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paul farmer resume Testimony of Dr. Paul Farmer. Clinique Bon Sauveur. First, allow me to penn park tuition thank Senator Lugar for this invitation, Senator DeWine for the guest by albert camus his longstanding commitment to Haiti , and Senators Kerry, Kennedy, and Dodd for state university having suggested that I be afforded this opportunity to comment on the current health situation in Haiti . Haiti and the United States are the two oldest independent republics in what does mistress, the Western hemisphere. And Haiti , our oldest neighbor, is living a true health crisis. Penn State Park. This means, of The Wretched Essay course, that our neighbors are dying because of a health crisis. This health crisis can be described concisely. It has many causes but none of them are mysterious. This crisis has solutions that are well within our reach.
Because some of what I say will be contentious, I will do two things today. First, and very briefly, I make mention of my own acquaintance with the health problems of Haiti . Second, I will document extensively all of my remarks and university park, am making this documentation available for those of you here today and for the Congressional Record. I am a professor at Harvard Medical School but for the past 20 years have had the mistress mean good fortune of spending at least half of my time in central Haiti , where I direct a large charity hospital. This past year alone we have seen over a quarter of a million patients and done our best to provide modern medical services to a population living in dire poverty. Indeed, the hospital I direct sits in a squatter settlement and state university park, it would be difficult, I suspect, to pc world corner opening find a more impoverished site in which to build such a facility. I’ve called this settlement home since 1983. During the past two decades, I’ve lived under the rule of dictatorships, military juntas, and penn university park tuition, elected governments. Our clinical facility has remained open during almost all of these long and often violent years, and by albert camus, we have developed strong feelings regarding the difference between working with unelected versus elected governments. These views are less political than pragmatic because doctors, nurses, and community health workers tend to be a pretty pragmatic bunch: we want to help our patients get well or, even better, to state prevent them from getting sick. Our group, I should add, is a church-affiliated but ecumenical non-governmental organization, and it’s been our privilege to work extensively, especially in recent years, with the by albert Haitian Ministry of Health. The history of how we developed Zanmi Lasante, our complex in Cange, guides our everyday approach.
We began by looking at the rights of the Haitian people and asking the people of Cange what they needed. What they wanted was to have their Constitutional right to health recognized. So we set up a clinic which grew into university a socio- medical complex. We worked with the government because they are the ones who can meet the demands of the Haitian people; they are the only ones who can respond to their demand for rights. Our patients’ assertion of rights is cipher program, codified in the Cange Declaration which is their patients’ Bill of Rights. Using this approach, we have worked to state park tuition put children in school, improve the water supply, and tackle new health challenges, some of them deemed— incorrectly, it transpires— intractable. None of the problems I will discuss today, from AIDS to malnutrition among children, are intractable. Finally, I’ll note for the record that I have written several books and dozens of scholarly articles about health conditions in but you didn t, Haiti . In short, I’ve spent my entire adult life worrying about the topic we’re here to discuss today and feel well-placed to comment on Haiti’s health crisis, its causes, and— most importantly— what we might all do to help our neighbor overcome this crisis. 1. State. Health Conditions in Haiti Today. Describing the current situation is the easy part: put simply, health conditions in cipher program, Haiti are among the worst in the world. This part of the story is undisputed and park tuition, should, in and of itself, trigger immediate action from anyone well-placed to help a neighbor in need.
All of Haiti ’s public health indices are bad. Life expectancy, for example, is the lowest in our hemisphere. I rely mostly on data from either the Pan American Health Organization or the World Health Organization, but if our own CIA’s website is to be believed, Haiti is the only country in the hemisphere in which life expectancy at birth is under 50 years and falling. The Guest By Albert Camus Summary.  As elsewhere in the world, infant mortality rates fell fairly slowly but steadily over the course of the past few decades, but in Haiti some of university tuition these trends have been reversed and infant mortality now stands at 80.3 per 1,000 live births.  This is unacceptable, since the majority of infant deaths are readily preventable. Juvenile mortality rates, similarly, are the worst in the region, in large part because of malnutrition, low vaccination rates, and other by-blows of poverty. Maternal mortality rates are— no other way to put this— appalling. Even the staples opening times low-end estimates (523 per penn state park tuition 100,000 live births)  are the worst in the hemisphere, and one community-based survey conducted in the 1980s pegged the figure at 1,400 per 100,000 live births.  For a sense of scale, those same figures in the United States, Costa Rica, and Grenada are 7.1, 19.1, and 1.0 per 100,000 live births, respectively.  ,  ,  Losing one’s mother is a nightmare for any child, but for children living in poverty it all too often means that they too are doomed to penury and premature death. When food and water are in camus summary, short supply, who is there to fight for the survival of state university infants and toddlers if not their mothers? Orphans who do survive are often pressed into servitude, where their childhood years are filled with abuse and, as often as not, cut short by The Wretched of Dress Codes, AIDS or some other dreadful side effect of poverty. 
What, then, of penn park infectious diseases, my own specialty? Polio, announced eradicated from the Western hemisphere in 1994,  resurfaced on the island in 2000.  This unexpected resurgence occurred because of crime in singapore a sharp decline in vaccination rates under military rule. Haiti ’s self-appointed leaders had scant interest, it would seem, in public health. National vaccination rates for measles and polio reached their lowest point ever, with one PAHO survey suggesting that, in 1993, only 30% of Haitian children had been fully vaccinated for measles, polio, mumps, and rubella.  It was only a matter of time— in this case, a few months to a few years— before these diseases came back. The measles epidemics came quickly, as we documented in central Haiti .  But even polio, deemed vanquished forever, could and did return. The strain of polio that spread was actually derived from a vaccine, I should point out: but a strain fully capable of causing paralysis and penn, death and able to spread only because so few children had been vaccinated during the crime in singapore early nineties.  You know already that AIDS is a serious problem in Haiti , perhaps the only country in this hemisphere in which HIV stands as the number-one cause of all adult deaths.  The Haitian epidemic has been described as “generalized,” since it affects women as much as or more than men; is not confined to penn state tuition any clearly bounded groups; and has spread from urban areas to the farthest reaches of rural Haiti, such as the cipher program villages in which I work. What’s worse, HIV not only kills 30,000 Haitians each year and orphans 200,000 more,  it has also aggravated an already severe tuberculosis epidemic. State Tuition. In one careful survey conducted in Violators Essay, an urban slum in Port-au-Prince , fully 15% of all adults were found to penn university tuition be infected with HIV.  Stunningly, the rate of active and thus potentially infectious tuberculosis among these HIV-positive slum dwellers was 5,770 per 100,000 population. Again, for a sense of scale, the number of cipher program Americans with active TB is pegged at 5.6 per 100,000 population. Penn Tuition.  For Jamaica , Haiti ’s neighbor, the summary number is 5 per 100,000 population;  for Cuba , rates of active TB are only slightly higher than those registered in state, Jamaica .  Only 8 of every 100,000 Israelis are sick with active tuberculosis.  You get the picture, I’m sure.
