State of Decay: Haiti turns to free-market economics and the UN to save itself

 

By David South

Id Magazine (Canada), July 11-25, 1996

Port-au-Prince – Brand-new four-by-four jeeps in various shapes and sizes bounce over the moon-like craters of Port-au-Prince’s roads. The presence of so many expensive vehicles in a country unable to feed all its citizens is hard to take, but it is not one of the worst paradoxes of Haiti.

The appalling state of the roads – more like occassional stretches of asphalt to break up the monotony of potholes – is an apt symbol of Haiti, a reminder with every jar of the tailbone of the public squalor of the many and the private wealth of the few. The shiny new jeeps are not a sign of recent good times, but reveal who has all the money in this nation of almost seven million: the tiny Haitian elite, thieves, the United Nations and the multitude of non-governmental aid agencies.

When democratically-elected president Jean-Bertrand Artistide, deposed in a 1991 coup, returned to complete his term in office in 1994, many Haitians hoped that this country would at last begin to shake off centuries of exploitation at the hands of a selfish elite backed by American corporate masters and begin to build a democratic future.

The United Nations mission in Haiti, which includes 700 Canadian troops, is intended to support the country’s fledgling democracy. But Haiti’s future remains uncertain – as does the role the UN will play in shaping it.

Despite negotiating a peaceful and democratic transition last February 7 from Aristide – a firebrand former priest and passionate advocate of Haiti’s poor – to successor Rene Garcia Preval, Haiti hasn’t stopped its economic freefall. Economists predict the country won’t match 1991 earning levels until the next century. Political unrest resulting from opposition to the government’s privatization plans could also spell trouble ahead.

The United Nations presence, due to end June 30, has been extended another five months at the request of the Haitian government. The newly-minted UN Support Mission in Haiti, a military force of 600 UN troops supported by 700 soldiers paid through voluntary contributions, is being assembled. It will replace the current force of 1900.

Lousy loans

Meanwhile, the government of Rene Preval is negotiating with the International Monetary Fund (IMF), the World Bank and the United States to get much-needed loans to help balance the budget. Critics say the world’s banks are trying to lock the poorest country in the Western hemisphere further into crippling debt. The Haitian budget is US $750 million, 60 per cent of which the government hopes to raise from loans.

But there is a condition. Haiti must embark on a structural adjustment programme: widespread firings of the public service, privatization of most of the public sector, loosening of controls over foreign capital, adherance to the ethos of global trading blocks espoused by the North American Free Trade Agreement (NAFTA). Some call this neo-liberalism, others neo-conservatism. Either way, it forces this impoverished country to limit how it can address rebuilding a crumbling infrastructure.

The government’s hands are tied, though, as the conditions were part of the deal to return Aristide to power.

A Canadian public relations company, Gervais-Gagnon-Covington Associates, has been paid US $800,000 by the American government to sell the idea of privatization of Haiti’s handful of idle and near-bankrupt state enterprises.

In order to plunge deep into this Haitian qaugmire, I pitch up at the legendary Hotel Olofsson -made famous by novelist Graham Greene in the Comedians – and begin interviewing in the languid atmosphere by the pool.

“Aristide has put Haitians in a giant trap with the IMF plan,” says Jane Regan, who runs an independent news service based in Port-au-Prince. “The US $1 billion in loans will double the national debt.

“Haiti used to be self-sufficient in rice – last year they bought US $56 billion in US rice. The roads are worse now than a year ago. Right now the UN mission is of questionable worth and Canadians are getting taken advantage of.  They have been sent to clean up after the Americans. These are the same neo-liberal economic policies that hurt Canadian workers – just imagine what Haitians are feeling!”

Regan thinks that, so far, the only people to make any money out of this arrangement are businesses and the more than 800 NGOs operating in Haiti. And on that note, the feisty Regan disrobes and plunges into the Hotel’s pool.

According to Kim Ives, a reporter with the Haitian newspaper Haiti Progres, there are a few cracks in the solidarity between Preval and Aristide: “Aristide is hitting out against privatizations. In a two-hour TV interview, he drew a line between himself and Preval.”

One of the few visible signs of change in Haiti is the dusty Octobre 15 road leading from the airport past former president Aristide’s palatial home on its way to the wealthy suburb of Petionville. It is bordered on one side by Camp Maple Leaf, and on the other by dilapidated shanty towns and desperate street vendors.

Cynics point out the road conveniently serves the interests of the elite once again. It offers a direct and more or less pothole-free route from the secluded mansions of Petionville to the airport – a crucial escape route in a politically volatile developing country. In fact, a development of monster homes that would make a Canadian suburbanite blush is going up near the airport to capitalise on this.

Canadian troops

Caught between the Haitian government and its people is the United Nations, including Canada’s troops. Canadian troops form the first line of defence – along with Preval’s personal secuity guards – to defend the National Palace. They accompany the president wherever he goes, 24 hours a day.

Some fear growing resentment among Haitians for government policies will pitch the population against the soldiers.

At Camp Maple Leaf, the home base of Canada’s military contingent in Haiti, the troops are scrambling to adjust to a new mission sanctioned by the United Nations. As of June 30, they must take a back seat to the troubled Haitian police force as it tries to prove that the intensive training provided by police from around the world has paid off.

In the first week of July, the Canadian soldiers of the Royal 22nd Regiment – the famous Vandoos  – receive confusing news about a change in their firing orders or Rules of Engagement. ROEs dictate the tone and behaviour of peacekeepers on a UN mission and, as the experience of Somalia demonstrates, they can be the difference between success and disaster.

