RESPONSE TO CHOLERA IN BELL FONTAINE, HAITI
(ReliefWeb) - By Nyka Alexander - Source: Pan American Health Organization (PAHO)
As the cholera epidemic wanes in cities, rural areas—especially hard-to-reach ones—are where people are now most vulnerable. This story is about the response in one of these communities.
The little town of Oupac in a commune called 4ème Belle Fontaine, is 30 km from Port-au-Prince, a 15-minute helicopter ride but almost inaccessible by roads. The town's people have to walk six hours to reach the nearest hospital. When cholera began circulating, they were far from help and information.
The head of the Ouest department (or province), Hans Legagnier, heard rumors of several cases and deaths in this community. On January 11, he called the PAHO/WHO Alert and Response team to let them know. Dana van Alphen, coordinator for the team, received the call while attending a Health Cluster meeting, and immediately shared the information with health partners participating in the meeting . After discussing the situation, Aide Medicale Internationale (AMI France) and the French Red Cross decided to send a medical team with sanitary engineers to dig latrines, set up a cholera treatment center (CTC) and provide prevention information to the community.
The Alert and Response system was put in place to identify sudden needs and to rapidly deploy support. It complements a broader network of surveillance that collects data from health centers across the country.
Alerts are investigated to verify all the content from a second source (exact location, numbers of people affected, etc.). For this alert, Patricia Santa Olalla, another member of the Alert and Response team, coordinated with AMI. "They did the field research. They sent someone to the community — I think it was a 4-hour walk – to find a place for the helicopter to land and for the treatment unit to be built." They also confirmed that the community would welcome the treatment unit and offer support, such as helping to move materials from the helicopter to the site.
Arrangements were made with AMI for a medical team, with UNOPS for helicopter transportation, with the PAHO/WHO-managed PROMESS warehouse for medications, tent and cholera beds, and with the French Red Cross for water and sanitation experts.
On Thursday, January 13, a helicopter departed Port-au-Prince with materials and a crew. But the mission failed. The GPS coordinates were incorrect. The crew landed twice to ask for directions but without success. They flew back to Port-au-Prince disappointed. An areal photo shows how mountainous the area is. The next day, AMI was able to send a local person who went by foot to the community to get precise GPS coordinates.
With the help of the local Scout troop, a 10-bed treatment unit was set up on Saturday night by the team of water and sanitation experts and AMI epidemiologist Dr. Luis Manuel Rosa Sosa.
They also built a meeting tent. At 6:30 in the morning, patients began to arrive. By 9:00 a.m., 15 had been seen by Dr. Rosa Sosa before the helicopter with the medical crew had even arrived.
"There were so many. The first thing I did was triage who were the most severe cases. There were many people who were sick, but not all with cholera," says Dr. Rosa Sosa. Once the medical team arrived, he was able to start his epidemiological work and headed into nearby communities to get a sense of the spread of the epidemic. "There were people ill with many other types of diseases, people with malnutrition. You feel almost impotent facing the scale of the problem," he says.
The Haitian medical team that AMI assembled, consisting of a doctor and four nurses, will be relieved every five days because of the extreme pressures of the work.
Patients from that first day included a 9-year-old boy whose mother said he had been sick for four days with vomiting and diarrhea.
Responses to other alerts are not always as dramatic. Often the solution is to set up oral rehydration points or to replenish exhausted supplies and materials.
Oupac's field clinic will stay in place at least through the end of January. On average, the team must care for six admitted patients at a given time. During the week of January 16-23, they had three deaths, one of whom was the older man seen in these photos.
For more information please visit our special page on the Cholera Outbreak on the Island of Hispaniola.
Sunday, January 30, 2011
ARTICLE - CHOLERA TAKES A BREATHER IN HAITI
CHOLERA TAKES A BREATHER IN HAITI, BUT COULD SURGE
(AP) –
SAINT-MARC — The cholera epidemic that has raged across this country is claiming fewer victims, with a sharp drop in new cases everywhere from the shimmering rice fields of the Artibonite Valley to the crowded urban slums.
It is a welcome development, but tinged with doubt: It's not yet known whether the epidemic that has killed nearly 4,000 people is fading or merely taking a break, only to surge again perhaps with the onset of the next rainy season.
"The general situation is improving. It's clear," Stefano Zannini, chief of mission for the aid group Doctors Without Borders, said Sunday. "The problem is that the possible development of the epidemic is unpredictable. It is impossible to say whether the situation will continue stabilizing."
Any progress on controlling the disease would be a rare bit of good news for Haiti, which is passing through a particularly gloomy period. The country is on edge amid a political crisis over a disputed presidential election, and could see more of the violent protests that paralyzed cities and hampered cholera treatment in December. Meanwhile hundreds of thousands are still homeless from last year's earthquake, and a much-reviled former dictator suddenly returned and took up residence in the past week.
Zannini, whose group is contemplating scaling back its more than 40 cholera treatment centers, was unable to muster even cautious optimism regarding the disease. The best he could say was that he was happy new cases and deaths are decreasing to levels not seen since soon after the disease emerged in October.
"I would not be optimistic," he said in an interview with The Associated Press at his Port-au-Prince office.
For the moment, at least, the statistics are moving in the right direction. The number of new cases has dropped to about 4,700 per week, down from more than 12,000 per week in November, and the trend is downward in all 10 of Haiti's departments, or regions, according to the Health Ministry's latest bulletin, released Thursday. The only places it appears to be still rising are in a few isolated spots in the northwest and south.
Behind the drop is a massive emergency public health campaign in response to the outbreak. A new network of cholera centers staffed by Haitian doctors and nurses, NGOs and international volunteers has made it easier for victims to get oral and intraveneous rehydration treatment, saving thousands of lives.
There have also been extensive efforts to ensure access to clean water, as well as public public health campaigns to teach people how to avoid cholera. Finally the dry conditions of recent weeks have slowed the spread of the bacteria.
Health statistics in Haiti are unreliable, so it's hard to get a precise picture of the situation. World Health Organization spokeswoman Nyka Alexander noted that it's hard to know what is happening in remote regions where many have little or no access to health care.
Some 40 patients a day are still coming to the Doctors Without Borders treatment center in Saint Marc, where the disease first exploded, but that's a third of what it was in December and there hasn't been a death in six weeks, said field coordinator Oscar Sanchez Rey.
"Is this is the end? Nobody really knows, but the situation is better," Sanchez said as he took a break from treating patients, including a family of six that all came down with the disease together. He cautioned that even though fewer people are getting sick, the center's work is still critical: "If no one is treating patients, they are going to die, because it's a lethal disease."
Lilane Estime, 42, tried to sleep on a wooden bench as doctors attended to three of her children. She said all four had piled onto a motorcycle taxi and traveled an hour along a dusty coastal road to reach the clinic. Seemingly healthy, she said she could feel cholera inside her, though she hadn't gotten sick yet.
"If there's a disease going around killing people, you're going to be scared," Estime said.
In Cite Soleil, the dense slum at the northern edge of Port-au-Prince, the number of new cases is now about 15 per week, down from a high of 700, and there are similar reports from nearby neighborhoods. In the hard-hit Artibonite Valley, the weekly new caseload is about 700, compared with more than 4,800 in November.
"We don't want to say, 'OK, cholera is finished,' because it's not," said Cinta Pluma, a spokeswoman for the aid group Oxfam. "But it does seem to be going down."
Caused by a bacteria that spreads through contaminated water, the disease so far has sickened more than 194,000 people and killed about 3,890 nationwide. It can lead to a rapid, painful death through complete dehydration, but is easily treatable if caught in time.
In December, U.N. Secretary General Ban Ki-Moon warned the outbreak could affect as many as 650,000 people over six months, but that seems less likely now. The Pan-American Health Organization still projects cholera will sicken about 400,000 people over a year.
The U.N. Food and Agriculture Organization warned in December that cholera would also worsen hunger in the impoverished nation. Surveys showed workers in the Artibonite, Haiti's main agriculture zone, were afraid to wade into rice fields and the public was shunning the region's produce, causing steep price drops in the local street markets. Jackson Dorgil, an FAO agricultural technician in the area, said prices for staple crops such as onions, tomatoes and melons plummeted — and much couldn't be sold at all.
But that too seems to have improved. At the region's main market in Pont-Sonde on Saturday, prices and sales were back to normal, with hundreds of women selling produce, fish and other products in neat little pyramids spread over burlap sacks. "Life is starting to be normal again," Dorgil said during a tour of the region.
Rice fields there were filled with barefoot workers up to their ankles in muddy water believed to be contaminated with the cholera bacteria, planting the crop under a blistering sun. Most earn about $2.50 for a six-hour workday.
Fresnel Louis, the president of a worker's association in the area, said radio commentators were warning people not to go into the water at the start of the outbreak, but there were few options.
"If you tell people in the Artibonite not to touch the water, you are telling them not to work — because that's what we have here," Louis said.
