So now, let me focus on Haiti. Rather than hearing much about all the good that has been done, the daily headlines are filled with reports hurricanes, more mud slides in the countryside from stripped mountains, of the spreading cholera epidemic in the Haitian countryside, and the potential spread of cholera even to the capital, Port-au-Prince, with reports of deaths increasing by the day.
Nearly nine months after the earthquake, more than a million Haitians still live on the streets between piles of rubble. One reason: Not a cent of the $1.15 billion the U.S. promised for rebuilding has arrived.
The money was pledged by Secretary of State Hillary Rodham Clinton in March for use this year in rebuilding. The U.S. has already spent more than $1.1 billion on post-quake relief, but without long-term funds, the reconstruction of the wrecked capital cannot begin.
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Meanwhile, deaths in Port-au-Prince are mounting as earthquake survivors scramble to live without shelter or food.
"There are truly lives at stake, and the idea that folks are spending more time finger-pointing than getting this solved is almost unbelievable," said John Simon, a former U.S. ambassador to the African Union, who is now with the Center for Global Development, a Washington think tank.
Other countries have also delayed sending reconstruction assistance. Less than 15 percent of the money promised at the donors’ conference for 2010-11 has been received. In the meantime, in late September 2010, an isolated storm destroyed about 8000 tarps, tents, and shacks in the capital, killing six people.
I hoped it would cool things down just a bit. And then I remembered the tents. Rain for us meant a cool breeze in our rooms as we slept; rain for those in the tents meant women would be holding their babies all night so they could sleep and everyone else would be standing to avoid the mud.
None of this is okay. It is not okay that they are hungry, that they sleep on dirt and gravel, that they stand when it rains, that they are malnourished, and get their water from a well miles away.
All eyes gaze up at the sky, nervously, as the gray creeps across like a demon. Hurricane Tomas comes early. Banks and markets close -- suddenly-- and panic strikes the streets of Port-au-Prince. For those who can leave, it is a mass exodus: traffic, fear and uncertainty.
Prior to late October 2010, Haiti never had a confirmed case of cholera. However, in late October a few cases of cholera along the Artbonite River were reported by health officials. According to the U.S. Centers for Disease Control and Prevention and reported in the Associated Press, the particular strain of cholera found in Haiti matches strains commonly found in South Asia. This has intensified scrutiny of a United Nations base above a tributary to the Artibonite River which is the home of a contingent of recently arrived peacekeepers from Nepal, a country in which cholera is endemic and which saw an outbreak this past summer. Within a week, the number of deaths from Cholera had increased dramatically, and the number of people infected and hospitalized strained the capacity of hospitals.
Hours later, she was doubled over in pain vomiting. "We did not know what was happening. One minute, she cooking lunch and then she was in so much pain," said her brother, Louis Marcellins, as he paced in front of a cholera clinic at Port-au-Prince's General Hospital. "It was all so sudden."
The speed at which cholera overtakes patients like Marcellins worries health officials and aid organizations as much as it surprises Haitians who received ample warning of the disease's strength.
But in the squalid slums of Port-au-Prince and the river towns where the cholera outbreak began three weeks ago, many Haitians held up their hands and shook their heads, saying they had no soap to stop an infection that is spread by contaminated food and water, and were a vigorous hand-washing, especially after using the toilet, is the number-one way to save lives.
A cake of yellow Haitian soap costs about 50 cents. But many Haitians don't have soap, because they cannot afford it. More than half of the population lives on less that $1.25 a day.
"They buy food instead," said Gaelle Fohr. a coordinator for hygiene programs in Haiti for the U.N. Children's Fund.
As the cholera situation worsens, with rapidly increasing number of people dying and hospitalized every day, violence then breaks out in Haiti. Anger over the cholera breakout erupts in violent demonstrations, first in the villages along the Artibonite River, particularly in the cities of Cap-Haitien and Hinche, where angry protesters blocked roads, lit burning barricades, threw rocks, and shouted anti-UN slogans. Many believed that the cholera outbreak originated in the U.N. camp housing the new Nepalese peacekeepers where the effluent reportedly trained into the water supply. The camp, of course, denies the link. U.N. officials admit that the base's sanitation is poor, but denied that the Nepalese soldiers brought the disease from south Asia.
