Mission to Haiti

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Title:
Mission to Haiti report of the United Nations Mission of Technical Assistance to the Republic of Haiti
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1 online resource (xvii, 327 p.) : ill., maps. ;
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English
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United Nations Mission of Technical Assistance to the Republic of Haiti
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United Nations
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Lake Success, N.Y
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Subjects

Subjects / Keywords:
Economic conditions -- Haiti   ( lcsh )
Social conditions -- Haiti   ( lcsh )
Conditions économiques -- Haïti   ( ram )
Conditions sociales -- Haïti   ( ram )
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international intergovernmental publication   ( marcgt )
non-fiction   ( marcgt )

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"United Nations publications. 1942.IIB.2."--T.p. verso.

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Columbia Law Library
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lcc - HC157.H2 U55
ddc - 917.294
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AA00001118:00001


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MISSION TO HAITI















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UNITED
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MISSION TO HAITI




Report of the

United Nations Mission of Technical Assistance

to the Republic of Haiti















Lake Success, New York
July 1949






















UNITED NATIONS PUBLICATIONS
1949. 11B. 2.

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The United Nations Mission of Technical Assistance to the Republic ot
Haiti deserves attention as a new departure in United Nations activities.
Undertaken at the request of the Haitian Government under Economic and
Social Council resolution 51 (IV) of 26 March 1947, it gave impetus to
General Assembly resolution 200 (III) of 4 December 1948, on Technical
Assistance for Economic Development, deliberated on and finally adopted
while the experts drawn from the United Nations Secretariat, the Food and
Agriculture Organization, the International Monetary Fund, the United
Nations Educational, Scientific and Cultural Organization and the World
Health Organization were actively engaged in Haiti in investigation of the
country's development problems. This Mission is in a sense a precursor of
the ampler efforts which, it is hoped, the international organizations con-
cerned will be enabled to display in realization of the bold programme of
technical assistance to underdeveloped countries envisaged by the President
of the United States, and the United Nations contribution to which will be
discussed at the forthcoming session of the Economic and Social Council.
The Mission having now submitted its report, the analysis and recom-
mendations of which have been duly brought to the Haitian Government's
attention, I have pleasure in making it public in full accord with the Presi-
dent of the Republic of Haiti.

TRYOVE LIE
Lake Success
June 1949

















TABLE OF CONTENTS

Page
FOREWORD
1. Origin, organization and procedure of work of the Mission.... xiii
2. Nature of the Mission's Report ........................... xvi


Introduction

1. Basic facts and findings .................................. 1
2. Recommendations ...................................... 7
(a) General recommendations ............................ 7
(b) Abstract of specific recommendations .................. 14


PART I

Demographic, Educational and Health Problems
Affecting Haiti's Economic Development
I. HAITI AND THE HAITIANS
1. The country, the nation, and the fundamental problem ..... 25
2. The people
(a) Size and growth of the population ................... 27
(b) Population density and occupational pattern .......... 29
(c) Deaths and births ................................ 32
(d) The population problem viewed in relation to economic
development needs ............................... 34
3. Income and standard of living .......................... 36

II. EDUCATION ............. ................. ................. 43
1. Structure of the educational system ..................... 43
2. Criteria for the educational effort ....................... 45
3. Reduce illiteracy ..................................... 46
4. Books- essential tools of learning ....................... 48
5. Vocational education and industrial training .............. 50





6. Community schools ..................... .............
7. T teacher training .....................................
8. Conclusions .................... .......... ............

III. PUBLIC HEALTH PROBLEMS
1. Basic factors .........................................
2. The Haitian health organization
(a) General structure ................................
(b) Central health administration ......................
(c) Provincial health administration ....................
(d) Rural clinics and dispensaries ......................
(e) Rural doctors ................... ..............
3. Prevalent diseases .................. ................. .
(a) Yaws ................. ... ... .................
(b) M alaria ............ ........... ...............
(c) Tuberculosis ............... ....... ............
(d) Ancylostomiasis ..................................
4. Public health and fundamental education at Marbial .......
5. Conclusions and recommendations .......................



Appendix

Plan and estimate of costs of a country-wide anti-yaws campaign ....




PART II

Problems of Production, Transport, Trade and Finance
as Determinants of Haiti's Economic Development
I. AGRICULTURAL DEVELOPMENT AND RURAL WELFARE
A. Natural characteristics, economic structure, and institutional
environment of Haitian agriculture
1. N ature of the land ...............................
2. Resources, tenure, and production methods ...........
3. W ays of life of the peasants ........................
4. T transport facilities ...............................
5. Irrigation .......................................
6. Taxation, credit conditions, and local trade practices ..
7. External trade in agricultural goods .................
8. Production for local consumption ...................


Page
54
57
58


60

61
64
64
65
65
66
66
68
70
72
73
75





Page
9. W ork practices ................................... 100
10. Agricultural training .............................. 102
11. Development measures ............................ 103
B. Recommendations on policy and procedure ............... 104
C. Recommendations on agricultural development projects .... 121

Appendix

Notes and recommendations on specific crops
(i) Cacao ............................................. 131
(ii) Coconut and oil palm ................................. 132
(iii) R ice ................................................ 134
(iv) R ubber ............................................. 135
(v) T tobacco ............................................ 137
(vi) Cotton and cotton seed ................................ 139
(vii) Sugar-cane .......................................... 141
(viii) Bananas ............................................. 141
(ix) Fruit trees ........................................... 141
(x) Bam boo ............................................. 143

II. FISHERIES ........... ... .. ..... ....................... 144
1. Condition of the fishing trade .......................... 144
2. Fisheries law s ........................................ 146
3. Estimate of the catch ............ .. ................ 147
4. Handling, marketing, and processing .................... 150
5. The future of the marine fisheries ....................... 151
6. The fisheries requirements of Haiti ...................... 154
7. Fish culture ......................................... 156
8. Recommendations .................................... 161

Appendix

I. Observations on salt and fish salting .................... 162
II. Expansion of the marine fisheries ...................... 164
III. Reference sources on fisheries ......................... 167

III. INDUSTRY
A. General conditions ................ ..................... 169
B. Potential industrial resources ........................... 172
1. Agro-industrial resources ........................... 173
2. M ineral resources .................................. 179
(a) Construction materials ......................... 179
(b) M etallic m inerals .............................. 181
(c) O their m inerals ................................ 182





Page
3. Fuel and power resources............................ 183
(a) Hydro-electric energy .......................... 183
(b) Lignites ........................... ........... 185
(c) Lumber and charcoal .......................... 186
(d) Wind power .................................. 187
4. Small-scale engineering and repairs ................... 187
5. Handicrafts ..................... ................ 187
C. Organizational measures
1. General organization ............................... 189
2. Industrial statistics ..................... ............ 191
3. Industrial promotion and its co-ordination with agricul-
tural development efforts ........................... 192
4. Legislation for industrial development ................ 193
D. Industrial research and technical training ................. 194
E. Tariff, fiscal-policy and credit-organization aspects of indus-
trial development promotion in Haiti .................... 195
F. Summary of recommendations on industrial development ... 197

IV. TRANSPORT, TRADE, AND FOREIGN INVESTMENT
A. Transport and communications
1. Structure and characteristics ........................ 200
2. Improvement of the road system ..................... 203
3. The sea transport situation ........................ 207
B. External trade ........... ........................... 209
1. Balance of trade ................................... 209
2. Exports and imports by commodities .................. 212
3. Geographical orientation of the external trade .......... 217
C. Tourism ......................................... 219
D. Foreign capital investment ............................. 221

V. CREDIT ORGANIZATION
1. Money and banking structure .......................... 227
(i) Banque national de la Ripublique d'Haiti
(a) Legal status ................. ............... 228
(b) Organization and functions ................... 229
(c) Assets and liabilities .......................... 231
(ii) The Royal Bank of Canada ....................... 239
(iii) Fractional currency .............................. 239
(iv) The money supply .................. ............ 241
(v) Private money lending ............................ 247





2. Analytical commentary Page
(i) The problems of an export economy ................ 248
(a) Stability .................................... 249
(b) Development ............................... 250
(ii) Inflationary and deflationary disturbances ........... 250
(iii) M monetary and fiscal policies ....................... 251
(iv) Development promotion .......................... 254
(v) Financing development ........................... 254
(vi) The exchange problem ........................... 259
(vii) The banking system .............................. 260
3. An agricultural and industrial development bank .......... 265
4. Assistance from international organizations ............... 268
5. Supplementary considerations .......................... 270
6. Summary of conclusions, suggestions and recommendations .. 271


VI. PROBLEMS OF PUBLIC FINANCE ............................ 275
A. Institutional framework of Haitian public finances ......... 275
1. Constitutional provisions ........................... 275
2. Fiscal administration ............................. 276
3. Budget procedure ................................. 278
4. Publication of public finance data .................... 281
B. Evolution of the public finances
1. Budget trends ..................................... 282
2. Revenue pattern ..................... ............. 285
3. Expenditure pattern ............................... 295
4. Public debt ............ .......... ............... 296
5. Local government finances .......................... 301
C. The functioning of the fiscal system ...................... 306
1. Fiscal administration and budget procedure ............ 307
2. Sources of revenue ................................ 309
3. Allocation of expenditure ........................... 314
4. Reporting of fiscal accounts ......................... 316
5. Relationship between local and central government
finances .......................................... 318
D. Summary of suggestions and recommendations ............ 318

Annex
Tables
18. R eceipts ........................................ 322
19. Expenditures .................................... 323
20. Outline for an adaptation of the Haitian budget classi-
fication to the Scandinavian model .................. 324












LIST OF TABLES
Page
1. Estimate of costs of a country-wide anti-yaws campaign ....... 79
2. Imports by principal groups, 1946/47 ...................... 93
3. Agricultural exports, 1946/47 and 1947/48 ................. 94
4. Percentage composition by weight of Liverpool salt, Turks Island
salt and H aiti salt ...................... .................. 162
5. External trade, fiscal years beginning 1 October 1916/17-1947/48 210
6. Partial balance of payments for Haiti, years ended 30 September
1947 and 1948 ............ .. .... .. ................... 213
7. Exports of principal commodities .......................... 214
8. Percentage distribution of imports of principal commodities .... 215
9. Percentage geographical distribution of imports and exports .... 218
10. National Bank of the Republic of Haiti
A. Retrospective summary of balance sheet position
31 December 1927, 31 December 1934, 31 March 1947 and
31 Decem ber 1948 .................................... 232
B. Analytical summary of Balance Sheet for 31 December 1948 233
11. Summary of budget accounts, 1936/37-1948/49 .............. 283
12. Sources of revenue ..................................... .. 287
13. Sources of customs revenue .............................. 289
14. Allocation of expenditures ................................ 295
15. Haitian public debt, amounts outstanding on 30 September 1937-
1948 ......................... ............. ............. 298
16. Local governments' receipts ............................. 303
17. Deductions made by the Internal Revenue Service from gross
receipts of the communes ................................ 305
Annexes
18. Budget receipts, 1936/37-1948/49 ......................... 322
19. Budget expenditures, 1936/37-1948/49 ..................... 323
20. Outline for an adaptation of the Haitian budget classification to
the Scandinavian model .................................. 324














LIST OF CHARTS AND MAPS


Page
I. Exports and imports, 1926-27 to 1947-48 .................. 211
II. Assets of the Banque national de la Ripublique d'Haiti, 1946-
1948 .................. .......... ....... ............. 234
III. Liabilities of the Banque national de la Ripublique d'Haiti,
1946-1948 ........... .......... ................... 235
IV. Assets of the Banque national de la Ripublique d'Haiti, 1927-
1948 ....................... ... ...................... 237
V. Liabilities of the Banque national de la Ripublique d'Haiti,
1927-1948 ................... ... .................. 238
VI. Assets of the Royal Bank of Canada in Haiti, 1946-1948 ..... 240
VII. Liabilities of the Royal Bank of Canada in Haiti, 1946-1948 .. 240
VIII. Domestic money supply, 1946-1948 ...................... 242
IX. Origin of the money supply, 1946-1948 ................... 243
X. Estimated money supply, 1927-1948 ...................... 246
XI. The Banque national de la Republique d'Haiti, monetary
liabilities and their origin, 1927-1948 ..................... 246
XII. Central and local Government receipts and expenditures,
1936/37 to 1947/48 ................................... 284
XIII. Value of exports and imports and total Government revenue,
1920/21 to 1947/48 ................................... 286
XIV. Receipts, 1936/37 to 1947/48 ............................ 288
XV. Components of customs duties, 1935/36 to 1947/48 ......... 290

Figure 1. Mean annual rainfall in Haiti ........................ 84
M ap of H aiti ................................. Inside back cover
Map showing distribution of present production and possible expan-
sion ....... .................................... Inside back cover












Foreword


1. ORIGIN, ORGANIZATION AND PROCEDURE OF WORK OF THE MISSION
Desiring to take advantage of United Nations technical assistance in
planning for the economic development of Haiti, the Haitian Government,
on 10 July 1948, requested the Secretary-General to organize a United
Nations Technical Mission for the purpose, in accordance with Economic
and Social Council resolution 51 (IV) of 28 March 1947.1 On 20 July 1948
the Secretary-General acceded to that request, the mutually agreed terms
of reference for the Mission being the following:
"At the request of the Government of the Republic of Haiti the Secretary-
General of the United Nations undertakes, in conformity with resolution
51 (IV) of the Economic and Social Council, to organize, in co-operation
with the appropriate specialized agencies, a team of experts to advise with
the Haitian Government on problems related to the economic development
of Haiti. This team will visit Haiti for an estimated period of about two
months, and will undertake:
"(1) To examine the problems of and the conditions affecting the eco-
nomic development of Haiti primarily in the fields of agriculture, industry
and related activities, having regard to the inter-related economic and
social problems bearing, in particular, on the improvement of health and
education;
"(2) In the light of this examination and in taking cognizance of related
government programmes or plans, to formulate proposals as to practicable
measures, including those of a public finance nature, designed to promote
the economic development of the country;
"(3) To appraise the needs in terms of organizational arrangements and
technical assistance implied by the measures proposed."
It was further agreed that the Mission should report to the Secretary-
General, who would transmit its findings to the Haitian Government.
In implementation of the above undertaking a team of experts was set
up in consultation with four specialized agencies, namely, the Food and
Agriculture Organization, the International Monetary Fund, the United
Nations Educational, Scientific and Cultural Organization, and the World

Part A, paragraph 3, of that resolution instructs the Secretary-General to render
assistance to Member Governments which seek expert advice in securing, on terms
mutually agreed upon, such advice, particularly in the form of teams of experts who
would study specific problems and recommend appropriate practical solutions for
the consideration of the Member Governments concerned".
Part B of the same resolution instructs the Secretary-General, in implementing
the above instruction, to work at every stage in close co-operation with the specialized
agencies.






Health Organization, which were requested to nominate experts in their
service who could participate in the United Nations Mission as members
conversant with the various problems in the field of agriculture, credit
organization, education, and health, having a bearing on the general prob-
lem of economic development of underdeveloped countries. The other
members of the team were drawn from United Nations economic affairs
officers, among whom the Special Adviser to the Assistant Secretary-General
in charge of Economic Affairs was selected to head the Mission.
As initially agreed with the Haitian Government, the Chief of the Mission
made a two-weeks' preliminary visit to Haiti in the early part of August
1948, for organizational arrangements, for exploratory examination of the
general economic picture with a view to determining the main lines of the
programme and the most expedient composition of the Mission, and for the
assembly of pertinent documentation in preparation for the studies to be
undertaken. To facilitate this preliminary exploration a comprehensive
committee of national experts had been set up in Haiti. Their continued
collaboration in the different phases of the investigatory work of the Mission
proved of great value.
The composition of the Mission as finally constituted is shown below. The
fields of special experience of the individual experts are broadly indicative
of the particular aspects of the Haitian development problem assigned to the
different members for study. All the members, however, were to work in
close consultation with each other in contributing to the joint team work,
and none was expected to report individually.
Members
Ansgar Rosenborg, Chief of the Mission, United Nations
William H. Dean, Secretary of the Mission, United Nations
William G. Casseres, expert in Agricultural Development, Food and Agri-
culture Organization
Carle Fritzle, expert in Tropical Agriculture, Food and Agriculture Organ-
ization
Ernest F. Thompson, expert in Development of Fisheries, Food and Agricul-
ture Organization
Edwin R. Henson, expert in Combined Resource Development, United
Nations
Adolfo Dorfman, expert in Industrial Development, United Nations
Alexander McLeod, expert in questions of Finance and Credit Organization,
International Monetary Fund
Elba Gomez del Rey, expert in Public Finance, United Nations
Frederick J. Rex, expert in Fundamental Education, United Nations Edu-
cational, Scientific, and Cultural Organization





Adolf Kundig, expert in Tropical Public Health Organization, World Health
Organization
Una M. Russell, Administrative Assistant and Secretary to the Chief of the
Mission, United Nations
The general situation as regards external trade and internal transport and
communications would have to be taken into account in the over-all review
of the country's economic development problem without provision at this
initial stage of specialists on these questions, as considerations of the costs
falling on the Haitian Government imposed certain limitations on the size
of the Mission. Nor was any specialist on labour questions included in the
team, as the Government had already had the benefit of advice on these
matters from the International Labour Organisation following a special
mission to Haiti by an expert of that organization.
Some time in advance of the date set for the departure of the Mission
the members gathered at United Nations Headquarters to study the docu-
mentation brought together and prepare the plan of work. The Mission
proceeded in the middle of October to Haiti, where it spent two months'
in intensive investigation of the development problems in the various
economic and related fields.2
At this point the Mission wishes to express its great appreciation of the
excellent arrangements made by the Haitian Government to aid in its task
and co-operate actively in the investigations. For office purposes the Gov-
ernment placed at the Mission's disposal in Port-au-Prince a house ade-
quately provided with equipment and supplies. In addition, the Government
furnished to the Mission local secretarial staff and junior research assistants,
while the senior officers of the various ministries and technical services
readily assisted the Mission experts with information and advice. The
Mission also wishes to record its gratitude to the Haitian Government for
its solicitude for the personal comfort of the members of the team.
The Mission found great encouragement in the deep interest shown in its
work by His Excellency Dumarsais Estim6, President of the Republic. As
'Some of the members spent less than two months in Haiti. Mr. Dorfman and
Mr. Thompson arrived somewhat later than the main party of the Mission, and
Mr. Thompson concluded his work in Haiti a few days earlier than the other mem-
bers. Mr. Casseres and Mr. Dorfman interrupted their Mission work for a brief
interval each to attend to pressing duties at the FAO and United Nations head-
quarters. Brief trips to other countries of the region for technical consultations and
study of solutions to development problems analogous to those confronting Haiti
were made, with the Haitian Government's approval, by the Mission's specialists in
the fields of agriculture, fisheries, small industries, education, and credit organization.
Most of these consultations took place in Puerto Rico, where special facilities gra-
ciously arranged by the United States Department of the Interior and the Insular
Government of Puerto Rico were provided for the purpose.
SValuable advice in the field of fisheries was obtained by the Mission from
Mr. Mogens Jul, officer of the Fisheries Division of FAO, who visited Haiti briefly
in November in connexion with his regular duties.





principal officer for liaison with the President and the various branches of
the State administration, Monsieur Stephen Alexis, Minister Plenipotentiary
and Delegate to the United Nations, rendered indefatigable service to the
Mission, greatly facilitating its task.
With the Mission headquarters at Port-au-Prince as a base, the members
travelled extensively, in groups or individually, making field studies through-
out the country. On these field trips they were accompanied by national
specialists in the subject matters studied, who shared generously of their
knowledge and ensured necessary local contacts. Living, working, and trav-
elling together the experts of the Mission had the opportunity of continuous
exchange of views and experience. Observations and conclusions were dis-
cussed with a view to the framing of duly integrated recommendations
concerning the different aspects of the over-all problem studied by the
Mission. The general lines of the joint report were laid down before the
Mission returned to Lake Success toward the end of December.

