said i will get a 40,000-dollar fine and you will get thrown in jail. i went on the beaches even though it meant risking being thrown into jail and i did what i could to try to tell the story, and we all did our best to do it, but the story became very difficult to tell. i knew that was going to happen and that is when i decided very early on that this was going to require more than an article, more than a few days. it was going to require a full book, an investigation was going to require spending as much time as possible in those communities most affected and i basically spent my time. my previous books for those of you who have read them are really policy books. my background is public policy. i worked for two united states members of congress. by masters is from public policy in georgetown. this was going to need to be a very different book and it is really a book that is the human story of the human impacts and the people who are impacted and

on all sides. i talk to people employed in the oil industry, the oil executive, environmentalists, policymakers. i spent a good deal of time in washington d.c. talking to policymakers here in down there, and the story that is told and just to say, i was just overwhelmed by the graciousness of the people at the hardest point in their lives taking me and. ..

>> i am keenly aware we have 30 minutes a and you are here to listen to paul fayyad and not to me. i will be a facilitator and on a personal note i want to thank you for entitling chapter number two practice and policy. what that told me is if you highlight a word in the amazon kindle the dictionary pops up a and you can learn what the word praxis means.

thank you for that. [laughter] that is why i wrote the book [laughter] we are physicians you'll love to use a physician metaphor. that will be the art in 30 minutes we will consider haiti like a patient. let's start of the past medical history. eight century 18 '04 had its revolution in rewarded 1825 france imposing $21 billion reparations bill that took them over 100 years to repay with interest. and it got worse from there. >> you say the collapse has been economic and political can you expanded 20 seconds? >> guest: that is his revenge for be canceling his endoscopy. [laughter] they give for having us here.

i said i cannot imagine anybody being here on a monday morning figure for the effort to be here. it is not a convenient time for any of you and thank you for doing that. by way it as a segue i want to express at the outset my a sincere gratitude and it sounds like a grandstanding move but those of you here today who are haitian will not exactly what i am talking about. the revolution that john just mentioned, is the only time in recorded history leading to the founding of the nation.

when we heard of the french revolution in the promises of liberty, how could that be true if there were slaves? the answer is the haitian said it cannot be true. no offense to anybody eight year from france because i really love french food. but it could not be meaningful without the haitian revolution. and they will tell you across all spectrums of haitian society and most of my experience has been in the rural region that you have visited and my knowledge it is actually quite limited. but across the spectrum that heche's will tell you no

small amount of their current problem is related to the haitian revolution in the price they paid for pushing for these idea is. how can you say that in a more concise way? for those of you not did not that is then we talk about somebody comes in with a complaint, usually a patient that says i have been coughing and in my case maybe four weeks and losing weight. menu gather the history to find out when it started and one of the things we like to do with my work infectious disease we always go chronologically and the patient mayor may not know

when a certain bill this started. but coming back in time to when the patient was well going forward, haiti was never well because it was a slave colony then it was a privation being punished by the great powers of that time. and what i always quote if books about haiti of the senate floor the senators from one of our states that is a little bit south of north carolina. [laughter] that the safety of our country permits us too not even talk about haiti. obviously there were still slaves in the u.s. >> the first convoy we send when abraham lincoln and sent the first ambassador. it has a very complicated

history before the revolution when we sided with the slave owners. as the only other independent nation in the hemisphere. we have a history as two countries, as an american, that is always on my mind. >> host: that sets the stage because they say it is a lost cause, they cannot get their act together but without knowing their history you cannot even start to talk about it. that is one part of the book that is terrific but even to think about it because coming into it brought it is hard for people to get it. let's talk about the 800-pound gorilla in the room. the ngos and i have been to haiti a number of times and i was there the day the

cholera outbreak started at and i saw the interview and he was astounding. i went up north and i saw the difference between the health care people got at the mission and in the ngo and going about 7 miles down the road to the public hospitals which was astounding never seen anything like that in my life. literally no doctors. three men who did not have their md etfs and then call other doctors. the patients have to bring their own sheets and food and no electricity and you cannot imagine so the big difference between public and private. but the critics would say

there is a code dependency between the ngo and the public and you talk about the friction between taking care of the patient that is right in front of you. you reach out in help them but taking care of the whole system so you talk about that and the whole controversy. >> attention and controversy i will try to attack both of those. >> i am here with friends that just came in from new york working on in call this the projects 9:00 at night everybody everybody would pitched forward and start

snoozing and i know five policy discussions that interesting but they are crucial. we're not talking just about the infrastructure but talk about a building the eighth. when the cholera outbreak started i hope we have a chance to discuss it but that area was not touched by the earthquake. so all what you saw with no electricity, no doctors and the underfunded public sector and then what you saw is a what needs to be built. the tension between policy i should not have used the word practice. [laughter] maybe old school marxist term. what paygo. [laughter] for my doctor friends they

knew i would never say that. >> that was the longest take i have never seen. and then i make that comment 20 minutes ago? >> i have a long memory. [laughter] and the tension between taking care of someone right in front of view is what we should all be confronting. and even if it is not of our own men like seeing patients but cholera is a great example because the epidemic is out of control. 425,000 patients already.

