Monday, February 22, 2010

The Undermining of Haitian Health Care: Setting the Stage for Disaster

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Posted on: February 22nd, 2010

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The Undermining of Haitian Health Care: Setting the Stage for Disaster
By: Kevin Edmonds

Feb 22 2010

In December 2003, the dedication ceremony of Haiti’s first and only public medical school, a project jointly supported by the governments of Haiti, Cuba, and Taiwan, took place at the University of Tabarre in Port-au-Prince. At the time of the school’s opening, Haiti had one of the worst doctor-to-patient ratios in the world (one to 10,000 in urban areas and one to 20,000 in rural areas), and the school’s ability to provide free medical education was considered one of the most important achievements of former president Jean Bertrand Aristide’s administration.

In a declaration full of optimism and hope, the Dean of Health Sciences, Dr. Yves Polynice stated: “The inauguration of the Aristide Foundation University is an opportunity to renew our Hippocratic Oath where each physician pledges to care for the poor, widows, and orphans free of cost. We must be conscious that any illness affecting one citizen represents a threat to us all. Today we say ‘health care for all, without exclusion.’ ” On February 3, 2004, the hospital officially opened its doors and began treating many of Haiti’s most vulnerable. For many it was their first visit to a doctor.

The mood of optimism and hope expressed by Dr. Polynice on that December day didn’t last long. Just two weeks later, on the evening of February 28, 2004, Aristide was overthrown and forcibly removed to the Central African Republic in an internationally organized coup d’état. Less than one month after its opening, the hospital and the university complex it was part of were closed down at gunpoint and occupied by U.S. Marines and the United Nations Stabilization Mission in Haiti (MINUSTAH). The 247 new medical students watched as their classrooms were turned into barracks, their instructors forced to flee from political persecution (due to threats on his life, Dr. Polynice fled to Europe), and much of their material and equipment pillaged to service the capital's private medical clinics. The school was finally abandoned by MINUSTAH and reopened to students in the summer of 2009, but with widespread budget cuts and curriculum changes that downplayed its original community service mission.

Despite the United Nations’ efforts to “stabilize” Haiti after the 2004 coup, politically motivated violence, and widespread, systematic persecution of Aristide supporters sharply escalated. In this politically charged atmosphere, the 247 medical students were never able to return to Tabarre to complete their medical education. Since the new medical facility was a collaborative project of the Haitian, Cuban, and Taiwanese governments, the Cubans extended a helping hand to the Haitian doctors and staff and allowed them to continue their medical training free of cost at the Latin American Medical School (ELAM) in Cuba.

The students from Tabarre were not the first Haitian students to study in Cuba. Since the devastation of Hurricane George in 1998, Cuba has promoted a humanitarian exchange with Haiti which provides medical professionals to the country’s remote regions and trains Haitian medical students. When the January 12 earthquake struck, there were an estimated 400 Cuban doctors working in Haiti, along with 573 Haitian doctors who were trained in Cuba, and now they are covering the entire nation.

Tabarre was not the only medical school in the country, but it was the only one that provided free education to its students. The school recruited prospective doctors from poor families from all of Haiti's nine departments. It also offered free room and board to students if they entered an agreement to serve for several years in remote regions of Haiti. These were significant agreements because some 90% percent of the nation’s doctors work in the capital, Port-au-Prince, while two-thirds of all Haitians live in rural areas. This concentration of doctors in the capital has created a situation in which the majority of Haitians—those who live in rural areas—are left without the most basic elements of health care.

At the time of the school's opening there were fewer than 2,000 Haitian doctors in the entire country. In a nation with so few doctors, this school was an ambitious, essential project. Before its closure, it was estimated that the school would train 600 new doctors during its first 12 years of operation. It was hailed as a step forward in the epic effort to provide the citizens of Haiti with a basic health care infrastructure, in spite of the ongoing aid embargo to Aristide’s administration.

After this year’s devastating earthquake, many of the medical students who had left in February 2004 returned to the site of the university and reunited with teams of Cuban doctors to provide emergency care and treatment for the disaster’s victims. Surprisingly, the medical school survived the quake intact, and by January 15 became a site of refuge for more than 10,000 victims of the earthquake. That same day Aristide Foundation spokesperson Toussaint Hilaire reported that there were many doctors on site, but critically lacking medical supplies. He emphasized that the road to the medical school was unobstructed and that supplies could be directed there. Several hundred yards away, at the newly occupied Toussaint L’Overture airport, U.S. forces were busy diverting planes bringing lifesaving medical equipment into the country in order to allow additional troops onto the island to maintain control of the on-the-ground situation.

The Aristide administration’s creation of this free medical school was a herculean achievement, contradicting the media’s claim that Aristide had abandoned his populist roots. The closure of the school has not only severely crippled Haiti’s ability to effectively deal with the barrage of hurricanes, floods, and landslides it has faced in recent years, but has also served the political purpose of erasing the legacy of Aristide and his political movement, Lavalas.

On February 10, filmmaker and activist Kevin Pina reported to the Canada Haiti Action Network that the medical school at the University of Tabarre had been once again occupied — this time by troops of the U.S. Southern Command. That a public medical school could have become a reality in Haiti despite the aid embargoes, massive debt payments, widespread destabilization, and privatization of nearly everything speaks to the iron will of the Haitian people to better themselves. Sadly, the closure and occupation of Tabarre once again reflects the equally hardened determination of others to prevent them from doing so. “While extreme earthquakes are acts of nature,” wrote Tracy Kidder in a recent New York Times op-ed piece, “extreme vulnerability to earthquakes is manmade.”