As the new mandate starts, the Canadians are first told they will be only able to use deadly force to defend themselves and not Haitians. If a member of the government is assassinated, they must stand by. If a Haitian is clubbed to death before their eyes, they must stand back. It is a qualitative change from their ROEs prior to June 30.

Ottawa military spokesman Captain Conrad Bellehumour says the change is indicative of an evolving mandate. But a military spokesman in Haiti says the old ROEs are now back in force, and Canadians can intervene to save a Haitian’s life.

“Maybe somebody’s been listening to Jean-Luc Picard too much,” quips retired Brigadier-General Jim Hanson, in a reference to TV show Star Trek’s prime directive of non-interference in a culture.

Preval’s police

A large banner hangs over a Port-au-Prince street: “Police + Population = Securite + Paix”. The UN has placed its greatest emphasis on reforming Haiti’s policing and justice system. The Police Nationale d’Haiti (PNH) was formed, and the RCMP and the American Federal Bureau of Investigation (FBI) were asked to provide training. The idea is to break from the past – when the military used policing as an opportunity to terrorize the population – and establish a police force to serve and protect.

But the efforts of the Haitians and their international police advisers have had a mixed success. According to Canadian soldiers, the Haitian police need to be coaxed into conducting routine patrols and have not given up patrolling in large numbers in the back of a pick up truck with rifles at the ready. To be fair, seven police officers have been killed since January, in what many believe is an organized campaign of terror orchestrated by sympathizers of the old dictatorship and drug gangs.

According to Sergeant Serge Martin of the Vandoos, “The PNH use 15 police officers to patrol and don’t talk to anybody.”

“You don’t depend on police to protect you,” claims Regan. “The Haitian government has no control over them. You don’t know if there is going to be a coup tomorrow.”

Jean-Yves Urfie, editor of the pro-democracy Libete newspaper in Port-au-Prince, believes the campaign to kill police goes back to the United States. “I am convinced the coup d’etat was financed by the Republican administration. I believe the Republicans want to destroy things here to show (President) Clinton wasted his time bringing Aristide back.

“The government was forced to incorporate former members of the military into the police force. And it would be terrible if the population develops the impression all cops are bad.”

“They are 10 years away from a viable police force,” concludes Hanson.

A stop at the fourth precinct police station shows just how far things still need to go. At the counter is a lone police officer, sharply turned out in his beige shirt and yellow-striped navy pants, courtesy of the Royal Canadian Mounted Police. But this proves to be a veneer of change. Canadian soldiers ask if everything is alright. They then ask to see tonight’s prisoners. The officer sheepishly leads the troops down a narrow corridor to 9 ‘ by 12 ‘ foot cell stuffed with nine prisoners. It is very hot and the stench from an open drain overflowing with sewage is nauseating.

Outside the Penitencier National in downtown Port-au-Prince, a yellow concrete structure with peeling pain, Haitians lined up to feed the inmates, talk about their frustrations with a justice system that has collapsed. Many complain that only the rich, who can hire lawyers, can enjoy the fruits of democracy. While state-directed beatings and killings have been dramatically reduced, most prisoners rot on remand until they are charged with a crime. Heiner Rosentdahl, the UN representative in Haiti in charge of prison reform, tries to be upbeat. “There have been no changes in conditions in Haiti’s prisons. Treatment of the prisoners is better, though there have been some abuses. We have developed a nation-wide register book of prisoners to help keep track of who is in prison.”

Another mixed blessing, according to Rosendahl, is the new requirement that all prisoners be fed two meal a day. The food is so poor, prisoners have been getting sick.

He is frustrated with the pace of penal reform. “The Haitian prison system hasn’t had a budget since October 1995, because of battles within the parliament,” he says. “The Haitian government didn’t ask for a plan to change this situation despite the minister of justice visiting the prison for the first time.”

According to Rosendahl, it is not the routine killing of thieves by mobs that worries the elite. Nor is it the assassination of police officers, or the untold thousands dying of disease and hunger. The only thing that is beginning to rock their world is a new phenomenon for Haiti: kidnapping and extortion.

Voodoo economics

For such a seriously depressed economy, there is an astonishingly large number of lottery booths – or Borlettes – on Haitian streets. They are so plentiful, they join gas stations as the main landmarks of the streets.

The industrial park which is now home to the remaining American troops stationed in Port-au-Prince, is a good monument to Haiti’s economic problems. Dilapidated and only barely functioning, this facility once supported, directly and indirectly, a large portion of the city’s population. As crummy as the sweatshop jobs were, they provided valuable income for the capital’s poor.

The Haitian economy under Francois Duvalier and his son, Jean-Claude, before the chaos of the late 1980s and 1990s, was based on assembling manufactured goods for the US market. Haiti was the world’s largest producer of baseballs, and ranked as “top three in the assembly of such diverse products as stuffed toys, dolls and apparel, especially brassieres. All told, the impact of international subcontracting was considerable,” according to author Paul Farmer in his book, The Uses of Haiti.

Today, Pierre Joseph, a Haitian-American from New York City, has a new job: he screens the ID cards of Haitian workers as they enter the park. He says there were once over 50 factories operating here; now there are 30.

Evidence of Haiti’s economic collapse is everywhere. On the walls outside the National Palace is scrawled Aba Preval Granhanje – Preval is a liar. Across the wide boulevard in a square are around 75 homeless children. They joke with the Canadian soldiers, especially boyish 2nd Lt. Marc Verret, who looks like a baby in soldiers clothes. The kids beg him for water and money.