Then, IRIN PlusNews reported on 17 November 2010, that health workers in Haiti were concerned about the spread of tuberculosis (TB) in the tent cities that had housed more than a million people since the earthquake in January. According to Macarthur Charles, a doctor with Group for the Study of Kaposis's Sarcoma and Opportunistic Infections (GHESKIO), one of the largest HIV- and TB- focused NGOs in Haiti, with the quake, the spread of TB in tent cities that housed more than a million people, this became a major emergency. Founded in 1982, GHESKIO is one of the world's oldest HIV-dedicated NGOs. It provides life-prolonging antiviral medication to 55 percent of all Haitian people on HIV treatment, an estimated 13,500.
The main TB hospital and sanatorium in Port-au-Prince collapsed during the earthquake, and the GHESKIO hospital in Leogane for treating multi-drug resistant TB also collapsed. GHESKIO also suffered losses to its health infrastructure worth approximately $10 million, and two government TB sanatoriums were also destroyed during the earthquake. According to William Pape, the director and founder of GHESKIO, "TB is an extremely important situation because transmission is facilitated by the situation of people living under tents." Yet, across the capital, people are crammed into tiny tents, with 6-10 people sharing a tent made for two people.
UNAIDS (the Joint UN Programme on HIV/AIDS) recently released a situation assessment report stating that some of the priority areas for Haiti included rebuilding the health system, restoring networks for people living with HIV, and protecting internally displace people (IDP) from HIV.
The attention to HIV and AIDS has produced another problem in health services generally in Haiti. For example, Haiti's only public hospital serving 500,000 people in the South-East Department is St. Michel Hospital in the coastal town of Jacmel. It has only one ambulance, no functioning X-ray machine, no medical director, a shortage of nurses, and was without electricity for months. However, one corner of the hospital, the HIV/AIDS clinic was fully staffed and well-equipped. Its medical services were completely free, unlike other departments of the hospital. As the hospital administrator, Margarette Vernet, said, "There are other illnesses we see every day, but because they don't have HIV, we can't help them." "They put so much money into AIDS and they don't even look at other programs, like maternal mortality.
A debate has raged globally in the past year as to whether the large sums of donor dollars dedicated to HIV/AIDS programs has strengthened or weakened national health systems. The Washington, D.C.-based Centre for Global Development, released a report in August 2010 in which it concluded that donors might have actually weakened health systems in the three countries it studied by creating AIDS-specific systems that competed for health workers, created additional administrative burdens, and strained inadequate infrastructures. Although Haiti was not one of the countries studied, this seems to be the case in Haiti as well.
In an IRIN report of 17 November 2010, there was a story of a young 16 year old girl who had been living with her aunt and was put out onto the chaotic streets of Port-au-Prince. She survived by befriending men who gave her a place to stay for the night and some money the next morning. She recounted her situation,
I don't want to do this kind of work, I want to finish school. But I feel I don't have anyone; my family can't help me.
"Women are particularly vulnerable," noted Steeve Laguerre of Catholic Relief Services, and international non-governmental organization (NGO) that provides food and other support to people infected by HIV. "We have a lot of cross-generational sex between young girls and older men who can provide for them."On 15 November 2010, the CBS television program, "60 Minutes," broadcast a segment on Haiti, 10 months after the earthquake. One of the places visited by the CBS crew was Carrefour, a large city on the outskirts of Port-au-Prince. There was a makeshift camp precariously located on the ten-foot wide center medium of a busy highway. "Even by Haiti's standards, this place is incomprehensible." The camp started out in the days following the January earthquake. As CBS reported on this visit, a woman had invited the reporter into her tent where she lived with five other people. When the reporter asked 7-year old Jean-Edouard about his home for ten months, the boy responded that it was not good, that he was afraid of a car. In the background, one could hear traffic whizzing by the tent, and as CBS reported,
Outside, traffic races by at breakneck speed, a few feet from where children play. A camp leader told us nearly 30 people have been hit by oncoming vehicles; ten were killed, three of them children.
