Good Words to Live By

War, want and concentration camps, exile from home and homeland, these have made me hate strife among men, but they have not made me lose faith in the future of mankind.

Personal experience, including my own unsteady progress through life, has taught me to beware of man’s capacity for plain stupid, irrational, as well as consciously evil, behavior, but it has also taught me that man has an even greater capacity for recovery from lapses. In a short thrust of planned, wisely guided activity, he is able to climb to higher levels of material and intellectual achievement than he ever reached before.

In short, I remain a rationalist and an optimist at a time when the prophets of doom have the floor. My query is: if man has been able to create the arts, the sciences, and the material civilization we know in America, why should he be judged powerless to create justice, fraternity and peace?

Ladis Kristof

What is Structural Violence? Look no Further than Peoria...

Photo by John Carroll

This is Jenny.

Jenny is being denied heart surgery by OSF-Saint Francis Medical Center in Peoria.

She e mailed the other day and is no longer able to work at her job in the bank in Port-au-Prince. And she wrote that she is afraid that I will not be able to find a hospital in the States to accept her.

I am afraid too.

Jenny is slowly dying. She is so viable and so alive now. She deserves so much more.

See paragraph below regarding structural violence.



"Structural violence" is one way of describing social arrangements marked by racism and other social inequalities. In the influential view of sociologist Johan Galtung, structural violence is "the avoidable impairment of fundamental human needs", embedded in longstanding "ubiquitous social structures, normalized by stable institutions and regular experience." Because they seem so ordinary in our ways of understanding the world, such violent structures are almost invisible. Disparate access to resources, political power, education, and health care as well as unequal legal standing are just a few examples. Such arrangements do violence to society's losers; the arrangements are structural because they are embedded in the economic organization of our social world. Those responsible for maintaining such inequalities are not the chief victims of structural violence....

Paul Farmer Reader

Thank You Letter to Haiti by Cindy Corell

Photo by John Carroll


June 27, 2010


A thank-you letter to Haiti

Cindy Corell
Connections

At last, we met, Haiti. I wonder if you felt also that it was as though this was not the first time. What a pleasure to be welcomed by you and your people.

I will admit to being surprised, though. I’d heard so much about you. Your other name, the poorest country in the Western Hemisphere, I knew, but I could spend days with you and not feel that. I was with some of your best and brightest. I was cared for and fed scrumptious food. Even if some of your family did without so I could be fed, they kept that from me.

Throughout my visit with you, one sentence kept flooding my mind.

Visiting a place like Haiti, where poverty is a way of life and the next meal might be a day or two away, it hits home to Americans how blessed we are. But it’s more than that. One characteristic I’ve heard about your people — over and over — sounds so trite. “They are poor, but they are happy.” “They don’t have worldly goods, but they are rich in spirit.”

I don’t think the stooped, elderly woman wearing a ragged dress and no shoes who approached me to tell me that she was hungry was happy. I’d just had a filling meal. She had not. I had nothing to help her but the hope that the resources we’d brought to the village would be passed down to those most in need.

I didn’t know what to tell her, so I said I was sorry. She said she was sorry, too, and she gave me a slight smile. But she was still hungry, and I was not.

And there was something in the eyes of a boy named Wikendy. He is 10 and very shy. He has trouble writing, and he looked as if he feared I would judge him. I worry about this young man, because I know that without a strong foundation and a strong school, life will be hard for him.

And a child wearing a shirt that proclaimed “Everybody loves a brown-eyed girl” took my heart with a shy grin and a tenacious desire to have her photo taken. Again. Wear your heart on your sleeve in Haiti, and somebody’s going to take it.

It was only a week, yet it seems it was a lifetime. So many faces, so many voices, smiles. Our group has been tremendous. What a fortunate combination of personalities, skills, gifts and hearts. We came to build a school, and your people helped build us.

My faith is elastic, and it was stretched in Haiti. If it is as John Calvin said, “a firm and certain knowledge of God’s benevolence toward us,” then God is in this place. He is who brings me here, like he has so many routes through my journey. I should learn to relax and let the worries go, because where I land is where I need to be.

What surprises me is how so much of my past (my other life — pre-Haiti) comes rushing back. I am walking across a field with a farm woman and what are we talking about? Corn. Agriculture, drawing sustenance from the land. My earliest memories are of cornfields, my father’s pride and joy. I am thinking about walking through rows of corn when I was about 3, holding my father’s hand.

And now four decades later, another walk, the same, but so different. I am holding the hand of Joselin, who has embraced me and answered my questions about what she grows. She’s probably in her 60s, wearing a soft brown cotton dress, with a blue kerchief on her head.

What is different is that among her corn, she and her husband grow pistachios. The feel of the soft earth beneath our feet and the feeling of absolute security, that I am in a safe place and with someone who will take care of me, that’s the same.
And for that short walk, in that short time, I am lost in Haiti again.

The unfairness of Haiti strikes you so quickly. Small babies held in mother’s arms, no diaper, no clothes. Skin against sweaty skin. The cry of an infant is the same here as everywhere. And a mother’s coos, as well.

My heart was filled. I am so grateful to have been there. To be hot and covered with sweat, to receive such love and hospitality not only from my hosts, but from my fellow travelers. This was a journey like no other.

The contradictions, the laughter, the running jokes, the startling realization — over and over — that we are in a land of pain and horrifying poverty.

It is so easy to get lost in Haiti.

Our trip leader, Roger Bowen, has taken dozens of school groups to Haiti. In the rural areas, he would ask the Haitian teachers to pair their students with his and send the Americans home with them for an afternoon. How else would you know how far the walk, or how Wikendy or the brown-eyed girl or Joselin lives? When they returned, the American students would often ask this question: Why was I born where I was born and my friend born where he was born?

Why indeed?

We have the resources, and they have the needs. Morality and justice would command us to share, but what does that mean?

It played out in front of us each day. Along the road to Mombin Crochu on Tuesday morning we stopped so some could answer nature’s call. No rest stops on the roads in Haiti. I walked back down to the stream we’d just forded. A man had his motorcycle in the shallow water washing it. An older woman, barefoot, with a simple dress and a kerchief on her head, greeted me. I asked if I could take her photo, and she smiled and posed.

A small girl, about 11 years old, approached the creek from the other side. She wore a peach-colored school uniform and white shoes. The woman called to her to stop. Walking across the rock-bottomed stream, she lifted the girl in her arms and carried her across. Then she straightened the girl’s collar and sent her on her way. She looked puzzled that I would take pictures of this. Why would helping someone in need be unusual, she seemed to say.

Why, indeed?

I traveled to Haiti to help tell your stories. Our relationship helps both of us. We offer you resources and hope to empower your people to build stronger lives with better education and opportunities for jobs. And your people give us strength of spirit and provide a mirror to the ways we live our lives.

Beyond the trite sentence-long descriptions of the Haitian people, I found resilience there. I met people at all levels of economic security, but they each had a richness in them.

Your people are in need, yet they choose joy. If the music is playing, they dance. If hands are lifted in prayer, they speak with God. If someone else is in need, they help.
Thank you for everything, Haiti. You have so much to teach us.

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

Les Cayes, Haiti

 

Rape in Haiti

Photo by John Carroll

Sexual Assaults Add to Miseries of Haiti’s Ruins
By DEBORAH SONTAG

NEW YORK TIMES - Published: June 23, 2010

PORT-AU-PRINCE, Haiti — The 22-year-old woman, wearing a gauzy blue dress that she had changed into after her release, spoke in a whispery voice.

Perhaps the worst part of the whole ordeal, she said, was the place where her kidnappers had chosen to imprison her. That they abducted her was terrifying. That they raped her, repeatedly, was too horrendous to absorb just yet.

But stashing her in the ruins of a home? Making her crawl on her stomach beneath a collapsed slab into a destroyed house where they hid her in a pocket of rubble? That was torture, she said.

