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The Doctor and the Haitian Machine

The Uses of Paul Farmer

by ANSEL HERZ

In the end, we will remember not the words of our enemies, but the silence of our friends.

– Martin Luther King Jr.

Port-au-Prince.

Dr. Paul Farmer stood alone in a corner of Hotel Karibe conference room, watching the spectacle.

Reporters buzzed around Bill Clinton, jostling with one another and yelling out questions. The former president was the newly-minted United Nations Special Envoy to Haiti.

It was September 2009, just a few months before the earthquake.

Farmer had been appointed as the Deputy Envoy. But it seemed perverse that the reporters would ignore him.

“Dokte Paul,” as his patients here call him, has been a true friend to Haiti.

A Harvard-educated doctor and public health expert, Farmer co-founded Partners In Health. As a tiny clinic in rural Haiti has grown into a medical complex and now a hospital, he’s innovated and delivered top-class healthcare to the poorest Haitians for three decades.

His accomplishments are profiled in Tracy Kidder’s book Mountains Beyond Mountains, which is taught in classrooms across the country. I was reading it at the time.

As a recent college graduate and a newcomer to Haiti, I wasn’t going to miss this chance to interview a personal hero of mine. So I ran over.

We talked about Haiti’s challenges. He folded his arms and leaned in, peering through round wire-rimmed glasses. His answers were thoughtful. Farmer had always been a sharp critic of the international community’s treatment of Haiti.

Eventually I asked him a blunt question: “Do you think the administration here was under pressure from international forces to fight the increase in the minimum wage?”

I’d seen graffiti calling for bump in wages in Port-au-Prince earlier that day. In the preceding months, as the government stalled on enacting the wage hike from $3 to a mere $5 per day, protests had engulfed the downtown area.

Farmer stammered a little bit, said he didn’t know, and subtly changed the subject.

One reader left an ominous comment on the interview. “No disrespect to Dr. Farmer, as I believe he is sincere,” he wrote, “but he is now a part of the ‘machine’ that essentially drives Haiti.”

***

Two years later, WikiLeaks provided me and two colleagues with a window into that machine: 1,918 secret diplomatic cables from the US Embassy in Haiti.

The cables proved beyond any doubt what had seemed obvious. Behind the scenes, American officials had mounted a full-scale assault on the minimum wage increase, financing studies against it and pressuring the president to oppose it.

If Farmer had “engaged in the hard process of discernment” – an idea he promotes in his book Haiti After the Earthquake – the answer to my question would have been “Yes, of course.”

It was strange. In the past, Farmer wrote disapprovingly of plans to give Haitians low-paying jobs in textile factories – what many consider to be sweatshops. Either he had changed his mind or was holding his tongue.

In 2004, Farmer hadn’t shrunk from castigating the United States and the Haitian elite for the coup d’etat they carried out against Haiti’s then-president, Jean-Bertrand Aristide.

To this day, he remains a board member of the Institute for Justice and Democracy in Haiti (IJDH), which is a strong defender of Aristide and his political party, Fanmi Lavalas.

But when Fanmi Lavalas was banned from entering candidates in the first post-earthquake election, Farmer’s response was tepid.

I ran into Farmer at a meeting of the now-defunct reconstruction commission (co-chaired by Clinton) just before the runoff round, in March of 2011.

I asked if he was worried about the Lavalas party’s exclusion from the ballot. “Of course I’m worried,” he said, “because if you have scant participation or exclude anyone from engagement. . .that’s a formula for instability.”

At the time, IJDH and most progressive advocates took the position that the election was unfair, fraudulent, and should be annulled. I followed up by email asking if he agreed with IJDH. Farmer wrote back:

“Good to see you. Sorry to have missed your deadline. But am on the board of ijdh so you are really asking questions for other reasons?”

I responded seeking to clarify what that meant, but received no reply.

***

The next time I saw Farmer, he warmly greeted me in the hall of a huge mansion.

I managed to evade the minimum $250 donation for a fundraiser being held in Austin, Texas, where I was visiting family. I wore some of my best clothes but still looked underdressed. The opulence on display seemed shameless.

