Adding up the 10 to 20 plane fares of a visiting spring-break crew . . . let’s say conservatively at least $500 each, totaling $5,000 to $10,000 . . . and throwing in the cost of their matching T-shirts (or in one case, fleeces, though I’ve never experienced a temperature below 80 in Haiti—fleeces?) . . . let’s say $40 each for another $400 to $800, the total amount could probably feed or provide medicine to a community for months, pay a schoolteacher’s salary for a year, or provide loans for several local groups to start businesses. And that would be with the money from just one week of one program’s flights and shirts.
But people want to go, to see, to experience. Bearing witness to poverty and suffering in Haiti and showing Haitians their solidarity could have positive effects beyond what can be measured or achieved through anonymous donations. And perhaps seeing firsthand how people live in Haiti inspires volunteers to open their hearts (and wallets) and encourage others to do the same in ways that reading about Haiti in a book or news story cannot. But did these volunteer groups really see Haiti? Or did their hosting organizations show them a sugarcoated version, with performances by locals, intended to show how well their projects were functioning?
When I find myself being critical, I try to turn the same critique on myself to see if I am equally guilty of what I find myself criticizing in others. Seeing the extreme poverty of Haiti, and being only a neurologist, I sometimes feel I have little to offer. I hope my work will allow local doctors to take better care of their patients with neurologic diseases, but whether there is neurologic care in Haiti or not, Haiti will likely remain poor and politically unstable for the foreseeable future, with the majority of its citizens trapped in vicious cycles of poverty.
Of course I’m not trained to solve Haiti’s economic, political, or social problems. I’m trained as a neurologist. If I can use my neurology training to the benefit of a few individuals while not causing any harm, and if I can work toward developing local capacity in neurology, perhaps I will accomplish some small good. Or should I be donating my plane fare to PIH instead of going to Haiti?
I was thinking about all of this as I boarded the plane and took my seat, which turned out to be next to Jack the plumber. In his late sixties, sporting a white handlebar mustache and a white ponytail, Jack had been coming to Haiti from Massachusetts for decades, supervising the plumbing construction and maintenance of nearly all the hospitals in the PIH/ZL network in Haiti. I often ran into him in the staff house at HUM, where we had enjoyed many dinner conversations.
“Fancy meeting you here, Aaron,” he said with a smirk.
“Was about to make the same joke, Jack,” I replied. “So what do you make of all these voluntourists with their matching Haiti T-shirts?” I smiled sarcastically. “What can a bunch of spring-break kids do down here anyway, right?”
I expected him to laugh and join in my critique. But he didn’t. “You know what they can do, Aaron?” he said calmly but sternly. “They can haul buckets of concrete. They can dig a well or a latrine. I’ve seen it time and time again on project sites here. And many of them support the local economy, buying trinkets made by women in the villages and staying in Haitian hotels.”
“Hmm,” I said. Clearly I had been overly judgmental and critical without thinking through some of the potential positives. I took solace in the fact that I’d tried to be equally critical of myself.
“And you know what?” he continued. “A lot of them keep coming back. One of our best facilities engineers at HUM got hooked on Haiti after a high school mission trip way back, and now he works here most of the year.”
“I didn’t think about it that way,” I conceded.
“Look, I know some of these organizations are just making a buck on a few tourists thinking they did something in Haiti when they really just goofed off and drank Prestige and Barbancourt,” he said and chuckled, citing Haiti’s local beer and rum brands. “But the big organizations are not beyond reproach. Did you ever read Travesty in Haiti?”
“I have it, but I haven’t read it yet,” I said. “I know the gist, though.” The book is an exposé of corruption in the aid industry in Haiti—its subtitle is A True Account of Christian Missions, Orphanages, Fraud, Food Aid, and Drug Trafficking. “You’re making me rethink this.” I smiled at him.
“The doctors and nurses who come down here always say stuff like that,” he said, smiling back. “I get it. But you know what I say? I say before we criticize the people who actually come down here to try to help, we should criticize the people who don’t.”
5
Applying for a visa requires a passport. Janel didn’t have one. Applying for a passport requires some form of identification. Janel didn’t have that either. Not even a birth certificate. As Martineau put it, Janel was so poor he had no proof that he existed.
Haiti is the poorest country in the Western Hemisphere, a distinction noted so frequently when Haiti is mentioned in the press that “the poorest country in the Western Hemisphere” has been referred to as Haiti’s last name. But what does it actually mean to be the poorest country in a hemisphere? By the numbers, Haiti’s GDP per capita—its national income divided by its number of citizens—is only $766 per person per year. That’s about $2 per person per day. For comparison, the US GDP per capita is about $60,000 per person per year—about $164 per person per day—more than eighty times higher. But Haiti’s GDP is not evenly distributed across its population. There are a few who are very rich and the vast majority is very poor. Being born in Haiti means an average life expectancy of sixty-four years, sixteen years shorter than the US average, even though the distance from Haiti to Miami is just half the distance from Miami to New York.
As tragic as these numbers are, they don’t capture the human face of this poverty, faces like Janel’s that become anonymous in these statistics. No passport means no visa. No birth certificate means no passport. And where do you stand in society if you can’t even prove that you were born?
After Martineau first met Janel and saw his CT scan, he thought nothing could be done for him—certainly nothing in Haiti. When I told Martineau that not only was treatment possible but we had figured out how to get it for free in the US, he was determined to do whatever it took to get Janel a passport. But Martineau knew all too well how hard it was to navigate the bureaucracy required to obtain a passport in Haiti. He had recently missed the chance to go to a conference in the US because he wasn’t able to get his own passport issued in time. It hadn’t been for a lack of trying.
“In Haiti, everything you do, you need a paren,” Martineau told me. “A paren literally means ‘godfather’ or ‘godmother,’ but it can also mean someone who is there to advocate for you—whether you need to buy a ticket at the airport, find a good school for your child, or even get the certificate that says you exist in this country. You can’t do it without a paren. It’s the Haitian reality.”
It took months for Martineau to get a passport with his national identity card—not to mention his education, his position in society as a doctor, and his car to go back and forth to the immigration office. How would he even start the process for Janel if Janel had no form of identification?