2. NATURE OF THE MISSION'S REPORT
The report as here presented is a product of team work incorporating
the contributions furnished by the different experts in consultation with
each other. In elaborating their contributions they have naturally taken
advantage also of advice from others, and especially from fellow experts in
the organizations to which they belong. While the findings, suggestions and
recommendations here given represent the consolidated views of the Mission,
it does not follow that they are necessarily endorsed in full detail by the
various United Nations organs from which the members of the Mission
were drawn. In other words, the members have served on the Mission
primarily in their capacity of experts in the substantive fields covered by the
Mission's investigations.
The Mission has set as its primary task to draw up, in the light of its
examination of Haiti's economic conditions and relevant problems, a com-
prehensive and consistent framework, as it were, for the policy it advises
the Government to apply in endeavouring to promote the economic devel-
opment of the country. Within this general frame we propose various
measures, in part of an organizational nature, designed to broaden the scope,
hasten the pace, and increase the efficiency of the national developmental
effort, and to ensure lasting beneficial results therefrom.
The review here given of conditions in the various fields to be taken into
consideration with reference to the over-all problem of Haiti's economic
development and the recommendations or suggestions made in the report
relate to the situation found to obtain at the time of the Mission's sojourn
in the country. Account has not been taken in the report of subsequent





developments or of measures subsequently initiated. The Mission wishes to
recognize, however, that some of these measures have in fact been initiated
on lines that broadly conform to recommendations contained in the present
report.1
In confining itself at this initial stage of United Nations technical assist-
ance to Haiti to reviewing problems and conditions, formulating recommen-
dations for policy guidance, and suggesting remedial measures, without
entering into details of implementation, the Mission has kept in mind the
desirability, not to say the necessity, of Haiti's having recourse to continued
expert assistance in the minute planning and execution of specific projects
undertaken in accordance with the advice here proffered. The Mission
wishes to draw the attention of the Haitian Government to the facilities for
technical assistance in various forms which the Secretary-General of the
United Nations is authorized under General Assembly resolution 200 (III)
of 4 December 1948 to render (in fact on somewhat more liberal terms than
those previously afforded by Economic and Social Council resolution 51
(IV) under which the Mission to Haiti has been operating) to Member
Governments in need of such assistance. In addition, technical assistance
m the substantive fields covered by the United Nations specialized agencies
may be sought directly from these agencies.
The Mission has not engaged in cost estimates for particular develop-
ment projects,2 and to attempt any "wholesale" estimate of the costs
involved in an over-all programme of economic development of the country
would obviously serve no practical purpose. On various points in our
report we stress the necessity for the development effort, if it is to be
lastingly successful, to rely in the first instance on efficient utilization of the
nation's own means. In view of the relative paucity of these means, how-
ever, recourse will have to be had to borrowing abroad for the financing
of larger Government-sponsored development projects requiring sizable
capital investment. It is for the Government to define such projects in
precise detail and to decide where, and in what form, to seek the
external capital needed. In undertaking projects requiring external financing
it is particularly desirable and necessary to proceed by steps and with great
circumspection, in order to allow the economy-strengthening results of
first priority projects to take effect before adding new foreign debt com-
mitments. Any foreign lender for specific development projects will
obviously wish to make his own appraisal of the costs and credit-worthiness
of the particular projects involved prior to risking his funds.

Reference to such measures is made in footnotes to relevant passages or recom-
mendations contained in the report.
2 An exception to this rule is the estimate of the costs of a country-wide -nti-vaws
campaign, which estimate is appended to part I, chapter II, Public Health Fioblems.









INTRODUCTION
Haiti's economic development is confronted with a great variety of
problems. Many of these Haiti has in common with other underdeveloped
countries; but some of the problems, and indeed the most difficult
ones, present themselves with particular acuteness in the Haitian economic
picture. They are dealt with at some length in the nine chapters con-
stituting the main body of our report, which are devoted to review and
analysis of conditions in the different substantive fields. Many suggestions
and recommendations are given in these chapters. For the convenience
of those primarily interested in one or the other of these fields who may
wish to obtain a concentrated over-all view of the Haitian situation and
of the suggestions made to improve it, a brief summary of facts and
findings is given here, together with (a) a series of general .recommenda-
tions relating to the Mission's observation of the field as a whole, and
(b) an abstract of the specific recommendations contained in the indi-
vidual chapters that follow.
1. BASIC FACTS AND FINDINGS
Agriculture is clearly the mainstay of the Haitian economy and is likely
to remain for many years to come the primary source of Government
revenue. Agricultural production is not large enough, however, to provitle
the population-either directly or by way of imports obtained in exchange
for exports-with the quantity and types of goods required to maintain an
adequate minimum standard of nutrition and clothing. As the mineral re-
sources of the country are small, the principal problem of Haitian economic
development consists in improving the agricultural and forest resources
and increasing the efficiency of their utilization. An effort towards a broad
rural development programme including the development both of agricul-
ture, forestry and fisheries, and of supplementary industrial and handicraft
activities, utilizing mainly agricultural materials, and including also the
development of the aptitudes and work capacities of the rural population
through health improvement, education, and organization of community
living, will therefore do the most good to the largest number of people.
In placing such emphasis on rural development we do not mean to
suggest that the development of activities in the urban sphere should
be delayed. All development problems, rural or urban, requiring support
in one way or another from the Government should be considered
jointly, and evaluated in terms of their probable net contribution to the




















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Mountain area showing great pressure on the resources. Area is deforested, cultivated by hand in small patches with machete
and hoe. Erosion takes heavy toll of fertility. Fields have very thin layer of soil. Note landslides, worn paths and gulleys.
Many fields are no longer farmed.




INTRODUCTION j


national economy, due account being taken of the period of time within
which a reasonable return may be expected; hence priorities should be
determined on the basis of a balanced approach.
Haitian agriculture is faced with the grave problem of sustaining an
expanding population on shrinking land resources. It is high time to arrest
the dissipation of the basic wealth of the country and to reverse the trend.
Impoverished land must be reclaimed and unproductive tracts opened up
for agricultural use by irrigation, drainage, flood control, reforestation,
and other anti-erosion and soil-conservation measures. Wasteful cultivation
methods practised by a little-educated and growing population steadily
pushing up the slopes, and wasteful methods of forest exploitation and of
consumption of forest products have led to a most serious denudation of
once well-wooded areas of great extent. Haiti's forest resources are now
small, and the loss of forest cover has entailed disastrous floods and
precipitated destructive erosion.
. The tillage area at present under irrigation is estimated at between
35,000 and 40,000 hectares. The possibilities for extended irrigation are
significant but by no means unlimited. The soil has been abused by back-
ward methods of cultivation-failure to apply manure or fertilizers, and
absence of crop rotation; but the soil appears to have good recuperative
powers in many places and there are substantial stretches where it is quite
fertile. In the midst of areas where the soil is largely exhausted some unused
land of good quality is not infrequently to be found.
The deforestation has for several decades gone hand in hand with a
steady decline in the production of coffee, Haiti's principal export product,
in the cultivation of which, mostly at or above an altitude of 1,500 feet, the
country has a natural advantage.
Plantations are few, covering perhaps ten per cent of the cultivated area.
Peasant holdings accounting for most of the non-plantation area are in-
dividually small, and often excessively parcelled. Land tenure is largely
ill-defined and insecure. Export taxes levied on the principal products
weigh heavily on the primary producers who also fall victims to usurious
credit practices. As, moreover, difficult transport conditions and various
institutional factors give rise to wasteful marketing procedures, keeping
the costs of marketing of peasant produce at a next to prohibitive level in
many instances, the net cash return to the producer is often pitifully small.
Technical retardation also characterizes Haitian marine fisheries, which
yield considerably less than their potential. The Mission viewed fisheries
exclusively from the standpoint of domestic consumption requirements,
which are at present very inadequately met, in part by imports. Fish
culture in ponds would appear the only means capable of expanding the












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An excellent irrigation structure built by the French, long neglected but recently dug, out from under debris several feet
thick and restored for use. Organization for consistent and continuing management and maintenance of such facilities is
essential. The local users should have more responsibility, as an inadequately or uncertainly financed agency of the
government cannot provide the constant care required.


A^





INTRODUCTION 5

supply of fish from local resources to a volume reasonably close to con-
sumption requirements. Haiti possesses a very considerable area of lakes,
rivers, irrigation canals and ditches, waste land capable of being flooded,
and a great variety of shallow lagoons both salt and fresh, which could,
under proper expert guidance, be put to good use in fish culture. Develop-
ment measures to that effect will have to be intimately tied in and co-
ordinated with the comprehensive measures for land reclamation and
improvement and water resource control called for by the broader
agricultural development effort.
Manufacturing and mining are little developed. Processing of sugar cane
and decortication of sisal chiefly for export, and lumbering and sawing
of timber for the home market represent major agro-industrial activities.
Encouraging results have been achieved in the production of essential oils
for export. Extraction of edible oils for domestic consumption is under-
taken in modern plants, and a technically perfected sizable cotton mill
capable of satisfying a substantial part of the country's present demand
for coarse cotton fabrics has recently been set up at Port-au-Prince. Such
other industries as are now to be found in Haiti are technologically little
advanced and are operated on a quite modest scale to meet the local
demand for certain elementary consumption goods. A notable expansion
has taken place of late in handicraft manufacture of fancy articles,
principally of sisal and mahogany, for export.
From such partial surveys as have been made of the apparently not very
varied mineral resources it would seem that Haiti possesses good raw
materials for lime and cement manufacture and in sufficient quantity to
satisfy domestic requirements. Fairly ample deposits of bauxite have been
located in different parts of the country and exploratory production has
been undertaken by a foreign concern. Other metallic minerals seem
relatively scarce, but their occurrence has not yet been adequately investi-
gated. There are deposits of lignite which might prove worth exploiting,
more especially for generation of thermo-electric power. There are also
some hydro-electric power resources which could be made use of for
economic development purposes.
This rapid review of the productive resources and the state of their
utilization will suffice as a general background for a succinct summary
of the principal findings in the light of which the Mission has formulated
its proposals and recommendations. These findings, stated more amply
and with pertinent qualifications in the subsequent chapters, are the
following:
The fundamental economic problem of Haiti derives from relentless
pressure of a steadily growing, insufficiently educated population upon





6 MISSION TO HAITI

limited, vulnerable and-so far as agricultural land is concerned-
alarmingly shrinking natural resources.
In the circumstances per capital real income is extremely low and family
incomes of the great mass of the people are barely sufficient to meet
rudimentary requirements of food, clothing and shelter; hence capital
formation is very slow, incapable of providing the means for such de-
velopment ventures as would require large capital sums for their execution.
The general standard of living is so low as not to permit of further
compression. This fact narrowly circumscribes the possibilities of broaden-
ing the tax basis to increase Government revenues, which are small and
call for careful husbanding in relation to vital current needs, leaving
little surplus, if any, for capital purposes.
Medical care is very inadequately provided for in the rural areas, and
for lack of education facilities the great majority of the population is
illiterate and, as such, bound by ancient traditions and retarded production
techniques. Without a minimum of fundamental education, however, it is
nQt possible effectively to improvethe health and raise the productive
capacities of the people.
Production and exports, though somewhat broadened in scope during
the last few decades and particularly in recent years, are still relatively
little diversified, and transport facilities are highly inadequate.
There is a lack of credit facilities, especially as regards medium- and
long-term credit to agriculture, small industry and handicraft, and lack
of facilities also for channelling into productive' investment such indi-
vidually small savings as are made by some parts of the population
despite the low general level of income.
The central aim to be set for the economic development is to raise
the general standard of living. To this end national real income must be
increased at a rate exceeding the rate of growth of the population; this
goal canofily be achieved by a determined expansion of physical produc-
tion by broadening its material basis and mobilizing for the purpose
(within the limits set by efficiency considerations) the abundant and now
poorly employed manpower.
To cope with this task a resolute national effort marshalling the energies
and skills of all the people is required. It is advisable that in this effort
primary emphasis be laid on broad rural development. In any organiza-
tional arrangements for developing community living, improving sanitation,
promoting melioration and better utilization of land and other local
resources, opening up new and improving already existing roads and other
transport and communications facilities, and so on, the active co-operation
of the local population should be enlisted. It is important to foster a spirit





INTRODUCTION 7

of self-help among the people, encouraging the use of such capital and
material assets as they may possess themselves and stimulating co-operative
ventures, for many things can be done by such groups which individuals
cannot do alone.
2. RECOMMENDATIONS
Good plans have been laid at different times in the past and worthwhile
development projects undertaken for their realization, but they would
appear not to have 'formed part of a well-conceived general programme
embracing all the different aspects of the national economic development;
they have therefore lacked in co-ordination and continuity, have fre-
quently been piecemeal in nature, have often not been consistently
followed up by appropriate care for and maintenance of capital assets
created, and have therefore in the long run fallen short of the desired
results. This unsatisfactory state of affairs is largely explained not only by
lack of adequately trained technical personnel-which, in principle, could
have been remedied, at least in some degree, by more extensive use of
external technical assistance-but also and above all by lack of organization
for comprehensive planning and continuous supervision of the develop-
mental endeavour.
Under its terms of reference the Mission should appraise the need for
organizational arrangements implied by the measures designed to promote
the economic development of Haiti which it might propose. Proposals
and recommendations of this nature are given at various points in our
report. Those of a general nature, bearing simultaneously on several if not
all of the different sectors of the Mission's field of investigation, are given
here in full, and are followed by an abstract of the specific recommenda-
tions which are to be found in the chapters examining these sectors
individually.
(a) General recommendations
(i) To ensure continuity of policy in the..determination of national
requirements and the formulation of development objectives and targets,
to advise on fiscal policy and budget planning, to provide for adequate
technical and economic study, for objective appraisal and establishment
of priorities of projects for agricultural reorganization and improvement,
encouragement of supplementary industrial and handicraft activities, utiliza-
tion of the country's economic resources, active development of the credit
organization, of trade, transport and communications, amelioration of
health conditions and advancement of fundamental education, in short,
for the promotion of the welfare of the nation, the Mission recommends
that an independent advisory national resources and development board be
established with five full-term members.





8 MISSION TO HAITI

The five appointed members of the board should be nominated by the
President of the Republic for renewable terms of five years each, but the
terms should be staggered so as to give the body continuity. As indicated by
the above enumeration of its tasks, the Board would have essentially plan-
ning and general supervisory functions and should report directly to the
President.
The choice of the five full-term members of the Board should be made
from citizens of Haiti-"notables" on the national level-taking no active
part in politics, distinguished in the present and in the past for their
knowledge and experience of the problems of the country, and for their
good judgment and devotion to the betterment of Haiti. (The Mission
suggests a small regular membership of the Board in order that it should
be an efficiently functioning body.) The Board's meetings should be closed.
The Secretaries of State for Agriculture, for Trade and National
Economy,1 and for Finance, and the President-Director-General of the
National Bank of the Republic should ex officio be non-voting associate
members of the Board. Any other Secretary of State would be entitled to
take part, at his own discretion and in a non-voting associate-member
capacity, in any meeting at which matters falling, from an executive point
of view, under the jurisdiction of his Ministry were being considered
by the Board. Secretaries of State would have the right to be represented
at meetings of the Board by Under-Secretaries of State, and the National
Bank President by a vice-president of the Bank. The Board would be
entitled to invite for hearings, at its own discretion, Under-Secretaries of
State, Directors-General of Government technical services, other technicians,
or representatives of agriculture, industry,. trade and transport, finance,
educational and health organizations or institutions, or any other person it
wished to consult with reference to specific development projects or prob-
lems. The Board would be entitled to hold at its own discretion working-
party meetings unattended by associate members or their representatives.
The Board should be provided with a permanent technical secretariat,
to work as an independent organ in close contact with the President of
the Republic. The secretariat should be provided with a budget sufficient
for its research, investigation, and clerical work, and for adding to its staff,
for long or short terms, such technical advisers as may not be available in
the Government ministries and other institutions. The Board would make
full use for its secretariat of technical advisers,- without neglecting sources
of advice in Haiti, but whenever necessary, and subject to the President's
approval, calling upon outside technical assistance and advice, particularly

'Reorganized ministry proposed in part II, chapter III, Industry, section C, 1,
page 191.





INTRODUCTION 9

from international agencies. The secretariat should be under the direction
of the Secretary-General of the Board, who should be a person technically
qualified by his experience in Haiti or in other countries with similar
problems, to guide the conduct of surveys and studies of development
projects and to aid in the technical evaluation and choice of projects to be
carried out. He should have the right of direct access to the President of
the Republic, should be given authority equivalent to that of an Under-
Secretary of State or a director-general of a technical department, and
should be empowered to call upon the staffs of the ministries, the National
Bank (particularly its Research and Statistics Service),' and other govern-
mental institutions for information in their possession and for the carrying
out of studies necessary for the evaluation of projects.
The chief function of the secretariat would be to provide for the Board
the technical information and recommendations necessary to enable the
Board to evaluate proposed projects for economic development and to
review progress of projects already under way. The Board, on the basis of
this information, would make recommendations to the President of the
Republic concerning plans, programmes, and specific projects and on
over-all policy with regard to economic development. The execution of
projects would not be the responsibility of either the Board or its secretariat,
but would remain the task of the existing governmental executive services
and institutions.
It is recommended that the Secretary-General of the Board be made the
Chairman of an Inter-Ministerial (Inter-Departmental) Technical Co-
ordination Committee, at the Under-Secretary of State level. Such a com-
mittee would be of great service for mutual information, contact and
co-operation, would facilitate the practical co-ordination of the execution
of economic development work in particular, and would be a means of
current checking of the progress made on projects in course.
In part II, chapter IV, Credit Organization, recommendation 4 (b),
the suggestion is made that the Secretary-General of the National Re-
sources and Development Board should be an ex officio member of the
proposed new General Board of the National Bank of the Republic. The
reciprocal representation of the Bank on the Resources and Development
Board and of that Board (through its highest permanent officer) on the
Board of the Bank would go far to secure the desired co-ordination of the
developmental work of these two important policy-guiding agencies.
;(ii) The capacity of the public administration for sustained action is
impaired by insecurity of tenure of the staff, exposed to the caprices of

'Reorganized service proposed in part II, chapter V, Credit Organization, recom-
mendation 6, pages 273-274.





MISSION TO HAITI


political change detrimental to the stability and efficiency of the civil
service. For lack of firm rules consistently applied to govern uniformly the
conditions of service of all categories of staff, administrative, clerical,
technical, and professional, circumstances have been inauspicious for im-
parting to the Haitian civil service that cohesion, awareness of purpose
and consciousness of duties and responsibilities which are necessary for
effective administration essential for successful pursuance of the develop-
mental effort. Therefore, the Mission recommends that measures be taken
to improve the civil service through appropriate reform of relevant laws,
regulations, practices, and administrative arrangements, including rules and
arrangements concerning recruitment, tenure, functions, rights and obliga-
tions, emoluments, promotion, retirement, or dismissal of staff. It is im-
portant to devise as a basis for the constitution of the civil service a merit
system free from political intrusions. Reform of the organization and
methods of the public administration is also required to improve its effi-
ciency. Expert help in the comprehensive reforms here envisaged may be
provided by the United Nations through its machinery for technical
assistance for economic development.
- (iii), In the examination made elsewhere in this report of the conditions
obtaining in particular substantive fields emphasis is laid in different con-
nexions on the importance of enlisting the active co-operation of the local
people, through organs of their own, in the national developmental effort.
Accordingly, the Mission recommends that the Government consider
measures to encourage-local initiative 'and self-help in a spirit evolving-
free from particularism-within the frame of national objectives and
endeavours. To this end it is recommended that the organs of local
government-weak at present under the impact of a centralization which
would appear to have been pushed too far-be strengthened to play their
proper part in developmental public works, in improving sanitary installa-
tions and water supplies, in providing other facilities for health improve-
ment, facilities for advancing education, etc. To this end they need enlarged
financial means and widened powers and responsibilities. Examples are not
lacking in Haiti of local entities which by organized effort have supple-
mented the resources accorded them for erection and maintenance of
schools and roads. Generalization and systematization of such joint
local/national efforts are needed.
Encouragement of local initiative and self-help should not be confined
solely to the strengthening of organs of local government. Community
organization in other forms designed to benefit in the first instance the
immediate participants in such ventures will be equally if not more
important. Co-operative action, if properly institutionalized, may prove
a particularly powerful lever for rural development. Expert advisers in





INTRODUCTION 11


$ *,,. '4.... .. 1 .- t. -' i.-: '*





Ferry carrying produce and passengers across Ravin du Sud near Les Cayes.
Lack of bridges, roads, and transport still greatly handicap
economic development.
both fields may be provided through United Nations technical assistance
machinery.
(iv) A serviceable system of transport and communications is a main
key to economic and social development. Haiti has as yet barely the begin-
nings of such a system, so far as road transport and coastwise shipping are
concerned. The Mission recommends that a master plan for speedy ameliora-
tion in the first instance of existing "national roads" and of "departmental
roads" of vital importance should be prepared without delay, a plan for the
country as a whole, to serve as a basis for developing road transport and
communications in the national interest and to guard against fragmentation
induced by local political pressure groups. Suggestions as to the scope of
that plan in its initial phase are made in part II, chapter IV, section A.2.
It should include, in the case of principal roads, provision of a permanent
surface which with appropriate and unfailing maintenance would be
capable of resisting the vagaries of the Haitian climate. Expert advice,
drawing on experience gained in countries with similar climate, topography,
and soil conditions, should be sought on the choice of material to be used
for such permanent surfaces, the elements of cost involved in initial con-
struction and subsequent maintenance of roads surfaced with one or
another kind of material in different types of terrain and on stretches
subjected to different traffic loads, to be carefully weighed against each
other in that choice.





