Tracy Kidder's recent opinion piece in the New York Times

Here's a link for the article.

And here's the text:

Country Without a Net

Those who know a little of Haiti’s history might have watched the news last night and thought, as I did for a moment: “An earthquake? What next? Poor Haiti is cursed.”

But while earthquakes are acts of nature, extreme vulnerability to earthquakes is manmade. And the history of Haiti’s vulnerability to natural disasters — to floods and famine and disease as well as to this terrible earthquake — is long and complex, but the essence of it seems clear enough.

Haiti is a country created by former slaves, kidnapped West Africans, who, in 1804, when slavery still flourished in the United States and the Caribbean, threw off their cruel French masters and created their own republic. Haitians have been punished ever since for claiming their freedom: by the French who, in the 1820s, demanded and received payment from the Haitians for the slave colony, impoverishing the country for years to come; by an often brutal American occupation from 1915 to 1934; by indigenous misrule that the American government aided and abetted. (In more recent years American administrations fell into a pattern of promoting and then undermining Haitian constitutional democracy.)

Hence the current state of affairs: at least 10,000 private organizations perform supposedly humanitarian missions in Haiti, yet it remains one of the world’s poorest countries. Some of the money that private aid organizations rely on comes from the United States government, which has insisted that a great deal of the aid return to American pockets — a larger percentage than that of any other industrialized country.

But that is only part of the problem. In the arena of international aid, a great many efforts, past and present, appear to have been doomed from the start. There are the many projects that seem designed to serve not impoverished Haitians but the interests of the people administering the projects. Most important, a lot of organizations seem to be unable — and some appear to be unwilling — to create partnerships with each other or, and this is crucial, with the public sector of the society they’re supposed to serve.

The usual excuse, that a government like Haiti’s is weak and suffers from corruption, doesn’t hold — all the more reason, indeed, to work with the government. The ultimate goal of all aid to Haiti ought to be the strengthening of Haitian institutions, infrastructure and expertise.

This week, the list of things that Haiti needs, things like jobs and food and reforestation, has suddenly grown a great deal longer. The earthquake struck mainly the capital and its environs, the most densely populated part of the country, where organizations like the Red Cross and the United Nations have their headquarters. A lot of the places that could have been used for disaster relief — including the central hospital, such as it was — are now themselves disaster areas.

But there are effective aid organizations working in Haiti. At least one has not been crippled by the earthquake. Partners in Health, or in Haitian Creole Zanmi Lasante, has been the largest health care provider in rural Haiti. (I serve on this organization’s development committee.) It operates, in partnership with the Haitian Ministry of Health, some 10 hospitals and clinics, all far from the capital and all still intact. As a result of this calamity, Partners in Health probably just became the largest health care provider still standing in all Haiti.

Fortunately, it also offers a solid model for independence — a model where only a handful of Americans are involved in day-to-day operations, and Haitians run the show. Efforts like this could provide one way for Haiti, as it rebuilds, to renew the promise of its revolution.

Tracy Kidder is the author of “Mountains Beyond Mountains,” about Haiti, and “Strength in What Remains.”

Friends - if you have joined the evil cult that is Facebook, please become a fan of PIH.

Third Review: Mountains Beyond Mountains by Tracy Kidder

Mountains Beyond Mountains by Tracy Kidder is the sort of book that you might avoid out of fear of spending hours curled up in a little ball crushed by the horrendous injustice in the world or shaking with rage and ranting incoherently for the same reason, but it's not. While it's true that Kidder, in his portrait of the amazing work that Paul Farmer and his cohorts at Partners in Health (PIH) do, doesn't shy away from the inexcusable conditions in Haiti (and Peru and the prisons of Russia, and elsewhere), I found the book to be mostly hopeful. Which, I think, is Farmer's point.

At some point in the book, one of the PIH members uses the following quote from Margaret Mead, "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever does." And that perfectly encapsulates what PIH does.

For those who are unfamiliar with Partners in Health, it is a public health organization bringing much needed health care to some of the poorest people in the world. Their mission is to "provide a preferential option for the poor in health care." The work that they do is amazing (yes, I am going to use that word at least 17 times in this review) and addresses the fact that providing health care to the impoverished can't happen in a vacuum, and therefore, they provide other support, as well, to make it possible for their clients to follow through on the steps they need to take for better health.

Mountains Beyond Mountains specifically focuses on Paul Farmer, the founder of PIH, his life story, how he came to design PIH's public health care model, and the work that PIH does. It's fascinating. Not surprisingly, Farmer had an unusual upbringing, and I think that helped him to have a different perspective both on his life choices, but also an ability to look beyond and challenge some of the health care paradigms. While it is true that it is unwise to compare oneself to Farmer (you'll just feel bad and unaccomplished), one of the points of the book is that no one should--even he thinks this. As a founding member of PIH, Jim Kim, is quoted as saying, "If Paul is the model, we're fucked." Meaning, that holding yourself up to Farmer's personal standard is impossible. Instead, you have to find a level of commitment that works for you. Burning out doesn't help anyone.

The work that Farmer and PIH does flies in the face of conventional health care wisdom regarding what is possible. And I found it totally uplifting to know that this committed group of citizens really is making a change in the world. Although it's easy to be cynical about the state things and how people treat other human beings, cynicism doesn't bring about change. And that's what is refreshing about PIH, these are people doing the impossible. I strongly recommend Mountains Beyond Mountains. It's eye-opening and engrossing. And I think it's the best way to find out the how and why of Partners in Health.

If you'd like to find out more about PIH, you can check out their website:

www.pih.org.

(And if you feel compelled to donate while you're there, that'd be amazing.)