"Solidarity can end structural violence"
Greetings from the Cange forum
on health and human rights

By Loune Viaud and Joia Mukherjee

On September 6 and 7, Zanmi Lasante held its thirteenth forum on health and human rights, “Sante ak Dwa Moun,” a gathering of the whole Zanmi Lasante family—patients, their families, people from the communities of the Central Plateau and the neighboring Artibonite Department, accompagnateurs, teachers, archivists, cleaners, nurses, doctors and students.  

Also in attendance were government officials, members of other non-governmental organizations (NGOs), and two members of our Rwandan partner organization, Inshuti Mu Buzima—Jean René Shema and Manzi Anatole.

	A women's health class run by Zanmi Lasante. Women's health was the focus of this year's forum on health and human rights.

Women’s health was the focus of this year’s forum. Haiti’s Surgeon General, Dr. Gabriel Timothé, opened the first day, after prayers by the executive director of Zanmi Lasante (ZL), Fr. Fritz Lafontant. Dr. Timothé’s moving speech supported the human rights foundation of ZL’s work. He emphasized not only that ZL’s work is defined by our commitment to women’s rights and human rights as a whole but that it strengthens the Haitian government’s ability to respect, protect and fulfill the human rights of the Haitian people.  

Dr. Timothé remarked that when he visited the Rwinkwavu site of Inshuti Mu Buzima in Rwanda earlier this year, he felt the spirit of Cange, of ZL’s work and of Haiti there and was proud to be part of this global effort.  He ended by pledging the support of the government to expand the model of solidarity, human rights and health care throughout Haiti, encouraging other partners to take up the lessons of the successful NGO-MOH partnership.

Women’s issues were highlighted from the beginning of the day. A panel from the ZL project sites discussed the challenges of increasing family planning coverage in the region. Nurse-midwife Agnès Jacobs, representing the Ministry of Health and Médecins sans Frontière team from Petite Rivière, led an engaging discussion about the causes of maternal mortality and how they can be addressed through improving emergency obstetrical services.  Much discussion followed about the barriers to access to care for women—particularly in regard to user fees and transportation support.  

The topic of vulnerable populations followed.  A tragic case of domestic violence was presented by Jinette Georges, the program nurse in charge at Hôpital Sainte-Thérèse in Hinche, which highlighted the importance of the psychosocial approach in all aspects of patient care.

A team of community educators with Dr. Ralph Ternier from Hôpital Notre Dame de la Nativité in Belladère presented their amazing work to reach out to commercial sex workers. The presentation highlighted the lack of basic rights for this vulnerable group of women along the Haitian-Dominican border—especially with respect to access to health care. Father Eddy Eustache described the work to deliver mental health services to children affected by HIV which we hope can help to lessen the heavy burden that they carry. Our friends from the Fond des Blancs-St. Boniface led by Briel Leveillé discussed the community organizing and human rights awareness raising they are doing around the right to school, health and water.

These examples, learned over the two decades of PIH and Zanmi Lasante and Haiti were highlighted in presentations about the PIH ZL work in Africa.  Jean René Shema and Manzi Anatole presented the work of Inshuti Mu Buzimi.  The numbers of the “HIV scale- up” in Rwanda were impressive. More impressive yet was their conviction that the lessons from Haiti at work in Inshuti Mu Buzima are the best thing that could happen to the people of Rwanda.

From the philosophy of making a preferential option for the poor to the practical work of accompagnateurs providing medical, psychological and emotional support, our Rwandan colleagues stated the model of PIH has brought reconciliation to communities still bearing the scars of the 1994 genocide. In this medical solidarity, they told the crowd, Rwandan communities had found real human solidarity. They described an accompagnateur who is Hutu (the group responsible for the genocide) caring for a patient who is Tutsi who had lost much of his family in the genocide. Now this pair—accompagnateur and patient who needs accompaniment—have become friends.

Jonas Rigodon, a Haitian doctor who worked with ZL for five years, is now the chief physician at one of three PIH clinics high in the mountains of Lesotho. Jonas was not able to attend the forum. But his presentation of how lessons learned in Haiti have been applied in Lesotho was conveyed by Paul Farmer and PIH Medical Director Joia Mukherjee, who also described and applauded the work of the whole ZL team working in Africa.

	Access to obstetrical care, including Caesarean sections, is essential to reducing the highest rate of maternal mortality in the western hemisphere.

Reflecting the forum’s focus on women and access to obstetrical services, a panel from our Haitian surgical team was joined by three visiting surgeons—Robert Boucher (an ear, nose and throat specialist from Pennsylvania), John G. Meara (Chair of the Department of Plastic Surgery at Children’s Hospital in Boston) and Michael Steer (Chief of Surgery at Tufts Medical School)—for a discussion of how the right to health care must extend to surgery.  Lack of surgery often causes death—especially in the case of Caesarean section. But in Haiti we also see that surgeries delayed result in higher morbidity—physically and socially. We wondered together how to frame the merits of surgery as a basic right. Weighing the costs of not doing such life-saving and life-changing surgeries against the costs of doing them, we realized that both the financial and moral costs of inaction are prohibitive.

On the second day, the forum opened the doors and the agenda to the wider community.  As always about 2,000 people participated in the day. The Director of the National HIV/AIDS Program, Dr. Joëlle Daes Van Onacker, opened the day and went back to sit in the middle of the room. When she was invited to sit in front with the dignitaries, she responded, “No, I am enjoying sitting in the midst of these people. It is from their reactions and comments that I learn.”

