Medjina's Mother Missing

On December 18, Haitian Hearts brought Medjina to the United States for heart surgery.

Medjina is a seven year old 44 pound little girl. I first examined her in November, 2008.

It took us 13 months to get her to the US. We applied for a visa for Medjina's mother so she could be with Medjina during her heart surgery, but her mother's visa was denied by the American Consulate in Port-au-Prince.

Medjina was examined and tested for six hours on December 30 by a prominent children's hospital. She would be put on the surgery schedule for the following week.

One more check with Medjina's mother in Port-au-Prince occurred on Monday of this week. Mother was in agreement with the surgery.

Haiti's earthquake hit the following day.

Medjina's mother has not been heard from.

Now Medjina may be an orphan facing daunting heart surgery.

Compassion and Self Congratulation....a Fine Line

January 16, 2010

The TV Watch

Broadcast Coverage: Compassion and Self-Congratulation
By ALESSANDRA STANLEY

One moment looters brandishing machetes trot through streets of Port-au-Prince lined with corpses, and soon after, Robin Roberts, a host of “Good Morning America,” kneels over a sleeping child, tenderly stroking her back.

On Friday, Ms. Roberts informed the adoptive parents in Iowa that ABC News had tracked down their daughter in her orphanage, unscathed and napping soundly. The network framed the moment with the words “Exclusive: GMA finds missing baby; adoption reunion miracle.”

Disaster is both one of the hardest and easiest sights to watch on television; the medium feeds on paradox, presenting extraordinary images that horrify and also comfort. Since the earthquake struck Haiti on Tuesday, network and cable news shows have organized the chaos with raw, graphic footage, as well as with beautifully edited vignettes, some scored to music, that calibrate the balance of hope and despair.

In a disaster this huge, television reporters are the heralds of the fund-raising effort. News organizations repeatedly let people know how and where to donate money for Haiti, and those reminders allow Americans to feel that they can do something useful. They also help television news organizations by reminding viewers — and earthquake victims — that journalists serve as a pillar of the rescue mission, on the scene to do more than just gather information.

Lines of communication are still poor, and conditions are not exactly cozy: some reporters are sleeping on the ground and using car batteries to record their stand-ups. Nevertheless, the need is so vast that the NBC anchor Brian Williams felt prompted to explain himself on MSNBC earlier in the week. As he toured a stricken area, Mr. Williams noted that he and his crew were the only ones there with food, water and power, but that they were using those resources to provide reportage that would galvanize viewers to get involved.

And the television reports are wrenching. Men in masks toss bloated bodies into garbage trucks. Relatives dig with their hands past slabs of cement. A lifeless foot sticks out of a pile of plaster. Helicopters circle streets strewn with corpses. Katie Couric clasps the hand of a scared and wounded boy screaming in pain as a doctor tends to his foot.

There are not enough successful rescues to go around. The same few — a freed United Nations security guard pumping a fist in the air, a woman who was trapped for countless hours in a toppled market, emerging on a stretcher — are shown again and again.

On Thursday night Dr. Sanjay Gupta, CNN’s chief medical correspondent, led a camera crew through one of the few remaining hospitals in the region. As he passed wounded and dying victims, he explained that there were no doctors or nurses there to treat them. But CNN made a point of repeatedly showing another scene in which Dr. Gupta ran through the street to minister to an infant, the camera lingering on him as he cradled her in his arms and examined her head for lacerations.

Repetition has its place in a frightening emergency; images shown over and over — be it 9/11, the 2004 tsunami or Hurricane Katrina — magnify an event but can also inure the viewer. A joyous reunion of mother and child helps defuse the bracketing tragedy. But too much repetition can backfire when it looks like promotional material. The line between compassion and self-congratulation is thin on television; in a calamity this vast and acute, many viewers flinch at any sign of reportorial showboating.

And this earthquake has its own rules. Usually television is accused of overselling a crisis. The cameras zoom in on a hurricane, a riot or a guerrilla battle, magnifying the most dramatic images and cropping out people walking to work or hanging laundry in the near distance.

The Haiti story doesn’t need hyping; if anything, television understates the horror by balancing harrowing sights with miniature portraits of hope.

The NBC weatherman Al Roker returned from Haiti to the “Today” show on Friday, and Mr. Roker, the usually jolly co-host, didn’t have too much to say. The situation is “awful,” he said. “The pictures almost can’t convey what’s going on down there.”

