constitution reported he was going back to mend this after this final march that had been handed to go redeem himself and do a second march. and without march is likely going to be in when he was back to memphis and he would be there. so it gave him some time to think and plan and coming in now coming to now coming to get me think, how do i intersect with the guy? ..

>> they would embrace him, he would hook up with these guys, but the, you know, whatever horrible racists they might have been over there, they were actually professionals. they weren't just going to embrace this stranger from america. and he never was able to connect those dots very well. things like that. but thanks for your question. yeah. i think we have time for at least one, one more question. um, anybody else? yes, sir, right here. >> in his last days, he admitted to martin luther king's sons that he did not assassinate king. what are your views about that? >> yeah. >> statement?

>> well, shortly before he died, dexter king had come to meet with him, and he asked him, did you kill my dad, and he said, no, i didn't. that's the story that got, that sort of made the wires, but right after that he said, but, you see, it's complicated. these things are very complicated. and that's the asterisk that wasn't reported, and that is classic ray. everything had a sort of asterisk. if he didn't kill king, why did he say that? if he did kill king, why did he plea bargain and said he did and then later recant three days later and say, well, this other guy actually did it. that's just classic ray. nothing was clear. that's the squid ink that i'm talking about. i think that the king family, very understandably, wanted a trial, wanted a real trial because there was never a trial. there was a plea bargain.

and so the evidence was presented, but not in an open, adversarial way that you would hope from a criminal proceeding. so understandably, that's what they wanted. and i think that, um, some members of the king family were convinced that ray was innocent, or at least that he was part of a larger conspiracy. in the way i'm convinced that he was part of a cruder conspiracy, but a conspiracy of more than one person for sure. um, but, you know, whether the king family found comfort in that or close crur in that -- closure in that, it's really hard for me to know. but to me, it was kind of a testament to ray's cunning, a kind of final testament to his cunning that he was able to convince people that this guy, raul, existed, when we've never seen a photograph, an address, we don't know what he looked like, you know, there's never been a witness who's ever seen this guy, raul, in the same room with ray. and that was, you know, the fact

that that was enough for members of the inner circle and for certain members of the king family, um, shows, i think, the element of conspiracy that we all kind of, it's human nature to believe in conspiracy, to look for these larger patterns in a huge crime like this. and so i don't know what to make of anytime the end. it's disturbing to me because no matter where you stand on the conspiracy question, there's absolutely no question that ray was there. to the day he died, he said he bought the weapon, he bought the scope, he was there at that crime scene. you're kind of stuck with james earl ray being there, yet a member of the king family shook his hand and said, i believe you, you had nothing to do with this. it's disturbing to me, but, you know, why they did that, um, that's their, that's their question, that's their business, and i think it has a lot to do with wanting that airing of a new trial that would have come if it had been possible. but by that point ray was dying

of liver disease, there was a movement to try to get him a new liver. he was way down on the list because, you know, he was a convicted criminal. and i think that, you know, maybe members of the king family thought if they could just get him a liver transplant, it would be possible to get him back on trial and really, finally, hear what we had to say. because i think in the end that's the frustration -- the most frustrating about this guy, ray, was he went to his grave as the king family knows and everyone knows, i think, with a lot of secrets. secrets that, you know, we may never have all the answers to. thanks for your question, and thank you so much for listening tonight. [applause] >> we'd like to hear from you. tweet us your feedback, twitter.com/booktv. and now paul farmer talks about the devastation caused by

the earthquake in haiti that occurred about a year ago on january 12, 2010. dr. farmer recounts the involvement of the united states and other countries in haiti and argues that they've contributed to making the impact of the earthquake worse than it may have been. this is about an hour. [applause] >> i guess i'll just start it up. first of all, thank you so much for inviting me, and i'm honored to come down here and leave my patients up in new york wondering where i am for the day. >> sure they're going to be upset about missing their endoscopies. [laughter] >> it's having done the prep without the procedure, what they're going to be really irritated about. [laughter] it's all right. no, they all know. they all knew. i'm also, i'm keenly aware that we have about 0 minutes -- 30 minutes, and that you're here to listen to paul, not to me. so i'm going to be a facilitator or paul talking. and on a personal note, i want

to thank you for one thing which was for entitling chapter two "practice and policy." because what that taught me was that if you highlight a word in the kindle, the dictionary pops up. and -- [laughter] and you can learn what the world praxsis means. >> my pleasure, jon. that's why i wrote the book. [laughter] >> your position, you love to use physician metaphors, and you talk about the history of the -- let's start off, so that's going to be the arc of today's 30 minutes. i think we'll consider haiti like a patient. let's talk, start with the past medical history, okay? is you start with a country that in 1804 had its successful revolution and rewarded in 1825 with france imposing a $21 billion reparations bill on them which took them over 100 years to repay with interest.