12 MISSION TO HAITI

The Mission recommends further that early consideration be given to the
establishment of an organized coastal small-boat transportation service,
preferably on a co-operative basis, providing frequent sailings according to
fixed time schedules and applying a unified tariff of freight rates.

Experts on the various aspects of transport improvement here envisaged
may be provided by the United Nations through its machinery for technical
assistance for economic development.

-(v) Impressed by the fact that continued, unrelenting pressure of a
steadily-growing population upon the limited natural resources is in prospect
for Haiti for years to come-for, developing the yield of those resources
first to catch up with and then substantially to surpass the population
growth is a process bound to take quite considerable time even in the most
favourable circumstances-the Mission recommends that serious considera-
tion be given to the possibility of encouraging emigration as a means of re-
lieving the acute population pressure. There are in the general orbit of the
Caribbean sparsely populated countries--whose population is largely of the
same stock as that of Haiti-which have made known their willingness and
desire to receive immigrants to help develop, their natural resources. Emigra-
tion from Haiti should preferably take the form of moving whole
family units from over-populated agricultural areas for permanent settle-
ment in the country of immigration, by contrast to the primarily seasonal
or temporary emigration that has taken place in the past. Both the United
Nations and the International Labour Organisation command facilities for
rendering technical assistance in and advice on implementation of the
policy here recommended.

(vi) The lack of statistics on important economic, financial and social
phenomena is stressed on numerous points of this report. Yet, compre-
hensive and reliable statistical information is essential for realistic and
purposeful planning, for following the progress of development projects
under way, and for checking their results. Technically satisfactory statistics
are indeed an indispensable policy tool of any modern nation. Accordingly,
the Mission recommends that measures be taken as soon as feasible to pro-
vide for the collection, preparation, and publication by the Government of
complete and accurate statistics regarding: (a) the population, its demo-
graphic and occupational structure and movements, its health and
educational conditions; (b) the agricultural, fishery, forestry, industrial, and
power resources and production; (c) trade, transport and communica-
tions; (d) price movements, money and credit, capital formation, national
income, and balances of payments; (e) the public finances in their different
aspects.





INTRODUCTION 15

Specific statistical reports will have to be furnished with reference to
development projects. Tourism and foreign capital investments are to be
covered as factors in the balance-of-payments picture. For the statistics on
births and deaths adequate registration is necessary; thorough reorganiza-
tion and improvement of the present defective system of registration is
hence required. The fact that preparations for the 1950 general census,
the first of its kind to be taken in Haiti, are well under way (with the
assistance of a United States expert in the matter) has been taken note
of with particular satisfaction by the Mission, which considers the taking
of the census an important step in providing basic information needed
for comprehensive development planning.
Certain elements of the economic and financial statistics broadly defined
above are presently compiled by the statistical unit of the Fiscal Depart-
ment of the National Bank of Haiti. In part II, chapter IV, Credit
Organization, recommendation 6, it is proposed that this unit be expanded
and developed into a broader gauge Research and Statistics Service
placed immediately under the Director-General of the Bank. To fulfil its
functions properly, the Bank will always be in need of such a service of
its own. Some other Government departments have of late begun the
organization, tentatively so far, of certain statistics relating to matters
falling administratively under their jurisdiction. In the Industry chapter
(part II, chapter III, section C.2), the nature of the industrial and
trade statistics required is defined in some detail. It may well be expedient,
at any rate to begin with, to have statistical services set up in the
different departments that are and will presumably remain responsible
for the collection of basic statistical data in one or another of the different
fields referred to above. But proper co-ordination between them and
agreement on methods and basic classification standards will be necessary.
A joint co-ordination committee will have to be provided for that purpose.
Ultimately it would be advisable to provide for a central statistical adminis-
tration charged with the preparation and publication of most if not all
official statistics. This central administration may be built up around the
Population Census Bureau, of which an embryo is already in existence,
and be placed in close contact with the secretariat of the National
Resources and Development Board.
Expert assistance in the detailed planning of the statistical organization
and of the statistics that are called for in the different fields may be
provided by the United Nations. Similarly, for the training of Haitian
statisticians abroad, whether in courses organized by the United Nations
Secretariat and the specialized agencies, or in the national statistical
institutions and services of countries with well-developed statistics, access





14 MISSION TO HAITI

may be had to fellowships that can be provided for the purpose within
the frame of the United Nations machinery for technical assistance for
economic development.
(b) Abstract of specific recommendations
The Mission recommends that:
As regards agricultural development (part II, chapter I, pages 104-131) :
1. The reorganization of Haitian agriculture be undertaken as a pressing
national enterprise;
2. The effort to improve agricultural production be centred successively
upon a limited number of comprehensive projects for agricultural
development;
3. The starting point of all agricultural development projects be a
study of the tenure and use of land in the respective areas;
4. All projects for agricultural reorganization and improvement. be
planned comprehensively-both on a long-term and on an immediate
basis-rather than with exclusive reference to a specific undertaking;
5. The delimitation of areas proposed for development be made when-
ever possible on the basis of topographic unity;
6. As a general policy, any agricultural development project directly
subsidized by Government funds be so planned as to secure repayment to
the Government of these funds;
7. Full use of land owned by the State be made to bring about improved
patterns of land utilization, special attention to be given to the possibility
of introducing leasehold tenure on such lands;
8. An experimental rural credit service be created;
9. The Government purchase exclusively high-grade coffee directly
from producers, at preferential prices;
10. The Agricultural Extension Service of the Department of Agricul-
ture be reorganized and strengthened;
11. Agricultural research and experimentation be intensified within a
limited scope;
12. The Agricultural School at Damien be reorganized;
13. The connexion between the Rural Normal School at Damien and
the Faculty of the Agricultural School be maintained and strengthened;
14. At each agricultural development project a community school be
established;
15. The Technical Service of the Ministry of Agriculture be oriented
towards studies of and participation in the execution of comprehensive
projects of agricultural development;
16. The Forestry Service of Haiti be centred on the forest-management
project of SHADA in the For&t des Pins;





INTRODUCTION 15

17. The present project for irrigation and resettlement of the lower
Artibonite plain be carefully studied in all its aspects as a project from
which valuable experience and training can be obtained for further under-
takings of a similar nature;
18. In the choice of projects for agricultural development through
irrigation, priority be given to existing systems, in which physical improve-
ment and the introduction of efficient management would effect a marked
increase in efficiency in the use of water and in production per unit of land;
19. Attention be given to increasing the crop area by irrigation from
wells;
20. Among types of projects for agricultural development, high priority
be given to the establishment of coffee, exclusively on the higher slopes,
where the quality of the product is best;
21. A technique similar to that recommended for coffee be used to
establish plantations of cacao;
22. Careful attention be given to the possibility of operating simple
reforestation projects;
23. Spontaneously afforestable areas be separated and protected from
damage due to grazing, woodcutting, burning, or cropping, in order to
permit the re-establishment of natural tree cover;
24. Attention be given to making available, especially for structures in
agricultural development projects, a sufficient quantity of straight service-
able poles;
25. In appropriate areas (e.g. the Plateau Central), agricultural develop-
ment projects be centred on improved methods of livestock and pasture
management; -
26. The control of torrential streams be taken as a central activity
around which to develop projects for rural improvements.
As regards fisheries (part II, chapter II, pages 161-162):
1. Appropriate regulation be instituted to guard against pollution by
industrial waste causing destruction of fish;
2. Measures be taken by means of gradual introduction of new methods,
by making available better equipment, and by propagating the use of such
methods and equipment to improve the yield of the present fishery industry
within its traditional frame;
3. The Government may sponsor a modest project for experimental
fishing, a model fishing vessel, power driven and relatively small in size,
to be provided for the purpose;
4. The possibility be explored of instituting a thorough survey, jointly
sponsored by the several countries of the Caribbean region, of the occurrence






16 MISSION TO HAITI

in Caribbean open waters of oceanic migratory fish-a seafood resource of
great potentiality-and of their characteristics and catchability;
5. The Government give full consideration to the feasibility of develop-
ing fish culture in ponds on an intensive scale;
6. A thorough survey of the possibilities for fish farming be made by a
first-rate specialist familiar with successful practices in other countries who
may organize pilot operations and train local men in the principles of
fish culture;
7. The possibility of enlisting the co-operation of the various countries
in the region in a jointly sponsored programme of research and experi-
mentation under supreme guidance of one and the same specialist be
explored;
8. Active steps be taken for improving the quality of the processed fish
supplied to the market;
9. Careful and continued experiments be undertaken at once to
determine the best methods for wet and dry salting of the various types of
fish under the particular climatic conditions obtaining in the different parts
of the country;
10. Organized measures be taken for improvement of the fish handling
and marketing facilities and for their amplification in the event of a
substantial expansion of the fish production.
A regards industrial development (part II, chapter III, pages 197-199):
1. The possibilities for advancing the domestic industrial processing of
such agricultural products as sugar, vegetable oil materials, cocoa and fruits,
milk, tobacco, cotton and coarse fibres be explored;
2. Investigation be made-with expert assistance-of the possibility of
bringing about at the Forit des Pins a small forest industry combine;
3. The carrying out of mineral resource surveys by those interested in
obtaining private concessions be encouraged and facilitated;
4. A number of medium-sized units for rationalized production of lime
with full utilization of chemical by-products be established at appropriate
points and integrated as far as possible with small wood gasification plants;
5. The establishment of a cement manufacturing plant to meet prospec-
tive demand for cement for building and construction activities, including
road improvement and other development works, be encouraged;
6. Spot surveying be undertaken to determine the availability of quartz-
iferous sand or quartz for glass manufacture;
7. A thorough survey of the lignite .deposits be made forthwith, together
with investigation of the best methods for mining and subsequent industrial
processing of the lignite and its utilization for electric power generation;





INTRODUCTION


8. A nation-wide survey be undertaken of potential hydro-electric
resources, this survey to include also studies of rainfall, water flow, etc.,
and examination of the possibilities of multiple utilization of the water
supply, e.g., for purposes of irrigation, besides power generation;
9. Consideration be given to the possibility of converting the energy of
prevailing winds into power;
10. Instruction and guidance in the organization of small-scale engi-
neering, repair and handicraft activities, more especially in conjunction
with community development projects, and in the use of production
methods and materials, acquisition of equipment, improvement of the
quality and appearance of the finished products, etc., be provided by
trained field agents;
11. Consideration be given to the possibility of strengthening, by means
of a structural reorganization, the administrative machinery most directly
concerned with the execution of industrial development programmes;
12. Provision be made for the organization, collection and publication
of adequate industrial and related foreign trade statistics;
13. The legislation in force be reviewed and legal practices be examined
with a view to determining in what respects and on what points adjust-
ments and ameliorations are required for removing obstacles to and
providing encouragement for industrial development;
14. A technical research and information centre be established in due
course as an adjunct to a remodelled Ministry of Trade and National
Economy;
15. Advanced technical research workers and technicians with solid
experience of Haitian industrial problems be given facilities for further
technical study and training abroad;
16. The possibilities for developing skills through supervised on-the-job
training of workers in Haitian industries be fully utilized in active
co-operation with existing industrial enterprises;
17. A thorough examination of the structure of the Haitian customs
tariff be undertaken with a view to necessary reform to render it con-
cordant with economic development aims.
As regards public education (part I, chapter II, pages 46, 48, 49-50,
52, 57):
1. As a basis for improving education to help in the economic advance-
ment of the nation, the Government undertake:
(a) An intensive national effort to reduce illiteracy through the
teaching of Creole and French;
(b) The preparation and publication of a series of basic readers for
the literacy campaign, and of a minimum series of elementary school books
for all the school children in Haiti;





MISSION TO HAITI


(c) The initiation of a practical industrial training and apprenticeship
programme;
(d) The extension of the rural community school programme.
2. With particular reference to 1 (a) above:
(i) A small and representative committee of interested Haitian leaders
be formed to draw up the programme and the policies to be followed
in the national literacy campaign for French and Creole;
(ii) A literacy department be established in the Ministry of Education
to take charge of all activities related to the efforts to reduce illiteracy
in Haiti;
(iii) The Government consider the advisability of setting as a definite
goal of achievement the reduction of illiteracy by 1955 to fifty per cent
of the population above seven years of age.
3. With particular reference to 1 (b) above, the Government undertake
forthwith:
The preparation, publication, and distribution of:
(i) A basic series, in Creole and French, of elementary textbooks and
supplementary materials for the school children;
(ii) Appropriate basic readers and almanacs, as well as weekly period-
icals in Creole;
And the organization of:
(iii) A special service in the Publications and Textbooks Section of the
Ministry of Education to carry out this task.
4. With particular reference to 1 (c) above:
(i) The plans for the reorganization of the J. B. Damier Vocational
School in Port-au-Prince be so revised that a unified vocational programme
can be developed at the school and-as a minimum requirement-the
existing shops be provided with adequate tools and modern equipment;
(ii) Serious consideration be given to the establishment of a central
Government garage and repair station with training facilities for apprentice
mechanics.
5. With particular reference to 1 (d) above:
(i) The type of community school and centre which the Rural Educa-
tion Department and the UNESCO Pilot Project at Marbial have initiated
be extended as rapidly as possible;
(ii) The leaders for the adult education activities in these centres be
chosen from the local population on the basis of their capacity for leader-
ship and training.





INTRODUCTION i1

As regards public health (part I, chapter III, pages 77-78):
1. Public health training be obligatory for the medical supervisors of
the rural health districts;
2. Medical officers in rural public health service be full-time appointees,
receiving adequate remuneration to compensate for the loss of private
practice;
3. Adequate means of transport at the charge of the public health
administration be provided for the medical officers in rural public health
service;
4. The planned construction of a new hospital at Bel-Air in Port-au-
Prince be reconsidered;
5. Where drainage works have been executed and installations made
for malaria control, they should be properly maintained and emergency
repairs undertaken without delay;
6. A comprehensive survey be made of the incidence of malaria in
the rural areas to serve as a basis for an expedient programme for treating
mosquito breeding places with DDT as a larvicide where engineering
projects for malaria control through drainage are not feasible;
7. Thorough surveys be undertaken to determine tuberculosis and
ancylostomiasis infection rates, more especially in rural Haiti;
8. A trial vaccination of children be made with BCG with a view
to deciding whether or not to undertake large-scale vaccination of children
endangered by tuberculous infection;
9. Rural clinics and dispensaries be regularly and adequately supplied
with the drugs they need for efficient operation, especially in fighting yaws;
10. The efforts of the Public Health Department be concentrated on
a systematic fight against yaws, which seriously impairs the work capacity
of the rural population and hence constitutes a major obstacle to the
economic development of the country;
11. An organized nation-wide anti-yaws campaign be vigorously pursued
to bring this plague under control.
As regards money and credit (part II, chapter V, Credit Organization,
pages 271-274) :
1. Consideration be given to the possibility of using monetary and fiscal
policies-with prudent attention to the limitations and risks involved-
for encouraging economic development, having regard to such means and
capital sources as:
(a) Lending by the banks:
The banks presently operating in Haiti may well pursue a more active
lending policy for developmental purposes than they have hitherto
practised.




20 MISSION TO HAITI

(b) Budget resources and fiscal devices:
Allocation for economic development ends of a larger portion of current
revenues than has been so allocated in the past is desirable.
(c) Individual savings:
Various steps may be taken to encourage saving by the people and to
channel these savings to financing development.
(d) Foreign private investment:
Energetic efforts should be directed towards inducing capital from
abroad to engage in direct investments on terms that will ensure equitable
treatment of the investors without granting too generous concessions.
(e) Loans or credits obtained abroad:
For the financing of important development projects which require
sizable capital investment exceeding the capacity of domestic financial
resources, recourse may be had to borrowing abroad, especially from inter-
national financial institutions or credit agencies of foreign Governments.
It is recommended in this connexion that the Haitian Government examine
the advantages of participation in the International Bank for Recon-
struction and Development and the International Monetary Fund with
a view to applying for membership, giving access to the divers facilities
they can offer.
2. The commercial law be revised to provide for an enforceable
chattel mortgage which will facilitate the granting of bank credit for the
acquisition of capital equipment serving development- purposes;
3. A unified monetary law to replace the multitude of partly obsolete
laws, contracts, agreements and treaties under which the National Bank
now operates and to include also the regulations governing the issue of
subsidiary coin, be provided, together with a general banking law setting
out the rights, powers, duties, and responsibilities of firms or persons
engaging in banking business in Haiti and instituting some form of super-
vision of the conduct of such business;
4. In connexion with-the review of the monetary system and codification
of the relevant legislation consideration be given to:
(a) The propriety of revising the monetary reserve requirements;
(b) The strengthening of the top management of the National Bank
by providing it with a general board to assume responsibility in policy
matters with particular reference to the part thee Bank should play in
economic development promotion;
5. An Agricultural and Industrial Development Bank be set up, either
as an autonomous department of the National Bank or as a separate




INTRODUCTION


Government-guaranteed institution to provide medium-term and long-term
credit principally to farmers, rural industries and handicrafts-preferably
through the intermediary of co-operative organizations;
6. The existing statistical unit of the National Bank be expanded and
developed into a well equipped Research and Statistics Service of the
Bank to provide adequate statistics and analyses of monetary and related
matters and furnish expert technical advice and information to the policy
organs of the Bank as well as to the secretariat of the National Resources
and Development Board and other bodies in need of such information.
As regards matters of public finance (part II, chapter VI, pages
318-321) :
1. The Government proceed to reshape its revenue and expenditure
policy so as to place the emphasis on economic development needs;
2. A comprehensive organic law of public administration be provided;
3. Steps be taken with a view to the introduction throughout the
public administration of a system of recruitment based on competitive
examinations;
4. Advice and assistance of public finance technicians be sought in
undertaking the organizational reform required for improving the operation
of the fiscal system;
5. Consideration be given to the creation in due course of a General
Revenue Office in the Ministry of Finance to be responsible for the unified
administration of all State revenues and to be consulted in all matters
relating to fiscal legislation;
6. The budget be conceived as a policy guide and work programme
intimately reflecting, if not defining, the Government's plans of activity
in the economic and social fields;
7. A Bureau of the Budget be organized to handle, in close contact
with the secretariat of the National Resources and Development Board,
the budget preparation in harmony with the general economic planning;
8. A structural revision of the import tariff with a view to shifting the
emphasis from the purely fiscal aspect of revenue collection to the broader
considerations of economic development promotion be undertaken at an
early date with assistance from the international organizations competent
in the field;
9. The whole system of export duties and assimilated taxes on agricul-
tural staples be re-examined for the purpose broadly defined under 8 above
and the relevant laws and regulations be overhauled to remove obscurities,
make their wording precise and simplify their application;
10. A comparatively slow progression and comparatively low ceiling
of income tax rates be maintained until substantial headway has been
made in the general economic development of Haiti;




22 MISSION TO HAITI

11. Re-examination be made of the income tax law of September 1948,
with a view to its clarification, improvement and completion in different
respects;
12. Serious consideration be given to the possibility of early repeal,
on economic development grounds, of the product-discriminatory "excess-
profit" tax levied on certain agricultural export products;
13. The method of assessment of the excise tax on alcohol production
be so modified as to increase its yield;
14. In the absence of conditions propitious to effective operation of
sales taxes, this form of taxation should not be attempted until substantial
economic advancement, with concomitant rise in levels of living and
education have been achieved;
15. In granting taxation favours, due consideration be given to their
compatibility with the long-term aspects of economic development as well
as to the curtailment of Government revenue that they involve;
16. In planning expenditures and appropriating means for meeting
them, due differentiation be made between (a) expenditures designed to
provide for current services to be covered in full each year by current
revenues, and (b) developmental or investment expenditures which may
be balanced over longer periods, the length of time depending on the
nature of the investment;
17. Consideration be given to organization of the budget according to
modern principles of budgeting, differentiating between "current account"
expenditures and "capital account" expenditures, this distinction being of
help in appraising the true budget position;
18. The reporting of the position and movements of the public finances
be improved; '
19. Study be made of the possibility of utilizing Government trust funds
to assist in the financing of productive development projects;
20. A commission be set up to study and report on the possibilities and
the means for buttressing the local government structure by strengthening
its financial basis.






