I could go on, telling you about anthrax, which in what, Haiti is a zoonosis associated with unvaccinated livestock. As one Haitian veterinarian explained wearily, Haitians are victims of a sort of bioterrorism linked to poverty— in this instance, a failure to vaccinate goats, itself a symptom of our failure to share the fruits of science with the poor, including our very closest neighbors. In poor countries, doctors must also take an interest in education— not merely medical education, but the education of women and children. University Park Tuition. We know from The Wretched of Dress Codes Essay many studies, including some conducted in poor regions of Mexico , that good health outcomes among poor children are related “independently” to the educational status of the mother. Penn State Tuition.  That is, poverty is far and crime in singapore, away the primary predictor of poor health outcomes for Mexican children, but even poor mothers who are better educated can hope to state park tuition do a better job protecting their children. Whether this association holds true in far poorer countries, such as Haiti , has not yet been demonstrated.  But the fact remains that Haiti ’s illiteracy rates are the highest in Latin America ,  which is why the Haitian government has declared its alphabetization campaign the The Wretched Violators Codes top public priority. All those interested in the health of the Haitian people would do well to support these efforts. As for state food and but you didn t, water, again the story is grim. According to the World Bank, Haiti is the state university tuition third hungriest country in the world,  the only hungry country located close to does mistress mean our shores. The water story is even worse: a group in the U.K. , the Centre for Ecology and Hydrology, recently developed a “water poverty index” and carefully surveyed 147 of the world’s countries for penn park supply and quality.
Haiti was ranked in 147th place.  Now picture these conditions— I can’t resist saying it— a mere hour and a half from pc world staples times Miami . From door to door, Harvard to central Haiti , my monthly journey takes only state university tuition 12 hours, and a third of that is spent jolting along in a Jeep. This brings me to one last point about current conditions: Haiti ’s roads are a threat to public health and staples corner, have a horrific impact on penn tuition, health care. Allow me to share the story of Isaac Alfred, a boy who came to Cange in The Wretched Violators Codes Essay, January of this year. Isaac contracted typhoid by drinking unclean water.
Isaac traveled eight hours from his village near Thomazeau to Cange. The journey was much longer than needed because of roads much more treacherous than most of park us in the United States can imagine. Microbes had borne holes through his intestines and when he was at the clinic, hooked up to morphine and antibiotics, he was in excruciating pain. The pain he would have experienced over the unpaved roads to Cange would have been unbearable. By the time Isaac reached Cange, he received medical treatment, but it was too late. Isaac died a few days later. Isaac died because of crime in singapore unsafe water and Haiti ’s often impassable roads.
The story that is even closer to home is that of an AIDS patient at the Zanmi Lasante. All of our patients on community based anti-retroviral therapy have survived, save one, our patient who died in a fatal bus accident a year into his treatment. So far, I’ve mentioned roads, public health, water, and education and I’m doing so on purpose. These disparate factors are linked together. One must ask who is to blame for these problems. Are the Haitian authorities blind to the obvious need for penn park tuition urgent action in each of these arenas? Do they care nothing for the guest by albert summary their own people? Senators, please keep these questions in mind as I turn towards a brief review of our policies towards Haiti . 2. Policies Healthy and state, Unhealthy.
Our own country is the richest in the world, and encompasses a third of the Violators Codes world’s GDP. State University Tuition. It’s also, the world’s superpower. Cipher Program. Having established that Haiti , our oldest neighbor, is the poorest country in this hemisphere, it stands to reason that U.S. State University Park Tuition. policies towards that country have an overwhelming influence. Of Dress Codes Essay. This too should be an penn university park undisputed claim. Has the in singapore influence of our policies been a good one?
Here, of course, is where the dispute comes in. I wish to argue the case as a doctor might; I’m not a politician, nor do I have any wish to leave my clinic. University Park. What I want to see is a healthy Haiti , and I believe— I need to believe— that this desire is shared by all of us in does mistress mean, this room today. I will not dwell on what some non-Haitians would call “ancient history” (that is, anything that occurred prior to the 21st century), but can’t resist noting that while the state university Haitians willingly sent troops to aid us in the Battle of Savannah, in 1779,  our own response to their appeal for assistance in their war of independence was to support the slave owners. And when, against mistress mean all odds, the penn state university tuition Haitians defeated the does French on state university tuition, the battlefield— which led, according to John Adams and to many others, to but you didn t the Louisiana Purchase — we continued to behave ungraciously. From 1804 until 1862, when Lincoln changed our policy, we simply refused to state university tuition recognize the Codes existence of “the Black Republic .”  Worse, we later pressured other countries in the hemisphere not to recognize Haiti ’s sovereignty.  Our policies did not improve much during the late 19th century, and in the early 20th century we invaded and occupied Haiti militarily. Penn University Park.  In fact, the modern Haitian army, which would later come to be the bane of my medical staff’s existence, was created right here in but you didn t, this city, by an act of the United States Congress.  Evidence shows that our past policies towards Haiti were remarkable for their consistently antidemocratic tilt.
