Saturday, November 27, 2010
How Do We Best Share?
The picture in the Saturday, November 13th, Wall Street Journal of a baby with cholera was heart-rending. The text in the article, "Aid Spawns Backlash in Haiti" (by Jose de Cordoba) was ominous:
"After January's devastating earthquake, there was hope the hospital could turn things around....Ten months later, the foreign doctors and charities are gone. The intensive care unit is closed. An unused defibrillator and a cardiac monitor lie askew atop a cart. Nobody at the hospital is trained on how to use either piece of equipment."
How can this be? Has Haiti become another one of those places in which wealthy people shower the victims of a natural disaster with immediate aid, only to abandon them when the headlines a few weeks or months later turn to the next earthquake or tsunami or the next season on American Idol? Weren't we all supposed to be treating Haiti differently?
Well. after you get further into the story, you see that things are, indeed, different in the case of Hiati. The opening paragraph was a description of a large government-run hospital. Inside, you see pictures of a sparkling new obstetrics unit at another hospital, run by a private charity. The point of the article is not that private charities have abandoned Haiti, but rather that the medium-run equilibrium continues to be that foreign charities largely bypass the Haitian government facilities and concentrate on more direct avenues of provision, including their own clinics and hospitals.
The article highlights both sides of the resulting argument. de Cordoba writes: "Critics say the NGOs have put Haiti in a Catch-22: By building a parallel state that is more powerful than Haiti's own government, aid groups are insuring Haiti never develops and remains dependent on charities." For example, the moral value of the NGOs of paying employees a good wage had the side effect of hiring the most well-trained personnel away from the government hospitals.
On the other hand, the author notes that the NGOs have cured, fed, housed, and educated many people and, contrary to the fear that I expressed in the opening paragraph, many seem dedicated to remaining in Haiti for years if not decades. So a counter-argument might go something like this: Who says that Otto Von Bismarck's model of a centralized welfare state has to be the only model for compassion in a country such as Haiti? If the socialized medical system of one of the most dysfunctional governments in the world is a failing model, so be it, if (and that's and important if) the ultimate result is an improved quality of life for the people of Haiti.
It seems to me that there is an important argument about finding a path so that the people of Haiti are eventually not perpetually dependent on "the kindness of strangers," especially when that means the kindness of non-Haitians. But nothing says that has to be through a return to a traditional government owned and operated health care system. Therein lies the uncertain path for NGOs and those of us who support them.