and it goes from there. so you say the collapse has been ecological, economic and political. do you want to expand on that in about 20 seconds? [laughter] >> that's his revenge for me canceling his endoscopies. [laughter] you know, first of all, perry, thank you for having us here. and i said on the way in here i can't imagine that there would be anyone here on a monday morning, so thank you all for making an effort to be here. it's not a convenient time for, i'm sure, for any of you. and thank you, jon, for doing this. in, by way of thanks and as a segway into the question, um, i also want to express at the outset my deep gratitude to the haitian people. and that sounds like a grandstanding move, but let me be specific. and those of you here today who

are haitian, um, will know exactly what i'm talking about. the revolution that jon lapook just mentioned -- i'm going to say jon even though it's dr. lapook -- that jon just mentioned was the only time that in recorded history that a slave revolt has led to the founding of a nation. and when we heard about the french revolution in 1789 and its promises of liberty, equality and fraternity, how could that be true if there were slaves, right? how could that be a real human rights revolution? and the answer is, of course, the haitians said it couldn't be true. it's not -- it wasn't, it wasn't real. no of course to neb -- no offense to anybody who is here from france, especially because i really love french food. [laughter] and, but it could not be meaningful without the haitian revolution. and the haitians will tell you,

and again, this across all spectrums of haitian society. and i, most of my experience has been in the rural regions, places you've now visited as a physician, and my knowledge of the haitian urban elites is actually quite limited. it's mostly through books, reading books that they've written. but across that spectrum haitians will tell you that no small amount of their current problems are related to the haitian revolution and the price they paid for actually pushing forward these ideas. now, i said, well, how can you say that in a more concise way, and that's why i took this medical metaphor, and for those of you who are not in medicine, we talk about the history of the present illness. that's what you're -- someone comes in with a complaint, different sort of complaints usually for jon's patients than mine. >> i'm an internist. >> we're both internists, so

they say, well, i've been coughing for, you know, in my case usually people are talking about coughing for weeks and losing weight, whatever it might be. and then you gather the history of the present illness. you find out when this started, and one of the things that we like to do, and i put this in the book maybe pushing a little bit, in my work, infectious disease work, we always go chronologically. and the patient may or may not have an idea about when a certain illness started. they always do have an idea, i shouldn't say they may or may not have an idea, but going back to that time when that patient was well, haiti was never well because it was a slave colony prior to the revolution. and then it was this pariah nation that was being punished by the great powers of the time -- >> and frightening to the united states, right? >> and very frightening to the united states. i always quote in books about history that on the senate floor the senator from one of our

states, i won't mention which but it's a little bit south of north carolina -- [laughter] saying, you know, the safety of our country forbids that we even talk about haiti. this is, you know, on the senate floor. >> and, obviously, there were still slaves in -- >> exactly. and the first envoy we sent was when lincoln sent the first ambassador. so the united states and haiti have this very complicated history that goes back to, actually, before the revolution when we sided with the slave owners as the only other independent nation in the hemisphere. the only independent nation in the hemisphere. so we have this history, i think also as two countries. and as an american writing about haiti, that's always on my mind, too. >> so that sets the stage. people say, haiti, it's a lost cause, i mean, they just can't get their act together, look at all the aid that's come in, but really without knowing the history, you can't even start to talk about it. and i think that's one part of the book that's terrific.

he's done it in other books, but just sort of set the stage to even think about haiti because just coming into it raw, i think it's very hard for people to just get it, okay? um, let's talk about the 800-pound gorilla in the room which is ngos, okay? and, um, i've been to haiti several times now, and i've seen the amazing work that ngos including partners in health -- i was there the day that the cholera outbreak started in st. mark, and i interviewed a doctor, he was astounding as were the colleagues from doctors without borders and other organizations. and i went up north, and i saw the difference between the care, the health care that people got in the mission, in ngo, and then just going about several miles down the road to the public hospital which was astounding. i've never seen anything like that in my life. you walk in, there were literally no doctors there when

i walked in. there were three guys who didn't have their md yet who were sitting there, and they were in training, they were going to call other doctors. the patients were on the right and the left, they had to bring their own sheets, and their family brought the food, and there was no electricity, i mean, you cannot imagine it. so you have this big difference between the public and the private. um, but there have been, the critics would say that there is this codependency between the ngos and the public government. and you talk about this friction between taking care of the patient who's right in front of you, that's the doctor. that's dr. farmer. you're always dr. farmer, but the person -- you can't even resist it, and you're going to reach out and help them and taking care of the whole system, the anthropologists, the public health experts. you've talked about that as the chief tension in your life. so talk about that and about this whole controversy. >> well, you know, the tension and the controversy i'll try to

give a, you know -- i'll attack both of those. you know, and i'm here with some friends who perry met who just came in from new york who, we have been working on some policy projects together. now, that sounds -- boy, that sounds f it were 9:00 at night, everybody would just, you know, pitch forward in their seats and start snoozing. [laughter] and i don't find policy discussions that interesting. but they are crucial to getting this right. and when we talk about build back better, we're not talking just about the destroyed infrastructure, we're talking about building aid back better. for example, you were in where the cholera outbreak started and, again, there's an entire history to where cholera came from and where it's going, and i'm very interested in that, too, and i hope we have a chance to discuss it. but that area was actually not touched by the earthquake. >> right. >> so what you saw when you went

in, there's no electricity, no doctors, terribly underfunded public sector and then some pretty good ngo, what you saw was part of what needs to be built back better. and so the tension between policy, okay, you know what? i shouldn't have used the word prax six. it was kind of smarty pants -- >> it was a cool word. let it go. [laughter] >> all right, i'm past it. for my doctor friends here today, they know i would never say that -- >> that was the longest take that i've ever seen when the -- didn't i make that comment like 20 minutes ago? [laughter] >> unlike gastroespecialliologists, we have long memories. [laughter] >> so it's come to this, paul. >> anyway -- [laughter] so the practice or praxsis -- >> sounds like a neurological term to me, praxia.