PART I


DEMOGRAPHIC, EDUCATIONAL AND HEALTH
PROBLEMS AFFECTING HAITI'S ECONOMIC
DEVELOPMENT












CHAPTER I


Haiti and the Haitians
1. THE COUNTRY, THE NATION, AND THE FUNDAMENTAL PROBLEM
The Republic of Haiti, with its 10,700 square miles, occupies the
highly mountainous and densely populated western part of the second
largest island of the West Indies,' which it shares with its far more
extensive but much less populous neighbour, the Dominican Republic.2
The mainland of the country is shaped like a horseshoe, two peninsulas
protruding westward from the central area to form the triangular Gulf
of Gonave, in the centre of which lies the Isle of Gonave, a mountainous
and now mostly barren island a little larger than Martinique. Equally
barren is the smaller Turtle Island lying to the north of the northern
peninsula, which points towards Cuba in the northwest. The elongated
southern peninsula reaches towards Jamaica in the southwest. Thus Haiti
is situated within the tropics.
Though the Haitian Republic is slightly smaller in area than Belgium,
or of about the size of the State of Maryland in the United States, its
total coastline is almost as extended as that of France.
"Haiti", the ancient name by which the aboriginal Indians called the
island, means "Land of Mountains". The Republic is indeed more rugged
relative to area than is Switzerland, for of its surface, transversed by
three principal and many secondary ranges, almost four-fifths is moun-
tainous. Elevations reach nearly 9,000 feet in the southern range, about
7,000 feet in the central range, and somewhat less than 5,000 feet in the
north. At some places along the coast, plains flank or wedge into the
highlands, and plateaux and valleys are interspersed among the mountains.
There are seven larger plains, ranging in extent from 2,000,000 acres down
to 20,000 acres, and fifteen plains of smaller size. The rugged mountain
chains dissecting the territory of the Republic render land communications
difficult and tend to fragmentize the country. Brown and Woodring3

'The island is variously known as Haiti (Haiti, Hayti), Hispaniola (Espaiiola),
or Santo Domingo (San Domingo, Saint-Domingue). Unless otherwise specified
Haiti will refer in this report to the Republic rather than to the Island.
2 The Dominican Republic comprises 19,300 square miles with a population of
some two million people. Haiti's population probably exceeds three million (see
page 29 below).
SRepublic of Haiti, Department of Public Works. Geology of the Republic of
Haiti, by Wendll P. Woodring, John S. Brown and Wilbur S. Burbank, Port-au-
Prince, 1924.





MISSION TO HAITI


delineate thirteen major geographic provinces or regions and numerous
sub-regions.
The national independence of Haiti was proclaimed in 1804 after a
protracted and fierce scorched-earth war of liberation from France, in
which slaves and freedmen joined forces. Few States have begun their
national existence in less auspicious circumstances. Having driven away
its former masters, who had at no time conceded to the subject people
any part in the conduct of public affairs, the country lacked a corps of
trained administrators; it feared re-conquest; its economy was devastated
and had to be rebuilt on a foundation different from the colonial economic
organization based on slave labour. The new State lacked even the
rudiments of an educational system.
Haiti came into existence as a linguistically and racially isolated nation
of the Western Hemisphere long before the emancipation of Negro slaves
had been achieved or even begun elsewhere in the world. At a relatively
early date England, the Netherlands, Sweden and Denmark entered into
diplomatic relations with the young State. France granted it conditional
recognition as an independent State in 1825, when Haiti agreed to pay
indemnities to former French property owners in the amount of 150 million
francs, various issues of a loan for that purpose being floated on the Paris
market. This amount was clearly in excess of Haiti's capacity to pay; a
considerable reduction was therefore agreed in 1838, when unconditional
recognition of the country's independence was accorded by France. Owing
partly to apprehension of repercussions on the North American slavery
issue, the United States withheld recognition until 1862.
New bases for the legal, social, and economic institutions were laid
during the early decades of the nation's independence. A system of small
holdings succeeded the plantation system of colonial times. The population
would appear to have increased at a rapid rate-during the succeeding
century, but the economic development lagged as agricultural methods
came to be enveloped in the traditionalism of an illiterate peasantry.
Independence was maintained, but mistakes were made in the internal
management of the State. Chronic 'political instability, inefficiency in the
financial administration of the country and in the organization and
equipment of its economy, and the unyielding pressure of a too-heavy
external debt burden militated against the creative development efforts of
earnest leaders.
In 1915, following a period of acute internal strife, Haiti was occupied
by United States military forces, which remained in the country until
1934. A system of stringent financial control was instituted during the
occupation and continued in modified form until 1941, when it was






further extended under an agreement that terminated in 1947 with the
redemption by the Haitian Government of the entire balance of old
(primarily political) debt restricting its freedom of movement in external
financial relations.
Haiti today is a land of striking contrasts. At the apex of its social
structure is a small, variously composed, educated class-commonly referred
to as the ilite-in possession of considerable technical skill and essentially
western European culture and outlook. The great mass of the people,
particularly in the countryside, is sharply differentiated from this group,
not only by education, culture, and technical knowledge, but also by
language, inasmuch as those belonging to the latter group-perhaps nine-
tenths of the population-do not as a rule master French, the official
language of the country/) Their language, the Creole, originally derived
from French, is, however, extensively used by the educated Haitians. Many
of the cultural roots of the large majority reach back to African origin,
although they have been profoundly modified by unique features of the
evolution of the Haitian nation. As an integral part of any comprehensive
programme for national economic development, if it is to succeed, effective
educational methods must be devised to awaken the mass of illiterate
country people and spur them on to higher levels of individual and
community achievement.
Situated in the economic problem area of the Caribbean, whose relative
contribution to world production and commerce has diminished on the
whole over the past century and a half, Haiti lags in respect of economic
development even more markedly than other countries and territories of
the region with which it may be compared. Confronted by the dilemma
of sustaining a steadily growing population on gradually shrinking land
resources, its developmental task is desperately urgent. There is increasing
awareness of this situation on the part of the Haitian authorities. The
task which lies ahead requires the united efforts of all the Haitian people.
In this task the generous and sympathetic assistance of the community of
nations and particularly of the economically advanced members of that
community is called for.
2. THE PEOPLE
(a) Size and Growth of the Population
There are no reliable statistics of Haiti's population, no proper census
ever having been taken. An attempt at a census was made during the
period September 1918 to August 1919, resulting in a figure of 1,631,000;
but it admittedly did not cover the whole population and was incomplete
also in other respects. An estimate of 1928 gave a total of 2,500,000,
which seems more plausible. Subsequent estimates have put the total at


27


HAITI AND THE HAITIANS




























BMr-*s ^*^-^^ Sj:?--''-' .
ki -




Typical peasant coage: mud walls, thatched roof, usually single room, no sanitary facilities and very little furniture

'and household equipment. Cooking is usually done in the open air.
o -




Typical peasant cottage: mud walls, thatched roof, usually single room, no sanitary facilities and very little furniture
"and household equipment. Cooking is usually done in the open air.





HAITI AND THE HAITIANS


3,000,000 in 1940,1 and 3,550,000 in 1947. But assuming that the estimate
of 1928 was reasonably close to reality, both the 1940 figure and that for
1947 seem unlikely. If the 1940 estimate is assumed to be reasonable,
that for 1947 would still be too high and the 1928 estimate rather too low.
Since births and deaths are very incompletely registered, no great reliance
can be attached to indications of population growth derived from such
data for Haiti. However, inferences might be drawn from the population
statistics of comparable countries. In British Caribbean territories with
essentially the same population stock as Haiti, but, on the whole, with
better developed sanitation and health care, the rate of natural growth
ranges between 1.3 and 2.0 per cent per annum. Judged on that basis
an annual growth of rather less than 1.5 per cent would seem likely in
Haiti. At the first session (in 1948) of the Economic Commission for
Latin America (ECLA), the representative of Haiti stated that there
were two and a half births to one death in Haiti. As a rough indication
this ratio, equivalent to a rate of natural increase of 1.5 per cent per
annum, may not be very far off the mark.
The official census to be taken in 1950, and which is now in course of
preparation, will, it is hoped, make it possible to determine the actual
size of the population within a reasonable margin of error. It remains
to be seen whether the result of the census will corroborate our guess made
on the basis of somewhat divergent evaluations by different observers to
the effect that in 1948 the population figure may have amounted to some-
what more than 3,000,000. It may well turn out as high as 3,500,000, but
probably not below 2,750,000.

(b) Population Density and Occupational Pattern
A total of something over 3,000,000 would mean an average density
of roughly 300 people per square mile, which is higher than that of any
other sovereign State in the Western Hemisphere and extremely high,
indeed, in relation to the productive area of such a very mountainous
country as Haiti, the inhabitants of which, moreover, depend for their
livelihood almost exclusively upon exploitation of the agricultural resources.
Only about a third of the total area of Haiti is considered tillable at
present; it is estimated that there is less than one acre of tillable land
per person.
A population density of 300 per square mile is higher in fact than
that of most of the industrialized nations of the world. But among
Caribbean countries and territories Haiti occupies a medium position on
the scale of population density. In the Dominican Republic the density,

'Another estimate for 1940 puts the total as low as 2,660,000.







r -*rr-? r


Jy/ l .. : .
'- ^ ,,- ,.,, .'.**." .' .' -' ..-_

-.. 2 .

A -
t24.i .." ..
,- '** -' *'" .';" "' 'P' '-, ~ .. *: :' '-^ *
-..* .,. .--;**-*-' *r ,-- .-. "' .,
7' ,* ." ....-- ,',^ *- ^ ^ .' S ^ q,"- .- ."

L^. ^ ^ ..:... :^-*.:. ..^ '. .,... .h^ -.^. -- ; ^ ,- .,


"'. **
d



A-!


Rural market centre near Pont Est&re. On market day thousands of people gather here to exchange their meagre produce:
agricultural products, clothing, food, and essential household equipment, all of poor quality.





HAITI AND THE HAITIANS 31

according to 1947 population estimates, was about 110 per square mile,
in Cuba 117, and in Jamaica, with 4,411 square miles, it was 294, in
1943. On the other hand, in Puerto Rico, with 3,436 square miles, the
population density was just over 600 in 1946; in Guadeloupe, with 688
square miles, it was 442, in 1940; in Martinique, with 385 square miles,
it was 654 in the same year; the tiny island of Barbados, with its 166 square
miles, is situated at the top of the density scale with as many as
1,159 persons per square mile in 1946.
It is not possible to state precisely the urban-rural distribution, as the
population number even of the principal towns in Haiti has not been
determined. The urban agglomerations are relatively few, however, and
are believed to account for only about a sixth of the total population.
As many if not most of these agglomerations are rather to be described as
villages of a distinctly rural character, about nine-tenths of the population
may be properly classified as rural.
Port-au-Prince has grown in size in recent years, and probably accounts,
together with the adjacent residential town of P6tionville, for around
200,000 people. None of the other urban centres-the majority of them
situated on the coast close to a natural harbour-probably has more than
30,000 inhabitants. Internal migration is oriented mainly from the pro-
vincial towns and the countryside towards Port-au-Prince, but the Govern-
ment has recently fostered some,settlement schemes in the rural area and
has other such schemes under consideration, for while the population
density is high, the people are not well distributed in relation to the
resource potentials. Hence there are possibilities for further redistribution
of the population on the basis of economic criteria.
Practically the whole of the rural population derives its subsistence from
agriculture, including, for a small part, fisheries, charcoal making, lime
burning, and rudimentary village handicraft. The townspeople gain their
livelihood mainly from commerce and connected distributive trades and
handicrafts, from Government employment (including employment with
the National Bank), domestic service, to a relatively minor extent from
industry, transport and communication services and, so far as the educated
class is concerned, from liberal professions.
The occupational structure of the Haitian population shows a striking
predominance of persons working for their individual account as pro-
prietors, lessees or tenant-owners, usually with the assistance of the members
of their families. Thus the proportion of persons employed for wages and
salaries is very small, as is suggested by the following estimate for 1943 pub-
lished by the United States Department of Labor:1
'Monthly Labor Review, vol. 59, no. 4, October 1944.





32 MISSION TO HAITI

Number of workers
Agriculture (and related industries) ..................... 83,500
Domestic service ................................. 75,000
Shop em ployees....................................... 12,000
Government (including the National Bank) ............... 9,400
R ailroads ............................................ 360
A irw ays ............................... 150 .
M miscellaneous ........................................ 1,830
TOTAL 182,240
The total shown, which may have been somewhat incomplete, repre-
sented only 6 per cent of the population-assuming that it numbered about
3,000,000 in that year.
(c) Deaths and Births
Because of the gross deficiencies in the registration of deaths, the mor-
tality rate arrived at by striking the ratio between reported deaths and esti-
mated total population is extremely low. Injuring the period 1935-1944 it
averaged about five ,deaths annually per 1,000 population, or approximately
one-fourth only of the Puerto Rican rate for that period. Experts of the
United States Bureau of the Census believe that only 20 per cent or less of
the deaths that occurred during the period were officially registered, which
would suggest that the true death rate lay between twenty-five and thirty
per 1,000. Some indirect evidence that the death rate is quite high is
afforded by the distribution by age of the average annual number of deaths
occurring in hospitals during the years 1936-1943: ,
Total number of deaths.............................. 16,246
Age at death unknown................................. 2,400
Age at death known................................... 13,846
Per cent
U nder 1 year........................................... 15.4
1-4 years.............................. .. .......... 12.1
5-9 ....... .. . .. ... ... 3.8
10-19 : ... .. ... .. ....... ............ .... 6.6
20-29 ........ .. .. ............ .... 13.2
30-39 .... .. ........ ......... ...... 13.1
40-49 .............. .................... 11.6
50-59 .................. ........... 8.3
60-79 ............. ............... 12.3
80 years and over........................................ 3.6
These figures, showing a significant concentration of deaths in early child-
hood-27.5 per cent in the first four years of 'life-and in the age span of
twenty to forty-nine years-37.9 per cent-with the age group of fifty years
and over accounting for only 24.2 per cent, suggests a quite low expectation
of life. As these statistics relate to the favoured few receiving hospital treat-
ment-the medically cared-for fraction of the population-the preponder-





HAITI AND THE HAITIANS


ance of early age groups among the great mass of deaths occurring outside
the hospitals is presumably even more marked, which indicates a low level
of public health and personal hygiene resulting in a serious waste of life
caused by preventable diseases. Further evidence on this point is offered in
part I, chapter III, Public Health Problems.
The registration of births is also grossly deficient. Thus, during the period
1935-1944, registered births averaged only seventeen annually per 1,000 of
the estimated population, compared with thirty-nine per 1,000 in Puerto
Rico during the same period; the true rate in Puerto Rico is believed to
have been above forty per 1,000, allowing for inadequacies of birth registra-
tion. There is no a priori reason to suppose that the fertility of the Haitians
is any less than that of the Puerto Ricans or of many other peoples in
underdeveloped agricultural countries throughout the world whose birth
rates range upward from forty per 1,000. The conditions generally asso-
ciated with low fertility-namely, a high degree of industrialization and
urbanization, high per capital income, and a high level of educational
attainment-are absent in Haiti. If the birth rate is actually in the neigh-
bourhood of forty per 1,000 and the death rate, as suggested above, some-
where between twenty-five and thirty per 1,000, it means that the rate of
natural growth lies between 1 per cent and 1.5 per cent annually. At a rate
of increase of 1 per cent, the population would double in seventy years, and
at 1.5 per cent in forty-six to forty-seven years. Any one of the above rates
for Haiti is hypothetical. The true rates and-more important perhaps for
the economic development policy-their trends will remain unknown until
an adequate system of vital statistics so essential for a modern State has
been developed.
Some observers believe that the population of Haiti has grown rapidly
over the past thirty or forty years. Part of the natural increase was diverted,
particularly in the 1920's and early 1930's, through emigration of Haitians
seeking work in the sugar fields of Cuba and the Dominican Republic.
Subsequently, however, the repercussions of the world economic depression
on the sugar industry caused a reflux of Haitian workers from the former
country, and many of the emigrants to the latter came back to Haiti in the
late 1930's seeking refuge from acts of repression perpetrated against
them in 1937. The number of resident foreigners in Haiti is small, though
there have been slight accretions in recent years, especially of European
refugees.
Naturalization laws are now more liberal than was the case during the
early history of Haiti when as an aftermath of the fight for independence
immigration was discouraged. The 1946 Constitution and other laws con-
tain certain provisions which in principle restrict foreign ownership of real





34 MISSION TO HAITI

estate and the exercise of business by foreigners.1 In actual practice, how-
ever, not all of these provisions are now enforced.
(d) The Population Problem viewed in relation to Economic
Development Needs
The central economic problem of Haiti is so to expand its national
product in relation to its population as to increase the real income per
head and so distribute it as to raise the general standard of living.
The present situation is characterized by heavy population pressure on
the limited and little-developed material resources. In order to achieve a
rise in the standard of living the economic development must proceed faster
than the growth of the population. Given the primitive state of the
education of the average Haitian and of his grasp of economic realities,
there is no prospect that the rate of natural growth of the Haitians will be
restrained for a long time to come, save by the check of ill-health and other
factors causing an extremely high mortality, which implies a deplorable
waste of life. On the contrary, as shown by experience elsewhere, it is rather
to be expected that amplification of the material basis for the life of the
nation and improvement of public health conditions will have the initial
effect of enhancing-at any rate for a transitory period-the natural
growth of the population, which will thus tend for some time to absorb the
gains from economic development. For by extending and improving sani-
tation and medical care and raising the standards of hygiene, it is possible
in the comparatively short run to reduce mortality, while fertility, governed
by deep-rooted behaviour, is influenced only in the long run by the spread
of education and gradual change of ideas and social environments.
Serious consideration should therefore be given to the possibility of en-
couraging emigration as a means of neutralizing this tendency and of
relieving the acute population pressure. There are in the general orbit of
the Caribbean sparsely populated countries-whose population is largely of

SThe most important of these provisions are:
(a) Resident foreigners or foreign companies conducting business in Haiti may
own real property only when required for their agricultural, commercial, industrial
or educational enterprise "within the limits and conditions to be determined by law".
The right of ownership terminates after two years if the foreigner has ceased to
reside in the country or if the company has ceased operations. Thereupon the
Haitian State becomes the legal owner of these properties;
(b) The exercise of commerce by foreigners is to be confined to the ports open
to foreign commerce, i.e., Port-au-Prince and eleven other coastal towns;
(c) The patente (business licence fee) payable by foreigners is twice that payable
by Haitian nationals. This fee is quite small;
(d) The exercise of retail trade and of the profession of spiculateur (middvlman
buyer of coffee from the peasants) is reserved to Haitian nationals;
(e) Only native-born Haitians are qualified to direct operations of handicraft
industries utilizing such local materials as mahogany (which has become scarce) and
sisal fibre.
Of the above provisions only (a) and (c) would appear to be enforced at present.






