we know the outcome but it keeps you turning the pages. thank you. .. >> and now on booktv, paul farmer talks about the devastation caused by the 2010 earthquake in haiti, and he takes a critical look at the aid agencies that have been working there since. dr. farmer's interviewed by cbs news medical correspondent jonathan for just over 50 minutes. [applause]
>> thank you very much. i guess i'll just start it up. first of all, thank you so much for inviting me, and i'm honored to come down here and leave my patients up in new york wondering where i am for the day. >> i'm sure they're going to be upset about missing their ins do cobuts. [laughter] >> it's having done the prep without the procedure, that's what they're going to be really irritated at. [laughter] it's all right. they all know. they all knew. i'm also, i'm keenly aware that we have about 30 minutes and that you're here, you're here to listen to paul, not to me. so i'm going to be a facilitator of paul talking, and on a perm note, i want to thank you for one thing which was for entitling chapter two, practice and policy. because what that taught me was that if you highlight a word in the kindle, the dictionary pops up. [laughter] and you can learn what the word practice sis means, which is
formal practice. anyway, i just want to thank you for that. >> my pleasure, jon. that's why i wrote the book. [laughter] >> okay. you're a physician, i'm a physician, you love to use physician metaphors, and you talk about the history of the present illness. let's start off -- and so that's going to be the arc of today's 30 minutesful we'll consider haiti like a patient. let's start with the past medical history, okay? you start off with a country that in 1804 had its successful revolution, and rewarded with france imposing a $23 billion reparations bill which took them over 100 years to repay with interest. and it got worse from there. so you say the collapse has been ecological, economic and political. you want to expand on that in about 20 seconds? [laughter] >> that's his revenge for me canceling his endoscopies. first of all, perry, thank you
for having us here. and i said on the way in here i can't imagine that there would be anyone here on a monday morning, so thank you all for making an effort to be here. it's not a convenient time for, i'm sure, for any of you. and thank you, jon, for doing this. in the -- by way of thanks and as a segway into the question, um, i also want to express at the outset my deep gratitude to the haitian people. and that sounds like a, you know, grandstanding move, but let me be specific. and i, and those of you here today who are haitian will know exactly what i'm talking about. the revolution that jon just mentioned, i'm going to say even though it's doctor, what jon just mentioned the only time in the recorded history that a slave revolt has led to the
founding of a nation. and when we heard about the french revolution 1789 and its promises of liberty, equality and fraternity, how could that be true if there were slaves, right? how could that be a real human rights revolution? and the answer is, of course, the haitians said it couldn't be true, it's not -- it wasn't real, no offense to anybody here who is from france especially because i really love french food. [laughter] and, but it could not be meaningful without the haitian revolution. and the haitians will tell you and, again, this across all spectrums of haitian society. and most of my experience has been in the rural regions, places you've now visited as a physician, and my knowledge of the haitian urban elites is actually quite limited. it's mostly through books, reading books that they've written. but across that spectrum
haitians will tell you that no small amount of their current problems are related to the haitian revolution and the price they paid for actually pushing forward these ideas. now, i said, well, how can you say that in a more concise way, and that's why i took this medical metaphor. and for those of you who are not in medicine, we talk about the history of the present illness, that's someone comes in with a complaint, different sort of complaints usually for jon's patients than mine. >> i'm an internist too. >> we're both internists, so they come in and say, well, i've been coughing or, in my case, usually people are doing their coughing for weeks and losing weight, whatever it might be. and then you've gathered the history of the present illness. you find out when this started. and one of the things that we like to do, and i put this in the book maybe pushing a little bit, in my work, infectious disease work, we always go
chronologically. and the patient may or may not have an idea about when a certain illness started. they always do have an idea, i shouldn't say they may or may not have an idea, but going back in time to when that patient was well and then moving forward. now, haiti was never well because it was a slave colony prior to the revolution x then it was this pariah nation that was being punished by the great powers of the time -- >> and frightening to the united states, right? >> and very frightening to the united states. and i always quote in books about haiti this, on the senate floor the senator from one of our states, i won't mention which, but it's a little bit south of north carolina -- [laughter] saying, you know, the safety of our country forbids that we even talk about haiti. this is on the senate floor. and, obviously, there were still slaves in the u.s. and the first envoy we sent was when lincoln sent the first ambassador. so the united states and haiti have this very complicated
history that goes back to, actually, before the revolution when we sided with the slave owners as the only other independent nation in the hemisphere. the only independent nation in the hemisphere. so we have this history, i think also it's two countries. and as an american writing about haiti, that's always on my mind too. >> so that sets the stage because people say haiti is just a lost cause, they just can't get their act together, but really without knowing the history, you can't even start to talk about it. and i think that's one part of the book that's terrific, you've done it in other books, but just sort of set the stage to even think about haiti. because just coming into it raw i think it's very hard for people to just get it, okay? um, let's talk about the 800-pound gorilla in the room which is ngos, okay? and aye been to haiti -- i've been to haiti several times now, and i've seen the amazing work that ngos including partners
in health, i was there the day that the cholera outbreak started in st. mark, and i saw a reporter who interviewed him, he was astounding as were the colleagues from doctors without borders and other organizations. and i went up north, and i saw the difference between the health care that people got in a mission ngo and then just going about several miles down the road to the public hospital which was astounding. i've never seen anything like that in my life. you walk in, there were literally no doctors there when i walked in. >> yeah. >> there were three guys who didn't have their mds yet who were sitting there, and they were in training, they were going to call other doctors. and the patients were on the right and the left, they had to bring their own sheets, and their family brought the food, and there was no electricity, i mean, you cannot imagine it. so you have this big difference between the public and the private. um, but there have been -- the
critics would say that there is this codependency between the ngos and the public government. and you talk about this friction between taking care of the patient who's right in front of you, that's the doctor, that's dr. farmer. you're always dr. farmer, but the -- you can't even resist it. you're going to reach out and help them and taking care of the whole system, the anthropologist, the public health expert. so you talk about that as the chief tension in your life. so talk about that and about this whole controversy. >> well, you know, the tension and the controversy i'll try to give, you know, i'll attack both of those. you know, and i'm here with some friends who perry met who just came in from new york who we've been working on some policy projects together. well, now sounds, boy, that sounds like if it were 9:00 at night, everybody would just, you know, pitch forward in their seats and start snoozing.
