Ekip Bon Fwa Final Report Anne Tagonist

11 February, 2010 — This is my final report on the expedition to Haiti, from 23 Jan to 4 Feb. I traveled as a medical relief worker, although the team with which I worked turned out to be better equipped, in terms of skill set and preparation, to work as organizers and intermediaries.

Medical notes

I will not, therefore, belabor this document with medical observations — those have been made already in other forms, and concern mostly the slow transition from post-injury infections to chronic epidemics, including diseases like measles and typhoid, which are rarely seen in immunocompetent populations in the US. One point already mentioned in previous reports, but worth returning to here, is that the first teams of trauma surgeons, orthopedists, and emergency physicians from the US were underequipped and underprepared for the disaster, and felt they were forced to improvise heroic treatments — notoriously, field amputations — which in the end merely created a second wave of dehisced, infected, or outright untreated surgical wounds for which the second wave of US providers were in turn similarly unprepared.

This placed the second wave of providers in a position where they, too, felt they had to improvise heroically, distributing antibiotics based on supply rather than appropriateness, or debriding necrotic tissue with non-medical implements. These measures in turn are created further downstream complications, and it is appropriate to ask whether acting inappropriately in the name of expedience is ever wise. Certainly, the providers who created this cascading crisis were convinced that they were "unlearning" their pampered American reliance on elaborate fixed resources and staff; perhaps it would have been better had they worked instead to unlearn their American belief in the necessity to "do something," and that this would be better than nothing.

Rebuilding

My primary concerns about Haiti from here on out are not medical, but relate instead to the idea of rebuilding, and the development issues that go along with it. With the US military ceding food distribution to civilian agencies, the relief effort has begun to take seriously the question of what happens next for Haiti, and what model, economic and physical, should guide Port Au Prince into the future. I have even begun to overhear, on the internet and through word-of-mouth, of specific efforts to send engineers to help construct permanent housing for the displaced poor. These rumours range from the established civil engineering model to wilder "permaculture" plans to build straw-bale houses (in a wet, tropical country without grain agriculture, no less!) to more practical determinations to assist poor people in reassembling the informal and improvised houses they occupied before the tend cities.

With respect, I can't imagine a worse use of informal resources or donated money. The poor people of Port-au-Prince do not need their overcrowded, unserviced, inaccessible vertical bidonvilles back. It is not as if all the various residents of Haiti sat down together in the 1960's and decided, collectively, how they all wanted to live — the bidonvilles, and the extreme disparities in wealth that go along with them, are a result of Haitian history, and an actual "rebuilding" project worthy of support by progressive or radical Americans, would have to somehow address this history before if could attempt to remediate the piles of stones that history — and the earthquake of 12 January — have left on the ground of Port-au-Prince.

Anarchic society

Haiti, currently, has no government. It is an anarchic society, and holds surprisingly close to the model proposed or expected by first world anarchists. There is not that much violent crime, most people not being criminals, and in fact violence is famously less now than it was before the disaster. Food is produced primarily by smallholders or in improvised gardens, prepared by people who manage to avoid poisoning their customers, streets are opened or closed by the collective efforts of residents (a common sight is an improvised barricade assembled nightly across an intersection, that marks the point beyond which displaced people have set up their nightly improvised shelters) and larger buildings are combed through for intact concrete blocks or rebar for sale. Microindustries like tire inflation or cell-phone recharging are everywhere, and somehow the football fields are always clear of rubble or tents in time for a game. That said, there is no trash pickup, centralized water distribution, or sewage, the roads are unmaintained, and while the rich complain that there are no police in Port-au-Prince, the poor complain that the police do exist, but have no particular program behind their actions other than self-enrichment and corruption. Public health is a disaster, and education ends about when kids start to get bored. Restaurants, stores, and organizational headquarters are safe, clean and modern, but you are always aware who pays the man with the shotgun outside the door.

Land occupancy

Land occupancy is both informal and complex. Both the dictatorship of the Duvaliers and the subsequent regimes of Aristide made significant changes in land use without ever formalizing or registering ownership for the poor. Under Duvalier, land was reserved for and tranferred to the rich, specifically those rich Haitians who patronized Duvalier. Squatter settlements, or even housing for the poor, were destroyed and occupants displaced, arrested, or killed by the "Tonton Macoutes." Aristide ended this, and even permitted semi-legalized squatting, but did so under a World Bank and IMF regime that created the land-use complexities that concentrated the poor into hillside arcologies called bidonvilles which lack water, sewer, or access to transportation or employment.

Simultaneously, Haiti has been swept by urbanization after rural farming has collapsed. Why this happened depends on whom you ask — American leftists point to deforestation and its effect on the topsoil, which Haitian leftists blame Duvalier's disenfranchisement and displacement of communist-leaning farmers and organizations. Another theory heard in Haiti is that during the swine flu scare in the 1970's, Haiti's naturalized pigs were all but wiped out, removing rural families' traditional mechanism for converting household and agricultural waste into meat. Regardless of why, the population in Port-au-Prince has swelled dramatically with internal migrants from the countryside.

