Thursday, November 18, 2010
Wednesday, November 17, 2010
Focus on Cholera
Photo by John Carroll
Laplaine, Haiti
November, 2010
-------------------
November 17, 2010
Officials in Haiti Defend Focus on Cholera Outbreak, Not Its Origins
By RANDAL C. ARCHIBOLD
MEXICO CITY — Medical authorities in Haiti defended their decision Tuesday not to focus on finding the origins of a cholera outbreak that has killed more than 1,000 people and stoked violent demonstrations against United Nations peacekeepers, whom many people blame for introducing the disease.
Protests that began Monday and carried into Tuesday in some places left two people dead as demonstrators directed their ire at the peacekeepers, a 12,000-strong, multinational force that arrived in Haiti in 2004 in response to political conflict.
A spokesman for the United Nations force said the protesters were using the escalating cholera epidemic as an excuse to push the troops out and destabilize the country before the Nov. 28 presidential election.
“These are not genuine demonstrations,” said the spokesman, Vincenzo Pugliese. “They are using spoilers paid to create chaos.” United Nations health workers said the demonstrations were hampering the treatment of victims in Cap Haitien, where supplies are running low and the death rate is high.
Some Haitians see the peacekeepers as hard-line occupiers while others support them out of concern that the national police are unable to maintain order.
Tensions around the force have increased after health officials identified the cholera strain as coming from South Asia and found that the bacteria, which lives in feces, had contaminated a river where Nepalese troops had arrived in October shortly before the outbreak began.
Reporters in Haiti found signs of poor sanitation at the camp, but the United Nations mission has steadfastly denied that the troops are to blame, and has said repeated tests have failed to link the cholera to them. South Asia is home to many cholera strains.
Scientists have said that based on initial testing of its genetic traits, the cholera strain appears to have been brought to Haiti in contaminated food, water or carried in an individual. Before this outbreak, cholera had not been documented in Haiti at least in the past century.
And while the testing has not linked the disease to the troops, the World Health Organization said, it could not be ruled out. A full inquiry of the outbreak’s origins has not been undertaken.
“We are focused on treating people, getting a handle on this and saving lives,” said Daniel B. Epstein, a spokesman for the Pan American Health Organization, the branch of the World Health Organization operating in Haiti.
Dr. Jordan Tappero, an epidemiologist with the United States Centers for Disease Control and Prevention, who is leading medical investigators in Haiti, said by telephone that it was unlikely that scientists would pinpoint where the outbreak began, and that he did not think mounting an all-out effort to find the answer “is a good use of resources.”
Outside epidemiologists said it was important to study the bacteria and where it came from to expand understanding of how the disease travels and mutates, but they generally agreed that treating victims was more important.
Studying the genetics of the strain “would give a better idea where it came from,” said Dr. David Sack, an epidemiologist at Johns Hopkins Bloomberg School of Public Health who studies cholera outbreaks, “But I agree it is more important to prevent the disease and control it. It should not be killing people.”
The Haitian government said Tuesday that the death toll had reached 1,034, with 16,799 people treated for cholera or symptoms of the disease.
Health officials in the Dominican Republic said Tuesday that they had found the first confirmed case of cholera, in a Haitian citizen who recently returned from his home country, The Associated Press reported.
Save Haiti from Aid Tourists, by Rory Carroll
Photo by John Carroll
Save Haiti from aid tourists
The 'republic of NGOs' is in a vicious circle of dependence and institutional infantilism
Rory Carroll
The Guardian
Tuesday 16 November 2010
There was so much goodness packed on to the plane there was almost no room for me. I had a boarding pass but by the time I got to the gate every seat was filled. This was American Airlines flight 575 from Miami to Port-au-Prince and the passengers were on a mission to help Haiti. A volunteer agreed to take a later flight and I squeezed on.
The front rows had people in orange T-shirts, further on there were blue ones and at the back lime-green, each with a Haiti-related logo. Instead of the in-flight magazine, people were reading engineering manuals, budget reports, the Bible and books with titles such as Touching Them Now and Forever.
Spirits were high. We were on our way to another world, which would provide a sense of purpose, not to mention adventure. "Welcome aboard!" beamed the steward. Two hours later, as we trooped off into blinding Caribbean sun, the steward was still beaming. "Bye bye!"
I was too depressed to smile back. During the flight I had been reminded by the passenger seated beside me how do-gooding outsiders can screw up Haiti. What made it all the sadder was the fact he was nice, decent and humane. It is harsh to identify Ed Hettinga and his group, Mission to Haiti Canada, as exemplars of an unfolding tragedy. Each member was coming on his and her own time and dime (air fare alone, £980) and was almost certain to improve the lives of some Haitians.
Villains in Haiti's suffering include France, which crippled its former colony with two centuries of immoral debt; the US, which bullied Haiti to cut food tariffs, swamping the country with US imports and destroying homegrown agriculture; donors who have welched on funding pledges; and Haiti's political and business elite, cocooned in luxury and indifference.
But what about people such as Hettinga, a retired dairy farmer from Ontario who is treasurer of a well-meaning non-governmental organisation? Where other westerners wring their hands, he wraps his around buckets of cement and builds houses. Hettinga can be admired, and his heart is in the right place. But in Haiti's ongoing disaster, his NGO – and thousands of others – is one reason why so much international goodwill has added up to so little.
Mission to Haiti Canada, founded in 1997, raised £32m after January's earthquake for medical treatment, drugs, housing and to run six schools and an orphanage. "We are faith-based but non-denominational," said Ed. "We don't evangelise and don't care if people are voodoo or whatever. We just want to help."