It makes me frustrated. I can understand if there was another earthquake that happened. But cholera? You know, it seems like the insults never end.
Haiti has so many international organizations working there that deridingly it's called a "republic of NGOs [nongovernmental organizations]." When I went to Washington in 2004, USAID was spending about $300 million in Haiti, and of that money, only about 3 cents on a dollar was spent on the Haitian government.
All of the money was going through NGOs. While some of them do work that the government has not been able to do (like in the fields of health and education), the NGOs cannot build the infrastructure. With little coordination, there is much duplication.
Things were done this way in the past because the governments were corrupt and nontransparent for so long. But the longer we depend on the NGOs, the longer the government does not receive any support. So my position is not to discourage the work of NGOs, but to have some control over them.
The Haiti that was shunned then is today, because of an earthquake, being embraced. For this, I am saying, "Thank you." For the first time the whole world -- I mean the whole world -- had come in solidarity around Haiti. For the first time, people are finding a new Haiti.
But while individual NGOs have educated children, drilled wells, planted trees, and saved tens of thousands of lives through vaccination and clinic programs, they have accomplished little detectable change in the country as a whole. Haiti remains the most underdeveloped nation in the Western hemisphere and over the past three decades, precisely when NGO activity flourished, it has sunk into abysmal poverty.
One reason for this failure is arguable the lack of transparency, feedback, accountability, and coordination discussed in the Part 1 of this blog. The NGO sector is best described as an uncontrolled mass of organizations de facto unaccountable to any governing or regulatory institutions, i.e., no accountants, no auditors, no reviews, and no publication of poor or dishonest performance.
The KODIAK is the next generation bush plane and is made for such a time as this. It can land on short, unpaved airstrips to get essential humanitarian help to its destination quickly and safely in absence of viable roads. The KODIAK will greatly expand our ability to quickly take aid where it is most needed.
This deployment of its finest aircraft is the latest MAF response to the tragedy that has claimed 200,000 lives and damaged most of the buildings in the capital city of Port-au-Prince.
After 38 seconds, the quake was over, but all around I could hear people everywhere making a commotion. Some were weeping or yelling in response to this terrible experience. I looked through a clearing towards downtown Port-au-Prince, about 7 miles away, where clouds of dust reminded me instantly of 9/11.One of the MAF Haitian staff members was killed in the quake. The MAF staff spouses and children were evacuated to the US shortly after the earthquake. Mark Williams wrote that,
MAF, working in concert with Missionary Flights International, based in Ft. Pierce, Florida, and the U.S. Air Force, has so far facilitated the logistics of bringing in about 670,000 pounds of disaster relief supplies, and the transport of 3,200 relief workers and evacuees. Within Haiti, MAF is flying relief supplies, along with relief workers, missionaries, medical teams, to outlying areas in desperate need of help. We also fly critical patients to outlying medical facilities better equipped to give necessary medical care.
Several small children had already died in the hospital that morning, since their veins had collapsed, and the doctors were unable to administer the IV through the blood leaving bone marrow IV as the only option. After flying them to PPS [Port-de-Paix] the MAF pilot drove with the medical team to the hospital, and watched as they held down a small child, and without anesthetics, drilled into the bone to insert the IV needle. They proceeded to do this procedure to as many children as they could, before the sun began to set, forcing the pilot to return back to Port-au-Prince. After starting bone marrow IV's, there have been no more deaths so far. Praise the Lord that many lives have been saved due to this special technique, and the fast reliable means of transportation that MAF provides.
