Rebuilding Haiti, Better Than Before

Guests

Dr. Joia Mukherjee, chief medical officer, Partners in Health
James Gordon, director, The Center for Mind-Body Medicine
Jose Andres, James Beard award-winning chef

Some aid groups in Haiti continue to provide immediate assistance — food, water and shelter. But many others are focused on long-term goals: rebuilding infrastructure and systems, supporting local farmers and meeting the demand for Haitian medical and mental health professionals.

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NEAL CONAN, host:

This is TALK OF THE NATION. Im Neal Conan in Washington.

Nine months after a catastrophic earthquake leveled much of Port-au-Prince, hundreds of thousands of Haitians still remain homeless, rubble still litters many neighborhoods, and now the country is grappling with its first cholera outbreak in decades, centered of the coastal city of Saint-Marc, 40 miles north of the capital.

Many aid groups continue to provide essentials: food, water, shelter, medical care. Others, though, focus on the long haul and work to rebuild systems to support local farmers or develop schools to help meet the demand for medical and mental health professionals.

If you've been to Haiti recently, did you see progress? Can Port-au-Prince be rebuilt better? 800-989-8255. Email us, talk@npr.org. You can also join the conversation on our website. Thats at npr.org. Click on TALK OF THE NATION.

Later in the program, Ask Amy's Amy Dickenson on productive ways to ask for an apology. If you've tried to solicit an I'm sorry, did it work, or are you still waiting? Email us your story, that's talk@npr.org.

But first, rebuilding Haiti, and we begin with Joia Mukherjee, chief medical officer for the group Partners in Health, also a professor with Harvard Medical School. She joins us now from member station WBUR in Boston. And Dr. Mukherjee, thanks very much for being on TALK OF THE NATION today.

Dr. JOIA MUKHERJEE (Harvard Medical School): You're welcome, Neal. Thanks for having me.

CONAN: And I know you've been coordinating Partner in Health's response to the cholera outbreak. Any signs that the illness is spreading into Port-au-Prince?

Dr. MUKHERJEE: No, we've been quite fortunate so far. I think there have been a few cases in Port-au-Prince, but we haven't seen spread within Port-au-Prince as of yet.

The coordination, I just want to make it clear, that is going on, on the ground by our Haitian team. I'm sort of helping to support what they need, but they have just done amazing work in reaching out to communities to prevent the spread even within our own catchment area of Saint-Marc and prevent the spread elsewhere in Haiti.

CONAN: And I'm told that cholera, though once you've got is quite terrible and easily spread, on the other hand is fairly also easily treated and prevented.

Dr. MUKHERJEE: Yeah, very easy to treat. All you do is rehydrate someone. You sometimes may use antibiotics, but it's not the mainstay of treatment. The mainstay is just making sure people don't die of dehydration.

The difficulty is it is a rapidly dehydrating, diarrheal disease, so much quicker than the other forms of diarrhea we commonly see in Haiti and elsewhere.

Prevention is soap, water, purifying, you know, water with chlorine tablets. I mean, it's fairly straightforward. But getting to all of the areas where people live is the big challenges, delivering those messages and the tools for prevention.

CONAN: Now, Partners in Health has been in Haiti providing services for two decades, including responses to crises like this cholera outbreak. But I wonder, has the earthquake provided an opportunity to help rebuild a more robust health system for the future?

Dr. MUKHERJEE: Not yet, Neal, and I hope that it will. I mean, we are, ourselves, working closely with the Ministry of Health to build a very large, state-of-the-art teaching hospital in central Haiti. But the medical school, the university hospital, the nursing school - all of those remain nearly incapacitated, if not totally incapacitated.

The facilities throughout Haiti are really under-funded, understaffed. We're very fortunate that we have been working for so long that the 10 facilities where we work in Haiti, we have staff, we have supplies. I'm very proud to report that we've not had a single stock-out since the beginning of this epidemic, and yet it's our warehouse, jointly operated between Partners in Health and the ministry, that's supplying all of the affected areas in Haiti.

So I think, you know, we know how to rebuilt systems, but that money has not been flowing reliably into Haiti as of yet. It has been pledged, but we have not seen a lot of movement for it on rebuilding or building the health infrastructure of Haiti.

