Revisiting the Past

http://www.nytimes.com/2012/07/06/world/americas/earthquake-relief-where-haiti-wasnt-broken.html?_r=1

In “The World Health Organization and the Transition from ‘International’ to ‘Global’ Public Health,” by Brown, Cuerto, and Fee, I read about the 1955 malaria campaign charged by the World Health Organization.

“As Randall Packard has argued, the United States and its allies believed that global malaria eradication would usher in economic growth and create overseas markets for US technology and manufactured goods…”

Yes, the World Health Organization had recognized malaria as a critical disease that needed intervention; therefore the fact that the WHO intended to make every effort to fight the disease is significant. It is obviously a great thing, but I was disgusted by the incentive of the campaign. The malaria campaign was going to help the economic growth for the US and create overseas market for the US. The “selling point” of the campaign was all about the benefits that the US would gain, not about the high morality rates caused by malaria or about the number of countries suffering from the epidemic. Regardless of the self-gain motive, I thought at least the campaign would make a difference in the infected developing countries, but the excerpt continued as follows…

“The campaign promoted technologies brought in from outside and made no attempt to enlist the participation of local populations in planning or implementation.”

I believe that the World Health Organization’s malaria eradication campaign ultimately failed in the end largely due to the manner in which the campaign was conducted.

Global health care needs to be centered on the problems, thoughts, and opinions of the community in need. That needs to be the foundation. I believe the most effective way to improve global health is through communication. Communication alone is not enough, but it must start with communication. The best way to impact global health is through communication between the recipient of health care and the donor of health care. A developed country cannot always understand the critical needs of developing countries because the glaring problems that a developed country witnesses may be minute compared to a greater problem that the developing country is experiencing.

As I continued to read the article, I found that concepts of action vs. time (accompanied with a continuation of communication) were plastered throughout the rest of the article. I want to highlight this particular quote by David Tejanda de Rivero that sums it up perfectly.

“It is regrettable that afterward the impatience of some international agencies, both UN and private, and their emphasis on achieving tangible results instead of promoting change… led to major distortions of the original concept of primary health care.”

I noticed that the problems in global health care tended to revolve largely around action and time. Taking immediate action minimizes the prolonged state of need and invites the potential for change to make all the difference. However, immediate action degrades the quality of work and risks more damage. Immediacy in action also lacks the quality of permanent change and growth and primarily focuses on temporary fixes. Yet at the same time, if a community, country, or region is deteriorating at an incredibly fast rate, time is critical, and no other factors compare. The alternative solution would be taking the time to evaluate, analyze, and then finally take the proper steps in making change that will last. The goal for this approach is not about a quick fix, but about permanent change that will stimulate growth and redevelop the community, country, or region. Yet this approach generally tends to demand greater costs and may cause detrimental consequences because it is not time sensitive.

After reading the entire article, it sparked memories and emotions I had during my trip to Port au Prince, Haiti. In 2011, I accompanied a medical team that was revisiting Haiti to provide follow-up care after the initial influx of people had left. Even after a year and a half since the disaster, much of Port-au-Prince, Haiti was still living in tents. The images above are a few of the photos I had taken of the scene. Take the pictures and multiply it because it was literally miles of tents that stretched across the city. Some of the doctors I spoke with said that although there were no longer injured bodies on the streets, the structure of the city remained much the same. Reconstructing the city had not even begun. Due to the experience of witnessing the brokenness and poverty in the country, although I was not conscious of it in the moment, I was thinking about global health. I blamed the problem on the short attention span of much of the world and the problems associated with global health. I realized that there is a significant difference between relief and recovery. Relief is immediate, but temporary, and recovery is slow, but strives for permanence. I realized that it aligned with the global health care problems of balancing action and time. When I visited Haiti, it was evident that relief had most definitely come, but there was no indication of recovery. As a result, I started researching if any activity in Haiti had changed another year later.

By some force of the universe, I stumbled upon an article in the New York Times, published on July 5, 2012 entitled, “Earthquake Relief Where Haiti Wasn’t Broken.” The Haitian government, the United States, and the Inter-American Developmental Bank are constructing an industrial park in Caracol, Haiti. Developers are stripping the land of Caracol, Haiti in attempts to head a project that will ideally generate jobs for the unemployed and stimulate economic progress. Although the motives of this project come with good intentions to genuinely alleviate many problems Haiti has been dealing with, if the title does not make it blatantly clear, this article reveals the striking problems of the project. This article demonstrates the same pattern of the wrong approach in striving for global health that was seen earlier in the “Internal to Global Public Health” article. “The development [of the industrial park,] designed to attract foreign investment and create jobs is the flagship project for Haiti’s reconstruction, even though it is far outside the disaster zone.” This indicates that the industrial park is the large-scale, primary reconstruction project that will be executed in Haiti. (This also indicates that if this project fails, there will not be any leftover funds to hope for another solution to Haiti’s unfortunate poverty). Therefore, it is sickening to imagine the aftermath realities of the project because it is highly likely that Haiti may lose more than it will gain from this project based off of the direction the project is heading so far.

Caracol, Haiti, far from the vast majority of displaced Haitians near the epicenter of where the earthquake hit, was chosen as the site for the development of the industrial park. Caracol was said to be one of the locations in Haiti with rich resources to sustain life without the need of intervention. Therefore “Earthquake Relief Where Haiti Wasn’t Broken,” analyzes the illogical reasoning behind clearing rich resources to implant an industrial park that will deteriorate the good land and replace it with a temporary “band aide” solution. When the industrial park ceases production, the land will be wasted, and resources, which were available, will be dry.

Because of the immediacy to execute reconstruction for Haiti, choosing Caracol Bay as the site for construction was done without taking the time to take appropriate steps to evaluate environmental concerns for building in Caracol, Haiti. The developers chose immediacy of action before careful consideration of their plan, and as a result, the people in Haiti will suffer. A Haitian interviewed about the project expressed,  “if environmental concerns are neglected, we are going to pay the consequence.”

The development bank manager, Mr. Agurre justifies the site by saying, “…to be honest, in a country like Haiti, maquiladoras are a good opportunity, a quick employment generator. Yes, it’s low-paying, yes, it’s unstable, yes, maybe tomorrow there will a better opportunity for firms elsewhere and they will just leave. But everyone thought this was a risk worth taking.” I want to bring attention to the phrase “but everyone thought this was a risk worth taking.” Who does “everyone” refer to? It most likely included the developers of the project. Therefore, this would mean that the company believes that this industrial park will be worth the risks of destroying the ecosystem of Caracol Bay, polluting the area, over crowding, stripping productive agricultural land, and evicting 366 farmers off of their land. I mention this because the judgment that the project is “worth the risks” is meaningless because the developers should not be the ones to determine that. The outcomes of this project will affect the people of Haiti directly; therefore, the people of Haiti should have been given the voice to decide whether they believed this was “worth the risk.” The decisions of the few should not determine the outcome of life of the many. Yet communication between the groups did not exist, and construction began.

Although I am speaking in a very one-sided perspective, I do not wish to discredit the intentions and hard work of the developed countries/organizations desperate to improve global health. I recognize without striving for action, there is no potential for improvement or change. However, every action inevitably has potential for negative undesired consequences. Therefore in order to go towards global health, it is essential that local communities be integrated into the developmental stages of reconstruction.