HAITI AND THE HAITIANS 35

the same stock as that of Haiti-which have made known their willingness
and desire to receive immigrants to help develop their natural resources.
Emigration from Haiti should preferably take the form of moving whole
family units from over-populated agricultural areas for permanent settle-
ment in the country of immigration. The emigration which has taken place
in the past has been largely seasonal or temporary, and has primarily con-
cerned individual agricultural labourers recruited for work in neighboring
countries. This movement has practically ceased. Such limited emigration
as now takes place from Haiti comprises mainly persons in possession of
skills, or precisely those persons who arc most needed at home to help in the
development of the country.
The gravity of the population problem raises important questions bearing
on the orientation, organization and conduct of a national development
effort. Economic development, the launching of which is always attended
by some risks, must eventually be undertaken on a scale sufficiently com-
preherisive to constitute not merely a series of small improvements which
will be neutralized by continuous population increase. In view of the limita-
tion of the investment resources at present available or in sight, great cir-
cumspection must be exercised in the selection of development projects,
those likely to be most broadly productive and thus capable of providing a
basis for additional ventures hastening the tempo of development to be
chosen in the first instance. Moderate expenditure on well-chosen specific
projects of rural development, intimately integrated with a practical pro-
gramme of education, can increase more than proportionately the output of
Haitian agriculture and at the same time, in encouraging active co-opera-
tion and initiative to self-help on the part of the population in rural com-
munities, foster those institutions necessary for sustained progress.
Proper balance will have to be sought between the .developmental activi-
ties in the different economic and inter-related social fields. The develop-
ment of fisheries and of forestry should be blended with that of agriculture
which, in realizing improved production techniques, will release surplus
manpower now inefficiently employed, and should therefore be interwoven
so far as possible with the promotion of supplementary industrial and handi-
craft activities capable of employing gainfully part at least of that manpower
surplus. To that end the effort at fundamental education should in large
part be concentrated upon the population at or approaching productive
age, the shaping of the educational programme to be closely geared to the
economic requirements of the country. Similarly, it is important that in the
effort at ameliorating public health conditions primary emphasis be placed
on reducing those diseases which cripple the labour efficiency of adults and
the remedying of which will therefore improve productivity and hence assist






MISSION TO HAITI


in the economic development. In Haiti such a programme will be above all
a rural public health programme.

3. INCOME AND STANDARD OF LIVING
Haiti lacks most of the basic statistics required for any direct estimate of
the national income. Such indirect estimates as have been attempted on
different occasions in the past rest of necessity on somewhat arbitrarily
chosen criteria. One estimate made for the relatively favourable fiscal year
1927/28 by United States authorities placed the per capital income at about
$25 and the aggregate national income at roughly five times the Govern-
ment revenues, then amounting to nearly $10 million. A later estimate1
relating to the last years before the war again worked out at approximately
$25 per capital. In a country where production for subsistence constitutes as
substantial a proportion as it does in Haiti, the uncertainty attaching to any
estimate of national income in monetary terms is so great as to deprive it
, of true numerical significance. Despite the very large margin of error in-
volved, however, any such estimate for Haiti serves to demonstrate the fact
that the national income is extremely low, though no precise comparison
with the national income of more industrialized or agriculturally more
developed countries can be made.
Whether national income per capital was in fact maintained between
1927/28 and, say, 1937/38-as the estimates cited above suggest-is open
to doubt. Reference to the table on the foreign trade of Haiti over the
period 1916/17 to 1947/48 given in part II, chapter IV, B, section 1, and
the movement of which is further illustrated in chart I,. page 211, will show
that the value of exports indicative of that variable part of the national
income which is derived from production for sale abroad dropped very
sharply, indeed by about two-thirds, between the boom year 1927/28 and
the 1937/38 year of recession. As this income item normally looms large in
the economy of Haiti, the national income per capital must have shrunk
substantially over that period. The reduction in the value of exports
reflected mainly a fall in price of principal Haitian products on external
markets, which, in conjunction with the simultaneous contraction of the
quantity of the products exported, had the effect of reducing the imports-
practically all of the nature of necessities-in nearly the same proportion as
the exports declined. Between 1937/38 and 1946/47-1947/48, on the other
hand, the value of exports rose sharply from 35 million gourdes to about
155 million (average for the last two fiscal years) or by 343 per cent. The

SDon D. Humphrey, chapter XV, "Haiti", page 365, in Harris, Seymour E.
(editor), Economic Problems of Latin America (New York, U.S.A.: McGraw-Hill
Book Co., Inc., 1944).






HAITI AND THE HAITIANS 37

wartime and post-war rise in prices1 may have accounted for some two-
thirds of that increase, which would nevertheless mean that the "quantum"
of exports was augmented by somewhat more than 100 per cent, reflecting
a substantial accretion to the national income. Compared with the inter-
war peak of 113 million gourdes reached in 1927/28, the value of exports
of the last two financial years had risen by 73 per cent. Since the prices
fetched abroad by Haiti's principal export articles would appear to have
been about as high in 1927/28 on an average as in 1947/48, the whole of
the value increase probably represented an expansion of the quantum of
exports. Whether the income accretion resulting from this expansion in new
products little developed in the 1920's was large enough to do more than
compensate for the decline in the more traditional lines of production is
very difficult to judge. The year-to-year growth of population taken into
account, however, it seems unlikely that the national income per capital in
1947/48 was any larger than, if as great as, twenty years earlier.

Judging by an index of world market prices for major Haitian export goods
calculated by the United Nations Secretariat in its study of terms of trade between
underdeveloped and industrialized countries, Haitian export prices in 1947 were
on an average 227 per cent higher than in 1938.
S. ,,- .0--r rr -,





















Large rural families living in small huts on the lands to be developed in the
lots of ground on which a meagre living is produced, for an opportunity
"r i.^L* -- -'^,,,.













Artibonite Valley Project. Success of this project may depend upon how
plots of ground, on which a meagre living is produced, for an opportunity
to improve their status by working with better equipment and under close
supervision as members of the Project.






MISSION TO HAITI


While no precise statistical comparison can be made, various socio-
economic indicators, such as the proportion of children attending primary
schools, educational expenditures, exports and government revenues per
capital, point to an appreciably lower national income per capital in Haiti
than in the neighboring countries of Cuba and the dominican Republic, in
Puerto Rico (whose development has been heavily subsidized by the United
States) and indeed in most other countries of Latin America.1
Studies made of family income in the Plaisance region in the north of
Haiti, in the Marbial Valley in the south, and elsewhere, show that the
cash income of the average peasant is next to negligible and the level of sub-
sistence extremely low on the whole, the family income being barely suffi-
cient to meet even rudimentary requirements of food, clothing, and shelter.
The majority of the rural population and a large part also of the people
living in the towns show signs of under-nourishment and a poorly balanced
diet. We observed some variations in the consumption of milk and proteins
as between regions, but even in the areas where the food intake seemed
higher than the average a substantial proportion of the people were appar-
ently under-fed or ill-fed.
Rural housing in particular is quite primitive and generally inadequate.
The Government has received technical advice from a United States expert
who in October 1948 wrote:2
"The family has limited resources with which to rent a home, let alone
buy a house. Consequently, it has been the tradition over more than -100
years for most Haitians of low income to build their own homes. The
typical house consists of a single room, usually with less than 100 square
feet, bare dirt floor, wood frame construction, woven clay mixed with grass
(not unlike the adobe walls found in the southwestern United States and
Mexico) and a thatched roof. The homes have no sanitary facilities or run-
ning water. The cooking is done on the ground outside, over a metal
brazier and charcoal fire. A handmade bed, chair, chest, counter and metal
eating utensils are all one usually finds inside. The more fortunate families
have a community privy nearby. The land is frequently rented from a large
land owner. Sometimes a plot of ground is handed down from father to
son and is owned outright and sometimes the .dwelling or shack is built on
public property. Thousands upon thousands of Haitian families in urban
as well as rural areas live in this fashion. Generations have lived in this
same way."
We have not examined the housing problem as such in any detail, as no
such study was envisaged in the terms of reference of the Mission. We wish

'See comparisons made by Louis R. E. Gation in Aspects de l'economie et des
finances d'Haiti, Port-au-Prince, 1944.
'Bourne, Philip W., Housing Study of the Republic of Haiti, prepared in con-
sultation with the Office of the Administrator, Housing and Home Finance Agency,
Washington, D.C., October 1948.






HAITI AND THE HAITIANS 39


Country woman wearing customary
dress of coarse white or blue cloth.


Heavy head loads are carried by old
and young.






MISSION TO HAITI


Improved housing at Belladre. The new agricultural colony of Batiste is on the
heights beyond the first ridge.
to note, without implying any elaborate consideration on our part, that the
report here quoted contains suggestions as to minimum standards and
presents a general outline of a long-term housing programme based in part
on the principle of self-help among the persons directly concerned, com-
bined with special long-term financing. The report in question does not
enter fully into the problem of- rural housing, but a great deal of literature
is available on the subject of tropical rural housing and village and town
planning which would seem pertinent, and considpetent architects are to be
found in Haiti.
The Government has under consideration various projects involving the
construction of new or the remodelling of existing villages and community
centres in key areas. These projects are designed to set higher standards of
rural housing and to form nuclei for the concentration of the presently
widely dispersed population into settlements affording possibilities and
facilities for the development of community life.
The population is generally ill-clothed; many have no shoes, and rela-
tively few outside the educated class wear them regularly. This fact is of
importance with regard to health conditions, inasmuch as certain of the
tropical diseases of high incidence in Haiti, notably hookworm, are trans-
mitted by way of the skin.
The greater part both of the urban and the rural population dards not
afford to pay much for the care of their health. Medical care is very inade-
quately provided for in the rural areas, which without exception are in
great need of public health facilities to extend medical services to the
people.






HAITI AND THE HAITIANS 41

As in many other little-developed countries, wages in Haiti are low. A
minimum wage of 12 gourdes ($0.30) per day of work was fixed by law
in 1939. In 1945 it was raised to two gourdes ($0.40) to take effect in
January 1946. The new Constitution introduced after the 1946 Revolution
guaranteed to labour the right to unionize and to bargain collectively. Sub-
sequently the legal daily minimum wage was raised in two stages to 3Y
gourdes ($0.70). Employment for wages, however, as is suggested by the
occupational picture roughly outlined on page 32 above, has not yet become
a very important factor in the Haitian economy. The number of people to
whom the minimum wage is applied in actual practice, therefore, constitutes
but a small fraction of the country's population.
For the economic development of the country the relation between wages
paid and the productivity of labour is of importance. In the absence of any
adequate statistical measures of the trends of productivity, the Mission exam-
ined the legal and administrative arrangements for adjustment of rates in
accordance with the economic conditions of the various industries. We found
in general that there is adequate provision for flexibility downward in cases of
hardship, but that precise criteria for hardship were not clearly established.


Portion of model town of Belladdre near the Dominican border. This town, with
its model buildings, well laid out streets and electric lighting system, must de-
pend upon a greatly enlarged agricultural development in the vicinity or on an
increased tourist trade for its economic well-being.





42


MISSION TO HAITI


Provision for upward adjustment in case of improvement in productivity
and in the general condition of the industry were not as adequately formu-
lated as might be desired. A considerable burden of review was conse-
quently placed on the Bureau of Labour, whose small staff was found alert
to the economic factors to be considered in the discharge of i, functions.
While these findings are mentioned at this point, the principal conclusion
as to the standard of living is that labour is so abundant relative to effective
demand and to conditions bearing on its productivity that wages are low.
An unskilled labourer, if fully employed at the legal minimum wage, would
realize an annual income in the order of 1,000 gourdes ($200).












CHAPTEI1 II

Education

Education can play a major part in freeing the people of Haiti from
want and fear. The importance of orienting education so that it may
further the desired material progress of the nation has not been fully real-
ized in the past, even in cultured circles in Haiti. The lack of a basic
education code with its underlying political and educational philosophy
makes it difficult to orient the teachers and to evaluate changes in the pro-
grammes. Spokesmen of the younger generation feel that Haitian unity and
progress will depend for their realization upon the creation of a mystique
national, by which they mean a passionate faith in the destiny of the
Haitian nation.1 This sentiment seeks its inspiration in the heroic deeds of
the great leaders of Haiti's wars of independence-Toussaint Louverture,
Dessalines, and Henry Christophe. Yet, in the words of an outstanding
Haitian writer, who gives the national purpose a broader and more realistic
formulation, "the age of heroic hopes and grandiose projects has passed;
what they (the Haitians) desire today is to secure for the nation which
they have founded, order and well-being in an atmosphere of peace by
bringing all their moral force to bear on the development of their economic
resources".2 It would be difficult to find a better statement of the philosophy
which should guide the Haitian educational effort.

1. STRUCTURE OF THE EDUCATIONAL SYSTEM
Before entering upon an analysis of the major problems confronting
Haitian education, it may be well to give a brief summary of the general
structure of the educational system.
The Haitian school system is centralized under the Ministry of National
Education. Until the 1946 Revolution rural education was under the super-
vision and control of the Ministry of Agriculture. Curricula for public and
private schools are fixed by the Government. Urban elementary educa-
tion is divided into six two-year courses for children from the ages of four
to fifteen. On completion of a six-year primary school course (ages six to
eleven) the Certificate of Primary Studies is awarded. The following two

Pierre, P., Ambroise, E., Devieux, S., L'Ecole haitienne et quelques-uns de ses
problems, typewritten report to Ministry of Education, Port-au-Prince, Haiti, 1948,
51 pp. See pages 12-13.
Bellegarde, Dantes, La Nation haitienne, Paris, G. de Gigord, 1938, page 351.





44 MISSION TO HAITI

years of the so-called Superior Primary Course entitle passing pupils to the
Elementary Certificate, and the last two years to the Superior Certificate.
All certificates are awarded on the basis of written and oral examinations.
The rural school system covers a six-year period, divided into three two-year
courses called Beginners, Intermediates, and Advanced. Pupils who com-
plete the six-year cycle are entitled to take the examinations for the Primary
Certificate. The system includes farm schools, rural schools, village schools,
a'nd communal schools. There is a special farm school for secondary school
age students at Chatard. Religious and private schools complement the
public schools in both urban and rural areas.
Teacher training is provided in official schools at Damien and at Matis-
sant, both on the outskirts of the capital, and also in the Elie Dubois Voca-
tional School run by the Belgian Sisters in Port-au-Prince. The teacher-
training courses of three years' duration in the two official schools accept
students who must generally have completed at least four years of the seven-
year secondary school course.
Secondary education is offered in ten public lycdes and twelve private
schools. Most of these facilities are located in the capital, including'P6tion-
ville. The religious secondary schools require payment for tuition and are
favoured by the middle class of Haiti. Admission to secondary schools is on
the basis of the Certificate of Primary Studies and of an entrance examina-
tion. The first three years of the secondary curriculum are called the Gram-
mar Division, the last three or four the Humanities Division. The bacca-
laureate degree at the end of tle secondary school is awarded on the basis


















School children playing on the school grounds in Marbial Valley Project. In
this co-operative project of the Haitian Government and UNESCO, methods are
being sought to develop a programme of fundamental education.






EDUCATION 45


Agricultural College building at Damien, not only the seat of the Extension
Service, the Experiment Station and the College, but also a training school for
rural teachers.
of two major examinations, the first given at the end of the sixth year
(rhitorique), the second after the seventh and last year philosophies) .
Vocational education is provided at both the upper elementary and the
secondary level in nine vocational or pre-vocational schools, four of which
are located in the capital.
The University of Haiti at Port-au-Prince was formed by bringing
together a number of separate or autonomous schools of higher education.
It comprises the Law School, the School of Science, the College of Medi-
cine, the School of Pharmacy, the School of Dentistry, the Polytechnical
School, the Superior Normal School for Secondary School Teachers, the
National School of Agriculture, and the Institute of Ethnology.
Enrolment in all urban primary schools of the country during 1946-47
was 48,996, in secondary schools 7,450, and in vocational schools 1,518.
Rural schools showed an enrolment of 52,667 during the same period.
The educational budget for the public schools amounted to 5,423,579.25
gourdes ($1,084,715.85).
2. CRITERIA FOR THE EDUCATIONAL EFFORT
What are the basic realities which education in Haiti must take into
account when thinking of the country's future?
As pointed out above, the Haitian population, almost entirely rural, is
highly dispersed over the mountainous surface of the country. Market
centres with permanent population concentrations are few. A survey made






MISSION TO HAITI


in recent years by an American educator reports that schools were available
for only one-fifth of the children of school age.' The most recent survey of
a committee of distinguished Haitian educators claims that only one-sixth
of Haiti's children are in school.2 Some 85 per cent of the population of
Haiti is illiterate. The close companions of illiteracy-poverty and disease-
occupy a prominent place among the national problems. Unless a chance
for a'minimum of fundamental education is provided, there is no possibility
of raising the health and productive capacities of the people, especially in
the rural areas. Only by a planned and continuous .development of the
human resources can the national resources of Haiti be appropriately
utilized as a basis for a widened range of economic activities.
The criteria for the educational effort here envisaged are:
Relevance to the improvement of the standards of living and production
of the Haitian population;
Evidence that most of the national and foreign personnel needed can
be secured without too great expense to the Government.
Guided by these criteria, the Mission recommends that as a basis for
improving education to help in the economic advancement of the nation
the Haitian Government undertake:
(1) An intensive national effort to reduce illiteracy through the teaching
of Creole and French;
(2) The preparation and publication, at Government expense, of a series
of basic readers for the literacy campaign, and of a minimum series of
elementary school books for all the school children of Haiti;
(3) The initiation of a practical industrial training and apprenticeship'
programme;
(4) The extension of the community school programme of the Rural
Education Department of the Ministry of Education.
Considering the number and importance of the rural population of the
country, the more specific proposals made below for educational improve-
merits in Haiti deal primarily with fundamental education. The apparent
neglect of urban, secondary, and higher education is justified at this time
only by the principle that "first things come first".

3. REDUCE ILLITERACY
French is the official language of the Haitian nation. To be part of the
great stream of French culture is an asset of inestimable value for Haiti.
French literature, philosophy, and political thought have decisively in-

Cook, Mercer, Education in Haiti, Bulletin 1948, No. 1, Federal Security Agency,
U.S. Office of Education, Washington, D.C., page 62.
2 Pierre, P., Ambroise, E., Devieux, S. L'Ecole haitienne et quelques-uns de ses
problimes, typewritten report to Ministry of Education, Port-au-Prince, Haiti, 1948,
51 pp. See page 6.






EDUCATION 47

fluenced and directed the formation of the modern democratic world.
French has for centuries been the language of diplomatic intercourse.
It is one of the original working languages of the United Nations, of which
Haiti is a Member. Mastery of the French language not only opens the
coors to the greatest treasures of western civilization, it is also a suitable
instrument with which to share in the scientific and technological progress
of the modern world.
To what degree can Haiti claim the possession of this great cultural
instrument as an asset to its national life and prosperity? At best, only 15
per cent of the adult population can speak and write French. The existence
and the use of a spoken language, side by side with the written, official
language, is a common phenomenon among some of the most advanced
peoples in Europe. When compulsory education and adequate schools and
teachers enable the children of a nation to become literate, the question of
class distinction based on language differences does not arise. As soon as this
goal has been reached in Haiti the present differences of opinion as to the
relative merits of teaching Creole or French, or Creole as a stepping stone
to the more rapid mastery of French, will be purely academic. The un-
deniable fact is that at present all Haitians speak and understand Creole,
but that French has very little functional use in the lives of the peasants
who live in isolation from the main stream of commercial and cultural
activities. If language is a carrier of culture-and it is so understood by
educated people all over the world-then it must be an integral part of the
spiritual and emotional life of a people. In their formative years most
Haitian children think, feel, and express themselves in their mother tongue,
which is Creole. For them, French when it is taught in school is an auxiliary
language, and remains so until such time as they can share as playmates or
as adults in the common command of the national language.
Learning is based on experience. It is an elementary law of learning that
one passes from the known to the new and unknown. Language makes it
possible to have vicarious experience. A language that is not spoken or used
cannot serve as a vehicle for direct or vicarious experience. It seems logical,
therefore, to develop a method of teaching French to the rural population
which is based on previous ability to speak, read, and write the native
language. The linguistic and phonetic relationships between Creole and
French are strong enough to make possible a rapid transition from the
former to the French. In urban areas where the use of French is current,
literacy classes in French are required. The adult classes for literacy in
French could serve employees, soldiers, workers and servants for whom the
knowledge of spoken French and a minimum reading knowledge is of im-
mediate value. A special course for teachers should be planned to develop a






48 MISSION TO HAITI

more rational method than the present memorization technique of teaching
French to children in the beginning years of elementary school. The teach-
ing of English would be valuable in the vocational schools and courses, I
since most of the technical manuals and guides for vocational and indus-
trial training are available in English only. Using and demonstrating identi-
cal methods for the teaching of English and of French would serve as a
double check and guide for the problems to be faced in the Creole teaching
campaign.
The reduction and elimination of illiteracy in Haiti is a national and
patriotic duty. Neither political nor class differences should interfere with
this task. Technical assistance for the preparation of the teachers and of
the materials and methods to be used can be secured through UNESCO.
All that is needed ,to succeed is sincerity of purpose, non-partisan support,
and persistence. To this end the Mission recommends that:
(a) A small and representative committee of interested Haitian leaders
be formed to draw up the programme and the policies to be followed in
the national literacy campaigns for French and Creole;
(b) A Literacy Department be established in the Ministry of Education
to take charge of all activities related to the efforts to reduce illiteracy in
Haiti;
(c) The Government consider the advisability of setting as a definite
goal of achievement the reduction of illiteracy by 1955 to 50 per cent of the
population above seven years of age.