With the onset of cholera in July, Samaritan's Purse clinics in Bercy north of Port-au-Prince, and its clinic in Cite-Soleil were crowded with cholera patients and those seeking hydration. There was an urgent need for doctors and nurses, and Samaritan's Purse sent out urgent requests for volunteer physician, nurses, and medical workers. Another Christian charity, HCJB Global Hands, based in Colorado and Ecuador, brought in medical teams to partner with Samaritan's Purse to provide the needed medical treatment and care as the cholera epidemic spread. Unlike the cholera cases reported by Doctors Without Borders, in Haiti's capital, Port-au-Prince, there was no evidence that any of the people living in Cite Soleil had been outside Cite Soleil and visited Artibonite District where cholera first appeared.
As a member of Samaritan's Purse response team wrote on 11 November 2010:
These last few days have played out on a figurative battlefield, in large dirt fields and between small clinic walls, school house yards and under bright blue Samaritan's Purse tarps. The Samaritan's Purse medical team has formed a fluid strategy which is carving our response, following the flow of cholera closely as it heads toward the capital--assessment, set-up, treatment, and education. We've seen first-hand how successful this is, and the Haitian medical community has joined with us, proclaiming a rallying cry against the attack.
They do not like to see their communities succumb to cholera. And we are committed to working alongside of them, instructing their doctors and nurse on how to treat and prevent the aggressive bacteria. We hosted a training at the Samaritan's Purse base, which brought nearly 70 Haitian medical personnel from around the Cabaret, Cite Soleil and Arcachaie region. This is the first time something like this has been done, and our goal was successful--to provide a forum for the sharing of ideas, resources and personnel as a unified, efficient approach.One other group active in Haiti, particularly immediately after the earthquake in January, was Operation Smile, based in Norfolk, Virginia. Operation Smile is a not-for-profit medical service organization founded in 1982. Its principal mission is to serve as a children's medical charity providing cleft-lip and palate repair surgeries to children worldwide. As such, it has established a network of professionals and volunteers engaged in restoring badly deformed faces of children in developing countries. In doing so, it organizes international volunteer missions to developing countries, coordinates programs for training physicians from around the world, manages programs to assist host countries, verifies the credentials and organizes the participation and travel arrangements for the teams of volunteers. These medical teams generally include a mission site coordinator, plastic surgeons, anesthesiologists, pediatricians, dentists and orthodontists, and intensive care physicians, as well as nurses, child development specialists, speech pathologists.
Harrison Ford, a legendary actor, humanitarian, philanthropist, and long time supporter of Operation Smile, was called to provide some assistance to Operation Smile's relief work in Haiti following the earthquake. He piloted his Cessna 208 Caravan to Santo Domingo, Dominican Republic with a team of medical volunteers and supplies, destined for Hinche to provide the much needed treatment for the victims of the earthquake. MAF pilots in Port-au-Prince provided Harrison Ford with airstrip charts of the Port-au-Prince airport and provided personal briefing. Battling adverse weather conditions as he flew from Los Angeles and Miami during a winter storm, he made several trips over several days into remote landing strips in Haiti delivering teams of volunteers, along with medical supplies. Mr. Ford simply wanted to provide support after seeing the devastating impact of the earthquake and all the suffering.
Here, Mr. Ford, rather than participate in a telethon with other celebrities to raise millions of dollars, donated his time, his flying skills, and his personal expense to provide this unique and valuable service so that Operation Smile could do what it does best, and in this case, not only repair of cleft-lips and palates of children in Haiti, but to provide expert medical care to those in need from the impact of the earthquake. After completing the flight shuttle services for Operation Smile volunteers and medical supplies, Mr. Ford was able to visit both pediatric and adult victims of the of the earthquake at the hospital in Hinche, all with the devastating injuries that required urgent surgery.
Most had been buried in the rubble of collapsed buildings, subsequently rescued and brought by family members to this remote area because of not alternative locations for care. Upon arrival, the Operation Smile medical team rapidly triaged patients according to the severity of their injuries and additional patients were directed to physical therapy volunteers to begin the process of rehabilitation.