Haiti

Up, Down.

in December 2005 this picture caught my attention because the UN soldiers in it happen to be Brazilians, and the kids obviously trust them ... that was going on four years ago ... now it is three young women, one shot in the head by police, one rescued by stubborn French men and women at the last possible moment, and the other giving birth ...

and the various governments playing hot-potato silly-buggers over who will pay for the flights and medical care ... I have been reading some history of Haiti, brutal, their governments seem to care most about lining their pockets, but then ... "the widowhood of every government, signs for all to see" said the poet, the widow who thinks mostly of herself and the black widow spider I suppose he means ...

none of 'em doin' nothin' that yer mama wouldn't disapprove ...

Fabianne Geismar: shot dead for stealing mirrors:


Darlene Etienne: pulled alive from rubble after 15 days:

the names of some of the French rescue team are: Claude Fouilla, Christophe Renou, Francois Valette, David Bernadou, Michel Orsell, Samuel Bernes, Mr. Arnaud; there were others whose names were not published, they all deserve to be remembered with honour, especially considering that René Préval had 'officially' called off the search days before

Roseline Antoine and her new daughter Kimberly, and her sister Enese Saint Silme: giving life in a land overflowing with pain:



Appendices:
1. Thinking About a New Haiti, Editorial, Jan 31 2010.

2-1. Cost Dispute Halts Airlift of Injured Haiti Quake Victims, Shalia Dewan, Jan 29 2010.
2-2. U.S. to Resume Airlift of Injured Haitians, Peter Baker, Jan 31 2010.
2-3. In Quake’s Wake, Haiti Faces Leadership Void, Ginger Thompson & Mark Lacey, Jan 31 2010.

3-1. Giving Life in a Land Overflowing With Pain, Damien Cave, Jan 29 2010.
3-2. Shot dead for stealing mirrors, Joanna Smith, Jan 20 2010.
3-3. Haiti: girl pulled alive from rubble after 15 days, Telegraph, Jan 28 2010.
3-4. French rescue team ignores practicality resulting in another rescue, Terri Fraracci, Jan 29 2010.



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Cost Dispute Halts Airlift of Injured Haiti Quake Victims, Shalia Dewan, Jan 29 2010.

MIAMI — The United States has suspended its medical evacuations of critically injured Haitian earthquake victims until a dispute over who will pay for their care is settled, military officials said Friday.

The military flights, usually C-130s carrying Haitians with spinal cord injuries, burns and other serious wounds, ended on Wednesday after Gov. Charlie Crist of Florida formally asked the federal government to shoulder some of the cost of the care.

Hospitals in Florida have treated more than 500 earthquake victims so far, the military said, including an infant who was pulled out of the rubble with a fractured skull and ribs. Other states have taken patients, too, and those flights have been suspended as well, the officials said.

The suspension could be catastrophic for patients, said Dr. Barth A. Green, the co-founder of Project Medishare for Haiti, a nonprofit group affiliated with the University of Miami’s Miller School of Medicine that had been evacuating about two dozen patients a day.

“People are dying in Haiti because they can’t get out,” Dr. Green said.

It was not clear on Friday who exactly was responsible for the interruption of flights, or the chain of events that led to the decision. Sterling Ivey, a spokesman for Mr. Crist, said the governor’s request for federal help might have caused “confusion.”

“Florida stands ready to assist our neighbors in Haiti, but we need a plan of action and reimbursement for the care we are providing,” Mr. Ivey said.

Mr. Crist’s request did not indicate how much the medical care was costing the State of Florida, but the number and complexity of the cases could put the total in the millions of dollars. The expenditure comes at a time when the state is suffering economically and Mr. Crist, a Republican, is locked in a tough primary battle for the Senate seat that had been held by Mel Martinez.

“Recently, we learned that plans were under way to move between 30 to 50 critically ill patients a day for an indefinite period of time,” Mr. Crist wrote in a letter to Kathleen Sebelius, the secretary of health and human services. “Florida does not have the capacity to support such an operation.”

A spokeswoman for the Department of Health and Human Services said the decision to suspend the flights was made by the military, not the federal health department. A military spokesman said that the military had ended the flights because hospitals were becoming unwilling to take patients.

