visibility in efforts to build food sovereignty in the country. Rural women and those struggling with them, here in Haiti or overseas, need to shore up their strength. We must advocate for the rights of women.

Many thanks to Joseph Pierre for translating.

Father Andre in Robillard

Robillard Cholera Treatment Unit
December, 2011
Photo by John Carroll


Father Andre from Robillard sent me an e mail last night.

See this post from Crof's blog.

Father describes a situation in his village which is probably going on in many places...too many cholera patients in "underserved" areas.

I will post his e mail to a couple of websites that address Haiti's cholera epidemic and see if there is an answer.

There are so many people of good will with public health backgrounds trying to slow the morbidity and mortality from cholera in Haiti. There has to be an answer.

Robillard

See this post from Crof's blog.

Photo by John Carroll
December, 2011

Cholera Legal Row in Haiti

Cholera Treatment Unit, Robillard
December, 2011

Photo by John Carroll


See this article.

(Thanks, Crof.)

MINUSTAH by Numbers

Photo by John Carroll

See this post.

Condemned Buildings in Port-au-Prince

See this video.

We Have Deported 250 Haitians This Year

See this article.

Cholera in Rural Haiti: Interview with Father Andre Sylvestre

See this article from CHAN.

Don't Restore Haitian Army

Good article in the Washington Post.