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November 08, 2010

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Haiti: Let's Get It Right

Remarks by Ken Hackett, President, Catholic Relief Services

Villanova University, Villanova, Pa.

Nov. 8, 2010

I should begin by disabusing you of some ideas you may have coming here today. If you expect an uplifting, inspirational talk about the great work CRS is doing in Haiti like some sort of motivational seminar, you are going to be disappointed. Haiti does not lend itself to that. This is a tough one.

I have seen and participated in major emergencies around the world throughout my entire professional life. I can tell you that what happened with this earthquake is like no other disaster I have ever experienced. The immensity of destruction; the many, many needs of the people on so many levels; the absence of a strong government; the extent of the displacement; and the difficulties of coordination among those who were — and still are - responding — these are but a few of the factors that make it so complex. And it's gotten even more complex in recent days with first an outbreak of cholera - first time that bacteria has been in Haiti in 50 years - and then this hurricane Tomas dumping all that rain. Add to that the fact that before the earthquake Haiti was one of the poorest countries in the world, the poorest in our hemisphere, and you begin to get an idea of the challenges groups like Catholic Relief Services face.

So when we talk about "getting it right" in Haiti, we are not talking about spending a few years cleaning the place up and leaving behind a prosperous, developed country with everyone nicely housed and fully employed and well-fed and healthy. That is not going to happen. Haiti was a poor country before the earthquake and it will still be a poor country after the earthquake relief work is finished.

That said, we do have a real opportunity here.

For one thing, there was, as you know, an unprecedented outpouring of generosity. At CRS we raised some $140 million after the earthquake. That's a lot of money, but it's only a fraction of what was raised by aid groups overall. Add in government money, and there are several billion dollars available for Haiti.

That kind of money is obviously important, but even more important is that we have the opportunity to re-think how we help Haiti.

We run a tremendous risk that unless we come together in ways like we have never done before, at the end of the day all we may be able to say is that many good acts of charity were done and some buildings were reconstructed. Yet Haiti remains as broken a society as it was before the earthquake with even more Haitians lived in soul-grinding poverty.

Why do I say that? Over the last three decades when faced with problems in Haiti, our solutions have too often been to do it, fix it, and run it. There are thousands of fragmented, individual initiatives and hundreds of humanitarian groups, religious organizations, individual parishes, and even individuals, active in Haiti.

While this fragmentation of effort has led to an improvement in the lives of many individuals, it has also promoted a mentality among Haitians of passivity and reliance on foreign solutions and resources. At the same time, it has also undermined the responsibility of the nation as a whole - both its government and its other civil institutions. That's what we have to change if we are going to get it right. It's a tall order.

I do think we should spend a few minutes contemplating the complexities of responding to this earthquake. Every disaster has its share of second-guessing and Haiti was no exception. It was in the first hours after the earthquake that criticism of the relief effort began. We weren't doing enough. We weren't fast enough. People were dying needlessly.

The fact is, given a destroyed port and barely functioning airport and roads clogged with rubble - not to mention the immensity of the destruction, deaths and injuries — the relief effort was quite amazing. Within days, hundreds of thousands of people were getting food, a lot of it from CRS as we already had stock in Haiti for our ongoing feeding programs. Though there were complaints about bottlenecks at the airport, a huge amount of supplies got in very quickly. The U.S. military did a good job dealing with logistics and security, including getting the port up and running well before anyone thought possible.

The problem was not the emergency response, the problem was the scale of the disaster. You organize a feeding program for 10,000 people in a couple of days, you're doing a great job. But when a million people have just lost their homes, it looks like a drop in the bucket.

There's another factor here that cannot be ignored - we like our aid for people suffering from disasters to look a certain way. Here's one example - within a few weeks of the earthquake, it became clear that there was food in Port-au-Prince markets. In such a situation, the right thing to do is to help people buy that food, not give them free food that might disrupt those markets. You want the markets to function as that's a much more efficient way of getting people fed. But try to get the media to cover a cash-for-work program - people getting paid to, say, remove rubble so they can buy food with the money. That does not fit into the media's idea of charity nearly as much as a food handout. The cameras show up for those, especially if the bags of food have USA printed on them.

I'll give you another example. Right after the earthquake, all sorts of doctors and medical personnel rushed to Haiti. They were needed. At CRS, we worked to get a makeshift hospital going at St. Francois de Sales, an important Catholic hospital that served the poor where we had been working in our AIDSRelief program. It had been devastated by the earthquake. At first we staffed our effort - before we even had tents we were working outside — with a variety of doctors from all over the world. Then one of our partners in AIDSRelief, the University of Maryland, began to send rotating teams of doctors and nurses, some from its world renowned Shock-Trauma unit. Of course many many more medical teams were arriving in Haiti, including the US Navy's hospital ship, the Comfort.

