From WBEZ Chicago it's This American Life, and distributed by Public Radio International, I'm Ira Glass. The voices that you are hearing is some children. What are they doing? They are just walking. Nothing else. This week I talked to a Haitian journalist, Romuald Felix, over his cell phone as he recorded himself walking around one of the tent cities where some of the 1.3 million displaced Haitians are still living. This was a small tent city in a plaza in the Place Saint Pierre crammed with people. You can see, you know this music that you hear is a man who is putting a big speaker out and some people are dancing. And you can see a man is just sitting there doing nothing. He is just watching. Four months after the earthquake, Romuald says that some people were working, selling fruit, charging cell phones for money on the street, but lots aren't. The rainy season-- which everyone has been dreading-- finally started in earnest last week. He was trapped in his office one day by water three feet deep. Camps get muddy. Water gets in the tents. People have trouble sleeping with it so wet. In this camp, people still have to bathe where everybody can see. There are only six toilets for a thousand people, or maybe it's a lot more than a thousand, so lots of people go in plastic bags. And in the six camps that Romuald visited this week, aid agencies had stopped giving out food. [SPEAKING FRENCH] You hear them? It was 5:00 at night. Romuald asked these four children if they'd eaten today. Two of them said, "I ate something today," and the others said, "No I haven't eaten anything." When I talked this week to Nan Buzard-- who runs relief operations in Haiti for the American Red Cross-- she was unsurprised to hear that people aren't getting food and services, with over 1,000 makeshift camps, there are a lot of gaps. She'd just returned from Haiti the day before we spoke and said that now that they're shifting from the immediate disaster relief to the rebuilding of the country, the decisions have gotten very complicated. I know in Haiti already there are some evaluations where it's showing that local farmers don't feel like it's worth buying seed or bringing their crops into market, because people have had free food distributions. And they're not going to buy from them. Yeah. So when should relief agencies stop giving away free food or providing shelter? When does that become counterproductive? What should they do about something as basic as water? Prior to the earthquake, 70% of the water in Port-au-Prince was sold out of water tanker trucks by small commercial firms. So do we use aid money to actually put those small, individual companies back in business so that they can then charge money for water? Do we try to support the government to actually create a water policy and plan, an infrastructure that provides a certain amount of water free, and then perhaps over that it's a cost to the government? So that seems like an impossible choice. What are we doing? We all-- we struggle. We all struggle. Today on our radio show-- there's been this fantastic outpouring of money and goodwill from around the world. Nearly half of all American households have donated to Haiti, according to one survey. Haitians and foreigners have dedicated themselves to rebuilding the country. And now the question is, how exactly do you do that? Even with all this money and expertise, it's incredibly complicated. And today we join the people on the ground as they try to figure out what would be best. Next. Our show in three acts. Stay with us. Act One, 10,000 Brainiacs. We're all used to the basics. Haiti is the poorest country in the western hemisphere, one of the 10 or so poorest countries on earth, with the special designation of being one of the few countries in the world that-- for decades-- has gotten poorer and poorer over time. This despite billions in foreign aid, despite the fact that even before the earthquake there were approximately 10,000 non-governmental organizations trying to do good in the country. Two of the reporters that you hear a lot on our show doing economic stories-- Adam Davidson and Chana Joffe-Walt-- have been trying to figure out how it is possible Haiti is still so poor despite all that. They've been traveling back and forth to the country following developments over the last few months and have this story. Here's something that happens a lot in Haiti. You meet someone poor and they tell you the sad reality of their life, some challenge they face every day that keeps them poor. You hear the details and you just can't believe the magnitude of the problem, not because it's big and complicated, because it is so, so small. For example, we met a farmer at this farm, a dusty, patchy field, nothing valuable growing on it, except in the corner, mangoes. How many trees do you have? He has two. The farmer tells us, two trees is barely enough to make a living. She wants more trees. She has the space for 100 trees. She has the time to tend them, but she has no water. Mango trees need water. But then we walk across the field. And right at the far end of it is this roaring river. Right there. Right next to her farm. Why is water a problem if you have water right here? We talked about this question for a long time. It was really confusing. It just did not make sense to us that she couldn't come up with some way to get water from the river right next to her farm onto her farm. At one point I thought, is she lying to us? Why would she lie? Is she just lazy? Does she not have a bucket? So many questions. How do you get water now? Why don't you have enough water to water these trees? Dozens of questions and a consultation with the local mayor-- Who happens to be a self-proclaimed, amateur, mango specialist. Yes, that all ultimately reveals a wildly undramatic truth. She needs a canal, some guys with shovels to dig a trench, some concrete to protect it. The world's simplest, shortest canal. It's a little tricky. The water needs to sit in a particular way around the roots of the mango tree, so you need some control over the water. But it's not that tricky. It's technology the Sumerians probably took for granted 5,000 years ago. It would cost-- at most-- $2,000. And if she gets a canal, she and her family go from being some of the poorest people on earth to much better off. This is what kept striking us in Haiti, just a little upfront investment and people could be living so much better. And with 10,000 organizations in the country doing nothing but trying to make people's lives better-- 10,000 organizations whose mission is to do things like building canals-- how come the average Haitian makes half as much as they did 50 years ago? How come life wasn't improving even before the earthquake? Well, to answer