Posts Tagged ‘Earthquake’

Haiti’s Wounded Long to Heal

Tuesday, February 23rd, 2010

 

February 18, 2010

 

For Elisa Zlami, the burden of her fractured leg just got heavier, literally. The day before, Marc, an ortho-tech at the General Hospital in Port au Prince, came immediately to her tent, “Post Op 3″, after I asked him to ”do something” about Elisa’s old split cast that was causing her pain. Haiti’s earthquake snapped her shin bone in two, and left an open wound that has finally healed. 

 Marc expertly rewrapped her leg in a new plaster cast. Despite a day of drying, the new cast must weigh 20 lbs. Yet her leg still hurts along the fracture point. A summoned orthopedic doctor inspects Elisa, and tells her the pain should go away, and Elisa need not stay in the hospital. But Elisa has lost her home and her family too.

A few weeks after the earthquake, Rea is desperately trying to get food for her community of children and their families from the school she ran before the earthquake. It now is a community center and clinic. Baz, an American medic, has told her that there might be food from the UN. But it is very confusing. The Italian Navy is also promising food in a few days. The prospect of being able to participate in that food distribution system seems daunting for Rea, whose English is not very good and whose Italian is nil.

Pediatric patient, HUEH

Pediatric patient, HUEH

A new French doctor, Michelle, breezes into Post Op 3 and cuts away the dressings from Mrs. Wintour’s heel. Mrs. Wintour’s wounds are now green with infection. I changed her dressing two days ago and there was no green then, so daily dressing changes are now mandatory. Better nutrition is essential too, since malnourishment is preventing healing.

At the sprawling, busy United Nations compound, there are no hungry people. Not many are Haitians either, who are being stopped at the gates while whites like me are waved through. I have no business there really; I am wandering around looking to book a flight to Miami. I see many cheerful foreigners working for NGOs, governments, militaries and businesses, because Haiti is now a boomtown. The opportunities for aid and development work are enormous thanks to the disaster and the millions or billions of dollars being pledged. Foreigners, especially Americans, are flocking to Port au Prince to pursue this offshore opportunity. Many are earnest, believing sincerely in their humanitarian mission. Of course, the thousands of mostly U.S. soldiers didn’t exactly come by choice.

When deposed popular Haitian President, Aristide told the UN in 1991, “Everyone must have a place at the table,” he was referring to Haiti’s hungry dispossessed. But it is the international community that has invited itself to feast. Little has changed since Columbus first colonized Haiti, including blaming the Haitians for their poverty.

Shanti town across from port in Port au Prince

Shanti town across from port in Port au Prince

Post Op 3 tent is a small community where Elisa and Mrs. Wintour live with 18 other patients, their families and friends. The young girl who often tends Elisa is a friend, the healthy sister of another girl living outside the tent, who also has a painful broken leg. Food brought in by the families to supplement the meager daily hospital meal is often shared. Nearby, the Haitian Adventist hospital sponsored by US Adventists and an evangelical food mission provides two large vegan meals a day with food mostly bought from the neighbouring Dominican Republic.

I asked Mr. Abelard, Elisa’s older neighbour in the next bed, to make sure Elisa gets to X-Ray. He knows how the informal system works – you flag down someone walking by in Transport, hand them your paper note saying “Radiograph – jambe droit”, and they put you on a stretcher and carry you to and from X-Ray.

Emmanuel has extensive injuries, including an amputated right arm, and is fighting an infection to hip and leg wounds that have been repeatedly surgically cleaned. He also has two sisters jealous of his neighbour, Mrs. Wintour’s new experimental mechanical wound suction device that aspirates draining fluid from her foot wound into a corrugated blue squeeze bottle. The sisters want one for Emmanuel. The device is being developed by a Boston medical team who work with Partners In Health based here in Haiti. Kristine, their engineer, thinks when the kinks are worked out, they can provide the molds for the plastic bottles to businesses in third world countries that can stamp out bottles for a few dollars. They hope each system will cost less than $75. In the U.S., a more efficient electrical system called a Wound Vac costs $25,000; its manufacturer made $1.4 billion from it in 2008. The next day, Emmanuel gets the blue bottle wound suction for his hip.

Shekhar, an Edmonton Red Cross volunteer called me the other night after assisting with food distribution that day. He can’t understand why food distribution is run so badly in Haiti. After all, Shekhar and the international agencies have done this successfully around the world. The Haitians are prepared to do anything they can to help. Those of us who have had the good fortune to hang out with Haitians or wander around Port au Prince’s poor neighbourhoods, remark to each other how kind and gracious these Haitians have been to us. This is in contradiction to their sinister portrayal by our media and governments.

I happened to have been in Washington when the quake struck down Haiti. I’m not a bad schmoozer, so with a little luck and effort, I found myself connecting with people and agencies that were to be some of the players in the emergency medical response.

Food lines for women, Place St-Pierre, Pietonville

Food lines for women, Place St-Pierre, Pietonville

Last week, Christine, a trauma surgeon in Washington told me that I should tell the director of the General Hospital that if he wants medical materials, he should go to the US A.I.D. web site. “Like a bridal registry,” Christine texted. I presented the message to Director Dr. Lassegue, who responded skeptically, “Oui, perhaps something will come of it.”

Many experienced in disaster response, label the beginning organization “a cluster fuck”. I bumped into David, a young tattooed American at the UN campground walking to a health-cluster meeting. David griped that the scheduled meeting times were often changed, and tended to be useless because the decisions had already been made overseas.

Like so many of the people sharing the Post Op tents, Elisa’s losses are more profound than her wounds. It’s not their crooked or missing limbs that will be their biggest impediment. It is the prospect of trying to make a home and a life out of their shattered country that again is being occupied – and is now run by a coalition of a post-coup regime, foreign governments, militaries, religious charities, NGOs and aid agencies – all under the umbrella of humanitarian relief.

Three weeks after the quake, the French-run Handicap International organization set up shop at the hospital with a plain green military tent and a team of about a dozen French physical therapists and Haitian trainees. The French will leave eventually, but they understand that the work must continue with the Haitian staff. This model has yet to be adopted by most aid agencies that have no plan to sustain their programs without their presence.

