Tag Archives: Cholera

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 – 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.

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: “Foul water is killing people” and we need to think of new ways of giving

Haitians are now dying of dirty water and insanitary conditions which they have been forced to endure for the past 10 months.  Over   250,000 Haitians have already died as a result of the earthquake and now thousands more are going to die because of failures by Bill Clinton, George Bush, the UN, the Red Cross, US and other governments,  and hundreds of NGOs  who  received $millions in donations and or are responsible for distributing the monies.     For months and months questions on where is the money have been fobbed off  leaving people to languish in increasingly more horrible conditions and still nothing happens.     Meanwhile Bill Clinton is not in Haiti at this time of crisis.  He is on his way to visit Jamaica.  Norman Given who writes the Caribbean Political Economy Blog”   Bill Clinton is coming to Jamaica  to speak about “humanity”  and people are being asked to pay  “$13,000.00 for the opportunity to hear this at a posh Hotel in Kingston”.  How disgustingly obscene is that?

It is even more revolting to remember that millions of dollars and tons of equipment were being deliberately withheld from suffering Haitians in need and perhaps still lie idle in banks and on the ground in Haiti now while the people die.   It is further distressing to remember that P.J. Patterson was also named by Caricom to manage the region’s input in helping solve the crisis in the country and clearly that has also been a failure.

Perhaps, the most revolting outcome however is that Bill Clinton is supposed to be coming to Jamaica to tell us about our common humanity and people are being asked to pay some $13,000.00 for the opportunity to hear this at a posh Hotel in Kingston. I call upon all decent human beings in Jamaica to boycott Bill Clinton’s visit and those who would wish to foist this hypocrite upon us at this time.

Former President Clinton’s history with Haiti is an unsavoury one as is the entire policy of successive American Presidents. Remember Aristide was evicted from office at gunpoint and the threat of being shot by goons sent by George Bush to bring democracy to Haiti.
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