CONAN: Where were those pledges from, other countries, including the United States?

Dr. MUKHERJEE: Yes, and I think it's it behooves all of us who care about global poverty, and Haiti in particular, to really track that money and say who's pledged what. And, you know, some of it is now posted on the website of the Office of the Special Envoy of the U.N., who's pledged what.

But it's a very small amount of money that's actually gone to Haiti and even a smaller amount that's gone to the government of Haiti, who is actually charged with providing the majority of public services, obviously.

CONAN: And if the, well, inadequate facilities that were there have now been destroyed and are not up and running, clearly this is going to be a continuing problem for years ahead, until they are up and running.

Dr. MUKHERJEE: Absolutely, absolutely. And we believe that there are really two discrete but interconnected aspects to this that need to be simultaneously done.

One is to develop a robust public system because that's the only system that will get as far as Haitians are living, where they are, you know, villages, towns.

And the second is really to mobilize the community to be agents of health. And we believe that paying people to do that work is also a way of giving employment and improving the economy. And the service sector can be a robust engine for economic development, as well.

And so another thing that's really been remarkable to me during this cholera outbreak, and again, this is I just got off the phone with our director of the program in the Artibonite at Saint-Marc, in Saint-Marc, Dr. Patrick Almazor, and he has told me that none of our HIV-infected patients have gotten cholera.

And that is because they're getting excellent community-based care. They have people that are working with them at the home level. They're giving them messages of general health and hygiene, helping them with water and food security.

Similarly, the kids that we're taking care of in our malnutrition program, none of those kids have gotten cholera. So these are groups that in general we would consider quite vulnerable to contracting cholera and dying from cholera, and yet in these two very vulnerable groups, we have had adequate prevention even without the additional effort we've put in, just because our community-based system works.

CONAN: We're asking those of you who have been to Haiti recently to call us and tell us: Have you seen progress? 800-989-8255. Email talk@npr.org. Dominic's(ph) on the line, calling from St. Louis.

DOMINIC (Caller): Yes, hi, how are you?

CONAN: Good, thanks.

DOMINIC: My brother's been to Haiti twice, recently. He went in March, after the earthquake, and he just got back last month. So I was asking him about how did it go. And he said, well, Haiti looks - Port-au-Prince look like, as if the earthquake just had happened in July.

I mean, nothing has changed from when he left. To him, he hasn't seen any changes from March, when he was there, to last month.

CONAN: Dr. Mukherjee, I know you've been there recently. What do you see?

Dr. MUKHERJEE: I agree with Dominic's brother. There's not a lot of forward movement. There's still a lot of rubble that hasn't been cleared. There are still huge numbers, hundreds of thousands of displaced people living in absolute squalor.

And I think again, you know, hopefully if there is one small, positive thing that can come from this epidemic I hate to even, you know, sort of conflate positivity with such a terrible thing, but it will be refocusing people's attention on the living conditions in Haiti and to say yes, there was an outpouring of support and sympathy, but where is that money, and let's figure out a real tracking system with real accountability both for governments that pledge the money but for NGOs that have received the money, as well. I don't see massive changes since January 12.

CONAN: Dominic, thanks very much for the call.

And finally, Dr. Mukherjee, a lot of people, as you say, transparent systems would make people more confident. You work with the Ministry of Health and have for a long time. Are they reliable partners? Does money vanish?

Dr. MUKHERJEE: Sure, they are reliable partners, and sure, money vanished. I think if if the crisis on Wall Street taught us anything, it should be that where there is money, there is corruption and that third-world governments don't have a lock on corruption, nor do governments have a lock on corruption, that the reason we are able to prevent corruption in most wealthier countries more easily than poor countries is because we put money into systems.

And once systems and regulation starts to fall apart, then corruption will occur, or corruption will become rampant. And so the government of Haiti is a very at least in the Ministry of Health very reliable partners we have.

But they need help - just as much as they need help with medicines and protocols, they need help with the systems of accounting and reporting. And they've asked for our help and been very open about, you know, us accompanying them as, you know, the government doing it, but we can help develop systems, we can help with accounting.