that translates at 12 million people that is 180,000 dead. >> it could be the under count because the reporting capacity is so weak. the tension is in our life in use the patient's but every time you go on the air to haiti or somalia, i think it is the same sort of thing when i write a book. you are seen by millions of people all i am not bitter in. >> i know jaime from public affairs is year. >> you did not let me finish the second part of the question.

>> the 800, in guerrilla the ngo and code dependency just to jog your memory. [laughter] >> after words we have the ct set up. >> day plunge no mri is the way to go. [laughter] >> here is my a chance to say thank you to abbey antigen a -- and jennifer who contributed to the book to bring it into existence and it takes a village. if you read the book, read the part at the end of that his wife wrote to what was going on from rural haiti. don't just talk with his last words but really do read to the end but the

hundred pound gorilla is the idea behind the book that i am from an ngo. the real job as a medical school professor but at the same time and to build that a better as strategy is to help local people do local procurement but it was not always that way but a community-based organization but what are we doing wrong? everybody says bill they a hospital to get our kids back to school. we get a lot of things and said what we're doing wrong is to allow the continued

degradation of the public sector that is haitian. and to allow them to collapse as we grow. that is not the way to build haiti back better. we hope that was a chance not only to improve our own practice but to improve the dialogue with our other partners. >> guy stood in the rubble of the ministry of health literally. it was a pile of rubble-- trouble and and that is whether have been pledged our has reached 80

is more efficient to give the ngo but they will help the person who's dying right there but it really needs to go to rebuilding the public health system. >> one example that i find uplifting and i have not clear this with with the american red cross but they will forgive me they told me that i cannot tell it this is their home town. but take the american in red cross. as they say, i only were cried never take breaks i did not want contagion this week and but if i had, i

would see a pretty compelling outbreak movie. the. >> i did not watch it with matt damon. [laughter] somebody else was in the movie. so it is an outbreak as you can imagine and i was thinking had i been at the movie theater maybe i could see my pals at the red cross. and nine government organization raise a lot of money for any visible disaster but they will say i want to help. went out of every -- households have

contributed so the red cross is the ngo. to help doctors without borders and here is my chance to apologize to doctors without borders i confess sometimes they do need borders. [laughter] but it was a joke but we can move very quickly. thank-you red cross floor respond -- responding to the cholera patients and they go from 10 or 15% at zero. if you get to the treatment center they will not die of cholera but it does not replace the public water system, a public hospital

hospital, like the cbc as you can see i am told that i did not see. that is an example of the red cross we said to them we need to keep said general hospital going and you were there. and that will require to find a way to get salaries pay for workers. >> how does that happen a logistical eight? >> by convincing them to do it to say baby applied to other groups to a company then as an alternative development strategy. and that we accompany the public sector. and to tell me if i had done a good job but that is a model of resources from bed

generous to the unfortunate who don't. one that i will not mention by name it is not partners and health that raised $134 million for earthquake relief, and the ministry of health which was completely leveled by the earthquake and probably lost 20% as dead or injured, it is still is a temporary shelter and if you go back to that lot, there is not a stone standing there which is good because it shows they cleared out the rubble but the budget is not one-third of that. that is a modern world the stores should going on in haiti and all over the

world. and then tens of millions of dollars raised with the public sector budget not one-third of what they raise for the earthquake. first one book that i sent that i bet you did not read come i just compare the budget of the republic of haiti undergoing difficult times come a cynical manipulation of paid by the international community what is the budget? >> that was less than the city of cambridge. that distorts the work that we do in going back to that 800-pound gorilla that is of

which there is more per-capita than any of their country in the world. i am sorry there is one for every 1,000 patients. >> and there maybe more. we're not even counting the of the two one's. >> everything sounds good. we have seven minutes left and right now but patient is not even been addressed we have to go through the physical exam in a treatment and exam in seven minutes. >> weigh in on that you just use endoscopy. >> i know that this, it's everybody wants to know what happened to the of money? >> says people reminded me

