Haiti After the Earthquake (27 page)

The coming rains also signaled the beginning of the planting season. The post-quake exodus from Port-au-Prince had placed great strain on rural host families, who had long struggled with food insecurity. They needed to turn their attention again to agriculture so that Haiti would not rely on imports for basic nutrition.

Back-to-school season was a sorry time. Many children in Port-au-Prince, especially those living in the camps, had nowhere to go; their schools had been damaged and many of their teachers killed in the quake. Schools needed to be rebuilt and temporary solutions were needed to keep children off the street and out of gangs. Before the quake, demographers and aid agencies spoke of the “youth tsunami” about to wash over Haiti, as if Haitian youth were more a threat than asset.
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Human capital had long been Haiti's chief asset, and getting children and young people into safe schools that offered modern pedagogy was a top priority.

We spoke often of building back better, but what did it really mean? Literally, of course, it meant building disaster-resistant homes and other structures. It meant rendering the infrastructure of Port-au-Prince capable of supporting the millions of people who lived there. It meant building roads and bridges, improving water and sewage systems, and repairing old hospitals and building new ones. It meant making sure schools didn't suddenly collapse and mudslides didn't take down hillsides covered with houses. All these desired outcomes could mean creating jobs in the short term, and some of us
felt that the most urgent task of all was the creation of jobs that would confer dignity to those in greatest need. With well-paid jobs, Haitians would themselves put safer roofs over their heads.

But only a minority of those displaced after January 12 would end up with more than plastic or canvas over their heads. By early summer, well over a million people were still living cheek-by-jowl in the camps, and moving people into safer housing was again declared a priority. Many Haitians were already patching up homes on their own. Haiti's government and the shelter experts had announced resettlement strategies by the dozen, but as usual, more design and planning occurred than implementation.

One project that attracted attention was a large resettlement complex proposed for Corail-Cesselesse, a windswept plain to the north of Port-au-Prince. This seemed an odd location because the region boasted little more than a few spindly trees. But we were eager to see people leave the muddy urban camps, and one of the most credible reporters living in Haiti had spoken of the project in fairly glowing terms: “The organized relocation camp at Corail-Cesselesse,” he commented, “has thousands of spacious, hurricane-resistant tents on groomed, graded mountain soil.... Camp Corail offers a glimpse at what relief efforts can achieve; sturdy tents, adequate food, sanitation, and security.”
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Corail, we read, would be transformed from a model camp into a planned community with three hundred thousand spacious homes, restaurants, stores, and garment factories. Some began calling it a “Zen city,” and “the key industrial city of the Caribbean.”
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Such hopes triggered a charrette of feverish planmaking and site design.

The promise of construction jobs lured thousands to the deforested plain of Corail to stake out a claim in this promising frontier settlement. But by July, the building process—the business of implementation—had stalled. Some disagreed about where to start construction; others about the right contractors for the job. Of the many planners, architects, potential builders, and engineers involved in the project, few seemed to be talking to one another. I asked one of them why the project was stalled, and he blamed the lack of clear title, an inept bureaucracy, fractious contractors, and a touch of sabotage.
Then summer rains revealed the area as an immense floodplain; the proposed buildings would sink in the mud.
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Corail was canceled. Many other resettlement initiatives lost steam as well, even as the rains continued to fall.

More modest efforts were easier to pull off, which is perhaps one reason why nimble NGOs seemed to thrive in Haiti. Although few displaced by the quake had the good fortune to end up under a real roof, among them were the more than fifty unaccompanied minors we'd come across in the General Hospital. Loune Viaud had been looking after them since the quake. With help from my Pétionville host Maryse, Loune sealed the deal on a property in northern Port-au-Prince, on the fringe of the quake zone. She hired health aides and rehab workers, mostly women rendered expert by their own experience as mothers, who were coached by professional physical therapists from Miami, Israel, and the Zanmi Lasante team. (Most of the children had severe disabilities.)

The place soon became a veritable oasis: a house full of kids and nurses surrounded by a few acres of well-tended land, lush with mangos and other fruit trees. It had a temporary library, a pool, and a humble fountain, which had been drained when they found the place but now flowed quietly. Chickens and guinea pigs were penned up around the periphery, and a tilapia hatchery and hydroponic gardens were being added in the backyard. Dozens of construction workers—there each time I visited, usually on weekends—were also putting up a large staff dormitory. The place was christened
Zanmi Beni
—“Blessed Friends”—and became an oasis both for the children and for a handful of displaced health professionals and volunteers.
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Three medical students, left homeless and school-less by the quake, were also living there in tents. For the first time in almost a century, the national medical and nursing schools would have no graduates. Although one class was receiving training in Cuba, few young health professionals would be entering service in the coming years. My colleagues at Harvard, Partners In Health, and Zanmi Lasante were trying to help fill this gap, including the Minister of Health's request that we triple the size of the Mirebalais hospital.
The Mirebalais expansion was already taking root, thanks to the hard work of volunteers in Chicago, Boston, and across central Haiti.