The I'm an AIDS doctor. If I went to central Haiti and dumped a bunch of anti-retrovirals in a town, I wouldn't be doing my job. My job is to help design systems and train people how to use those systems. And I think we should look at foreign aid that way.

Rather than just say governments are corrupt, say governments have inadequate regulation and systems, and let's help them both get the money and manage the money.

And I think we can do that, and we've done that successful for many years in Haiti. We're doing it in Rwanda and Lesotho and elsewhere.

CONAN: Dr. Mukherjee, thanks very much, and good luck you.

Dr. MUKHERJEE: You're welcome. Thank you, Neal.

CONAN: Dr. Joia Mukherjee, chief medical officer for the international nonprofit Partners in Health, joined us today from member station WBUR in Boston.

In the aftermath of disaster, meeting people's physical medical needs is often the highest priority. Tragedies, though, can take a tremendous emotional toll that lasts long after rebuilding is underway.

We turn now to Dr. James Gordon, founder and director of the Center for Mind-Body Medicine, which has worked with trauma survivors on the U.S. Gulf Coast, in Kosovo and in Gaza, and he joins us now by phone from San Diego. And Dr. Gordon, nice to have you back on TALK OF THE NATION.

Dr. JAMES GORDON (Founder, Director, Center for Mind-Body Medicine): Good. It's nice to be here, Neal.

CONAN: You were last with us in March and anticipated a growing need for mental health support for quake survivors. Have you seen the need, and have you seen the need met?

Dr. GORDON: Well, the need has not yet been met. The need has become clear to everybody. We at the Center for Mind-Body Medicine are working with every major health and mental health organization in Haiti, including the Ministry of Health and Partners in Health and the Catholic Church and the medical school and the nursing school and the general hospital.

And everyone says, although there are the short-term needs, the direct, medical needs - of course, cholera being the most striking example right now - but the long-term need that everyone agrees is likely to be paramount is the psychological need.

And there really, there weren't before the earthquake, and there certainly aren't after the earthquake, the kind of organized services or organized response that's needed.

And so we are in Haiti to train people to provide the kind of primary mental health care that's needed for the whole population.

CONAN: And do you have a facility to do that?

Dr. GORDON: Well, we have funds to begin, and we have funds from one of my board members. Donald de Laski has funded the first effort, which will train 120 leaders from those major organizations.

And we're working and everybody has been so responsive. That's quite because they all recognize the need, the long-term goal of training 1,500 people and creating a network of healing throughout Haiti, we need considerably more support to do. We're ready to do it. It's what we have done in Gaza.

CONAN: Dr. Gordon, hang with us. We're going to take a short break. And those of you who have been to Haiti recently, give us a call, report on what you've seen and experienced there. Has there been measurable progress? 800-989-8255. Email us, talk@npr.org. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION from NPR News. Im Neal Conan in Washington.

The cholera epidemic in Haiti appears to have stabilized, for now. Health care workers are watching the situation closely. More than 300 people are reported dead.

Still, more than a million people now live in camps around Haiti. January's earthquake destroyed more than 100,000 homes and apartment buildings. Rebuilding is slow, where it's begun at all.

We're talking today about building a better Haiti. If you've been there recently, did you see progress? Can Port-au-Prince be rebuilt better? 800-989-8255. Email us, talk@npr.org. You can also join the conversation on our website. Thats at npr.org. Click on TALK OF THE NATION.

Right now we're talking with James Gordon, a psychiatrist and founder and director of the Center for Mind-Body Medicine. Just before the break, you were talking about training - setting up a facility, and there's money for it, to train a cohort of new mental health professionals. It's significant, it's a start, but it also seems like a drop in the bucket.

Dr. GORDON: Well, it's you know, one of the things that's so striking is that everybody is so on edge in Haiti. I think we saw little glimpses of it with the response to trying to establish clinics for cholera, that the anger and the is just under the surface, not on the sense - terrible sense of loss.

When I was down there a month or two ago and did some workshops, one of the things that virtually everyone in the workshop said is: I'm so irritable. I get angry so much more easily than before.

So everyone recognizes that the anger, the sadness and there's been no opportunity for most people to express what's going on inside. So we create groups for the helpers, both the professional helpers and also the leaders in the community, priests and nuns and voodoo healers, leaders of women's groups, as well as doctors and nurses.