The Underlying Tragedy

January 15, 2010

Op-Ed Columnist (New York Times)

The Underlying Tragedy
By DAVID BROOKS

On Oct. 17, 1989, a major earthquake with a magnitude of 7.0 struck the Bay Area in Northern California. Sixty-three people were killed. This week, a major earthquake, also measuring a magnitude of 7.0, struck near Port-au-Prince, Haiti. The Red Cross estimates that between 45,000 and 50,000 people have died.

This is not a natural disaster story. This is a poverty story. It’s a story about poorly constructed buildings, bad infrastructure and terrible public services. On Thursday, President Obama told the people of Haiti: “You will not be forsaken; you will not be forgotten.” If he is going to remain faithful to that vow then he is going to have to use this tragedy as an occasion to rethink our approach to global poverty. He’s going to have to acknowledge a few difficult truths.

The first of those truths is that we don’t know how to use aid to reduce poverty. Over the past few decades, the world has spent trillions of dollars to generate growth in the developing world. The countries that have not received much aid, like China, have seen tremendous growth and tremendous poverty reductions. The countries that have received aid, like Haiti, have not.

In the recent anthology “What Works in Development?,” a group of economists try to sort out what we’ve learned. The picture is grim. There are no policy levers that consistently correlate to increased growth. There is nearly zero correlation between how a developing economy does one decade and how it does the next. There is no consistently proven way to reduce corruption. Even improving governing institutions doesn’t seem to produce the expected results.

The chastened tone of these essays is captured by the economist Abhijit Banerjee: “It is not clear to us that the best way to get growth is to do growth policy of any form. Perhaps making growth happen is ultimately beyond our control.”

The second hard truth is that micro-aid is vital but insufficient. Given the failures of macrodevelopment, aid organizations often focus on microprojects. More than 10,000 organizations perform missions of this sort in Haiti. By some estimates, Haiti has more nongovernmental organizations per capita than any other place on earth. They are doing the Lord’s work, especially these days, but even a blizzard of these efforts does not seem to add up to comprehensive change.

Third, it is time to put the thorny issue of culture at the center of efforts to tackle global poverty. Why is Haiti so poor? Well, it has a history of oppression, slavery and colonialism. But so does Barbados, and Barbados is doing pretty well. Haiti has endured ruthless dictators, corruption and foreign invasions. But so has the Dominican Republic, and the D.R. is in much better shape. Haiti and the Dominican Republic share the same island and the same basic environment, yet the border between the two societies offers one of the starkest contrasts on earth — with trees and progress on one side, and deforestation and poverty and early death on the other.

As Lawrence E. Harrison explained in his book “The Central Liberal Truth,” Haiti, like most of the world’s poorest nations, suffers from a complex web of progress-resistant cultural influences. There is the influence of the voodoo religion, which spreads the message that life is capricious and planning futile. There are high levels of social mistrust. Responsibility is often not internalized. Child-rearing practices often involve neglect in the early years and harsh retribution when kids hit 9 or 10.

We’re all supposed to politely respect each other’s cultures. But some cultures are more progress-resistant than others, and a horrible tragedy was just exacerbated by one of them.

Fourth, it’s time to promote locally led paternalism. In this country, we first tried to tackle poverty by throwing money at it, just as we did abroad. Then we tried microcommunity efforts, just as we did abroad. But the programs that really work involve intrusive paternalism.

These programs, like the Harlem Children’s Zone and the No Excuses schools, are led by people who figure they don’t understand all the factors that have contributed to poverty, but they don’t care. They are going to replace parts of the local culture with a highly demanding, highly intensive culture of achievement — involving everything from new child-rearing practices to stricter schools to better job performance.

It’s time to take that approach abroad, too. It’s time to find self-confident local leaders who will create No Excuses countercultures in places like Haiti, surrounding people — maybe just in a neighborhood or a school — with middle-class assumptions, an achievement ethos and tough, measurable demands.

The late political scientist Samuel P. Huntington used to acknowledge that cultural change is hard, but cultures do change after major traumas. This earthquake is certainly a trauma. The only question is whether the outside world continues with the same old, same old.

-------------

Now, please read this:


From: Greg Chamberlain

(The Nation, Jan 2010)

The Haiti Haters

By Amy Wilentz


The Haitian tragedy has opened up a whole new industry for what I call
the genteel racist point of view. A week into the crisis I heard an
otherwise intelligent report on NPR in which the correspondent opened
her piece from Port-au-Prince by declaring that it "is not falling into
a...pit of violence," thereby giving us an idea of what she had been
anticipating, almost breathlessly. We heard this kind of thing
frequently in the days after the earthquake, with scores of fresh
reporters receiving their Haitian baptism amid the rubble. There are
many problems in Haiti, but most of the negative pronouncements that
have been circulating do not touch on them. The commentary has been
psychopolitical rather than analytical.

