Hard to let go

Dye mon gen mon

I completed my work for IDA Foundation in Haiti in January 2011. I am leaving this blog up for any interested persons (my site stats still show a few random visits a day). It’s hard to let go – a year later I’m still listening to compas almost daily, and I still sometimes update the content in the Resources on health, development and access to medicines and More on Haiti pages. Hopefully someone will find them useful. It doesn’t really fit in my immediate plans, but I look forward to going back to Haiti one day.

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Green along the coast

A few more photos of the countryside, this time along the coast (but no photos of the gorgeous sea, unforgivable I know!) These were taken in October on my way to Petit-Goâve, 75 km from Port-au-Prince, where I visited a project of the small but dynamic Pharmaciens Aide Humanitaire , who are rehabilitating a regional medical store. At the time they were also planning a similar project for Les Cayes, including a pilot school for the training of pharmacists.

On the way to Petit-Gôave


Banana trees and sugar cane

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In the Central Plateau

I am back in The Netherlands, but there are a few things I still want to share, so before I conclude this blog, a few posts are coming up this month.

Something that I really wanted to do while in Haiti was to visit more clinics and health centers outside of Port-au-Prince. I had already visited a few of Partners in Health’s clinics in the Haitian Artibonite and Plateau Central regions. However Partners in Health is a large organization, and I also wanted to visit small organizations. Both small and large organizations face similar issues, but each have their unique challenges too. Dealing with the bureaucracy of customs clearance is for example comparatively much more of a burden for a small organization based in the countryside, who have to send staff to the capital city in order to go through the administration-and-waiting process, than for (larger) organisations who have staff in Port-au-Prince.

My visit ‘into the field’, as they say, was delayed several times. In November the response to the cholera epidemic was still in early stages and it made more sense for me to be in Port-au-Prince, following the progress of the response and keeping organizations up to date on our cholera medicine stocks. Medical staff throughout the country was generally quite overwhelmed too, not the best time for a visit. In December there were the elections and the riots after the preliminary results were announced, not the best time to venture out. Around Christmas I went to visit a good friend in Chicago. The 12th of January was the one-year anniversary of the earthquake, with political suspense all around as the conclusions of the Organisation of American States report on the first round of elections had been leaked two days earlier, and an official response from President Préval was expected a few days later. Not knowing when announcements would actually be made, what they would say, and what the reaction would be, I wanted to be cautious about traveling out of Port-au-Prince for a few days.

In the end however, Préval was still not making any official announcements, the country seemed relatively calm, and my time was running out, so I organised a two-day trip to visit three organizations in the Plateau Central. There is always a degree of uncertainty in Haiti these days, but these two days seemed safe. Bastien and I drove out to Thomassique first, a 6-hour drive. It took us about 1 hour just to get out of Port-au-Prince and Croix-des-Bouquets, a neighbouring town which has become part of the large Port-au-Prince urban area. Once out of the city, we crossed a range of dry mountains to reach the Central Plateau. The way up these dry mountains is scary. Trucks full of stone from a nearby quarry suddenly appear in the bend of the road as they come down the mountain. They drive fast and close to the middle of the road, so both Bastien and the truck driver have to swerve to avoid a collision. I felt like I was in the middle of a real life ‘game of chicken’. In addition, tap-taps and other cars are also coming down and overtaking the trucks. Bastien is a great driver, but I held my breath between a few scared gasps for most of the way up.

Arriving in the Central Plateau

Once we were in the Central Plateau, I was still gasping, but this time out of joy. The view is beautiful: a large expanse of mountains, plains and the occasional undulating river, the whole splashed in shades of green in the lush areas and patches of more rocky, desert colors in the dry areas. Driving through the small villages dotted along the road (or is the road winding through the small villages?) has a double-edged feeling. The little houses with wooden-panel and pointy-roofed fronts are very cute – often the wood is carved, and painted in pastel blue, pink or green. We drive through a busy market which includes a large cattle section. I love these long-horned cows and their peaceful no-nonsense demeanor. For kilometres before and after the market, people are walking along the road with full or empty baskets depending on whether they are walking towards the market or back home. It is the characteristic beauty of the countryside, the shade of large mango trees, fields of spinach and other greens, goats grazing seemingly in the middle of nowhere, donkeys pulling carts, chicken coops,  children running after hoops with sticks or bopping up and down on little horses, families on the porch, little businesses everywhere (including hundreds of little lottery booths)…

Elevated chicken coop next to a painted house


Typical countryside house (photo from 'Caribbean Houses' book)

Yet the Haitian countryside is also characteristic poverty. How much electricity does this village have to keep business and studying going after the night falls, to refrigerate food, to end the day with some radio or television? How much clean water is pouring through taps? How far do students have to walk to school? I can only imagine much of this, but I can tell you how far they have to go in case of a medical emergency. In the village of Juampas for example, the little clinic, run by a single doctor, two nurses, a stock-keeper and an administrative assistant, there are no specific small surgery or maternal services. These are referred to the town of Mirebalais, an hour’s drive on a very bumpy road through several river points which easily flood during the rainy season. And I didn’t see any cars parked by the corrugated iron or wood shacks, so motorbike, donkey cart, or walk seem like the only options This is quite close, as Juampas is right on the main road, but other villages are further away.

