Category Archives: Health

FOR COLORED BOYS WHO HAVE CONSIDERED SUICIDE WHEN THE RAINBOW WAS NOT ENUFF

FOR COLORED BOYS WHO HAVE CONSIDERED SUICIDE WHEN THE RAINBOW WAS NOT ENUFF

BY DIRIYE OSMAN

 

There’s a revelatory Lauryn Hill song called “Little Boys” , in which she sings, “What happens to young men/ Disappointed once again/ When they find out they’re not supposed to grow?/ Do their lives become a lie?/ Should they wither up and die/ When they find out they deserve more than they know?”

As a young, gay, African man living in the west, these lyrics always hit me in the heart because I know what it’s like to feel an earth-deep sense of disconnect from who I am, where I’ve come from and, crucially, where I’m headed in relation to the wider culture.

When I was a kid growing up in Kenya, I imagined that one day I would step out of the closet and find a sense of brotherhood and belonging in the beautiful, rainbow-flag-waving LGBT community. But the reality differed a great deal from my dreams.

In Somali culture, like the majority of the African, African-American and African-Caribbean communities, there’s a premium placed on masculinity. Any deviation from this ideal is frowned upon and homosexuality is considered not merely unpalatable but unacceptable. This lack of familial and communal support seeps out into feelings of unworthiness in the still-developing minds of young LGBT men whether they’re from Kinshasa, Kuala Lumpur or Kansas. Such psychic damage manifests itself as a corrosive form of self-hatred that often results in self-medication with illegal drugs and alcohol, unsafe sex, body dysmorphic perceptions taken to the point of anorexia and bulimia, and suicidal ideations.

When these young men eventually step out into the wider gay community in search of acceptance and companionship, they’re confronted by a mainstream gay culture that prizes whiteness, muscularity and the hypervalorization of a particular narrow construction of hypersexualized masculinity. Individualism on a visceral scale is deemed an unattractive quality and clone-culture the epitome of desirability. It’s a situation that creates a Russian Doll-like effect of otherness, a series of lacquered layers that give the impression of wholeness but are either empty or contain only other, smaller, frightened selves. Considered alien by kin and unappealing by both sides of the cultural coin, one’s sense of difference as an LGBT man of color is often felt in an intense and harrowing way.

I get emails every day from young, black gay men who tell me about their painful experiences as survivors of suicide attempts, mental illness, heartbreak and ostracism from first their families and then the gay community where they dreamt they would find kinship. These emails are threaded together by a sense of sadness spiked with hopefulness. “Maybe it will get better?” seems to be the subtext of each email. “Maybe I’ll be okay.” My heart breaks every time I read these emails. They’re beautiful and overwhelming testimonies that knock the air out of my lungs and leave me feeling helpless. As a minority-within-a-minority who happens to be a writer, I know that I have a sense of responsibility to my readers, most of whom are young and vulnerable. When they write to me, I often forget to say the things that these young men need to hear the most: “You are valuable”, “You are wanted”, “You are necessary and you matter”.

So I’m saying it now.

This is for colored boys who have considered suicide when the rainbow was simply not enuff. You are valuable. You are worthy and wanted. You are necessary and you will always matter.

***

FAIRYTALES FOR LOST CHILDREN is available via the following links:

UK: http://amzn.to/12nRtp7?

US: http://amzn.to/13p8PGk?

CAN: http://amzn.to/1ePjj6u

Diriye Osman is photographed by Boris Mitkov.

HIV in the Time of Cholera

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Long before 9/11 and the subsequent incarceration of hundreds of so called “terror suspects” in Guantanamo Bay, thousands of Haitian refugees fleeing the military junta in the early 1990s, were detained on the US base. Many of those were detained because they were suspected of being HIV Positive [+].

The marking of Haitians as carriers of AIDS goes back to the early 1980s when the Center for Disease Control [CDC], identified four high-risk groups, known pejoratively as the 4-H club — “homosexuals, haemophiliacs, heroin users and Haitians”.  This was the first time a disease was tied to a nationality but not the first time black bodies have been tied to racist notions of deviance and contagion and of being a threat to whiteness.  [1]

The first documented case of HIV in Haiti was from the Clinique Bon Sauveur in the Central Plateau in 1986. Within two years the clinic had introduced a programme of free testing, counselling, condoms, HIV education and prevention.  By the early 1990s 25% of admissions were related to HIV and by 1995 this had risen to 40%. Two other medical centres have been at the forefront of HIV/AIDs and TB in Haiti; the GHESKIO Centre in Port-au-Prince, a global pioneer in HIV/AIDS research and treatment, and Partners in Health, which has run an extensive preventative and treatment programme for the past 25 years.  Both must take considerable credit for the massive decrease in the HIV+ rate from 9.4% in 1993 to 1.8% in 2011, an estimated 51% of whom are women and 12% children.  Even with the disruption to treatment caused by the January 2010 earthquake the infection rate continued to decrease.

The underlying and most significant contributory factor to both the spread and death from HIV/AIDS and TB in Haiti is not lack of awareness or failure to follow medication regimes as policy officials tend to argue, but life-shortening conditions, that is the material conditions and structural violence under which people become infected.  Paul Farmer writing on Haiti describes structural violence as
……..one way of describing social arrangements that put individuals and populations in harm’s way… The arrangements are structural because they are embedded in the political and economic organization of our social world; they are violent because they cause injury to people … neither culture nor pure individual will is at fault; rather, historically given (and often economically driven) processes and forces conspire to constrain individual agency. Structural violence is visited upon all those whose social status denies them access to the fruits of scientific and social progress.[2]

After talking to dozens of patients, nurses, doctors and health officials over the past six months, I am very much aware of the violence of poverty which impacts on people in multiple ways.    Gustave and Emile and their families are just three of millions.

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Gustav Renaud was born in Port de Paix in the north, not too far from Cap Haitian. He is 30 years old and came to PAP six months ago after falling ill. He lives with his mother, sister, brother-in-law and their three children in Camp Acra at Delmas 33. His mother, Gustave Taliette, was the first to move to PAP two years ago to look for work and was followed a few months later by her son-in-law, Jonas, and then his family; altogether they are seven. The family was given the tent by someone who moved out from the camp. This was better for them as there is no rent to pay. Since arriving Jonas has only managed to find a few weeks’ work here and there and much of the burden for feeding the family has fallen on Mdm Taliette, who occasionally finds work washing clothes in the city.

Like the dust in the camp, hunger is ever present in their lives. There is nothing to do except to sit and sit some more as the day passes into night. The day I first met Gustave he was sitting in front of his tent with his mother and some neighbours. On the ground in front of Gustave’s tent are a few very old dusty shoes and bags laid out for sale on a piece of equally old plastic. They reminded me of a piece of still-life art moulded into the ground.

We were meeting to talk about his TB. However, during the nearly two hours we sat outside his tent, he hardly coughed, although he was visibly very ill. His hair was thinned out, and he was covered in dried sores. He complained of feeling dizzy with headaches, diarrhoea, vomiting and pains in his legs. Gustav said he left his wife and two children in Port-de-Paix because she threw him out when he became sick. I found myself wondering if he was really HIV+ and possibly the TB story was a cover. Since arriving he had been to two hospitals, Petit St Luke in Tabarre and Kings Hospital in Delmas33, but he said he did not know what was wrong with him. Although the consultations were free, patients have to pay for the test results and since he had no money he could not get the results. I asked him why he thought he had TB? “Because I am coughing and I am tired, also my chest hurts.” He had been given some medication but he didn’t know what it was and anyway it was finished and this was months ago. It was difficult to really assess what was happening. I explained to him that in Haiti everyone who has TB is also tested for HIV and asked if he had had either test. He said no, he did not think so.

As we sat and talked neighbours passed by along the narrow path between the tents. Some kept walking, others stopped to listen until asked to please move on. At one point, Mdm Taliette got up and began walking away. A while later I noticed her return with a bucket of water. She then sat down on a bench in front of the adjoining tent and proceeded to undress to her underpants and bathe herself. I watched briefly as she stared straight ahead and despite the circumstances of bathing in the public glare, there remained a dignity and a defiance in her actions. I looked at the others; no one was watching. There is no privacy in the camp. No privacy to speak, not even for a 50-year-old woman to bathe. She must do so in front of her grown son, her son-in-law, neighbours and strangers like me.

Later, Mdm Tailette returned from bathing with a smile and a photo of Gustave taken about a year ago. In the photo he is a tall, 6ft. 5in heavy-set young man, far removed from the wafer-thin, balding, aged person sitting next to me.

I was concerned that Gustave might be HIV+. I asked Gustave, his mother and brother-in-law what they were going to do as clearly he needed to see a doctor quickly. They said they wanted to go to a doctor but they had no money so they had no choice but to sit and wait. No need to wait, I thought, there is Dr Coffee!

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A few weeks earlier I had gone to meet Dr Megan Coffee, an American infectious disease specialist and a truly amazing woman. She had come to Haiti a few months after the earthquake and stayed. Dr Coffee runs a TB clinic in the grounds of the Hopital l’Universite d’Etat d’Haïti [General Hospital] in downtown PAP. Her clinic consists of three permanent tents laid out on concrete under the glaring 95° degree heat. The first tent is for in-patients, who are extremely sick and near dying of TB and/or HIV+. The middle tent, which is the smallest, is a meagre office consisting of a desk with an assortment of drugs, papers, masks etc; a second desk with more assorted bits and medical files; a camp bed behind a curtain and a wardrobe. There was also a group of four Haitian nurses who are paid by the General Hospital to assist in her clinic.  She volunteers alongside the infectious disease nurse and they survive on donations, as does the clinic. Food for patients is donated by various charities. The third tent, which is really just a piece of tarpaulin giving shade, is for outpatients and family.

This is the only dedicated TB clinic in PAP. On the day of my first visit I arrived around 11am.  There were six people crowded into the small office tent and the one fan blowing hot air did little to relieve the heat. Dr Coffee hadn’t yet arrived so I took the opportunity to speak to the other volunteer, the infectious disease nurse who had been here for a few months. As we spoke she continued to work, emptying the contents of various capsules into a mortar and mixing away. I was fascinated and wondered if this was what chemists do behind pharmacy doors or was this part of the make-shift world of healthcare in Haiti? The nurse explained she was mixing the cocktail of drugs into individual dose bags to make it easier for the patients to take. The bags were for newly discharged out-patients to take home.

Soon Dr Coffee arrived in her usual outfit of long-sleeved t-shirt, overshirt and broad-rimmed hat to protect her from the glaring sun. Patients immediately surrounded her as she spoke in an impressive accented but fluent Kreyol. Eventually with a few minutes to spare she turned her attention to me and I rushed through my interview, not wanting to take time away from very sick people.

The clinic started with just three patients and now treats 800 annually. At present she has 70 bed-patients, four of whom were near death. I asked Dr Coffee what were her biggest challenges?

“Ensuring the patients take their medication. The patients have their own challenges such as food and surviving so I have to stress the pill is their life… missing it will lead to death.”

TB patients burn excessive calories and they need a great deal of food but at the same time they don’t feel the need to eat. Even when they are eating they are still thin. This is additionally problematic when people are hungry and those coming to Dr Coffee’s free clinic are the very poor. One positive system she has managed to create is a “buddy” system where cured patients give back by returning to support sick patients. This could be by helping to exercise patients, helping to feed them or just keeping up their spirits.

Another problem is due to the poor material conditions under which patients live; they wait until they are really ill before attending the clinic, thereby reducing their chances of full recovery.
The majority of sick people I have met over the past six months have been ill for weeks or months before they went to a clinic and often pregnant women will only attend the hospital after they have gone into labour. Even when hospitals are free people are still reluctant to go for fear of being presented with a bill they cannot pay.

I told Gustave and his family about Dr Coffee. I explained she was a TB specialist and all the treatment would be 100% free. All they had to do was to get to the hospital by 10am and she would see them. I explained that he would have a TB and HIV test and then wait and see what happens. Everyone was happy with the suggestion and we said our goodbyes. The next day I learned that Gustave and Jonas had gone to the clinic but were unable to register. I frantically tweeted direct messages to Dr Coffee who responded saying they must return immediately.

This time I decided to go with them. We all met at the hospital and Gustave registered, saw Dr Coffee and had his tests.  It took a few more visits but finally he received the news that he was HIV+ but did not have TB. Now he has transferred from Dr Coffee’s clinic to the Hopital l’Universite d’Etat d’Haïti as an HIV+ patient. At one point he was going to the hospital a couple of times a week. Attending the hospital has been extremely difficult for Gustave. He is weak from the illness which is exacerbated by food insecurity and poor diet. It takes two buses to get to the hospital which costs 100 gds which is 100 less to spend on food for the family. The choice often becomes either the hospital or food to eat. One day he was so weak he collapsed on the street and Jonas had to carry him by motorcycle taxi. At this point it was hard to persuade Gustave to return to the hospital as he said he no longer cared if he died.

If Gustave was HIV+ then it was very possible his wife was also positive and possibly their three-year-old son. When I asked him whether he had told his wife, he replied she was positive and she had been taking medication even before their son was born, who is also positive.  However, he continued to insist that he did not know he, too, was HIV+.  His wife remains in Port-de-Paix so there is no way for me to follow up on her and the baby’s present health status.

Emile Charles is 16 years old and is HIV+. His whole family have died of AIDS-related illnesses. First his younger sister, then his mother and finally his father. I had seen Emile many times during my visits to the workshop at Delmas 33. He was one of the many young boys and girls who made the shoes and jewellery for the camp shop. I was told he might be HIV + and may also have TB as he was coughing a great deal. He is a thin, intense young man with a soft, gentle, inquisitive face. He doesn’t smile often but when he does, it’s like a burst of light.

Emile’s family were from Hinche in central Haiti. He is not sure but thinks he was six when his father died and he came to live with his uncle in PAP. His uncle did not allow him to play with his own children and Emile had his own food utensils. In 2008 or 2009 he became very ill and was taken to hospital where he ended up spending a year. As a minor, Emile’s uncle would have been told his status and it would be up to him to inform the child. He did not do this. After he was released from hospital he was given a patient card, medication and an appointment. But his uncle never took him back and soon after that Emile was adopted by a neighbour, Jean-Louis [Elie] Joseph who is now one of the main organisers of the Chanjem Leson movement at Camp Acra.

Elie had complained to the uncle about his treatment of Emile and in the end the uncle told him to take the boy but he did not tell Elie about Emile’s medical history. Soon after Emile moved in with Elie and his wife Esther, the earthquake happened and they all moved to Camp Acra.   Emile was constantly sick and at one point was very ill with what Elie believed was shingles. It seems that everyone involved suspected Emile was HIV+ but no one made a decision to take him for a test, the main concern being cost.
At the time I formally met Emile he had again become ill with fever and night coughs. It was at this point that the uncle, who also lives in the camp, finally told Elie that Emile’s family had all died of AIDS-related illnesses and Emile told us he had spent a year in GHESKIO hospital so it made sense for him to return there and continue his treatment. However the hospital had no record of him ever being a patient.

To understand some of the confusion — how was a six or eight-year-old child supposed to know which hospital he had attended, how long he had stayed or what medication he was given? The uncle, possibly not wanting people to know about his nephew’s status, was not forthcoming with information. Despite the decrease in HIV/AIDS and increase in awareness and prevention, there remains a high level of stigma around the illness. Eventually Emile’s guardians found out he had been in a hospital run by nuns in Delmas 18 but the uncle could not remember the name.

By this time four weeks had passed and Emile’s health was deteriorating rapidly. Soon after I received a text message from my interpreter, Serge Supre, saying he was going to Delmas 18 to try to find out the name of the hospital and to collect Emile’s records so they could treat him again or refer him to the Hopital l’Universite d’Etat d’Haïti. The hospital turned out to be run by the Sisters of Mercy of Mother Teresa fame. But it was not a good ending.

The overall context in which Gustave and Emile are trying to live with their illnesses is compounded by the general insecurity and fear in the camp itself. In April someone claiming to be the owner of the land threatened to burn down the camp unless everyone left. The following day a fire broke out in one section which everyone took as a warning. Camp residents reported the fire and threats to the police who said there was nothing they could [would] do. They then decided to protest against the threats and lack of police action during which two men were arrested and one died in custody. Chanjem Leson activists worked with the family of the deceased and reported the police in question to the Inspector General of Police. Since then they have faced daily phone threats from unknown men, including repeated night visits to their tents.

The whole camp is nervous and fearful of being evicted at any moment. Emile’s adoptive parents, Elie Joseph and Esther Pierre have gone into hiding and he is being cared for by Esther’s cousin Serge Supre. Serge is unemployed except for the little he earns from interpreting, and worries about how he will pay for his 18-year-old daughter to finish high school. Regular evictions have begun to take place around the city and each night people go to sleep wondering if this will be their last. This has also meant disruptions to the small craft and art workshop and the school.

Gustave has started ARVs and although the family is happy with his treatment they want more than anything to return to Port-de-Paix – “if we have to be hungry better to be hungry at home than in PAP!”
For the first few weeks Gustave responded positively to the medication and even planned to find work and try to visit his wife and children. However over the past two weeks he has deteriorated, becoming aggressive, removing his clothes and disappearing for days and worst of all, he has stopped taking his medication. The stress of caring for him has taken its toll on his family especially his mother for whom this is one burden too many.

Statistics tell us the numbers of people living with HIV and dying of AIDS / TB in Haiti has decreased dramatically over the past 10 years due to a policy directed at prevention based on education and increased access to treatment. But there are other realities excluded from official reports and statistics.  Gustav and Emile, and millions like them, are forced to struggle to receive the most basic healthcare. Emile has spent two months trying to get treatment and he’s still waiting. It is hard to say no one cares and even though I have followed him through the repeated hurdles and I know we, his family and his friends care, but without money and without agency people like Emile and his family are regularly treated with disdain. You attend the hospital and people don’t even look you in the face, preferring to watch TV or chat with their colleagues. People treated as “expendable non-persons”!
And Emile is doing badly. The hospital run by the Sisters of Mercy is now in Carrefour but they refused to see Emile because “his uncle gave trouble”. Serge tried to appeal to their “mercy” but in vain…

“They said they will do something for the poor but they cannot help Emile because his uncle brought trouble. I would like to know who are the poor – are we not poor, is Emile not poor and sick and a child? Something must be done for him. He cries at night and I don’t know what to do. On Monday I will return to GHESKIO and hope they will help. If not we have to go back to Dr Coffee.”

Emile didn’t get to GHESKIO. Through a “friend of a friend” he is now waiting for an appointment at Dikini hospital in Kafou where they receive HIV+ patients. I hope he finally gets the treatment he needs.

UPDATE: After visits to numerous hospitals and clinics in PAP, finally with the help of Dr Coffee, Emile finally started on ARVs at the end of September 2013.   He had fallen ill yet again and was in a very poor state and was immediately admitted to Dr Coffee’s TB clinic and placed on medication.  In total it had taken  four months since the initial visit to the hospital for Emile to receive ARVs.  Emile then spent another 4 weeks of almost daily hospital visits waiting for a pediatric and  psychology assessment that would enable him to enter a food and school programme providing him with rice, beans and oil plus school fees and text books.   By the end of October he had begun to put on weight and regain his strength.  Now we all look in awe at the new Emile who is twice the size we all thought he was.  He hopes he will start school in January

1] A. Naomi Paik “Carceral Quarantine at Guantanamo: Legacies of US Imprisonment of Haitian Refugees, 1991-1994”  published in Radical History Review Issue 15 /Winter 2013].
2] Castro, Arachu and Paul Farmer, “Infectious Disease in Haiti” EMBO Reports 2003.
[3] ARDTA – Asosyasyon Respekte Dwa Timoun – Ans Wouj [Association for the Respect for the Rights of Children]
* Not his real name!

 

This article was supported in part by the International Reporting Project.