4. BOOKS-ESSENTIAL TOOLS OF LEARNING
Textbooks from France or Canada are used in some of the schools. A few
history or geography books have been written by Haitians, and the
Christian Brothers of Canada have published some readers with Haitian
background. The Haitian Government does not provide free school books,
and most parents are too poor to buy them for their children. Education
without school books and supplementary reading materials can only per-
petuate Haiti's non-literary culture. To become a useful instrument for the
forging of Haitian nationality, education must teach children and adults to
use and love books as keys to the experience of the human race. Such books
should be written by Haitians for Haitian children. They should describe
the life and problems of Haiti, and should be practical in'pointing to a
better way of life through understanding, self-help, and organized com-
munity life. They should encourage and direct activities which satisfy the
emotional and social as well as the intellectual needs of children. Without
books to learn from and to read with pleasure and profit, children and
adults will soot forget their knowledge and lose the reading skill.






EDUCATION 'ft

During the last war airmen of the Allied armies were all given two books
-How to Land and Survive in the Arctic, and How to Land and Survive
in the Tropics. The knowledge and information acquired through the read-
ing of these books saved many lives. The Haitian people are in a critical
situation as far as survival is concerned. The right kind of school books
dealing with food production and soil conservation, protection against
malaria, hookworm, yaws, or tuberculosis, the making of household equip-
ment and agricultural tools, the proper care and use of animals, the making
of charcoal and lime without wasting scarce firewood, could turn books into
weapons for survival. Such books or' series of books, pamphlets, almanacs,
or periodicals, have been prepared for children and adults of other coun-
tries. Haiti could profit from their experience. Present techniques of repro-
duction and printing have reduced the costs of publication of school texts
to a reasonable minimum. Varitype, multilith, and offset printing processes
make the installation of a Government printing service for textbooks pos-
sible today, even for smaller countries with limited budgets. The Insular
Bureau of Education of Puerto Rico has recently established such a pub-
lication service for all types of printed matter needed in its educational
institutions.
A graded series of readers for the six years of the elementary school
course is a necessity in Haiti. Equally important are arithmetic and ele-
mentary science work-books. The preparation of such a series of books
would be a major undertaking for which technical assistance should be
sought outside of Haiti. The Government's investment in the free distribu-
tion of school books would be amply repaid in greater effectiveness of its
educational efforts. It is of little use to build schools without equipment or
teaching materials; it is even more futile to try to teach and learn without/
books.
If serious efforts are made to reduce illiteracy in Haiti, the preparation
and publication of reading matter in Creole and French for the newly
literate is vital. Excellent basic series and collateral reading material have
been produced in certain Latin-American countries-particularly Mexico
and Brazil-which have undertaken long-range campaigns against illiteracy.
Technical assistance for this task should be sought. The UNESCO Funda-
mental Education Clearing House is ready to assist the Haitian Govern-
ment with sample materials from many different countries.
As a means of achieving the desired improvement in literacy, the Mission
recommends that the Government undertake forthwith the preparation,
publication and distribution of:
(a) A basic series, in Creole and French, of elementary textbooks and
supplementary materials for the school children;






50 MISSION TO HAITI

(b) Appropriate basic readers and almanacs, as well as a weekly period-
ical in Creole;
(c) A special service for carrying out this task should be organized in the
Publications and Textbooks Section of the Ministry of National Education.

5. VOCATIONAL EDUCATION AND INDUSTRIAL TRAINING
The use of automotive and electric power is increasing rapidly in Haiti.
Construction activities in housing and public improvements are especially
noticeable in or near the capital. Sugar mills and oil extracting plants are
working at full capacity, and at a newly established modern plant for
cotton spinning and weaving the training of workers is in full swing. The
banana and sisal industries, land reclamation and irrigation works in the
Artibonite and elsewhere, and various sanitation projects call for an in-
creased number of workers. Only a minor proportion of these workers are
now being prepared through vocational education and training. The .stu-
dent body of the only real vocational school, that of the Salesian Brothers
in the capital of Haiti, consists of eighty students, twenty of whom are
graduated each year. Four trades are being taught in that institution:
carpentry, tailoring, shoemaking, and mechanics. The tailors and cobblers
learn their trade on an individual artisan basis, with no modern tools and
machinery. The work in mechanics consists primarily of rebuilding motors
and machine shop equipment, including simple foundry work.
The two apprenticeship and pre-vocational schools in the capital are
inadequately planned, staffed and equipped. Their curriculum follows the
antiquated patterns of some four basic trades-tailor, cobbler, carpenter,
and tinsmith-with classes so large that no individual teaching or super-
vision is possible. The Maison Centrale is a combination of orphanage,
reformatory, children's home, and elementary trade school. It lacks tools,
shop equipment, and supplies. Even good teachers, if they were available,
could not cope with the heterogeneous mass of youngsters sent to the
institution. The Apprenticeship School is housed in fairly modern buildings
just outside of town. It has possibilities for practical training and outdoor
activities, but lacks a proper curriculum, staff and supervision. Several of
the provincial towns still have remnants of the vocational training
programmes established during the time of the American occupation of
Haiti. Again, lacking trained teachers, supplies, and guidance from specially
prepared supervisors, these schools can do little to increase the appreciation
of a practical education in Haiti. That the need for trained workers it
great, is shown by the fact that twelve of the graduates of the vocational
courses in Cap-Haitien last year found immediate employment in local
plants.






EDUCATION


The only vocational school of the secondary type, J. B. Damier in
Port-au-Prince, is now in the process of reorganization. The plan for the
development of this school provides for a three-year training programme
for skilled workers, and an additional three-year programme for the abler
students to become foremen and technicians. The physical capacities of the
present buildings could take care of 200-250 students. Admission is set
now for 400. There are a limited number of worn-out hand tools, some
woodworking machinery, one forge, and a welding set. The automobile
mechanics shop lacks both teacher and equipment. The desire to make
vocational education respectable in Haiti has led to an ambitious plan
of setting up a full academic secondary curriculum, a vocational, and a
polytechnical programme in the same institution. In view of the lack of
vocational education facilities and of the great need of skilled workers, it
would seem advisable to turn the J. B. Damier school into a purely
vocational school. It should select its students on the basis of a primary
school certificate and some evidence of mechanical aptitude and interest.
The first two years of the curriculum should be devoted to general shop
work and a basic academic programme comprising French, arithmetic,
elementary notions of geometry, general science, English, and drawing.
The specialized trades courses should last from two and a half to three
years. The certificate should be awarded on a job and performance basis
to encourage able students to save half a year. The following courses should
eventually be offered either in day classes, part-time trade preparatory
and extension classes, or through evening and general continuation courses:
auto mechanics, machine shop, welding, electric motors, electric wiring,
plumbing and pipefitting, carpentry and woodworking, furniture-making,
masonry and stucco, radio. Elective or special classes should be organized
in leather work, wood-carving, printing, refrigeration mechanics, meat
preparation, and power sewing machine operation.
The vocational school of Caguas in Puerto Rico (300 students) is a good
example of what can be done in a small-scale vocational school which is
staffed by experienced and competent teachers and is provided with the
necessary budget for equipment, maintenance and supplies. Vocational
education needs no special defence against the prestige of the classical or
academic curriculum. The economic value of skilled workers is ample
compensation for the lack of a Bachelor of Arts degree.
In the absence of any effectively functioning vocational school with
adequate resources and personnel and with a curriculum answering
present-day needs, the initiation of a practical industrial training pro-
gramme should be considered. The establishment of a central garage and
service station in Port-au-Prince for all Government-owned motor vehicles





52 MISSION TO HAITI

could provide opportunities for twenty to thirty young men every year to go
through apprenticeship training while actually earning their maintenance.
Such a shop should be organized and directed preferably by an experienced
foreign master mechanic. If another specialist could be brought in to
teach the theoretical classes, the nucleus of a technical training programme
could be provided. Eventually the initial training activities could be located
in separate rooms or in a separate building. When the new reformatory
building is completed, a similar arrangement for furniture-making, wood-
working, and power sewing machinery use could be initiated. The
co-operation of industrial enterprises and such projects as the Artibonite
development enterprise could furnish opportunities for supervised on-the-job
training of mechanics and construction workers.
In general it is to be recommended that the Haitian Government
employ one or two outside vocational education specialists for, say, half a
year, to make an occupational survey and study the possibilities and
required facilities for the training of skilled workers. Past experience with
teachers or students who were sent abroad for technical training indicates
that the higher pay available in private enterprises deprives the schools of
the services of vocational teachers. It is probable that the training of
vocational teachers and supervisors by specialists brought to Haiti on a
contract basis would be more economical and practical for a time.
Vocational guidance and a placement service are considered today
integral parts of a vocational education programme. In view of the high
cost of technical education and training, fitting the right person to the
proper job becomes a necessity. The co-operative training programmes in
the United States have demonstrated the value and practicability of
combining study and work experience to the satisfaction of students and
employers. Competent supervisors who know the trades they teach could
probably find a few employers in Port-au-Prince or Cap-Haitien who
might be willing to work out such a co-operative arrangement with
the vocational schools.
The Mission recommends that:
(a) The present plans for the reorganization of the J. B. Damier Voca-
tional School in Port-au-Prince be so revised that a unified vocational
programme can be developed at the school, and-as a minimum require-
ment-that the existing shops be provided with adequate tools and
modern equipment;
(b) Serious consideration be given to the proposal for the establish-
ment of a central Government garage and repair station with training facili-
ties for apprentice mechanics.






V


^.s~.s^ -- --SS


Public school below one of the old forts of Dessalines serves people of this, historic town. Other towns of similar size are not
as well equipped and schools serving the rural population are inadequate.


^ 't ;'.*- *;-AMBi
7ts ''"'





54 MISSION TO HAITI

6. COMMUNITY SCHOOLS
The dispersal of rural properties and dwellings, the lack of roads and of
adequate police protection, have proved a very serious obstacle to the
development of rural communities in Haiti. Without community centres
or cores, essential public services for the protection of health and property
and for the promotion of education and of agricultural production are
impossible. In order to enlist all Haitians in the programme of national
rehabilitation, the organization of villages or rural centres is a necessity.
Any scheme for the development of rural communities must be accompanied
by a nation-wide effort to provide a minimum of fundamental education for .
the rural people of Haiti. Such educational efforts should consist in .
teaching the peasants the simplest notions of hygiene, government, science,
tools and machines, and how to use the skills of reading and writing in
their daily activities.
When the Mexican Cultural Missions began their work in rural education ?
more than twenty-five years ago, they found about the same problems and
meagre local resources as are now confronting Haitian educators. To be
sure, native villages had been in existence for a long time in Mexico, while
very few such aggregations exist in Haiti. The Mexican idea of fundamental
education was to identify education with the life of the community, however
primitive and poor it might be. The Cultural Missioners were convinced "
that education in such a setting would have to be of immediate use to the k
inhabitants; otherwise they could see no place or need for it. Once the
elders became aware of their latent capacities to improve the local resources f
for their own benefit, the notion of a community centre or school took "
on a useful meaning. The teachers in these community schools had to be
versatile and resourceful. They had to be doctors to men and beasts, to
know how to build a house or a well, to lay out and start gardens and-
irrigation schemes, to show how to make furniture and to prepare leather.
They taught people how they could do together what one alone could
not accomplish. They organized recreational activities and co-operatives,.
helped settle disputes fairly and in accordance with the mores of the
people. Finally, they had to demonstrate through their teaching that knowl-
edge was more useful than superstition.
The pattern of a Haitian community school is in the making. It is true
that the ninety-one farm schools (fermes-icoles) which were reported
functioning in 1945 have fallen into the regular pattern of rural schools, in
which little practical training in agriculture is possible because of the lac f
of trained teachers, equipment, and land. The new orientation schools
(1coles d'orientation), however, give promise of developing into real
community schools. In addition to regular six-year elementary school
I .





EDUCATION


programmes, these schools, three in number, have a school kitchen, a
first-aid station, adult classes for women in nutrition and sewing, and literacy
classes. They are staffed by men and women teachers who received special /
training in summer courses last year. Since their work extends beyond the
school walls and includes home visits and community activities, the
teachers are called "social missioners". The need for their services is so
great that the present allotments for materials and equipment are com-
pletely inadequate. Moreover, the Social Missions are not yet receiving
the co-operation from the Public Health and Agriculture Departments
which are so essential for health education, disease control and agricultural
work. The Department of Rural Education in the Ministry of Education
should be in a position to call for and receive the technical assistance and
public services which they are not qualified to render through their
own resources.
A common experience of the present school construction programme
is to find that within a month or two of opening a new school the number
of students has increased to twice the number that can be accommodated.
Costs can be reduced by designing a basic unit capable of expansion
through local or communal efforts, and by relating the layout and basic
construction to the functions of the school as a community centre.'
Every community school ought to have an adequate supply of potable
drinking water. Their efforts in health education are obviously frustrated
where polluted rivers and irrigation canals are their only source of
drinking water.
The curriculum of the present community schools is too academic. It is
puzzling to see children in one part of such a school going through the
same bookish exercises and memorizations that are practised in the towns,
while in another room adult women engage in the preparation of a school
lunch to put into practice what they have just been taught about nutrition
and food problems. The subject matter to be taught to the children in these
schools should be related to their chief concerns: food, livelihood, health,
their home, community, and country; when they learn to read, write, and
figure, they should do so with the purpose of using their knowledge for
improving their way of living. This problem of what to teach and how
to teach it in the rural and community schools should be one of the
chief subjects in next year's training courses.
Buildings and grounds and a curriculum do not make a school. The
teachers are the most important element. The type of teacher or director

SNote: The Mexican Ministry of Education has established a special department
of school architecture. In view of the great diversity of climatic and economic con-
ditions in Mexican rural areas, the working plans of that department might be
suggestive for future planning in Haiti.





56 MISSION TO HAITI

now working in the three community schools is still an exception in rural
Haiti. It would seem advisable to use some of the experienced and
successful members of the Social Missions as instructors in future training
courses. The training should not be given in Port-au-Prince, but in the
actual setting of a community school, such as Descloches, which is near
enough to the capital to make use of the hospitals and the National
Agricultural School'for observation and laboratory practice. The UNESCO
centre in Marbial was used last year for a two-weeks' special seminar to
teach the social missioners the techniques of community study. For most of
them it was the first experience in field study. The manner in which these
teachers are carrying over what they learned to the solution of the
community school problems shows the value of training in. real situations.
With the completion of the community centre and the technical organiza-
tion of the UNESCO pilot project in Marbial, a valuable training centre
for rural teachers could be developed there. The combination of agricul-
tural, medical, and educational activities of the proposed Marbial project
offers opportunities for learning, which could not be found in specialized
courses given in the capital.
The agricultural school of Chatard near Plaisance in the northern part
of Haiti was originally designed to train young men as practical farmers.
At the present time there are about twenty-two young men in training
there. Most of the building and staff facilities, however, are absorbed by
an elementary school for over 300 children of the neighbourhood. There
is not enough farm land for crop production and demonstration work..
The school has no safe water supply. There are no' farm animals. In
short, the Chatard School is unable to furnish' the practical training for
young farmers who could become leaders in their own communities. If the
programme of regional vocational schools envisaged in the recommenda-
tions concerning agricultural development' is adopted, then a new school
will have to be organized in the Chatard region.
While the director of the Chatard School has some space in the buildings
of the school for .his private living quarters, none of the community
schools in existence or planned has provisions for the director's house or
teachers' quarters. One of the essential conditions of a good rural teacher
is that he be a member of the community where he works, and that he
enjoy living conditions commensurate with his position and responsibilities.
It is doubtful whether a larger number of good directors of community
schools could be secured without making satisfactory provisions for then
and their families to live near their schools. Their. work is of such vital
importance to the development and welfare of the country that their

See part II, chapter I, Agricultural Development and Rural Welfare, page 117.






EDUCATION' 57

salaries should be fixed in proportion to their responsibilities and the
climatic and other difficulties of the region where they work.
With the approval of the Artibonite development project, the necessity
of establishing community centres there will be immediate. The directors
and supervisors of the community schools project, together with the
director of rural education, should make a critical survey of the problems
of the three existing community schools and of the Marbial UNESCO
centre with a view to preparing a practical plan for the new centres in
the Artibonite.
There is every indication that a closer co-ordination of the departments
of rural, adult, and vocational education with the agricultural training
facilities available at Damien and the public health service at Port-au-Prince
would produce better results in the near future than these departments
are now trying to achieve separately.
An analysis of the construction costs of the Orientation School of Haut
St. Marc reveals that a good standard community school in rural Haiti
would cost about $4,000 gourdess 20,000) to build, provided local
resources and labour are used. This estimate allows for a somewhat larger
and better built school than that at Haut St. Marc: it would have a well
with sufficient potable drinking water, a simple dispensary, a workshop
for the making and repair of tools and simple furniture, and a residence
for the director of the school, with two extra rooms for teachers. Funds
for the early construction of ten such schools should be provided. It is
important that no building projects should be approved unless provision
is made for securing a properly trained staff for each school. The teachers
must have special training and practice in established centres, such as
could be provided at the Marbial Centre.
The Mission recommends that:
(a) .The type of community school and centre which the Rural Educa-
tion Department and the UNESCO pilot project at Marbial have initiated
be extended as rapidly as possible;
(b) The leaders for the adult education activities in these centres be
chosen from the local population on the basis of their capacity for leader-
ship and training.

7. TEACHER TRAINING
Any proposal for the improvement of education in Haiti depends upon
a large increase in the number of teachers. The maximum number of
teachers who expect to graduate in 1949 from the normal school course
at Damien and the women's training school at Matissant is forty. A few
more may come from religious schools which offer teacher training facilities







. 58 MISSION TO HAITI

for a limited number of students. It is doubtful whether more than
thirty candidates will apply for teaching positions. The special report
referred to earlier in this chapter1 gives as the chief reasons for the lack
of interest in a teaching career the inadequate remuneration and facilities,
the hardships of living in isolated -rural areas, and the lack of security of
tenure due to political influence in appointments and promotions.
Until recently the men teachers for primary schools, and rural schools in
particular, were prepared at the National Agricultural School at Damien.
Following a regular agricultural course, and during the last two years
special courses in methods of teaching and psychology, most of the rural
teachers and principals had at least a sympathetic understanding of the
environment in which they were going to work. With the separation of
the training programme from that of agricultural specialists, however,
the curriculum now consists primarily of lectures. Not one of the educators
or agronomists who were familiar with the teacher training programme
carried on in the National Agricultural School before 1946 appeared to be
in favour of the present separation of the two programmes. It would
seem advisable to reconsider the situation, with a view to returning to the
former arrangement or finding some other appropriate way to bring the
rural education programme into close relation with the practical work
of the Agricultural School.
The Girls' Training School at Matissant is well-housed and provided with
buildings for the practice school and adequate grounds for gardening and
the care of farm animals, but it is no longer making use of these facilities.
The fields are neglected; the laboratory for home economics and health
education has become just another classroom. Home economics and
health education should be given a prominent part in the school pro-
gramme. Emphasis should be placed upon nutrition, gardening, child
care, home improvement, and social work among the poor.
The two normal schools should give short, intensive training courses
during the summer vacations such as those that were initiated last summer.
Competent special teachers who have studied abroad are available. The
courses should have a double purpose: to give teachers in service a chance
for promotion as principals or instructors for in-service training courses, and
to prepare rapidly candidates for the emergency teacher certificates.

