Everything you touch is a problem

For several days last November, protests over the government’s failure to provide consistent electricity shut down Fort-Liberté, a small coastal city in northeast Haiti. Video footage of the events shows an atmosphere alternately festive and frightening. At times, throngs of men, women, and children paraded through the streets, dancing and chanting to music created by marching drummers and blaring loudspeakers.

But macabre visuals and intermittent violence provided a jarring contrast to the peaceful processions. A burned-out car propped on its side kept vehicles from passing through the town’s main entrance, while a coffin and human skull next to an uprooted children’s swing set blocked a road near the town square. Rowdier demonstrators threw rocks at passing cars, hurled Molotov cocktails at the local United Nations office, and destroyed the equipment connecting buildings to the local electrical plant.

The week ended in injury and death. National police forces called in to restore calm fired rubber bullets and tear gas into the crowd, wounding protesters and killing a young child.

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To the extent that most North Americans think about Haiti at all, they think about tragedy and failure: failure to stop the widespread—and preventable—death and destruction that accompanied the 2010 Port-au-Prince earthquake and the cholera epidemic that broke out later that year; failure to build a stable political system and modern infrastructure; failure to lift its people out of poverty.

While these problems are all too real, the image of the nation that emerges is, of course, far from complete. Haiti has a rich history and culture, and blame for its ills lies with a wide range of actors. Born from a successful slave rebellion that pitted kidnapped Africans against the French army, it was the world’s first black republic. For decades after its 1804 founding, however, racism and fears of slave revolts spreading to neighboring countries—the United States, for example—made it a pariah in the international community.

Haitian slave revolt

In 1825, under threat of invasion and re-enslavement, the Haitian government agreed to give France the modern equivalent of billions of dollars (a figure far out of proportion to the young nation’s assets) in reparations for the property that colonists lost during the rebellion: i.e., the Haitians themselves. It took the government over a century to pay off the massive debt, leaving it with little to invest in its own people or infrastructure. In the twentieth century, decades of trauma, much of it initiated or enabled by foreign powers—U.S. occupation, political coups, the dictatorships of Papa and Baby Doc Duvalier—led many who could flee the country to do so, eviscerating the professional class.

Today, Haiti has the lowest GDP and life expectancy in the Western hemisphere. It lags far behind its neighbors in education, healthcare, sanitation, infrastructure, and governance. “If Americans want to understand Haiti, they should know that Haiti needs everything—drinking water, electricity, everything,” a man named Clercues Altedor who I met in Fort-Liberté’s central market told me. “That’s the only thing you need to keep in your mind, that we need everything. We’ve got nothing.” He then launched into a plea for help in obtaining surgery for his daughter.

If the problems are clear, however, the solutions have proven less so. In the past few decades, the country has become a magnet for international aid workers and celebrity activists, earning it the nickname “Republic of NGOs.” The phenomenon has its origins in the Duvalier era. Although foreign governments—primarily the U.S.—knew that much of the aid money they sent was simply stolen by the ruling class, they were afraid that cutting it off entirely could destabilize the country. Increasingly, they simply avoided the state altogether, funneling cash through independent organizations.

Today, everything from tiny, unofficial aid groups to giant NGOs crisscross the country working on projects related to infrastructure, education, sanitation, health, and more—with greater or lesser degrees of sophistication and success. Many have little or no communication with Haitian authorities, who, in turn, may not possess the resources necessary to give them any meaningful guidance or oversight.

Haitians and foreigners alike bemoan this system. “Donor assistance to NGOs comes in the form of small projects to support individual clinics or schools that are too often poorly coordinated, incoherent, and make no effort at harmonization with national development priorities,” claimed a 2010 OXFAM report. Meanwhile, “State institutions have no money to provide services, hampering their ability to develop their own capacity and thus ensuring that any service they do provide is of low quality.” The failure of many high-profile international campaigns aimed at rebuilding Port-au-Prince after the 2010 earthquake created a fresh source of bitterness.

I grew curious about the landscape of help in Haiti last year, when I traveled there with a small nonprofit co-founded by a friend. While in Fort-Liberté, I asked anyone who would talk to me about what the town’s needs were and who was working to address them.