Haiti: Liberation Ecology: Poo to compost to nutrition and sustainable living

World Toilet Day! [19th November] reports that 40% of the world’s population do not have access to toilets which is about 1 in 3 people.  Sanitation and waste disposal is a human right but like most rights, exist only on paper and in echo chambers of  election promises, UN organisations and NGOs. The consequences are sickness, death, and for women the increased risk of sexual violence and the loss of dignity in having to piss on the streets, behind parked vehicles or some small little corner of space.   The alternative is to have to hold your bladder for hours on end till either night or when somewhere private can be found which results in excruciating pain and repeated infections.  Repeatedly we hear of ‘development’ measured in the number of mobile phones in the global south particularly in Africa where we are told the growth is astronomical and bringing positive changes to  the lives of everyone.  Why not begin to measure developing and rising countries in the numbers of people who have everyday easy access to toilets and water?

The Africas are rising  and here in Haiti, which is now also open for business, the largely unregulated construction industry is booming at huge environmental costs, along with new garment factories opening every few months.  You may now have a job, albeit a low paid one, but still there is no private, safe, sanitary  place to shit.  Still there are no houses being built and there are no government plans to improve sanitation.  As I wrote in “BAYAKOU, Why I Am Talking Shit on World Water Day

 We know that in certain situations shit can kill and the poorer you are the more likely you could die of a shit related illness CHOLERA is a prime example, so shit is a poverty issue and a class issue.  We know there are issues of privacy, access to ‘toilets’ especially at night and sexual violence in unlit densely populated urban areas, so shit is also a gender issue…….

The crisis in toilets is exacerbated by the accompanying crisis in access to water both for sanitation and for consumption.   To meet both these challenges in Haiti, SOIL [Sustainable Organic Integrated Livelihoods] was formed in 2006 by Sasha Kramer and Sarah Brownell.  A small venture which began with installing compost toilets, one toilet at a time for compounds and households in Cap Haitian in the north of the country.

SOIL Poop Truck
SOIL Poop Truck

In the aftermath of the 2010 earthquake, SOIL was approached by Oxfam to build 200 toilets across the internally displaced people’s camps in Port-au-Prince.  I recently met with Sasha to discuss SOILs progress over the past three years and the move from building compost toilets to using human waste as a fertilizer and then  to full scale production  of compost for both their own small scale garden use and commercial sale.

“SOIL first began  producing compost towards the end of 2010 and since then 100,000 gallons of compost has been generated from the emergency response. The primary buyers are local nurseries, NGOs working on agricultural projects which is somewhat a false market and not necessarily a sustainable market, but a market nonetheless. Also resellers  and backyard gardeners – people who buy a few bags for their own use.

The next step after compost toilets was then to focus on  on refining our composting process, testing and trying to make the process as operationally efficient as possible.  The third year has been focusing on getting the compost back into agriculture and testing it on various crops for efficiency and then marketing and generating revenue as well as reducing cost of the whole process.

Sasha’s logic about using human waste as a fertilizer was that if she was eating nutrient rich food then surely she would produce nutrient rich poop and all that was necessary was to find a way to kill off the unwanted pathogens and  reuse the nutrients.  Although this made sense,  I was still skeptical as most human poo is produced by carnivores  which seems unsuitable,  so is there a history of recycling human waste?

Interesting there is an ancient history of using recycling human waste for agriculture and because its based on biological process on decomposition its always happened.  Before we had sanitation our waste was always naturally recycled.  In China they had this organized for over 5000 years where people would collect human waste for farming.  However they were not using a compost process and where putting it on raw which has risks due to human pathogens which can make you sick.  And now the US some 50% of human waste is recycled back onto farms and in Europe the percentage is even higher.

Like the Bayakou who are responsible for cleaning the septic tanks in Haiti, shit, poo, poop is not something we  talk about in daily conversation.  I was surprised to learn from Sasha that  human waste in the US and UK is used for farming and often used as untreated sludge and as she points out, there is considerable controversy around this process.  However this is different to composting human waste which is growing as a commercial process through heating and removing dangerous pathogens.  As far as SOIL is concerned the process of producing the compost is itself low tech and very safe.

SOIL is the largest scale operation of composting human waste outside of the US and Europe.  The interesting thing with meat and human waste is that even though people say your poop smells more if you eat meat which is probably true but if you eat meat you are probably eating more protein unless you are careful with your beans and nuts intake.  So naturally you are then excreting more nutrients so there isn’t any risk as long as the waste is heated to at least 122F for at least a week which kills all the pathogens.  Actually the poop heats itself when its mixed with sugar cane waste so all the moisture, carbon, nitrogen mix and reproduce. and naturally heats itself up.   The process takes two months for the pathogens are removed then a further 6 months till decomposition.

The next stage in SOIL’s development of human waste as as fertilizer was to carry out various tests and experiments on different crops which is still ongoing so a large part of their work could be seen as research.   SOIL also have their own gardens where they grow vegetables and some fruits.  The process of composting toilet waste is a long one and can take up to 12 months but once ready it is a fine rich black texture and proven to be effective as the photos below show.

Rich compost ready for use as fertilizer
Rich compost ready for use as fertilizer

3/4 gallon compost

3/4 gallon compost
1/4 gallon compost
1/4 gallon compost

SOIL has  now shifted its focus from building toilets which they see as the role of the government and or private entrepreneurs, to that of promoting and demonstrating the functionality and sanitary benefits of installing compost toilets. I mentioned to Sasha the experience of SOPUDEP school with their compost toilets installed by Give Love.   Due to lack of support and maintenance, last month the school decided to remove the toilets and return to traditional latrines.   The problem was with 700 children it was impossible to maintain the toilets daily and they could not afford to pay someone to do this.   Also the waste compost was stored only yards from the toilets and the kindergarten classrooms – a classic case of NGOs installing technology and then failing to follow up with support.   We both agreed that follow up and in this case collection of poo on a regular basis is essential.

SOIL is presently at a turning point in their organization as the plan is to move away from implementation towards research and in doing so recognizing that we as people are responsible for the earth and its ability to reproduce or not.

The idea is that over the next three to five years is to move from being an implementation organization to a research and consultancy organization where we will work on training people in Haiti who are interested in business opportunities in sanitation and composting.    The idea of moving from toilets to composting developed around the question how could we create a great sanitation system in Haiti that not only addresses sanitation but also begins to get all that human waste that’s polluting rivers, streams and the sea and get it back onto the soil so that it can be used to rebuild the soil that is being lost.  So how can we not only address sanitation but also livelihoods, malnutrition and so many of the problems that are really tied into the fact that we are not closing the loop we are eating all this food,  we’re stripping nutrients  from the lands, we excrete them and they go into the water instead of recycling and using them.

In addition to selling their compost to NGOs and local gardeners SOIL recently sold $30,000 of compost to Heineken [ last year they bought the Haitian beer, Prestige] who will be using it for the production of Malta as well as for research testing it on Sorghum.  Whilst SOIL has focused on urban needs and big business I was interested to know if they had been able to work with farmers in rural areas.

Compost is very tricky for small farmers living on the edge economically as its expensive to produce so in order for them to benefit it has to be subsidized from one end to the other.  Either you subsidize the production and sell it at a cheaper price or just cut your price and loose on the money.  So its a difficult situation. We have to decided that we have this quality product which we can sell to a high end market and that then makes our sanitation services cheaper so we can reach more people with sanitation.  or do we sell it at lower price which makes our sanitation more costly.

Its a tricky one. There are two ways to support small farmers. First is to train them in how to produce the compost which is the most effective and the other way is through the Heineken model where they buy it at the price and sell it or distribute to the small farmers. So either the government or big business supporting the small farmers.

Finally I asked Sasha what she felt was the relationship between SOIL’s work in sanitation, recycling,  creating compost and agriculture to the issue of preventative health in Haiti.

I’m glad you said preventative because it really is important because sanitation addresses diarrhea  diseases which are the leading cause of death of children under five and then agriculture addresses good nutrition. even in the case of mental health just the tremendous amount of stress families feel due to the medical issues they are dealing with  has to be enormous. So preventive health around physical issues also impacts on mental health.

SOIL’s success is lies in the fact they started small with one specific tasks, installing compost toilets in Cap Haitian.   They then grew according to local needs and in dialogue with the communities where they worked.  Over the years they have included the training of Haitian staff at all levels and developed an excellent understanding of the environment including WASH and the socioeconomic landscape in which they work.

This article was supported in part by the International Reporting Project.

Haiti – Feminist Series 6, In conversation with Souzen Joseph

Souzen Joseph, photo by Sokari Ekine
Souzen Joseph, photo by Sokari Ekine ©

Souzen Joseph is an independent journalist, a musician, community activist and vodou practitioner.   In addition to her job at TNH [Haitian National TV], Souzen is the host of a weekly radio show covering all aspects of health and self-care produced by the Haitian Red Cross.  She is a founding member of a Haitian women’s intergenerational collective, ‘Back to Natural’ which works to encourage women to use Haitian traditional health remedies, wear natural hair and generally promote a pride in being Haitian.  She is also a member of Fondation Felicité, a movement to promote Haitian history and culture, named after the wife of the leader of the revolution, Jean Jacques Dessalines.

In 2002 she began a career in music, initially singing at private parties then in 2010 following the earthquake along with five friends and family formed the band SALAH, which mean ‘joy Holders’.  They play a mixture of jazz, roots, soul and bossa nova.    As a vodou practitioner, Souzen’s way of living is an inclusive one which sees humanity and natural life forces at the center of our existence and

SE: Do you consider yourself a feminist and if so how do you explain your feminism, where did it come from and what does this mean in a Haitian context.

SJ: I didn’t know the word feminism, or realize when I would get mad when people talked about women.  But I think it comes from my mother because from the age of 12 I lived with her and I realized how women’s lives can be difficult when they are on their own, even when they are not it is pretty difficult.   I realized that something had to be changed and that this could be me in the future.  My feminism is not like how they define it in Haiti because it is not a fight against men.  It’s a fight to get what is my right.  Sometimes these things could be small but you realize when you grow up that even a small act can be a big thing.

SE: You mentioned that sometimes in Haiti the word ‘feminism’ or being a feminist has negative connotations?

SJ: Yes, just like a lesbian.  Before when you say you are a feminist they make generalizations.  It’s not like this now but the general population still defines feminism as a fight against men. Even some women think  this.   In Haiti, rural women do not have the same relationship with men as urban women. It is sometimes more cordial but equally unfair to women. However, the women do not quite capture  the importance of feminism and the duty to fight for their rights. And most Haitian women associations don’t act to try to understand its real definition. So that’s why I think people misunderstand the movement [feminism] and don’t get involved.

I am a feminist because I think women have rights and we have to get those rights but I don’t want to defend myself as a feminist in the way it is defined in Haiti.

SE: You mentioned earlier that life for women in rural areas is different to those in urban areas.  What is the difference in the relationship to feminism between  women in the rural and urban areas.

SJ: Women in the rural areas are more free than urban women.  This is a paradox.  Women in rural areas are the head of the family, the head of the land, the plantations.  Officially they don’t have ownership of the land but they manage it everyday, they maintain it, they do everything and the relationship with men is so different.  Men know they don’t have the right to beat the women.  Of course everywhere there is violence, but it is there is less tension in the rural areas. But women in rural areas are still victims of laws for example if they don’t marry the man they have no land ownership rights.

SE: You have a degree in communications and a freelance journalist.  You’ve worked in for MINUSTAH [UN force in Haiti] which is controversial and also you worked for TNH.  What was your experience like working for MINUSTAH given that many Haitians see them as an occupying force?

SJ: First when you are in a country where there is little employment when a job comes you have to take it.  I worked with UN civilians and had no relationship with the army.   But there was still a daily tension with the civilian staff.  Professionally they were great but in the personal relationships they were pretty bad.  A lot of people resigned and others only stayed because the salary was reasonable. In summary, there is a lot of tension and we don’t appreciate them any more.

SE: As we come to the end of 2013, what is your opinion on the continued presence of MINUSTAH in Haiti after 7 years?

SJ: We made a mistake to accept them coming to Haiti but they are already here and though we must tell them to leave promptly, but not before we reinforce our structures ourselves. So we might ask them to leave partially under our supervision by reducing their army and civilians.

SE: So are you saying that Haiti does not have enough security eg police for the UN to leave?

SJ: No, it’s not about security. Haiti is a safe country, maybe the safest country in the world.  But the UN have a lot of people working in Haiti, they have their structures in every part of the country so we have to prepare ourselves. If we want to do it in the best way for Haiti then we cannot ask them to take everything and go when we don’t have the government or the state to replace them.  But still they have to leave and Haitians have to decide.

SE: You have been presenting and producing a radio program on health and self care for the Red Cross, can you talk about the program, your role and how important the program has been and what you will be doing next?

SJ: Just to be clear, the program had already started when I came on board.  I was hired to rearrange it as professionally as I could.  When I came I had to prepare the Haitian Red Cross volunteers to be able to run the program. In the beginning it was just after the earthquake and the objective was to inform people where they could get help, clean water, distribution and so on and then came cholera.  Now it’s three years since the earthquake.  We realized that we no longer knew who were our beneficiaries because three years on, the resilience of the population is OK . We need to move on to other things though they still need information about their health, about risk management.   So now we provide information on cancer, sexual infectious diseases, breast feeding, disaster management, violence prevention and so on.

Also the purpose of the show is to increase the capacity of the Haitian Red Cross and to inform the population of what they do. No one wants to talk about the earthquake anymore so the International Red Cross is leaving and I will be leave-taking the program and they will manage it themselves.

When the program started it was on Radio ONE and more rural people called.  After 4 months it moved to Radio Caraïbes and more urban people called. But really it depends on the topic so if the program is on sexually transmitted disease you will get more women callers because they know they are more vulnerable.  If it’s about violence prevention you get equal calls. The program runs for one hour and is played twice a week and is very popular. We had a survey and discovered that people have been following it for 3 years and even ask for more time.

My next radio project is something I have been planning for three years. It’s called  “Au Feminin Pluriel”.  I realized that the program with the Haitian Red Cross was restrictive but if someone else was discussing a subject they could be more expansive.  For example we could talk about family planning but we would not mention abortion.  So in this new program there will be some difference but using the same format so that social issues and other topics are discussed.

SE: This sounds really exciting which leads to my question around your project ‘Back to Natural”

SJ: Yes,   I realized that many Haitian women are using artificial things. It’s not about make up but false hair, false nails, skin lightening.  I made a show about the skin lightening which is dangerous for us because every woman wants to have a light skin.  There are some magazines which advertise the creams which are now being used by men and women.  So we will also talk about medicine and traditional herbs.  When I was young, the tradition was that parents keep their child’s umbilical cord. At 3 or 7 years old, the parents accompany the child to bury it while planting a plantlet [tree].  At that time, the parents explain to the child the responsibility henceforth to take care of this shrub and protect it until it becomes great enough. Now, this tradition is respected in very rural areas. I did have mine at 7 years old, in Carrefour. I had a coconut tree. I did it for my daughter and I will do for my son too.

SE:  You’ve also expressed strong views on education which connects with your involvement with the Foundation Felicité.

SJ:  Felicité, is one of the most fascinating elements I have had to date.  When I first met Bayyinah Bello [the founder of Foundation Felicité] I was 22, my hair was permed like every woman in Haiti but I had a lot of questions and she was wow you have a lot of questions so let’s do it step by step.   I asked about [Haitian] history, and then I realized our history was very much linked to vodou.   When I was 22, I began to see my grandmother who died when I was 2.  I explained it to my mother and she said how could you see her when she is dead.  So when I talked to Bayyinah she said you are not so crazy and everyone in Haiti has these kind of experiences.  She helped me with this and I was told to ask my grandmother what she wants me to do.  I did and she answered me so after three months of seeing her often, Bayyinah Bello suggested I go to see someone so I can understand it better.   I did and I met the Lwa who told me they have been waiting for me for so long and he explained to me about my family.  It was something pretty impressive. He told me a lot of things about my father who was in New York and he was surprised.

I understand a lot of things now and my father was not in agreement with my choice to become a practitioner of vodou but my mother respected my choice.

Foundation Felicité was started by Bayyinah Bello and the objective is to research our history and to publish these; take care of the elders because some aspects of our history are kept by our elders who have a lot of information and to document this.   The foundation also works to maintain our culture such as the event we had to celebrate the birthday of Dessalines. To remember the importance of our culture and history.

Felicité, is the wife of Jan-Jak Dessalines, a strong woman who was much older than him. He was her third husband.   She was our first nurse.  They talk about Florence Nightingale but she was before her. She took care of the soldiers even the French soldiers. She had a strong personality and told Dessalines ‘your enemies are not mine, let me choose mine’.  Sometimes, she negotiated with Dessalines to return the French soldiers to France. She taught him to read and write as her first husband who freed her, taught her.   She had no children but adopted all of Dessalines children.   Her house remains in Dessalines ville [the first capital of Haiti called the Imperial Town] near Arbonite in the north.

In school, we do not learn any of these, they don’t tell us where Dessalines comes from, sometimes they talk about him as if he is a bad person.  The problem is our history books were written by Frères de l’Instruction Chrétienne and the point is: how can you ask someone to write your story and this person is the one you beat up!

SE:  Yes, I wondered about this for example why  Alexander Petion is included as one of the founding heroes of the revolution in the museum? And even he is the one pictured in the PetroCaribe promotion in Petion-Ville [at a recent conference in Haiti]

SJ: Pétion was not part of the revolution but I think [and some Haitians are sick of talking about this] but up till now some countries are trying to prevent Haitians knowing about their history.  Dessalines was someone extraordinary but they don’t want us to know this.  Even now they are always talking about Toussaint Louverture just because at the end they captured him and he died in their prison.  But Dessalines was killed by Pétion and they cannot say “we captured Dessalines”.

SE: So would you say there is some tension between those who want to engage with the history and those who don’t care?

SJ:  Yes. It’s about class system too. Most of our ancestors [not to say all], those who really fought for our independence were Vodou practitioners. Last week I said to my husband: “don’t you realize vodou is in fashion? Everyone is in vodou now. They have bags, shirts with ‘vèvè’ [vodou symbols]. Maybe it’s a good thing! [Laughs]

SE: Just to develop this a little, you’ve already explained  you are a vodou practitioner and although vodou was declared an official religion by President Aristide, it is still marginalized and demonized both in Haiti and beyond.   For instances blaming vodou for illnesses. Last week I watched a TV drama which was a struggle between Christianity and Vodou – of course we know who won.

SJ:  We are still marginalized but vodou practitioners are less impressed by this marginalization but we are still victims of their opinions. For example when the cholera started and they blamed it on vodou.  In many cities, they assassinated oungan and mambo [vodou priests and priestesses] because of this and it was many months before the health authorities explained where it [cholera] came from and what it was. Nobody has been punished for these murders. But they use vodou to go to the international and talk about our culture but they really don’t care.  For example everyone buys the vèvè on the bag but no one cares what its role is, why is it important.  The international are fascinated by this but that’s it.  It’s about sensationalism.

People should know that vodou is not a religion. It is a word that Haitians use to explain their relationship, the harmonization with god and our guides.

SE: Recently in Haiti there has been a change in the way Haitians relate to gays and lesbians when a christian group held a protest against homosexuality.  Two people were killed and many more beaten. What is the position of vodou on homosexuality and sexual minorities.

SJ: In vodou, and that’s why a lot of people don’t like us, we don’t judge anyone we don’t have the right to.  Usually they say when you assume yourself we don’t have the right to make a restriction for you and that’s why gay men and women they can be mambo or oungan. We don’t choose.  Vodou has the saying: Every child is a child”, even sexuality, black, white, they are children and we have to protect them.  All you have to do is have respect for the principals of life and of living with each other.   A sexworker, this is about survival, gay is about feelings, how can I then judge, it’s not that which makes a person who they are.

