Partners in Health / Zanmi Lasante

Yo dudes. I keep talking about Partners in Health on this blog, which makes sense, because we work with them, and they were hosting us, and they are totally amazing. I thought I’d take minute to get into a few of the details of what I mean when I say “Partners in Health”—-because, really, the name is kind of short hand for all sorts of different people and ideas and all that.

Before I get started, one little thing: If at any point in reading this stuff about Haiti or Partners in Health you get excited and you want to help out, well, one of the most efficient ways to help is to give PIH money. Because they put it to good use. You can specify what part of PIH you want to give money to—-either the organization in general, or to different parts of their work in Haiti, or to any of their projects worldwide. 

Additionally, one small but meaningful act you can make is to pledge to stand with Haiti. Crassly, this means that you will think about Haiti every once in a while. That you will on occasion Google Haiti to see what’s going on there. And that when there are no recent Google results you won’t think “Oh, well, I guess it’s all good down there.” And as you think about Haiti every once in a while, the hope is that you will think about Haiti more and more frequently. And the hope is that you will be Googling Haiti not just for the next year, but for the next 50 years. The hope is to make Haiti an integral part of your world. And, if in the next fifty years you have an opportunity to act, or you make an opportunity to act, why, that would be ideal. But step one is to say that you care, and that you’ll keep caring.

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So, Partners in Health. PIH started in Haiti, but it now runs programs all over the world: Haiti, Lesotho, Peru, Russia, all over. If you want the deeper story, go read Mountains Beyond Mountains. Or, more lazily, spend a couple afternoons on the internet. It’s all out there. 

So Partners in Health works all over. The Haitian branch of Partners in Health is called Zanmi Lasante—-Creole for “Partners in Health”. Zanmi Lasante is an almost entirely Haitian organization. It’s about 5,000 employees (it’s grown a lot since the earthquake). It’s run by an executive board that headquarters up in Cange, the town where PIH started in the ’80s. 

The international, non-Haitian PIH staff presence in Haiti is about 10 people. These international PIHers travel back and forth, but since the earthquake they spend the bulk of their time in Haiti. The bulk of day to day doctoring, nursing, janitoring, construction, maintenance, cooking, decision making, project brainstorming, problem solving, patient visiting, etc., is done by Zanmi Lasante. International coordination, financing, logistical support—-things like this are mostly done with the assistance of PIH’s international crew headquartered in Boston. 

For instance, in my previous post I about Zanmi Beni I said that the director of the General Hospital of Port-au-Prince contacted Partners in Health, and that Partners in Health said they would help. And then Partners in Health went out and found and bought a property. But saying Partners in Health is really just shorthand for saying “Partners in Health and Zanmi Lasante”. The General Hospital did not reach out to a foreign organization based in the US for help—-they reached out to a domestic Haitian organization based in rural Haiti, that is funded internationally. The chief mover in the project, and the person who took upon herself to find the right home for the children of Zanmi Beni (from what I heard from the staff I met) was Loune Viaud, the Director of Stragetic Planning and Operations for Zanmi Lasante. Funding for the project came from international money, both from PIH and from Operation Blessing. 

Now, I’m trying to draw some distinctions between Partners in Health and Zanmi Lasante. But never mind. Partners in Health is Zanmi Lasante is Partners in Health. It doesn’t matter which staff is foreign or domestic. Haitian Dr. Anany Prospero works with the same fervor and purpose for the future of Haiti as does Irish Dr. Louise Ivers. Haitian doctors working for Zanmi Lasante travel to Rwanda to help out with PIH projects there. American Dr. Paul Farmer drawing blood from a patient is doing it for the same reasons as a Haitian nurse in a clinic in rural Haiti. 

Really, I just want to draw attention to the fact that PIH in Haiti is truly, truly part of the fabric of Haiti. And I wanted to make clear that “PIH” encompasses office workers in Boston, nurses living in the camps of Port-au-Prince and caring for their neighbors, Haitian lab technicians performing lab tests, Americans with public health degrees arguing with UN people over where to put clinics, Haitians with public health degrees arguing with UN people over where to put clinics, a Haitian just wanting a decent job as a janitor, a Haitian driver not giving a f—- about what anyone else on the road is doing, an Irish doctor working without sleep to bandage wounds, American electricians teaching Haitians how to wire, Haitian construction workers building hospitals, Haitian women arguing for more protection from the police, Europeans lobbying the international community for more protection for Haitian women, doctors prescribing medicine, nurses checking on patients, nurses assistants checking on patients, and normal people working as health workers checking on patients. Though if I’m going for clarity, I could probably have made a more organized list.

