As we near the one year anniversary since the Haiti quake (which, initial estimates suggest, racked up a solid $8 billion in losses and damages or 120% of Haiti’s 2009 GDP), there’s a somber tone to the news coverage. There’s nothing even a little bit surprising about this; we’ve seen scarce tangible progress in the past year. In fact, the stability and absence of public health crises touted at the six-month mark have been blown to smithereens by cholera and silly-fraudulent elections, but let’s not eclipse the arguably more important long-term projections. Let’s feel perfectly at ease with our displeasure at the current situation (a woman next to me on the train the other day asked if anyone had seriously considered just “canceling” Haiti as a country, and since neither of us knew who to talk to about that, I suggested we table the idea), and then, with a bit more wind in our sails, move further out in our projections. Charles Kenny makes an interesting case for this in Foreign Policy, reprinted by NPR today:

In the long term, this economic impact could be far more muted, if history is any guide. Analysis of previous catastrophes suggests that economic performance of countries in the decade after a natural disaster is indistinguishable from that of countries that didn’t suffer comparable misfortunes. Even for countries suffering the largest earthquakes, floods, and hurricanes, GDP per capita was the same three, five or 10 years after the disaster — as it would had there been no disaster at all.

[A study financed by the IADB] jibes with what we know about the long-term impact of wars on economic performance. For example, by 1960 Germany was back to where you’d expect its income to be based on long-term growth trends from 1850 to 1910 — two World Wars and the Great Depression notwithstanding. All the bombing that the United States carried out on Japan in World War II didn’t alter city growth in the country over the medium run. And University of California, Berkeley, economists Edward Miguel and Gerard Roland argue that the American bombing of Vietnam — which totaled 7.5 million tons of explosives — hasn’t impacted long-run performance in that country, either.

So, the good news for Haiti is that:

…the things that determine long-term growth can’t be blown up. It isn’t factories or schools, or even individual people. Mounting cross-country evidence suggests that what separates poor countries from rich is differing paths of institutional development.

The bad news, then:

…The country’s history involves virtually all the features that economists have correlated with weak institutions and slow growth over the long term, from its history of slavery and colonial rule to its post-independence succession of coups, U.S. invasion, and some of the Americas’ worst dictatorial misrule under “Papa” and “Bebe Doc” Duvalier. The country’s weak institutions were tragically on display in the aftermath of the earthquake. One reason the death toll was so high was that building and land-use codes were patchily written and almost completely unenforced — so when the earthquake struck, buildings collapsed and slid down hillsides, trapping or killing those inside. In 2006, Transparency International declared Haiti the world’s most corrupt country. Poor institutions of governance help to explain why, between 1950 and 2002, Haiti’s average income actually fell, from $1,051 to $752 per capita. If, as it recovers from the earthquake, Haiti merely manages to stay as poor as it is today, that would count as an improvement.

Ok, so not a totally bright picture, but at least we know where to set the bar. Onward:

Still, there is some real good news to report regarding the benighted country’s broader development prospects. While Haiti’s income per capita dropped over the second half of the last century, infant mortality also fell dramatically, dropping from 22 percent to 8 percent of children under age 1. Meanwhile, life expectancy climbed from 42 to 61 years between 1960 and 2008. The progress in health in the country over the last 20 years is one reason why in the post-quake period, epidemics of infectious disease were limited to a cholera outbreak that was reasonably quickly contained. Similarly, adult literacy increased from 11 percent to 50 percent, and the primary school completion rate from 27 to 47 percent, between 1980 and 1997.

That progress reflects a considerable rollout of services central to the quality of life in Haiti over the last 30 years. For example, immunization rates against diphtheria, tuberculosis, and whooping cough climbed from 3 to 59 percent between 1980 and 2006. Schools were built and staffed. Children turned up. Some of them even managed to learn something.