>> yeah. but that tension between taking care of someone right this front of you and thinking about the right policy should be something we should all be confronting. i like seeing patients. but if i were sitting there, cholera's a great example, you know? you can have as many patients as you want because the epidemic is out of control. so you have 425,000 patients already -- >> by the way, that translates if we were in the united states to 12 million people. 12 million people for the united states, 6,000 dead is 180,000 dead in the united states just to put it -- >> and we're not even sure if there's, it could be an undercount, of course, as you all know because reporting capacity is so weak. so this tension is in our lives, and it should be in our lives. again, regardless of our own druthers. i mean, in your life, for example, you see patients, but you're also every time you go on the air or go to haiti or go to

somalia, you're also taking on the big picture. i think that it's the same sort of thing when i write a book. of course, you know, you're seen by millions of viewers, and four people read my book. [laughter] but i'm not bitter about it. >> don't -- >> i think, i know jamie from public affairs, jamie's here, so she's fighting to -- >> you know, paul -- >> you didn't let me finish the second part of the question. >> with you remember it? >> of course i remember it. >> go. go for the second part. >> the 800-pound gorilla in the room and the codependency, just to jog your memory, jon. [laughter] afterwards, speaking of neurologist, we have a ct set up for you. >> i think a functional mri would be the way to go. >> anyway, what i wanted to bring in the book, and here's my chance, also, to say thank you to abby gardner and jenny block who, um, contributed to the book and help today bring it into

existence. because, you know, it takes a village, as you said. >> and by the way, when you read this book, read the end. the parts at the end that jenny wrote, didi, his wife wrote, and especially the witnesses to what was going on, you know, from right down there in rural haiti and other parts. it's -- don't just stop with his last word but really do read the part at the end. >> well, the 800-pound gorilla is the idea behind this book is i'm from an ngo. i'm a volunteer, but i am an ngo creature. you know, my real job is being a medical school professor, but i've always, you know, believed in the work of partners in health, and there are other great ngos work anything haiti. at the same time, what's our long-term strategy to build aid back better? now, our strategy with partners in health has been to hire local people, do local procurement whenever possible and work to rebuild the public sector. but, you know, the public health

institutions, but it wasn't always that way. it was always a community-based organization with haitian employees, but it's really been the last ten years or so where we said, wait, what are we doing wrong? everybody says thank you for building a hospital in the middle of a squatter settlement or, you know, thank you for helping get our kids back to school. we get a lot of thanks from the people we serve. but we said, well, what are we doing wrong? we decided what we're doing wrong is to allow the continued degradation and collapse of the public sector which is, after all, haitian. our employees are haitian too, but this is the institutions of that country, the public institutions, allow them to collapse even as we grow. that's not the way to build haiti back better. and the earthquake was a chance, we hoped, not only to improve our own practice, but also to improve the dialogue with our other ngo partners. >> how does that translate to real life? i stood in the rubble of the ministry of health, literally in one of these shot that is we did

for one of our pieces, and it was the rubble. i was literally on a pile of rubble, and i thought rebuilding this is the easy part. but rebuilding, not even rebuilding, creating for the very first time a public health system, that's the tough thing. and you have all these, you know, whether it's ten billion or six billion, however many billions have been pledged and however much has actually reached haiti, which is another question, um, it's more efficient for tomorrow to give that money to the ngo. they're going to help that person who's dying right there. but really -- and you've written -- it needs to go to the, to rebuilding the public health system, right? >> it does. and i'll give you an example that i find uplifting, and i haven't cleared this with the -- i'll just say it, the american red cross. but they'll forgive me because i hope -- and it's a positive story, you know? i'm, they haven't told me i can't tell it.

so -- >> you tease now? >> no. they're probably here. this is their hometown. [laughter] anyway, so take the american red cross or the international federation of the red crosses. when there is a disaster, um, people will give to the red cross. it has, as they say in business parlance, it has a good brand. i watched, of course, i only work, i never take breaks. i did not watch "contagion" this weekend with matt damon -- [laughter] but if i had watched it, i would have seen -- by the way, pretty good, pretty compelling outbreak movie. >> when he says he watched it with matt damon, he literally might have watched it with matt damon. [laughter] somebody else was in the movie. >> you got to admit, anything with him in it is good. anyway, so there's the red -- it's about an outbreak, as you might imagine, and there's the red cross. and i was thinking, oh, i'm going to, well, had i been at the movie theater, i would have thought if i'm going to washington tomorrow, maybe i'll

get to see my pals at the red cross. ngo, right? it's a nongovernmental organization. it raised a lot of money in response to the earthquake. or katrina, right? or any visible, um, you know, disaster whether we call them natural or unnatural, it matters, but they're going to have people saying i want to help. more than half of all american households donated to haiti earthquake relief. that says something good about everyone in this room and about this country. so the red cross is an ngo, and can they're used to working with ngos. they helped partners in health, doctors without borders, and here's my chance to apologize to anyone who's from doctors without borders who i called in the book, i confess, doctors who sometimes need borders. [laughter] but having worked with them, it was kind of just a joke, okay? but we can move like this -- >> pleasant ri. >> we can move very quickly, doctors without borders can move very, very quickly, and so can partners in health.

