Even Before Coronavirus, Haiti was in Crisis

  • Posted on: 21 April 2020
  • By: Bryan Schaaf
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China Maurice’s closest brush with death came during Haiti’s catastrophic 2010 earthquake. She was working at a pharmacy when the walls and roof crumpled around her. Several of her colleagues were killed. Suffering from chronic asthma, the 49-year-old now wonders if she will survive COVID-19.  She is not alone. Many of the 11 million people in the Caribbean country – from the doctors and nurses, to economists and aid workers, to others with underlying health conditions like Maurice – are also wondering how bad things are going to get.

The poorest nation in the western hemisphere is ill equipped to handle a health crisis of this magnitude. For more than a decade, Haiti has lurched from crisis to crisis. It has yet to fully recover from the earthquake – let alone subsequent cholera outbreaks, political upheaval, hurricanes, and other natural disasters.  It is also in an ongoing economic and political crisis. Just as the pandemic arrived, Haiti was dealing with the fallout from protests that have paralysed the economy for more than a year and demonstrations that have tested the government’s authority.  So far, three Haitians have died, and 47 others have tested positive for the virus. More than 30 cases are people who have flown in from abroad, but the first death was that of a 55-year-old man with no travel history or underlying health issues, suggesting there may already be community transmission. 

A lockdown has nominally been in place since 19 March. Schools and businesses are closed, and public gatherings such as Souvenance – a Vodou festival that usually draws thousands to gather and celebrate around Easter – have been cancelled or postponed.  However, although vehicle traffic has slowed, there has been little to no enforcement of the lockdown. Many workers who sell food and other items on the street corners of the capital, Port-au-Prince, and other towns and cities say they can’t afford to stay home.

The virus has yet to hit slums like Cité Soleil on the edge of Port-au-Prince where some 500,000 people live in squalid conditions. More than a third of Haitians lack access to clean drinking water, and two thirds lack sanitation – stark realities that contributed to nearly 11,000 cholera deaths after the earthquake. Maurice lives in one of the capital’s many densely populated communes, Martissant, an area swollen with people living side by side in small cinder block dwellings. Haiti has one of the highest rates of urbanisation in the world, with much of its population living cramped in cities – an increasing trend that contributed to the large death toll in the earthquake, estimated to be between 100,000 to 300,000 people. More than 1.5 million people were also displaced, and thousands are still without homes a decade on. “There are a lot of people living on top of people; families with very little money and many children,” Maurice, who hasn’t left her house in two weeks, told The New Humanitarian by telephone. She fears continuing her job as a clothes vendor on the streets may put her at greater risk of contracting the virus, but she also worries about how she will feed her four children, and how her underlying health condition might worsen her chances if she becomes sick. 

Haiti has the highest incidence of tuberculosis in the Americas and high rates of other chronic health problems such as diabetes and hypertension. It also has the most HIV/AIDS cases in the Caribbean – the region with the highest HIV prevalence outside sub-Saharan Africa. “There are a lot of people living on top of people; families with very little money and many children.” “We're talking about a weak health system that has already failed to meet people’s needs,” said Elizabeth Campa, senior health and policy adviser for Partners In Health, a Boston-based non-profit known as "Zanmi Lasante" in Haiti. The group runs University Hospital in Mirebalais – a commune about 60 kilometers northeast of Port-au-Prince – which was created by Partners In Health after the 2010 earthquake. It is now one of the only hospitals treating COVID-19 cases in the country. The hospital has also started providing rapid blood testing.

Haiti does have one advantage over some countries. More than half of its population is under 25. The vast majority of global COVID-19 deaths have occured in people over 40.  The earthquake damaged or destroyed much of Haiti’s infrastructure and essential services, including dozens of hospitals and clinics. A sprawling general hospital in Port-au-Prince, intended as a flagship reconstruction project, is still to be completed more than 10 years on. According to a 2019 study, Haiti only has 124 intensive care beds and 64 ventilators. Campa told TNH the number of working ventilators could be closer to 20. There is also a lack of oxygen for potential coronavirus patients, and only one national laboratory that can test for COVID-19.  Journel Ito, head of the Molecular Biology Laboratory Service at the National Public Health Laboratory in Port-au-Prince, told TNH there are two machines in the lab that can conduct up to 100 tests a day. Plans are underway to have five more test sites across the country, Ito said.

There have already been lags in testing. Several doctors told TNH that when patients with COVID-like symptoms are admitted in hospitals, it can take days for them to be tested.  Some patients, meanwhile, have been turned away by fearful medical staff who lack protective gear, Dr. Jean Ardouin Louis Charles, director of the Sanatorium Hospital in Port-au-Prince, told TNH.  “One of our hospitals said they had received a patient who had been rejected by at least three other institutions before they came to them,” said Frank Geneus, president of the Haitian Association of Private Hospitals. 

Other patients with serious health conditions are choosing to stay away – a trend that has been reflected in other parts of the world. Some fear the Haitian healthcare system simply can’t cope. Many rely on free healthcare provided by NGOs rather than go to underfunded public hospitals where treatment can be expensive but haphazard.  Dr. Vincent DeGenarro Jr., executive director of Innovative Health International – Haiti’s largest cancer programme – said they have seen a 20 percent drop in patients getting chemotherapy. For others with weakened immune systems like 20-year-old Christinsen Lamye, who contracted HIV from his mother, arrangements have been made to obtain six months’ worth of medication to avoid the risky four-hour crowded journey to the hospital.  “Coronavirus is something I am really afraid to catch,” Lamye said. 

Haiti also has the highest rates of childhood malnutrition in the western hemisphere, and nearly four million people – more than one in three Haitians – are estimated to be in need of urgent food assistance.  “During an infectious disease outbreak, like COVID-19, malnutrition rates can increase sharply, leading to higher mortality rates due to compromised immune systems,” said Antoine Vallas, a spokesperson for the World Food Programme in Haiti. The WFP has limited its movements in Haiti, with nearly all of its staff working remotely. Emergency distributions of cash and food were suspended but have since restarted in five of the 10 departments across the country.

