The wealth of global response to Haiti’s January earthquake suggests a tremendous sense of global responsibility for a country whose current death toll is over 200,000. Now that Haiti is on the world’s central radar, how might those involved in rebuilding ensure that Haiti become a lasting center of global responsibility? That is, what’s the relationship between empathy for those affected by disaster and an engagement in transformation?

Certainly Haiti is in desperate need. Yet the discrepancy between the aid provided before 16:23 on Tuesday, January 12, 2010, and the outpouring of funds since then is hardly consistent with the constancy of need that Haiti has expressed for decades. Will Haiti remain a point of awareness for those who feel this recent increase in responsibility, or will it disappear back into the realm of public health experts and anthropology lectures at elite universities as it has so often before?

If a similar event struck even one American city — a hypothetical transformation in 12 hours, in which time all basic health indicators, poverty levels, and living conditions become identical to a portion of the population on the outskirts of Port-au-Prince in 2008 — gross national income per capita would drop US$43,000. Infant mortality would jump 857%. Three percent more people would have AIDS, and TB rates would increase by 1,344 %. Unimaginable? Yet even these changes would fail to convey the years that Haiti has lived as one of the most impoverished nations of the world. A history of discord and poverty has combined to create an unshakable stigma that shrouds any association with the country. With this comes outside prejudice, and from prejudice the extensive debilitating components of social suffering. An earthquake with a magnitude of 7.0 hitting the country’s capital city is only the tip of the iceberg. Haiti needs the world to extend a hand not only in the coming months, but the coming decades.

Psychological factors make it so easy for us to forget, and sometimes hard to empathize with, suffering. Perhaps by acknowledging our psychological default setting we can improve everyday awareness of global suffering and increase long term action.

There are two primary limitations to comprehending the suffering of others. The first is internal: we are naturally programmed to feel more sympathy towards individuals than groups. Several studies have been done tracking gross donation quantities based on the picture that accompanied a campaign. Those pictures with a single child staring with longing into the camera resulted in considerably more money than the simple addition of one more child to the picture. Human empathy is simply not hardwired to deal with numbers and vast areas of suffering. A death count of 105 seems not much different from 103, yet when a report states that two were dead, we care. Indeed it appears that the fewer the number, the easier it is for onlookers to develop collective empathy. The second limitation is that of language: there are many instances when a limited vocabulary cannot convey the intense emotion that accompanies a tragedy; and increasingly in the medical world, there is an absence of jargon to fully explain the subtleties of suffering. Reading of one’s suffering, in short, can limit our ability to fully comprehend its depths.

Of course, some possess a greater ability to empathize than others, and empathy measures are inevitably generalizations. But taking human nature into account and applying it to a sustainable support strategy could perhaps keep Haiti on the radar. As the world marches on in the coming months and years, it is important that we not only remember Haiti, but also that we actively fight against the natural processes that makes us forget.

For more opinion on this subject see: http://www.nytimes.com/2010/01/14/opinion/14thu1.html

http://www.washingtonpost.com/wp-dyn/content/article/2010/02/01/AR2010020103183.html

http://www.nytimes.com/2009/07/09/opinion/09kristof.html?_r=2

For the empathy study cited see: http://pluto.mscc.huji.ac.il/~msiritov/KogutRitovIdentified.pdf

For up to date info on Haiti see:
http://topics.nytimes.com/top/news/international/countriesandterritories/haiti/index.html?scp=3&sq=haiti%20death%20toll&st=cse

Click here shortly before 8:00 pm to participate.

More information on the webcast from Stand With Haiti, the Partners In Health blog covering their work in Haiti, including earthquake relief efforts:

Join PIH physician Dr. Evan Lyon for a presentation on his recent trip to Haiti and a live Q&A.

Tuesday, February 16, 8:00 pm EST

Dr. Evan Lyon has been a volunteer physician with Partners In Health/Zanmi Lasante for over a decade. He participated in PIH’s initial response to the earthquake on January 12, 2010 — just over one month ago. Since that time, the official death toll has reached 230,000 and continues to climb. At least 1.5 million are out of their homes — many have migrated back to the countryside. Those who remain in and around Port-au-Prince occupy makeshift refugee centers.

Dr. Lyon will speak about his two weeks at the University General Hospital (HUEH) in Port-au-Prince where PIH has helped coordinate efforts to bring this — the largest hospital in Haiti and its only public teaching hospital — back into a functional facility. After a brief presentation, he will answer your questions about the progress of Partners In Health so far, and the challenges that lie ahead.