and thank you, red cross, for supporting us to respond to the suffering of cholera patients and reduce what's called case fatality rate, the number of patients with the disease from 10 or 15% to almost 0. that's already done. if someone gets into one of these cholera treatment units or centers, they're not going to die of cholera. but that does not replace a public water system, it does not replace a public hospital, it does not replace a public reporting system like the cdc which does a lot more than reporting. as you can see, i'm told about this movie i didn't see. but that's an example. so the red cross we said to them, you know, help us keep the general hospital going, and you were there in the general hospital. haiti's largest hospital. and that's going to require finding a way to get salaries paid for workers. >> but how does that logistically actually happen? >> well, it logistically actually happens by convincing

them to do it and then saying, okay, maybe you want other groups to accompany you, that's the word we're trumpeting a lot in this book, accompaniment, as an alternative development strategy. so the red cross accompanies us financially, and we accompany the general hospital or the public sector. and that's the idea behind it, and there are other -- my colleagues who are here from new york could tell you if i've done a good job talking about this, but that's a model of moving resources from the generous who have resources to the unfortunate who don't. and let me just give one last number: there is a health ngo which i won't mention by name. it's not partners in health, but partners in health is way up there too, that it raised $134 million for earthquake relief, an international ngo, and the ministry of health which as you noted was completely leveled by the earthquake and probably lost 20% of its or to, you know, to dead or injured, the ministry of

health which was, is still in a temporary shelter, um, and now if you go back to that lot which i hope you will, there's not a stone standing there which is good because that means they cleared out the rubble. but they, their budget is not a third of that. so that's the modern world distortion that we have going on this haiti. and all over the world. you've got one country, this one for example, where, you know, there would be tens of millions or hundreds of millions of dollars raised out of generosity going into a country where the public sector budget is help for the whole country is not a third of what one health ngo raises for the earthquake. a few years ago in a book i sent you but i bet you didn't read -- [laughter] i just compared the budget of the republic of haiti which was undergoing difficult times because, again, cynical manipulation of aid by the

international community which is a term that gets picked apart in this book, this is in 2003, i said what's the budget of the republic of haiti? well, the budget of the republic of haiti was less than the budget of the city of cambridge with 100,000 people in it. so those kind of, you know, those distort the work we do. and the 800-pound gorilla, he said, going back to the question and wrapping it up neatly, the 800-pound gorilla is ngos of which there are more per capita -- >> so there's one ngo for every thousand haitians. >> so think about that. >> ten million people, right? >> and there may be more because we're not counting all the little bitty ones, as president clinton would say, the little bitty ones. [laughter] everything he says sounds good, i find. [laughter] >> i have -- we have, like, seven minutes left, and i want to get -- right now the patient's not even undressed yet, and we have to take him

through the physical exam and then get a diagnosis and a treatment and a prognosis, all that in seven minutes. i know this is -- >> we know you don't examine the patients, you just use endoscopy. [laughter] >> i know that this is not your, you may know -- everybody here wants to know what's happened to the money. >> yeah. well, you know, on the way in here one of my colleagues reminded me it's not just about the pledges, it's obviously about do the pledges get delivered, and the answer is a very substantial majority of them do not. >> i think people need to know, i mean, they want to know the numbers, and then they want to know what percentage goes to the public and what goes to the -- >> well, and i'm self-conscious because katherine gilbert is here, and she should correct me, but $5 billion or more were pledged and then there's some long-term pledges that were made as well. >> but for 2010-2011 it was

about 6.2 billion in your book, and then on the next page -- >> that's right. and tough pick these apart. that's why we have a web site that really is just devoted to looking, what are these prejudices? are they recycled, old pledges? >> what percentage has actually been given? >> i think we're pushing 30% -- >> okay. >> which is not bad, but that means the majority has not delivered. >> how much went to the government? >> a vanishingly small amount. maybe -- i'll tell you the number i do know which is the acute relief. you know, you've already given us a picture of why it's difficult to put acute relief money into the public sector, because it was destroyed. i mean, 28 of 29 federal buildings in haiti were destroy inside the quake. imagine washington, which, you know, this is one city. we have los angeles and chicago, new york, it's all one city in haiti. and that city, the nerve center was just leveled, as you saw. so the public infrastructure,

the government infrastructure from palace to ministry, you know, to the our equivalent of even a building like this flattened. so it was hard to put money in. i get that. and this is where humility -- we understand why it was hard for the big ngos and the so-called bilateral means, you know, like cuba, haiti, united states, haiti, those are bilateral relationships and then the multilaterals like the world bank. we understand it was hard. but to have it be less than 1% of the relief money, i think -- >> that gives you some idea. i have to -- i'm going reel you in a little bit if it's okay because i know we talked beforehand that we could go on an hour on each one of these topics, but i do want to just very quickly, first of all, i have to ask you the cute patient, what is -- since we're doing the patient metaphor, what is haiti allergic to? >> haiti's allergic to heavy-handed meddling and any assault on its, real or perceived, on its sovereignty. that's what haiti's allergic to.