This performance is particularly impressive given that Haiti has a central government that only spent around $530 million a year for 9 million people before the quake, or less than $60 per citizen. This is a little less than 1 percent of what New York City spends per capita on city services alone. Even though the general quality of the country’s governance could only be described as grim and the record of donor assistance mixed at best, Haiti has seen some innovative approaches to providing for basic needs.

Mixed bag, but let’s be honest: state-building isn’t easy work, and Rome wasn’t built in a day.

Hi Everybody,

It’s a pleasure for me to join you today and go together with you on this trip, where we are going to look back on the year 2010 events in Haiti – that poor and small piece of earth with an amazing history that has been occupying the news since the beginning of the year.

I just turned 30 years old a few days ago and the milestone fills me with dreams for my country. Dreams powered by strength and hope – this is precisely what you need to live and survive here.

2010 will always remain in Haitians’ minds and hearts.  On January 12th a terrible earthquake of 7.3 magnitude hit Haiti and destroyed our main infrastructure, a country that was already plagued with deep struggles.  At that moment, all the world’s attention turned to us. Some of you discovered for the first time a country were people were living like fighters, like heroes.

We had to adapt to an even more complex and difficult situation than we’d been living in before, and, notably, we are dealing with it. Before that quake I had a video studio. It is gone, so you can imagine like thousands of other haitians I had to adapt my life and career to survive. Survival is a key word in Haiti, and this year revealed the true meaning and test of it.

The January disaster killed about 300 000 people and left 1.5 million homeless living in tent camps.  We topped that off with a Hurricane, cholera outbreak and fraudulent elections.

The hurricane came as little surprise: we are used to these, though perhaps I can say that we could have avoided having too much victims. But as usual, our leaders are unprepared for good decision-making.  The cholera outbreak should also shock no one: who doesn’t know that when you are living in bad sanitary conditions, you are exposed to the worst diseases? We can spend days and months saying and giving proof that the United Nations Nepalese soldiers imported the cholera. But, tell me why in 2010, in this century, people still have to drink dirty river water?  It has already killed upwards of 3000 people and 50,000 have been treated in hospital. It has reached all 10 departments in Haiti. And nobody can predict when we’ll be able to contain this epidemic.  Is this not enough to wake up the conscious of our public servants? No, not in Haiti because then came the fraudulent elections:  who can remind me of the last time we had good and supposedly democratic elections here?  Is a poor democratic record any reason to maintain old bad habits and fight at any price for power? Meanwhile, your people die in the tent camps and streets…

Life in Haiti is uncertain.  Still, there is hope and progress, and as we welcome 2011 we have to believe that 2011 will be better.  2010 was violent. 2010 was crazy. The time has come for us to seriously think about a mentality change – some habit changes, some radical turn around to definitely look and work for the best of our society, our country. If not our kids will receive a poisonous heritage and will have to fight and relive our struggles. Remember, the most popular heroes are the ones who fought for a collective cause.

Happy New Year to All!

Cheers,

Handy

It’s amazing how much more “accessible” data feels through visual representation. Hans Gosling’s trend-revealing software (visit Gapminder.org) animates global health and economic trends over the last several centuries and digests an extraordinary amount of data. Bringing statistics to life and pitting them against broader trends, economic and health bull and bear markets, reframes an awesome macro-level view of human progress indicators.

I hit upon this discussion while perusing the Huffpost this morning, and it’s a solid follow-up to what we talked about on this blog a few months ago about metrics for non-profit progress evaluation and efficiency in our social capital markets. Let’s organize their conversation with three questions: why do non-profits exist in perpetuity; how do we know that the ones surviving (i.e. the ones with high fundraising success) are the best solutions; and how can we leverage their dependence on donors to increase efficiency? I’m inclined to say that the most important of these questions is the last, since (I think) it represents a significant part of the demand for social solutions: non-profits are responsive to the strings attached to their grants, so let’s throw the onus on the informed philanthropist who wants to invest confidently in social improvement:

However, the largest funders in the nonprofit sector (government and foundations), have no appetite for risk, and individual donors generally invest in known brands regardless of impact. Therefore, an organization must be an institution before it can attract significant investment. These funders generally come in when the organization does not NEED the money anymore. Money follows money and ends up creating large organizations with more money than they know what to do with – and that leads to mission creep. The organizations who achieve some great feat are then rewarded to hang around and burn up money just to exist.