8. CONCLUSIONS
The magnitude of the educational task to be accomplished with the
limited resources of Haiti is great. The country needs more schools and
more teachers, and the teachers need adequate pay and security of tenure,

Page 43, footnote '






EDUCATION 3!

independent of the vagaries of political change, which must not be
permitted to break the continuity of the educational system or to block
its improvement. The curricula of all the schools-primary, secondary, pre-
vocational, vocational, and special-need revision to bring them in closer
relation with the life and economic realities of Haiti. Without books and
other printed materials no modern nation's schools and teachers can
produce any worthwhile learning. Progress in civic consciousness, public
health, and economic endeavour depend upon the efficient service of
public education.
The Government's task is to make the masses of the population more
effective participating and producing members of society. This is a world-
wide trend. For its advancement Haiti-no less than any other country in a
comparable situation-needs the continuous stimulation of cultural impulses
from the outside. It cannot afford not to utilize to the fullest extent any
competent educators from among its nationals who have been trained
abroad with Haitian or foreign scholarships. Whatever is good in other
lands should be examined objectively for its value to the improvement
of the organization of Haitian education and its efficient operation in urban
and rural areas alike.
There is no evidence of a critical review or survey in the last twenty-five
years of the purposes, programmes and results of public education in Haiti.
While there are certain advantages in a centralized school system, one of
the most serious disadvantages is the tendency in the central offices to lose
contact with the realities of the local problems in the rural areas, and to
turn the supervisory personnel into controllers, rather than advisers and
guides of local teachers and school boards. The report of Messrs. Pierre,
Ambroise, and Devieux1 indicates that there is a felt need among Haitian
teachers for a reconsideration of the work and achievements of the
national system of education. We understand that plans have been drawn
up for a comprehensive survey of the educational system to be undertaken
within the next two or three years, with the assistance of outside experts.
The Mission strongly supports early realization of this survey.

1 Page 43, footnote '.











CHAPTER III


Public Health Problems

1. BASIC FACTORS
The Haitian public health problem is in the main a rural problem, as
peasants and their dependants living mostly on tiny farmsteads widely
scattered over the whole countryside form the overwhelming majority of
the people. With the exception of Port-au-Prince, the adjoining town of
'Ftionville, and the few departmental capitals harbouring in all but one-
tenth of the population, most of the agglomerations designated as cities or
towns are in fact hamlets lacking in lighting installations, sewerage, paved
streets, and other amenities of municipal life characterizing city formations
in economically more developed countries.
Lacking as a rule the very essentials of wholesome housing, the peasant
huts, described in a previous section,X are difficult to keep reasonably
sanitary. Rarely has a peasant family more than one bed, if any, and
several people share it simultaneously; the less fortunate sleep on mats on
the bare ground. The water available for use in the household seldom
fulfils the demands of hygiene; as properly capped wells are scarce, the
rural population commonly relies on more or less polluted surface water
for drinking and cooking, washing and bathing. Latrines and other toilet
facilities are mostly lacking. In the circumstances, obviously, a heavy task
confronts the Haitian health authorities, whose work in the rugged
countryside is further complicated by the very poor state of communica-
tions, causing whole areas to be practically isolated during the major
part of the rainy season.
There are virtually no statistics of diseases. The cause of death is
established only in deaths occurring in the hospitals. Of the 16,450 deaths
registered in 1944, only 2,298 were accompanied by a statement of the
cause of death (excluding ninety-six deaths classified in the uncertain
category of "sudden death" and of other causes not more fully determined).
The small number of well-defined causes of death does not admit of any
conclusive inferences. Nevertheless, the distribution of these causes furnishes
at least some information. About 40 per cent of them were attributed to
one or another of the, "infectious and parasitic diseases", with an over-
whelming preponderance of tuberculosis (46 per cent of this group).
According to these statistics other diseases of this category such as malaria,
Part I, chapter I, section 3, page 38.






PUBLIC HEALTH PROBLEMS 61

typhoid fever, tetanus, etc., are of minor importance. In fact, most of the
malaria patients in Haiti receive no treatment or are at best treated in
dispensaries only. Consequently these statistics offer no conclusive evidence
on malaria mortality.
However, the well-known fact that tuberculosis takes its heaviest toll of
human lives in the period of young adulthood is established once more
in Haiti, as is shown below.
Number of Number of
deaths from deaths from
all causes tuberculosis Per cent
20-29 years ................... 216 91 42
30-39 years ................... 223 79 35
40-49 years ................... 197 46 23
Since the number of deaths occurring in hospitals represents only a
fraction of all deaths in Haiti, it seems that no precise conclusions can be
drawn from these figures.

2. THE HAITIAN HEALTH ORGANIZATION
(a) General Structure
The central official agency for health matters, the Public Health Depart-
ment, subordinated to the Secretary of State for National Education and
Public Health, dates from the time of the United States occupation of
the country (1915-1934). Organized in various technical divisions, it
supervises the public hospitals, one each in the eleven health districts into
which the republic is subdivided, as well as the medical officers in charge of
105 public clinics and dispensaries distributed among the health districts in
rough proportion to their estimated population.
Among the provincial public hospitals, one has just come into operation
at Belladere, the recently inaugurated model town constructed on the site
of a previous ramshackle agglomeration on the eastern border. In co-
operation with the American Sanitary Mission, the maternity hospital
Chancerelles at Port-au-Prince has also just been completed, and the
Government is contemplating the building at Bel-Air (Port-au-Prince) of
a new hospital to supplement the accommodation offered by the General
Hospital, which has proved inadequate.
The last-mentioned hospital, employing thirty-two doctors, has 525 beds.
The ten provincial public hospitals,1 employing forty-four doctors, have
944 beds in all. In addition, there are 101 beds in private hospitals or
clinics, chiefly in Port-au-Prince. Thus 1,570 beds altogether are available
in the three categories of hospitals.
'These are located at Cap-Haitien and Port-de-Paix in the north, at Gonalves,
St. Marc, Hinche, and Belladere in central Haiti, and at Jacmel, Petit-Go.ve, Les
Cayes, and J6rnmie in the southern peninsula.






62 MISSION TO HAITJ


Health Centre-Port-au-Prince.

As far as could be ascertained, the hospitals are in general properly
maintained and sufficiently equipped in relation to local needs. All of
them are provided with operating facilities and a maternity ward. Isolation
facilities, however, are lacking in the smaller establishments; even at the
General Hospital in Port-au-Prince the isolation ward is quite inadequate.
The relatively high number of physicians at the General Hospital in
Port-au-Prince-high, that is, in relation to the number of beds, this.
ratio being 1: 16-is explained by the fact that specialists in surgery and
treatment otherwise of all kinds of ailments must be available there and
that these doctors are at the same time professors at the Medical
School of the University. The General Hospital is, in fact, the only
centre for practical teaching and training of medical students, nurses and
midwives. The number of doctors employed in the smaller hospitals seems,
on an average, rather high in relation to requirements that are obviously
much less diverse in the case of almost all of them. In the ten provincial
hospitals taken together the ratio of physicians employed to beds available
is 1:21. If some part of the medical staff now employed at hospitals in the
towns could be spared and trained for public health work in the field,
especially in rural areas which are as a rule sadly lacking in medical
attendance, this would no doubt be of benefit to the country and-
indirectly, at any rate-to its economic development.
Some fifteen doctors are graduated every year fr6m the Medical School
in Port-au-Prince. Of the 292 physicians in service at the end of 1948,
seventeen were abroad for study,1 150 resided in the capital and the nearby

'Twenty-four Haitian physicians were exercising their profession abroad.






PUBLIC HEALTH PROBLEMS


residential town of P6tionville (thirty-two of them serving at the General
Hospital), and ninety-nine were exercising their profession in the principal
provincial towns (forty-four of them being attached to the provincial
hospitals), thus leaving only twenty-six physicians to care for the ordinary
medical needs of well over 2,500,000 people living in the smaller towns and
the rural areas.
A nursing school annexed to the School of Medicine, while actually
located in the General Hospital, provides nurses and midwives for employ-
ment in the hospitals, which seem well staffed in this respect, or for other
health service, chiefly, if not exclusively, in the towns. The professionally
trained nurses and midwives in service at the end of 1948 numbered 317
and seventy, respectively, of which number 146 nurses and twenty midwives
were employed in hospitals.
Since 1942 the Public Health Department, in co-operation with the
Rockefeller Foundation and the American Sanitary Mission, has executed
some major public health projects-an anti-yaws campaign, drainage works
for malaria control, and medical education measures. Before discussing
these activities in some detail it may be of service to attempt an appraisal
of the organization of the Public Health Department and its capability of
carrying out public health measures by its own means (i.e., without such
assistance as that just referred to), and this for the following reasons:
1. Where a project has been undertaken with the assistance of a foreign
agency and this assistance is discontinued, maintenance of the work is the
Department's responsibility;


The University of Haiti, College of Medicine and Pharmacy, Port-au-Prince,
graduates approximately fifteen medical doctors annually.







64 MISSION TO HAITI ,

2. Knowledge of the Department's capacities and achievements in public
health work, past and present, is essential for future planning;
3. It should prove of service to the Department to have its attention
drawn to such shortcomings as may be detected in its organization and
activities.
Needless to say, this appraisal is attempted on the basis of strict objectivity
with no intent of commending or of casting blame upon anyone.

(b) Central Health Administration
A director-general is at the head of the Department of Public Health;
he is assisted by a deputy director-general and by the chiefs of the
technical and administrative divisions, which are six in number and are
concerned with epidemiology and prevention of epidemics, malaria control,
vital statistics, quarantine, hospitals, and rural clinics and dispensaries. All
of these medical officers, with one or two exceptions, are trained in
hospital service only, and for this reason tend to take greater interest in
hospitals than in health problems of the country districts.

(c) Provincial Health Administration
In each district is an administrator (administrateur) charged with the
medical supervision of the district, under the direct orders of the
director-general. Except in Port-au-Prince the administrator is also doctor-
in-chief of the hospital. Most of these administrators are surgeons who are
necessarily tied to the hospitals and, as a rule, have had no public health
training in the field.1 Moreover, rural public health work is greatly handi-
capped by lack of means of transport available to the health officers. Most
of the smaller districts have but one or two dilapidated vehicles for all
medical purposes, and even for these gasoline supplies are frequently
insufficient. There is a further reason why the health administrators and
other physicians are disinclined to absent themselves from their home
station: they are all of them private practitioners, who could not possibly
make a decent living on their salaries ranging from $60 to $160 a month.2
As no efficient public health work can be performed in the countryside of
Haiti without travelling, the activities of the supervisors tend on the
whole to be confined to the provision of medical supplies to the clinics
in their districts, and to some administrative matters of minor importance.'

A' few of the provincial health districts have recently been placed under the
direction of trained public health officers charged simultaneously with the supervision
of the local hospital.
In general the level of salaries of Haitian civil servants is very low.
'According to information received in June 1949, there are actually ten doctors
among those serving as division chiefs in the Central Health Administration or as
administrators of provincial districts who have received public health training at
recognized American universities.







PUBLIC HEALTH PROBLEMS bi

(d) Rural Clinics and Dispensaries
In order to improve conditions at the rural clinics and dispensaries
and to bring back into operation a number of such establishments closed
down on account of economic or other difficulties, the Public Health
Department in the course of 1948 had some sixty young men and women
trained in dressing, simple medication, and administering of intra-muscular
injections. On final examination after nine months' training, these trainees
were given the title of medical auxiliaries and were entrusted with operating
a rural clinic or dispensary more or less on their own-a none too easy task
and responsibility to shoulder after such a limited training course. Yet, if
their operation of the establishments entrusted to their charge were sub-
jected to strict medical supervision, some positive results could be expected.
As pointed out above, however, the medical supervision of rural clinics
and dispensaries is manifestly deficient. The system of medical auxiliaries
cannot, therefore, be commended in its present form.'
If the rural clinics were attended by a doctor every market day they
could be effectively utilized in combating yaws, and could prove useful also
as observation posts for detection of incipient epidemics. Furthermore, they
could be put to good use for examination and care of the health of school
children. Without regular supervision, however, they are of little value.
Recently an inspector-general, with his staff, was appointed head of
the division of rural clinics and dispensaries. The efficacy of this appoint-
ment must be questioned. Wanting in the first place are physicians for the
treatment of the patients in these clinics and for their medical supervision.
Superimposing a top-heavy and expensive central staff upon a system which
rather needs strengthening in what concerns its local ramifications, and
amplification of the means of transport for servicing them, does not seem
to have been a well-considered measure.

(e) Rural Doctors
There are some ten doctors of the Public Health Department residing
in the rural districts with a number of clinics under their care. In a certain
village one of these doctors was interviewed. He stated that he had been
unable to visit most of the dispensaries in that area because of lack of
transport and allocation of travel expenses. Nevertheless, he did sometimes
travel, but was obliged to make good his travel expenses by private
practice. The poor will. get very little help, indeed, from rural doctors in his
position.

'According to observations received in June 1949, the corps of medical auxiliaries
is not envisaged as a definite organism, but rather as a provisional step towards the
solution of rural public health problems pending the creation of rural health centres
directed exclusively by qualified doctors.







MISSION TO HAITI


It must be feared that travel practices are the same everywhere, for a civil
service which does not provide means of transport or compensation for
travelling expenses cannot reasonably order its officials to travel on duty.
Yet it must have been the intention of the department that the hospital
physicians should attend the clinics and dispensaries; in fact, in the annual
report for 1944 it is stated that they must visit these institutions by turns.
It cannot be readily ascertained whether this instruction has ever been
generally and effectively lived up to; that this is not the case at present
seems evident.
Summing up the observations on the health organization, it must be
stated that with respect to its responsibilities in the rural areas the Public
Health Department has not proved equal to its task. Neither the adminis-
trators nor the other physicians, with but few exceptions, have received
adequate training in public health work. Their exercise of private practice
and the lack of means of transport available to them are the main factors
deterring them from more active pursuit of public health activities.

3. PREVALENT DISEASES
Yaws, malaria and, in a certain degree, hookworm and tuberculosis are
prevalent diseases in Haiti. As to the prevalence of syphilis, a statement in
a recent issue of the Public Health Department's annual report contends
that some 57,000 cases were treated at hospitals and dispensaries during
the year 1944. There are reasons to doubt, however, that all of the
physicians on whose reports this total is based sufficiently master the some-
times difficult differential diagnosis of yaws and syphilis. The figure
therefore is subject to reservation and may well be too high.
Little or no reliable information is available on epidemics. Typhoid fever
seems to be slightly endemic in some areas, sometimes giving rise to more
or less severe epidemics. Amoebic dysentery is well known, bacillary
dysentery, however, is seldom diagnosed. It seems quite possible that a more
careful bacteriological examination of cases of diarrhoea would establish a
higher incidence of this disease.
(a) Yaws
Yaws and malaria are the two major health problems in Haiti. An
account of the activities of the American Sanitary Mission given in a recent
issue of the Haitian periodical Panorama contains the statement that as
many as 85 per cent or more of the population in certain rural areas of
;Haiti have been found to suffer from yaws.1 Endemic in all parts of the
country, yaws is encountered chiefly in the rural districts.
For the last five years the American Sanitary Mission in co-operation

'Panorama, Port-au-Prince, Haiti, March-April-May 1948, page 294.







PUBLIC HEALTH PROBLEMS 67

with the Haitian Government has been carrying out an anti-yaws campaign.
At the present time the following clinics are in operation:
Full time Once a week Once a fortnight
Moron Cressier Kenscoff
Cavaillou Mirebalais Cabaret
P6r6do (Marigot) Vilaret
Port-de-Paix
Pilate
Dondon
Though this anti-yaws work has undoubtedly a considerable effect,
it must be kept in mind that patients unable to make the long trip to
the clinics will not receive the treatment they need.
A more serious defect is the failure to carry on maintenance work in the
areas where mass treatment has been discontinued. An anti-yaws campaign
properly conducted reduces the incidence of the disease in a very high
degree, but it is not capable of eradicating yaws. Relapses and new infection
will occur continually, and only treatment in due time will maintain the
low incidence. In Haiti this maintenance work would be the task of the
Public Health Department and could be accomplished in the dispensaries.
For the reasons discussed above, however, the system of rural clinics and
dispensaries as organized at the present time is not equal to the task. It is
true that the medical auxiliaries in the dispensaries treat yaws with intra-
muscular injections of bismuth preparations, but this therapy cannot
substitute for the intravenous injections of arsenicals, which must be
administered by a physician or an especially trained aide.
Treatment with penicillin has been tried with encouraging results. Thus,
in the words of a concluding observation on the experience gained from
such treatment in Haiti some years ago of 500 patients with primary
and secondary yaws infections.1
it is felt that penicillin is probably the present-day drug of
choice in the treatment of yaws, and that penicillin in oil with beeswax is
of considerable public health value in countries such as Haiti where large
numbers of patients must be treated on an ambulatory basis in rural clinics.
Its use can be expected to successfully control cutaneous lesions and there-
fore prevent the spread of infection".
A more comprehensive experiment undertaken in Haiti between March
1947 and August 1948 (the results of which are shortly to be published)
has been summed up as follows by the physicians directing it:2
"Approximately 1,200 Haitian peasants with early yaws were treated
with penicillin in peanut oil and beeswax (Romansky formula). Injections
were administered in a two- or four-day schedule for a total of 1.2 and
'James H. Dwinelle and co-operators, "Evaluation of Penicillin in the Treatment
of Yaws", American Journal of Tropical Medicine, vol. 27, no. 5, September 1947.
Charles R. Rein, Delmar K. Kitchen and Edouard A. Petrus.





68- MISSION TO HAITI

2.4 million O.U. Blood specimens were collected from each patient prior to
treatment. Approximately 65 per cent of the patients treated were followed
clinically and serologically at three-month intervals for at least one year. All
patients were seropositive before treatment. At the end of one year approxi-
mately 30 per cent were serologically negative (Kahn standard test) and an
additional 63 per cent showed a definite reduction in serologic titer. Only 7
per cent .were classified as serologic failures and some of those might have
been re-infections. The clinical results with penicillin therapy were unusually
good."
The anti-yaws campaign will be given further consideration below.
(b) Malaria
Malaria is prevalent in many sections of the country. According to the
survey of J. Harland Paul and Ath6mas Bellerive,' but a few areas in Haiti
are malaria free. These authors state that spleen and parasite rates
presented for many areas of Haiti are as high as or higher than those
reported from anywhere else in the Western Hemisphere.
From Panorama, March-April-May, 1948, page 302, the following ento-
mological data are quoted:
"Four species of anophelines have been found in Haiti: A. albimanus,
A. grabhamii, A. vestitipennis, and A. crucians. A. albimanus is the pre-
dominant species-and apparently the principal vector, although A.
grabhamii is believed to play a secondary role as a vector of malaria.
A. vestitipennis is seldom encountered and is not thought to have any im-
portance as a vector. Larvae of this species have been collected only on two
occasions from ponds adjacent to the coast. A. crucians was found for the
first time in Haiti when five adults were taken in two trap collections at
L6ogine, in January 1945".
MALARIA CONTROL DRAINAGE PROJECTS
In most of the coastal towns, which are all more or less malarial,
engineering projects have been executed.
Petit-Godve
From 1942 to 1944 an extensive drainage project was executed here
under the auspices of the Rockefeller Foundation. The parasite rate
dropped from 86 per cent in 1940 to 20 per cent in 1944 after the com-
pletion of the project. This is a striking result of the execution of an
excellent malaria control programme, and it is, therefore, the more regret-
table that the maintenance of this drainage system has been badly neglected.
On a visit to the spot by the Mission's expert on public health it was
found that some of the main drainage channels were filled with sand, a dike
was broken, and in consequence the once perfectly drained area had been
inundated and become marshy. If necessary measures are not taken in
'J. Harland Paul and Ath6mas Bellerive, "A Malaria Reconnaissance of the
Republic of Haiti", The Journal of the National Malaria Society, vol. 6, no. 1
March 1947.





PUBLIC HEALTH PROBLEMS


' ""'1 -' "-y**
^- ..S'' '!" e .