With schools closed, Vallas said the WFP has started to provide take-home food rations to schoolchildren and their families. He said the UN agency feeds approximately 300,000 students a year, many of whom would go hungry without a school meal.  Food insecurity was a problem before the pandemic, exacerbated by rolling protests that began in 2018 over increases in fuel prices. The demonstrations grew in 2019 and into 2020, with calls for the resignation of President Jovenel Moïse, accused, with other senior officials, of embezzlement. 

The Ministry of Finance predicts Haiti’s economy could contract by 2.7 percent this year due to the ramifications of the coronavirus. It already contracted by 1.2 percent due to protests and unrest last year, according to economist Kesner Pharel, who told TNH that Haiti can expect to see the 20 percent inflation rate rise to nearly 30 percent, further straining unemployment and poverty because of declining exports and trade with the United States. So far during the pandemic, the prices of goods have largely remained the same; government officials have been penalising merchants for any price hikes.

Haiti shares the island of Hispaniola with the Dominican Republic, which has seen 4,680 confirmed COVID-19 cases and 226 deaths.  Although Haiti closed the border between the two countries on 16 March, some commercial trade is still being allowed and there has been an increase in overall border crossings, with Haitians in particular returning from the Dominican Republic due to its larger number of cases.  In a report published by the UN’s migration agency, IOM, there have been more than 16,200 reported border crossings since 12 April. Before, there were fewer than 7,000 a day, according to Giuseppe Loprete, IOM’s chief of mission in Haiti.

It is unclear how many Haitians who have fled the Dominican Republic could have been exposed to the virus or carried it home.  Authorities say they have too few resources to stem the flow completely.  Macluche Ledoux, mayor of the Haitian border town of Belladère, said he had tried to impose a lockdown but didn’t have the needed police to implement it – there is only one police station and a handful of officers for a population of 120,000. Angenor Brutus, who coordinates the work of eight associations and NGOs on migration issues along the border, told TNH the virus is likely to spread unless more border controls are put in place. “People coming from the (Dominican Republic) where there are many more cases of coronavirus should be put in quarantine,” she told TNH. “Instead, they are administered a quick test at immigration and then left to enter the country.”

Radio stations and TV broadcasters have been playing jingles about COVID-19 to encourage people to practise social distancing and proper hygiene.  Although there has been less vehicle traffic and fewer large gatherings, most people can’t afford to stay home. Market women continue to sit selling their goods, and motorcycle taxis knot the roads. “At least during the cholera outbreak doctors knew how to help you if you went to the hospital. What is so scary this time is that there is no treatment.” Few people wear masks; most make do with cloth bandanas or with nothing at all. 

On a street corner where throngs of passers-by and neighbours stop to talk, Lelene Gentileus, a 32-year-old mother of two sells goods such as cigarettes and candy.  Gentileus is no stranger to loss from diseases. Her grandmother died from cholera – believed to have been brought in by UN peacekeepers from Nepal in the wake of the 2010 earthquake.  “At least during the cholera outbreak doctors knew how to help you if you went to the hospital,” Gentileus told TNH. “What is so scary this time is that there is no cure.”

Photo Credit: Jessica Obhttps://www.thenewhumanitarian.org/feature/2020/04/20/coronavirus-Haiti-earthquake?utm_source=The+New+Humanitarian&utm_campaign=4fb94499c6-EMAIL_CAMPAIGN_04_20_2020_DAILY&utm_medium=email&utm_term=0_d842d98289-4fb94499c6-15657769ert

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New York Times

4/22/2020

By Catherine Porter and Ianthe Jeanne Dugan

The man stood in line, shaking with fever, one of countless others trying to cross the border and return to Haiti. A doctor screening them for coronavirus infection pulled him aside. Like thousands of Haitians, he had been laid off in the Dominican Republic, which has been hit hard by Covid-19, the disease caused by the coronavirus. Now he and the other Haitians were returning home, threatening to bring the virus with them. The coronavirus has been slow to come to Haiti, partly because protests and political violence virtually shut down tourism and drove away the foreigners who could have brought the disease to the country.

A month after the first case was announced, there have been only 58 confirmed cases and four deaths. Prime Minister Joseph Jouthe last week congratulated the country and announced that factories would reopen at reduced capacity, a rare bit of encouragement for a nation that has been lashed by tragedy — with a deadly hurricane, a cholera outbreak and a horrific earthquake in just the past decade.

But with the influx of workers returning from the Dominican Republic, where there have been 5,044 cases and 245 deaths from Covid-19, the odds are stacked against Haiti and its weak health system, warned a presidential panel run by Dr. Jean William “Bill” Pape, a widely respected doctor who is racing to set up centers to treat Covid-19 patients. “This monster is coming our way,” said Dr. Pape, who runs Gheskio, a large AIDS and TB clinic in Port-au-Prince, the capital. “If a place like New York can be so overwhelmed, how is Haiti going to deal with this?”

Most Haitians lack access to clean water, let alone soap, and many live in tightly packed slums where self-isolation is physically impossible. Protests over government corruption shut down the country last fall, barricading roads and crippling the already fragile economy, leaving even fewer people with enough resources to quarantine.

The nation’s health care system is so threadbare that Haitians regularly die of easily treatable ailments like diarrhea, and public hospitals often have to charge patients for basics like syringes and gloves. The sick man pulled aside at the border crossing had to be quarantined at a vacant building, since an adequate area had not been set up yet.