The medical students at Zanmi Beni reminded me of three Haitian medical students I'd met on that first night back in the darkened General Hospital. They hadn't eaten much since the quake, had lost their homes, and were there trying to help out at the hospital. But the only question they asked was: “How can we continue our medical studies?” Here was another role for American universities: to make sure that the current generation of trainees—in medicine and dentistry, nursing, pharmacy, and all the allied health professions—had a chance to complete their training. After Katrina, Harvard and other universities had taken students from Tulane, Dillard, Xavier, and the University of New Orleans, and now we need to help students from Haiti, too. Jim Kim, the President of Dartmouth, was up for it. At the Harvard Medical School Dubai Center, half a world away, health providers were being trained with the same methodologies we used in Boston. The goal was to realize the same standard of pedagogy and care at the two institutions. Most American research universities undertook similar “twinning” efforts in China, Singapore, and elsewhere in Eastern Europe and Asia and Latin America. But these sorts of collaborations were rare or weak in the poorer reaches of the world. The teaching hospital we were planning in Mirebalais would offer another home and a center of excellence, we hoped, for the next cohort of Haitian health professionals.

If we could build a major teaching hospital in the middle of central Haiti, seek the blessing of the Interim Haiti Recovery Commission, bring in new partners, and use private capital, we could help strengthen public health and medical care and medical education all at the same time. It was possible to imagine making a significant contribution to reconstruction, which was a lot more appealing than complaining about its glacial place and bemoaning failure.

I had personal reasons for wanting to work in Mirebalais, too. It was my first home in Haiti, where I'd first met Mamito and Fritz Lafontant. The summer of frustration, 2010, opened with a personal loss: Mamito died in June from a stroke. Mamito had taught me a lot over the previous twenty-seven years. She liked to give instructions,
but her versions of “wipe your feet” or “clean up your room” were broader in scope, if equally to the point: “Make this house waterproof for this family; put tin on the roof and cement on the floor.” She issued more typical maternal fiats as well, and everyone who visited Cange got a little dose of Mamito's mothering.

During the months after the quake, Mamito and her close-knit team received medical volunteers from all over and thousands of patients. She spent her days between the hospital and the church, which had remained an ersatz trauma ward for months. Well or unwell, she rose every day to give instructions to the planefuls of doctors and nurses and physical therapists who arrived in Cange. Mamito's job was to mother them a bit too: to make sure they ate enough and had clean scrubs and got a little rest now and then.

Her passing left a huge void in my life and the lives of many others. Didi flew back for the funeral, and then we returned to Rwanda for our daughter Catherine's confirmation. (Our work in Rwanda was going well; we were trying to hasten the completion of a flagship hospital in the northern Burera district.) I needed a break from Haiti and the grueling back and forth to Boston, and my coworkers did, too. The transnational doctors, a hardy lot, were weary—even the indefatigable Claire Pierre seemed tired. I was also falling behind in my Harvard duties and leaning on colleagues there to pick up the slack. But most of all, I wanted to see my kids.

Somewhere on the long list of reasons why the camps kept growing over the summer—the top reason being that the displaced had nowhere else to go—was that some supplies and provisions were reaching the camps, and the situation outside them was dire. By some reports, water insecurity had lessened throughout Haiti because aid groups were providing clean drinking water in the camps. One survey in Port-au-Prince suggested that diarrheal diseases had dropped 12 percent below the pre-earthquake level.
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However, the massive importation of bottled water wasn't sustainable, and some local bottlers and merchants began urging aid groups to stop distributing free water. But given the lack of sanitation in many settings,
the local water supply would be “sustainable” only if it did not become a conduit for waterborne disease.

By mid-July, most involved in quake relief—including officials from USAID, which in previous years had tried to skirt Haitian institutions—understood all too well the need for a new approach to delivering services. After reporting the improved water security in Haiti, Paul Weisenfeld, Haiti Task Team Coordinator for USAID, observed: “I think it's key to us that if we're going to have sustainability we are going to have to work through Haitian institutions, which requires strengthening them. Obviously [they've] been weakened tremendously by this earthquake, so at the same time that we implement reconstruction programs, we need to strengthen government institutions so that we can work through them.”
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The term “sustainability” has long been abused in development circles. It admits too many meanings. Sustaining lives in these camps would mean sustaining supply lines for as long as people lacked homes and jobs. Otherwise, we would see outbreaks of waterborne disease before the rains ended.

The greatest challenge of economic development in Haiti had always been massive job creation. By summer, more and more agencies were implementing “cash-for-work” programs. Such initiatives were surely one good way to move resources from the self-described donor nations to the survivors who were able-bodied and anxious to work. But the UN reported that these programs had generated only about thirty-five thousand jobs. What was needed was more on the order of five hundred thousand paying jobs, and soon. Haiti needed jobs that would confer dignity on the poor. As FDR said early in the Depression, “The Nation asks for action and action now. Our greatest primary task is to put people to work.”
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Martin Luther King and many others had echoed the view that paid labor confers dignity.
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Most champions of rights for the poor, it seems, had come to this conclusion. A jobs campaign of this magnitude—with a focus on young people, especially young women—would not be a panacea for Haiti, but it would be a step forward on the long road to reconstruction.