The following is a talk delivered by Scott Weinstein to a public forum in Winnipeg, Manitoba on May 7. Weinstein is a Montreal-based nurse who volunteered for five weeks of medical duty in Haiti shortly after the January 12 earthquake. The full speech can be read at Rabble.ca.
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I am sure that the arrival at the General Hospital in Port au Prince of foreign health professionals was welcomed by the Haitian patients like Mr Abeldard, suffering from a bad foot fracture, Jeanne Aurilus, whose right arm had been amputated, and Emmanuel Sovereign, who lost an arm and had multiple fractures and deep, infected wounds.
These good people, and several hundred others, were in the large makeshift tents that made up the reconstituted hospital when I arrived. They were grateful for the international volunteers, like myself, and the millions of dollars of medical supplies we brought with us.
But ethical humanitarian response is undermined by charity aid. Such aid can be self-serving, or worse, perpetuates poverty and disempowerment. I believe there is an option to provide ethical, solidarity aid as opposed to the more common charity aid.
After a massive disaster, Haiti required all the international help and resources that could be poured into the country. The emergency needs were so tremendous that only a rapid response of skilled medical workers, plus hundreds of millions of dollars in rescue aid, could hope to meet the desperate requirements for immediate survival.
For example, in the first week after the earthquake, the lack of medical care led to many grave wound after which the only way to save the person’s life was to amputate the infected limb. This is a legacy of that first week that will forever haunt the patients and the health workers who amputated thousands of limbs — often without the luxury of anesthesia or proper medical equipment.
The needed emergency response does require a combination of rapid availability of skilled volunteers, independent organisations and NGOs, plus huge resources from the United Nations and wealthy countries.
Why is charity aid to Haiti less helpful? Why does charity often serve as a political weapon directed against poor countries?
Why are many NGOs and charities working hand in glove with neoliberal policies to keep poor people disempowered, and, in the case of Haiti, keeping an entire nation disempowered? Why is solidarity aid too rare?
After all, is there a difference between, let’s say, a wound dressing change on Emmanuel that is performed by Louise, a Haitian nurse who worked for the general hospital but has not been paid for the last three month; by Sland, an expatriate Haitian nurse who returns to Haiti to help; by a Canadian nurse like me who wants to be in solidarity with the Haitian people; by an American nurse sent by her university hospital in Baltimore as part of its corporate charity program; or by a Mormon missionary medical team from the US that sees Haiti as fertile recruiting grounds for its church?
There really isn’t much difference in the “how” we treat the patients. But there is a huge difference in what happens after the emergency is over.
Before the earthquake, the general hospital was the main public hospital in Port au Prince. Most other hospitals were private.
The Haitian government was broke and barely functional due to several centuries of rapacious colonialism from Western counties that plundered and invaded the country for its rich resources.
In 2004, the democratically-elected president Jean Bertrand Aristide was overthrown by a coup with support from the US, Canadian and other foreign governments. The general hospital also was crippled, lacking funds for adequate staff and medical supplies.
There are many things wrong with the charity aid recently directed at Haiti:
• Most of the hundreds of millions of dollars spent on Haiti in the first month after the earthquake was spent outside of Haiti, including salaries to non-Haitians.
• Donated medical supplies for Haiti either enriched the foreign manufacturers who sold them, or they got a tax break for donating them.
• The doctors and nurses paid by organisations such as the Red Cross and Doctors Without Borders were from North America or Europe. They provided essential health aid to Haiti, but their mission does not extend to helping Haiti build a sustainable health care system.
• The Quebec government will spend millions of dollars on Haiti reconstruction projects — but that money will go to Quebecois, not Haitian, construction firms.
• The Canadian government-funded Canadian International Development Agency (CIDA) is spending millions to build health care and education infrastructure, and helping the government re-establish itself. But this is the same Canadian government that helped overthrow the Aristide government that was trying to do the same.
The 2004 coup installed a government more beholden to the neoliberal policies of the Western nations. So this CIDA aid package is a total contradiction to what Canada’s real Haiti policy is — it is propaganda at best.
CIDA is not providing credit to Haitian businesses or farmers to produce sustainable products and food.
• Foreign investment is aimed at setting up foreign-owned sweatshops in Haiti, not sustainable local enterprises.
Here are a few examples of what solidarity aid looks like:
• The French-run Handicap International organisation set up shop at the general hospital. It visits the handicapped patients with a team comprising French therapists and Haitian interns. The French will leave eventually, but they understand the work must continue with the Haitian staff.
This concept seems counter-productive to many NGOs and international aid agencies, who don’t have any plan to give up their jobs and projects.
• As Haitian medical staff returned to the hospital, I sought to ensure they could manage the wards after I left.
• A Haitian school called Sopudep is supported by a Canadian charitable foundation. The school was founded by a community organiser who envisioned a community school for poor children that can become a model for public schools. Though it is run as a private school, the assistance it receives from Canada and the US supports Haitian employees and Haitian students, and is designed to build a Haitian public education system.
• An experimental mechanical wound suction is being developed by a medical team from Boston, working with Partners In Health (PIH) based in Haiti. They hope each system would cost less than US$75. The high-tech US version costs thousands of dollars. Its manufacturer made $1.4 billion from it in 2008. The next day, Emmanuel got his blue bottle wound suction for his hip.
• PIH’s work is an important example of solidarity — not charity. PIH was started by Harvard doctors who had the radical idea that poor communities could be mobilised to treat community members who had multi drug-resistant tuberculosis —a deadly disease.
They used a combination of health care, a few health professionals, and many community health workers who frequently visited the TB patient at home. The model worked. It also has the effect of strengthening community structures around important projects.
Then PIH began to target AIDS, with the same community mobilisation response.
In Haiti, PIH is based in the countryside, where there are little public services and the poverty is appalling. They have attracted hundreds of volunteers from the US and raised millions of dollars, but they spend their money paying and training Haitians.
In post-earthquake Haiti, about 5000 to 7000 Haitians are employed by PIH. The US medical staff are volunteers. The Haitians are in the PIH leadership.
PIH also funds sustainable community farming to grow healthy food and it funds local schools.
• Cuba has made a long-term commitment to health care in Haiti. It had about 400 workers serving before the earthquake. It mobilised hundreds more for earthquake relief.
For years, Cuba has run a free medical school for Haitians on the condition graduating students practise medicine in underserved Haitian communities. More than 500 Haitians have graduated and are serving right now.
Meaningful aid for victims of natural or human-made disasters means supporting humanitarian relief by organisations that: spend their money in the places they operate in; have an organisational plan democratically decided by the affected people; have a plan to train local people to acquire the skills needed to take the program over.