Dr. Daniel Fitzgerald, who works with Gheskio and is the director for the Center for Global Health at Weill Cornell Medicine, said he expected tens of thousands of people to become sick in Haiti. “It’s just a question of time,” he said. Dr. Pape’s team has been feverishly drafting a treatment protocol that is both effective and realistic for a country like Haiti. Learning from the experience of the United States, where the majority of patients on ventilators have died, Dr. Pape is focusing on treating hospitalized patients with oxygen.

Dr. Pape estimates that the country will need 6,000 beds dedicated to Covid-19 patients. “Now, I have not even 100,” he said. But the plan, which requires trained staff, personal protective equipment, as well as oxygen, is costly. Dr. Pape estimates the first month alone will cost about $30 million — about half of what the Haitian government spends on health care a year. Dr. Pape and panel co-chairman Dr. Lauré Adrien, who is the director of the Ministry of Public Health and Population, are sorting out details and funding.

The International Monetary Fund announced $111 million in financing to help Haiti with “health-related expenditures and income support” to ease the impact of Covid-19. The State Department and the U.S. Agency for International Development committed $13.2 million. With many in Haiti living from what they earn by working each day, measures like self-quarantining are impossible. Local businesses have donated, and some foreign nonprofit organizations are raising money that, given the recent U.S. ban on exporting medical supplies, and the increase in costs that followed, needs to stretch further. “It’s more expensive but it was the only way we could do it,” said Geoffrey Boutros, a Miami-based broker who arranged for masks and gloves to be shipped to Gheskio directly from China.

A month after Haiti’s president announced an emergency, banning gatherings of more than 10 and closing schools, tap taps — the converted pickup trucks that run as private buses — are still jammed with people. And while the upscale supermarkets that cater to Haiti’s elite now offer customers hand-cleaning stations and demand they wear masks, the open markets that serve the country’s poor remain a cacophony of jostling humanity. “People don’t believe it because it’s coming from the government,” said Karl Jean-Louis, a Haitian entrepreneur who interviewed workers and vendors along Port-au-Prince’s crowded streets. Some claimed the epidemic was a ruse for the government to make money from aid agencies. Others said staying home was impossible, as they had to work to feed their families.

More than half of the population lives hand-to-mouth, earning less than $2.41 per day, according to the World Bank. While recovering from Covid-19, a couple in Haiti’s rural south became so stigmatized that Dr. Inobert Pierre, director of St. Boniface Hospital, sent a car with loudspeakers blaring: Covid-19 is not a crime; it can strike anybody; prevention is the best cure. To his own scared staff, Dr. Pierre explained “this is like a war” and “we are the soldiers.”

Dr. Pape has trained more than 1,000 people to go door-to-door, seeking out anyone with symptoms and urging them to go to the hospital. Crews are delivering tubs of water and hand soap in the slums, where people normally buy water by the bucket. And through loudspeakers, they’re asking: Wash your hands, or lave men in Creole.

Experts say Haiti’s current low number of infections partly reflects the country’s dysfunction. Protests and gang warfare drove away would-be visitors, and with them the potential of importing the virus. Kidnappings have become so chronic that the United States issued a “do not travel” warning in early March.

But those conditions are changing. Over recent weeks, thousands of Haitians have flooded back home each day from the Dominican Republic, said Giuseppe Loprete, the chief of mission for the International Organization for Migration in Haiti. Doctors have been screening at four official border checkpoints, but not at dozens of illegal crossings. As Dr. Pape and his team furiously prepare a countrywide response, hospitals have been left to their own devices.

In Port-au-Prince, a century-old French hospital that had been caught in the crossfire of gang warfare for two years shut down altogether after the first suspected case hit the emergency room. “The situation created a panic,” said Dr. Jean Venèse Joseph, the medical director at the hospital. “Coronavirus came and worsened a situation that was already bad.”

Not far away, the founder of St. Luke Hospital, Father Richard Frechette, converted an old hospital building — last used to treat cholera patients — into a 40-bed Covid-19 ward. Instead of face shields, he outfitted staff with the snorkels and welders’ masks he found at a local market. He has commissioned tailors to fashion 15,000 masks out of bathrobes for use in the hospital’s non-Covid areas. “Rich countries are hoarding all the stuff,” said Father Frechette, who is also a doctor and built the country’s only children’s hospital.

Until recently, he hoped the country would be spared by the unpredictable virus, which seemed to strike rich northern countries, and was said to not flourish in the heat and humidity of countries like Haiti.

But watching it erupt in the Dominican Republic next door, he worries it could become comparable to the cholera epidemic that, starting in 2010, ripped through Haiti’s slums and burgeoning tent camps, infecting more than 820,000. That came months after an earthquake that left between 220,000 and 316,000 people dead. Although billions of dollars and aid workers poured into Haiti, vowing to “build back better,” the dreams of planned communities, public health care and free schools remain dreams 10 years later, leaving many Haitians bitter and skeptical.

This time, as countries around the world fight their own battle against the virus, Haitians do not expect aid. “We do not have hundreds of NGOs here and there, doing things. It’s not the same,” said Franck Généus, president of the association of private hospitals that provides about 40 percent of Haiti’s health care. The group has offered 300 beds to coronavirus patients, at a cost of $200 a day. “Basically we are alone,” he said. “For once, we need to solve this ourselves.”

Harold Isaac contributed reporting.

 

By Pamela Constable 

Washington Post 

April 24, 2020 

Haiti is a country where untimely deaths occur all the time. In remote villages, women die in childbirth and older people succumb quietly to untreated infirmities. In crowded urban shantytowns, gang violence, police repression and political feuds leave bodies in the streets. When a powerful earthquake struck the country in 2010, much of the capital region was flattened and at least 200,000 people perished in the rubble.