The story of the Comfort is a good illustration of one of the problems with many peoples' ideas about such medical aid. I think in the minds of a lot of Americans, that ship was going to be like the cavalry arriving in those old western movies, saving the day in the nick of time. But very soon, its 400 beds were full — again, due to the scope of the disaster. And then, as the Navy doctors took care of broken bones and other problems that came with the quake, they found their beds filling with chronic patients, most with health problems that pre-dated the earthquake. The question became how to extricate the Comfort from Haiti without tossing patients overboard, a delicate dance.

Of course the medical response got huge coverage in the media. It's great stuff — doctors coming in and giving free, top-of-the-line service to the people of this poor country. Who could have a problem with that? Well, one group could - Haitian doctors. So maybe Haiti did not have the best health system in the world, but it did have a health system. And its doctors were losing their patients - their paying customers - to these free services. So the unintended result of this popular act of charity could be to leave behind a destroyed Haitian health system. Not a good thing. What was going to happen when those first world doctors went home? Which inevitably they would.

I want to mention one other aspect of the response that got a great deal of publicity - the rescue teams that pulled people out of the wreckage of buildings. In no way do I want to disparage the work done by these people, but I would like to put it in perspective. I believe the statistics show that they saved 132 people. Now, those 132 lives are sacred and we are grateful they were saved, but compare that to the 230,000 that were lost. In fact, compare it to the thousands who were saved by getting antibiotics to stem the infections of their wounds - or died because they could not get such treatment. Should we have brought in more antibiotics instead of rescue teams? It's a legitimate question.

But clearly the work of these rescue teams got a tremendous amount of TV time in the days after the earthquake, out of proportion to their actual impact on the casualties. Why was that? Obviously it's a very dramatic story watching them work to save a life, much more dramatic than giving someone medicine or an IV drip in clinic. But there is another reason this work had such appeal - it fits into our conception of the delivery of aid following a disaster: We in the developed world have the smarts and the technology and we swoop down from the heavens and rescue the poor, uneducated, helpless victims. The rescue teams were the perfect image of that, but it's a story line that goes through feedings in camps for the displaced and medical care from Western doctors.

And frankly that's exactly the narrative we have to get away from if we want Haiti to progress. It's a popular narrative. It's very effective, I have to admit, for raising money. And certainly after a disaster people need to be fed, they need to get medical attention, they need to be rescued if trapped in buildings. But once that's happened, we have to go further. And in Haiti we have not succeeded in doing that.

One reason that we at CRS feel a particular responsibility for Haiti is because it is a Catholic country. The church is an important institution in every city and town and village. We work with church partners in many of our projects. And one reason America was so generous with its outpouring of aid for Haiti is because it is so close, just off our shores. Our histories are intertwined.

From a Catholic perspective, this proximity has resulted in many parishes in the United States adopting parishes in Haiti, sending money and other contributions. Such generosity is admirable and should be praised. But the problem is that rarely do these adopted parishes grow up and walk on their own. They remain adopted children. It is a relationship, formed with the best of intentions, that breeds dependence. Once the money is spent, probably on good and needed programs, too often the Haitian church simply goes back to its American adoptive parent and asks for more.

Such an approach leads to haphazard charity. A parish that has a particularly charismatic priest who has formed good relationships with Americans might get a great deal of money, while one with a priest equally dedicated to his parishioners but who does not have appeal or connections to Americans gets none.

This, by the way, is analogous to the popular adopt-a-child programs that many international charities run. Again, the generosity that these programs generate is to be praised. But we don't do that at CRS because we want to help all the vulnerable children in the communities where we work, not just ones who attract an adoptive parent.

This is the dilemma we face, the tightrope we have to walk, as we move forward in Haiti - how do we praise and encourage the generosity that so many have shown to Haiti, both throughout the years and in the wake of the earthquake, while fighting this fragmentation, steering the money in new directions so its use will be coordinated and have longer lasting benefits?

That's what we have to do if we are going to get it right.