Those rice fields could lead to a resurgence of the disease. There were no latrines in sight, nor any supplies of potable water — the same conditions that helped spread cholera so rapidly in the first place.
Zannini said any immunity typically lasts six to eight weeks, so people will be prone to catching it again when the rainy season starts in the spring, sending the bacteria coursing through rivers and streams.
"Lack of immunization, lack of access to clean water and a difficult hygienic situation still keep the population exposed to a new outbreak," he said.
(AP) –
SAINT-MARC — The cholera epidemic that has raged across this country is claiming fewer victims, with a sharp drop in new cases everywhere from the shimmering rice fields of the Artibonite Valley to the crowded urban slums.
It is a welcome development, but tinged with doubt: It's not yet known whether the epidemic that has killed nearly 4,000 people is fading or merely taking a break, only to surge again perhaps with the onset of the next rainy season.
"The general situation is improving. It's clear," Stefano Zannini, chief of mission for the aid group Doctors Without Borders, said Sunday. "The problem is that the possible development of the epidemic is unpredictable. It is impossible to say whether the situation will continue stabilizing."
Any progress on controlling the disease would be a rare bit of good news for Haiti, which is passing through a particularly gloomy period. The country is on edge amid a political crisis over a disputed presidential election, and could see more of the violent protests that paralyzed cities and hampered cholera treatment in December. Meanwhile hundreds of thousands are still homeless from last year's earthquake, and a much-reviled former dictator suddenly returned and took up residence in the past week.
Zannini, whose group is contemplating scaling back its more than 40 cholera treatment centers, was unable to muster even cautious optimism regarding the disease. The best he could say was that he was happy new cases and deaths are decreasing to levels not seen since soon after the disease emerged in October.
"I would not be optimistic," he said in an interview with The Associated Press at his Port-au-Prince office.
For the moment, at least, the statistics are moving in the right direction. The number of new cases has dropped to about 4,700 per week, down from more than 12,000 per week in November, and the trend is downward in all 10 of Haiti's departments, or regions, according to the Health Ministry's latest bulletin, released Thursday. The only places it appears to be still rising are in a few isolated spots in the northwest and south.
Behind the drop is a massive emergency public health campaign in response to the outbreak. A new network of cholera centers staffed by Haitian doctors and nurses, NGOs and international volunteers has made it easier for victims to get oral and intraveneous rehydration treatment, saving thousands of lives.
There have also been extensive efforts to ensure access to clean water, as well as public public health campaigns to teach people how to avoid cholera. Finally the dry conditions of recent weeks have slowed the spread of the bacteria.
Health statistics in Haiti are unreliable, so it's hard to get a precise picture of the situation. World Health Organization spokeswoman Nyka Alexander noted that it's hard to know what is happening in remote regions where many have little or no access to health care.
Some 40 patients a day are still coming to the Doctors Without Borders treatment center in Saint Marc, where the disease first exploded, but that's a third of what it was in December and there hasn't been a death in six weeks, said field coordinator Oscar Sanchez Rey.
"Is this is the end? Nobody really knows, but the situation is better," Sanchez said as he took a break from treating patients, including a family of six that all came down with the disease together. He cautioned that even though fewer people are getting sick, the center's work is still critical: "If no one is treating patients, they are going to die, because it's a lethal disease."
Lilane Estime, 42, tried to sleep on a wooden bench as doctors attended to three of her children. She said all four had piled onto a motorcycle taxi and traveled an hour along a dusty coastal road to reach the clinic. Seemingly healthy, she said she could feel cholera inside her, though she hadn't gotten sick yet.
"If there's a disease going around killing people, you're going to be scared," Estime said.
In Cite Soleil, the dense slum at the northern edge of Port-au-Prince, the number of new cases is now about 15 per week, down from a high of 700, and there are similar reports from nearby neighborhoods. In the hard-hit Artibonite Valley, the weekly new caseload is about 700, compared with more than 4,800 in November.
"We don't want to say, 'OK, cholera is finished,' because it's not," said Cinta Pluma, a spokeswoman for the aid group Oxfam. "But it does seem to be going down."
Caused by a bacteria that spreads through contaminated water, the disease so far has sickened more than 194,000 people and killed about 3,890 nationwide. It can lead to a rapid, painful death through complete dehydration, but is easily treatable if caught in time.
In December, U.N. Secretary General Ban Ki-Moon warned the outbreak could affect as many as 650,000 people over six months, but that seems less likely now. The Pan-American Health Organization still projects cholera will sicken about 400,000 people over a year.
The U.N. Food and Agriculture Organization warned in December that cholera would also worsen hunger in the impoverished nation. Surveys showed workers in the Artibonite, Haiti's main agriculture zone, were afraid to wade into rice fields and the public was shunning the region's produce, causing steep price drops in the local street markets. Jackson Dorgil, an FAO agricultural technician in the area, said prices for staple crops such as onions, tomatoes and melons plummeted — and much couldn't be sold at all.
But that too seems to have improved. At the region's main market in Pont-Sonde on Saturday, prices and sales were back to normal, with hundreds of women selling produce, fish and other products in neat little pyramids spread over burlap sacks. "Life is starting to be normal again," Dorgil said during a tour of the region.
Rice fields there were filled with barefoot workers up to their ankles in muddy water believed to be contaminated with the cholera bacteria, planting the crop under a blistering sun. Most earn about $2.50 for a six-hour workday.
Fresnel Louis, the president of a worker's association in the area, said radio commentators were warning people not to go into the water at the start of the outbreak, but there were few options.
"If you tell people in the Artibonite not to touch the water, you are telling them not to work — because that's what we have here," Louis said.
Those rice fields could lead to a resurgence of the disease. There were no latrines in sight, nor any supplies of potable water — the same conditions that helped spread cholera so rapidly in the first place.
Zannini said any immunity typically lasts six to eight weeks, so people will be prone to catching it again when the rainy season starts in the spring, sending the bacteria coursing through rivers and streams.
"Lack of immunization, lack of access to clean water and a difficult hygienic situation still keep the population exposed to a new outbreak," he said.
ARTICLE - PANAMA, COLOMBIA - CHOLERA CONTROLS
VENEZUELAN CHOLERA CASES TRIGGER CONTROL MEASURES IN NEIGHBORING COUNTRIES
(Medical News Today) - By Christian Nordqvist
Panama has upped sanitation and hygiene measures at all its ports and airports and Colombia has enhanced its border vigilance after 35 cholera cases were reported and confirmed in Venezuela. Franklin Vergara, Panama's Health Minister added that since Haiti's cholera outbreak in October 2010, the country has been "careful and vigilant".
Local media in Venezuela, Colombia and Panama report that between 37 and 111 cases of cholera have been confirmed so far in Venezuela, as well as 12 in the Dominican Republic, 1 in the USA, 2 in Madrid (Spain), and 1 in Mexico. (See below, 6 more cases in Massachusetts)Vergars stressed that although there is no cause for alarm..:
"..sanitation measures must be adopted to the full (sí hay que extremar las medidas sanitarias)."
Although no cases have yet been reported, Vergara explained that Panama, being a popular hub for passengers in transit, is an ideal location for infection to spread into if authorities lower their guard.
Colombian Health and Wellness Deputy Minister, Beatriz Londoño, said that although there is no cholera outbreak in Columbia, authorities' vigilance has been heightened along the country's borders with neighboring Venezuela since new cases have been reported there.
Londoño has called on all competent authorities in her country to..:
"..intensify all vigilance and control measures, inform communities about effective preventive measures, and to report any suspect cases immediately (intensifiquen todas las acciones de vigilancia y control, que informen adecuadamente a la comunidad sobre las medidas preventivas y que de manera inmediata notifiquen cualquier caso sospechoso)".
Columbia has spend over US$1.6 million to prevent cholera from entering since October 2010.
Six residents in Massachusetts have tested positive for cholera after returning from a wedding in the Dominican Republic, the Massachusetts Health Department announced today.
Spokesperson, Julian Hurley said today that all six have been released from hospital and that the authorities do not believe the infection will spread into the community.
According to Dominican Republic health officials, the patients became infected after eating tainted lobsters during the wedding reception. Other wedding guests were treated for similar symptoms in Spain, the Dominican Republic and Mexico.
(Medical News Today) - By Christian Nordqvist
Panama has upped sanitation and hygiene measures at all its ports and airports and Colombia has enhanced its border vigilance after 35 cholera cases were reported and confirmed in Venezuela. Franklin Vergara, Panama's Health Minister added that since Haiti's cholera outbreak in October 2010, the country has been "careful and vigilant".
Local media in Venezuela, Colombia and Panama report that between 37 and 111 cases of cholera have been confirmed so far in Venezuela, as well as 12 in the Dominican Republic, 1 in the USA, 2 in Madrid (Spain), and 1 in Mexico. (See below, 6 more cases in Massachusetts)Vergars stressed that although there is no cause for alarm..:
"..sanitation measures must be adopted to the full (sí hay que extremar las medidas sanitarias)."
