“Safety” and health in Haiti

February 4, 2010

AS PEOPLE are pouring their hearts and money towards Haiti's earthquake relief efforts, two issues have come to my attention. First, the issue of "security" and the extent to which defense is prioritized over health care. Secondly, the issue of health and building an infrastructure that provides free comprehensive health care to everyone.

In an attempt to address the issue of security, I will evaluate the U.S. State Department's guideline for travel and how the language is a subtle remark against Black political resistance. Concerning health, I will discuss the obligation of the Haitian state and the international community to provide public health infrastructure--not just providing immediate clinical relief to the earthquake survivors.

The U.S. State Department provides guidelines for U.S. citizens in their excursions abroad. According to the U.S. State Department Web site, "Incidents of violent demonstrations, looting, and transportation disruptions in Les Cayes and Port-au-Prince resulted in several deaths." The paragraph continues by describing student demonstrations in 2009 that began with alleged "rock throwing," police intervention, and subsequently, death.

By classifying these students as agents that perpetuate mayhem and not as citizens who are exercising their political rights, the U.S. government pigeonholes Black political resistance as inherently bellicose. Political demonstrations with police intervention and "object throwing" occur in France and Germany, yet there are no U.S. travel warnings against these nations.

Subaltern resistance has been integral to improving the conditions of the oppressed. When African Americans (and their allies) in the civil rights movement organized against Jim Crow laws and racial segregation, their political demonstrations were met with police brutality and brute racism.

Many of these groups were categorized as violent, but years later, we see these people as harbingers of their time. In portraying Haitian political demonstrations as violent, without looking at the conditions and contexts behind these demonstrations, the U.S. State Department is thwarted to a limited notion of democracy.

Additionally, the U.S. State Departments argues, "There is a persistent danger of violent crime, which can be subject to periodic surges sometimes not obviously explained by other events or conditions."

Violence is sparked by starvation, desperation and destitution. When people live in a dilapidated post-disaster zone, they respond to the conditions of their community--not an innate response. If people are provided with access to food, housing and health care, instances of aggression will be minimized. Classifying Haitians as violent through policy and practice limits the capacity that community leaders can build infrastructure in the country and reproduces racialized depictions of Black political resistance.

MAINSTREAM RELIEF campaigns on Haiti have focused on donating money to non-governmental organizations to provide direct care and relief to earthquake victims. Many of these organizations working in Port-au-Prince and surrounding areas are attempting to fulfill the World Health Organization's definition of health, i.e., "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

It is commendable that various organizations are investing their resources and staff to aiding earthquake victims. However, public health is a system that extends beyond direct relief.

Health care is a right, not a commodity, and should be provided to all citizens. One way to mitigate health inequalities in Haiti is to provide free and equal access to all people. Proponents against free, comprehensive care often cite cost as the greatest barrier to care. Yet if one delves deeper, one would find that multinational pharmaceutical and biotechnological corporations which limit who has access to these resources drive high prices high.

We must be cautious of emergent diseases and prevent them in the short- and long-term. For example, clean water can diminish a host of diseases such as cholera and typhoid. We must be reflective of health intervention and provide 100 percent coverage to Haitians in the same way that we should provide 100 percent coverage to people living in the United States.

When Europe had cholera outbreaks in the 1840s, Edwin Chadwin suggested that government provides clean water sanitation, removal of animal feces from water and ventilation of work spaces--a radical idea. He recognized that the health of the population is determined by access to health facilities, by physical structures that influence the environment, social structures that regulate organizations and behavior, and by health education.

The role of public health is to conduct research and empower communities. Thus, public health initiatives should work in conjunction with urban planners, agronomists and educators.

Academic institutions in the U.S. can work closely with higher institutions in Haiti by building the research capacity of Haitian scholars. Exchanges should be multi-directional and not just hierarchal--i.e., U.S. researchers should recognize that they could learn from Haitian scholars. Furthermore, medical training should encompass both Western and traditional methods in order to give medical providers the cultural competency, knowledge, and tools to avoid a colonial approach.

Social movements have been an upheaval for change. When we condemn political activism in developing nations as necessarily violent, we encourage political silence in "developed" states. If Haitians are challenging their government, the United Nations, and the U.S. military, they are pushing for a democratic system that fulfills progressive policies for the masses. Finally, health initiatives should consider the broader social and political contexts.

In rebuilding Haiti, there must be a national effort to protect the health of the people--not the interests of multinational corporations. Health is inextricably linked to environmental and social conditions such as education, housing, and labor. If we want to improve the overall health of Haiti, we must provide the Haitian government and people with the capacity to build that infrastructure. As health care practitioners and global citizens, we should advocate free, comprehensive public health for everyone.

There is a Haitian proverb that states, "Genyen tout yon sosyete ki pou change" (There is a whole society to be changed). The society that the proverb refers to is not just Haitian society, but the larger political economic structure that is extracting resources and cheap labor from the masses in Africa, Asia, Latin America and the Middle East.
Edna Bonhomme, New York

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