that, we have to leave the farm for a couple minutes-- we will be back-- and meet a businessman name Jean-Maurice Buteau and watch him try to work with one of those non-governmental organizations-- NGOs-- to solve one problem for Haitian farmers. The story begins two years ago. I heard about Jean-Maurice weeks before we met him. We'd been going around Port-au-Prince asking, what are the main industries? Who are the main players? And there aren't a lot of big businessmen in Haiti. The ones that do exist all know each other. They're unusual Haitians in almost every way. They tend to have light skin, they drive cars, have college degrees, speak English. Jean-Maurice though, he's the only one known by a special name. First of all, what do you sell specifically? Well, we export mangoes. Mango is the number one agricultural export from Haiti. Are you Mr. Mango? That's what they call me. Just people started calling me like that. We actually found out later that most people call Jean-Maurice "Mango Man," not Mr. Mango. And Mango Man is one of the biggest mango exporters in Haiti. Mango Man has a very consistent look. Most any day, any context, he's in a white linen button-down, sunglasses with the strap around the back of his head, and a Bluetooth headset. He talks on the Bluetooth a lot, usually while ramming his Jeep through Port-au-Prince's potholes, even while he's talking to you. It's Bluetooth, you, Bluetooth, you, seamless, and confusing if you're you. And Mango Man has a problem. Fruit wholesalers in New York and Miami want to buy a lot of his mangoes. But he can't get enough to meet the demand-- Which is strange, because Haiti actually grows enough mangoes to send to all of the Floridians and New Yorkers who want them. But most of those mangoes aren't grown on big farms. They're grown by individual farmers with just two or three mango trees each. And every season, those farmers pick the mangoes and then store them in a pile outside their houses, or under their beds, where they wait until some middle man-- usually a local guy with a donkey-- comes by and buys them. Americans-- as it turns out-- don't like mangoes that have sat under Haitian beds. Those usually have bruises on them, marks. And so, two years ago-- long before the earthquake-- Jean-Maurice came up with a solution, a business concept that would double his revenue. The concept is-- the simplest thing is cleaning the fruit, transporting it in a plastic crate, to a facility that is not exposed to the sun. So basically, you lose a huge amount of your crop because people don't use plastic containers? And they don't clean the fruit and they don't transport it correctly. The amount of damage we witness-- over 40% to 50% of our production in all sectors-- lost between the field and the table. So you are on a mission to get plastic crates to mango farmers. I mean, it's very self-serving because I'm going to have more product. I mean, I'm not a philanthropist. I'm doing this because I need the product. So back two years ago, before the earthquake, the first thing Jean-Maurice did was he took a bunch of crates, drove 45 minutes out of town to a small mango growing village called Casale. And he went to each house one by one. He'd find the mango farmers on some tiny dirt road. He'd get out of his jeep and hand out his crates. Unfortunately, that with an enormous failure. Well, first they used them as chairs. They would sit on them. They would carry too heavy stuff on it. They were being used for different things that is appropriate for them, in school as bookshelves. Right? And they got lost. Well, a lot of them got broken. When you talk to Jean-Maurice about the crate problem, it seems confusing why this would ever be a problem in the first place. Just tell the farmers, hey, if you pack your mangoes in these crates, everyone will make twice as much money. And then you actually go to the farms and you meet the farmers and you completely get it. Because you meet someone like [? Jealin ?] [? Jermouse ?]. Jealin ?] is that mango farmer from the beginning, the one who needs a canal. And she lives in Casale where Jean-Maurice went and handed out his crates. She didn't know who he was. In fact, it's unclear that [? Jealin ?] even knew that her mangoes are being sent to America. Here's what she did know. Her trees earned her around $600 a year, $2 a day. And in Haiti, $2 a day gets you a house made out of cinder block and metal sheets with a dirt floor on a dirt road. She can only afford to send one of her two kids to school. She chose the younger one. She has no electricity, no running water, no doctor, which makes [? Jealin ?] precisely the average Haitian. Average in every way but one. It's that laugh. She starts every single sentence with it. People in the neighborhood will say I love to laugh, I love to joke. The loudest, laughing mom with the two most sullen, withdrawn teenagers in all of Haiti. I tried and tried. And here are the only few words I managed to extract from her oldest daughter. She's telling me about her sister's school. Again, daughter. Mother. Jealin ?] has no car, no bike, no irrigation, no mattress. So for some white guy from Port-au-Prince-- that's how she sees Jean-Maurice-- for him to show up at Jealin's in his jeep and start handing out crates, she's not going to say, oh OK, this is a tool to increase my earning capacity. [? Jealin ?] doesn't mind bruises on her mangoes. She doesn't know anyone who does. She has no way of even conceptualizing a picky, American consumer. If Jean-Maurice is at about the level of a US exporter 50 years ago, [? Jealin ?] is living in the 1700s, well, with a cell phone. Jean-Maurice realized he was going to need an intermediary, someone who could spend the time to train the farmers how to use the crates, to train them why they should want to use the crates. Basically, someone who can help the farmers accommodate the needs of people living in the 21st century, people these farmers have never met before and can't imagine. And here is where Jean-Maurice hooked up with one of those 10,000 NGOs in Haiti-- non-governmental organizations. Lots of them specialize in training small farmers in agricultural techniques. In fact, many are focused specifically on mangoes, because study after study shows that mangoes are one of the greatest areas of potential growth for Haiti. So there's lots of money and there's lots of specialists ready to help those mango farmers. And here is where we begin to see what those 10,000 organizations are up against. Now Jean-Maurice-- like a surprising number of Haitians-- does not like those NGOs. He says-- and we heard this all the time in Haiti-- those NGOs have been helping for 50 years. And every year, Haiti is poorer and the NGOs are richer. Well, we