Needless to say, people from all walks of life in Haiti feel some bitterness after the past half-century or displacement. Latifundistas (yes, I know the word is Spanish) reminisce about the days when the police would keep the dirty people off their horse ranches, and the poor (and the relict institutional left) resent the lost promises of Aristide. It has been better explained by other people from my team, but before any short-handed reconstruction project sets up in Haiti, lets at least remember that these grievances are all real and deeply felt, and the expedient solution that obtained prior to the earthquake, wherein the rich guarded their dwindling estates with dogs, guns, and razor-wire walls, while the poor packed in literally on top of each other, pleased no one. Also, these folks are armed.

Walled utopias vs Haitian civil society

Complicating all of this is Haiti's dubious long-standing honor as the poorest country in the western hemisphere. For the past two decades especially, political and religious organizations, from the Venezuelan government to the Scientologists to "punk rock permaculture" (dot com) have looked to Haiti as a blank spot for which any change could only be for the better. As misguided as the surgeons in the first paragraph, these assorted NGOs have assumed their utopian projects couldn't possibly make anything worse than it already was, and have subdivided Haiti into a patchwork of walled compounds and demographic turf, within which they have each attempted to make their case for a better world. The crazy evangelicals stealing babies are simply one more group of do-gooders who can't imagine how leaving well enough alone would be preferable (and yes, Haiti does have a little child slavery problem, which is part of why parents are so willing to hand their kids over to western "orphanages" — but that's a very different topic). The problem here is that none of these NGOs are Haitian. And they are, with their schools, clinics, factories, extinguishing the possibility of a Haitian civil society.

The argument I am going to attempt to make is best elaborated (for my taste) in Mike Davis' fantastic Planet of Slums, which I wish I had read prior to leaving for Haiti, but it goes to the heart of one of the most carefully exegeticized debates in modern development economics. By way of translation, it's way over my head and I only cite Davis' position because it matches up best with the experiences and opinions of Haitians I talked with last month.

Bluntly, NGOs take a struggle or an imbalance that undermines the stability of a political regime, and attempt to resolve it using the best available expertise, technology and planning, and as many international resources as they can qualify for. Often, for smaller populations, they are more than transiently successful (though their failures may get more press in donor nations.) In doing so, however, they restructure questions of power and change into the technocratic language of professionalism and problem solving, and essentially do an end-run around larger-question organizations that lack the education, professionalism, or financing to effect comparable results in the short term, or within a narrow focus. Even seemingly obvious measures like primary schools or technical academies can be problematic, because no Haitian organization could ever provide equivalently educated teachers, or fixed resources, compared to a US NGO, and have to compete for turf — paying professionals, buying computers, attracting students — with other academies who have all the resources of, say, France, or the Southern Baptist Convention, to draw on.

This process, what Davis calls "monopolizing expertise," creates a situation in which it is impossible for any Haitian-based organization to accrue the credibility needed to be a serious player in domestic politics — all those slots are currently occupied either by NGOs or by government proxies. Rene Preval is functionally a US proxy. Even BIC, the all-Haitian organization my team allied with, which had some residual legitimacy from the founders' pasts as business owners and land owners, could not get the time of day from either the US military or the WFP, who felt food distribution would be more efficiently handled by internationals like Save the Children (worst name ever!) or the 7th-Day Adventists. One can only imagine the reception a neighborhood organization from Cite-Soleil would recieve!

Reconsidering rebuilding

However, without this kind of Haitian civil society, there can be no national consensus or mandate that accurately reflects the participation of the Haitian people. Without this national mandate, any "rebuilding" plan is doomed to create another situation in which those in power are virtual clients of the US military, and those out of power are way, way, way out of power. Right now, the talk among educated Haitians is that Port-au-Prince is doomed; that the poor will never be rehoused, will have to be removed to the countryside, and the city will be bulldozed and rebuild as a sort of Santa-Monica-on-the-Atlantic. Among the poor, the talk is of prices for rebar and cinderblock, to recreate anything that will keep a roof over the head. Among the internationals, the plan is to create whatever perfect world their host church, or political program, thinks best. Any attempt to rebuild Haiti, in the absence of an independent social revolution, will ineluctably lead to strengthening one of these.

Of course, I'm not a foreign development economist. I'm a paramedic. I don't have answers to these questions, nor do I know if the problems I'm bringing to light here are even the most relevant. All I ask is that people remember — the government has diverted the tents, and the encampments are made of stripped sapling poles and bedsheets. In April it will rain and in the fall there will be hurricanes. The idea that going in and "doing something" must be better than nothing has caused untold misery so far, but there are real people living in Haiti.

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