In April a team of 28 Canadians and 38 Haitians built a hurricane-proof two-room house. "It cost $6,000 and we did it right, just like back home. Why should we expect people here to live in garbage?" says Hettinga. The plan was for locals to build dozens more. "We're teaching them. The idea is to be self-sustaining." The NGO spent $10,000 shipping a container with three big tents, clothes, rice and beans. They felt they were filling a vacuum left by a useless, predatory state.
Sounds noble, but consider this: more than 1 million homeless people urgently need housing. Here you can build a decent home for a fraction of what the Canadians spend. The group, which does not speak Creole, relies on a young local fixer to select beneficiaries, disburse funds and keep records. Locals have no realistic way to build in the absence of occasional Canadian visitors. The group has zero contact, and therefore no coordination, with the housing, health or education ministries. Hettinga's cheerful countenance briefly clouded as he acknowledged some problems. "As soon as we leave, everything stops. You try to teach . . . but really you just touch the people you deal with directly."
Better than nothing? Consider that this picture is multiplied across Haiti via more than 9,000 organisations. It is a republic of NGOs. Most are not registered, pay no tax and are not accountable. They shun cost-benefit analysis but soak up aid money, saying Haiti's state is incompetent and corrupt. The latter may be true but is a self-serving argument, which starves the government of resources and legitimacy, creating a vicious circle of dependence and institutional infantilism.
How can Haitians make policy when foreign-run fiefdoms suck up funds for pet projects? How can local farmers harvest crops when free food floods markets? These questions were far from the minds of the passengers of Flight 575 as they spilled out of the plane rubbing their hands with anti-bacterial gel and shooing away tip-hungry porters. "I'm just here for the ride," grinned an amiable, skinny teen from Kentucky's Grace Foundation. "I'm not sure what we're going to do. Build a wall, I think, move some concrete."
There are some professional NGOs that are registered and do excellent work – Christian Aid, MSF and Oxfam, among others – but despite jargon about "capacity building" they too breed dependence. The solution is not for all foreigners to pack up and leave. Haiti needs NGO help. But it also needs to rein in aid tourists who turn the country into a zoo and to fold the serious NGOs into a coherent, Haitian-directed strategy. Fingers crossed the 28 November election produces a strong government to start the process.
guardian.co.uk © Guardian News and Media Limited 2010
Are You Surprised?
Photo by John Carroll
Cite Soleil
November, 2010
Posted on Wed, Nov. 17, 2010
Violence won't be tolerated, Haitian leader warns protesters
BY JACQUELINE CHARLES AND TRENTON DANIEL
jcharles@MiamiHerald.com
As a tense calm enveloped the streets of Haiti's second-largest city Tuesday after a day of violent protests, Haitian President René Préval warned those behind the demonstrations that his government would not tolerate attempts to destabilize the country.
``Those who are creating the violence, who are looting warehouses, who are destroying other citizen's wealth, you should be reminded that no serious government will tolerate the state of disorder you are creating,'' Préval said in a written statement. ``The food you are pillaging so that you can do your own business belongs to school children, sickpeople in hospitals, the poor.''
CHOLERA EPIDEMIC
Préval said news that Cap-Haitien and Hinche, a town in the Central Plateau, had erupted into violent protests as Haiti was dealing with January's earthquake and a cholera epidemic made his ``heart ache.''
The epidemic has killed at least 1,000 Haitians and left thousands more hospitalized with severe diarrhea and vomiting.
``While cholera is attacking us, it's not the moment for us to be fighting,'' Préval said. ``Cholera is already killing people. But the chaos you are creating will kill more people.''
On Monday, demonstrators in Cap-Haitien burned tires, threw rocks and bottles, and wielded guns at U.N. peacekeepers. They also looted a World Food Program warehouses, and other businesses. They demanded the United Nations leave, blaming the organization for the cholera outbreak.
WAITING HELICOPTER
Presidential candidate Leslie Voltaire was unable to get from his hotel to a waiting helicopter during the protests.
``People are upset with the absence of government and the unsanitary conditions,'' Voltaire said by telephone from Cap-Haitien, once one of Haiti's cleanliest cities and today among its dirtiest. ``The streets are empty, no vehicles can circulate because there are barricades, the roads are blocked and tires are burning.''
Some U.N. and Haitian officials believe the protests were less about cholera and more an organized attempt to mire the county in chaos and violence ahead of the Nov. 28 presidential and legislative elections.
© 2010 Miami Herald Media Company. All Rights Reserved.
http://www.miamiherald.com
Tuesday, November 16, 2010
Sunday, November 14, 2010
Microlending and Haiti
Photo by John Carroll
Southern Haiti
November, 2010
November 13, 2010
Can Microlending Save Haiti?
By DANIEL COSTELLO
Léogâne, Haiti
VENANTE LINO, a small-business owner who lost nearly everything in the devastating earthquake in January, stood in line here along with dozens of other impeccably dressed women, all waiting to pay the latest monthly installment on the emergency loans they received to rebuild their businesses.
Mrs. Lino approached a folding table in the courtyard of one of the few remaining buildings in this town, located near the quake’s epicenter. She emptied her pockets of cash and gave all $40 to the loan officer.
“Every day, I wake up and ask God to make this better. Many days, I don’t think he’s listening,” says Mrs. Lino, a 63-year-old grandmother who lives under a tarp in her backyard with three grown children and four grandchildren, surviving on the meager income from a small food and cooking-oil business she reopened this summer with loan money. “Without this help, I don’t know where my family would be.”
Here in this once-bustling coastal town about 20 miles west of Port-au-Prince, more than 30,000 people — a third of the population — died as a result of the quake. Throughout Haiti, the toll may be as high as 250,000, and the economic effects have been staggering. The country’s economy is expected to contract by as much as 9 percent this year, and more than a million residents live in tent cities. And an outbreak of cholera, as well as a hurricane early this month, have left the nation even more vulnerable.