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I arrived on January 27, 2014, just a few days after the year’s first round of protests over electricity. By this time, the only traces of the turmoil that remained were the charred scraps of tires and trash that had been set on fire in the intersections.

People on the street went calmly about their business. “The authorities haven’t said what they’ve decided yet,” Farness Peter, a middle-aged motorbike taxi driver, said as he waited for customers near the town’s entrance. “We’ll be patient, waiting to hear what the authorities will say.”

Ask anyone who lives there to describe this city of 30,000 near the Dominican border, and you’re likely to hear that it’s tranquil and friendly. Despite the recent troubles, it has a reputation as an oasis compared to Haiti’s largest cities, Port-au-Prince and Cap-Haitien. “Fort-Liberté is the most peaceful place I’ve ever visited,” said Doudy (pronounced dutesy) Charles, who fled the earthquake-ravaged capital for Fort-Liberté in 2010. A lanky, affable thirty-one-year-old, he now works part-time for my friend’s group, Empower and Advance, while pursuing a college degree. “The people are really fantastic. Anywhere you go people greet you.”

Despite being shared by SUVs, donkey-drawn carts, motorbikes, horses, pedestrians, dogs, and chickens, the streets are relatively quiet. In the afternoons, chattering kids in brightly colored uniforms and neat braids spill out from schools; copper-colored hair, a sign of child malnutrition, is less common than it was only a few years ago.

Shoppers crowd the town’s sprawling central market, where flies swarm thickly on the produce and huge slabs of raw meat on display. Men sit in small groups on the street, drinking Prestige beer and playing dominoes, old kompa hits playing on radios perched behind them.

One of the nation’s oldest settlements, Fort-Liberté was founded by Spanish colonists in the sixteenth century, then fell under French control. Haiti’s Declaration of Independence was signed there in 1803.

The area has changed dramatically in the past few decades. In the mid-’70s, “there was really nothing there. There was no market . . . it was all thatch roofs and naked kids in the streets,” said Annette Crislip, an American who visits the town regularly.

In recent years, a new road has made traveling to the nearby Dominican border a matter of minutes rather than hours. Many of the town’s streets have been paved. Residents pooled money to buy two ambulances. The first municipal sewer system opened last year after a major construction effort. Cell phones and Facebook accounts are common. An open-air dance club named Dolphin’s boasts the most surreally elaborate light show I’ve ever seen.

Infrastructure in construction, 2014.

Infrastructure construction, 2014.

Poverty is still the norm, however, as a quick walk in any direction makes all too clear. As the capital of the nation’s northeastern province (the country’s poorest), Fort-Liberté is home to a number of government offices and international organizations, located in handsome buildings surrounded by tall fences.

Venture outside the town center, however, and the structures quickly become smaller and more ramshackle. Locals say that the standard cinder block houses are better constructed than their now-notoriously unsafe Port-au-Prince counterparts, but some residents don’t have the luxury even of bare concrete walls and floors. Precarious-looking wattle-and-daub huts dot the back streets, and one family near my hotel—which sits practically empty for most of the year—seemed to be living in a makeshift tent propped up on a roof.

Image credit Lusana Schutz.

Image credit Lusana Schutz.

As in the rest of the country, steady paychecks are hard to come by. In the past, large-scale sisal production employed many in the region, but by the late 1970s the widespread adoption of artificial fibers had decimated the industry. A port once provided good jobs in the town, but talks of opening a new one have stalled.

Some locals earn their living through fishing, carpentry, and other trades, or make ends meet through informal employment and subsistence farming. Others seek jobs in the many local schools, another fairly recent addition—and a vital one, given that almost half of the town’s population is under the age of eighteen. As a teacher, “you won’t get a lot of money to have a great life,” Charles told me. “But you can survive. Only survive.”

The tall yellow arch marking the entrance to the town is flanked by a billboard advertising jobs at nearby Carocol, an industrial park that opened in 2012.

A pet project of the Clintons, who honeymooned in Haiti in the 1970s, it was intended to jump-start an export-focused, textile-based economy that would eventually provide good jobs throughout the country. “Haiti is open for business!” ran the popular refrain.

