Haiti: Charity alone is not enough

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Jeanne finally allows Slande, a volunteer from Florida, to clean and redress her amputation stump at the very busy Hopital d'Etat de la Universite Haiti. Photo: Scott Weinstein

The following is a talk delivered to a public forum in Winnipeg, Manitoba, on May 7, 2010. The forum was organized by the Winnipeg Haiti Action Group under the theme, "Perspectives on Haiti After the Earthquake."

I am sure that the arrival at the general hospital in Port au Prince of foreign health professionals was welcomed by the Haitian patients like Mr. Abeldard, suffering from a bad foot fracture, Jeanne Aurilus, whose right arm had been amputated, and Emanuel Sovereign, who lost an arm and had multiple fractures and deep, infected wounds. These good people and several hundred others were in the large makeshift tents that made up the reconstituted hospital when I arrived [shortly after Jan. 12, 2010's devastating 7.0 Mw earthquake]. They were grateful for the international volunteers, like myself, and the millions of dollars of medical supplies we brought with us or arranged to be shipped.

But ethical humanitarian response soon gets undermined by charity aid. The latter can be self serving, or worse, resulting in perpetuating poverty and disempowerment. This provocative issue is what I want to touch on this evening. I hope to show that there is an option to provide ethical, solidarity aid as opposed to the more common charity aid.

After a massive disaster, Haiti required all the international help and resources that could be poured into the country. The emergency needs are so tremendous that only a rapid response of skilled medical workers, for instance, plus hundreds of millions of dollars in rescue aid can hope to meet the desperate requirements for immediate survival. For example, in the first week after the earthquake, the lack of medical care led to many grave wound infections following which the only way to save the person's life was to amputate the infected limb. A legacy of that first week will forever haunt both the patients and the health workers who amputated thousands of limbs, often without the luxury of anesthesia or proper medical equipment.

So the needed emergency response does require a combination of rapid availability of skilled volunteers like myself, independent organizations and NGOs, plus massive resources from the United Nations and wealthy countries like Canada and the United States.

Why is charity aid to Haiti less helpful than what we hope it to be? Why does charity often serve as a political weapon directed against poor countries? Why are many NGOs and charities criticized as the "Non-Profit Industrial Complex" -- working hand in glove with neo-liberal policies to keep poor people disempowered, and in the case of Haiti, keep and entire nation disempowered? Why is solidarity aid too rare, and misunderstood?

For Mr. Abelard, Jeanne and Emanuel, they probably won't understand the dynamics of how news photos and television images of them, and even NGO website photos, are being used to fund foreign charities, for better or worse.

After all, is there a difference between, let's say, a wound dressing change on Emmanuel that is performed by Louise, a Haitian nurse who worked for the general hospital but was last paid three month previously; by Sland, an expatriate Haitian nurse who returns to Haiti to help; by a Canadian nurse like me who wants to be in solidarity with the Haitian people; by an American nurse sent by her university hospital in Baltimore as part of their corporate charity program; or by a Mormon missionary medical team from the U.S. that sees Haiti as fertile recruiting grounds for their church?

There really isn't much difference in the "how" we treat the patients. But there is a huge difference in what happens after the emergency is over.

In 2005, I responded to Hurricane Katrina. In perspective, it was relatively small compared to Haiti's disaster. In New Orleans, we set up the free Common Ground Health Clinic with the motto "Solidarity -- Not Charity".

Previous to the earthquake, the general hospital was the main public hospital in Port au Prince. Most other hospitals were private. The Haitian government was broke and barely functional due to several centuries of rapacious colonialism from western counties that plundered and invaded the country for its rich resources. More recently, in 2004, the popular, democratically-elected president Jean Bertrand Aristide was overthrown by a paramilitary uprising with vital support from the U.S., Canadian and other foreign governments. Naturally, the public general hospital also was crippled, lacking funds for adequate staff and medical supplies.

Charity Aid

Let me describe some examples of charity vs. solidarity aid.

There are many things wrong with the Charity Aid recently directed at Haiti:

- Most of the hundreds of millions of dollars spent on Haiti in the first month after the earthquake was spent outside of Haiti, including salaries to non-Haitians.

- Donated medical supplies for Haiti either enriched the foreign manufacturers who sold them, or they got a tax break for donating them.

- The doctors and nurses paid by organizations such as the Red Cross and Doctors Without Borders were from North America or Europe. They provided essential health aid to Haiti BUT their mission does not extend to helping Haiti build a sustainable health care system.

- The Quebec government will spend millions of dollars on Haiti reconstruction projects -- but that money will go to Quebec, not Haitian, construction firms.

- The Canadian International Development Agency (CIDA) is spending millions to build healthcare and education infrastructure, and helping the government re-establish itself. Why, that looks like exactly what we are advocating, so what's the problem? Well, this is the same Canadian government that previously helped overthrow the Aristide government that was attempting to do the same. The 2004 coup installed a government more beholden to the neo-liberal policies of the Western nations. So this CIDA aid package is a total contradiction to what Canada's real Haiti policy is -- and at best propaganda. CIDA is not providing credit to Haitian businesses or farmers to produce sustainable products and food.