Most charitable aid to “take care of Haiti’s poor” spends little actual money inside Haiti. We long to hear announcements that there will be substantial aid for Haiti’s peasant farmers to provide credit and resources to plant sustainable crops for local consumption, and to help Haitian businesses produce essential local goods.

Back at the trauma ward, we have to figure out who will be operating on the patients now that after a month, the Red Cross Norwegian orthopedic surgeons have left to another health facility, and the Medecins du Monde surgeons are leaving this weekend. The rapid turnover of many volunteers is maddening. In the operating room, I ask the Haitian surgeon in charge, who says, “When you need a surgeon, just come in and grab one of us.” Sounds like a plan.

The staffing at least during the dayshift at the hospital is much better now than three weeks ago when I first arrived. Many more Haitians are able to work. Even the Israelis just sent in a half dozen Mogen David staff, while they are still busy blocking medical aid to Gaza after destroying hospitals and ambulances there last year.

Diana is an American nurse running a clinic inside a tent community of 2,500 homeless and hungry people. Talking with worker at the airport where supplies are being delivered, she found out that his friend has a quadriplegic child who needs a wheelchair with a head support. With the help of a Mr. Fix-It friend, Diana presents the worker a retrofitted wheelchair with a headrest, and drives back to the tent community with four pallets of food. But two weeks later, Rea still has not been able to tap into a food pipeline for her community.

The informal networking ways of getting things done described above can only work on an international scale if the Haitian people are included and are allowed to be masters of their destiny.

International businessmen are urged take advantage of the new manufacturing climate in Haiti. Foreign aid earmarked for security will also revitalize Haitian security forces who historically have been its death squads, attacking labour and community organizers who might reduce profits from such sweatshops.

The Toussaint Louverture Airport was being run by the US Military when I arrived yesterday evening, despite the handful of Haitians who stamp our passports before we walk out onto the tarmac. Homeland Security’s immigration police and border agents then check our passports as we board. Three weeks previously when I arrived, no one asked for my passport – in fact, no one asked me for any identification or professional license during my entire stay. On the tarmac are Canadian soldiers, RCMP officers, CIDA aid employees and diplomatic personnel waiting to board their military transport plane to Ottawa. There is also a tent for the US soldiers, and the US State Department processing civilians for their humanitarian transport to the U.S. in military C-130s. 

The aid response is not so confusing after all. The Montreal Meeting of international donors, the Davos Forum, the Clinton-Bush Haiti Fund, US A.I.D., the UN, and the various security forces in Haiti all seem to be navigating the humanitarian response ship to further their interests in Haiti. Most NGOs and religious missions have found a niche to plug into.

Humanitarian aid is perceived as just and moral. But until Haitians like Elisa, Mr. Abelard, Mrs. Wintour and Rea are permitted at their own table and given the chance to build a sustainable infrastructure, so-called aid becomes another weapon to exploit these good people who liberated themselves from slavery, and are still paying the price.

Securing Disaster in Haiti

Tuesday, February 2nd, 2010

 

http://www.haitianalysis.com/2010/1/29/the-land-that-wouldn-t-lie-foreign-intervention-in-haiti
 
 
Reprinted with permission from Haiti Liberte. 

An abbreviated version of this article first appeared as ‘The Land that Wouldn’t Lie’ in the New Statesman, 28 January 2010, at http://www.newstatesman.com/international-politics/2010/02/essay-haiti-france-colonial
 
Nine days after the devastating earthquake that struck Haiti on 12 January 2010, it’s now clear that the initial phase of the U.S.-led relief operation has conformed to the three fundamental tendencies that have shaped the more general course of the island’s recent history. [1] It has adopted military priorities and strategies. It has sidelined Haiti’s own leaders and government, and ignored the needs of the majority of its people. And it has proceeded in ways that reinforce the already harrowing gap between rich and poor. All three tendencies aren’t just connected, they are mutually reinforcing. These same tendencies will continue to govern the imminent reconstruction effort as well, unless determined political action is taken to counteract them.
 
I
 
Haiti is not only one of the poorest countries in the world, it is also one of the most polarized and unequal in its disparities in wealth and access to political power. [2] A small clique of rich and well-connected families continues to dominate the country and its economy while more than half the population, according to the IMF, survive on a household income of around 44 US pennies per day.[3]
 
Mass destitution has grown far more severe in recent decades. Starting in the 1970s, internationally imposed neo-liberal ‘adjustments’ and austerity measures finally succeeded in doing what no Haitian government had managed to do since winning independence in 1804: in order to set the country on the road towards “economic development,” they have driven large numbers of small farmers off their land and into densely crowded urban slums. A small minority of these internal refugees may be lucky enough to find sweatshop jobs that pay the lowest wages in the region. These wages currently average $2 or $3 a day; in real terms they are worth less than a quarter of their
1980 value.
 
Haiti’s tiny elite owes its privileges to exclusion, exploitation and violence, and it is only violence that allows it to retain them. For much of the last century, Haiti’s military and paramilitary forces (with substantial amounts of US support) were able to preserve these privileges on their own. Over the course of the 1980s, however, it started to look as if local military repression might no longer be up to the job. A massive and courageous popular mobilization (known as Lavalas) culminated in 1990 with the landslide election of the liberation theologian Jean-Bertrand Aristide as president. Large numbers of ordinary people began to participate in the political system for the first time, and as political scientist Robert Fatton remembers, “panic seized the dominant class. It dreaded living in close proximity to la populace and barricaded itself against Lavalas.” [4]
 
Nine months later, the army dealt with this popular threat in the time-honored way, with a coup d’état. Over the next three years, around
4,000 Aristide supporters were killed.
 
However, when the US eventually allowed Aristide to return in October 1994, he took a surprising and unprecedented step: he abolished the army that had deposed him. As human rights lawyer Brian Concannon (director of the Institute for Justice and Democracy in Haiti) observed a few years later, “it is impossible to overestimate the impact of this accomplishment. It has been called the greatest human rights development in Haiti since emancipation, and is wildly popular.” [5] In 2000, the Haitian electorate gave Aristide a second overwhelming mandate when his party (Fanmi Lavalas) won more than 90% of the seats in parliament.
 