This is what’s keeping the “vampires” (as Lublin calls them) alive — they’re organizations with compelling images and anecdotal evidence of success, good branding and name recognition. Meanwhile, innovative approaches to social improvement are eclipsed because funders are risk adverse and won’t back new projects. Now, what if funders set up performance financing plans and hedged their investments by investing in first-round activity and progress reports (with pre-finance agreed upon metrics) before committing to longer-term investment? Also, funders need to be more informed of the management and program staff as well as of the problem and project nature, so that they can critically assess the odds of a new project’s success.

Read the discussion; it’s good food for thought and hits on a central fact of life in the non-profit sector: we’re money driven (not greedy, but dependent), so let’s get the money to flow more intelligently and maybe the sector will fall into step.

The day has come: the first results of the presidential election in Haiti will be announced.

Some of us had so much “HOPE” about these elections.  We always thought that after all the problems and disasters that hit Haiti these last months, the people in charge would be more conscious of our needs and what would work best for Haiti.

But once again – if the elections on Nov 28 serve as any indication – we are to be disappointed. Once again they pulled Haiti back on the road of uncertainty.  While this might seem predictable, the majority of Haitians really want change and are ready to work for it. These elections were a big chance for us to prove that we are still a proud people.  It was our chance to prove that we have learned from the past and that we don’t want to restart doing the same mistakes. Unfortunately, we find ourselves in the same cycle of selfishness, greed and lack of consciousness, which perpetuates the same old power struggle.

Today, December 7th, the CEP (Election council) will publish the results. The tension is very high in Port-au-Prince. The stress and fear of violence is increasing. The intimidation has started with gunshots last night and tires burning in Port-au-Prince. Regardless of the result, we will never find the peace that my young friends and I were expecting.  I am trying not to be pessimistic, but it’s a fact.  I am trying not to be angry, but my anger is overloaded. My shame of what they are making of the country is terrible.  I hoped that this election would support my peace of mind and that I would start really thinking about a bright future for my kids.  What I forgot was that the problem isn’t solvable by the elections – the problem is Haitians themselves. Our mentality is the thing to change. We don’t need any election for that.  We don’t need any money for that. No international observers or advisers are going to change our mentality for the better.

Now what is going to happen? Today the CEP will publish the results of the last “Masquerade,” and then we’ll move deeper into the crisis.  A lot of my friends are cursing on 2010, saying that this year carries very bad luck for Haiti; earthquake, Hurricane, Cholera and they add the “Masquerade” they call election. But, if it hadn’t been for all those problems, all those disasters and emergency situations, would things be better now?  I DON ‘T THINK SO!  In this exceptional time, we are still fighting each other for power instead of fighting for the best of Haiti – what does that say about our mentality?

The future of Haiti is uncertain.  It is truly dark.  I implore everyone not to forget Haiti in their thoughts and prayers, but I hope it will go beyond that and into activity – not money, but activity.  Focus on efforts of education and health, and drive your support and enthusiasm with whatever resources you have.

My fight for the best of Haiti will never stop, and I hope your interest in its improvement is also enduring.  I’ll be 30 years old in two weeks and I don’t want my kids to spend another 30 years in that situation.  It’s my duty to fight and prepare a brighter future for them.  As you can see, i didn’t take the time to remind you of the actual situation here. Because i am pretty sure that the main words that will come to your mouth is: “HAITI AGAIN!”  My young friends and I, organizations like C2C and those focused on educational opportunities are working to make sure that the next big time you’ll pronounce an interjection about Haiti it will be happily: “HAITI FINALLY!”

