Chile vs. Haiti

My sister in law Rachel, is a doctor currently living in Kenya doing research on pediatric AIDS.  I asked if I could repost this blog because I thought it was especially insightful and moving.  If you ever need to put your life in perspective, check out her blog.  There have been many times, while in the midst of a pity party that I’ve read her latest post and have remembered how much I actually have in my life that I take for granted. None of us have been given resources simply for ourselves- we’ve been given them to care for others.

Reuben loves seeing his aunt Rachel!

“The earthquake in Chile has been very much on my mind during the past few days, largely because of our cousins living in Santiago and extended family around the country. It has been a relief to gradually receive confirmation that all of our loved ones are safe. While the damage in Chile was significant and the pictures of collapsed buildings and bridges made me worry as I waited to hear about our family, I could not help but think about how much worse the situation in Haiti was after their earthquake in January. The differences reflect so clearly the disparities between a country with resources and a country without resources.

The Huffington Post provided a great description of why Chile could have an 8.8 magnitude earthquake and yet have so much less damage than the 7.0 earthquake in Haiti:

The earthquake in Chile was far stronger than the one that struck Haiti last month – yet the death toll in this Caribbean nation is magnitudes higher.

The reasons are simple.

Chile is wealthier and infinitely better prepared, with strict building codes, robust emergency response and a long history of handling seismic catastrophes. No living Haitian had experienced a quake at home when the Jan. 12 disaster crumbled their poorly constructed buildings.

Last week, I used the example of Haiti in a lecture to illuminate what global health looks like and what the needs (and consequences) for global health are in a resource-limited setting like Haiti. For many of us, it took a massive, horrific earthquake to remind us about Haiti. The earthquake woke us up to what was or was not in place before this disaster hit.  The earthquake created something truly awful that we had to pay attention to, but it also makes us look at Haiti.

And, what do we see in Haiti? For a long time, most Haitians have not had the most basic of human rights: clean water, decent shelter, and adequate nutrition. Without these basic necessities, Haitians face chronic disasters of disease, the diseases of poverty and malnutrition – HIV, diarrhea, malaria, poor survival at birth.

  • Haiti is the poorest country in the western hemisphere
  • Half the population lives on less than a dollar a day
  • Life expectancy at birth is only 59 years
  • Haiti has a miserable infant mortality rate: 80 out of 1000 kids die before their 5th birthday
  • Children constitute almost half of Haiti’s population of 9 million, and, before the earthquake, 350,000 lived in orphanages

We see the pictures of Haitians trying to cope with the horrible disaster of this earthquake, but it’s one of many chronic disasters that the country’s inhabitants wrestle with – they have had to cope with chronic disasters of the environment, chronic disasters of disease, and chronic disasters of politics. Haiti is vulnerable to flooding, with 98% of trees cut down and severe deforestation. Four storms in 2008 left one million homeless. As I mentioned, the country is plagued by disease: diarrhea, HIV, hepatitis, typhoid fever, dengue fever, malaria, leptospirosis. And, to top it all off, they have a disastrous political history, with legacies such as Francois (Papa Doc) Duvalier who assassinated and tortured more than 30,000 people.

Much of Haiti’s devastation from the recent earthquake results from the fact that they had such limited resources to begin with. Haiti’s vulnerability to disasters stems fundamentally from poverty.  As Tracy Kidder described expertly in the New England Journal of Medicine, Haiti’s poverty is both material and institutional, manifested not only in buildings made with unreinforced concrete but also in a Ministry of Health that lacked buildings, vehicles, Internet access, computers, and even pens and paper.

The Huffington Post article sums up some of these differences with a description of the presidential responses in Chile and Haiti:

“The fact that the president (Michelle Bachelet) was out giving minute-to-minute reports a few hours after the quake in the middle of the night gives you an indication of their disaster response,” said Sinclair.

Most Haitians didn’t know whether their president, Rene Preval, was alive or dead for at least a day after the quake. The National Palace and his residence – like most government buildings – had collapsed.

This is a rough sign outlining the donations needed in Haiti after the earthquake:

Food, medical, power, hygiene, shelter, water.  It’s also a pretty good outline of what Haiti’s biggest needs were before the earthquake. The very basics of a system to promote global health. They needed food, medical care, power, hygiene, shelter, and water. And Haitians need a country that would be stable enough to let them keep those things. Chile — Latin America’s wealthiest country — reminds us of the power of building codes, of government contingency planning, and of having the systems in place to provide basic healthcare, shelter, food and water. Let’s keep working to give Haiti and the world’s other poorest countries the same things.”

Amen and amen.

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