At least reporters, while their views may be wrongheaded, are giving us
new information from the ground. Far more insidious are the armchair
commentators who know nothing about Haiti--many never having set toe
there--but enjoy rebuking suffering Haitians from the comfort of their
white bastions in the United States and Europe. I've never seen victims
so roundly blamed for their fate. David Brooks's recent column in the
New York Times--one of the paper's most e-mailed articles the
week it was published--blamed Haiti's culture for the quake's violence.

"It is time," Brooks writes sententiously, "to put the thorny issue of
culture at the center of efforts to tackle global poverty. Why is Haiti
so poor? Well, it has a history of oppression, slavery and colonialism.
But so does Barbados, and Barbados is doing pretty well."

By all means, let's turn to actual history, which Brooks has mangled. As
has been mentioned repeatedly, the Haitian slaves rose up in 1791 and
began what was to become the only successful slave revolution in modern
history. That war ended, after much loss of life on both sides, with the
establishment of the world's first black republic, in 1804--just
twenty-eight years after the American Declaration of Independence. The
Haitians' models were the American and French revolutions, and they
based their ideas on the Declaration of the Rights of Man. But their
revolution seems to have been a little premature for the tastes of the
world in which they had to operate. Haiti was almost immediately saddled
with a gargantuan and punitive reparations payment to France in exchange
for recognition and the ability to engage in unhampered international
trade. The wealthy, slaveholding United States did not recognize Haiti
until 1862, after the Southern states seceded. Haiti has been a pariah
nation for its entire history.

Barbados, on the other hand: the Barbadians made their bold stand for
independence from Britain in... 1966. The British had already given up
slavery more than a century earlier. It was an unbloody, negotiated
independence, and Barbados is still a part of the British Commonwealth.
In fact, its membership began on the date of independence, as did
Jamaica's, in 1962, when it shrugged off the very loose shackles of the
remnant of British colonialism. The British were less brutal masters
than the French, and in the eighteenth century it was probably wiser to
remain a colony under them than, as the Haitians did, gain your freedom
at the expense of your economic welfare.

Brooks goes on to discuss the Haitian family, seemingly basing his
argument on a book by Lawrence Harrison, a conservative cultural critic
who also knows nothing about Haiti. "Child-rearing practices" in Haiti,
Brooks writes, "often involve neglect in the early years and harsh
retribution when kids hit 9 or 10." I don't know where this assertion
comes from, but it reminds me of nothing so much as Daniel Patrick
Moynihan's controversial and misguided report on the black family in the
1960s. I've never seen either of these child-rearing practices in my two
decades of living in and covering Haiti. In fact, I see more parents
carrying small children around in Haiti's markets than I do at the
farmers' markets in Los Angeles. You can't write these kinds of things
about people whose culture and nation you respect. Nor would an editor
permit you to say such things blithely about people who are considered
our equals or are able to respond in equally august publications. Right
now, the Haitians cannot--they're too busy getting water for their
neglected children.

Let's move briefly to Anne Applebaum's similar column, which appeared in
the Washington Post. Anne's a little depressed. She opens her
piece (as she so often does) by telling us about herself; her reactions
are important to her: "For the past several days, I have found myself
unable to look at the photographs from Haiti. I have also found that
when I start an article datelined Port-au-Prince, I have to force myself
to read to the end." Although she doesn't like to read about it, she
knows what's at the heart of her reluctance: "I have no illusions about
anyone's ability to help, for this...is a man-made disaster first and
foremost, and so it will remain." She goes on to fault the weakness of
Haiti's public institutions for the physical collapse of buildings,
including the Presidential Palace (constructed by the Marines during the
1915-34 US occupation of Haiti) and many other public edifices built by
perfectly well-educated architects using the best practices of their
day. It's a stunningly heartless argument.

Applebaum tells us that she was not this hopeless after the Indian Ocean
tsunami or Hurricane Katrina, and that it was easy to coordinate basic
assistance in those cases. Of course, this is patently not true, as
anyone who has read about or experienced those situations knows.
Applebaum goes on to say that there were no scenes in Aceh, Indonesia,
of "what everyone always calls 'biblical' tragedy." The reason some
people call the Haitian quake biblical is that they believe, whether
consciously or not, that it is a sort of divine retribution for the
temerity of the Haitian Revolution, and for the idea that black people
could take charge of their own lives. As Pat Robertson put it, the
Haitians made a deal with the Devil to throw off French rule. That's how
he sees it, and by extension, though in much more genteel terms, that's
how many other commentators see it. One cannot help but wonder, then,
what the Lord was avenging when he brought down an earthquake on San
Francisco in 1989, or on Los Angeles in 1994. Gay rights? Bad movies?

