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MISSION TO HAITI
The impressive National Palace, the seat of government in Port-au-Prince, is located in the centre of an attractive development of parks and other government structures.
NATIONS, /Y'ziY;5- k -
MISSION TO HAITI
Report of the
United Nations Mission of Technical Assistance
to the Republic of Haiti
Lake Success, New York
UNITED NATIONS PUBLICATIONS I 1949. 11B. 2.
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 (111) 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 concerned 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 recommendations of which have been duly brought to the Haitian Government's attention, I have pleasure in making it public in full accord with the President of the Republic of Haiti.
TABLE OF CONTENTS
1. Origin, organization and procedure of work of the Mission . xiii 2. Nature of the Mission's Report . xvi
1. Basic facts and findings . 1 2. Recom m endations . 7
(a) General recommendations . 7 (b) Abstract of specific recommendations . 14
Demographic, Educational and Health Problems
Affecting Haiti's Economic Development
1. 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
I. Structure of the educational system . 43 2. Criteria for the educational effort . 45 3. R educe illiteracy . 46 4. Books- essential tools of learning . 48 5. Vocational education and industrial training . 50
54 57 58
64 64 65 65 66 66 68 70 72 73 75
6. Com m unity schools .
7. T eacher training .
8. C onclusions .
111. 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) R ural doctors .
3. Prevalent diseases .
(a) Y aw s .
(b) M alaria .
(c) T uberculosis .
(d) A ncylostom iasis .
4. Public health and fundamental education at Marbial .
5. Conclusions and recommendations .
Plan and estimate of costs of a country-wide anti-yaws campaign .
Problems of Production, Transport, Trade and Finance
as Determinants of Haiti's Economic Development
1. AGRICULTURAL DEVELOPMENT AND RURAL WELFARE A. Natural characteristics, economic structure, and institutional
environment of Haitian agriculture
1. Nature of the land .
2. Resources, tenure, and production methods .
3. W ays of life of the peasants .
4. T ransport facilities .
5. Irrigation .
6. Taxation, credit conditions, and local trade practices . .
7. External trade in agricultural goods .
8. Production for local consumption .
9. W ork practices . 100 10. Agricultural training . 102 It. Development measures . 103
B. Recommendations on policy and procedure . 104
C. Recommendations on agricultural development projects . 121
Notes and recommendations on specific crops
(i) C acao . 131 (ii) Coconut and oil palm . 132 (iii) R ice . 134 (iv) R ubber . 135 (v) T obacco . 137 (vi) Cotton and cotton seed . 139 (vii) Sugar-cane . 141 (viii) Bananas . 141
(ix) Fruit trees . 141 (x) Bam boo . 143
II. FisH ERIES . 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
1. Observations on salt and fish salting . 162
11. Expansion of the marine fisheries . 164
111. Reference sources on fisheries . 167
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 ther m inerals . 182
3. Fuel and power resources . 183
(a) Hydro-electric energy . 183 (b) L ignites . . 185 (c) Lumber and charcoal . 186 (d) W ind power . 187
4. Small-scale engineering and repairs . 187 5. H andicrafts . 187
C. Organizational measures
1. General organization . 189 2. Industrial statistics . 191
3. Industrial promotion and its co-ordination with agricultural 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 industrial 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 . T ourism . 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 onetary 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 adm inistration . 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
18. R eceipts . 322
19. Expenditures . 323
20. Outline for an adaptation of the Haitian budget classification to the Scandinavian model . 324
LIST OF TABLES
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 I 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 J 2. Sources of revenue . - 287 13. Sources of customs revenue . 289 14. Allocation of expenditures . 295 15. Haitian public debt, amounts outstanding on 30 September 19371948 . . . 298 16. Local governments' receipts . 303 17. Deductions made by the Internal Revcnue 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
I. Exports and imports, 1926-27 to 1947-48 . 211
II. Assets of the Banque nationale de la Ripublique d'Haiti, 19461948 . 234
III. Liabilities of the Banque nationale de la Ripublique d'Haiti, 1946-1948 . 235
IV. Assets of the Banque nationale de la Ripublique d'Haiti, 19271948 . 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 expansion . Inside back cover
1. ORIGIN, ORGANIZATION AND PROCFDURF 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 SecretaryGeneral 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 economic 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 SecretaryGeneral, 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 problern 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.