And they express what's inside, often for the first time, and then they learn very simple we teach them very simple techniques: to relax, to quiet themselves down, to access their imagination and their intuition so they can solve or at least take a more positive look at these incredibly difficult problems that everyone is facing.

CONAN: here's an email we have from Mary Lou(ph) in New London, Ohio: I just returned from Haiti this past Sunday. I was part of a team representing the Ohio State University's Haiti Empowerment Project.

Our team conducted professional development seminars for the teachers of five tent communities and two other schools. Three of them also taught three days at a Port-au-Prince university. This was my first trip, and my emotions ranged from despair to hopefulness.

And also on the line with us is Mark(ph), and Mark's calling us from Charlotte.

MARK (Caller): Yes, I recently returned. I'm actually going back tomorrow. But, you know, as far as progress, there isn't any progress. I mean, when you go to Port-au-Prince, you just see the people and the rubble, and all the tent cities. There's trafficking in children.

There you know, there was a lot of funds collected for Haiti or designated that just hasn't happened. Even the American Red Cross, as recently, said that only 25 percent of what they received for donations Haiti has actually gone to Haiti.

CONAN: And what are you doing there in Haiti, Mark?

MARK: We're building a school up near Cap-Haitien.

CONAN: And is it going ahead? Do you have money for that?

MARK: Yes, thanks, thanks to the lord we have a generous donor that's helping us. But it's with a group called Hands for Haiti, and we're trying to build schools. But there's so many children. Half the children never get to go to school.

CONAN: And Mark, good luck to you. Thanks very much for the call.

MARK: All right, thank you.

CONAN: Bye-bye.

Dr. GORDON: Neal, what the email was saying, and also a little bit of what Mark was saying, is so familiar if you're in Haiti. At times there is this feeling of being so overwhelmed and so despairing, as so many people are.

At the same time, when people come together, and when they can have something they can work on - whether it's building a school or developing skills for mental health or doing the kind of work that Partners in Health is doing out in the countryside - that changes the atmosphere.

I think one of the most devastating problems is people feeling that there's no way for them to participate in the massive and creative change that's necessary. As we give people that opportunity, what I've observed is if they respond, then that helps them to shift how they feel, as well.

CONAN: It's also if you can start to see progress, would not morale improve? You know, a little rubble is removed, doesn't that help?

Dr. GORDON: Yes, of course it does. And there's so much more to be done. I think one of the things that really needs to be and this is not my area of expertise, but it's clear that more attention needs to be paid to mobilizing people to do all of these practical tasks.

We're doing that in the area of psychological self-care and mutual help. But it needs to be one with removing the rubble, with building houses, with, you know, restoring the educational system. Every step of the way, these projects have to be undertaken.

And there are many, many people of good will, and I think that we need to really appreciate all the goodwill that's being shown. And all of us I was just talking with Quincy Jones, the composer and arranger.

CONAN: Sure.

Dr. GORDON: We're saying, you know, we've got to work together. He's working on creating a music school. We're working psychologically. These efforts have to come together.

CONAN: Dr. Gordon, we wish you the best of luck. Thanks very much for your time today.

Dr. GORDON: Thanks so much, Neal. It's great to be here and great you're doing the show.

CONAN: Dr. James Gordon joined us by phone from San Diego, founder and director of the Center for Mind-Body Medicine, author of "Unstuck: Your Guide to the Seven-Stage Journey Out of Depression."

Joining us here in Studio 3A is Jose Andres. He's a James Beard award-winning chef and co-owner of a number of restaurants in the Washington, D.C., area and in Los Angeles. He also hosts the PBS television series "Made in Spain." Thanks very much for being with us today.

Mr. JOSE ANDRES (Chef; Host, "Made in Spain"): Very happy to be with you.

CONAN: And you were in Haiti. What does a chef bring to Haiti?

Mr. ANDRES: That's what I was asking myself. But they were so happy I took the decision of going. A year and a half ago, a friend of mine gave me a solar kitchen.

CONAN: A solar-powered kitchen?

Mr. ANDRES: Cook stove, only used in the sun. And we were in the middle of a snowstorm in Bethesda. The power went off, and after the snowstorm, I put the cook stove, with my daughters, and we began cooking. Minus-five Celsius degrees, and we were cooking.