Today the Caribbean nation of 11 million, often described as the poorest in the Western Hemisphere, is bracing for another potential disaster: the novel coronavirus. To date, only five people in Haiti have died of the covid-19 disease and 72 cases have been confirmed. With a mere 439 tests conducted, those figures are undoubtedly low. Meanwhile, in the past week, fears of a major outbreak have surged as thousands of Haitian migrant workers flood home across the border from the Dominican Republic, which has reported over 5,000 cases and more than 250 deaths.

 

“Urgent action at the border is needed,” tweeted Giuseppe Loprete, who heads the Haiti office of the International Organization for Migration. With few public hospitals functioning, news reports have described private clinics and health centers in Haiti’s capital, Port-au-Prince, racing to prepare isolation wards and makeshift personal protection kits. Haitians have long lived in a state of perpetual emergency. Once enslaved under French colonial rule, then kept in poverty by a series of domestic dictators until the 1980s, they still struggle to survive. Only half the population has access to health care or drinking water; the per capita income of under $900 is on par with Eritrea and Burkina Faso. Somehow, though, people carry on with a resilience born of spiritual belief, resourcefulness and joie de vivre in circumstances that would sap the will of many.

During the 1980s and 1990s, I made numerous trips to Haiti as a correspondent for the Boston Globe. I saw how a blend of beliefs combated people’s despair, with Christian services promising redemption and voodoo rituals summoning dead spirits. I saw creativity flourish amid dire need, with impromptu musical concerts and village houses painted bright pink or blue.

I saw desperate poverty everywhere: children with hair discolored by malnutrition, hospitals where patients lay on pads in the corridors and relatives begged for money to buy medicines, families crammed into one-room shacks with rain pouring through the roofs.

It was an era of constant political turmoil, with danger in the air. The army staged a military coup, a dictator fled, and a radical slum priest rose to power on a wave of protests against the wealthy elite. I was nearly shot by a drunk policeman in the capital; threatened by machete-wielding militiamen after a rural massacre; and almost trampled by a mob protesting outside a prison, until a stranger grabbed my hand and pulled me to safety.

And yet I felt welcomed by almost everyone I met. In one village, a gaunt farmer wrapped an egg and a mango for me to take as gifts. In the fetid urban shantytown of La Saline, I met a tailor whose only possession was an old sewing machine. This dignified man invited me to community soccer games, with plastic jugs substituting for balls. He invited me to his daughter’s baptism in a church yard, and to this day I remember the light streaming down through the trees. “Haitians have faced one disaster after another. But they are determined to celebrate life, because they never know how long it will last,” said Jeff Liteman, a longtime friend and retired U.S. diplomat who was stationed in Port-au-Prince at the time. He noted that there is an “uglier side” to Haitian society, where violence is rampant. “People do terrible things,” he said, “but the spirit that pervades is to partake of life as if they were diving into a feast.”

In the years since then, Haiti’s hopes for progress have been repeatedly dashed. A series of elected governments have proved inept, corrupt or repressive. Poverty has risen and the economy has stagnated. The country has never fully recovered from the 2010 earthquake, which left hundreds of thousands homeless and was followed by an epidemic of cholera, which killed thousands more.

Last month, when the first cases of covid-19 appeared, the government declared a state of emergency, but many people ignored it. Amid an ongoing spate of gang violence and political unrest, the director of a private hospital was kidnapped, reportedly for ransom. But last week, Prime Minister Joseph Jouthe suggested Haiti had managed the virus better than wealthier countries.

“I can’t say I have 100 corpses, like all those developed countries and their big infrastructure,” Jouthe said at a press briefing April 14. He insisted the ban on public gatherings had succeeded, even as people continued “dancing [and] having block parties.” He announced the reopening of the local textile industry, which stitches T-shirts for export and provides 58,000 workers with rare salaried jobs.

But Haiti’s hospitals are still woefully equipped, with more than 90 percent of medical services funded by foreign or private charities. If the virus surges, there are fewer than 60 ventilators in the country to handle it. “To tell you the truth, we are not prepared at all,” one Haitian respiratory therapist told the BBC last week.

On social media, the specter of covid-19 has aroused a heated debate between Haiti’s detractors and defenders. One Facebook post claimed that the country is ungovernable and needs another “dictatorship or slavery.” Another retorted that Haiti’s “obituary has been written several times” but added that, like a phoenix, “the Haitian will always rise from his/her ashes. We will survive.” But Haitians have already endured more than their share of natural and man-made calamities. I pray that, somehow, this one passes them by.

What Haiti’s youngest COVID-19 death says about how prepared the country is for pandemic
BY JACQUELINE CHARLES
APRIL 29, 2020 

A decade after France and the U.S. promised to build Haiti a new hospital following the 2010 earthquake, the General Hospital remains mired in problems and concerns about sustainability. 

The private hospital in Haiti’s capital had done everything to try to keep the coronavirus at bay. It had capped the number of patients at no more than 35 a day for social distancing, limited visitors to one per patient and put tailors to work making masks — obligatory for everyone who stepped into the building.

Then an 18-year-old stumbled through the emergency room earlier this month, displaying signs of meningitis. The staff didn’t think they had reason to worry. “He didn’t show any symptoms” of the coronavirus, recalls the hospital director. The Miami Herald is not naming him or his hospital because of continued threats that hospitals treating coronavirus patients will be burned down. “And now you have a block of rooms that’s out of service... because of one patient, and twenty-something doctors, nurses and auxiliary staff who are all in quarantine.”

As COVID-19, the respiratory disease caused by the novel coronavirus, spreads in Haiti, the risk of healthcare workers and hospitals falling victim to the pandemic grows. Every patient walking into a medical facility is a potential spreader who can knock an already fragile health system on its knees. “People with this disease can be shedding [the] virus while asymptomatic,” said Dr. Jean William “Bill” Pape, the founder of GHESKIO, a leading HIV/AIDS treatment center and co-president of a Haitian presidential commission charged with overseeing management of the pandemic. “Health workers in Haiti and all over the world should take extra precautions whether they are a primary COVID-19 center or not.”