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 Agriculture Organization
Carle Fritzle, expert in Tropical Agriculture, Food and Agriculture Organization
Ernest F. Thompson, expert in Development of Fisheries, Food and Agriculture Organization
Edwin R. Henson, expert in Combined Resource Development, United
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 Educational, Scientific, and Cultural Organizatioiz
Adolf Kundig, expert in Tropical Public Health Organization, World Health
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 documentation 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 Government placed at the Mission's disposal in Port-au-Prince a house adequately 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 members. 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 headquarters. 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 graciously arranged by the United States Department of the Interior and the Insular Government of Puerto Rico were provided for the purpose.
'Valuable 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 throughout 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 travelling together the experts of the Mission had the opportunity of continuous exchange of views and experience. Observations and conclusions were discussed 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 n ' ot 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 comprehensive and consistent framework, as it were, for the policy it advises the Government to apply in endeavouring to promote the economic development 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.'
In confining itself at this initial stage of United Nations te -Fnical assistance to Haiti to reviewing problems and conditions, formulating recommendations 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 (111) of 4 December 1948 to render (in fact on somewhat more liberal terms than those previously afforded by Economic and Social Council resolution 51
(W) under wiich the Mission to Haiti has been operating) to Member Governments in need of such assistance. In addition, technical assistance in the subFtantive 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 development projeCtS,2 and to attempt any "wholesale" estimate of the costs involved in an over-all programme of economic development of the country wr uld 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, however, 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 commitments. 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 recommendations 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 H, Public Health Fioblems.
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 constituting 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 recommendations relating to the Mission's observation of the field as a whole, and
(b) an abstract of the specific recommendations contained in the individual 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 resources 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 agriculture, 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
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.
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-erosic i 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 backward 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 individuAlly 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
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.
supply of fish from local resources to a- volume reasonably close to consumption 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. Development measures to that effect will have to be intimately tied in And coordinatcd 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 can I e 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 undertaken 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 investigated. There are deposits of lignite which might prove worth exploiting, more especially for generation of thermo-clectric 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 concernedalarmingly shrinking natural resources.
In the circumstances per capita 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 development 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 broadening 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 improve.the 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 a agriculture, small industry and handicraft, and lack of facilities also for channelling into productive' investment such individually 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 can-ofiIy-be achieved by a determined expansion of physical production by broadening its material basis and -mobilizing for'the purpose (within the limits set by -efficiency considerations) the abundant and now poorly employed manpower.
T6 cope with thiï¿½ 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 organizational arrangements for develop g 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
of self-help among the people, encourage ing 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.
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 havc'formcd 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 frequently 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 developmental endeavour.
Under its terms of reference tne 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 recommendations which are to be found in, the chapters examining these sectors individually.
(A) Generat 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, utilization 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 Afission recommends that an independent advisory national resources and development board be established with five full-term members.
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 planning 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-"notabIes" on the national level-taking no active part in politics, distinguished in the present and in the pastor 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,' 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-Secfetaries 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 problems. The Board would be entitled to hold at its oWn discretion workingparty 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 oth er 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.
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 UnderSecretary 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 governmental 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 Coordination Committee, at the Under-Secretary of State level. Such a committee 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 Resources 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.
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, recornrnendation 6, pages 273-274.
