Sunday, November 21, 2010

Disaster Aid, Revisited

My college alumni magazine came in the mail recently, and like most folks, I immediately picked it up to start reading.  But, what caught my eye almost immediately was a story about Haiti and an interview with a former college colleague of mine, The Honorable Raymond Joseph, the former Haiti Ambassador to the United States and now a candidate for that nation's presidency.  I was fascinated with what he said, and it prompted me to revisit the disaster aid issues for Haiti and Pakistan.  But, more about his comments in a moment.

I ended my last post with these thoughts:

Could it be that most of us can watch scenes and events like this on television, and yet could never watch or experience them in real life?  Put them on the screen and we can watch them.  Whether it is an earthquake in Haiti, or a flood in Pakistan in the midst of a war, we may start to analyze them, and marvel at the destructive power of an earthquake, the power of the river and the horribleness of war, but that is it.  However, if one were to see them in real life, one would be expected to intervene, to rescue the victims or to come to the aid of the victims.  To do something.

I think one of the things that has happened with our ability to see things on the screen may be illustrated by what happened in Haiti, or the starving in Darfur, or the death and destruction and hopelessness of Pakistan, is that we see them and absorb them, realizing something horrible has taken and is taking place on our television screens, knowing that there is no question about what we are seeing, and then we simply just move on with our lives.  And we say that, yes, people starve in places like Darfur, and lose their lives and homes and livelihoods in places like Haiti or Pakistan, but what can one do about that?  We don't necessarily become harder or colder to what we are seeing.  Rather, we simply accept it.  We become detached, and therein lies profound social problem.

Watching and participating is the basis for a real moral dilemma.  If we are just an audience, it is easier for people to do terrible things, or for us simply not to take any more than a fleeting interest in what we see.  I am not sure that even responding to an appeal for funds on television by calling a number or texting a donation to a large and somewhat anonymous NGO can be considered moral participation in the relief of the disaster.  But then, why respond when all of the emphasis is on what the UN should do through its agencies, what the international community, particularly, national governments, should do, and what the Pakistani government or the Haiti government should do for its own people.  Doesn't this just say what we think but are afraid to say out loud?  Does this seem to explain why so little aid has been provided to the people of Pakistan as I wrote in my last post, and as repeated in the media?

Now, more than ten months since the earthquake in Haiti, and almost six months since the flooding in Pakistan, I was curious about what has been done for the Haitians and the Pakistanis in the intervening months and how the people that have suffered through these two disasters are doing.  We all agree, that with the level of devastation, it is too early to see some significant difference and improvement in the living conditions.  But, has there been any improvement?

With all of the attention given to the UN conferences, particularly the donors' conference in March 2010 to address the needs in Haiti, the pledges by countries to provide for relief and development aid to Haiti, and to start the process of rebuilding the country for a more stable and prosperous future, I wondered how we were doing.

But, first a word of caution here.  Frequently, I write these posts over a period of several days or a week.  Such was the case here.  The story or substance of what I am writing, particularly if it is about an ongoing crisis or situation, evolves as the situation changes and as data are updated.  As one will see here, that is what has happened, particularly in the case of Haiti.

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.

In an Associated Press report in late September 2010, we learned that:
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.
 * * *
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.
Shortly after the earthquake hit Haiti, the U.S. government sent ships, troops, rescue teams, aid workers, and supplies to Port-au-Prince for emergency rescue and relief operations.  On March 24, President Obama sought from the U.S. Congress $2.8 billion for emergency assistance to Haiti.  Approximately one-half of this was to reimburse money already spent by USAID, the U.S. Department of Defense, and other government agencies.  In May, Congress approved a total of $2.93 billion for Haiti which was divided into three categories: $1.642 billion was earmarked for relief; $1.15 billion for recovery and reconstruction and $147 million for diplomatic operations.  It was this $1.15 billion that Secretary Hillary Clinton pledged at the UN Donors' Conference in late March 2010.