We encourage students and teachers of all levels to join the discussion. To submit questions before the presentation, please email sdhr@dartmouth.edu. You may also submit questions during the presentation, via the live chat window found next to the livestream video. When submitting a question, please state your name and your school or location.

Please join us for this special presentation by visiting this webpage at 8:00 pm EST on Tuesday, February 16.

Suggested background reading:

“Haiti: A Creditor, not a Debtor” by Naomi Klein
http://www.thenation.com/doc/20100301/klein

“‘Break Hearts Open’ in Haiti” by Evan Lyon:
http://english.aljazeera.net/focus/haitiearthquake/2010/02/20102272125725938.html

“Fault Lines: The Politics of Rebuilding in Haiti”
Video: http://tinyurl.com/ydz7z7p

A transcript of this segment can be found here.

Dr. Lyon was also interviewed yesterday on Here and Now.

Meanwhile, rescue operations continue at full speed — medical personnel, military forces, and other aid workers and peacekeepers have arrived in droves in Haiti over the past week. There has been bottleneck at the airport in terms of receiving and distributing goods, due mainly to capacity, security, and communications issues. The provision of surgical services, food, water, shelter, and medical supplies has been mobilized as quickly as possible; nothing seems efficient enough, though, considering the sheer size and immediacy of the demand.

Dr. Evan Lyon, a Partners In Health clinician currently in Haiti, executive editor of Health and Human Rights: An International Journal, and co-founder of the OpenForum blog, shares his experiences on the ground in Haiti. His communications have been published on the Partners In Health website, and we share his latest update below.

Click here to read more of Dr. Lyon’s experience in Haiti.

Click here to hear the January 16 “Radio Rounds” interview with Dr. Lyon.

[Editor’s Note: The following note from Dr. Lyon is reposted from the Partners In Health website.]

01/19/2010

Dr. Evan Lyon has been on the ground working at the general hospital in Port-au-Prince since Saturday [January 16]. He’s working with a partnership between PIH and the Haitian Ministry of Health to coordinate restoring services at the hospital.

For many years, PIH’s sister organization Zanmi Lasante (“Partners In Health” in Haitian Creole) has been one of the largest and most attractive training sites for graduating medical students. The majority of our doctors and nurses, pharmacists, and lab technicians, have trained at the general hospital in Port-au-Prince, Hôpital de l’Université d’état d’Haiti (HUEH). Until less than a decade ago, all doctors trained in Haiti graduated from the national medical school and received training at the general hospital. Zanmi Lasante has been honored to host many of the top graduates of the national university in their first year out of medical training for a year of social service. Zanmi Lasante’s finest medical staff are among these graduates, who are now leading Partners in Health’s efforts to respond to the disaster.

The general hospital sustained massive damage; at least 50 percent of the campus cannot be used. Many buildings are destroyed. All are cracked. Only some are safe to work in. The adjacent nursing school was completely destroyed–we are working in its in the dusty shadow, where the bodies of many, many second year nursing students remain trapped in the rubble. It will be weeks or months until the rubble is cleared. The smell of death is everywhere. Many of the dead are our sisters and brothers in health, who had worked alongside us to relieve suffering.

Today we worked to get the university hospital on its feet again.  Dr. Lassegue, the hospital’s director, and his staff are leading efforts to care for the injured.  Partners In Health is working closely with the hospital to provide care and to help organize relief efforts from international aid agencies from around the world.  Surgeons had been operating with daylight and flashlights but electricity is now restored. Seven operating rooms are now performing surgeries.  An estimated 1000 patients have already been assessed and are awaiting surgery on the campus. People are lying on mats on the ground, in shade where it can be found, under sheets strung from the trees.

Inpatient wards are coming together. We hope to increase to ten operating rooms in the next 48 hours, with 24-hour service now that the electricity has been restored. The hospital must stand again.

As I left the hospital compound this evening, I saw the lights of a large front-end loader working near the morgue. Three dump trucks were at the ready. Where thousands upon thousands of bodies had lain just days ago, only 40-50 bodies remained. Swollen, alone, pushed to the side of the pavement slippery with blood and body fluids.

As I walked past the morgue and the largest pile of bodies, I noticed that one was wearing a Zanmi Lasante t-shirt. I cannot begin to understand why this small detail made a scene of unspeakable sadness even sadder.

