Jean-Jean, six, is part of the pack of kids that races to meet me each time I arrive at one internally displaced people's camp in Port-au-Prince. Jean-Jean is usually at the front, all flashing eyes and big toothy grin, out-shouting the others or engaging in some ridiculous antic for my attention.
On one visit, Jean-Jean's mother appeared dragging by the arm a very different little boy, slow and sad. Jean-Jean feebly raised his eyes to me; the whites were just one shade this side of mustard-yellow. Hepatitis.
"How long has he been like this?" I asked, trying to mask my panic.
"And what have you given him?"
"Nothing. I know he's supposed to be drinking a lot of water, but we don't have any money just now." Of course, that also meant no medication and little food - or perhaps, on some days, no food. Many of the people in these camps can go days without a single small coin touching their palm. Some have asked me if it's true that Haiti has received billions of dollars in aid.
"Have you taken him to the doctor?"
I knew the answer before I asked. There are a few free clinics around town, but even then the tests and medicines usually cost money, and there is bus fare to be paid. "No, but I will," she said. I bought a shopping bag full of small water sacks, two for a quarter; asked Jean-Jean's neighbor, my friend, to keep an eye on him; finished my business at the camp; and moved on with the day.
Three days later, I returned. Jean-Jean had still not gone to the doctor. An all-too-familiar look on the mother's face - some combination of shame and desperation - let me know that that had not been an option for her. This time we worked together and devised a way to get medical care.
This story has a happy ending. Jean-Jean is now well and back to being a heart-stealing mischief-maker.
But I've known it to go the other way, many times over. At one point, decades before the earthquake when I was living in a Haitian village, an unofficial part of my job description was to transport to the hospital babies and little children who were sick or dying, effectively, from poverty. Another part of my de facto duties was to collect from the morgue the bodies of some of those same small patients.
Late one night, someone knocked on my door. It was a woman I didn't know, clutching a baby to her chest. The child's wizened face, loose skin, distended stomach, and thin hair made it clear that she was in the final stages of dehydration and starvation.
Not having a car to drive her to the Leogane hospital forty minutes away, I instead wrote a note to the staff. By virtue of my knowing many of them through repeated visits there with children such as this, and of my U.S. citizenry and white skin, this note was all but guaranteed to give the infant quick access to health care.
The next morning, a neighbor came to tell me the baby had died. "Died?" Her admission was good to go and the treatment was free. "Didn't they connect her to an IV?"
"No," the neighbor said. "The mother didn't go to the hospital. She couldn't come up with the gourde" - at that time, twenty cents - "to take the bus there."
An estimated 62 Haitian children out of each 1,000 die in the first year of life, and 85 of those 1,000 never made it to age 5.1 A Haitian child under 5 dies every hour from hunger, according to the World Food Programme,2 while chronic undernutrition of children under 5 is 24%.3
The U.N. Special Rapporteur on the Right to Food, Jean Ziegler, says that there exists enough food worldwide to feed 12 billion people, almost double the number of the global population. Yet hunger is growing. And according to Ziegler, none of its causes are natural; they are all human-made. "Every child who dies from hunger is assassinated," Ziegler commented.4
Similarly, the World Health Organization's Commission on the Social Determinants of Health credits the "grand scale" of death from illness and disease to "social injustice." The Commission attributes the fact that the majority of the world's inhabitants do not have the good health that is biologically possible to "a toxic combination of bad policies, economics, and politics."5
If the government or more rich citizens of Haiti and other low-income countries, or the governments of wealthy countries, or the World Bank and IMF, valued the fate of poor children over profits and were willing to better share wealth and other resources, a lot more babies and children like that starving one who showed up at my door would be alive today. (See Paul Farmer's excellent The Uses of Haiti for more on the role of the U.S. and other powers in getting Haiti to its current state.) More would be alive, too, if the international financial institutions and World Trade Organization did not strong-arm low-income counties into accepting policies that promote so-called free trade at any cost. The costs have been borne by an unknowable number of children.