In the market area, the piles of garbage, rotting meat and excrement make a muddy devil’s stew. Homeless children sleep on top of the abandoned crates. One small child is curled up in an American flag, asleep.

Desecrating dead

The dead also suffer the indignities of economic ruin. Outside the gates of the Hopital Generale, a man lies dead on a broken trolley in the yard. Others still alive, with limbs missing, are sprawled out on the ground. Chickens and goats roam the grounds. In the back is the main morgue for Port-au-Prince. The odour just 25 feet from the entrance to the morgue is normal for this city strewn with rotting garbage and stewed by a hot sun.

Inside, an overpowering odour like rotten chicken meat is the product of 450 human cadavers. Like rag dolls laid out in a ghoulish toy store, row upon row of children dead from starvation and disease – Haiti’s infant mortality rate is 127 per 1,000 babies born – are stacked almost to the ceiling. There are also adults. Old women, young men badly mutilated for stealing, are strewn out on the dirty concrete floor and on shelves.

There is no refrigeration, and according to military doctor Major Tim Cook, “something really nasty is going to come out of there if they don’t do something.”

Proving peacekeeping

More is at stake in Haiti than the re-building of a politically and economically devastated nation. For Canada’s armed forces, shaken and little stirred by the Somalia scandal, it is an opportunity to make amends. This time around, the peacekeepers are keeping the needs of the local population foremost in their gun sights. When the Vandoos head out on another one of their 24-hour patrols, the atmosphere is friendly and filled with gentle ribbing with the locals. They have the advantage of being able to speak French, a language understood to varying degrees by most of the population.

The approach of the individual soldiers varies widely. On a routine patrol, Alpha Company engaged in good-natured kidding around, with splashing the locals the worst offence. But a day out with Charlie Company, led by Sergeant Serge Martin, proved another story. The two privates assigned to accompany a group of journalists were a couple of operators. The day included a visit to a perfume shop, a trip through the wharf area looking for prostitutes and constant propositioning of the local women.

One Canadian corporal with the Vandoos, Eric Charbonneau, has been trying to make a small difference to the lives of the 400 people living in the community of Cazeau, a shanty town near the international airport. He has started literacy and hygiene lessons and raised money to help the residents build concrete houses to replace the mud dwellings they currently inhabit.

“I was walking along the fence and started to build a relationship with the kids,” he explains. “Some guy approached me and needed some help. It took three weeks to build a relationship. They are too used to white people giving away things for doing nothing. They were surprised when they had to work for it.”

At the gates to Camp Maple Leaf is a spray-painted sign. In Creole, French and English beside a Canadian flag, it says “No More Jobs.” While it could look at home back in Canada, it illustrates how important the presence of soldiers, the United Nations and charities are right now to the economy.

Some observers see the UN presence as part of a slide back into dependency on foreign money, restricting Haiti’s ability to assert itself. But others believe the turn to the international community is Haiti’s last hope of breaking with a past littered with dictatorships and poverty.

According to Captain Roberto Blizzard – an erudite and wise observer of the situation – the base has been stampeded with desperate Haitians looking for work. Blizzard has tried to find work for as many Haitians as he can, even helping them to form a laundry co-operative he hopes will survive long past the Canadians’ stay.

“There is a danger of the Haitian people turning into full-time beggars,” he says with sadness.

Id Magazine was published in Guelph, Ontario, Canada in the 1990s. This story was researched and published in 1996.

I covered the UNMIH mission in Haiti for Id Magazine in 1996.

Opinion: Canada is allowing U.S. to dictate Haiti's renewal: More news and opinion on what the UN soldiers call the "Haitian Vacation"

By David South

Id Magazine (Canada), August 22 to September 4, 1996

An August 19 attack on the Port-au-Prince police headquarters by pissed-off former Haitian soldiers should be a wake up call to Canadians. So far, the Haiti UN mission has seemed as safe as the soldiers' quip, the "Haitian Vacation". The UN soldiers patrol the capital in rickety Italian trucks, stopping to chat with the locals. On the surface, this mission looks like summer camp compared to the nightmare of enforcing peace in the former Yugoslavia.

But for one crucial factor: The UN troops are propping up an increasingly unpopular government. A government that is seen by many Haitians to be getting its orders from Washington, not Port-au-Prince. Canadian troops lead the UN mission in Haiti and make up 700 of the 1500 soldiers stationed there (the rest are from Pakistan and Bangladesh). There is a serious danger they will be caught in the crossfire of any uprising or coup attempt.

Canadian troops shadow president Rene Preval 24 hours a day and also guard the National Police. When I visited the dilapidated palace in July, with its handful of Canadian troops banging away on laptop computers, I could only hope nobody will want to mess with the UN.

The two prongs of Haitian renewal - reforming the economy and the justice system - are both being directed by the U.S.. Haitian senator Jean-Robert Martinez had a theory about the August 19 attack, which killed a shoeshine boy. Martinez believes it was in retaliation for government plans to privatize Haiti's rotting nationalised industries - a condition for receiving loans from the U.S. and the Washington-based International Monetary Fund and the World Bank.

Haiti is a good example of the carnage of cynical U.S. foreign policy. The U.S. wooed and then coddled the corrupt Haitian elite to run its sweatshops. As the "development" organization USAID once said, Haiti could be the "Taiwan of the Caribbean". The U.S. trained the Haitian death squad Front pour l'Avancement et le Progres Haitien (FRAPH), who then littered the outskirts of Port-au-Prince with the bodies of former president Jean-Bertrand Aristide's supporters during the dark days of the 1991 coup.