“The places they were being taken, without being specific, were not willing to continue to receive those patients without a different arrangement being worked out by the government to pay for the care,” said Maj. James Lowe, the deputy chief of public affairs for the United States Transportation Command.

Florida officials, meanwhile, said the state’s hospitals had not refused to take more patients. Jeanne Eckes-Roper, the health and medical chairwoman of the domestic security task force for the South Florida region — where the Super Bowl will be played on Feb. 7 — said she had requested only that new patients be taken to other areas of the state, like Tampa.

The Health and Human Services spokeswoman, Gretchen Michael, who works for the assistant secretary for preparedness and response, said the agency was reviewing Mr. Crist’s request for financial assistance. The request would involve activating the National Disaster Medical System, which is usually used in domestic disasters and which pays for victims’ care.

Some of the patients being airlifted from Haiti are American citizens and some are insured or eligible for insurance. But Haitians who are not legal residents of the United States can qualify for Medicaid only if they are given so-called humanitarian parole — in which someone is allowed into the United States temporarily because of an emergency — by United States Citizenship and Immigration Services.

Only 34 people have been given humanitarian parole for medical reasons, said Matthew Chandler, a spokesman for the Department of Homeland Security. The National Disaster Medical System, if activated, would cover the costs of caring for patients regardless of their legal status.

Some hospitals have made their own arrangements to accommodate victims of the earthquake, which occurred on Jan. 12. Jackson Health System, the public hospital system in Miami, treated 117 patients, 6 of whom were still in critical condition, said Jennifer Piedra, a spokeswoman. The system has established the Haiti’s Children Fund to cover the costs of treating pediatric earthquake victims.

In the aftermath of the earthquake, Haitian medical facilities were quickly overwhelmed. Since then, medical help has come in the form of mobile hospitals and other aid. Major Lowe said that as medical care had become available in Haiti, the need for the flights had declined significantly. But Dr. Green and nonprofit groups with a presence in Haiti said the need for evacuations remained dire.

“Right now we have in the queue dozens of paraplegics, burn victims and other patients that need to be evacuated,” Dr. Green said. “And other facilities are asking us to coordinate the evacuation of their patients.”

A spokeswoman for Partners in Health, a Boston charity with doctors and nurses in Haiti, said the group had a backlog of patients, many with head, spine or pelvic injuries, who needed surgery that could not be performed there.

Major Lowe said patients could still be evacuated in private planes, but Dr. Green said medically equipped planes were very expensive and generally could carry only one or two patients.

Federal officials could not provide the total number of earthquake patients airlifted to the United States, but Florida seemed to have received the bulk of them.

In his letter, Mr. Crist outlined his state’s efforts to support the rescue effort, helping both the healthy and the sick streaming into the state. “Florida’s health care system is quickly reaching saturation,” he wrote.



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Giving Life in a Land Overflowing With Pain, Damien Cave, Jan 29 2010.

PORT-AU-PRINCE, Haiti — Biology and the earthquake dictated that Roseline Antoine would give birth at 9:42 a.m. Thursday to a healthy baby girl who has no home but the street. The same irrevocable forces left Delva Venite naked a few feet away, in pain, waiting nearly a day for doctors to deal with the stillborn son inside her.

The women shared one of the better medical facilities here — a maternity tent outside General Hospital — but there were not enough beds or doctors. Flies were their roommates, bunching like crows on the intravenous drips, and as for the joy found in most maternity wards, that had been lost to the cracked earth.

“The street where I live, it’s so dirty; there isn’t enough food or water,” Ms. Antoine said. “I’m scared to bring a baby into this awful situation.”

Pulling down her blue dress after giving birth, she added, “I need to find a way to survive.”

The pregnant are an especially vulnerable subset of victims of the quake that has left so many Haitians homeless and desolate. The United Nations estimates that 15 percent of the 63,000 pregnant women in the earthquake-affected areas are likely to have potentially life-threatening complications. For the roughly 7,000 who will give birth in the next month, the risks are even greater.

Aid groups are doing what they can. CARE has been handing out hygienic birthing kits, and doctors from around the world have taken a special pride in delivering babies. Along with rescues, newborns have become beacons of uplift amid the darkness of death.

