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Tuesday, October 18th, 2016

By: Mark Brender


My range of emotions two weeks after the devastation of Hurricane Matthew: Sadness and grief at the loss and fragility of life for the people of Haiti, again; endless gratitude for PIH supporters who make our work possible; admiration for the commitment and dedication of our Haiti colleagues; and anger at the human actions that created such vulnerability.

Matthew is said to have killed more than 1,000 people in Haiti. Its aftereffects threaten thousands more through a spike in cholera and dire food shortages from the crops and animals that were washed away. Hurricane Charley, a similar Category 4 storm that hit Florida in 2004, killed nine in that state.

The 2010 earthquake in Haiti measured 7.0 on the Richter scale, killed more than 250,000 people, and left more than a million homeless. A 2011 earthquake off the coast of Japan that measured 9.0 on the Richter scale – one of the five strongest earthquakes ever recorded with roughly 1,000 times the energy of the Haiti quake – killed about 16,000 people.

Yesterday was the UN’s International Day for the Eradication of Poverty. If we’re serious about that goal, we must understand what’s causing the difference in these scenarios. All natural disasters are social disasters, and the extent of a country’s vulnerability is a function of pre-existing social conditions – in Haiti’s case, substandard housing, poor infrastructure, a weak public sector, and widespread poverty. The historical forces that created the conditions for such devastation when a crisis hits have rarely been driven by Haitians.

In 1825, as punishment for its victory over France to become the world’s first free Black republic, Haiti was forced to assume a 150-million franc debt to France in reparations, a staggering sum that crippled its economy for decades. Then came the undermining of Haitian rice, sugar and coffee markets, US occupation, trade embargoes, foreign support of brutal dictatorships and a 2010 international earthquake response that did little to capacitate and much to undermine the Haitian public sector. It also introduced cholera.

So we know poverty and despair are human-made and can be created from a great distance. But the flipside is also true: When solutions are driven by those with an understanding of historical legacies and local context, aided by the solidarity and generosity of others, much positive change can happen. Cynicism about Haiti and its people gets in the way of seeing so much important work being done every day by Haitian civil society – before and during so-called ‘natural’ disasters and also long after.

Nearly 20 years ago, Haiti was the site of one of the first programs in world to provide free antiretroviral therapy for poor people living with HIV. The PIH program was funded by foreign sources, but it was only successful because it was implemented by Haitians, including scores of Haitian community health workers. The ‘Haiti model’ influenced HIV programs and advocacy world-wide at a time when it was thought HIV/AIDS couldn’t be successfully treated in poor countries.

The 300-bed public sector University Hospital of Mirebalais, built by PIH after the 2010 earthquake and funded in part by Canadian donors, employs 1,000 Haitians and is both the largest training site of Haitian health professionals and the largest solar-powered hospital in the developing world.

PIH partners including GHESKIO, Fonkoze, and Prodev are Haitian organizations with deep roots in the country and technical capacity and know-how, run by and for Haitians. By their nature they provide the kind of long-term, open-ended investments in their own communities that are necessary for sustained change. It has become a cliché to say that poverty alleviation requires community-driven solutions, but when we consider who actually does most of what we think of as ‘global health’ or ‘international development’ in developing countries, it becomes strikingly obvious.

The overwhelming majority of this work is done every day by farmers and activists and innovators and doctors and nurses and leaders from these same countries. One of the best ways of fighting poverty through positive and pragmatic human action, from afar or up close, in times of crises or in calm, is to honour their knowledge, ask them what they need, and work in solidarity to support them.

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Mark Brender is the National Director of Partners In Health Canada

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