SE: To end I want to ask you about your life as a musician and the band SALAH

SJ: When we first started it was just for pleasure and I used to sing for pleasure. People told me I had a beautiful voice. After the earthquake we needed something to keep us strong so after three months we started again playing together. A friend in Florida brought us another guitar and microphones and we start to make noise.   People started to ask us to play and we realized we could make a band.   There is a Lwa and he told me that’s your destiny, you are going to be a singer. I was so shy but he taught me how to sing and then last year he asked me to start playing the guitar, so it’s good.  We are seven friends, father, husband, wife, brothers and friends in the band.

Additional reading suggestion for a full understanding of the relationship between Haitian history, slavery, the 1804 revolution and vodou, : Haiti, History and the Gods by Colin [Joan] Dyan

This article was supported in part by the International Reporting Project.

Haiti: Soli Medic Movement – Mobile Clinics

Make a cursory search of mobile clinics in Haiti and you will come up with thousands of results.  I searched the first three pages and found clinics operated by mainly US  faith based charities and a couple of  international medical NGOs such as International Medical Corps, the International Red Cross and  Médecins Sans Frontières (MSF) but apart from one clinic initiated by Sophia Martelly, there was no mention of any Haitian led mobile clinics.  And its not just in health related projects that Haitians are presented solely as passive receivers reliant on western donors.   Haiti is at the center of the ‘white saviour industrial complex’, especially faith based charities from the US.  I’ve always wondered about white faith groups that have no relationship with Black people in their own country, [the USA]  yet travel thousands of miles to ‘save Haitians from all manner of miseries and see them only as infantile victims!

Doctors & Nurses at the Azile Communal home for the elderly in Port-au-Prince
Volunteer doctors & nurses at the Azile Communal home for the elderly in Port-au-Prince

What I have tried to do over the past 10 months in reporting on health, education and housing,  is to present a different Haitian narrative which puts Haitians at the center as initiators, organizers and participants.  I believe I’ve achieved this through actively participating with people and organizations I’ve written about but at the same time, removing myself from the story.   This is how I met Dr Theordore Rony Brown.  I was sick, my host Rea Dol, introduced me to Dr Brown, we had a conversation about a mobile clinic in Camp Canaan organised by Rea.  I discovered Dr Brown had organized two clinics at a home for the elderly where the family at Solidarity House regularly volunteered.

 

Dr Theodore Rony Brown
Dr Theodore Rony Brown

Dr Brown  graduated from Université Quisqueya Medical School in 2010.  Initially he was a reluctant medical student having gone under parental pressure.  Nonetheless he was one of the highest performers in his class which he explained was the primary reason behind his decision to create a movement of Haitian doctors and nurses under Soli Medic Haiti – an all volunteer medical project which runs outreach and community health clinics across Haiti.

I was very fortunate to pass my exams with no problem but this was not the same for many of my friends who had to repeat and worry about how to pay their school fees.  Because of this I felt blessed and decided that I would give back to my community by volunteering my services in addition to my official paid work.

I started with a friend running  a mobile clinic at my mother’s church because there are many people who cannot pay for attending the doctor or buying medicines.   We run the clinic every two months and we are always full with hundreds of people.  The way we fund this is by giving 10% of our salary and asking our families and friends for support.  We run the clinic every two months.

Mobile clinic at Iglise Baptiste Evangelic le Messi
Mobile clinic at Iglise Baptiste Evangelic le Messi

Before that, after the earthquake I was part of a group of 26 Haitian doctors and nurses who went to Corail near Okay  for a three day mobile clinic.  We had received a letter from a local priest that they needed help after the earthquake so spoke to a local deputee who agreed to help.  We hired a car  ourselves then set up three mobile clinics in the town.

Patients waiting to see the doctors
Patients waiting to see the doctors

Another mobile clinic I have been involved with is in Limbe near  OKap at the Hospital Saint Jean. Here we were dealing with terrible motorcycle accidents as this is the main form of travel but the bikes are in bad condition.

Last week I visited the elderly home at Azil Communal to deliver some personal care and medical supplies a friend had brought over from the US.  I wasn’t sure what to expect but was impressed with the cleanliness and general organization of the home.  There are 86 residents- [45 women] ranging from mid 60s to the oldest who is over 100.  Although the residents and patients are well cared for the funding for the home provided by the local government is grossly lacking and it is only due to the dedication of the unpaid staff and volunteers like Rea Dol, Marie Anise Flaurantin and Dr Brown.  Dr Brown agreed

A   Communal
Azile Communal

They do very good work at Azil Communal but they’re short of capacity and resources.  For example the patients are elderly and many are diabetic or have high blood pressure or TB or in some cases all three of these. Yet all the patients eat the same food.  There is no funding for special diets according to the illness. This is a very bad situation but there is little that can be done without more government funding.

This is a general problem in Haiti.  The government doesn’t pay doctors and nurses on time.  Sometimes in the public hospitals and homes like Azil, there is insufficient equipment or for example, no gas for surgery.  But its not just the government to blame.  I have a complaint against the foreign NGOs who come to Haiti with expired medicine and expect us to be happy about this.   This is wrong, we need medicines but not medicines discarded by Americans.

Azile Communal
Azile Communal

**Dr Theodore Rony Brown is the Chief Practitioner for nights at a private hospital in Pernier.  He is also a consultant physician at Kay La Sante in Delmas

 

 

This article was supported in part by the International Reporting Project.

 

HIV: A silent relative

by Kopano Sibeko

“It’s amazing how the death of someone can also be a blessing” shares Thembela ‘Terra’ Dick. She walks me on a tale of how her sister, Thembi Ngubane’s memorial service was the day her life really started.
“Thembi” was an AIDS activist who was diagnosed with the Hi-virus at the age of 14, so at her memorial service I was courageous enough to speak out, because she had always motivated me to come out and be open about my sexuality and stop hiding as a “boy” she sighs .

Thembela sounds a bit skeptical I can tell by the tone of her voice, and I quiclky pick up that she doesn’t know whether to be grateful that her sister passed on or that the thought of how her life has shaped up is a bit discomforting considering how far she’s come since then. However shares with me that her speech at the service  where she officially came out about her lesbianism created an interest in Richard Mills and Jo Menel from Street Talk, a media production company that was documenting the memorial that day.

terra in Paris with TFC member_2008

Thembela Dick & Mpilo Cele during Paris visit in 2012

She utters that “they approached me and asked if I could be a Researcher for my sister’s story and they offered me training which also afforded me the chance to learn about the visual media.” She currently  holds a position as a researcher, a filmmaker, a director and she also does some editing. She stresses that she can’t do this on her own but she gets the support from her colleagues.

Terra tells me that she is a very persuasive person and that it is easy for people to trust her, so those are the traits that she uses to communicate with people of different cultures, age groups and races because StreetTalk is about stories in the township and putting people together, “I deal with two types of filming,  those are profiling and group discussions” she said.  Then she explains that in the meantime there are only covering the Western Cape. In the midst of our telephonic interview I also get an awakening that her voice is pretty gentle and akwardly convincing so it makes sense that people could easily warm up to her.

Though her life  might seem picture perfect  with her doing what she’s passionate about, but Terra  tells me that she didn’t complete her matric and she knows that one day that reality will catch up with her “I wanna go back to school, I need to know the basics of these technicalities”. She admits that she has to know how to talk and be knowledgable about what she does “I only see a future in film” she insists.

After a few minutes of silence, I ask her to tell me more about her family and where she comes from, “I was born in Gugulethu township, Cape Town, but I was raised in Queenstown in the Eastern Cape”. She tells me that she is a child of Buyiswa Komeni Mtshakazi and Mbambeleli Mtshakazi, who were not so actively involved in her childhood as she grew up with her siblings and that the absense of her mom in her life made her bitter “I refused to go for almost 3 months to see my mother, I was angry at her and after a while I discovered that she was HIV positive” she confesses.

I could easily sense her discomfortness resurface, though she assures me that she is comfortable and  transparent “it’s time we stopped hiding, we need to be there and support our family members who are HIV positive” she confesses.
Thembela also opens up to me about how the virus has become so much a part of her life “it has become a silent relative” she shares with me that five people in her immediate family are living with the virus and she encourages the society at large that they need to do away with the mentalty of not using a condom .

She tells me that she was lucky to have met Zanele Muholi who has been so supportive “Zanele has been great, though sometimes she doesn’t show how much she cares, but she does and she motivates me” she giggles. She also mentions that she’s an emotional person and all this can be too much for her  to handle at times.

Thembela Dick in F&P 151

Thembela Dick’s portrait in Faces & Phases series by Zanele Muholi (2011)

In the reality of it all it suddenly hits me that Terra featured in Muholi’s Faces & Phases and also in a 4 mins intimacy video. In the latter she was part-taking in unprotected sex, so I asked her if that is not hypocritical of her to preach that people should  use condoms while she is not, her response was “my girlfriend and I have been together for sometime now and we get tested almost every after three months and when we did that video we both knew each others statuses” she explains calmly.

I also voice out the fact that most people that don’t know the beauty of art will say that, that clip is not any different from pornography she says “sex is not a taboo and it’s also not porn especially if you’re doing it with you’re partner.”
She laughs gently as she explains to me that, that video was not even planned. She recalls that it was on Human Rights day in 2012 and Muholi took our intimacy photos for Being series which forms part of lesbian safer sex education. She photographed Terra and her lover Lithakazi Nomngcongo and she explains that they were standing, but later on pose on the mattress which heated the moment.

“I was very close to my girlfriend and it just happened, so I even forgot that Muholi was there” she laughs with excitement. She also adds that Muholi didn’t stop them so  they also didn’t care, because they were focused on what they were doing . However she tells me that Muholi asked if they wouldn’t mind if s/he exhibits their video” I asked my girlfriend, she said she doesn’t mind and I thought why not?”.

“I want to make the best of my life, this is a memory I’ve created” she adds while giggling. She slowly moves away from the topic and tells me that she is learning photography and that she is currently filming two documenataries called ‘Lesbian Love‘ and another one  called ‘Terra the Les’ it’s about her personal life telling the story about her family members who are HIV positive.

 

Haiti: Missing healthcare on the frontline of HIV

Long before 9/11 and the subsequent incarceration of hundreds of so called “terror suspects” in Guantanamo Bay, thousands of Haitian refugees fleeing the military junta in the early 1990s, were detained on the US base. Many of those were detained because they were suspected of being HIV Positive [+].

The marking of Haitians as carriers of AIDS goes back to the early 1980s when the Center for Disease Control [CDC], identified four high-risk groups, known pejoratively as the 4-H club — “homosexuals, haemophiliacs, heroin users and Haitians”.  This was the first time a disease was tied to a nationality but not the first time black bodies have been tied to racist notions of deviance and contagion and of being a threat to whiteness.  [1]

The first documented case of HIV in Haiti was from the Clinique Bon Sauveur in the Central Plateau in 1986. Within two years the clinic had introduced a programme of free testing, counselling, condoms, HIV education and prevention.  By the early 1990s 25% of admissions were related to HIV and by 1995 this had risen to 40%. Two other medical centres have been at the forefront of HIV/AIDs and TB in Haiti; the GHESKIO Centre in Port-au-Prince, a global pioneer in HIV/AIDS research and treatment, and Partners in Health, which has run an extensive preventative and treatment programme for the past 25 years.  Both must take considerable credit for the massive decrease in the HIV+ rate from 9.4% in 1993 to 1.8% in 2011, an estimated 51% of whom are women and 12% children.  Even with the disruption to treatment caused by the January 2010 earthquake the infection rate continued to decrease.

The underlying and most significant contributory factor to both the spread and death from HIV/AIDS and TB in Haiti is not lack of awareness or failure to follow medication regimes as policy officials tend to argue, but life-shortening conditions, that is the material conditions and structural violence under which people become infected.  Paul Farmer writing on Haiti describes structural violence as
……..one way of describing social arrangements that put individuals and populations in harm’s way… The arrangements are structural because they are embedded in the political and economic organization of our social world; they are violent because they cause injury to people … neither culture nor pure individual will is at fault; rather, historically given (and often economically driven) processes and forces conspire to constrain individual agency. Structural violence is visited upon all those whose social status denies them access to the fruits of scientific and social progress.[2]

After talking to dozens of patients, nurses, doctors and health officials over the past six months, I am very much aware of the violence of poverty which impacts on people in multiple ways.   Rosi-Ann, Gustave and Emile and their families are just three of millions.

I met activist and youth worker Maxo Gaspard on 31st May during a protest march against the lack of support for cholera victims and the UN’s refusal to admit responsibility.  Maxo is a former restavec and now runs ARDTA,* an organisation working with restavecs, street children and teenage sex workers. Many young girls are trafficked to the Dominican Republic and part of his work is to try to educate families in rural areas on the dangers of giving their children away, and to find homes for the girls.
One of the girls, Rosi-Ann, is 15 years old and lives in the Nazon district of Port-au-Prince [PAP]. Rosi-Ann is a child.  She is beautiful, shy and at first she feels too full of shame to speak.  We spend hours talking; the conversation is slow at first but eventually it breaks free and is interspersed with smiles and laughter as her confidence grows.

Rosi-Ann was a restavec child originally from a poor family near Les Cayes in the south of the country. When she was four her “godmother” brought her to PAP where she suffered 10 years of physical and sexual abuse. About a year ago, Rosi-Ann met another young girl who was already working the streets after her father had died and her mother threw her out. She told Rosi-Ann she should leave her godmother and join her on the streets. Now she lives in a “Chambre Garson” [room or house of men] with a 19-year-old man. She uses the room to work and gives the man some of her earnings. Rosi-Ann says she always wants to use a condom but sometimes the men are violent and beat and / or rape her. She is not HIV+ but is aware of her extreme vulnerability and the repeated vaginal infections, which are often left to fester before being treated, are a warning of what could happen.

The hope is that Maxo can first find a family to care for her and then take her back to her village to search for her family. She knows she has two older sisters but does not know if her mother is still alive as she hasn’t seen her for 10 years. Maxo had a similar experience: he was rescued by someone who came to visit the woman he was working for and ended his misery. Now he wants to do the same for Rosi-Ann. But there are thousands of young girls on the streets of Haiti’s cities and with no support from the government or NGOS, people like Maxo and his colleague Kethia, become despondent.

It’s like looking at a 10ft wall and wondering how to climb to the other side. After so many jumps no one can blame you for giving up.

IMG_0524

Gustav Renaud was born in Port de Paix in the north, not too far from Cap Haitian. He is 30 years old and came to PAP six months ago after falling ill. He lives with his mother, sister, brother-in-law and their three children in Camp Acra at Delmas 33. His mother, Gustave Taliette, was the first to move to PAP two years ago to look for work and was followed a few months later by her son-in-law, Jonas, and then his family; altogether they are seven. The family was given the tent by someone who moved out from the camp. This was better for them as there is no rent to pay. Since arriving Jonas has only managed to find a few weeks’ work here and there and much of the burden for feeding the family has fallen on Mdm Taliette, who occasionally finds work washing clothes in the city.

Like the dust in the camp, hunger is ever present in their lives. There is nothing to do except to sit and sit some more as the day passes into night. The day I first met Gustave he was sitting in front of his tent with his mother and some neighbours. On the ground in front of Gustave’s tent are a few very old dusty shoes and bags laid out for sale on a piece of equally old plastic. They reminded me of a piece of still-life art moulded into the ground.

We were meeting to talk about his TB. However, during the nearly two hours we sat outside his tent, he hardly coughed, although he was visibly very ill. His hair was thinned out, and he was covered in dried sores. He complained of feeling dizzy with headaches, diarrhoea, vomiting and pains in his legs. Gustav said he left his wife and two children in Port-de-Paix because she threw him out when he became sick. I found myself wondering if he was really HIV+ and possibly the TB story was a cover. Since arriving he had been to two hospitals, Petit St Luke in Tabarre and Kings Hospital in Delmas33, but he said he did not know what was wrong with him. Although the consultations were free, patients have to pay for the test results and since he had no money he could not get the results. I asked him why he thought he had TB? “Because I am coughing and I am tired, also my chest hurts.” He had been given some medication but he didn’t know what it was and anyway it was finished and this was months ago. It was difficult to really assess what was happening. I explained to him that in Haiti everyone who has TB is also tested for HIV and asked if he had had either test. He said no, he did not think so.

As we sat and talked neighbours passed by along the narrow path between the tents. Some kept walking, others stopped to listen until asked to please move on. At one point, Mdm Taliette got up and began walking away. A while later I noticed her return with a bucket of water. She then sat down on a bench in front of the adjoining tent and proceeded to undress to her underpants and bathe herself. I watched briefly as she stared straight ahead and despite the circumstances of bathing in the public glare, there remained a dignity and a defiance in her actions. I looked at the others; no one was watching. There is no privacy in the camp. No privacy to speak, not even for a 50-year-old woman to bathe. She must do so in front of her grown son, her son-in-law, neighbours and strangers like me.

Later, Mdm Tailette returned from bathing with a smile and a photo of Gustave taken about a year ago. In the photo he is a tall, 6ft. 5in heavy-set young man, far removed from the wafer-thin, balding, aged person sitting next to me.

I was concerned that Gustave might be HIV+. I asked Gustave, his mother and brother-in-law what they were going to do as clearly he needed to see a doctor quickly. They said they wanted to go to a doctor but they had no money so they had no choice but to sit and wait. No need to wait, I thought, there is Dr Coffee!

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A few weeks earlier I had gone to meet Dr Megan Coffee, an American infectious disease specialist and a truly amazing woman. She had come to Haiti a few months after the earthquake and stayed. Dr Coffee runs a TB clinic in the grounds of the Hopital l’Universite d’Etat d’Haïti [General Hospital] in downtown PAP. Her clinic consists of three permanent tents laid out on concrete under the glaring 95° degree heat. The first tent is for in-patients, who are extremely sick and near dying of TB and/or HIV+. The middle tent, which is the smallest, is a meagre office consisting of a desk with an assortment of drugs, papers, masks etc; a second desk with more assorted bits and medical files; a camp bed behind a curtain and a wardrobe. There was also a group of four Haitian nurses who are paid by the General Hospital to assist in her clinic.  She volunteers alongside the infectious disease nurse and they survive on donations, as does the clinic. Food for patients is donated by various charities. The third tent, which is really just a piece of tarpaulin giving shade, is for outpatients and family.

This is the only dedicated TB clinic in PAP. On the day of my first visit I arrived around 11am.  There were six people crowded into the small office tent and the one fan blowing hot air did little to relieve the heat. Dr Coffee hadn’t yet arrived so I took the opportunity to speak to the other volunteer, the infectious disease nurse who had been here for a few months. As we spoke she continued to work, emptying the contents of various capsules into a mortar and mixing away. I was fascinated and wondered if this was what chemists do behind pharmacy doors or was this part of the make-shift world of healthcare in Haiti? The nurse explained she was mixing the cocktail of drugs into individual dose bags to make it easier for the patients to take. The bags were for newly discharged out-patients to take home.

Soon Dr Coffee arrived in her usual outfit of long-sleeved t-shirt, overshirt and broad-rimmed hat to protect her from the glaring sun. Patients immediately surrounded her as she spoke in an impressive accented but fluent Kreyol. Eventually with a few minutes to spare she turned her attention to me and I rushed through my interview, not wanting to take time away from very sick people.

The clinic started with just three patients and now treats 800 annually. At present she has 70 bed-patients, four of whom were near death. I asked Dr Coffee what were her biggest challenges?

“Ensuring the patients take their medication. The patients have their own challenges such as food and surviving so I have to stress the pill is their life… missing it will lead to death.”