The day highlighted panel on people’s right to self-determination with the awareness that all human rights – economic, social, cultural, political, and civil - are interrelated.  Human rights lawyer Mario Joseph, the Director of the Bureau des Avocats Internationaux (BAI) and Monika Kalra Varma, the Director of the Center for Human Rights at the Robert F. Kennedy Memorial, discussed how human rights are framed into the legal rights of Haitian people. [For Monika Varma's reflections on the Cange forum and human rights in Haiti, click here.] Other members of the panel included the first senator from the Central Department, Hon. Edmonde S. Beauzile, who emphasized how ZL and the Haitian government must work together to fulfill the rights of the people of the Central and Artibonite departments.  Lucette Fetière, a patient who coordinates ZL’s group for women living with HIV/AIDS, gave a rousing speech on the right to live with AIDS in health and dignity.

This panel also addressed the concerns of people who fear they will be displaced from their homes in order to make room for the highway running from Port-au-Prince to Hinche to finally be widened and paved. Earlier this summer, community members expressed their anxiety to ZL after their houses were numbered in red paint and marked for demolition. Road workers informed them that they will be forced to vacate. This is an especially painful issue for the people of the central plateau, many of whom were already uprooted from their homes to make way for the Péligre dam more than 50 years ago.

In 1956, with a loan from the International Bank for Reconstruction and Development (now the World Bank), a hydroelectric dam was built in one of the most fertile valleys of Haiti, the Péligre basin of the Artibonite River of the central plateau. Thousands of families, who had farmed this fertile land and lived decently for generations, were suddenly forced to leave their land. When the dam was closed, the valley flooded. With little warning the water rose rapidly to such levels that many families fled up the steep hillside with nothing but the clothes they were wearing.  All their possessions and even animals were lost. The displaced peasant farmers, many of whom are our colleagues, friends and patients at Clinique Bon Sauveur today, received no compensation for the permanent loss of their fertile land. To this day, they recount stories of the nightmare when the water rose. Cange, where we started working more than two decades ago, is a squatter settlement just north of the dam that still does not appear on maps of Haiti.

The history of this brutal displacement must not be repeated under our watch. Senator Beauzile was asked to talk to the community and the mayor to develop a plan to protect, respect and fulfill the rights of the people marked for displacement. Mario Joseph discussed the importance of infrastructural projects such as the road as a public good and part of the government’s duty to respect the right to movement and a decent life. But shelter is also a basic right, he added. A way must be found both to improve the road and to respect this basic right that was neglected in 1956.

This panel was a heated one. ZL’s Director of Operations, Loune Viaud had the difficult task of moderating both speakers and audience as we struggled to understand how a government can be held accountable for the rights it has promised to uphold—especially with regard to housing and health—when the international community has a stranglehold over its resources. 

As the moderator, Loune decided, diplomatically, to end the panel by calling forward a team of young people from Cange to perform a song about the 200 years of struggle of the Haitian poor.  The song (“Men nan men nou ta renmen mache, ak lespwi damou, L’Union fait la force…”) broke the tension and ignited a spirit of solidarity in which the Hon. Marie Laurence Jocelyn-Lassègue, Haiti’s Minister of Women’s Rights, delivered the closing speech. The Minister had not been to Central Haiti in a long time. Although she knew the great work that was happening in Cange, she did not realize how far it had spread in medical and philosophical breadth throughout Haiti.  She pledged her unswerving support to work with the Ministry of Health and Zanmi Lasante around all women’s.  In her speech she outlined the priorities of the Ministry of Women’s Rights which echoed the themes that resonated throughout the forum—women’s access to health care and education, a stand to end violence and exploitation of women, and protection of the rights of children. 
Before her closing remarks, Dr. Raôul Raphaël, the head of the Ministry of Health in the Central Department felt compelled to speak.

“As Health Commissioner of this region it is my pledge that all pregnant women will have free access to prenatal care.”---Cheers erupted.

“And we will work to increase access to free Caesarean section as it is a life-saving operation that CANNOT be sold as you would sell a side of beef or a goat.”—Massive applause ensued.

“Here in the Central Department, we will have ZERO tolerance for domestic violence and the abuse of women and children”—The crowd stayed on its feet to cheer with excitement. 

And the Minister went on to close the day remarking on the solidarity of the people in that room, on September 7th, the closing day of Zanmi Lasante’s 13th forum on Health and Human Rights.

So, this is what Zanmi Lasante and Partners in Health are all about. “Whatever it takes” may take the form of fighting for an individual patient, a community, or for basic human rights in the world.  We write this brief report to share this important gathering in the life of our patients, community members and we can say, the world, to share the sentiment here with all of the PIH family.

One international journalist was almost in tears, saying good-bye. She said: “I never experienced anything like this in my whole life and I’ve been to many places… This is the best thing that could have happened to me. Thank you, (Zanmi Lasante), for giving me this opportunity…”

Shema and Manzi, our colleagues from Rwanda, said, “This was an amazing experience! People here treat all people like people, with respect, with dignity and without the hierarchy that creates division and violence.”  Shema went on, “I see here that solidarity can indeed end structural violence.”

Tout moun se moun.

We need more gatherings like this worldwide. Period.

Men nan men ak lespwi damou ak solidarite from Cange,

Loune ak Joia.

Loune Viaud is Director of Strategic Planning and Operations for Zanmi Lasante. Joia Mukherjee is Medical Director for Partners In Health.

[published September 2007]