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'Haiti After the Earthquake': Assessing the damages of a disaster

Paul Farmer is well-known as a doctor who looks beyond the physical symptoms an individual exhibits in searching for the causes of disease. His goal is not only to ease what ails the patient, but to prevent a relapse.

By Paul Farmer

PublicAffairs, 429 pp. $27.99 nolead ends nolead begins
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Reviewed by Carolyn Davis

Paul Farmer is well-known as a doctor who looks beyond the physical symptoms an individual exhibits in searching for the causes of disease. His goal is not only to ease what ails the patient, but to prevent a relapse.

In his new book, Haiti After the Earthquake, Farmer applies that ethos to examining how the January 2010 temblor affected that Caribbean nation - and why the damage was so great. It's a valuable book filled with insights, though at times he puts too many details in the way of the best information.

Farmer's perspective flows from having been an intimate of Haiti long before the 7.0-magnitude earthquake turned most of the capital, Port-au-Prince, to rubble. He began working in the country's central plateau even before becoming a medical student in 1983 and cofounding the well-regarded medical nongovernmental organization Partners in Health in 1987. He helped build that NGO into one of Haiti's top medical providers and expand its work into other countries.

Before describing how post-earthquake reconstruction efforts have been faring, Farmer, who is on the faculty at Harvard University and on the staff at Brigham and Women's Hospital, reviews what he aptly calls Haiti's "acute-on-chronic" condition, which made the country so vulnerable to the earthquake. (After all, the magnitude 8.8 earthquake in Chile shortly after Haiti's caused far less destruction and killed hundreds of people, not hundreds of thousands.)

Haiti's woes are centuries old, Farmer writes. Damage has been done by outsiders, including French colonizers. Also harmful are U.S. trade policies that force, for example, American crops to be used in food aid to Haiti instead of produce bought from Haitian farmers. Haiti's own tyrants and corrupt politicians have stymied development, too, though they deserve much more blame for their misdeeds than Farmer gives them. No wonder poverty has been so stubborn amid these constraints.

It's all interesting, relevant background. But the book is at its best when the emergency and reconstruction efforts are seen through Farmer's filter in his dual roles as a doctor leading an NGO and as U.N. deputy envoy for Haiti.

Farmer points out many of the problems in delivering emergency aid. Donors failed to give promised funding. The United Nations' division of duties put its assistance out of sync with the needs of as many as 1.2 million displaced Haitians.

Logistical confusion and a lack of collaboration among the throngs of international aid groups that rushed to Haiti limited the effectiveness of their assistance, including during the subsequent cholera outbreak.

Some groups (Farmer, cognizant of being a U.N. envoy, doesn't name names) acted inhumanely, if not unprofessionally. He writes about how "one NGO installed lights in a settlement only to take them away again when their tour of duty was up."

Farmer relentlessly, in his work and in his book, swings the spotlight back to ordinary Haitians, what they suffered, how they helped other victims - and how they should be deeply involved in rebuilding Haiti. Sometimes, the author's propensity to give others (Haitians and non-Haitians alike) their due works against the book: No one possibly could keep track of all the people Farmer names.

But that's how Farmer is, which also may be why he turned over more than 100 pages to "Other Voices," including Haitian Americans, doctors who work with Partners in Health in Haiti, and Naomi Rosenberg, a Partners in Health staffer who interrupted her University of Pennsylvania medical school studies to bring a number of earthquake survivors to the Philadelphia area for emergency medical care. (I wrote a story on Rosenberg and the Haitian survivors in Philadelphia.)

While the switch to other writers is jarring, it opens the door to insights I haven't read elsewhere.

Nancy Dorsinville, who works in the U.N. Office of the Special Envoy for Haiti, describes a visit to one camp where she saw people with broken bones who weren't seeking medical care because they had heard doctors were performing amputations to avert gangrene.

"Having lost their homes and their loved ones, many people chose to remain in the camps so as not to lose limbs," she writes.

Overall, Farmer strikes an optimistic note for the country, based on Haitians' resilience, tested in all of those centuries of sorrow. But it is the kind of image Dorsinville relates that lets us know most vividly how Haiti really is after the earthquake.