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Haiti After The Earthquake

An international relief expert examines the “unnatural disaster” of a chronically ill-served country and what it needs to recover in the years to come.

Read this article at the Washington Independent Review of Books.

“Haiti needs and deserves a modern Marshall Plan that rebuilds public institutions and creates jobs outside of the worn-down agricultural sector. Without one, it will have a hard time surviving the hurricane season. And next year will be worse.”

So Paul Farmer prophesied in September of 2008, less than two years before a devastating earthquake struck Haiti on January 12, 2010. As a physician, Harvard University Professor of Medical Anthropology, co-founder of the international aid organization Partners in Health that seeks to provide better healthcare for the poor and UN Deputy Special Envoy to Haiti, Farmer has a multitude of perspectives from which to view the crisis. Thus, his book is equal parts memoir of a relief worker bearing witness to the horrors of post-earthquake Port-au-Prince, social history of a country scarred by centuries of international political machinations and analysis of the shortcomings of modern aid organizations. More than any of these, however, Haiti after the Earthquake is the story of a community, of the extraordinary strength and dedication of doctors and diplomats both local and foreign working to save the country from disaster.

Farmer diagnoses the earthquake and Haiti’s subsequent health crisis as an “acute-on-chronic” malady that, while directly caused by the shifting of tectonic plates, owes the extreme difficulty of recovery to a series of political and social handicaps going back hundreds of years. Therefore, the book is not written in chronological order but rather alternates between chapters dedicated to the months after the quake and those telling the history of Haiti’s neglected public sector.

The contemporary sections vividly detail Farmer’s days spent in tent hospitals and donor meetings. Doctors at the General Hospital work 24-hour days and watch in frustration as their patients die of complications that could have been cured easily with the necessary medical supplies. The palace and most ministry buildings have been flattened. Months later, almost no rubble has been cleared from the city, displaced-persons camps still leave women and girls at risk of attack by other camp-dwellers whenever they leave their shelters at night, and cholera runs rampant through the countryside. In a few short bursts of optimism, the author tells the stories of survivors Shilove and Carmène, who had legs amputated but were then fitted for prostheses, learned to walk again and went on to inspire other young amputees.

In the chapters dealing with Haiti’s troubled past, the author examines the idea of the “unnatural disaster.” Disturbingly, he points out that Haiti was particularly vulnerable to earthquake due to its lack of building codes, understaffed and underfunded hospitals, and unstable government. That the billions of dollars being poured into the country from nongovernmental aid organizations do not seem to be doing any good is even more unsettling. The “Republic of NGOs,” Farmer insists, weakens the public sector by not allowing the government to organize the aid projects effectively or to sustain them once the NGOs have moved on.

The earthquake, Farmer and numerous other activists assert, provides the opportunity to “build back better” in Haiti, a phrase coined by UN Special Envoy to Haiti Bill Clinton. The author’s simple solution, repeated far more often than necessary: support and fund Haiti’s public sector by having aid organizations work through the government rather than around it. To convince readers of the effectiveness of his plan, Farmer provides parallels between Haiti and the other country served by Partners in Health, Rwanda. He asserts that national sovereignty was the critical factor leading to long-term reconstruction and growth in Rwanda, and that the same must happen in Haiti. Because Farmer does not elaborate on conditions in Rwanda post-genocide, it is difficult to determine objectively whether that country could or should be a model for Haiti post-earthquake. What is indisputable, though, is Farmer’s commitment to the proposition.

The last third of the book is a series of essays written by other contributors, many of whom the reader has already grown to know from Farmer’s tale of the weeks after the quake. The articles vary in quality; some merely repeat information from the first part of the book while others provide fascinating insights into the Haitian and aid communities. Haitian-American author Edwidge Danticat shares a story of Miami’s Little Haiti after the quake to demonstrate how far the Haitian community extends. Anthropologist Tim Schwartz tells a fascinating and disconcerting tale of his failed attempt to link the disconnected field hospitals by establishing a taxi service, revealing the lack of organization among the various aid organizations.

Haiti After the Earthquake is a captivating book about not just what has happened in Haiti in the past 18 months but why recovery has been so difficult, and how the next unnatural disaster can be prevented. It is a story of the extraordinary strength and courage of the Haitian people, and of their great need now and in the years to come. While at times a bit too insistent on his planned program of recovery, Paul Farmer has written an empathetic, critical and informative analysis of the modern aid structure, Haiti and how the two must be reconciled if the Western Hemisphere’s poorest nation can ever hope to stand on its own.


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