“Since I had not slept under any roof since the earthquake, I was so scared I could not breathe,” said the woman, Rose, who requested that her full name be withheld.

Rose’s kidnappers told her brother-in-law, who delivered the ransom of about $2,000, that they would kill her if she talked. She had no intention of doing so. But police investigators showed up at the family house in the Delmas 33 neighborhood shortly after her release, and a reporter from The New York Times happened upon the scene, later accompanying Rose to a women’s health clinic at the family’s request.

Being present when Rose and her family were grappling with the horror of her ordeal offered a firsthand glimpse inside the vulnerability that many Haitians, and particularly women, feel right now. Sleeping in camps, on the street and in yards, many feel themselves at the mercy not only of the elements but of those who prey on others’ misery.

So many cases of rape go unrecorded here that statistics tell only a piece of the story. But existing numbers, from the police or women’s groups, indicate that violence against women has escalated in the months after the Jan. 12 earthquake. Kidnappings are rare, but they, too, have increased, and “the threat is constant,” said Antoine Lerbours, a spokesman for the Haitian National Police.

Malya Villard, director of Kofaviv, a grass-roots organization that supports rape victims, said that the presence of thousands of prisoners who escaped during the earthquake aggravated an environment where insecurity and despair feed on each other.
Ms. Villard said that Kofaviv’s two dozen case workers, in Port-au-Prince, had counseled 264 victims since the earthquake, triple the number in an equivalent period last year. Arrests for rape are fewer — 169 countrywide through May, but more arrests have been made in the last few months than during the same period last year.
Since the earthquake, international relief groups have expressed concerns about violence against women, especially in the camps under their watch. Poor or nonexistent lighting, unlockable latrines, adjacent men’s and women’s showers and inadequate police protection have all been problems.

Recently, security in eight big camps has improved, with joint Haitian-United Nations police posts or patrols; about 100 Bangladeshi policewomen arrived late last month to deal with gender-based violence at three of them. But there are about 1,200 encampments throughout Haiti, and this city’s battered neighborhoods are largely left to their own defenses, too.

Rose and her relatives recently moved back to their properties when the owner of the property where they were squatting threatened the tent city residents with eviction. Their homes have been marked with a yellow stamp by surveyors, meaning they are damaged but fixable. Rose and her relatives sleep outside them, fitfully. They were scared of the “young thugs in Mafia sunglasses,” Rose’s cousin said, even before Rose’s abduction.

On May 10, Rose, a statuesque woman who is learning to be a beautician, went out to buy some cookies. A police officer whom she knew beckoned her to sit in his unmarked car, she said. She did. Then two men ordered the officer out of the car, taking his gun and driving off with Rose.

The men shoved her into the back, and made her lie face down. She does not know what neighborhood they took her to; it was empty and rubble-filled, and had many destroyed houses. When she protested entering one, they slapped her, she said, and forced her to squeeze through the collapsed entrance. They pushed her into a crawl space beneath a fallen ceiling.

“I was scared mute,” she said. “Only when they raped me did I scream. It hurt.”
Clutching her pelvis as she talked, Rose said that the men had taken turns, raping her seven times. “Or maybe eight,” she said, shutting her eyes.

The police officer showed up at Rose’s house the morning after she was kidnapped to tell the family what had happened. “He waited all night while we lay awake terrified,” her brother-in-law said. “He was looking for his car. We said, ‘What about Rose?’ He said, ‘We’ll look for her, but, you know, you will hear from them first.’ ”

The kidnappers used Rose’s cellphone to call. They put it on speaker phone and hit her repeatedly so her family could listen to her cry out in pain.

“They demanded $50,000 American,” her uncle, a vendor, said. “That’s crazy. I don’t have 10 gourdes to my name. But they said, ‘Don’t bother going to a voodoo priest. He can’t help you. Don’t bother calling Obama. He can’t help you, either. Just give us money, or we will kill the girl.’ ”

Over the next few days, the family managed to raise $2,000 in gourdes, the Haitian currency, from neighbors. The money was left at a drop site on Sunday evening. At 3 a.m. Monday, Rose was blindfolded and put on the back of a mototaxi. When she arrived home, she collapsed into a fetal position at the door to her house and knocked weakly.

Several hours later, the police investigators arrived. Family members encircled Rose as she answered questions in a monotone. Occasionally they peered out at the street through the cracks in their home, fearful that the kidnappers were watching.
Rose had already changed her clothes and bathed, which she did not know would frustrate the collection of evidence. But the police did not raise the issue, anyway, her family said.

When the police left, Rose rode in the back of a car to a Doctors Without Borders clinic, wincing in pain as it bumped over rutted roads. At the tented clinic, she was instructed to take a seat on a bench.

Another woman, slim and poised, entered the open-air waiting room and told a nurse she needed to see a gynecologist.

“Infection?” the nurse asked. “A case of rape,” the young woman answered, in clipped French. She had been invited to a “literary circle” in a tent city the previous evening, she said. “No books were discussed,” she said. The two victims sat side by side and stared straight ahead. The nurse said that the clinic had treated about 60 victims in May.

When Rose was discharged with pills and other treatments, her uncle — whom Rose calls Papa — watched her from a distance, tears streaming down his face.

“Beautiful child, oh beautiful child,” he said. “Look into my eyes and you will know how I feel. When is this all going to end? Haven’t we suffered enough?”

Haiti for Haitians

Good post by Richard Morse.

Harsh Words from US Lawmakers Regarding Haiti

Photo by John Carroll
Delmas, Port-au-Prince
May, 2010


Posted on Mon, Jun. 21, 2010
Worry, harsh words from U.S. on Haiti recovery
BY JACQUELINE CHARLES
jcharles@MiamiHerald.com

More than five months after a devastating earthquake, there are worrisome signs that the massive rebuilding efforts have stalled, a strongly worded report by the chairman of the powerful U.S. Senate Foreign Relations Committee says.

Sen. John F. Kerry, D-Mass., is calling on Haitian President René Préval to show greater leadership in Haiti's post-quake reconstruction and for international donors, including the United States, to improve coordination and speak with one voice.

``Key decisions remain in flux and critical humanitarian issues related to shelter and resettlement are not resolved,'' the report said.

The report, to be released Tuesday, also notes that fragmentation and lack of coordination among donors ``are undercutting recovery and rebuilding.''

Haitian Prime Minister Jean-Max Bellerive, who co-chairs the Interim Haiti Reconstruction Commission, defended the government's handling of the crisis, saying that Préval's leadership has allowed for Haitians to remain united despite the challenges.

``We've kept a united nation during this period; that is leadership,'' he said.

And Bellerive said the government has a plan to rebuild the country.

``We know where we are going but no one is going to make us go any faster, or in a direction that doesn't benefit the Haitian people,'' he said.

The , 7.0-magnitude quake on Jan. 12 killed a government-estimated 300,000 Haitians, and 1.5 million people remain underneath tents and tarps in a country where a few days of rain could lead to deaths.

MOVING FASTER

It is the second time this month that an influential member of Congress has issued a report critical of Préval's lack of prioritization and decision-making.

Richard Lugar, R-Ind., ranking member of the Senate Foreign Relations Committee, earlier this month urged Préval to move faster to schedule presidential and parliamentary elections, or risk losing the confidence of the U.S. Congress.

Kerry and Lugar hold significant sway over U.S. efforts in Haiti, and can hold up funds to the embattled country if they're not satisfied with the pace of reconstruction. The United States is Haiti's biggest ally, and while support for Haiti remains on Capitol Hill, a $2.8 billon aid package the Obama administration is seeking remains stalled in Congress.

Foreign Affairs Committee staffers compiled the report after site visits and extensive interviews with those involved in Haiti's recovery.

It cites the lack of scaffolding on a crumbled presidential palace as emblematic that the rebuilding has stalled.

While the rebuilding must be Haitian-government led, the United States has to take an active role in the process, Kerry wrote.