Turns out the mansion belonged to Roy Spence, chief executive of a big marketing agency. He was Hilary Clinton’s “messaging guru” during her 2008 campaign.

Farmer humored the crowd with an engaging speech calling for accompaniment with, rather than mere charity to, the poor.

Cheryl Mills, Clinton’s chief of staff at the State Department, stood next to him, beaming. Mills had just taken a shellacking in a Rolling Stone investigation of Haiti’s faltering reconstruction effort.

But this wasn’t a fundraiser for Partners In Health, Farmer’s highly-respected health organization. It was for an obscure group called Students of the World, which is run by Roy Spence’s daughter, Courtney.

A documentary filmmaker friend of mine went to the second fundraiser in East Austin – the one for the non-rich – the following night. Unprompted by me, he complained a few days later about how bad it was.  He said it seems like they “parachute in” and produce “bad promo videos” about charities in Haiti and other poor countries.

And yet that night, there was Farmer wrapping up his speech. He urged the assembled guests – influential Texas politicians and businessmen among them – to donate to Students of the World.

Before I left, Farmer autographed a copy of his book for me. He said he’d flown all the way from Rwanda for the event.

In the book, Farmer argues that humanitarian funding should be directed to Haiti’s public sector – the government – instead of to foreign charities. Groups like Students for the World are lambasted as haphazard and unaccountable to Haitians.

***

“Oh, he adores Clinton,” a senior member of Partner in Health, told me as our plane approached the Haitian coastline. “I don’t get it.”

It was March 2012. By chance, our seats on the flight to Port-au-Prince happened to be next to each other. We’d struck up a conversation.

She said Paul had changed over the years and that now she represents the “left-wing of PIH.” But the organization had taken a decidedly non-political turn.

I told her how disappointing it was when PIH had refused to sign on to a petition to protect Haiti’s displaced from forced evictions not long after the quake. She wasn’t surprised.

The petition was addressed to Bill Clinton, the UN Envoy to Haiti, among other authorities. And Clinton is “close to Paul,” the petitioners were told by Donna Barry, PIH’s Advocacy and Policy Director.

A week later, I found myself facing Clinton at a press conference at PIH’s new hospital in Mirebalais. I asked a pointed question about the UN’s responsibility for Haiti’s cholera outbreak.

His frank response, in which he stated that cholera had arrived in Haiti via the fecal waste of a UN peacekeeping soldier, was a welcome surprise.

Farmer got up after him and delivered a boilerplate call for improved water and sanitation in Haiti. Clinton put his arm around Farmer’s back when he sat back down.

“I think he knows what he’s doing, and I trust his judgment and his integrity,” political analyst Noam Chomsky told an interviewer who asked about Farmer’s involvement with Clinton and the UN.

“Paul Farmer, that is. I’m not talking about Clinton,” he added, with a derisive laugh.

As Chomsky explained, by any objective measure, Clinton has severely damaged Haiti.

After the quake, he admitted to destroying the livelihoods of Haitian farmers during his presidency when he pressured Aristide to lower tariffs on imported rice. It was a “devil’s bargain,” he said, that was beneficial for “some of my farmers in Arkansas.”

In October, both Clintons inaugurated a sprawling, scandal-ridden industrial park in Haiti’s north, where thousands of Haitians will sew garments for Wal-Mart and other US retail giants for meager wages.

Farmer, meanwhile, has been awfully quiet when it comes to public advocacy on Haiti’s behalf. His name last popped up in the news when the UN, in a slick PR move, appointed him a special advisor for a brand new $2.2 billion cholera initiative.

In fact, the initiative is anything but new. It’s been around for years, unfunded, and the UN itself has only contributed 1% of the overall funding goal.

The epidemic continues apace. Cholera killed 27 Haitians in the first week of January.

Farmer is still on the board of IJDH, which is suing the UN to accept responsibility for the outbreak and pay reparations to the victims. He’s made no public comment about the lawsuit. Neither has the UN, except to say it’s studying the claims.