are working-- it's the first time I'm working with some NGOs. I've stayed away from them for the longest time, because sometimes I realized that they were causing more damage than good. But throughout the years, I've identified certain ones that seem to want to do some things. The one he likes most is called MarChE. Well, it was actually this guy he liked the most, one of the staff named Pierre Brunache. Jean-Maurice liked that Pierre grew up in Haiti, even though Pierre lives in D.C. now. So Mango Man calls Pierre and says, hey, I can't get these mango farmers to use plastic crates. You're the expert. Can you help me? And Pierre says-- I didn't think it was difficult at all. Jean-Maurice thought, great. And then Pierre went on. It's just a matter of getting the land, provide the technical assistance. I never thought it was something difficult. This is where Jean-Maurice gets nervous. Getting land? Technical assistance? Pierre explained. You can't just hand out crates to thousands of dispersed farmers. You need a central place with just a simple structure. Picture a carport, a quarter acre of land, with a hose. Farmers will bring their mangoes, learn how to pack the crates correctly, how to wash the mangoes. Pierre says, we have some rules about this because we've done this in other places. We've seen what works and what doesn't. And when you team up with an NGO, you have to follow their rules. So, if Mango Man wants crates, he has to find a farmer with some land that they can build the mango carport on. To which Jean-Maurice replied, have you ever met a Haitian farmer? Just imagine. You are a small farmer and you own that piece of land. That's all you have. To which Pierre replied, and there's one other rule. The farmer can't own the land the center will be on. They have to donate it. The center will become the economic powerhouse of the community, so you need a neutral place. You can't let one family own it. It has to become a cooperative owned by all of the farmers. And so, Jean-Maurice began his campaign to convince some poor farmer to give up some of his precious land. He called someone he knew in Casale to find out who might have some land. The guy talked to his cousin, [? Jealin, ?] the one with the laugh. [? Jealin's ?] family has a very nice piece of land in a great spot, near the road and near the mango farms. Now, this is where the mission to get some mango farmers a few plastic crates goes from involved to complicated. Because the thing is, the land was passed down from a great-great-grandfather. Maybe a great-great-great-grandfather, nobody remembers exactly. The point is, a whole lot of cousins have equal claim to the land. Jealin ?] called a meeting, gathered her family together to decide whether or not they wanted to donate the land. Where we met, there's a big tree. We have a lot of shadow. It's cool there. Then we sit down on some chairs around the tree. How many people? 60 or 80 people all sat under this tamarind tree? Really? A big, big tree. Everyone, all the cousins started asking questions. Who is this white guy from the capital? Why doesn't he buy our land? What if he never does anything with it? We're going to give away all our land? What will we leave for our children? Everyone, all the 60, must agree. And then nine of them will sign for everyone. There were factions, big disagreements. For a while, Jealin's brother was a holdout. So were the loud cousins, who nobody likes, who left town a while ago but came back when they heard someone was interested in the land. So many meetings under that tamarind tree. Jean-Maurice drove in for many of them. It took months. It took months. I didn't go everyday. We held meetings here. I went there. And their family came here, now they're doing it with the land. So, we've got the land. We can get those crates here. Training. Those mangoes will be beautiful. The farmers will start earning twice as much, so will Jean-Maurice. He calls the NGO and says, all right guys, you can start building the center. The NGO says, great, we just need to see a copy of the deed. The deed. So, Jean-Maurice goes back to the mango farmer with a quick, simple request. The family had acquired the land from somebody else. They never did the papers, but they had their understanding. So these papers first had to be transferred from the original owner to this family. Nobody knew who the original owner was, who sold the land to Jealin's great-great-grandfather. Or great-great-great-grandfather. Right. Nobody knew who had the deed now. But finally, [? Jealin's ?] brother remembered, wait, there was that uncle who always kept papers, the guy who left Haiti a while ago. The person who had the paper is in New York? New York. How did you get the paper from him? Someone who this person-- who is living in New York-- trusts, came with the paper. The brother tells me, that guy sent the paper from his basement in New York with someone he trusts to Haiti. So after weeks and weeks of waiting, they get the paper. But it turns out, to transfer a deed in Haiti involves, literally, hundreds of steps and hundreds of dollars. Transfer of land deed was not in the budget, and if there's one rule every NGO sticks to it's, you do not change the budget. This is where Jean-Maurice loses it. It has to go through this process, it had to go through this process, we had to put it in the budget. I said, well, we had to put it in the budget, but you know, there are sometimes things that occur that-- you know, I'm not God. I don't know every little detail of it. It's like, Hilary Clinton has to approve it at the State Department. Can I just remind everyone, we're talking about getting some farmers a few plastic crates? Crates that they want, that Mango Man wants to just give them, that the NGO wants them to have. But to get those crates to the village of Casale, 60 farmers had to donate some precious land. And they did it. Mango Man had to trust an NGO. And he did it. MarChE-- the NGO-- had to be flexible and pay for something that wasn't in the budget. And they did it. Together, all these people had to overcome more than a century of legal confusion, and they did it. Success. They get to the final, last step. December, 2009, a year and a half after they began. [? Jealin ?] and the other farmers form into a cooperative that would own and operate the crate center. They did that. They took all the paperwork, that very final document one last time into Port-au-Prince and delivered it to the government. This all happened at the very end of last year. And then on January 12 came the earthquake. The document that recognizes them is at the Ministry of Social Affairs. The Ministry of Social Affairs has been flattened like a pancake. Those certain documents are in the pile of rubble