The report cites 10 critical issues for Haiti's rebuilding that require urgent attention by the Haitian government and Obama administration. They include conflicting messages from donors to Préval, setting an election schedule and the lack of government guidance about its plans.

``The government has not done an effective job of communicating to Haitians that it is in charge and ready to lead the rebuilding effort,'' the report said. ``President Préval should take a more visible and active role, despite the difficulties confronting his government.''

Préval, who has relied on close supporters to lead the recovery and reconstruction, should make the rebuilding more inclusive and empower top lieutenants to make key decisions about land tenure, for instance, to relocate Haitians living in squalor camps, the report says.

U.N. CONCERN The U.S. Senate's reservations are echoed by others in the international community including the U.N. Security Council. Member states have expressed concerns about building materials being delayed and donors -- who pledged more than $5 billion over the next two years -- not fulfilling their pledges. At the same time, the international community appears poised for a showdown with Préval over presidential and parliamentary elections. Préval and the international community want to avoid an interim government after his term ends early next year. But two diplomats say their governments are growing increasingly frustrated and impatient with ``his disengagement.''

Préval has yet to formally set the elections date, and has refused repeated requests to revamp the beleaguered Provisional Electoral Council (CEP), which is responsible for carrying out elections. The credibility of the body is key to avoiding a boycott or another Haitian political crisis, top diplomats warned as late as last Thursday in a close-door meeting with Préval.

``The extraordinary challenges Haiti must face in the coming years demand responsive leadership, unwavering commitment and a clear vision,'' Lugar said in a statement.

``If elections are not held before President Préval's mandate expires, Haiti may be confronted by a vacuum of power at every level of its government. Haiti does not need to add a political crisis to the death and destruction caused by the Jan. 12 earthquake.''

Préval has countered that changing the CEP -- which would require groups to appoint members -- could invite spoilers from opponents who have been demanding his resignation and the move toward an interim government.

``What's important is that the Haitian people have an opportunity to go to the polls and make their choice,'' Préval told The Miami Herald.

But there is growing concern that a Haitian political crisis could derail U.S. efforts to help.

``Republicans and Democrats may disagree on many issues related to U.S. Haiti policy, but the importance of having fair, transparent and free elections is not one of them,'' said a top Republican aide.

Special correspondent Stewart Stogel at the United Nations contributed to this report.






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

© 2010 Miami Herald Media Company. All Rights Reserved.
http://www.miamiherald.com

Rebuilding Stalled in Haiti

US Senate report says Haiti rebuilding has stalled

By JONATHAN M. KATZ (AP)

PORT-AU-PRINCE, Haiti — Haiti has made little progress in rebuilding in the five months since its earthquake, because of an absence of leadership, disagreements among donors and general disorganization, a U.S. Senate report says.

Obtained Monday by The Associated Press, the eight-page report is meant to give Congress a picture of Haiti today as U.S. legislators consider authorizing $2 billion to support the country's reconstruction.

That picture is grim: Millions displaced from their homes, rubble and collapsed buildings still dominating the landscape. Three weeks into hurricane season, with tropical rains lashing the capital daily, construction is being held up by land disputes and customs delays while plans for moving people out of tent-and-tarp settlements remain in "early draft form," it says.

The report was written by staff of Sen. John Kerry, the Massachuetts Democrat who is chairman of the Senate Foreign Relations Committee, and other Democrats who interviewed U.S., Haitian, United Nations and other officials and visited resettlement camps, hospitals and schools throughout the quake zone.

"While many immediate humanitarian relief priorities appear to have been met, there are troubling signs that the recovery and longer term rebuilding activities are flagging," said the report, which is scheduled to be released Tuesday.

Three times it says the rebuilding process has "stalled" since the Jan. 12 disaster.
The report also criticizes the government of Haitian President Rene Preval and Prime Minister Jean-Max Bellerive, saying it has "not done an effective job of communicating to Haitians that it is in charge and ready to lead the rebuilding effort." The report calls on Preval to take a "more visible and active role, despite the difficulties."

Bellerive responded to the criticism in a Monday interview with the AP. He said officials are working hard behind the scenes to ensure reconstruction does not simply mean the rebuilding of barely livable slums.

"We understand the impatience and we are the ones more frustrated than anybody," the prime minister said. "It took some time. I believe four months (since a U.N. donors' conference in March) to plan the refoundation from such a disaster is pretty acceptable."

With a chuckle, he also said it is unfair for U.S. officials to take him to task when the Senate still has not approved aid money that Secretary of State Hillary Rodham Clinton promised at the donors' conference.

"They ask me to move more projects when the money is still on hold," Bellerive said.
In all, just 2 percent of the $5.3 billion in near-term aid pledges have actually been delivered, up from 1 percent last week.

The report expresses concerns that even once the money is in hand, it will not move quickly enough to help. The funds are managed by a 26-member reconstruction commission led by Bellerive and former U.S. President Bill Clinton that started its operations last week.

While the report calls the commission the "best near-term prospect for driving rebuilding," it also says the panel "has the potential to dramatically slow things down through cumbersome bureaucratic obstacles at a time when Haiti cannot afford to delay."

The report notes disagreements among donors over strategy, approach and priorities, saying the disputes "are undercutting recovery and rebuilding."
The reconstruction panel includes representatives of donors who pledged at least $100 million in cash or $200 million of debt relief, including the United States, Venezuela, Brazil, Canada, the European Union, the Inter-American Development Bank and the World Bank.

Bellerive said the report's criticism that the panel has been too slow in organizing is already moot. "We had a meeting, we have an office, we have administrative support," he said.

One thing on which all parties agree is the importance of November elections. The legislature has almost entirely dissolved after members' terms expired because the quake forced the cancellation of February legislative elections. Preval's five-year term ends next February; an attempt to prolong his term by several months if elections are not held resulted in protesters clashing with police in front of the ruins of the presidential palace.

Failing to hold the November elections on time, even despite the losses of the electoral commission's headquarters and records, could imperil "Haiti's fragile democracy," the report says. But it expresses limited optimism that a plan for holding the vote is "apparently imminent."

Copyright © 2010 The Associated Press. All rights reserved.

Seeds and Water a "Common Patrimony" in Haiti

Photo by John Carroll, Les Cayes, Haiti
June, 2010


Haitian Farmers Leery of Monsanto's Largesse

Peter Costantini


PÉTIONVILLE, Jun 21 (IPS) - Haitian farmers are worried that giant transnational corporations like Monsanto are attempting to gain a larger foothold in the local economy under the guise of earthquake relief and rebuilding.

"Seeds represent a kind of right to life," peasant leader Chavannes Jean-Baptiste told IPS. "That's why we have a problem today with Monsanto and all the multinationals who sell seeds. Seeds and water are the common patrimony of humanity."

Earlier this month, in the central square of Hinche, an agricultural town in Haiti's Plateau Central region, a mass of small farmers wearing red shirts and straw hats burned a symbolic quantity of hybrid corn seed donated to Haiti by the U.S. agricultural-technology giant.

They called on farmers to burn any Monsanto seeds already distributed, and demanded that the government reject further shipments.

The actions in Hinche (pronounced "ansh") were spearheaded by the Mouvman Peyizan Papay, a regional peasant movement that claims 50,000 members, and the national coalition of some 200,000 members to which it belongs. Despite divisions among Haitian peasant organisations, several of the most important groups joined together to participate.

Jean-Baptiste has led the MPP since 1973 and plays a major role in the international peasant movement.

"Our primary goal is to defend peasant agriculture," he said, "an organic agriculture that respects the environment and fights against its degradation. We defend native seeds and the rights of peasants on their land."

The international peasant movement advocates for "food sovereignty", Jean-Baptiste emphasised, the right of each country to define its agricultural policy, of communities to decide what to produce, and of consumers to know that the products they consume are healthy.

"We work with indigenous groups as well, and with them we believe that the earth has rights that we must respect, just as people have rights," he said.