Especially hard hit are the tens of thousands of small-business owners, known as ti machann, who sell everything from heating oil to school uniforms from their homes and are often the sole breadwinners for their families. Because Haiti’s credit markets remain frozen, people like Mrs. Lino would have had almost no chance to rebuild if it weren’t for microbanks like Fonkoze, Haiti’s largest, which gave loans to the women in Léogâne.
In the best circumstances, sustaining a “bank to the poor” is no easy feat, but in Haiti after the earthquake, the challenge has been extraordinary. Even before the quake, 80 percent of the population lived on less than $2 a day. Today, while some 50 nations and organizations have pledged a total of $8.75 billion for reconstruction, less than 15 percent of the total promised for 2010-11 has arrived. (The United States has not yet paid all the $1.2 billion in reconstruction funds it pledged.)
Haitian microbanks provide a crucial lifeline to the poor, but their financial situations are sometimes nearly as precarious as those of their clients. Moreover, the banks are operating in a country that lacks many of the basic building blocks for businesses — reliable transportation, communication and supply networks — thus making the challenges all the more complex.
Their importance to hundreds of thousands of Haitian borrowers and savers gives these little institutions an outsize importance, making them “simply too big to fail,” said Greta Greathouse, a consultant with the United States Agency for International Development’s microsavings and lending program in Haiti.
“You are dealing with a very vulnerable and fragile population,” she said. The banks “need to get stronger on a permanent basis so they can offset the operational risks that come with Haiti because of the earthquake and the inherent risks that are unfortunately a way of life for the country and its people.”
MICROCREDIT banks, or microbanks, were pioneered by Muhammad Yunus, the founder of the Grameen Bank, which started 40 years ago by giving loans of a few dollars each to poor entrepreneurs in Bangladesh. In 2006, Mr. Yunus received the Nobel Peace Prize for this work.
In most cases today, microcredit clients start off with loans of as little as $25 to start a small business. The loans are often given to women who tend to spend their earnings directly on their families and communities. Many borrow in groups of five or more, and all members of the group work together and are responsible for repayment.
Some microlenders provide only loans, while others also offer education and health services. Partly because costs are so high, effective interest rates are often significantly steeper than those at traditional banks. In Haiti, rates range from 30 percent to 55 percent a year.
“Haiti is one of the most complicated environments for anyone to do business, let alone a small lender with an extremely poor clientele,” said Alex Counts, president of the Grameen Foundation, a nonprofit in Washington that fosters microlending. “Appropriate levels of interest are important, but it’s also essential these organizations continue to do the important work they do.”
One of the largest of Haiti’s microcredit groups, Finca Haiti, wrote off almost a third of its portfolio after many clients died in the earthquake or lost their homes and businesses. A staggering 53 percent of its borrowers were late on their payments. After losses of its own, ACME, another Haitian microbank, raised additional capital this summer.
Fonkoze, Creole for “shoulder to shoulder,” was started by the Rev. Joseph Philippe, a Haitian priest, in the mid-1990s. It has 45,000 clients and 43 branches across the country, but it lost $2 million in the three years before the earthquake. In 2008, after losses from a particularly bad hurricane season, the organization considered closing its for-profit bank and incorporating that division’s 24 branches.
Over all, the share of microcredit clients in Haiti who have defaulted or are at risk of doing so has risen to 18 percent, more than double the rate of a year ago. The international standard is 2 to 3 percent. Several of the Haitian microbanks, particularly some very small ones, could close or reduce their operations if their portfolios don’t improve, according to microbanking experts in Haiti and elsewhere. It’s likely that some will have to consolidate in order to survive.
Microbanks in other countries are increasingly aiming to become self-sustaining so they don’t need to continually raise funds to pay operational expenses. Some have transformed themselves from nonprofit into for-profit banks, raising questions of whether altruism and capitalism can co-exist. India’s largest microlender, SKS Microfinance, went public this summer, raising $358 million, and other banks may do the same.
While most microbanks in Haiti remain nonprofits, and have less financial transparency, Fonkoze started a for-profit bank (in addition to its nonprofit arm) in 2004 and reports both divisions’ earnings. It operated at a loss for three years but has stabilized after $15 million in donations this year.
Haiti has had natural disasters before, of course. But the earthquake’s impact on the nation’s banks was staggeringly high, in no small part because of the damage in Port-au-Prince, the capital, which accounts for 60 percent of the country’s gross domestic product. The banking sector, already fragile, was crippled. Out of 1,800 microbank employees in the affected region, 600 lost their homes. A quarter of the $38 million in outstanding microcredit loans in the region could end up defaulting, according to an analysis by Ms. Greathouse.
Despite the risks and financial costs, several Haitian microbanks are expanding, saying their loans are one of the only paths to self-sufficiency for the growing number of poor people in Port-au-Prince and the countryside.
For example, after losing a third of its 12,000 clients after the earthquake, Finca added back 1,000 clients this summer with the help of a grant from the Citibank Foundation. It’s a risky move: the percentage of Finca Haiti clients who are more than 30 days behind on their payments, a standard known as portfolio at risk, remains at 35 percent.
In July, after its director was ambushed in an attempted robbery, the bank moved its headquarters from the capital to a nearby coastal city, Saint-Marc, according to Rupert Scofield, the president of Finca, which is based in Washington and operates in 21 countries.
When it comes to doing business, “Haiti is probably the hardest place in the world right now outside maybe Afghanistan,” Mr. Scofield says. “It always seems just as things get stabilized, something else happens to pull the country back.”