The teen with meningitis had been at the hospital for 13 days before doctors decided to transfer him to another hospital because they could not help him. Days later, one of the director’s nurses shared a rumor she had heard: There was a death related to COVID-19 at a not-for-profit hospital in Port-au-Prince not designated for coronavirus patients. After additional digging, she discovered that it was their former patient, who on Friday became Haiti’s sixth — and youngest — coronavirus fatality after he had problems breathing and fell into a coma.

That the church-run hospital found out about the case through the medical rumor mill — and not from the Ministry of Health or other official channels — is bad enough. A bigger problem: Nearly 10 percent of its medical staff is out on quarantine and more than two dozen hospital rooms are out of service, highlighting the challenges facing Haiti as it prepares for an onslaught of coronavirus cases.

With a population of more than 11 million, Haiti has over 900 health institutions, of which 38 percent are public, 42 percent are private and 20 percent are mixed government and non-profit, according to the World Health Organization. More than half of the health facilities, which include primary care centers, community referral hospitals and 10 departmental public hospitals, are located in metropolitan Port-au-Prince.

A 2017 World Bank study noted that there are 1.2 health centers per 30,000 inhabitants and Haiti had significantly more hospitals than many similarly poor countries. But its hospitals, the majority of which charge user fees, are often under-equipped.

The director of the church-run hospital in Port-au-Prince, which is among more than 36 private hospitals in the capital, doesn’t yet know if any of his staff is infected. After confirming Friday that the teen had died from COVID-19, he quickly shut down the internal medicine unit, pulling 24 beds in a common area and four others in private rooms out of service until the unit is properly decontaminated. He ordered doctors, nurses and nurses’ aides who may have had contact with the teen to self-quarantine for two weeks, and asked the ministry of health to run tests on three staffers who had close contact with the teen. The earliest they could send someone, the ministry told him, was Monday.

The operators of the second hospital, which is a private nonprofit, have not responded to repeated requests from the Miami Herald about what measures have been taken, including whether hospital staff has been properly notified of possible exposure to the deadly disease. That hospital, like the first, was not equipped to receive COVID-19 patients and there are concerns that both a hallway and operating room next to the intensive care unit where the teen had been on a ventilator, near other patients, could have been contaminated.

Haiti currently has 76 confirmed cases of COVID-19, but few believe it’s an accurate count. Few people outside Port-au-Prince have access to testing. Many Haitians still do not believe in the existence of the flu-like virus and see it as a government ploy to get international aid. Others, frightened by what they do not understand, view the disease as a death sentence and anyone with it as tainted. That makes contact tracing difficult if not outright impossible in some instances.

The Pan American Health Organization, which has been urging countries in the region to expand testing and accelerate their preparation for COVID-19, said it remains concerned about health systems collapsing under the weight of the pandemic as community spread and fatalities continue to escalate in Latin America and the Caribbean. “The backbone to fight this epidemic is a strong health system, and strong health services in hospitals,” said Marcos Espinal, PAHO’s director of the Department of Communicable Disease for the Pan American Health Organization.

For weeks, Haiti has been trying to come to some agreement with its private hospitals over increasing the number of COVID-19 beds, as officials expect as many as 432,000 infected Haitians would be in need of hospitalization, according to health officials’ latest projections. But the private hospitals, several sources told the Herald, want reimbursements of $336 per patient per day, a sum Haiti’s cash-strapped government says it can’t afford. “We met with private hospitals several times to establish a memorandum to see how we could help them financially.... But we must admit, to date, we cannot find an agreement,” said Dr. Lauré Adrien, the director general of Haiti’s Ministry of Public Health and Population and co-chair of the coronavirus commission.

The head of the Association of Private Hospitals in Haiti, Dr. Franck Généus, declined to be interviewed for this story. Généus has been a vocal critic of the government’s failure to include privately owned medical facilities in its plans from the outset. Last week, he submitted a proposal to the presidential coronavirus commission. The proposal does not cite a cost, which Généus has said was originally raised only as a basis to begin deliberations, and based on a “World Health Organization forecasting tool” on the cost of caring for a patient in Haiti with COVID-19. While both sides stand their ground, a crisis looms. “Cases are increasing and an increase in the number of cases is very likely expected for the month of May,” said Adrien, the health ministry director. “I cannot say that Haiti is sufficiently ready, equipped at this stage to deal with an influx of cases... We are preparing with our means.”

The government has ordered $18 million worth of equipment from a Chinese supplier including face masks, ventilators and respirators for each of the country’s 10 regions along with hospital beds. But a month after the order, the equipment has yet to arrive. In March, the health ministry estimated that it would need between $30 million and $35 million a month to respond to COVID-19. The estimate has since grown significantly. “It’s a race against time, and more needs to be done now, not tomorrow, as the epidemic is starting to progress with community spread,” said Bruno Lemarquis, the United Nations’ resident coordinator in Haiti.

Lemarquis, who also serves as deputy special representative of the United Nations Integrated Office in Haiti, said Haiti is facing “a perfect storm, with two back-to-back tsunamis — a health crisis followed by a severe socioeconomic impact.” “This comes on top of an already very concerning humanitarian situation, itself generated by Haiti’s chronic vulnerabilities but exacerbated by the series of crises the country went through in 2019,” he said.

The Haitian government needs to do more to quickly designate health structures across the country to treat COVID-19 patients and to ensure that the necessary personal protective equipment is available to health workers, Lemarquis added, so they aren’t sidelined before the spike.

Adrien said the ministry is currently designating buildings around the country that can be repurposed as COVID-19 treatment centers. Ideally, it would also like to have charity and privately run hospitals provide at least 40 beds for infected patients. It is more than most hospitals, however, are willing to provide. “To date we can count on approximately 3,000 beds that have already been identified, with a capacity to quickly put 1,500 to 2,000 more beds with certain adjustments,” he said.

