Haiti After the Earthquake by Paul Farmer '82

November 30, 2011
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Haiti After the Earthquake by Paul Farmer '82. PublicAffairs, 2011. 456 pages.

As a scholar, doctor, and cofounder of Partners In Health, Paul Farmer has long inhabited a particularly complex crossroads. In Haiti After the Earthquake, he combines moving firsthand accounts of his work in Haiti after the January 2010 earthquake with careful analysis of the problems surrounding foreign involvement in Haiti.

Farmer majored in cultural anthropology at Duke and went on to earn an M.D. and a Ph.D. from Harvard as a medical anthropologist. His 1992 book, AIDS and Accusation, explored how the new epidemic affected one community in Haiti while debunking the widely circulated myth that Haitians had brought the epidemic to the U.S. The work brought together a range of critical questions—about epidemiology, culture, discourse, history, and global economy— into a striking portrait of a particular community and a powerful exploration of the larger forces that shaped its experience. The Uses of Haiti followed with a searing critique of how the policies of the U.S. and international financial institutions had deepened poverty and devastated the infrastructure of Haiti.

By the writing of his 2003 book, Pathologies of Power, Farmer had moved to a set of broader, agenda-setting interventions, arguing that health issues could only be understood in relation to global power and economy. He drew on the work he had done with Partners In Health, which over the years grew from a small project in rural Haiti to a widely celebrated humanitarian organization with global reach. His long engagement with Haiti, as well as a pivotal role in thinking through and enacting new approaches to humanitarian aid, put him at the center of the global response to the 2010 earthquake.

Farmer defines the earthquake as an "acute-on-chronic" event, one in which a natural disaster took a particularly devastating toll because of the context in which it took place. Haiti's government budget in 2002, he notes, was a quarter of that of the Harvard hospital in which he had trained to become a doctor, and a broader lack of resources created a particularly vulnerable urban landscape. "Port-au-Prince is the most fragile city I can think of," he writes.

This is partly the story of many heroes: of his colleagues with Partners In Health, including young Haitian-American healthcare workers, but also of the various Cuban doctors—described as "masters in the field of social medicine"—whose long-term presence in the country enabled them to make valuable contributions after the disaster. He also emphasizes the key, yet sometimes overshadowed, role of Haitian doctors. He describes how, at one point, an elderly man in a hospital grabbed his arm and declared: "Haiti is finished." Two young Haitian doctors overheard the comment, however, and immediately told him, "Haiti will never be finished."

Even as he worked on the ground as a doctor, Farmer also had access to centers of political power. He has worked closely with former President Bill Clinton, who played a central role in shaping the recovery effort. He clearly admires Clinton, whom he notes "wasn't shy about discussing any of Haiti's dilemmas…with deep historical roots; nor did he mince words about our country's role in worsening Haiti's plight, unwittingly or otherwise." But Farmer also describes, at times wryly, the inefficiencies of the global response—at one point he was called to Canada to participate in "a meeting about a meeting"—and criticizes organizations that pursue "competition rather than cooperation" in Haiti, each pushing their own particular approaches without working together to create holistic, coordinated responses to crises.

Ultimately his account is a cautionary one, for it lays out the many ways in which the initial hopes surrounding reconstruction have faded, with much of the promised money still undelivered, political and institutional problems hampering the process, and a complex and often inefficient network of international governments and organizations struggling over the future of Haiti. And, as he points out, the failures of aid, rather than becoming an occasion for soul-searching and careful critique, often end up just being blamed on Haitians and their culture. Though he lays out alternate futures for Haiti, one pessimistic and one optimistic, Farmer ultimately—and rightly—leaves one feeling discouraged and anxious about what the coming years will bring in Haiti.

Still, there is inspiration to be found in the book, both in Farmer's words and in the series of essays by other contributors. The personal touches of the story—at one point his daughter asks him, "Dad, can we stop talking about cholera at the dinner table?"—make the challenging and vital information in the book easier to take in. And we can hope that the book, and the work it showcases, ultimately offers us a sense of how to engage Haiti with clarity, humility, and commitment.

Laurent Dubois