II
 
More than anything else, what has happened in Haiti since 1990 should be understood as the progressive clarification of this basic dichotomy – democracy or the army. Unadulterated democracy might one day allow the interests of the numerical majority to prevail, and thereby challenge the privileges of the elite. In 2000, such a challenge became a genuine possibility: the overwhelming victory of Fanmi Lavalas, at all levels of government, raised the prospect of genuine political change in a context in which there was no obvious extra-political mechanism – no army – to prevent it.
 
In order to avoid this outcome, the main strategy of Haiti’s little ruling class has been to redefine political questions in terms of “stability” and “security,” and in particular the security of property and investments. Mere numbers may well win an election or sustain a popular movement but as everyone knows, only an army is equipped to deal with insecurity. The well-armed “friend of Haiti” that is the United States knows this better than anyone else.
 
As soon as Aristide was re-elected, a systematic international campaign to bankrupt and destabilize his second government set the stage for a paramilitary insurrection and a further coup d’état, and in 2004, thousands of US troops again invaded Haiti (just as they first did back in 1915) in order to “restore stability and security” to their “troubled island neighbor.” An expensive and long-term UN “stabilization mission” staffed by
9,000 heavily armed troops soon took over the job of helping to pacify the population and criminalize the resistance. By the end of 2006, thousands more Aristide supporters had been killed.
 
Over the course of 2009, a suitably stabilized Haitian government agreed to persevere with the privatization of the country’s remaining public assets, [6] veto a proposal to increase minimum wages to $5 a day, and to bar Fanmi Lavalas (and several other political parties) from participating in the next round of legislative elections.
 
When it comes to providing stability, today’s UN troops are clearly a big improvement over the old indigenous alternative. If things get so unstable that even the ground begins to shake, however, there’s still nothing that can beat the world’s leading provider of peace and security.
 
III
 
In the immediate aftermath of the earthquake that struck on 12 January 2010, it might have seemed hard to counter arguments in favor of allowing the US military, with its “unrivaled logistical capability,” to take de facto control of such a massive relief operation. Weary of bad press in Iraq and Afghanistan, US commanders also seemed glad of this unexpected opportunity to rebrand their armed forces as angels of mercy. As usual, the Haitian government was instructed to be grateful for whatever help it could get.
 
That was before US commanders actively began – the day after the earthquake struck – to divert aid away from the disaster zone.
 
As soon as the US air force took control of Haitian airspace, on Wednesday
13 January, they explicitly prioritized military over humanitarian flights. Although most reports from Port-au-Prince emphasized remarkable levels of patience and solidarity on the streets, US commanders made fears of popular unrest and insecurity their number one concern. Their first priority was to avoid what the US Air Force Special Command Public Affairs spokesman (Ty Foster) called another “Somalia effort” [7] – which is to say, presumably, a situation in which a humiliated US army might once again risk losing military control of a “humanitarian” mission.
 
As many observers predicted, however, the determination of US commanders to forestall this risk by privileging guns and soldiers over doctors and food has only succeeded in helping to provoke a few occasional bursts of the very unrest they set out to contain. In order to amass a sufficiently large amount of soldiers and military equipment ‘on the ground’, the US Air Force diverted plane after plane packed with emergency supplies away from Port-au-Prince. Among many others, World Food Program flights were turned away by US commanders on Thursday and Friday, the New York Times reported, “so that the United States could land troops and equipment, and lift Americans and other foreigners to safety.” [8]
 
Many similar flights met a similar fate, right through to the end of the week. Médecins sans Frontieres (MSF) alone has so far had to watch at least five planeloads of its medical supplies be turned away. [9] On Saturday 16 January, for instance, “despite guarantees given by the United Nations and the US Defense Department, an MSF cargo plane carrying an inflatable surgical hospital was blocked from landing in Port-au-Prince and was re-routed to Samana, in Dominican Republic,” delaying its arrival by an additional 24 hours.[10] Late on Monday 18 January, MSF “complained that one of its cargo planes carrying 12 tons of medical equipment had been turned away three times from Port-au-Prince airport since Sunday,” despite receiving “repeated assurances they could land.” By that stage one group of MSF doctors in Port-au-Prince had been “forced to buy a saw in the market to continue the amputations” upon which the lives of their patients depended. [11]
 
While US commanders set about restoring security by assembling a force of some 14,000 Marines, residents in some less secure parts of Port-au-Prince soon started to run out of food and water. On 20 January people sleeping in one of the largest and most easily accessed of the many temporary refugee camps in central Port-au-Prince (in Champs Mars) told writer Tim Schwartz, author of the 2008 book Travesty in Haiti, that “no relief has arrived; it is all being delivered on other side of town, by the US embassy.” [12] Telesur reporter Reed Lindsay confirmed on 20 January, a full eight days after the quake, that the impoverished south-western Port-au-Prince suburb closest to the earthquake’s epicenter, Carrefour, still hadn’t received any food, aid or medical help. [13]
 
The BBC’s Mark Doyle found the same thing in an eastern (and less badly affected) suburb. “Their houses are destroyed, they have no running water, food prices have doubled, and they haven’t seen a single government official or foreign aid worker since the earthquake struck.” Overall, Doyle observed, “the international response has been quite pathetic. Some of the aid agencies are working very hard, but there are two ways of reporting this kind of thing. One is to hang around with the aid agencies and hang around with the American spokespeople at the airport, and you’ll hear all sorts of stories about what’s happening. Another way is to drive almost at random with ordinary people and go and see what’s happening in ordinary places. In virtually every area I’ve driven to, ordinary people say that I was the first foreigner that they’d met.” [14]
 
Only a full week after the earthquake did emergency food supplies even begin the slow journey from the heavily guarded airport to fourteen “secure distribution points” in various parts of the city.[15] By that stage, tens of thousands of Port-au-Prince residents had finally come to the conclusion that no aid would be forthcoming, and began to abandon the capital for villages in the countryside.
 