Three weeks ago American troops from the 82nd Airborne plopped down on the streets of Port-au-Prince to spend a week patrolling. What kind of message does this send? This tells the Haitians that the UN isn't the real deal; that if they get out of line, the Americans will kick their butts. Why does Canada allow the U.S. to undermine the credibility of our peacekeeping mission?

More visits by the Americans can be expected. It is no accident that a medical team attached to the 82nd Airborne remains on duty at the American base in Port-au-Prince.

The so-called justice reforms are mostly window dressing. Canada spent $4,750,000 to build and renovate court houses for the same corrupt judges that were the problem in the first place. That's the equivalent of punishing a thief by buying him/her some new furniture.

Rather than telling the Haitians to tighten their buckles around hungry bellies, Canada should be leading the fight to pave roads and provide clean water and social services to all. Canada should not be helping to impose austerity economics on the Western hemisphere's poorest country.

David South is the Features Editor of id Magazine

U.S. Elections Update: Clinton is using Canada to keep control of Haiti

By David South

Id Magazine (Canada), October 31 to November 13, 1996

Canadian troops are not only on the frontline of peacekeeping in Haiti but also the frontline of U.S. foreign policy - a policy that is unravelling during the run-up to the November 5 presidential election. While the living standards of Haitians in the poorest country in the Western Hemisphere continue to decline despite free elections, Canadian troops are charged with keeping the island nation peaceful. It’s a task that is proving more and more difficult as Haiti suffers a crime wave and violent political unrest.

While American president Bill Clinton tries to snatch another victory from a grumpy U.S. electorate, his advisors are desperately trying to keep the lid on his foreign policy “victories” in Bosnia and Haiti.

Things are so bad, Clinton sent his secretary of state, Strobe Talbott, and his national security advisor, Anthony Lake, to Haiti on August 30 in response to high-profile assassinations of right-wing leaders.

“The administration are hoping, with fingers crossed, nothing will happen before November 5,” says Larry Birns of the Washington-based Council on Hemispheric Affairs (COHA). “What the United States would like to do is cryogenically freeze all its foreign policy engagements so they don’t produce any problems. But we are losing very valuable time in Haiti because of Washington’s paralysis over negative developments occurring there.

“Washington didn’t realize an economic success story had to be bred there in a couple of years. The USAID programme is a scandal waiting for an investigation.”

There is also another election-year factor: Republicans are not fond of anything that whiffs of a humanitarian approach to Haiti. Since they dominate Congress, this is also Clinton’s problem.

Given the history of American support for dictatorships in Haiti, the Clinton administration has chosen a low-key approach. After the 1994 invasion, the Americans pulled out the vast majority of their troops within a year, handing over responsibility for internal security to a UN peacekeeping force. But the U.S. never fully cut itself off from interfering in Haiti, keeping a military base operating in the country’s only industrial park in Port-au-Prince.

And Canada is key to U.S. plans because of that sour legacy. Canadians are seen as free from the burden of colonialism, and as a plus, our 700 mostly French-speaking troops can communicate better with the local population.

This policy has gone as far as hiring a Canadian public relations company to promote structural adjustment programmes that are conditional upon Haiti receiving any foreign aid from the International Monetary Fund and the World Bank, both based in Washington.

Gilles Morin is co-ordinating manager for Montreal firm Gervais-Gagnon-Covington Associates, who won the contract. Morin says, while his company did win the contract, like many other things to do with Haiti, they have heard nothing since Fall 1995 because of disorganization.  

“On a personal basis there was a strong anti-American feeling among the population because of the past,” says Morin. “A lot of the financial institutions are based in Washington and they needed international support because banks in Washington are seen as American.”

But there is a risk that a switch in U.S. priorities during the heat of an election will endanger Canadian troops.

“If the president feels he has political risk in Haiti, he’s not going to take Canadian concerns into consideration,” warns Birns. “The UN mission gets caught up in the wake of U.S. efforts and it’s not able to define an independent course. Right now, the problem really is the USAID mission in Haiti is a total failure. The international donor function, you couldn’t exaggerate how disappointing it’s been in terms of almost no relief. The unemployment rate of 80 per cent is exactly what the unemployment rate was when the UN arrived.”

On August 28, American troops from the 82nd Airborne plopped down on the streets of Port-au-Prince to spend a week patrolling. Many observers questioned the motives for this intervention. Was it to say to Haitians the UN isn’t the real deal, and if they get out of line, the Americans will kick their butts? Why doesn’t Canada protest the U.S. undermining the credibility of our peacekeeping mission?

To Birns, sending in the 82nd was the foreign-policy equivalent of fast-food. “Sending in the 82nd Airborne merely aimed at getting a one-day headline,” he says. “The administration’s position has been staked on the fact there has been a number of foreign policy wins. But each of these victories is held together by corn starch and could unravel at any moment.”

Birns sees an escalation in political violence just around the corner. He fears the current economic crisis will help the formation of a violent left-wing guerrilla movement to rival existing right-wing paramilitaries.

“Without former president Jean Bertrand Aristide,” he explains, “there is growing apprehension that president Rene Preval will not be able to project a sufficient leadership to keep the average Haitian, who is sacrificing with no expectation of an improved standard of living, happy.”

While it has been almost two years since Haiti was the media’s darling, observers point out the cycle of violence has returned to the country’s streets despite the presence of UN peacekeepers and American troops.