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.

In early November 2010, Haiti was scrambling to prepare its crowded towns and survivor camps for a possible hit by a hurricane Tomas.  As one blogger wrote in early November, "there's nothing quite like walking into abject poverty to make you painfully aware of your wealth, your full belly, your watch, your shoes, your sunglasses, your backpack with its small store of emergency rations, your bottle of clean water, your camera."  The first thing she noticed, and the first thing friends of mine working with NGOs in Haiti noticed were the children, their "enormous eyes, wide smiles, and the way they greeted people. "Every time I walked through a tent community, or got out of the truck to visit a school, the children came running and they made me their friend, holding my hand as we walked."

Looking at the storm clouds rolling in over the mountain and hearing the thunder nearby, she wrote about the stifling heat and:
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.
"Ou we sa wgenyen ou pa konn sa wrete."  "You know what you've got, but don't know what's coming."
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.
The government's text message arrives advising all displaced persons to evacuate their tent camps, prepare supplies and protect their families.  To many, this advice seems absurd faced with the reality these people face.  If they could have found shelter, why would the be living in tents in big, crime-ridden tent ghettos in Port-au-Prince, or in tent shantytown compounds in the center medium strips of the highways?  If they could afford clean water, why would they be drinking contaminated water from the stream and rivers and canals?  If they could afford food for tomorrow, why is it a struggle every day just to survive and eat today?

Haiti, a nation with an outbreak of cholera in the countryside spreading toward the capital, Port-au-Prince, now faced hurricane Tomas.  Cholera, a bacterial infection that spreads through contaminated water, causes severe diarrhea and vomiting that can lead to dehydration and death within hours if left untreated.

Tomas destroyed houses and turned streets into rivers.  According to the Haitian Civil Protection Authority, six people were killed by the storm as water several feet deep rushed through the streets of Leogane, the town closest to the epicenter of the 12 January 2010 earthquake.  But, Haiti got lucky as the storm pushed northward from Haiti, missing the capital by about 140 miles, or 230 kilometers.  And so in depths of the tent ghetto in the capital, in a neighborhood overlooking the broken down Presidential Palace, women dressed in white danced with offerings as a voodoo ceremony greets a new day, calling forth Haiti's ancient spirits and celebrating a past not forgotten.

But with over 10 inches of rain, and the threat of ongoing rain, the possibility of the spread of waterborne disease, especially cholera, increases.

The first cases of cholera appeared in October 2010.  As of 30 October 2010, Haiti reported 337 as the number of people that had died as a result of the cholera outbreak, with an additional 4,764 people infected and under medical treatment.  Health officials were battling to contain the disease, fearing it could spread to the capital, where 1.3 million displace people were living in the squalid tent cities.  As of 16 November, more than a thousand people had died from the disease and at least 15,000 had been infected and hospitalized.  The U.S. Centers for Disease Control and Prevention found that that the strain, which resembled one from South Asia had reached all ten departments (or provinces) of the country and swept into the capital.

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.

Today, 19 November 2010, as I write this, the number of deaths from cholera now exceeds 1,200 and more than 20,000 have been infected and hospitalized in Haiti.  The EU is urging its member states to provide beds, medical expertise, ambulances, medicine, and other aid to help Haitians combat this epidemic.  Health workers consider those numbers to be understated, as Haitian hospitals face overcrowding as the epidemic continues to spread. The United Nations projected that as many as 200,000 Haitians could contract cholera as the outbreak continued.  This is approximately 2 percent of the population.  Some humanitarian workers estimate a substantially larger number, approximately 5 to 8 percent of the population of Haiti, or 500,000 to 800,000 cases of cholera.