will [laughter] and i don't find policy discussions that interesting. but they are crucial to getting this right. and when we talk about build back better, we're not talking just about the destroyed infrastructure, we're talking about building aid back better. for example, you were in -- when the cholera outbreak started and, again, there's an entire history to where cholera came from and where it's going, and i'm very interested in that too. but that area was actually not touched by the earthquake. so what you saw when you went in there's no electricity, no doctors, terribly underfunded public sector and then some pretty good ngos, what you saw is part of what needs to be built back better. so the tension between policy, okay, you know what? i shouldn't have used the word prsxis. old school, marxist team. >> it was a cool word. let it go.
>> all right. [laughter] i'm past it. you know, for my doctor friends today, they knew i would never say that -- >> that was the longest take that i've ever seen, you know, when the guy pulls off the masking tape and about five seconds he goes how, didn't i make that -- >> we have long memories. [laughter] >> so it's come to this, paul. >> anyway -- [laughter] so the practice or praxis -- >> sounds like a neurological term to me. >> yeah, it could slide into neurologic syndrome. but that tension between, you know, taking care of someone right in front of you and thinking about the right policy is really the one we should all be confronting if we care about building back better. and it's not about our own personal likes or dislikes. i like seeing patients. but if i were, you know, sitting there, i mean, cholera's a great example. you could have as many patients as you want because the epidemic is out of control. so you have 425,000 patients
already. and by the way -- >> that translates to 12 million people. 12 million people for the united states. 6,000 dead is 180,000 dead in the united states. just to put it in perspective. >> and we're not even sure, it could be an undercount, as you all know, because reporting capacity's so weak. so this tension is in our lives, and it should be in our lives. again, regardless of what our own druthers. i mean, in your life, for example, you see patients, but you're also every time you go on the air or go to haiti or go to somalia, you're also taking on the big picture. i think that it's the same sort of thing when i write a book. of course, you know, you're seen by millions of viewers and four people read my book. [laughter] i'm not bitter about it. i know jamie from public affairs was here, so she's fighting to -- >> you know, paul -- >> you didn't let me finish the second part of the question. >> you remember it?
>> of course i remember it. >> go. go for the second part. >> the ngos and the codependency, just to jog your memory, jon -- [laughter] and you know afterwards, speaking of neurologists, we have a ct set up for you. >> i think a functional mri would be the way to go. [laughter] >> anyway, what we wanted to bring into the book, and here's my chance, also, to say thank you to abby gardner and jenny block and johan sedke who contributed to the book and helped to bring it into existence. because it, you know, it takes a village, as you said. but, by the way, when you read this book, you should read -- read the end. the part at the end that jenny wrote, dede, his wife wrote, and especially the witnesses to what was going on, you know, from right down there in rural haiti and other parts. it's really -- don't just stop with his last word but really do read the book at the end.