-- "4 -...... .. _

Pure water supplies do not exist in the villages and rural areas. Water for
domestic use comes from polluted rivers and springs similar to the one shown
here. Peasant women may walk several miles carrying water in calabashes for
their household use.
due time, the purpose of this malaria control drainage project will be
frustrated. The sanitary inspector in charge of the maintenance of the
project has but four day-labourers at his disposal, a number just sufficient
for the regular digging out of the obstructed outlets of the drains, but
absolutely inadequate for emergency repairs.
Needless to say, this neglect of maintenance of expensive malaria drain-
age projects seriously affecting the malaria control in the area concerned,
must be considered a grave shortcoming of the administration responsible.
If the upkeep of existing public health installations is not effectively
attended to, the undertaking of further projects of this nature would be
of doubtful value.
Aquin
In this small coastal town a malaria control programme was executed
under the supervision of the Rockefeller Foundation from 1945 to 1946,
in consequence of which the spleen and blood rate dropped from 34.2 and
50.5 per cent, respectively, in 1945, to 20 and 8 per cent in 1948, also
a very satisfactory result. This project has been better maintained, though
some minor emergency repairs have not been executed because of permanent
lack of day-labourers.
Further malaria control drainage projects have been executed by the
American Sanitary Mission, in co-operation with the Haitian Government






MISSION TO HAITI


in the towns of Jacmel, Les Cayes, LUogane, Gonaives, St. Marc, and
Cap-Haitien.
Apart from the data collected in the above-mentioned survey by Paul
and Bellerive, which related only to schools, nothing is known about the
malaria incidence in the rural areas. Failing adequate knowledge on this
point, no precise suggestions of anti-malaria measures can usefully be made.
Institution of a thorough malaria survey of the rural areas with a view to
obtaining the information or indications needed for drawing up a purposeful
larviciding programme is highly desirable, considering that DDT has proved
a very effective larvicide that can be used in places where engineering
projects for malaria control through drainage are not feasible.
An alternative measure worthy of encouragement would be the cultiva-
tion in such breeding places for anopheline mosquitoes as ponds, pools,
lagoons, rivers and irrigation ditches, of top-feeding minnows, particularly
gambusia,1 as a larvicidal agent.
(c) Tuberculosis
According to the statistics for the year 1944, tuberculosis was the most
important cause of death among hospitalized patients. Although these
statistics cover only a small number of all deaths in Haiti, it may safely
be assumed that there is a great deal of tuberculosis in the slum quarters-
of the larger towns.
Some evidence that the disease is most prevalent in large communities is
given by the ratio of deaths from tuberculosis to all recorded deaths as
shown below.
Number of Deaths
Hospital deaths from Percentage
1944 tuberculosis
Port-au-Prince ............. 1,405 306 21.7
Cap-Haitien .............. 319 64 20
Les Cayes ................ 189 38 20
Gonaives ................. 138 5 3.7
Hinche .................. 50 1 2
Jacmel ................... 69 -
J6remie .................. 75 8 10.6
Petit-Goave .............. 29 2 7
Port-de-Paix .............. 63 4 6
St. M arc ................. 62 6 9
Remarkable results have been achieved in Europe and the Far East through
the cultivation of this predatory fish, a potent enemy of all kinds of mosquito larvae
which it devours. According to L. W. Hackett, Malaria in Europe, ed. 2, London,
Oxford University Press, 1944, page 312, the gambusia adapts itself easily to every
climate and every kind of water, fresh or salt, and is extraordinarily resistant to all
sorts of untoward circumstances. It is rarely sufficient by itself, however, to accom-
plish the whole task of malaria control. Its contribution to health improvement will
be most conspicuous in localities where the anopheline density is close to the critical
level at which the percentage of new infections in the population is equalled by the
percentage of recoveries, and below which malaria can no longer maintain itself
as an endemic disease.


70





PUBLIC HEALTH PROBLEMS /I

These figures show the highest proportion (about 20 per cent) of deaths
attributed to tuberculosis in the hospitals of the three largest towns.
According to Leyburn,' in 700 autopsies performed in one year at the
General Hospital of Port-au-Prince, 26 per cent of the deaths were due
to tuberculosis.
It is common knowledge that one important factor in the spread of the
disease is that people live crowded together in great number in small rooms.
Housing in Haiti is generally poor, but nowhere is it so bad as in the slum
quarters of the big towns, and above all those of Port-au-Prince, the capital.
There in limited spaces abundant crowds live in the most intimate
contact in the poorest dwellings imaginable, erected on ground that in the
rainy season becomes a quagmire, and surrounded by carelessly discarded
garbage. New accretions to these miserable crowds are continually drifting
in from the countryside. Years ago an attempt was made by the Govern-
ment to improve the situation in Port-au-Prince by constructing close to the
waterfront a number of very simple but more sanitary houses of concrete,
with more space between them; subsequently the open spaces were again
occupied by slum dwellings of the old style.

'Leyburn, James G. The Haitian People, page 275.





72 MISSION TO HAITI

A renewed attack upon the slums has been undertaken in conjunction with
the works for the international exposition at Port-au-Prince planned to be
inaugurated at the end of 1949. The projected site along the waterfront
embraces a large part of the slum quarters referred to above. These are
to be cleared to give place to constructions for the exposition, the building
of which has actually begun. The people are to be moved to higher land
away from the shore. Thus there are now prospects for ameliorating the
situation of the inhabitants of the quarters in question.
To check the increasing spread of the disease an anti-tuberculosis associa-
tion was founded some years ago, funds were collected, and a sanatorium
was constructed in Port-au-Prince and partially equipped, but for lack of
working capital it was turned over to the Government for operation.
Fully equipped this sanatorium will have a capacity of 100 beds (at
present facilities are available for sixty patients). Rather than a sanatorium,
it is a tuberculosis hospital where a very active surgical therapy is practised.
In addition, there are in operation in the capital three health centres
where some anti-tuberculosis work is also performed. But it must be kept
in mind that all these attempts fall short of providing the solution of the
problem, which must be sought in improvement of the standard of living
and of the general sanitary situation. Hence, for many years to come
tuberculosis will, it is feared, continue to take a heavy toll of human lives
in Haiti.
Although living conditions and housing in the rural districts are not so
bad as in the slum quarters of the towns, it may be assumed that the rural
population is also suffering from tuberculosis. No figures at all, however,
are available with regard to the incidence of the disease in the countryside.
Since children in many countries and especially in various parts of
Europe are now being vaccinated on a large scale with BCG against tuber-
culosis, a trial with this vaccine is to be recommended with regard to the
children of Haiti endangered by tuberculous infection. Furthermore, it is
desirable that research and investigations be made using the skin test
method for determining the rate of tuberculous infection in certain areas,
such as the slum quarters of the larger towns as well as-for purposes of
comparison-selected rural districts.

(d) Ancylostomiasis
Hookworm disease is well known in Haiti. In a survey conducted in 1925
under the auspices of the Rockefeller Foundation 47 per cent of 6,652
persons examined were found infested. In our recent survey of- school
children in Marbial, to be mentioned below, some clinically typical cases of
severe hookworm disease were found.






PUBLIC HEALTH PROBLEMS 73

In the mortality statistics of the Haitian hospitals for the year 1944 but
three deaths were attributed to ancylostomiasis as against seventy-eight
deaths due to infestation with other (not specified) intestinal worms. This
strange distribution of'intestinal worms will not be discussed further here;
suffice it to say that hookworm disease is common in this country. It is
desirable that the rate of infection be established by future surveys.
In conclusion of the rapid review made above of the principal diseases,
it may be stated that in Haiti yaws and malaria are prevalent, that the
incidence of tuberculosis is high, particularly in the large towns, and that
infestation with hookworm is common. The only epidemics reported to have
taken place in recent years were caused by typhoid fever; precise data are
lacking, however, and the observation of health developments in the rural
areas is so inadequate that epidemics may occur unknown to the health
authorities.
4. PUBLIC HEALTH AND FUNDAMENTAL EDUCATION AT MARBIAL
Concrete illustration in local miniature of some of the nation-wide
phenomena considered above and their relationship with educational and
other aspects of the Haitian problem of economic development is afforded
by the findings made in the Mission's field survey of conditions in the
Gosseline River Valley, the operational area for the fundamental educa-
tion project initiated by UNESCO at Marbial, some ten miles northeast
of the coastal town of Jacmel. The present section is a summary of the
relevant field report of the public health expert of the Mission. /
When UNESCO stated this pilot project in the spring of 1948 the
food situation in the valley was very bad on account of two consecutive
crop failures. Even under more normal climatic conditions, however, the
yield of the cultivable land, which constitutes only a small proportion
of the total area of this steep-walled valley, is low and permits but a poor
living for the too numerous population still caught in farming traditions
which pay little regard to the necessary husbanding of the natural resources.
A survey made in the fall of 1948 by the writer in co-operation with
a senior officer of the Haitian Public Health Department revealed spleen
and blood rates of 7.0 per cent and 12.7 per cent respectively in 216 school
children examined. While this indicates a very slight malarial infection,1
it should be kept in mind that only the more prosperous peasants can
afford to send their children to school, and that for this reason malaria
infection among children of this age in general might be somewhat higher.
Anopheles albimanus breeding areas in the Marbial section of the Gosseline
River Valley are only to be found in marginal pools left over in the broad riverbed
after flooding of the river, and hence are never so extensive as, for instance, in
lagoons and marshy regions on the coastal plains. This peculiarity of the breeding
areas accounts for the relatively low incidence of malaria in this region. By the end
of 1948 all breeding places had been treated with DDT.






MISSION TO HAITI


Some of the children werc found to show the typical symptoms of
hookworm disease, and thirty-three out of 126 children had pronounced
anaemia, in seventy-seven children malnutrition was evident, in spite of
three meals a week provided by the UNESCO station since 1 September
1948. This combination of malnutrition and the two diseases mentioned,
though each of relatively low incidence, might in the long run exert a
devastating effect on the health of the community. Mortality. among
infants and children would seem to be high.'
While the heavily polluted river has until recently been practically
the only source of water supply for all purposes, the situation was greatly
improved in the fall of 1948 by the drilling at the UNESCO station of a
well yielding some 800 gallons per hour. Although this water may not be
quite unobjectionable from a bacteriological standpoint owing to the close
proximity of the well to the living quarters, simple measures of protection
can be taken, rendering the well a great asset to the community.
A school has been established in connexion with the project, and a
limited school-feeding programme has been put in operation; young girls
are receiving training in weaving; a workshop for the production of cement
I bricks, and a plant nursery have been set up; a market and a slaughter-
house have been constructed; road building and soil preservation work
have been organized on a co-operative basis; and a community centre for
both adults and children is under construction.
It stands to reason that the matter of public health should receive full
attention in the creation of a rural community centre to point the way
for the future development of Haitian rural life. As a first step towards
public health promotion the broad mass of the peasant population, as
yet mostly illiterate, should be taught the elements of sanitation necessary
to guard against disease, and should be encouraged to co-operate to that
end among themselves and with the health authorities. This public health
instruction should be" intimately combined with, indeed made an integral
part of the fundamental education provided under the UNESCO pilot
project.
Yaws, which seriously affects the work capacity of the peasant popula-
tion, should be systematically combated, as part of the nation-wide anti-
'An attempt was made to make up in some way for the lack of reliable birth
and death figures by interrogating a number of old women about their offspring.
Forty-two of these women had given birth to 122 boys and 126 girls; of these
247 children 97 (39 per cent) had died (55 boys and 42 girls), and then alive were
150 children (67 boys and 83 girls). The number of childbirths per woman was
thus 5.8, and the number of children still alive 3.5. The basis is of course too
narrow for conclusive inferences; nevertheless, there is a striking agreement with
figures established on a much larger scale for certain underdeveloped areas in
Indonesia showing the same exceedingly high birth rate and a steady increase of
population, in spite of a very high mortality in infants and children.





PUBLIC HEALTH PROBLEMS


yaws campaign, in order to achieve that amelioration of labour efficiency
on which the .needed improvement of the agricultural situation of the
community must depend in the last resort. While malaria control b)
engineering methods is not required in this region, anopheline mosquito
breeding places should be treated regularly with larvicides.
To ensure sustained activity towards public health promotion in this
region, there should be provided at Marbial a health centre to include
not only a dispensary and a section for health education, but also a
laboratory and a research section for investigations and tests to determine
the prevalence of endemic diseases and detect epidemics.
The personnel should comprise: one physician, one secretary-
stenographer, one male nurse for the dispensary, two public health nurses,
-two aides for the anti-yaws campaign, one technician for malaria control,
one technician for public health education, two chauffeurs, one groom.
It must be emphasized that the physician (who may have his home
station at Jacmel) ought to be a field worker, well trained in' the activities
specified above, and in good physical condition. His would be a full-time
job, hence not allowing the exercise of private practice. With the increase
in the number of the community centres one physician could be charged
with the care of several public health centres, the possibility that a number
of communities might be able in the future to 'establish a modest rural
hospital to be kept in mind.
The health centre at Marbial could be amplified to serve, in addition,
as a centre for training physicians and other medical personnel in methods
and practices of public health and research work that may be profitably
applied in operating rural health centres in other parts of Haiti. Such
extension of the scope of the Marbial centre would call for the inclusion
of one more physician in its permanent staff.
For the purposeful development of the organization of rural public
health Haiti needs medical men with enthusiasm and initiative, young
doctors whose minds are open to the needs of the peasant, and who are
willing to co-operate with the agencies concerned. It would not be advisable
to start at once a large number of rural health centres, but rather to
proceed slowly, learning by experience; success will depend entirely on
the men who do the job.

5. CONCLUSIONS AND RECOMMENDATIONS
The above review of Haitian health problems has been confined to
their "public health" aspect-as was indeed the Mission's investigation of
this matter. The important related problem of nutrition has not been
dealt with here, and on housing but cursory observations have been madq







76 MISSION TO HAITI

above.1 Some brief reference to both these problems is, however, made
elsewhere in this report.2
In examining the over-all situation it was found that the fundamental
difficulty in the field of health, and the one having the most immediate
bearing on and raising the gravest obstacle to the economic development
of Haiti, is the highly unsatisfactory state (not to say the virtual absence)
of public health service in the rural areas, whose more than 2,500,000
,people are sadly lacking in medical care.
/ The urban population is much better, on the whole fairly adequately,
provided for in this respect, with the notable exception of the slum
quarters in some of the principal cities. Hospitals exist in the larger towns,
are in general properly maintained and equipped, and would appear to
be even more than adequately staffed on certain points.
By contrast, the system of rural clinics and dispensaries, inadequately
equipped and lacking in medical attendance and supervision, needs
vigorous strengthening and vitalization. Indeed, the institution of a well-
conceived, comprehensive and dynamic rural public health programme
is an urgent necessity.
This programme should provide for amplification of the present inade-
'quate organization by establishing rural health centres to include, in
addition to a clinic or dispensary, a small laboratory, a research section
for investigating the prevalence and incidence of diseases, detecting
epidemics, etc., and a section for public health education to work hand
in hand with the local organs for fundamental education and agricultural
development promotion. As expounded elsewhere in this report, the
Mission conceives of the specific centres as integrated though autonomous
components of broader-purpose community centres. In connexion with
the possible creation of such comprehensive rural community centres
(where feasible by transformation and development of already existing
local institutions), the early establishment or completion of model health
centres at Marbial, Fond Parisien, and at a suitable point in the lower
Artibonite should be considered.
It is advisable not to establish at once any large number of health
centres, but rather to proceed by steps. At present but few medical men
in Haiti are well versed in the matter of public health organization and
fewer still are adequately trained in rural public health service. One of
the first established health centres, e.g., that at Marbial, should be made
use of as a training centre where physicians could go to learn the profession

The Mission included no specialists on these problems, nor could the public
health expert attempt, in the time available, to examine them in any detail.
See part I, chapter I, 3 and part II, chapter I, A.3.






PUBLIC HEALTH PROBLEMS 77

of public health, officer. Additional training centres may be established
later on to help in the formation of the medical staff needed for efficient
operation of the rural public health organization as a whole.
Having in mind these general conclusions and considerations, and also
the several observations and suggestions made in the preceding review
of Haiti's health problems, the Mission recommends more specifically that:
1. Public health training should be obligatory for the medical super-
visors (administrateurs) of the rural health districts; in principle, surgeons
should not be appointed to these posts;
2. Medical officers in rural public health service should be full-time
appointees, receiving adequate remuneration to compensate for the loss
of private practice; this ,compensation may be given in the form of a
monthly allowance, additional to the regular salary;
3. Adequate means of transport at the charge of the public health
administration should be provided for the medical officers in iural public
health service;
4. The planned construction of a new hospital at Bel-Air in Port-
au-Prince should be reconsidered, with a view to its postponement for
the time being in favour of what seems the more economical and no less
effective solution of extending the premises of the General Hospital;
5. Where drainage works have been executed and installations made
for malaria control, these health engineering works should be properly
maintained and emergency repairs undertaken without delay;
6. A comprehensive survey should be made of the incidence of malaria
in the rural areas on the basis of which an expedient programme should
be drawn up for treating mosquito breeding places in' malarial regions
with DDT as a larvicide, where engineering projects for malaria control
through drainage are not feasible;
7. Thorough surveys should be undertaken to determine tuberculosis
and ancylostomiasis infection rates, more especially in rural Haiti, for
which practically no data of this nature are now available;
8. A trial vaccination of children with BCG may be made, with a
view to deciding whether or not to undertake large-scale vaccination of
children endangered by tuberculous infection;
9. Rural clinics and dispensaries should be regularly and adequately
supplied with the drugs they need for efficient operation, especially in
fighting yaws, e.g., penicillin and arsenical compounds; yaws must never
be treated exclusively with bismuth preparation, which may only be used
to supplement treatment with arsenicals;







MISSION TO HAITI


10. As probably well over half of the rural population of Haiti suffers
from yaws, seriously impairing the capacity for work of those afflicted
and hence constituting a major obstacle to the amelioration of labour
efficiency on which the country's economic development so largely depends,
the Department of Public Health should concentrate its efforts on a
systematic fight against this plague, which the endeavours attempted so
far have failed to master;
11. With a view to bringing this disease under effective control-a goal
which can be attained by determined full-scale effort, though the encoun-
tering difficulties are great-an organized nation-wide anti-yaws campaign
should be vigorously pursued for, some three years; the costs of such a
campaign are considerable, it is true, but, if incurred, would in fact
represent an investment in the labour factor of production, increasing
its efficiency with beneficial effects on the economic development of the
country.
An operational plan and a cost estimate for the nation-wide anti-yaws
campaign here recommended are immediately annexed.

APPENDIX
Plan and Estimate of Costs of a Country-Wide Anti-Yaws Campaign
The full-scale campaign should be set up in such a way that 600,000
cases per year could be treated. Within three years 1,800,000 cases, or--
even allowing for a certain proportion of relapses-half or more of the
whole population, could thus receive treatment. (The number of cases
treated by the American Sanitary Mission during the years 1944-1946
was 205,000, 183,000, and 244,000, respectively.) Once the rate of infection
has been reduced to a minimum by means of this powerful attack over a
relatively short period, regular treatment in the rural clinics combined
with a limited campaign in the more remote regions would keep the
incidence at that low level.
By concentrating the campaign within a brief period of two to three
years, the usual slackening of effort which occurs during a protracted
campaign could be avoided. All the remote regions should also be cleaned
up, notwithstanding the great difficulties-a strenuous task for the
physicians and their aides, who should therefore receive adequate salaries.
Arsenicals are not practicable in the countryside of Haiti because of
the difficulty of getting the patients back for a second and third injection.
For this reason penicillin in oil with beeswax (two injections administered
at an interval of ten to twelve hours) is the drug of choice.
The campaign carried out by twelve physicians each assisted by five
medical aides could be started from the rural clinics throughout the
country, each physician having five of these under his care. Later, moving
into more remote regions, ambulant clinics should be brought into use.
The treatment of 600,000 patients per year would require 100,000 injections
per month.






PUBLIC HEALTH PROBLEMS 79

A country-wide anti-yaws campaign should be carried out only on the
condition that in the meantime the rural clinics are equipped and irade
operative to such an extent that the results of the campaign can be'
maintained. The costs of such an enterprise are undoubtedly considerable,
as is shown below; on the other hand, it is clear that a relatively short
full-scale operation has many advantages over a protracted campaign
lasting many years.

TABLE 1
Estimate of Costs of a Country-Wide Anti-Yaws Campaign
Per year
Initial costs:
14 pick-up cars ............................ $22,400
Instruments ................................ 1,700
1 typewriter ................... ............ 150
$24,250
Periodic costs:
Monthly salaries:
1 director ................................ $ 600
12 physicians at $200 ....................... 2,400
60 medical aides at $60 .................... 3,600
1 secretary-stenographer ............ .. .. 80
14 chauffeurs at $60 ........................ 840
$ 7,520
TOTAL SALARIES ................ $ 90,240
Materials, etc.:
Penicillin, 600,000 treatments ........................ $760,000
Other drugs, alcohol, syringes, etc. .................... 17,000
Gasoline, oil, etc., for 14 motorcars 1,000 miles per month
at 3Y2 cents per mile ....................... ....... 5,880
Upkeep and maintenance 14 motor cars at 2/2 cents
per mile ................. ................... ... 4,20C
Expenses for travel subsistence, hire of horses, transport of
drugs, etc. .......................... ............. 12,000
W writing materials, forms, etc ........................ 3,000
TOTAL MATERIALS, ETC. $802,080

The total costs of this anti-yaws campaign during three years would
thus amount to roughly $2.5 to $2.7 million.