We get a sense of the despair and effects of this outbreak of cholera in a story published on 16 November 2010, by the GlobalPost in which it reported from Port-au-Prince a story about a Ysabelle Marcellins who went about her normal morning chores like she did most Saturdays, cooking and cleaning house in this city of rubble and recovery.
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.
 As reported in a story in The Washington Post newspaper of 15 November 2010, the difference between life and death in Haiti is now an ordinary bar of soap.  Soap could slow the terrifying outbreak of cholera that is spreading so quickly and has even entered the capital,
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.
In the past two weeks, international aid groups have been scrambling to deliver soap and hygiene kits to some of the million people living in tarp and tent camps in Port-au-Prince and to the most vulnerable populations in the countryside.  UNICEF brought 100,000 pieces of soap to 500 of the country's orphanages, and distributed another 82,000 bars of soap along the Artibonite River valley.  The group, Clean the World, has distributed 100,000 bars of used soap it had collected from 550 hotels in North America, rather than allowing the hotels to throw away the bars after their use by one guest.

The United Nations has warned that the outbreak could last for months and said that the entire nation of 10 million people is at risk because they have no immunity to cholera.  Haiti is facing one of the most severe outbreaks of the disease in the past 100 years and the UN is appealing to international donors for $164 million in response money, saying that $163.9 million in aid is needed over the next year to combat the epidemic, with $89 million going to sanitation and hygiene efforts.  This, notwithstanding the fact that only about 10 to 15 percent of the amount pledged for the rescue and rehabilitation efforts pledged at the UN donors conference in late March 2010 had been provided.

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.
Even if she finished school, things may not have been much different because she lives in the poorest country in the Western Hemisphere.  More than 60 percent of Haitians live in poverty on less than $2.00 per day, and the unemployment rate is over 30 percent.
"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.
Partners in Health, a Boston, Massachusetts-based NGO focuses on the delivery of quality health care in poor communities around the world, including Haiti.  Partners in Health was founded in 1987 to support activities in the village of Cange on Haiti's Central Plateau, has been in Haiti since 1987, and currently operates 15 hospitals and clinics in Haiti.  It has been heavily involved in addressing the cholera epidemic.  Dr. David Walton, a physician with Partners in Health, when asked about the rapidly increasing number of deaths from cholera responded:
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.
"In Haiti, the insults never end."

As the former Haitian Ambassador to the US, the Honorable Raymond Joseph, said during this class reunion in early May 2010:
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.
Now, according to Ambassador Joseph,
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.
These observations of Ambassador Joseph were spoken before the outbreak of cholera, but they have really gotten me thinking more about the role of NGOs in Haiti generally, not just in relationship to the earthquake and cholera epidemic.

You see, I am not sure that we really know how many NGOs are operating in Haiti.  According to the United States Institute of Peace, there are at least 3000 NGOs operating in Haiti, and have been operating there for some time.  A number of other sources, including the World Bank, put the number at approximately 10,000.  At the same time, Jean-Max Bellerive, the Haitian Minister of Planning reported that there were only about 400 NGOs that were registered with the government, but that there may be as many as 10,000 to 20,000.

The consensus appears to be that there are about 10,000 NGOs in Haiti.  There is a problem with NGO credibility that is especially onerous in Haiti.  According to former U.S. President Clinton, with the exception of India, Haiti has more NGOs and charities per capita than any other country on the planet.

NGOs began arriving in Haiti shortly after the end of WWII, but their presence and number increased dramatically over the past 30 years.  In 1981, USAID began bypassing what U.S. officials defined as an extremely corrupt Haitian government and delivering dollars directly to international NGOs.

According to InterAction, NGOs have done a job that the Haitian government was not equipped to do.  InterAction reports that NGOs working in Haiti over the past 30 years have addressed a broad list of critical needs, including healthcare, education, sanitation, micro-loans, and agricultural assistance at the community, city, or regional levels.  There have been 10 presidents of the country since 1990, and several coups.  International embargoes led by the United States, and donor fickleness led to the ebb and flow of tightly controlled donor dollars, meaning that foreign assistance often bypassed the Haitian government for NGOs as a result of fear of corruption, lack of capacity, and deficient regulations and controls.  Hence, as the United States Institute of Peace and others, call Haiti, "A Republic of NGOs," the questions arises whether the NGOs are part of the problem or part of the solution.