On Sunday 17 January, Al-Jazeera’s correspondent summarized what many other journalists had been saying all week. “Most Haitians have seen little humanitarian aid so far. What they have seen is guns, and lots of them. Armored personnel carriers cruise the streets” and “inside the well-guarded perimeter [of the airport], the US has taken control. It looks more like the Green Zone in Baghdad than a centre for aid distribution.” [16] Late on the same day, the World Food Program’s air logistics officer Jarry Emmanuel confirmed that most of the 200 flights going in and out of the airport each day were still being reserved for the US military: “their priorities are to secure the country. Ours are to feed.” [17] By Monday 18 January, no matter how many US embassy or military spokesman insisted that “we are here to help” rather than invade, governments as different as those of France and Venezuela had begun to accuse the US of effectively “occupying” the country. [18]
 
IV
 
The US decision to privilege military over humanitarian traffic at the airport sealed the fate of many thousands of people abandoned in the rubble of lower Port-au-Prince and Léogane. In countries all over the world, search and rescue teams were ready to leave for Haiti within 12 hours of the disaster. Only a few were able to arrive without fatal delays – mainly teams, like those from Venezuela, Iceland and China, who managed to land while Haitian staff still retained control of their airport. Some subsequent arrivals, including a team from the UK, were prevented from landing with their heavy lending equipment. Others, like Canada’s several Heavy Urban Search Rescue Teams, were immediately readied but never sent – the teams were told to stand down, the Canadian Foreign Affairs Minister Lawrence Cannon eventually explained, because “the government had opted to send Canadian Armed Forces instead.” [19]
 
USAID announced on 19 January that international search and rescue teams, over the course of the first full week after the disaster, had managed to save a grand total of 70 people. [20] The majority of these people were rescued in quite specific locations and circumstances. “Search-and-rescue operations,” observed the Washington Post on 18 January, “have been intensely focused on buildings with international aid workers, such as the crushed U.N. headquarters, and on large hotels with international clientele.” [21] Tim Schwartz spent much of the first post-quake week as a translator with rescue workers and was struck by the fact that most of their work was confined to places – the UN’s Hotel Christophe, the Montana Hotel, the Caribe supermarket – that were not only frequented by foreigners but that could be snugly enclosed within “secure perimeters.” Elsewhere, he observed, UN “peacekeepers” did their best to make sure that rescue workers treated onlooking crowds as a source of potential danger rather than assistance. [22]
 
Until the residents of devastated places like Léogane and Carrefour are somehow able to reassure foreign troops that they will feel “secure” when visiting their neighborhoods, UN and US commanders clearly prefer to let them die on their own.
 
Exactly the same logic has condemned yet more people to death in and around Port-au-Prince’s hospitals. In one of the most illuminating reports yet filed from the city, on 20 January Democracy Now’s Amy Goodman spoke with Dr. Evan Lyon of Partners in Health/Zanmi Lasante from the General Hospital, the most important medical centre in the whole country. Lyon acknowledged there was a need for “crowd control, so that the patients are not kept from having access,” but insisted that “there’s no insecurity [...]. I don’t know if you guys were out late last night, but you can hear a pin drop in this city. It’s a peaceful place. There is no war. There is no crisis except the suffering that’s ongoing [...]. The first thing that [your] listeners need to understand is that there is no insecurity here. There has not been, and I expect there will not be.” On the contrary, Lyon explained, “this question of security and the rumors of security and the racism behind the idea of security has been our major block to getting aid in. The US military has promised us for several days to bring in machinery, but they’ve been listening to this idea that things are insecure, and so we don’t have supplies.”As of 20 January, the hospital still hadn’t received the supplies and medicines needed to treat many hundreds of dying patients. “In terms of aid relief the response has been incredibly slow. There are teams of surgeons that have been sent to places that were, quote, ‘more secure,’ that have ten or twenty doctors and ten patients. We have a thousand people on this campus who are triaged and ready for surgery, but we only have four working operating rooms, without anaesthesia and without pain medications.’ [23]
 
Almost by definition, in post-quake Haiti it seems that anyone or anything that cannot be enclosed in a “secure perimeter” isn’t worth saving.
 
In their occasional forays outside such perimeters, meanwhile, some Western journalists seemed able to find plenty of reasons for retreating behind them. Lurid stories of looting and gangs soon began to lend “security experts” like the London-based Stuart Page [24] an aura of apparent authority, when he explained to the BBC’s gullible “security correspondent” Frank Gardner that “all the security gains made in Haiti in the last few years could now be reversed [...]. The criminal gangs, totaling some 3,000, are going to exploit the current humanitarian crisis, to the maximum degree.” [25]
 
Another seasoned BBC correspondent, Matt Frei, had a similar story to tell on 18 January, when he found a few scavengers sifting through the remains of a central shopping district. “Looting is now the only industry here. Anything will do as a weapon. Everything is now run by rival armed groups of thugs.” If Haiti is to avoid anarchy, Frei concluded, “what may be needed is a full scale military occupation.” [26]
 
Not even former US president (and former Haiti occupier) Bill Clinton was prepared to go that far. “Actually,” Clinton told Frei, “when you think about people who have lost everything except what they’re carrying on their backs, who not only haven’t eaten but probably haven’t slept in four days, and when the sun goes down it’s totally dark and they spend all night long tripping over bodies living and dead, well, I think they’ve behaved quite well [...]. They are astonishing people. How can they be so calm in the face of such enormous loss of life and loved ones, and all the physical damage?” [27]
 
Reporters able to tell the difference between occasional and highly localized bursts of foraging and a full-scale “descent into anarchy” made much the same point all week, as did dozens of indignant Haitian correspondents. On 17 January, for instance, Ciné Institute director David Belle tried to counter international misrepresentation. “I have been told that much US media coverage paints Haiti as a tinderbox ready to explode. I’m told that lead stories in major media are of looting, violence and chaos. There could be nothing further from the truth. I have traveled the entire city daily since my arrival. The extent of the damage is absolutely staggering [but...] NOT ONCE have we witnessed a single act of aggression or violence [...]. A crippled city of two million awaits help, medicine, food and water. Most haven’t received any. Haiti can be proud of its survivors. Their dignity and decency in the face of this tragedy is itself staggering.” [28]
 
As anyone can see, however, dignity and decency are no substitute for security. No amount of weapons will ever suffice to reassure those “fortunate few” whose fortunes isolate them from the people they exploit. As far as the people themselves are concerned, “security is not the issue,” explains Haiti Liberté’s Kim Ives. “We see throughout Haiti the population themselves organizing themselves into popular committees to clean up, to pull out the bodies from the rubble, to build refugee camps, to set up their security for the refugee camps. This is a population which is self-sufficient, and it has been self-sufficient for many years.” [29] But while the people who have lost what little they had have done their best to cope and regroup, the soldiers sent to “restore order” treat them as potential combatants. “It’s just the same way they reacted after Katrina,” concludes Ives. “The victims are what’s scary. They’re black people who, you know, had the only successful slave revolution in history. What could be more threatening?”
 