Although no cases have yet been reported, Vergara explained that Panama, being a popular hub for passengers in transit, is an ideal location for infection to spread into if authorities lower their guard.
Colombian Health and Wellness Deputy Minister, Beatriz Londoño, said that although there is no cholera outbreak in Columbia, authorities' vigilance has been heightened along the country's borders with neighboring Venezuela since new cases have been reported there.
Londoño has called on all competent authorities in her country to..:
"..intensify all vigilance and control measures, inform communities about effective preventive measures, and to report any suspect cases immediately (intensifiquen todas las acciones de vigilancia y control, que informen adecuadamente a la comunidad sobre las medidas preventivas y que de manera inmediata notifiquen cualquier caso sospechoso)".
Columbia has spend over US$1.6 million to prevent cholera from entering since October 2010.
Six residents in Massachusetts have tested positive for cholera after returning from a wedding in the Dominican Republic, the Massachusetts Health Department announced today.
Spokesperson, Julian Hurley said today that all six have been released from hospital and that the authorities do not believe the infection will spread into the community.
According to Dominican Republic health officials, the patients became infected after eating tainted lobsters during the wedding reception. Other wedding guests were treated for similar symptoms in Spain, the Dominican Republic and Mexico.
ARTICLE - VENEZUELA - CHOLERA WEDDING
CHOLERA CASES RISE TO 111 IN VENEZUELA AS MORE TEST POSITIVE AFTER CARIBBEAN WEDDING
(CP) - By The Associated Press
CARACAS, Venezuela — The number of cholera cases has jumped to 111 in Venezuela as more people tested positive after attending a wedding with contaminated food in the Dominican Republic, the country's health minister said Friday.
The patients were all receiving treatment, and 27 were hospitalized, Health Minister Eugenia Sader told the Caracas-based television network Telesur.
The number of cases rose swiftly on Friday. Venezuelan authorities had said a day earlier that 37 people had the virus in the country and that 12 others were hospitalized in the Dominican Republic.
Dominican officials said wedding guests became infected when they ate tainted lobster at a wedding Jan. 22. Health Minister Bautista Rojas said lobsters for the lavish celebration were bought in Pedernales, a town bordering Haiti, where more than 3,000 people have died from a cholera epidemic.
Many of the 452 guests were Venezuelans, and health officials hope to provide treatment to all of them to keep the illness from spreading, Sader said. She has said several who returned to Madrid, Mexico and Boston also have cholera.
The Massachusetts health department said Friday that six state residents tested positive after attending the wedding, but all were released from local hospitals and officials were not concerned the disease could spread.
Jose Rodriguez, a vice minister in the Dominican Health Department, said the wedding menu consisted of 25 dishes, so not everyone ate the lobster.
Clemente Terrero, an infectious disease specialist and member of the Dominican Medical Association, questioned the reliability of government statistics on cholera.
"It is not possible that so many people became infected with cholera at one party, and that only 300 cases have been reported in the Dominican Republic in three months," he said.
Cholera fears have led to mass deportations of Haitian migrants since the beginning of the year.
One death has been reported in the Dominican Republic.
Cholera, which causes severe diarrhea that can lead to dehydration and death, is spread through fecal-contaminated water and food. It had been rare in the Americas recently, until the outbreak in Haiti.
A large outbreak centred in Peru in 1991 spread to other countries and a total of 396,536 cases were reported throughout the Americas that year, according to the Pan American Health Organization. However a massive public health program subsequently helped all but eliminate the disease in the region, with just 13 known cases in 2006.
Before this month, Venezuela had not reported any cholera cases since 2000.
(CP) - By The Associated Press
CARACAS, Venezuela — The number of cholera cases has jumped to 111 in Venezuela as more people tested positive after attending a wedding with contaminated food in the Dominican Republic, the country's health minister said Friday.
The patients were all receiving treatment, and 27 were hospitalized, Health Minister Eugenia Sader told the Caracas-based television network Telesur.
The number of cases rose swiftly on Friday. Venezuelan authorities had said a day earlier that 37 people had the virus in the country and that 12 others were hospitalized in the Dominican Republic.
Dominican officials said wedding guests became infected when they ate tainted lobster at a wedding Jan. 22. Health Minister Bautista Rojas said lobsters for the lavish celebration were bought in Pedernales, a town bordering Haiti, where more than 3,000 people have died from a cholera epidemic.
Many of the 452 guests were Venezuelans, and health officials hope to provide treatment to all of them to keep the illness from spreading, Sader said. She has said several who returned to Madrid, Mexico and Boston also have cholera.
The Massachusetts health department said Friday that six state residents tested positive after attending the wedding, but all were released from local hospitals and officials were not concerned the disease could spread.
Jose Rodriguez, a vice minister in the Dominican Health Department, said the wedding menu consisted of 25 dishes, so not everyone ate the lobster.
Clemente Terrero, an infectious disease specialist and member of the Dominican Medical Association, questioned the reliability of government statistics on cholera.
"It is not possible that so many people became infected with cholera at one party, and that only 300 cases have been reported in the Dominican Republic in three months," he said.
Cholera fears have led to mass deportations of Haitian migrants since the beginning of the year.
One death has been reported in the Dominican Republic.
Cholera, which causes severe diarrhea that can lead to dehydration and death, is spread through fecal-contaminated water and food. It had been rare in the Americas recently, until the outbreak in Haiti.
A large outbreak centred in Peru in 1991 spread to other countries and a total of 396,536 cases were reported throughout the Americas that year, according to the Pan American Health Organization. However a massive public health program subsequently helped all but eliminate the disease in the region, with just 13 known cases in 2006.
Before this month, Venezuela had not reported any cholera cases since 2000.
ARTICLE - PAUL FARMER - RECOVERY EFFORTS
Q&A: DR. PAUL FARMER AND OPHELIA DAHL ON RECOVERY EFFORTS IN HAITI (LA Now) - By Molly Hennessy-Fiske
Dr. Paul Farmer, U.N. deputy special envoy to Haiti, and Ophelia Dahl, who founded the nonprofit Partners in Health with him in Boston in 1987, are in Los Angeles this week to attend Saturday's "Haiti Stories" conference at UCLA’s Fowler Museum that runs from 1 to 6 p.m. and is free to the public.
Farmer, a Harvard medical professor whose work was chronicled in Tracy Kidder’s bestselling "Mountains Beyond Mountains," and Dahl sat down Friday to talk to Los Angeles Times staff writer Molly Hennessy-Fiske about their work in earthquake- and disease-ravaged Haiti.
Farmer and Dahl spoke at the home of Dahl’s sister, Lucy Dahl, in Larchmont, which is decorated with photographs and other mementos from their parents, children’s author Roald Dahl and actress Patricia Neal.
Q: What do you feel the biggest public health challenges in Haiti are now, a year out from the earthquake?
Farmer: The biggest public health challenge is rebuilding health systems. In other words, if you look at cholera or maternal mortality or tuberculosis in Haiti, they’re major problems in Haiti, but the biggest problem is rebuilding systems. What I mean is going from community-based care to health centers to hospitals, putting in place a robust system. The second is how to coordinate all the different actors. There’s so many [nongovernmental organizations], there are different hospitals, there’s the health ministry, there are private providers -- it’s a very chaotic delivery situation.
Q: But wasn’t it that way before the earthquake?
Farmer: Yes. After the earthquake, some of the problems of -- I’m going to just call it healthcare delivery -- were exposed to a broader audience. ... The chronic problems that you’ve known about before -- weak health systems, not enough investment in primary healthcare or specialty care, and now, on top of that, this acute problem of the earthquake.
Dahl: I would just add something that’s often not thought of as a medical problem but a lack of support for public infrastructure, so no municipal water systems, that sort of thing -- the cholera being a direct result of that. Haiti’s place of 147 out of 147 countries for water quality, on that index [in 2002].
Farmer: And while we’re listing problems, can I just say the destruction of the urban health education infrastructure, I would put that up there, No. 3 -- the nursing schools and medical schools. We’re a health-focused group, so we’re acutely aware of that. That’s why we have invested so much time and energy in the Mirebalais hospital project. We’re hoping not just to provide good secondary and tertiary medical care that will complement the community-based care we have been working on for 20 years, we’re also hoping to help spark a renaissance of better training programs too.
Q: Why did you choose that area, that hospital?
Farmer: We’ve been working in that area for 20 years. In fact, we met in that city 28 years ago, by my count. So we’ve been wanting to work there for a long time, and have been in recent years in that town. It’s one of the two largest cities in central Haiti. It deserves a good district hospital, community hospital. So why did we grow it into this big project? Because the ministry of health, the public health sector, asked us to be more ambitious after the earthquake and to try to reimagine this project, not only responding to the needs of central Haiti but also the training needs of the next generation. Haiti is always talking about decentralization and nothing has been so obvious, perhaps a weakness, as the centralized nature of Haitian society as being revealed by the earthquake. I mean, they lost all these medical training programs because they didn’t have them anywhere else.