When id reported from the Haitian capital of Port-au-Prince in July (id July 11 to 24, Number 18), it was obvious no progress had been made to improve the standard of living or rebuild the country’s crumbling infrastructure.

In an ironic twist, attempts to step up deportations of Haitian-Americans convicted of crimes in the U.S. has led to an increase in killings in Haiti according to the October 22 issue of New York weekly, The Village Voice.

More and more, the UN troops are propping up an increasingly unpopular government. A government that is seen by many Haitians to be getting its orders from Washington, not Port-au-Prince. Canadian troops lead the UN mission in Haiti and make up 700 of the 1500 soldiers stationed there (the rest are from Pakistan and Bangladesh).

There is a serious danger Canadian troops will be caught in the crossfire of any uprising or coup attempt, since Canadian troops shadow president Rene Preval 24 hours a day and also guard the National Palace, which was attacked August 20, killing two Haitians.

"U.S. Elections Update: Clinton is using Canada to keep control of Haiti": Id Magazine (Canada), October 31 to November 13, 1996

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Taking Medicine to the People: Four Innovators in Community Health

Preventing and treating illness at home or in small local clinics makes financial sense. It also makes patients a whole lot happier.

By David South

Canadian Living (Canada), January 1993

Your health is your wealth, my grandmother used to say. It certainly is our most valuable resource – and when its caretaker, universal health care, is under attack, people take notice

Provincial health ministries across Canada are scrambling to find new cost-efficient ways to deliver health care, and community health care is an increasingly talked-about option.

“Every royal commission has suggested we need to shift resources to community care and stop focusing on institutions,” says Carol Kushner, co-author, with Dr. Michael Rachlis, of Second Opinion (HarperCollins, 1990), a blockbuster book that challenges the way we approach health care in Canada. According to Rachlis, health care nationally cost more than $60 billion in 1992 and is primarily delivered through hospitals and doctors’ private practices. Yet 20 per cent of all patients in acute care hospitals don’t belong there, and about five per cent of hospital admissions for people over age 65 are the result of improper use of prescription drugs.

One study of the Toronto Health Unit found that as many as 50 per cent of seniors residing in nursing homes who were admitted to hospitals with pneumonia had contracted it through mouth infections. If they had received regular dental check-ups in the community or at institutions, these unnecessary and costly admissions could have been avoided.

Increasing numbers of people see community health care as the way of the future. In this model, health care providers – doctors, nurses and support staff – work as a team, and users of health care are involved in making important decisions. Community-based care supplements a medical approach to illness, with emphasis on social and environmental factors like work-related stress. Its advocates say community care can wean us off our addication to expensive hospitals (where one bed costs at least $100,000 a year), drugs and surgery – and make us all healthier.

“Fee for service” encourages doctors to see as many people as possible, emphasizing quantity over quality. In community health centres, doctors are put on a salary and encouraged to give as much attention as necessary to each patient. By simply spending more time with each patient, and by taking into account factors such as illiteracy and cultural differences, community clinics can cut down on misuse of medication.

Jane Underwood, director of public health nursing for the regional municipality of Hamilton-Wentworth in Ontario, says we have reached the limit of what hospitals can do to improve health. “Other factors are now more important than a strictly medical approach, which was the foundation of the old health care system. In 1974, a Health and Welfare paper urged a behavioral approach – stop smoking, get more exercise. Now we are moving to a socio-environmental approach, looking at poverty, social isolation, and unemployment, and their effects on health.”

“Community health care is inevitable because we can now do many procedures on an outpatient basis. With the new technology, all kinds of things can be done outside institutions,” says University of Toronto professor Raisa Deber, co-editor of the recently released book Restructuring Canada’s Health Services System (University of Toronto Press, 1992).

“Just as people can work out of their homes because of computers and faxes, technology can take medical care to the home.” This trend can already be seen in the treatment of cancer. Many patients now receive their chemotherapy at home, with the help of computerized IV pumps.”

If the debate over community health care often seems confusing, it may be because of the haphazard patchwork of programs across Canada. Quebec is the only province that took community health care seriously enough to set up clinics across the province in the 1970s and make those clinics an integral part of the provincial system. Elsewhere in Canada, programs sprang up in the ’60s and ’70s at the initiative of community activists but were met with indifference or hostility from government.

The challenge for community care advocates is to educate both the public and governments. Jane Underwood admits it will be a tough struggle. “Governments are beginning to understand, but the public still has reservations. They panic when there are fewer surgeries and feel that lots of high tech will provide a safety net for health. In fact, it is more scientific to probe for the true causes of illness and not think that just taking a pill will make us better.”

Four Innovators in Community Health

South Riverdale Community Health Centre, Toronto

This fully functioning health centre opened in 1976 in Riverdale, a multicultural and economically diverse neighborhood. The staff consists of doctors, nurses, chiropodists, social workers, health promoters and a nutritionist. Innovative in taking on economic concerns of the community, the centre has set up a community food market to provide cheap and healthful food and recently started workshops with business and community members to come up with strategies to recover jobs lost during the recession. "We consider ourselves part of a movement," says executive director Liz Feltes. And this is played out in projects with local groups and citizens on a variety of issues - from wife assault, drug abuse and sexually transmitted diseases, to medication literacy for seniors. 

Victoria Health Project, Victoria

Originally started in 1988 to tackle the problem of poor communication between hospitals and community health providers, the project first targeted Victoria's large senior citizen population. Twelve programs were launched, including Wellness Centres, palliative support teams for patients dying at home and elderly outreach service focused on mental health. The project has been successful at getting local services to cooperate and eliminate duplication. "There are 500 different agencies for seniors in Victoria, so we linked up with them and increased cooperation," says Susan Lles, excutive coordinator of the project.