“According to everyone I spoke with in the centre of the city,” wrote Schwarz on 21 January, “the violence and gang stuff is pure BS.” The relentless obsession with security, agrees Andy Kershaw, is clear proof of the fact that most foreign soldiers and NGO workers “haven’t a clue about the country and its people.” [30] True to form, within hours of the earthquake most of the panicked staff in the US embassy had already been evacuated, and at least one prominent foreign contractor in the garment sector (the Canadian firm Gildan Activewear) announced that it would be shifting production to alternative sewing facilities in neighboring countries.[31] The price to be paid for such priorities will not be evenly distributed. Up in the higher, wealthier and mostly undamaged parts of Pétionville everyone already knows that it’s the local residents “who through their government connections, trading companies and interconnected family businesses” will once again pocket the lion’s share of international aid and reconstruction money. [32]
 
In order to help keep less well-connected families where they belong, meanwhile, the US Department of Homeland Security has taken “unprecedented” emergency measures to secure the homeland this past week. Operation “Vigilant Sentry” will make efficient use of the large naval flotilla the US has assembled around Port-au-Prince. “As well as providing emergency supplies and medical aid,” notes The Daily Telegraph, “the USS Carl Vinson, along with a ring of other navy and coast guard vessels, is acting as a deterrent to Haitians who might be driven to make the 681 mile sea crossing to Miami.” While Senegal’s president Abdoulaye Wade offered “voluntary repatriation to any Haitian that wants to return to [the land of] their origin,” American officials confirmed that they would continue to apply their long-standing (and thoroughly illegal) policy with respect to all Haitian refugees and asylum seekers – to intercept them on the high seas and repatriate them automatically, regardless of the circumstances. [33]
 
Ever since the quake struck, the US Air Force has taken the additional precaution of flying a radio-transmitting cargo plane for five hours a day over large parts of the country, so as to broadcast a recorded message from Haiti’s ambassador in Washington. “Don’t rush on boats to leave the country,” the message says. “If you think you will reach the U.S. and all the doors will be wide open to you, that’s not at all the case. They will intercept you right on the water and send you back home where you came from.” Not even life-threatening injuries are enough to entitle Haitians to a different sort of American reception. When the dean of medicine at the University of Miami arrived to help set up a field hospital by the airport in Port-au-Prince, he was outraged to find that most seriously injured people in the city were being denied the visas they would need to be transferred to Florida for surgery and treatment. As of 19 January the State Department had authorized a total of 23 exceptions to its golden rule of immigration. “It’s beyond insane,” O’Neill complained. “It’s bureaucracy at its worst.” [34]
 
V
 
This is the fourth time the US has invaded Haiti since 1915. Although each invasion has taken a different form and responded to a different pretext, all four have been expressly designed to restore “stability” and “security” to the island. Earthquake-prone Haiti must now be the most thoroughly stabilized country in the world. Thousands more foreign security personnel are already on their way, to guard the teams of foreign reconstruction and privatization consultants who in the coming months are likely to usurp what remains of Haitian sovereignty.
 
Perhaps some of these guards and consultants will help their elite clients achieve another long-cherished dream: the restoration of Haiti’s own little army. And perhaps then, for a short while at least, the inexhaustible source of “instability” in Haiti – the ever-nagging threat of popular political participation and empowerment – may be securely buried in the rubble of its history.
 
NOTES
 
[1] An abbreviated version of this article first appeared in The National,
21 January 2010, http://www.thenational.ae/apps/pbcs.dll/article?AID=/20100121/REVIEW/701219960.
 
[2] See Pål Sletten and Willy Egset, Poverty in Haiti (FAFO, 2004), 9.
 
[3] IMF, Haiti: Interim Poverty Reduction Strategy Paper (November 2006), 7.
 
[4] Robert Fatton, Haiti’s Predatory Republic (Boulder: Lynne Rienner Publishers, 2002), 86-87, 83.
 
[5] Brian Concannon, ‘Lave Men, Siye Ate: Taking Human Rights Seriously’, in Melinda Miles and Eugenia Charles, eds. Let Haiti LIVE: Unjust US Policies Towards its Oldest Neighbor (Coconut Creek FL: Educa Vision, 2004), 92.
 
[6] See for instance Jeb Sprague, ‘Haiti’s Classquake’, HaitiAnalysis 19 January 2010, http://www.haitianalysis.com/2010/1/19/haiti-s-classquake.
 
[7] BBC Radio 4 News, 16 January 2010, 22:00GMT.
 
[8] Ginger Thompson and Damien Cave, ‘Officials Strain to Distribute Aid to Haiti as Violence Rises’, New York Times 17 January 2010.
 
[9] ‘Médecins Sans Frontieres says its plane turned away from US-run airport’, Daily Telegraph 19 January 2010, http://www.telegraph.co.uk/news/worldnews/centralamericaandthecaribbean/haiti/7031203/Haiti-earthquake-Medecins-Sans-Frontieres-says-its-plane-turned-away-from-US-run-airport.html.
 
[10] ‘Doctors Without Borders Cargo Plane With Full Hospital and Staff Blocked From Landing in Port-au-Prince’, 18 January 2010, http://doctorswithoutborders.org/press/release.cfm?id=4165&cat=press-release.
 
[11] ‘America sends paratroopers to Haiti to help secure aid lines’, The Times 20 January 2010, http://www.timesonline.co.uk/tol/news/world/us_and_americas/article6994523.ece.
 
[12] Email from Tim Schwartz, January 20, 2010.
 
[13] “No aid [in Carrefour]. In the morning at UN base they said they would distribute there, but it didn’t happen.” (Reed Lindsay, Honor and Respect Foundation Newsletter, 20 January 2010, http://www.hrfhaiti.org/earthquake/). Cf. Luis Felipe Lopez, ‘Town at epicenter of quake stays in isolation’, The Miami Herald 17 January, 2010.
 
[14] BBC Radio 4, News at Ten, 18 January 2010.
 
