Michael Kamber, for The New York Times

Jeanne Bazard with four of her five children and a niece. Pregnant again, she sells charcoal to live.

PLAINE DANGER, Haiti, March 11 — Diplomats call Haiti "a failed state," a nation done in by dictators and disasters.

What that means is a hungry life and an early death for five million people in Haiti's little villages, places like Plaine Danger, 500 miles from Florida and light-years from Port-au-Prince, the capital, where President Jean-Bertrand Aristide fell last week.

Mr. Aristide always promised to make life better in Haiti, where public health, education and the economy have been collapsing for decades. But he never did; no Haitian leader ever has, and many made life worse. Governments and juntas rise and fall, 15 in the last 18 years, doing nothing to stop Haiti from sliding into the sea.

Haiti is slowly disappearing. The soil slides away from its steep hills, where all the trees are turned to charcoal, the only thing people can sell for a profit.

"There are no trees to hold the land and when it rains the earth washes away," into the river and down to the sea, said Didier Dipera, a farmer and a voodoo priest in Plaine Danger.

Then Christine Delille comes walking across the Grand'Anse River, and she is a force that can stop death itself, a slender thread connecting Plaine Danger to life.

The river runs through the most remote part of Haiti. Two roads connect Grand'Anse Province to the capital; one is impassable, the other impossible. Isolation provides some insulation from the armed politics of Port-au-Prince and the collapse of agriculture in Haiti's heart. But it provides no protection from 200 years of bad government, going back to slavery days.

Life goes on, no matter who holds power, and "life is hard," and getting harder in Grand'Anse, said Mrs. Delille, a barefoot nurse providing health care to 2,700 people, dispensing medicine and information, saving lives and bringing some small hope to Plaine Danger and surrounding hamlets.

"Many people are sick with fever, malaria, pneumonia," she said. Many children are malnourished, and the rains wash down waste from villages upstream, bringing sickness and death.

Mrs. Delille covers Plaine Danger, her village, and its hamlets as a field worker for the Haitian Health Foundation, run by a handful of tough nuns in the provincial capital of Jérémie. In a country where almost nothing works, the group looks after 200,000 people.

Jeanne Bazard, pregnant with her sixth child, is one of the foundation's clients. This is how she lives: "When I put a dollar together I walk up the hill and buy a bag of charcoal and then walk into town to sell it," she said. "If I leave at dawn I arrive at 9. It might sell for twice as much there."

She buys roots, sometimes rice and beans. It adds up to one rudimentary meal a day for herself and her children.

"I only care about whether we can eat," she said. "It doesn't matter who's in power. We've never gotten anything from anyone in power. The least any leader could do would be to make jobs so we could buy an animal or two and find a way for my kids to go to school. It's not possible for my kids to have a better life than mine, because they can't go to school."

A generation ago, a family here could pay a child's tuition with a pig. But then a swine disease struck and the dictator Jean-Claude Duvalier ordered all the pigs in Haiti killed. Few people have the money to buy school uniforms or books, much less shoes to walk to school, and illiteracy runs to 80 percent in the countryside.

Free basic education for children is demanded by Haiti's Constitution. No government ever has provided it. School fees are the equivalent of two months' income for the rural poor.

Now the economy is based on burning. "People have no choice but to make charcoal," said Alexis Charlemagne, 40, a nurse in Jérémie. "There's no other way to live here. There are no jobs, no factory here, and charcoal is a quick buck."

The taking of the trees began with the French slave masters who ran Haiti until they were overthrown in 1804.

"The only remaining forests are those on the peak of the mountains," Girod de Chantrans, a Swiss visitor to Haiti, wrote in 1782. "All the slopes have been cleared."

The French bought and cut millions of mahogany trees in the 19th century, export records show; by World War I they were almost gone.