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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 imparting 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 developmental 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 obligations, emoluments, promotion, retirement, o'r dismissal of staff. It is important 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 efficiency. 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 connexions 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 evolvingfree 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 fat-be strengthened to play their proper part in developmental public works, in improving sanitary installations and water supplies, in providing, other facilities for health improvement, 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 supplemented 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 orians 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
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 beginnings of such a system, so far as road transport and coastwise shipping are concerned. The Mission recommends that a master plan for speedy amelioration 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 construction 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.
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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 sailin*gs 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 consideration be given to the possibility of encouraging emigration as a means of relieving 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. Emigration from Haiti should preferably take the form of moving whole family units from over-populated agricultural areas for permanent settlement 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, comprehensive 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 provide for the collection, preparation, and publication by the Government of complete and accurate I statistics regarding: (a) the population, its demographic 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 communications; (d) price movements, money and credit, capital formation, national income, and balances of payments; (e) the public finances in their different aspects.
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 reorganization 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 or comprehensive development planning.
Certain elements of the economic and financial statistics broadly defined above are presently compiled by the statistical unit of the Fiscal Department 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 11, 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 administration 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
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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 a,,Yricultural development (part II, chapter 1, pages 104-131)
1. The reorganization of Haitian agriculture be undertaken as a pressing national enterprise;
2. The effort to improve agricultural production be centrcd 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 whenever 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 att ntion 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 produce rs, at preferential prices;
10. The Agricultural Extension Service of the Department of Agriculture 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 ihe 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& des Pins;
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 undertakings of a similar nature;
18. In the choice of projects for agricultural development through irrigation, priority be given to existing systems, in which physical improvement 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 serviceable poles;
25. In appropriate areas (e.g. the Plateau Central), agricultural development 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 11, 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 developing 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 experimentation 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 themarket;
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 111, 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 For t 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 prospective demand for cement for building and construction activities, including road improvement and other development works, be encouraged;
6. Spot surveying be undertake n to determine the availability of quartziferous 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;
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 engineering, 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 adjustments 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 concordant with economic development aims.
As regards public education (part 1, chapter II, pages 46, 48, 49-50,' 52, 57)
L As a basis for improving education to help in the economic advancenient 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 public tion of a series of basic leaders for the literacy campaign, and of a minimum series of elementary school books for all the school children in Haiti;
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(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 I (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 periodicals 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 I (c) above:
(i) The plans for the reorganization of theJ. B. Damier Vocational School in Port-au-Prince be so revised that a unificA 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 I (d) above:
(i) The type of community school and centre which the Rural Education Department and the UNESCO Pilot Project at Marbial have initiated be extended as rapidly as possible;
(ii) The leaders for the adult dedication activities in these centres be chosen from the local population on the bdsis of their capacity for leadership and training.
As regards public health (part 1, chapter III, pages 77-78):
1. Public health training be obligatory for thc 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-auPrince 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 ancylostorniasis 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) :
I. Consideration be given to the possibility of using monetary and fiscal policies-with prudent attention to the limitations and risks involvedfor 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) 4oans or credits obtained abroad:
For the financing of important development projects which require sizable capital investment exceeding the capacity, of domestic firlancial resources, recourse may be had to borrowing abroad, especially from international financial institutions or credit agencies of foreign Governments. It is recommended in this connexion that.the Haitian Governmen t examine the advantages of participation in the International Bank for Reconstruction and Development and the International Mon ' etary 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 cqt ipment 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 supervision of the conduct of such business;
4. In connexion with-the re,0ew 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 tl-fe 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
Govcrnment-guarantecd institution to provide medium-term and long-term credit principally to farmers, rural industries and hand i c raf ts-preferably through the intermediary of co-operativc 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 11, 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 agricultural 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;
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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 "excessprofit" 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 structu re by strengthening its financial basis.
DEMOGRAPHIC, EDUCATIONAL AND HEALTH PROBLEMS AFFECTING HAITI'S ECONOMIC DEVELOPMENT
Haiti aiid 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 mountainous. 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 Woodring'
'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. ' 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).