[15] Ed Pilkington, ‘We’re not here to fight, US troops insist’, The Guardian 18 January 2010.
 
[16] ‘Disputes Emerge over Haiti aid control’, Al Jazeera 17 January 2010.
 
[17] Ginger Thompson and Damien Cave, ‘Officials strain to distribute aid to Haiti as violence rises’, New York Times 17 January 2010.
 
[18] ‘Haiti aid agencies warn: chaotic and confusing relief effort is costing lives’, The Guardian 18 January 2010, http://www.guardian.co.uk/world/2010/jan/18/haiti-aid-distribution-confusion-warning.
 
[19] Don Peat, ‘HUSAR not up to task, feds say: Search and rescue team told to stand down’, Toronto Sun 17th January 2010, http://www.torontosun.com/news/haiti/2010/01/17/12504981.html.
 
[20] USAID, http://www.usaid.gov/helphaiti/index.html, accessed on 20 January 2010.
 
[21] William Booth, ‘Haiti’s elite spared from much of the devastation’, Washington Post, 18 January 2010.
 
[22] Tim Schwarz, phonecall with the author, 18 January 2010; cf. Tim Schwartz, “Is this anarchy? Outsiders believe this island nation is a land of bandits. Blame the NGOs for the “looting,”‘ NOW Toronto, 21 January 2010, http://www.nowtoronto.com/news/story.cfm?content=173333.
 
[23] ‘With Foreign Aid Still at a Trickle, Devastated Port-au-Prince General Hospital Struggles to Meet Overwhelming Need’, Democracy Now! 20 January
2010, http://www.democracynow.org/2010/1/20/devastated_port_au_prince_hospital_struggles.
 
[24] Stuart Page is chairman of Page Group, http://www.pagegroupltd.com/aboutus.html.
 
[25] Gardner then explained that, with the police weakened by the quake, “thousands of escaped criminals have returned to areas they once terrorised, like the slum district of Cité Soleil [...]. Unless the armed criminals are re-arrested, Haiti’s security problems risk being every bit as bad as they were in 2004″ (BBC Radio 4, Six O’clock News, 18 January 2010). In fact, when some of these ex-prisoners tried to re-establish themselves in Cité Soleil in the week after the quake, local residents promptly chased them out of the district on their own (see Ed Pilkington and Tom Phillips, ‘Haiti escaped prisoners chased out of notorious slum’, The Guardian 20 January
2010; Tom Leonard, ‘Scenes of devastation outside Port-au-Prince “even worse”‘, Daily Telegraph 21 January 2010).
 
[26] BBC television, Ten O’clock News, 18 January 2010.
 
[27] BBC Radio 4, News at Ten, 18 January 2010. It sounds as if Clinton, in his role as UN special envoy to Haiti, may be learning a few things from his deputy – Zanmi Lasante’s Dr. Paul Farmer.
 
[28] David Belle, 17 January 2010.
 
[29] ‘Journalist Kim Ives on How Western Domination Has Undermined Haiti’s Ability to Recover from Natural Devastation’, Democracy Now! 21 January
2010, http://www.democracynow.org/2010/1/20/journalist_kim_ives_on_how_decades. Ives illustrates the way such community organisations work with an example from the Delmas 33 neighbourhood where he’s staying. “A truckload of food came in in the middle of the night unannounced. It could have been a melee. The local popular organization was contacted. They immediately mobilized their members [...]. They lined up about 600 people who were staying on the soccer field behind the [Matthew 25] house, which is also a hospital, and they distributed the food in an orderly, equitable fashion. They were totally sufficient. They didn’t need Marines. They didn’t need the UN. [...] These are things that people can do for themselves and are doing for themselves.” Kershaw makes the same point: “This self-imposed blockade by bureaucracy is a scandal but could be easily overcome. The NGOs and the military should recognise the hysteria over “security” for what it is and make use of Haiti’s best resource and its most efficient distribution network: the Haitians themselves. Stop treating them as children. Or worse. Hand over to them immediately what they need at the airport. They will find the means to collect it. Fill up their trucks and cars with free fuel. Any further restriction on, and control of, the supply of aid is not only patronizing but it is in that control and restriction where any ‘security issues’ will really lurk. And it is the Haitians who best know where the aid is needed.” (Andy Kershaw, ‘Stop treating these people like savages’, The Independent 21 January 2010).
 
[30] Andy Kershaw, ‘Stop treating these people like savages’, The Independent 21 January 2010.
 
[31] Ross Marowits, ‘Gildan shifting T-shirt production outside Haiti to ensure adequate supply’, The Canadian Press, 13 January 2010, http://www.canadianbusiness.com/markets/headline_news/article.jsp?content=b131693719.
 
[32] William Booth, ‘Haiti’s elite spared from much of the devastation’, Washington Post 18 January 2010.
 
[33] Bruno Waterfield, ‘US ships blockade coast to thwart exodus to America’, Daily Telegraph 19 January 2010; ‘Senegal offers land to Haitians’, BBC News 17 January 2010, http://news.bbc.co.uk/1/hi/world/africa/8463921.stm.

Dispatches from Port au Prince, Haiti

Monday, February 1st, 2010

February 9th, 2010

Slande flew out of Miami two days after the Haitian earthquake struck. She is a nurse at a Ft Lauderdale nursing home, and her home country was devastated. “Well, I had to come” she explained.  Slande went immediately to work at the HUEH or public General Hospital in downtown Port au Prince, as it is known by most.

haiti-photo0077The hospital was in as bad a shape as the surrounding neighbourhood. The five story nursing school annex collapsed, killing many – reports of between 100 – 500 nursing students died. Inside the hospital, many sections were damaged. “But the courtyard was intact, and that is where the injured and the dead were brought. It was too much! We had nothing then. People were lying outside in the boiling sun during the day. The entrance to the X-ray department was crowded – because it had shade”.

“Yeah, we treated them of course. People came in with open fractures, dirty, flies, untreated. It was really bad”, Slande says wearily. “There were no tents. People were dying too”.

Over the last few weeks, the destroyed hospital has turned into a functional hospital with large 10 -20 bed size tents serving as specialized wards crowded in the courtyard, there is a mixture of HUEH staff and international organizations providing health care. Food is minimal for the patients, and none for the staff, but there is plenty of drinking water. Essential pain medications, antibiotics and wound dressing supplies are generally in adequate supply. The operating room is functioning, and the x ray department has two machines running.

