During a recent visit to Haiti, I visited homes at internally displaced persons locations throughout Port-au-Prince and noticed a general void of mosquito nets. In fact, I did not see one. This was perplexing; with the rest of the world, I had read and watched the extensive news coverage of the 2010 earthquake, including the distribution of hundreds of thousands of mosquito nets to these same communities I was now visiting.
Mosquito nets are important to vulnerable populations in the developing world. They can provide an essential preventive measure against mosquitoes carrying life-threatening diseases such as malaria. Of the most vulnerable people in Haiti, are the 350,000 that remain displaced by the earthquake and reside in makeshift homes and tents at internally displaced person sites. Conditions at these sites are deteriorating. Residents lack access to basic services such as clean water, education, shelter and healthcare. As sanitation and drainage systems continue to weaken, pools of standing water are expanding, forming larger and new breeding grounds for the disease-carrying mosquitoes.
To Haitians and many long-term expats residing in Haiti, the void of mosquito nets is far less perplexing. As Sam Bloch, founder of Port-au-Prince based Haiti Communitere explains "There are a lot of people doing work here in Haiti, but without coordination and analysis of impact, even the most well-intentioned projects can fail." Malaria prevention efforts in Haiti are no exception. Mosquito nets are universally regarded as an important tool in malaria eradication. However, simply passing out mosquito nets without further deliberation has failed in Haiti. As one resident of an internally displaced persons site informs, "The nets had either been of poor quality and no longer functional, or had been sold by the recipient to pay for other more urgent needs such as food and clean water." He added, "The initial influx of free nets also had the effect of competing with local suppliers of mosquito nets, affecting the local economy, and with the decrease in international donations of nets, it is impossible now to find a net for free or for sale."
There is a spectrum of international-sponsored work being done in Haiti. On one side are the sustainable, long-term, capacity building projects and on the other side are the disastrous, disaster relief projects. After the earthquake the global community sent everything to Haiti without thinking much about where it was going. Haitians received items ranging from equipment without instructions, to board games in different languages to winter jackets and snow skies.
But mosquito net distribution and many other internationally-sponsored efforts fall somewhere in the middle of this spectrum. They are well-intentioned efforts with both negative and positive impacts. Stories similar to that of the bed net are unfolding throughout Haiti. Take for example short-term medical relief. Over 60 percent of Haitians lack access to quality healthcare and Haiti has the highest infant mortality rate in the Western Hemisphere. Medical professionals from around the world have responded by donating time and money and traveling to Haiti to provide important care from basic rehydration to advanced surgeries. The need for these services is great. However, resources are not endless, medical mission groups go home, and there is little follow-up with patients. Community clinics, and Haitian doctors and nurses find it challenging to compete with the free medical care provided by international groups, and many close up shop and move elsewhere. Now, when medical relief groups are not present, it is hard to find local care in many communities. In other parts of the country, internationally-sponsored road construction is connecting communities and increasing access to services such as healthcare. However, many of the roads are poorly engineered and are flooding surrounding areas, destroying crops and increasing standing pools of water. Elsewhere, schools and healthcare facilities have been built, but sit empty as they are unfunded or rely on short term international groups for intermittent staffing.
On my last day in Port-au-Prince, Dr. William Cadet, a long-time Haitian pediatrician and hospital administrator, provided some insight, "Nobody collaborates. Well-intentioned groups fail because resources are not shared, short-term efforts are favored over long-term ones, and there is a general disinterest in collaborating with Haitians and the Haitian government." Over 9 billion dollars has been committed to Haiti since 2010, yet the average Haitian's quality of life has not improved. Sam Bloch's organization understands this. Haiti Communitere is based on a bold yet simple principle - by creating a physical space for relief work, groups will be forced to collaborate and deliberate. Haiti Communitere welcomes anyone doing work in Haiti to stop by for a short visit, pitch a tent for a few nights, or even develop a project on the property. By visiting, groups can form connections with local collaborators and better coordinate efforts with other groups doing similar work in Haiti. But until other international organizations start working with local collaborators in Haiti, and make efforts to appreciate economic and sociological dynamics "on the ground", the efficacy of relief work will continue to be questioned.