and, you know, all of us, i'm sure all of us read the newspapers yesterday or reflected on 9/11, and i read "the new york times" and just read a piece by a pakistani who i'd had the privilege of meeting, actually, in this city, in this building, i think. and he writes about the impact of some of the things that have happened since then on his own country and the popular perception of the united states. but in haiti it's deeper. and it's much less fraught. there's no, there's never been, there's been the american occupation of haiti which is a dark chapter for them, 1915-1934. but if we want to find out how to proceed, we have to be aware of that allergy. and that's a great metaphor. i hadn't thought about it. if i had to choose one thing, it would be perceived attack on the sovereignty. and it doesn't have to be, you know, real.

that's -- and it's very hard to, you know, to inform all one's work with that awareness of an allergy. >> here's what -- we have three minutes so what i wanted to talk about the diagnosis, i wanted to talk about rwanda, how it's a role model and what it can teach us following the 1994 genocide, and i want to talk about the role of the haitian diaspora. about the need to decentralize haiti, i wanted to talk about deforestation, i wanted to talk about the plight of women in haiti which is an amazing thing. i was there when katie couric interviewed -- this was back in april of 2010 -- a woman who had been raped, and we know in the big camps and all around there there is that problem, but since there's only two minutes left -- and then i loved the end where you're imagining all of the different scenarios for reconstruction. if you were king of the young l, what it would look like. but since we only have two minutes, i thought the most delicious part of the book -- although your parts were very

tasty -- but for me the most delicious part was the woman who took the histories from the people, from the haitians -- >> michelle. >> and i want you to talk about that and what the haitians themselves are saying. because those are the people, as you point out so beautifully, who weren't at the table. they couldn't afford a ticket to fly up to the u.n. talk about that, and then we'll toss it to some questions. >> well, again, if i'm right about the allergy, and i'm going to use this metaphor as if i didn't overuse medical metaphors already. um, you know, to write a book about the earthquake even though i was there and working as a physician, it needed to have haitian voices. and a friend of mine is michelle. and some of you will have seen the film called "the agronomist" which is about a martyred journalist, and that's her. she's his widow, jean dominique,

who was killed in haiti. he was murdered maybe 10 or 11 years ago. anyway, she after -- they're both radio journalists, pro-democracy radio journalists. i asked her if she would help on a project. not this book, but, um, and other people got together, we decided to go out to all, what is it, jenny, nine or ten departments, the geographic -- i'm looking at jenny block because she bought the tape recorders. you've got to do things like that, too, by the way, you have to have the infrastructure of inquiry. and a group of haitians and a couple non-haitians but who spoke fluent creole just fanned out, and they asked people who were market women or fishermen or displaced people or people in the camps, street vendors, school kids, farmers, um, not

farmers like me, but farmers -- you know. what do you want for your country? and the thing that was inspiring and as you said delicious was that they didn't say -- the theme that came back was not we don't believe in the future of our country, we don't -- none of that. they were actually optimistic about the possibility of of reforming the state, making it work for the people, getting their kids back to school and rebuilding the country in a way that would make it easier for them to live in haiti. and there was something really inspiring about that theme. and she does a great job, michelle does a great job on the, on writing the chapter too. i haven't listened to the audio version of the book, but she does her own chapter. i said, no, i want meryl streep to do mine because i'm the meryl streep of public health. [laughter] >> i heard a story, by the way, i'm going to share which was in new york -- there was a get together, and meryl streep was

in the same room with -- and everybody was around meryl streep, and then paul farmer walks in, and suddenly meryl streep is all alone in the corner. [laughter] >> it was at nyu, you know, not the oscars. >> so within a certain community of people for whom -- >> meryl streep did the, did read a lot of it, but michelle reads her own. she has a beautiful voice too. >> and we love meryl streep. >> she's a great person. um, just so if you get a chance, do listen and read what the haitians have to say about this, and michelle, thank you for bringing that up. >> my final question, doc, what's the prognosis? >> i think the prognosis if you go back to that chapter, the prognosis is good. someone said, you said what's the allergy, what's the great resource of haiti? it's people. you know, anybody can say that, but there is a lot of talent in haiti and a lot of young talent in haiti. there are lots of -- it's a young country in terms of the

demographics. and we didn't get a chance to talk about the diaspora. but in the book i write about some of my students from harvard who are haitian and who are, you know, so committed to working in haiti. and one of them, i don't want to -- you can read about him, but one of them, you know, is a harvard, he was a harvard medical school student, grew up in canada, you know, went to school in, you know, in the united states. was, as i said, at harvard medical school, and he said to me i remember the first week of school, he said -- of course, all the americans said, hey, terry, what's up. so he said i want to go back to -- i want to go to haiti. and he'd never been to haiti, it turns out. and i said what kind of medicine do you want to do? he said surgery. we definitely have a place for someone who wants to be a surgeon. so his first time in haiti was coming back as a young adult working in the operating room, and he would spend -- he'd work in the operating room up in central haiti and spend the

