The Uses and Abuses of Haiti

Helen Scott interviews Paul Farmer

Internationalist Socialist Review, April 2003

Paul Farmer has worked for two decades as medical director of a hospital in the village of Cange in Haiti that serves the rural poor. He helped establish two organizations-Zanmi Lasante in Haiti and Partners in Health in Massachusetts-that aim to redress inequalities in access to health care. Farmer used a 1993 MacArthur "genius grant" to establish the Institute for Health and Social Justice, which has supported important research on the link between sickness and social and economic inequality. Farmer has published several books that expose the connections between poverty, inequality and infectious diseases, especially AIDS. His work rejects the brutal logic of a for-profit system of health care that reserves cutting edge research and technology for the wealthy while denying the poor the most basic provisions necessary for survival.

In 1994 he wrote The Uses of Haiti, a sweeping history that reveals the consistent role of foreign powers, especially the United States, in the exploitation and oppression of the Haitian people. After several years out of print, an updated version of The Uses of Haiti has now been reissued.

The book rips apart the myth, so often repeated in the New York Times and other mainstream media outlets, that Haiti is a world apart, inexplicably the "poorest country in the Western hemisphere." Farmer shows that Haiti has always been enmeshed in a global system of imperialist competition, its resources and people ruthlessly exploited for profit, its repeated struggles for liberation brutally suppressed. As Noam Chomsky wrote in the 1994 introduction, the book "tells the truth about what has been happening in Haiti, and the U.S. role in its bitter fate."'

The Uses of Haiti tells of the vicious Duvalier dictatorship, headed first by Francois "Papa Doc" and then his son Jean-Claude "Baby Doc," that maintained a reign of terror over Haiti's workers and poor through the infamous armed thugs, the Tontons Macoutes. The U.S government maintained a steady flow of aid to the regime even as it blatantly violated political, social and human rights at every level. Jean-Claude Duvalier was overthrown by a popular uprising in 1986, and in 1990 a large majority democratically elected the immensely popular activist-priest Jean-Bertrand Aristide-only to watch the Duvalier forces organize a military coup within months. The (first) Bush and then Clinton administrations worked to undermine Aristide while supporting the forces behind the coup. They also broke an embargo imposed by the Organization of American States (OAS) to protest the atrocities of the coup regime. Yet the U.S. officially opposed the coup regime and eventually, in 1994, launched a military invasion ostensibly to "restore democracy." Nothing could be further from the truth. As Noam Chomsky puts it in a recent interview, "When the United States government thought that the Haitian population had been tortured enough...the Aristide government was allowed back in under the condition that it accept U.S. demands for an extremely harsh neoliberal regime which has pretty well devastated what's left of the country."

This background is crucial for understanding the current crisis in Haiti and particularly for seeing through the despicable hypocrisy of the U.S. government. Levels of poverty are worse than ever, yet the U.S is blocking the aid that is desperately needed while working to destabilize the Aristide government. Farmer explains: "The current U.S-sponsored embargo against Haiti targets the most vulnerable population in all of the hemisphere, the poorest people with the most fragile economy, ecology and society." The rationale for the embargo-"irregularities" in local elections in 2000-stinks of hypocrisy given the decades-long flood of money to the dictatorial Duvaliers-not to mention the United States' own election irregularities in Florida that took place at the same time. Unlike the Florida case, which led to the second Bush presidency, the Haitian irregularities played no part in Aristide's reelection; in fact the senators involved all subsequently resigned their seats. Meanwhile, the minority political group opposing Aristide's government, the right-wing and misnamed "Convergence Democratique," more accurately known as the "Macouto-Bourgeois alliance," is receiving funding from Republican organizations in Washington. As Farmer puts it, "we hear endless complaints about the corruption of the Haitian government, with no mention of the industrial-strength corruption of the United States and its vassals."