The actions against Monsanto also were targeted "against the policies of the government that don't help peasants, but rather accept products that poison the environment, kill biodiversity and destroy family, peasant agriculture," he contended.

According to Monsanto, 130 tonnes of hybrid corn and vegetable seed out of a promised 475 tonnes have been sent so far, with the first shipment arriving in Haiti during the first week of May. The remaining 345 tonnes, which will be hybrid corn seed, are to be delivered over the coming 12 months.

The company stressed in a news release that the seeds are not genetically modified, as some early reports stated, but acknowledged that some seeds are coated with fungicides and pesticides.

Monsanto consulted with the Haitian Ministry of Agriculture on what seeds would be acceptable to Haitian farmers and well-suited for Haitian conditions, Darren Wallis, a spokesman for the firm, told IPS in an e-mail.

A programme of the U.S. government's Agency for International Development, the Watershed Initiative for National Natural Environmental Resources, and the non-profit Earth Institute will distribute the seeds along with inputs such as fertilisers and provide technical support, Monsanto said.

WINNER describes itself as "a 127-million-dollar project … which aims to improve the living conditions of the rural populations in Haïti".

But speakers at the Jun. 4 rally saw the project in a different light, accusing President René Préval of "collusion with imperialism" and "selling off the national patrimony".

Although Jean-Baptiste was a key architect of the election of Préval to his first term in 1995, the peasant leader now says bitterly of the politician: "He has simply betrayed the ideas that we stood for."

Jean-Baptiste sees the seed donation by Monsanto as a beachhead in a battle between Haitian popular organisations and the U.S. and European transnational corporations who, he says, dominate the Haitian government and the reconstruction effort.

"The government is selling off the country or giving it away as a gift. Not only is Monsanto trying to get in, but they're talking about Coca Cola coming in to plant mangoes. The Haitian people are fighting to make sure that all the generous international aid will be channeled into genuine programmes of sustainable development."

Mistrust of the intentions of transnational corporations and the United States government is strong among many Haitians and based on a long history. The square in Hinche where the demonstration took place is named after Charlemagne Péralte, the leader of a peasant uprising against the occupation of Haiti by the U.S. Marines, which lasted from 1915 until 1934.

The history of damage to Haitian farmers by foreign aid is also long and painful.

In the 1980s, Creole pigs were almost completely eradicated under heavy pressure from the Ronald Reagan administration. The animals were once known as "the savings bank of the Haitian peasant", and were bred over centuries to thrive in the Haitian environment.

An epidemic of African Swine Flu that began in the neighbouring Dominican Republic was killing pigs, and U.S. authorities feared that it could spread to North America. Although some Haitian organisations proposed alternatives for controlling the disease, the Duvalier dictatorship violently imposed the will of the U.S. in the face of resistance by many Haitian farmers.

The variety of pig sent from the U.S. as a replacement was much less hardy and required expensive inputs and facilities. Virtually none survived. Many Haitian families were never compensated and suffered a crippling blow to their livelihood, in some cases having to pull their children out of school, according to Grassroots International, a U.S. non-governmental organisation.

The group has been working with Haitian peasant groups since 1997 to repopulate Creole pigs across Haiti.

Testifying before the U.S. Senate in March, former President Bill Clinton offered a notable apology for the policies of his administration towards Haitian agriculture. He lamented that forcing Haiti to lower tariffs on subsidised U.S. rice may have helped rice farmers in his home state of Arkansas, but destroyed the capacity of Haitian rice farmers to feed their country.

Calling his policy a "devil's bargain," he said: "We should have continued to work to help them [Haitian rice farmers] be self-sufficient in agriculture."

Chavannes Jean-Baptiste traveled to the U.S. and the United Nations from Jun. 11 to 14 for meetings to discuss the Monsanto donation and alternatives for Haitian agriculture proposed by Haitian peasants.

*Peter Costantini blogs at http://www.huffingtonpost.com/crossover-dreams. He spent the month of May in Haiti.

Haiti's Private Medical Sector

Photo by John Carroll, Cite Soleil, June 2010

Haiti's private medical sector collapsing as charities rush to provide free health care

Sunday, June 20, 2010
By SCOTT FARWELL / The Dallas Morning News
sfarwell@dallasnews.com

PORT-AU-PRINCE, Haiti – Minutes after the earthquake, mangled bodies began appearing in the courtyard of Hospital of the Sacred Heart.

Dr. Reynold Savain becomes emotional while discussing the failure of Centre Hospitalier du Sacre'-Coeur/CDTI, the hospital that he and his family owned. Dr. Reynold Savain remembers stepping over the dead and dying that first night, careful not to slip on the blood and body fluids. He remembers the chaos, the plaintive cries for help, the pile of broken and crushed corpses.

There is no other word to describe it, he said, but "nightmare."

Centre Hospitalier du Sacre'-Coeur/CDTI, a private medical facility owned by Savain and his family, was the most advanced hospital in Haiti. Days after the quake, foreign doctors and nurses transformed it into one of the city's most bustling intensive care units.

Today, it is closed. Bankrupt. Silent.

CDTI's troubles illustrate a great paradox in Haiti.

Thanks to volunteer doctors from abroad and donated medical supplies, health care here has never been better.

But local doctors and private hospitals are dying.

"Health care is free now," said Savain 55, a whip-thin radiologist and third-generation physician. "And so, unless something changes, the private Haitian medical sector will not be able to survive."

CDTI may seem like an improbable casualty of a natural disaster typically described as a medical crisis – an estimated 230,000 people dead and a half-million more injured.

But five months after a 7.0 quake reduced much of the city to rubble, CDTI's sophisticated equipment – a CT scanner and a suite of digital X-ray machines – sits idle in the country's most modern operating rooms.

Boxes of donated medical supplies clog hallways, where in the macabre days after the quake, doctors with scalpels and saws performed dozens of guillotine amputations.

"I gave everything," Savain said. "I turned the hospital over to the Americans and some of these big NGOs [nongovernmental organizations such as the American Red Cross] because they said they had money and they would help me.

"But nobody gave me a dime."

After three months without paying his 177 employees, Savain, by Haitian law, had to make a decision: either pay up or fire them. He closed the doors March 31.

"All the NGOs were willing to give was rotational doctors," Savain said. "But I told them I needed to repair the building, we had used all our supplies, and we had to pay the staff. The only way to do that is with money."

CDTI was once a source of national pride, a modern, Western-style medical center designed by Haitian architects, built by local engineers and financed by wealthy entrepreneurs. Last year, it was the site of the country's first organ transplant.

The procedure, Savain and others said, sent a clear message to the nation's wealthy: "You no longer have to travel to Miami or the Dominican Republic for modern medical care. You can go to CDTI."


The quake strikes

Then, on Jan. 12, the earth shifted under Port-au-Prince.

Six months later, local doctors and private hospitals say they still feel the aftershocks.

"Free care is perfect. You can imagine more and better things now," said Dr. Michel Theard, a Haitian cardiologist who sits on the board of the Canape-Vert hospital.

But the struggling 30-bed private facility now serves only six or seven patients, and the staff has been slashed in half.

"Local doctors gave away free care at the beginning, like everyone else," Theard said. "But they have to survive. They have their own families and their own responsibilities."

Canape-Vert, he said, is hanging on because it is a 50-year-old hospital without the debt of the more modern, 3-year-old CDTI.

"CDTI was the best hospital in Haiti, but it was not making as much money," Theard said. "It had no financial reserves. It was so young. If you make a mistake – or something happens like an earthquake – you die."

Haitian doctors agree that the prospects for patients have never been better.

But what happens when the money dries up and foreign doctors leave? The medical system could be worse than ever.

Theard said the answer is obvious. International aid should be used to keep the local health care system alive. Hire local physicians, he said, and subsidize private hospitals.