Reading about what happened in Haiti, knowing all the issues they were having using charcoal, 98 percent of the country total deforestation.

CONAN: Yeah, there's very few trees left.

Mr. ANDRES: I pick up the phone, and I call my friend, the one that gave me the solar kitchen, and I told him: how soon can you go to Haiti with me?

And in less than three weeks, we took 20 solar kitchens with us, and we went to Port-au-Prince, and I stayed there close to 11, 12 days. And I didn't go to help; I went to learn. I was very selfish. I went to try to learn if these solar kitchens could be, somehow, the solution to the future of a huge problem. And I came back, and I learned that they can be part of the solution.

CONAN: Obviously, trees in Haiti, as you said, most of them have been cut down for fuel. They also, the lack of the deforestation contributes to the erosion problem because the trees are not there to soak up the water and hold the soil in place.

So obviously, 20 cook stoves, anything helps, but there's lots more to do.

Mr. ANDRES: We need so much more to do. I'm about to go on Monday. I'm going six more days, because I already we identified already an orphanage. We are trying only to start feeding 1,000 kids to begin, because I need the home to start proving that using these solar ovens can be the solution for Haiti.

So take a look at the issue. The mothers, that they are cooking, sometimes with their children right on their backs, using charcoal, all the fumes coming up in their lungs.

CONAN: Sure. We just heard from the U.N. session a few weeks ago about the dangers of dirty cook stoves that contribute to all kinds of diseases.

Mr. ANDRES: On top of that, I spent - I went to a beautiful village in the frontier with the Dominican Republic called Fonbarette(ph), beautiful. It looks almost like paradise if you look at the mountains, at the skyline.

But then you see what happens, and these guys, the young kids, they spend half of their days looking for wood or going two, three hours away to bring one gallon of water back to their home. The only thing they do all day is to provide for the family's water, or in this case some wood, used to make a fire to being able to cook.

Imagine for a second that we are able to start providing cook stoves that use the sun. All of a sudden, these people have time in their hands to do something else, to start helping to be a part of the solution, rebuilding, to start going hopefully to schools, et cetera, et cetera. That's why these solar cook stoves, this clean energy, should be part of the future not only for Haiti but for any other country's needs around the round.

CONAN: And did try out some of the 20 you brought down last time? Did they work well?

Mr. ANDRES: We tried many. The difficulty is to convince people that the need to stop using charcoal. Even you and I, we will have a hard time saying that we have to be feeding our families with this kind of UFO-look-alike kitchen.

(Soundbite of laughter)

Mr. ANDRES: So the issue here is to start having a place that can have 20, 30, 40 of these kitchens up and running every day in a very efficient way to feed people. So I've been doing a lot of things, like, for example, partnering with Dr. Muhammad Yunus, the Nobel Prize 2006, where he's behind social business. You know one problem in Haiti? There's no other country in the world that has more nonprofits, more NGOs, but somehow we have these huge issues.

We need to start not throwing money at the problem but starting investing more in the solutions and try to create a social business where people don't feel they're entitled to free things but try to create a system - very difficult, it's easier to say than to do - but trying to create a social business where people don't expect everything for free, that they have to start working and creating a system where they will feed people by making sure that the economy is helped by buying locally. Let's not send more food. Let's send food the first week, but after, let's work with the local farmers to make sure that those farmers become part of the solution of creating jobs, of making sure that the economy is self-sustaining. And this is - this should be the beginning of, hopefully, a long but beautiful recovery.

CONAN: This is chef Jose Andres. 800-989-8255. Email talk@npr.org. And let's go next to Terry(ph). And Terry is with us from Brainerd in Minnesota.

TERRY (Caller): Hello.

CONAN: Hi there.

TERRY: Yes, I just couldn't agree more with your previous caller there. I just returned from a 10-days trip to Haiti as a tourist, and I know that sounds a little odd, but it might be like my second midlife crisis, but I just decided to kind of head there and see things firsthand for myself. And I got to tell you, you know, I saw progress. I saw things getting done, but the most overwhelming thing that you see in Port-au-Prince and in Petionville is just the enormous amount of NGOs and their staff running around. I mean, they're just everywhere, and they themselves are almost a huge part of the economy.