Three weeks later, Slande is now running between 50 patients in three trauma tents. She cleans their wounds and changes their dressings; make sure they get their pain medications and antibiotics, and puts out fires. She coordinates with the irregular and rapidly changing staff. Slande is of course very popular, not just because she is a friendly, excellent, dedicated nurse, but because she is speaks the three languages that operate here: Creole, French and English. Her past experience as an Emergency Room nurse prepared Slande “only a little bit” she confesses, to the overwhelming demands here.

Jeanne is 26, pretty and has a large shoulder bandage at her shoulder where her right arm used to be. Being tended by her younger sister, and two children she survived the traumatic crush injury to her arm, but now finds herself among the hundreds of amputees.

She has a note from her surgeon dated Jan. 30th, stating she needs to return for surgery February 10th, and her wound needs to be cleaned and dressed daily. But Jeanne can’t read much English, so when I approached her on Feb 2nd, she is convinced that the doctor wrote that her wound dressing will be changed next on Feb. 10th. My French is good enough to explain to her what the note says, and to warn her that wounds like hers’ must be cleaned daily to prevent deadly infections. Her French is good enough to understand me. Jeanne refused nevertheless.

haiti-photo0149

Slande doing the dressing of Jeanne's wound, while Jeanne's son is looking on from behind

I asked a Haitian doctor to lay it out for her. If Jeanne gets a serious wound infection, she will die. He did. She refused. The next day, Slande made it clear to her what the deal was, and reassured her that we would give her pain medications before doing the dressing change. Fear of pain, we thought, might be the underlying reason for her obstinacy. Jeanne agreed. But Slande got caught up with other patient’s wounds and needs, so Jeanne who lies at the far end of the ward, didn’t get her dressing changed that day.

When Slande cleaned Jeanne’s wound of Feb. 4th, she said it looked “really bad”. “Really bad” means it’s infected. We made sure Jeanne was on appropriate antibiotics. I asked Slande if the dressing change was painful, and she said, not really.

The next day, Slande changed the dressing again- Jeanne readily agreed- and the wound improved significantly. This is more a testament to Jeanne’s age, than our treatments. Young people can heal that much quicker. (Photo is from Feb 7th, after 3 dressing changes).

Our wards are little communities. There is no privacy between the beds or cots. Most of the patients have family members staying with them all the time, there is a buzz of conversations and activity throughout the day. The families are essential – feeding, cleaning their kin, and advocating for them. They clean the mess on the grounds too.

 Occasionally the cacophony of various evangelical preachers and prayers. By my second day, enough patients or family members know me by name to call for me. Usually their needs are basic: pain medications (which they rarely ask for); when will I get around to changing their wound dressings; but mostly it is to say Hello. In fact, all the foreign staff are shaking their heads about how little we are asked to treat anything – especially the pain which must be considerable. Bone pain from fractures, even amputations, are considerable. But most of our patients are getting by with the occasional Tylenol or ibuprophen. We use narcotics for a few.

C.M. and E.F. are two Haitian nurses who come in for the night shift. They work for the HUEH hospital, yet like all the medical staff, haven’t been paid in four months. “The government is broke”, they explain. Pierre, a Miami accountant who is back in Haiti helping with logistics after being gone for 25 years, is like me, astounded. “Why do you come to work then?” he asks. “This is typical for Haiti” replies E.F., “no one gets paid here”.

She exaggerates; clearly, some Haitians are getting paid very well. They drive nice cars, and live in big houses, with servants and gardeners. But one aspect is clear about this extremely poor country, there is little money for public services like health care or education. Which is why the patients appear very happy to have this foreign health care all of a sudden?

Not only are the staff here because we want to be, but we bring in tons of free medications and supplies that previously, they would have had to pay for, even at the public hospital. Yet, this is creating a black market too – the supplies and medicines disappear. Desperate people may be taking them, or common criminals. The patients go without, as their donated supplies are now for sale on the streets. Haiti has long been a country where the poor are grievously exploited – and this influx of relief aid without accountability and justice, is not going to change the corrupt economic system.

Emanuel is a young man with wounds on all four limbs, including a high right arm amputation has not been having much relief in the last two days. Three nights ago, one of his sisters assisted me with the wound dressing changes, while I instruct the other squeamish sister to “not look”. Previously, her natural reaction to her brother’s pain during a wound cleaning forced the doctor to stop.  I told him I was going to medicate him well with analgesics before I began. Emanuel got 10 mg of morphine, but to my surprise, he was wide awake when I began the dressing change. So I sprayed lidocaine anaesthetic on his wound, and even injected a few cc’s into the necrotic area. It worked fine. The squeamish sister stayed calm, the other sister assisted with holding E.S. leg up and unwrapping dressing supplies, and Emanuel felt nothing as I removed a patch of dead tissue from his calf.  Last night when I did his dressings, he refused extra medication, took deep breaths, and did fine.

One consequence of 1 million homeless is that a bed in a hospital tent is a bed for someone without a home. I have had to play the bad sheriff, this morning telling a man with a finger wound and a limp, to leave, because he snuck in and spent the night in one of our beds, despite his children pleading. But our beds are for people much worse off than him. Where can he go? To a crowded camp with a mixture of homemade tents and fancy Red Cross tents. The situation was difficult before, and now it is just overwhelming. We all hope that the Haitian people will be able to take over the services the international volunteers are providing, and rebuild a better country.

Scott Weinstein, RN

 

February 4, 2010

 

Hi, Very quick message because I’m borrowing a computer. I’ve been working the post op ’ward’ of 3 tents w 50 people at the very busy HUEH hospital in Port au Prince – mostly fractures and amputations. There are probably several hundred in patients and just as many ‘out patients’.   We are trying to save their limbs and lives with the materials and medications we have. It is very busy, and not as coordinated as I hoped it would be. Part of the problem is that there are teams from everywhere who don’t have similar systems and styles. Lots of turnover, unreliable transport, etc…   But folks are trying hard and doing good work. The Haitian nurses and staff are invaluable to the rest of us, especially the non-French or Creole speakers. I would say that Haitian and French or Creole speaking RNs and MDs are still very much needed. We are seeing still a lot of trauma, plus acute and chronic medical issues, and peds. Babies are being born and, yes, patients are also dying. I can’t say everyone is getting adequate care because of the holes in our supplies personnel and equipment.   X-ray is now available. MSF just opened a 200 bed rehab hospital. We are mostly in tents, it’s hot humid, but plenty of drinking water. The patients have their families with them which is the only way they will get most of their daily care.   Again, I am choked up about how little the people here expect from us. They rarely ask for pain meds, despite their fractures and amputations. The people are very resilient.