Q: You mean anywhere else outside Port Au Prince?
Farmer: Yes.
Q: Can we trust the ministry of health to be doing these things, how much of this should be done by outside NGOs?
Dahl: You cannot afford not to trust that system. We’ve now been working with them for more than a decade and had tremendous success in doing so. We’ve worked in different countries with different kinds of governments and in Haiti, with every imaginable type of government, but our favorite type is the democratically-elected type.
Farmer: You can’t have public health without a public health system. We just don’t want to be part of a mindless competition for resources. We want to build back capacity in the system.
Dahl: For us to build a separate parallel health system is not doing anything to forward the rights of the Haitian people. Much better to beef up the public health system than to build a separate one.
Q: Could you talk a little bit about the cholera epidemic in Haiti and what treatment you would recommend?
Farmer: There’s been a lot of bogus discussion about this. You can spend half your resources telling people to wash their hands or drink clean water, but if they don’t have access to clean water, it’s a peculiarly noxious way of approaching the problem because you’re basically taking a social problem -- which is lack of access to potable water or municipal water supplies -- and making it a cognitive or psychological problem. It’s a terrible kind of irony. ...
The treatment for cholera is rehydration and in our view should include antibiotic treatment because it shortens the shedding of the organism. So it has benefits to the patients in the views of many but it also makes them less infectious over less time. That’s not something that’s about adherence. That’s something we learned 20 years ago -- it’s about access. You put the medicines in the patient’s mouths. You get compliant.
Can we rebuild municipal water systems in short order to save the lives we need? No. We can’t.
So we have to focus on point-of-use water purification, which includes filtration for this pathogen. ...
And then, of course, there’s the question of prevention beyond access to clean water for washing and drinking, and that’s access to vaccine. And I think it’s unfortunate there’s been a debate about that.
Q: Could you explain what your point of view is on the cholera vaccine?
Farmer: We should move quickly to make greater investments, not only through cleaning up water but through creating vaccine. The arguments against that, which I think are fading away, is that it’s too hard to manufacture. It seems to me in the last couple of weeks, that debate has moved forward.
Dahl: It was much harder to do that with HIV, to make sure daily doses of antiretroviral therapy was available -- there were so many barrier-laden arguments put forward.
Q: Where should the vaccine be focused now -- in the tent camps in Port Au Prince or the rural villages?
Farmer: There’s a little more water security in the tent camps, ironically. They’re just bringing in water. In a rural village, there’s even less water security than in one of these camps.
Dahl: On top of that, the rural villages that were a little more sparse have now received hundreds of thousands more people. Where once you had eight people living in a house, you now have 15 people in the same two-room hut without access to clean water.
Farmer: One of the things we’ve been talking about in terms of if we were to prioritize those doses is to put some into a rural setting and some into an urban setting and track the impact that has. That’s one of the suggestions being discussed this week -- not a trial in the classic sense, but a division of labor between groups that work in the rural areas like us and others. But it would be nice to get rolling.
I noticed some aid workers or diplomats from Europe and elsewhere, as soon as this started happening, they started getting cholera vaccines.
Q: Are there other diseases in Haiti that people should pay attention to?
Farmer: HIV seems to be under some control. There have been some victories in Haiti. Over the last 15 years it has been halved.
Q: Was all the money donated after the earthquake put to good use?
Farmer: The $2 billion that came in after the earthquake, almost none of it went to the public sector. That was earthquake relief, not reconstruction. The relief monies were used in a pretty good manner. I don’t think people need to feel bad about the relief -- a lot of medical care, a lot of people who lost homes. It’s the reconstruction that’s the problem. It’s rebuilding. That money, a lot of it is tied up, it’s quite literally tied to aid or tied to some conditionality and hasn’t arrived yet. Schools, roads, water, hospital systems. We regard the Mirebalais hospital as reconstruction, not relief.
Dahl: That’s where more of the focus has to go. But I do think people get stuck, almost creating a rut in the ground saying the money hasn’t been well spent so we shouldn’t release any more money. We don’t think the Haitian people deserve this at all. It takes a while to rebuild. If you want to, there are all sorts of ways to do things like monitor how money’s being spent.
Q: Will the return of Jean-Claude “Baby Doc” Duvalier have any impact on the work you do and the reconstruction?
Farmer: I have no idea. It just seems to add more turmoil. I can’t see anything good that would come out of it unless there’s accounting for crimes.
Dahl: It doesn’t take a lot to mess with a fragile system. Finding ways to support democracy would be the most useful thing anybody can do. He doesn’t have a history of wanting to support democracy or not sabotage it.
I keep thinking about that famous photograph of Baby Doc, him and Michele Bennett driving out in that car, speeding out of Port Au Prince and she’s smoking like she’s going to a hair appointment. And that was so huge for Haiti. And I just didn’t think I would ...
Farmer: Live to see it?
Dahl: No, I didn’t.
Q: How can a person living in Los Angeles without contacts in Haiti help?
Dahl: Doing a little bit of research into the organizations you’re giving your resources to. Don’t go down and dig pit latrines -- Haitians need those jobs.
Farmer: Some of these camps, in Parc Jean-Marie Vincent, which is about 51,000 people in one little tiny space, they have 286 latrines. Plus, it’s dangerous for women to go to them at night. In Port Au Prince. The numbers are pretty scary. Like with vaccine production, can’t there be a much more ambitious endeavor? We keep talking about Depression-era interventions -- WPA, Civilian Conservation Corps -- that engaged millions of people otherwise idle in public good. Even if half the aid pledge gets in, imagine if that money could go towards creating jobs for people.
... We’re all for moving capital back to Haiti -- the way it’s done is what’s important. If you had to choose between conventional aid programs with a lot of use of contractors, lots of overhead, dumb trainings. If you had to choose between that and lots of money going into creating jobs for Haitians, we obviously vote for the latter. If you want to support good work in a place that’s troubled, you have to do some homework.
Dr. Paul Farmer, U.N. deputy special envoy to Haiti, and Ophelia Dahl, who founded the nonprofit Partners in Health with him in Boston in 1987, are in Los Angeles this week to attend Saturday's "Haiti Stories" conference at UCLA’s Fowler Museum that runs from 1 to 6 p.m. and is free to the public.
Farmer, a Harvard medical professor whose work was chronicled in Tracy Kidder’s bestselling "Mountains Beyond Mountains," and Dahl sat down Friday to talk to Los Angeles Times staff writer Molly Hennessy-Fiske about their work in earthquake- and disease-ravaged Haiti.
Farmer and Dahl spoke at the home of Dahl’s sister, Lucy Dahl, in Larchmont, which is decorated with photographs and other mementos from their parents, children’s author Roald Dahl and actress Patricia Neal.
Q: What do you feel the biggest public health challenges in Haiti are now, a year out from the earthquake?
Farmer: The biggest public health challenge is rebuilding health systems. In other words, if you look at cholera or maternal mortality or tuberculosis in Haiti, they’re major problems in Haiti, but the biggest problem is rebuilding systems. What I mean is going from community-based care to health centers to hospitals, putting in place a robust system. The second is how to coordinate all the different actors. There’s so many [nongovernmental organizations], there are different hospitals, there’s the health ministry, there are private providers -- it’s a very chaotic delivery situation.
Q: But wasn’t it that way before the earthquake?
Farmer: Yes. After the earthquake, some of the problems of -- I’m going to just call it healthcare delivery -- were exposed to a broader audience. ... The chronic problems that you’ve known about before -- weak health systems, not enough investment in primary healthcare or specialty care, and now, on top of that, this acute problem of the earthquake.
Dahl: I would just add something that’s often not thought of as a medical problem but a lack of support for public infrastructure, so no municipal water systems, that sort of thing -- the cholera being a direct result of that. Haiti’s place of 147 out of 147 countries for water quality, on that index [in 2002].
Farmer: And while we’re listing problems, can I just say the destruction of the urban health education infrastructure, I would put that up there, No. 3 -- the nursing schools and medical schools. We’re a health-focused group, so we’re acutely aware of that. That’s why we have invested so much time and energy in the Mirebalais hospital project. We’re hoping not just to provide good secondary and tertiary medical care that will complement the community-based care we have been working on for 20 years, we’re also hoping to help spark a renaissance of better training programs too.
Q: Why did you choose that area, that hospital?
Farmer: We’ve been working in that area for 20 years. In fact, we met in that city 28 years ago, by my count. So we’ve been wanting to work there for a long time, and have been in recent years in that town. It’s one of the two largest cities in central Haiti. It deserves a good district hospital, community hospital. So why did we grow it into this big project? Because the ministry of health, the public health sector, asked us to be more ambitious after the earthquake and to try to reimagine this project, not only responding to the needs of central Haiti but also the training needs of the next generation. Haiti is always talking about decentralization and nothing has been so obvious, perhaps a weakness, as the centralized nature of Haitian society as being revealed by the earthquake. I mean, they lost all these medical training programs because they didn’t have them anywhere else.