at the ministry, under the rubble. It was several weeks before Jean-Maurice could even bring himself to go back to Casale to visit the farmers. It wasn't clear if the earthquake destroyed the crates project entirely, or just set it back months, maybe years. But as survivors started to think about their future, they started asking this question we'd hear every now and then-- usually after someone apologized for even thinking it. Was the earthquake the best thing that could've ever happened to Haiti? The argument goes like this, the world is now focused on Haiti like never before. There's lots of money coming in. Before this, you had those 10,000 NGOs working independently on little projects, making slow progress, maybe, if at all. But what if now there is an opportunity to take all the attention, all the money, and work together like never before? What if this is the shot-- instead of solving one small problem at a time-- to address all the country's problems all at once. Think about [? Jealin ?] and her mangoes. Her problems go way beyond those plastic crates. Remember, she needs a canal. And while we're at it, she needs a road. Once her mangoes get on the truck, they go down this crazy, choppy dirt road. In the rainy season, sometimes the road isn't even there. She really needs a paved road. But then, if there's a lot more trucks carrying a lot more mangoes, the Haitian port can't handle that. Haiti's main seaport is really old. And they'd need to buy new equipment, which means a better banking system to give loans and more professional folks to operate things-- Which means better education to train those professional folks, and while we're at it, health, hospitals. [? Jealin's ?] brother can't help her on the farm because he's really sick. She thinks he has malaria. Thinks. She doesn't know because there's no doctor around to ask. If all that seems like a lot for the world to take on, seriously, we went to the place where this is truly the ambition. We're in a conference room in a new hotel on a hill outside Port-au-Prince where experts from all over the world are sitting around foldable tables and trying to figure out how to do every one of those things and more. They're trying to figure out how much it would cost to address all of Haiti's problems at once. Experts are here from the U.N., the World Bank, from all over the world, doing the thing experts do, staring at Excel spreadsheets and writing assessments. And they're all in these tables divided into groups. There's education, water, infrastructure. And Adam, you and I go table to table asking, what are you going to do for [? Jealin? ?] And everyone has really long, in depth answers. Infrastructure. Well first, if she has a better telephone link in her village, that is the first step to sell her products. If the roads are improved, again, a better way to sell the products. The health table tells us they're working on a plan for hospitals in her area. Education table? They're working on a plan for more free schools. At which point, a Trinidadian woman grabs my arm to tell me, kids need more than schools, you know? They need activities, dance classes, that we are offering over at this table. And over at the environment table, they're offering canals. So you have-- right here in your grid-- millions of dollars for canals. That's exactly the thing that she wants. She wants a canal. Yeah, so hopefully she'll get some. Hopefully. Hopefully your computer will result in her getting a canal. We are hoping so. So the people in this room have their plans. And the world is going to spend billions of dollars on those plans. But now that we've seen how complicated it is to do something basic like get some crates into the hands of some mango farmers, it raises the question, what'll it take for all that money to do something? To actually result in canals and roads and electricity and crates actually getting to [? Jealin? So, let's say you're the US government. You're committed-- as the US government is-- to spending lots of money rebuilding Haiti. You basically have two choices. Chana, the first please. Number one. You could hire Haitian companies and American companies do build things. The Haitian companies will be the Haitian elite. The American companies will leave after a year or two. And if you're Hilary Clinton, in a year-- the anniversary of the earthquake-- you can point to a bunch of successes, big ones. Hospitals rebuilt and roads that are way better than any Haiti has seen. If you're [? Jealin, ?] you probably still don't know how to pack your mangoes into crates and you probably aren't lucky enough to have your tiny piece of land chosen for a tiny canal either. So, Adam, let's look at number two. Number two, you do what development experts call capacity building. You teach the people of Haiti how to do all these things. You use this rebuilding process to give Haiti the ability to build itself. Which means, do for [? Jealin, ?] what America did for farmers more than 100 years ago, create a class of ag-extension agents who go to farms and figure out the best solution for each one, train farmers and laborers how to do things like build proper canals, create small banks to lend the money to farmers for this kind of investment, and you teach [? Jealin ?] how to pack her produce correctly, to wash it and to sell it directly to the exporter. This option, capacity building, do I even need to say it? It takes a long time and it's really, really hard. You need foreign money and you need Haitians to believe in the projects and to participate fully. And you need NGOs that are willing to stay for as long as it takes, which brings us to a classic problem with NGOs and foreign assistance. How you doing? I'm OK. I had a long day. I had a very long day. Several months after the earthquake, we meet up with Jean-Maurice at his cousin's hotel, the same place where the world's experts gathered together to figure out how much it would cost to build Haiti out of poverty. The conference room has emptied out and Jean-Maurice-- Mango Man-- told us he got a call earlier in the week from MarChE, the NGO that was helping train [? Jealin ?] and the other farmers. USAID cut their funding. MarChE is closing their doors. Jean-Maurice shakes his head. Again, that's the habit. It's the norm. They start something, they don't finish it. These NGOs, when they come on the field they make promises and they don't finish up and they don't deliver. This was confusing. There was just a major earthquake and everyone wants to help Haiti. People are sending money, texting money, and USAID is cancelling programs? I called USAID and our conversation with confusing too. We didn't decide to close any program. This is Anthony Chan. He's deputy director for USAID in Haiti, and