>> the 800-pound gorilla is the idea behind this book is i'm from an ngo. i'm a volunteer, but i am an ngo creature. you know, my real job is being a medical school professor, but i've always, you know, believed in the work of partners in the health, and there are other great ngos working in haiti. at the same time, what's our long-term strategy to build aid back better? now, our strategy with partners in health has been hire local people, do local procurement whenever possible and work to rebuild the public sector. but, you know, the public health institutions. but it wasn't always that way. it was always a community-based organization with haitian employees, but it's really been the last ten years or so where we said, wait, what are you doing wrong? everybody says thank you for building a hospital in the middle of a squatter settlement or, you know, thank you for helping get our kids back to school. we get a lot of thanks, but we said what are we doing wrong? we decided what we're going
wrong is to allow the continued degradation and collapse of the public sector which is, after all, haitian, our employees are haitian too, but this is the institutions of that country that are public institutions allow them to collapse even as we grow. that's not the way to build haiti back better. and the earthquake was a chance, we hoped, not only to improve our own practice, but also to improve the dialogue with our other ngo partners. >> how does that translate to real life? i stood in the rubble of the ministry of health literally in one of these shots, you know, we did for one of our pieces, and it was rubble. i was literally on a pile of rubble, and i thought rebuilding this is the easy part. but rebuilding, not even rebuilding, creating for the very first time a public health system that can's the tough thing. and -- that's the tough thing. and you have however many billions have been pledged and however much has actually reached haiti, um, which is
another question, um, it's more efficient for tomorrow to give that money to the ngos. they're going to help that person who's dying right there. but really -- and you've written -- it needs to go to rebuilding the public health system, right? or creating it. >> it does. and i'll give you an example that i find uplifting, and i haven't cleared this with the -- i'll just say it, the american red cross. but they'll forgive me because i hope it's a -- and it's a positive story, you know? they haven't told me i can't tell it. >> [inaudible] >> no, they're probably here. this is their hometown. anyway, so take the american red cross or the international federation of the red cross. when there is a disaster, um, people will give to the red cross. it has, as they say in business parlance, it has a good brand. i watched -- of course, i only work, i never take breaks. i did not watch contagion this
weekend with matt damon -- [laughter] but if i had watched it, i would have seen, by the way, a pretty good, pretty compelling outbreak movie. >> when he says he watched it with matt damon -- >> i didn't watch it with matt damon -- [laughter] >> somebody else was in the movie. >> you've got to admit, anything with him in it is good. anyway, so it's about an outbreak, as you might imagine, and there's the red cross. and i was thinking, oh, i'm going to -- well, had i been at the movie theater, i would have thought if i'm going to washington tomorrow, maybe i'll get to see my pals at the red cross. ngo, right? it's a nongovernment organization. it raised a lot of money in response to the earth quake or katrina, right? or any other visible, you know, disaster whether we call them natural or unnatural, it matters. but they're going to have people saying i want to help. more than half of all american households donated to haiti
earthquake relief. that says something good about everyone in this room and about this country. so the red cross is an ngo, and they're used to working with ngos. they helped partners in if health, doctors without border, and here's my chance to apologize to anyone who's from doctors without borders who i called in the book, i confess, doctors who sometimes need borders. [laughter] but having worked with them, it was just a joke, okay? but we can move like this. we can move very quickly, the nxos. doctors without borders can move very quickly, and so can partners in health. and thank you, red cross, for supporting us to respond to the suffering of cholera patients and reduce what's called case fatality rate, the number of patients with the disease from 10-15% to almost 0. if someone gets into these cholera treatment units or centers, they're not going to die of cholera. but that does not replace a public water system, it does not
replace a public hospital, it does not replace a public reporting system like the cdc which does a lot more than reporting. as you can see, i'm told about this movie i didn't i didn't se. but that's an example. so the red cross we said to them, you know, help us keep the general hospital going, and you were there in the general hospital, haiti's largest hospital. and that's going to require finding a way to get salaries paid for workers. >> but how does that logistically actually happen? >> well, it logistically actually happens by convincing them to do it and then saying, okay, maybe you want other groups to accompany you. that's the word we're trumping a lot in this book, accompaniment, as a alternative development strategy. so the red cross accompanies us, and we accompany the public sector. and my colleagues who are here from new york could tell me if i've done a good job talking
about this, but that's a model of moving resources from the generous who have resources to the unfortunate who don't. and let me just give one last number. there is a health ngo which i won't mention by name. it's not partners in health but partners in health is way up there too, that it raised $134 million for earthquake relief, an international ngo, and the ministry of health which as you noted was completely leveled by the earthquake and probably lost 20% of it to, you know, dead or injured, the ministry of health which is still in a temporary shelter and now if you go back to that lot which i hope you will, there's not a stone standing there which is good was that means they cleared up -- because that means they cleared out the rubble. but their budget is not a third of that. so that's the modern world december torsion that we have going -- distortion going on in haiti and all over the world. you've got one country, this
one, for example, where where there would be tens of millions or hundreds of millions dollars raised out of generosity going in to a country where the public sector budget is, help for the whole country is not a third of what one ngo raises for the earthquake. a few years ago in a book i sent you but i bet you didn't read -- [laughter] i just compared the budget of the republic of haiti which was undergoing difficult times because, again, cynical manipulation of aid by the international community which is a term that gets picked apart in this book, this is in 2003, i said what's the budget of the republic of haiti? well, the budget of the republic of haiti was less than the city of cambridge with 100,000 people in it. so those kind of, you know, those, those distort the work we do. and the 800-pound gorilla, he said, going back to the question and wrapping it up neatly.