'Republic of Haiti, Department of Public Works. Geology of the Republic of Haiti, by Wendll P. Woodring, John S. Brown and Wilbur S. Burbank, Port-auPrince, 1924.
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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 succ eding 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 ninetenths 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
HAITI AND THE HAITIANS
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 Ameiica (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 tr, 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 somewhat 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.
TA,~ r2 .:
Rua ake etenerPn str.O are a hosnsofpol ate eetoecag termarepoue
agiulua prdcs ltig od n seta oshl qimnalo orqaiy
HAITI AND THE HAITIANS l
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-thc 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 provincial towns and the countryside towards Port-au-Prince, but the Government 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 pre-dominance of persons working for their individual account as proprietors, 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 published by the United States Department of Labor:'
'MonthlY Labor Review, vol. 59, no. 4, October 1944.
32 MISSION TO HAITI
Number of workers
Agriculture (and related industries) . 83,500 Domestic service . 1 75,000 Shop em ployees . 12,000 Government (including the National Bank) . 9,400 R ailroads . 360 A irw ays . 150 .
M iscellaneous . 1,830 1 TOTAL 182,240
The total shown, which may have been somewhat incomplete, represented 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 mortality rate arrived at by striking the ratio between reported deaths and estimated total population is extremely low. Injuring the period 1935-1944 it averaged about fivedeaths 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 1 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 I year . .
1-4 years . 12.1 5-9 . . I . :. 3.8 10-19 " : . 6.6 20-29 . . * * * ' * * * - ' ' I . 13.2 30-39 . . 13.1 40-49 . . 11.6 50-59 . . . 8.3 60-79 1 . . 12.3 80 years and over . 3.6
These figures, showing a significant concentration of deaths in early childhood-27.5 per cent in the fir ' t 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 treatment-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-ni ne 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 registration. 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 associated with low fertility-namely, a high degree of industrialization and urbanization, high per capita income, and a high level of educational attainment-are absent in Haiti. If the birth rate is actually in the neighbourhood of forty per 1,000 and the death rate, as suggested above, somewhere 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 I 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-morc 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 contain certain provisions which in principle restrict foreign ownership of real
34 MISSION TO HAITI
estate and the exercise of business by foreigners.' In actual practice, however, not all of these provisions are now enforced.
(d) The Population Problem viewed in relation to Economic Development Need
The central economic problem of Haiti 4 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 'ilian 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 con ' editions 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 sanitation 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 encouraging 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
The 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 patented (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 (middvman 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 1 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 settlement in the country of immigration. The emigration which has taken place in the past has been largely seasonal or temporary, and has primarily conccrned individual agricultural labourers recruited for work in neighbouring 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 comprehei)sive to constitute not merely a series of small improvements which will be neutralized by continuous population increase. In view of the limitation of the investment resources at present available or in sight, great circumspection 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 programme of education, can increase more than proportionately the output of Haitian agriculture and at the same time, in encouraging active co-operation and initiative to self-help on the part of the population in rural communities, foster those institutions necessary for sustained progress.
Proper balance will have to be sought between the -deve lopmental activities in the different economic and inter-related social fields. The development 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 handicraft 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 capita income at about $25 and the aggregate national income at roughly five times the Government revenues, then amounting to nearly $10 million. A later estimate' relating to the last years before the war again worked out at approximately $25 per capita. 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 involved, however, any such estimate for Haiti serves to demonstrate t e 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 capita 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 1. 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 capita 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 importspractically all of the nature of nccessities-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 ab;Tt 155 million (average for the last two fiscal years) or by 343 per cent.
'Don D. Humphrey, chapter XV, "Haiti", page :365, in Harris, Seymour
(editor), Economic Problems of Latin America (New York, U.S.A.: McGraw-Hill Book Co., Inc., 1944).
HAITI AND THE HAITIANS :31
wartime and post-war rise in prices' may have accounted for some twothirds 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 interwar 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 capita 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.