Q: You mean anywhere else outside Port Au Prince?
Farmer: Yes.
Q: Can we trust the ministry of health to be doing these things, how much of this should be done by outside NGOs?
Dahl: You cannot afford not to trust that system. We’ve now been working with them for more than a decade and had tremendous success in doing so. We’ve worked in different countries with different kinds of governments and in Haiti, with every imaginable type of government, but our favorite type is the democratically-elected type.
Farmer: You can’t have public health without a public health system. We just don’t want to be part of a mindless competition for resources. We want to build back capacity in the system.
Dahl: For us to build a separate parallel health system is not doing anything to forward the rights of the Haitian people. Much better to beef up the public health system than to build a separate one.
Q: Could you talk a little bit about the cholera epidemic in Haiti and what treatment you would recommend?
Farmer: There’s been a lot of bogus discussion about this. You can spend half your resources telling people to wash their hands or drink clean water, but if they don’t have access to clean water, it’s a peculiarly noxious way of approaching the problem because you’re basically taking a social problem -- which is lack of access to potable water or municipal water supplies -- and making it a cognitive or psychological problem. It’s a terrible kind of irony. ...
The treatment for cholera is rehydration and in our view should include antibiotic treatment because it shortens the shedding of the organism. So it has benefits to the patients in the views of many but it also makes them less infectious over less time. That’s not something that’s about adherence. That’s something we learned 20 years ago -- it’s about access. You put the medicines in the patient’s mouths. You get compliant.
Can we rebuild municipal water systems in short order to save the lives we need? No. We can’t.
So we have to focus on point-of-use water purification, which includes filtration for this pathogen. ...
And then, of course, there’s the question of prevention beyond access to clean water for washing and drinking, and that’s access to vaccine. And I think it’s unfortunate there’s been a debate about that.
Q: Could you explain what your point of view is on the cholera vaccine?
Farmer: We should move quickly to make greater investments, not only through cleaning up water but through creating vaccine. The arguments against that, which I think are fading away, is that it’s too hard to manufacture. It seems to me in the last couple of weeks, that debate has moved forward.
Dahl: It was much harder to do that with HIV, to make sure daily doses of antiretroviral therapy was available -- there were so many barrier-laden arguments put forward.
Q: Where should the vaccine be focused now -- in the tent camps in Port Au Prince or the rural villages?
Farmer: There’s a little more water security in the tent camps, ironically. They’re just bringing in water. In a rural village, there’s even less water security than in one of these camps.
Dahl: On top of that, the rural villages that were a little more sparse have now received hundreds of thousands more people. Where once you had eight people living in a house, you now have 15 people in the same two-room hut without access to clean water.
Farmer: One of the things we’ve been talking about in terms of if we were to prioritize those doses is to put some into a rural setting and some into an urban setting and track the impact that has. That’s one of the suggestions being discussed this week -- not a trial in the classic sense, but a division of labor between groups that work in the rural areas like us and others. But it would be nice to get rolling.
I noticed some aid workers or diplomats from Europe and elsewhere, as soon as this started happening, they started getting cholera vaccines.
Q: Are there other diseases in Haiti that people should pay attention to?
Farmer: HIV seems to be under some control. There have been some victories in Haiti. Over the last 15 years it has been halved.
Q: Was all the money donated after the earthquake put to good use?
Farmer: The $2 billion that came in after the earthquake, almost none of it went to the public sector. That was earthquake relief, not reconstruction. The relief monies were used in a pretty good manner. I don’t think people need to feel bad about the relief -- a lot of medical care, a lot of people who lost homes. It’s the reconstruction that’s the problem. It’s rebuilding. That money, a lot of it is tied up, it’s quite literally tied to aid or tied to some conditionality and hasn’t arrived yet. Schools, roads, water, hospital systems. We regard the Mirebalais hospital as reconstruction, not relief.
Dahl: That’s where more of the focus has to go. But I do think people get stuck, almost creating a rut in the ground saying the money hasn’t been well spent so we shouldn’t release any more money. We don’t think the Haitian people deserve this at all. It takes a while to rebuild. If you want to, there are all sorts of ways to do things like monitor how money’s being spent.
Q: Will the return of Jean-Claude “Baby Doc” Duvalier have any impact on the work you do and the reconstruction?
Farmer: I have no idea. It just seems to add more turmoil. I can’t see anything good that would come out of it unless there’s accounting for crimes.
Dahl: It doesn’t take a lot to mess with a fragile system. Finding ways to support democracy would be the most useful thing anybody can do. He doesn’t have a history of wanting to support democracy or not sabotage it.
I keep thinking about that famous photograph of Baby Doc, him and Michele Bennett driving out in that car, speeding out of Port Au Prince and she’s smoking like she’s going to a hair appointment. And that was so huge for Haiti. And I just didn’t think I would ...
Farmer: Live to see it?
Dahl: No, I didn’t.
Q: How can a person living in Los Angeles without contacts in Haiti help?
Dahl: Doing a little bit of research into the organizations you’re giving your resources to. Don’t go down and dig pit latrines -- Haitians need those jobs.
Farmer: Some of these camps, in Parc Jean-Marie Vincent, which is about 51,000 people in one little tiny space, they have 286 latrines. Plus, it’s dangerous for women to go to them at night. In Port Au Prince. The numbers are pretty scary. Like with vaccine production, can’t there be a much more ambitious endeavor? We keep talking about Depression-era interventions -- WPA, Civilian Conservation Corps -- that engaged millions of people otherwise idle in public good. Even if half the aid pledge gets in, imagine if that money could go towards creating jobs for people.
... We’re all for moving capital back to Haiti -- the way it’s done is what’s important. If you had to choose between conventional aid programs with a lot of use of contractors, lots of overhead, dumb trainings. If you had to choose between that and lots of money going into creating jobs for Haitians, we obviously vote for the latter. If you want to support good work in a place that’s troubled, you have to do some homework.
ARTICLE - SQUATTING AID
AT HAITIAN PORT, DESPERTELY NEEDED AID SITS AND SITS AND SITS...
(Miami Herald) - By Frances Robles
Why is desperately needed aid logjammed at customs? Some say it's because you have to grease the right palms to get it through.
PORT-AU-PRINCE -- Water filtration tanks that would provide orphans with clean water during a cholera epidemic have been stuck at Haiti's main port since Nov. 22, hostage to customs red tape.
They're joined by 700 dust-covered automobiles and at least six ambulances shipped by nonprofit groups. Two donated rescue vehicles have been there for nearly a year.
``You spend days and days getting some paper customs asked for, and then they come up with something else,'' said Chad Walsh of Grassroots United, a small aid organization that needs the 450 water filters for an orphan de-worming program.
Haiti's struggle to recover from last January's 7.0 earthquake has been hamstrung by a massive bottleneck at customs. To some, the culprit is corruption, and the solution is to grease the right palms to get products moving to their intended destinations.
DELAYS DEFENDED
But to others it's not that simple. Haiti has a culture of bureaucratic inefficiency that has been overwhelmed by a tidal wave of incoming charitable goods. The government defends the delays, arguing that some alleged donations are actually intended for sale but disguised as aid by opportunists who hope to maximize profits by avoiding Haiti's enormous import fees.
And so, desperately needed goods sit at the port while reconstruction stalls and people get sick and die.
Whether due to corruption or ineptitude, Grassroots United learned that getting water filters into Haiti is not as easy as it sounds.
``They wanted an invoice showing the monetary value,'' Walsh said. ``We got that; it had a black speck on it from the printer, so the guy at customs said: `Hmmm. I don't know if this is going to work.' ''
Oxfam, the British aid organization, had eight cars stuck in customs for a full year.
On Wednesday, Broward County-based Great Commission Alliance finally received 40 utility poles donated by FPL to bring power to a village. They had arrived in Haiti three months earlier.
$6,000 FEE
The 48 bunk beds the church group sent for its Mirebalais orphanage sat in customs for four and a half months until a $6,000 fee was paid last week, despite its 10-year history as a nonprofit group in Haiti.
``We want to pay taxes, but how much should it be?'' said Homestead pastor Marcel Baptiste, a missionary. ``If you bring a car, they want to charge you 48 percent of the price. They wanted to charge us $20,000 for a loader that was given to us for $1.''
Aid agencies routinely pay steep storage fees for the time the ``duty free'' items gathers dust at customs during the haggling. Baptiste's group paid seven grand to get the loader out.
Great Commission Alliance's founder, Weston pastor Brian Kelso, calls the charges the ``extortion tax.''
``If Haiti gets $10 billion in aid, I would say anywhere from 1 to 5 percent of that is going straight to corruption,'' said Kelso, who spent so much time doing quake relief last year that he contracted malaria and lost portions of both feet.
