I went to Haiti in April of 2017 as a supernumerary on a nursing mission trip in conjunction with the Episcopal University Nursing School in Leogane. My interest was the usual curiosity of a seasoned traveler, but also, as a healthcare architect, I had prepared preliminary drawings for a surgery center in Canaan, a suburb of Port a Prince—I wanted to get a ground level view of healthcare delivery in Haiti. This article was published on the Cargo website January 2018 and a shorter version in Dewey Thorbeck’s book Agricultural Landscapes published by Routledge January 2019.

We are the Blan—a Kreyol term applied not only to whites but to foreigners regardless of skin color. We come on a mission trip with a nursing NGO and all but three of us are here for a week of nursing and college or continuing education credits. We bivouac in the coastal town of Leogane, not far from the epicenter of the magnitude 7 earthquake which struck in 2010, sequestered at the nursing school, a gated compound which is protected by razor wire atop concrete block walls and a 24/7 uniformed guard armed with an assault weapon.

Men’s dorm at the nursing school.

Haiti presents the picture of poor countries the world over—street vendors, partially constructed concrete buildings with rusty re-bar sticking out, men just standing around (unemployment at 40 percent), garbage and skeletal vehicles littering the roadways, badly broken or nonexistent tarmac, fences and walls all over topped with rusting razor wire (the razor wire vendor must have had a field day in Haiti). In most other under developed countries the scene improves toward the center of the city, but not here.

In the native Taino, Ayiti means “mountainous place,” and indeed the mountains are its saving grace, rising above the squalor and folding into angry storm clouds most afternoons. And the serenity of the surrounding sea offers much needed relief, a sense of peace. 

I’ve traveled to many parts of the world, seen many poor countries, but Haiti is so profoundly impoverished it brings a tear to my eye.  It is one of the most poverty-stricken countries in the world, the poorest country in the Western Hemisphere and the tenth most fragile state in the world, better than Afghanistan but worse than Iraq. Half of the population lives on less than $1.00 a day. Nobody smokes cigarettes. However, Haitians are big into the state-run lottery—this and their Voodoo infused Christianity must give them some hope. The Haitian-made rum gives them some escape. 

The nursing students and nursing educators in our group spend their days working with translators alongside the Haitian nursing school students and local doctors. They visit homes, villages, schools, orphanages and do assessments on the locals, handing out free medications which they’ve purchased or scrounged from their respective healthcare systems in the US. They diagnose and treat (or recommend treatment by a specialist) but, of course, there is no follow up. Meantime the three non-nurses paint a half-block long exterior wall at the hospital and build bedside stands at an orphanage. Mike, a maintenance tech from Arizona is here with his nurse educator wife; Dana, a retired auto enthusiast from Minnesota, is here with his daughter. I’m odd man out, a healthcare architect and compulsive traveler who wants to understand Haiti and also do some sketching.

On the nurses’ first day at the hospital a patient in a wheelchair somehow presents in the ER DOA. Although the hospital has a morgue, his body is wheeled out and sits in the sunny courtyard in front of the main entrance—healthcare (and death) is strictly COD. Fortunately, there’s an undertaker right across the street. The sting of this death moved the younger nurses in ways unimaginable.

Hospital courtyard and main entrance.

Haiti has suffered from colonialism, revolts, revolutions, wars, earthquakes, hurricanes (most recently 2010), crushing debt and repayment, unstable governments, missionaries, corrupt and oppressive dictators who looted the treasury, cholera outbreak (brought to Haiti by Nepalese UN Peacekeepers in 2010 and now endemic) and US involvement.  In 1915 we sent in the Marines and for the next 19 years took control of Haiti’s finances, security and government. Initially backing ‘Papa Doc’ Duvalier, Haiti’s most brutal dictator, as a bulwark against Communism, the US later cut off all aid. In the 1980s a crippling embargo was imposed.  

One afternoon we go with the nurses on home visits in the villages near Leogane. The homes are one-room shacks with perhaps a separate building for cooking but no inside plumbing nor outside latrine. The Haitian families are destitute and their condition causes a flood of tears among some of the young US nursing students (one of which had never been on an air plane before this trip). The family members are diagnosed and treated and receive a gift bag of American, not Haitian, rice. American rice has been less expensive since the US convinced Haiti to drop their import tariff during the Clinton Administration, thus stifling Haiti’s agriculture.

Typical dwelling in a Haitian village.

Since Haiti’s 2010 earthquake there have been from 3,000 to 10,000 NGOs operating here more or less independently. The theory is good but the reality less so.  The NGOs bring supplies with them rather than boosting the Haitian economy by purchasing locally. Classic examples are the distribution of free soap after the Cholera epidemic, bankrupting the major Haitian soap maker, and a town in Wisconsin which sent US peanut butter thus undermining the Haitian peanut industry. It is said that 70 percent of US aid is spent inside the beltway, benefiting our economy but doing little to help Haiti’s.

Midweek we take a hair-rising ride across the Massif de la Selle to visit the resort town of Jacmel, which lies south of Leogane on the other side of the peninsula. Our bus driver cuts the air conditioning to gain enough power to negotiate the mountains which are much too steep for crop farming. The residents live in hovels, keeping a pig or some goats if they’re lucky. When the swine flu epidemic hit Haiti USAID and the Duvalier government came up with a scheme to kill all the Kreyol pigs and these pigs are just now making a comeback.

