Haiti After the Earthquake (8 page)

Although uncomfortable with the heavy protocol, which was often completely over the top, I settled into a good working relationship
with the UN Haiti team. This group of eight or so people led a staff of several thousand, most of them military peacekeepers. My chief interlocutor was the Secretary-General's special representative, an oldschool diplomat named Hédi Annabi. We got along well despite different views on Haitian politics. A native of Tunisia, Mr. Annabi had been working in tough settings for decades. He was courtly and reserved, spoke several languages fluently (Creole not among them, as he once pointed out sharply when I began speaking to President Préval in the Haitian language), and followed protocol to the letter. When he invited me to address him by his first name, I did, but felt impertinent.

Annabi's second-in-command was a tall man named Luis da Costa, who was to my thinking very Brazilian: warm and witty and unreserved. By nature a peacemaker, he sought to patch over debates and discord, the coin of the realm everywhere the UN deploys stabilizing forces. The two of them were somehow complementary. Da Costa also represented influential Brazil, which had invested heavily in peacekeeping in Haiti. The Brazilian general who led the peacekeepers, especially when it came to development, was another ally in this work. “We should do more to help the poor,” he said to me the first time we met. “Too much time is wasted in meetings in Port-au-Prince and on protocol.”

Early on, I told Annabi and da Costa that I'd been chosen for the job because of my knowledge of Haiti and of health care, food security, and education. I made it clear that I'd have little to contribute about peacekeeping, security, or Haitian party politices. (I had my doubts about the peacekeeping mission in Haiti, stemming from the events of 2004 and after.) It was a fraught topic and far afield from clinical medicine. The Special Envoy, Clinton, would be the leader and I, his deputy, would focus on what I knew best. On this first official trip, Annabi and da Costa listened carefully to my comments, trying to figure out where I fit into the complex UN structure. Sometimes I thought they were thinking, “Why on earth has an academic physician been chosen for a diplomatic role?” But no one ever said anything of the sort.

I also had the impression that some fraction of the UN leadership,
which surely knew of my concerns about law-and-order approaches to security, was disappointed to hear my views. After all, security and local politics were the principal focus of UN peacekeeping missions. But others in the humanitarian-assistance machine seemed relieved when I emphasized human security. The food riots the previous year had led many UN officials to push for a shift in the focus on military peacekeeping toward development efforts, including providing basic services to the Haitian majority. Many Haitians noted the irony that this had long been the platform of the popular movement that arose in the mid-eighties. It was unclear, however, how widely the irony was appreciated within what was termed “the international community,” which included not only the UN but representatives of many nations, international organizations, and nongovernmental groups. The United States had far and away the largest presence in Haiti, with a new ambassador and new leadership for USAID, its lead development agency.

This new, human-security-based approach had been long agreed upon but never really implemented. In espousing this approach—security will follow investments in basic social services and freedom from want—I was only trying to be honest. I'd long before concluded that jobs and such services, along with full political participation of the poor, were the best (and perhaps only) way to lessen violence and discord in the places we'd worked. But this was not an agenda I could push forward alone. The incoming UN development coordinator, Kim Bolduc, a Canadian born in Vietnam who had barely survived the destruction of UN headquarters in Iraq, shared this view. On a preliminary visit to Haiti, Bolduc had pushed to redirect the UN's focus toward sustainable and equitable development.

After letting the UN leadership know that I had Clinton's blessing to focus on health, education, and food security, even as we both promised to be cheerleaders for any and all decent (meaning pro-poor) development projects, I invited my new UN colleagues to visit our sites. “Come up to our hospitals and clinics,” I suggested, “and you will see that basic services are what Haitians are asking for and can themselves, with accompaniment and support, provide. And President Clinton will help bring in private investors to support large
projects and small ones, including those that help Haiti's farmers and artisans and market vendors.” Saying this sort of thing wasn't innovative, but implementing it would have been—at least in Haiti.

With Harvard's support, I began commuting between there, Haiti, and Rwanda. My new rank meant not only checking in with Mr. Annabi and others on each trip but also a great deal of time spent “interfacing with the international community.” Listening to complaints was a big part of the job, and we heard from everyone: UN development experts seeking more resources to fund their projects rather than peacekeeping and military efforts; representatives of influential governments with bilateral development projects in Haiti; leaders of the Haitian government, who rightly deplored the scant support they received to monitor all (and implement many) of the health, education, and sanitation services; NGOs, large and small, which complained about the UN
and
the Haitian officials and took ill any critique of their efforts; and the business élite, who told us that government rules and regulations were not to their liking.

But if anyone had real cause for complaint, it was—and still is—the Haitian people themselves, so long excluded from any meaningful discussion of their fate.
²¹
To a list of grievances spanning at least two centuries, they added the inability of state and nonstate providers to ensure basic succor to those in great need, in spite of the large presence of humanitarians and NGOs. These sentiments—these complaints—have been the constant companions of almost everyone working in Haiti to deliver such services.