Beauty and poverty, the bittersweetness of Haiti. I think of more two-sided coins as we arrive at the large Lac de Péligre. The lake is beautiful, surrounded by green mountains, and bordered by little houses whose dwellers plow the steep sides plunging towards the water. Yet this lake was created by a dam in the 1950s, at the expense of farming land vital to the regions’ inhabitants. (This is, by the way, the region where Paul Farmer started working in Haiti.)

Lac de Péligre

After the lake, we enjoyed a smooth couple of hours on the newly asphalted road, through more lovely countryside. The last hour, however, after passing the town of Hinche, was one of serious bumps on a dirt road. There had been no rain for a while, and the road was covered in a layer of white dust – as were the plants and houses bordering the road. This gave the scenery a strange ghost-like impression, sometimes dotted by a few bright red hibiscus flowers, like when photos are developed in black and white except for a certain colour.

White dust covering the road, but not the bright red hibsiscus 

Finally we reached Thomassique, and after spending an hour with the staff responsible for the St Joseph Clinic medicines supply chain, headed back west to visit another clinic in Hinche, and then back to Mirelabalais for the night.

The clinic in Thomassique


Driving back in the evening

The next morning is when we drove to Juampas, east of Mirebalais. After showing me around the clinic, the doctor took some time to tell me about the medicines-related challenges. When I gave him our new catalogue, his first reaction was an anxious question: ‘have the prices changed?’ I answered that while I did not know specifically which products and how much, in general prices would have changed a little, yes. It is later in our conversation that I realized the measure of his anxiety. He showed me his list of medicines need for the coming three months. It totaled about US$ 27,000, and he had sent it to the small headquarters of the organization in the US. They had replied that they had not been able to raise more funds than to allow him a medicines budget of US$6,000, so he had to go through his list and almost cut it down to a fifth. He managed to make a new list of about US$7,500, and any small increase of price from our side would mean he would have to sacrifice yet a few more products.

‘Affordability’ is one of IDA’s core pillars, and not only do we strive to negotiate the best prices with manufacturers, we also aim to keep transport, administrative, etc. costs low. However talking with this doctor, native to the very village in which he works, I was soberly reminded that what may seem like a few, small, not too significant cost increases along the long supply chain process can have serious, direct consequences on his work. And as much as I enjoyed being in the countryside for the beautiful landscape, it is for this reminder and to be able to witness the tireless work of these small organizations at the end of bumpy dirt roads that I am most glad to have been able to make it out of Port-au-Prince, even if just for a couple of days.

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Access to Essential Medicines: 10 stories that mattered in 2010

And matter for 2011 too! See the ten stories on the MSF website.

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Elections and protests update

What you can read in the news

Tuesday evening the Conseil Electoral Provisoire announced the preliminary results of the national elections which took place last week. In the presidential race, Mirlande Manigat was announced to be in the lead with 31.37% (336,378 votes), Jude Celestin second with 22.48% (241,462 votes), and Michel Martelly third with 21.84% (234,617 votes). Candidates now have some time to appeal on the announced results, the final results will then be announced on December 20th. The top two candidates will be presented for a second round (required if no one has more than 50%), which will take place January 16th.

The elections were already unpopular with some or many (I can’t actually tell how much of course) Haitians to begin with, considering the fact that the popular Lavalas party (of former president Aristide) was exluded from participation, and that no candidate seemed to especially represent ‘the people’. In addition, the organisation of the campaigns and elections, as well as the costs, were seen as extravagant when the country faces so many reconstruction challenges. Not all of those who wanted to get registered to vote were able to either, and on the day of the election there were also issues with registration, claims of fraud, and  ransacking of some polling stations. Again, I definitely can’t tell how much actually went well or not, but TV and radio reported quite a bit of dissatisfaction with the day of the election. The electoral commission and international observers admitted to some hitches, but declared the election valid.

When the results were announced, they did not match previous estimates (from before and after the election), which indicated Joseph Martelly, a popular singer, to be in the lead, instead of the Jude Celestin, the ruling party’s candidate. This was followed by immediate protest in the streets Tuesday evening, all day Wednesday, as well as today, Thursday. The airport is closed, and not many are venturing outside their houses. Following this, the electoral commission ordered an urgent review of the presidential poll results today.

What it’s like to be here

Tuesday night was a bit impressive, the protests started in the neighbourhood right above mine and moved down to my area too. I could hear some of the crowd, gun shots, and smell burning tires.

Wednesday everyone that wasn’t out demonstrating stayed at home – there wasn’t much choice anyway as thousands of people walked down the main streets, and as burning tires, rubble and big rubbish containers were placed to block the roads.