Anne Hastings, Fonkoze’s co-chief executive, has become something of an international aid celebrity: she was a high-profile attendee of the Clinton Global Initiative conference this fall in New York. (The bank’s profile rose significantly in the days after the earthquake, when it was one of the only banks operating outside Port-au-Prince, and Ms. Hastings secured American military assistance to airlift $2 million in cash to desperate clients.)
Soon after the quake, Fonkoze wrote off 10,000 loans — almost a quarter of its total number — with funds from the Red Cross and others. The bank then gave each client a new loan and a one-time cash payment of $125, at a total cost of $8.5 million.
In recent months, the bank has broadened its health program and aggressively stepped up its operations, particularly in rural areas where poverty rates are highest and seem to be growing.
The bank has enlarged a loan program, called Ti Kredi, or Little Credit, to reach poor families that are not ready for larger loans. Ti Kredi offers loans of just $25, shorter repayment periods, additional support from loan officers, and literacy and health classes.
In another program, clients are offered goats or chickens so they can sell milk or eggs, as well as a weekly stipend of $7 to help with expenses, and to ensure that they don’t need to kill the animals because they are hungry.
SINCE the summer, Fonkoze loan officers have canvassed the lush, mountainous region on motorcycles, in pickup trucks or on foot to sign up as many as 3,000 new clients and to meet with existing ones to monitor their progress and to collect loan payments.
One recent rainy day, Steve Werlin rode for more than an hour on the back of a pickup truck outside Mirebalais, a small, central plateau town two hours north of Port-au-Prince. Mr. Werlin, a regional Fonkoze director, was on his way to meet Marie Ange Joute, a 30-year-old mother of two. Ms. Joute joined Fonkoze in September and lives with her children, mother, sister and niece (who was sick with a severe eye infection) in a small mud house with a tin roof on a 20-by-20-foot parcel of land. The house, which Ms. Joute inherited from her father, is her only asset, and she said the family had sometimes gone without food and medical care over the last year.
She has no business background but recently received two chickens and a goat from the bank and started selling eggs and heating oil from her house. To save enough money to expand her inventory, she joined a savings club with 10 local Fonkoze clients. Each woman saves a third of her weekly stipend so that once every 10 weeks, they get a lump-sum payment of $20 for larger purchases.
Clients are required to do many things on their own, and face penalties if they cannot meet certain goals. On the day of the visit, Ms. Joute had yet to build a shed for her goat, which could become sick in the rain. So she was told she wouldn’t get her stipend the next week unless the shed was built. (Fonkoze gave her materials and training to build the shed, and she complied.)
“I want to make my own money and care for my family,” she said. “I want to provide for us if something goes bad. I know how to work.”
AFTER the upcoming presidential elections, Haiti’s government is expected to issue new banking regulations, including rules for microlenders. They aren’t regulated now, though they have appealed for years to the government for rules that could bring more certainty to the industry. If a microbank went out of business, for example, it is not clear what would happen to the many clients who deposit their savings in the bank.
Fonkoze has 200,000 savings accounts, totaling $14 million. Currently, it uses those funds to make new loans, and it says that all of its accounts are secure. Because it was able to write off risky loans early this year, according to James Kurz, a senior Fonkoze financial adviser, its portfolio at risk has fallen to 5 percent in recent months.
If Haiti’s economy doesn’t improve and the country cannot stem various other problems, even some people who have managed to eke out a living with the help of microcredit could face more difficulty.
Sainte Anne Louis sells sodas, canned goods, clothing and homemade peanut butter outside her home in Mirebalais, yards away from a construction site for a new rural teaching hospital. She says her sales have fallen by nearly half this year, in part because it has been hard to secure enough inventory.
Mrs. Louis, 54, supports her entire family, including her husband, two daughters and their families. She worries about what will happen if things don’t improve soon. “We are grateful for what we have today,” she says, “but we pray tomorrow will be better.”
Cholera Deaths Climb
Photo by John Carroll
November, 2010
November 14, 2010
Cholera Deaths Up in Haiti, With Worst to Come
By RANDAL C. ARCHIBOLD
MEXICO CITY — The death toll in Haiti’s cholera epidemic has reached more than 900, the government reported Sunday, as aid groups rushed soap and clean water to a disaster-wracked population to fight the disease.
The Ministry of Health reported that as of Friday, there had been 917 deaths and more than 14,600 were hospitalized with cholera-like symptoms. That is up from the 724 deaths and 11,125 hospitalizations reported a few days before.
The disease has been found in 6 of Haiti’s 10 provinces, known as departments, and is most severe where it originated, in Artibonite, which accounts for nearly two-thirds of the deaths.
Several epidemiologists have said the disease has not peaked and will likely worsen and break out in other regions of the country, with United Nations health officials estimating about 270,000 may be sickened in the coming years. Several new cholera treatment centers are springing up in the capital and other areas.
“The trend is increasing and it is propagating from department to department,” Roc Magliore, the Ministry of Health’s epidemiologist, said in a telephone interview on Sunday. He referred questions to the ministry’s director general, Gabriel Timothee, who could not be reached.
Hospitals in Port-au-Prince, where more than one million earthquake refugees live in congested, squalid tent encampments, are overflowing with patients exhibiting cholera symptoms, and the death toll there has reached 27. The disease was first reported in the capital on Nov. 8.
President René Préval, at a conference on the disease on Sunday in Port-au-Prince, urged people to wash their hands frequently and drink only potable water, The Associated Press reported. But even before the earthquake, most of the population lacked access to clean water and sanitation.
Cholera, a bacteria that thrives in feces-contaminated water, causes severe diarrhea and vomiting that can dehydrate and kill its victims in hours without treatment. The rate of severe cases, about 30 to 40 percent, is far higher in Haiti than the 25 percent in a typical outbreak because of extreme poverty, unsanitary conditions and the fact that cholera has not been there for 40 years.
