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Some perspectives on Haiti

The current relief and rescue efforts are being hampered by the chronic, dismal state of the Haitian physical infrastructure (communication, transportation, health-care network, sanitation, urban planning, education, etc.) and the limited response capabilities of the nation’s population. These two factors are compounding the impact of the earthquake.

I worked in Haiti in 1981, conducting an epidemiological study of an acute outbreak of gastroenteritis. Also, I became familiar with the nation's history for personal reasons when I followed closely Professor Leslie Manigat's victorious presidential campaign in 1988.

As the international community works to help Haiti recover from last week’s earthquake, many of my friends and colleagues have asked: How did Haiti’s situation become so dire, and what is the solution? In my opinion, the situation stems from the following interacting scourges:

(1) Colonization/occupation: Spaniards (1492-1697), French (1697-1804) and Americans (1915-1934) have ruled the island primarily in their own interests.

(2) Politics:

(a) Early independence (first in Latin America), for various reasons, greatly isolated the island from the rest of the world.

(b) Dictatorships from emperors, military rulers and the Duvaliers alienated the majority of the population

(c) Instability from coups-32 of them in 206 years prevented progress by lack of leadership continuity.

(3) Natural disasters: Recurrent tropical storms (four in 2008 alone) and earthquakes (the most severe in 1770 and 2010), which can be largely predicted and whose aftermaths can be mitigated (like in Japan), have resulted in periodic setbacks.

(4) Diseases:

(a) Epidemics like those caused by anthrax (1770), yellow fever (1790s and early 1800s), smallpox (1518, 1920), syphilis (1927), malaria (1963), measles (1990s), meningitis (1994, 1995), pandemics (plague, cholera, influenza) and water-related diseases (cholera, typhoid fever, hepatitis A, leptospirosis, acute gastroenteritis) primarily after floods have been devastating. Currently, HIV/AIDS is disproportionately affecting the young adult population, main source of manpower.

(b) Endemic diseases such as tuberculosis, tetanus, parasitic diseases (particularly, intestinal worms and schistosomiasis), acute respiratory infections, goiter, Type III diabetes;.

(c) Genetic diseases, mainly sickle cell disease. People who survive these illnesses, which have high prevalence in Haiti, are often weakened against infections.

(5) Malnutrition: The Pan-American Health Organization states that more than one-third of all Haitian children who survive their first birthday show signs of severe growth retardation. These children will have serious immunological and intellectual-development challenges.
(6) Diaspora/brain drain. Two million Haitians, or 20 percent of the nation’s population, live mainly in the United States, Canada, France, Cuba, the Dominican Republic and the Bahamas. This deprives the local workforce of its valuable elite.

However, the country has natural resources such as bauxite, copper, gold, marble, calcium carbonate, coffee, sugar cane and fish. Moreover, geothermal, solar, wind and hydropower energy (80 percent of all Haitian energy is renewable) and scenic settings ideal for tourism could be tapped for the first time or on a much bigger scale.

The economic solutions proposed and implemented by international institutions to lift Haiti out of misery have shown sketchy and disappointing results, mostly because of the paucity of multidimensional approaches. The GDP grew negatively in 2001, 2002 and 2004, and the nation received assistance equivalent to $1 billion in U.S. dollars from 2004 to 2006 (for an annual economy equivalent to $9 billion in U.S. dollars), according to the International Monetary Fund. The same organization announced in 2007 that Haiti had turned the corner while at the same acknowledging the country’s horrendous poverty, with 76 percent of its population surviving on less than $2 per day.

It is high time that developed nations met their full historic and moral responsibilities toward Haiti through a Marshall-like plan to ensure that massive financial and technical aid is sustained after the crisis intervention. Linked to assistance of this magnitude would be a mandate for the emergence of stronger and more reliable democratic and educational institutions, like in post-WWII Europe. This will lay the foundation for the development of a large middle class, which will increase the chances of democratic stability. Success will be declared when Haitians begin to return en masse to their native land.

Hopefully, the 2010 earthquake will serve as a wake-up call.

Yann Meunier, MD, is the health promotion manager for the Stanford Prevention Research Center. He formerly practiced medicine in developed and developing countries throughout Europe, Africa and Asia.

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