So far, things haven’t worked out exactly as hoped. As a recent New York Times article put it, the “signature American-led redevelopment project . . . which was supposed to create as many as 60,000 jobs—had created 2,590 at the end of 2013. Workers’ rights advocates reported last fall that garment factories at Caracol and elsewhere routinely violate Haitian minimum-wage laws and pay most workers too little to live on.”

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After the 2010 earthquake, more than half a million Port-au-Prince residents fled the devastated capital for other parts of Haiti. Like Doudy Charles, many of those who ended up in Fort-Liberté stayed.

The number of foreigners (who local children follow around with good-natured shouts of “blanco!” regardless of the person’s ethnic origins) also shot up temporarily in the earthquake’s aftermath. Although Fort-Liberté was hundreds of miles from the epicenter, volunteers flew in to help those who had come from the capital. One of those was Ayesha Khan, an emergency physician at Stanford and co-founder of Empower and Advance. “The earthquake brought more visibility to Haiti in general, and more of an influx of money,” she told me one afternoon in the hotel, a quietly wry look in her eyes. “And so here we are.”

Healthcare has long been a major challenge in the country. “[As] for the health in Haiti . . . I can say Haiti has problems everywhere. And everything you touch is a problem,” Charles said.

In Fort-Liberté, a small hospital and health clinic have opened in recent years. However, many people don’t have the money to pay for medicine, relying instead on traditional remedies such as herbal teas. For anything other than routine complaints, those who can afford the fare pay a motorcycle taxi to take them an hour away to a larger hospital in Cap-Haitien.

While working in Haiti and elsewhere, Khan became increasingly concerned by the fact that one of the most common models of providing care in the developing world—raising money to fly foreign medical workers from country to country—was fundamentally unsustainable. Together with my friend Brad Penoff, she decided to trial a community healthcare worker program in Fort-Liberté, where she had developed strong ties over repeat visits. The program’s goal: improve access to care while creating good local jobs. After getting it off the ground, they hoped to drop out of the picture as much as possible, letting Haitians take things from there.

To reduce the need for Khan and the other doctors involved with the program to travel to Haiti, they developed an eight-month training regime based on electronic instruction modules and video check-ins. She developed the medical curriculum together with colleagues at Stanford, while Penoff, a Google engineer, created a tablet-based interface that allowed students to make their way through the lessons largely on their own. The instruction focused on the most common complaints reported in the local emergency room.

On the trip I joined, a group of American and Canadian pharmacists, nurses, and doctors (all volunteers) taught hands-on skills like placing splints. The program plan called for the next class of students to learn these procedures from alumni instead.

The first four community health workers—all promising recent high school graduates from poor families who had few other employment prospects­— completed the course last spring and were certified to practice by the regional Ministry of Health. They are now based at a clinic in Perches, a small town within the Fort-Liberté hospital’s catchment area, where their reputation for providing quality care has spread.

Community health workers with Doudy Charles (center).

Community health workers with Doudy Charles (center).

“Wildiane, on[e] of the CHWs [community health workers] went to Grand Basin a town next to Perches to see a dentist in the hospital there,” Charles posted on the group’s Facebook page last October. “There is a patient that showed up and the other people asked him where is he from and he said in Perches. Soon after that there is a guy that said to him: they [sic] is a new clinic up there in Perches, thanks to CHWs that work [there] l had a wound that heals now. Wildiane heard that, stayed quiet and feels proud of the project.”

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Empower and Advance’s model relies on an increasingly popular aid strategy known as task shifting, in which a limited set of critical functions are transferred from professionals to trained laypeople. The method has been applied in fields from education to construction, strengthening communities’ internal resources while making up in part, at least, for the severe shortage of specialists of all kinds in many parts of the world. In medicine, the idea of training community health workers to provide care for their neighbors, while far from new, has become more popular in recent years. “I see task shifting as the vanguard for the renaissance of primary health care,” wrote Dr. Margaret Chan, Director-General of the World Health Organization (WHO), in 2008. The strategy is not without detractors, however. Many community health worker programs have failed in the past; others have been criticized for providing poor care, overburdening workers, taking jobs from health professionals with more training, and a multitude of other ills.