Large rural families living in small huts on the lands to be developed in the Artibonite Valley Project. Success of this project may depend upon how effectively these families can be induced to exchange their claims to small 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 socioeconomic indicators, such as the proportion of children attending primary schools, educational expenditures, exports and government revenues per capita, point to an appreciably lower national income per capita in Haiti than in the neighbouring 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.'
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 subsistence extremely low on the whole, the family income being barely sufficient to meet even rudimentary requirements of food, clothing, and shelter. j
The majority of the rural population and a large part also of the people living in the towns show signs of u nder-nourishmcnt 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 apparently under-fed or ill-fed.
Rural housing in particular is quite primitive and generally inadequate. The Government has received technical advice from a United Stat s 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 arc all one usually finds inside. The more fortunate families have a community privy nearby. The land is frequently rented from a large i 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. Cation in Aspects de l'iconornie et des finances d'Haiti, Port-au-Prince, 1944.
'Bourne, Philip W., Housing Study of the Republic of Haiti, prepared in consultation with the Office of the Administrator, Housing and Home Finance Agency, I Washington, D.C., October 1948.
HAITI AND THE HAITIANS 39
Country woman wearing customary dress of coarse white or blue cloth.
Heavy head Ioads are carried by old
MISSION TO HAITI
Improved housing at Bella&re. 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, combined 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 coinpetent 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 relatively 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 hookwokm, are transmitted by way of the skin.
The greater part both of the urban and the rural population cannot afford to pay much for the care of their health. Medical care is very inadequately 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 I V2 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. Subsequently the legal daily minimum wage was raised in two stages to 3Y2 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 examined 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 Bellad re near the Dominican border. This town, with its model buildings, well laid out streets and electric lighting system, must depend upon a greatly enlarged agricultural development in the vicinity or on an
increased tourist trade for its economic well-being.
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 formulated as might be desired. A considerable burden of review was consequently 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 p 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).
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 realized 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 programmes. Spokesmen of the younger generation feel that Haitian unity and progress will depend for their realization upon the creation of a mystique nationale, by which they mean a passionate faith in the destiny of the Haitian nation.' 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 supervision and control of the Ministry of Agriculture. Curricula for public and private schools are fixed by the Government. Urban elementary education 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., Amnbroise, E., Devieux, S., L'Ecole haitienne et quelques-uns de e Pro blrnes, typewritten report to Ministry of Education, Port-au-Prince, Haiti, 1948, 51 PP. See pages 12-13.
Bellegarde, Dant~s, La Nation haitienne, Paris, G. de Gigord, 1938, page 351.
44 MISSION TO HAITI
yea rs 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 complete the six-year cycle are entitled to take the examinations for the Primary Certificate. The system includes farm schools, rural schools, village schools, '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 Matissant, both on the outskirts of the capital, and also in the Elie Dubois Vocational School run by the Belgian Sisters in Port-au-Prince. The teachertraining courses of three years' duration in the two official schools accept students who must generally have completed at least four years of the sevenyear secondary school course.
Secondary education is offered in ten public lycies and twelve private schools. Most of these facilities are located in the capital, including'Ptionville. 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 examination. The first three years of the secondary curriculums are called the Grammar Division, the last three or four the Humanities Division. The baccalaureate degree 'at the end of tlie 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.
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 philosophice).
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 Medicine, 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. Ihe 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 diseaseoccupy 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 hooks 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 thie number and importance of the rural population of the country, the more specific proposals made below for educational improvemeits 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.
2Pierre, P., Amnbroise, E., Dcvieux, S. L'Ecole haitienne et quelques-uns de ses problimes, typewrilen report to Ministry of Education, Port-au-Prince, Haiti, 1948, 51 pp. See page 6.
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 Goors 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 basedon 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 undeniablc 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 immediate 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 teaching of English would be valuable in the vocational schools and courses, since most of the technical manuals and guides for vocational and industrial training are available in English only. Using and demonstrating identical methods for the teaching of English and of French woul d 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 neededto 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 ot age.