the 800-pound gorilla is ngos of which there are more per capita in haiti than ever -- >> there's one ngo for every thousand ngos -- i'm sorry, for every thousand patients. ten million people, right. >> >> and there may be more because we're not counting out little bitty ones, as president clinton would say, the little bitty ones. [laughter] everything he says sounds good, i find. >> we have, like, seven minutes left, and i want to get -- because right now the patient's not even undressed yet and we have to take him through the physical exam and then get a diagnosis and the treatment and a prognosis, all that in seven minutes. i know -- >> we know you don't examine the patients, you just use endoscopy. [laughter] >> i know that this is not your, you may know, everybody here wallets to know what's happened to the -- wants to know what's happened to the money. >> yep. well, you know, on the way in
here one of my colleagues reminded me it's not just about the pledges, it's obviously about do the pledges get delivered, and the answer is a very substantial majority of them do not. >> people need to know, i mean, they want to know the numbers, and they want to know what percentage goes to the public -- >> i'm self-conscious because katherine gilbert is here, and she should correct me. $5 billion and more were pledged, and then there's some long-term pledges that were made as well. but for 2010-2011 it was about 6.2 billion. >> and you really have to pick these apart that's why we have a web site that dredges through -- >> what percentage has it actually been? >> with okay. i think we're pushing 30% -- >> okay. >> which is not bad. that means the majority is not delivered yet. >> of that how much went to the
government -- >> oh, a vanishingly small amount, maybe it's -- i'll tell you the number i do know which is the acute relief. you've already given us a picture of why it's difficult to put acute relief money into the public sector, because it was destroyed. 28 of 29 federal buildings in haiti were destroyed in the quake. imagine washington which, you know, this is one city. we have, you know, los angeles and chicago, new york, it's all one city in haiti. and that city, the nerve center was just leveled, as you saw. so the public infrastructure, the government infrastructure from palace to ministry, you know, to our equivalent of even a building like this flattened. so it was hard to put money in. i get that. and this is where humility, we understand why it was hard for the big ngos and the so-called bilateral, you know, like cuba, haiti, united states, haiti. those are bilateral organizations and the multilaterals like the world
bank. we understand why it was hard. but to have it be less than 1% of the relief money -- >> less than 1%, and that gives you some idea. i have to, i'm going to reel you in a little bit if it's okay because i know we talked beforehand that we could go on an hour on each one of these topics, but i do want to just very quickly, first of all, i have to ask you the acute question, since we're doing the patient metaphor, what is haiti allergic to? >> allergic to heavy-handed meddling and any assault on its -- real or perceived -- on its sovereignty. that's what haiti's allergic to. and, you know, i'm sure all of us read the newspapers yesterday or reflected on 9/11, and i read "the new york times" and just read a piece by a pakistani who i've had the privilege of meeting, actually, in this city, in this building, i think. and he writes about the impact of only of the things that have
happened since then on his own country and the popular perception of the united states. but in haiti it's deeper, you know? and it's much less fraught. there's no, there's never been -- there's been the american occupation of haiti which is a dark chapter for them, 1915-1934. but if we want to find out how to proceed, we have to be aware of that allergy. and that's a great metaphor. i hadn't thought about it. if i had to choose one thing, it would be perceived attack. and it doesn't have to be, you know, real. that's, and it's very hard to, you know, to inform all one's work with that awareness of an allergy. >> here's what -- we have three minutes, so i wanted to talk about the diagnosis, i wanted to talk about rwanda, how it's a role model and what it can teach us following the 1994 genocide, and i want to talk about the role of the haitian diaspora,
about the need to decentralize haiti, i want to talk about deforestation. i wanted to talk about the plight of women in haiti which is an amazing thing. i was there when katie couric interviewed a woman when had been rape inside april 2010, and we know in the big camps and all around there is that problem. but since there's only two minutes left -- and then i loved the end where you were imagining all of the different scenarios for reconstruction. if you were king of the jungle, what it would look like. so you're going to have to read the book for that. since we only have two minutes, i thought the most delicious part of the book -- although your parts were very tasty -- but for me the most delicious part was the woman who took the histories from the people, from the haitians -- >> michelle. >> and i want you to talk about that and what the haitians themselves are saying. >> yeah. because those are the people, as you point out so beautifully, who weren't at the table. they couldn't afford a ticket to fly up to the u.n. so talk about that, and i think that's how we'll end it, and
then we'll toss it to some questions. >> well, again, if i'm right about the allergy and i'm going to use this metaphor as if i didn't overuse medical metaphors already. you know, to write a book about the earthquake even though i was there and working as a physician, it needed to have haitian voices. and a friend of mine and -- is michelle. and some of you will have seen the film called the agronomist which is about a martyred journalist, and that's her. she's his widow. sean dome anemic. who was kill inside haiti, was murdered maybe 10, 11 years ago. anyway, she after -- they're both radio journalists and pro-democracy radio journalists. i asked her if she would help on a project not this book, but, um, and other people got together we decided to go out to
all, what is it, jenny, nine or ten departments. the geographical -- i'm looking at jenny. he bought the tape recorders. you have got to do things like that too, by the way, you have to have the infrastructure of inquiry. and a group of haitians and a couple nonhaitians but who spoke fluent creole just fanned out. we asked people who were market women or fishermen or displaced people or people in the camps, street vendors, school kids, farmers -- not farmers like me, but farmers with, you know. you know, what do you want for your country? and the thing that was inspiring, and as you said delicious, they didn't say -- the theme that came back was not we don't believe in the future of our country, we don't -- none of that. they were actually optimistic about the possibility of reforming the state, making it
work for the people, getting their kids back to school and rebuilding their country in a way that would make it easier for them to live in haiti. and there was something really inspiring about that theme, and she does a great job, michelle, does a great job on the, on writing the chapter too. i you would, i haven't listened to the audio version of the book, but she does her own chapter. i said, no, i want meryl streep to do mine because i'm the meryl streep of public health. [laughter] >> i heard a story, by the way, i'm going to share which was in new york, there was a get together, and meryl streep was in the same room, and everybody was around meryl streep, and then paul farmer walks in, and suddenly meryl streep is all alone in the corner. [laughter] >> it was at nyu, not, you know, the oscars. >> so within a certain community
>> meryl streep did read a lot of it, but michelle reads her own. she has a beautiful voice too. >> and we love meryl streep. she's a great person. >> so just so if you get a chance, do listen and read what the haitians have to say about this and, michelle -- thank you for bringing that up. >> my final question. doc, what's the prognosis. >> >> i think the prognosis, if you go back to that chapter, the prognosis is good. someone said, you said, what's the allergy? what's the great resource of haiti? it's people. anybody can say that, but there's a lot of talent in haiti, and a lot of young talent in haiti. there are lots of -- it's a young country in terms of the demographics, and then we didn't get a chance to talk about the diaspora. but in the book i write about some of my students from harvard who are haitian and who are, you know, so committed to working in haiti. and one of them who -- i don't want -- you can read about him.
