Haiti After the Earthquake Paperback – July 10, 2012

[...]Dr. Farmer gets a lot of the issues right in his book, "Haiti After the Earthquake", including one of his central points: public and private aid has bypassed Haitian institutions further weakening the country and the government to the point where it was unable to even respond to the earthquake. This is the primary reason why Haiti has come to be known as the "Republic of NGOs". Dr. Farmer also correctly points out that some NGOs do this intentionally (to keep getting their funding) and some unintentionally. This process of bypassing of Haitian institutions is truly the central reason that the more than $20 billion in aid Haiti has received over the past few decades has really left no lasting mark on the country.However, Dr. Farmer seems to try to have it both ways. While he recognizes that bypassing Haitian institutions is a critical problem and touts his and President Clinton's efforts to promote greater direct support for the Haitian government, including financially, his organization, Partners in Health, is the largest healthcare provider in Haiti. How's that for bypassing Haitian institutions? The senior representatives at the Haitian Ministry of Health note that Dr. Farmer's group built a kitchen in the state hospital and some medicine and equipments, but that's all he's done. His hospitals and clinics all operate under the banner of Partners in Health, and his funding goes directly into those institutions rather than through the Ministry. His plans now include building a massive teaching hospital in Haiti, but will operate it as Partners in Health, rather than under the banner of the Haitian Ministry. To the Ministry's knowledge, he has never provided any sort of technical assistance or institution building programs for the Ministry.While he advocates for greater strengthening of and direct funding for Haitian institutions, he has not funneled any of the $80 million in donations for earthquake recovery that he was granted into the Ministry. He received tens of millions of dollars in funding from USAID and the UN Special Envoy's office, led by President Clinton, where he serves as the Deputy Special Envoy (seems to be a conflict of interest there?). In short, Dr. Farmer talks the talk in Haiti, but does not walk the walk.Finally, and most disturbingly, Dr. Farmer turns partisan in this book. He is an unabashed advocate of former President Aristide. Again, given his role as UN Deputy Special Envoy, this seems to be a conflict of interest. The Haitian people actually forced President Aristide out of Haiti in 2004 because they were fed up with his corruption and violence. The Haitian Government Accounting Office estimates that Aristide departed Haiti with more than $350 million in stolen government funds see: [...]. Aristide has never been held accountable, and in fact, returned to Haiti shortly after the earthquake. The people were so happy he was returning that they ransacked his home the night he arrived taking everything from the mangoes on the trees to the bed linens. How's that for a welcome home? Dr. Farmer's partisanship in Haiti is cause for great concern among many Haitians, particularly given his role at the UN and his dominance in the healthcare sector.Aside from Dr. Farmer's questionable political intentions, no one can deny the sincerity of his humanitarian intentions. Dr. Farmer quite clearly loves Haitian culture and the Haitian people. He has done a lot of good in the country, including making an enormous contribution to combating AIDS and the provision of health services, particularly in remote regions. He speaks fluent Creole and is married to Haitian woman who is truly a force of nature in her advocacy for women in Haiti and healthcare. There's no doubt that he's made a real difference in the lives of thousands of Haitians.So in the end, it seems this review wants to have it both ways too. As a Haitian, I admire and appreciate Dr. Farmer's work - and am deeply touched by his love for my country. As someone who is frustrated by aid organizations bypassing Haitian institutions, I am disturbed and discouraged by how he has operated his NGO in Haiti. And, as someone who has personally seen and experienced the violence of President Aristide, I am outraged by his partisanship.

Dr. Paul Farmer, Partners in Health and its sister Haitian organization Zanmi Sante, have transformed health care delivery in rural Haiti. When the earthquake shook Haiti to its very foundations in January, 2010, Farmer and his colleagues were jolted out of the "comfort zone" that they had established in and around rural Cange, and were confronted with the need to respond to the overwhelming acute medical needs that the earthquake had created in urban Port-au-Prince. This book represents Dr. Farmer's reflections one year after the earth-shaking event. His thoughts are supplemented beautifully by colleagues who were impacted in their own way by the ramifications of the earthquake.Farmer speaks authoritatively from a variety of perspective - as head of a successful NGO, as the Deputy to Bill Clinton in the UN's Office of the Special Envoy to Haiti, as a expert in public health and epidemiology. The book sheds light on many of the decisions and actions that were taken in the hours and days after the earthquake, and the ongoing struggle to respond to what Farmer call an "acute upon chronic crisis" in helping Haiti move from rescue and recover to "building back better." For those of us who love Haiti and its people, this is a "must read" book, for it chronicles with great detail the ways in which the Haitian government, the U.S. government, the international community and NGO's interact with each other. The author has strong opinions about how things should work going forward, so the book is both descriptive and prescriptive. One would expect nothing less from a physician than for him to sign his name to a prescription pad to help alleviate Haiti's suffering.Like the history of Haiti itself, this memoir is a mixture of despair and hope. I recommend it highly for anyone who wants a glimpses behind the curtain of what is happening (and not yet happening) in re-building Haiti.