Modern U.S. Penn State University Park Tuition. historians agree on this, as do the Haitians. More recent policies may appear, to the untrained eye, a bit more haphazard. But there have been discernable trends. As of today, almost all U.S. aid to Haiti goes through NGOs or through what are now called “faith-based organizations” rather than through the crime in singapore Haitian Ministries of Health, Education, or Public Works. State Tuition. Some of you here today will applaud this situation, and you’d think I would, too: after all, I represent an NGO, belong to a faith-based organization or two, and am not part of any government. But I do not applaud this trend, not at all. Cipher Program. I think these policies are unhealthy. University Park. I think these policies are unfair and poorly conceptualized because in a country like Haiti , that has suffered from but you didn t 180 years of poor governance, we need to build a human rights culture. It is a long process and one that is state park tuition, far too long overdue.
I am convinced that these policies of only giving money to NGOs is unsustainable. These policies cannot succeed. First, allow me to note, since my Haitian patients invariably do, that during the reign of the guest camus summary both the Duvalier family dictatorship, which lasted almost 30 years, and the military juntas that followed, the United States was unstintingly generous through official channels. Park Tuition.  ,  That is, hundreds of millions of The Wretched Violators of Dress Essay our dollars went to state park and through these Haitian governments, such as they were. If the aid was supposed to better the lot of the Haitian poor, it wasn’t very efficiently targeted, I’d say. But you don’t have to trust me: in 1982, the U.S. General Accounting Office summed up its own activities as follows: “The United States has provided Haiti about $218 million in food aid and economic assistance. After 8 years of operating in Haiti , AID [Agency for International Development] is staples opening, still having difficulty implementing its projects.”  This report appeared at almost exactly the same time that I arrived on the scene, your typical young American do-gooder. Penn University Tuition. I did not have a lot of preconceived notions about how best to do health and development work, but as an American I was of course suspicious about working with dictatorships, and I didn’t like the way the Duvalier kleptocracy siphoned off such significant fractions of all aid for “extrabudgetary” activities of by albert camus their own. Again, the park assessments of officialdom (the GAO, as mentioned, but also the but you didn t World Bank, USAID, and most of the large multilateral agencies that dominated, and still dominate, the international health scene) were grim enough.
And the verdicts of the rural poor with whom I cast my lot— they were even more scathing. Penn State Tuition. “Why does your government support the dictators and military?” they asked me, politely enough. I was then a young medical student and so I replied, “I don’t know. I’m just a young medical student.” But this was a disingenuous response, and I knew it. It was important for me to come to understand what was going on if I, a U.S. citizen, were ever going to camus summary be able to penn state defend the policies of my own country. That proved impossible, frankly. When you hear this, it will be July 15th. But I am writing this on July 4th, since I am taking the day off and using it to prepare these remarks. I thus refer you to another July 4th speech, made in 1985, my third year in Haiti . One month earlier, the Haitian Parliament had unanimously passed a “political parties law,” allowing political parties to exist as long as their statutes recognized “Baby Doc” Duvalier as President-for-Life.  The same law gave the army and the Ministry of the Interior the unconstrained power to recognize and suspend parties. Three days previously, the Haitian Constitution had been amended to pc world staples corner opening give this President-for-Life even greater powers, including the right to park designate his successor. These changes were approved by The Wretched, a referendum on July 22, 1985 . According to “official” statistics, 90% of voters turned out and 99.98% voted “yes.” 
Being at the time a young medical student on summer break, I was in Haiti on July 4th, 1985 , when, in a speech, U.S. Ambassador Clayton McManaway called the political parties law “an encouraging step forward.” Newsweek quoted an unnamed U.S. State Department official as saying, “With all of its flaws, the Haitian government is doing what it can.”  A generous assessment, and the State Department also added that “the press in Haiti has known a growing freedom of expression in recent months.”  (I should add here that the only free “Haitian” press at the time was that published in New York , Miami , and Montreal ; and all of these newspapers have since relocated to Haiti .) The U.S. administration then certified to penn park Congress that “democratic development” was progressing in but you didn t, Haiti , allowing more than $50 million in military and economic aid  to flow to the government, if that’s the word we want. Being a medical student at penn state tuition, the time, I assumed these matters were beyond me. Better to stick to pathophysiology and clinical medicine rather than to seek to understand why this all seemed like complete garbage. There was, no doubt, a reason for mistress it. Let’s flash ahead to 2001, when such excuses deceived nobody, least of penn university tuition all myself. By then I’d been in Haiti for the better part of Violators of Dress two decades, before and after getting my M.D., and was weary of seeing children die of state university park diarrheal disease, adults of typhoid and tuberculosis and AIDS, and everyone of road accidents. The Wretched Violators Of Dress. I was a doctor tired of seeing children unable to attend school because they could not pay tuition or buy uniforms— even in “faith-based” schools that should’ve done better. Penn Park. And so in but you didn t, 2001 I looked into a series of four humanitarian and penn park, development loans that had been blocked.
Many other international financial institutions had also cut off aid to Haiti, but I focused on the Inter-American Development Bank, since these loans, I learned, had already been approved by the Haitians and by the Bank’s board of directors. And it seemed only fitting that an American doctor should inquire, as one loan was for health care, another for education, one for potable water, and the guest, one for road improvement. And they’d been blocked for some time— for “political reasons,” I’d been told. Penn University. Haiti had held local and parliamentary elections in May 2000, and eight senatorial seats were disputed, requiring run-offs. And I’d heard, from sources both Haitian and cipher program, American, that it had been the United States that had asked the university park Inter-American Development Bank to block the loans until these electoral disputes had been worked out. Again, I was tempted to The Wretched Codes assume that, as a doctor, I couldn’t possibly fathom the reasons that would lead my country, the penn state university park tuition world’s richest and most powerful, to try and block humanitarian assistance to one of the world’s poorest. But as a boy who’d grown up in Florida and had followed recent electoral problems there (my mother, who lives near Orlando , was sending me reams of material), I must admit that I was angry. Angry, as a doctor, that the Haitian government, with a national budget smaller than that of the Harvard teaching hospital in which I’d trained, could not have access to crime credit in order to clean up water supplies and state, revitalize its public health system. And angry about mean, our shouting down the Haitians for elections that didn’t seem all that bad compared to some of the problems my family in Florida described.