TB patients burn excessive calories and they need a great deal of food but at the same time they don’t feel the need to eat. Even when they are eating they are still thin. This is additionally problematic when people are hungry and those coming to Dr Coffee’s free clinic are the very poor. One positive system she has managed to create is a “buddy” system where cured patients give back by returning to support sick patients. This could be by helping to exercise patients, helping to feed them or just keeping up their spirits.

Another problem is due to the poor material conditions under which patients live; they wait until they are really ill before attending the clinic, thereby reducing their chances of full recovery.
The majority of sick people I have met over the past six months have been ill for weeks or months before they went to a clinic and often pregnant women will only attend the hospital after they have gone into labour. Even when hospitals are free people are still reluctant to go for fear of being presented with a bill they cannot pay.

I told Gustave and his family about Dr Coffee. I explained she was a TB specialist and all the treatment would be 100% free. All they had to do was to get to the hospital by 10am and she would see them. I explained that he would have a TB and HIV test and then wait and see what happens. Everyone was happy with the suggestion and we said our goodbyes. The next day I learned that Gustave and Jonas had gone to the clinic but were unable to register. I frantically tweeted direct messages to Dr Coffee who responded saying they must return immediately.

This time I decided to go with them. We all met at the hospital and Gustave registered, saw Dr Coffee and had his tests.  It took a few more visits but finally he received the news that he was HIV+ but did not have TB. Now he has transferred from Dr Coffee’s clinic to the Hopital l’Universite d’Etat d’Haïti as an HIV+ patient. At one point he was going to the hospital a couple of times a week. Attending the hospital has been extremely difficult for Gustave. He is weak from the illness which is exacerbated by food insecurity and poor diet. It takes two buses to get to the hospital which costs 100 gds which is 100 less to spend on food for the family. The choice often becomes either the hospital or food to eat. One day he was so weak he collapsed on the street and Jonas had to carry him by motorcycle taxi. At this point it was hard to persuade Gustave to return to the hospital as he said he no longer cared if he died.

If Gustave was HIV+ then it was very possible his wife was also positive and possibly their three-year-old son. When I asked him whether he had told his wife, he replied she was positive and she had been taking medication even before their son was born, who is also positive.  However, he continued to insist that he did not know he, too, was HIV+.  His wife remains in Port-de-Paix so there is no way for me to follow up on her and the baby’s present health status.

Emile Charles is 16 years old and is HIV+. His whole family have died of AIDS-related illnesses. First his younger sister, then his mother and finally his father. I had seen Emile many times during my visits to the workshop at Delmas 33. He was one of the many young boys and girls who made the shoes and jewellery for the camp shop. I was told he might be HIV + and may also have TB as he was coughing a great deal. He is a thin, intense young man with a soft, gentle, inquisitive face. He doesn’t smile often but when he does, it’s like a burst of light.

Emile’s family were from Hinche in central Haiti. He is not sure but thinks he was six when his father died and he came to live with his uncle in PAP. His uncle did not allow him to play with his own children and Emile had his own food utensils. In 2008 or 2009 he became very ill and was taken to hospital where he ended up spending a year. As a minor, Emile’s uncle would have been told his status and it would be up to him to inform the child. He did not do this. After he was released from hospital he was given a patient card, medication and an appointment. But his uncle never took him back and soon after that Emile was adopted by a neighbour, Jean-Louis [Elie] Joseph who is now one of the main organisers of the Chanjem Leson movement at Camp Acra.

Elie had complained to the uncle about his treatment of Emile and in the end the uncle told him to take the boy but he did not tell Elie about Emile’s medical history. Soon after Emile moved in with Elie and his wife Esther, the earthquake happened and they all moved to Camp Acra.   Emile was constantly sick and at one point was very ill with what Elie believed was shingles. It seems that everyone involved suspected Emile was HIV+ but no one made a decision to take him for a test, the main concern being cost.
At the time I formally met Emile he had again become ill with fever and night coughs. It was at this point that the uncle, who also lives in the camp, finally told Elie that Emile’s family had all died of AIDS-related illnesses and Emile told us he had spent a year in GHESKIO hospital so it made sense for him to return there and continue his treatment. However the hospital had no record of him ever being a patient.

To understand some of the confusion — how was a six or eight-year-old child supposed to know which hospital he had attended, how long he had stayed or what medication he was given? The uncle, possibly not wanting people to know about his nephew’s status, was not forthcoming with information. Despite the decrease in HIV/AIDS and increase in awareness and prevention, there remains a high level of stigma around the illness. Eventually Emile’s guardians found out he had been in a hospital run by nuns in Delmas 18 but the uncle could not remember the name.

By this time four weeks had passed and Emile’s health was deteriorating rapidly. Soon after I received a text message from my interpreter, Serge Supre, saying he was going to Delmas 18 to try to find out the name of the hospital and to collect Emile’s records so they could treat him again or refer him to the Hopital l’Universite d’Etat d’Haïti. The hospital turned out to be run by the Sisters of Mercy of Mother Teresa fame. But it was not a good ending.

The overall context in which Gustave and Emile are trying to live with their illnesses is compounded by the general insecurity and fear in the camp itself. In April someone claiming to be the owner of the land threatened to burn down the camp unless everyone left. The following day a fire broke out in one section which everyone took as a warning. Camp residents reported the fire and threats to the police who said there was nothing they could [would] do. They then decided to protest against the threats and lack of police action during which two men were arrested and one died in custody. Chanjem Leson activists worked with the family of the deceased and reported the police in question to the Inspector General of Police. Since then they have faced daily phone threats from unknown men, including repeated night visits to their tents.

The whole camp is nervous and fearful of being evicted at any moment. Emile’s adoptive parents, Elie Joseph and Esther Pierre have gone into hiding and he is being cared for by Esther’s cousin Serge Supre. Serge is unemployed except for the little he earns from interpreting, and worries about how he will pay for his 18-year-old daughter to finish high school. Regular evictions have begun to take place around the city and each night people go to sleep wondering if this will be their last. This has also meant disruptions to the small craft and art workshop and the school.

Gustave has started ARVs and although the family is happy with his treatment they want more than anything to return to Port-de-Paix – “if we have to be hungry better to be hungry at home than in PAP!”
For the first few weeks Gustave responded positively to the medication and even planned to find work and try to visit his wife and children. However over the past two weeks he has deteriorated, becoming aggressive, removing his clothes and disappearing for days and worst of all, he has stopped taking his medication. The stress of caring for him has taken its toll on his family especially his mother for whom this is one burden too many.

For the past month, Rosi-Ann has stopped working and is being treated for a vaginal infection whilst staying with her youth worker Kethia. The plan is for her to travel to Les Cayes with Kethia and Maxo to begin the search for her family but going home brings with it another set of problems. Recently Maxo returned two teenager sex-workers to their families in Jeremie but their families are extremely poor. Millions of Haitians, especially in rural areas, are without food and adequate shelter and the chances of the young girls staying is in the balance – will they stay and remain hungry or try to return to the city forced again to sell their precious bodies? Altogether there are nine girls waiting to return to their families.

Statistics tell us the numbers of people living with HIV and dying of AIDS / TB in Haiti has decreased dramatically over the past 10 years due to a policy directed at prevention based on education and increased access to treatment. But there are other realities excluded from official reports and statistics. Rosi-Anne, Gustav and Emile, and millions like them, are forced to struggle to receive the most basic healthcare. Emile has spent two months trying to get treatment and he’s still waiting. It is hard to say no one cares and even though I have followed him through the repeated hurdles and I know we, his family and his friends care, but without money and without agency people like Emile and his family are regularly treated with disdain. You attend the hospital and people don’t even look you in the face, preferring to watch TV or chat with their colleagues. People treated as “expendable non-persons”!
And Emile is doing badly. The hospital run by the Sisters of Mercy is now in Carrefour but they refused to see Emile because “his uncle gave trouble”. Serge tried to appeal to their “mercy” but in vain…

“They said they will do something for the poor but they cannot help Emile because his uncle brought trouble. I would like to know who are the poor – are we not poor, is Emile not poor and sick and a child? Something must be done for him. He cries at night and I don’t know what to do. On Monday I will return to GHESKIO and hope they will help. If not we have to go back to Dr Coffee.”

Emile didn’t get to GHESKIO. Through a “friend of a friend” he is now waiting for an appointment at Dikini hospital in Kafou where they receive HIV+ patients. I hope he finally gets the treatment he needs.

UPDATE: After visits to numerous hospitals and clinics in PAP, with the help of Dr Coffee, Emile finally started on ARVs at the end of September 2013. He is still very ill but we are hopeful he will be included in a special programme for orphaned children to receive food, school fees and text books.

1] A. Naomi Paik “Carceral Quarantine at Guantanamo: Legacies of US Imprisonment of Haitian Refugees, 1991-1994”  published in Radical History Review Issue 15 /Winter 2013].
2] Castro, Arachu and Paul Farmer, “Infectious Disease in Haiti” EMBO Reports 2003.
[3] ARDTA – Asosyasyon Respekte Dwa Timoun – Ans Wouj [Association for the Respect for the Rights of Children]
* I have changed the names of Emile and Rosi-Ann because they are minors.

 

This article was supported in part by the International Reporting Project.

Haiti: Occasional Musings, 18 – climbing mount Canaan with a mobile clinic

On Sunday a dream came true.   Organized by Rea Dol, women from Le Phare in Jalouzi and SOPUDEP including volunteer nurses  came together to provide the women of Canaan with their first mobile clinic. One hillside community coming to support women from another hillside community and together they climbed mount Canaan or as Jacques Roumain puts it

Today I work your field, tomorrow you work mine. Cooperation is the friendship of the poor [Masters of the Dew]

and Jean Bertrand Aristide

That [this] is the force of solidarity at work, a recognition that we are all striving towards the same goal, and that goal is to go forward, to advance, to bring into this world another way of being…………  I live in Haiti [In the Parish of the Poor]

There is no clinic in the whole of Canaan, a IDP camp of somewhere between 60,000 and 200,000 so for this group of women, members of Aide Humanitarian, Sunday was a special day.  The first tasks was registration and then on to receiving patients and handing out medication.

7 nurses attended 48 children 90% who had infections, flu and malnutrition. Of the 40  women who came, the majority had  vaginal infections and many also had eye infections from the dust plus 4 women were pregnant.  It was really an amazing day.  None of the women or children would otherwise have received treatment and even if they could have afforded to pay it would have taken them hours to reach the nearest clinic.

Over 300 women came on Sunday to attend the clinic and due to the nature of the illnesses, Rea and the other volunteers will try to return next weekend with another clinic.

Sorting out the medication in Solidarity House
Sorting out the medication in Solidarity House

 

Enough for the next few mobile clinics
Enough for the next few mobile clinics

 

Women in Canaan 1 waiting to receive treatment
Women in Canaan 1 waiting to receive treatment

 

Volunteer nurses
Volunteer nurses

 

Nurses and patients
Nurses and patients

The plan is to try to hold the mobile clinic at least once a month but though it will be a huge challenge to find ways to purchase medicines and vitamins and to sustain the clinic, I have no doubt a way will be found.  If  anyone is interested in working in solidarity with this project and wish to know, more please email me at sokari AT blacklooks DOT org.

This article was supported in part by the International Reporting Project.

Haiti: Occasional Musings – 16, Willgesta’s hole in the heart surgery

 

Recently I passed through the high security zones of Petion-Ville and Delmas on my way to Cite Soleil where policing is limited to the neighbourhood parameters. It’s very possible I was missing something and the police were hiding at the ready as the tap tap driver complained that he did not like coming to CS because there were bad people here.  Unfortunately with my limited Kreyol I could not understand the reason for his nervousness.   I had gone to visit with Dr Carroll at the  pediatric clinic at the ‘House of the Sisters’ * where he has worked for many years.  The clinic is set in a large tranquil compound with a school, a sewing training center for women and a nutrition center for underweight babies to attend with their mothers.  There are two security guards at the entrance but thankfully they are not armed.   As usual the shaded courtyard was filled with mothers, babies and toddlers. Many more  waited patiently inside in the large airy waiting room.

Lunch at the nutrition center for babies

It was already 11am and  Doktor John’s morning clinic had been running for a few hours.  I opened the door hesitantly and entered. He immediately greeted me and began to tell me about 11 month old baby Willgesta Pierre who needs hole in the heart surgery.  A previous patient, baby  Elie Joseph who at the time was living in the one of the worst camps in PAP, Aviation City  [a shameful reminder of the assault on human dignity and the failures of post earthquake humanitarianism]. Baby Elie needed similar treatment but died after his mother failed to get her passport to the Dominican Republic for the operation.   Dr Carroll described Elie’s death as a series of failures including his own

Big mistakes plus little mistakes plus big negligence plus little negligence all adds together and equals death. Just because his parents don’t know how it all works, doesn’t mean people aren’t at fault.

And we are all failing the hundreds of thousands of innocents living in the tents now. There is no urgency for the poor. There never has been.

I imagine Elie’s death was foremost in Carroll’s eyes and the need to ensure that baby Willgesta did not die through a similar set of failures.  Repairing a hole in the heart [ventricular septal defect] is just a 15 minute operation but it requires sophisticated medical technology to keep the blood pumping whilst the heart is being repaired, high medical expertise in a specialist pediatric heart surgeon, and reliable electricity, a combination not present in Haiti at this time.    Willgesta was admitted to hospital in April but needs her surgery quickly.  Already the pressure is building up around her lungs and if this continues she will need both lung and heart replacement which is not going to happen.  So now he has to sell the surgery to his local hospital in the US, find a surgeon willing to operate for free [this is the easiest of his tasks] and get visas for baby and mother all in the next few weeks.    In his words

There is absolutely no excuse for this baby to die – ZERO!

One of the biggest problem in providing appropriate and timely treatment is clinic hopping  Patients go from one clinic to the next  often without a clear knowledge of the diagnosis and or forgetting the treatment they received.   The lack of documentation is time wasting and patients are retreated for the same problems whereas with documentation the doctor would be able to see a particular patient has repeated problem and look for an underlying problem.   Willgesta is an example of this.  She has been to five clinics and all she she has to show is a bag full of payment receipts but nothing has been done for her daughter.  Now she is critical with fever and sweats and worse, possibly TB which is rampant throughout Haiti.  How does one begin to understand any of this when the struggle to pay for doctors is pitted against the struggle to eat. Three, four hours spent traveling from clinic to clinic, each time waiting in hope that someone will care enough to do something.

Earlier I mentioned the root cause of illness amongst Cite Soleil residents is structural violence – those social conditions which determine   ‘who will suffer abuse and who will be shielded from harm‘ and their discriminatory affects. [Paul Farmer**]. Lets take as one example the  cost of maintaining the 2012-13 UN occupiers which is  $648,394,000.   In contrast the World Bank just announced $70 million for maternal and child health in Haiti. We are told that 1.8 million  women, children and vulnerable families will benefit though we are not told the quality and quantity of that benefit and more importantly how much of that money will go towards operational and staff costs?    But its deeper than that as whilst any improvement in the access and use of health services is of course  a positive step, the real cause of illness in Cite Soleil and elsewhere, is due in large to living conditions and since  the World Bank money will not be used to improve these in any way,  then the programme ends up as a bandaid used to cover a bullet wound.

 

* The Rosalie Rendu Pediatric Clinic in Cite Soleil is run by the Daughters of Charity. The Daughters are Sisters of St. Vincent de Paul which

This article was supported in part by the International Reporting Project.

Haiti: Caracol, Cholera and Dignity

Evel Fanfan is a Haitian human rights lawyer and activist.  He is the co-founder of AUMOHD [Action des Unités Motivées pour une Haiti de Droits) or Action for Human Rights in Haiti founded in 2002.   Despite constant intimidation of Fanfan he continues to speak out against the worker exploitation and human rights abuses of the poor and marginalized minorities.   Presently Fanfan is a leading figure in the campaign to obtain justice for Haitian cholera victims and workers rights [ especially those in the textile sector in SONAPI ] the form of the Caracol Industrial Park – the site of a new wave of exploitation of Haitian workers under the guise of job creation and reconstruction.

SE: Lets begin by introducing yourself and your organization AUMOHD. 

EF: First let me say thank you for this interview.   I am Evel Fanfan, a lawyer, a defender of human rights promoting the rights and the dignity of the people especially the poor people who cannot pay for lawyers fees in the goal to get justice in Haiti.

I  am Co-founder of AUMOHD,  action for human rights in Haiti.  WE founded it in 2002 and our special work is to support the people and to help them understand their rights and their responsibilities in the law and how they can campaign so that everyone respects their rights and the law.  We provide free legal assistance for workers and also training and promoting human rights for people like you see here today.  Our work also includes developing a network of different groups in  civil society and our goal is to build a new society here in Haiti.  AUMOHD has created different (in Cite Soleil, Grand Ravin, Simon-Pele, Croix des Bouquets and Bainet) communities which we call the Community Council for Human Right, CHRC.

SE: What  kind of training do you provide? 

EF: Different training, legal training on what the law is, so for workers, we provide information and training on international labour laws and workers rights.  For small businesses, we help them understand their rights and how to build their business and also leadership training. We have a  mobile education car which travels throughout Port-au-Prince, in Cite Soleil, Carrefour, Delmas, Petion-Ville and here we educate on whatever is needed at the time cholera, violence against women and we will soon do some special education on elections such as what do they [elections] mean for the people and how can they get involved.

SE:  Do you see your organisation as having a political position?

EF: The status is non political.  Our politics is to help the people get a voice – to build a network, to teach and know what the law says.  We are not involved in party politics.  Its a broad politics.

SE: Yes, but  by teaching the people about their rights, voting labour laws and so on, isn’t that subversive particularly with the present government. 

EF: Our mission is to help people understand why they should vote for a candidate and who to vote for.  By that I mean we explain to the people that they need to vote for the action not because someone paid them.  For example when someone needs help we do not care about their politics – whether they are Lavalas or some other party, if people are being abused them we support them.  Thats why in 2004/5/6 a lot of people said ahaaa AUMOHD is Lavalas because we defended victims who were Lavalas.  Then the people said we are against Lavalas.  Then with Preval it was ahh they dont agree with Preval and now its the same thing ahh we do not agree with this government.

So we promote the rights of the people and if the government promote the rights of people then we support the government.

Cholera

Misthaki Pierre cries after the burial of his mother, Serette Pierre, who died of cholera October 29, 2010 in Back D’ Aguin, Haiti. Her death has left Misthaki without a mother and father, one of the thousands of orphans from cholera. (Spencer Platt/Getty Images) #

SE:  I would like to move on to Cholera. The situation now is that the UN has refused to receive the law suit.  Where do you go from here? 

EF: First AUMOHD was not really involved with the original suit. That was BAI [Bureau des Avocats Internationaux ] and others. But we agreed with them that we needed to do something.  I discussed with Mario Joseph of BAI that the first suit was to ask the UN to agree they introduced cholera to Haiti and they must pay compensation to the victims. That was the first step. The UN have now said they will give $2 billion to eliminate cholera in Haiti. Thats a lot of money but they said this money is not for victims but to eliminate the cholera and we know they can collect this money and give it to large NGOs who will spend the money.

SE: It seems this is yet another opportunity for the water and sanitation NGOs and the private sector to make a great deal of money from Haiti.

EF: Exactly that is why we will try to oppose this through out campaign and explain to them that if they want to give money to Haiti to address this problem then we will show them the way.  You know that more than 8,000 people have died and lot of children have been left orphans.   It is a huge problem that cholera has given to the Haitian people and this is why we say cholera is a crime against Haitian humanity.  Another crime is when the UN refused to admit they introduced cholera into Haiti.  So we need to do something for the dignity of the people  because one thing we do not want to do is blame the people who introduced cholera directly into Haiti,  that is the UN soldiers.  This is not our goal. The UN is supposed to ensure that the soldiers they deploy are in good health.

SE:  Could you explain for readers why you consider  the state of Haiti also culpable in introducing cholera. 

