Archive for the ‘Haiti’Category


Paul Farmer has a piece in Foreign Affairs titled “Partners in Help”. Much of it is a re-telling of stories and ideas Farmer has used before (to great effect, of course), focusing largely on the idea of ‘accompaniment.’ I especially like (and wish he would expand on) this ending section:

Another way of putting this is: Beware the iron cage. About 25 years ago, when I was a graduate student at Harvard, I bought a copy of sociologist Max Weber’s collected works. It hurt my back and brain to even look at this giant tome, but his topic — how the “iron cage” of rationality comes to suppress innovation — remains relevant to this day. It occurs through “routinization,” a process by which rationalized bureaucracies gradually assume control over traditional forms of authority. This is often a good thing: Rationalized procedures can improve efficiency and equity. (Atul Gawande made this insight the core of his “checklist manifesto.”) When the World Health Organization launched its directly-observed therapy protocol for tuberculosis, many countries, such as Peru, made great strides against the ancient scourge.

But exceptional events — black swans, in popular parlance — expose the limits of this form of efficiency. When patients began falling ill with drug-resistant strains of tuberculosis, WHO guidelines suggested they be treated with the same first-line drugs as non-resistant patients. Yet treating patients with the very drugs to which their disease had developed resistance not only failed to help them; it enabled the worse strains to spread unchecked among patients’ families and co-workers. This is the double-edged sword of routinization: Rationalized treatment protocols first helped health providers increase the effectiveness and reach of treatment but later prevented them from taking necessary steps to curb the spread of drug-resistant strains. Increases in bureaucratic efficiency can come at the price of decreased human flexibility. In other words, as institutions are rationalized, and as platforms of accountability are strengthened, the potential for accompaniment can be threatened, since it is open-ended, elastic, and nimble.

When the iron cage of rationality leads to a poverty of imagination, cynicism and disengagement follow. It is easy to be dismissive of accompaniment in a world in which arcane expertise is advanced as the answer to every challenge. But expertise alone will not solve the difficult problems ahead. This was the long, hard lesson of the earthquake: We all waited to be saved by expertise, but we never were. True accompaniment does not privilege technical expertise above solidarity, compassion, and a willingness to tackle what may seem insuperable challenges. It requires cooperation, openness, and humility; this concept may, I hope, infuse new vitality into development work.


08 2011

Haiti: Constancy and Change

A friend of mine recently moved to Haiti to work for a local organization. I’ve never been to Haiti, and as with many places to which I have yet to travel, it’s difficult for me to picture the reality on the ground, especially when I know how much the places I’ve traveled to have differed from media reports and books I’ve read. While my friend and I were talking about Haiti, I mentioned that it would be interesting if I could email some questions and post the answers here on my blog. While I don’t think any of the sentiments below are that controversial, I hope this will be a continuing series where I can ask questions and get frank answers (and share them with my readers), so we decided to keep it anonymous.

I’ll call my friend “F” here. Please let me know (in the comments or by email) if you have any questions you’d like me to relay to F for follow-up posts.

Brett: Can you tell me a little about how long you’ve been in Haiti, how long you lived there in the past, and what you’re doing now (in a vague sense)?

F: I spent a nearly a year in Haiti in 2005-06. I always knew I’d be back some time, and after the earthquake on January 12th, 2010, I regretted that I hadn’t returned sooner. I finally arrived back a few weeks ago, to take up a new position with the same organization I worked for five years ago.

Brett: How have things changed since the last time you were there? Did you have a lot of expectations about how things would be post-earthquake, and if so, how does the reality compare to what you were expecting?

F: Of course it’s very sad to see so many landmarks in Port-au-Prince reduced to rubble, and what used to be great public spaces packed full of thousands and thousands of people living under tents and blue tarpaulins. Walking around the city is a little creepy: I’ll wander down streets I know well, and find that a house or church I used to pass every day is gone.