Cultural anthropologist, Timothy Schwartz, a specialist in Haiti who lived and engaged in research there and in the Dominican Republic over several years wrote in a recent blog. Save NGO Sec. from Itself (and Haiti from the NGOs):
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.
My question is this: Is the third sector responsible to accomplish detectable change in a country as a whole?  It seems to me that this is part of the debate with respect to those who stress the importance of effectiveness of NGOs, and in particular, that portion of the philanthropic community that seeks to produce change in society.

Former President Bill Clinton, speaking on the CBS television broadcast, "60 Minutes," on 15 November 2010, made the comment that one of the major problems he faced as the United Nations Special Envoy to Haiti and as leader of his Clinton Global Initiative (CGI), providing leadership and coordinating the aid program there, was the fact that there were so many NGOs, but that there was no mechanism for coordinating their activities, that they were all just doing their own thing.

This then is the context of what is going on in Haiti.  In my post of 28 March 2010, I noted that American charities had raised close to $1billion for Haiti relief within nine weeks after the devastating earthquake, and also the fact that donors gave approximately $66 million in response to a start-studded telethon Hope for Haiti Now organized largely by actor, George Clooney and singer/performer Wyclef Jean.

In this post, I want to briefly note several NGOs that have been providing assistance to the people of Haiti but that have not been widely reported for their fundraising efforts or work in Haiti.  I am familiar with all of them, having served on the Board of one of them and have been a regular contributor for over 40 years to that organization, and have been familiar with the others for over 20 years, and in the case of HCJB Global, all of my life.  In the general scheme, none of these would be considered to be in same league as those charities listed in my post of 28 March 2010.

The first is Mission Aviation Fellowship (MAF).  MAF is a Christian, faith-based organization founded after WWII, by a group of Christian pilots from Britain, America, Canada, New Zealand, and Australia, with its first flight in 1946 in a remote region of Mexico.  It provides aviation, communications, logistical service, and learning technology services to more than 1,000 faith-based and humanitarian agencies around the world, as well as to thousands of isolated missionaries and indigenous villagers in some of the most remote areas of Africa, Asia, and Latin America.  Averaging about 101 flights every day in 31 countries across Africa, Asia, Eurasia, and Latin America, MAF pilots transport missionaries, medical personnel, medicines, and relief supplies, as well as conduct thousands of emergency medical evacuations in remote areas.  MAF staff also perform tasks as diverse as digging wells in Eastern Africa, disaster relief, operating computer centers in rural African villages, and air ambulance services in all of these regions of the world.  Additionally, there are currently national affiliates or branches of MAF-International in a number of countries around the world.

MAF has been providing critical aviation services, including air ambulance, communications services, including email service, and distance education services in Haiti since 1986.  It operates primarily out of Port-au-Prince, and services and operates 14 or 15 landing strips around the country, with an additional four or five that are presently closed, but available to be reopened.

We can gain a little perspective of the value added and effectiveness of MAF in providing flight services to the outposts and cities depicted on this map.  On a typical day, these pilots may spend much of the time in the air making several flights each day and 35-50 flights per week.  Normal travel around the country on the road system may take many hours or maybe several days.  However, by MAF airplanes, the trips to airstrips served by MAF may take anywhere from 18 minutes to an hour from Port-au-Prince, with many flights taking well under an hour.  Road conditions are dangerous with bandits along the way, and in extremely poor condition, in some case impassible.  So, for example, a 10-15 hour trip by road takes only 30 to 45 minutes to fly by MAF pilots.  Airstrips operated by MAF and others help, and in medical emergencies, the time saved by these short flights can mean the difference between life and death.