EF: Generally the state is supposed to be sure that in the contract between the UN and Haiti,  the soldiers [staff] are in good health  and if not, the government is supposed to say no these people cannot enter. The government of Haiti have the responsibility to refuse any UN soldier or official who they think is ill or has some other problem.

SE:  So the government has also been negligent?   What was their response? 

EF:  You have to understand this government is not the state.  There is a difference between the state and the government and we are suing the Haitian state which is permanent. This government is just a temporary guardian of the state.  The present government is comfortable with the international NGOs and agrees with all the actions of these people, they do not want to clarify, by legal process, who is responsible.

SE: But hasn’t the Haitian government always been in this position of subservience to the US since the occupation?

EF: Yes historically we are supposed to be a strong people, it is really difficult to see that because of the way our government accepts anything.

SE: What are the next steps in the cholera campaign.

EF: Right now the UN has refused to accept responsibility so we need to go to the second step,  which is to go to the international or regional courts to get a redress against the UN. We are working with different civil society organizations to see how we can mobilize against the way things are going with cholera.  We want to show them how to eliminate cholera and to compensate the victims.

SE: Two things – first of all there are the damages payable to the relatives of the  dead, then there is the question of how to stop the spread of cholera which requires changes in the water and sanitation.  What kind of programme would you like to see to eliminate cholera?  

EF:  For us the first thing we want from the UN and the Haitian state is to have the participation of  Haitians in this programme especially those from  the areas where there is cholera and those who are affected. We want something that is clear, that has a structure for clean water.   A programme that includes the victims and where Haitians are able to monitor how the money is spent. We want to divide how the money is spent:  50% by the state,  25% by NGOs and 25% by the grassroots organizations.

Caracaol 

SE: I would like to move to workers rights.  Since the earthquake we have seen disaster capitalism at work in Haiti with the introduction of factories which under the guise of reconstruction, use Haiti as a place of cheap labour.  For example I just read a news report that Clintons next venture is agribusiness and the setting up of coffee plantations. I wonder what this means for Haitian farmers?   There is now a free trade zone where corporations pay no tax and workers are paid $3 per hour. 

EF: Let me introduce this policy of the international corporations who want to come to Haiti. Its  like in 1791 when we had slaves, we gave the work to the people but they worked as slaves.  Now its the same. We want to give a lot of jobs in Haiti so the question is what kind of jobs?  With the textile industry we understand there is an increase in this sector because of the cheap labour costs and abuse of workers rights.  Its a similar exploitation but its also a big dilemma because we have a lot of people who want jobs and we have these kinds of cheap labour jobs.   So people have little choice but to work.  You cannot say don’t work when a person has no job.

Now we are at a point where we can try to change our situation because with $3 a day its terrible.  People are supposed to pay for food, transport, school everything – its really difficult so we need to ask what do these corporations and organizations especially USAID mean when they want to provide jobs in Haiti?  We say, AUMOHD says,  we need decent jobs. The problem is not really the amount but what people have to do with the money.  It’s not possible and people are working for the USA .

Another problem with Caracol is they used agricultural land and this was a big mistake.  They could  have used other land so I try to understand why they used the agricultural land which could be used for farming?

Another thing is they said they will build houses for the workers, but if you go there you will see the kind of houses they built and how much money they said they spent for building these houses.  I call them tombs because they are  really really small.  These people need to review the way they work in Haiti.  I would also add that Haitians in the US need to put their hands together and understand  that we need to work together, to think of another way to develop Haiti, not this way.

SE:  Are you trying to negotiate with some of the companies?

EF:  Right now we are trying to organize the workers so they understand what the project means for them,  now and in future; what will this area look like.  Because think of it, HASCO gave us Cite Soleil, is that what we want?  We  have to explain these things to the workers so they can empower themselves.  [Cite soleil was originally built by Hasco to house sugar workers in what was known as an Export processing zone - very similar in concept to Caracol]

We have Cite Soleil today and the same thing will happen in Caracol in 10 years so thats why we need to help the workers.  The best thing is to put pressure on the companies that if they want to be positive we cannot continue to pay people  $3 a day like before.

SE:  Is it not also possible to put pressure on the Haitian government to provide fairer tax policies for these corporations who pay nothing? 

EF:  We are now in a system of domination and I don’t think the Haitian government can do anything about this.

Sexual Violence and Sexual Minorities. 

There has been much discussion and media reports on violence against women, sexual violence especially since the earthquake.  Recently BAI reported an increase in the number of successful prosecutions of rapists.  In addition Haiti is poised to make changes in its penal code which will make it easier to prosecute rapists.  However I am interested to know your thoughts on how effective the new laws will be in really making it easier for women to report rape.

EF: We need to educate women on the law itself and on how to use it to their advantage.  Another thing is we need to provide the capacity and possibility to do that.  So we need to provide lawyers who can support them and attend court on their behalf.  But still education is the most important, for example in cases of sexual harassment.  In some cases the perpetrators themselves do not know what they are doing that is harassment.  So we need a campaign of education which is for the community so everyone is clear on what is rape, what is sexual violence because at this moment it is not always clear.   Also one reason women are afraid to report rape,  especially by a neighbour,  is that they need to be sure that something will be done. So we need a good strong structure for example they don’t have to go to the police alone but with a lawyer.

SE: What is the law on sex workers and with regards LGBTI people which is not altogether clear.

EF:  Here too more education is needed but there also there needs to be a judicial review on sex workers.   But really the problem is the same,  people not understanding their rights.  For example homosexual rights, we are in a culture where homosexuality is not accepted.  We need to take the time to understand this situation.  I recently had a meeting with a gay activist and I explained to him that we need to go to slow with this issue.  Here in Haiti you cannot even go into a church with a tattoo people will say you are the devil.  In some churches women cannot wear pants, its something terrible.   So now people come from the US with tattoos and the society tries to accept these new ways.  The same thing with homosexuality;  the international situation is one thing and here the law doesn’t even recognise it.  The culture influences the law and since homosexuality is not in the peoples perception, then we have to think of [a solution] it in a different way.

Movement Building 

SE : When we first met you mentioned a desire to build a movement which suggests a particular political positioning and one that might clash with your professed neutrality as a human rights lawyer? 

EF: I resolve this problem through justice.   For example politically I can have a view such as for Lavalas but as a human rights defender I have no view other than to seek justice.

The problem is the influence of my citizenship on my human rights position and I solve this through justice.  For example, when this government agrees to send children to school,  I say bravo but when they spend our money traveling the world I say no, you need to stop this. When they agree to reduce the number of people in the jail I say yes, this is a good thing but when they arrest members of congress, I say no you cannot do that. So when they decided to arrest Aristide, I said OK let me see the case you have. If I see they have proof and evidence then go ahead and arrest him but if not then leave him alone. And not just for Aristide but for everyone, even Jean-Claude Duvalier.

I was asked to take a case against Duvalier  but  we have to be careful because if we take these cases then we need to be prepared to collect all the evidence, bring in all the people and to build a proper case.  If this happens,  then I will be there, because I do not want to begin this process if we are not going to be able to build a strong and clear case.

People have to make a commitment. Right now we have to send a sign to the people that we need to change the way we are doing things in Haiti.  People need to know where they want to go and what result they want.  Also how will this benefit Haiti?  If the prosecution of Duvalier will help Haiti then we must go ahead but if it will divide us more then I don’t want this.

Right now we cannot get a good judgement against Duvalier because they [Duvalier and the elite] control the justice system. And thats why I advise people [who want to go to court over Duvalier] that we need to have a structure that everyone agrees  that these crimes committed by Duvalier were terrible and we cannot accept this ever happening again.

This article was supported in part by the International Reporting Project.

Haiti: No Doctor Available

In writing this piece I searched the internet for definitions of ‘access’ and came up with a range of gobbledygook that really says nothing.  So I came up with my own simple definition in relation to healthcare for poor and low income women.    It has to be free or minimal cost;  it has to be located in the neighbourhood; it must be  community focused;  it has to provide a range of services;  it has to have a referral system for specialist care which is also free and or minimal cost; it has to be welcoming and patient orientated;  it has to provide primary health care including education on reproductive health, sexual health, maternal health, nutrition and mental health support.

Unfortunately this is an ideal which probably doesn’t exist anywhere in the global south with the exception of the two pariahs of global capitalism, Cuba and Venezuela. It isn’t that Haiti is exceptional, its most certainly is not.   According to a recent Ted X talk quoted in ThoughtLeader,  – one new born baby dies every 10 seconds which is 10,000 babies a day. Every day some 800 women die in pregnancy or giving birth and 10 million a year, suffer from injury and or infection.  It’s the normalcy of death at the time of birth for women in Haiti and elsewhere which is most shocking.

Contrary to some media reports Haiti is far from being on the road to recovery.  Stories of camps being shut down, people being rehoused, factories opening, and a general air of what the President calls ‘Open for Business” are greatly exaggerated.  Behind the new factories there is a struggle for fair wages,  decent accommodation and healthcare.  There are struggles for compensation for land seized as people are left destitute without a means to make a living.  Cholera remains an emergency whilst the level of healthcare provision decreasing.

No amount of paintwork and covering of the structural and systemic cracks can hide the truth.  Over the past few months I have spoken to dozens of people, visited clinics and hospitals, observed patient / doctor visits, witnessed medical crisis and listened to the stories  told to me  by nurses, community organizers, and patients, most of whom are from the community of Jalouzi and Camp Acra in Delmas 33, as well as Haitian health officials and staff of Medicines Sans Frontier [MSF]

Jalouzi is a hillside neighborhood of about 200,000 people overlooking lower Petion-Ville.  Although it was not damaged by the earthquake many of the residents were still affected from being in other areas of the city in those moments.  It is accessible from two roads, one at the top and one below.  The view from the top is stunning. From here you can see  Port-au-Prince [PAP]looking east to the sea and north to the mountains.  You can also see clearly the newly built Clinton Oasis luxury hotel and of course those guests in rooms facing the mountain can see Jalouzi.   Jalouzi is one of those cracks which must be painted over and I am told this is being done through the curtesy of one of the newly opened Petion-Ville supermarkets who it is rumoured are painting the hillside houses.  The government may not feel it imperative to provide healthcare for the the poor but it is prudent to paint their houses, so at least from a distance, everything looks oh so quaint.

The only way to travel  through Jalouzi is by foot through a series of alley ways and narrow paths of gravel, stones or the occasional step, and for those like myself who are challenged by gravel and stones on slopes, difficult to negotiate.  The promised building of new steps has begun but is proving a slow process.  I am with Flaurantin Marie Anise, a community activist and founder of Le Phare [the light] which works with the most vulnerable women in the neighbourhood.  We had driven to the top so she could she could walk me down the hillside neighbourhood.  Flaurantin lives midway, where in addition to her home she has a small meeting room and clinic for dispensing over the counter medication.  She also runs a kiosk on the lower Jalouzi road and is the Jalouzi coordinator for Fam SOPUDEP an Aksyon [FASA]. 

It took us over an hour to walk down the hillside, largely due to my constant stumbles and fear of breaking a limb or two and needing rest periods from the associated anxiety.  Once down we had another 20 minutes walk to the FASA shop where we relaxed with sodas and warm bread.

There are no clinics in Jalouzi and the nearest truly free hospitals, are between 1 and 2 hours away by public transport and foot.   The nearest emergency maternity center is the Centre de Référence en Urgences Obstétricales (CRUO) run by MSF [1].    Most babies in Jalouzi are delivered either by the 150 Matwons living in the neighbourhood or women like Flaurantin who have no formal training but are regularly called to help with childbirth and other medical emergencies.  As we sat and discussed the difficulties of negotiating the hillside in a medical emergency we heard a commotion outside on the street and seconds later two men rushed into the shop carrying a pregnant woman.  Flaurantin immediately ushered them to the rear and brought out a stretcher for the woman who looked in her 50s and  appeared weak and confused.   She made no sound as if her body did not have the energy even to cry out.  Her breasts which should have been heavy were soft and clung to her chest.   A large sheet was found to provide some privacy as Flaurantin eased on  rubber gloves and proceeded to examine her.  She determined she had a few hours to go so it was decided to try to get her to the MSF CRUO hospital in Delmas 33. This required her being carried up a steep path, then across Petion-Ville into a tap tap taxi for a journey of about 40 minutes, then a further tap tap before reaching the MSF hospital.  She was lucky, her child, a boy was delivered safely and the two are now back home.

Everyone I have spoken to in PAP on health issues always mentions and speaks highly of MSF so I decided to visit the CRUO at Delmas 33 which opened two years ago. The hospital, a free emergency referral center for the whole of  PAP, admits  pregnant women who are “gravely ill’.   The MSF maternity project has a six year history which began in at the Maternity Judan Hospital in Delmas 18 and was open to any pregnant woman who was sick.  This was the first truly free hospital in PAP.  Although public hospitals are designated as free, in reality patients have to pay for medication, drips, sometimes even gloves and consultation.

“Before being admitted the hospital will present you with a list of things you have to buy but sometimes you buy everything but they don’t give you what you bought. For example there is a hospital ‘Community hospital’ which is cheaper than a private hospital but this hospital is very expensive. When you arrive they give you a prescription which you pay for but you never see all the drugs.   I was very upset as my brother was sick and I paid a lot of money but I don’t know what they did with the money I paid. “ [Resident]

Because the MSF was free, women from all over the city were attending the clinics and eventually they had to introduce specific criteria for admissions. They also moved to a new larger location near the airport which was called ‘Lopital Solidarity ‘.  The earthquake destroyed the hospital and two years ago  they moved to their present location where they only receive pregnant women who are in ill with complications like Eclampsia which is extremely common.

The nurses and women in Jalouzi had explained that Eclampsia was probably the most common pre-natal complication, an acute life-threatening illness which in its final stages causes convulsions followed by death.  Eclampsia develops from untreated high blood pressure, and is entirely preventable with proper pre-natal care.   Because of costs and other poverty related access problems including a lack of education on what services are available and where, many women do not attend pre-natal clinics therefore  illnesses including hypertension cannot be detected.  With poor nutrition, hunger, lack of clean water and repeated pregnancies due to marital rape,  lack of access to healthcare information, pregnancy becomes a life threatening condition.  But as one resident explained, everyone in Jalouzi is living in a life threatening environment as there is no emergency service.

“Last Saturday a neighbour of mine died.  She had an asthma attack but we could not find a way to bring her to a hospital.  I have been traumatized this past three days as this woman died in my presence because there is not even a clinic here. There is no emergency service here.  These kinds of emergency deaths are happening all the time.

Even now across the street there is a woman who is in a bad condition vomiting and we do not know what we can do. ” [Pastor Remy]

There is an emergency ambulance service operating in PAP [115/116] and some of the women had tried using it but never managed to get a response and even if they did they still had to get up or down the hill without proper steps and pathways.  Flaurantin explains one response from a doctor and from 116.

“ A woman was near to delivery and I called the doctor. He told me to give the woman Buscopan but I could not.  So I called the emergency 611 but they said they were in Carrefour and could not come now.   I managed to find some people to carry the woman up the hill and we took a tap tap to MSF CURO at Delmas 33.   The service is a good idea but there is not enough, they need more before they can call it a service for PAP. When we arrived the doctors told us the woman was very sick with high blood pressure and eclampsia. ”

As I understand it Buscopan is a drug to reduce muscle spasms of the gastrointestinal tract and according to my google search not recommended for pregnant women.  A strange medication to suggest to a woman in labour and disturbing disregard for patients.

The reliance on CURO and MSF  across the city was enormous.  The MSF manager of CURO* explained that the capacity in the public health system did not extend to  more complicated illnesses which is where MSF is now focused.  Nonetheless he admitted that it was not always easy in an extreme situation to define ‘emergency’.   The risk factors designated as emergency complications by MSF ranged from  multiple partners [increasing risks of STIs], poverty [poor nutrition and food security],  and age related risks, that is girls under 16 who were rape victims and are referred by MSF France which runs a programme to support rape victims in Cite Soleil.  And cholera remains a significant health issue so much so that MSF has a dedicated cholera facility at the emergency center as well as a separate hospital.  On a positive note MSF is predominantly staffed by Haitian doctors, nurses as well as auxiliary staff and most importantly is staffed 24 hours a day.   The day I visited there were three sets of tiny premature twins who were being cared for under a system called “Kango” where the baby is placed skin to skin on the mother’s stomach.  The very premature babies were in incubators and their mothers were allowed to stay until they reached full term weight which could be as long as three months.  On average they deliver 600 ‘at most risk’ babies per month.

In addition to  the risk factors mentioned by MSF,  women complained that quite often there were no doctors available in the public hospitals, a fact supported by a health official I spoke with.

“Sometimes there are no doctors or they have no medicine or there is no electricity. Sometimes it is all of these.” [Anon official]

Another pediatrician described the General Hospital and other public hospitals  as ‘very sick’ often decrepit with no anesthesia, no ER and no supervision.  Both Rea Dol and Flaurantin Ansie spoke of their experiences of being turned away from hospital during labour because there was no doctor.  Flaurantin explains as follows

“ I took a pregnant woman to one of the hospitals the Ministry of Health said we can use free of charge. When we arrived, the hospital told us we have to pay 4,500 goudes and if it is a complicated birth then it’s 10,000 goudes.  I told them they are thieves because it is supposed to be free for poor women.   I then took the lady to Petit Frere near Tabarre where she gave birth.”

“In another case a woman had a breech baby but by the time I arrived the baby had died.  I was not able to deliver the baby so I took the woman to the hospital.  They said there was no doctor.  I went to another hospital and again I was told no doctor.  I then took the lady and laid her on the street and covered her.  She was in labour even though the child was dead.  I stood up on the street and said who will help this woman.  I blocked a passing car and asked the driver, a man to  look  at this woman.   So he drove us to Delmas 18 MSF where they accepted the woman and gave her the treatment she needed. “

Another woman reported going to five hospitals when she was ready to deliver and being repeatedly refused until she found one that was willing and able to accept her.  Women also reported that many private hospitals refuse emergency patients if they cannot pay and in one instance a woman was turned away because she was short of 100gdes and later died.   The family sued and the hospital ended up having to pay US$36,000 in compensation.

MSF is not the only medical NGO used by Jalouzi residents. St Luc and Petit Frere et Soeur in Tabarre are also free but are even further away than the MSF facility.   However many of the faith based hospitals have come under threat as the Haitian government makes it more and more costly for them to operate by for example having to pay astronomical sums for importation of drugs and other medical equipment.  Some of the nurses I spoke with said their salaries had already been cut by  as much as 19% and there were threats of redundancies in nursing and administrative staff plus a reduction of beds in some of the hospitals.

Because these are the only entirely free hospitals and generally with good care, they are over subscribed serving hundreds of thousands. Any reduction in services would entirely undermine the already inadequate health service for the majority of PAP residents.

As one health official put it to me – for the rich, Miami can as well be included as part of Haiti’s healthcare provision.  The time it takes to fly to Miami International and drive to Memorial Hospital is probably less than the average waiting time of between 5 and 7 hours at any of the free hospitals.  But for most other people just getting to hospital is physically exhausting not to mention being sick at the same time.

[1] In PAP, MSF has the following medical centers in addition to CRUO;  2 MSF general emergency hospitals,  1 emergency stabilization center and 1 emergency Cholera response.

Interviews conducted with nurses from various public, private and faith based hospitals in PAP.  The nurses wished to remain anonymous.

This article was supported in part by the International Reporting Project.

BAYAKOU: – Why I’m talking shit & cholera on World Water Day*

We are born, we eat, we shit. And so it continues till at the end we  pass on. We talk about birth, about maternal health, choices we have or don’t have on birthing methods, on reproductive rights.  We most definitely talk a great deal about food which if you stand on most streets and look around, seems to be in abundance even though in Haiti and other parts of the global south, millions,  are food insecure, an easy to manage way of saying at risk of  death from hunger.