Today from what I can tell things were slightly calmer, but there were still demonstrations and one more death, in Port-au-Prince this time after Haitians threw rocks at UN peacekeeping forces (yesterday there were four in Les Cayes, in the south, and one in Cap Haitian, in the north, reportedly due to fighting between rival political supporters). People stayed at home again.

It is a bit crazy to hear demonstrations going on outside quite close by of course, but I haven’t felt unsafe at all. My Internet has been down most of the two days, but not on my phone, and in the evenings it gets better, so I’ve been able to both work a little and not feel isolated. The appartment complex I am in is running low on water, but I have a tank that can last a few days. Electricity has been totally fine, and I’ve got food stocked up. So it’s not tough and not scary. Still it would be good for everyone if things got back to normal. I do expect things to be improved tomorrow, especially considering the poll review.

I definitely respect that if Haitians are unhappy about how the elections have gone, they express it. One very bad effect of freezing up the whole city and part of the country however is that it also freezes a lot of the cholera response: ambulances can’t circulate, medicines are not being distributed to the instituions that need them, and I guess many, if not most or all, health workers are not going to work.

Finally, a note on the violence: ruling party offices and some other buildings were burnt down or ransacked, there have been gunshots and grenades in the streets, and rocks thrown at the police and UN peacekeeping forces, who responded with tear gas and gunshots in the air. Still, I feel like from what I saw on TV, a lot of people yesterday were simply marching down the streets. Yes, they were shouting, chanting, running, and protesting, but they weren’t wildly shooting around. I’m not saying just a bit of violence and a few deaths are acceptable – not at all! – but media reports of ‘armed clashes’ and footage of the burning tires and grenade throwing sometimes make it seem more violent than it is. It’s definitely a big deal, but at this point it’s not a civil war.

If you want to stay up to date, here are two aggregator websites for news about Haiti:

General news: http://www.haitinews.net/

Humanitarian news: http://www.reliefweb.int/rw/dbc.nsf/doc104?OpenForm&rc=2&cc=hti

There is a bit of a time lag between events and reporting of course (yesterday it was quite fast, but somehow today since things had relatively calmed down news reports were coming in slower) – fastest way to get news is via radio, and friends who luckily share security updates with you! Yesterday I also got to see quite a bit of coverage of the streets on Haitian television (and not just the violent bits, especially as Haitian reporting features a lot of very long moments where the camera just walks or motorbikes down streets, without any commentary except where they are), but I had to look for it because not all my channels always work, and sometimes all channels thought it was fine to play Spanish and Indian soap operas, Christmas movies, and music videos for several hours in a row despite what was going on!

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A friend of mine sent me this article: http://archive.truthout.org/how-rumors-rule-cholera-torn-haiti65656. It is a must-read! (*if you are interested in Haiti and/or development…)

Some thoughts:

It might be the best article I have read about Haiti so far. Maybe because it expresses and reinforces my own observations, and we always like our own feelings to be confirmed!Nonetheless, I think the article highlights something critical to ‘understanding (a part of) Haiti’: the perception of many Haitians with regards to the international community, aid and peace-keeping. In addition to the relevance of the topic, I feel the tone is right and the description quite accurate and sensitive. I am tempted to say it is ‘unfortunately’ quite accurate, because it does break my heart.

The article also points to how important it is for development work to understand the context it is working in (socially, but even in terms of infrastructure too, when you consider the paved road story for example). Logistics, technical design, funding – they are all very important too. However understanding the context – most probably by really involving those you are actually working for – may be one of the most important factors for lasting positive impact. And one which much of the development community is not very good at so far.

You may have noticed that I don’t really write about aid and development – I definitely have a lot of feelings about these topics and often spend most of my time thinking about it, but I don’t actually have enough knowledge and experience to write sensible things (or at least not without a lot of time and effort that are better spent on my work right now). However this article resonated with me – both in my attempt to understand some of Haiti while I am here and reflect it via this blog, as well as in its illustration of the importance of ‘the way NGOs are perceived by a community that they are supposed to serve’ (the article focuses on how this can affect aid effectiveness, but it’s also a very interesting topic in terms of human relationships). So here no hesitations in encouraging you to read it.

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On the walls: it’s Jerry!

I’m not the only one whose eye was caught by graffiti – thanks to a colleague I discovered the graffiti artist from earlier posts signs ‘Jerry’ and not ‘Jezz’, and has definitely been noticed by the media. There are YouTube videos of him at work too. Check these out if you’re interested:

CNN video: http://edition.cnn.com/video/#/video/world/2010/03/07/mckenzie.haiti.graffiti.champ.cnn?iref=allsearch

Featured in ‘Day 10’ of this remarkable photo-essay: http://voicesofhaiti.com/photos

Miami Herald: http://www.miamiherald.com/2010/06/29/1706326_p2/graffiti-depicts-frustration-hope.html

And just today I happened to take a new photo:

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