The failure to provide basic services—health care, education, water, sanitation—had reached a parlous state. In the fall of 2009, the Ministry of Education estimated that half of all school-age children were not in school, and that many of those who were in school attended what the Haitians call
lekol bolèt
—“lottery schools,” so-called because, pedagogically, you take your chances there. The great majority of schools, maybe 90 percent, were private and relied on families' ability to pay tuition. President Clinton was convinced that if all children were in school and had at least one decent meal there, the stain of child servitude, referred to in Haiti as the
restavèk
system, would be dealt a serious blow.
²²
The Haitians with whom we
spoke agreed in principle, but finding the resources to make school fees, uniforms, books, and lunches available, and to improve the quality of education by training teachers, proved difficult. Although everyone seemed to agree on the diagnosis, and many on the treatment plan, failure to deliver led to another round of recrimination and blame. Similar discord was heard whether the topic was health care, access to potable water, clean energy, or ports and customs—the entire range of topics we were supposed to be addressing.

Practicing medicine in settings as different as Haiti and the urban United States taught me that scarcity (real and perceived) of resources was at the root of most of the discord. The team in the OSE—the Office of the Special Envoy—was committed to building back better in several senses. One was of course building or rebuilding infrastructure (from bridges to roads) and farmlands damaged by the storms. But we also had aspirations to build the development machinery back better. One of the books I gave to my new coworkers was a scathing indictment of development assistance,
Travesty in Haiti,
by anthropologist Tim Schwartz. I suspected it had won him few friends, but the book taught me a lot. His description of several abandoned windmills in the northwest could serve as a parable of foreign aid in Haiti:

We agreed that it was our duty to learn why foreign aid had failed, and to engage in goodwill efforts to improve it. Another of the duties of our small UN office (fewer than a dozen people, including volunteers) was to track pledges of development aid and see if they really ended up in Haiti. This process, which was directed by a hardworking and savvy young Australian on loan from UNICEF, Katherine Gilbert, marked the first time that one could check whether or not promised capital was moving. President Clinton also reached out to governments and agencies slow to keep their pledges, prodding diplomatically. These two interventions—a real-time window onto pledges and the courtly chivvying of the Special Envoy—led sometimes to more recriminations (including official letters of complaint from sovereign nations protesting that they had, in fact, fulfilled their pledges) but also started to speed up disbursement of some of the money. But this did not mean effective implementation, as Schwartz's windmills suggested.

Because many of the implementers were nongovernmental organizations, we also sought to develop a registry of NGOs working in Haiti. Nancy Dorsinville and Abbey Gardner, two longtime colleagues and friends who'd come with me to the UN, took on this project, promising to produce an online platform by the end of 2009. Although we found thousands of NGOs, we had no way to assess the quality or even the goals of their efforts. Sometimes we weren't sure organizations were still in existence. (Official records had not been updated in years.) Most importantly, despite the fact that the NGOs with the largest budgets (those funded by the United States and other bilateral and multilateral donors) were providing services for which the government was responsible, government officials had no way to monitor or coordinate their work.

We knew from experience that after the money arrived, if it did, issues of implementation would take over. Delivery of quality services and coordination of nonstate providers were the biggest challenges in health care efforts, certainly. For example, Partners In Health and
Zanmi Lasante had recently built the Ministry of Health a small community hospital, our tenth together, for only $700,000, and thereby created another two hundred permanent jobs. But such projects seemed too modest to those looking at the
big picture
, and critics—they were too numerous to count in all Haiti endeavors—could always dismiss any one project as either irrelevant or unsustainable.

Sometimes the
small picture
augured well for the bigger one, which invariably included, in development jargon, both implementation and integration of efforts across diverse sectors: social services, energy policy, governance, economic growth. It wasn't hard to point to regions needing improvement in all sectors—across Haiti but especially in isolated, rural areas. Part of my role as Deputy Special Envoy was to focus attention outside the “Republic of Port-au-Prince,” where all development meetings took place. Again, this idea was hardly innovative—integrated rural development is one of the great clichés in such circles—but implementation itself was innovation. “GSD,” as Clinton liked to say: get stuff done.

Some of the UN leadership in Haiti, along with a few friends of Clinton, visited central Haiti together in the fall of 2009. On one excursion to the town of Boucan Carré, isolated by a river that often flooded, we visited a rehabilitated public hospital covered with solar panels placed by locals working with Walt Ratterman. (He, along with the Solar Electric Light Fund, had solarized clinical facilities with us in Rwanda, Burundi, and Lesotho.) There was nowhere Ratterman wouldn't go to promote clean, renewable energy, and how he got those panels across the river was something I planned to ask him. He was all about GSD.