Friday, July 31, 2009

A week in Haiti - Part I

I am gradually making good on my promise to write some of what I learned over the summer.  This is the beginning of my Haiti trip.  As I go along, I'll try to separate the wheat from the chaff for myself.  But I never know what is wheat and what is chaff for others.  So, here is the raw stuff.  Make the bread you harvest be tasty.

A week in Haiti (“ayiti“) - Part I

I didn’t keep a journal during my first trip to Haiti.  Although I generally keep a journal when I’m traveling, I was too involved with the work and perhaps a bit overwhelmed.  But I took careful notes and those notes began to resemble a journal, something more intimate, more about my experience, more about keeping track of how this experience was affecting me, more about my relationship with God.

The first page simply states, “Life is hard in Haiti.”  It was a quote, from Dr. Agathe Jean Baptiste, on my first day.  It was striking because those are the exact words that Rada spoke, eight years ago, about India.  Both stated a profound truth by women who know what it is like to live in the United States, but who have returned to the place of their birth nonetheless.  Yet, they live with that truth and felt no need to sugarcoat or deceive.  Perhaps they needed to communicate a truth to someone who would recognize it as the truth and appreciate how difficult it is to live with that truth.

June 1

I left Salem for PaP (via Portland, San Francisco, and Miami) after a serious two weeks of collecting stuff to take with me: a community water treatment system worth about $1100, destination as yet undetermined; $600 of medical supplies for the MPP clinic in Papay founded by Dr. Agathe Jean Baptiste, Jenny Hare, and volunteers; and my collection of tropical clothes, survival gear, and anti-mosquito paraphernalia.  I was anxious; the non-essential travel ban made me paranoid.  I had prepared a holographic will; even though I knew it would not be upheld in court, I hoped that my ex-partner would honor it.  I wasn’t certain who was meeting me at the airport in Port au Prince (PaP).  I was a tight ball of worry, trying to project calm.  

During the trip, in Miami I believe, I made e-mail contact with my host Mark Hare, who passed on an e-mail from Pix Mahler.  She provided me with extremely detailed information about what to expect and how to deal with the airport scene.  Her notes were a Godsend and I started to be more excited than anxious.

June 2

I arrived in PaP in the morning.  I cleared customs by mentioning that my baggage contained medicine for the MPP clinic of Chavannes Jean-Baptiste.  I was immediately cleared from the purgatory of the red lane.  I went outside carefully following Pix’s instructions, and within seconds spotted the most wonderful sight, a sign with my name and MPP.  The two MPP men swept me by red caps and everyone else who hoped to profit from a naïve new arrival.  I felt uncommonly safe and comfortable in their presence, even more so because one of them spoke English.

I spent the day waiting for Tracy and Lionel to arrive so that we could leave for Papay, part with Agathe and her new baby Agla, part with Chavannes wife, who was at a loss because she had thought I would speak French, and part with one of their sons, who was an electrical engineer trained in Florida.  Agathe taught me my first word of Creole, water (“dlo“).  Her brother taught me my second word, chair (“chais“).  

Then, in the late afternoon, we began the long ride to Papay, with the fellow who worked with Church World Service, Lionel, and Tracy.  The three of them are all traveling to a conference intended to form an advocacy network or coalition of civil society in Haiti, both international groups and indigenous groups.  Lionel is charged with helping create these networks, Mano a Mano, Hand in Hand, (“men nom men”) throughout Latin America and the Caribbean.  They provided me with some background…my introduction to Haiti -- a long, excruciating introduction to Haiti, made more productive by their willingness to share.  Then finally, we arrived, had a meal of sweet porridge, fried goat, fried plantains, French fries, and limeade. I tried everything except the porridge.  I discovered I don’t like goat -- at all.  A bit embarrassing because goat was the delicacy served at Mark’s wedding and I should have been more appreciative of a great source of protein.  But then, I am still a lapsed vegetarian at heart.

Mark set an early morning meeting for me with Chavannes Jean-Baptiste, the head of MPP.  When I tried to protest the early hour, Mark was very clear that was the only possible time, before Chavannes began his real work at the conference.  Mark treats Chavannes with great deference, as does everyone at MPP.  He is not just the head of MPP, not just a boss, not just in charge; he is revered by those who work with him.