But how do you do it? One possible model is the way we're going about reconstructing church buildings. Most of you probably know that this is not what we do at CRS. We do not build churches or other religious buildings nor do other sorts of distinctly religious work. That said, we recognized that Haiti was a special case as such a Catholic country with a church that had been so devastated, losing not only its landmark cathedral in Port-au-Prince but other churches throughout the affected areas of the country. The Archbishop died - I attended his funeral - along with many other members of the church hierarchy as well as seminarians and other religious, members of many different orders. We were not about to turn our back on our brothers and sisters in the church.

So we got involved in helping to create an entity called PROCHE which means "close" or "togetherness" in French and Creole. Operating under the leadership of the bishops of Haiti, governed by a steering committee composed of representatives from the Church in Haiti and sponsoring Church organizations from around the world, it will provide a contact point for all Church-related reconstruction projects.

PROCHE is going to be staffed with certified architects, engineers, and consultants - both Haitian and international — to ensure that Church building projects meet earthquake- and hurricane-resistant construction standards and adhere to appropriate building codes.

We're trying to get everyone involved in this reconstruction effort. Again, we do not want to discourage the generosity that leads a parish here to connect with a parish in Haiti, but neither do we want church reconstruction to be on a piecemeal basis. It should be coordinated.

But most important is what we want to leave behind after all the churches are reconstructed - a group of Haitians who have, with a lot of support to be sure, run this organization, who have learned from that experience, who have been empowered by that experience, who can build on that experience to go forward into Haiti's future.

That's what we are going to try to do in everything we do in Haiti. You know in most places where CRS works around the world, we are not that operational. That means we don't actually do that much of the work on the ground ourselves, instead working with local partners who know and often live in the communities we are helping. We support these partners, some more than others, but it is important that they share responsibility. On the ground, they are usually better than we are. They know the community, its needs. And when the program comes to an end, we've left behind people with useful experience that benefits the community.

In Haiti, we do work through local partners but we are also very operational and that's because our local partners are too often not strong enough. We haven't done enough to make them strong. Far too many aid groups and charities have done business this way in Haiti. It is the way, by the way, Sean Penn wants to keep doing business in Haiti, but that's another story. Handout after handout does not generate empowerment, it does not increase ability and capacity, it breeds dependence. That's what we have the opportunity to stop in Haiti.

Let me talk a bit about what we are doing at St. Francois de Sales hospital. In the aftermath of the earthquake, we set up temporary facilities amid the wreckage. In recent weeks, most of the medical work has been moved to another site - some distance away - where we have helped set up a more substantial temporary facility, a real tent hospital. That will allow us to proceed with demolishing and clearing away the collapsed structures and then building back a new hospital. We want to leave behind a top quality teaching hospital. Working with our partners at the University of Maryland, we want it to be an important part of raising the standards of the entire Haitian medical community, training generations of doctors and nurses. These would be Haitians, taking care of Haitians.

Will St. Francois de Sales stand on its own right away? No. We and other partners will be working with it for years to come. But the goal of that help will be to get the institution to take steps toward standing on its own. This is one block in the foundation we are trying to build.

It's the vision we see throughout our work in Haiti. We need the money going into Haiti to flow in a coordinated way. We want our partners there to be stronger so we are not using our money just to hand out things to the poor - knowing they will need more when those run out. So we are using some of our money to train our partners.

In our housing programs, moving people out of tents to more substantial temporary shelters as we face up the myriad problems of rebuilding permanent homes, we are working with communities, getting them involved in the whole process, not just telling people where to move. This is the way Haitians will work and build their way into a new country.

We are working with the church, with Caritas Haiti, with others, to build the capacity of Haitians to lead the recovery process so that their lives are more dynamic, productive and dignified.

I'm no Pollyanna about this. This is a tough mountain to climb. You should see Port-au-Prince. So much of it is still clogged with rubble. The traffic is terrible; it takes an hour to get anywhere. The government - weak to begin with, almost destroyed by the earthquake - is now at a standstill awaiting elections later this month. And the needs are so immense that just meeting them on a day-to-day basis could occupy us 24-7 without ever even thinking about building for the future.

But that's what we have to do if we are going to get this right. CRS has been in Haiti for 55 years and we are proud of that. We've been with Haitians through thick and thin; we were with them through the earthquake - you should hear the stories our staff told of those terrifying minutes - and we are going to be with them in this recovery for years and years to come. Though we have gotten some criticism because we have not spent all the money we raised - and the needs are clearly so great - we will have no problem spending it all, and more. There's a lot of work to do.

But my dream, if we get this right, is that in the future, we will be playing a smaller role, supporting Haitians who are doing the work, through their Church, through their government.

And maybe 55 years from now, we won't be there at all. Because they won't need us.