PORT-AU-PRINCE - Visiting Haiti this past week, I was humbled by the incredible work InterAction members are doing to help a traumatized nation slowly recover from the earthquake a year ago. Observing the efforts of former colleagues and friends working in Haiti reminded me of their tremendous dedication and the enormous effort that goes into every major aid operation. There are obvious signs of progress but I was also struck by the difficult choices NGOs have to make on a daily basis as they juggle emergency after emergency.

World Vision kindly hosted us, along with Concern Worldwide, Save the Children, Catholic Relief Services and Habitat for Humanity International,  who are among about 100 of InterAction’s members doing work in Haiti.

First stop on Tuesday was to see Port-au-Prince’s only landfill – Truitier. The stench is overwhelming, not surprising seeing as latrine sludge is dumped there from trucks hauling in waste from camps. Heavy equipment turns over the waste and men pick over compacted muck for anything that might provide a livelihood. In the designated medical waste section of the landfill, intravenous pipes and crushed syringes along with tattered latex gloves litter the ground.

This is unglamorous work and not a job World Vision would usually take on, but it has become all the more vital as Haiti seeks to contain a cholera outbreak that has already killed more than 3,400 people. Along with clean water, the safe disposal of human waste is a priority in the fight against cholera.  As trucks leave the landfill to collect more waste, WASH teams disinfect the vehicles – including ours -- with chlorine so they won’t take back cholera to the camps from where they have come.

Another kind of debris -- rubble -- is still a major problem in Haiti although there is considerably less since I was last there in March of 2010. Big trucks are hauling it out but most comes out of the dense neighborhoods in wheelbarrows. Catholic Relief Services has an ingenious “rubble-to-reconstruction” project which I was honored to see. In the Delmas 62 area, I watched men and women carting rubble in wheelbarrows from collapsed homes. They then used hand-cranked crushers to grind the debris down which is then sold to rebuild houses. Everyone involved in this and similar projects is paid by the sale of the gravel and sand they make.

Port-au-Prince was built to house 300,000 people but actually has ten times more that number. The earthquake exacerbated the space problem and tents now take up any available spot to accommodate the more than one million people left homeless by the quake.

NGOs are working as hard as they can to get people out of tents and into transitional shelters. About 31,000 wooden homes with tin roofs have been constructed so far and building has been ramping up in recent months. For example, in Tabarre Issa camp, eight new shelters are being built every day, according to Concern Worldwide. The tent where building materials are stored and frames for new homes are built is a hive of activity.

As NGOs hit their stride, they are juggling priorities and dilemmas at every turn and must take difficult decisions according to their mandates. Among some of the dilemmas I heard during my trip were:

• Should you close a basic health facility in a camp in order to provide 24/7 coverage at a new cholera center? The answer there from one NGO was yes.
• Should NGOs actually decrease services in camps that many people depend on – from clean water to basic health care?  Will decreasing those services make camps less of a magnet and enable NGOs to increase services in neighboring communities? The answer there is both yes and no, depending on the non-profit's mission.
• One NGO built a school for children whose families moved into 1,000 temporary shelters. The government failed to provide teachers. Should the NGO now step in and fund staff? What happens to those staff when NGOs pulls out? That decision has yet to be made.  

Second guessing any of these is pointless without knowing the local context. Much of that local context now depends on how the current political impasse can be resolved and whether the new government has a clear vision and direction for Haiti. Watch this space for how that unfolds....

- Sam Worthington, President & CEO, InterAction

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