The new edition of The Uses of Haiti is crucial reading for anyone who wants to see beyond the current crocodile tears shed by the U.S. government and its media over "human rights abuses" and "corruption" in Haiti. One of those "vassals," the OAS, released a report last year lamenting the "deteriorating human rights in Haiti" and even pointing out that poverty, child mortality and disease "represent by themselves human rights violations." Farmer responds:

[O]f course Haiti's health and sanitary disasters 'represent by themselves human rights violations'. That's why it's wrong for the hemisphere's most powerful nation to block the humanitarian aid to the most impoverished and wronged one. The violations are caused not by Haiti, but by its powerful neighbor to the north.

The following exchange recently took place between the ISR's HELEN SCOTT and PAUL FARMER.

The US. invasion of 1994, named "Operation Restore Hope," was ostensibly to reinstate democratically elected President Jean-Bertrand Aristide who had been ousted by a military coup. Yet the US. government and media have been consistently critical of Aristide. What is your assessment of the real reasons for the invasion?

I suspect it would be best to make a list of reasons, and then try to put them in order of importance. Although "restoring hope" or "restoring democracy" (or even "constitutional rule") may figure somewhere on that list, it won't be anywhere in the top 100 reasons. Were I to speculate as to what the ranking reasons were, I would say they're similar to the ones that are pushing the State Department, and its faithful prop the OAS, to reconsider their current sanctions against the democratically elected government of Haiti: fear of refugees, of continued social dislocation, and of violence as "contagious."

Then there is contagion itself. It's no accident that polio, declared eradicated from the hemisphere, resurfaced recently in Haiti. It's no accident that the prevalence of infectious diseases is higher here than anywhere else. For example, malaria has been more or less eliminated from both Cuba and Jamaica, as it has from many of the smaller CARICOM (Caribbean Community) nations. Here in our clinic in central Haiti, we diagnosed almost 2,000 cases of malaria last month alone. Then come a host of other reasons internal to U.S. politics and resulting from pressure, weak as it was, from the human rights groups and UN system. But "restoring hope" was not, it would seem, a ranking reason, since our policies since then have been designed to weaken the broad-based popular movement that advocates social and economic rights. Destroying hope would be a better term. The U.S. and also the Haitian elite have long been opposed- openly, not clandestinely-to such a platform.

Can you describe current conditions in Haiti?

Conditions are what you'd expect after a couple centuries of extracting everything the land and the people have to give. Haitians, especially the ones I see as a physician, draw direct connections between the current conditions and their history. (I've noticed the same tendency in Chiapas and even Peru: an interest among the poor in restoring their history, and history of what's been done to them. This is, alas, countered by even more powerful efforts to erase or rewrite history.) The latter part of the 20th century was worse than any period since slavery was abolished by force of arms in the Haitian Revolution (1791-1803). Well before the Duvalier regime was entrenched, Haiti was declared the poorest country in the hemisphere, even though, in the 19th century, there were probably more peasant landholders here than elsewhere in Latin America. The past few decades have been more or less an undeclared war against the poor. Under Jean-Claude Duvalier, there was a massive amount of aid funneled into Haiti through the "government"-the dictatorship- from the "international community." The World Bank, the IDB (International Development Bank), USAID (U.S. Agency for International Development), all the big players. Even their own report cards on this aid are pretty bad; the local grades were even harsher.

Finally, the poverty and corruption were so bad that a popular uprising led to the collapse of 29 years of family dictatorship in 1986. In 1986, there was one institution to avoid strengthening if democracy was to take hold. That was of course the army, which was completely duvalieriste, having been reshaped by 30 years of family dictatorship. Yet that was precisely the instrument supported by the U.S. (and thus the international community over the next several years, with military juntas receiving over $200 million in aid in the 18 months after the collapse of the dictatorship. These are the same folks that brought you, by the way, the sacking and burning of the Church of St-Jean Bosco-during mass, with great loss of life.

Note that these are the very same institutions, only too happy to finance aid and development efforts through the dictatorship and military juntas, are the ones who now have an embargo against aid to the Haitian government. A lot of the arrears the Haitian government "owes" these institutions were loans disbursed to decidedly antidemocratic governments. This sounds to Haitians a lot like the 150 million francs in "reparations" they were obliged to pay the French in the early 19th century after the revolution.

