Partners In Health: History, Human Rights, and Haiti November 13, 2008

1. Partners In Health: History, Human Rights, and HaitiNovember 13, 2008 Evan Lyon, MD Partners in Health / Zanmi Lasante Department of Social Medicine and Health InequalitiesBrigham and Women’s Hospital

10. Why Haiti? • French colony of Sainte Domingue was the most productive colony in the New World. • Two-thirds of France’s overseas trade. • More than 50 percent of the world’s sugar. • Haitian Revolution of 1804. • Only successful slave revolt in history. • Roots of Haiti’s poverty begin here.

11. Debts Owed - I • French naval blockade 1833, demanding reparations for war to allow diplomatic and financial ties with France. • Haiti borrows money to pay this “debt.” Paid until early 20th century. • France – as the banker – demanded their terms for economic development. Largely export production. • The world’s first example of neocolonial debt and structural adjustment. • The U.S. became the leading trading partner with Haiti through the 19th centrury, but the U.S. did not – could not – recognize Haiti as a nation until 1865.

12. Human Rights in One Slide • Rights afforded to individual human beings / citizens. • States / governments are responsible to citizens for maintaining, protecting, and encouraging rights. • Civil and Political Rights – voting, freedom from violence or slavery, freedom to organize, a fair and transparent justice system, habius corpus, etc. • Economic, Social, and Cultural Rights – health, housing, food, water, language and culture protection, environmental rights, etc. • To date, civil and political rights have been more central to human rights discourse and activism than economic, social, and cultural rights – but this is changing! • Lowndes County, Alabama.

13. The U.S. and global Human Rights • The U.S. is arguably the greatest perpetrator of human rights abuses in the world. • Even if one does not accept the U.S. is a leader in this shameful category, as residents of this nation the government is responsible to us and we are responsible to it. • “I love America more than any country in this world, and, exactly for this reason, I insist on the right to criticize her perpetually.” James Baldwin, Notes of a Native Son, 1955

14. U.S. Imperialism • The United States has been an imperial nation since its founding. “Salt water fallacy.” • Benjamin Franklin: 25 years prior to our Revolution, complained the Britain was imposing limits on U.S. expansion. • George Washington: the U.S. was founded as a nascent empire. • Thomas Jefferson: “We shall drive them, the savages, with the beasts of the forests into the stony mountains and the country will ultimately be free of blot or mixture.” • Haiti invaded in 1915 in the context of U.S. hemispheric control at time of WWI. Puerto Rico (1898), Cuba (1899), El Salvador, Honduras, Panama, Columbia, Philippines, Pakistan, Afghanistan, Iraq, next?

15. Bush Doctrine • Not a new idea. • John Lewis Gaddis, Yale Professor of Military History ties directly to John Quincy Adams. As secretary of state, Adams praised Andrew Jackson’s 1817 invasion of Florida to conquer from the Spanish. • Adams advocated preemptive war, assuming expansion is the path to security. Florida’s threat was “runaway slaves and lawless Indians.” • This was the first “executive war” bypassing Congress and the Constitution. A pattern that’s still followed. • Still pushing outward.

16. Debts Owed - II • 1915-1934: U.S. Military Occupation. • 1934-1954: U.S.-backed elite governments. • 1954-1986: U.S.-backed Duvalier family dictatorship. • January 1, 2004 was the Bicentennial. Haiti “celebrated” 200 years of economic isolation and exploitation. • The hated and feared Black Republic. • The U.S., France, Britain sent no official representation to the bicentennial celebration.

28. HIV Prevention and Treatment: Expansion and Integration into Primary Health Care

29. Before and After • 4 pillars / primary health infrastructure in place. • This meant a working pharmacy with 30 essential meds plus about 100 other regularly stocked medicines. • Inpatient capacity – staff, supplies, and materials. • Laboratory – HIV testing, TB microscopy, RPR testing, manual hematology, several basic chemistries. • Radiology. • Comprehensive coverage of communities with Community Health Workers (CHWs) and DOT workers. • Systematic Community Health Education – HIV focused. • 250-300 patient visits per day. • Improved access to “tertiary” care.

30. PMTCT / PTME

31. HIV Equity Initiative Now • 9 clinical sites, each with inpatient capacity. • Seeing on average > 1500 patients per day. • Approximately 20,000 HIV serologic tests per quarter. • 3 functioning and staffed ORs. 300+ Hospital beds total. • Over 4000 patients on HAART triple therapy with twice a day DOT. • Expansion of primary health care services throughout the Central Plateau. • Unique stability during political chaos. • We have never closed our doors!

32. Ajan Sante, Ajan Fanm and Accompagnateurs • Community Health workers • Since 1985. • One CHW for every community. Responsible for referrals, vaccines, hygiene, maternal and infant health. Some DOT. • 3 month intensive training plus ongoing training at ZL • Accompagnateurs • The “missing infrastructure” in resource poor settings. • 100 percent DOT coverage for TB and HIV patients. • All are paid employees.

39. Carter Doctrine and the Iraq War • Access to oil under the middle east is a vital U.S. security interest. • We reserve the right to protect this interest, with military action if necessary. • One root of the Iraq war. Perhaps the most important. • Unilateral invasion, likely more than 1 million Iraqis dead, devastation of human and physical health infrastructures, 4+ million displaced, total cash cost approaching 1000 billion dollars, likely long-term cost > 2 trillion. • The U.S. has affirmed the use of torture, rendition, extrajudicial detention, suspension of habius corpus, and continuing threats of pre-emptive war.

40. Disaster Capitalism, Naomi Klein • War and humanitarian work is becoming privatized. • Blackwater and other civilian contractors in Iraq work completely outside the law. Accountable to no one. How can rights be assured in this setting? • Security, separate electric grid, functioning hospital, phone and sanitation system in Baghdad’s Green Zone. • Parsons, Bechtel, Blackwater, CH2M took no bid contracts for 3.4 billion in post-Katrina period. • “…the compassionate federal impulse to provide emergency assistance to the victims of disasters affects the market’s approach to managing its exposure to risk.” Neglected Defense: Mobilizing the Private Sector to Support Homeland Security. 2006, Council on Foreign Relations

41. Health and Human Rightswww.hhrjournal.org

42. Ongoing Challenges…

46. Goals