It was such a great success that the minister of health created the Capital Health Council to expand the program to the rest of the community. Now, for example, in hospital emergency rooms, quick response teams of nurses assess whether a patient would be better served by other services in the community or by being admitted to hospital. 

Centres locaux de services communautaires (CLSC), across Quebec

Started in 1972 as part of province-wide health reforms, these comprehensive health centres now number 158, with more than 500 satellite offices all over Quebec. Every citizen is guaranteed access to a CLSC, even in remote areas. With five per cent of the provincial health budget, they are able to serve 41 pr cent of the population. They also involve the community through elected boards. "We think it is a unique model in that it integrates health and social services in the same place - both prevention and cure," says Maurice Payette, president of the federation of CLSCs. Because CLSCs are close to the community, governments, schools, community groups and other organizations have turned to them for advice during the last five years. In rural areas, CLSCs have been crucial in reducing the number of farm accidents. 

Canadian Healthy Communities Project (CHCP), across Canada

Started in 1989, the program is aimed at municipalities and gets them to pledge that they will review all their actions with community health (including impact on the environment and economy) in mind. CHCP is part of an international movement linked with the World Health Organization's Healthy Cities movement. With more than 150 participating programs, it is an innovative attempt at getting the powers that be to plan for overall health. "We bring together community leaders to make a list of top 10 health problems and then decide what can be done with the existing budgets and staffing," says David Sherwood, project director. The city of Sherbrooke, Que., is a classic example. Facing reduced funds for road and sidewalk repairs, the city concentrated on repairs in neighborhoods with hig numbers of the disabled and elderly, thereby reducing the number of accidents. Unfortunately, funding was recently reduced dramatically by Health and Welfare Canada, but programs in Ontario, British Columbia and Quebec continue with the help of their own provincial government. 

"Taking Medicine to the People" was published by Canadian Living in 1993.

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Take two big doses of humanity and call me in the morning

By David South

The Toronto Star (Toronto, Canada), January 1, 1993

“Anybody going into medicine should read a whole bunch of good novels.” Dr. Alvin Newman isn’t kidding. The head of curriculum renewal at the largest English-speaking medical school in the world, the University of Toronto, feels strongly that doctors have been ill-prepared for their profession’s challenges.

How doctors become doctors is being hotly debated as Ontario’s five medical schools institute a potpourri of curriculum reforms. After a century of taking a back seat to scientific achievement, bedside manners and the art of medicine are in vogue again.

“Around the world, medical education is undergoing significant changes,” says Newman. “Medical schools must strike a balance between the incredible explosion of scientific knowledge and re-establish the role of the physician as wise counsel and empathic healer.”

It’s a role that many feel doctors have ignored. An American Medical Association poll, conducted between 1985 and 1988, found that fewer than 50 per cent of respondents said they thought doctors listened well and half believed doctors no longer care as much about patients as they used to.

In response to these criticisms, current reforms are shifting medical education away from reliance on the turn-of-the-century science-based approach, says Professor Jackie Duffin, a medical historian at Queen’s University who helped organize the new curriculum introduced there in 1991.

“In the old days doctors could probably make a diagnosis and tell people what was happening to them, but not do very much for them,” says Newman.

“Yet society had more trust and fondness for physicians than they do now. Much of the condemnation of the medical profession is because we have become the custodians of high-tech medicine.”

While the Ontario government embarks on the most sweeping reforms to health care since the 1966 introduction of comprehensive health insurance in Ontario and the founding of national medicare in 1968, many doctors feel their profession cannot afford to maintain the status quo.

The concensus at Ontario’s five medical schools – U of T, Queen’s, University of Western Ontario, University of Ottawa and McMaster University – has gelled around a belief that doctors need to be as comfortable dealing with people as they are with scientific medicine. To this end, revamped curricula supplement basic science and clinical medicine with emphasis on early exposure to patients, communication skills, psychological issues, medical ethics, medical literacy and health promotion.

These schools hope to produce new doctors to fit into a rapidly-changing health care system – one that many believe will rely far less on large hospitals.

Instead, many procedures will take place in the home or in the day clinics. Expanding community health care care centres will try to tackle extensive social and health problems. This preventive approach ot medical education was pioneered by Hamilton’s McMaster medical school.

Since its founding in 1967, McMaster has experimented with teaching methods that steer away from mass lectures to concentrate on the individual student. The evolution of McMaster’s curriculum has placed greater emphasis on communication skills, psychosocial aspects of medicine, community issues, and disease prevention and health promotion.

How do McMaster students rate against other medical students?

Last year they scored above the national average on licencing exams. A higher proportion of McMaster students enter research and academic medicine than their counterparts from other schools. One study comparing them to U of T suggested they were more motivated to be life-long learners.

Dr. Rosanna Pellizzari practices the kind of medicine everyone is talking about these days. Working out of renovated church, Pellizzari’s practice at the Davenport/Perth Community Health Centre in westend Toronto serves a working class neighbourhood that has been home to generations of recent immigrants.

A member of the Medical Reform Group – which has long advocated significant reforms to health care – and trained at McMaster, Pellizzari can be seen to represent the doctor of the future: Sensitive, salaried and working in community health.

“McMaster’s curriculum attracts people with innovative ideas,” says Pellizzari, who was active in community health education before going to medical school. “It is a very supportive environment.

