Amid Quake Recovery, Can Haiti Build a Different Port-au-Prince?

Eighteen months after the massive and devastating earthquake, Haiti is still reeling from the wreckage and a cholera epidemic. Ray Suarez and Dr. Paul Farmer discuss his new book, "Haiti After the Earthquake."

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    We turn now to Haiti 18 months after the massive and devastating earthquake.

    In a book interview, Ray Suarez talks again with a physician at the center of that country's difficult rebuilding.


    Dr. Paul Farmer co-founded Partners in Health in the central Haitian town of Cange nearly 25 years ago, its mission, provide free, essential medical care to a vastly underserved population. That need exploded Jan. 12, 2010, with the earthquake that leveled large swathes of Haiti, upending its society, killing 200,000, and leaving nearly two million homeless, and maiming thousands.

    The calamities didn't stop there. Political upheaval followed. And in an almost biblically cruel twist, an outbreak of cholera began last fall that has killed nearly 5,000. Now 18 months after the quake, the work of rebuilding and healing grinds forward, long after the spotlight has shifted elsewhere.

    But Farmer, appointed U.N. deputy special envoy to Haiti in 2009, and his colleagues will be there for the long and arduous journey back.

    And Dr. Paul Farmer is the author of "Haiti After the Earthquake." And he joins us now.

    Dr. Farmer, welcome back to the program.

    I would like to begin our conversation with an excerpt of an interview you and I did near the ruined airport in Port-au-Prince as you were about to take off for a conference in Montreal to ask the governments of the world to get involved in rebuilding Haiti. I asked you how you were going to do it.

    And here is what you had to say.

    DR. PAUL FARMER, "Haiti After the Earthquake": What you have to do is say, look, let's plan this out. This is not something that's 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. I mean, rebuilding this is going to take many, many years.


    How do you keep the world engaged and understanding that this is a long-term process?


    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.


    That was the goal you set a year-and-a-half ago.

    Has Haiti managed to keep the world's attention?


    Well, I think that there are different ways of keeping the world's attention, some of them constructive and some less so.

    I think part of what we feared would happen, that there would be a transient interest in reconstruction, that has — that has happened. There are also some people who and institutions who have been committed and are still involved in rebuilding. But this attention-deficit disorder that we see on a global level has — has not been good for Haiti.


    Well, a crisis is something that gets people energized, gets them pouring in and helping out. Eventually, they go home. But have you managed to hold on to some people for the long haul?


    I think we have.

    I think there have been new — new people who have gotten involved, who have stayed involved. The — what we feared back in January right after the quake, that there would be some groups that would come in and out, and part of what has been called the crisis caravan, that all came to pass. They have come in. They're gone.

    But there are some new players. I just am thinking about some of those who have been involved in medical education and helping to rebuild infrastructure for medical education. We have got some new partners in, universities, physician groups, nursing groups, that have — are planning to stick with us, I think, over the long haul.


    When I was back in Port-au-Prince over the summer, I saw blockages everywhere. There were a lot of smart people, a lot of energetic people on the ground, but there were workers without equipment, equipment without workers.

    Plants were rebuilding in places that hadn't been cleared yet, and no plans to rebuild in places that had been cleared, sort of impediments, things that had to be busted through, yet somehow couldn't. Are things getting better?


    Well, I mean, I — we have, as usual, some very positive experience and some very negative experience.

    On the positive side, one of the projects that we were — I think I spoke to you about right after the quake, the idea of building a medical center outside of Port-au-Prince that would help restore training and service capacity for medical professionals — I mean, that's part of my job, is to think about medicine — we have actually advanced that project, with the public authorities, the Ministry of Health and some of the leading medical educators in Haiti.

    That project in central Haiti, in Mirebalais, is a giant hospital, is due to come online or start to come online just two years after the quake. So I think we can say, look, you can get stuff done in Haiti. You work with Haitian colleagues and public health authorities, you can get things done.

    But it does require, as you say, just gutting it out, you know, sticking with it and not being discouraged. That's another thing is, there are so many impediments to work, that — to effective work — that people get discouraged and quit too early or for the wrong reasons.

    But there are also people who stick with it. And a lot of my Haitian colleagues, some of whom you have met, are still at it. And they're an inspiration to me. On the negative side, of course, there are lots of projects that are much discussed, but really haven't been started. Implementation and delivery is, as predicted — are, as predicted, different from commitment, pledges, promises.


    Over the last year-and-a-half, you have expressed a desire to see Port-au-Prince rebuilt in a different way, so that it wouldn't be the vulnerable place that it was on Jan. 12.

    But the delays also make people take the situation into their own hands and rebuild in an informal way. Has — have some steps been taken toward building a different kind of Port-au-Prince, one that wouldn't kill its own citizens when the earth starts to shake again, as it will some day?


    I think some steps have been made. And I am not as familiar as I should be with what is going on in terms of urban reconstruction.

    Steps have been made, for example, new building codes promulgated. Commitments have been made for financing safer construction. Some construction actually has happened in Port-au-Prince that's been — some buildings have been rebuilt or raised and are being built — rebuilt now.

    In terms of the urban planning that a lot of people dreamed of — that is, a safer city, a city that's less congested, that has proper water systems and security — that hasn't come to pass yet. And I think part of what also needs to happen is — I mean, how do you — you said it very well.

    People, when they don't have help rebuilding their homes, they're going to try and do it themselves. And I think a lot of those who have moved out of the tented cities that hit maybe 1.3 million and are now down to 600,000, 650,000 people, a lot of those people are, unfortunately, housed in the same kind of sorry conditions that they were before the quake.

    So, Haiti has had a lot of difficulties after the quake, political unrest, the cholera epidemic, and then a lack of follow-through from some of the big development agencies and those who made pledges. So, it's going to — so, as I said in January, it's going to be a real long haul, a long row to hoe.


    The book is "Haiti After the Earthquake," the author Dr. Paul Farmer.

    Good to talk to you again.


    Thank you, Ray. Good to be in touch.