Paul Farmer on His New Book, Haiti After the Earthquake

Paul Farmer talks in his new book, “Haiti After the Earthquake,” about how far the country still has to go—and the devastation he witnessed.

The 2010 Haitian earthquake killed an estimated 220,000 people, flattened much of Port-au-Prince, and led to a huge outpouring of international aid. But was the response good enough?

If you ask Dr. Paul Farmer, the deputy U.N. special envoy to Haiti—a man with deep roots in the country who is famous for his extensive work on public health and AIDS treatment before and after the quake—he would grade the relief effort this way: “I would say for humanitarian relief, right after the quake, I’d give a pretty decent grade, like a B,” he tells The Daily Beast. But, he adds, “For reconstruction, I would say we’re lucky if we’re at C- / D+.”

Now, almost 19 months after the quake, an estimated 30 percent of the rubble has been cleared. And, as of the end of May, 634,000 people remained in temporary camps, according to the International Organization for Migration, down from a peak of 1.5 million in the summer of 2010.

“It feels terrible to go back there and see so many people living in such squalor,” says Farmer. “At the same time, from what we can tell, it’s half as many people in those circumstances than a year ago.”

The reconstruction effort, as well as the conditions in Haiti that made it particularly vulnerable, are the subject of Farmer’s new book, Haiti After the Earthquake. In the first two-thirds of the book, Farmer traces his experience in Haiti after the quake and provides some contextual history of the country. The last third of the book is comprised of essays on Haiti by other writers, including Edwidge Danticat and Farmer’s wife, Didi Bertrand Farmer.

“I wanted to put some sort of punctuation” on the experience of the quake, says Farmer, explaining why he wrote the book. “It was a very grim experience for a lot of us. It was for me anyway. I’ve been working in Haiti 28 years—I thought I’d sort of seen it...I’ve gone through a number of coups, the storms of 2008, I thought, you know, that I’d seen things as bad as they were going to get, and I was wrong.” But more than a catharsis, he notes, the main reason behind writing the book was to be “instructive, as we think not just about building Haiti back better, but about building humanitarian assistance back better.”

Dr. Paul Farmer—he has an M.D. as well as a Ph.D. in anthropology—is one of the co-founders of the international health-care nonprofit Partners in Health, and is also the subject of the 2003 book Mountains Beyond Mountains by Tracy Kidder. Toward the beginning of the book, after spending hours with Farmer looking after a specific patient in Haiti, Kidder concludes, “Education wasn’t what he wanted to perform on the world, me included. He was after transformation.”

Farmer, who is also professor at Harvard University, writes about Haiti with a medical vocabulary. A phrase he uses in the book to describe the earthquake is “acute-on-chronic” event—the earthquake was a trauma on top of an already chronically weak patient.

To understand Haiti’s history is to better understand that weakness. Following its independence came both external exploitation and then, later, internal coups and dictatorship. “If you look just at the decades after 1934,” Farmer says, which was when a long U.S. military occupation ended, “you know it’s hard to point to really inspired and positive support from outside of Haiti, to Haiti, and much easier to point to either small-minded or downright mean-spirited policies.” But, Farmer says, “I don’t think it needs to be that way. I think that looking forward it’s easy to imagine more constructive help for Haiti.”

So what’s next for Haiti, and how to make that “constructive help” happen? Farmer is emphatic that a large part of the solution is much more investment in Haiti’s public sector. He’s still worried about the cholera epidemic, which he says has not been contained, and cites that as a reason that public-sector utilities like water systems need to be strengthened.

“For public health and public education, trying to bypass the public sector is a big mistake,” he says.

“The public nursing school was destroyed completely, the medical school more or less destroyed, so we’re also trying to start up training programs for doctors and nurses, again with the public sector in central Haiti, outside of Port-au-Prince.” Farmer uses Rwanda—another place from which he gained deep experience—as a model, arguing that the way the country was reconstructed in 1994 after the genocide, where the Rwandan government dictated to aid groups the way the country should be rebuilt, resulted in a successful reinvention. “I can’t think of a better model for Haiti rebuilding than Rwanda,” Farmer says.

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While Farmer’s book contains valuable insights into how to improve humanitarian aid both in Haiti and in general, it is most powerful when he presents stories of individual projects in Haiti, or patients he encountered after the quake. On a day that he thinks was the eighth after the earthquake, Farmer, whose organization had one of the few still-functioning hospitals in the country, came across an injured man who, it turns out, was also the son of a friend. The patient was having trouble breathing. “He looked whole but was gasping for breath,” Farmer writes. He treated him with morphine, and antibiotics for pneumonia, and arranged for him to be flown as soon as possible to the U.S. Navy ship Comfort, a floating hospital. Later, on a visit to the ship, he learned that the man had died. This isn’t the only case Farmer presents, and they don’t all end in death.

But how did he deal with the earthquake personally? “It was the most difficult experience I’ve gone through, I can say that, emotionally,” Farmer says. “It was very wrenching. It was nightmarish. The only thing that kept me going, and some of my coworkers who were medically trained, is there was at least something we can do most of the time. We could do—did do. And many of the people we tended to, unlike that young man, many of them recovered.” 
But Farmer, careful to be precise, qualified that last statement. The percentage saved was “probably not that good of the people badly injured. Many did not recover,” he added. “But a lot of the people who we took care of, got better,” even those who needed amputation. And those who received good rehabilitation after treatment, he notes, have done well.