4. Booxs-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 perpetuate 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 coinmunity life. They should encourage and direct activities which sati4 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 soog forget their knowledge and lose the reading skill. . .
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 reading 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, hookwon-n, yaws, or tuberculosis, the making of household equipment and agricultural tools, the proper care and use of animals, the making of charcoaland lime without w ' casting scarce firewood, could turn books into weapons for survival. Such books oe series of books, pamphlets, almanacs, or periodicals, have been prepared for children and adults of other countries. Haiti could profit from their experience. Present techniques of reproduction 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 possible today, even for smaller countries with limited budgets. The Insular Bureau of Education of Puerto Rico has recently established such a publication 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 elementary 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 distribution 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 withoutJ 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 Fundamental Education Clearing House is ready to assist the Haitian Government 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 periodioal 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 increased number of workers. Only a minor proportion of these workers are now being prepared through vocational education and training. Thestudent 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 supervision 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 i - 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.
The only vocational school of the secondary type, J. B. Damici 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 staffedd 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 programme 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'reforrnatory building is completed, a similar arrangement for furniture-making, woodworking, 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 vocationzil 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 Stat ' es 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 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-that the existing shops be provided with adequate tools and modern equipment;
(b) Serious consideration be given to the proposal for the establishment of a central Government garage and repair station with training facilities for apprentice mechanics.
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.
54 MISSION TO HAITI
6. COMMUN6Y 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 i sure, native villages had been in existence for a long timd 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 tothe 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 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 andirrigation 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 eo'le. Finally, they had to demonstrate through their teaching that knowledge 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 Yermes-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 lacy of trained teachers, equipment, and land. The I new orientation schools (1coles orientationo, however, give promise of developing into real community schools. In addition to regular six-year elementary school
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 complcteIy 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.1 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 aca ' demic. It is puzzling to see children in one part of such a school going through the same bookish exercises and memorization that are practised in the towns, whilein 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
'Note: The Mexican Ministry of Education.has established a special department of school architecture. In view of the great diversity of climatic and economic conditions 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 AgriqulturaI 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 organization of the UNESCO pilot project in Marbial, a valuable training centre for rural teachers could be developed there. The combination of agricultural, 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 Ch~tard 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 recommendations concerning agricultural devel opment' is adopted, then a new school will have to be organized in the Chfltard region.
While the director of the Chtard School ha some space in the buildig of the school for,his private living quarters, none of the community sclools 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 theln and their families to live near their schools. Their. work is of such vial importance to the development and welfare of the country that their
1See part 11, chapter I, Agricultural Development and Rural Welfare, page 1 .17.
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 Education 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 leadership 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 chapter' 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 i ' s 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 programme. 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.
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
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, prevocational, 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 worldwide 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 Devieux' 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.
Page 43, footnote
Public Health Problems
The Haitian public health problem is in the main a rural problem, as peasants and their dependants living mostly on tiny farrn steady widely scattered over the whole countryside form the overwhelming majority of the people. With the exception of Port-au-Prince, the adjoining town of Utionville, and the few departmental' capitals harbouring in all but onetenth 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",)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 communications, 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 "su dden 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 overwhelming preponderance of tuberculosis (46 per cent of this group). According to these statistics other diseases of this category such as malaria, ' Part I, chapter 1, 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 Department, 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 Bella&re, the recently inaugurated model town constructed on the site of a Previous ramshackle- agglomeration on the eastern border. In cooperation 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,' employing forty-four doctors, have 944 beds in all. In a ' 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 Bellad re in central Haiti, and at Jacmel, Petit-Gofive, Les Cayes, and Yr6rnie in the southern peninsula.
