Menus Subscribe Search

Book Review: Helping, or Harming, in Haiti?

• October 03, 2012 • 4:00 AM

A new book analyzes the successes and failures of the Haitian earthquake relief effort and offers some lessons for future well-meaning humanitarian interventions.

Killing with Kindness by Mark Schuller. Rutgers University Press, $26.95 (paperback).

Is humanitarian aid good for those who receive it? This deceptively simple question with a not-so-straightforward answer has been the subject of lively debate in recent years, as well as the subject of books by Timothy Schwartz, Dambisa Moyo and Linda Polman, among others.

The answer is undoubtedly yes in an acute disaster—the sort of situation which temporarily overwhelms the ability of otherwise well-functioning local governments to marshal the necessary resources to mitigate its impact.

The damage Hurricane Katrina inflicted on the city of New Orleans and rest of the Eastern Gulf Coast was simply too great to be dealt with by local agencies and authorities. Without the assistance provided by the federal government, non-governmental organizations such as the American Red Cross, and ad hoc relief efforts by private citizens and church groups, the personal suffering of those directly affected—as well as the economic impact on the region as a whole—would have been far greater.

When it comes to providing aid to populations that suffer from poor governance and chronic neglect, the issue becomes much more nuanced. Having done medical volunteer work in Haiti, I can attest to how satisfying it is to help sick children who would have otherwise have gone uncared for, or perhaps even died due to the lack of resources. However, that 85 percent of Haitian medical school graduates wind up leaving that country to work in North America certainly explains why there’s such a lack of Haitian physicians in Haiti.

This, in turn, probably has something to do with poor, sick Haitians preferring to get their care for free from well-intentioned foreigners than from Haitian physicians whose services they have to pay for. The presence of foreign medical volunteers may actually be making things worse for Haitians by undercutting their own physicians’ ability to earn a living by caring for them. After all, at some point foreign medical volunteers will stop coming to Haiti, and then what?

In Killing with Kindness, Mark Schuller, assistant professor of African American studies and anthropology at York College, CUNY, explores foreign aid to Haiti and specifically how the culture of NGOs active in that country has affected the success of their operations. He focuses on the internal culture of two NGOs, Sove Lavi (saving lives) and Fanm Tet Ansanm (women all together), as well as well their interactions with donors, and the degree to which they were able to engage their target beneficiaries in their projects and achieve results. Schuller’s analysis is based upon his own field work in Port-au-Prince between the years 2003-2005, and subsequent follow-up visits.

Schuller found Fanm Tet Ansanm to be much more successful than Sove Lavi in reaching its short-term goals and in achieving medium- and long-term success. The key to its success was its ability to engage the target beneficiaries and to consider their needs when planning its programs. Its competence was also reflected in the way it was able to promote its agenda to its foreign donors, mostly European NGOs.

Schuller contrasts this with how Sove Lavi, supported by the Global Fund and USAID, was less engaged with its beneficiaries, and often found itself forced to adhere with agendas that were many times driven by domestic American political concerns that were of little (if any) benefit or relevance to their ostensible beneficiaries.

Schuller describes how Sove Lavi, with very little room to maneuver within these constraints, co-published a pamphlet with USAID in 2006 that included recommendations to postpone sexual activity until the age of 23, in keeping with the message of abstinence as “the most appropriate policy and message for youth” to prevent infection with HIV/AIDS. This message was entirely at odds with Sove Lavi’s own campaigns of condom promotion and distribution targeting the very same demographic.

He contrasts this with how the clinic director of Fanm Tet Ansenm responded to a demand by a representative of one of the donor organizations that they set and meet specific targets for numbers of women given certain forms of contraception:

“We know you are a medical doctor, and that you are good at what you do….  We… have no objection in principle to the idea, but we know the terrain. We have been working here for almost 20 years. We know what will work here and what will not work here.” The donors wound up retreating from that demand.

Killing with Kindness concludes with a concise afterword, whose subtitles could serve as a shorthand summary of his recommendations: “For Haiti’s government: steer, not row; for USAID and other donors: accompany, not dictate.” Schuller provides a seven-point list of suggestions for how USAID (of which he is highly critical) could improve its “policy and implementation in this spirit.”

Killing with Kindness will be of interest to anyone who has ever wondered how he or she might be able to effectively help those truly in need of assistance without making matters worse for them in the long run. While meandering at times, it provides valuable insight at all levels of the process, from donor through beneficiary. It is an important book, one which deserves to be taken seriously by anyone involved in the planning and provision of humanitarian aid.

Dennis Rosen, M.D. is Assistant Professor of Pediatrics at Harvard Medical School. His e-book, Sleep Tight (Without the Fight) will be published by Harvard Health Publications in early 2013.

Dennis Rosen
Dennis Rosen is a pediatric pulmonologist practicing in Boston. His book Vital Conversations: Improving Communication Between Doctors and Patients will be published by Columbia University Press in September 2014.

