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.
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)…
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.)
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.
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 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.