He estimates that his organization paid $30,000 in extra customs taxes last year alone.
``That money is in the pocket of a small and elite group of people,'' Kelso said.
Customs director Jean Jacques Valentin becomes irate at the suggestion of corruption and indicated that many organizations are profiting from donations.
``I spent all of 2010 explaining the customs process. I am not going to spend any more time trying to defend it,'' Valentin said. ``This is a public operation that is a service, which has rules and regulations which need to be respected.''
CORRUPTION INDEX
The Haitian government estimates that the Jan. 12 quake killed up to 300,000 people and in the early months destroyed 65 percent of Haiti's commerce and 85 percent of its tax receipts. Haiti's government was largely financed through port tariffs, which were among the highest in the Caribbean.
Its corruption index was also rated by Transparency International as among the world's highest.
Months after the quake, the country was eager to return to normalcy, when the majority of items being sent to the country were not tax-free donations.
According to a trade analysis done for The Miami Herald by Datamyne, a Miami company that has the largest searchable trade database in the world, a third of the $504 million in goods exported to Haiti from the Miami customs district the first 10 months of 2010 were charitable goods.
Soon after the quake, Haitian authorities began to suspect that disaster relief agencies were using their tax-free status to ship items they planned to sell.
``They come here to make money,'' Valentin said. ``People are profiting from this country's problems. They are liars. Can they explain the money they are spending or stealing?''
ALL ABOUT HAGGLING
Port Director Joseph Alcime Henry said many people blame the port for delays that are outside its control.
``You say, `You have to pay this amount,' and people say, `What? I am not paying! I have no money,' '' Henry said. ``They ship something that's worth $10, and they make a customs declaration that says $1.''
It's all about haggling, said Chuck McCune, founder of Prizm Foundation, a New Mexico charity.
``The government is underfunded and needs to get as many dollars possible from every box,'' McCune said. ``I don't necessarily think it's nefarious. You have government officials going around in beat-up trucks and on foot seeing all these brand new trucks coming in, thinking:
`Wait a minute. We can't even get a ride to the clinic!' ''
His community's donation of a school bus filled with clothes and food took several months and cost $5,800 to release, McCune said.
Small organizations like his say they feel the brunt of the delays, because they have less experience and influence. Like many groups, Prizm has tried for months to become a registered nongovernmental organization in Haiti, which brings with it duty-free status.
But even the largest emergency response organizations that are registered in Haiti report the same difficulties, and are hit up for steep fees.
``We have had cars sit there for months,'' said Red Cross spokeswoman Julie Sell. ``Sometimes the problem is the license plate, so they let them out but don't let us drive them. Of course, there's always various requests for money.''
Henry, the port director, said all requests for money are official fees. The system is computerized, and it would be too difficult for a single person to hit a shipper up for a bribe, he said.
``We don't work in cash,'' he said. ``We work with checks.''
He acknowledged that the port operates with 300 employees when it used to have 1,000. Most of those former workers, he said, were political ghost jobs.
RULES FOR NGOS
Prime Minister Jean-Max Bellerive said it's unfair to paint the entire system as corrupt.
Haitian law requires organizations to be working in Haiti for at least a year before they can enjoy NGO status.
``A lot of people are coming to Haiti but only to have a one-time business,'' he said. ``They come with a truck, they come with a container, and they want to have all of the benefits of an NGO here.''
Bellerive said many of the complaints about red tape are false.
``In many instances where we were directly involved, we learned that in a lot of cases, they didn't have the first documentation necessary to introduce the product or goods or container into the country,'' Bellerive said.
But aid groups say they can never get the right documentation.
``They keep changing what a `proper document' is,'' Kelso said. ``It's a shell game: now you have it, now you don't.''
Many groups wind up hiring fixers or brokers to help get goods released, which critics say helps feed an inefficient system rife with corruption.
Adam Marlatt, founder of Global DIRT (Disaster Immediate Response Team) has become a volunteer fixer. He said even well-respected organizations such as the United Nations' World Food Program and the University of Miami's Project Medishare have vehicles stuck at the port.
Project Medishare's three ambulances have been there for at least three months, he said.
``Today we rolled up on a dump truck that had crashed into an SUV and a tap-tap,'' -- a Haitian bus, Marlatt said. ``The ambulances we could have utilized were sitting in customs.''
Experts say the reasons for the delays vary, and include the government's desire to protect local industry. Every four-wheel drive vehicle that sits in the port represents one that must be rented from local companies.
``I'm sure there's a tipping point where someone says it's not worth it, but I haven't gotten there yet,'' Kelso said. ``When you see a lady walk away with two weeks of groceries on her head, and when you see kids sleeping in a bunk bed with a mattress and a pillow, you see it's worth it.''
Miami Herald staff writers Mimi Whitefield and Jacqueline Charles contributed to this report.
(Miami Herald) - By Frances Robles
Why is desperately needed aid logjammed at customs? Some say it's because you have to grease the right palms to get it through.
PORT-AU-PRINCE -- Water filtration tanks that would provide orphans with clean water during a cholera epidemic have been stuck at Haiti's main port since Nov. 22, hostage to customs red tape.
They're joined by 700 dust-covered automobiles and at least six ambulances shipped by nonprofit groups. Two donated rescue vehicles have been there for nearly a year.
``You spend days and days getting some paper customs asked for, and then they come up with something else,'' said Chad Walsh of Grassroots United, a small aid organization that needs the 450 water filters for an orphan de-worming program.
Haiti's struggle to recover from last January's 7.0 earthquake has been hamstrung by a massive bottleneck at customs. To some, the culprit is corruption, and the solution is to grease the right palms to get products moving to their intended destinations.
DELAYS DEFENDED
But to others it's not that simple. Haiti has a culture of bureaucratic inefficiency that has been overwhelmed by a tidal wave of incoming charitable goods. The government defends the delays, arguing that some alleged donations are actually intended for sale but disguised as aid by opportunists who hope to maximize profits by avoiding Haiti's enormous import fees.
And so, desperately needed goods sit at the port while reconstruction stalls and people get sick and die.
Whether due to corruption or ineptitude, Grassroots United learned that getting water filters into Haiti is not as easy as it sounds.
``They wanted an invoice showing the monetary value,'' Walsh said. ``We got that; it had a black speck on it from the printer, so the guy at customs said: `Hmmm. I don't know if this is going to work.' ''
Oxfam, the British aid organization, had eight cars stuck in customs for a full year.
On Wednesday, Broward County-based Great Commission Alliance finally received 40 utility poles donated by FPL to bring power to a village. They had arrived in Haiti three months earlier.
$6,000 FEE
The 48 bunk beds the church group sent for its Mirebalais orphanage sat in customs for four and a half months until a $6,000 fee was paid last week, despite its 10-year history as a nonprofit group in Haiti.
``We want to pay taxes, but how much should it be?'' said Homestead pastor Marcel Baptiste, a missionary. ``If you bring a car, they want to charge you 48 percent of the price. They wanted to charge us $20,000 for a loader that was given to us for $1.''
Aid agencies routinely pay steep storage fees for the time the ``duty free'' items gathers dust at customs during the haggling. Baptiste's group paid seven grand to get the loader out.
Great Commission Alliance's founder, Weston pastor Brian Kelso, calls the charges the ``extortion tax.''
``If Haiti gets $10 billion in aid, I would say anywhere from 1 to 5 percent of that is going straight to corruption,'' said Kelso, who spent so much time doing quake relief last year that he contracted malaria and lost portions of both feet.
He estimates that his organization paid $30,000 in extra customs taxes last year alone.
``That money is in the pocket of a small and elite group of people,'' Kelso said.
Customs director Jean Jacques Valentin becomes irate at the suggestion of corruption and indicated that many organizations are profiting from donations.
``I spent all of 2010 explaining the customs process. I am not going to spend any more time trying to defend it,'' Valentin said. ``This is a public operation that is a service, which has rules and regulations which need to be respected.''
CORRUPTION INDEX
The Haitian government estimates that the Jan. 12 quake killed up to 300,000 people and in the early months destroyed 65 percent of Haiti's commerce and 85 percent of its tax receipts. Haiti's government was largely financed through port tariffs, which were among the highest in the Caribbean.
Its corruption index was also rated by Transparency International as among the world's highest.
Months after the quake, the country was eager to return to normalcy, when the majority of items being sent to the country were not tax-free donations.
According to a trade analysis done for The Miami Herald by Datamyne, a Miami company that has the largest searchable trade database in the world, a third of the $504 million in goods exported to Haiti from the Miami customs district the first 10 months of 2010 were charitable goods.
Soon after the quake, Haitian authorities began to suspect that disaster relief agencies were using their tax-free status to ship items they planned to sell.
``They come here to make money,'' Valentin said. ``People are profiting from this country's problems. They are liars. Can they explain the money they are spending or stealing?''
ALL ABOUT HAGGLING
Port Director Joseph Alcime Henry said many people blame the port for delays that are outside its control.