“When we go around and give advice about hygiene, they say, ‘Let me have soap, I can’t afford it,’ ” said Leonard Doyle, a spokesman for the International Organization for Migration, an agency that is distributing water purification tablets and cleaning supplies.
On Friday, the United Nations requested $164 million from humanitarian agencies and donors to put in place a strategy to help the government respond to the disease. The largest piece of the plan is $89 million for clean water, sanitation and hygiene.
Officials in the neighboring country, the Dominican Republic, say they are limiting markets on the border and taking other steps to ensure cholera does not reach that country, where thousands of Haitians live and work.
A suspected case turned out not to be cholera, the country’s health minister said Sunday, according to a Dominican newspaper, Listin Diario, which said the Dominican Republic is prepared to treat 7,500 to 10,000 cholera patients.
Saturday, November 13, 2010
Friday, November 12, 2010
Crisis and Opportunity, by Beverly Bell
Photo by John Carroll
Laplaine, Haiti
-----------------
AMIDST HAITIAN CRISIS, OPPORTUNITY
By Beverly Bell
When people ask me, as they do all the time, “Is there any cause for hope in
Haiti?” I answer yes.
It’s more tempting to think that the situation is so hopeless that it can’t
any worse, especially right now. Last week, Hurricane Tomas brought three
days of heavy storms, causing flash floods which washed away farmers’ homes,
animals, and crops throughout the island. The storm also left filthy
standing water in towns, promising to spread cholera even more rapidly
throughout the country. Cholera has already killed more than 500 people and
infected about 7,500, and will surely ravage many more, particularly as the
best measures for prevention –using a sanitary toilet and washing one’s
hands often – are not possible for most of the 1.5 million living in
internally displaced person’s (IDP) camps. (One recent, extensive study of
IDP camps
30% have no access to toilets of any kind; a
second
untreated water and 27% have no toilet.)
Despite this grim state of affairs, I like to recall two definitions for
‘crisis’ offered by historian Rebecca Solnit. The Greek origin of the word
means “a point of culmination and separation, an instant when change one way
or another is impending.” And in written Chinese, ‘crisis’ is a combination
of the ideograms for ‘disaster’ and ‘opportunity.’[1]
The natural disaster of January 12 and the social and economic crises it has
propelled mark a sharp rupture with Haiti’s past, a fulcrum in an as yet
uncertain future. Labor organizer Yannick Etienne told me, “This earthquake
was one of the worst things that could have happened, but we have to turn it
into something positive. We have to make sure that people are agents of
change and right now this is a good opportunity, positive in a political
sense. There are so many things that can be done to shake up the traditional
way things have always worked here.”
My hope comes from the power of progressive movements in Haiti, which have
been active at many periods since the slave uprisings began in 1791 and
which are again today, slowly, gathering force. Throughout Haitian history,
united action from the grassroots has been the locus of all systemic change
benefiting the majority. Just a few advances from modern political history
(a period usually demarcated by the fall of the Duvalier dictatorship in
1986) are a popularly ratified constitution, universal elections (though
their results have already been ruptured twice by coups), and the right to
free speech and free assembly (not always protected, but infinitely more so
than in past times). Sometimes progress has built slowly. Other moments have
seen the camel’s-back phenomenon, in which one act has set off long periods
of relative quiescence, such as when the killing by Tontons Macoutes of
three youth in November 1985 ignited the spark of fury against the
dictatorship; Duvalier survived a scant ten weeks of the resulting social
upheaval.
A few examples of recent advances from the post-earthquake work of social
change organizations include the following:
- A few environmental groups like Haïti Survie are using this moment not
just to address the symptoms of ecological crisis like deforestation, but to
challenge the root causes, including lack of income opportunities for the
rural population which force them to over-exploit natural resources.
- Women’s organizations, such as Women’s House (Kay Fanm) and Solidarity
among Haitian Women (SOFA), are using the visibility created by
post-earthquake
gender-based violence to draw attention to the ongoing need to reinforce
women’s rights;
- Friends of Health, the Haitian branch of Partners in Health, has
developed an alliance with the Haitian Ministry of Health to remake the
University Hospital, the largest public hospital in the country and a
long-standing symbol of the deplorable state of health care available to the
poor;
- The networks Society for Social Mobilization and Communication (SAKS)
and Haitian Women’s Community Radio Network (REFRAKA) are literally giving
voice to earthquake survivors, providing radio transmitters to camps around
the country;
- Several IDP camps have, under women’s leadership, created a culture of
community support and initiated programs – cultural, skills-building,
income-generating, educational, and empowerment - which model what a
nurturing society would look like.
A wholly new movement – though rooted in the long tradition of organizing -
arose within days after the quake to claim a just reconstruction. The
effectiveness of the women’s sector, peasant farmer cooperatives, popular
media, human rights groupings, youth and student associations, and other
mass organizations is a critical variable in how equitable, rights-based,
and democratic their country becomes. The grouping is not yet strong, both
because coalitions were already fissured by political divisions when the
earthquake hit, and because in the quake they lost members and organizing
fundamentals (computers, internet possibilities, cell phones, offices,
supplies, archives, etc.). This movement has in its short history already
repeatedly stalled and restarted in new configurations. But given the
urgency of the crisis, they are gaining steam. And two moves toward
reconciliation between former adversaries - amongst peasant organizations
and amongst some groups long divided by their positions around former
president Aristide – give hope for greater unity and thus greater strength.