weekends with his family who he was getting to know again, his aunts and uncles and many, many cousins. and his aunt and uncle were killed in the earthquake. and so he brought all of his cousins, and there were eight of them. and i know that because he sent me an e-mail, a picture of hem in montreal -- of them in montreal with his patients. can you imagine thinking, yeah, we got our kids out, we're going to enjoy empty nest syndrome, then they get eight more. [laughter] of course, that's a story of great adversity for that family, but it's also a story of really how the haitian people can be. yes, we'll take our cousins in. we'll make sure they grow up safely. and this young man, i was going to say this kid s indeed now doing a surgery call residency. and i meet people like that a lot, and we don't have enough of their stories out there. so that's just an example of not only the haitian people in haiti, you know, making the prognosis good, but also there's a diaspora that i think we still

have yet to draw on -- >> haitians helping haitians. >> yeah. that's a big theme in the book. >> okay. i think probably we're out of time for the q&a, and -- oh, was that the q&a? >> that was the conversation. >> that was the conversation, this is the q&a. so i guess we should have questions. and, please, i'm not hurt, ask paul. >> [inaudible] >> dr. pardon farmer, i'm here h some high school student leaders and colleagues, and we are part of the episcopal school's education partnership in haiti. and about about two and a half years from the carnage is a village, about 400 families

there, about 25% of the young people clearly were malnourished and, um, our question -- we go with joseph jean -- [inaudible] >> i was just going to say he's a good friend of mine. >> we want to get community health workers there as well as food aid. we're going to build a modest school. but even joseph thought that we would be more effective in figuring out a way to get the health workers in there and the food aid than he has been able to do. and be so can you give us some advice on how to do that? >> um, i sure can. and, you know, it's great that the students who are with you and you, their teacher, are willing to shoulder some of this burden, you know? the father, after all, you know, he has so many duties as do a lot of people who serve, as he does, as a living link between in this case the united states and haiti.

and that's a very difficult role. i've done it all my life, is to be -- you end up being a choke point as well, right? because there's so much, i told you half of american households donated to haitian earthquake relief. and on the other end there's great need. so it's hard to be in the middle because you don't want to -- and my, i want you to take my advice as more advice to you than to him. right? because i, he's already working 60 hours a week or however many. and my advice to you is if you're going to get involved in food aid, try and think about food, security and food sovereignty. and this is my colleagues from new york, i make them sound like, you know, people with briefcases and my colleagues from new york. [laughter] they're actually all ladies in smart suits. but we're working on this accompaniment effort because we're not trying to say you need to do your food programs better and only procure local food, right?

what we're saying is you need to think about local food procurement in a very hummen and congenial -- humble and congenial tone, and this is how we've done it. haiti is the most food insecure country in the hemisphere. 25%, doesn't surprise me. um, and, unfortunately, what's happened with food aid if you go back to the history of food aid in haiti, it's largely surplus grain from the united states or canada or elsewhere that is -- i'm not going the say dumped, but that is being moved to haiti which can then increase this cycle of dependency because it undercuts the value of local food production, right? and we did this for years. you know, you have a school lunch program, you know, we still -- probably still doing it. we're trying to move away from that and not use those food sources, but buy produce locally. and we're not there yet. but ideally, that's where we're

going because then you support local farmers, you make sure kids get a nutritious meal which, of course, everybody, every study shows that for kids not to get a meal in school means they perform less well. and that's as true in the united states as it is in haiti. but it's especially true when the best meal of the day maybe is coming during school. so that's one thing. help take that burden off his shoulders and don't impose anything on him, but try to have, um, that be maybe a pilot project for the schools. um, so that's one bit of advice. for the health workers, very specific advice, find a way to allow them to make a living being health workers. i, and we've worked, actually, back to the world bank, we've worked with the world bank here in washington because a lot of international financial institutions are so obsessed with what they call sustainability that they recommend that that cadre of health care providers not be paid at all.

how can you be a health care worker, i mean, it's got the w word in it, work, as my daughter would say. [laughter] how can you be a health care worker if you're a volunteer? you know, we should -- the people like me should be volunteers or people like those being paid by the world bank should be volunteers. but the workers, the women and men who are doing that work cannot afford to be substantial, you know, interveners in their home villages if they can't, you know f they have to be -- if they have to be volunteers or charge people for their services. so those are two very specific suggestions for you and your students and, please, give my best to the father. >> is there ool -- we're headed towards, i know it's going a little long, because it's, what, three to ten? >> my colleague, jenny block, who happens to be a theologian, by the way. other people come to washington with their lawyers, i come with my personal theologian.