Mrs. Delille goes up the path in Plaine Danger, to the home of Nicole Bienvil, who lives with her five children and her relatives, 13 people in a shack. She supports the household as a seamstress, fixing old clothes on a foot-pedal Singer sewing machine. There is no food in the house, the littlest children have scabies, and the rains washed away the Bienvil family garden last year. "It's erosion," she said with a sigh. "There haven't been trees up there in the hills since I was a kid."

While close to 90 percent of the nation is denuded, there are still some trees in Grand'Anse Province, bearing mangoes, bananas, cacao and coffee. But there is little market for them, and even if a farmer makes a sale, he risks being robbed on the road back home.

"If we had someone to represent us in the government, I would say to him, we cannot live in a nation without security," said Mr. Dipera, the voodoo priest of Plaine Danger. "There is no law here."

There once was a fishing fleet in the port of Jérémie, but no more. All the boats have gone with the boat people, the many thousands who sought refuge from hunger and oppression and never returned. There once was a school of sorts in Plaine Danger, but it closed last month as armed rebels swept through the country trying to overthrow Mr. Aristide. No one knows when it might reopen.

There once were many millions for Haiti from the World Bank, but the bank says the money bought almost nothing, and it says it will exercise "extreme caution" before it resumes trying to help Haiti.

"Of course the World Bank and the international community gives, but who to?" said the Rev. Willy Romélus, the pro-Aristide bishop of Jérémie. "To the government and to groups that invest a lot of money in bureaucracy, cars and logistics, leaving nothing for the people."

One Haitian child in three under age 5 is malnourished, the same as in 1960. The infant and maternal mortality rates here are as high as in many African nations. Malaria, dengue fever, typhoid and tuberculosis are endemic. AIDS is rampant and polio has returned.

Haiti, one of the world's most densely populated and environmentally damaged places, is not only the poorest nation in the Western Hemisphere, but one of the poorest on Earth. It ranks 150th out of 173 countries on the United Nations' human-development list.

The fundamental barrier to development in Haiti, and the reason so much international aid has failed, the World Bank says, has been two centuries of terrible government controlled by "a small elite" that always monopolized money and power, and "often used force to control the country."

After a military coup overthrew Mr. Aristide in 1991, international aid all but ceased. Haiti's factories and industries crumbled. Taxing, spending and services broke down. No Haitian government has fixed a road in a generation.

Aid resumed with the American-led restoration of Mr. Aristide in 1994. But so did a flood of imported food that undercut farmers; many thousands gave up.

In the end, the aid delivered to Haiti's government by the World Bank had "no impact," the World Bank concluded two years ago, though aid delivered by small nongovernment groups like the Haitian Health Foundation did some good.

The United States and other nations cut off most aid to Haiti by the time the second Aristide government took power in February 2001. The newly inaugurated Bush administration was hostile to the leftist slum priest who ran Haiti. As Vice President Dick Cheney said last week, "We're glad to see him go."

Now that he is gone, the United States Agency for International Development and the United Nations plan to spend millions more for Haiti — but there is a sense that it comes with the weariness attached to large-scale, long-running failure.

A smaller scale may work. The Agency for International Development provides roughly 30 percent of the Haitian Health Foundation's $1.2 million operating budget, covering the salaries of three managers and 80 workers like Mrs. Delille, who makes $100 a month.

Two agency officials met Tuesday with Sister Maryann Bérard, a Franciscan nun who runs the foundation, which also builds houses and latrines and runs the only home for expectant mothers in Haiti.

They may have absorbed a lesson Sister Maryann says she learned from her 15 years in Haiti: aid works when it flows from the ground up, not the top down.

"A lot may have changed in Port-au-Prince," Sister Maryann said, "but very little has changed in the villages," where nearly two-thirds of Haiti's eight million people live.

"You know that saying, `It takes a village?' " said Bette Gebrian, a medical anthropologist who works with the foundation.

"It takes a generation."

Copyright 2004 The New York Times Company. Reprinted from the New York Times of Sunday, March 14, 2004.