one of them is, you know, he was a harvard medical school student, grew up in if canada, you know, went to school in the united states, was, as i said, at harvard medical school. and he said to me i remember the first week of school, he said -- of course, all the americans said, hey, terry, what's up? [laughter] so he said, i want to go to haiti. and he'd never been to haiti, turns out. and i said what kind of medicine do you want to do? he said, surgery. we definitely have a place for someone who wants to be a surgeon. so his first time in haiti was coming back as a young adult working in the operating room, and he would spend -- he'd work in the operating room up in central haiti and spend the weekends with his family he was getting to know again, his aunts and uncles and many, many cousins. and his aunt and uncle were killed in the earthquake. so he brought all of his cousins x there were eight of them. and i know that because he sent me an e-mail, a picture of them in montreal with his parents can you imagine thinking, yeah, we
got our kids out, we're going to enjoy empty nest syndrome, then they get eight more. [laughter] so, you know, that's the kind of story -- of course that's a story of great adversity for that family, but it's also the story of really how the haitian people can be. yes, we'll take our cousins in. the we'll make sure they grow up safely. and this young man, i was going to say this kid, is indeed now doing a surgical residency. and i meet people like that a lot. and we don't have enough of their stories out there. and so that's just an example of not only the haitian people in haiti, you know, making the prognosis good, but also there's a diaspora that i think we still have yet to draw on fully. >> haitians helping haitians. >> yeah. that's a big theme in the book. >> okay. i think probably we're out of time for the q&a, and -- or was that the q&a? >> that was a conversation. >> that was the conversation, this is the q&a. so i guess we should have questions. and, please, i'm not hurt.
ask paul. >> [inaudible] >> dr. farmer, i'm here with some high school student leaders and colleagues, and we are part of the episcopal school's education partnership in haiti. and about two and a half hours from -- [inaudible] is a village. and we went last year for the first time, we're going again. there's about 400 families there, about 25% of the young people clearly were malnourished, and, um, our question -- we go with joseph jean ginot. >> yep. >> and our question is -- >> i was going to say he was a good friend of mine. >> we want to get community health, um, workers there as
well as food aid. we're going to build a mod school. but -- modest school. but even ginot thought we would be more effective in figuring out a way to get the health workers in there and the food aid than he has been able to do. so can you give us some advice on how to do that? >> um, i sure can. and, you know, it's great that the students who are with you and you, their teacher, are willing to shoulder some of this burden, you know? father ginot, after all, he has so many duties as do a lot of people who serve, as he does, as a living link between, in this case, the united states and haiti. and that's a very difficult role. i've done it all my life, is to be -- you end up being a choke point as well, right? because there's so much -- i told you half of american households donated to haitian earthquake relief. and on the other end there's great need. so it's hard to be in the middle because you don't want to -- and
my, i want you to take my advice as more advice to you than to him, right? because i -- he's already working 60 hours a week or however many. and my advice to you is if you're going to get involved in food aid, try and think about food, security and food sovereignty. and this is my colleagues from new york, i make them sound like, you know, people with briefcases and my colleagues from new york. [laughter] they're actually all ladies in smart suits. but we're working on this accompaniment effort because we're not trying to say you need to do your food programs better and only procure local food, right? what we're saying is you need to think about local food procurement in a very humble and congenial -- and this is how we've done it. haiti is the most food insecure country in the hemisphere. it is the ranking problem for many families. you said 25%, doesn't surprise me. and unfortunately, what's
happened with food aid if you go back to the history of food aid in haiti, it's largely surplus grain from the united states or canada or elsewhere that is -- i'm not going to say dumped, but that is being moved to haiti which can then increase the cycle of dependency because it undercuts the value of local food production, right? so, and we did this for years. you know, you have a school lunch program, you know, we still -- probably still doing it. we're trying to move away from that and not use those food sources, but buy produce locally. and we're not, you know, we're not there yet. but ideally, that's where we're going because then you support local farmers, you make sure kids get a nutritious meal which, of course, everybody, every study shows that for kids not to get a meal in school means they perform less well, and that's true in the united states as it is in haiti. but it's especially true when the best meal of the day maybe
is coming during school. so that's one thing. help to take that burden off his shoulders and don't impose anything on him, but try to have that be maybe a pilot project for the schools. um, so that's one bit of advice. for the health workers, very specific advice, find a way to allow them to make a living being health workers. and we've worked, actually, back to the world bank. we've worked with the world bank here in washington because a lot of international financial institutions are so obsessed with what they call sustainability that they recommend that that cadre of health care providers not be paid at all. how can you be a health care worker? i mean, it's got the w word in it, work. [laughter] as my daughter would say, work. how can you be a health care worker if you're a volunteer? you know, we should -- people like me should be volunteers or people like those being paid by the world bank should be