This book is a must read for Haiti watchers. Paul Farmer is always great but this is urgent stuff. The problem is that a conserted effort to break through the Haitian and Donor bottlenecks to "buld back better" has not been mounted. How this can be done is far from clear. Too bad that the new Haitian President has not created a real working team with the UN under Bill Clinton, with a mandate to coordinate (read "direct") the multidonor effort at reconstruction. Such a vehicle is needed to simply powerhouse the whole enterprise.This new Farmer book should be read in tandem with Tim Schwartz, Travesty in Haiti. In his book you get more insight into the powerful impediments to development that have been built over time in the Haitian cultural fabic and in the peprvasive self-interest of donor agencies both governmental and in charitable NGOs.The problem is that a wholistic approach on a 20-30 year time frame is needed. The starts and stops of foreig aid programs, the lack of coherence among donor programs, and the constant debilitation of government agencies - all demand time to fix. At the base of it all is the urgent need to get to work on building a literate, informed and engaged citizenry. Education, Education, Education.Harlan Hobgood, former USAID Director in Haiti

The book talks about the situation in Haiti after the earthquake as witnessed by Dr. Paul Farmer, who established and maintains an NGO in the country, providing hospital care to the most needy. As a result, most of the information in the book is health-related.There are a lot of things that I found disappointing in this book, the main one being that I expected a more complete picture of Haiti after the earthquake. Instead, most of the information is about patient care and injured people. Very little information is given on statistics, human and material loss and the exact needs of the population. Overall, I did not really understand what happened in Haiti after the earthquake by reading this book. I was also annoyed by the author's continuous emotional involvement with the situtation, which took away from being objective and factual. Telling me how "overwhelming", "terrible" and "bleak" a situation is not really describing what is happening. In fact, I had to pick up another book ("The big truck that went by") to actually understand what was going on. Farmer was not in Haiti when the earthquake struck. However, instead of presenting eyewitness' descriptions of the eathquake, he writes about where he was (in Florida reading a book) and what phone calls he made as soon as he found out (for example he talked to Clinton on the phone). So this is more of a personal diary of what he did when the earthquake struck Haiti rather than a description of what happened in Haiti. He gives some account of the wounded he tended to, but that's just one chapter in the book. For the rest, he goes on tangents about the work of his NGO (Partners in Health) not only in Haiti but globally and he keeps comparing Haiti to Rwanda and how Haiti could benefit from Rwanda's example of rebirth (which is great but I really wanted to know what happened in Haiti after the earthquake first!). In a sense, I didn't really get a picture of what happened in Haiti after the eathquake but I surely did learn a lot of things about Rwanda! (which is great but this is not the initial reason I bought this book!).The author also refers to the cholera epidemic that took place after the earthquake. Again I was disappointed as he describes it as an inevitable event that was expected but does not pass the blame to the UN soldiers who introduced it in the country (nor demands accountability from the UN). Unlike his other books where he claims that medical doctors shouldn't just watch things happend without taking a stand, here, at this particular instance he failed to take a stand.Overall, the book fails to give a clear picture of what happened to Haiti after the earthquake. It gives interesting pieces of information that you might not find in other books--for example, it includes other people's accounts in the end which give some more detail and a better picture of how uncoordinated humanitarian aid was at the site, but again they make up pieces in a puzzle that is still missing all the pieces to give a clear picture of what was going on. I kind of got lost. His wife's account of how devastated she was when she found out about the earthquake while she lived in Rwanda (being from Haiti herself) only gave me a picture of how people felt not what had happened.Having read other books by Dr. Paul Farmer and having admired his insight and analysis of difficult situations I have to say that I was disappointed by this book. His style is different (less academic and analytical, more emotional). Maybe if the book had a different title, something less misleading, something like "My experiences in Haiti after the earthquake" I would have liked it more. Or, if it had been written by another author, I would have been less demanding. This is not Paul Farmer that I am used to. Again, if you are looking for a book to find out what happened in Haiti after the eathquake, this should not be your first choice. Once you do get a picture of what happened in Haiti though (from another book) this book is great to fill in the details.

Having just been to Haiti I found this book invaluable in providing detailed, well researched and thoughtful insights into the past, present and potential future of this fascinating and tragic country. There is hope but Haiti needs much help and affordable energy to reduce poverty, slow down deforestation, and empower communities and small businesses with greater ability to develop competitive businesses in farming, manufacturing and tourism. Cheap clean energy is a key for reducing poverty and donors should focus on the huge opportunities for ocean thermal energy, solar, wind and hydro.

<3 Paul Farmer.

A trully fascinating insight into events post earthquake and into the history of Haiti itself. A doctors view of post disaster events and the struggles to cure a system broken by outside influences and instabillity.