ZANMI BENI

Zanmi Beni is an oasis. There’s none of the dust and chaos of Port-au-Prince. The grounds are green and shaded. Instead of damaged buildings still waiting to be torn town—-the National Palace (the National Palace!) for instance—-there are the hopeful sounds of new construction. And there are all these kids.

Some of the kids are bold. I was walking past the pool (there’s a pool and fountain in the central courtyard) when one came up from behind and grabbed my hand. A little girl, maybe 4. “Bonjou,” I said. “Bonjou,” she said. One of our PIH hosts—-Joan, I think—-started peppering her with questions in Kreyol: “How old are you now? What do you want for lunch? How are you today?” and the like. The little girl mumbled some responses and firmly stated others. They seemed like old friends. Well, as old as friends can be when one of them is four. There were soon three or four kids running around us and playing.

There was also a group of kids in wheelchairs, hanging out in the shade with their caretakers. Well, maybe they weren’t hanging out—-maybe there was an activity on. But the day was so nice, and it was such an appropriate place to just be hanging that I hope they weren’t wasting the opportunity.

There are 48 kids who live at Zanmi Beni. Most had been abandoned at the General Hospital on account of their disabilities. One child’s only disability was crossed eyes. But some have serious developmental issues. When the earthquake happened, the director of the hospital—-overwhelmed by the emergency, but not wanting to just abandon the kids to their fate—-contacted Partners in Health to see if they could help. Partners in Health—-themselves pushed by the emergency response—-felt compelled to say yes.

With the help of Operation Blessing International, they found a property and bought it and adapted it. Now imagine that last sentence in action—-trying to find property for sale in a disintegrated city. Trying to contact property owners. Trying to drive around through the rubble to see the property. All while at the same time your organization is one of the prime providers of medical care for a whole city under emergency.

But the results are impressive. We toured the facility (Richie with some child or other on his shoulders most of the time. You think they’d be terrified of a 6’5” redhead (shouldn’t we all be?), but I think he was their favorite). The outdoor spaces are lovely. A plantain grove. Nice lawns. Mango trees everywhere. It was dangerous—-I hit my head on low hanging fruit more than once. The indoor spaces are bright and cheerful. There are staff everywhere—-nurses and caretakers, cooks slicing up watermelon, groundskeepers.

There’s a chicken coop full of laying chickens—-eggs for the staff and children (and for the market, if any extra). There are plans for a bakery. There’s a self contained tilapia farm on one end of the property, donated by a Californian who had bought it for himself but found his home climate not appropriate. The fish farm really pushed me over the edge. To be in a place that was innovating; that was moving towards self sufficiency; that was responding to crisis so thoroughly and boldly—-it made me laugh. A freaking fish farm. And all these hilarious kids running around. So joyous. So…functional. Ha!

My only complaint is that some of those kids were too cool for school:

too cool

TOMORROW

Tomorrow I’m going to write about our trip to Zanmi Beni. Tonight, I’m-a just-a gonna go to bed. If, however, you can’t wait until tomorrow, here’s what Zanmi Beni is: BOOYAH.

ALWAYS READ THE LABEL

We were setting up to play a short acoustic set outside the clinic in Camp Dadadou—-a few acoustic guitars, an acoustic bass, accordion, a couple megaphones. Jeremy had a snare drum, but we had forgone packing a tom because we thought we’d just use a bucket whenever we played acoustically. You know, street corner styles.

But we’d kind of forgotten about it until right before we were gonna play. So there was a bit of a scramble—-“Does anyone have a bucket we can borrow?” Which, weirdly, nobody in earshot did.

I spotted two red plastic wastebaskets just inside the clinic gates. One was mostly empty, so I dumped it out into the other one and brought it over. I thumped it experimentally. Sounded fine. I handed it to Jeremy. He thumped it. Sounded fine.