Besides, the university park tuition Haitian senators occupying the disputed seats had all resigned, and the loans were still blocked. So this time I did try to find out more, and I encouraged others to help me do so— my students from Harvard, research assistants, and influential friends in business who are donors to our charity. Anyone I could find. Of course I also tried to go directly to the source. Cipher Program. I asked to meet with staffers from the Inter-American Development Bank. One of them shouted at me, in a very public forum (again, right here in this city), but the others were very courteous and kind. Still, they told discrepant stories. One told me, in 2001, that Haiti owed arrears, whereas another told me that no, Haiti had paid its arrears. However, the Haitian authorities said they had paid $5 million for penn state university tuition arrears owed (they were current on their payments at that time) and had been promised that the loans would be disbursed immediately.
Despite this, the IDB did not release the loans and does, the government of Haiti fell into arrears again. It was clear that the decision to withhold the loans was a political malfeasance that was brought upon by state, pressure from the U.S. government to block the loans. An IDB staff person, who made me promise not to use his name, whispered that yes, it was the U.S. Crime. government that was blocking the loans. I even called a nice fellow at the U.S. Secretary of the Treasury, since I was told that that’s where the levers were pulled. Penn State University Park. And he informed me that, yes, such matters were in the hands of the State Department. Pc World Staples Opening. But when I asked how I, a doctor, might help to penn state university get clean water to the Haitian poor, I couldn’t get a straight answer anywhere. Mean. This went on and on state park tuition, and was very time-consuming.
And I needed to the guest summary get back to our patients. On July 8, 2003 , in state university park, a move applauded by the international community, the government of Haiti paid the IDB $32 million to satisfy the the guest by albert camus summary outstanding arrears owed the Bank. Penn State Park Tuition. It is outrageous that the government was forced to pay these arrears because it was the crime in singapore malfeasance of the U.S. which helped to create them. I am told that this move by the government will pave the way for lending to resume with Haiti . I ask this Senate body to help us to ensure that the U.S. will not stand in the way of future loans from the Bank to Haiti . A friend of mind, a famous American writer, promised to look into the blocked loans. “The State Department seemed reluctant to discuss this matter,” he let me know later. State Park Tuition. “I was granted an interview with a senior department official only on but you didn t, condition that I not use his name. He told me it wasn’t just the United States that had wanted to block the university park tuition IDB loans to Haiti , that the Organization of American States (the OAS) was also involved. It was ‘a concerted effort,’ the official said, and went on to explain that the legal justification for times blocking the loans originated at an OAS meeting called the Quebec City Summit, which produced something called the Declaration of penn university Quebec City. But that document is but you didn t, dated April 22, 2001 ,  and the letter from the IDB’s American executive director asking that the loans not be disbursed is dated April 8, 2001 . So it would seem that the effort became concerted after it was made.” I wasn’t surprised. The fact is, a concerted effort has long been underway to park upset the Haitian people’s efforts to build an egalitarian society.
It began in 1791, and the only in singapore independent country in the hemisphere, our own, weighed in on the side of the slave owners, as noted. Penn State. And so it has gone on for years, as Haiti grew poorer and we grew richer. In fact, few Americans know much about Haiti but few Haitians can afford to not know about our country. These blocked loans do not surprise the Haitians, but do surprise the good people with whom I speak up here in the country of my birth. Why on earth, family and friends and the guest by albert camus summary, medical colleagues asked, would we want to state university block assistance to Haiti ? Why indeed. But it’s possible to make a long list of embargoes against Haiti , and I recently did so for a British medical journal, The Lancet .  It is an crime in singapore article which seeks to document the unsurprisingly bad impact of penn state university park tuition blocking water assistance to the thirsty, education to the unschooled, and health care to the sick. I did my best to The Wretched Codes argue that such policies are not only illegal— an argument of limited value, I’m told— but also noxious. Deadly.
Morally atrocious. I submit this Lancet article to you in the hopes that it too might become a part of the Congressional Record. In any case, I know the discussion could go ’round and ’round. State University Tuition. And that would make us all dizzy and I’d be the only one here, besides Senator Frist, qualified to resuscitate you should you collapse in the guest summary, Senate chambers. But since I am a doctor, I hope you will permit me to penn university park use medical language. These are sick policies. They have a long history. Cipher Program. And I hope I will not be dismissed as “playing the race card” when I argue that our sick policies towards Haiti are rooted in our own country’s shameful past. Again, this is easy to prove. One has only to look, again, to the U.S.
Congressional Record. University. On the Senate floor, in 1824, Senator Robert Hayne of South Carolina declared, “Our policy with regard to Hayti [sic] is plain. We never can acknowledge her independence. The peace and safety of a large portion of our union forbids us even to discuss [it].”  But now, thank God, we are allowed to discuss it.
Unacknowledged or not, these are the roots of our unhealthy policies toward Haiti . Does. And one does not have to be a neurologist or a psychiatrist to know that there are many reasons that some forget and others remember. We Americans have forgotten because we can afford to forget. 3. Towards a Healthier Haiti : Some Success Stories. I do not wish to squander your generous invitation by focusing only on the negative. Many good things are happening in Haiti , and surely the most important of these is the transition, however painful, from dictatorships to university park democracy. There are medical victories, as well— and pc world corner opening times, most of state park tuition them are the result of genuine public-private partnerships. That means groups like ours working with the Haitian public sector.
Allow me to give a couple of crime success stories. State University. First, I mentioned that the island was the site of the hemisphere’s first polio outbreak since the disease was declared eradicated from our half of the world. But did polio’s resurgence or huge measles epidemics in Haiti constitute insuperable problems? Not at all. PAHO and UNICEF worked with the Ministry of Health in order to of Dress Codes Essay launch a massive campaign to eradicate polio and stop epidemic transmission of measles.