CONAN: Because they're obviously buying a lot of local things and employing local people?

TERRY: Yeah. You know, if you went into restaurants and bars and discos, I mean, everywhere I went - and even though, you know, some might disagree with that, I mean they're very present. They're very - they're everywhere. And of course, you know, some of the Haitians kind of question that, you know, if they're there spending the money appropriately. The other thing the NGOs I couldn't help but notice is that they're very obsessed with their security, and to the Haitians, that's extremely offensive and often gets in the way of their progress.

CONAN: Just going back to something you said a moment ago, we don't think of Port-au-Prince as a place where discos are up and running.

TERRY: Oh, yes. You know, Petionville, especially a little bit more of a middle class neighborhood, you know, life goes on. I mean I met a lot of local university students, English-speaking students that, you know, there's discos, there's restaurants. There's a nightlife that's very vibrant, particularly in Petionville.

CONAN: All right, Terry, thanks very much for the call. Appreciate it.

TERRY: Thank you.

CONAN: We're talking about rebuilding Port-au-Prince better nine months after the earthquake. You're listening to TALK OF THE NATION from NPR News.

And Jose Andres, I know - I read an account that you wrote about your visit to Port-au-Prince, and you were having what sounded like a wonderful meal in a local hotel - the restaurant of a local hotel, and I know you felt a little conflicted about it.

Mr. ANDRES: Very conflicted. What the last caller mentioned, it's what's happening, but you know, it's - as he said, it's part of the economy of rebuilding. Unfortunately, this is part of our world - is people that have everything, and these people that have nothing. I mean, a place like Haiti, you see everyone working side by side. You're in a hotel having a perfect meal, and right across from your hotel, literally two meters, three, five meters away from the door, you have a camp. And that makes you think. That makes you think. And this is why I came back and I incorporated these organizations that right now we are only three, four people, all central kitchen, with the intention of feeding the world in a clean sustainable way.

CONAN: Have you considered the idea - and I'm just throwing this out there -that, you know, if you opened a restaurant there and employed people, that might be another way to contribute?

Mr. ANDRES: Its some people that are thinking of doing this, even thinking about opening a hotel and becoming like a school. Me, I rather prefer trying to be helping those that have completely nothing. One of the great things that happened not too long ago, on September 21st, Secretary Hillary Clinton announced a global alliance for clean cook stoves. United States...

CONAN: Yeah.

Mr. ANDRES: ...is going to be almost putting over $50 million over the next five years to research and development to clean cook stoves of the future. This is a huge thing. This is a huge moment in history because probably it's the first time in history that you hear, in this case, the secretary, nonetheless, of the United States of America saying part of the future is clean cook stoves, and we're going to invest in it.

CONAN: Let's get another caller in. Onife(ph) - and I hope I'm pronouncing that correctly - from Port Saint Lucie in Florida.

ONIFE (Caller): Yes.

CONAN: Go ahead.

ONIFE: How are you?

CONAN: I'm well, thank you.

ONIFE: Yes. To respond to your question, like what we have seen in Haiti during our last visit - I was there a couple of weeks ago. What I realize is that the people feel as if they're not getting involved in the solution to the problem. They're just waiting around, not knowing what's going on. Until, as the chef just said, until we get them involved, until we show them the solution have to come from within, no matter what we do, we will not bring about the solution to that situation. As he said, we - the people will feel a sense of entitlement, as if everything is owed(ph) to them, or we're going to bring everything free to them. If you give me every day, I'm going to hope to get something from you every day. If you do not show me how to fish, when you're not around, how am I going to survive? If my economy is not sustainable, doable, how I'm going to survive when you're not around to bring me food?

CONAN: Onife, good points. Thank you very much.

ONIFE: You're very welcome.

CONAN: Bye-bye. And Chef Jose Andres, thank you for your time today and good luck with your project.

Mr. ANDRES: Thank you very much.

CONAN: And I hope you enjoy your visit. Jose Andres, an award-winning chef, co-owner of several restaurants in the Washington, D.C. area, hosted the PBS cooking program "Made in Spain," was kind enough today to come in to join us here in Studio 3A.

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