A broad-ranging historical review of community health worker programs published by the WHO in 2007 found mixed results and a need for further study. Overall, however, the authors concluded that, when thoughtfully designed and well managed, they can play an extremely important role in a region’s overall healthcare system. “CHW programmes are not a [sic] cheap or easy,” they wrote, “but remain a good investment, since the alternative in reality is no care at all for the poor living in geographically peripheral areas.”

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A West Virginian with a soft twang, Annette Crislip has been deeply involved with Haiti since graduating from high school. Now a full-time volunteer for a faith-based American nonprofit called Friends of Fort Liberté, she has visited the town often for almost four decades.

Friends of Fort Liberté started as an informal partnership between American architect J.D. King, Crislip’s late husband, and Andre Jean, pastor of Jerusalem Baptist Church. Over the years, the influential pastor and his late wife Justine helped to steer the group’s direction as it designed and constructed new churches, a school, an orphanage, a farmhouse, and a clinic.

Main church with protest debris in foreground.

Town square and main church with protest debris in foreground.

The organization runs a scholarship program, allowing over five hundred local children from poor families to attend school. It’s now rebuilding the orphanage and working to get a farm project off the ground. “We’re like a situation comedy with spin-offs,” Crislip told me.

Changing ideas about charity and international aid have made Crislip and her fellow volunteers increasingly concerned about the unforeseen consequences of their actions, however. Books like When Helping Hurts: How to Alleviate Poverty Without Hurting the Poor . . . and Yourself, which argues that many Christian missions rely on flawed assumptions and create dependency in those they’re trying to assist, have influenced their recent conversations. She thinks that Friends of Fort Liberté will continue to evolve in response to this and other challenges. “We understand that in the next ten years we’ve got a huge transition,” she told me.

Like Penoff and Khan, she also hopes to see locals take over more of the work that has been done by outsiders. “People like Doudy . . . they are the ones that will make it happen if they get a chance,” she said. “If they have some chance to do something besides just try to survive.”

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Fort-Liberté’s tiny tourism industry caters almost exclusively to volunteers and NGO workers, although locals hope that the town’s scenic bay and historic fort will one day attract others.

The only other guest at our hotel in January was Rafael Rodriguez-Leal, who had lived there for the past year while working for the United Nations. He quickly befriended our group and made valuable introductions around the town.

As a civil affairs officer, he spends much of his time trying to understand and improve conditions on the ground. “I’m responsible for making  liaisons between the civil affairs section and local authorities, including mayors, municipal councils, civil society organizations, universities, and these types of actors that have a social or political interest in the country,” he told me. His group also partners with local organizations to build infrastructure like police stations and women’s shelters, and is providing extensive logistical support for this year’s elections.

The UN’s troubled history in Haiti provides a complex background for this work. Although the organization has never officially claimed responsibility, the overwhelming consensus is that the cholera outbreak that has killed more than 8,000 people in the past four years was introduced by a Nepalese peacekeeping delegation whose poorly maintained latrines leaked into a nearby river. Haitian and international groups alike have criticized the UN for its failure to own up to the disaster. “The organization’s ongoing unwillingness to hold itself accountable to the victims of cholera violates existing obligations under international law,” two Yale Law scholars wrote in The Atlantic in 2013. “Moreover, by failing to lead by example, the UN is undercutting its core aims of promoting international peace, law, and human rights.”

The UN established its Stabilization Mission in Haiti, better known by the acronym MINUSTAH, in the wake of unrest surrounding the 2004 exile of then-President Jean-Bertrand Aristide (who either fled the country or was pushed out by the international community, depending on who’s telling the story). After the earthquake, the Security Council decided to scale up the program to support the country’s recovery. According to its website, the 7,000-strong international force­—the vast majority of whom are military and police troops, plus a few hundred civilians and volunteers—now focuses on “its original mandate to restore a secure and stable environment, to promote the political process, to strengthen Haiti’s Government institutions and rule-of-law-structures, as well as to promote and to protect human rights.”