- Evan Lyon

A number of international aid efforts have already been mobilized. The US government, the US Coast Guard, the US Agency for International Development (USAID), and Haitian communities in the US have organized a range of support efforts. International aid agencies such as Oxfam, the International Red Cross, the British Red Cross, and Médecins Sans Frontières, among other agencies, have also announced their emergency assistance support. Haiti has recently been able to operationalize its airport to receive resources.

Boston-based Partners in Health has worked on health and development in Haiti for over two decades, and the organization has set up an emergency field hospital and has sent out various communications about the tumultuous event. Executive Director Ophelia Dahl writes, “In an urgent email from Port-au-Prince, Louise Ivers, our clinical director in Haiti, appealed for assistance from her colleagues in the Central Plateau: ‘Port-au-Prince is devastated, lot of deaths. SOS. SOS… Temporary field hospital by us at UNDP needs supplies, pain meds, bandages. Please help us.’” You can help Partners in Health and earthquake victims by making a contribution, as explained on the PIH website.

The US State Department has set up the following number for US citizens seeking information about family members in Haiti: 1-888-407-4747.

For the latest developments in Haiti, see the following news and information web links:

PIH Updates

US Department of State

ReliefWeb

BBC News

CNN International

Al Jazeera’s The Americas Blog

USA Today

Oxfam

This appointment will complement Farmer’s already extensive involvement in Haiti. In 1983, Farmer was part of the group that started a community-based health project in Cange, a project that lead to the establishment of the Clinique Bon Sauveur in 1985 and the founding of Partners in Health (PIH) in 1987. As Deputy Special Envoy, Farmer will aid Clinton in his efforts to support social and economic development in Haiti.

In addition to his work with PIH, Farmer is also Chair of the Department of Global Health and Social Medicine at Harvard Medical School, Chief of the Division of Global Health Equity at Brigham and Women’s Hospital, and Editor-in-Chief of the FXB Center’s journal, Health and Human Rights.

Airborne: A Journey into the Challenges and Solutions to Stopping MDR-TB and XDR-TB is a powerful new book written by John Donnelly that features interviews and images to put a human face on the TB epidemic across the world. In her foreword, WHO Director-General Margaret Chan wrote, “I urge you to read the personal stories collected in AIRBORNE. These are human tragedies that should never have happened. But these are also stories about the uplifting success possible when the right elements are in place.”

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Australian Abortion-Aid Ban Lifted

A thirteen-year ban in Australia on providing foreign aid for abortions has been lifted and Australia will provide  funding of up to $15 million for reproductive health activities to help reduce maternal deaths across the world.

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$50 Million US Contribution to UNFPA

President Obama has recently signed legislation to provide $50 million to the United Nations Population Fund (UNFPA) to improve the health of women and children and reduce poverty throughout the world.

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US Capital Blighted by HIV/AIDS

The U.S. Capital has an HIV/AIDS rate on par with or worse than some African nations the city’s health department reports.

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US Urged to Fix Iraqi Refugee ‘Mess’ It Created

As the Iraq war enters its 7th year, the United States is urged to provide aid to Iraqi refugees displaced by the fighting.

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In Reversal, US to Engage with Human Rights Council

President Obama’s decision to become actively involved in the U.N. Human Rights Council raises hope that the administration will take a multilateral, human rights approach to international diplomacy.

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Living in a Sea of Mud and Drowning in Dread

Hurricane season has left Haitians to navigate mud-covered towns; without clear evacuation and reconstruction plans, Haitians fear an even worse situation this year.

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Chad: Fighting Violence Against Women — But How?

Violence against women is endemic in Chad, where in December dozens of women took part in a protest march against the legal gaps and cultural norms that allow for rampant domestic violence, sexual abuse, and underage marriages.

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In Iraq, A Story of Rape, Shame and ‘Honor Killing’

Killing of a pregnant rape victim by her brother reveals the terrible frequency of ‘honor killings’ in Iraq.

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Mentally Ill and in Immigration Limbo

Xiu Ping Jiang, an illegal immigrant from China, faces the harrowing choice of deportation  or detention in a facility where she has, allegedly, received inadequate care for her mental condition.

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Women’s Health Insurance Fairness Act

U.S. Senator John Kerry has introduced a bill that would prohibit health insurance companies from charging women higher premiums and from discriminating against women based on whether they are pregnant.

During four visits to Haiti, Farrell documented the plight of victims who faced blow after blow of hurricanes and tropical storms, on top of existing suffering in the poorest country in the Western hemisphere. His photographs helped raise international awareness of the damage wreaked by the storms and of Haitians’ struggle for survival.