Sanergy Overview from Ani Vallabhaneni on Vimeo.

When I started reading about the riots in Port-au-Prince this week, the first thing I thought was “finally.” I don’t think that’s totally irrational, so let’s dig into this a little: first of all, I think I felt relieved to see the world working and people reacting to stressors exactly like I anticipated they would. Previously, one of the things I found most unsettling about the situation in Port-au-Prince was the relative stability. The estimated 1.3 million people living in camps literally have almost nothing: very little government, few sources of income, scare educational opportunities, and often there they don’t even have their health or families. How were people not revolting?

Certainly, there’s been plenty of small-scale violence in the camps as people became desperate in an uphill battle to survive (I’m thinking about what’s been coined as “survival sex” and the women who have no means of taking care of themselves or their children but to take on multiple “boyfriends” who “provide.” I’m putting a temporary ban on my use of air quotes; I default here when I’m feeling extra acerbic. Also, I don’t at all mean to undervalue the very real sexual violence facing unwitting women. The violence I saw absent was more systemic and manifested in public displays of social discontent.) But the idea that life was so bad and there was so little hope that there wasn’t even an incentive to revolt – i.e. there’s no responsible or empowered apparatus to respond to expressions of displeasure with the status quo – worried me. Hopelessness is not a starting point for reconstruction. It’s a wasteland. That people are acting out now, despite how disruptive violence can be to health delivery and the democratic process, suggests that they think someone’s listening and that there is a limit to what they can tolerate.

The idea behind a new book by Derek Bok (The Politics of Happiness: What Government Can Learn from the New Research on Well-Being) is that we’re starting to understand what makes people happy and that some of it is malleable by government action. One of the key ideas is that better living standards bring only temporary improvements in happiness. After a while, people are about as happy or unhappy as they always have been. People do not anticipate that this will happen, so are constantly demanding more in the belief that more will make them happier, and are just as constantly disappointed. It seems that people feel their happiness more lastingly increase when it’s evaluated relative to other people around them. Recently, there was an interesting conversation on Huffington Post’s “Impact” blog about whether or not the developed world was imposing its standards of success and happiness on communities for whom these levels flew off their charts; basically, the idea that happiness and success valuation are calibrated to each environment, resource availability and opportunities. Maybe happiness really is just relative. But that’s a slippery slope.

What worried me about the stability from pre-cholera Haiti was that people seemed anemic and completely beaten down by the limitations of their environment. I know the riots aren’t good. Obviously. But on a purely intellectual level, it gives me hope that they know they want better, that happiness can be something more than survival. Protest seems to be the most reasonable response to the situation. I may be trying too hard to find a silver lining and I’m sure that to some this will read like a stretch. Either way, here’s hoping it cools down in time for the elections on November 28.

Fighting an Epidemic & Planning an Election

I am officially convinced that there is nothing we can’t virtually simulate. For anyone who wants a finger on the pulse of everything that’s interesting and worth talking about, bookmark good.is. As an example of what they’re working on, check out Inside Disaster, an interactive educational website about the Haiti earthquake and humanitarian work. When you get to the site, read about what they’re doing and then scroll down on the homepage til you see the button, “Survive. Report. Save Lives. Go Inside the Haiti Earthquake.” Then it’s like you’ve been vacuum-sucked through a wormhole and back to reading “choose your own adventure” books, only this time they’re virtual and animated and you’re seeing and hearing the repercussions of your decisions as either a survivor, journalist or humanitarian aid worker in Port-au-Prince on January 12, 2010.