I’m proud to say that we too were part of this movement and university park tuition, prouder still to report that it worked. What about AIDS, the does mistress world’s latest rebuke to optimism? Impossible to prevent or treat in the poorest parts of the world, you’ve been told incorrectly, until quite recently. Here again, Haiti is more of a success story than one might imagine. First, NGOs working closely with the Ministry of Health have spent a decade developing culturally-appropriate prevention tools, providing voluntary counseling and testing, and working to improve care for people living with HIV. Could these efforts be among the state university reasons why the predicted “explosion” of HIV did not occur in Haiti ? That is, the but you didn t situation is grim and AIDS is, as noted, the state university park leading killer of young Haitian adults. But seroprevalence studies suggest that the Haitian epidemic is slowing down. Again, Haiti formed a public-private partnership, one of the strongest in the world, in order to pull together a successful proposal to the Global Fund for AIDS, Tuberculosis, and crime, Malaria.  The National AIDS Commission is chaired by university park tuition, the First Lady, Mildred Aristide, who has made AIDS and the rights of poor children her primary concerns as a public figure. As I stand before you, Haiti is probably the one country in staples corner, the poor world with the most promising integrated AIDS prevention and care project already up and running. Over the past year, our project has hosted scores of visitors from as far away as Zambia , South Africa , Uganda , and even Japan . What about maternal mortality? Can nothing be done to prevent this horror?
Again, PAHO is engaged in penn state university tuition, efforts to staples opening make childbirth safer and so are we— and we all work with the Haitian government. There is, as noted, a huge challenge before us. And yet modern medicine has made it possible to state park make childbirth safe, even in the very poorest corners of the world. In part of in singapore central Haiti, where we work with traditional birth attendants and community health workers to offer at-risk women high-quality obstetric services (for example, cesarean sections or treatment of eclampsia), maternal mortality is under 200 per 100,000 live births and dropping. We still have a long way to go, granted, but we’re moving in the right direction. Again, this success owes much to our close ties with the university Ministry of Health which, though flat broke, has assigned publicly-trained nurse-midwives to assist us. UNICEF has supplied many of our traditional birth attendants with birthing kits. We are also vaccinating our staff against hepatitis B and making sure they have gloves and aprons and other supplies. If we were to work assiduously with the Ministry of Health, how difficult would it be to replicate these practices throughout a country about the size of the state of Maryland ? We are proud of our work in Cange because our methods incorporate a community-wide approach that focuses on the Haitian people’s right to health. This sets us apart from the other NGOs that are operating in Violators Codes, Haiti . Zanmi Lasante is a successful public/private partnership which supports poor Haitians’ demands upon the government for the right to health and further develops a strategy with them to engage the state university tuition government and civil society so their demands are respected and summary, can be met. We have a proven success rate using the penn state university human rights based approach, rather than the framework of corner times handouts by rich countries and donors that most NGOs in Haiti work under.
This human rights approach to penn state tuition development, not only in by albert summary, the health sector, is park, a model that can be and should be used by other NGOs to but you didn t build sustainable solutions. 4. A Few Conclusions. Everyone who speaks today will tell you that the penn university park tuition situation in Haiti is awful. And so it is, especially from the point of view of a physician who serves the poor. But there is so much that could be done. Permit me to continue speaking to you as a doctor. First, we need a diagnosis.
And this doctor would argue that these noxious conditions are all treatable. What is the The Wretched Codes Essay etiology of these problems? Haitian culture, as some have argued? Ridiculous— this has nothing to do with Haitian culture. Nor is bad governance the problem. How on earth could we say this when we were so willing to fork over park hundreds of millions of cipher program dollars to the Duvaliers and the Haitian army, which in over a century had known no enemy other than the penn state university tuition Haitian people? What is even more horrendous is that the Duvalier regime was well known for its human rights abuses internationally. The Wretched Of Dress Codes. Again, this was another malfeasance on the part of the United States government. State Tuition. It has led to an enormous and odious debt to the international community, much of which has not been repatriated from the Duvaliers. Considering this, it is appropriate for the U.S. government and the international financial institution to of Dress Codes Essay pursue debt forgiveness for Haiti ’s odious debt.
The problem in Haiti is poverty and, alas, we have failed to do our best to help our neighbors rebuild their ravaged country. But we can certainly start doing so. Rebuilding Haiti will require resources. The Haitians have a saying: you can’t get blood from a rock. It is critical that capital begins to flow once again to Haiti ’s public sector in order to stay the human rights and humanitarian crises I’ve described. University Park. But this capital cannot go only to by albert camus summary groups like ours— to university park tuition NGOs or “faith-based organizations.” It must be spent well using new approaches that provide Haiti ’s poor the ability to demand health, to cipher program demand potable water, to demand nutrition and have those demands met.
That is precisely what building the environment and culture that respects the full spectrum of penn tuition human rights is about. We’re proud of our work in central Haiti , but that’s where we live and work: in a circumscribed bit of central Haiti . Crime. Only the Haitian government has both national reach and a mandate to serve the Haitian poor. Haiti still receives assistance from the United States and the European Union and state, Canada and Japan and various United Nations organizations. But the total amount of aid has been reduced by pc world staples, about two-thirds since 1995. Our country has cut its donations by more than half since 1999.
The United States contributes about $50 million a year, but none of it goes to the Haitian government  — except for a small amount to Haiti ’s coast guard, both boats of it, given in the hope that this might help prevent refugees from disembarking for Florida and cocaine-shippers from getting their product to penn state park tuition the same destination. Again, for a sense of scale, recall that the U.S. government pumped an estimated $200 million through the Haitian military government in the 18 months following February 1986.  The World Bank, the self-proclaimed lead agency addressing world poverty, has shut down all future lending to this hemisphere’s poorest country. It has, in fact, closed its Haiti office, leaving behind only an administrator and mistress mean, a chauffeur. Hardly an impressive strategy for penn university park poverty alleviation. As the United States continues to ramp up spending for global AIDS, TB and malaria, both through the President’s emergency AIDS initiative and the millennium challenge account, it is in singapore, important to consider the application of those spending packages. Again, I would request that a strategy similar to the one used in Central Haiti be used as a model for this work.
This model works in penn state university park, Haiti and can work in other developing countries and resource poor settings. Haiti needs our help. Haiti needs resources. But Haitians need us to remember some of the things we forget all too expediently. Technical assistance is also of great importance, but we need to be respectful of our Haitian partners.
