Lessons for Practice-- Re: Haiti After the Earthquake

            The further I get in my education, the more I realize that learning is a never-ending process. A salient lesson I have encountered in my last semester of college has taken place in a final reflective sweep of my education at the University of Montana. I have recognized that any subject of any discipline can be viewed as the interaction of interdependent and cyclical forces. It is with this perspective that I approach Paul Farmer’s book, Haiti After the Earthquake (2011), in an attempt to siphon out lessons for practice in international social work from Farmer’s medical jargon and clinical mindset. Farmer’s account of pre and post-earthquake Haiti illustrates an exemplary case study for many issues of social work; in this essay I will focus on lessons of ‘acute-on-chronic,’ local expertise, transformation of worldviews, and assuaging the unremitting contradictions of humanitarian being.

            Paul Farmer eloquently weaves top-tier and on-the-ground perspectives through a handful of coined phrases, my favorite being ‘acute-on-chronic.’ As a medical professional, he reminds us that immediate illnesses and social ills alike must be viewed in terms of the chronic history of symptoms and infrastructural fragility facilitating the onset of struggle. With this, Farmer reminds us to always contextualize the present issue with knowledge of history, systemic injustice, generational trauma, and other contributions to the social mélange. In essence, Farmer reminds practitioners to confront problems with a holistic lens—to account for the delicate ecological nature of social ills and not attribute blame to any one cause or propone any one solution.

            The idea of ‘acute-on-chronic’ segues into Farmer’s dialogue about the importance of language in our conceptualizations of practice. Through language, ‘experts’ construct certain realities. Farmer uses the example of the use of  ‘natural disaster’ to describe the earthquake in Haiti. He claims that the disaster in Haiti was in no way ‘natural,’ but was a social disaster resulting from, “policy decision[s] made far from the…affected areas,” (213). Farmer challenges the reader to recognize who is present at the table when big decisions or definitions are made; we should always question the agenda at hand, examining who is benefiting from the policy prescriptions. Furthermore we should identify whose perspectives are missing from the equation and “[seek] to echo and amplify the voices of those we encountered as well as those silenced,” (2).

            As Farmer stresses in the aforementioned quote, and to continue with the role of language in social work practice, I am learning that it is essential to let those affected define their experiences, problem, and solutions. It is necessary to vouch for the inclusion of locals into the decision-making and implementation process. As Farmer quotes Hillary Clinton, “we cannot any longer in the twenty-first century be making decisions for people and their futures without listening and without giving them the opportunity to be as involved and make as many decisions as possible,” (90).

The case study of Haiti honestly examines the role of humanitarian aid in the development process. His account attests to the fact that ingenuity and hard earned experiential knowledge should not be wasted on top-down innovation and implementation, as this route often proves futile. There is a vast potential of local expertise that often goes untapped. Our role as social workers should be to crack the well—organize an efficient means of fostering the flow.

             Even on an interpersonal level, I must practice letting go of a solution-driven mindset and recognize when bearing witness is the deficient resource. As well-to-do Americans, in the words of Farmer, “it’s tempting to focus on immediate clinical questions,” (118) and facilitate the urge to ‘fix,’ as opposed to recognizing the value of inaction. As a westerner I put a premium on visible progress, but there are times when my agenda does not suit the present situation and in fact can stifle change. I have to remember to let go of my way of doing things and practice holding the uncomfortable space, allowing for a humble exchange of knowledge and experience.

            Farmer speaks to the interplay of praxis and policy in one of his chapters; I can also apply this to the conceptualization of opposing tensions within the self—that social work is the interplay of action and reflection. As social workers, our engagement with individuals or communities has reciprocal, and indeed transformational, effects on our personal selves. It is essential to examine the push/pull factors within our own selves in order to explore the motives behind our participation in this work.

            Taking from Fetcher’s Professional is Personal, one can recognize that our work is not passive. Social workers are racialized, socialized, historicized creatures who cannot help the tides of sociopolitical time nor check our worldviews at the door. Personally, I must be aware of the deep-seated guilt that accompanies my status as a privileged white American. I must also reconcile with the fact that people may only view me as a potential dollar sign, temporarily invested in a project for self-centered gains. As Isla asked recently in a class lecture, “how do we balance the responsibility of coming from a country that has access to virtually all of the world’s resources,” and in contrast practice being present with a humble spirit?

            In learning from Farmer, my classmates, and various voices from the readings over the semester, I believe this is answered in the process. To paraphrase Rilke, we must live the questions themselves. We must also learn to balance the fundamental tensions between being, at all times, the learner and the teacher, the researcher and the subject, the doctor and the patient, the sojourner and the native. Likewise at the micro-level are macro-level tensions between relating international experiences back to local issues in our home communities. How can we transform the vision of globalization to facilitate connections in terms of promoting social justice?  

            Social work is a balancing act; we straddle incongruous paths, digging for a nugget of change out of obstinate soil. Farmer’s book has reminded me to always remain a humble learner, even if social norms label me ‘the expert.’ Every human’s individual experience is incomprehensible, yet it is through the power of human stories that I believe we can reconcile coming home to advocate the process of reverse mission and accompaniment. In the end, as Farmer alludes to, we must put our energy in drawing out people’s stories—look for shared patterns, themes, to develop deeper discussion that probes into peoples’ experience so that we can extract, expand, and humanize the struggles against injustice abroad and at home.