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Delivery of Aid Remains the U.N.’s Toughest Job in Haiti

January 25, 2010 at 12:00 AM EDT
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Ray Suarez talks to the United Nations' deputy special envoy to Haiti about the obstacles facing aid workers in Port-au-Prince, where thousands require urgent care.

RAY SUAREZ: Paul Farmer is the United Nations deputy special envoy to Haiti. In that capacity, his boss is former President Bill Clinton. Farmer has been working in medicine in Haiti for more than two decades.

We caught him at the Port-au-Prince Airport on his way to a donor’s conference in Montreal.

Hi. How you doing?

He says the number-one job now for Haiti’s injured thousands is coordinating the delivery of services from throngs of volunteers.

DR. PAUL FARMER: Coordination is very difficult, as I’m sure you have seen already. There are so many balkanized, fissured groups trying to do good, that, you know, it is very difficult for the government or the U.N. or any organization to coordinate them. And then I said delivery because it seems to me, having worked here a long time, that delivery is always the stumbling point.

RAY SUAREZ: Those people are here as part of a sort of international gush of goodwill toward Haiti in its tragedy.


RAY SUAREZ: Do you let that energy roll to take advantage of it? If people land with a mobile unit and want to start fixing people up, do you let that go on for a while?

DR. PAUL FARMER: It’s a tough call. I mean, I would be reluctant — I’m not a — I can’t — I’m not an authorized spokesperson for the Haitian people, but I think one of the things I have heard from my friends and co-workers who are Haitian is, look, we can’t afford to be turning — spurning, you know, gestures of goodwill right now.

And, so, I think, in a way, you are obliged to let that gush of goodwill flow. It’s not easy. It’s not pleasant. And I’m sure it’s very frustrating for people who have been here a long time or people who are really trying to coordinate. But I — I don’t see how you can say, you know, go away.

What you have to do is say, look, let’s plan this out. This not something that is going to be over in two or three weeks or two or three months. This is — rebuilding — you know, you have been all the places I have been. And rebuilding this is going to take many, many years.

And, in the short term, we have got to, you know, focus on some immediate needs as well. So, I — as difficult as it is, I don’t think that we’re in a position to be rejecting goodwill.

RAY SUAREZ: There are now thousands of people who are, in medical terms, on different, but parallel tracks, people who need another week of treatment…


RAY SUAREZ: … people who need another two months of treatment, and people who need another year of treatment.

DR. PAUL FARMER: That’s right.

RAY SUAREZ: How do you meet all those needs at the same time with such a degraded infrastructure?

DR. PAUL FARMER: Well, you know, I — it’s a very — it has been a big challenge. And I will just go through each one of those very briefly.

The short-term needs, the acute needs, for example, amputation or debridement of a wound, those are, in a way, the easier things to do. But then comes — you know, you have to have prosthesis. You have to have wound care.

And, in the first couple of days, as I’m sure you have heard, we tried to focus our efforts — and President Clinton did this as well — on trauma, orthopedics, you know, the acute — the needs of people who were injured in the event, in the earthquake. But now we’re going to have to have rehab medicine, a lot better post-op nursing.

But the real challenge is going to be rebuilding here in Port-au-Prince and further south. And we need — you know, you are going to have to have a massive rebuilding of public health infrastructure now, hospitals, clinics, health posts. And that’s going to require significant investment of capital, human capital, but it’s going to create lots of jobs, rebuilding that, same for — so, safe hospitals and safe schools, I think, you know, we have to also regard that as a chance to create jobs. Those are what’s needed most, are jobs.

RAY SUAREZ: Let’s talk about the chance created by this terrible moment in Haiti’s history. There is no long tradition of competent, caring, efficient provision of government services in this country. Does starting from scratch creates some opportunities to right some past wrongs, and end up with something better at the end?

DR. PAUL FARMER: Well, you know, as you probably have heard already, I have been working with President Clinton the last several months, working with the U.N. on — he’s the special envoy for Haiti.

Unfortunately, many of the people we were working with perished in the earthquake. And it is his, President Clinton’s, view that that is exactly what we should be doing, that we should — you know, he — he taught me something in 2008. He used this expression, I guess, after the tsunami about building back better.

And I just asked him, well, what does that mean with — there weren’t institutions in the first place. And he said just what you said. You know, you have to seize this moment to start a fresh and, you know, give it a new try.

And, so, I think people — better minds than mine who know things beyond health care and medicine believe that now is a time to rethink public infrastructure, rethink the city. I mean, as you have seen, this — you can’t have two, three million people living, you know, in such a — a densely packed area.

I can’t imagine that people are going to want to rebuild Port-au-Prince in the same way it was built, which is to say this sprawling, unplanned, you know, city. So, that is why I’m leaving Haiti and going to Montreal with no coat today, is because I think there are a lot of people meeting, or a group of key people meeting to talk about how we can build back better.

I — I — maybe I just have to leave in believe in that message to kind of get through the next few months.

RAY SUAREZ: What’s the pitch when you go to Montreal? How do you keep the world engaged and understanding that this is a long-term process?

DR. PAUL FARMER: Well, I don’t know, but we’re all going to try, especially those of us who have been engaged in Haiti for a long time. We’re going to have to be very explicit that transient interest in this problem is not only unhelpful, but very destructive.

And that’s what we have had to date. There is a wave of interest. There is a crisis. And people pay attention. There is a crisis. People always pay attention from outside.

If you are a trauma surgeon, I think it’s just fine that you feel good after you get back on the plane. You know, that’s — that’s what we ask the orthopedists and others who are helping us now. That is what we want them to do, is come in, intervene. And I think they can go with — and those who are working with them — with a clean conscience.

But the rest of us, you know, who are involved in other projects, rebuilding the health care infrastructure, thinking about education, thinking about economic development, even tourism, we cannot have this, you know, transient interest. We have — we have to get that message out.

RAY SUAREZ: When asked about a successful example of the kind of rebuilding he’s prescribed for Haiti, Dr. Farmer has a ready answer: Rwanda, torn by genocide and civil war, now stable and even sending aid to Haiti. He’s recommending a 10-year rebuilding program for Haiti.