it is not just the pledge but the answer is a very substantial majority of them. >> people need to know that and want to know what percentage goes to the public. >> i am self-conscious because catherine gilbert is here and will correct me but $5 billion or more were pledged of long-term pledges made as well. with 6.2 billion. >> then to pick these the part that is why we have a web site that is looking at these pledges. are they recycle old pledges? are they new? i would be pushing 30% which is not bad. >> day vanishingly small

amount but it is the iq relief. because it was destroyed. 28 out of 29 federal buildings in haiti were destroyed at the quake. los angeles, chicago and new york and that city, the nerve center was bubble. and then to even put it flat and. we'll understand why it was hard for those ngos that is a bilateral relation. we and a stand why it was hard but to be less than 1%

we could have done better and that gives you an idea. >> i will really win talking beforehand that we could go one hour on each topic but first of all,, what is it allergic to? >> heavy-handed meddling and any assault the real or perceived on its sovereignty. all of us read said newspapers just a day are reflected on 9/11 and i read "the new york times" and read of peace by a pakistani in the impact that has happened on his own country

and in the popular perception of the united states but in haiti, if this deeper. there has been the mayor can occupation third 1934 but we want to find out how to perceived it is a great metaphor but that is just one thing to be a perceived attack and it doesn't have to be real. to inform of the awareness of an analogy. >> host: i want to talk about the diagnosis, rwanda, how it is a role model to teach about the genocide in the role of the haitian diaspora than

the to decentralize pay that day shady and deforestation in the plight of women which is an amazing thing. i was there with katie couric april 2010 out woman who had been raped. we know that is a problem, but. and then i love the and where you imagine in the different scenarios of reconstructions if you were king of the jungle what it would look like but only two minutes. i thought the most delicious part of the book although yours was tasty but the most delicious part was the woman in talk about that and what the haitians themselves are saying. >> those of the people that you point* out who were not at the table and could not afford a ticket. >> that is how we will and it. >> if i am right about the

allergy to use this metaphor if i did not overuse them already, to write a book about the earthquake even though i was there, and it needed to have haitian voices and a friend of mine mine, as some of you will have seen a film that is about a murdered journalist and she is his widow 10 or 11 years ago. they are both radio journalist and pro democracy journalist and asked her if she would help on a project and other people got together to go out to nine o

or 10 departments. you have to do things like that to have the infrastructure of ann curry and a group -- inquiry a group of haitians coming to stand out and ask people who were market women or fishermen zero or displace people, and street vendors vendors, farmers, not like me but, you know, . what do you want for your country? the thing that was inspiring and delicious is the theme that came back is not we don't believe in the future of our country, none of that. of they're actually optimistic of the possibility to reform the

state and look for the people getting them back to school to rebuild the country in a way to make it easier for them to live in haiti. there was something inspiring by that theme on writing the chapter but i have not listened to the audio version but she does her own chapter. i want merrill street to do mine because i am merrill street of public health. [laughter] i heard a story there is a get together real street was in the same room everybody was around her then paul farmer walks in in seven a-barrel street is all alone. [laughter] it was that and why you. [laughter] >> it was within a certain community of people. >> dave did read a lot of it

but michele reeves her on. >> she is a great person. sewed to listen and read what the haitians have to say about this. >> my final question, what is the prognosis? >> and what is the allergy? anybody can say that but there is a lot of talent in haiti in a young country with the demographics week could not talk about the diaspora but i write about some of my students from harvard who are haitian and so committed to working in haiti. and it was day harvard growing up in canada and

said to me he said one is up? and i want to go to haiti. so for someone to be a surge in coming back as a young adults the woodwork in the operating room and spend the weekend with his family the was getting to know weekend. and then they were killed in the earthquake. he brought all of his cousins, there were eight of them because he sent me a picture of them in montreal with his parents can you imagine we got the kids out

with empty nest egg get eight more? [laughter] that's is the story of great diversity for that family we will take our cousins to make sure they grow up safely and this kid is doing a surgical residency. we don't have enough of their stories. not only enough haitian people in haiti to make a prognosis but the diaspora that we still have yet to draw on. >> patients helping haitians . >> we are out of time q&a. that was the conversation. so i guess we should have questions. >> i am here with some high

school student leaders and we're part of the episcopal schools partnership in haiti and about two 1/2 hours away we went last year for the first time and going again with about 400 families there in 25% of the young people were clearly malnourished hawks . >> he is a good friend of mine. >> we want to get community workers there as well as food aid and even if they thought we would be