But let's look at things clearly, without prejudice. Haiti was in bad
shape before the earthquake. Though outside forces like debt, economic
sanctions, US interference and a big but diffuse and uncoordinated
development community have grievously harmed the country, Haitians too
are responsible for their problems. The government is weak and--although
much improved in recent years--still corrupt here and there, and still
plagued by internecine fighting over the tiny bits of funding that are
available in a country with microscopic national coffers. Taxes are not
properly collected, and well-connected families and officials fight to
the death over things like where emergency response teams or bridges
should be located (my province or yours?). Appropriations battles are
even harder fought in the Haitian legislature than in the US Congress,
and over much smaller streams of money. And powerful drug traffickers
have taken refuge in this governmentally lax situation, as they have in
Mexico and Colombia.

The country is also too centralized. Everything depends on the
government in Port-au-Prince. All the money flows out of that great city
to the provinces, when it flows at all. But with people fleeing the
destroyed capital, now's a good time to consider federalizing Haiti. The
countryside needs funding sources other than the usually paralyzed
national legislature. Strong and honest provincial councils that can
levy taxes and craft local solutions to local problems would vastly
improve the quality of life, and fewer Haitians would feel compelled to
move to Port-au-Prince to seek their fortune--and build slums that
pancake in earthquakes.

We need constructive answers to these big questions now. Good ideas are
coming in from people like Paul Farmer, who's run Haiti's Partners in
Health for years and who is now Bill Clinton's deputy at the United
Nations. They're coming in from Haitian survivors in all rubble-strewn
walks of life. New paradigms are also being offered by hardheaded
analysts like Jocelyn McCalla, a Haitian who consults on government,
immigration and business affairs, and from economists who have turned
their view toward global poverty eradication. Not all their ideas are
useful or plausible, and everything will be difficult to implement in
the months immediately following such a catastrophe. But people like
this are trying to find a way toward rebuilding Haiti, and building it
better.

You have a choice in a situation like the one we're confronting. You can
sit back in your chair and fondle your nihilism, or you can try to be
original and work toward something creative. People like Brooks,
Applebaum and Robertson are tapping into something very dark and
atavistic indeed. Those who read them or hear them are bound to ask
themselves, "What is it about Haiti?" Some will shrug and, like
Applebaum, turn away. In a moment of such death and destruction, that's
not the reaction one should hope to elicit.

Haiti's Earthquake....Another Bad Day for Haitians

In the next few weeks and months, Haiti's poverty and lack of functional infrastructure will take the lives of many Haitians that could have been saved after the earthquake yesterday.

I saw a video clip on television last night of a man walking down a street in Port-au-Prince. I recognized the street and location. There were burning piles of garbage in the middle of the street. Frankly, I think this video was shot BEFORE the earthquake hit, but am unable to say for sure. Port-au-Prince, on a good day, looks semi-destroyed.

Haitians cannot get out of the way of natural disasters. Most people can't get out of the way of unpredictable natural disasters.

But the disasters created and exacerbated by man are avoidable. Man-made racism and injustice have put Haiti in a child-like, helpless position for the last 200 years.

This segment of Peoria's Channel 25 covered the local efforts of various aid groups in Haiti.

Upstander

"...few of us feel as though we’re going to be perpetrators; and most of us hope we’re never going to be victims... most of us live in the space not between perpetrators and victims but between bystander and, potentially, ‘upstander,’ to coin a term. The question of how we relate to this history that goes on around us, or to matters of injustice."

Samantha Power
http://www.portsmouthpeacetreaty.org/powerforum2.cfm

Father, Take This Cup From Me

 

Not all Bad Behavior is Actionable

Peoria's OSF/SFMC behavior towards their Haitian Hearts patients was again abysmal in 2009.

OSF/SFMC is denying medical care to two patients, Jenny and Henri, both who had heart surgery at OSF/SFMC ten years ago. They both need repeat heart surgery. Both are in Haiti and both receive medications and exams from Haitian Hearts year after year.

They both have hope to stay alive. But where is the hospital in Peoria that "turns no patients away"?

----------

A couple of days ago I received a comment on this blog.

The commenter was a local Peoria blogger who actually signed his name.

The fact that the blogger/commenter signed his name was unusual...most comments are made anonymously because people fear OSF.

What even made this more unusual was that the blogger/commenter wrote that OSF/SFMC was indeed sliding downwards with regard to quality of care. The blogger/commenter had been a patient at OSF/SFMC recently and wrote that OSF/SFMC ignored and laughed at his requests for pain meds.