June 3

I’m waiting…I’m waiting to meet with Chavannes…I’m waiting to see what the day holds….I’m waiting to find out whether I will be able to understand any of the conference proceedings…I’m waiting.  It is not an easy thing to wait…and yet…waiting is time that can be used, enjoyed, spent.

I pinched a nerve on the trip from PaP to Papay.  I shared the front seat with the driver, who never gave his name [turns out that he was just a hired driver, not someone from MPP], and Tracy, the Presbyterian churches’ Central American supervisor who has lived and worked in Nicaragua for eight years and recently married a Nicaraguan man who certifies scales for the Nicaraguan national department in charge of weights and standards.  Our journey to Mirabile was a mere three hours on mostly paved roads [but Mark says that it takes only 45 minutes --not that night!].  We stopped at the only hotel -- a beautiful place, an “oasis” in Lionel’s words.  Beyond the pavement to Papay were four or five tortured hours at 0-20 kilometers an hour, across five rivers created by a not very intense rain, a total of 80 kilometers in perhaps 8 hours.  The road was as rough as the worst forest road in Oregon.  It was two or three trucks wide, but frequently narrowed to a single lane by mounds of rocks or dirt, part of the road construction recently funded by the French that will extend the pavement from Mirabile to Hinche.  From there, Papay is a mere 5 kilometers and MPP’s compound another 2-3 kilometers.  The distances are important only because each kilometer was an exercise in tolerant patience with the discomfort of the middle console bouncing against the small of my back.

The road was a video of the lives of people in the countryside, sitting beside the road. In the afternoon, endless rows of people offering recycled goods and food and drink of every imaginable variety.  The parades of uniformed school children we saw going to and from the airport (aeroporto) to pick up Tracy and Lionel were gone, replaced by people sitting or standing and chatting, or more frequently walking, sometimes with sacks or bowls of food on their head, stabilized with a towel.  Often they sat encircling a small fire.  In the towns we passed through, there were dozens of small stone front businesses offering every service and good imaginable, from recharging electronics to sessions in massage chairs to auto repair.  

People sat in front of ruined houses without a roof or windows or doors, but staying at what was obviously still their home, ruined perhaps by hurricanes.  Most looked healthy and well-fed, but none obese.  A sizable minority were extraordinarily and unhealthily thin.  Most were adequately clothed.  Most I saw had sufficient energy to go about the business of life.  I didn’t see a great deal of beggin or near death listlessness.  Everywhere there were people involved in lots of energetic discussions, even friendly (or not so friendly) argument and objections.  Apparently Haitians are free to do just about anything they want because there is no enforcement of law, but they are also free to object, vociferously, to the behavior of others.

And water (“dlo”) -- evidence of water poverty everywhere.  The water tankers in the streets pump 1000 gallons of water into cisterns in nice homes for $40 a month and a family may need two refills a month, which is much more than the average wage of $2/day given by the 16 Haitian companies that employ 26,000 people and have successfully pressured the government not to raise the daily wage to $5.  There are 10 gallon bottles of water that many families must buy -- probably costing many more goudes than they can possibly afford.  There are the offerings of sodas and juices and water by vendors at the side of the road -- and equally common offerings of dirty refilled glass bottles of undoubtedly contaminated water for those who cannot afford the clean water.  But most dramatically, as we narrowly missed them, our headlights spotlighted a six year old boy and his older sister carrying two 1 gallon jugs of water down the road, collected from the sediment filled stream, at midnight.  And as to the hour, as Tracy noted, there is no knowing how close or far away they live from the stream.

Less than a third, probably less than a quarter, of the homes in PaP have running water.  Even if they did, the water is not potable, it is too contaminated to drink.  But the people seem to use it for cooking nonetheless.  Although here at MPP and in Chavannes house, they are very health conscious and they boil it.

Haitians need water.  But they need roads, doctors, medicine, food, fuel, homes, and everything else too.  Where to start?  What to do?  Can it be done?  Will anything built just be torn down by the next political regime’s supporters or by sabotage?  How can the educated be convinced to stay?

Ah, they just called breakfast; it is time to work -- to talk with Chavannes before the conference begins.