>> byot. >> she just said we'll help, so meet with my co-workers when you're done -- >> somebody tell me since i'm supposedly moderating what time we really -- >> [inaudible] >> yeah. >> yeah, yeah, yeah. i don't want to -- >> he's got to fly to -- >> no, that's all right, i can stay until -- >> [inaudible] >> yeah, yeah. so that's, i know people want to ask questions. here's your chance. >> dr. farmer? >> where are you? >> i'm here on your right. about halfway back. my name is bob abernathy, i'm with religion and ethics news weekly. whenever there's a disaster, there's just such an outpouring of desire to help. >> yeah. >> and over the years and especially in haiti a great many religious groups and people of faith have gone to haiti to try to help. i'm wondering since the earthquake how do you assess the effectiveness, the usefulness,

the problems that need to be learned for people who go there with a strong religious motivation to try to help the least of these? >> it's a hard question meaning it's a morally hard and personally hard question to ask. but it's, i'm glad you did. i think that i don't doubt for a minute the motivations -- and even if i did, i wouldn't mention it. [laughter] so i'm not interested in that. the motivations, i assume the best, right? so it's not about that. these are people, in my experience, people of goodwill. one of the contributors to the book wrote a very grim book about this called travesty in haiti, and i invited him to participate in the book because i think we need critical, you know, he has a much worse experience than i do, and his name's timothy schwartz, and he's a very learned person, speaks good creole, wrote -- has been working in haiti for years. so you can read his take on this. but i have a lot of experience

with people like the -- i didn't catch the schoolteacher's name, but i will later. um, i've worked with a lot of good people including people of faith, working with church-based groups. a lot of good experience. now, the question you didn't ask did i meet a lot of them or what were their motivations, it was how effective has it been. i would say let's not give ourselves more than a c grade. i'm inspired by the school kids, the high schoolers. [laughter] you know, we shouldn't, right? because you look at all the goodwill, and then you look at the -- i just told you haiti's the most food insecure country in the hemisphere, i could also tell you before the earthquake half of all school-aged children in haiti were not in school. and so we can't be patting ourselves on the back too much. we should pat a little bit lower. >> but it goes back to -- [laughter] it goes back to this business, though, right? of having to empower -- and everybody talks about this who's

thought about this for 14 seconds is you need a strong central organization, public health system, and then maybe these ngos -- right now the ngos, we'll go back to the patient metaphor. it's like having one patient with 100 doctors. you know something's going to get lost in the sauce there. >> yeah. >> but if you could somehow coordinate those and have them facilitating the work of a central organization that then was able to say, you know what? we don't need five buildings within 100 yards of each other. why don't we spread them out? the decentralization of haiti because it's all, a lot of it is in the capital, and it needs to go out to the rest of the country. >> well, mr. abernathy, let me just say another thing, is this book is aimed to, it's a loyal critique, right? an inside critique of the ngos, of the u.n., you know, of the, of the development machine. it's not a savage critique.

it's saying how can we do better as you just did. >> but the 80-pound gorilla in the room is the fact that, if organized correctly, these ngos could be much more effective. so they're doing amazing stuff. i saw it with my own two eyes. >> yeah. >> amazing stuff saving lives, but imagine what they could be doing if they were -- >> but in general, in general to the many church-related, synagogue-related, mosque-related, all religion-related groups, what would be your message? >> my message would be although your mission is maybe different, um frrk -- from the, say, public health and i'm talking about those areas largely although we've got to talk about agriculture and food security, even though your mission is different, it can be complimentary to the goals of the public health and public and education public water systems. let me put it even more w more humility on my side. don't forget that cholera, i'm

pointing at him because he was there, not because he's obsessed with stool -- >> or that i have cholera. [laughter] >> cholera spread like wildfire through the very part of haiti where we'd been working 25 years. imagine how that felt. it's a disease, it's a waterborne disease, and there we are for 25 years to ten years, and it spread right along that river system. so we should feel, gee, you know, we didn't do everything right, or, you know, what we did do right was build an infrastructure that could, again, save lives. that's not only about saving lives, it's about preventing cholera. church groups, mosque-related groups, synagogue-related groups, it's not necessarily their mission to go and promote water security. but if it's their mission to help their neighbors, which it always is, then we're going to have to think, you know, rethink and think hard about how we can, you know, work together. the clinton foundation -- and i'm assuming this is of general

interest as well in addition to of interest to mr. abernathy, the clinton foundation put together a list of health health-related ngos for the ministry of health, and, you know, it's really the first time that we've really registered as health-related ngos. now, these are larger health ngo like doctors without pord borders, partners in health, save the children, etc. but it was the first time that this had been done. and, again, using a platform, a technology platform that everybody should be using. and i think it's going to be good to do that with church group z --s as well. >> and one of the themes of this book is trying to think correctly even if it's painful. >> yeah. >> and it is, and it is painful sometimes. you have the best intentions. i saw real magical thinking when i was there when the cholera epidemic was happening. there were people, officials saying it is going to be contained, it's going to stay