Louise looked over. “I wouldn’t, um, I wouldn’t use that I don’t think,” she said. Jeremy looked at the bucket. It was very clearly labeled BIOHAZARD MEDICAL WASTE.

"Oh, goddamn it," he said.

"I guess I’ll put that back," I said, and, a little hesitantly, took it from him.

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But that’s why hand sanitizer is so exciting.

Shortly thereafter someone who spoke Kreyol found us a bucket. Which we broke while playing Haiti. Oh, goddamn it.

CAMP DADADOU

Camp Dadadou was less mental than Parc Jean Marie Vincent. Only 12,000 or so living under tarps. Only. 

The PIH clinic at Dadadou has, in addition to the militaresque tents, a medium sized wooden building made of plywood nailed to two by fours. It’s the kind of structure that in an American suburb would get you a stern letter from the town council: “No unauthorized garages, sheds, or free standing structures. Let’s keep our town beautiful!” But here in Dadadou, even a whiff of permanence gets you a little high. Maybe Haiti can rebuild. 

We were met at the clinic by Dr. Anany Prospero and Genevieve Joubert, a nurse. A few days after we got home, the husband of Marika (our violist) saw this article about Genevieve.

And it’s like, holy shit. But I didn’t realize her whole history when we met her—-she was just another member of the PIH team. But it’s like, holy shit. 

She and Dr. Prospero and Dr. Ivers showed us around the camp a bit. They took us to the latrine and shower area. Genevieve talked about how for many months after the latrines were installed, they were never emptied. People used them until they were full. And then they went to the bathroom in bags or buckets, and dumped the refuse on any of the various garbage piles around the camp. But recently an organization had started emptying the latrines regularly. She said that the quality of life was much better. To put it mildly, I imagine.

Dr. Ivers (Louise, I think I’ll start calling her at this point) pointed out the separated groups of showers—-there were ten or twelve stalls grouped in one area (the stalls were made of tarps—-but they looked clean and crisp and strung up on a real structure), and a couple hundred yards away another group of stalls. The two groups were for men and for women. Louise talked about the horrific violence against women in the camps. She talked about how, now, these separate stalls weren’t a solution. But they were a little bit of a help. It was so small and simple, to have separate bathing areas for men and women. And it barely put a dent in the problem of violence. But it increased the dignity of life a little bit. Yet all over Port-au-Prince—-in Parc Jean Marie Vincent, for example—-these small dignities, these small measures of safety and protection: they aren’t being done. I can’t communicate the heavy sense of sorrow in the air. To be in a place where separate showers for men and women felt like some miracle. In a place where the united goodwill of almost the whole planet had been at work for more than a year. 

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From February 2010

From a year after the quake, January 2011

From two weeks ago

PARC JEAN MARIE VINCENT

Now, our trip to Haiti was not a sad trip. I did not leave the country despairing, overcome by tales of poverty and woe. There is massive suffering, yes, and poverty. But we spent the whole trip in the company of people who were active—-people who were either helping to rebuild Haiti, or healing the sick, or creating art and music, or educating themselves. It was exciting. I feel hopeful.

But the camps in Port-au-Prince were dark, there’s no denying.

We were originally going to spend more time in Parc Jean Marie Vincent, but tensions had been high in the camp recently. Violence had increased some. And the PIH staff thought that a group of our size (on all accounts—-we’ve got a 6’5” redhead with us for crying out loud. We tend to stick out)—-they thought it was probably wiser not to tour the camp.

A brief aside: PIH is not scared of poor people living in poor conditions. They don’t travel with security. They don’t carry guns. They go into places like the camps openly and serve the people. They are a bunch of doctors, and they tend to believe (and for the most part rightly) that people aren’t stupid enough to pick a fight with the people who will save you when you get cholera. But there’s no sense in tempting fate when the fate of so many Grammy winners is in your hands. Bwa hahh ah hahhaha ah. So we didn’t see most of the camp.

We did see the PIH clinic. It’s a collection of 8 or 9 large army green tents set up on a piece of graveled land just inside the border of the park. Dr. Louise Ivers was guiding us. It was pretty “M*A*S*H style,” she said. Except, we assumed, for the hilarious antics of Hawkeye and the gang. 

