A Miami hospital loses a Haitian patient to an illness that has no name yet

On a Wednesday afternoon in the autumn of 1979 a man called Jean Baptiste came into the general medical clinic at Jackson Memorial Hospital in Miami. Two weeks earlier he had left the wards with tuberculosis confirmed by biopsy and drugs that were known to work against it. He was emaciated, could barely walk, fell to one side when he did, and the left side of his face had dropped. The senior emergency room resident argued that he needed time to heal. A week later he returned unable to walk at all, held up by friends, and was admitted only under threat of disciplinary action. A scan showed several large lesions in his brain, read at the time as pockets of tubercular pus. He died within a fortnight. His physicians concluded that he had come in too late carrying too much disease, which was a reasonable conclusion in 1979. Nothing in the training of anyone on that ward described what had actually killed him.

An estimated 540,000 hectares of good arable soil existed in Haiti in 1938. By 1954 the figure had shrunk to 370,000. By 1970 it was 225,750 hectares, and the figure reported for 1985 was 205,000, with no sign afterwards that the trend had reversed. In the mid 1980s between six thousand and ten thousand hectares of arable land were being lost each year, and in the early 1990s the range ran from six thousand to fifteen thousand. The mechanism is a substitution. As the rural population grows, labour intensive food crops replace land intensive export crops, above all replacing coffee, whose roots and canopy hold the soil, on steep hillsides. Food crops are cleared and replanted in the rainy season, when the ground is soft, and the downpours then wash the soil into the valleys and streams. Once running, the process feeds itself without further population growth.

The Duvaliers held power in Haiti from 1957, and by the end of the 1970s the reckoning stood at more than thirty thousand people disappeared, victims of a daily repression built up into a system of government, and close to a million Haitians in exile for economic or political reasons. The country was kept alive by international aid that in practice protected foreign capital and the local fraction allied with it. American power on its own does not explain how one family took the state and held it. Haitian opposition groups had proved unable to produce a radical critique of the language the regime spoke, and often reproduced that language without noticing, out of fear of an analysis that would show where it came from. Explaining the regime as a natural inclination of the masses toward dictatorship was the most common form of that failure.

In 1960 South African police fired on an unarmed crowd at Sharpeville, and most of the dead were hit from behind as they ran. The government banned the African National Congress and the Pan Africanist Congress, which pushed the opposition underground and into exile. The ANC formed an armed wing, Umkhonto we Sizwe, and in 1963 Nelson Mandela and his co-accused were sentenced to life. Resistance came back through trade unions and through Steve Biko's Black Consciousness movement. In 1976 police fired on fifteen thousand schoolchildren in Soweto who were protesting against the schooling designed for them, and parts of the country stopped being governable. Biko died in police custody. Botha declared a state of emergency in 1985. In 1989 F W de Klerk repealed the Population Registration and Group Areas acts, lifted the bans, and released Mandela in February 1990. The first election open to every adult was held in 1994 and Mandela won it. Political rights changed hands that year. The ownership of the economy did not move.