Still, Haiti is a frightening nursery. Even before the quake, this small country had the highest rates of infant, of under-5 and of maternal mortality in the Western Hemisphere; on average, according to United Nations reports, 670 Haitian women out of every 100,000 die in childbirth, compared with 11 in the United States.

The troubles are especially visible in the tent cities all over the capital. Earlier this week on the grounds of a former military airfield, Venold Joseph, 29, devoured a tin of spaghetti, her first meal since having her baby there four days earlier.

In another tent camp, on a soccer field of a school near the downtown, one meal a day was as much as Mirline Civil, 17, could hope for. Her baby, born Sunday, struggled, too. When she tried to breast-feed the little boy, named Maiderson, he failed to latch. She rocked him back and forth and asked, “Why are you crying so much?”

In three days of visits to General Hospital, which is operating mostly out of tents, mothers were desperate to avoid returning to their own patch of dirt.

The recovery tent, a short walk from the birthing tent, included 15 mattresses Thursday, on gravel, each with a mother and child.

Sandia Sulea, 24, leaning on her elbow, and Nativita Thomas, also 24, said they both had their babies three days earlier. Their homes were flattened. They were left to sleep in the street.

The medical tent, though hotter than 100 degrees in the afternoon sun, was a step up. Here, nurses bring crackers and juice. Here, if something goes wrong, a medical team will help.

“I know they need space for other people,” Ms. Sulea said. “But I don’t know what to do.”

Across the tent, an older woman nodded toward a quiet young mother in a men’s navy blue golf shirt, picking at her nails. While the other women had family or friends crowded around, she sat with her infant son, Mackendi.

“I’m from an orphanage,” said the new mother, Aristil Fabian, 18. “My mother and father are dead.”

Without family — her husband fled to the country — she said she had been roaming the street, bedding down in the closest camp when it was time to sleep. She made it to the hospital on Wednesday, when she had the baby, but by Thursday afternoon, she had no idea what was next.

“I don’t have anyone,” she said. “I’m alone.”

Inside two pediatric tents a few yards away, steel cribs with chipping paint sat crammed together. There were babies with broken arms, a boy with four amputated toes, and two abandoned children — one cross-eyed, the other, doctors believe, with cerebral palsy. No one seemed to know whether the parents died in the earthquake or just gave them up.

The most severe case, however, lay in another crib: the boy with no name. He was 13 months old, according to a man who was waving away flies, but he was so severely malnourished, his eye sockets looked like the cardboard tubes that hold toilet paper. His arms were thin enough to reveal separate bones and ligaments.

“We’re trying to do what we can,” said Dr. Carole Dubuché, a Haitian-American pediatrician who practices in Brooklyn, as she filled a bottle of formula.

Few of the doctors were local. Most of the Haitian obstetricians and pediatricians have still not returned to work full time. The young residents who are trying to fill the gap say a few show up for the morning or afternoon but do not stay long.

Ms. Venite’s husband, Gérard Joseph, said he understood why. “Everyone is looking for their family,” he said.

But not everyone sees it that way. “People here are getting a paycheck and they don’t come to work,” said Dr. Gerard Guy Prosper, a former head of pediatrics at General Hospital who now works in the Bronx. “And no one does anything about it.”

He nearly shook with anger.

The result, for now, seems to be a scramble to keep up. On Thursday, Ms. Venite’s pregnancy ended nine months after it started, with a small, still figure in a cardboard box on the dirty ground. It was only chance that kept someone from accidentally kicking it.

And on Friday by 3 p.m., two women had already had Caesarean sections; two others were waiting their turns. A resident said that all four women were at high risk for complications.

Inside the recovery tent, meanwhile, Ms. Fabian and Mackendi were gone. So was the malnourished little boy. He died Friday.

By comparison, the triumphs here are small. A group of doctors linked to a global health group out of Johns Hopkins in Baltimore opened three operating rooms this week inside the hospital, so some Caesareans no longer take place in the surgical tent where doctors are amputating gangrened limbs.