June 3 notes

`

A $3500 Breakfast

Chavannes, Mark, and I had breakfast together.  We went over the engineer’s estimate of two projects -- a remote mountain village where MPP would capture a spring and a nearby area that needs a well.  The first would cost about $ 14,000 with  us providing $10,000; the second would cost about $4-5000.  That fits with the $14-15,000 estimate I had given Mark before our 2009 Drink Water for Life challenge.  Unfortunately, 2009 was not double 2008 (which was the target that our senior pastor, Gail McDougle, and I set); instead it was about 75% because of the economic debacle that began in Fall 2008.  So I had $ 6500 in hand, not $15 k.  So, we could fund the simple well -- or we could do the hard project in the remote village.  I chose the harder project: I wasn’t sure why.  It seemed more significant, more worthwhile, somehow.  I didn’t know what a difference that choice would make in my experience of Haiti and in my calling.


I told Mark and Chavannes that I would raise the extra $3500.  Never one to waste words, Mark just said “When?”  I told him by September 15th.  Clearly skeptical, he asked, “How certain is that?”  I told him about 90-95% certain.  He didn’t seem satisfied.  So, not wanting this partnership to founder at so early a stage, I promised that if I couldn’t raise the money, I would write a check myself.  That commitment seemed to satisfy him and he translated the discussion for Chavannes.  The decision to start with the remote village set part of my agenda for the week: a 2+ hour hike, one way, into the village, Z’briko.  I was also interested in having a larger list of places that needed water projects and proposed that MPP do community assessments of 30 more villages, spending a day or two at each.  Chavannes indicated that it would take an MPP engineer about two or three months of effort to do that -- at a cost of about $1000/month, or $3000.  I told Chavannes that I would try to raise funds for that after we did the first two projects.

Then Chavannes left to start the conference and Mark and I migrated to his “office” under the gazebo.  I met the other members of the MPP technical team: Pauleon St. Fleur, a civil engineer, and Vernat Supreme, an agronomist working in the Northwest.  Pauleon was the engineer who had prepared the estimates on the water projects.  We planned an intense agenda for my week in Haiti.  But first, I was expected by Chavannes to attend the beginning of the civil society organizing conference.

The FONDAMA Civil Society conference

The conference involved about 25 people, sitting in a U shape with a blackboard, table, and two facilitators at the top of the U.  I wasn’t sure who was there because they did not have placards: they all knew one another, I guess.  The facilitation team had a man and a woman, with the woman being the stronger and more controlling of the two.  She needed every bit of strength, power, and control for the morning that was to come!  The agenda was choosing a name and creating by-laws for the new organization.  A draft of the by-laws had been prepared, but unlike my experience with the Ecumenical Water Network, in which we were told to simply ratify the draft, this meeting was going to truly debate and formulate by-laws.  It would no doubt be a painful process, but it had a dramatic and crucial advantage: once the by-laws were adopted, the group that created them would be invested in the organization, not just passive observers.  

It was indeed painful.  The first two hours or more were spent debating the name of the organization.  It ended up as Foundation Joining Hands in Haiti (“Foundation Men Kontre Ayati“).  The natural acronym was FMKA, or FOMKA,  which means “I am able” in Creole, a seemingly fitting acronym.  But Chavannes was concerned that acronym lent itself to abuse (FOM “KA KA”) by opponents.  After much heated debate, apparent threats to withdraw from the representative from another peasant organization (MPK), speeches, votes, votes about voting procedure, misunderstandings of voting procedure, re-voting about voting procedure, and more votes, the acronym FONDAMA was adopted.  Apparently in Latin America, the acronym is more important than the name; the name and initials may change, but the acronym remains.
I grew impatient watching FONDAMA go through its labor pains.  I hope that someday I will look back on witnessing the birth of this organization and it will be a turning point for better governance in Haiti.  But, since Tracy and I did not speak the language, Lionel felt it necessary to translate for us, which prevented him from fully participating.  After offering my one outside observation that the name should include “Haiti” in it for foreign recognition, I left for lunch and a bit of down time in my room.

I lived in Residence 2, a concrete block building with a poured concrete floor and a common area with some chairs and a couch; clearly it was designed for dignitaries because each of the four rooms was a large single.  My room was certainly luxurious by Haitian standards: a desk, a wardrobe, and a double bed with a mosquito net.  Down the hall, there was a toilet, sink, and shower with running, though not potable water.  It was frankly nicer than my accommodations in India at MC Mehta’s old house, but not quite as nice as my hotel in Haridwar. 