MINUSTAH was controversial in Haiti even before the cholera outbreak. Protests have broken out around the country in response to allegations of sexual misconduct, much of it involving minors, by peacekeeping troops. The program’s long tenure has also been questioned. “There has been no serious armed conflict in Haiti since 2006—which can be taken as evidence either of MINUSTAH’s effectiveness or of its irrelevance,” wrote The Economist in 2012. “Even if the troops do contribute to security, critics of the force note that a single year of its $800m budget might be enough to revamp the country’s decrepit water infrastructure. That might well have prevented cholera from spreading in the first place.”

UN SUVs, a common sight in the town.

UN SUVs, a common sight in the town.

Responding to these and similar criticisms, last fall the UN Security Council authorized a withdrawal that will halve the number of military personnel on the ground within the year. The Haitian government requested that UN military and police levels remain roughly the same during the lead-up to December’s elections, with levels dropping significantly afterward.

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While complaints about outside interference are not uncommon in Fort-Liberté, a number of locals I spoke with also said that their neighbors could be doing more to improve their own fates.

Doudy Charles told me that the townspeople would benefit from being more proactive and creative. Although they often talk about starting new farms and other businesses, he said, “no one ever raises one of his fingers to do it.”

Despite Fort-Liberté’s poverty, he pointed out, substantial amounts of money pass through the city due to the many government and NGO offices located there, as well as its close proximity to the Dominican border, where Haitians from throughout the region go to buy and sell goods. However, partially because of a lack of enterprise, he claimed, little of that money remains with locals.

“Haiti, and especially Fort-Liberté, is dependent on the Dominican Republic for food and that kind of thing,” he told me. “I think the best thing to increase things in Fort-Liberté is to start doing our own food, because we have the same soil—we have water here, we have many things here. We have everything. But the Dominican Republic does these things, and we go buy the things from them. So the best thing is to do our own planting, our own tomatoes, our own things we should need everyday. That is the way to increase better jobs, I think. It’s a good way for the future.”

Charles is not naive about the obstacles involved. He’s all too familiar with stories like that of a would-be farmer who told me about contracting tuberculosis but not being able to stop working in the fields despite a sensation of being stabbed repeatedly in the chest: poor irrigation in the area means crop yields so small that he has difficulty surviving even when toiling constantly.

However, despite the all-too-real problems of insufficient capital and infrastructure, Charles and others continue to advocate for self-starters. “People need to be more creative here,” he told me. “If you don’t do something, don’t expect people will do it for you.” A few popular new local businesses—bakery, funeral parlor, small entertainment center—demonstrate that it is possible, if not easy, to be entrepreneurial in Fort-Liberté.

He broadcasts these and other thoughts on his weekly show on Radio Gamma, itself a local success story. Housed in a small building on a residential street, it was for a time the town’s only radio station. Due to political problems, “from 1991 to 1995, there was no radio station in Fort-Liberté,” founder Judson Michel, a middle-aged man with a calm, confident demeanor, told me. “Every state in Haiti had a radio station; only the northeast didn’t have one. My brother is an electrician, so I bought my own equipment to make a radio station in order to fill the void. And the people in Fort-Liberté really liked it.”

Judson Michel in front of Radio Gamma.

Judson Michel in front of Radio Gamma.

Radio remains the dominant means of accessing information in Fort-Liberté, as in much of Haiti. Although Internet use is growing, the nation’s telecommunications infrastructure is extremely underdeveloped by international standards.

Radio Gamma’s programming, which is funded by ad sales, falls into three categories: information, education, and entertainment. With respect to the former, “most people are attracted by political news and want to know what the government does,” Michel said. As for education, “this radio station teaches people how to have good manners in the society, teaches them how to be someone that plays their role for themselves and for the community. We teach them their rights and what they have to do.”