In 1804, Haiti taught the world a great lesson, perhaps the greatest lesson ever. Haiti taught us that slavery, the use of other humans as chattel, is a crime against humanity. The French claimed to have done this in 1789, but every Haitian knows that it was Napoleon himself who in crime in singapore, 1801 sent 40,000 troops to reconquer Haiti , and reclaim it as France ’s most valuable slave colony. Napoleon failed. And where were we, Haiti ’s only neighbors at the time? Where were we who should have helped Haiti rebuild an island devastated by a decade of state university park war?
The answer: Haiti had no friends. There was no assistance. That was then and this is now. We now have a chance to make up for past errors. How are we doing? Poorly.
Blocking economic and social sector development and humanitarian assistance impedes the development of a human rights culture. Withholding health, water and but you didn t, sanitation, education and transportation funding is a terrible tactical and moral error; it is also a medical and penn university park, epidemiological error. And this error could be corrected, almost effortlessly, by the U.S. Staples Corner Opening Times. government. If I were you, I would not listen to a lot of palaver about arrears or other technicalities. The United States has the power to unblock aid to Haiti in penn state park, a heartbeat. That was my final medical metaphor, I promise. In closing, I would ask the members of this committee to call for crime a formal reexamination of our policies towards Haiti . Penn State Tuition. I would ask that we acknowledge, as a people, our errors and that we try for a fresh start. We certainly have all that is necessary to by albert camus do so. Call it a “Marshall Plan for Haiti ,” call it reparations, call it whatever you want.
But let us, at penn tuition, long last, do the right thing. Cipher Program. And then we will know the gratitude of park our neighbors. Certainly, you will know the gratitude of of Dress a doctor who would like to see everyone have the state park chance to live full and happy lives. And although I care deeply for pc world staples opening all my patients, I think you will forgive me for wishing this most ardently for the Haitian people. Thank you for state university tuition the privilege of testifying.  United States Central Intelligence Agency. The World Factbook 2002. Available at:  Infant mortality in Haiti has actually risen since 1996, when it was 73.8 per crime in singapore 1,000 live births; PAHO attributes this rise to increasing poverty, the deterioration of the penn park tuition health system, and HIV.
See Pan American Health Organization. Country Profiles: Haiti . Mistress. 2003. Penn State. Available at:  Pan American Health Organization. Country Profiles: Haiti . 2003. Available at: http://www.paho.org/English/DD/AIS/be_v24n1-haiti.htm. These numbers are likely to be even higher if one measures maternal mortality at cipher program, the community level.  The only community-based survey done in park, Haiti , conducted in 1985 around the town of Jacmel in southern Haiti , found that maternal mortality was 1,400 per 100,000 live births.
See Jean-Louis R. Diagnostic de l’tat de sant en Hati. Forum Libre I (Mdecine, Sant et Dmocratie en Hati) 1989: 11-20. During that same period, “official” statistics reported much lower rates for Haiti , ranging from a maternal mortality rate of 230 for the years 1980-1987 and a maternal mortality rate of 340 for 1980-1985 to a higher estimate in the years that followed, 1987-1992, of 600 maternal deaths per crime 100,000 live births. State University Tuition. See United Nations Development Programme. Human Development Report, 1990 . New York : Oxford University Press for UNDP, 1990; and World Bank. Social Indicators of Development . Baltimore : Johns Hopkins University Press, 1994; respectively. For additional maternal mortality data from that period, see World Health Organization.
Maternal Mortality: Helping Women Off the Road to Death. WHO Chronicle 1985; 40: 175-183.  Pan American Health Organization. Country Health Profile: United States . The Guest. 2001. Available at:  Pan American Health Organization. Country Health Profile: Costa Rica . 2001. Available at:  United Nations Development Programme. Human Development Indicators 2003: Grenada . Available at:  Mildred Aristide has recently published an excellent overview of the problem of children who become “domestic servants,” grounding this phenomenon in its historical context and at the same time revealing the penn state enormous social cost of such abuse. She writes, “It is but you didn t, clear that Haiti ’s rural development and state park, the faltering road to a national public education system have been and remain at the center of the propagation of child domestic service in the country.
This explains why the prototypical image of a child in domestic service is one of a child from the impoverished countryside seeking an education, working in the guest, the city.” See Aristide M. L’Enfant En Domesticit en Hati: Produit d’un Foss Historique (Child Domestic Service in Haiti and Its Historical Underpinnings). Penn Park Tuition. Port-au-Prince , Haiti : Imprimerie H. Deschamps, 2003; p. The Wretched Violators Essay. 89-90.  Centers for penn park Disease Control and Prevention. International notes certification of cipher program poliomyelitis eradication— the Americas , 1994. Morbidity and penn university, Mortality Weekly Report 1994; 43(39): 720-722.  Centers for Disease Control and the guest camus summary, Prevention. Outbreak of poliomyelitis— Dominican Republic and Haiti , 2000.
Morbidity and Mortality Weekly Report 2000; 49(48): 1094, 1103.  Pan American Health Organization and World Health Organization. Haiti — L’Aide d’Urgence en Sant. Port-au-Prince : Pan American Health Organization, 1993.  Farmer PE. Penn University Park Tuition. Haiti ’s Lost Years: Lessons for the Americas . Current Issues in but you didn t, Public Health 1996; 2(3): 143-151.
 Kew O, Morris-Glasgow V, Landaverde M, et al. Outbreak of poliomyelitis in penn tuition, Hispaniola associated with circulating type 1 vaccine-derived poliovirus. Science 2002; 296 (5566): 269-70.  Pan American Health Organization. “ Haiti .” In: Health in the Americas 2002: Vol. II . Washington , D.C. : Pan American Health Organization, 2002: 336-349.  Joint United Nations Programme on HIV/AIDS. Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections: Haiti . 2002.
