I have finally fleshed out the research agenda:
Citizenship has been at the fore of political struggles since before the Haitian Revolution in Saint Domingue, and later Haiti. Beginning with the tightening of colonial citizenship conferral on people of color in 1769, followed by the struggles over the granting of full (, or French) citizenship rights to freed blacks in 1792, thus began a long history of citizenship as a project of exclusion (Garrigus, 2006; Popkin, 2010; Carolle, 2011). American interventions (dating back to the first occupation in 1915) have been particularly successful in reifying these exclusionary practices, often through aid and development projects – particularly in medicine. While much has been written about Haiti as the NGO Republic (World Bank 2008), there has been little excavation of the very processes of economic, political and social negotiation, or citizenship, that have made the NGO’ization of Haiti so pervasive and successful. This project seeks to examine the discourses through which outside aid and development programs have exploited the deeply historical project of exclusion that colours not only Haiti’s history, but more importantly, its present. While these exclusionary processes have been in place for 250 years, and interventionist projects for nearly 100, the 7.0 earthquake on 12 January 2011, has opened this devastated island nation even further to these exploitative interventions.
This project is explicitly interested in the transnational mediation of the health citizenship project in Haiti. Health citizenship is the economic, political and social negotiation related to the rights and responsibilities of individuals to and within the nation-state and of the nation-state to the individual with regard to healthful living. This is not limited merely to access to health care, but includes all that is incumbent in letting live well. That is to say that this research project is interested in the ways in which transnational aid and development project organizations – in this case, USAID (and their role in guiding the redevelopment of Haiti), the CDC (and their role in rebuilding Haiti’s public health system), and Save the Children (and their role in managing health services within the post-earthquake humanitarian context) – are engaging with and mobilizing understandings of Haitians’ health citizenship. Further, this research is interested in considering how these understandings are being mobilized to construct an imaginative geography which has materialized, on the ground, as health enclaves through the international patchwork of health service provision sites and internally through displaced people (IDP) camps. This research is employing an explicitly top-down approach to these questions, meaning, this research will investigate the discourses that drive aid and development projects in Haiti and the impact they have on the geography of health citizenship, from afar. This research project seeks to answer the following questions:
1. In what ways have American and other international aid and development programs been dependent upon the uneven and unequal citizenship rights of Haitians, and (how) did these projects re-inscribe and reify this unevenness – both in the past and currently?
2. In what ways do USAID, CDC, and Save the Children, who have all been charged with managing the mechanical aspects of mediating the health citizenship of Haitians in both the humanitarian crisis and in the rebuilding efforts, understand, articulate, and work toward an even and inclusive health citizenship project in Haiti (or do they?)?
3. How do programmatic understandings of the needs of Haitians translate into geographical demarcations of differential health citizenship? Particularly, how do imagined geographies of need become materialized through the micro-territorialized IDP camps, and how will these be further inscribed as health service areas, or health enclaves?
Implicit in this project is an exploration of the continual exploitation of uneven citizenship projects through medicine and health in Haiti by the U.S. over the past 100 years. This research is specifically focused at the sites of power – among those who define and manage health needs – to explore the processes by which decisions are made that, in turn, will have real and every-day impacts on those experiencing the outcomes of those projects.
Researchers and practitioners have, over the last 20 years, been heavily interested in the impact of international aid and development projects on the lived experiences of the Haitian population, particularly with regard to health (Farmer, 1999, 2004; Chomsky, Farmer & Goodman, 2004; Brodwin, 1996; James, 2010; Schwartz, 2010; Maternowska, 2006). And while examining and understanding the lived experiences of those most affected by aid and development interventions in health in Haiti are extremely important, in the words of Ananya Roy (2010: ix), “It [is] not enough … to understand poverty at the ground zero of lived experience. It [is] also essential to make senses of this management of poverty.” So it is that this research project proposes to engage precisely in those centers of power that manage health.