Ms. Antoine on Friday also found a place to live, in a neighbor’s yard. She had been sleeping in a sewage-drenched camp outside a flattened school in her neighborhood of Bel-Air. Now, she and her new daughter, Kimberly, live just behind it, under a thin white sheet near a mostly empty set of cages with a few chickens and a litter of puppies.

Her two older children, David, 12, and Osnort, 5, seem happier with their new quarters, but Ms. Antoine remains beleaguered. From her new dwelling, she can see the crushed house where she used to live — and where her husband died while she sold cookies from a pushcart downtown.

She lost everything that day, and she said she hated that she was suddenly dependent on the charity of others.

“I don’t think I can live like this, just waiting for someone to bring me food,” she said. She shook her head, and stared away, as her day-old daughter tried to suck her thumb.



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Shot dead for stealing mirrors, Joanna Smith, Jan 20 2010.

Girl, 15, killed by police while trying to take merchandise from abandoned building

PORT-AU-PRINCE–The coins clanged as they bounced off the roof and she lay with her arms still wrapped around the cardboard box of ornamental mirrors she had grabbed from the abandoned building.

Moments earlier the girl in the short pink skirt had been one of dozens of people taking stacks of plastic chairs and other household items from a damaged store just off the Rue Grand Rice in downtown Port-au-Prince a week after the earthquake turned the thoroughfare into a post-apocalyptic landscape.

Crowds below her were carrying the chairs – mostly beige, some rusty red – down the street covered in garbage and grime.

They were tearing at each other as police officers in fluorescent yellow vests shot their rifles into the air, at one point aiming them at a man before drop-kicking him into the dirt and then letting him go.

She was standing on the roof.

The officer was standing on the street.

He shot her. She died.

Others stopped by the body of the girl, identified as Fabianne Geismar, 15, on their way down the roof to rifle through her pockets for change.

A week after the earthquake struck, the streets form a worsening nightmare, even as medical teams and water trucks make their way through parks turned into increasingly crowded and dank camps for the homeless.

Humanitarian organizations are chaotically busy trying to distribute supplies to the needy – the appearance of a truck giving out water bottles is always sure to attract a queue of hundreds – but many residents are just trying to get out.

The bus station was a cacophony of horns Tuesday as families lined up for hours, breathing in the fumes from idling engines with the sun beating down on their heads, to leave the capital for Gonaïves and other regions of the troubled island nation.

There were loud beeps and bleats but very little movement as hundreds of people – including one elderly woman with broken legs in a wheelbarrow – were loaded into pickup trucks and old school buses painted with bright and colourful slogans, often religious. At least one enclosed delivery truck opened its back door to let in some fresh air.

Most squeezed into the seats, the pouting face of one little girl staring sullenly through the clouded window, but others climbed up to the roof to ride along with the roped-down cardboard boxes that served as luggage.

Men and women carrying goods in baskets on their heads – tiny bags of water, along with cellophane pouches of dried plantains, crackers, even beaded bracelets and faux pearl earrings – circulated between the vehicles hoping anyone would be wanting a snack or some cheap jewellery for the ride.

One woman stuck a hand carrying a cellular phone out the window to tap the side of a woven basket as it passed her window. The man below it stopped and she withdrew her hand to return with a crumpled bill in exchange for a bag of plantains.

The man examined the bill carefully, straightening it out and fingering the tape holding its wet pieces together, before carefully putting it into the left front pocket of his denim shorts and moving on to the next vehicle.

Near the front of the station, 4-year-old Annie Curie curled her fingers around the edge of the open window from her seat on a bus, raising her index finger to wave to the man standing on the pavement below.

"That's my daughter," Arence Alexis said as he smiled up at the girl. She was on her way to Cap-Haïtien and her father was staying behind in Port-au-Prince.

"I have my responsibilities: my house, and I am a driver, so my truck," Alexis said, explaining why he would not be travelling with his wife and daughter.

When asked when he expected to see his family again, he said, "It depends on the situation.

"Her mother is there, too," he said, reassuringly. "She is with her mother."



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Haiti: girl pulled alive from rubble after 15 days, Telegraph, Jan 28 2010.

A teenage girl has been pulled from the rubble of a collapsed Port-au-Prince school, a remarkable 15 days after an earthquake devastated the Haitian capital.