Kevin Edmonds is a NACLA Research Associate.

Thursday, February 4, 2010

St. Lucia: Life After the Lomé Convention

Originally posted on:

Febraury 4 2010
Kevin Edmonds

My uncle, George James, a longtime St. Lucian banana farmer, sits on the front step of his dimly lit kitchen, sucking his teeth loudly to show his frustration. “I have land, but can’t sell it because nobody wants to work it,” he says. “Bananas are not making money. Nobody wants to be a farmer. Young people look at us as fools. The work is too hard, and the money is too small. That’s why all the young boys want to move drugs. It wasn’t always so bad.”

The frustration in his voice comes from almost 20 years of living in a constant state of uncertainty and continually declining prices due to a trade dispute between the European Union (EU) and the United States. In December an agreement was reached that will see the EU further reduce tariffs on imported Latin American bananas. St. Lucia is now facing a widespread economic and social breakdown—including a crisis in the government’s ability to provide basic social services—that threatens to reverse 40 years of genuine development achieved through protected trade.

The Lomé Convention was a preferential trading policy established in 1976 between European countries and their former colonies in Africa, the Caribbean, and the Pacific (ACP). It was the key article in the development of a European banana regime that guaranteed ACP banana growers a market for their produce in an otherwise Latin American–dominated industry.

Despite the fact that the Windward Islands as a whole (Dominica, Grenada, St. Lucia, and St. Vincent) contributed only 2% of the world’s total banana exports at the end of the 20th century, these tiny islands and their protected trade agreements were portrayed in the World Trade Organization as a threat to the entire global economic order of free trade. Since the creation of the EU’s banana regime in 1993, the prices paid for St. Lucian bananas have been steadily declining. Far too many farmers could not cover their cost of production and abandoned their plots. In 1993 the island produced 132,854 tons of bananas, and in 2008 it produced 38,359 tons, a drop of more than 70% in 15 years. The massive decline in production brought a staggering loss of revenue, from $72 million in 1993 to $16.2 million in 2008, creating an army of newly unemployed farmers.

The collapse of the rural economy has echoed through every corner of the island. The most recent comprehensive poverty report—The Population Reference Bureau’s 2009 World Population Data Sheet—stated that more than 40% of St. Lucian nationals now live on less than $2 a day. With the dramatic reduction of banana-related income, the government is increasingly unable to provide basic services to the population. Many families lack the ability to purchase nutritious food; a common meal is a soft drink and bread. As a result, St. Lucia led the world in 2007 with the highest per capita diabetes rate. Another statistic that captures the breakdown of social services and growing inequality is the infant mortality rate. Both the World Bank and the St. Lucian government report that infant mortality almost doubled between 2000 and 2008, reaching about 25 in 1,000.

The rural banana industry’s decline has led to a large amount of rural migration to the capital city of Castries, swelling the ranks of squatter communities, aggravating the breakdown of existing services, and contributing to a rising crime rate linked to drug trafficking and other gang-related activities. In the rural areas, in order to feed their families, many banana farmers have begun to use their land to cultivate the only crop that offers a considerable return, marijuana. St. Lucia has also become an increasingly attractive transhipment point for South American–produced narcotics on their way to the United States.

The collapse of the agricultural industry across the entire Caribbean has coincided with the area being declared by the United Nations Office on Drugs and Crime as the most violent region on earth. The poorest neighborhoods in Castries, like Marchand, Grass Street, and Wilton’s Yard, are now ground zero in the ever-intensifying warfare between rival drug gangs. Largely because of the drug trade, St. Lucia now has a murder rate higher than Haiti’s, and sits just below Brazil at 23 homicides per 100,000 citizens.

The island’s political situation is best described as in a state of paralysis. In an examination of national headlines, both the governing United Workers Party and the opposition St. Lucian Labour Party are excellent at unearthing scandals to discredit their rivals but have demonstrated a lack real leadership in a time of economic and social breakdown. Understandably, this economically vulnerable island of 160,000 residents cannot be expected to tackle the world’s superpowers, institutions of global governance, and multinational corporations alone. That is why December’s Treaty of Basseterre—the creation of an economic union within the Organization of Eastern Caribbean States (OECS)—might be a step in the right direction. The deepening cooperation among nations facing the same problems is vital to finding a solution that will ensure their survival. The inclusion of several members of the OECS in the Bolivarian Alliance (ALBA) might also introduce new ideas into the static political system.

In order to help the banana-dependant economies deal with the increased competition, EU trade commissioner Karel De Gucht stated that “the EU will do its best to help.” It has since been revealed that the EU has created a compensation fund of 200 million euros (about $287 million) to help economies like St. Lucia adjust to the new realities of the post-Lomé world. When compared to the previous income earned from bananas in St. Lucia alone, the EU’s charity seems to be too little, too late. At the peak of banana production, St. Lucia exported 133,777 tons, contributing $187 million to the economy, in 1990 alone.

The St. Lucian example makes it clear that free trade is indeed a zero sum game. All St. Lucia managed to get out of a free trade deal was increased unemployment and an ever declining standard of living while the large fruit corporations increased their market share in Europe. Looking at the long-term history of the region, one can hardly be surprised of the outcome.

Back on the steps of his kitchen, George James stands up and puts the padlock on the weathered wooden door. As he turns around he shrugs his shoulders. “It’s nothing new,” he says. “That’s what we farmers and poor people do. We work to feed other people, then go home hungry.”

Kevin Edmonds is a NACLA Research Associate.