at first he tells me, technically, they're not closing the program. They're just letting its funding run out. Then he tells me that with all this new money after the earthquake, they need to reassess all their programs and think bigger than little ones like MarChE. And finally he tells me, OK, the program is going away, but it's not his fault. I mean, it's not us deciding. We have bosses in Washington and they are the ones who make those decisions. I mean, eventually they're going to communicate that to us and we'll get the money and we'll begin to work in those areas. And the response to the farmers, we are not going away forever. We are going to be back. Maybe the partners are going to be different, but she shouldn't feel abandoned. The actors may change, but the movie and the plot will still go on. That movie has been going on for more than half a century. There's this recent report called "Haiti in the Balance," which documents how time after time, USAID programs are started and then-- before they can actually help anyone-- a decision is made in Washington to send aid in a whole new direction. The two Marche staff we met left Haiti a couple of weeks ago. Mango season has opened without crates. And this, of course, is how you can continue to have 10,000 NGOs in a country that keeps getting poorer. Chana Joffe-Walt and Adam Davidson are part of the Planet Money team. If you like this kind of story-- economics, but interesting. You can be getting it twice a week on the Planet Money podcast and at their blog, www.npr.org/money. It's a co-production between our program and NPR news. Coming up, a new definition of atheist during an earthquake. That's in a minute. From Chicago Public Radio and Public Radio International, when our program continues. This American Life, I'm Ira Glass. Today's program, "Island Time," stories about what happens next in Haiti, now that the world is flooding it with money and help. We've arrived at Act Two of our show. Act TWO, Compound Fracture. According to the US State Department, there are about 40,000 American citizens who live in Haiti year round. These are business people, NGOs, missionaries. In the 1980s and 1990s, Apricot Irving's family was among them. Apricot's parents were missionaries, agricultural missionaries. They did erosion control farming, reforestation projects. They lived in a town called Limbe, about 150 miles north of Port-au-Prince. It's been 20 years since her family left, but her parents still go back to the north of Haiti every couple of years. And in March, Apricot went with them to see how people are building a new Haiti and how different that effort is from when she was a kid. The missionary compound where I grew up-- that's what we called it, the compound-- is about 15 miles away from where Columbus sank the Santa Maria in 1492. Columbus was just the first of many foreigners with big dreams of how to improve Haiti. We heard a lot about Columbus growing up on the compound because Dr. Hodges-- who ran the missionary hospital in Limbe-- was a huge fan. When I was a teenager, the compound had everything we needed, a missionary school, a TV room, friends. But when I went back this time to visit, it was like a ghost town, a ghost town with a very loud generator. It is kind of creepy in here. There's nobody around. There's all these houses that used to be full of missionary families and kids running around and there's not really anybody else. There's Joanna. Hi Joanna, how are you? You look pretty good. You look pretty good too. Travelling all over the world. Feel great as long as I don't walk. Dr. Hodges died 15 years ago, but his wife Joanna still spends a lot of time in Limbe. She's 87 years old and she's formidable. Everyone thought she'd retire in 2004 when three guys with guns broke into her house. She ended up chasing them down the driveway as they tried to steal her car. One guy broke her arm by beating her with a stick. The watchman later found that the thing that he'd hit me with, it was the walking stick that my husband used to use. But anyway, my arm is OK now. You can't even see the scar. What did you tell the men when they came to your house? I told them, if they killed me, that was all right. Because I knew that God would take care of me, and that I'd come to Haiti mainly to tell the Haitians about God. And I knew that he had a place for me. And I said, "Does he have a place for you?" Because I said, "I don't think he would want you to be doing what you're doing because it's not very nice." They said, "Shut her up," and they tied a cloth around my mouth. [LAUGHTER] I can't believe she can laugh about this now. But maybe that's what spending 52 years in Haiti will do for you. I'm really fond of Joanna. I've known her since I was six years old and she's like a grandma to me. She epitomizes the old way of doing aid work, sort of 19th century benevolence. The foreigners-- usually whites-- lead the way, set an example, do whatever they can, and hope the Haitians catch on. In other words, the foreigners are always in charge. It sounds a little crazy, but until a few years ago, Joanna kept the keys to the medical supply storage room on a chain around her neck. When the Haitian doctors needed to perform an emergency surgery in the middle of the night, they had to wake her up. And, because she was in her 80s, carry her over the mud puddles to open it. The hospital is still run by Joanna's son, even though he now lives in Florida and hasn't been to Haiti in years. So with all the different aid organizations coming into Haiti right now to help out with earthquake relief, is there any advice that you would give to somebody who has never been to Haiti before? I would say that, don't try to change the Haitian people. Try to deal with him and try to understand them. And take them as you would other people. They're people and they need help. They look at life differently than we do. But that doesn't mean that they don't deserve help. Sometimes they're grateful and sometimes they're not. Far fewer patients come to the hospital now than when I lived here for a few reasons. People really loved Dr. Hodges, and when he died, things changed. The hospital got rid of its old payment system, where you were offered credit if you couldn't pay right away. Instead, they started charging a fee upfront for a consultation. It's not much, about $1. But it was more than a lot of people could afford. People resented it. Things got ugly for a while. Graffiti, threats, some protests. Also, there's more competition than there used to be. The number of small Haitian run clinics have opened up that didn't exist 20 years ago. The hospital feels pretty empty right now. But these clinics are jammed with patients. This is Steve James, Dr. Steve James. I