French rescuers who found Darlene Etienne, 17, said it was a miracle that she had survived for more than two weeks trapped in the debris. Miss Etienne's family said she had been studying at the College of St Gerard when the powerful earthquake struck on Jan 12.

"We thought she was dead," Jocelyn A. St. Jules, her cousin, said.

Her discovery comes five days after the Haitian government officially announced the end of search and rescue operations.

"I don't know how she happened to resist that long. It's a miracle," said rescue worker J.P. Malaganne.

Rescuers said she was shocked and dehydrated but happy to be free.

"She just said 'thank you,' she's very weak, which suggests that she's been there for 15 days," Commander Samuel Bernes of the rescue team said. "She was in a pocket surrounded by concrete."

Mr Bernes said that neighbours had been searching in the rubble of their home in the central Carrefour-Feuilles district when they heard a voice and alerted rescue teams. The girl was trapped between a collapsed wall and a door and was able to lie down, rescuers said.

Miss Etienne, who has an injury to her leg, was given oxygen and taken to a French-run field hospital for treatment.

More than 130 people have been unearthed since the earthquake, but most of those were in the immediate aftermath of the disaster and authorities have said it is unlikely for anyone to survive more than 72 hours without water.

But the stories of survival against the odds in Haiti continue.

Earlier this week a man whose house collapsed during one of the strong aftershocks to hit the city was rescued after 12 days trapped in the rubble.



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French rescue team ignores practicality resulting in another rescue, Terri Fraracci, Jan 29 2010.

Haiti miracles continue: French rescue team ignores practicality resulting in another rescue.

On January 27, 2010 17 year old Darlene Etienne was found because a French rescue team ignored practicality and common sense in favor of their own feelings that there were more survivors. After 15 days in the rubble, the teenager, who was left for dead, will now live.

French Ambassador Didier le Bret praised the persistence of the French rescue team, which has kept looking for survivors for days after the Haitian government officially called off the search. "They are so stubborn because they should not have been working anymore because, officially, the rescue phase is over. But they felt that some lives still are to be saved, so we did not say that they should leave the country," he told Associated Press Television News.

Stubbornness? Persistence? Yes. But could it be that the rescue team was so stubborn because they were simply listening to that still, small voice that inhabits all of our hearts and souls and leads us to what we call miracles in ordinary lives if we will only listen? The team was told to move from rescue to recovery. Science says that 15 days is just too long. Others have given up because practicality says it is time. And yet they continued.

Darlene Etienne is alive today because the French team chose to ignore the realistic expectations of survival in favor of the unrealistic, but empowering spiritual expectations that lived in their hearts. Imagine a world full of people willing to listen to that still, small voice. Just imagine.



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U.S. to Resume Airlift of Injured Haitians, Peter Baker, Jan 31 2010.

WASHINGTON — The White House said Sunday that it would resume a United States military airlift of Haitians seriously injured in the Jan. 12 earthquake, reversing a five-day suspension that doctors worried would strand patients with devastating burns, head and spinal cord trauma, amputations and other wounds.

The flights were halted on Wednesday after Florida officials complained that their hospitals were overwhelmed and that they needed a plan for reimbursement for the care they were providing. Federal and state officials worked through the weekend to address concerns enough to restart the medical evacuations.

“Having received assurances that additional capacity exists both here and among our international partners, we determined that we can resume these critical flights,” said Tommy Vietor, a White House spokesman.

With an estimated 200,000 people in Haiti dead and a similar number injured, the halt to the evacuations quickly evolved into a roiling controversy distracting from the enormous efforts made by the United States to help. Aid groups complained that the suspension was putting lives at risk, while officials from Florida to Washington provided conflicting explanations and disclaimed responsibility for the decision.

Gov. Charlie Crist of Florida wrote to the Obama administration last week warning that “Florida’s health care system is quickly reaching saturation” and requesting that the National Disaster Medical System be activated to help with the cost. The military suspended the flights, saying that Florida hospitals had stopped accepting patients.

But Mr. Crist adamantly denied that and, as Florida newspapers dubbed it the “airlift scandal,” said he never wanted to stop taking the injured; he only wanted more help.