Best, Scott

Jan 31, 2010 

Hi,
 
Roger & I walked around for an hour today in crowded Pietonville which has the rich and lots of poor, and 4 hours in crowded downtown which is all poor in tents and shanties. We went by the port, the national palace camps and by Cite de Soleil. The worst thing that happened to me was a sunburn. Downtown which is flat is really pummeled by the earthquake, a lot of houses down. Shanties on hills collapsed too.
 
But everyone was very nice. Very busy, but safe all around. No fights, no yelling, other than hailing ‘tap-taps’.  It helps to be white guys. Very little hustling even – less than a NYC street. In a shanty town, an orange wholesaler gave us free oranges, because it was too complicated to sell individual ones. This was so unlike the fear propaganda that is drummed into our heads, which is why we didn’t see any other white person on foot the whole time, except one guy with his young Haitian girlfriend. We didn’t see much in the way of soldiers or police either.
 
There appears to be a lot of food for sale in the streets & sidewalks, but most is non caloric, most is fruit. I saw very little rice, no corn, some potatoes, sugar cane, a little wheat, some beans & oil. I saw no one actually eating…, and not a lot of people buying. We saw no food aid at all, on the streets or in the camps. We hear rumors of food aid now for sale in the stores…
 
In the camps, we put a sling on a young girl with a possible fractured arm and gave her some Tylenol. She was afraid to go to the hospital because she thought it would cost, and they would amputate… So we had to dispel that myth.
 
At the hospital, I took a photo of 4 guys with the US 82nd Airborne armed with M16s guarding a cart of patient’s food being distributed! It was so ridiculous, because others were distributing food by themselves.
 
Certainly, the Haitians are resilient, and also self sufficient. I imagine they don’t expect people to help them.
Best,
Scott
 

 

Jan 30, 2010

Hello All,  
 
I can only write about my very limited impressions over 2 days here, so take what I write as having an very narrow perspective.
 
Port au Prince in the four neighbourhoods including downtown that I’ve been through is teeming with people, buses and cars. It really seems like any crowded city in an under-developed country. Unlike abandoned New Orleans when Americans were barred from returning to their damaged neighbourhoods, and also they felt unable to return without electricity, water and sewage, this is not the case here.
 
People appear very industrious, and a lot of small businesses and street vendors are operating.  I am aware that small business, schools and churches are now functioning in a public relief mode – helping people with food, water, medical and other essentials. Everyone I have spoken too has been polite and friendly. Haitian French is very easy to understand, and many Creole speakers understand my French.
 
Most of the streets are cleared of rubble. I would estimate that about 5 – 10% of the buildings have collapsed, but a lot more are structurally damaged to the point that people do not feel safe to live in them.
 
Every town square and park is teeming with the new homeless, thousands. There are also people camped out on the sides of streets.  Yet, I was prepared for the odor of decomposing bodies or food, and it is no longer present in the areas I have been.
 
The airport is down to 40 flights a day from 120 last week according to an Air Force soldier I spoke to there upon arriving. The Air Force and the FAA control it. Immigration did not even ask me any questions or stop me before I left the building.
 
Medicine/Medical
 
I visited and spoke with the director of the main hospital yesterday (HUEH/General), a very kind and welcoming Dr. Lassegue. He notes that the trauma period of medical care is over, and medical needs are post op care, wound care, and chronic illnesses.
 
There are still shortages of essential medical materials and medicines on the ground – analgesics, anesthetics, antibiotics, and regular meds for the usual chronic diseases. (I sent in another email, their staff and material/medicine needs).
 
The hospital itself is a combination of medical tents outside, and some services inside. There are many Haitians working and volunteering there, plus a good compliment of international teams. It appears very well organized and staffed. I note a busy, but focused and calm atmosphere, despite the improvisational nature of the services. They are doing it all from Labour and Delivery, neo-natal, pediatrics, trauma, OR, medical, ER, mental health and triage.
 
Many patients are on simple beds or cots. Few have running IV’s, and probably few have pain meds. Remarkably, people seem awfully stoic and quiet. I heard no complaining or yelling (less so than our hospitals!). Patients often had their family there – especially the kids. Everyone was polite who I spoke with and let me take their photo when I asked.
 
Outside the hospital, the medical needs are wound care, and regular illness. I noticed very few internationals medical people besides my acquaintances from the US and Medecins Sans Frontiers. Of course, sanitation, drinking water and food in the new homeless camps is essential.
 
Problems:
Food, water, money & armed troops.
 
Food is simply not being distributed adequately to those who need it the most. Yet there is both food in the restaurants and stores for sale, and I believe food in the warehouses that the UN and the International bodies are controlling. I was in a store today to change money and the shelves were full. It seems horrible to think that many are going hungry or even starving, but across the street, if they had money, they could eat their fill. Food in Haiti is expensive because most of the essentials are imported. Their agriculture is more geared for export crops like fruit.
 
I keep hearing about security concerns for the teams distributing food, but my strong impression is that there is a lot of ill prepared teams and paranoia about crushes & violence. If food can be distributed safely around the world in other emergencies, it could be done here too. Frankly, the streets are busy, but I have yet to notice any threatening behavior. Like the hospital, people seemed focused and calm. A business association I was visiting today was busy distributing water, and there are no armed guards with their operation.
 
Because of the class divisions in Haiti, those that have money will not go hungry unlike those without who are dependent of food aid and distribution.
 
Drinking water is in short supply like food.
 
There are pockets of US soldiers around the downtown that are noticeable, and I have heard comments from Haitians about them. Since there seems to be no general security threats, people are wondering why they are here. My lame answer is that is what the US does best; send troops, because it has no civilian emergency corps. But they would be more helpful if they were not carrying around M-16s, but had medical supplies or food.
 
 
Best,
Scott