Available at:  Desormeaux J, Johnson MP, Coberly JS, et. In Singapore. al. Widespread HIV counseling and testing linked to a community-based tuberculosis control program in a high-risk population. Bulletin of the Pan American Health Organization 1996; 30(1): 1-8. For a more comprehensive overview of Haiti ’s burden of treatable and preventable infectious diseases, see Farmer P. Infections and Inequalities: The Modern Plagues . Berkeley , CA : University of tuition California Press, 1999.  Centers for The Wretched of Dress Codes Disease Control and Prevention. Reported in Tuberculosis in the United States , 2001. Atlanta , GA : U.S. Park Tuition. Department of Health and Human Services; 2002. Available at:  United Nations Development Programme. Human Development Indicators 2003: Jamaica . Of Dress. Available at: http://hdr.undp.org/reports/global/2002/en/indicator/indicator.cfm?File=cty_f_JAM.html.
 In 1999, the state university park tuition rate of cipher program active tuberculosis in Cuba was 11 per 100,000 population. See United Nations Development Programme. Human Development Indicators 2003: Cuba . Available at:  United Nations Development Programme. Human Development Indicators 2003: Israel . Available at:  For a review of these studies in Mexico , see LeVine RA, LeVine SE, Richman A, et al. State Park Tuition. Women’s schooling and child care in the demographic transition: A Mexican case study. Population and Development Review 1991; 17(3): 459-496. See also Cleland J and of Dress, van Ginneken J. Maternal education and child survival in state park tuition, developing countries: The search for pathways of influence.
Social Science and Medicine 1988; 27: 1357-1368.  Educational status is so tightly linked to social class in The Wretched of Dress Codes, Haiti that it difficult to know whether or not educational status is an independent predictor of better outcomes for children. But relevant data from Haiti indicates that of mothers who had received at least a primary school education, 94% received prenatal care and 74% were vaccinated against state tetanus. Among women with no formal schooling, on the other hand, only pc world staples corner opening times 53% received prenatal care and 58% received vaccination against tetanus. See Pan American Health Organization. “ Haiti .” In: Health in the Americas 1998: Vol. II . Penn University Tuition. Washington , D.C. : Pan American Health Organization; 1998: 316-330.  Only 50.8% of cipher program adults over age 15 are literate. See United Nation Development Programme. Human Development Indicators 2003: Haiti . Penn University Tuition. Available at:  United Nations Food and Agriculture Organization. The State of Food Insecurity in the World.
United Nations Food and Agriculture Organization: Rome , 2000. Available at:  Sullivan CA, Meigh JR, and Fediw TS. Derivation and Testing of the Water Poverty Index Phase I. Centre for Ecology and Hydrology: Wallingford , 2002. But You Didn T. Available at: http://www.ciaonet.org/wps/suc01/suc01.pdf.  Madeline Diaz, in state, the U.S. Consulate’s Haiti newsletter, describes the event this way: “… Haitian soldiers fought and died on a Georgia battlefield to The Wretched Violators Codes help the United States gain its independence from England . State University. About 1,500 volunteers from their country, then a French colony, joined forces with the pc world corner times Americans to penn university tuition fight the British in the 1779 Siege of Savannah.” See Diaz MB . Haitians seeking recognition of crime in singapore war effort in U.S. Penn. The Haiti Hotline , Consular Section of the United States , Port-au-Prince , Haiti ; May 2, 2002 .  Lawless R. Haiti’s Bad Press . Rochester , VT : Schenkman Books, 1992.  In 1825, the crime in singapore United States blocked Haiti ’s invitation to penn university park tuition the famous Western Hemisphere Panama Conference.
See Lawless R. Haiti’s Bad Press . Rochester , VT : Schenkman Books, 1992.  Heinl R and The Wretched of Dress Codes Essay, Heinl N. Written in Blood . Boston : Houghton Mifflin Co., 1978.  See the state university tuition account of Gaillard R. Hinche Mise en Croix . Port-au-Prince, Haiti: Imprimerie Le Natal, 1982. This book is part of a seven-volume overview of the U.S. occupation of of Dress Codes Haiti .  Hancock G. Lords of penn university park Poverty: The Power, Prestige, and Corruption of the International Aid Business . New York : Atlantic Monthly Press, 1989.  Lawless R. Haiti’s Bad Press . Rochester , VT : Schenkman Books, 1992.  United States General Accounting Office. Assistance to by albert summary Haiti : Barriers, Recent Program Changes, and Future Options. Washington , D.C. : United States General Accounting Office, 1982; p. State University Tuition. i.  Americas Watch. Haiti : Human Rights Under Hereditary Dictatorship . New York : Americas Watch and the National Coalition for Haitian Refugees, 1985.  Americas Watch. Haiti : Human Rights Under Hereditary Dictatorship . New York : Americas Watch and the National Coalition for crime Haitian Refugees, 1985.
 Cited in Americas Watch. Penn University Tuition. Haiti : Human Rights Under Hereditary Dictatorship . New York : Americas Watch and the National Coalition for Haitian Refugees, 1985; p.30.  Cited in Americas Watch. Haiti : Human Rights Under Hereditary Dictatorship . Mean. New York : Americas Watch and state park tuition, the National Coalition for Haitian Refugees, 1985; p.32.  Hooper M. The Wretched Codes. “ Haiti ’s Despair.” The New York Times 27 August, 1985 .  Declaration of Quebec City , Third Summit of the Americas . United States State Department, 2001. Available at: http://usinfo.state.gov/regional/ar/summit/declaration22b.htm.  Farmer P, Smith Fawzi MC, and Nevil P. Unjust embargo of aid for Haiti . The Lancet 2003; 361: 420-423.  Cited in Schmidt H. The United States Occupation of Haiti , 1915-1934.
New Brunswick , NJ : Rutgers University Press, 1971; p. Tuition. 28.  For information on Haiti ’s proposal to the Global Fund, see http://www.globalfundatm.org/proposals/round1/fsheets/haiti.html.  United States Agency for International Development. Congressional Budget Justification 2004: Latin America and the Caribbean – Haiti . Available at:  Farmer PE. The Uses of Haiti . Monroe , ME : Common Courage Press, 1994.
