Haiti After the Earthquake by Paul Farmer

Seven months after the Haiti earthquake of January 2010, Paul Farmer took a 20-minute chopper flight from Port-au-Prince to Léogâne in the company of former U.S. president Bill Clinton.

The observed aerial view of the quake’s epicenter — “pancaked buildings and slab roofs angled downward like wet cardboard” — reinforced what we tragically knew: After all those months, only a teacup full of rubble had been cleared from the earthquake zone. There were few notes of optimism amid the misery.
On the ground, Farmer did something enterprising — journalistic, even. He hung back. Clinton, the United Nation’s special envoy for Haiti, was swept up in a group of officials and aid workers eager to show off new shelters being erected for displaced Haitians who were camped out by the tens of thousands under tents, tarps and, as a last resort, bed sheets.
Farmer — who, among his many abilities, can claim fluency in Creole — decided he wanted to take a “quieter look” at the temporary houses. Fewer than 30 “t-shelters” had been thrown up from a planned goal of 100,000. Casting his clinical eye, Farmer found them “something of a disappointment: solid two-by-fours were used as supports, but the walls were of white plastic; the roofs, cheap tin.”
Clinton and his entourage were ushered toward a “model” shelter. Farmer kept his ears open. “The model t-shelter Clinton visited was inhabited by a woman who had nothing good to say about her new home,” Farmer writes. “She launched a stream of invective in Creole even as the disaster-relief folks were describing, in English, the sturdiness of the t-shelters — ‘these are built to withstand high winds and to serve as transitional shelters that can tide people over until more permanent shelters are built; they’re much safer than tents.’ The model inhabitant scowled and complained, ‘Who would want to live in a house like this? The walls could be split open with a kitchen knife.’”
How gratifying it would be if Farmer’s latest book, Haiti After the Earthquake, were heavy with such moments. The Harvard University doctor has achieved revered status on the Haiti file, having worked in the country on and off for close to three decades. Co-founder of Partners in Health, which has become the standard bearer for health services delivery in Haiti, Farmer’s early work was focused on the village of Kay in the Central Plateau, a wretched settlement of the impoverished and the suffering who had lost their homes and agricultural lands to flooding caused by the building of a hydroelectric dam.
Farmer started a two-room clinic nearby at Cange, which grew into a full-fledged hospital with branches and roots extending into social and long-term health supports. When I visited the hospital some months after the quake, I wandered through a maze, past operating rooms and a pediatric ward, and sat with women hard at work in a shaded courtyard making that nutritional wonder food: peanut butter. There were patients everywhere in this “medical Mecca” — those are Farmer’s words.
He has big billing to live up to. When Pulitzer Prize-winning author Tracy Kidder was moved to write Mountains Beyond Mountains (2003) about the good doctor, who holds a PhD in anthropology, he acknowledged that his subject inspired “moral envy” among its readers. The book dubbed Farmer “a man who would cure the world,” which set the bar rather high. Farmer saw himself more simply as “a poor people’s doctor,” an infectious diseases specialist who wondered how any serious practitioner could study emergent pathogens in a country like Haiti without accepting social inequality as a factor.
The summer before the quake, Clinton named Farmer as his deputy special envoy at the UN. “He knows the country. He loves the people. They love him,” Clinton said then.
Reading Haiti After the Earthquake makes me wish Farmer had declined the offer.
Within weeks the poor people’s doctor found himself being transported in an armoured car — in a motorcade no less — with a bodyguard. “Clinton counseled me to focus on two broad agendas: the medical and public health issues I knew best but also the economic issues that influenced who got sick and who did not,” Farmer writes, admitting that he sometimes felt lost in his new role as a dollar-a-year man.
Somehow, in addition to spending time in the UN bubble he intended to keep up his teaching and clinical work, which meant toing-and-froing to Harvard as well as spending a great deal of time in Rwanda, where Partners in Health has focused much of its efforts.

And a book on top of all of that.
In his previous writings — I’m thinking especially here of The Uses of Haiti, published in 2006 — Farmer was angrier; angry and aseptic, which is a potent combination.
It would be good to hear an angry Paul Farmer right now. Given his stature, such words just might have some effect.
Those who read the shelter report in The Nation last week must be angry. The investigative piece examines American-built trailers used as classrooms in Léogâne. The trailer project was a Clinton Foundation initiative, approved by the Interim Haiti Recovery Commission, which Clinton co-chairs. Classes were prematurely suspended at two of the four installed schools this year due to temperatures in the trailers frequently exceeding 100 degrees, The Nation reports. A 6th Grader confided that her teacher would regularly distribute painkillers to children suffering from headaches in this let’s-boil-the-students atmosphere. In one trailer, levels of formaldehyde were found at two and a half times the level at which the Centers for Disease Control say children can experience adverse health effects. Formaldehyde is deemed a known carcinogen by the International Agency for Cancer Research.
If Farmer is angry now, he doesn’t much show it, coming across instead as merely unsettled.
His self-stated mandate in writing the book was to “lend clarity to the debates about reconstruction” as well as serving as an account of the first months after the quake.
That first task eludes him. Pondering the effectiveness of the recovery commission, he notes the $3 billion in projects approved in its first three months. Most of those projects remained incompletely funded or not funded at all. Why? “It wasn’t clear why, other than the usual bureaucratic siloing.”