62 MISSION TO HAITI
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.J
The relatively high number of physicians at the General Hospital in I 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 andindirectly, 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,' 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 employment 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:
I. 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;
Ile 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 divWons, 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 administratoru) 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 doctbrin-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.' Moreover, rural public health work is greatly handicapped 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.' As no efficient public health work can be performed in the countryside o ' f 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 subjected 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 appointment 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 ems 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 administrators 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 mo re 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 dbubt, however, that all of the physicians on whose reports this total is based sufficiently master the sometimes difficult differential diagnosis of yaws and syphilis. The figure therefore is subject to reservation and may well be too high.
Little or no re ' liable 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.
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.' 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 b7
with the Haitian Gov~rnment 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
P6do (Marigot) Vilaret
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 o nly 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 intramuscular 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.'
"---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 therefore 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 Treatme-nt 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 approximately 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.
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 entomological data are quoted:
"Four species of anophelines have been found in Haiti: A. albimanus, A. grabhamiij, A. vestitipennis, and A. crucians. A. albimanus is the predominant 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 importance 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-Gove
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 completion of the project. This is a striking result of the execution of an excellent malaribt control programme, and it is, therefore, the more regrettable 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
2J. Harland Paul and Ath~mas Bellerive, "A Malaria Reconnaissance of the Republic of Haiti", The Journal of the National Malaria Society, vol. 6, no. March 1947.
PUBLIC HEALTH PROBLEMS
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 drainage 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.
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
70 MISSION TO HAITI
in the towns of Jacmel, Les Cayes,* LogAne, Gonaives, St. Marc, and Cap-Hlaitien.
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 cultivation 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.
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 quartersof 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
shon blowNumber of Deaths
Hoptldeaths . from Percentage
Port-au-Prince .1,405 306 21.7
Cap-Haitien.319 64 20
Les Cayes .189 38 20
Conaives.138 5 3.7
Ilinche.50 1 2
j6r~mie.75 8 1.
Petit-GoAve .29 2 7
Port-de-Paix.63 4 6
St. Marc .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 accomplish 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.
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 Leyburnl 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 Government 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.
11yGrant provides water near the farmers' market in Fort-au-Frince. Improved
facilities to furnish unpolluted water are needed throughout Haiti.
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 association 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, therc are in operation in the capital three health centres where some anti-tubercuIosis 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 tuberculosis, 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.
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 MARTIAL
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 education 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,' 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 MarbiaI 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 If 1948 all breeding places had been treated with DDT.
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Some of the children N%,crc found to shoN v the typical symptoms of hookworm disease, and thirty-three out of 126 children had pronounced anaernia, 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 eern 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 b
,y 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-f6eding programme has been put in operation; young girls are receiving training in weaving; a workshop for the production of cement bricks, and a plant nursery have been set up; a market and a slaughterhouse 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. I 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 population, 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. Whi!c malaria control bl'y engineering methods is not required in this region, anopheline mosquito breeding places should be treated regularly with larvicides.
To ensur e 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, ,)ne 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 irY 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 healt ' h 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." 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,dOO peoplee are sadly lacking in medical carL i. 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 wellconceived, comprehensive and dynamic rural public health programme islan 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 1, chapter 1, 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 rec ornmends more specifically that:
1. Public health training should be obligatory for the medical supervisors administratorsr) 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 imral public health service; . 1
4. The planned construction of a new hospital at Bel-Air in Portau-Prince should be reconsidered, with a view tc 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 iW malarial regionswith 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 encountering 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.
Plan and Estimate of Costs of a Country-Wide Anti-Yaw% 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 203,000, 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 strenu * ous '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 injection, per month.
PUBLIC HEALTH PROBLEMS 79
A country-widc 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 b6' 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.
Estimate of Costs of a Country-Wide Anti-Yaws Campaign
14 pick-up cars . $22,400 Instrum ents . 1,700 1 typew riter . 150
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
TOTAL SALARIES . $ 90,240
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 2Y2 cents
per m ile . **'** 4,2OCr
Expenses for travel subsistence, hire of horses, transport of
drugs, etc . . 12,000
W riting materials, forms, etc . . s'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.