The roots of profound suffering on the western portion of the island of Hispañola go back to 1492, when the Spanish colonists who arrived with Columbus enslaved the Arawaks and Caribs, and worked almost all to death, literally, within 27 years.6 This led the Spanish to replenish their labor force with captive Africans, which the French later imported at much higher numbers.7
After the 1804 revolution, large Haitian landowners replaced the French landowners and the slaves became serfs. Neglect and exploitation by landowners and other wealthy classes were backed by successive regimes, whose raison d'être was to serve that small elite while keeping profits flowing to government officials. Violent security forces helped accomplish the job.
Social abandonment and economic exploitation by the Haitian government and elite have been mirrored in foreign policies. Their roots go back to Haiti's beginning as a free nation, too, when the U.S. imposed a trade embargo so that word of the successful slave emancipation didn't spread. Moreover, France kept Haiti in debt until it paid off the former colonist for lost income due to the revolution.
Post-earthquake politics offer new twists on the same theme. The IMF, for example, is apparently still considering whether it will convert a $100 million post-earthquake loan to a grant. (Surely the IMF doesn't expect to ever collect this debt, but its creditor status gives it a lot of power over Haiti's economy.) As another example, the disaster food aid which the U.S. procures from domestic agribusiness has further crippled local agriculture and the national economy. The U.S. and U.N.'s plan for reconstruction is based on a sweatshop model, a ‘race to the bottom' in which the lowest wages, the fewest health and safety standards, and the worst possibilities for unionizing are considered advantages for the industry.
All of these historic and global forces converge to affect whether a child like Jean-Jean survives.
But alternatives do exist. As the U.N. Special Rapporteur on the Right to Food and the World Health Organization indicate, the suffering with which Haiti and other low-income nations are branded is not inevitable. It is the result of economic and political choices by a few. But other choices can be made that will yield different outcomes. Progressive Haitian social movements - the grouping of women's, youth, student, farmer, street vendors, and many other sectors - are advocating those other choices. They are urging the Haitian government and international community to adopt policies and programs which can produce a more just and equitable future. They are demanding that all citizens, not just a few wealthy ones, be active participants in the process. (For more about alternative redevelopment options in Haiti, see other articles in this series, including: Post-Disaster Reconstruction: Putting Haitian Citizens into the Equation; A Future for Agriculture, A Future for Haiti; Haiti: "Post-Disaster Needs Assessment" - Whose Needs? Whose Assessment?; and Raising Up Another Haiti.)
I have thought about the baby girl that died that fateful night in the village hundreds of times throughout my life. She is an indicator of the failure of our global society.
I have also wondered about the woman she might have become. I have always imagined that she would be fighting to create a new world in which no one dies for lack of twenty cents. Today, I like to think, she would be out there working hard to ensure that the Haiti that is reconstructed doesn't look anything like Haiti before the earthquake. She'd be making sure that the rebuilt Haiti is based on equity, rights, and democratic participation in a world in which all, not just a few, stand a chance.
1 Figures are estimates for 2005-2010 from "World Population Prospects: The 2008 Revision," United Nations Population Division. data.un.org/Data.aspx?q=haiti&d=PopDiv&f=variableID%3a80%3bcrID%3a332.
4 United Nations Department of Public Information, "Press Conference by United Nations Special Rapporteur on Right to Food," October 26, 2007. http://www.un.org/News/briefings/docs/2007/071026_Ziegler.doc.htm.
5 World Health Organization, "Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health," Geneva, August 20, 2008.
6 Brutal labor practices and the spread of European diseases killed off roughly 900,000 of the million indigenous people in 27 years of colonization. "Histoire des caciques d'Haïti," (Editions Panorama, Port-au-Prince, 1894), quoted in Carolyn Fick, The Making of Hatii: The Saint Domingue Revolution from Below (Knoxville, University of Tennessee Press, 1990), p. 288.
7 The French introduced the highly labor-intensive sugar cane to the French West Indies. This led the colonists to increase the number of Africans they brought into the region each year to roughly 37,000. Fick, Op. Cit., p. 22.