Who knows if that was true or not, but that was the comment.

I was really surprised that this person actually signed their name.

However, by the next morning, the blogger/commenter had removed the portion of their comment which regarded OSF's poor care.

Thus, another blogger/commenter thought twice about going after OSF with their name attached. Fear of OSF had won out again.

In this blog I have documented how Keith Steffen, OSF's Administrator, told me that fear is a good thing among OSF employees. I clearly documented how he intimidated two of his nurses in his office at OSF.

I have spoken with many people in the Peoria community during the last decade who genuinely fear OSF and Mr. Steffen. Even a huge benefactor to OSF won't come out against Mr. Steffen in attempts to have him replaced because she fears for her own medical care at OSF/SFMC.

Is this the way a Catholic hospital (or ANY hospital) should act?

Numerous members of the Peoria community fear losing their job and their health insurance if they go after OSF. Our business boards are related and when you go after one business you go after all of them.

And to make matters even worse for OSF/SFMC, this year their legal counsel Douglass Marshall contacted the US Consulate in Haiti regarding a Haitian Hearts patient receiving medical care in Peoria. Many people knew about Marshall's action, but they did nothing.

For good reason they fear OSF.

The seven remaining OSF Sisters that live in the massive convent near the hospital don't walk with a bounce in their step. They know all this is happening, but have lost their mission and their spirit and their will to stop the fear engendered by OSF's secular leaders.

How sad for OSF and for Peorians.

Web Album of One Day in Haiti, 2009

Please go to this album and view as a slideshow.

This was July 1, 2009 in Cite Soleil.

Hospital in Soleil

 

The World's One Hope

 
"When a child steps out in front of a moving car, someone will snatch the child back to the sidewalk. It's not only a kind person who'd do that, not only the kind of person they honor with statues, and memorial plaques. Anyone would pull a child out of the path of the car. But here, many people have been run down, and many pass by, doing nothing. Is that because there are so many suffering people? Shouldn't there be more help when there's more suffering? There's less help. Even kind people walk past, doing nothing, and they're just as kind as they were before."

--from The World's One Hope, a poem fby Bertolt Brecht translated by Tony Kushner

Neglected Diseases Amid Wealth

Slaves who survived the Middle Passage, "the largest forced migration in recorded history," were forced to live in filthy and unsanitary conditions that facilitated the introduction of parasites from west Africa to the New World. These included hookworms, whipworms and amebae, as well as parasites causing malaria, yellow fever, and schistosomiasis. Today the major tropical diseases introduced into the Americas during the slave trade remain endemic among the people living in Latin America and the Caribbean.

Neglected tropical diseaes are not exclusive to low-income countries. These diseases include ascariasis, dengue fever, congenital cytomegalovirus, and others. Such infections account for a sizable but largely hidden disease burden among minority populations living in poverty in the United States..particularly people of African American descent.

(Health Affairs, November/December 2009, Peter Hotez)

Photo by John A. Carroll, M.D.

Modjina

 
Modjina got her visa today to travel to the US for heart surgery!

Keeping her supplied with medication for her heart failure, obtaining her Haitian echocardiogram, finding a children's medical center with an excellent pediatric heart surgeon, obtaining her Haitian passport and her non-immigrant visa, acquiring notarized statements from the Haitian government, purchasing her roundtrip airfare to and from the US took 13 months. (I examined Modjina for the first time in November, 2008.)

Children in the developing world just don't count much...except to their mothers.

But Modjina is on her way....

A Christmas Carroll

 

Found this Poster Yesterday

Yesterday, while cleaning, I found this poster.

Haitian Hearts and Peoria Area Peace Network carried this poster in 2005 in front of OSF-SFMC as we protested OSF's discriminatory and dangerous policy against Haitian Hearts patients.

OSF refuses to operate on any Haitian Hearts patients even if OSF operated on them initially. In other words, OSF is refusing to give medical care to their own patients even after Haitian Hearts has offered full or partial charges for their medical care.

My wife and I took care of both of these young people in our room in Haiti. Jackson was with us for one month in cardiogenic shock and heart failure. Faustina had severe heart failure.

OSF did not answer repeated requests to save their lives.

Haitian Hearts was able eventually to get both Jackson and Faustina accepted into other medical centers in the United States.

However, it was too late for Jackson. Jackson Jean-Baptiste died a slow and very painful death in January, 2006. He is buried in Goodfield, Illinois.

However, Faustina was operated and did very well. She is a happy thriving teenager today.

Other OSF patients are sick in Haiti. I examine them and we provide them with their heart medication. They need surgery and will die without it.

