Success in Haiti - one program at a time

When Paul Farmer founded the nonprofit Partners in Health in Haiti in the late 1980s, he thought providing healthcare would be enough. But soon he found that Haitians needed much more.

They needed personal bank accounts, for one thing. They needed concrete floors, tin roofs, safe drinking water, and schools.

"It's not going to be enough to do a vaccination program," says Partners in Health (PIH) president and executive director Ophelia Dahl. "You have to fix the water, make sure people have houses."

So PIH teamed up with a Haitian microlending bank, Fonkoze, to open branches at all of its clinics. PIH also asked Haitians what else needed to be done and included them in the process.

The nonprofit's multifaceted and unconventional approach to aid attracted the attention of a major philanthropic foundation. It's the latest recipient of this year's $1.5 million Hilton Prize, an annual humanitarian award that will be announced Monday.

"This is the best thing that's ever happened to us," says Dr. Farmer of the award. "I have had personal accolades before," he adds, but "the Hilton prize is all about the team."

"PIH combines idealism and brilliance to a degree I've never witnessed before in the public charity arena," says bestselling author Tracy Kidder who published a book about Farmer's work in 2003 ("Mountains Beyond Mountains"). "These are people who know where to draw the line. The point is not to build an empire for PIH, but to start a movement to try to bring decent healthcare to the poorest people in the world."

The intransigence of Haiti's poverty, political turmoil, and environmental degradation is well known. It surfaces in the media periodically. Haiti's recent history includes desperate waves of Haitian "boat people" landing in Florida, the overthrow of a dictator, the democratic election of a president (and his subsequent overthrow last year), and devastating floods that killed an estimated 3,000 people last September.

Haiti is "living on NGOs [nongovernmental organizations], private initiatives, church groups, that take the place of state-sponsored services," says Kathie Klarreich, author of "Madame Dread," a book about Haiti. "Initiatives like Partners in Health are invaluable because they pick up what the government is unwilling or unable to do."

"We have refused to be defeated," PIH director Dahl says. With the money from the prize, "we'll continue to do what we've been trying to do with more financial security."

PIH "puts people first," says Catherine Maternowska, an assistant professor at the University of California, San Francisco, and a medical anthropologist who worked in Haiti for 22 years. "Although that doesn't sound like it's an anomaly, it is," she says.

PIH has extended its approach to healthcare and ending poverty to Guatemala, Mexico, Peru, Russia, Rwanda, and the United States.

PIH is one of many groups working to alleviate world suffering. Recently, a spate of high-profile charities, governments, and other organizations have announced their intention to help end poverty. Paul Farmer attributes this sudden awareness to the increasingly interconnected world. "I could see images in rural Rwanda from Katrina every day," he says. "I don't think that was the case a decade ago."

He is sober about Haiti, but committed. "Conditions in Haiti are not improving," Farmer says, but people on the ground there still have hope for the future. Dahl agrees: "I have enormous faith that Haiti can become stable again, but I don't think that it became unstable on its own and will need help becoming stable again." For more than a century, Haiti was the source of two-thirds of France's imports, Farmer notes. "It would be great if people would acknowledge that the state of Haiti was because of the resources we took away."

In a country like Haiti, an organization that has found success can offer a glimpse of what is needed to help bring about change. What Haiti most needs now is "for other countries to respect their autonomy" and a democratic government, Farmer says. It also needs "support from NGOs like us and real support from our government," Dahl adds.

PIH has succeeded because its volunteers understand the history of Haiti and work with the community to find solutions to the problems it faces, says Bob Maguire, a Haiti expert and professor of international affairs at Trinity University. PIH seems "very deeply rooted in not only addressing a need but in respecting the way the Haitians need to have their needs addressed," he says.

But success is grounded on more than identifying with the people. "You have to have tremendous faith in humanity to keep you going," Dahl says. "Particularly at the moment, it's a world that could be discouraging, but it's very important not to look at the world in terms of problems - not to change the world, but concentrate on one project at a time, one community at a time. And that if it's done well, it will have an amplifying effect."