But I’ve also been surprised by how much hasn’t changed. The same fruit vendor I used to buy from five years ago still sits on the same street corner with her basket of oranges – even though the grocery store behind her has completely vanished. From my first morning back in the office, catching up with old friends and co-workers, it was as if I’d never left. Knowing how Haiti had switched from being a developing country to being (in international NGO terms) a humanitarian emergency, I think I was expecting to see some kind of fundamental change in the way things happen here. In reality, while the problems are perhaps more urgent now, the way of life is just the same as before.

Brett: What’s the latest on cholera? Is everyone incredibly concerned, or is it just one crisis among many?

F: I think people see cholera as yet another disaster in a terrible year for the country. It’s very sad that cholera seems most probably to have been brought here by the UN “assistance” force (which was already almost-universally reviled among Haitian people). However, I have to say I’ve been genuinely impressed with the speed and effectiveness of the response by the government and NGOs. I’m as cynical as anyone else about how little there is to show for years and years of public health efforts by international NGOs in Haiti: but this time, they seem to have got it more or less right. I arrived only two weeks after the outbreak started, and already by then everybody I met knew exactly what the steps for prevention were. I see people living in even the most basic conditions being meticulously careful about washing their hands and chlorinating their water.

Last week I was visiting a rural community, and I met a woman who was using water from an irrigation channel to wash her pots and pans. My colleagues, and also the local woman who was showing us around, were furious, telling her in no uncertain terms that her children will die of cholera if she continues doing that. But three months ago, it would have been completely normal.

Brett: What do you think I’m missing about Haiti from reading the news and the occasional blog?

F: Wow, where to start? I don’t think that the journalistic staples of tent cities, cholera, rock-throwing demonstrators, and heroic Americans battling against poverty gives you much idea of what life in Haiti is really like. Perhaps what would most surprise an outsider is just how normal life here is most of the time. For example, Haiti was again in the international headlines with post-election protests in December. It’s true that most people stayed at home for a couple of days while the situation was tense. But on the third day things started quietening down – and by the fourth day, the merchants were back on the streets, children were again hurrying to school in their little checkered uniforms, and the morning traffic jams were as bad as ever. Haitian people have seen a lot of political upheaval and many natural disasters over the years, they’ve seen international attention come and go, and life has carried on throughout.

There’s a fascinating story waiting to be told about the social and economic effects of the 2010 earthquake. Almost every newspaper article I read about Haiti starts by describing it as the poorest country in the western hemisphere. That’s true – but the situation is far more complex than that. This country has a lot of very poor people, but also quite a number of reasonably wealthy people too, and some super-rich. (Port-au-Prince has long had a Porsche dealership, believe it or not.) Before the earthquake, the level of inequality in Haiti was even higher than Brazil. Of course the earthquake was indiscriminate: it hit rich and poor alike, destroying the National Palace and the Montana Hotel as well as tens of thousands of single-room block-and-tin-roof houses. But this destruction of houses (combined with an enormous influx of foreigners, who all need a place to stay) has meant a huge increase in the price of accommodation, and a boom for landlords whose property was not damaged. My landlady is frantically adding extensions to our apartment building: that means she’s employing a dozen or so construction workers, which is great. Some jobs are being created, but at the same time inflation is soaring. Then there’s the complication of the massive internal migrations caused by the earthquake. I don’t think anyone really knows what all this means for the long term, but it would be great to see some informed analysis.

Most of all, while there’s a lot that’s going wrong in Haiti, I wish the media would sometimes mention some of the great things about the country: the lively kompa music which surrounds you constantly in the street, the colorful, expressive language, the way Haitian people are so scrupulously polite and courteous (even among the urban youth, or more so than you’d expect), and the way they have such a strong sense of identity and of their proud history. Coming back has also made me realise how I had missed the Haitian sense of humor. When I get on a bus in the city and ask the people next to me how they’re doing, I sometimes get a response of “lamizè ap kraze nou“: “we’re crushed by misery” – that seems to be the sort of thing people expect foreigners want to hear. But then more often than not, before we’ve gone a hundred yards down the road, my neighbors are laughing and joking with me – often teasing me about my terrible Creole. People here are certainly resilient: even after all the troubles and tragedy of the last 12 months, they are still able to find reasons to be cheerful.


01 2011