The Uses and Abuses of Haiti
Helen Scott interviews Paul
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
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
[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
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
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
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. marxists.de/culture/twain/noteach. htm.