- Foreign investments are setting up foreign-owned sweatshops in Haiti, not sustainable local enterprises.

    Solidarity aid defined

    Here are a few examples of what solidarity aid looks like:

    - The French-run Handicap International organization set up shop at the General Hospital. They visit the handicapped patients with a team comprising of French therapists and Haitian interns. The French will leave eventually, but they understand that the work must continue with the Haitian staff. This concept seems counter-productive to many NGOs and international aid agencies, who don't have any plan to give up their jobs and projects.As Haitian medical staff returned to the hospital, I oriented those in my nursing wards to how it was now functioning with the international volunteer teams so they could manage the wards as I was leaving.

    - A Haitian school called SOPUDEP is supported by a Canadian charitable foundation. The school was founded by a community organizer who envisioned a community school for poor children that can become a model for schools in a public school system. Though SOPUDEP is run as a private school, the assistance it receives from Canada and the U.S. supports Haitian employees and Haitian students, and it is designed to build a Haitian public education system.

    - Mrs. Wintour got an experimental mechanical wound suction that aspirates draining fluid from her foot wound into a corrugated blue squeeze bottle. The sisters of her neighbour, Emmanuel, wanted one for Emmanuel. The wound device is being developed by a medical team from Boston who are working with Partners In Health based in Haiti. Kristine, PIH's engineer on the project, thinks when the kinks are worked out, they can provide the molds for the plastic bottles to businesses in third world countries that can stamp out bottles for a few dollars. All together, they hope each system would cost less than $75. The high-tech US version costs thousands of dollars. Its manufacturer made $1.4 billion from it in 2008. The next day, Emmanuel got his blue bottle wound suction for his hip.

    - Some of you may have heard of Partners in Health. They are a very important example of solidarity -- not charity. PIH was started by Harvard doctors who had this radical idea that poor communities could be mobilized to treat community members who had multi drug-resistant tuberculosis, a deadly disease. They used a combination of health care, a few health professionals, and many community health workers who frequently visited the TB patient at home to make sure they were taking their year-long drug regime and were getting help with other health needs. The model worked. Until 20 years ago, TB was spreading throughout impoverished nations. The medical community felt the only realistic solution was containment, and developing a new antibiotic.

      This model not only worked for the patient, but it has the effect of strengthening community structures around important projects.

      Then PIH began to target AIDS, with the same community mobilization response.

      In Haiti, PIH is based in the countryside where there is very little public services and the poverty is appalling. They have attracted hundreds of volunteers from the U.S. and raised millions of dollars, but they spend their money paying and training Haitians. Today, in post-earthquake Haiti, some 5,000 to 7,000 Haitians are employed by PIH. The American medical staff are volunteers, (and many of us in the medical community would love to volunteer with PIH). The Haitians are in the PIH leadership, and in fact, the medical care services are only a fraction of what the agency does. PIH also funds sustainable community farming to grow healthy food and it funds local schools. So they opportunistically use health care to build sustainable democratic community infrastructure.

      Cuba has made a long-term commitment to health care in Haiti. It had some 400 personnel serving prior to the earthquake. Then it mobilized hundreds more for earthquake relief. For years, Cuba has offered free medical school for Haitians on the condition they return and practice medicine in underserved Haitian communities. More than 500 Haitians have already graduated and are serving right now.

      At the March 31 UN donors conference for Haiti held in New York City, Cuba presented a bold plan to build a comprehensive health care system in Haiti. It challenged the world's governments funds to put the plan into action.

      In my opinion, these solidarity examples show how we can re-vision help to both support ethical projects and demand ethical foreign aid.

      Guidelines for solidarity aid

      So meaningful aid for Haiti and other victims of natural or human-made disasters it means that we need to support humanitarian relief by ethical organizations that:

      - Spend their money in the places they operate in.

      - Have an organizational plan that is democratically decided by the affected people.

      - Have a plan to work themselves out of their job by training local people to acquire the skills needed to take over the local organization.

          The Canadian government must change its policies. I think it would be marvelous if Canada re-oriented its presence in Haiti towards helping Haitians build sustainable infrastructure. For example, Canada must no longer undermine popular governments that put people first. Canada should stop subsidizing Canadian industry and agriculture that export finished goods to Haiti. Instead, Canada should subsidize only the donation of Canadian products that are essential for Haitian enterprises and farmers to develop their own capacity to produce sustainable products and food. Canada should provide credit to Haitian business and farmers.

          Above all, Canada should cease a foreign policy towards Haiti that amounts to keeping the country as a reserve of cheap labour and cheap natural resources.

          Humanitarian aid is a moral sounding concept. But like any financial deal, it can be ethical, or it can be exploitative. Haitians like Jeanne, Mr. Abelard, Mrs. Wintour and Emmanuel must be allowed to decide their fate and have the chance to re-build a sustainable country. Ethical solidarity aid can be a valuable means to assisting these good people who liberated themselves from slavery, and are still paying the price.

          Scott Weinstein is a Montreal-based nurse who volunteered for three weeks of medical duty in Haiti shortly after the earthquake.


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