More From Dennis Rosen

A weekly roundup of the best of Pacific Standard and PSmag.com, delivered straight to your inbox.

Recent Posts

September 2 • 9:12 AM

Conference Call: The Graphic Novel


September 2 • 8:00 AM

Why We’re Not Holding State Legislators Accountable

The way we vote means that the political fortunes of state legislators hinge on events outside of their state and their control.


September 2 • 7:00 AM

When Men Who Abstain From Premarital Sex Get Married

Young men who take abstinence pledges have trouble adjusting to sexual norms when they become husbands.


September 2 • 6:00 AM

The Rise of Biblical Counseling

For millions of Christians, biblical counselors have replaced psychologists. Some think it’s time to reverse course.


September 2 • 5:12 AM

No Innovation Without Migration

People bring their ideas with them when they move from place to place.


September 2 • 4:00 AM

Why Middle School Doesn’t Have to Suck

Some people suspect the troubles of middle school are a matter of age. Middle schoolers, they think, are simply too moody, pimply, and cliquish to be easily educable. But these five studies might convince you otherwise.


September 2 • 3:13 AM

Coming Soon: When Robots Lie


September 2 • 2:00 AM

Introducing the New Issue of ‘Pacific Standard’

The science of self-control, the rise of biblical counseling, why middle school doesn’t have to suck, and more in our September/October 2014 print issue.


September 1 • 1:00 PM

Television and Overeating: What We Watch Matters

New research finds fast-moving programming leads to mindless overeating.



September 1 • 6:00 AM

Why Someone Named Monty Iceman Sold Doogie Howser’s Estate

How unusual names, under certain circumstances, can lead to success.



August 29 • 4:00 PM

The Hidden Costs of Tobacco Debt

Even when taxpayers aren’t explicitly on the hook, tobacco bonds can cost states and local governments money. Here’s how.


August 29 • 2:00 PM

Why Don’t Men and Women Wear the Same Gender-Neutral Bathing Suits?

They used to in the 1920s.


August 29 • 11:48 AM

Your Brain Decides Whether to Trust Someone in Milliseconds

We can determine trustworthiness even when we’re only subliminally aware of the other person.


August 29 • 10:00 AM

True Darwinism Is All About Chance

Though the rich sometimes forget, Darwin knew that nature frequently rolls the dice.


August 29 • 8:00 AM

Why Our Molecular Make-Up Can’t Explain Who We Are

Our genes only tell a portion of the story.


August 29 • 6:00 AM

Strange Situations: Attachment Theory and Sexual Assault on College Campuses

When college women leave home, does attachment behavior make them more vulnerable to campus rape?


August 29 • 4:00 AM

Forgive Your Philandering Partner—and Pay the Price

New research finds people who forgive an unfaithful romantic partner are considered weaker and less competent than those who ended the relationship.


August 28 • 4:00 PM

Some Natural-Looking Zoo Exhibits May Be Even Worse Than the Old Concrete Ones

They’re often designed for you, the paying visitor, and not the animals who have to inhabit them.


August 28 • 2:00 PM

What I Learned From Debating Science With Trolls

“Don’t feed the trolls” is sound advice, but occasionally ignoring it can lead to rewards.


August 28 • 12:00 PM

The Ice Bucket Challenge’s Meme Money

The ALS Association has raised nearly $100 million over the past month, 50 times what it raised in the same period last year. How will that money be spent, and how can non-profit executives make a windfall last?


August 28 • 11:56 AM

Outlawing Water Conflict: California Legislators Confront Risky Groundwater Loophole

California, where ambitious agriculture sucks up 80 percent of the state’s developed water, is no stranger to water wrangles. Now one of the worst droughts in state history is pushing legislators to reckon with its unwieldy water laws, especially one major oversight: California has been the only Western state without groundwater regulation—but now that looks set to change.


August 28 • 11:38 AM

Young, Undocumented, and Invisible

While young migrant workers struggle under poor working conditions, U.S. policy has done little to help.


August 28 • 10:00 AM

The Five Words You Never Want to Hear From Your Doctor

“Sometimes people just get pains.”


Follow us


Subscribe Now

When Men Who Abstain From Premarital Sex Get Married

Young men who take abstinence pledges have trouble adjusting to sexual norms when they become husbands.

Your Brain Decides Whether to Trust Someone in Milliseconds

We can determine trustworthiness even when we’re only subliminally aware of the other person.

Young, Undocumented, and Invisible

While young migrant workers struggle under poor working conditions, U.S. policy has done little to help.

Education, Interrupted

When it comes to educational access, young Syrian refugees are becoming a “lost generation.”

No, Smartphone-Loss Anxiety Disorder Isn’t Real

But people are anxious about losing their phones, even if they don’t do much to protect them.

The Big One

One third of the United States federal budget for fighting wildfires goes toward one percent of such fires. September/October 2014 big-one-fires-final

Copyright © 2014 by Pacific Standard and The Miller-McCune Center for Research, Media, and Public Policy. All Rights Reserved.