OSF does not answer when contacted about their current sick Haitian patients. The Ethics Department does nothing. And The Catholic Diocese of Peoria remains silent.

As OSF continues to expand with their one-half million dollar Milestone Project, OSF continues their deadly policy against innocent Haitian Hearts patients as 2009 comes to a close.

Luke

 

Good News for Two Haitian Girls

Please read this good news!

Bill Moyers

See this video.

Urbanization...A Humanitarian Disaster

GLOBAL HEALTH

New England Journal of Medicine

Volume 361:741-743 August 20, 2009 Number 8


Urbanization — An Emerging Humanitarian Disaster

Ronak B. Patel, M.D., M.P.H., and Thomas F. Burke, M.D.


In 2008, the proportion of the world's population living in urban areas crossed the 50% mark. The current rates of urbanization suggest that in China, 870 million people — more than half the population — will be living in cities within less than a decade, and the capital of Botswana, Gaborone, will grow from 186,000 to 500,000 inhabitants by 2020.1 Most observers believe that essentially all population growth from now on will be in cities: the urban population is projected to grow to 4.9 billion by 2030, increasing by 1.6 billion while the rural population shrinks by 28 million.1

This transition is happening chaotically, resulting in a disorganized urban landscape. Although many expect urbanization to mean an improved quality of life, this rising tide does not lift all boats, and many poor people are rapidly being absorbed into urban slums. Urbanization, in fact, is a health hazard for certain vulnerable populations, and this demographic shift threatens to create a humanitarian disaster. The threat comes both in the form of rising rates of endemic disease and a greater potential for epidemics and even pandemics. To protect global health, governments and international agencies need to make commensurate shifts in planning and programs, basing all changes on solid epidemiologic and operational research.

Although natural disasters and armed conflicts cause migration into urban centers, most people relocate to cities in search of employment. When they arrive, many find only one affordable housing option: illegal and unplanned dense settlements lacking basic public infrastructure, where they must live in lodgings made from tenuous materials, such as used plastic sheets, discarded scrap metal, and mud. The United Nations Human Settlements Program (UN-Habitat) reports that 43% of urban residents in developing countries such as Kenya, Brazil, and India and 78% of those in the least-developed countries such as Bangladesh, Haiti, and Ethiopia live in such slums.2 These slums, which are making up an increasing proportion of growing cities, lack not only most basic government services but also political recognition; as a result, so do their inhabitants. These residents are usually tolerated and their presence tacitly accepted, but the local government generally ignores them, accepting no responsibility for accounting for them in planning or the provision of services.

The current public health paradigm delineates urban health hazards as comprising injuries, pollution, and chronic diseases, such as diabetes and hypertension. Although these hazards are indeed more specific to urban than to rural areas, urbanization also exacerbates long-standing hazards specific to populations that have not undergone the epidemiologic transition from a predominance of infectious diseases. Increasing the population density in cities without proper water supplies and sanitation increases the risk of transmission of communicable diseases. Mortality among children under 5 years of age and among infants is higher in urban slums than in rural settings (see table).3

Though in most countries health care is more limited in rural than in urban areas, the urban environment may lack health support often provided in rural settings while also posing new risks. For example, for women and children, the rural environment provides a community of kinship that often ensures physical safety, food security, and the availability of child care. Without these safeguards, many women's mobility is limited in urban areas. Mobility and child care assistance from more experienced women allow mothers to perform two of the three steps that are theoretically fundamental to health care utilization: identifying illness and seeking care (the third being delivering care). Differential rates of death reflect this effect of urbanization, but we require more data in order to assess the true extent of this problem and other urban health risks. Currently, collected data are rarely disaggregated down to the level of individual city neighborhoods, and slum populations are generally not included when health statistics are reported.

Improved systems for collecting data in slums are urgently needed for the planning of infrastructure construction, programs, and resource allocation. Precise data that distinguish among types of residence, locations, and socioeconomic strata would reveal the varied effects of urbanization on health indicators, allowing for focused interventions.

We believe that the world's wealthier countries need to invest in capturing these data and improving public health systems. Doing so is not purely altruistic; it serves the self-interest of all countries, because poor urban areas can easily become a breeding ground for emerging infections and potential pandemics. The outbreak of severe acute respiratory syndrome (SARS) in Hong Kong in 2002 and 2003, which was believed to have originated in rural China, demonstrated how dense urban living could ignite a global health crisis. In a slum, the lack of surveillance and adequate health care might well result in more rapid spread of undetected diseases; without the necessary resources, it is difficult to implement any kind of preventive, containment, or treatment measures. Developed countries also have a financial stake in the requisite surveillance and health care systems: even conservative estimates of the cost of SARS to the economies of Europe and North America run to billions of dollars.