So there’s the clarity piece.
Farmer throws down “foreign-grown political obstructions” and “bookkeeping tricks” as root causes, along with a lack of “absorptive capacity.” In other words, too few on-the-ground resources were available to deal with funds being tantalizingly waved offshore. Should the commission fail in its mandate, Farmer frets that the default mode will be to blame the Haitians.
As to the second task — a personal account of the time that followed 4:53 p.m., January 12 — Farmer suffers an emotional disadvantage. He was in Miami reading The Best and the Brightest when the 7.0 tremblor hit the capital and areas beyond. His first desire upon hearing the news may have been to go to his second home in Haiti, but his first obligation was to head to New York for an emergency UN session, where he found himself sitting on a dais, behind Clinton, wishing he were in Port-au-Prince, helping.
Three days later he flew to the capital aboard a private jet. “A soon as we opened the door, it hit us: a charnel-house stench filled the air of the windswept runway. I knew this smell but never imagined I would encounter it in an open space.”

Yes, that bit holds promise.
But soon enough Farmer is back in harness with Clinton, back in the bubble.
Even his recount of the cholera cruelty is strangely feeble, which seems especially odd coming from an infectious diseases expert who argued for a maximum assault against the epidemic (ie., vaccines) versus the adopted minimalist approach (health education and the distribution of chlorine tablets). Farmer wanted an investigation into the source of the outbreak. Genetic fingerprinting and point of origin were important in his view to predicting the speed with which the cholera might spread and in pinpointing appropriate treatment. The UN unconscionably denied — repeatedly — that its base near the town of Mirebalais, on a tributary of the Artibonite River, was the source of a crisis that has felled more than 4,000 Haitians (thus far).
By his own account, Farmer’s response was exceptionally meek. “It was certainly not my attention to fan the blame game,” Farmer writes. He quietly suggested to the then head of the UN mission that it “might be prudent” to conduct an investigation.
Surely we need smart, knowing people like Farmer to do much more than that. Consider the July issue of Emerging Infectious Diseases, a CDC journal. “Our findings strongly suggest that contamination of the Artibonite and one of its tributaries downstream from a military camp triggered the epidemic,” concludes the study. Here’s the bit I found most interesting: “Determining the origin and the means of spread of the cholera epidemic in Haiti was necessary to direct the cholera response, including lasting control of an indigenous bacterium and the fight for elimination of an accidentally imported disease.”
Nine months have passed since the outbreak.
Well, there’s much to get riled up about.
Farmer can sound exasperated — give him credit for that. A year after the quake he revisits Parc Jean-Marie Vincent. Or at least he appears to revisit the park, though he writes as a distanced observer. The park is the second largest displacement camp in Port-au-Prince, run by a Partners in Health team under Dr. Dubique Kobel. I visited the park a month after the quake, and interviewed Kobel there. Some 35,0000 Haitians were barely making do in the camp, a stultifying patchwork of makeshift shelters on a sun-baked plain of a place. It was awful. Menacing. People were fighting. The stink was terrible. Kobel was tireless, cheerful, patient as the camp dwellers lined up to see this good doctor.
It was Kobel, displaced from his own home, who started operating on people in the park the day after the quake. Two weeks later, physicians from Partners in Health came by, stayed, and Kobel, miracle worker, soon became a paid staffer.
At the time of the anniversary, PIH was still running the camp with no end date in view. “We were sick of hearing the words ‘exit plan’ from disaster-relief NGOs,” Farmer writes. “How could we leave when most of the conditions that had first led us to work in the camps persisted a year after the quake?”

What of the future?
That’s a mug’s game, and, sadly, Farmer decides to play. Before he hands the final 52 pages of Haiti: After the Earthquake over to a dozen writers who were invited to add their own essays, he engages in a frivolity of imagination. Let’s say it’s 2015. Where will Haiti be?
On the one hand, reconstruction could be in fabulous shape. On the other, the disaster could be ongoing. Health care and education? Same deal. Yes, the analysis gets as thin as that.
I suspect that Farmer’s publisher had hoped to get what ultimately reads like an anniversary book out long before now. I suspect that Farmer too late came to the realization that he didn’t have it in him to get the job done right. I know that the opportunity to write a better book lies before him.
Jennifer Wells is a Star feature writer.
http://www.thestar.com/news/books/article/1026324--haiti-after-the-earthquake-by-paul-farmer