grew up with his kids at the missionary compound in Limbe. For a while, Steve was Medical Director at the hospital there, the Hodges Hospital. The work he's doing now is an attempt at something different, a totally different approach to development work. He spends much of his morning greeting people and kissing them. This is how you start the day in Haiti. Everyone asks how your family is, how you slept last night. You can usually tell who the visiting Americans are, because they're the ones trying to skip the handshakes and get straight to work. But not Steve James. He's been in Haiti 30 years now. Every month, he visits 11 small Haitian clinics, including this one. All the clinics Steve visits are faith-based, community-run organizations, meaning the decisions are made by a board of locals. Steve is not on any of the boards. It's kind of a new state of affairs here. He's a white guy and he's not in charge of anything. Yeah, I'm not a program director. I don't run anything. I just stand by and ask questions and encourage, is all. And this is the business office. He shows me around Ebenezer clinic, which was five miles away from the old missionary hospital in Limbe. It's a small, two story building. But there are at least 100 people waiting to be seen, both inside the building and outside under a tree. The clinic has far fewer resources than the hospital. They don't have a surgery wing. They don't even have a place for patients to spend the night. But they let you pay what you can and give you credit for the rest. After the earthquake, they let everyone in for free, not just earthquake victims. Even though the clinic was already $8,500 in debt. Ah, Dr. Manno, we are on the radio with the medical director. Hi. Good morning, Manno. How was Port-au-Prince? A lot of work. A lot, a lot of work. If anyone's in charge here it's Manno. He just got back from doing relief work in Port-au-Prince. Manno's a few years older than I am and I've known him since I was 14. Since I last saw him, Manno has become a doctor. He's the medical director for this clinic, though some patients still want to see the blonde, the foreigner with the American medical degree, the white guy. It happens while I'm standing there and it's awkward. A Haitian pastor comes in and asks for an appointment with Steve who's rushing to make another appointment, so he turns to Manno to see if he can do the consultation instead. He doesn't have his chart yet. So I don't know if you can see him for me, or-- When these people come they want to be seen by you. I know, I'm sorry. Ask him to go home and come when you are here? Well, that's the problem. I told him today I would be here. Say you are not afraid of, but he has to come back on Monday because-- You can hear the frustration in Manno's voice. Because of course, this has happened before. It makes Steve uncomfortable. I will tell him that I have two doctors better than me, and he can see them. Oh here we go, Bonjour, Bonjour. The baby just came. A few days before I arrived, Manno had come back to town with a family of earthquake refugees in the back of his truck, including this three-month-old, who Steve's been waiting to see. Her arm looks terrible. It hangs at a strange angle from her elbow. She comes in with her aunt and her aunt's sister-in-law. They said the baby's got diarrhea and they're worried that the baby's dehydrated today. That's a pretty little baby, baby girl. Her name is-- she has an unusual name. It's Quincy [SPEAKING FRENCH] Kaira. Jacque is her last name. She was a month old when the earthquake hit and she was trapped under the rebel for two days. Neighbors could hear a baby crying. What they didn't realize-- until they dug her out-- was that she was cradled in the arms of her dead mother. Steve thinks she might have survived by nursing. The women have brought an X-ray of her arm, taken at another rural clinic Steve had sent them to, because Ebenezer doesn't have an X-ray machine. OK, we don't yet have electricity in the clinic. They haven't turned on the generator yet, so-- So in a clinic like this, what do you use electricity for? Well, for one, right now I need it to look at this X-ray. That would be nice. Otherwise, I have to hold it up to the window here and make my best guess on a window X-ray. The X-ray isn't the exact angle he'd asked the technician for. So he can't really tell if the elbow's fractured or dislocated, though he suspects both. Steve wants to send the baby to another clinic-- an hour and a half away-- to see one of the visiting orthopedic surgeons-- an American who came to help out with earthquake relief. He makes sure to consult with Manno first. What I would like to know is whether-- at this age-- you would want to intervene or you would want to just wait for the baby to be older. Or, I just would like some help on that. I guess the best is to have the opinion of the orthopedics. If Steve had still been director of the hospital in the compound, he could have had everything done at the same place, X-rays, surgery, an overnight room. Instead, he has to send the baby to three different places-- over horrendous roads-- and someone has to pay for all that. It makes you understand why a lot of NGOs still operate the old foreigners in charge way, it's efficient. This way, the opposite of efficient. But what Steve's doing is that term you heard earlier in the show, capacity building, even though Steve would never call it that. He calls it, "building community." If you want Haitians to create and sustain their own institutions, this is what it looks like, slow and sometimes cumbersome. But Steve knows the pitfalls of the other model. When he was in charge of the old missionary hospital, he found the job so stressful that he even considered leaving medicine. He came to a kind of crossroads and had to make a hard choice. We talked about it in the car. The choice really is-- it almost became for me-- an either/or. On the one hand was that in the face of dysfunction, and in the face of extreme human need, what was required of me was to build a citadel, to become a dictator. And in that dictatorship-- benevolent dictatorship-- I could be the cowboy to fix the problems that would bring efficiency, service and security. What's wrong with that? Why not become a benevolent dictator? The problem that I found with that, is that model creates, in a way, a new slave plantation mentality, where the slaves become dependent on the slave masters. And in the end, one reaps the fruit of slavery, discontent, anger, violence. The choice to then go the other extreme, to purposely work hard at not becoming a dictator-- for the sake of building community-- means that people are going to suffer. People are going to die. Goods will not be provided. Services