A declaration from this movement stated the priorities as “strengthening
national production, valuing the riches of the country…; [and]
establish[ing] a reconstruction plan where the fundamental problems of the
people take first priority. These include housing, environment, food,
education, literacy, work, and health for all; a plan to wipe out
exploitation, poverty, and social and economic inequality; and a plan to
construct a society which is based on social justice.” As usual in Haiti,
the means to the solution is collective action, or what the statement calls
building “a social force.”[2]
Today the united action is most visible in the form of street
demonstrations, which reemerged in August. The demands of the protests span
the political gamut, mostly concentrating the right to permanent housing for
those in camps. The movement is also engaged in information-sharing,
consciousness-raising, and advocacy.
The potential for a real rebellion against the unacceptable status quo is
strongest within the camps, where 1.5 million or so people – all of them
desperate, many of them angry – have languished for ten months. Small groups
of activists have been moving through some camps, trying to raise political
awareness there. Though the population’s response is repressed by hunger,
illness, and depression, increasing engagement by camp committees indicates
the potential for mass mobilization.
Rising self-organizing from within the camps may be a fear among the Haitian
and U.S. elite and others. A Wall St. Journal article hinted at the logic
for the fear: “Inside the many tent cities… a rudimentary social order is
beginning to emerge as committees agitate to secure food, water and supplies
in high demand from international aid organizations. ‘We knew we wouldn't
receive any assistance unless we formed a committee,’ says Mrs. Beaupin… She
presides over an executive committee [which]… handle[s] everything from
getting people to sweep outside their tents in the muddied terrain to
ensuring that the sick and injured get treatment. ‘There is no government
but us,’ says Mrs. Beaupin.”[3]
In the bleak landscape, it may be tempting to think that the Haitian people
are losing their shot at the structural transformation alluded to in the
disaster/opportunity dyad. But to believe that they have lost the battle
discounts the evidence of their history. My own reading is that in politics,
as in love, remarkably unpredictable shifts can and often do happen; any
number of factors could flip the downward trajectory of the majority’s
well-being and power since January 12. The organized grassroots are working
to ensure that they do.
[1] Rebecca Solnit, Paradise Built in Hell: The Extraordinary Communities
That Arise in Disaster (Penguin Books, 2009), p. 142. The quote is by Samuel
Prince, cited by Solnit.
[2] On January 12, the Earth Shook and Encountered a Country without
Governance. Let’s Raise Up the Dignity of the Country and the Haitian
People,” Port-au-Prince, February 13, 2010, signed by dozens of popular
organizations.
[3] Miriam Jordan, “Social Structures Form in Haiti's Tent Cities: As
Homeless Settle in for the Long Haul, Committees Lobby for Aid and Keep
Order; 'There Is No Government but Us'”, Wall Street Journal, March 8, 2010,
http://online.wsj.com/article/SB10001424052748704869304575103930724274178.html?mod=WSJ_WSJ_US_World
.
*Beverly Bell has worked with Haitian social movements for over 30 years.
She is also author of the book Walking on Fire: Haitian Women's Stories of
Survival and Resistance. She coordinates Other Worlds,
www.otherworldsarepossible.org, which promotes social and economic
alternatives. She is also associate fellow of the Institute for Policy
Studies.*
--
Cholera Death Toll Close to 800
Photo by John Carroll, Cite Soleil
---------------------
Haiti cholera death toll approaches 800 with rapid increase feared
• Anger at leaders' response to health crisis
• Experts warn epidemic could last for years
Rory Carroll in Port-au-Prince
guardian.co.uk
Friday 12 November 2010
Slumped in a wheelchair in the hospital yard, Dieuson Dorvil had just begun spelling his name when a spasm gripped his chest and he turned away to vomit.
His mother, Isma, held him as he shuddered and heaved, filling a bucket at his feet. It seemed impossible that such an emaciated figure could produce so much but the disease was sucking the fluid from his body.
Around the yard and inside the wards babies and children, men and women, lay curled and motionless, their stares glassy. The only sound was the occasional retch.
Every so often a stretcher with a figure half shrouded in a white, soiled sheet was wheeled to the morgue. They bounced over the gravel and potholes, giving the impression the corpses were trembling.
This is what Haiti's cholera epidemic looks like. It turns people into vomit- and faeces-producing spectres. It is filthy, smelly and a horrible way to die.
The official death toll has approached 800, with 11,000 taken to hospital, and there is dread that this is just the beginning. What started a month ago as isolated diarrhoea cases in the rural Artibonite valley has turned into a nationwide cholera outbreak, with more than 1,000 new cases daily.
People in towns and villages around Gonaïves, in the north, are burying victims in mass graves, according to aid workers and photographers, and suspected cases have been detected in the south and in the Dominican Republic, which shares this Caribbean island with Haiti.
The biggest concern is the capital, Port-au-Prince. Still in ruins from January's earthquake, it is a metropolis of rubble and tents and open sewers that condemn most of its 3 million inhabitants to unsanitary, crowded conditions.
"All of the hospitals in Port-au-Prince are overflowing with patients and we're seeing seven times the total amount of cases we had three days ago," said Stefano Zannini, Médecins sans Frontières' head of mission in Haiti. "I can easily see this situation deteriorating to the point where patients are lying in the street, waiting for treatment."
Outside the gate of the cholera clinic at the city's main hospital lay a teenage girl in a peach T-shirt and khaki shorts. She appeared unconscious, her head lolling at an awkward angle, brown stains down her left leg. No one knew her name or how she had come to be there.
The clinic, an improvised centre with tarpaulin, was full. Before entering, visitors wiped their feet on a ratty yellow cloth sprayed with chlorine. The yard had about 10 silent patients attached to IV drips. The only light was a sliver of moon.
"The doctor hasn't see him yet, I don't know what's going to happen," said Isma, 42, after another bout of vomiting from Dieuson. Eyes sunken, the 24-year-old student drifted in and out of the interview. "It feels like there's something inside, squeezing," he said.