“I think the important question is: Who do we choose to be medical students? They should open up medical schools to those who know what it’s like to be a parent, a mother or disabled. Doctors should represent the population they serve. We are still getting mostly white, inexperienced young males as physicians. They aren’t going to practice the way that is necessary.”

In Ontario, many doctors see the 1986 doctors’ strike as a watershed for public opinion.

As a result of the negative fallout from the strike and perceived gap between physicians andhe public they serve, a five-year project entitled Educating Future Physicians for Ontario became a major advocate for reform.

Started in 1988, EFPO has examined fundamental issues in designing and implementing new medical school curricula. These issues include defining societal health care needs and expectations, faculty development and student evaluation. While each medical school has adapted reforms to its particular situation, EFPO hopes to prod further reforms.

“This is a unique venture in Canada, and could have implications far beyond Ontario if successful,” says Dr. William Seidelman, a key player in EFPO. “It captures the unique sense of the Canadian scene, and will build on the implied contact in the Canadian health system.”

Pellizzari sees the attitude of medical schools and teaching hospitals towards medical students as a significant factor in creating insensitive doctors. She recalls the high rate of suicide among medical students and the abusive work environment that forces doctors-in-training to work shifts unthinkable for other workers.

“The way we train doctors is inhumane,” she says. “We don’t expect other workers to put in 30-hour shifts. It creates in new physicians the attitude that they paid their dues and now society owes them.”

Many critics feel that changing training methods isn’t enough; the whole ethos and selection process must be changed. If doctors are to better serve the population, they must better reflect it.

“We are getting very close to gender equality and a laudable distribution of ethnic and racial backgrounds,” says Newman. “But students still come from a fairly narrow social spectrum,  very middle class kids. Their exposure to the extremes of society, to poverty, to homelessness and related illnesses have been very limited.”

Pellizzari found how out-of-date the medical profession was in her first year. One teacher wanted her to work till 10 at night. When told that she needed 24 hours notice for a babysitter, the teacher shot back that motherhood and medicine don’t mix.

“I was a mother before I was a physician. When I get a call at night from a mother, I understand this. With 30 per cent of visits to doctors having no biological basis – like depression due to unemployment – you can’t do anything unless you have experienced life.

“If we don’t address this, you can design the best training in the world, but things won’t change.”

But Newman also feels many factors outside of medical school discourage a more diverse student body.

“To go through medical school in the United States requires large indebtedness. That’s not true in Canada. You can calculate what a year of medical school costs in terms of a finite number of CDs, a leather jacket and ghetto blaster. So something is dissuading people from pursuing this career, and it isn’t money.”

While there is a concensus among academics that medical schools haven’t prepared doctors well enough, there is little support for a dramatic change in selection criteria. “I can’t muster a lot of support from colleagues for serious changes,” says Newman.

Dr. Jock Murray, the former dean of Dalhousie medical school in Halifax, recently told an EFPO meeting he doesn’t see any significant changes ahead.

“Physicians have a reputation for being conservative and self-serving,” says Murray. “If reform is going to be successful we have to be clear that it is about what is good for the people.”

Pellizzari believes life experience and empathy with social circumstances just can’t be taught.

“I grew up in this neighbourhood. I understand their powerlessness, the conditions. Doctors have to see themselves as a member of a team of health professionals, not as the top of the social and medical totem pole.”

U of T’s experience is a classic example of the hurdles ahead. Newman admits it has come as a shock to students loaded with society’s ingrained expectations.

“They spend half a day a week in the community seing things like drug rehab clinics and community health centres. But being out in the community doesn’t make the students feel comfortable. Their image of what they are going to do involves big buildings, chrome and steel, scurrying personnel and banks of computers.”

'Take two big doses of humanity and call me in the morning' was published in the Toronto Star in 1993.

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Study says jetliner air quality poses health risks: CUPE takes on airline industry with findings of survey

By David South

Now Magazine (Toronto, Canada), March 11-17, 1993

Canada’s troubled airline industry is about to face some more turbulence, as the union representing more than 6,000 flight attendents presses its concern that many of its members’ health problems are related to poor air quality in jets.

The Canadian Union of Public Employees (CUPE) says its locals have compiled data that paints a fairly stale profile of in-flight air quality and its relationship to altitude, passenger load and length of flight. As part of the survey, the union recorded flight crews’ complaints of chest pains and lack of oxygen, as well as other work-related problems like back injuries, hearing loss and high incidence of colds and flu.

Of more interest to frequent fliers might be the opinion of some experts that even the more common jet lag may be caused by excess carbon dioxide, ozone and radiation. More than half the air in many aircraft is recirculated, “stale” air that is high in carbon dioxide and may be carrying bacteria and viruses, according to some experts.

CUPE health and safety chair Tracy Angles says the union now has enough evidence to at least pressure the carriers to undertake more comprehensive air quality studies. CUPE represents workers at Air Canada, Canadian, Nationair, Air Transat and some smaller feeder carriers.

While the union’s study is the first of its kind in Canada, a survey by the US department of industrial relations found, among other things, that flight attendents had 20 times the expected frequency of respiratory illness.

Flying mines

“Flight attendants have been equated with coal miners in terms of the bad air they have to breathe,” says Angles. “But this is not something the companies want to study.”

However, spokespeople for Air Canada and Canadian Airlines say they have not heard of such health problems. Jerry Goodrich of Canadian simply says, “It’s not an issue.”