will not be rendered. Here we are praying when there's somebody that needs a C-section and we can't get it for her. There's a terrible choice. And why is it that, in choosing community, there are these added costs? Why do people die? Why are the goods not distributed? Because community takes time, perseverance and relationship building. Yeah, it drives Americans crazy. We're a fix it culture. That's the height of evil probably, from an American cultural point of view, is to not fix a problem when it's right there to fix. And what's the problem? Fix it. The good news-- Steve says-- is that the slow, cumbersome process is working. There's progress. These clinics are surviving basically on their own, supporting themselves with very little outside help. And when the earthquake hit, that progress paid off. It was Haitians who were on the scene first-- doctors like Manno-- pulling people out of the rubble, distributing water, days before the foreign aid organizations arrived. Apricot Irving. She's writing a book about growing up on a missionary compound in Haiti. Right now she's looking for a publisher. Act Three, "Hait is Destiny." Ben Fountain is a fiction writer who has been going to Haiti two or three times a year for 20 years. He has close friends there. He's written short stories set there, based on the things he's seen. He returned in March to catch up with people. "Did you think we were dead?" This was the first thing asked me by the 13-year-old daughter of my friend Gary, when I reached them by phone a few days after the quake. "Did you think we were dead? She said, as soon as she came on the line. And I hesitated, it seemed rude just to say to a child, "Yes, I thought you were dead." But there was a firmness in her voice, a focus and calm that showed she was beyond all the finer points of etiquette. For the past several days, she'd been very possibly dead to her family and friends back in the states. And now she was testing it, probing this other reality, the one where she died on January 12. How would it feel to be dead? What would it mean to exist only in old emails, pictures, the minds of others? Then the phone was passed to her brother, and he wanted to know too. "Did you think we were dead?" But they hadn't died. Their house had held and they'd ridden out the quake jammed in a doorway with their parents and uncle, the five of them lurching and pitching in that tight space like shipwrecked survivors tossed in a storm. But from their front yard, you could look across the neighboring ravine at the remains of 100 houses that hadn't held. It's like a lobotomy, seeing destruction on this scale. Not just the outsize scale, but the mind-numbing density within the scale. The sheer sensory overload of detail and texture. That football field-sized wilderness of junk and rubble that used to be a trade school, you could find entire geographies of ruin within that expanse. Hills, butes, hummocks, valleys and craters, broad flats cut through with twisting gullies, shredded clothes, shoes, papers, mangled furniture, dark oily clumps of decomposing human matter, rebar twisted and raveled like giant spaghetti balls. And then something impossible and ridiculous, an easy chair, a thickly upholstered loveseat, perched at the top of a free-standing spiral staircase that spun off into nowhere. It didn't make sense. Port-au-Prince was making me stupid. "I have a new definition of the word atheist," my friend, a Haitian eye doctor, told me. "This is the person who doesn't cry out to God in the middle of an earthquake." My friend, the eye doctor, comes from one of the old Mulatto families. And he may be the one true genius I've known in my life. He's fluent in six languages and proficient in three more, knows long passages of world literature by heart, plays the piano beautifully, and placed third in the Haitian National Chess Championship when he was 12. I met him almost 20 years ago, when he was a handsome, young doctor with jet black hair down to his shoulders and the slightly mad eyes of a Rasputin or Houdini. He was brilliant and knew it. On finding out he was a doctor, I made some trite comment about all the good he must be doing in his work. "No," he answered brusquely. "On the contrary, in Haiti, I'm like a jet pilot without a plane." I went to see him as soon as I arrived in Port-au-Prince and found him living with his family in their backyard. Most of their two story house was still standing, though the west wall had sheared away entirely, leaving that side of the house open to the air. And what remained was too shaky for habitation. So now they were living outdoors, sleeping in tents and a re-purposed tool shed and cooking on the stove they'd dragged outside. "And this is luxury," the doctor exclaimed, "We're the lucky ones." He and his wife and one of their sons had been on their small front gallery when the earthquake struck. And at first, they thought it was a heavy truck going by, some gargantuan piece of construction equipment. And then they told me something I would hear many times in the coming days, "We thought it was the apocalypse or Armageddon. We thought the world was blowing up. We thought this was the end of everything, so we just stood on the gallery hugging one another and waited for it to finish." Such were expectations in Haiti, where the apocalypse comes more readily to mind than anything so far-fetched as an earthquake. A Danish filmmaker, a long time acquaintance of mine, was on the third floor of his house in Jacmel when the quake started. And he simply couldn't process what his eyes were seeing. The room started shaking. And then the walls started rippling and bending. And he wondered, how can the walls be moving like that? And there was a hole in the wall, and he wondered why there was a hole in the wall. And then the balcony was gone, and how could that be? He sat on his bed, watching it all unfold in slow motion, but his brain wouldn't accept the information. I asked him, did you think you were losing your mind? "Yes," he cried, "I did think I was losing my mind, because these things I was seeing just didn't make sense." "You think the one thing that's certain in your life," the eye doctor told me, "Is the ground beneath your feet. You think this one thing at least is solid. And when that starts to shake, you experience real terror." We sat down at the small kitchen table in their backyard. So how were they doing? "We're surviving," the doctor said with a shrug, though this might not seem so obvious. Their teen-aged sons hadn't had a school to go to since January 12. The wife's video rental business was lost in the quake. The doctor was doing a lot of meetings these days, but he said they were starting to make him feel like a character in a Kafka story. As