volunteers. [laughter] but the workers, the women and men who are doing that work cannot afford to be substantial, you know, interveners in their home villages if they can't, you know, if they have to be volunteers or charge poor people for their services. so those are two very specific suggestions for you and your students. and, please, give my best to father ginot. >> is there another -- we're headed towards, i know it's going a little long because somebody tell me, three to ten or manager like that? >> my colleague, jenny block -- who happens to be a theologian, by the way. other people come to washington with their lawyers, i come with my personal theologian. >> byot. >> she just said we'll help. so meet with my coworkers when you're done. >> somebody tell me since i'm supposedly moderating what time we really -- >> [inaudible] >> yeah. >> yeah, yeah, yeah. i don't want to -- >> he's got to fly to -- >> no, that's all right, i can
stay til -- 10, 15 minutes. >> [inaudible] >> yeah. i know people want to ask questions. he's -- here's your chance. >> dr. farmer? there where are you? >> i'm here on your right, about halfway back. my name is bob abernathy. whenever there's a disaster, there's just such an outpouring of desire to help. >> yep. >> and over the years and especially in haiti a great many religious groups and people of faith have gone to haiti to try to help. i'm wondering, since the earthquake how do you assess the effectiveness, the usefulness, the problems that need to be learned for people who go there with a strong religious motivation to try to help the least of these? >> that's a hard question meaning it's a morally hard and personally hard question. to ask. but i'm glad you did. i think that i don't doubt for a
minute the motivations -- and even if i did, i wouldn't mention it. [laughter] so i'm not interested in that. the motivations, i assume the best, right? so it's not about that. these are people of, in my experience, people of goodwill. one of the contributors to the book wrote a very grim book about this called "travesty in haiti," and i invited him to participate in the book because i think we need critical -- you know, he has a much worse experience than i do. and his name's timothy schwartz, and he's a very learned person, speaks good creole, has been working in haiti for years. so you can read his take on this. but i have a lot of experience with people like -- i didn't catch the schoolteacher's name, but i will later. i've worked with a lot of good people including people of faith working with church-based groups over -- a lot of good experience. now, the question you didn't ask did i meet a lot of them or what were their motivations, was how
effective has it been. i would say let's not give ourselves more than a c grade. i'm inspired by the school kids, the high schoolers. [laughter] you know, we shouldn't, right? because you look at all the goodwill, and then you look at the -- i just told you haiti's the most food insecure country in the hemisphere, i could also tell you before the earthquake half of all school-aged children in haiti were not in school. so we can't be patting ourselves on the back too much. we should pat a little bit lower. >> it goes back to this -- [laughter] >> another metaphor. >> which is where i come in. it goes back to this business, though, right? of having to empower, and everybody talks about this really who's thought about this for 14 seconds, is you need a strong central organization, public health system, and then maybe these ngos -- right now the ng ooh,s, we'll go back to the patient metaphor. it's like having one patient with 100 doctors. you know something's going to get lost in the sauce there. >> yeah.
>> but if you could somehow coordinate those and have them facilitating the work of a central organization that then was able to say, you know what? we don't need five buildings within 100 yards of each other. why don't we spread them out. the decentralization of haiti because it's, a lot of it is in the capital, and it needs to go out to the rest of the country. >> well, mr. abernathy, let me just say another thing, is this book is aimed to -- it's a loyal critique, right? an inside critique of the ngos, of the u.n., you know, of the, of the development machine. it's not a savage critique. it's saying how can we do better, as you just did. >> but the 80-pound gorilla in the room is the fact, if organized correctly, these ngos could be much more effective. so they're doing amazing stuff. i saw it with my own two eyes. >> yeah. >> i mean, amazing stuff, saving lives, but imagine what they could be doing if they were
coordinated -- >> but in general, in general to the many church-related, synagogue-related, mosque-related, all religion-related groups, what would be your message? >> my message would be, you know, although your mission is maybe different, um, from the, say, public and education public health, and i'm talking about those two areas largely although we've got to caulk agriculture and food security, even though your mission is different, it can be complementary to the goals of public health and public and education public water systems. let me put it even more, with more humility on my side. don't forget that cholera, i'm pointing at him because he was there, not because he's obsessed with stool. [laughter] cholera spread like wildfire through the very part of haiti where we'd been working for 25 years. imagine how that felt. it's a disease, it's a waterborne disease, and there we are for 25 years to ten years,
and it spread right along that river system. so we should feel, gee, you know, we didn't do everything right or, you know? what we did do right was build an infrastructure that could, again, save lives. but it's not only about saving lives, it's about preventing cholera. church groups, it's not necessarily their mission to go and promote water security, but if it's their mission to help their neighbors, which it always is, then we're going to have to think, you know, rethink and think hard about how we can, you know, work together. the clinton foundation, and i'm assuming this is a general, of general interest as well in addition to of interest to mr. ab bear nat think, the clinton foundation put together a list of health-related ngo for the ministry of health, and, you know, it's really the first time that we've really registered as health-related ngos.