However, while earlier-model jets supplied the cabin with 100 per cent fresh air, increasing fuel costs led to some modification. Modern jets mix fresh air – expensive to produce – with stale air from inside the cabin, which is passed through filters. The percentage of recirculated air in some aircraft, such as the popular Boeing 747-400, could be as high as 52 per cent, Boeing’s figures show.

Boeing’s Tom Cole says air circulation in Boeing’s jets is better than in an average office building, and that the passengers are “washed” with air to eliminate carbon dioxide and other hazards.

Critics like Georgia doctor William Campbell Douglass, publisher of the health newsletter Second Opinion, charge that the high rates of recirculated air, and the reliance on passengers’ own breath and perspiration to humidify the dry air, provide a perfect environment for bacteria and viruses. Douglass even speculates that planes could transmit serious diseases like tuberculosis. He suggests jet leg could be “nothing more than CO2 intoxification and oxygen starvation.”

“There is no doubt if you are in a confined space, you are at greater risk,” says University of Toronto microbiologist Eleanor Fish. “Aircraft filter systems aren’t sophisticated enough to filter out all the bacteria and viruses. But I’d be hard pressed to believe that you are at greater risk traveling on airplanes than on elevators.”

It is difficult for public health authorities to pin down the health risks of airplane travel because passengers disperse immediately after a flight. However, medical journals have documented two cases where virus transmission could be established because the passengers were easily traceable.

In 1977, 38 of the 54 passengers on a plane grounded in Alaska for four and a half hours came down with the same strain of flu.

“We consistently hear complaints about certain aircraft,” says Angles. “The Airbus320 is one of the worst” Angles says many airlines exacerbate the problem by over-crowding planes and flying them longer and farther than they were designed for.

Cut corners

“With deregulation, they have more people in there than was ever planned on. Nationair is a good example. A normal class Air Canada 747 carries about 420 people. In the all-economy configuration the load is upwards of 496.”

Angles also says airlines have been known to cut corners by turning down air flow to save money. In their 1990 book The Aircraft Cabin: Managing the Human Factors, Mary and Elwin Edwards cite a study indicating that 1 per cent saving on a fuel bill can be achieved by reducing the ventilation rate in a McDonnel-Douglas DC-10.

"Study says jetliner air quality poses health risks": Now Magazine, March 1993.

The Google Snippet for the story. According to Neil Patel, "99.58% of featured snippet pages already rank in the top 10 SERPs in Google for a particular search query."

More resources: 

Jetliner Cabins Are Quickly Cleared of Virus, Pentagon Says

"Particles the size of the new coronavirus are quickly purged from a commercial aircraft cabin, according to a U.S. Defense Department study touted by United Airlines Holdings Inc. in its effort to reassure wary travelers.

Filtration systems and rapid air-exchange rates mean that only about 0.003% of infected particles entered a masked passenger’s breathing zone, said the report, released Thursday."

Aircraft Air Quality – Protecting Against Contaminants, Association of Flight Attendants

"On October 5, 2018, a 5-year FAA bill became law. Included in the bill is a study on technologies to combat contaminated bleed air. This is significant progress!"

'Contaminated air' on planes linked to health problems, 21 June 2017

AEROTOXIC SYNDROME: A NEW OCCUPATIONAL DISEASE?, Public Health Panorama, Volume 3, Issue 2, June 2017

Influenza Air Transmission, Influenza A (H1N1) Blog, September 28, 2009

"What does this tell us? Aerosols, very small particles of saliva containing the virus we exhale when we sneeze or even when we breathe if we have the flu, probably have an important role in the transmission of influenza. In addition to that we have public transportation, with a great number of people circulating in a place that may be closed and badly ventilated at times and we may have a notion of the importance of public campaigns that promote education and awareness of contaminated people to avoid leaving their homes when they have the flu and that they cover their mouth and nose with a disposable tissue when they sneeze and discard it right after that."

An outbreak of influenza aboard a commercial airliner, American Journal of Epidemiology, Volume 110, Issue 1, July 1979

"A Jet airliner with 54 persons aboard was delayed on the ground for three hours because of engine failure during a takeoff attempt. Most passengers stayed on the airplane during the delay. Within 72 hours, 72 per cent of the passengers became III with symptoms of cough, fever, fatigue, headache, sore throat and myalgia. One passenger, the apparent Index case, was III on the airplane, and the clinical attack rate among the others varied with the amount of time spent aboard. Virus antigenlcally similar to A/Texas/1/ (H3N2) was Isolated from 8 of 31 passengers cultured, and 20 of 22 ill persons tested had serologic evidence of infection with this virus. The airplane ventilation system was inoperative during the delay and this may account for the high attack rate."

The Airliner Cabin Environment and the Health of Passengers and Crew.

"At the end of its review of health data in the 1986 report The Airliner Cabin Environment: Air Quality and Safety, the National Research Council (NRC) committee concluded that “available information on the health of crews and passengers stems largely from ad hoc epidemiologic studies or case reports of specific health outcomes [and] conclusions that can be drawn from the available data are limited to a great extent by self-selection…and lack of exposure information” (NRC 1986). This chapter reviews data on possible health effects of exposure to aircraft cabin air that have emerged since the 1986 report and the emergence of data resources (e.g., surveillance systems) and studies that have particular relevance for the evaluation of potential health effects related to aircraft cabin air quality. Selected earlier sources are also reviewed. The decision to ban tobacco-smoking on domestic airline flights in 1987 and on flights into and out of the United States in 1999 reduces the relevance of some studies of exposures and reported signs and symptoms that clearly could have been related to the products of tobacco smoke." 

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