right there, and i actually went on air and said this is magical thinking. there is no possibility that it's not going to spread because you have -- among every other reason, you have an incubation of up to five days, people can be perfectly fine, go to ore parts of the country and spread i. so there was no chance. so, you know, there is this need especially in tough times to just think correctly even if it's not what you want to really hear. >> well said. >> do -- we have time for one more question? >> dr. farmer, my name's emily bowerman, i'm right over here. i'm pursuing a master's in international development at american university, and i was reading pathologies of power when -- >> see, someone read it. [laughter] >> there were so many long words. >> my dad gave it to me for christmas. i was just wondering if you could comment on how the earthquake influenced the views that you express in that book particularly about the u.s. ambivalence towards haiti and

whether or not you think that has changed or it's move anything the right direction or if we still have work to do. >> um, you know, my views of the history of the united states and haiti are not really very subject to revision unless there's some new cache of troves i missed like the 18th century wikileaks. [laughter] so looking backwards, none of that -- i mean, i already knew that there were good people in government on both sides, i already knew, of course, you know, i'm older and, i hope, wiser. i already knew there were good people in both, on both governments. i knew there were good people, i knew there were generous people. partners in health has grown, as perry said, into a very large concern mostly because of the generous support of private individuals. so i knew all that. the question that i would ask and have been trying to ask publicly, i don't do that much of this, but i do it, i've done a lot of it this summer is do we need to have a mean-spirited foreign policy toward haiti?

and the answer is, of course we don't. so i don't think we're stuck in the same pattern necessarily. i think there are people of goodwill. the difference, of course, from 1804 when there were two independent countries in the hemisphere, the difference was there are only two. united states and haiti. now one of them has become probably the most powerful country in the world, and one of them has become very trampled upon and poor. it was, it had, it's had those origins as well in one sense, but also glorious origins, right? so that historical trajectory has really pulled these two peoples apart when they should have been, you know, allied as the haitians were with the independence movements in south america with bolivar. so my answer to that question as usual, someone said to me con decision is not your strong suit. we don't have to be stuck in that, you know?

and i think there are people in the u.s. government who are changing those policies and making them better and having them be based on, you know, again, knowledge of that allergy. >> i have a perfect way to end this. it's a follow-on to that question where you were fantasizing about there were some bad scenario possibilities, give me the good one. everything goes right, everything's perfect, we're in the year 2015. >> yeah. well, unfortunately, and i hate, i hate not being able -- i hate having to say this. unfortunately, the good one can't really happen, the really good one. because you need to have, for that you need to have full inclusion of all of the haitian, um, adults, you know? and there's a saying -- [speaking in native tongue] that means including them in the democratic process voting. that means all the parties and

groups need to be engaged. so that hasn't happened, but that doesn't mean that we can't hope for a really good performance from the ngos, the church groups that were mentioned already, the haitian government, the international players. so if everything goes forward now as best we can, and i think this is something people of goodwill should be committed to, we need to find ways to help the haitian government. first of all, it has to be formed. there's still no government in place. you need a prime minister. so let's hope maybe this week there'll be a prooment. i want -- prime minister. i want haiti to have a government just like i want my own country to have a government. let's hope it's formed, good people in it, and they find real solidarity. what will haiti look like? there'll be a major series of public works programs for reforestation that this time are linked to infrastructure. you know, just one little, tiny example. how can you reforest haiti without an alternative fuel source for cooking? >> right. they grow the trees, all right,

we're going to plant them, it gets to be a sapling, they cut it down. and you fly over, you cannot imagine what it looks like. on the right is the dominican republic and it's all green, and on the left it's deforested. >> and one last optimistic point in medical care which is not the main thing, but it's pretty important, right? to have medical care, not that we're biased. [laughter] we're -- the book, the hospital that's describe inside the book -- described in the book which is in central haiti. first of all, it's not in the capital, it's built to rigorous earthquake standards, and it will be done or open bl on the second year anniversary. and to me, my experience working in haiti is that you can get stuff done. just this past month, um, our groups including the haitian public sector opened a new residency training program and family practice in a city you visited during the cholera epidemic which is still going on, by the way.

we checked on progress in the hospital, and the foundation reopened the medical school with cuban faculty. let me tell you, there are 1500 cuban doctors and health professionals in haiti. they've been great. and they're unsung heros. i put them in the book too. they really helped us a lot with cholera and also with teaching. so there's lots happening in health care and medicine. that's my area and yours. but people also need to know these positive stories. and then we, again, let's all be committed to helping the haitian people and the people they chose to lead them regardless of our own personal leanings or inclinations or political views. that's not the point. it's really can we help the haitian people and their leaders move forward. i think we can. so i'm gearing myself up for some optimism like what we heard from those people interviewed by michelle. if they can, if they can still have some optimism and belief in their future, then we who are not subject to these kind of

pressures -- how do we feed our kids, how do we have a safe place -- we're not summited to those pressures. if those people can have optimism, then we can too. thank you all for having me here. >> thank you. [applause] well done. >> you're watching booktv on c-span2. 48 hours of nonfiction authors and books every weekend. >> a quick reminder, the deadline's soon for c-span's student cam video competition. this year we're asking middle and high school students which part of the constitution has meaning to you and why? there's a grand prize of $5,000 and $50,000 in total prizes. get your 5-8 minute documentary to c-span by friday, january 20th. for last minute details, go online to studentcam.org. >> and now on booktv, laurie sandell recounts the fallout