The Silence

But when it comes to shit, there is silence.  Where does it go, how is it removed, what happens to it.  In this instance I am talking about Haitian shit but shit is shit as they say. The only difference from country to country is what happens to it after we have, at least metaphorically, flushed the toilet.  I don’t know where Haiti falls in the hierarchy of shit management, say compared to my own country Nigeria which I don’t think  is that great.  I suspect that most of the global south remains challenged by  sanitation as well as food and water.

We know that in certain situations shit can kill and the poorer you are the more likely you could die of a shit related illness CHOLERA is a prime example, so shit is a poverty issue and a class issue.  We know there are issues of privacy, access to ‘toilets’ especially at night and sexual violence in unlit densely populated urban areas, so shit is also a gender issue. We know that some people risk physical violence or are refused entry into toilets such as a proposed ban in Arizona where transgender people would not have the rights to choose the toilet of their choice so shit is also a transgender issue. With shit playing such a prominent part in our lives, why is what happens to it so mysterious?

In 2009  DINEPA [1] was created to take control of the management of water and sanitation in Haiti.  Prior to that, the management of water  was minimal with little regulation.  Various initiatives had been created in the past such as  CAMEP, set up by Francois Duvalier in the 1960s and much later the neighbourhood water committees created during President Jean-Bertrand’s first presidency.  Sanitation management though was close to zero.  The earthquake changed everything though not for everyone!  There are still only 6 people to service the sanitation needs of 10 million people. Seriously how is that possible?

2010 Earthquake

The earthquake changed everything because at that point water and sanitation became a crisis issue which was again taken to another level with the October 2010 outbreak of cholera.  The cholera outbreak  has now been proved to be a direct result of  cholera infected shit from a UN camp being introduced into the Artibonite River which is a source of water for thousands who live in the area.  8,000 people have died from Cholera – a shit and water related bacterial infection. Thousands of children were made orphans during the earthquake and more thousands have been orphaned through cholera.  Families left destitute as the main breadwinner has died from cholera.  Shit kills!

Since the 2010 earthquake the role of DINEPA has become more crucial as it forms a major part in the management of the prevention of cholera and other illness.  This is done through its camp monitoring work consisting of : Data collection – information gathering of water, sanitation and hygiene; municipal coordination mechanism which analyses data – water supplies, number of working toilets, desludging [nice word for shit removal].  All of these are crucial in a country with a cholera epidemic that could get out of control at any given moment particularly as the rains begin next month.  The danger was put to me by Oliver Schulz of MSF

 “My personal fear is that things will get worse before they get better.  The structures are weaker today than in 2011/2012.   Every year the structures deteriorate.  There is no plan for cholera and without a WHO supported comprehensive national health care plan with clear directives, clear action plans and milestones then it will not get better. Also many of the big agencies have left and there are too many unknown NGOs, charities and faith groups”

Crisis of Cholera

At this moment, cholera is a crisis.  Access to clean water is a crisis and sanitation levels are a crisis.  The refusal to see these as crisis is a major contribution to the crisis itself.  Despite these crises the United Nations which has refused to receive the claims of Haitian cholera victims for compensation claiming immunity  under the UN’s 1946 Convention is suggesting that 99% of the cholera elimination programme  be funded by the private sector.  Read Haitians will have to pay and pay hard for clean water and sanitation. As one official said to me, private companies are always ready to cut corners for profit so you cannot trust them.    The Haitian government and its partners in exploitation – The Clintons, USAID, Canada, France, Corporations,  have two solutions for Haiti and neither have the interest of the popular masses who make up 80% of the population.  The first is charity which is invariably unsustainable and merely papering the gaps.  The second is to privatize Haiti so even the supply of water becomes an opportunity to profit from earthquakes and disease.

Removing the shit

To return to the shit situation, there are two ways of desludging, mechanical and manual.  The former uses a truck with a pump which extracts the shit from the septic tank which if you can afford it, is made of blocks and cement.  This is the system I grew up with in Nigeria and remains the way it is done.  The shit is then removed  but no one ever  talks about where the shit goes.   In Haiti the mechanized method is also used in the camps. In Port-au-Prince [PAP] the pumped  shit is taken to one of two newly built treatment plants.  The plants provide 500 cubic meters for 500,000 people which means the two plants are only meeting treatment needs of 1/3rd of PAP’s population.   Although the camps have the benefit of a mechanized system the rest of the city does not.  And here lies one of the problems. The post earthquake crisis has meant the focus for water provision and sanitation [as well as rape and other forms of sexual violence] has been concentrated on the camps leaving millions living in poor neighbourhood with minimal or no support.

However the majority of desludging is done manually in the depth of the night by BAYAKOU  - men who literally stand in the pits and remove the shit.   Unfortunately rather than get respect for doing the worst job imaginable,  Bayakou’s are stigmatized which might be why they work at night.  Once exposed, they are often victims of violence so very often they live secret double  lives.  Bayakou’s  do not live long.  Imagine you are in the pit and cut yourself, the wound soon becomes infected plus your liver is compromised after regularly drowning yourself in alcohol to remove the smell and taste.  BAYAKOU are unregulated and no one asks where the shit goes.   The government has been trying to formalize manual desludging and provide the men with proper protective clothing and regulate the disposal and to some extent this has been started in the Cap.  But when there is so much anti-shit bias where no one wants to discuss any aspect of shit management, it is a slow process.

SHIT is the dark side of life, and until it is cool to brag about how my shit is removed and treated or recycled and used for compost or we begin to look at shit as a health issue, change will be slow.  Along with access to clean affordable drinking water, management of shit are central to healthcare and the prevention of cholera.

The Last Word – The UN is responsible for Cholera

The NGOs and International aid agencies came and now most of them have left.  Many of those that remain are scaling down their services of water, sanitation, healthcare provision.   DINEPA itself is now sure how long it will be fully funded and inevitably something or someone will loose and it wont be the UN or the private sector.  To quote Oliver Schulz again there is simply no plan.

In the hope of obtaining justice and reparations for the thousands of cholera victims, the Bureau des Avo­cats Inter­na­tionaux [BAI] and Institute for Justice and Democracy in Haiti [IJDH] filed a groundbreaking suit against the UN on behalf of 5,000 cholera victims.  In addition to insisting on accountability the suit  demands that the UN

  • Install a national water and sanitation system that will control the epidemic;
  • Compensate for individual victims of cholera for their losses; and
  • Issue a public apology from the United Nations for its wrongful acts.
After the demands were dismissed by the UN Haitian Civil Society will proceed with their campaign to for the UN to meet their demands.   In a joint action CSOs, released the following press statement on Cholera in Haiti in which they  demanded the UN pay reparations for the 8,000 dead; demanded the UN / MINUSTAH admits to its responsibility in introducing Cholera;  develop a sustainable programme with consultation from the population for elimination of cholera; Present an apology to the Haitian people worthy of  the greatness and pride of the First Independent Black Republic in the free world

Par devant cette situation inacceptable, nous, AUMOHD, Erzili DLO, BAI, Batay Ouvriye, SOFEJH, CCDH, FEHATRAP et des d’Organisations de la Société Civile, des Organisations populaires, des Organisations des victimes comptons lancer un appel à la mobilisation générale et de faite lançons un appel patriotique, humanitaire et de dignité au nom du PEUPLE Haïtien à l’ensemble de la population mondiale pour :

1.- Forcer aux autorités Onusiennes/MINUSTAH de RECONNAITRE leur faute relative au cholera en Haïti.

2.- Réparer dignement les 8.000 victimes et autres

3.- Eradiquer de manière réaliste avec la participation citoyenne l’épidémie du cholera en Haïti

4.- Présenter au Peuple Haïtien des excuses dignes de sa grandeur et de sa fierté de la Première République Nègre libre et Indépendante du monde.

There will be a protest march to  the UN / MINUSTAH headquarters at 10am – starting at ‘Carrefour l’Aéroport to the l’Aéroport route and UN HQ.

 

 

[1] National Directorate for Water Supply and Sanitation in the Ministry of Public Works

*The blog post is based on a series of conversations over the past two months with MSF staff, human rights lawyer, water and sanitation official, camp and neighbourhood residents.  The conversations are ongoing.

This article was supported in part by the International Reporting Project.

Haiti – Cholera still an emergency issue

From Medecins Sans Frontieres (MSF) a report on the deplorable condition of cholera related healthcare in four departments in Haiti.   Part of the problem is that increasingly over the past 18 months cholera has been downgraded to a ‘development’ issue rather than an emergency one.  However as the report states there has been an  increase in mortality rates  in part of the country of 4%  towards the end of 2012.  Another factor which has the potential to exacerbate the cholera situation is the downsizing of DINEPA staff responsible for all aspects of monitoring water and sanitation in the ‘official’ camps.

A lack of funds and supplies has crippled cholera treatment programs in Haiti, leading to unnecessary deaths and increasing the risk of greater outbreaks during the upcoming rainy season, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

In recent evaluations of public health facilities in four Haitian departments–Artibonite, Nippes, Southeast, and North–MSF found that the quality of cholera treatment declined significantly in the last year due to funding shortfalls.

“Some of the staff at the cholera treatment centers have not been paid for several months,” said Dr. Mamady Traoré, MSF deputy medical coordinator, who participated in the Artibonite assessment in late December 2012. “Infrastructure and equipment are worn out because they haven’t been maintained and there are frequent shortages of medical supplies. As a result, hygiene precautions that are essential to limiting the spread of the disease are no longer enforced. Sometimes patients are left without treatment or must pay to obtain it. That is intolerable.”

Cholera-related mortality has risen since late 2012 in Haiti’s North Department. “The mortality rate exceeds 4 percent in certain treatment centers–this is four times the acceptable rate,” said Joan Arnan, who was in charge of the evaluation. “This reveals the shortcomings in treatment. Cholera is not difficult to treat if it’s done promptly. But sometimes there are only two nurses to manage 50 patients. That’s not nearly enough to ensure quality care.”

In December 2012, the United Nations launched an appeal for $2.2 billion to fund a plan by the Haitian Ministry of Public Health and Population (MSPP) to eliminate cholera by 2022. The plan is yet to be funded, leaving many current cholera patients without adequate treatment.

“Cholera now appears to be seen as a development issue to be resolved over the next 10 years, whereas the current situation still calls for an emergency medical response,” said Duncan McLean, MSF program manager in New York. “The necessary resources for such a response are becoming increasingly scarce.”

The deplorable state of the treatment centers suggests that the worst is yet to come with the looming rainy season. In 2011 and 2012, rains led to sudden localized epidemic spikes between May and November. MSF responded within the limits of its resources.

“Prevention–by improving water, sanitation, hygiene conditions and vaccinations–is obviously the long-term solution, but sufficient resources are still needed today to treat patients and prevent deaths,” said Oliver Schulz, MSF head of mission in Haiti. “The priority today must be to strengthen the treatment centers and the early warning and rapid response systems. The Haitian government and international donors need to ensure that existing treatment sites are equipped and staffed before the rains. That means as soon as possible.”

Since the cholera outbreak was identified in late October 2010, MSF has treated nearly 200,000 patients at a total cost of approximately $60 million and with a mortality rate below 1 percent. During 2011, MSF gradually handed over responsibility to Haitian health authorities for treatment centers outside the area affected by the January 12, 2010, earthquake, after training Haitian staff and donating supplies and equipment. MSF continues to provide cholera treatment in Port-au-Prince and Léogâne, with 23,000 patients treated in 2012.

This article was supported in part by the International Reporting Project.

Haiti: Occasional Musings – 12 , Solidarity House Update

It’s been a hectic three weeks with lots of visitors, an earthquake scare that shook Petion-Ville, and a trip to a mountain village to meet potential barefoot solar warriors who will return on Tuesday.  There have been various illnesses including me loosing my voice and after two months my back went into crisis on Wednesday but now seems to be ok.  On the same day someone had an Okada accident that fortunately only resulted in a damaged toe.

Its been raining mostly at night but there’s a  sense that the rains are on their way and with that the possibility of floods. For those living in camps, floods or not, the rains bring pools of stagnant water, mosquitoes, mud, streams of running water between  and in the tents.

Two criticisms of aid and charitable support to countries in the global south, are the problem of inappropriate technologies being introduced without local consultation or participation. The other is sustainability of projects.  During this extended stay I’ve come across a number of  these development nightmares. For example the compost / eco  toilet sounds like a brilliant idea for a country like Haiti where there are no sanitation structures.  Whilst in many cases they are appropriate such as private homes and emergency situations,  they are not always the best solution.   First of all unlike ‘Haitian’ toilets which can easily be cleaned with water and disinfectant and which work with a underground cesspit  emptied every 10 years or so, compost toilets need daily care of emptying and separating urine from poo.    Then there is the collection of the poo which is placed into drums for collection.  For an institution like a school with 700 children or a mountain village with poor access,  the compost toilet becomes an additional burden and the end result is it doesn’t get used.

Another idea that was suggested to me was using ‘bricks’ made of twigs, leaves and newspaper instead of charcoal.   A great idea except  when you consider the time it takes to collect the material for the briquettes and make them.  For example SOPUDEP school cooks rice and beans every morning for nearly 700 children, and for many it is their only meal.  The cooking process starts at midnight with the soaking of the beans by one of the women who has to sleep at the school.   The other  4 cooks arrive at 5am to begin the actual cooking. The food is ready around 10.30 and takes a couple of hours from start to finish after which they need another two hours for the clean up.   By the time the women finish it is near to 3pm.  It is therefore totally unrealistic to expect them in addition to everything else, to begin to search for twigs etc and make brickettes which unlike charcoal have to be constantly monitored.  It is possible of course to employ someone to make the briquettes but where does the money come from to pay them?  These are just two examples but there are many more, especially water based solutions, that are not appropriate or turn out to be white elephants sitting in an overgrown field.    The lesson is work with the people who are going to use the technologies and they will tell you whether they are appropriate or not.  People have enough work to do plus the time it takes to get to and  from work without having extra work being dumped on them because you have a great idea on how to produce this or that.   And if you still want to implement your idea make sure you have the funds or the project is sustainable to pay for workers – people cannot afford to work for nothing.

With these factors in mind, I would ask readers to support the Camp Acra enterprise and training project which is sustainable through the enterprise programme.  They need two specialist machines to enable them to cut the shoe soles themselves rather than outsource the process which cuts into their profits.   They will need some additional funding at some point for an inverter and battery but they can and have been working without these.  And of course if the $3,000 target is not met this will undermine their plans for the future.

Camp Acra & Adoquin  - The Chanjem Leson committee and camp residents are an amazing group of people who have spent the past three years building a community out of the informal post-earthquake settlement camp.  They have created a support network for the protection of women, care of cholera victims, built schools and an enterprise workshop.  They need now solidarity support to help them move forward with their enterprise activities.  For more information and to support the Indiegogo Building Back Fundraiser see here. All funds go directly to the camp with complete transparency.

Facsdis Haiti - A LGBT organization which also works with sexworkers and people living with HIV/AIDS in Port-au-Prince. Due to my lost voice I wasnt able to attend their IWD event but managed an initial cafe meeting with two members. They expressed isolation and the need to connect with family from Africa, the Caribbean and the Diaspora.  I will be meeting with a larger group next week to talk about some of the challenges they face in Haiti and from me, an overview of whats happening across the continent.  Its a beginning and hopefully this will lead to them making new allies and friends.

 

Growing Haiti [Haiti Micro Gardens]  - is a South-South collaboration which focuses on strengthening Haitian women and families via sustainable micro gardening initiatives.   With the support of friends and family, Mark Jacobs- a Guyanese farmer, writer, and educator has been working with Haitian people growing vegetables and other sustainable agriculture related initiatives. One of the main focus is income generation from selling excess produce. The second is training in sustainable urban [micro] gardening including working with children in schools and neighborhoods.

Barefoot Solar Engineers – Two weeks ago, along with Rea Dol, Flaurantin Anise and Paul Christian,  I visited Fon Batis, one of the two villages [Archaie] that will benefit from the Barefoot Solar Engineers projec.   Four women [two from each of the villages] are attending a six months training at the Barefoot College in India after which they will then train and assemble solar panels for households in their respective villages.  They return on Tuesday so more next week on their experience and on the project as it develops.   The project is partly funded by the HLLN/Ezili Network.

 

 

African Literature - thanks to a donation of some Kindle Readers and Amazon we can now go ahead with the classes starting next week though I’m still trying to decide where to start so any feedback would be welcome.

English lessons - after a two week downtime between the Los Altos visit and my lost voice, classes are back on track with a solid group of 7, the majority of whom decided to place a temporary ban on all drifters and chatterers.  They are not happy of course but it’s out of my hands but I hope they will return when the next session starts at the end of April.

 

FASA [Fam SOPUDEP an Aksyon (Women of SOPUDEP in Action) is not just about micro-credit.  Its about progress, enterprise, social responsibility, organizing and most importantly it is rooted solidly in community solidarity.     The next step is FASA Mamba – watch this space for more on this new venture.

 

 

 

 

 

Haiti – Feminist Series 4, In conversation with Flaurantin Marie Enise

Looking up into Jalouzi

Jalouzi is a hillside neighborhood of about 200,000 people overlooking lower Petion-Ville.  It is accessible from two roads, one at the top and one below.  The view from the top is stunning. From here you can see  Port-au-Prince looking east to the sea and north to the mountains.  The only way to travel is by foot through a series of alley ways and narrow paths of gravel, stones or the occasional step, and for those like myself who are challenged by gravel and stones on sloppy paths, difficult to negotiate. Flaurantin lives midway where in addition to her home she has a small meeting room and clinic for dispensing over the counter medication.  She also runs a small kiosk on the lower Jalouzi road.  The following are excerpts from conversations over the past 6 weeks between myself and Flaurantin and which are published with her permission.   Originally from Jacmel she began her community work in 1990.

I started working in the community in 1990  working with women.  We had a small school and mobile clinic where we would offer support and medicines to families.  Sadly I had to leave to come to Port-au-Prince 15 years ago with my husband and children.  I would love to return to Jacmel and even now there are women waiting for me to return but unfortunately my house was destroyed so it is not possible.  The community of Jalouzi is extremely poor with some of the most vulnerable women and children.  In 1999 I  decided to start the organization Le Phare [meaning Light] so I could participate in my community by  providing support and education to women and children and yes everybody who needs my help.  [FME]

Flaurantin Marie Enise

Le Phare is now part of the SOPUDEP community and the micro-credit project, Fanm SOPUDEP en Aksyon [FASA].   FASA began in March 2010 after the earthquake.  Rea Dol of SOPUDEP had been using donations to buy and distribute food and supplies to women however she saw that this was just not sustainable.  The next money she received she called a meeting with a group of women and explained they had a choice. Buy food with the money or try something more long term and sustainable such as a micro-finance scheme.  Everyone agreed on the latter and FASA cooperative was born.  Le Phare then became part of the  SOPUDEP  and FASA family.  Flaurantin is the Jalouzi sector coordinator which has  75 active members.  It is also in Jalouzi that  FASA recently opened a store for the programme.  They buy food in bulk and each week the women collect supplies to sell in the market.  Recently police have been driving street traders off the streets of Petion-Ville where all of the Jalouzi women sell their market.

More than 20 of our members were affected by these raids. They lost all their market, everything.   If they cannot sell on the streets in Petion-Ville what are they supposed to do?   Now each day the women go on the streets to try and sell but it is hard as they have to hide all the time from the police. It is too much stress but there is no other way to feed themselves.

As well as the micro-credit programme we now have cooking and sewing classes for young women and we hope this will help the women find ways to generate income once they have completed their training. [FME]

Women of FACE

Jalouzi was miraculously not affected by the January 2010 earthquake but nonetheless the residents like in other PAP neighbourhoods, face major challenges such as lack of access to healthcare, food insecurity, unemployment, lack of water and gender based violence.  Although there are some 100 matwons [midwives] in the neighborhood, community leaders like Flaurantin find themselves attending to various health crisis, intervening and supporting victims of domestic and sexual violence and generally helping those living in extreme poverty.