"In the first days, the NGOs came from all over, like bulldozers," Theard said. "And they gave free care for surgery, for deliveries of pregnant women, for consultations, without ever going to the locals and asking, 'Can we do some of this together?' "

Before the earthquake, most health care in Haiti was theoretically free. But doctors say the system was crippled by lack of supplies, poor management and widespread corruption.

"You might have surgery scheduled, and it is postponed one day because there is no oxygen, the next day because there are no cleaning supplies," said Brigitte Hudicourt, an ophthalmologist who now works part time for Doctors Without Borders. "You might spend a month in the hospital and spend more money waiting and waiting than if you went to a private hospital."

As a result, some Haitians sought care at church-sponsored institutions such as Adventist Hospital in Leogane or other clinics. Many just went untreated.

Cristian Morales, a spokesman for the World Health Organization, said Haiti's private health care system and exclusive hospitals like CDTI have simply not been a priority for relief organizations in the first six months after the earthquake.

He said fewer than 5 percent of people – the wealthy and well-connected – could afford to visit private hospitals and physicians.

"The earthquake put CDTI out of business because of the general lack of resources in the country," he said. "For the first times in their lives, many Haitians have access to health care.

"People have lost their homes and their source of income, and they're just not in a position to contribute to the private system."

Savain called that philosophy shortsighted – the international medical relief will one day pull out of Haiti – and hypocritical.

"Before the earthquake, when anybody at WHO got sick, guess where they went to the hospital?" he said. "They were glad CDTI was in business."


No financial support

Dr. Craig Hobar, a Dallas plastic surgeon, and a medical team from his nonprofit LEAP Foundation arrived at CDTI the fourth day after the earthquake. He, too, remembers the heroism of Haitian doctors.

"I know there were a lot of supplies coming into that hospital, but there was no financial support," Hobar said. "We always thought that some of the massive money donated to Haiti would end up going to that hospital.

"But as far as I know, [Savain] never got a dime and he just kept it open."

Records from USAID, the international relief arm of the U.S. government, show that a representative from CDTI applied for aid from the U.S. Foreign Disaster Assistance field staff in February, but withdrew the request in May – two months after the hospital closed.

Savain said he suspended his $1.5 million request because his business was belly-up and he had been told his application was denied. He hopes to sell the facility to the Haitian government or a U.S. nonprofit group.

"That hospital was built on a poor but stable Haitian economy that doesn't exist anymore," Hobar said. "I don't think this is the time to be a private hospital trying to make money, but a hybrid or some sort of subsidized hospital would allow people to provide care and be reimbursed a fair value for it."

Judith Timyan, USAID's health team coordinator, said the Haitian minister of health is developing a sliding-scale national insurance system based on patient income. That way, patients receive care and doctors get paid.

"We're supporting the government of Haiti to make sure Haitian doctors and nurses get back to their jobs and earning salaries," she said.

"That will ensure the health care system is ongoing, sustainable and operating 18 months from now and 10 years from now."
-------------

My comments regarding this article:

Haiti's wealthy should not have to go to Miami to get high tech medical care. But Haiti's 9 million poor people can't get high tech care ANYWHERE. Haiti's poor have had a hard time getting malaria medication that costs pennies, let alone an organ transplant.

And are Haitians recieving the best medical care they have ever recieved because of the influx of NGO medical groups? I don't know. I think the care overall in Port-au-Prince and the provinces is still very, very poor...

If You Don't Read Anything Else Today, Read This!

Maria and I adopted Luke from Haiti several years ago.

It was not easy but we were very fortunate.

Luke's adoption took 20 months. He lived with us in Port-au-Prince the last seven months of his adoption process.

Haiti's thousands of homeless kids, many in orphanages, and Haiti's restaveks are treated miserably. For Haitian officials to slow down valid adoptions after the earthquake is unthinkable.

Please read this article below:


Child rescued from Haiti rubble is orphaned again
Saturday, June 19, 2010

Associated Press

PORT-AU-PRINCE, Haiti — Time was up, not 10 minutes into the visit. The social worker went to pull the 3-year-old orphan out of the arms of the woman he calls "Momma."

The boy turned his face and dug his hands into her clothes. He kicked his legs. He screamed as they carried him away.

Tamara Palinka covered her mouth to hold back the sobs. The 37-year-old Canadian volunteer aid worker did not know when — or if — she would get another glimpse of the child she was desperately trying to adopt.

International adoption has always been a sensitive subject in Haiti, a reminder that the country is too poor to care for its own. After January's quake, the Haitian government effectively slammed the door shut on most adoptions altogether. With no foster care system and virtually no domestic adoption in Haiti, untold numbers of children orphaned by the quake — like the 3-year-old known as Sonson — now face a lifetime inside an institution.

The crackdown on adoption came in response to two incidents. First, Pennsylvania Gov. Ed Rendell flew 53 children from a destroyed orphanage run by two Pittsburgh sisters back to the U.S., after a tense standoff with officials at the Haiti airport. Then a group of U.S. missionaries tried to take 33 Haitian children out of the country without papers, claiming they were orphans when in fact all had at least one living parent.

Infuriated, the Haitian government announced that all children leaving the country would need the signature of Prime Minister Jean-Max Bellerive. Since then, the government has relented somewhat, but it still allows only the adoption of children orphaned before the quake or those relinquished by their parents in the presence of a judge.

"The sad part is that because of a few people's mistakes, children that could find a good home and are waiting for a home will now have to suffer for years — and may never get a home at all," says Miriam Frederick, founder of the New Life Childrens Home orphanage.

At another orphanage, Sonson sits apart from the other children.

He stares at the floor.

"Who is your momma?" asks an orphanage worker. "Mara," he whispers. "Do you miss her?" He nods.

___

The first thing people saw after the ground stopped shaking on Jan. 12 was the thick, white cloud. It was the dust kicked up by hundreds of falling buildings. People pulled out of the destruction looked like they had been doused in flour.

Three weeks passed before anyone noticed the 3-year-old. The only part of him not covered in white dust was his foot, which was stained red with blood.

Two women saw him playing by himself on top of a destroyed house and assumed his parents were nearby. But after four days and nights, they realized he spent all day on top of the rubble by himself.

Then they noticed his belly was getting bigger, a sign of malnutrition. He was picking through the rubble for trash to eat. They carried him to the nearby office of the Salvation Army.

The toddler was covered with dust, didn't talk and looked dazed, according to the charity's report. His foot was infected, so they transferred him to a field hospital set up by the University of Miami on the grounds of the airport.

___

Palinka could hear the hospital before she saw it.

Hundreds of people were screaming. Children moaned in pain as nurses changed bandages on their raw stumps. Families yelled out for help for their dying relatives.

For the next two months, she often worked 24-hour shifts without a break. She was paged when the generator stopped working, when the medical supplies ran low, when the water ran out and multiple times a day when a patient died.

"Everyday I catch my heart in my throat," she wrote in a journal entry.

An athletic blond, Palinka had been working drafting safety procedures at an oil refinery. By the time the quake hit Haiti, she had enough saved up to take a leave of absence.

She had been at the hospital for three weeks when the 3-year-old was brought in and placed in a cot. It was dark when they told her an orphan had been rescued from a trash pile.

The other children in the pediatric ward had parents nearby. At night, the mothers crawled into the cots with their children.

Palinka felt a sudden sadness. The boy looked so small, swallowed by the adult-sized cot. She didn't want him to wake up alone.

On a whim, she got in the cot with him.

She tried to sleep but couldn't. She listened to the sounds inside the sauna-like tent — coughing, the whimpering of a child in pain, nurses brushing past, doctors talking and the alarm set off by a little girl in the emergency room.

In the morning, the 3-year-old stirred. He rolled toward her, glanced at her, then quickly turned away. She felt that her side was wet. He had peed all over the cot.

She changed him. She gave him baths inside a plastic laundry tub. She rummaged through the donations flown in from Miami to find him fresh clothes and a play pen.

When she first tried to clip his toe nails, he pulled in his feet and curled them into little balls. Coaxing him in Creole, a Haitian nurse slowly got him to extend his feet.