The MPP Integrated Health Clinic

In the afternoon, Mark, Jane, and I hiked down to the MPP clinic.  Pix’s friend, Jane, had come from the north where she was overseeing the work of a dispensary.  She apparently had already visited a couple of other dispensaries during her two week trip.  She is a pharmacist from a southern Presbyterian congregation and has spent 14 years coming down to Haiti for two week stints.  She loves Haiti -- yet surprisingly she has not learned much Creole.  I was fortunate that she hadn’t because it meant that I had Pix, Jane, Tracy, and Lionel to talk with my first three days in Haiti.  Jane apparently is not comfortable with learning new languages.  Thankfully, I’m not talented at language, but I’m determined.  I can’t imagine coming back to Haiti without trying to pick up the language.


We spoke to the new doctor for awhile.  He has been there for only a few weeks.  It took MPP a long time to find someone who would accept the paltry salary it can pay.  Most of the discussion was consumed by Jane’s news that there is a 24 hour regimen that can be used with certain parasites.  It is only about 85% as effective as the two week course of treatment, but patients seldom comply with that full regimen and so they continue to have problems.  The intelligence I obtained was that 80% of his patients suffer from severe diahhrea or parasitic infections caused by bad water.  Nurse (“Mis”) Mary clarified the situation, noting that the patients know their health problems come from bad water, but they don’t have the means to treat the water or sometimes they do, but they forget or can’t summon the energy to treat each bucket of water with Chlorofacil -- a two bucket chlorination process that is widely available in the towns.  This gave me a clue that community chlorinization might be a more successful approach to water treatment, so my community water treatment system might just be useful.  

Mis Mary also received my medicine and other medical supplies with thanks.  I was disconcerted though to realize that the medicine would be sold, not provided free, to those who needed it.  This is the common practice of all clinics in Haiti, except perhaps those founded by Dr. Paul Farmer and Partners in Health.  Medicine is generally provided at cost, which is steeply discounted by means of an organization known as Mercy International.  In Tracy Kidder’s book “Mountains Beyond Mountains,” Farmer is on record as being extremely critical of that cost-pricing practice.  I sympathize, especially after hearing stories of people who die for lack of medicine that could have saved them.  On the other hand, Farmer and PIH has access to resources that other organizations like MPP do not.

Village to Village

That evening after dinner, I had a long discussion with Tracy and Lionel about my intended work with MPP.  Lionel, it turns out, was the Regional Director for East Africa for Church World Service before it terminated the East Africa program.  He had 12 years of experience running water projects in East Africa for CWS, but was particularly proud of his hunger project.  Lionel’s basic message, of course, was strongly influenced by his current mission: to create coalitions of civil society in Latin American and Caribbean countries to demand that governments fulfill their function of providing services to their citizens.  His message was that it is important that the government not be replaced by the churches and other parts of civil society.  This message was an echo of the perspective that I heard repeatedly from church organizations that belong to the Ecumenical Water Network and a point made in a particularly powerful way by the Brazilians and other Latin Americans.  The difference is that Latin American civil society, especially the churches, are particularly strong and powerful compared to civil society in Africa, Asia, and North America.  I’m not sure that the Haitian national government has any capacity to provide services to its citizens -- or at least that capacity is quite limited.   

I explained my concept and plans for “village to village” development, community water projects funded by wealthy natural communities, driven by community leadership with technical support provided by indigenous regional organizations.  He seemed to believe that it was feasible.  He thought that the database was feasible, that matching villages with villages was feasible, with the caveat that the resources provided by communities to fund community projects should not be seen as discharging government responsibility to provide services.  He loved the emphasis on indigenous organizations, empowering and building local capacity.  He underscored the need for staff in the indigenous organizatiions with the time and expertise necessary to run the program, especially the community involvement aspect of the program.  He suggested focusing on a single delivery mechanism (well drilling, cisterns/ catchment systems, water treatment, or water abduction /capturing springs) rather than having an organization attempt to develop expertise in all of these techniques.  While I think this is sound advice for an organization without significant experience in water projects, MPP is uniquely qualified because of their prior water resources efforts, which have included wells, cisterns, and capping springs.  This is especially true, now that I’ve learned that MPP is bringing a water engineer on staff.