The simulation walks you through the critical hours after the earthquake, the decisions that each group of people faced, and the horrific images that became their world and that we saw on the front page of every print news publication for days afterward. The site’s not a total downer, I promise – mostly, it’s just incredibly interesting. It’s certainly graphic, but it’s main – and in many ways unprecedented – accomplishment is bridging not only geographical but experiential divides, and that’s an extraordinary proposition. Certainly, there’s no amount of virtual exposure that will ever get you or I anywhere near the real emotional, mental and physiological experience, but this is the closest we’ll ever get to empathy and I think it’s an exceptional stride.

Additionally, the site accompanies a three-part documentary that follows the Red Cross’ response to the disaster. Insidedisaster.com says of themselves,

The goal of the site is to help users explore the complexities of humanitarian work in the 21st century, as well as the specific challenges and experiences that arose from the aftermath of the Haiti quake.

Like I said, I actually think it does more than this. In fact, I think the primary objective is a bit mislabeled – this doesn’t touch on a lot of what humanitarian work is: in short, a lot less exciting, efficient, and impactful than the images in the simulation. But now I’m digressing. Point is, this project offers an incredible look at the immediate aftermath of earthquake and has been skillfully put together. Spend some time with it, and let them know what you think.

This is our fourth operational day, which after a year of planning, feels huge. Liz and I were joking last week that we’ve been throwing “launch” parties for the pilot clinic for about a year (see: C2C at the Institute of Contemporary Art, November 16, 2009), and last week the clinic opened with neither pomp nor circumstance. Truth be told, we’d been working with ICC/Grace Children’s and MSH on an inauguration event to celebrate the resurgence of the hospital as a fully functional healthcare provider in Port-au-Prince. The invitation list included several heads of Haitian ministries (e.g. of health, foreign affairs, finance) and the entire diplomatic corps. Unfortunately, John Steinbeck might as well have coined the phrase “the best laid schemes of mice and men go oft awry” specifically for Port-au-Prince, and after a cholera outbreak and promises of Hurricane Tomas’ deluge, the ceremony was called off. And so the C2C clinic opened quietly. But hey – I’ll take an open clinic any way it wants to come.

We’ve so far seen a daily average of about forty-five women and their babies, and reports from C2C’s Project Coordinator, Handy Tibert, at Grace Children’s Hospital suggest that everyone’s adapting to the space very well, and vice versa. The clinic was committed as maternal care center, and is staffed by two gynecologists, a midwife and two nurses. The pharmacy space should be fully functional by the end of today and the head laboratory technician continues to transition services into the C2C lab. This is all coordinated in conjunction with the C2C program staff but decisions are made and “actioned” by the leadership of Grace Children’s Hospital. This partnership relationship has been interesting. It’s new for GCH to have a partner as hands-on as C2C: the way we explain ourselves seems almost entirely novel in this environment – we aren’t donors, we’re partners; we don’t do anything for GCH, rather we do everything with them. This isn’t a typical aid relationship, but then again, we aren’t your typical aid organization.

C2C is committed to expanding access to critical primary care for maternal and pediatric populations, and the clinic is our vehicle. However, we don’t believe it’s enough to provide “access” simply via the facility. We don’t drop a clinic down, dust off our hands, and say “you’re welcome.” Far from it. In fact, having been in the trenches the past few months, I’d actually say that it isn’t until we drop a clinic that the real work begins. Once the clinic is set up and we begin evaluating the systems it absorbs (e.g. medical record keeping, pharmaceutical inventory management, efficiency/comprehensiveness of lab diagnostics), we start making recommendations for improvements. C2C’s entire bent is monitoring and evaluating the quality of the services patients receive at our facilities. This may only be our pilot, but eventually we want the C2C moniker branded with quality standards – marketing both to patient and partner NGO populations.

We’re in the early, early stages of second site development, and making certain that the emphasis we put on being hands-on around quality assurance is front and center in our preliminary conversations. There’s a sweet spot between micromanaging and donating, and we’re honing in on it. In the meanwhile, check out a few photos taken by Handy’s phone. Not great quality, and we’ll have to get him to take a break from setting up the lab to capture a few real shots.