On 12 January 2010, MAF instructor pilot Will White was on the ground to experience the catastrophic earthquake that hit Haiti.  Now, he spends a large part of every day in the cockpit of a small airplane, flying Haitians, missionary groups, and relief workers to their destinations within Haiti.  Even from the sky, it is apparent that the country is still struggling to recover.  This in addition to his other instructor pilot duties which include flight scheduling, maintenance on all of the MAF planes in Haiti, and assigning other pilots to specific flights and tasks.

Although the field staff in Haiti is small, in the last 12 months it has saved humanitarian workers 4,163 days of travel time, it has operated 2,853 flights, it has transported 7,296 passengers, and it has delivered 799,000 pounds of cargo.  All with nine missionary staff families, including the five guys who are pilot/mechanics, 18 or 19 Haitian nationals, and five or six small airplanes.

MAF headquarters in Nampa, Idaho deployed a new Kodiak airplane and a crew of four to join its fleet in Haiti  This Kodiak was diverted from its assigned destination to MAF's operations in Papua, Indonesia.  The deployment of this new specially designed aircraft, designed and manufactured specifically for bush flying and missionary service, marks the first time that it has been used in disaster relief.  The Kodiak carries more cargo and passengers than the Cessna airplanes currently in use in Haiti and runs on jet fuel which is more readily available than the costly aviation gas which fuels the Cessna airplanes and is in short supply in Haiti.  Following a brief dedication ceremony in Nampa, the Kodiak took off for its 3,000 mile, 18 hour flight to Haiti.

MAF president John Boyd said:
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.
As CBS news reported,
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.
By way of background, Quest Aircraft was established as a nonprofit organization, for the purpose of designing and manufacturing a backcountry/utility aircraft suited to the needs of the mission and humanitarian aviation communities which provide access to the most remote regions of the world.  The Kodiak was designed with the participation of the Quest mission team, which included Adventist World Aviation, Air Serve International, Arctic Barnabas, Asas de Socorro, Flying Mission, JAARS, MAF, Mercy Air South Africa, Mission Padamo, New Tribes Mission, Seventh-Day Adventist Church, Samaritan Aviation, Spokane Turbine Center, and Zululand Mission Air Transport.  All of the U.S.- based organizations are registered charities with the U.S. Internal Revenue Service.  A number of these based in the U.S. have been accredited by BBB Wise Giving Alliance and/or ECFA, both member of ICFO.

Mark Williams, a pilot/mechanic with MAF in Haiti recounts the events of 12 January 2010, when the earthquake hit a little before 5:00 PM.  He was out in the street in front of his house.  The ground shook, its intensity kept growing until the walls and poles lining the street were wobbling and surging .  "Everything appeared to be made of rubber."  Anyone who has experienced an earthquake can visualize what he was experiencing.
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.
In January 2010, MAF had provided earthquake assistance bringing into Haiti over 1.5 million pounds of disaster relief supplies and transported 3,500 relief workers, doctors, and evacuees.  Then, on 24 September 2010, a microburst storm lasting 35 minutes hit Port-au-Prince.  The storm destroyed or damaged the tent and tarpaulin homes of more than 10,000 families.  MAF responded by flying hundreds of tents for distribution to those in dire need, thereby fostering relationships with the inhabitants of the tent and tarpaulin communities.

In addition, MAF partnered with 208 relief agencies to distribute 23,049 cases of food through its Port-au-Prince airport hanger.  The shipment of this food benefited over 144,000 people.  Included among the groups with which MAF partnered to distribute food was the United Nations World Food Program.

