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Haiti now, from the inside

After the flooding and the departure of Aristide, former Hernando County doctor Paul Farmer fights more difficulties in providing care to the poor.

By DAN DeWITT
Published June 13, 2004

photo
[Times photo: Daniel Wallace]
Dr. Paul Farmer exams AIDS patient Thelemaque Innocent at the Partners In Health hospital in Cange in January.
  Related story:
A healer in Haiti

Dr. Paul Farmer believes people have the right to medical care no matter how rich or poor they are or where they live. The former Brooksville resident's methods are being copied around the world. [2/22/04]


In January, the St. Petersburg Times visited former Hernando County resident Dr. Paul Farmer, who has provided health care in central Haiti for more than 20 years. We interviewed him again recently to ask how his organization, Zanmi Lasante, withstood last month's flooding and the political uprising in February, when U.S. troops arrived in Haiti and former President Jean-Betrand Aristide departed.

The floods have been devastating in low-lying areas of Haiti. What has the impact been in the Central Plateau?

Mudslides and flash flooding have been bigger problems than groundwater flooding. The road to Boucan Carre (a town where Zanmi Lasante operates a hospital and several social programs) was impassable last week. Impassable, at least, to the trucks carrying the building supplies for the housing project. But the biggest problem for people in central Haiti is they can't stay dry during the rainy season. The thatch huts just can't keep the heavy rains out. These houses are just not worthy of the name and need to be replaced with tin and cement.

The arrival of U.S. Marines seemed to some people in America to be at least a short-term solution to the chaos of the revolt this winter. From what you've seen, have the Marines helped restore order?

In central Haiti there have been no Marines, and there are no Haitian policemen. Many of the latter were shot by the "rebels," who are really the former military who came in across the border near us. And although I hear there are Chilean troops in Hinche (in the Central Plateau) the other cities and towns you visited are all pretty much in the hands of former Haitian military. They are the people who in the past stole our ambulances, took members of our staff hostage, etc. They've been pretty tame recently, but then again, who is there to stand up to them?

So at least the paramilitary aren't setting up roadblocks and hassling your workers the way it did when it controlled the country in the early 1990s?

Actually, there have been numerous roadblocks since the beginning of March, and most of them have been paramilitary. The delivery of supplies has been interrupted on a number of occasions, and we have been unable to travel to places like Hinche or Port-au-Prince. We have taken steps to prevent staff from being harmed in any way. We remind our staff that they are not obliged to travel on the road when they feel unsafe. We listen to the radio, try to be prudent and do not travel at night.

Your treatment of AIDS and tuberculosis patients depends on residents delivering medication to fellow villagers, usually on foot. With the roadblocks and flooding, have these community health care workers been able to keep up with their deliveries?

Yes, the workers have done a great job. On this score, we have discovered that good community-based care can function even in times when roads are blocked. They've been keeping their neighbors alive.

We saw horrible deprivation among the people in the Central Plateau when we visited in January. Has that changed since the arrival of the Marines and the departure of Aristide?

There has been no visible improvement from the vantage point of the rural poor. The real crises in Haiti are humanitarian and political. As far as I know, the Marines are not involved in either the humanitarian crises - although certainly they helped bury those drowned last week - or the political ones. The humanitarian crisis will only be addressed by dealing with hunger, excess burden of disease, unsafe drinking water and dangerous roads. These were the problems that were to be addressed by the aid that was blocked by the U.S. administration for the three years preceding Aristide's removal.

There was promise of restoring aid after the takeover. Has that happened? Has aid made its way to the Central Plateau or to the governmental department you work with most closely, the Ministry of Health?

I don't know that the aid has been released. Some has been sent to Port-au-Prince, but has it filtered into the Ministry yet? I doubt it.

If the living conditions haven't improved and, as you often say, most of the disease that you treat is caused by poor living conditions, I guess the Zanmi Lasante hospitals and clinics are still overcrowded?

We are overwhelmed. We are seeing people from southern and northern Haiti, as well as from the area we seek to serve. The health crisis is far from over, and more bad weather will worsen it by polluting groundwater and triggering more flash flooding.

You were trying to address the overcrowding with an ambitious expansion program. Has this proceeded as planned?

Perhaps not as planned, but we have proceeded. On the day we were to open our office in Hinche, one of our vehicles was commandeered by paramilitary forces. They're still around, but we opened the office anyway. And we are dedicating the Boucan Carre community hospital and microcredit bank on July 8, pretty much on time. We're determined to continue our efforts to improve medical and educational services to the people of central Haiti, and this is not work we care to see politicized in any way.

You said the humanitarian process can be solved only with more international aid. How about long-term solutions to the political crisis?

It's popular to say things like "The Haitians have to solve their own problems," but it's silly. The Haitians did not create slavery, chronic interference with their internal affairs, gunboat diplomacy, foreign occupations and a long history of trade and aid embargoes. The Haitians did not create unfair economic policies. These were created outside of Haiti. Erasing Haiti's debt, restoring constitutional rule, ending arbitrary aid embargoes and sinking significant resources into public health, public education and public infrastructure would be central to addressing and indeed solving Haiti's social problems. Haiti's flooding is a result of the ecological disaster (deforestation) that's been worsening over the past several decades, and that could be addressed, too. But exhorting peasants not to cut down trees for firewood is not the way to address deforestation. How else are they going to cook their food?

According to a recent New York Times story, the Bush administration has spent about $191-billion on wars in Middle East. At the same time, the U.S. government has cut back on the president's pledge to dedicate $15-billion to fight AIDS. Do you ever think about what could be accomplished if some of the military funding had been redirected to health care?

I think about it every day. I never fail to think about it. The program for rebuilding Haiti, and for taking on the diseases of the poor globally, would cost peanuts compared to what it's cost to finance the wars you mention. And of course I'm just talking about the financial costs. As a physician, I think every day about the human cost of war, too. I can't imagine it's possible to put a price tag on that.

- Dan DeWitt can be reached at 352 754-6116 or dewitt@sptimes.com

[Last modified June 10, 2004, 13:29:16]


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