While welcoming the church-affiliated hospital’s measures after learning of the 18-year-old’s death from COVID-19, there is one unfortunate reality, Adrien said. “By quarantining a large part of the staff, the hospital is unable to provide services as usual,” he said. The incident shows that “it is imperative to continue with the training of staff on prevention and precautionary measures, and especially to begin to have enough protective equipment for staff.” But the main challenge he believes Haiti faces “is raising public awareness to limit the community spread of the virus.”

Several recent incidents — including the escape of a recently returned U.S. deportee from government quarantine after he learned he had COVID-19, and later, five individuals in the city of Hinche also escaped while awaiting test results — are all linked, Adrien said, to Haitians’ fear and lack of knowledge about the pandemic. The stigma surrounding COVID-19 and the lack of protective equipment have left healthcare workers and hospital staff feeling vulnerable and exposed, as some Haitians threaten to burn down facilities caring for patients with the coronavirus.

Last week, a crowd forced its way into an isolated coronavirus treatment center opened by the Bishop Joseph M. Sullivan Center for Health in the southeastern town of Côte-de-Fer. In the dead of night, they took their dying pastor, who was in a coma after testing positive for COVID-19, from his hospital bed. Not believing he had the disease, they transported him in the back of a pickup to Aquin, another southern town, where he died.

Counting down the days since the incident, some of those who were part of the crowd have warned the hospital’s staff of imminent protests if no one in the group dies during the 14-day incubation period since contact was made with the infected pastor. “For them, it’s as if the ministry of health is making up cases and the cases are not real,” said Dr. Jean Daniel Laguerre, the hospital’s medical director, who filmed the incident. “The population doesn’t believe.” “Even in a country of affluence like the United States, it’s evident there wasn’t preparation given the amount of deaths,” Laguerre said, “so just imagine for Haiti, which is truly limited economically and human-resources wise, and we are really limited in terms of equipment.”

The director of the church-run hospital in Port-au-Prince said they were in the throes of preparations for the coronavirus pandemic when President Jovenel Moise confirmed the virus’ arrival in Haiti on March 19. “Everything just collapsed,” said the director, describing the announcement’s impact. “It was as if an airplane was flying and then it just crashed.” In the month since, the flow of patients seeking medical care has slowed immensely, he said. The pediatric clinic, which used to see as many as 90 patients a day, last Thursday only saw 10. While some people aren’t coming because they can’t afford care, others aren’t coming because of the virus. “People are afraid to come to the hospital,” the director said. “They are afraid of the coronavirus. They are afraid of crossing paths with anyone who has it and if you tell them that they have it, it’s a catastrophe for them.... With this coronavirus, we truly cannot function. It’s a huge hit.”

Still, the hospital has responded to the health ministry’s call, committing to provide a block of rooms consisting of 24 beds separated by curtains in a common space and four private rooms, plus another eight beds for isolation. But concerns remain. “If we don’t have equipment to protect us, if there is no possibility to provide it to us, then it is increasingly possible that you will find among those who are working those who will say, ‘It’s my life before everything else,’ ” the director said. “I have to always have at the back of my mind that some may quit. “Whether we like it or not, whether we create a space for COVID or not, whether we find the means to have it function as a COVID space or not, COVID is coming here.”

 

BY JACQUELINE CHARLES

MIami Herald

MAY 05, 2020

While transmission of the novel coronavirus is still in the early stages in Haiti, global health authorities are worried that the deadly pandemic could unleash civil unrest and an even deeper humanitarian crisis in the country, not to mention thousands of deaths. “There is real danger of a large scale outbreak followed further by a humanitarian crisis in Haiti,” Dr. Carissa Etienne, the director of the Pan American Health Organization, said Tuesday. “There is the real risk that growing food insecurity will result in famine.” And the lack of food could give rise to social unrest, she added.

Health experts in Haiti have been working with models that suggest the country could see a death toll of 20,000 or more, with 432,000 infected Haitians in need of hospitalization. This would require 9,000 hospital beds that the poverty-stricken country currently does not have..

Such projections and the mounting concerns about the country’s lack of preparation are further compounded by a lack of availability of medical supplies, the country’s ongoing political crisis and polarization, and many Haitians’ refusal to accept that the pandemic, which has already killed more than 80,000 people in the hemisphere, including in the United States and Canada, is real.

“People believe that the pandemic is political gimmickry and they do not appreciate the severity,” Etienne said. “In fact... they have physically obstructed access to the setting up of COVID hospital facilities, threatening to burn them down and also to attack health care workers.” “The ongoing threat to hospitals and the safety of community health care workers is also of great concern,” added Etienne, who devoted part of her weekly press briefing on the situation of COVID-19 in the region to focus attention on Haiti.

Haiti so far has only 101 laboratory-confirmed cases of COVID-19, the respiratory disease caused by the flu-like virus, compared to the Dominican Republic, which has registered 8,235 infections and 346 deaths. But with 55,000 unemployed and scared Haitian migrants expected to illegally cross the closed but porous land border between the two nations in the next two to three weeks, Etienne and others in the United Nations system are sounding the alarm. “The situation has been described as a perfect storm approaching,” said Etienne, echoing similar concerns that have been expressed by the U.N.’s humanitarian coordinator in Haiti, Bruno Lemarquis. “There are already 17,000 Haitians who have returned from the Dominican Republic, where there is community transmission.”

Etienne said the wide discrepancy between the Dominican Republic and Haiti, which share the island of Hispaniola, can be explained by the virus’ late arrival in Haiti, on March 19, compared to the Dominican Republic, on March 1, when the country confirmed that an Italian national had checked into a Santo Domingo hospital with symptoms. Also, the Dominican Republic normally has more than eight times the number of daily international flights than Haiti, with tourists flowing in from Italy, New York and Florida, early hot spots for the virus’ spread.