one of only 50 ophthalmologists in the entire country, he was much in demand by foreign governments and NGOs to consult on health care projects. And after two solid months of meetings, he was going a little crazy. "What happens at these meetings," he said, "Is that they meet to agree to evaluate the situation, so they can meet to agree to evaluate the situation, so they can meet to agree to evaluate and on and on." He'd been at one such meeting that very afternoon. "I told them it was all bull[BLEEP] and bluff. But even when I insult them, they don't listen to me. They just want a couple of Haitians at the table for decoration. We're there so they can keep on getting their money. "On the plus side," he continued, "There was always plenty of food at these meetings," so he rarely needed to eat at home, which was good because he wasn't making any money these days. His office had been destroyed in the quake and the few pieces of equipment he'd managed to salvage sat in a forlorn little pile in his living room. These days, his practice consisted of people randomly dropping by his house. Doc, everything's all blurry. Doc, my eyes hurt. Doc, can you find me some glasses? I lost my glasses in the quake. Several days a week, he hitch a ride out to one of the tent camps and treat people for free. But otherwise, he sat in his backyard studying Chinese and reading the classics of western philosophy. "You know what I've noticed," he told me that first evening at his house, "God gives you 205 years to do something with Haiti and if you fail, he passes it on to someone else. The Spanish had it from 1492 to 1697, 205 years. Then the French from 1698 to 1803, 205 years. Then the Haitians, from 1804 to 2009, 205 years." So what was coming next? "Maybe a revolution," he answered cryptically. "Or maybe Haiti would survive as a sprawling industrial park for the international aid complex. Or maybe it would become a satellite of the United States, a kind of protectorate." And then I brought up the subject of art. The doctor is-- among his many other talents and accomplishments-- an astute critic and tireless promoter of Haitian art. When I asked him whether anything had been rescued from the iconic institutions of Haitian art, the National Gallery, the Centre d'Art, or the murals of the Trinity Episcopal Church, his brow drew down and he brooded for a minute. "Art is finished in Haiti," he said abruptly, "After what happened here, art has nothing more to say to us." And he went on, "The philosopher Hegel said that before the end of time there will be the end of history, and before the end of history there will be the end of art, maybe this is what we're seeing here, the enacting of Hegel's theory. Haiti is leading the rest of the world to the end of time." Riding around Port-au-Prince during the day, seeing the sheer biblical scale of the destruction, this could definitely put you in an apocalyptic frame of mind. "Poor Haiti," people say, "So primitive, so backward, so far behind the times." I've been hearing about how backward Haiti is for as long as I've been going. But how about this, what if Haiti is ahead of the times? It seems to be on the leading edge of so many current trends, environmental degradation, serial ecological disasters, crumbling infrastructure, a population that exceeds resources, plus a skewed economic order that channels vast wealth to a privileged few while the great majority of people stagnate and struggle. By any objective measure, Haiti appears well-advanced on the track that the rest of the world seems hell bent on following. The eye doctor proposed yet another alternative for Haiti's feature which was the extinction of the Haitian people. In other words, no future at all. And why not? Many countries, many peoples have disappeared over the course of history. Why should Haiti be any different? From a sheer numbers standpoint, the earthquake had been a strong push in that direction. And now, he pointed to the mountains looming over Port-au-Prince. Every year there were fewer trees up there. Every year the rains loosened the soil a little more. Unless drastic changes were made, it was only a matter of time before the mountains crashed down in a kind of land tsunami and buried the city whole like a modern day Pompeii, only with mud and rock instead of volcanic ash. "The terrible thing about existence," the eye doctor told me a few days later, "Is not that there is suffering, but that there's no limit to suffering. I think there's going to be an explosion," the doctor confided, a sentiment that was echoed many times by many people over the course of my visit. Even Haitians, as resourceful and tough as they are, have their limits. They were watching in the camps. They were waiting. [FRENCH PHRASE] was a line of graffiti you saw everywhere. [FRENCH PHRASE]. We're tired, we've had enough. We're simply, [FRENCH PHRASE]. We're here. That was what people often said when you asked how they were doing. [FRENCH PHRASE] we're here. Or a sassier variation, [FRENCH PHRASE]. Better that we're ugly and here than not here. All those tents in Port-au-Prince, all those thousands of tents, sometimes I'd look at them and imagine an army was massed out there. The last time I talked to my friend Gary, the one whose children had wanted to know if I'd thought they were dead, he told me a barricade had been erected outside the gate of the warehouse where he works. Gary is a logistics manager for one of the big NGOs, and those his warehouse operation was clearly there to do good, people were protesting, they wanted jobs. Gary had hired all the workers he could, but for the people outside it wasn't enough. For two days running, he'd had to negotiate his way through the barricade to get home. It's getting radical, he told me. And then he added, come back soon. Ben Fountain. A few of the short stories that he's written, set in Haiti, are in his collection, brief encounters with Che Guevara. Our program today was produced by our senior producer, Julie Snyder with Alex Blumberg, Ben Calhoun, Jane Feltes, Sarah Koenig, Lisa Pollack, Robyn Semien, Alyssa Shipp, and Nancy Updike. Production help from Brian Reed, Seth Lind is our production manager. Emily Condon is our office manager. Our website, thisamericanlife.org. This American Life is distributed by Public Radio International. WBEZ management oversight for our program, by our boss, Mr. Torey Malatia, oh we have complained, do we have to wear these silly This American Life blazers to work every single day? Can't we stop that? But he just replies, I mean, it's not us deciding. We have bosses in Washington and they are the ones who make those decisions. I'm Ira Glass, back next week with more stories of This American Life. PRI-- Public Radio International.