In the winter of 2003, when war loomed in Iraq and every rock was suspected of concealing a terrorist, one might have imagined that the last thing on the minds of American diplomats would be a little impoverished country like Haiti, a mere third of an island, which lacks even an army. But the United States has a foreign policy everywhere, and, as a rule, the weaker and poorer the nation, the more powerful the policy is.
Most Americans if they visited Haiti would, I imagine, come away with new definitions of poverty. What you notice most of all are absences of the most basic things. Water, for instance. In a recent survey of the potable water supplies in 147 nations, Haiti ranked 147th. It’s estimated that only 40 percent of Haiti’s roughly 8 million people have access to clean water.
In the capital, Port-au-Prince, the morning after rain, you see working men take up manhole covers and lean in beneath the pavement, dipping buckets into the city’s brimming drainage channels. They use the water to wash cars for pay, and occasionally, when the day gets hot, you’ll see one of them invert a bucket over his head. This is very dangerous, because any contact with sewer water invites skin diseases and a mere thimbleful swallowed can cause bacillary dysentery.
All over Haiti, you see boys and girls carrying water, balancing plastic buckets on their heads as they trek long distances up and down the hillsides of Port-au-Prince or climb steep footpaths in the countryside. Many of the water-carriers are orphans, known as restavek–children who work as indentured servants for poor families. Contaminated water is one of the causes of Haiti’s extemely high rate of maternal mortality, the main reason there are so many orphans available for carrying water. “Sanitation service systems are almost nonexistent,” reads one development report. Many Haitians drink from rivers or polluted wells or stagnant reservoirs, adding citron, key lime juice, in the belief that this will make the water safe. The results are epidemic levels of diseases such as typhoid, and a great deal of acute and chronic diarrhea, which tends to flourish among children under 5, especially ones who are malnourished. Hunger is rampant. “Haitians today are estimated to be the fourth most undernourished people on earth, after Eritrea, Ethiopa, and Somalia,” the World Bank reported in 2002. The cures for many waterborne ailments are simple. But in Haiti, it’s estimated (almost certainly overestimated) that only 60 percent have access even to rudimentary healthcare. In the countryside, the vast majority have to travel at least an hour, over paths and main roads that resemble dry riverbeds, to reach health centers, which not only charge fees that most can’t afford to pay but also lack the most basic provisions.
Last winter, I visited the centerpiece of Haiti’s public health system, the University Hospital in Port-au-Prince. It was founded in 1918, during the time when American Marines occupied and essentially ran the country. It’s a large complex of concrete buildings in the center of the city, and it seemed to be open when I arrived. My Haitian guide and I strolled over toward the pediatric wing. It seemed unnaturally quiet. No babies crying. Inside, the reason was obvious. There were no doctors or nurses or patients in sight, only a young male custodian, who explained that the doctors had recently ended a strike but that the nurses had now launched one of their own. Strikes at the hospital are frequent; this one had to do with current political strife.