Dr. Ivers is an Irish doctor who’s been working in Haiti for PIH since 2003. She’s been working in Port-au-Prince since the earthquake. Things that would make a person laugh, she laughs at. Things that would make a person furious, she gets furious about. She is amazing and lovely. But then again, as a band, we are racist for Irish people. 

The clinic was mostly empty when we were there. There was a Red Cross food disbursement going on elsewhere in the camp, so potential patients and much of the staff (many who live in the camps as well) were off waiting in line. 

Dr. Ivers pointed out the women’s health tent, and the closed tent within the women’s health tent—-facilities were minimal, but PIH wanted to provide privacy and dignity to patients. 

Out in front of the clinic were a couple of basketball courts, with kids playing on them (not basketball at the moment, but Dr. Ivers did say games occasionally went on). Across the basketball court, there were two large white tents labeled “British Red Cross”. That, Dr. Ivers said, was the school. Or rather, not the school, but a gathering place for children. Because there weren’t enough teachers to call it a school really, and it was hard to judge if the kids could be learning anything. But it was a space for children to gather during the day, a safe place, rather than wandering around aimlessly through the camp. But then again—-there was space for, what, 500 kids? From a town of 50,000?

Dr. Ivers never projected despair. She projected pride in the work the people around her were doing to help. She projected an intense determination to make life in the camps better. But that determination was colored by a full and painful consciousness of the suffering that her patients face; a sharp sorrow at the inhuman conditions that these people have to live in. That determination was intensified, too, by anger at ineffective help, from any sort of bureaucratic dithering or avoidance of the truth. 

The sense of tragedy piled upon tragedy came to me with the story of the schools in the camps. They weren’t exactly schools because of the lack of manpower and infrastructure. But additionally, there is pressure from outside sources and the government not to designate official schools in the camps. They don’t want to “incentivize” people to stay in the camps—-implying that the more permanent services that are installed, the less likely people are to leave. But people aren’t likely to leave no matter what. Because there’s nowhere to go.

Much of the international staff of PIH expressed deep frustration with the international funding situation. Emergency funding for projects in Port-au-Prince is drying up, so NGOs, unfunded, leave to go where the money is. Like a team of surgeons, partway through an emergency operation, leaving to check on other patients. The next phase of “development money” has yet to flow. Dr. Ivers described setting up with PIH in Parc Jean Marie Vincent along with the Red Cross, and being the only people providing services for essentially a whole city. After appeals for help, other organizations came and things began to get better—- logistics were improved, things began to get more organized. But now it’s back down again to just PIH and the British Red Cross.

Parc Jean Marie Vincent used to just be a sports park. A place for community basketball and soccer and the like. At the clinic, we talked briefly to the director of the—-still technically—-sports park. He was active—-visiting people, talking to his, well, the term now I guess would be constituents. Trying to find out the people in the most trouble, trying to help them. Trying to identify services that could be provided. He was a governmental officer, after all. He did have some measure of authority and responsibility. But he was really looking forward to someday just working on sports again. 

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Here’s a video on Parc Jean Marie Vincent from January. Conditions are still largely the same as described: http://becrollins.com/2011/01/pjmv/

This quote jumped out at me, from Jacky Coutier, a resident of the Parc:

For myself, I’m asking again for a proper sanitation plan. This isn’t something that can be done by a cash for work program in just 2 days. And I’d like to say Partners in Health could use a partner themselves. Partners in Health takes care of health, but health and sanitation go hand in hand.

TERMINOLOGY

The technical name for most of the tent cities and camps throughout Port-au-Prince is “spontaneous internally displaced person camps.” Which is a governmental mouthful, but it’s worth chewing over:

Spontaneous, because these camps formed quickly and on their own wherever there was space to put up shelter. No organization or government planned the layout of these places. No land was flattened or prepared. No space was set aside for basic services—-latrines, showers, schools, medical areas. Nobody checked the drainage; nobody planned where roads would go through. There’s no central authority.