The White House, acutely aware of the lessons from Hurricane Katrina, stepped in to resolve the problem. Thomas E. Donilon, the president’s deputy national security adviser, led an effort all weekend to address the capacity issue; among other things, the government persuaded other Caribbean nations to help with urgent cases.

Mr. Vietor said the issue of who would pay for treating evacuated Haitians was not the reason for the suspension of the flights, only the concern about whether Florida hospitals could handle the additional patients.

“This wasn’t about cost,” he said. The matter of reimbursement raised by Florida officials is a separate concern, he added, saying, “we’re having ongoing conversations about that issue.”

Until their suspension, the flights had transported hundreds of gravely injured patients, all but a handful to Florida. David Halstead, an official with the Florida Division of Emergency Management, who is coordinating the state’s rescue effort for earthquake victims, said by telephone that Florida has treated 530 Haitian patients and that 190 remained in its hospitals.

“The rest of the states combined have accepted four patients, and it’s not that other states aren’t willing,” he said. “We can certainly accept patients, but there has to be a plan.”

In Port-au-Prince, doctors welcomed the news of resumed airlifts, which they called vital for some of their neediest patients.

“Keeping them in this environment, it’s like you’re sentencing them to a life of misery,” said Dr. Brian Crawford, a volunteer with the International Medical Corps, a relief and development group in Santa Monica, Calif.

He said he hoped that many states, not just Florida, would find a way to share the burden of Haiti’s broken bodies and minds.

He said he had one particular patient in mind: an 11-year-old girl who suffered a severe spinal fracture during the earthquake. She ended up a paraplegic, he said, and a few days ago Dr. Crawford transferred her from the General Hospital here to a charity hospital outside the city, which he hoped would lead to a flight out.

“This could be an open window for her,” he said, referring to the airlifts. “Hopefully it will be.”

The White House said patients were being identified for transfer and evaluated by doctors to ensure that they can handle the flights. In addition, the White House said that the government was arranging for in-flight care for children in need, and that Florida was designating which hospitals could receive the influx of patients. Mr. Vietor said the flights would probably evacuate “a couple hundred of the most severely injured patients.”

Ultimately, though, evacuations are not a long-term solution to the problem. Dr. Barth A. Green, co-founder of Project Medishare for Haiti, a nonprofit group that has been evacuating patients, said the American government has decided to create “a world-class trauma hospital” at the Port-au-Prince airport along with private relief groups. At the same time, a 250-bed hospital for post-operative care and rehabilitation will be completed, and after that a second 250-bed facility for rehabilitation.

“Things are the way they should be again,” he said. “We’re in sync. We are going to show Haiti what we are capable of.”

Confusion disrupted a smaller humanitarian effort involving Haitian children. A Baptist church in Idaho, whose members were among 10 people detained for trying to take 33 children out of Haiti, said Sunday that the team was “falsely arrested” and that the church was trying “to clear up the misunderstanding.”

A statement on the Web site of the church, Central Valley Baptist in Meridian, Idaho, said the team traveled to Haiti to rescue children from orphanages destroyed in the quake. The children, the statement said, were headed for an orphanage across the border in the Dominican Republic. Haitian officials detained the church members out of concern the children might be susceptible to trafficking and said some of the children might have parents.

Peter Baker reported from Washington and Joseph Berger from New York. Damien Cave and Shaila Dewan contributed reporting from Port-au-Prince, Haiti.



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In Quake’s Wake, Haiti Faces Leadership Void, Ginger Thompson & Mark Lacey, Jan 31 2010.

PORT-AU-PRINCE, Haiti — The journalists had assembled and the cameras were rolling. Seated at center stage were the American ambassador and the American general in charge of the United States troops deployed here.

At the back of the room, wearing blue jeans and a somber expression, stood President René Préval, half-listening to the updates on efforts to help Haiti recover from its devastating earthquake while scanning his cellphone for messages. Then he wandered away without a word.

That moment last Wednesday was revealing of the leadership crisis taking hold in Haiti as it faces the task of rebuilding almost every corner of Port-au-Prince, the capital.

Foreign nations have sent hundreds of millions of dollars in assistance, only to find the government too weak to harness it. Virtually every symbol of this country’s political system vanished into the rubble. The seat of government has been reduced to little more than a platform beneath a towering mango tree outside a police station near the airport.