Still, one-third of the infections in Haiti, where 12 people have already died, are local transmissions and “the probability of further spread is extremely high,” Etienne said. “This situation is a precarious one.” “The health system has limited capacity. There are a few beds for treating COVID-19, insufficient numbers of health care professionals and insufficient personal protective equipment,” she said of Haiti, which has one of the weakest health systems in the region.

Etienne noted that while the Haitian government “continues to say” it has ordered $18 million worth of beds and supplies from China, “the United Nations, had no, no involvement in that.” “There is a continuing delay on when are we going to receive those supplies in Haiti,” she said. “Every week, you are given another date.”

Addressing the purchase of supplies during an early morning appearance Tuesday on Port-au-Prince’s Magik9 radio program, Haitian Prime Minister Joseph Jouthe said air transport has been expensive and Haiti has been about if by those who can pay more. Asked why he did not turn to the U.N., which has a small political mission in country for help with logistics, Jouthe responded: “Ask the United Nations how much money was available to help us buy tests when the pandemic started. They did not give us a cent.”

Etienne noted that PAHO, which is part of the U.N health system, has provided the only testing kits that Haiti has available to screen for COVID-19. Of those 9,000 PAHO-supplied tests kits, Haiti so far has only tested 600 people. In addition to the test kits, UNICEF early on donated medical supplies and hygiene kits to the Ministry of Public Health and Population to promote hand washing. The donation was documented by the health ministry with photos of Jouthe’s health minister posing with the buckets. “The U.N. agencies are really engaged with strong action and strong coordination,” said Etienne. “But the political instability in Haiti is significant. Parliamentary elections were [delayed] from last October. The president is ruling by decree.“

Haiti’s weak governance, which continues to spur protests and an overall precarious security situation, only add to the challenges of an already weak health system. Before COVID-19, 4.1 million Haitians out of nearly 12 million were facing food shortages or outright famine, which Etienne and others expect to only get worse. The slowdown of economies in Haiti and abroad has led to a reduction in the nearly $3 billion in yearly remittances Haitians have come to depend on.

Recognizing it’s been extremely difficult for the government to enforce physical distancing and lockdown measures due to the day-to-day reality of Haitians, who live in overcrowded conditions and need to go out daily to put food on the table, Etienne said measures can still be implemented. “They can observe no-contact greetings, hugging and kissing and maintaining six-foot distance,” she said. “They can establish one-way flows... in supermarkets; they can assign schedules by neighborhoods to access markets and to access food establishments and business places can apply markers for social distancing. It is imperative that hand hygiene stations are set up.” “Something has to be done,” she sad, “to avoid a humanitarian crisis in Haiti.”

Jacqueline Charles has reported on Haiti and the English-speaking Caribbean for the Miami Herald for over a decade. A Pulitzer Prize finalist for her coverage of the 2010 Haiti earthquake, she was awarded a 2018 Maria Moors Cabot Prize — the most prestigious award for coverage of the Americas.

Prime minister orders Haitians to wear masks in public and orders firms to make more masks
BY JACQUELINE CHARLES
MAY 05, 2020 0

Haiti’s prime minister has ordered all Haitians to wear masks in public as of Monday and banned factories from exporting the personal protective gear until they supply the government first.  Haitian Prime Minister Joseph Jouthe, who has struggled to enforce social-distancing measures in the fight against the global coronavirus pandemic, said anyone caught without a mask risks imprisonment because “they are trying to kill themselves.” “I have a population to protect,” he said, speaking during a morning radio interview Tuesday on Magik 9, a Port-au-Prince radio station owned by the country’s daily newspaper Le Nouvelliste.

But where Haitians — the majority of whom live on less than $2.41 a day — will get masks to comply with the order remains a mystery. Since last month, the government had been promising to distribute 20 million masks to the population. But Jouthe, blaming the local textile industry for the government’s failure to deliver, admitted that he barely had a fraction of them in his possession for the country’s nearly 12 million inhabitants. As a result, he said, the government is banning factories from exporting masks until they each provide a minimum of 500,000 masks to the government at a cost of 50 cents each.

Jouthe issued the order in a communique on Monday. He later reiterated his position in the radio interview, while accusing factory owners — whom he allowed to reopen last month despite the dangers of the global pandemic — of failing to live up to “a gentleman’s agreement” to produce 20 million masks to be sold to the government at 50 cents a piece. “We will only give authorization to export if they deliver to us between 500,000 and 1 million. Anyone who fails to hit that number will not get an authorization,” Jouthe said. “I have no choice but to play on two levels: When they sell abroad, it’s good. [But] secondly, I have to take precautions so that I don’t lose the textile industry in Haiti.”

Jouthe said he was recently approached by the president of the Association of Haitian Industries, Georges Sassine, seeking authorization for some of the country’s factories, which see an opportunity in the hard-to-get personal-protective-equipment arena, to export face masks. “It’s an aberration,” Jouthe said. “One, you’ve never been able to deliver the masks, those that you promised you would produce. Two, I cannot now give authorization to export masks when that’s not the agreement we had before.” Still, he acknowledged giving authorization to one company, which he declined to name, to export its masks.

“I have to find a plan for everyone to find masks for them to wear,” he conceded. “I am confronting an extremely dangerous epidemic.” In late March, unable to purchase masks after shutting down the country’s textile industry as part of anti-COVID-19 measures, Jouthe authorized the reopening of seven factories, saying they would provide 1 million masks for free to the government.

Three weeks later, despite concerns about the virus further spreading in the workplace, he authorized all factories in Haiti to resume operations at 30%, while not making any provisions to protect workers from infection by avoiding overcrowded public buses. Jouthe complained that he now had to assign people in his office to call each of the factories to try to negotiate an agreement with them.