The food at the hospital came in a styrofoam takeaway container. She placed the box in front of the 3-year-old. He opened it and threw one leg over it, as if to shield it from anyone who might try to steal his food.

He ate in famished gulps until he couldn't eat anymore. Then he hid the box under a table. When she took him outside, he grabbed a fistful of dirt and stuffed it inside his mouth. The doctors determined that he had worms, most likely from eating food off the ground.

At lunchtime, the nurses placed the takeaway box on the floor of his play pen. Palinka returned to find him asleep in a pile of rice. When he lifted his face, chunks of rice were glued to his cheek.

One morning, as she lowered him into his play pen and turned to leave, he threw up his arms and screamed out, "Momma!"

___

At first the little boy only looked at his feet. She would tell him softly, "regarde moi" — "look at me." He started to give her furtive glances. She took him into her tent, away from the clamor of the pediatric tent.

He started to talk to himself. Sometimes he sang. One of his favorite games was to blow on her stomach, making the sound of a motorboat.

She asked a Haitian translator to figure out his name. The translator got down on one knee to ask him. The child stared at his feet. He repeated the question. And then the child answered.

"Sonson," he said.

She brought a different translator. And then a third one. Each time the answer was the same. On her Facebook page on Feb. 13, Palinka wrote: "Sonson is a good name."

Two days later she posted: "Tamara Palinka wants to take Sonson home! will start the process tomorrow."

In Alberta, Palinka's mother Kate Millar wrote back: "Is Sonson a child you are hoping to adopt??? Am I going to be a grandmother???"

International adoptions by U.S. households have fallen from a high of around 23,000 in 2004 to roughly half that last year, according to U.S. State Department figures. Haiti is the latest of several former "donor" countries to put a freeze on such adoptions.

Vietnam and Guatemala have halted adoptions altogether. South Korea — one of the first countries from which orphans were sent — has revised its rules to make adoptions increasingly difficult.

"There is a sense in many many countries that to be a 'sending' country is an embarrassment," says adoption lawyer Diane Kunz, executive director of the Center for Adoption Policy and an expert on adoptions from Haiti. "Their perspective is 'Our patrimony is our children.' It's as if you are giving this away."

___

By his second week at the hospital, Sonson was transformed. He sang and danced. At dinner, he beat a stick on the back of the styrofoam container like an instrument.

He begged for food. Other volunteers gave him candy and snacks. Some days Palinka would come to feed him and see he had already two empty styrofoam boxes in front of him. Several times he vomited on her. One night she took him to see a doctor at 2 a.m. because he was complaining of a stomach ache.

She taped a sign to the back of his shirt. "Please do not feed me," it said. "My mommy does that."

One time, she went to get him for his nap and couldn't find him. A volunteer had walked off with him.

"I was like, 'What are you doing?' Don't you ever ever walk off with him again."

___

"I've made up my mind so don't even try to stop me," Millar wrote her daughter in an e-mail. "I'm coming down to see my grandson."

The two slept with Sonson between them.

Millar saw her daughter transformed into a mother. It was in every gesture — from the soft way she spoke to him, to the constant attentiveness she showed him.

"In my case that is something that I grew into by giving birth myself to a child. She didn't grow into it by being pregnant," Millar says. "When I saw her, she was a mom — in every way she is a mom. This is her son. ... I'm so proud of her."

___

As Palinka spent more time with Sonson, her attention began to shift away from the hospital.

Then the order came from Miami. The rainy season was starting. The hospital needed to downsize.

None of the orphans had medical conditions that required them to stay. Palinka was tasked with contacting the government to transfer them to orphanages.

She clashed bitterly with the hospital's management, according to several volunteers. She accused the hospital of trying to 'unload' the orphans. Hospital officials accused her of letting her feelings for Sonson blindside her. A spokeswoman for the hospital said it does not comment on personnel issues.

Within days, the orphans — including Sonson — were registered with the state's child welfare agency.

When Palinka returned, hospital officials relinquished her of her duties. They said she was spending too much time with Sonson.

A 6-minute video shot on a co-worker's Blackberry phone shows Palinka's final moments with Sonson before he was taken away.

He is sitting on her lap in the backseat of an SUV. He pinches her lips together, like a fish. Then he leans forward and kisses her over and over again.

When the SUV pulled away, Palinka waved until the car had driven out of sight. Then she sobbed until she started dry heaving in the hospital's parking lot.

Within a week she aged. Her eyes were hollows. Her face was taut. She carried his toy car in her pocket for comfort.

"I see her, and you don't even want to ask what's going on," says Jen Jasilewicz, the hospital's chief nursing officer. "It amazes me. You have someone who wants to give her love and all those beautiful things to a child, and she is not being allowed to."

Haitian officials say they are trying to protect children from possible exploitation.

"International adoption should always be a last resort," says former Deputy Gerandale Telusma, who headed a committee charged with drafting the country's new adoption law. "We need to first make sure there is no other family willing to take the child ... to make sure they don't enter into some kind of nightmare."

It is a position backed by the United Nations Children's Fund, which helped create a database for unaccompanied children after the Haiti quake. The aim is to reunite children with their extended families, even if family members say they cannot care for the child.

Michel Forst, the United Nations' independent expert on human rights in Haiti, says the adoption freeze is necessary.

"There were lots of people that were coming here and doing whatever the heck they wanted. So it needed to be put on hold so that we could make sure that these adoptions were being done in a legal manner," Forst says.

"And yes, it's hard. It's hard for the well-meaning families that are waiting to adopt children. And it's hard for the children that are being prevented from running into the arms of these families."

___

Sonson was transferred to a modern orphanage in a village a 1½ hour drive from downtown Port-au-Prince. Palinka spent her remaining weeks in Haiti trying to get visitation rights.

On her first visit, she was told to call a child welfare case worker at 8 a.m. Palinka says she called more than 20 times between 8 and noon and each time was told to call back "in 10 minutes." She was then told to drive to the side of the highway leading to the village and wait.

She says she waited for more than two hours in the sweltering car before the case worker arrived. Jeanne Bernard Pierre, the head of the child welfare agency, declined to comment.

The woman took her to see Sonson. She didn't recognize him.

His head had been shaven. He was sitting by himself on the floor. The other children rushed at her, screaming. "Where is he?" she asked.

"Don't you recognize him? That's him," said the woman.

She crouched on her knees. "Sonson?" she said. He looked up and then away. She scooped him up in her arms. He held on tightly. He made no sound, until they tried to pull him away. And then he screamed.

In the month since they were separated she has seen him twice more. Each time she finds him diminished. "He looks smaller. He's no longer making eye contact," she said.

He cannot be declared an orphan for at least six months, to give his family a chance to reclaim him if they are alive. After that, he enters the bureaucratic labyrinth of Haiti's adoption limbo.

Even before the earthquake, the waiting time for the roughly 300 Haitian children adopted each year into U.S. households was two to three years. So even if the government accepts Palinka's application, 3-year-old Sonson will be waiting for about as long as he has been alive.

___

On her last supervised visit, Palinka was allotted 20 minutes with him. She arrived an hour early. She brought him his bike with the training wheels.

Through a translator she tried to explain what would happen next. "I'm going to go away for a long time, but I will come back for you," she told him.

When the visit was up, she lifted him onto the bike. Engrossed, he pedaled away.

She quietly slipped out. She kept her bloodshot eyes on the ground as she walked briskly out of the gravel driveway, his toy car in her pocket.



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Post-Bulletin Company, L.L.C.
www.postbulletin.com

Flood Threat for Caribbean Islands

Flood Threat for Caribbean Islands, Including Haiti

By Kristina Pydynowski, Senior Meteorologist
Jun 18, 2010; 10:39 AM

The tropical disturbance that was once being monitored for development threatens to spread flooding downpours across the Caribbean islands into this weekend. This includes earthquake-devastated Haiti.