I delivered a baby at the weekend and the mother did not even have anything to cover where she was sleeping, it was terrible.     The women prefer to deliver their babies at home  but there are often problems such as breech birth and  pre-eclampsia is a very big for the women as they cannot attend pre natal clinics so those with high blood pressure end up very ill.  They are the ones who need emergency treatment but the nearest emergency  [free] hospital is the MSF in Delmas 33 which is far from here. There are a lot of women with HIV and recently gonorrhea has become a problem, which if the woman is pregnant can also be passed to the child. [FME]

Whilst many of victims of gender based violence including rape,  in the the post earthquake camps, have benefited from interventions by local and international NGOs, neighbourhoods such as Cite Soleil and Jalouzi seem to be off the NGO radar and as Flaurantin remarked “The NGOs dont come here. We see them driving up and down in their cars but they never stop”.

We try to give the support for women who have been raped or beaten by their husbands but it is not easy as we do not have any resources only ourselves.   There is a lot of domestic violence but rape is not too much. The most difficult thing is getting women to make police reports even where children are the victims and this has happened in our community even recently.    We try to educate and it is important to give support and to participate [in the community] to know what is happening. That is all we can do keep talking about the problem.  Another problem more often than rape is forced sex in marriage and the women end up getting pregnant over and over which, with the poverty leads to women always being sick.   We do advise the women on birth control and there is ‘depo provera’ and one injection lasts for three months.  We also have female condoms but these are more expensive than male condoms. One of the forgotten groups of women is the elderly. Of course many are cared for by their families but many either have no family or their families are too poor to care for them.  These are probably the most vulnerable with street children –  many also live on the streets.  It is important that we include them in our work.   [FME]

The levels of poverty in neighbourhoods like Jalouzi are massive.  The people who live here  the cost and consequences of global capitalism and as Mahmood Mamdani states the actions of brutal regimes all over the global south break the backs of the poor in the interest of their imperial masters and capital.  And it is poor  women who are criminalized, disenfranchised further pushed to the margins of margins having to deal with multiple acts of violences.

Jalouzi sits next to the elite neighbourhood of Petion-Ville but the distance in the reality of lives is a thousand miles.  Whilst we celebrate Women’s History Month and International Women’s Day in all manner of ways,  its worth considering the question:  what we mean by  sisterhood, whether global or local.. what does it really mean?  In Haiti the media have gone, many of  the NGOs and UN agencies are gone and those remaining are scaling down.  For them the crisis is over, earthquakes and cholera, stories from yesterday.  Voices like Flaurantin’s, which speak to the many violences of poverty but also to the frontline work of women activists and their  commitment to movement building,  don’t get heard.

A last word from Flaurantin

The levels of poverty are so great [that] sometimes we cannot see our way out, we just survive.   But what is good about our organizing is though there is much misery, there is solidarity amongst us. [FME]

 

This article was supported in part by the International Reporting Project.

Haiti: Occasional Musings, 11 – International Women’s Day

I have a general wariness around national and international days which are set aside to remind us of a particular issue or celebration such as the Day of the Child, Human Rights Day, Water Day, Day Against Homophobia and International Women’s Day [IWD]. There seems to be something condescending about such designations not least of all because we often have no historical or other context for such days. I had thought to mark IWD 2013 with a profile of four Haitian women activists, three I have known for a number of years and one I just met this January. However after talking with each of them and considering the impact of their work in their communities I felt I needed to bring something deeper to my understanding of the relationship between IWD, feminism and activism in an Haitian context.

I started by reading on the history of IWD which I had always believed to be a post WWII creation along with the various declarations around human rights. Not so. IWD was born within the European and Russian socialist politic of the late 19th century along with May Day, as a celebration and recognition of working class struggles including ‘universal women’s suffrage’. In other words IWD was created out of the the intersection of class and gender and was formalised at the August 1910 at the “International Socialist Women’s Conference in Copenhagen”.

“In agreement with the class-conscious political and trade organisations of the proletariat in their respective countries, the socialist women of all nationalities will hold each year a Women’s Day, whose foremost purpose it must be to aid the attainment of women’s suffrage. This demand must be handled in conjunction with the entire women’s question according to socialist precepts. The Women’s Day must have an international character and is to be prepared carefully. Clara Zetkin, Käte Duncker, and other comrades

In her lecture “Wars Against Women” Angela Davis points to the multiple origins of IWD so in addition to the 1910 Socialist International there was the

“ Russian women’s strike for bread and peace in 1917 against the wishes of the revolutionary leadership which [later] helped to bring down the Czar. There was the triangle shirtwaist factory fire in New York in 1911 during which 140 women, mostly Jewish and Italian immigrants were killed. There was also a 1857 strike on March 8th in New York by women in the garment and textile industry, in which they demanded, better wages, shorter working hours and generally better working conditions.”

The first IWD was in 1911 under the banner of ‘equal rights, protection of working woman and women’s suffrage. The ideology behind the early IWD was driven by a desire to end capitalism which was seen as the barrier to equality, to internationalize the struggle of women and workers and to oppose the impending war in Europe [WWI]. By the 1970s, IWD, which grew out of a socialist workers international was appropriated and incorporated into global capitalism through the institution of the UN, which despite the tensions of the east west cold war period, was always leveraged as an instrument of global capital. The first global recognition of IWD and women’s struggles, was through the UN Commission on the Status of Women which held a series of ‘internationals’ in Mexico (1975), Copenhagen (1980), Nairobi (1985) and Beijing (1995).

Another interesting  example of the early IWD socialist connection took place  following the first UN  sponsored international in Mexico which designated March 8th as IWD.

“Cuba marked the occasion by launching it’s attack against the second shift – the shift women do when they get home from work and began to address some of the major issues that confront working women within a feminist framework.” [Angela Davis]

Davis also asks us to recognize the importance of the global in “recognizing the recognition of women’s pivotable role” in creating hope for a better future. I would add that these internationals also led to  the recognition of the ‘pivotable role’ played by women from the global south in the independence movements in the 1930s onwards and of course in post-colonial struggles. It is within this international or global history as well as Haiti’s own revolutionary history that I would like to view the activism of the Haitian women. Each of the four women’s organizing grew out of the struggle of the popular masses against the subjugation and brutality of the 1930s US Occupation, Duvalierism, militarisation and the desire to reclaim the revolutionary narrative which had long since been appropriated by Haitian elites, imperialist forces as well as local patriarchies.

Each of the women prioritise women’s struggles in the context of a broader activism of an inclusive movement of the popular masses.  So water rights, land rights, food insecurity, an end to the UN occupation, an increase in the minimum wage, free accessible education, sit alongside issues of gender discrimination, sexual violence, domestic violence, imprisonment of girls and women for extended periods often with delayed trials or years, access to healthcare,  and adult literacy.

Globalised Women

The clothes we wear the majority of which are made in China or the global south by women are invariably manufactured under extremely exploitative labour conditions. Even in Europe and the US, it is immigrant and often undocumented women’s labour that is used.   The food we eat.  Most of the sugar imported into the US comes from the Dominican Republic where Haitian men, women and children many of whom have been trafficked across the border,  work in slavery conditions on huge plantations.  The conditions are horrendous, there are few schools, clinics or access to alternative employment.  The petrol we use to travel has destroyed the livelihood of women in rural Niger Delta.

At the beginning of this post I said I was wary about the ‘celebration’ of designated international Days though I wasnt sure where or why my ambivalence.  But understanding the history of IWDs particularly learning the socialist history has given IWD a much needed context.

Haiti: Occasional Musings – 10, Doctors for Liberation

Solidarity Visit

Last Thursday we visited the Medical School of the Aristide Foundation [UniFA] and had the privilege of an audience with former first  lady, Mdm Mildred Aristide.  She spoke about the history of the medical school which though it was started in 2002 can be traced back to 1996 when Haiti restored diplomatic relations with Cuba which had been ‘ruptured’ through the years of Duvalier rule. In 1997 a medical cooperation began between Haiti and Cuba which enabled Haitian students to study medicine.   However President Aristide felt that even more students could benefit from the cooperation if Cuba doctors came to Haiti and trained students in their own country.   The school was then established ‘as a cooperation amongst the Aristide Foundation for Democracy, the Haitian government, the Taiwanese government and the government of Cuba.   In 2003 there were 247 medical first and second year students.

Following the 2004 US supported coup  against President Aristide, the school was completely trashed, shut down and many students and staff forced into hiding or exile.  The school compound was then occupied by the US and used as a military barracks until 2007 when it was finally returned to the Aristide Foundation.  Following the coup, many of the staff and students had to flee into hiding or exile for their own safety.  Others went to the Cuban embassy and were able to secure passage to Cuba to finish their studies.

After the 2010 earthquake the compound became a refuge for thousands of quake survivors from the neighbourhood of Tabarre where the Foundation is located.   The Foundation was able to explain they needed the grounds to rebuild and reopen the medical school and it was on this basis that residents voluntary left the camp.  Prior to returning to Haiti in March 2011, President Aristide reiterated his commitment to working in education and reopening the medical school was seen as the first step in this direction.  The school reopened in September 2011 with the help of Partners in Health and a group of Cuban doctors who remained in Haiti a year after the earthquake.  The first intake was an evenly divided 126 women and men and is now in its second year with 254 students.  By the second year, realising the school was not a political space they were able to attract Haitian doctors to the teaching staff and a nursing programe with 73 students was introduced.  Students are chosen strictly on merit but recruitment is encouraged from those living outside the capital particularly in rural areas and from poor families who would otherwise not have an opportunity to study medicine.

Madam Aristide went on to explain that despite the advances made by the foundation, the programme is

‘merely  a drop in the bucket, because every year Haiti graduates in terms of high school students taking the baccalauréat there are between 55,000 and 60,000 students who pass.  But when we look at the number of university seats in Haiti there are maybe 6,000 places available if you include the technical schools, so you can see right there a gaping hole. Again the concentration of university places are in the capital so its a tiny drop and a tiny drop in terms of Haiti’s medical needs when there are only 1.5 doctors to 11,000 people.  In terms of the Cuban relationship, since 1997 they have trained about 750 doctors, which is huge….So we have a lot of  challenges in the medical sector and we know our contribution is going to be a tiny drop but if we don’t start then further down the road we will face more difficulties.”

She went on to explain that though foreign doctors, were without doubt essential in the post-earthquake period,  the solution to a  sustainable healthcare programme in Haiti is to train it’s own doctors rather than continue to depend on  intermittent clinical care from overseas.   With this in mind the school works with for example,  Physicians for Haiti who provide a rotation of visiting doctors for up to two weeks in a training capacity.

The school also works within the medical schools immediate community,  Tabarre, where there are over 400 schools on education and healthcare through programmes on Radio TiMoun and a clinic serviced by the staff and students of the medical school.   These are some of the Foundation’s contribution to education and healthcare in Haiti where the challenges are huge ..

Its impossible to think you can construct a country and build and really go forward when you have the youth as a number one goal is to find a foreign visa and travel.  But that unfortunately is the reality because of the economic situation. We think we can train these medical professionals to work and stay in Haiti. That is part of the job, the second part is now  making sure they will be able  work and not only in the capital but in the countryside.   We also have to work with Haitian society so these students are not picked up by the US and Canada.  We already have an agreement with the new Partners in Health hospital at Mirebalais which is where our students will do their clinical training.

Just to bring the Haitian healthcare system into perspective, on Wednesday I witnessed a pregnant woman – a mother of 7 children, being carried down the hillside of Jalouzi by two men.  It had earlier taken me over an hour to stumble down the steep gravel, stone laden path and only with the help of two hands prevented me falling and seriously wounding myself.  So I imagine it most have taken them at least half that time if not more.   She was then rushed into the SOPUDEP micro-credit store where we immediately laid her on a camp bed and covered the space with a cloth.
Looking up from the bottom of Jalouzi
About a third of the way down in the distance you can see the yellow awning of the micro-credit store
Flaurantin Marie Enise of Le Phare, a women’s organisation based in Jalouzi, put on her gloves and proceeded to examine the woman. From this she estimated she had about two hours before giving birth.  Flaurantine  said she was concerned about whether to try to get her to the MSF hospital, about an hours journey, or to wait for her to go into the final stages of labour.  The woman was very weak but in the end Flaurantine decided there was time for her to get to the hospital and she was carried out onto a stretcher up another very steep hill that climbing makes one consider the marvels of gravity, and onto a tap tap to the MSF hospital in Delmas 33. A journey, at that time of the day, of at least one hour on foot and by tap tap.  She had a baby boy and he is fine.
On the way down Flaurantin had introduced me to the two other women whose babies she had helped deliver.  There are a number of ‘matrons’ and nurses in Jalouzi but with a population of about 200,000 its really only with women helping each other that crisis such as these don’t end up in  deaths.  I was also reminded of the time my mother delivered a baby after a woman had gone into labour outside our house at Ikeja in Lagos.  Someone told my mum what was happening so she went out and brought the woman into the house where she gave birth with mums help.   It was a girl and they called her Florence after my mum.

This article was supported in part by the International Reporting Project.

Cholera and Healthcare in Haiti

It is impossible to talk about health care in Haiti without mentioning the 2010 earthquake and the subsequent cholera epidemic which so far has affected 630,000 people and taken the lives of 7,500.  It would be easy to believe that cholera was a direct result of the devastation of the earthquake and the heavy rains of June, July and August.  In fact the media spent much of 2010 speculating on the possibility of a medical epidemic.  2 million people were forced into overcrowded internally displaced camps [IDPs] where living conditions were  appalling. People were traumatized and fearful of further earthquakes and even to mourn the dead was hard as the struggle to live became harder as months passed.

Pediatric Clinic Cite Soleil

Many women and girls in the tent camps especially, were raped and lived with the fear of physical and sexual violence; food and clean water were scarce; latrines dangerously inadequate; and sewers overflowed. So why were so many health care providers and humanitarian aid agencies caught off guard when in October, the first cases of cholera began to appear and not in the IDP as might have been expected? The answer to this question and others, such as why did it spread so rapidly,  who was responsible and what has been the response all serve as an excellent lens from which to examine healthcare and the socioeconomic realities of the UN/US occupation of Haiti.

Cholera is an acute dehydrating bacterial infection spread through contaminated water and food.  The source of the contamination is human feces and the illness is exacerbated by poor sanitation, limited clean water, heavy rains and associated poor hygiene such as failure to wash hands after going to the toilet.   Symptoms can be mild or severe with leg cramps, white watery dirreahea and profuse vomiting. They can appear within hours or over a period of days.  However once severe symptoms appear, those most vulnerable such as children, the elderly, pregnant women and those already malnourished and or suffering from chronic illness, rapid dehydration can lead to death in just a few hours.  Treatment for most people is a surprisingly simple:  oral rehydration treatment [ORT] and in severe cases, an intravenous rehydration with antibiotics.

I visited Haiti in November 2010 and by then cholera was already embedded in Haitian lives.  Banners and posters announcing the dangers and prevention of cholera hung from streets and decorated what walls were left standing.  Radio and TV jingles blared out similar messages whilst schools, camp committees and women’s organisations reinforced all these messages whilst trying their best to create hygienic environments and most important provide clean water.   SOPUDEP school did not escape cholera as many parents and students were taken ill.  Their priority was to provide clean water through a mix of water treatment tablets and clorox as well as to reinforce basic hygiene regimes – with 700 children it was not an easy task and there were constant school closures as children or their parents were taken ill.  Nonetheless they were able to avoid a local epidemic.

In the early hours of one morning, a diabetic friend was rushed to the Médecins Sans Frontières [MSF] hospital in  Martissant 26 which at the time was one of their cholera treatment centers [CTCs].  I arrived in the evening just as dusk was falling to visit my friend.  As I waited outside, I watched as cholera patients came and were directed to the side entrance.  Some walked, some were carried, frantic parents with a baby wrapped in a bundle but visible enough to know she or he would die very soon;  an elderly woman in a wheelbarrow, shrunken and surely at the point of death.  In  Martissant 26 Cholera was everywhere.  It was unavoidable as vendors and customers vied with mountains of rotting refuse and pools of stagnant water lying amidst rubble and buildings destroyed by the earthquake.

Prior to October 2010  there had been no cases of cholera in Haiti for nearly a century.  The first hospitalizied case was on the 17th October in Mirebalais, in the region of Haiti’s longest river, the Artibonite. By October 22nd cholera was confirmed and the outbreak in the costal areas of St Marc was established.    The disease was able to spread rapidly due to initial misdiagnosis, lack of Oral Rehydration Treatment [ORT]  and an already overstretched medical infrastructure. Cholera was not the epidemic in waiting. The first responders to both the earthquake and the cholera outbreak, were the largely ignored by western media,  Cuban brigade, who had been in Haiti since 1998, along with the well established MSF also in Haiti for many years.   At the start of 2013 these are the only two sizable medical teams left from those first 12 to 18 months.  From an initial 72 CTCs in 2010/11, MSF which now accepts all cholera referrals as well as walk in patients,  has just four CTCs,  in Leogane [40 beds] Delmas 33 [80 beds],  Carrefour  [275 beds] and Cite Soleil/Drouillard [100 beds].

In order to place Haiti’s health challenges in a global south context I asked  Oliver Schulz,  the head of the MSF mission in Haiti  how the country compares to African countries. He gave the example of the eastern Congo, where in general, there is a structure and willingness by the Ministry of Health to get involved. So within six months of starting a MSF cholera project  the ministry is ready to take over.  However in Haiti, because the disease is new and because there is neither the capacity nor the necessary health infrastructure, the government has been unable to take over.   However as Oliver Schulz, program director for MSF, pointed out, the situation in Haiti is far more complex than simply pointing a finger at the government as they simply do not have the resources.   In particular, Schulz was critical of the WHO and UN whose role should be to support the government in developing a comprehensive health care infrastructure yet despite years of talking little has actually happened.

even with cholera some of the things we discussed two years ago are still being discussed. I do not know how much they are involved in activities like plans etc but it seems to me that by now we should have a national health plan and it seems to me normally the WHO supports the government in making such plans as thats what they do in other countries.”

The problem with healthcare in Haiti is there is no system, no structures, no plan – at least not one that has been implemented. What healthcare facilities exist are wholly inadequate – insufficient medical staff, support staff, equipment and treatment, and left to medical NGOs such as MSF, the Cuban Brigade and a few faith based and charity clinics.  For example there is one MSF hospital in  Carrefour with 275 beds serving about 400,000 people.  In Cite Soleil the figures are similar. In addition to MSF hospital there is public hospital, St Catherine’s  which like most government hospitals is staffed by excellent Haitian doctors but is  rundown and under equipped.

The Charity Mission runs a small hospice for HIV/AIDs patients and a few other small clinics serve at least 250,000 people.   Finally there is the Centre de Nutrition et Sante Rosalie Rendu which has a pediatric clinic and sees up to 300 under 5s a day, many mothers traveling across the city to reach the clinic.   The round trip from for example, Delmas to Cite Soleil can take up to 4 hours and three tap taps at a cost of about $2 – a long and costly journey.  But the Haitian and American doctor are excellent and the clinic includes a nutrition center for malnourished children who attend everyday for six months or until their weight and overall condition has improved.

The public hospitals including the country’s main teaching hospital and clinical and trauma referral center, L’Hôpital Université d’Etat d’Haïti (Haitian State University Hospital or HUEH), are in terrible condition and have effectively been abandoned by all those involved in running the country – the government, the UN, the USAID and other country donors, and the NGOs.  HUEH was partially damaged in the earthquake -  150 nursing students were killed and two thirds of the buildings destroyed.    Even before the earthquake, it wasn’t in great shape and the rebuilding  of HUEH was supposed to be a priority as shown in this  2010 proposal by Partners In Health [PIH].