Understanding health-related behavior and the logistics of the health care environment of urban areas can also aid in the design of appropriate interventions. All three factors necessary to the effective utilization of health care — illness identification, care seeking, and care delivery — vary within urban settings. Although slum residents often live close to many health care providers, they generally have little access to high-quality care. Care-seeking patterns show that although less expensive, higher-quality government clinics are often available, slum residents who do seek care tend to choose more expensive private providers — for a multitude of reasons, from perceived quality to ease of access.4 Studies show that the care received by the urban poor is often of low quality. One study examining the care provided by 100 private practitioners in an urban slum in Mumbai, India, found 80 different treatment regimens being used for tuberculosis, only 4 of which met the guidelines of the World Health Organization.5

In some cases, new interventions are required for this population, but in others, interventions that are known to be effective simply need to be translated into effective programs. Fundamental public health services, such as vaccination, a safe water supply and sanitation, and oral rehydration therapy, remain important, and operational research is required in order to implement them effectively. Adapting interventions for implementation by community health workers or trained midwives has shown benefit, and we believe that a cadre of health care workers practicing in slums must be trained in order to reach this population.

Our knowledge base also needs to be supplemented through dedicated research. Epidemiologists must develop methods for collecting precise and accurate data and surveillance on the health of urban populations. Research must be conducted on the design of interventions and approaches to using proven public health tools that exploit the advantages conferred by urban settings, such as the concentration of target populations and better communication and transportation infrastructures for delivery of care and health education. And governments, nongovernmental organizations, and private providers must commit themselves to implementing new policies and programs. Many projects and field research efforts fall by the wayside when no governing or implementing agency "scales up" initial results. Governments need to determine the structure of health care provision, administration, and regulation, and nongovernmental organizations should aid in promoting good governance, increasing capacity, and ensuring access to care.

As the world becomes increasingly urban, the health of the urban poor may suffer. Decades of progress in public health could be erased, and the stage could be set for devastating pandemics of infectious disease. Action is needed now to avert such a disaster.



No potential conflict of interest relevant to this article was reported.


Source Information

From the Harvard Affiliated Emergency Medicine Residency based at Brigham and Women's Hospital and Massachusetts General Hospital (R.B.P.), and the Division of Global Health and Human Rights, Department of Emergency Medicine, and the Department of Pediatrics, Massachusetts General Hospital, and Harvard Medical School (T.F.B.) — all in Boston.

Makes Sense to Me....

From: Bob Corbett
Date: Thu, Aug 13, 2009 at 1:58 PM
Subject: 35006: Morse (comment) Rules of Engagement (fwd)
To: Bob Corbett's Haiti list

Photo by John Carroll

I'm trying to get a better understanding of why the United Nations could keep so silent about the fraud during Haiti's April Senatorial elections and the June runoffs and my mind keeps drifting back to Rwanda and the genocide which saw the killing of 1,000,000 people, all under the watchful eye of the UN. That's right the UN witnessed the killing of one million people and yet, did nothing. Why? It's a standard phrase that comes up during interventions and occupations: "Rules of Engagement". The UN is invited by a host country and the "rules of engagement" are determined with the host country. In Rwanda the genocide was seen as an "internal political conflict" and under the "Rules Of Engagement", the UN was not permitted to "Engage". One million people died and the UN did nothing. I can't stress this enough.


I don't want to put the deaths of one million people on the same scale as senatorial election fraud but perhaps these failures by the UN have similar starting points. Perhaps there is an intrinsic weakness in the UN intervention process that leads to failure.

In Haiti there are a couple of things to consider:

1) The UN is here at the "invitation" of the Haitian government, so the UN doesn't want to embarrass "the hand that invites them".

A successful UN mission may mean
Brazil's becoming a part of the UN Security Council. The Brazilians may not want to open a can of worms by criticizing the hand that is so tied to their future; the "hand" that could potentially get them membership to the UN Security Council.

A conflict with the Haitian government could mean the end of the UN mission. If the invitation to the UN is withdrawn, a lot of UN jobs and careers will be sidetracked; the UN mission will be seen as a failure. What will happen to all those resumes (curriculum viteas)? What will happen to Brazil's standing with the UN Security Council and with the international community?

2) If things are perceived as "moving along nicely", then the UN, the UN Special Envoy along with all UN employees will be seen as having had a successful diplomatic intervention; more jobs for all. A "cover up" or "spin" is not the same as making things better but some at the UN may see spin and cover up as necessary evils; an alternate political truth or reality at the expense of the Haitian people.