MAF also partnered with top NASCAR (National Association of Stock Car Auto Racing) racing teams through Missionary Flights International (MFI), which is based in St. Pierce, Florida to shuttle relief workers and supplies into Haiti, and transport evacuees, workers and earthquake victims out of Haiti.  Right after the earthquake, Hendrick Motorsports owner offered MFI the use of three of his Saab 2000 series, 45-seat airplanes for Haiti relief.  These planes which were used to carry crew and family members to NASCAR races each weekend would now be used to carry supplies and relief workers to Haiti.  The aircraft would be rotated in daily round-trip flights carrying humanitarian workers and other volunteers from the US to Haiti, and then on the return flights, transporting evacuees, volunteers returning home, and orphans who before the earthquake had been awaiting permanent placement with adoptive parents in the US.  The Joe Gibbs Racing team, also loaned a Saab 2000, 45-seat airplane to MFI.  Both Hendrick Motorsport and the Joe Gibbs Racing team paid for all the flights, including fuel, food, and hotel accommodations.  John Woodberry, MAF's Disaster Response Manager estimated that this assistance to the Haiti relief cost these teams hundreds of thousands of dollars.

In January after the earthquake, MFI transported 1.5 million pounds of relief supplies and more than 4,000 relief workers through its Ft. Pierce hanger bound for Haiti.  Additionally, 100 volunteers worked for several weeks in the hanger sorting, boxing, and loading airplanes headed for Haiti.

With the outbreak of cholera in late October, MAF was actively involved in transporting doctors and medical supplies to help fight the growing epidemic in Port-de-Pais, a city in northwest Haiti.  The hurricane Tomas brought washed out roads making it impossible to drive to Port-de-Pais.  As cholera spread through the flooded rivers, infecting hundreds of local people, MAF was needed more than ever.  Immediately after the onset of the cholera epidemic, MAF provided flight service transporting approximately 900 pounds of IV solution for the hospital in Port-de-Pais that was providing medical care for over 100 patients, most of whom were children.  As the epidemic worsened, and staffing and supplies began to run short, there was an increased need for MAF to fly doctors north to Port-de-Pais, including teams of doctors to teach hospital personnel how to administer the IVs through the marrow of the leg bone.
In describing MAF's operations in which transport of medical teams and medical supplies were provided to the needs in the northwest area of Haiti, Mark reported:
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.
Through a partnership with Samaritan's Purse, a Boone, North Carolina based Christian humanitarian organization, MAF added a Cessna Caravan to its fleet in Haiti, that has a much larger capacity, both for passengers and for cargo.  MAF is leasing this aircraft from Samaritan's Purse for two years at a cost of $1.00, and example of how these two mission organizations can work together.  MAF installed an aircraft payload extender on the plane which allowed it to take off and land with more weight on the short airstrips in Haiti.

Unlike MAF, which had been providing flight and technical service is Haiti since 1986, Samaritan's Purse mobilized immediately after the earthquake in January.  Within hours after the earthquake, Samaritan's Purse had a team in Haiti focusing on providing emergency medical assistance, shelter, clean water, and hygiene supplies.

Since the earthquake, Samaritan's Purse continued to respond to the suffering from the earthquake, the continuing situation throughout the country of IDP living in tent and tarp cities, and the health and environmental crises that continued to cause so much hardship to the Haitians.  Samaritan's Purse had committed to construct 7,500 shelters for the homeless.  As of early July, Samaritan's Purse had completed 2,360 transitional shelters, more than any other relief agency in Haiti.  The shelters were wood framed buildings, 12-by 12 feet and provided some relief from the summer heat and intense evening storms.

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.
What I find interesting here is that a number of these NGOs I have written about are accredited by ECFA and have been reviewed by BBB Wise Giving Alliance, both member of ICFO.  The accreditation, for example of MAF, Samaritan's Purse, and HCJB Global, is based on these two organizations being in full compliance with the respective standards of accountability.  Neither MAF or Samaritan's Purse were granted BBB Wise Giving Alliance seal due to compliance issues with one or more of Wise Giving Alliance's Standards.  Although both have reputations for integrity and accountability, the lack of BBB Wise Giving Alliance accreditation demonstrates the differences between charity monitoring organizations, and I think, in the case of MAF, a lack of understanding or communication between the charity and the monitoring organization.  However, BBB Snake River Region awarded MAF honorable mention for its Integrity Counts Award for 2010.  Samaritan's Purse also received a four star rating from Charity Navigator.