Internally displaced just means that these aren’t foreign refugees. Now, when someone mentions a camp with 50,000 people living in it, I picture a space out on a plain somewhere on the outskirts of a city. I picture people driven from one place and waiting outside the gates of another, hoping to be let in. But that’s not the case in Port-au-Prince. These camps are all throughout the heart of the city. And the people living in the camps are Port-au-Princers. There’s no hope, however slim, of returning to some different home. This is their home. Now, there are camps on the outskirts as well, but they are largely comprised of people who were pushed out of earlier settlements because they were on private property. The only place they could find space was outside the city—-where if anything access to services and general organization is weaker. 

And “camp”. The word sounds deceptively temporary. A cynical view: if something sounds temporary, there’s less reason to make it better. Why build better infrastructure? It’s just a camp—-people will move on to real homes at some point. I suppose the other option would be “settlement.” But that’s too permanent, and sounds almost too purposeful. People are always on the move—-leaving to look for something better, returning when they don’t find it. “Tent city”? Too formal, organized. Most of these places only have names because they happen to coincide with some natural boundary. All around Parc Jean Marie Vincent are other camps that are exactly the same—they just happen to be across the street. So they have a different name. Or no name. There’s no perfect term for what these places are.

Now, I will never again use the term ”spontaneous internally displaced person camp”. Because it’s a cold, unwieldy phrase, and this isn’t a governmental report. But it’s a useful phrase, and for all it’s UN vibe, it does communicate something about these places.

PORT-AU-PRINCE

Port-au-Prince is, well, it is hard to take in. Parts of the city feel like a Jehovah’s Witness-style pamphlet on a particular hell for libertarians: “You wanted a weak government, low taxes, and no ticky-tack regulations on driving or construction? Bwa hahah ah hahah…”

In parts of the city the suffering and chaos are beyond my comprehension—-people living, not in tents, but under tarps stretched across walls made of junk and rope. People living in these structures all the way up to the edge of the road—-all the way down into the slopes of the drainage ditches. And the drainage ditches aren’t draining. Garbage and garbage fires are everywhere.

We’re being driven around in a big white bus. In the Hobbesian state of nature that is the roads of Port-au-Prince, it’s good to be in a big vehicle. I feel confident that in a collision we’ll come out on top. I’m pretty sure the other drivers know this, too—-at least, they tend to swerve first. This isn’t true of the UN APCs and tanks around town, and we duly cede them the right of way.

Our first destination is Parc Jean Marie Vincent, the site of a tent settlement of 50,000 people. 

HULLO AND DISCLAIMER(S)!

Hi. Will Butler from the Arcade Fire here. The band recently went to Haiti and I wanted to write a bit about our trip there.

First, a disclaimer: what follows are my own thoughts and opinions, etc, etc. It doesn’t necessarily reflect the official position of the Arcade Fire. It doesn’t necessarily reflect the official position of Partners in Health, or Kanpe, or any other organization. Not that I’m gonna, like, get all controversial and stuff. But should I inadvertently say something stupid or inaccurate, why, the fault is mine. Your honor, I chopped down that cherry tree. Or rather, I will have chopped down that cherry tree, should it come to that. You get what I’m saying.

A second disclaimer: I spent three and a half days in Haiti. Not enough time to truly and deeply understand the country I was seeing. Though I’ve read books and talked to people who do know what they’re talking about, there ain’t nothing like first hand experience. So don’t mistake this blog for the ravings of an expert. That said, I don’t want to downplay how much I learned, and how much I was moved, by what I saw. The trip spurred a lot of thought amongst our band—what follows is some of them thoughts.

Thirdly: I will ramble a bit. Apologies for rambling.

Finally, I would like to thank everyone in Haiti who showed us something of their lives and of the country. I would especially like to thank Partners in Health for hosting us: Ali, Jon, Joan, Cate, Louise, Bec, Kathryn, Robinson, Domic, Dr. Almazor, Dmitri, Genevieve, Joel, John (different John), the amazing cooks, the doctors and the nurses who met with us, and everyone else who I’m forgetting to mention. These people lead busy lives helping people who truly need help, and that they took so much time to host us and show us their work, well, we were truly honored. Also, thank you to Fritz from Kanpe, Richard and everyone with RAM, Leah, Charlotte, and Maureen and Scott.