During the ‘50s Jacmel was a tourist hot spot. Today there are few if any tourists and the beaches are littered with trash. We enjoy Prestige beer with our lunch at a resort hotel but are the only patrons. Jacmel has a good collection of colonial ‘gingerbread’ buildings all in a state of chronic decomposition much worse than what I saw in Havana.

At the beach in Jacmel.

Compared with most Haitians we have plush accommodations: air conditioning, fans, bottled water (only six percent of Haitians have properly treated water) and plenty of food including excellent Haitian coffee (once the world’s third-largest coffee exporter, Haiti no longer grows much coffee thanks to the US embargo).

I bunk in the men’s dorm and have a private room but without air conditioning or electricity (it’s just a couple cuts above camping in Minnesota’s Boundary Waters). Modern plumbing is down the hall, where the students also do their laundry, but no hot water for showering. My floor fan is connected by an extension cord running under my door and across the hall to another room. There is power for my ceiling fan when the electricity is not cut (which it is every night) or when the generator is running. The generator provides electricity and also charges a bank of batteries which provides power through an inverter when the generator isn’t running. I have no email, vmail or texting but ironically I call my wife Sheryl every night for just 20 cents a minute.  At night by the light of my headlight I read Graham Green’s The Comedians and as I drift off I find myself in Papa Doc’s Haiti and wake to a rooster’s crow.

For our sorties in to the community we have two air-conditioned buses and we drive down the streets in our bubble staring at the poor people while the adults stare back and the kids wave at us. Haitians don’t much enjoy having photos taken of them or their impoverishment; we shoot nonetheless.

Painting the hospital wall puts Mike, Dana and me, along with three Haitian translators who somehow got assigned to us, in the midst of the locals who are walking by or stopping to watch (really just looking for work).  In the 90 degree heat it’s a smelly effort because the space between the curb and the wall is used as a public urinal.  We acquire supplies at a construction materials store which is large but has little variety on offer. Motorcycles buzz by carrying families or 16’ long pieces of lumber or rebar dragging behind. The translators, who have never prepped or painted before, are quick studies and hard workers. As we start cleaning up an eight-year-old who is watching us jumps in of his own accord and washes out a roller pan—I give him a couple hundred Haitian Gourdes (about $2) which he will, of course, bring home to his family.

The painters at work.

We finish the wall painting and next day are picked up by a Rastafari-looking driver who turns out to be the director of the orphanage where our job is putting together 28 bedside stands for the orphans. The director in his aviator sunglasses and long dreadlocks looks like what Papa Doc’s secret police, the Tontons Macoutes, must have looked like. Pretty scary—not your supportive father figure. The stands are banged together, none of them sits level, but then neither does the concrete slab they’ll sit on.

On Saturday we return to the orphanage to watch the kids paint their new bedside stands.  They are a real joy!

Youngsters learning how to paint.

The nurses come along to do a community clinic and we all tour the premises. The rabbits, touted as a food source although chickens seem to abound, were out of water so we water them. Likewise the goats, one of which has a newborn. Watching us is an orphan too small to do painting. He has a razor blade in his hand—we distract him and take it away. The orphanage is looking less and less legitimate.

Back at the nursing school I confront our NGO leader and ask how he has vetted the orphanage. He says the orphanage is supported by a couple NGOs which pay salaries for teachers and nannies (although I didn’t see any nannies nurturing any of the children). I say, “Yes, and those bishops vouched for all those priests, too.”

But there are a couple high points besides coffee and scenery. The first is the kids painting the bedside stands; the second is on the way back from the orphanage when we make a stop. I elect to sit and sketch. Half a dozen children appear out of nowhere to watch. They speak Kreyol and we can’t understand each other but we talk and laugh and have a good time together. I’m their entertainment for the afternoon.

Sketching with my newfound friends.

What should be the future plan for Haiti? It can be summed up quite easily: 1) Industry to employ Haitians, 2) Exports to bring in outside money and 3) taxes to support healthcare and education (average education level is fourth grade—school is not free) and infrastructure such as roads and garbage pickup. But industry will take outside money, and before that can occur Haiti’s investment rating must improve, and in order for that to happen there must be a stable government.

Jovenel Moise, banana grower and member of the Bald Head Party.

Jovenel Moise, who has never held public office before, has been sworn in as president in an unusually peaceful transfer of power. In the past many presidents have been quickly thrown out of office for not delivering on their campaign promises. In the US we know that our politicians are liars so we don’t believe them in the first place, but in Haiti, where literacy is just 48 percent, people tend to believe their politicians and expect immediate improvements. We’ll have to wait and see how Moise fares.

This trip helped me better understand Haiti’s circumstances and the role played by the US government in contributing to Haiti’s deplorable situation. I totally changed my opinion on humanitarian aid. The work I did took away a Haitian job. I could have bolstered the economy more by simply donating what I spent for airfare and lodging directly to the hospital and orphanage so that unemployed locals could be hired to do the painting and carpentry work.

Aid to Haiti must focus on helping the Haitians become self-reliant and we should quit doing work that they could and should do for themselves. In the end, although I respect and admire the good intentions of our NGO, “it’s like pissing in the ocean,” to quote Susan, one of the nurse educators from Yonkers. Haiti’s fix under the very best of circumstances may take generations. We can only hope that Jovenel Moise’s leadership will turn the tide.