What is behind the US. decision to withhold aid to Haiti and what is the impact of this embargo on ordinary Haitians?

Well, the reason given by officialdom couldn't possibly be the correct one. The reason given is that we're unhappy with the legislative elections of May 2000, when there should've been run-offs for seven or eight senatorial races. Instead of runoffs, the elections went to the person who had the most votes-a real crime against democracy. This could never be the reason for withholding aid since we disburse fantastic amounts of aid to governments that were not elected. Pakistan, Egypt and so on-these are military governments. The former came to power in a military coup, but since September 11 we've lifted all restrictions and are giving them tons of money. The real reason we have an embargo against Haiti, in my view, is that every time the Haitians are allowed to elect who they want they make the mistake of not electing the kind of people the U.S. government wants. They keep electing, in fact, the same guy, the one who is pushing social and economic rights for the poor. The same guy who is vilified by the establishment press (when Aristide was recently given an award by the UN Food and Agricultural Organization, the Wall Street Journal said, "What next? A prize for Fidel Castro?" or something like that). The sad thing about a lot of so-called progressive commentary from outside of Haiti is that it too erases history. How can you rebuild Haiti without massive resources, perhaps something on the scale of half of what has been drained from Haiti?

It will require, as noted, a billion dollars to rebuild ruined health, educational and sanitary infrastructure here. So I'm not against moving funds back to Haiti. I'm all for it. And until that happens, there will be misery and hunger and inequality here. That "structural violence," which has been perpetrated from without, will be reflected in local violence, just as it is everywhere in the world. You'd think that progressive observers would at least make this connection. But they don't. The "human rights community" rarely dares to criticize the United States government and its obedient appendages (such as the OAS), but we should be following the chain of command and asking why it is, for example, that the International Republican Institute and the National Endowment for Democracy are so keen on financing the Haitian opposition. As for the impact of the embargo on the Haitian poor, what do you think would happen if: 1) the public infrastructure of the country were run into the ground; 2) the Haitian poor desperately need clean water, good medical care and educational opportunities; and 3) the three IDB loans that were blocked-as far as we can tell, by U.S. veto power, since the loans were already approved by the Haitian government and the IDB-are for water, health care and education?

As the Haitians say, you can't get blood out of a rock. The situation here is as bad as I've seen it, with an international aid embargo on a democratically elected government and "progressive" analysts spending all of their energies, it would seem, criticizing David, not Goliath.

Can you explain the work of the Zanmi Lasante Clinic and the role it plays in Haiti?

Part of me is tempted to say that we don't really have a national role per se, that ours is a regional effort, a community-based effort. That would all be true. At the same time, what I've seen over the past 20 years leads me to believe that Zanmi Lasante may well be playing an important role in other parts of Haiti and beyond its borders. Allow me to give some specific examples, and then link them to a general contribution to the struggle of the poor.

Zanmi Lasante has pioneered a number of interventions around complex health problems including hard-to-treat tuberculosis, AIDS prevention and care and maternal mortality. We've done these projects from the middle of a squatter settlement inhabited almost exclusively by landless peasants. We've even performed open-heart surgery here. We've done this with an all-Haitian staff-non-Haitians like me have been volunteers. We have recently welcomed our first Cuban staff, a very experienced surgeon and a pediatrician, but we don't have to pay them either. It's part of Cuba's aid program to Haiti.

In "pioneering" these projects, we have attracted attention from other places in Haiti. For example, we were named, years ago, the national referral center for the treatment of drug-resistant tuberculosis. So there are people referred from the capital city to receive their "high-tech" care in the middle of a squatter settlement on the central plateau. The Ministry of Health called upon us to lead public health efforts in the region. And our AIDS treatment program-perhaps the first donor-supported one m such a poverty-stricken setting-has been visited by doctors from across sub-Saharan Africa. The staff of Zanmi Lasante, which is underpaid and works under adverse conditions, is proud of these victories, as slender as they are in the face of current global trends.