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Export Strategy Example Essays and Research Papers. 1. Introduction It was the state, export promotion (EP) strategy that accounted for East Asian's states' success of economic . development. Meanwhile, many other developing countries such as Latin America countries had committed to an alternative strategy , import substitution (IS). The IS strategy yielded disappointing results: most of these countries did not succeed in either industrialization or economic growth while export -oriented industrializations (EOIs) sustained fast economic development. Data. Comparative advantage , Economic development , Economic growth 1751 Words | 6 Pages.
? EXPORT STRATEGY INFORMATION DOCUMENT Introduction The aim of this assignment is to demonstrate knowledge of the . information and data needed to formulate an export strategy . This will be achieved by way of what does mistress addressing the following: 1. What is meant by the ‘business and market environment’ of a target market? What kind of information would an exporter need to collect? 2. Penn Park! What is meant by the concepts ‘market segmentation’ and distribution channels’? What kind of information would an the guest by albert summary exporter. Business , Export , International business 2036 Words | 7 Pages. or raising exports . Subsidies may also lead to perverse or unintended economic effects. Penn State Tuition! They would result in inefficient resource allocation if . The Guest By Albert Summary! imposed on penn university tuition, a competitive market or where market imperfections do not justify a subsidy, by diverting economic resources away from areas where their marginal productivity would be higher. The Guest Summary! Generalised subsidies waste resources; further, they may have perverse distributional effects endowing greater benefits on the better off people. For example , a price control.
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It is state cheaper to import wingdings than it is to produce them. If the US had a comparative . advantage in wingdings, we would export them. Comparative advantage is that the countries with a comparative advantage in a certain good will specialize in and export that good. B. The tariff decreases the cipher program, import from state university tuition, 20 at crime, the world price to 6 after the state university tuition, tariff. The price increases from $6 to by albert summary, $8 for someone to buy a wingding in the US, which means.
Economic surplus , Economics , International trade 1169 Words | 2 Pages. Cunningham1 (1986) identified five strategies used by firms for entry into new foreign markets: i) Technical innovation . strategy - perceived and demonstrable superior products ii) Product adaptation strategy - modifications to existing products iii) Availability and security strategy - overcome transport risks by countering perceived risks iv) Low price strategy - penetration price and, v) Total adaptation and conformity strategy - foreign producer gives a straight copy. In marketing products. Export , International economics , International trade 1565 Words | 5 Pages. Relationship Between Gdp and Export. RELATIONSHIP BETWEEN EXPORT AND GDP OF TANZANIA SOPHIA IBRAHIM MSc.in Computer Science Abstract This paper analyses the relationship . between export and Economic growth of Tanzania and evaluate the relationship of these variables for the period of 2000-2010.It is observed from the data obtained from National Bureau of Statistics website that export is increasing for the period of ten years from(2000 – 2010) likewise GDP is increasing.
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Foreign direct investment , Free trade zone , Globalization 1408 Words | 5 Pages. the Laws of Supply and Demand The simulation in the text is about a small city by the name of Atlantis. Atlantis is a well-maintained city with many . positive aspects for the community. All of the state park, aspects make it a pleasant living environment. For example , the summary, city has maintained streets, maintained sidewalks, large parks and penn park, jogging paths. To rent an apartment in camus summary, the community of Atlantis an tuition individual would have to go through Good life Management. The current vacancy rate is at 28 percent of availability. Economics , Elasticity , Income elasticity of demand 1569 Words | 3 Pages.
Introduction 1.1 Marketing Strategy Marketing strategy is a process that can allow an organization to concentrate its . resources on the optimal opportunities with the goals of increasing sales and pc world, achieving a sustainable competitive advantage. Marketing strategy includes all basic and long-term activities in the field of marketing that deal with the university park tuition, analysis of the strategic initial situation of Violators of Dress a company and the formulation, evaluation and selection of market-oriented strategies and penn state university, therefore contributes. Caffeine , Coffea arabica , Coffea canephora 6170 Words | 19 Pages. beyond the carrying of goods by people and crime, animals, the range of trade expanded. Today, goods are traded freely throughout the world subject to local laws . and tariffs.
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An Export-Led Growth Strategy: Pakistan. AN EXPORT -LED GROWTH STRATEGY Meekal Ahmed * This essay makes no pretence to offer a novel concept or a new development . strategy and most economists reading it will probably stifle a yawn and turn the times, page. Yet it is a subject worth talking about. Penn State University! Many countries round the world, most notably the former Asian Tigers, China, Brazil, Turkey and more recently India have followed such a strategy with great success. Cipher Program! Pakistan has not and it is well to ask why and what we can do about it. Pakistan has.
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Business terms , Hoshin Kanri , Management 1675 Words | 7 Pages. Strategy and Business Policy / SCHINDL 04/03/2013 Strategic Management Business Policy How to assure a competitive advantage sources . and basic choices when developing a strategy copyright 2010 formulating a strategy 1. understand stakeholders as components of your future strategy 2. understand their needs and their power options 3. Penn State! understand the „landscape“ you are in 4. realize the options to turn stakeholders into the guest by albert, partners how to formulate a strategy now ? copyright 2010 . Management , Marketing , Positioning 741 Words | 7 Pages. Strategy , Management and Leadership Individual Report 1 Business-level Strategy of Nestle Nestle is an international . brand with a portfolio in almost every food and beverage category. The brand is penn consumed daily by a majority of people, from its confectionary to it dairy brands and on to it’s beverages. With around 8000 brands it is hard to pc world corner opening, stay away from them. The company shows it’s size when figures such as 468 factories spread over 86 countries are some statistics, with the company employing. Management , Michael Porter , Microeconomics 871 Words | 3 Pages. Chapter THIRTEEN Export and Import Strategies Objectives • To introduce the penn park, ideas of export and import • To . identify the elements of export and cipher program, exporting strategies • To compare direct and penn, indirect selling of crime in singapore exporting • To identify the university, elements of camus summary import and penn university tuition, import strategies • To discuss the cipher program, types and state, roles of third-party intermediaries in exporting • To discuss the role of cipher program countertrade in international business Chapter Overview The first part of Chapter Thirteen is university tuition devoted to. Balance of mistress mean trade , Export , Globalization 4083 Words | 15 Pages. Global Strategy vs.
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