``You say, `You have to pay this amount,' and people say, `What? I am not paying! I have no money,' '' Henry said. ``They ship something that's worth $10, and they make a customs declaration that says $1.''
It's all about haggling, said Chuck McCune, founder of Prizm Foundation, a New Mexico charity.
``The government is underfunded and needs to get as many dollars possible from every box,'' McCune said. ``I don't necessarily think it's nefarious. You have government officials going around in beat-up trucks and on foot seeing all these brand new trucks coming in, thinking:
`Wait a minute. We can't even get a ride to the clinic!' ''
His community's donation of a school bus filled with clothes and food took several months and cost $5,800 to release, McCune said.
Small organizations like his say they feel the brunt of the delays, because they have less experience and influence. Like many groups, Prizm has tried for months to become a registered nongovernmental organization in Haiti, which brings with it duty-free status.
But even the largest emergency response organizations that are registered in Haiti report the same difficulties, and are hit up for steep fees.
``We have had cars sit there for months,'' said Red Cross spokeswoman Julie Sell. ``Sometimes the problem is the license plate, so they let them out but don't let us drive them. Of course, there's always various requests for money.''
Henry, the port director, said all requests for money are official fees. The system is computerized, and it would be too difficult for a single person to hit a shipper up for a bribe, he said.
``We don't work in cash,'' he said. ``We work with checks.''
He acknowledged that the port operates with 300 employees when it used to have 1,000. Most of those former workers, he said, were political ghost jobs.
RULES FOR NGOS
Prime Minister Jean-Max Bellerive said it's unfair to paint the entire system as corrupt.
Haitian law requires organizations to be working in Haiti for at least a year before they can enjoy NGO status.
``A lot of people are coming to Haiti but only to have a one-time business,'' he said. ``They come with a truck, they come with a container, and they want to have all of the benefits of an NGO here.''
Bellerive said many of the complaints about red tape are false.
``In many instances where we were directly involved, we learned that in a lot of cases, they didn't have the first documentation necessary to introduce the product or goods or container into the country,'' Bellerive said.
But aid groups say they can never get the right documentation.
``They keep changing what a `proper document' is,'' Kelso said. ``It's a shell game: now you have it, now you don't.''
Many groups wind up hiring fixers or brokers to help get goods released, which critics say helps feed an inefficient system rife with corruption.
Adam Marlatt, founder of Global DIRT (Disaster Immediate Response Team) has become a volunteer fixer. He said even well-respected organizations such as the United Nations' World Food Program and the University of Miami's Project Medishare have vehicles stuck at the port.
Project Medishare's three ambulances have been there for at least three months, he said.
``Today we rolled up on a dump truck that had crashed into an SUV and a tap-tap,'' -- a Haitian bus, Marlatt said. ``The ambulances we could have utilized were sitting in customs.''
Experts say the reasons for the delays vary, and include the government's desire to protect local industry. Every four-wheel drive vehicle that sits in the port represents one that must be rented from local companies.
``I'm sure there's a tipping point where someone says it's not worth it, but I haven't gotten there yet,'' Kelso said. ``When you see a lady walk away with two weeks of groceries on her head, and when you see kids sleeping in a bunk bed with a mattress and a pillow, you see it's worth it.''
Miami Herald staff writers Mimi Whitefield and Jacqueline Charles contributed to this report.
ARTICLE - DUVALIER - REOPENING OLD WOUNDS
IN HAITI, RETURN OF DUVALIER REOPENS OLD WOUNDS
(New York Times) - By Ginger Thompson
PORT-AU-PRINCE, Haiti — The remains of the cells at Fort Dimanche, where political prisoners were once crowded in their own excrement, are now being used as a school, though without electricity or running water, much less books.
Women sell mud cakes — a staple for the many Haitians who cannot afford to fill their bellies any other way — on the pavement out front, where detainees were forced to stand naked under the scorching sun until they collapsed.
And in the field where guards once dumped prisoners who had been hacked and beaten to death, the families of a nearby slum now bury their own loved ones.
The havoc that Jean-Claude Duvalier, the former dictator known as Baby Doc, wrought on this country has never been overcome. Old misery is simply layered over by new misery.
Whatever infrastructure had not succumbed to neglect in the 25 years since riots forced Mr. Duvalier to flee was destroyed by last year’s earthquake. Much of the nation’s focus has shifted to surviving newer tragedies, like cholera and mass homelessness.
Still, there has been a deafening silence among those who intimately remember places like Fort Dimanche: the number of the cell where they were held, the way they ate grits off the floor. In the two weeks since Mr. Duvalier’s surprise return from exile, only a handful of the tens of thousands of people who human rights groups say were illegally detained and tortured by his regime have come forward to press charges.
To Mr. Duvalier, the fact that so few people are clamoring against him is proof that this country is ready to move forward, a process he claims he wants to help.
“Haiti is in my blood,” Mr. Duvalier said in a brief meeting with The New York Times on Monday. “I cannot be indifferent to its suffering.”
But those who have brought charges against him — a journalist, a doctor, an agronomist, a historian and a soccer coach — worry that the absence of an uproar shows that Haitians are still afraid.
“That’s the strength of the stigma that Duvalier left on this country,” said Robert Duval, a soccer coach who spent 17 months in Mr. Duvalier’s dungeons until he was released in 1977, after the Carter administration intervened on his behalf and on that of 105 other prisoners. “He may not have been on our minds, but now that he’s back, we see that the fear of him is still in our hearts.”
He added, “I struggle against it every day.”
A bear of a man whose voice rises to a growl, Mr. Duval does not seem easily flustered. Yet now that he is again sharing the same streets with Mr. Duvalier, who faces charges of corruption and crimes against humanity but is not being detained, he is tense and experiences radical mood swings. At one moment Mr. Duval riffed triumphantly about finally seeking charges against the ousted leader. And then, he suddenly collapsed into heaving sobs over the effect his time as a political prisoner had on his mother.
Mr. Duval said he lost more than half his weight and a little of his humanity as he watched 180 people die in cell No. 10 at Fort Dimanche. The cell, he said, was 13 feet by 14 feet. It held as many as 40 men at a time.
“I counted the ones who died, because usually it meant more space to sleep for the rest of us,” he said. “And sometimes we didn’t tell the guards a person died until their body started to stink because we wanted the extra food.”
The son of a businessman, Mr. Duval still does not know why he was detained. He said that he had just returned to Haiti from studying business in Canada, and that he was helping his father run a tire retread factory.
At the end of 1975, a soldier dressed in civilian clothes and sunglasses arrived to say that military officials wanted to see him. Mr. Duval had known the soldier since childhood, so he was not afraid, until he got in the back seat of the officer’s car and found two other officers with guns in their laps.
“I thought it was all a joke until they sent me to Fort Dimanche.”
Alix Fils-Aimé, an agronomist, had the same sinking feeling when he was hauled off to Fort Dimanche in April 1976. He said he was helping organize farmers in the northeast when he was detained by men in military uniforms and others in the dark blue pants and shirts worn by Mr. Duvalier’s feared militia, known as the Tontons Macoutes, Creole for boogeymen.
Mr. Fils-Aimé said he spent much of his time in solitary confinement in a windowless cell the size of a closet, with a narrow opening where guards passed him occasional handfuls of rice. He went without seeing light for weeks, and the only voices he heard were screams from other prisoners.
“Sometimes guards would open the door and ask my name,” Mr. Fils-Aimé recalled. “I told them, ‘What am I doing here if you don’t even know my name?’ ”
Human rights advocates hope to get answers to that and other questions if Mr. Duvalier is taken to court on charges of corruption, embezzlement, illegal detention and torture. The former dictator has surrounded himself with lawyers, including three Americans led by former Representative Bob Barr of Georgia. And he is holed up in a mountainside estate named the Château Phoenix, making clear he is not ready to give many answers.
The former “President for Life,” as Mr. Duvalier was known, made a brief, boilerplate comment last week about returning to help Haiti rebuild after last January’s earthquake.
But when asked to explain why he had decided to help now, considering Haiti’s many needs during the years he enjoyed a lavish exile in France, Mr. Duvalier’s lawyers interrupted; his chain-smoking companion, Véronique Roy, tapped his shoulder to say he had been urgently called to attend a friend’s funeral, then escorted Mr. Duvalier away.
Michèle Montas, who helped run one of this country’s most important radio stations during the late 1970s, says she has both covered Mr. Duvalier and been terrorized by him. In a crackdown against Mr. Duvalier’s opponents on Nov. 28, 1980, she and dozens of other journalists, academics, union organizers and activists were rounded up and jailed. She considers herself one of the lucky ones who were released and deported. Several others, she said, were brutalized to death.
“The country fell silent for years after that day,” said Ms. Montas, a former spokeswoman for United Nations Secretary General Ban Ki-moon, and another plaintiff against Mr. Duvalier. “We were just beginning to recover from that, and now Duvalier has returned, threatening to put the country back where he left it 25 years ago.”