Most of all, we're known for seeing patients. The provider of last resort for the region's poor. We may see, here in Cange, close to 200,000 ambulatory visits this year, more than three times the number we saw last year. We never would have thought it possible. Of course the staff is exhausted and raising funds for the medications is a constant headache for Partners In Health-Boston. And that figure would not include patients seen in their homes by community health workers, nor would it include patients seen in our sister institutions in Thomonde, Boucan Carre, and Lascahobas. We're involved in seeing that decent services are made available in those places, too.

One of the unusual things about Zanmi Lasante is that it is a health NGO that is skeptical about NGOs. It's a private facility on the side of public facilities. We regard our primary mission as rendering service to the poor without losing sight of why it is that there are so many poor people out there, without forgetting why it is that the public sector has had its legs cut out from under it-and not by the Haitian government. It is the so-called international community that is weakening the public sector in Haiti. So to have a private NGO always complaining about the "NGO-ification" and "privatization" of Haiti and other poor regions of the world is unusual.

What is your assessment of the current state of movements for social and economic rights in Haiti? And what can progressive forces in the US. do to assist those movements?

So far, progressive forces in the United States have been pretty silent on Haiti. They've been silent or divided. What we all know is that Haiti has been driven into the ground over the past couple of decades. As a doctor and a progressive, I'd like to underline the following point: When something is driven into the ground, resources are required to rebuild it. A person who has been kicked to the ground must expend energy to get back up again. This was clear in 1986, more so in 1990 and 1994, and clearest of all right now. "A Marshall Plan for Haiti" some said. "Reparations," observed the more historically minded. (A few truly ahistorical ideologues, some of them self-declared progressives, have argued, "Haiti needs no aid. It can recover on its own." This is absurd and dangerous ideology.)

The real reason we have an embargo against Haiti, as I already mentioned, is that every time the Haitians are allowed to elect who they want they make the mistake of not electing the kind of people the U.S. government wants. In almost all of his public utterances, Aristide brings forth the significance of social and economic rights. An article in the Village Voice, which was not at all flattering to the Aristide government, quoted Aristide saying the following: "The people of Cite Soleil [a poor area of Port au Prince] are the sons and daughters of the country. Their rights are violated when they cannot eat; their rights are violated when they cannot go to school. We must work with all sectors, the opposition and the elite, to improve their lives. We are committed to working with them and we will not rest until we do that."

The Wall Street Journal might deny the relevance of Aristide's comments to the situation, but any inhabitant of Haiti would see the connection: without social and economic rights, political rights have no soil to grow in. The brutality in Haiti's streets will not be tamed by legal reforms or by extralegal police action, but by confronting poverty and disease. And that will require a major influx of capital.

As of today, all significant aid to the public sector remains blocked, although smaller amounts are being routed through NGOs (some of them doing excellent work, but on a local scale), through right-wing political parties, and through churches, some of them also quite conservative. Haitians abroad continue to send home remittances, but remittances, though vital to the survival of many families here, cannot substitute for the aid necessary to rebuild the country.

Progressive forces in the United States and Europe should spend their energies denouncing the abuses of the powerful (our governments) and working to move resources back to a place that has been devastated by mean-spirited policies from without.

I was struck by a talk you gave recently in which you quoted Roman historian Tacitus, who said of Roman conquest, "They make a desert and call it peace." Given the US. record of verbally espousing democracy while actually working to undermine it in Haiti what is your assessment of the current war on terror in Afghanistan and shortly in Iraq, which is waged in the name of democracy and freedom?

Any honest assessment of the historical underpinnings of these two "wars" will teach us the same lesson that Haitian history does: We have had a hand in creating these "failed states" and "rogue states." Erasing history is always expedient to the powerful, as Tacitus pointed our many centuries ago.


Helen Scott is an assistant professor of English at the University of Vermont. She is the author of "The Mark Twain they didn't teach us in school" from International Socialist Review issue no. 10, available online at www. htm.

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