Comment from the Field: Reflections on Disability in Haiti

On Tuesday, January 12, 2010, a magnitude 7.0 earthquake struck southern Haiti. It was centered just to the west of the capital of Port-au-Prince, and caused widespread destruction in and around the metropolitan area, where more than two million people were living. The numbers are staggering: more than 230,000 people died, and close to a million were left without homes. Many of those whose homes collapsed were relocated to camps or tent cities outside of Port-au-Prince, where they faced not only a lack of basic services but also dangerous, potentially violent conditions. Thousands of commercial and government buildings were destroyed and the already-fragile infrastructure of the city-including medical, transportation, and communication services-was devastated. Dozens of aftershocks, some as high as magnitude 4.0, rocked the city for weeks after the initial earthquake. The United Nations called off the search for survivors on January 23. The earthquake was the most catastrophic natural disaster since a tsunami centered off the coast of Indonesia killed an estimated 300,000 people in south Asia in December 2004. The disability issues connected to the Haitian earthquake are multiple and layered. The Haitian government estimated a population of about 800,000 disabled people prior to January 2010 (the population of the country as a whole was nine million). These numbers of course increased dramatically following the earthquake. Many survivors of the disaster were trapped, sometimes for days, beneath heavy rubble. In the weeks following the earthquake, between 6,000 and 8,000 amputations were performed. An immediate need for prosthetic limbs and mobility devices was evident, particularly wheelchairs capable of negotiating rugged terrain; Port-au-Prince was not easily accessible for those using chairs and other mobility devices prior to January 12, and was infinitely less so afterward. All of the metropolitan area's hospitals were damaged in the earthquake and two of the country's three prosthetic labs were destroyed. An estimated 120,000 people were living with HIV or AIDS in Haiti in 2008; the country has the highest prevalence of HIV infection in the western hemisphere. The earthquake disrupted the treatment regimen for thousands of HIV-positive people in and around the capital, while conditions in the makeshift camps were conducive to the spread of HIV as well as other infectious diseases. Despite these immense challenges, Partners in Health, which was founded by Paul Farmer and has been operating in Haiti for more than two decades, continued its work on the island in solidarity with Haitian health care workers, particularly members of Zanmi Lasante. Together, these two groups quickly opened four medical clinics in the camps, with the goal of providing not only immediate and emergency medical care, but also of putting in place structures that would allow Haitian-led long-term care and rehabilitation services. The challenges faced by Partners in Health, Zanmi Lasante, and other organizations were obviously compounded by other basic facts about the country: three quarters of the adult population prior to the earthquake was unemployed; half of the population was below the age of eighteen. The issues I have surveyed above are clear and material disability issues in Haiti. The disaster, however, also exemplified a less material fact that has been part of Haitian history for more than two hundred years. Since 1804, when the revolution of slaves led by Toussaint L'Ouverture against the French colonizers resulted in the country's independence and the world's first black republic, Haiti has been metaphorized in relation to both disability and illness more than almost other any location on Earth. France and other European powers, in alliance with the newly formed United States, feared the establishment of radical democracy in Haiti, along with an alternative economy not founded on slave labor. Of course, European powers had extracted massive amounts of wealth from slave labor in Haiti and throughout the Americas; an alternative, democratic order and economy not based on the brutal exploitation of slaves would be, from the colonizers' perspective, obviously non-profitable. …