She added, “We’re not going to let that happen.”
A few days after Mr. Duvalier’s return, the government charged him with corruption — mostly involving an estimated $300 million that Mr. Duvalier is accused of looting from Haiti’s treasury — and crimes against humanity. Ms. Montas and four others came forward to press separate charges in the days after, and urged others to do the same.
Even though Mr. Duvalier appears older and more fragile, his myth remains powerful. And with close friends and former colleagues involved in the campaigns of all three of this country’s leading presidential candidates, it is clear that powerful parts of Mr. Duvalier’s network are intact.
Others who have refused to press charges said they lacked faith that they could get justice in Haiti.
“There is no doubt that Duvalier should be tried,” said one former senior justice ministry official who asked not to be named because he still has professional dealings with officials involved in the case. “The question is whether there is the will.”
Students at the La Saline Education Village, built on the ruins of Fort Dimanche, took a break from their grammar lesson to talk about Mr. Duvalier’s rule. Some students said they were aware that their school was once a prison camp, and talked in vague, albeit graphic, terms about prisoners being brought here but not leaving alive.
But most seemed to have little patience for the past. The killings at Fort Dimanche might have been tragic, they said, but what bothered them more were the gangs who gunned down people in the slum that has been built in the old prison camp’s shadow.
“My father told me that when Duvalier was here, it was easy to find food,” said Verginho Rejiste, a lanky 15-year-old. “And if you crossed him, he used the baton.”
Elcide Geodol, 19, jumped up from her seat. “It’s true that Duvalier used the club to push a political agenda,” she said. “But now we have gangs killing people, and we don’t know why.”
Alice Speri contributed reporting.
(New York Times) - By Ginger Thompson
PORT-AU-PRINCE, Haiti — The remains of the cells at Fort Dimanche, where political prisoners were once crowded in their own excrement, are now being used as a school, though without electricity or running water, much less books.
Women sell mud cakes — a staple for the many Haitians who cannot afford to fill their bellies any other way — on the pavement out front, where detainees were forced to stand naked under the scorching sun until they collapsed.
And in the field where guards once dumped prisoners who had been hacked and beaten to death, the families of a nearby slum now bury their own loved ones.
The havoc that Jean-Claude Duvalier, the former dictator known as Baby Doc, wrought on this country has never been overcome. Old misery is simply layered over by new misery.
Whatever infrastructure had not succumbed to neglect in the 25 years since riots forced Mr. Duvalier to flee was destroyed by last year’s earthquake. Much of the nation’s focus has shifted to surviving newer tragedies, like cholera and mass homelessness.
Still, there has been a deafening silence among those who intimately remember places like Fort Dimanche: the number of the cell where they were held, the way they ate grits off the floor. In the two weeks since Mr. Duvalier’s surprise return from exile, only a handful of the tens of thousands of people who human rights groups say were illegally detained and tortured by his regime have come forward to press charges.
To Mr. Duvalier, the fact that so few people are clamoring against him is proof that this country is ready to move forward, a process he claims he wants to help.
“Haiti is in my blood,” Mr. Duvalier said in a brief meeting with The New York Times on Monday. “I cannot be indifferent to its suffering.”
But those who have brought charges against him — a journalist, a doctor, an agronomist, a historian and a soccer coach — worry that the absence of an uproar shows that Haitians are still afraid.
“That’s the strength of the stigma that Duvalier left on this country,” said Robert Duval, a soccer coach who spent 17 months in Mr. Duvalier’s dungeons until he was released in 1977, after the Carter administration intervened on his behalf and on that of 105 other prisoners. “He may not have been on our minds, but now that he’s back, we see that the fear of him is still in our hearts.”
He added, “I struggle against it every day.”
A bear of a man whose voice rises to a growl, Mr. Duval does not seem easily flustered. Yet now that he is again sharing the same streets with Mr. Duvalier, who faces charges of corruption and crimes against humanity but is not being detained, he is tense and experiences radical mood swings. At one moment Mr. Duval riffed triumphantly about finally seeking charges against the ousted leader. And then, he suddenly collapsed into heaving sobs over the effect his time as a political prisoner had on his mother.
Mr. Duval said he lost more than half his weight and a little of his humanity as he watched 180 people die in cell No. 10 at Fort Dimanche. The cell, he said, was 13 feet by 14 feet. It held as many as 40 men at a time.
“I counted the ones who died, because usually it meant more space to sleep for the rest of us,” he said. “And sometimes we didn’t tell the guards a person died until their body started to stink because we wanted the extra food.”
The son of a businessman, Mr. Duval still does not know why he was detained. He said that he had just returned to Haiti from studying business in Canada, and that he was helping his father run a tire retread factory.
At the end of 1975, a soldier dressed in civilian clothes and sunglasses arrived to say that military officials wanted to see him. Mr. Duval had known the soldier since childhood, so he was not afraid, until he got in the back seat of the officer’s car and found two other officers with guns in their laps.
“I thought it was all a joke until they sent me to Fort Dimanche.”
Alix Fils-Aimé, an agronomist, had the same sinking feeling when he was hauled off to Fort Dimanche in April 1976. He said he was helping organize farmers in the northeast when he was detained by men in military uniforms and others in the dark blue pants and shirts worn by Mr. Duvalier’s feared militia, known as the Tontons Macoutes, Creole for boogeymen.
Mr. Fils-Aimé said he spent much of his time in solitary confinement in a windowless cell the size of a closet, with a narrow opening where guards passed him occasional handfuls of rice. He went without seeing light for weeks, and the only voices he heard were screams from other prisoners.
“Sometimes guards would open the door and ask my name,” Mr. Fils-Aimé recalled. “I told them, ‘What am I doing here if you don’t even know my name?’ ”
Human rights advocates hope to get answers to that and other questions if Mr. Duvalier is taken to court on charges of corruption, embezzlement, illegal detention and torture. The former dictator has surrounded himself with lawyers, including three Americans led by former Representative Bob Barr of Georgia. And he is holed up in a mountainside estate named the Château Phoenix, making clear he is not ready to give many answers.
The former “President for Life,” as Mr. Duvalier was known, made a brief, boilerplate comment last week about returning to help Haiti rebuild after last January’s earthquake.
But when asked to explain why he had decided to help now, considering Haiti’s many needs during the years he enjoyed a lavish exile in France, Mr. Duvalier’s lawyers interrupted; his chain-smoking companion, Véronique Roy, tapped his shoulder to say he had been urgently called to attend a friend’s funeral, then escorted Mr. Duvalier away.
Michèle Montas, who helped run one of this country’s most important radio stations during the late 1970s, says she has both covered Mr. Duvalier and been terrorized by him. In a crackdown against Mr. Duvalier’s opponents on Nov. 28, 1980, she and dozens of other journalists, academics, union organizers and activists were rounded up and jailed. She considers herself one of the lucky ones who were released and deported. Several others, she said, were brutalized to death.
“The country fell silent for years after that day,” said Ms. Montas, a former spokeswoman for United Nations Secretary General Ban Ki-moon, and another plaintiff against Mr. Duvalier. “We were just beginning to recover from that, and now Duvalier has returned, threatening to put the country back where he left it 25 years ago.”
She added, “We’re not going to let that happen.”
A few days after Mr. Duvalier’s return, the government charged him with corruption — mostly involving an estimated $300 million that Mr. Duvalier is accused of looting from Haiti’s treasury — and crimes against humanity. Ms. Montas and four others came forward to press separate charges in the days after, and urged others to do the same.
Even though Mr. Duvalier appears older and more fragile, his myth remains powerful. And with close friends and former colleagues involved in the campaigns of all three of this country’s leading presidential candidates, it is clear that powerful parts of Mr. Duvalier’s network are intact.
Others who have refused to press charges said they lacked faith that they could get justice in Haiti.
“There is no doubt that Duvalier should be tried,” said one former senior justice ministry official who asked not to be named because he still has professional dealings with officials involved in the case. “The question is whether there is the will.”
Students at the La Saline Education Village, built on the ruins of Fort Dimanche, took a break from their grammar lesson to talk about Mr. Duvalier’s rule. Some students said they were aware that their school was once a prison camp, and talked in vague, albeit graphic, terms about prisoners being brought here but not leaving alive.
But most seemed to have little patience for the past. The killings at Fort Dimanche might have been tragic, they said, but what bothered them more were the gangs who gunned down people in the slum that has been built in the old prison camp’s shadow.
“My father told me that when Duvalier was here, it was easy to find food,” said Verginho Rejiste, a lanky 15-year-old. “And if you crossed him, he used the baton.”
Elcide Geodol, 19, jumped up from her seat. “It’s true that Duvalier used the club to push a political agenda,” she said. “But now we have gangs killing people, and we don’t know why.”
Alice Speri contributed reporting.
Subscribe to:
Posts (Atom)