Sassine, the president of the textile association, said while the prime minister had raised the matter of the 2 million masks with him, and said the government would “not pay more than 50 cents per mask” — a price well below the cost of production — there exists no formal agreement. The association, whose members include representatives of the 38 factories in Haiti, can bring everyone together in the same room, Sassine said, but it’s up to the government to negotiate agreements with the individual factories, the majority of which are foreign-owned. “All of the factories here are being run by employees, they are not the owners,” Sassine said. “They cannot base their decision solely on someone’s word. ... I cannot orally tell a foreign company to do this, or do that. They need something written.”

Sassine said the factories that were allowed to open on the condition that they would donate masks to the government are living up to their promise and are using their own materials to do so. “We’ve already delivered 704,906 masks by 19 factories and we have all of the receipts,” he said.

With U.S. retailers filing bankruptcies and COVID-19 threatening to undo what’s left of the U.S. retail market, Sassine said it’s imperative that the factories, which mostly export T-shirts to the U.S. market, begin producing to export so they can generate revenue. The factories that donated the free masks to the government — along with 15,000 medical scrubs, bed sheets and even money — all have workers, rent and electricity bills to pay, he said. “It’s a huge effort,” he said.

Jacqueline Charles has reported on Haiti and the English-speaking Caribbean for the Miami Herald for over a decade. A Pulitzer Prize finalist for her coverage of the 2010 Haiti earthquake, she was awarded a 2018 Maria Moors Cabot Prize — the most prestigious award for coverage of the Americas.
 

By Amelie BARON (AFP)

06/05/20 

On paper, Haiti so far has everything it needs to battle the coronavirus crisis -- unoccupied hospital beds, medical staff and supplies. But in reality, the population's skepticism about whether the contagion even exists has led to a quickly mounting death toll. "The illness is real. Many of our citizens are experiencing respiratory symptoms and other tell-tale signs," said Erneau Mondesir, a doctor who works in impoverished Cite Soleil. "It's really important for them to believe this disease exists."

And yet, despite the hundreds of thousands of deaths around the world, medical personnel are baffled by the unwillingness of many Haitians to take the pandemic seriously.

The first cases were detected in Haiti two months ago. In recent days, an increasing number of people are reporting symptoms consistent with COVID-19, the disease caused by the virus. They insist they have a "bit of a fever" or a "mild illness" -- but people are dying in and around the capital Port-au-Prince. Those who are ill and relatives of those who have died refuse to believe that they are susceptible to getting sick. Instead of seeking medical attention, some are relying on tea-based home remedies.

Doctors Without Borders has set up a coronavirus-only hospital in Cite Soleil, Haiti -- so far, the country has what it needs to manage the pandemic, but skepticism among the population could lead to a spike in infections Mondesir works at a hospital in Cite Soleil -- located just outside the capital -- opened by Doctors without Borders (MSF). The 45-bed facility is restricted to coronavirus patients.

Two weeks after it opened, more and more people are being admitted. But there is still room for more. "Today, one thing is clear: there are many people who stayed at home too long and then came to the hospital," explained Mondesir, the medical director for the MSF project. Erneau Mondesir is the medical director for the Doctors Without Borders hospital in Cite Soleil -- the left arrow points to the area for those with confirmed COVID-19 cases, the right leads to the area for suspected cases "That means treating them will not be as effective at the outset," he added, before donning all of the necessary protective gear.

In the intensive care unit, oxygen machines hum and heart monitors beep -- the repetitive rhythm of the otherwise calm room. Doctors and nurses, their names scrawled in marker on their disposable gowns, regularly check on their patients. For now, only three of 10 beds are in use. "These are the patients in critical condition. They arrive in a coma, and with complications," said Antonio Plessy, another doctor in the unit. Behind him, an elderly man lies unconscious. "We're trying everything: giving them high levels of oxygen, anticoagulants, antibiotics... We're doing everything until they breathe their last breath," said the anesthesiologist.

According to the latest data, published late Wednesday, there have been 50 virus-related deaths in Haiti, out of 2,640 confirmed cases. But even the national crisis management committee acknowledges that the real figures are higher, given the relatively small number of tests conducted so far.

In a country where so many rely on the informal economy to get by, lockdown measures have been impossible to impose, and social distancing in crowded markets is a pipe dream. Even getting people to wear a mask properly -- technically required in public spaces since May 11 -- is a challenge. Medical experts are certain that an uptick in infections is coming. "If we can't limit the spread of this pathogen now, we can at least try to limit the damage," said Mondesir, adding that he wishes contact tracing were a viable possibility. "It usually takes a week or two from the time that symptoms first appear for patients to show up at the hospital," he noted. "It's very hard to trace all the people these patients have been in contact with, beyond those who live with them."

Jonel Cadet, 25, only found out he had coronavirus because he had a motorcycle accident and broke his leg. "I developed a bit of a fever when I was in the hospital. It dropped quickly, but then they put something in my nose and then my throat, and then they told me I was infected," he said. Before he ended up in the hospital, he was among the skeptics. He even had to convince his relatives to let him seek treatment at the MSF facility. "I didn't believe it, and I even said the president was talking nonsense," he said with a laugh. "It was only by coming here that I really started to believe, because I saw people who were much worse off."

Beyond the general skepticism that reigns in Haiti, there are also those who believe a rumor that any treatment involving a needle in a coronavirus treatment center will be deadly. "My brother thought they would kill me at the hospital," said Cadet, who has now recovered after two weeks of inpatient care."I told him God would decide. But no, it has to be said -- no one kills people at hospitals." Cadet advises his countrymen to "wear masks, and then there you go, no corona." His broken leg is now healing in an exterior metal brace, and he is eagerly awaiting a return to a "normal" hospital as it heals.

 

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