I have been in Haiti for just over a week, on my second trip this year to support a public health partnership in the North, in Cap Haitien, Haiti's second largest city. It feels like a trip akin to freshmen orientation, a step in the process of becoming a student in a place that is suffering under one of the largest health crises in modern times. Our primary work, which began nine years ago, has consisted of partnering with local public health institutions in Cap Haitien to build their capacity to provide care for their own people. Since the outbreak of cholera seven weeks ago, over 30 of our Haitian staff that we know as coworkers and friends have responded heroically to a cholera epidemic that continues to rage out of control.
Haitians are too often portrayed as people to pity or bent on burning tires. In a country of over 10 million people with the majority under 24, little is said about the level of restraint that has been shown by the masses of displaced and financially impoverished people who have seen little if any change in their quality of life since the earthquake, despite the high profile celebrity pandering and international donor (or more accurately public relations) conferences.
Some of my efforts have been to report back to people in the United States what is happening here. I have coordinated outreach to media for over a decade on many international issues including banning cluster bombs, ending sanctions and war in Iraq, and promoting humanitarian efforts there and in Gaza, the West Bank, Sudan, and Afghanistan. This week, I sent out a press release to over 700 US and international media outlets announcing that interviews are available with colleagues, including an American water engineer conducting tests on the presence of water borne disease in Haiti's water supply and a Haitian obstetrician and gynecologist who is spearheading community outreach for cholera prevention. It is the first time in over a decade that I received no response, where normally I receive dozens of inquiries; a telling tidbit that speaks to the interest in, and the lack of, Haitian voices represented in the current discourse -- facts on the ground from Haitian perspective are of little interest.
Cholera has gained some media attention, but to what avail and in what context? Systems are overwhelmed, their efforts and challenges underappreciated: try moving supplies around when the ports and airports may close at any moment, when roads are blocked and difficult to travel when not, when clearance through customs becomes an exercise in patience. Try explaining to a person who is severely rehydrated why there is nothing that can be done. Try understanding why estimates of patients are unknown, when those affected do not have the money (the equivalent of 8 cents) to pay for transportation to a treatment center.
This is the world we live in and, yes, have helped create. Over 800 million people, almost three times the number of people in the United States, have no access to safe drinking water. In many ways, cholera is an accelerated version of the ordinary state of affairs, where water borne disease affects the most vulnerable and marginalized. Perhaps one difference is that cholera is less discriminating -- impacting adults as well as children. It also carries a strong stigma, in terms of fear of its potency, and a tendency to believe in the US that it only exists as a footnote, in titles from Gabriel Garcia Marquez or as a bygone, eradicated disease that we have little awareness of in industrialized societies, like polio and rickets. In quiet contrast, cholera rages from Nepal to Nigeria, in Zimbabwe, Iraq and Laos, and many other countries where a lack of access to sanitation and potable water increases on this planet of growing slums. When one of ten children under the age of five in Haiti succumbs to death from diarrhea, epidemiologists provide little comfort to families by identifying the strain and source of the illness that afflicts their loved ones.
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Quite simply, many existing agencies are underequipped to respond to the perfect storm of illness, poverty, wealth and land inequality, and the vast limitations of current political representation. I learned in Iraq that balancing humanitarian needs and security concerns is a challenge yet to be mastered -- you can guess who loses out in this scenario. Land Rovers and weapons are plentiful; oral rehydration salts, chlorine, disinfectant and clean water are not.
Despite these challenges, the efforts of Medecin Sans Frontiers (MSF), Haiti Hospital Appeal UK and others have been extraordinary. MSF has responded with their single largest initiative, hiring over 5000 local workers and treating patients and coordinating cholera treatment centers throughout the country. Chain smoking, 100-hour work weeks are the norm. Haiti Hospital Appeal, in Cap Haitien with limited resources, seems to be everywhere at once -- receiving patients with disabilities, coordinating treatment and prevention. This happens in the midst of an active construction site, as they literally build their facilities as they need, and can afford them.
People come to Haiti thinking they have all the answers, and as a colleague stated recently, "There is no shortage of good ideas in Haiti." We don't come here with answers, but strive to listen and learn, to partner in appropriate ways that humbly recognize our incomprehensible privilege and disconnect that accompanies the wealth and walls constructed by the West. Yesterday, I was with a close partner from the Haiti Hospital Appeal at their hospital in Quartier-Morin, where MSF has constructed one of the many cholera treatment centers they manage, and manage well. We went scrambling to find a umbilical clamp for a cholera patient about to give birth -- I have yet to hear of her and her newborn's condition. How does the world this child is entering mesh with the world I left, where the current holiday season of celebration is signified by a mad scramble for crap we don't need, for plastics to be disposed of, for toxic toys that will never meet the expectations of spoiled children?
And yet, we often forget that the struggle for life with dignity continues unabated. Driving to witness one of the education efforts we are conducting, trucks with sound systems driving through the market to share prevention techniques, I passed a wedding party. The day before, hundreds of children impeccably dressed in uniform on their way home from school, young men lining up for the chance at employment, farmers on their way to markets to sell produce, mothers providing for their children against all odds, while depriving themselves of their own needs.
You are reading this, perhaps expecting some happy conclusion, a winning paragraph that ties everything together, that preserves the crumbling vision we as Americans have projected onto others and ourselves: never-ending growth and prosperity that rewards those who earned it, and still trickles down to those in need. This does not happen. What is happening is that not enough people care.