The disturbance's downpours are currently impacting the Leeward Islands. Numerous downpours will spread over the Virgin Islands and Puerto Rico tonight into Saturday, then Haiti Saturday night into Sunday.

The mountainous terrain of Puerto Rico and Hispaniola, the island shared by Haiti and the Dominican Republic, will enhance the rainfall produced by the disturbance.

Some mountainous locations, especially those that face southeast, could receive up to 6 inches of rain. Dangerous mudslides and flooding are serious concerns.

The mountains in far southern Haiti should actually help the nation's capital, Port-au-Prince, escape the heaviest rain. As the air descends from these mountain peaks, some moisture will get lost.

Haiti is still trying to rebuild after the devastating 7.0-magnitude earthquake in January.

The Associated Press reported on Thursday that rebuilding has been hampered by organizational problems, government disfunction, and the overall scale of the disaster.

Even though five months have passed since the earthquake, collapsed buildings still line the streets in Port-au-Prince. Residents are living under leaky tarps and tents that may not be able to withstand extreme weather.

According to the New York Times, roughly 1.5 million Haitians remain homeless.

On Thursday, former U.S. President Bill Clinton officially inaugurated the commission overseeing Haiti's post-earthquake reconstruction.

Worsening the situation for Haiti is the fact that the quake left behind unstable hillsides, increasing the danger of mudslides due to torrential rainfall.

Many of the forests of Haiti have been clear-cut years ago, adding to the vulnerability of flooding and mudslides.

Giovanni Riccardi Candiani, head of contingency planning for the U.N. Office of Coordination of Humanitarian Assistance, told the Palm Beach Post that flooding is a significant concern in Haiti. Tropical storms in 2004 killed almost 3,000 people; many of these victims died due to the floods.

Haiti may also be at greater risk to suffer from hurricane damage due to its weakened condition. AccuWeather.com Hurricane Expert Joe Bastardi is expecting a top-10 hurricane season, which could include as many as 18 named storms.

Bastardi also said that Haiti may be overdue for a significant hurricane season. Haiti was hardest hit by hurricanes Flora, Cleo and Inez in the 1960s.

Disturbance Could Impact Florida Next Week

Beyond this weekend, the disturbance will continue to press northwestward next week. Downpours are expected to spread across Cuba and the Bahamas early in the week. Around midweek is when heavy thunderstorms may invade South Florida, including Miami.

The disturbance should then enter the Gulf of Mexico. It is here where AccuWeather.com meteorologists will have to monitor the potential for tropical development.

Strong winds high in the atmosphere, also known as wind shear, are currently preventing the disturbance from developing.

Kristen Rodman and Kirstie Hettinga, AccuWeather.com Staff Writers, contributed to the content of this story.

Haiti---June, 2010

 

Bill Clinton and Pledged Money for Haiti

Photo by John Carroll

Clinton-led commission starts up in Haiti
Posted: Jun 17, 2010 1:09 PM CDT
Updated: Jun 18, 2010 5:50 AM CDT

By JONATHAN M. KATZ
Associated Press Writer

PORT-AU-PRINCE, Haiti (AP) - Former U.S. President Bill Clinton officially inaugurated the commission overseeing Haiti's post-earthquake reconstruction on Thursday, pledging to accelerate and organize a process that has raised less than 1 percent of the money promised by international donors.

The Interim Haiti Reconstruction Commission aims to oversee every rebuilding dollar that comes to Haiti through next year. The hope is that it will ensure transparency and encourage investment, helping transform a dysfunctional, cripplingly poor country crushed by the Jan. 12 earthquake into a self-sustaining nation with a prosperous middle class.

"The prime minister and I have made a commitment to the people of Haiti and the people of the world to make this process both transparent and accountable," Clinton told reporters before the meeting.

Outside the cracked, upscale hotel where it met in a convention room, a better future seems a long way off. More than five months after Port-au-Prince shook, collapsed buildings line the streets and families live under leaky tarps at risk from floods, hunger and disease. Rebuilding has been hampered by organizational problems, government disfunction and the scale of the disaster itself.

Long-term money has also been slow to arrive. Some $3 billion has been committed for humanitarian aid such as immediate post-disaster rescue, medical care, emergency shelter and food, according to the United Nations.

But despite international pledges of some $5.3 billion over two years at the United Nations donors' conference for Haiti in March, only a fraction has actually been delivered - just $40 million from Brazil. Though other pledges are expected to be delivered soon, much of that to be held in a Multi-Donor Trust Fund administered by the World Bank, Haitians are growing restless.

Enter the commission. The 26-member body was empowered under an 18-month emergency declaration by Parliament passed shortly before most members' terms expired and the body essentially dissolved last month.

Half its voting members are Haitian officials, the rest representatives of each donor pledging at least $100 million or $200 million of debt relief: the United States, Canada, Brazil, Spain, France, Norway, Venezuela, Japan, European Union, Inter-American Development Bank and World Bank. President Rene Preval has a veto.

The concept is that the commission will oversee the spending of every donation above $500,000 to Haiti. Organizations will present their projects to the fund, needing its approval to get government and other support to move forward. The process will be tracked on the commission's website.

On Thursday, Clinton and Bellerive announced the commission's first approved spending projects:

- $45 million from Brazil and Norway in direct funds for the Haitian government, closing a quarter of its estimated $170 million budget shortfall.

- $1 million from the Clinton Foundation for buildings that can be used as storm shelters in the quake-ravaged towns of Leogane and Jacmel, which are often in the path of Atlantic hurricanes.

- A $20 million fund to provide loans to small- and medium-sized Haitian businesses, provided by Mexican communications magnate Carlos Slim and Canadian mining investor Frank Guistra.

If this Can Happen in Rwanda, Why Not Haiti?

Photo by John Carroll, Port-au-Prince

June 14, 2010

A Dirt-Poor Nation, With a Health Plan
By DONALD G. McNEIL Jr.

MAYANGE, Rwanda — The maternity ward in the Mayange district health center is nothing fancy.

It has no running water, and the delivery room is little more than a pair of padded benches with stirrups. But the blue paint on the walls is fairly fresh, and the labor room beds have mosquito nets.

Inside, three generations of the Yankulije family are relaxing on one bed: Rachel, 53, her daughter Chantal Mujawimana, 22, and Chantal’s baby boy, too recently arrived in this world to have a name yet.

The little prince is the first in his line to be delivered in a clinic rather than on the floor of a mud hut. But he is not the first with health insurance. Both his mother and grandmother have it, which is why he was born here.

Rwanda has had national health insurance for 11 years now; 92 percent of the nation is covered, and the premiums are $2 a year.

Sunny Ntayomba, an editorial writer for The New Times, a newspaper based in the capital, Kigali, is aware of the paradox: his nation, one of the world’s poorest, insures more of its citizens than the world’s richest does.

He met an American college student passing through last year, and found it “absurd, ridiculous, that I have health insurance and she didn’t,” he said, adding: “And if she got sick, her parents might go bankrupt. The saddest thing was the way she shrugged her shoulders and just hoped not to fall sick.”

For $2 a year, of course, Rwanda’s coverage is no fancier than the Mayange maternity ward.

But it covers the basics. The most common causes of death — diarrhea, pneumonia, malaria, malnutrition, infected cuts — are treated.

Local health centers usually have all the medicines on the World Health Organization’s list of essential drugs (nearly all are generic copies of name-brand drugs) and have laboratories that can do routine blood and urine analyses, along with tuberculosis and malaria tests.

Ms. Mujawimana gave birth with a nurse present, vastly increasing the chances that she and her baby would survive. Had there been complications, they could have gone by ambulance to a district hospital with a doctor.

“In the old days, we came here only when the mother had problems,” her mother said. “Now the village health worker orders you not to deliver at home.”

Since the insurance, known as health mutuals, rolled out, average life expectancy has risen to 52 from 48, despite a continuing AIDS epidemic, according to Dr. Agnes Binagwaho, permanent secretary of Rwanda’s Ministry of Health. Deaths in childbirth and from malaria are down sharply, she added.