now, these are larger health ngos like doctors without borders, save the children, etc., but it was the first time that this had been done. and, again, using a platform, a technology platform that everybody should be using. and we have to, i think it's going to be good to do that with church groups as well. >> and, you know, one of the things that's a theme of this book, again, is trying to think correctly even if it's painful. >> yeah. >> and it is, and it is painful sometimes. you have the best intentions. i saw real magical thinking when i was there when the cholera epidemic was having. there were people, officials saying it is going to be contained, it's going to stay right there, and i actually went on air and said this is magical thinking. there is no possibility that it's not going to spread because you have -- among every other reason, you have an incubation period of up to five days, people can be perfectly fine and then get their cholera and spread it. so there was no chance.
there is this need, especially in tough times, to just think correctly even if it's not what you want to really hear. >> well said. >> do we have time for one more question? >> dr. farmer, my name's emily powerman -- i'm right over here. i'm pursuing a master's in international development at american university, and i was reading pathologies of power when -- >> see, someone read it. [laughter] >> my dad actually gave it to me for christmas. i was just wondering if you could comment on how the earthquake influenced the views that you express in that book, particularly about the u.s.' ambivalence towards haiti and whether or not you think that has changed or it's moving in the right direction or if we still have work to do. >> um, you know, my views of the history of this united states and haiti are really not very subject to revision unless there's some new cache of troves i missed like the 18th century
wikileaks. [laughter] so looking backwards, none of that. i mean, i already knew that there were good people in government on both sides, i already knew -- of course, you know, i'm older, and i'm, i hope, wiser. i already knew there were good people on both governments. i knew there were good people, i knew there were generous people. i mean, partners in health has grown, as perry said, into a very large concern mostly because of the generous support of private individuals. so i knew all that. the question that i would ask and have been trying to ask publicly on -- i don't do that much of this, but i do it, have done a lot of it this summer is do we need to have a mean-spirited foreign policy towards haiti? and the answer is of course we don't. so i don't think we're with stuck in the same pattern necessarily. i think there are people of goodwill. the difference, of course, from 1804 when there were two independent countries in the hemisphere, the difference was there were only two, united states and haiti, is now one of
them has become probably the most powerful country in the world, and one of them has become very trampled upon and poor. it was, it had, it had those origins as well in one sense, but also glorious origins, right? so that historical trajectory has really pulled these two peoples apart when they should have been, you know, allied as the haitians were with the independence movements in if south america with bolivar. so someone said to me, paul, con decision is not your strong suit -- con decision is not your strong suit. [laughter] we don't have to be stuck in that, you know? we can change our policies. and i think there are people in the u.s. government right now who are committed to changing those policies and making them better and having them be, you know, based on, again, knowledge of that allergy. >> i have a perfect way to end this. you had your imagine nearing at the end, and it's a follow on to
that question where you were fantasizing there were some bad scenario possibilities, give me the good one. everything goes right, everything's perfect, we're in the year 2015. >> yeah. well, unfortunately, and i hate, i hate not being able -- i hate having to say this. unfortunately, the good one can't really happen. the really good one. because you need to have, for that you need to have full inclusion of all of the haitian adults, you know? and there's a saying -- [speaking in native tongue] you know, that means including them in the democratic process voting. that means all the parties and groups need to be engaged. so that hasn't happened. but that doesn't mean that we can't hope for a really good performance from the ngos, the church groups that were mentioned already, the haitian government, the international players. so if everything goes forward now as best we can, and i think this is something people of
goodwill should be committed to, we need to find ways to help the haitian government. first of all, it has to be formed. that is there's still no government in place. you need a prime minister. so let's hope maybe this week there'll be a prime minister. i want haiti to have a government just like i want my own country to have a government. and let's hope it's formed, that good people are in it, and that they find real solidarity. what will haiti look like? there'll be a major series of public works programs for reforestation that this time are linked to infrastructure and just one little tiny example. how can you reforest haiti without an alternative fuel source for cooking? >> right. and, you know, they grow the trees, i spoke to somebody up north about this. they grow the sprees, it get to be a sapling, they cut it down. they need it for firewood. and you fly over, you cannot imagine what it looks like. on the right is the dominican republic, it's all green, and on the left it's deforested. >> and one last optimistic point. in medical care which is not the