Significant, strategic, and ongoing improvements to the comprehensive infrastructure, staffing, training, operations, and clinical practice of this central public health facility are investments in the future of all public health throughout Haiti. ………..More immediately, HUEH is in a state of emergency. If conditions at the hospital are not improved in a matter of months, it will become the site of a second round of catastrophic deaths due to disease outbreak or total health system collapse. There has been a vision articulated by the Haitian leadership of the hospital, but they cannot implement it alone. Please join the effort to build Haiti back better by first investing in the health of Haiti’s people

One medical improvement to HUEH and which is exemplary of how things happen in Haiti, is the TB clinic set up in 2010 by an American volunteer, Dr Coffee and a group of Haitian nurses.  The clinic initially operated under tents is now housed in a building and has cared for over 1000 patients TB since 2010.

Since 2004, when the Medical School of UNIFA (the University of the Aristide Foundation] was forcibly closed,  HUEH has been the sole medical training center in Haiti.  UNIFA was founded by President Jean-Bertrand Aristide in 1996 in order to ‘amply the voices of Haitian people’ by creating an inclusive educational space from adult literacy to training doctors and nurses.   In August 2011 the much needed medical school reopened with 63 men and 63 women.  In the politics of US imperialism in Haiti, the contribution of UNIFA and the Cuban brigade doctors,  to the health infrastructure have been ignored by western media. I doubt this is by accident given the election of puppet and Duvalierst, Michel Martelly, and the resurgent post earthquake neo-liberal agenda driven by the US, it’s allies and NGOs.

Although the rebuilding of the HUEH and other public health clinics have not taken place the new Paul Farmer led, PIH, state of the art, University Hospital of Mirebalais [HUM] has now opened.    I asked a number of  NGO personnel, doctors and Haitian activists why the HUEH has been abandoned yet the PIH NGO hospital has flourished.  The response was always the same – “we ask the same question”.  No one would question the importance of HUM to Haiti’s health infrastructure.  It is the largest post-earthquake project in the country and has taken three years to build.  HUM has 300 beds, plus primary and secondary health care for up to 500 people a day. As a teaching hospital HUM along with UNIFA will provide doctors and nurses for Haiti.  However questions remain as to the location and who will have access to the hospital.

There is no doubt that both the earthquake and cholera epidemic played a leading role in the funding and realization of the PIH project.  One of the uses of founder, Paul Farmer is that he is able to raise funds especially since he became a spokesperson for ‘the machine that drives Haiti”.   When questioned by journalist Ansel Herz about the stalling of a wage increase from $3 to $5, Farmer, the new voice of the occupiers, also stalled as he seemed to have forgotten his own treatise on ‘pathologies of power’.

The inadequate provision of healthcare for the poor in Haiti and elsewhere, as Farmer himself has written over and over, is due in large part to structural violence and a pathology of greed which has left over 2 million people food insecure, forces women into relationships which are detrimental and often abusive; results in people dying needlessly of cholera or because they couldn’t  access simple surgery as was the case for Elie Joseph.

In February 2012, Elie Joseph was diagnosed with a heart murmur which is a common congenital heart defect called ventricular septal defect [VSD] where the blood flows the wrong way, putting stress on the heart and lungs which can lead to infections. The charity Haitian Hearts, which sends children suffering from heart related illnesses to the Dominican Republic or the US, arranged for Elie to travel to the Dominican Republic for the 15 minute procedure which would fix his heart.  Elie received his travel documents but not his mother so he was unable to undertake the operation which would have taken some 4 hours plus the follow up treatment.  In December 2012 Elie Joseph died from pneumonia in the tent at Aviation camp where his parents are forced to continue to live three years after the quake.  VSD is not an illness to die of and Elie is one child out of thousands who have died needlessly as a result of structural violence.

The violence of poverty is multifaceted so that even when healthcare is accessible there are still other obstacles to overcome.  Gladis* lives with her three children aged 6 months, 4 and 9 years in a camp in Delmas 33.    She is fortunate because the camp is not too far from both the MSF cholera treatment center in Delmas 33  and the La Paz clinic run by Cuban doctors.    Gladis came to Acra camp a few days after the earthquake with her two children.   Her home in Tabarre was destroyed in front of her eyes and she wandered the streets for three days disorientated , traumatized, sleeping and walking with the children till eventually she came to Acra.  At that time there were no tents and people were sleeping in the open or under whatever makeshift covering they could find.  It was about three months before the people at Acra were able to secure tents by searching out various NGOs themselves.

It was a dangerous time for women in particular as sexual violence was rampant,  the only food and water was being handed out by NGOS and you had to queue for hours.   Three years later, Gladis is hardly coping with her life and its possible that only the support of her neighbours and the camp committee which has kept her going.   In October 2011 when she was about 6 months pregnant, Gladis caught cholera.   It started in the morning and within a few hours she was unable to walk.  Her neighbours gave her water with the RHT salts but these did not help.   She had two problems – she would have to leave her children with neighbors and luckily hers were trustworthy. Secondly she had to get to the MSF treatment center.  She was in no condition to travel by Tap Tap or motorbike and besides she did not have the money. The only way was by car. Again Gladis was lucky as one of the camp leaders saw she was ill and suspected cholera. He had an old truck that just about ran and its with this that Gladis, near death, was taken to the hospital where she spent 15 days.

“I didnt know what was happening until after some days.  I saw they had put me in the last room where many people were dying and I thought I would die too.  So many people died, I don’t know how many but every day they were dying……When I started to get better, I was able to eat.  They gave us food sometimes three times a day.“

Although Gladis was released after 15 days she was still ill suffering from headaches and with a fever. But for the MSF her cholera had been treated and they needed the beds as new patients were arriving all the time.   Gladis survived but she remains unwell, fearful and hardly able to breast feed her baby. Again this is one story.  Although I have heard many complaints from women on the public hospital and clinics, I have only ever heard good things about both the Cuban doctors, MSF the pediatricians at Sante Rosalie Lendu.

The cholera epidemic is not over by far and once the rains start the numbers are expected to rise again.   The estimates for 2013 are are 118,000 cases.  To put these numbers in a global context,  there were 160,000 cases in the whole of Africa in 2010, thats nearly 1 billion people compared to the 10 million population in Haiti.  I asked Oliver Schulz of MSF his thoughts on the year ahead.

 “My personal fear is that things will get worse before they get better.  The structures are weaker today than in 2011/2012.   Every year the structures deteriorate.  There is no plan for cholera and without a WHO supported comprehensive national health care plan with clear directives, clear action plans and milestones then it will not get better. Also many of the big agencies have left and there are too many unknown NGOs, charities and faith groups”

Within weeks suggestions began to appear that the origins of cholera lay with the UN and specifically a Nepalese contingent based near the  Artibonite river and spread through the base toilets.  Initially the UN denied being responsible however there has been  mounting evidence of  the UN being the source.  By October 2012, two years after the outbreak,  the evidence against the UN was irrefutable

“We can now say,” Dr Lantagne said, “that the most likely source of the introduction of cholera into Haiti was someone infected with the Nepal strain of cholera and associated with the United Nations Mirabalais camp.”

In the hope of obtaining justice and reparations for the thousands of cholera victims, the Bureau des Avo­cats Inter­na­tionaux [BAI] and Institute for Justice and Democracy in Haiti [IJDH] filed a groundbreaking suit against the UN on behalf of 5,000 cholera victims.  In addition to insisting on accountability the suit  demands that the UN

  •  Install a national water and sanitation system that will control the epidemic;
  • Compensate for individual victims of cholera for their losses; and
  • Issue a public apology from the United Nations for its wrongful acts.

The UN role in  introducing cholera is one more abuse in a long list of  violent acts  against the Haitian people with no accountability.  From sexual abuse, rape, cholera to the  killing of innocent civilians.  UN appointed special Envoy of Occupation,  Paul Farmer suggested as early as December 2010,  a vaccination programme as part of a 5 point intervention to halt the epidemic. However Haitians had little reason to trust a UN led initiative even if it was supported by a world renowned physician.   Three years later the only evidence of improvement in the healthcare is the teaching hospital at Mirebalais.  More than anything Haiti needs clean water, not just for cholera but for a range of illnesses and because everyone has a right to clean water.  Provision of clean water however does not make money for pharmaceutical companies – being well does not make money for pharmaceutical companies. But a cholera vaccine every three years is highly profitable disaster capitalism at work.    Rashid Haider explains the case against vaccination..

The vaccines Shanchol and Dukoral contain large amounts of killed cholera bacteria, the latter having an additional component known as the recombinant B subunit of cholera toxin (rCTB). Both vaccines are two-dose oral vaccines that are taken with an interval of two weeks, and are meant to cause development of protection against cholera one week after the second dose.

Harmon’s assumption that these vaccines are 60 to 90 percent protective for a period of two to three years does not concur with facts. The Shanchol that is intended for field testing soon in Haiti had offered a poor protection of 45 percent during the first year of surveillance in a large-scale field trial in India in 2006. Dismal results were obtained in a large-scale field trial in Peru in 1994 when the two-dose vaccine Dukoral was tested.

The alternative argument for a national water and sanitation system is a far more sustainable and realistic solution to ending the epidemic and preventing new outbreaks.  It is long term, benefits everyone and responds to a range of preventable illness and improves the overall quality of lives.

UPDATE

A March 2013 report by MSF speaks to the deplorable condition of cholera patients in Haiti.

 

“Some of the staff at the cholera treatment centers have not been paid for several months,” said Dr. Mamady Traoré, MSF deputy medical coordinator, who participated in the Artibonite assessment in late December 2012. “Infrastructure and equipment are worn out because they haven’t been maintained and there are frequent shortages of medical supplies. As a result, hygiene precautions that are essential to limiting the spread of the disease are no longer enforced. Sometimes patients are left without treatment or must pay to obtain it. That is intolerable.”

Adoption, Sexual Abuse and Aid

I read a recent post on Women In and Beyond the Global on the forced powerlessness of pregnant women which refers to a study on

two  sets of interrelated events: [1] the effort to pass laws that give a fetus the constitutional right of a person, thus far passed in 38 states; and [2] the increased number of arrests and incarceration of pregnant women.

The study looks at the arrest and incarceration of pregnant women on which the basis of arrest was to protect the fetus.   It’s not clear what happens once the babies are born – how long do they get to stay with their mothers, what happens afterwards, are they given up for adoption, taken into foster care? Or a mix of all of these?   Being pregnant then becomes part of the regime of punishment both for the mother and child!  This is incarceration and the concept of punishment at its lowest and most obsene. It does nothing but satisfy the need for that ‘pound of flesh’.    One example of the punishment of women and young girls dates to the 1940s  when  white teenage girls being used to fuel the adoption business and Black teenage mothers were punished by denying them public assistance.

“Beginning in the late 1940s, community and government authorities together developed a raft of strategies some quite coercive, to press white unwed mothers to relinquish their babies to deserving couples” (70). Those teenagers were presented as “mentally disturbed” because they failed to have a husband to protect them, “a proof of neurosis,” making them potential bad mothers. The same authorities singled out and removed unwed Black teenage mothers from any public assistance, intensifying their already precarious situation.

Reading this report, I was reminded of the raid on Haitian children in the immediate aftermath of the 2010 earthquake.  No one knows the number of  children, who were taken to the US and Europe for adoption.  In the initial period many adoptions took place without proper  background checks into prospective parents or  confirmations on the real status of the children.  There were thousands of orphans already living in orphanages at the time of the earthquake and in the first few months  5,000 of these children, were fast tracked to adoption in the US. Yet 6 months after the earthquake, families were still being reunited.

Under a sparingly used immigration program, called humanitarian parole, adoptions were expedited regardless of whether children were in peril, and without the screening required to make sure they had not been improperly separated from their relatives or placed in homes that could not adequately care for them.

Some Haitian orphanages were nearly emptied, even though they had not been affected by the quake or licensed to handle adoptions. Children were released without legal documents showing they were orphans and without regard for evidence suggesting fraud. In at least one case, two siblings were evacuated even though American authorities had determined through DNA tests that the man who had given them to an orphanage was not a relative.

Often the media would report from Haiti, Ethiopia, and Guatemala about stories  of mothers and fathers giving away their children for a ‘better life in the US’.   Stories like this one from Haiti where parents decided to give up their youngest also raise questions on whether ‘orphans’ are really orphans and how much coercion takes place.   People have to do what they need to do to survive and the morality in question here is the violence of poverty which forces them to make hurtful choices.  For example in this report from Ethiopia the father believes the ‘adoption’ is temporary and that his child will return. A  recent study  found that 4 out of 5 children in orphanges actually had one living parent but this is not surprising as running an orphanage or adoption agency whether in Haiti or in the west, is a lucrative business and in many cases they are nothing more than legal trafficking agencies buying and selling children.  Right now there are  over 2 million food insecure people in Haiti.  I agree with my host, community organizer and educator, Rea Dol who believes these figures are under estimated.    Families in crisis need support to keep their children but instead of struggling with the people, saviors  assault their dignity’.  Save the Children has much to say on this and it would be interesting to know what kind of support THEY are providing in Haiti or do they just write good reports?  Rea Dol who runs SOPUDEP, a free school for 700 children and located directly opposite Save the Children can tell you a great deal about the ‘real work of that NGO

As far as organizations that could have helped SOPUDEP, there is Save the Children who sponsored a lot of organizations. They’re located right next door to us and they never helped us at all. They had a cash for work program for rubble removal, but I had to pay out of pocket to arrange rubble removal. When they finally came six months after the quake, they asked how they could help us and said they could fix the roof and clean out the toilets. But we didn’t see these as problems. We had more urgent needs related to our classrooms, but that assistance wasn’t there.

The school had reopened in April under tarps surrounded by rubble  and collapsed walls.  They needed urgent supplies for the children but like hundreds of thousands of other Haitians the republic of NGOs was nowhere to be seen and even when they are they come with bags with their logos, some water treatment tablets, tarps, a few pencils and expect Haitians to sign so they can write fancy reports on how they helped this organisation and that camp – like missionaries and colonials handing out trinkets to the natives!  Arriving at SOPUDEP four months later after the school had broken up for holidays was an assault!

There were genuine adoptions both prior and post the earthquake  and the Haitian government is revising the laws.  However  laws on adoption don’t protect children in orphanages.   A number of orphanages in Haiti have been found guilty of sexually abusing the children under their care [see here and here and here and here] but these stories are just the tip of the iceberg.  There is no monitoring or  control over faith based organizations  and charities who can enter the country and establish themselves at will. In a matter of days they can set up an orphanage, a church, a mission, an NGO  - whatever they want whether in the town or in the rural areas.   There have also been repeated abuses by the UN occupying force in Haiti, MINUSTAH and in some instances officers have been removed but as far as I am aware none have been punished.  According to Save the Children  sexual abuse by aid workers is significant and underreported.  These actions are not taking place in secret – people know whats going on as many of the assaults take place with groups of abusers.  Its not one aid worker or one solider its a couple of aid workers or a couple of soldiers.

Our research suggests that significant levels of abuse of  boys and girls continue in emergencies, with much of it going unreported.The victims include orphans, children separated from their parents and families, and children in families dependent on humanitarian assistance.

Its also happening to children walking on the street, going to school, running errands, vendors and so on.  The report suggests that to limit the underreporting,  parents and children need to speak out .  But as  families are afraid to break the silence  due to stigma, fear of loosing aid/food, powerlessness, there needs to be another way  of monitoring those who work at ground level.   Haitian children are  especially vulnerable to sexual abuse as the country is awash with NGOs, missionaries, faith compounds and assorted people.    Women’s organisations such as those run by the SOPUDEP, Fanm Voudou Pou Ayiti and Kofaviv  work with women victims of sexual violence but much of their work is in the camps and with limited resources  it is impossible to undertake the necessary investigative work into what is happening in orphanages and within the aid sector.   Why are aid agencies not responding to sexual abuse by their staff?   Whether Sudan, Congo or Haiti – these are all highly militarized states and in the case of Haiti, under occupation and the NGOs and aid workers are part of the militarized structure and the violence it reaps.

 

Haiti: Occassional Musings – 6

Last week I visited two clinics in Cite Soleil. The first was  a pediatric clinic which is part of a complex run by the Catholic church for the past 37 years. In addition to the clinic which sees pre-natal mothers and children up to 5, there is a free primary school and a women’s training and work center. Despite the media’s representation of Cite Soleil as a dangerous space, I have always found it calm and friendly and have yet to meet anyone who says otherwise.

Like much of the media reports on  Haiti, events are rarely contextualised accurately and Haitians are presented as being undisciplined  and violent or as ‘famous’ US journalist, Amy  Wilentz, described them “poor, needy and desperate” – but this fits well into the victim narrative so thats OK!   Nonetheless Cite Soleil residents have a history of protest against violent repression and more recently from the UN following the 2004 coup against President Aristide as depicted in Kevin Pina’s film “We Must Kill the Bandits“.   And yes there is gang violence and it can be a dangerous place for youths in particular, much as the streets of  cities in the US and Europe  - Miami, Chicago, London and Paris are zones of violence against youth.  But the deeper violence that seeps into everything and that kills people is poverty.

The complex consists of  a large compound with low rise buildings – classrooms for adults, the workshops, dinning halls, playgrounds and the clinic –  set amongst palm trees and flower gardens. There is a sense of tranquility both in the outside areas and in the classrooms and clinic rooms. The clinic along with nearby St Catherine’s Hospital, serves the whole of Cite Soleil and beyond. By far the majority of children who attend the clinic are suffering from poverty related illnessness or illnesses or illnesses aggravated by poverty – dirty and insufficient water, poor or non-existent santitation facilities, and lack of protein diets. Illnesses such as anemia, malnutrition, TB, parasites and diarrhea.  Often illnesses lead to a needless death as in the case of 2 year old  Elie Joseph.   In February 2012, Elie Joseph was diagnosed by Doctor John Carroll, with a heart murmur which he explained as

a common congenital heart defect called ventricular septal defect [VSD] where the blood flows the wrong way, putting stress on the heart and lungs which can lead to infections.

Dr Carroll who runs a charity Haitian Hearts, which sends children suffering from heart related illnesses to the Dominican Republic or the US, arranged for Elie to travel to the Dominican Republic for the 15 minute procedure which would fix his heart.  Elie received his travel documents but not his mother so he was unable to undertake the operation which would have taken some 4 hours plus the follow up treatment.  In December 2012 Elie Joseph died from pneumonia in the tent at Aviation camp where his parents are forced to continue to live three years after the quake.  Elie should not have died.   Aviation camp is like other camps is so crowded you can hardly move between tents, there  are  pools of stagnant water and rotting garbage everywhere.

Sometimes even those who claim to be ‘helping’ do so with paternalistic disdain. Like the person I met at a nearby  mission which includes a hospice for  men and women HIV/AIDS patients.  I can’t say t his view was shared by others who worked there, but it was shocking to hear someone supposedly caring for the dying blaming  their illness on  “Haitians lack of morality”.

It seems to me that no matter the level of health care available without addressing the underlying poverty, any health care is ‘bandaid’ medicine and yes a bandaid is better than nothing but people deserve something more than ‘better than nothing’.    HIV /AIDS patients arrive very sick many on the verge of death. They are treated, fed and made relatively well.  Then they return home back home to the same environment that brought them to the hospice in the first place so its not surprising when they soon die or return once again for a three months break from poverty.

Thousands and thousands of people, maybe even hundreds of thousands, have been disappeared in Haiti over the past 50 years.   The obscenity of the living conditions and  insufficient though often excellent,  health provision largely lies in the fact of $billions of disappeared  monies and the building of monuments to aid workers such as the Clinton Foundation funded,  Hotel Oasis.

 

 

This article was supported in part by the International Reporting Project.