Of course, many things that are routine in the United States, like M.R.I. scans and dialysis, are generally unavailable. Cancer, strokes and heart attacks are often death sentences. The whole country, with a population of 9.7 million, has one neurosurgeon and three cardiologists. (By contrast, New York City has 8 million people; at a national softball tournament for neurosurgeons in Central Park 10 days ago, local hospitals fielded five teams.)

(In another contrast with the United States, obesity and its medical complications are almost a nonissue. Visitors to Rwanda are quickly struck by how thin everyone on the street is. And it is not necessarily from malnutrition; even the president, Paul Kagame, a teetotaling ascetic, is spectral.)

General surgery is done, but waits can be weeks long. A few lucky patients needing advanced surgery may be treated free by teams of visiting doctors from the United States, Cuba, Australia and elsewhere, but those doctors are not always around. Occasionally, the Health Ministry will pay for a patient to go to Kenya, South Africa or even India for treatment.

Still, even with rationing this strict, how can any nation offer so much for $2 a year?

The answer is: It can’t. Not without outside help.

Partners in Health, the Boston-based health charity, which runs two rural hospitals and a network of smaller clinics in Rwanda, said its own costs ran $28 per person per year in areas it serves. It estimated that the government’s no-frills care costs $10 to $20.

According to a study recently published in Tropical Medicine & International Health, total health expenditures in Rwanda come to about $307 million a year, and about 53 percent of that comes from foreign donors, the largest of which is the United States. One big donor is the Global Fund to Fight AIDS, Tuberculosis and Malaria, which is experimenting with ways to support whole health systems instead of just treating the three diseases in its name. It pays the premiums for 800,000 Rwandans officially rated as “poorest of the poor.”

In a nation of poor farmers, who is officially poorest is decided by village councils. They weigh assets like land, goats, bicycles and radios and determine whether a hut has a costly tin roof or just straw.

“People know their neighbors here,” said Felicien Rwagasore, a patient coordinator at the Mayange clinic. “They do not make mistakes.”

Making every Rwandan pay something is part of President Kagame’s ambitious plan to push his people toward more self-reliance and, with luck, eventually into prosperity. The country has been called “Africa’s Singapore.” It has clean streets and little crime, and each month everyone does one day of community service, like planting trees. Private enterprise is championed, and Mr. Kagame has been relentless about punishing corrupt officials. In the name of suppressing remarks that might revive the hatreds that spawned the 1994 genocide, his critics say, he suppresses normal political dissent, too.

A more practical obstacle to creating a health insurance system, however, is that most of the world’s poor, including Rwanda’s, resist what they see as the unthinkable idea of paying in advance for something they may never get.

“If people pay the $2 and then don’t get sick all year, they sometimes want their money back,” said Anja Fischer, an adviser to the Health Ministry from GTZ, the German government’s semi-independent aid agency.

Also, the co-pays can be overwhelming. Even $5 for a Caesarean section can be too much for people as close to the edge as the Yankulijes, who live by growing beans and sweet potatoes and wear American castoffs (Mrs. Yankulije’s T-shirt read “Wolverines Football”).

Many live by barter and cannot scrape together even $2 in coins, said Dr. Damas Dukundane, who works in a poor rural area. Since the government accepts only cash, he said, his patients sometimes go to traditional healers, who could be dangerous quacks but will take goats or chickens.

As a result of all these factors, Rwanda is a patchwork of small clinics, some richer or better-run than others. Mayange’s, for example, gets donations and guidance from the Access Project founded by Josh N. Ruxin, a Columbia professor of public health who now lives in Kigali.

For example, the computer that prints the insurance cards has a Webcam on it. Previously, Professor Ruxin said, for insurance costing $2, villagers had to bring in photographs that had cost them $1 or more.

A clearer example of how the system overburdens the poor, he said, was the fact that the wealthiest Rwandans pay the same $2 that the rural poor do.

Dr. Binagwaho, the Health Ministry official, agreed.

“It’s totally insane that my mother pays the same as the woman who cleans her house,” she said. “That law is being changed.”

Still, Dr. Binagwaho said, Rwanda can offer the United States one lesson about health insurance: “Solidarity — you cannot feel happy as a society if you don’t organize yourself so that people won’t die of poverty.”

Prison Massacre, Les Cayes

 

Photo by John Carroll

See this New York Times editorial.

Les Cayes, Haiti

 

Saint Louis

 

This is Saint Louis Catholic Church in Delmas. It sustained significant damage during the quake, however mass is still held in the church with overflowing crowds.

Saint Louis has the largest and most influential Catholic high school in Haiti.

On the grounds in front of the church where tennis courts and soccer fields were once located, is a large tent city of very desperate people.

I never thought I would see anything quite like this.

 

Broken Port-au-Prince

 
 

The Pearl of the Antilles

 

The Pearl of the Antilles

 

The Pearl of the Antilles

 

Obama, We Need Change

 

Jenny (continued...)

 

Photo of Jenny in June, 2010 by John Carroll.

Dear OSF-Saint Francis Medical Center, Mr. Steffen, Mr. Marshall, and Sister Judith Ann,

This is Jenny.

She is 30 years old now and had heart surgery at OSF in Peoria in 1999 when she was 19 years old.

Haitian Hearts paid $23,000 dollars cash to Children's Hospital of Illinois for Jenny's surgery in 1999.

During the last decade we have examined Jenny in Hati many times, evaluated her Haitian echocardiograms, and supplied her with medication.

Jenny needs repeat heart surgery now because her valve repairs at OSF need to be revised. Jenny is in congestive heart failure now and managed with medication.

I have looked for several years for a US medical center to reoperate Jenny but cannot find a center that wants to accept Jenny. They all feel that Jenny is OSF's ethical and medical responsibility.

On January 12 of this year Jenny was seated at her desk on the fourth floor of the bank where she works in Port-au-Prince. She heard a loud noise and the bank began to shake back and forth.

Her friend/employees ran down the stairs and out of the building, but Jenny sat frozen in fear at her desk. She said that her legs would not work.

Several minutes later, after the shaking had stopped, her friends ran upstairs and grabbed her and led her down the stairs. No one was hurt at the bank and the building suffered no major damage.

Jenny had to walk home not knowing whether her family survived the quake. As she walked down the dark streets, Jenny heard many people screaming because they were trapped in buildings and she saw dismembered extremities lying in the streets. Bodies were everywhere.

Jenny did not know it at the time, but 140,000 of her Haitian brothers and sisters had just died during the violent 45 second earthquake, and over the next few months, the estimated number of dead would be 300,000.

She arrived home three hours later and found her family to be fine, but the walls of her house were cracked and her house was not safe to live in.

For the next few months after shocks continued and Jenny and her sister slept in a small abandoned car near her house. After a small tent was donated to them by Rotary Club, they started living/sleeping in the tent.

Jenny kept going to work through all of this upheaval and was able to do this in congestive heart failure.

Jenny's history and physical exam now is not good and she needs surgery soon.

Sister Judith Ann, Mr. Steffen, and Mr. Marshall, if you will open your arms once again for Jenny, Haitian Hearts will pay you $23,000 dollars again, we will get her Haitian passport renewed, we will obtain her US visa to travel to Peoria, we will purchase her roundtrip airline tickets, Jenny can live with us in Peoria, and we will continue to provide her with medication post operatively.

I plead with you to follow OSF's founding Sisters Mission Philosophy. Jenny has survived the earthquake. Please give her another chance with her heart.

Sincerely,

John Carroll

Arawak Indian Artifacts, Les Cayes

 

Les Cayes at Sunset

 

Cerebral Malaria, Les Cayes, Haiti

 

This little girl entered the hospital a couple of days ago in a coma with a fever of 105 degrees F. Her malaria prep came back positive.

IV quinine has awakened her and she is now on oral chloroquine.