more effective to get the health workers out there and the food aid what he has been able to do. can you give us advice? >> sure. it is great you are willing to shoulder the burden. >> and they have so many duties and that is a very difficult role. i have done it all my life. wright told you half of american households donated to the asian earthquake relief but there is the needs of their makes it hard to be in the middle because i want you to take my advice

has more advice to you than to him. he is already working 60 hours per week. my advice is if you get involved with food, but try to think about food sovereignty. and we are working on this. so only to procure global food. but to think about that. haiti is the most food insecure country in the hemisphere in drinking problem and unfortunately what happened going back to the history of food aid and

i will not say it is down but the move to haiti which then can increase the cycle of dependency because it undercuts the value of local food production. we have a school lunch program and probably still doing that and we're trying to move away and not use those food sources but to buy produce locally. we're not there yet but ideally that is where we're going. because then you support local farmers making sure the kids get a nutritious meal and it shows if they don't that means they perform less well. that is especially true when the best meal of the day out -- day comes during

school. help to take the burden off of his shoulders and don't impose anything but that could be a pilot project for the schools so that is one bits of advice. find a way to allow them to make a living. >> back to the world bank here in washington because a lot of the international financial solutions are so upset with sustainability they recommend that cod drug of what providers not be paid at all. how can you be a health care worker? if you are a volunteer? people like me should the volunteers but the women and men doing fact could not

afford the substantial intervening to be volunteers or to charge for their services. please give my best to the father. >> please give me a the time. other people come to washington with her lawyers i come with my theologian. meets with my a co-workers. the somebody tell me what time really? >> he has to fly. >> i can stay. i know people want to ask questions.

>> dr. farmer? my name is bob and i am with religion and ethics newsweekly whenever there is a disaster there is the outpouring of desire to help. over the years especially in haiti and three deal of religious groups and people of faith have tried to help. since the earthquake how do you assess the effectiveness usefulness, the problems that need to be learned for people who go with a strong religious motivation? >> that is a hard question. but i am glad that you did. i don't doubt for a man in the motivation and even if i

did i would not mention it. [laughter] i am not interested in that. i assume the best so it is not about that. one of the contributors to the book program book about this and i invited him because he has them much worse experience than i do he speaks good creole so you can read his take on this by have a lot of experience my work with a lot of good people including people of faith with a lot of good experience. you did not ask their motivation but how effective

has it been? what's not give ourselves more they and the electors the grade. we shouldn't. because you look at the goodwill is the most insecure country in that have -- hemisphere before the earthquake half of all school-age children not in school. so we cannot pat ourselves on the back that it goes back. [laughter] to the business to empower and everybody talks about this that you need a strong central organization and then maybe the ngos right now it is like having one patient with 100 doctors. you know, something will go wrong. so if they would facilitate

the work, we don't need five buildings within 100 yards of each other. why don't we spread them out? and it needs to go out. >> let me say another thing if this book is aimed as a loyal critique, and the inside critique of the ngo and the un. it is not a savage critique but how do we do better? >> the 80 lb. drilling it is if organize correctly the ngos could be much more effective. they are doing amazing stuff. imagine what they could do if they were coordinated?

>> but in general to the many church related and all related related groups, what is your message? >> although your mission is different from the public education and health all the talking about agriculture and food security, although it is different it could be complementary and let me put it with more stability. don't forget to i am pointing at him because he was there. but cholera us spread like wildfire after we have been working 25 years imagine how that felt. is say waterborne disease

then 25 years and it is right along the river system. we should feel we did not do everything right to or rebuild the infrastructure to save lives but not only that but also prevent the cost. it is not necessarily a their mission but to help their neighbors in behalf to think hard about how we work together. the mcclinton foundation and i assume it is a general interest as well the clinton foundation put together the list of the ngos for the ministry of health. that is the first time these are large ears like doctors without borders, etc. but

the first time that this had been done and using this technology platform that everybody should be using. it is good to do that with church groups as well. >> also with the theme of the book is try to think correctly even if it is painful. a and it is. with the best intentions i saw a magical thinking when i saw the cholera epidemic and it would be contained and i went on air to say it is magical thinking is in no possibility of widespread because you have the incubation period up to five days and then get in the

darfur pro but there is a need to think correctly even if it is not what you want to hear. one more question. >> i am pursuing master's from the american university in reading pathologies of power when the earthquake have been the. >> somebody read it. [laughter] >> but could you comment on how the earthquake influenced your view about the u.s. ambivalence towards haiti and whether or not you think that has changed or moving in the right direction or have work to do? >> my views of the history are not subject to revision like the 18th century wikileaks -- wikileaks. [laughter]