From this discussion, I sketched a schematic drawing of a “village to village” approach to community water projects (which unfortunately is in an unsupported BMP format), so I'll just describe it:

The basic idea is that we should create an alternative paradigm for funding community water projects.  The paradigm uses the wide variety of organizations currently involved in community water projects, but organizes them in a different manner.  Relatively wealthy natural communities should be encouraged to form partnerships with communities in less developed countries (i.e. village to village).  The funding community would provide the bulk of financing for water, sanitation, and hygiene education projects sought by a recipient community. Natural communities include schools, churches, service clubs, youth organizations, towns, and other elements of civil society.  A key aspect of the partnership would be the recipient community hosting visitors from the funding community to deepen the ties between the two communities and to create a deeper commitment by the funding community. 

Water projects would be identified, designed, and constructed by the recipient community in conjunction with a regional indigenous NGO or conceivably a local government, which would provide technical, logistical, administrative support for project development.  Water projects would be operated, maintained and governed by a water committee set up by the recipient community. 

The operational role of international water NGOs would be limited to developing capacity of regional indigenous NGOs to fulfill their function.  Along with implementation of sound WASH projects, this village to village approach seeks to empower and build capacity in civil society and government at the local and regional levels. However, international water NGOs would have two other key roles.  First, in areas without regional indigenous NGOs or governments capable of implementing community water projects, the international NGOs would seek to enable existing NGOs or governments to assume that role.  Second, international water NGOs would certify the capacity of regional indigenous NGOs or governments to provide the support necessary to facilitate community water projects.   This certification would be the key to acquiring matching funds from a wide variety of sources, including official development assistance from donor governments, international financial institutions, international development agencies, and foundations.  Matching funds would leverage the ability of natural communities to fund community projects and develop meaningful ties with the recipient community. 

This matching funds feature would accomplish transparency and accountability in a natural manner.  Funding communities would be investing funds acquired with their own blood, sweat, and tears and would naturally seek to assure that those funds were used as efficiently and effectively as possible.  Recipient communities would likely feel a reciprocal commitment to efficient and effective use of funds, realizing that the funds were largely the product of hard work by people from the funding community and were limited in amount. 

The much aligned by-product of international aid, so-called "aid dependency" would be less likely to develop in a village to village approach because recipient communities would realize that aid was likely to be limited in both amount and duration.  This would further encourage effective prioritization and efficiency in implementing projects.
 

The MPP Health Promotion Program

My church has contributed a modest amount of money to fund the MPP health promotion program over the course of the last two years.  When we originally heard about the program from Dr. Agathe (as she is known there), she discussed the key role of the health promotion coordinator and we decided to provide funds to staff that position.  However, the program has been reconfigured since Agathe left the clinic to pursue her M.P.H. at University of Washington.  Of the 30 health promoters trained by Agathe in 2007, only 6 remain because they are volunteers and some have moved, e.g. to the US to study. 

One of the original trainees, an incredibly dedicated woman who is known as "Mis Gislaine," now coordinates the efforts of six health promoters who serve 16 communities.  She was and remains a volunteer.  It wasn’t clear where the First Congregational funds went since they were not used for staffing.  They may have been used to provide the health promoters with simple medicines; this practice has been discontinued due to lack of funding. 

She described the current operation of the health promotion program.  The health promoters must contact the whole community so they usually have community meetings inviting all of the adults.  They provide preventative health information on matters such as hygiene and diet, encourage the planting of vegetable gardens, and identify people who are sick, providing information on self-care and natural remedies as well as encouraging those who need medical attention to seek it.  The free medication available when Agathe was in charge, became a 50% discount, and now people must pay the full cost of their medicine. 

MPP plans to grow the health promotion program from 16 communities now in 2009 to 22 communities in 2011, primarily by training new health promoters.  That plan assumes that they will not lose any of the existing six community health promoters -- their work has been expanded from one community to as many as three communities, a real burden on these volunteers..  MPP also hopes to produce two posters to aid in health promotion education: one depicting an unhealthy community and another depicting a healthy community.  Each health promotion leader would be given a copy of each poster to aid in community training.  Tomorrow I'm scheduled to visit Twa Koch and people from the community who have experienced the health promotion program.  I'm waiting to see if the reality is as good as the theory.

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