Since the storms, agriculture has far from recovered, children are severely malnourished, and heavy deforestation will allow hurricanes to continue to devastate the poor nation, according to IPS. Although people are no longer lying dead in the streets, the world should not forget about Haiti.

To view Farrell’s moving photographs, click here.

More links below the fold.After Hurricanes, How To Heal Haiti – NPR, Mar 2009

‘We are going to disappear one day’ – Guardian, Nov 2008

“Haiti’s Unnatural Disaster”, interview with Dr. Paul Farmer – Haiti Action Committee, Sep 2008

In his opening remarks, Dr. Kim challenged the audience to extend their rights-based framework beyond just conceptual clarity and advocacy to the level of implementation, noting that “effective programs are needed to ensure the human right to health.”

Dr. Binagwaho took the stage first and spoke of how Rwanda’s history, and particularly the role of state-controlled radio stations in the genocide, had demonstrated that the right to information was critical to protecting individuals. The Rwandan government sees information and communication technology as a top priority, and is working tirelessly to increase internet access nationally and achieve the goal of one laptop per child. This priority was clearly illustrated by the topic of last week’s Compton Lecture given at the Massachusetts Institute of Technology by His Excellency Paul Kagame, President of the Republic of Rwanda entitled Imperative of Science and Technology in Accelerating African and Rwandan Development.

Dr. Binagwaho reflected on the irony of research done in developing countries that is never available to the study subjects, and she applauded efforts like PLoS Medicine and Health and Human Rights for working to promote access to a wider audience. In addition, she stressed the need for intellectual exchange. She saw these discussions as “necessary to make the best decisions.” Citing the example of GHDonline.org, she told of the value for herself and others in executive positions to bounce ideas off of each other (for example, should children of HIV-positive parents undergo mandatory testing?) and also the value gained by including field workers in the conversation. “People at the community level may not have the theories, but they have the knowledge,” she said. Finally, she outlined that the sum of these efforts, of fighting for access to health, information, and education, is to eliminate poverty.

Dr. Yamey focused on the need to change the way we look at medical publications. He pointed out that information is so expensive to access that patients, and many doctors and researchers, simply cannot afford to survey the literature and make fully informed decisions. “Only a tiny fraction of the intended audience can read a work. This paradigm is wrong — medical research should be a global public good.” The consequences of the current model are hazardous: often, doctors and patients are forced to rely on abstracts, which convey “dangerous half-truths.” Also, because researchers in the global south often have less access to literature than their counterparts in the north, a dynamic of inequality is introduced in their interactions. The world would benefit from a “knowledge commons,” which would better allow research and practice efforts to “build on the shoulders of giants.” Dr. Yamey was instrumental in getting the journal online in an open access format, and he applauded the journal’s new format.

Tracing the history of the human rights movement, Mr. Alston reflected that the discourse had been dominated by lawyers, resulting in a legal focus that often failed to garner enthusiasm or trust among social advocates. While the civil and political aspects are critical, Mr. Alston emphasized the need to link that with the right to health. He also challenged the journal not to let its focus waver from what he considered the ultimate task at hand: making the case for the right to health. “Until we confront the right of every individual to health and health care, then we are not looking at the central concern, and we are failing to achieve our objectives.” Changing the political dynamics and infusing society with a sense of moral outrage about violations of the right to health were objectives that he also lay out for the human rights community.

Dr. Farmer described his relationship with human rights as a “voyage,” and credited Haiti for being his greatest teacher. It was in conversations with his Haitian friends and colleagues almost 20 years ago that he saw a divergence between the goals and values of the academic community and those who did not enjoy their basic human rights. He observed “the limited faith of the poor in the non-poor’s promise to protect their interests, including health, housing, and food.” This rift, along with others between legal frameworks and social advocates as outlined by Mr. Alston, needs mending and harmonization. Citing an example of Russian prisons fighting TB epidemics and outcries that prisoners were starving to death, he said that “it is of utmost importance to get the diagnosis right in human rights. It determines whether we apply the right treatment.” His hope for the journal is that it will bring the discourses together in an “honest way,” and he was excited about the new format, adding, “The internet provides an opportunity to push through an agenda that is pro-poor.”

A reception in honor of Dr. Jonathan Mann, founder of the journal, concluded the event. Two of his children, along with Drs. Kim and Farmer, both of whom knew Dr. Mann very well as an early supporter of Partners In Health, shared some of their memories and told of his influence on their lives and that of many more, adding that he would be thrilled with the new direction the journal is taking.