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BBC Interview with Dr. Paul Farmer: Challenges in Post-Earthquake Haiti

PRI's The World
23 February 2010

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Anchor Marco Werman speaks with Dr. Paul Farmer, the United Nation’s deputy special envoy to Haiti. Farmer says international aid groups working in Haiti post-earthquake can’t “go it alone” and must ensure that Haitians take the lead in the country’s reconstruction.

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MARCO WERMAN: I’m Marco Werman and this is The World, a co-production of the BBC World Service, PRI and WGBH-Boston. We’re going to spend the next segment of our program focused on Haiti. In a few minutes we’ll hear about the ethical dilemmas faced by medical personnel who responded to the earthquake six weeks ago. But first we hear from Dr. Paul Farmer. He has a long history of working on healthcare issues in Haiti. He is now the United Nations’ Deputy Special Envoy to Haiti and he’s just back from the country. Farmer says there are still huge obstacles to rebuilding Haiti. One immediate problem, hundreds of thousands of Haitians now live in crude makeshift camps and the rainy season is coming.

PAUL FARMER: A lot of these camps are on either lowlands that are going to be flooded or they’re on hills which are going to be subject to avalanches when they’re wet and fire risk when they’re dry. Quite understandably, people have taken things into their own hands and made these informal camps. There are probably 500 just in Port-au-Prince alone but I saw them over the course of the last week, spreading ever northward as people seek safe places.

WERMAN: Haiti’s got a pretty awful state of infrastructure generally speaking, a nation of ten million people and from what we know, doesn’t have a single sewage treatment plant for example. With the rains and disease coming from open sewers, do development groups have to just grab the reins and create infrastructure? For example, like a sewage plant for Haiti? FARMER: You know development groups and I’m part of that world so I hope this sounds like a sort of self-critical view of this. Development groups can’t take the reins alone. They really have to share that with the Haitian people because you know, even though they lost all of their federal buildings, they’re still there. They don’t have offices, they don’t have buildings, they don’t have a place to stay. Some of them are in tents just like everybody else, but they’re there so above all, we have to be able to listen to Haitian voices and find a way to make our efforts work in conjunction with theirs.

WERMAN: But I mean isn’t the very basic tension here that we can’t just wish that they had the capacity if they don’t have the capacity?

FARMER: That’s right and it took a long time, many decades to either prevent the development of that capacity or sometimes even, I’m afraid, to take it away from them. But that said, it is not impossible, even while delivering relief services, to start building up local capacity and that has to be done through job creation programs for Haitians. I don’t like this word empowerment but creating, you know, decent jobs for Haitians so that they can, you know, help decide what gets done and implement. So again, you can’t wish that capacity there. As you point out, that’s romanticism and that’s also to be rejected. The question that we would raise is how do we strengthen the capacity of the people who should be responsible for providing basic social services, even as we acknowledge that we’re going to, you know, they’re going to require the solidarity of the whole world really, of the international community; however it is parsed, to deliver these services now. At least as an American who’s been working in Haiti a long time, I don’t think that we’re only talking about rebuilding Haiti. We’re also talking about rebuilding the way that aid gets done because we have some serious problems in our house, too.

WERMAN: One thing that’s got to be mucking things up right now are the hundreds of millions of dollars that are poured into Haiti and I imagine there’s a danger that that money is translated into power in the hands of international groups, including the UN whom you work for and I’d like to know whether the money is eclipsing the voice of Haitian community leaders and others.

FARMER: Let me just say, how do you make sure that money doesn’t dominate everything? Well, the way that a doctor would do it is to actually talk to the patient. We have to go out and talk to people in all ten departments of Haiti, talk to women’s groups and unemployed people and ask them, well what do you see as being important to the reconstruction of Haiti?

WERMAN: Well Farmer, you just got back from Haiti. What does that periodic shift from affluent mid-town Manhattan to absolutely destroyed Port-au-Prince do to your psyche?

FARMER: It’s very jarring emotionally to go from a place where you know, you’re helping a teenager understand what it will mean to have an amputation, you know, to coming to a place where you know, just listening to what people are saying, you know, outside in the street or in a restaurant, it’s somehow jarring you know because whatever they’re talking about, it’s not going to be the kind of life and death struggle that you see in a place like say Port-au-Prince or even the rural areas where we were.

WERMAN: Paul Farmer is the UN’s Deputy Special Envoy to Haiti and a co-founder of the NGO Partners in Health. He’s also a professor in medicine at Harvard. Dr. Farmer, thank you so much.

FARMER: Thank you very much, Marco.