Parliamentary elections have been indefinitely postponed. Radio programs have become soap boxes for opposition leaders to strike the government while it is down. A nation that had been looking forward to a rare, peaceful transfer of power is now experiencing familiar — albeit faint — rumblings of chaos and coups.

During the greatest disaster Haiti has ever faced, its president has seemed incapable of pulling himself together, much less this deeply divided society.

“What the country has seen since the earthquake is not a leader, but a broken man,” said Mirlande Manigat, a former first lady of Haiti who makes no secret of her presidential aspirations. “He’s not doing. He’s not speaking. He’s not acting. He’s not moving. And if he’s not moving, how’s the country supposed to move?”

In the immediate aftermath of the quake, Mr. Préval seemed to wander around in a daze, lapsing into moments of disorientation. The morning after, he sent a taped message to the nation, his only one so far, to a radio station, dispassionately reporting details of the damage and urging listeners, “Kembe,” the Creole term for “hold on.”

In recent days he has begun to take steps to reassert authority and restore his government, but given Haiti’s turbulent and unforgiving politics, the damage may have been done.

Mr. Préval makes no apologies for his low profile. “I don’t do politics, O.K.?” he huffed in one recent interview. “My work is to find ways to ease the pain of those suffering, instead of being trailed by journalists to pose for pictures with people who suffer.”

He boasts that government workers have cleared the streets of about 170,000 bodies. But with so little else to show for his efforts in the nearly three weeks since the earthquake, few are convinced that Mr. Préval is doing anything at all. Despite a flood of foreign aid, hundreds of thousands of people continue to languish in squalid shelters.

Publicly, the international organizations here emphasize at almost every turn that they are working under Mr. Préval’s direction. Privately, United Nations and American officials said they did not believe he was up to the task.

Because of concerns about the government’s history of corruption and inefficiency, only a fraction of the aid flowing into Haiti is permitted to pass through government channels.

The disappointment in the president seems most palpable. Judith Marceline, a former nurse who lost everything in the quake but the dirty flowered dress she was wearing Sunday, said that she stood in line for hours to vote for Mr. Préval in 2006. Today she wonders why.

“When he needed us, we went out to support him,” she said. “Now that we need him, where is he?”Mr. Préval, like Haiti, is no stranger to crisis. In fact, he rose to power as its antidote. After several volatile decades marked by dictatorships and populist governments, the simple, soft-spoken agronomist appealed to a country looking for a cool technocrat to lower the political temperature.

During his first term in office, from 1996 to 2001, he is credited with building dozens of public schools, putting tens of thousands of people to work and issuing titles to thousands of acres of farmland.

In his second term, which began in 2006, Haiti experienced modest, but hopeful, levels of growth and security.

Political tensions, however, began to flare after Mr. Préval’s handpicked electoral council disqualified more than a dozen opposition parties from taking part in this year’s elections. The move put Mr. Préval at odds with his old mentor, former President Jean-Bertrand Aristide, who, even in exile, remains adored by the poor.

Mr. Aristide and other opposition leaders accused Mr. Préval of trying to stack the Parliament so that he could make the constitutional changes necessary to run for a third term.

“The only way to confront Préval’s plan is to mobilize the population,” Evans Paul, a former presidential candidate, told The Associated Press in early January. “The people have a right to rebel whenever the government is acting antidemocratically.”

Since the earthquake, its hand strengthened by government weakness, the opposition has seized on the leadership vacuum as another truncheon to swing at the president.

Slowly it appears that Mr. Préval has gotten the message, many say.

In recent days, he sent his prime minister, Jean-Max Bellerive, to address a meeting of donors in Montreal. He ordered public works projects outside the capital to get back to work, and children in those areas to return to school.

He appointed a group of government ministers and private-sector leaders to serve as liaisons between his government and the hundreds of international organizations delivering assistance to this country. Most notably, he has begun to stake out a place on the public stage, giving interviews and holding news conferences. On Friday, he spoke at length to reporters at Radio Television Caraibes, outlining his vision for a new, less congested capital, where the government employs people to help clear the rubble and rebuild their own homes.