Unfortunately, the UN seems to have become blinded by some of it's earlier successes. Overseeing the 2006 Presidential elections and the ensuing political calm has given the UN in Haiti the false impression that they can do no wrong in this impoverished nation. The impression that the UN is "so smart, they can get away with anything" is not the impression
to have when dealing with a country like Haiti. Haiti's population is so politically astute that in the long run, they'll make the UN pay for it's miscalculations.

The very thing wanted by ruling authorities in Haiti (factory investment), will be the very thing they're not going to get. Who wants to invest in a volatile country where workers are demonstrating in front of factories; where factory owners are going to embassies for protection; where the very family visited by the US Secretary of State was seen going to the Spanish embassy for protection after a particularly aggressive demonstration? A US embassy car was even attacked last week.

This isn't an investment climate. It could be an investment climate, but the current decision making process is leading us away from political calm.

Issues that have to be addressed and investigated for Haiti to get on track:

1) The election fraud of April and June. When I say the election fraud has to be addressed, I mean those implicated in the execution of the fraud as well as those involved in the cover up. Haitian Presidential elections are coming up next year and if this election process isn't put back on track immediately, we're all in for a long bumpy ride.

2) Economic development for the rural sector has to be initiated rather than si
mply bringing more factories to Port au Prince. Haiti's cities cannot support an influx of people coming in from the provinces looking for work. The infrastructure in Haiti's cities cannot absorb the people already living there; why attract tens of thousands more people now?

3) Why do St Mark and Gonaives still have sub human living conditions? What happened to all the money that has been allocated to these regions since 2004? Since 2004 at least five hurricanes (four in one month) have decimated the region.
We have to find out what's happening to the aid and why the intended recipients aren't getting it. Is it "local politics" or is it "corruption" that keeps these cities in their current states.

I've recently been to Gonaives and St Mark and I don't see how the UN can keep quiet about the current living conditions.

In conclusion, I have to say that things are deteriorating in Haiti right now and the signs tell us that they're going to get worse before they get better and the reason for this is not the Haitian people but the collective leadership of local decision makers along with the international community. It's time to make some significant changes; now.

Richard Morse

Port-au-Prince, Haiti

Minimum Wage Increased in Haiti

Haiti lawmakers OK minimum wage hike after clashes

By JONATHAN M. KATZ (AP) – Tuesday, August 4

PORT-AU-PRINCE, Haiti — Lawmakers voted to more than double Haiti's minimum wage Tuesday night after long hours of debate and clashes between police and protesters, who complained they can't feed and shelter their families on the current pay of about $1.75 a day.

The plan adopted fell short of the $5 wage demanded by the demonstrators, although it would more than double the minimum pay to about $3.75 a day.

The raise would include workers at factories producing clothes for export, an idea that President Rene Preval opposed. After refusing to publish into law a plan passed by Parliament in May to nearly triple the minimum wage, Preval proposed giving the garment factory workers an increase to about $3.

Given the lateness of Parliament's 55-6 vote to adopt the new raise, there was no immediate reaction from the president or from the protesters.

Earlier in the day, police fired tear gas at some 2,000 protesters who gathered outside Parliament to demand a big increase in the minimum wage. As legislators prepared to meet on the issue, some of the protesters threw rocks at police and began ripping down flags of U.N. member countries near the building.

Most of the crowd dispersed before the Parliament session began, with no arrests and only two reported injuries, including a cameraman who was hit in the head with a rock.

Many of the protesters were minimum-wage factory workers, such as Banel Jeune, a 29-year-old father who sews sleeves on shirts.

"Seventy gourdes, that doesn't do anything for me," he said, referring to his current minimum wage. "I can't feed my kids, and I can't send them to school."

The issue has been inflammatory in Haiti, which is the Western Hemisphere's poorest nation. But despite the heated debate and occasional violence, few people would be affected by the wage increase.

Most of Haiti's 9 million Haitians who are employed work on small farms or sell basic goods on the street. Only some 250,000 people have jobs covered by the minimum salary law, said lawmaker Steven Benoit, who sponsored the bill.

Still, some development experts argue that a pay increase would hurt plans for fighting Haiti's widespread unemployment by creating more jobs in the factories that produce clothing for export to the United States.

With new trade advantages that allow for duty-free exports of clothing to the U.S., such factories could provide "several hundred thousand jobs to Haitians ... over a period of just a few years," according to a report submitted to the U.N. in January. But it said that plan requires costs be kept down.

The report had been requested by Secretary-General Ban Ki-Moon and prepared by Oxford University professor Paul Collier. It is now being promoted by former U.S. President Bill Clinton, the new U.N. envoy for Haiti.