Isma said she was a restaurant cook but that business had evaporated. "No customers. Everyone's afraid of getting the infection." The family lived near the Cité Soleil slum where hundreds, possibly thousands, have been stricken. "My son is the first in our family to get sick," she said, feeling his forehead. "We don't know how it happened."
The clinic's wheelchairs have white plastic seats cut from garden furniture, lending an incongruous jauntiness to the wretchedness. When a patient missed the bucket, or became lathered in slickness, a man with a white mask and blue overalls sprayed chlorine.
In the wards men and women lay on wooden frames with a round hole cut in the middle and a red MSF bucket beneath. "We call it the Calcutta stretcher," said a young Haitian doctor, the only one on duty. "I don't know if we can keep up. It's spreading so fast." From a handful of patients earlier in the week there were now more than 70 daily.
The doctor declined to give his name. With elections due on 28 November, and mounting anger at the government's response to the crisis, the epidemic is politically sensitive.
The UN is also defensive over speculation Nepalese peacekeepers inadvertently introduced the disease, which closely resembles a south Asian variant, into the Arbonite river. Now that it is in the water supply it will last months or years, according to epidemiologists.
The UN appealed today for $163m to respond to the crisis, which it said could infect up to 200,000 people. "Cases are expected to appear in a burst of epidemics that will happen suddenly in different parts of the country," Elisabeth Byrs, of the Office for the Co-ordination of Humanitarian Affairs, told a news briefing in Geneva.
With timely treatment most cholera victims survive, but poverty, fear and a destroyed infrastructure mean many Haitians seek help late, if at all. Records at Port-au-Prince's main clinic showed 24-year-old Marie Renée arrived at Rue Mgr Guilloux at 4.30pm. By 4.33pm she was dead.
A few hours later it was the turn of an elderly man. Evelt Pierre Juste, bearer of the dead, rolled the body, his 16th of the day, up the hill to the morgue. He went fast, lest other patients' eyes lingered on the shrivelled figure. He entered a dank passageway and tipped the body on to a cement floor beside the curled, naked form of Marie Renée. The fridge was locked for the night so the two strangers would lie side by side until morning.
At the morgue entrance a watchman, Wilzor, huddled by a radio listening to upbeat Compas music. He needed to listen to something cheerful, he said. "I ask myself how bad it's going to get. But only Jesus and the disease can answer that."
guardian.co.uk © Guardian News and Media Limited 2010
Wednesday, November 10, 2010
Battle Rages in Cite Soleil
Photo by John Carroll, M.D.
St. Catherine Laboure Hospital
Cite Soleil, Haiti
--------------------------
Posted on Wed, Nov. 10, 2010
Battle rages in slum, this time against a disease
By JONATHAN M. KATZ
Associated Press
A wooden wheelbarrow is pushed to the high green gates of a slum hospital, carrying an unconscious woman, her lips white and cracked with dehydration. She is 22, and two days ago she was healthy.
The concrete passageway leading to the hospital is filled with victims of the cholera epidemic that has entered Haiti's capital. Three weeks after it was confirmed for the first time ever in the Caribbean nation, the waterborne sickness has claimed at least 643 lives, mostly in the countryside.
If Wednesday's traffic is any indication, cholera is growing fast in the seething slum of Cite Soleil and perhaps all of Port-au-Prince, a city of more than 2.5 million.
A taxi truck known as a "tap-tap," painted with green and yellow hearts, backs in to the hospital to unload an elderly woman. An unemployed father carries his limp daughter, wrapped in a yellow blanket.
Two-year-old Clercilia Regis had been sick since Sunday, when she lost control of her bowels during church and had to be carried out by her worried parents to their dark, one-room concrete home on a side street nearby.
Since the rumors of the sickness arrived in the capital they had taken their pastor's advice and mixed their water with bleach and some lime juice. Clercilia got sick anyway, but her father, Jedson Regis, says she didn't seem too bad off at first. Then came Tuesday.
"Last night around seven, the worst started," he said Wednesday. Clercilia was producing water at a terrifying rate. But at night in a lawless slum, he couldn't do anything.
When the sun broke, Regis put on a gray T-shirt reading "Turkey Run State Park, Indiana," and walked his daughter to Hospital Saint Catherine Laboure. Along the way he passed the canals that make perfect breeding grounds for the disease, green-brown soups of floating plastic bottles and human waste, with chickens pecking at the surface.
The aid group Doctors Without Borders and the health ministry have set up tents inside the hospital. The sick are lined up in beds with clear IV tubes in their arms. Those too weak to turn their bodies get beds with holes and buckets in the center. The woman carted in by wheelbarrow - actually a gray, 10-foot contraption known as a "bouret" - was transferred to another facility for the most extreme cases.
Nearly 10,000 people have been hospitalized for cholera across Haiti with symptoms including serious diarrhea, vomiting and fever. The deaths usually come from the extreme shock brought on by dehydration.
Nobody knows how cholera came to Haiti. An outbreak of some sort was expected in the wake of the Jan. 12 earthquake, but this came out of the blue - there had never been a case of cholera confirmed in the island nation. So far nobody is investigating the cause; suspicions are high that the South Asian strain was carried by U.N. peacekeepers from Nepal, but the case is politically sensitive and health organizations who might investigate say they are currently focused on controlling its spread.
Port-au-Prince officially has had 1 death and 175 people hospitalized, but those figures are based on two-day-old reports, and were out of date before they were announced. There are reports all over Port-au-Prince of infections, in earthquake camps, slums and neighborhoods.
At the hospital in Cite Soleil, worried families wait on benches. Pans of bleach-laced water are placed at the doorways inside and out, to kill the bacteria being tracked in.
