The road to Cange for Haiti, hope still awaits its time.

The road to Cange, like most roads in Haiti, isn't really a road. It's a strip of gravel and boulders, punctuated by deep potholes that stretch across its width. To the left is mountainside and to the right are buts, some topped with tin roofs and others with dried banana leaves, and beyond those and straight down lies a wide plain, which long ago ceased to produce anything nourishing. Apart from mango trees and a few shrubs, the landscape is desolate. The people who live in this central plateau area are among the poorest in Haiti, a country that is among the poorest in the world.

A few miles to the east lies a different country, lush, with an apparently thriving population. According to the U.S. State Department, the Dominican Republic's economy was one of the fastest-growing in the hemisphere over the past decade. More than 80 percent of its population is literate, and lire expectancy is over 70 years. In contrast, Haiti's economy bas actually declined. Only half of the people of Haiti tan read and write, and extreme poverty and disease most of it treatable shorten the lire expectancy to about 50. The two countries share the same island; a visitor from another world might wonder, does the sun not shine on Haiti?

Extreme political, economic, and social instability characterize Haiti's history, from its early colonial days when slaves were brought in to work the sugar cane fields and coffee plantations slaves who after their successful revolt were forced to pay "reparations" to their French slave-owners all the way to the present. Current news reports cite the "new" wave of violence surging in Portau-Prince slums and elsewhere--specifically the kidnappings of those considered ransom-worthy--but it isn't really new. Tactics may change, but the violence doesn't: Structural violence begets episodic violence. Those reports rail to mention the systemic oppression Haiti bas endured by its own elite as well as by countries such as the United States that have blocked aid, removed democratically elected presidents, and enforced trade policies that exploit the Haitian labor force.

The United States took some positive action in 2004 in providing 8180 million to Haiti for civil conflict, flood, and hurricane relief, with $40 million for humanitarian assistance, according to the U.S. Agency for International Development. There are also bills pending that would amend the Immigration and Nationality Act to grant special visa status for Haitian families separated by immigration to the United States. Concrete steps, yes, but small in the face of Haiti's seemingly insurmountable challenges.

BUT ABOUT THREE hours' drive northeast of Portau-Prince, a distance of about 35 miles, the road to Cange rounds a bend and the walls of a hospital emerge from the foliage. Zanmi Lasante (Creole for Partners in Health) treats the poorest Haitians for free, and has for almost 20 years. Hundreds of people sit in the shaded courtyards and lie on the low stone walls lining the walks, waiting to be seen by clinic founder Dr. Paul Farmer and his colleagues.

Ifs a luxury to be seen by a doctor at all, let alone in such a comprehensive way. Patients who need to get to Cange for treatment are given transportation money to travel there and food to eat, so they can take their medicine. Community health workers trained by Zanmi Lasante journey around Haiti's central plateau to care for those too ill to travel, make sure patients take their medicine and have enough food, or arrange for homes to receive concrete floors.

The health center is a bright spot in a country that needs relief in every form, and it represents a strategy that is working in a country much of the world bas forgotten. "Even in situations that seem overwhelming, you try to focus on the individual patient," Dr. Farmer recently told a New York Times reporter. "At the same time, you develop strategies to change the larger picture." And changing that larger picture is exactly what's needed if the sun is ever to shine on a renewed Haiti.

Molly Marsh, an associate editor of Sojourners, recently visited Haiti.