main thing, but it's pretty important, right? not that we're biased. [laughter] we're, the book -- the hospital that's described in the book which is in central haiti, first of all, it's not in the capital, it's built to rigorous earthquake standards, and it will be done or openable on the second year anniversary. to me, my experience working in the haiti is that you can get stuff done. just this past month our groups including the haitian public sector opened a new residency training program in family practice in a city you've visited during the cholera epidemic which is still going on, by the way. we checked on progress in the hospital, and the foundation reopened the medical school with cuban faculty. let me tell you, there are 1500 cuban doctors and health professionals in haiti. they've been great, and they're unsung heros. i put them in the book too. they've really helped us a lot
with cholera, but also with teaching. and so there's lots happening in health care and medicine. that's my area and yours, but people also need to know these positive stories. and then we, again, let's all be committed to helping the haitian people and the people they chose to lead them regardless of our own personal leanings or inclinations, political views. that's not the point. it's really can we help the haitian people and their leaders move forward. i think we can. so i'm gearing myself up for some optimism like what we heard from those people interviewed by michelle. if they can still have some optimism and belief in their future, then we who are not subject to these kind of pressures -- how do we feed our kids, how do we have a safe place, we're not subjected to these pressures -- if those people can have optimism, then we can too. thank you all for having me here. >> thank you. >> well done. [applause] >> for more on dr. paul farmer and the work he does, visit the
partners in health web site at pih.org. >> here's a short author interview from c-span's campaign 2012 bus as it travels the country. >> mr. waterman, set the stage for this book. what is it based on, and take us through what readers can expect. >> well, the book's based on my time in the navy in active duty from 1964 to about halfway through 1977. the reason i wrote the book was i was speaking to my cousin one day about how i hadn't done anything in my life and blah, blah, blah. he looked at me with this funny look x he said, done anything? you've done stuff people just get to read about a. i went, huh. maybe that's an idea.
so i went home, and i talked to my wife, she's now deceased, but she said, yeah, you've done a lot of stuff. and i said, well, like what? she said just start writing, just write it out in chapters. just write each event like a chapter and then figure out the time frame, where they fit in and then clean it up, and somebody will buy it. i went -- so i did. and as i wrote it, i mentioned to some people that i was writing about my experiences, and they said, oh, yeah, i remember doing things like that. so what turned out once it was published, i got feedback over the internet, guys were saying, boy, this reminded me a lot of the stuff i did and got away with and didn't -- and lived through. so it had an appeal for most any young kid who joined the military. i was 18 when i went in, and that was '31 or something like that when i got out off active
duty. and i still meet people that have read it and said, boy, that was great. i loved it. it was, it just reminded me of is some of the things that went on when i was in the service. so i said, well, maybe i got a inwe are. but that's about -- >> you write in detail about the circumstances which led you to serve in a branch of the armed service -- armed forces. can you explain how you ended up serving in the navy in the capacity that you served? >> um, i was, i was interested in scuba dyeing -- diving, but i'd sort of put it aside by the time i graduated from high school. and i'd gotten into photography, and i worked at the current newspaper running the darkroom when somebody went on vacation. i learned a lot of things from that. but i decided my only option due to my imwe kind rouse situation was to join the military if i wanted to get out of rockland, maine, and do something
interesting. one day i was down at the post office where the recruiters were, and i was going to go see the recruiters. well, the only one that was there was the navy recruiter. and i spoke to him for a while, real nice guy. and boozman's mate first class allen, i can remember his name. i'm going to quit high school and get out of town. he says don't quit high school. he said stay in, and i'll guarantee you'll get a school. i went, oh, okay. so i stayed the extra two or three months, whatever it was, and be graduated and went in the navy, and then the rest is history. but i did choose to be a photographer's mate which is kind of the closest thing that i could think of that i was doing on the outside. and ended up later becoming a diver. >> you talk about what people thought about military service in the 1960s. can you explain how you feel it was viewed then and how you talk about it in your book?
>> um, it was actually worse than what i talk about in the book. after, after i got back from vietnam last, late '69 i got back, but i went back to the east coast, and a friend of mine and i used to go to washington and take pictures of these demonstrations. we didn't have an opinion about them, but i couldn't believe the stuff that was being said about vietnam veterans. and they were portrayed as druggies and nut cases and people that couldn't make it on the outside and things of that nature. and later on i found out this was, basically, a bunch of garbage. they had a better chance of getting a job, they had less suicide, they had less drug addictions than the general population and so on. so i didn't think too much of the way that we were treated. and i never had anybody spit on me as can be proven by the fact that i'm not still in prison --
[laughter] and we sort of didn't pay a lot of attention to that. we hung around with people who were of our same way of thinking, and we didn't pay any attention to it for the most part. >> there are a lot of books written about individuals' experience during vietnam. what makes yours different or sets it apart? >> well, based on, like i say, information, feedback from the book guys saying this is not just another one of those me, me, me vietnam books. i give people credit where credit's due on anything, any ideas that came out. i love to help other people succeed. if possible. there are some interesting stories, there's a fair bit of humor in there. and i tried not to get too technical, and in cases whe