"If we were in hygienic conditions, maybe we would be able to say we were in control of the situation," said Dr. Juliet Olivier, a Haitian physician on the Doctors Without Borders team working there. "The disease is easy to treat, but the patients take a long time before coming to see a doctor."
Outside, the traffic is nonstop. The concrete passageway painted in hospital green and cream is sprayed with slogans from the planned Nov. 28 election - long live this candidate, vote for that. One excited scrawl reads, "Viv MSF nan Site Soley" - long live Doctors Without Borders in the City of the Sun. Market women selling fried plantains and spaghetti are doing a good business, and so are they boys selling plastic bags of water that may or may not have the disease.
"Dlodlodlo," they rattle. It means "waterwaterwater."
Clercilia Regis and her family got theirs from a tap when they couldn't afford the water their church sells from a donated machine for 15 gourdes, or about 38 cents, a gallon.
As the young girl grew sicker, she did her business on the floor, leaving her parents to clean it up with a bucket. There are few latrines on the street, and those are for adults.
The buckets were emptied across the alley, seven feet from the family's door, into an empty home abandoned by former neighbors in the 2000s when the local threats were bullets from gang wars and clashes with U.N. peacekeepers.
As Wednesday morning becomes afternoon, Regis walks out of the hospital. Clercilia is again in his arms.
Her stiff body is wrapped in a plastic bag. A death certificate is in her father's right hand.
"It was night, I couldn't take her until the morning," he said. With no money to bury her, he wasn't sure what he would do with her body. He straightened it in his arms and walked his daughter home, still draped in the yellow blanket.
© 2010 Miami Herald Media Company. All Rights Reserved.
http://www.miamiherald.com
Tuesday, November 09, 2010
Pediatric Clinic, Cite Soleil
Pediatric clinic in Cite Soleil looks like this every morning Monday through Friday.
Waf Jeremie and Cholera
Photo by John Carroll
9 November 2010
Cite Soleil clinic fronts Haiti's fight against cholera
By Laura Trevelyan
BBC News, Cite Soleil, Haiti
Waf Jeremie is a port at the outer edge of Cite Soleil, the sprawling slum in Port-au-Prince.
People live in derelict corrugated iron shacks and the streets are full of rubbish, which the pigs are nosing through.
We come here one day after meeting Jonathan at Cite Soleil's hospital. He was vomiting and had watery diarrhoea, the symptoms of cholera. Jonathan lives in Waf Jeremie and said that people in his neighbourhood had died from cholera.
At the end of a stony track we find a small health clinic, run by Sister Marcella, an Italian nun from the Franciscan Order.
A pristine body bag lies by the entrance of the clinic.
He was a young boy, Sister Marcella says. His first bout of diarrhoea was at 0400. He came here, and he died six hours later, she says, fingering the brown wooden cross around her neck.
Sister Marcella tells me she has a lot of sick patients. Is it cholera?
"We don't know, we don't have the means to find out, but they died after vomiting and diarrhoea," she says.
Six people died on Monday. Twenty patients are being treated with intravenous drips containing rehydrating fluid.
Sister Marcella thinks the floods after the recent hurricane may have played a part in spreading the cholera epidemic. That and the national holiday at the start of November, when people travelled all round the country.
Camps and slums
Now everyone coming into and out of this immaculately clean clinic has their feet sprayed with chlorine, and their hands doused with sanitiser.
Medicins Sans Frontieres, the specialist medical charity, is helping Sister Marcella with the supplies she needs, like rehydrating fluid, and its staff are taking the most serious cases to be treated at their specialist centre.
Sister Marcella fears it will now be impossible to contain the disease, because of the conditions in Waf Jeremie.
"People have no toilets, no clean water, they use the street as a toilet," she says.
The only toilets are those right by the clinic that Sister Marcella managed to get built with aid money after the earthquake.
Cholera is spread via infected faeces and contaminated water.
How can you stop the disease spreading, I ask her.
"I pray that God will end it," she says. She is talking to everyone she can, trying to mobilise those with the means to help. This small clinic could soon be overwhelmed with patients.
More than 100 of the suspected cases of Cholera in Port-au-Prince are in Cite Soleil.
Across Haiti, 1.3 million people have been displaced by the earthquake. Many are living in survivors' camps, which are crowded and often unsanitary.
However, at least in the camps there are aid agencies. and better access to healthcare and preventative measures like water purification and chlorine.
In the slums there is very little. Waf Jeremie has Sister Marcella, dedicated to serving the poor.
BBC © MMX The BBC is not responsible for the content ofd
Pain in Haiti
This young eleven your old boy had a benign locally aggressive soft tissue tumor of his left arm.
Shortly after this video was made, he underwent an amputation of his arm just below his left shoulder.
This amputation could have been prevented if the tumor had been removed when it was much smaller several months ago.
Sunday, November 07, 2010
Multidrug Resistant Tuberculosis
Photo by John Carroll, November 2010
Chest x-ray: Pulmonary tuberculosis afflicting a 25 year old Haitian female
Multidrug-resistant (MDR) tuberculosis is a treatable, airborne infectious disease that killed an estimated 1.5 million people between 2000 and 2009 — an annual rate 10times that of the H1N1 influenza virus.1,2
During this period, barely 0.5% of the estimated 5 million people who became ill with MDR tuberculosis received treatment with quality-assured second-line drugs. The rest continued to transmit resistant bacteria to others — in their homes, communities, workplaces, and other places where people congregate.
The results: an increase, in a number of locales, in the proportion of tuberculosis cases that were MDR; a frightening increase in the proportion of strains with broad-spectrum resistance, especially in areas with a high prevalence of human immunodeficiency virus (HIV) infection; and, in some areas, an unraveling of hard-won progress in tuberculosis control.
New England Journal of Medicine, November 2010
Subscribe to:
Posts (Atom)
