How a Boston Health Charity is Responding to Haiti: An Interview With the Organization’s Co-Founder

Paul Farmer has been working in Haiti since the 1980s, helping to strengthen rural communities’ ability to provide health care.

The nonprofit group he co-founded, Partners in Health, employed nearly 5,000 Haitians before last month’s earthquake, making it one of the largest providers of medical assistance in the island nation.

Immediately following the disaster, Partners in Health and its Haitian sister organization, Zanmi Lasante, set up mobile clinics and began to treat earthquake victims at the main hospital in Port-au-Prince. The group has also been helping thousands of Haitians who have left Port-au-Prince for the rural areas where it works, a migration that is expected to continue.

The organization has raised more than $56-million so far to help with its work in Haiti. That is a huge sum given that the charity expected to raise $64-million this year for its work in 11 nations.

In an e-mail exchange with The Chronicle, Dr. Farmer, a doctor and Harvard University professor, discussed how the disaster is affecting Partners in Health’s work in Haiti and other places it operates. Following are his answers; to read more about his group, see this article from The Chronicle’s February 25 issue.

How will the work of your organization have to change or expand to respond to the needs created by the earthquake?

A lot of philanthropies, community-based organizations, and service organizations pride themselves on partnership models. That’s what we have tried to establish over the last 25 years, first in Haiti, afterwards elsewhere in Latin America, in Africa, in the former Soviet Union (Russia and Kazakhstan), and, of course, in the U.S. But partnership models are hard to do unless the local organizations direct their own destinies.

So it’s not “my” organization by any stretch of the imagination. What is happening right now is that PIH and its sister organization in Haiti, Zanmi Lasante, are doing some soul-searching about how to respond to a cataclysmic event that has shaken and brought down much of the health-care infrastructure.

So what is our collective responsibility to respond to the quake? The questions we are looking at right now include, for example:

• How to have a national presence when our strengths have been as regional, district-level and village-level providers.

• What areas should we expand into?

• Should we continue to try to build back better, as we’ve been doing, in the Central Plateau and Artibonite Valley?

• Should we build a teaching hospital?

• Provide services in informal squatter settlements, like the 500 that have blossomed since the earthquake?

• Should we focus on building a major new medical center in central Haiti to take the pressure of the ones that were destroyed in Port-au-Prince?

• Should we strengthen our partnership so that we are not trying to be experts in agriculture, education, job creation, etc?

These are the things we’ve been thinking about for the past few years, and the urgency has been intensified by the quake.

Perhaps the most important thing is to link our work on the ground with a feedback loop of research and teaching that would allow us to improve the quality of our services, regardless of where or what they might be.

Having said that about the collective struggle to make these decisions, the greatest satisfaction always comes from saying “Yes, we should do these things.”

Partners in Health has already received more than $56-million in donations for Haiti, a big percentage of its annual budget. What are your plans for ensuring the outpouring of generosity is spent most effectively?

I suspect that the great majority of this welcome influx has been for Haiti. PIH works in 11 countries, not one, and one of the most satisfying things for me personally has been seeing the way our colleagues in Rwanda, Lesotho, Peru, have responded to the disaster that has befallen the team in Haiti. The majority of our staff are community health workers who don’t make much money themselves, and they have raised significant amounts to send to their colleagues. This is the sort of pragmatic solidarity that’s required.

The influx of money for Haiti needs to be spent wisely in Haiti: creating jobs, improving infrastructure. We will keep listening to what people need, and we will spend the new funding the way we have always spent funding: on job creation, transferring resources from rich to poor, ensuring that basic social and economic rights—health care, food security, water, education, shelter—are met.

What are the most important things that donors and charities need to do now to ensure that Haiti recovers?

We need to work with and through and for the Haitian majority and the leaders they’ve elected.

Looking back over philanthropy over the last 100 years, I think donors—especially institutional donors—have a long way to go to improve their performance too.

First of all, the desires of the donors should not dictate what a project looks like: the needs of the people to be served should determine the outline of a project.

A self-critical reflection on how philanthropy works—and doesn’t—is an important exercise. Donors, broadly conceived, have poured resources into Haiti over the past few decades, often to little avail. The default is to blame the Haitians, and Haitian culture—might there not be something wrong with the way we’re doing it?

Could the focus on Haiti divert attention and resources from your work in other countries?

If you’re asking me personally, the answer is “of course.” It’s hard to concentrate on anything else right now. It’s all Haiti all the time; I am totally distracted from everything else I’ve ever worked on.

If you’re asking whether PIH’s focus will be diverted, the answer is both yes and no.

Everyone in our organization has pitched in, often in quite remarkable ways, to support the work in Haiti. That includes our colleagues from Rwanda, Lesotho, and Peru. Many know that the best way they can support the effort in Haiti is to keep the other programs thriving. And the current situation in Haiti illustrates perfectly the great need for an integrated system of service delivery, teaching and research—across all our countries.