“He’s been bought off by people who acknowledge that his critiques had merit and gave him a position, meaning Clinton and the UN,” one longtime Haiti aid worker told me.

A Washington insider who works on Haiti policy called him “their useful idiot.”

“We see the same problems,” he said.  ”Haiti needs a voice of reason to stand up to these powerful players. He could be that voice.”

“It’s sad, really.”

***

Sadder still are the dusty, bleak encampments where thousands of Haitians displaced by the quake eke out an existence each day.

At a huge camp called Carradeux, withered tents flap listlessly in the wind on a crowded hillside. Aid agencies have long since left most camps, leaving clogged and overflowing latrines in their wake.

“Haiti’s reconstruction? It began in [Clinton’s] mouth, but it never materialized on the terrain. I don’t see it,” Bemès Bellevue, a 31-year-old taxi driver whose worn features make him look much older, told me on Thursday.

It was the 1090th day Bellevue has lived under a tent with his wife and two girls, aged 5 and 7. Human beings are not supposed to live like this, let alone for three years.

I’ve never met a camp resident who knows about Farmer. They haven’t heard his talk of “building back better.”

I asked Samuel Maxime, editor of Defend Haiti, an online news magazine popular with the Haitian diaspora, what he thinks of Farmer today.

He said it’s hard to criticize anyone working on health in Haiti because lives are at stake.

Indeed, this makes it difficult to subject Farmer or any humanitarian to critique. But meaningful accountability is precisely what’s been missing from the aid sector. Farmer himself made the point in our first interview.

“Nonetheless, I think Farmer is a large part of the machine that enables corruption in Haiti,” Maxime continued. “In the grand scheme of things I believe someone like Farmer, who knows right from wrong, integrity from corruption, and looks the other way as he does – he enables it, in fact, like MLK Jr. would say – they are complicit in it.”

Maxime said he’s especially disappointed Farmer hasn’t stepped up and stated clearly that all the evidence shows the UN brought cholera to Haiti.

“I don’t think that’s becoming of a Harvard man.”

***

After several unanswered emails, Dr. Farmer responded just before this went to publication. He called me on the way to the airport, where he was to catch a flight to China for a meeting on tuberculosis.

We spoke cordially for two hours. Farmer said he hoped his words with give me pause. But they haven’t.

I found him to be defensive, wishy-washy and self-contradictory.

“I chuckled at that because I think it’s good to be useful,” he said, taking particular umbrage at the phrase “useful idiot.”

He asked repeatedly whether I agreed with that. I said he was being silenced and used.

Farmer eventually disclaimed any leadership role, saying, “I’m really not a UN official. I don’t have any obligations.”

“On the second year anniversary [of the quake] I wrote what I had to say and I don’t really have any more to say.”

When I said he had lost the razor-sharp critical voice from Uses of Haiti, he said, “I hope you’re wrong about that.”

I asked several times whether the UN brought cholera to Haiti. He talked around the question, never answering it directly. Isn’t it important to identify the source of the outbreak?

“I don’t think that’s true. I don’t think it was true with the [past] HIV or cholera outbreaks…If I were to rank the top 5 interventions, to slow cholera…I would not put legal action before building a water system or treating Haitians.”

Do you believe in IJDH’s advocacy work? “Yeah, I do! I would never disassociate myself from IJDH.”

But later, “I’ve never worked in any social justice organization where there aren’t serious disagreements inside.”

On the failed reconstruction commission, the CIRH, he said,  “I didn’t have a dog in that fight other than wishing it well…I hope there will be many other iterations of trying to coordinate aid. I didn’t assert that it would work.”

He agreed that Rwanda, which he has often held up as a model, would not have accepted the CIRH.

I asked if he has been successful in encouraging aid to flow directly to the Haitian government. Farmer admitted, “The answer is no, not much success.”

“I definitely care most about Haiti of all the places I’ve worked, but I don’t claim omniscience,” he said.

Ansel Herz is a freelance journalist who lived through the 2010 earthquake and has reported from Haiti for over two years. His work has been published by ABC News, the Nation Magazine, the New York Daily News, and Al Jazeera English, among other outlets.