but looking backwards iowa the new there were good people in government but proclaim older and i hope wiser. line new there were good and generous people. of big a large concern but i knew that. what i have to convince trying to ask publicly, do we need to have a mean spirited for policy toward haiti? >> of course, we don't. we're not stuck in the same pattern necessarily. people of goodwill, the difference when there were two independent countries in the hemisphere, the

difference is their role in the two, no one has only become the most powerful and one is trampled upon. to have those origins but also glorious origins. so that historical trajectory has pulled these people apart when they should have been allied. so my answer to that question which somebody said it being concise is not your strong suit. [laughter] we don't have to be stock. we can change. people in the u.s. government who are committed to changing to making it better and based on the knowledge of the allergy, i have a perfect way to end the. >> pisses.

>> you are fantasizing about the possibilities. everything is perfect in the years and. >> unfortunately, i hate having to say this but a good one cannot really have been. for that you need to have full inclusion of all of the haitian adults. that means in the democratic process voting, all of the group's need to be engaged. that hasn't happened but that does not mean we could not help for a good performance affirms the ngos, church groups, haitian government of international players.

and this is something that people should be committed to. to help the haitian government, is still not in place and to need a prime minister so let's hope i want haiti to have a government just like my own. let's hope that good people are in it. what will they look like? a major series of public works programs for reforestation that is linked to infrastructure and one tiny example, how can you reinforce 80 without the alternative fuel source? >> great. they grow the trees and then they cut it down for firewood. you cannot imagine what it looks for on the right with the dominican republic is all zero green. >> one last optimistic

point*, it is pretty important to have medical care not that we are biased. the hospital described in the book, which is central haiti. bill to rigorous earthquake standards. it will be done on the second anniversary. and my experience is you can get stuff done. just this past month there was a new residency training program just opened in the city during the cholera epidemic which is still going on. we checked on the progress of a hospital in the foundation reopened the medical school with faculty. there are 1500 cuban health professionals there they are

the unsung heroes. they have helped us a lot with the cholera in teaching. a lot is happening in health care and medicine but people need to know the positive stories. but let's be committed to helping the haitian people regardless of our own personal leanings. that is not the point*. can we help them move forward? i think we can. i am gearing up for optimism like those interviewed by michelle. if they can have optimism in believe in their future, then we are not subject to these kind of pressures of how to feed their kids, if they can have optimism, we can too. >> thank you for having me here.

[applause] >> the tale of nail biting jobless starting in 1955 denver colorado on the golf course. joint eisenhower had not enjoyed a vacation so much in years. believe it or not the president of the united states had cut a huge breakfast that morning for his fishing buddies. the golf was the priority for the day. at a briefing at his airforce base office he headed to the country club and then the secretary remember she had never seen him look or act better. eisenhower's golf game was interrupted four times that

day for phone calls from the secretary of state bill less. this was before cellphones so he had to return to the clubhouse for each call but actually only one got through provenge was important the confirmed he knew that would make a new dorga to the cold war and he agreed the president should send a message to the soviet premier bennett he wanted to think about it overnight and said he would call him the following morning. that phone call was never made. i went back to golf but the game deteriorated then experience growing discomfort. he declined his drink and little appetite for dinner and retired early.

. . a.m. she called the doctors physician who rushed to the white house. snyder initially put out the word this was a digestive upsets when he knew it was a massive heart attack. he waited until midafternoon before transporting the president to the hospital and even then had he walked to his car instead of calling an ambulance, if you want more detail on the mismanagement of the situation you have to read the book. eisenhower was in the hospital six weeks. in those-- the gold standard for heart attack patients was total bed rest.

his doctors would not permit him to read a newspaper, watch a movie, listen to a football game on the radio let alone do much presidential business. he did not take one step across his room for one month. this incredibly active man felt like a caged animal. so the soviet union attempted to change the balance of power and eisenhower was out of commission and secretary of state was on his own unable to consoled says he normally did. and we will bury the of but this fact vellis ran american foreign policy and everyone close to both men knew that i was in charge. dwight eisenhower was out of the what -- white house four 3-1/2 months. excepting two nights on his

way to recuperating at gettysburg. number two, the heart patient was so prospected in his activities whether he should run for a second term in 1956. i am satisfied he always was intending to run a added age of roosevelt you have to be a second term to be a great president but the heart attack raised the question of whether physically he could run. . .