STEVE INSKEEP, host:
The deaths from Haiti's cycles of violence do not all come by gunfire. Riots, revolutions and lawlessness have also interrupted the health care that Haitians receive. The life expectancy in Haiti is just over 50 years old. That's decades shorter than the life expectancy nearby in the United States.
We've contacted a doctor who spent much of his life treating people in Haiti. Paul Farmer is executive vice president of Partners in Health, which founded a medical center in a settlement of Haitian squatters. He's also the subject of a book called Mountains Beyond Mountains. And he's with us on the line from Miami, Florida. Welcome to the program.
Doctor PAUL FARMER (Executive Vice President, Partners in Health): Thank you for having me.
INSKEEP: How does political turmoil affect medical care?
Dr. FARMER: Well, there's the obvious, the gunshot wounds, the people showing up in health facilities ill-prepared to receive of them, lack of blood for blood banking. But there are other, more pernicious ways that disrupted political systems can affect health. For example, if you're thinking about any kind of chronic illness where you're providing care to patients over long periods of time, say, for diabetes or AIDS, then you have to have a steady supply of medication, certainly, but also laboratory equipment.
People have to be able to go back and forth to their place of work, if they're health providers. Those sorts of disruptions are really even more common than gunshot wounds and people injured by explosives.
INSKEEP: You've spent a couple of decades in Haiti. Have there been cycles of times when the health care system seemed to be improving a little bit, and then it would get worse again?
DR. FARMER: That's exactly what's happened. It seems to me that you can make a fairly direct link between democratic governance and improved health care. The ministries of health and education function more efficiently. The public health system functions more efficiently. You know, we've gone through a number of different periods over the last 20-something years, family dictatorship, military regimes, elected governments, more coups. So, we've really seen it all. We've had a sampling of what it's like to try and provide good medical care in each of those times.
INSKEEP: When Haitian doctors are thinking about their own futures, and the country is unstable, what kind of decisions have they been making?
Dr. FARMER: They've made decisions very similar to their peers in other countries, like Rwanda, where I've done a good deal of work, or, or Guatemala during a civil war. They've tried to leave with their families. They'll also leave if they don't have the tools that they need, the tools of the trade. If they can't get medicines, or they can't get lab equipment, or the nurses don't show up. They'll try to leave.
INSKEEP: Are non-governmental organizations, foreign organizations able to step in and replace all the doctors ad other health professionals who would leave in a situation like this?
Dr. FARMER: They can step in, and they do. But they can't replace the Haitian public health system or the Haitian professionals. They really can't replace the people who speak the language, who have been trained in the medical system, who are there for the long haul.
INSKEEP: Has the Haitian government ever been very good at providing clean water for any percentage of the population, or basic sewage systems?
Dr. FARMER: Well, the easy answer would be, no, they haven't. And, you know, all the data from, about health care show us that. At the same time, there have been many times when the Haitian government has tried to do its job, to provide clean water and good sewage systems. And in order to understand why that's fallen apart, you really have to look at uncomfortable things, like how aid is used as a political tool by the countries that give aid. And the story on Haiti is pretty shameful. There have been lots of efforts to block assistance to Haiti that have nothing to do with good governance or need. It's had to do a lot with the policies of donor nations.
INSKEEP: Is this donor nations who are concerned about whoever the latest government might be?
Dr. FARMER: That's right.
INSKEEP: Do you include the United States in that?
Dr. FARMER: United States, France, even Canada recently, and, you know, it's not a very pretty chapter of the history of development assistance.
INSKEEP: Are Haiti's problems, health problems, so serious now that any new government would have difficulty making a difference?
Dr. FARMER: Certainly, it's going to be a huge challenge. If you can't do public help in a war zone. You know, you can do your best to patch up wounds, and, you know, make sure that someone who's bleeding gets sewn up and transfused, but you really can't do good public health in the middle of political violence. It's just not possible.
INSKEEP: Dr. Paul Farmer of Partners in Health, thanks very much.
Dr. FARMER: Thank you for having me.
INSKEEP: You're listening to Morning Edition from NPR News. Transcript provided by NPR, Copyright NPR.