Responding to criticism of his displays of distress after the earthquake, he said, “Even though I am president, I am human first.”

To those who have suggested that the recovery ought to be moving more quickly, he said, “They underestimate the magnitude of the problem.”

And when asked for a political forecast, he sounded more hopeful than sure, saying that he would try to push ahead with the presidential election, scheduled for November, as the best way to guarantee political stability.

“I want this to be a new country,” he said, waving his hands for emphasis. “I want it to be totally different.”



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Thinking About a New Haiti, Editorial, Jan 31 2010.

Three weeks after Haiti’s earthquake, the search for survivors has been called off, the TV crews are trickling home, and the celebrity telethon is over — usual signs that the floodwaters of compassion will be ebbing soon. The United States, Canada and other nations, meeting in Montreal last week, vowed that wouldn’t happen. They began to map out a 10-year recovery plan and set the stage for a big donor conference in March.

Leaders there also acknowledged the difficult truth: It will take years of sustained help, and aid alone will never pour the foundation of a new Haiti.

In old Haiti there is still mostly horror. It is a nation of the homeless and maimed. Despite a stunning global surge of aid, many survivors still lack water, food and tents. Thousands sleep outdoors in Port-au-Prince, in terror of aftershocks. Roads, ports, communications — all in terrible shape before — are shattered. Managers and civil servants needed to help run the recovery are dead; the buildings they would run it from are flattened.

And yet there are reasons for optimism in the rubble. Well before the quake, experts like Paul Collier, an Oxford economist who was a special adviser on Haiti to the United Nations, were disseminating sensible proposals for rebuilding Haiti. The quake altered the landscape but not the validity of these ideas.

Here are a few that donor countries and Haitian leaders should take a hard look at in coming weeks:

PROMOTE SELF-SUFFICIENCY Professor Collier has noted that Haiti has considerable economic advantages, like low labor costs and a law that grants its goods preferential access to the United States market. Extending that law and encouraging investments in industries like garment-making and tourism could swiftly create tens of thousands of jobs. Rebuilding and modernizing agriculture to grow staples and export products like coffee and mangoes would mean food, cash and employment.

OPEN UP THE COUNTRYSIDE Dispersing the population beyond overbuilt, overburdened cities, like the now-shattered capital, is a good idea now cloaked in urgency. Haitians need to get out of disaster-prone areas, and well-placed development could enable them to lead sustainable lives in rural areas and new small towns instead of as the huddled, jobless urban poor. They also need help with tree-planting and topsoil restoration projects, which could create jobs and begin to undo the profound environmental damage that has left the countryside so impoverished and vulnerable to natural disasters.

REBUILD (AND MAINTAIN) INFRASTRUCTURE Haiti obviously needs homes, schools, roads, a reliable power system — but it also needs the money to maintain them, instead of the usual practice of building projects and leaving them to rot. Technology offers hope here, too. Instead of waiting for someone to build an expensive, centralized power grid, donors could think more flexibly on a smaller scale, using solar panels and LEDs to provide electricity and light cheaply, portably and quickly.

TAP THE DIASPORA Haitian immigrants in the United States, Canada and elsewhere already send home hundreds of millions of dollars every year. They surely will be sending more, now that the Obama administration has wisely, if belatedly, granted temporary protected status to undocumented Haitians in the United States. Haitians in Canada proposed another excellent idea: government-paid leaves of absence to allow expatriates (employed in government or the private sector) to return and rebuild civil society in their place of birth.

In a country scarred by endemic corruption and waste, relief funds and projects need to be carefully monitored. Those who know Haiti well note that in the years before this latest disaster, civil order had already begun to take root. President René Préval is far more capable than his predecessors, although we wish he would be a lot more visible to his own people and a lot more assertive. Haiti needs strong and honest leadership.

Expert analysts like Jocelyn McCalla, a Haitian-American development consultant, noted an encouraging upswelling of political good will and common purpose after the devastating hurricanes of 2008. This, he says, helps explain why Haitians have endured these horrific weeks with relative calm.

It will take a lot of money, creativity, and vigilance and sustained commitment to rebuild Haiti — from Haitians and from the world. There are smart people thinking about how to do it. And that is a start.