Dr. Paul Farmer - Friend of Haiti
Dr. Paul Farmer has worked in rural Haiti for the past two decades, where he and his Haitian co-workers have implemented an extremely effective community-based health network to treat HIV, tuberculosis, and other widespread diseases. Dr. Farmer was awarded the American Medical Association's "Outstanding International Physician Award" in 2002. He is a long-time Haiti activist and author of many books, including "The Uses of Haiti" and most recently, "Pathologies of Power."
Dr. Paul Farmer about The Uses of Haiti:
Almost ten years ago, when The Uses of Haiti was first written, I noted that it was written to serve as a tool for activism. It has been updated for the same reason: to fight for an end to the racist and mean-spirited policies that have characterized our official policies towards Haiti for almost 200 years. Because we believe these policies to be related to the health crisis unfolding before us, we have asked Common Courage Press to jump it's ! print schedule up 4 months, which it did despite cashflow risks.
Please support Common Courage by ordering a copy now, to defray printing costs. Orders can be placed at 800-497-3207.
"A classic..." -Jonathan Kozol
"The Uses of Haiti tells the truth about uncomfortable matters-uncomfortable, that is, for the structures of power and the doctrinal framework that protects them from critical scrutiny. It tells the truth about what has been happening in Haiti, and the U.S. role in its bitter fate." -Noam Chomsky, from the introduction
Unjust embargo deepens Haiti's health crisis
By Paul Farmer and Mary C. Smith Fawzi, Boston Globe 12/30/2002
IN HAITI'S central plateau, lack of resources and medical personnel combined with a growing burden of disease are responsible for increasingly desperate social conditions. The causes of worsening conditions are many, but the connection between unnecessary suffering and an aid embargo led by the United States is undeniable.
US-sponsored embargoes against Haiti have a long history. From 1804-62, the United States, a major slave-owning economy, simply refused to recognize the existence of Haiti. According to a US senator from South Carolina speaking on the Senate floor in 1824, ''the peace and safety of a large portion of our union forbids us even to discuss'' it. The United States occupied Haiti militarily from 1915-34, and since that time has supported a number of undemocratic governments. Under the Duvalier dictatorships, generous aid, primarily from the United States, flowed steadily, as it did during the military juntas later convicted of war crimes after the violent overthrow of Haiti's first democratically elected president, the Rev. Jean-Bertrand Aristide.
During the early 1990s, the UN imposed a trade embargo in order to push forward the restoration of Aristide. When in 1994 he returned to office and a devastated country, $500 million in development aid was promised by the United States and multilateral organizations. This aid might have helped resuscitate the hemisphere's poorest country, but it has been withheld.
The lack of development aid has been a burden, but even more troubling has been the embargo on humanitarian assistance and loans. For example, loans totaling $146 million (for health sector improvement, education reform, potable water enhancement, and road rehabilitation) already approved through the Inter-American Development Bank have been blocked by the United States in response to alleged irregularities during May 2000 legislative elections.
After the presidential election of November 2000 (widely recognized as free and fair), the funds were to be released, but the Bush administration used its veto power to continue to block release of funds on the grounds that Haiti has not demonstrated an adequate commitment to governing the country in a democratic manner - objections not heard during the long years of dictatorship.
This policy persists despite a September resolution by the Organization of American States stating that the Haitian government has taken the appropriate steps to foster democracy and that normal relations with international financial institutions should be reinstated.
Putting legal arguments aside for the moment, what are the health implications of withholding $500 million in development assistance and blocking $146 million in loans to improve health, education, and water quality?
During the past two years, at our 80-bed hospital in rural Haiti, we have seen demonstrable declines in the public health infrastructure and the health status of the populations surrounding our clinic. With a staff of 10 Haitian physicians and a large corps of community health workers, our organization, Zanmi Lasante, runs one of the largest charity hospitals in Haiti. Our support comes largely from private donors and foundations, and we see ourselves as disinterested observers of the events above given that we have never received significant government assistance or funding from the Inter-American Development Bank or the US government.
Over the past year, our general ambulatory clinic has seen an enormous increase in demand. We are staffed to receive no more than 25,000 visits per year, but will this year see an estimated 160,000 patients.
Meanwhile, neighboring clinics and hospitals have seen a decrease in patient load. While several neighboring facilities remain open, they sell or prescribe medications at prices that are beyond the reach of the population, over 80 percent of which live in poverty. We have noted a spike in trauma cases due in large part to road accidents (there is no money to maintain the rural road network). Malaria remains a major contributor to anemia and death, exacerbated by lack of access to care. Polio, previously believed eradicated from the Western hemisphere, has again resurfaced on the island. Other infectious disease outbreaks - anthrax, meningitis, and drug-resistant tuberculosis - have also occurred. The degree to which these pathogens spread will be determined largely by the capacity of the public-health system to respond.
The story is no different beyond our hospital's expanding catchment area. For example, there has been a significant decrease in Haitians' access to potable water, particularly in Port-au-Prince ($54 million of the $146 million that has been blocked was intended for improving water treatment). This situation recalls the years of military rule in the early 1990s, when the population with access to potable water in Port-au-Prince declined from 53 percent (1990) to 35 percent (1994). It should come as no surprise that during the past several years, Haiti's life expectancy has continued to decline.
Can this decline in life expectancy be attributed directly to the embargo? This question is difficult to answer, but it is clear enough that our affluent and powerful country is failing once more to help the Haitian people achieve decent conditions for themselves and their families. It is also clear that aggressive humanitarian aid could have an immediate and salutary impact if it can be channeled through institutions with national reach.
Increasingly, however, aid has been decreased or funneled to nongovernment organizations that, like our own, are often limited to serving local populations of no more than some tens of thousands of people. UN agencies and other multilateral organizations need to play a critical role in providing humanitarian assistance to vulnerable populations in Haiti to mitigate the effects of the aid embargo currently imposed by the United States.
In the 19 years that Zanmi Lasante has been working in Haiti, we have seen US aid flow smoothly and generously during the years of Duvalier dictatorship and the military juntas that followed. The current embargo has been enforced during the tenure of a democratically elected government, a situation inconsistent, in our view, with the articulated US policy and the views of the American people, and is on the face of it immoral.
Such policies are both unjust and a cause of great harm to the Haitian population, particularly to those living in poverty.
Dr. Paul Farmer is medical director of Zanmi Lasante and a professor at Harvard Medical School. Mary C. Smith Fawzi is an epidemiologist Zanmi Lasante and an instructor at Harvard Medical School.
This story ran on page A15 of the Boston Globe on 12/30/2002. © Copyright 2002 Globe Newspaper Company.