Michel reaches out to locals like Charles to host shows on the station, and sometimes accepts requests to join his lineup. Etienne Juvenal, the Cuba-trained doctor at the local clinic, uses his slot to teach basic health facts. “The majority of the problems that we see in the clinic are preventable,” he told me. “But the problem is that the population, at least a lot of people, aren’t educated. They don’t know how to prevent them.” Because Haiti’s schools lack a standardized curriculum, many children never learn basic facts about nutrition, sanitation, and other critical subjects. “To improve the health situation in this community, education is the most important thing.”

Health education mural.

Health education mural.

Junior Mesamours, a minister who earns a living as a translator, has a show called “The Haiti of Tomorrow.” “Haiti can realize its potential,” he said, “but the first thing will be consciousness . . . Unfortunately too many people, especially Haitians, are OK with the way we are. Or if they pretend they are not, they don’t do much to really change it. The second thing will be the effort of changing the mentality: a mentality of defeat, a mentality of pessimism, a mentality of ‘someone else needs to do it.’”

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In April 2014, Haitian president Michel Martelly signed a contract to connect four local communities to electricity generated at the Carocol industrial park, responding to the demands of the January 2014 protests. However, Fort-Liberté and a few other cities that had been promised power were left off of the list. Protests broke out in the nearby border town of Ouanaminthe. Roadblocks stopped traffic (and trade) to the Dominican Republic for several days. Protesters threw broken bottles and smeared feces on public authorities’ offices.

Officials suspect that much of the violence that has broken out in the region has been fueled by opposition politicians paying out-of-towners to stir up chaos at strategic times. Regardless, the protests tap into deep popular frustration in cities that remain without power for most of each day. “People is fighting for their due,” Charles wrote me recently. “[It’s] the role of our government to ensure that. If they cannot, people has to stand up. Cause no one can’t live without electricity in this century.”

The Haitian government’s failure to provide basic public services is often blamed on corruption or incompetence. Like most, however, the story is more complicated than it appears. A long history of political instability and chronic underfunding of government agencies has created a cycle in which Haitians, considering the state useless at best, don’t pay the taxes and bills critical to meeting their own needs. Opaque and often inaccurate invoicing only adds to the problem. This chicken-and-egg dynamic exacerbates tensions in Fort-Liberté as well as the rest of the country.

Further complicating the situation, Rafael Rodriguez-Leal told me that he believes there are very good reasons to oppose the proposed Carocol plan—for one, the fact that it would make Fort-Liberté dependent on fossil fuels.

“Haiti has an opportunity to develop at a sustainable rate,” he told me. “They’re not burning that much carbon to generate electricity, because people are used to just six hours a day of electricity, and they’ve managed. That’s what we’re trying to do in other parts of the world, right? Cut. So we shouldn’t expect them to do the same things we’ve done, and then end up having to cut on carbon generation.” He and his colleagues are advocating for the use of renewables—and helping find ways to finance and install them—instead. “Once they get into that pattern of burning more fossil fuels at the plant, they’re not going to stop.”

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After the city’s energy meters were smashed during the November 2014 riots, residents suffered through three months without any electricity. Peak-hour power was finally restored during the week of March 19, coinciding with the annual festival of Saint Joseph, Fort-Liberté’s patron saint.

Government officials continue to promise more and better power soon. Haiti’s newly appointed prime minister attended the March celebration, giving a speech promising to work toward round-the-clock electricity—and exhorting residents to pay their bills.

Protests have continued, however. Mid-April 2015 witnessed another round of demonstrations in Fort-Liberté and Ouanaminthe. The latter resulted in the death of MINUSTAH soldier Rodrigo Andres Sanhueza Soto, a 35-year-old Chilean father of two who was shot in the head as he sat in the back of a Jeep during a routine errand.

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U.S.-based scholars and journalists who write about Haiti often emphasize the two nations’ intertwined histories. Although most Americans know virtually nothing about Haiti, the world’s top superpower would not have evolved in the way it did had things worked out differently on this small, impoverished Caribbean island.

As the threat of climate change looms ever larger, it’s easy to twist this line of thought, imagining that a future U.S. could look more like today’s Haiti than we might like to think, facing widespread challenges with energy, water, food, and other vital resources. Lessons learned in Fort-Liberté and other struggling cities in the developing world may one day prove critical in our own neighborhoods.