In March, Haiti began convulsing with violence stemming from heavily armed street gangs that took control of the country. The groups closed the airport, freed several thousand prisoners and demanded that Prime Minister Ariel Henry step down — which he did. We interviewed physicians and nonprofits in Haiti at the time and published an article about the disastrous impacts on access to routine and long-term health care.
Now, almost six months later, the gang violence continues even after the arrival of 400 Kenyan police officers to serve as an international peacekeeping force. The UN Migration Agency reports that some 5% of Haitians are now internally displaced — over half a million people as gang warfare continues, We spoke to representatives of health-care organizations about the continuing challenges of providing basic medical services.
Much of Dr. Joseph Reginald Fils-Aimé’s time these days is consumed with coordinating logistics.
For instance, last Tuesday, he spoke with the manager of a screening program in southern Haiti. “She has diagnosed someone with cervical cancer,” he says, “and was calling me to decide, ‘OK, we need that person to find care.’ In the south, she doesn’t know of any places where she can send her.”
Fils-Aimé directs strategic planning for Zanmi Lasante, a nonprofit connected to Partners In Health and Haiti's largest health-care provider after the government. He explains that in normal times, the capital of Port-au-Prince would be the best option for the cancer patient. But many of the public and private health facilities there (and elsewhere) are no longer operating due to gang violence and looting.
So on that phone call, he and his colleague were strategizing how to get this patient to Mirebalais, a community northeast of the capital where Zanmi Lasante runs its largest hospital and has oncologists and a cancer treatment program. “Mirebalais becomes her only option now,” Fils-Aimé says matter-of-factly.
“Some people take the road [there] even if it's controlled by armed group[s],” he continues. “They take the risk because they need health care. They desperately need the care.”
But he and his colleague weren’t willing to risk the seizure of a car and everyone inside it by the gangs. So they worked through the details of getting the patient onto a flight to Mirebalais and finding her a place to stay for the days she’d need to have her diagnosis confirmed and her treatment started.
Fils-Aimé admits they can’t make those highly personalized arrangements for every patient — so Zanmi Lasante gives priority to women in precarious situations, including those with risky pregnancies. In addition to moving patients, they’re also considering transporting medication and other supplies on a boat that will travel from port to port to avoid the risky roads.
Here’s what the situation comes down to: Across Haiti, a patient no longer presents with just their symptoms and medical history. Their treatment plans and care must also be filtered through the complex geography of a country that’s become a deadly obstacle course. “This is very, very…” Fils-Aimé pauses before concluding: “This is tough.”
Mobile medicine
Every Monday to Friday from 8 a.m. to 3 p.m., a couple of Toyota Landcruisers from the NGO Alliance for International Medical Action (ALIMA) pull into a different school or empty lot in central Port-au-Prince. Six people file out, including a doctor, nurse, midwife and psychologist. One of the SUVs is loaded up with drugs and medical equipment. Someone sets up a table and chair in the parking lot.
This is a free mobile clinic. Over the course of each day, the medical team might see up to 100 patients spanning all ages. “It’s very busy,” says Dr. Abdoulaye Ousmane, ALIMA’s medical coordinator in Haiti.
The mobile clinic is equipped to handle minor cases — “outpatient consultation, antenatal care, postnatal care, family planning, psychological support,” says Ousmane.
Anyone who shows up with an emergency is brought by ambulance to one of the hospitals still open. “But of course, the issue become[s] the day we are not there and they have emergency cases,” he says. That’s when such a patient would be out of luck.
To reach more people, ALIMA has a second mobile clinic. Other NGOs are running them in Haiti too. Ousmane says his teams have seen 3,000 patients in the last few months. “Of course we are [making a difference],” he says. “We feel proud.”
And yet it’s possible to view these mobile clinics as a partial effort to plug the holes of a health system that’s falling apart. “Five million people are suffering from acute hunger and nearly 1.6 million are at a risk of severe hunger,” he says, based on reporting from UNICEF and the World Food Programme.
In late June, Kenya began sending private security forces to Haiti to take on the gangs and bring order. But Ousmane says the danger continues. “We still record a lot of security incidents, a lot of attacks,” he says, adding that he’s seen no improvements in health care or security since the street gangs first took control six months ago. “You have a higher rate of mortality at the community level.”
“All the hospitalization, all the surgery… all those services are not available because of this insecurity,” he says.
Ousmane agrees that women are the most vulnerable population in Haiti currently. “When one woman need[s] to give birth,” he says, “and she cannot because there is no place to give birth, it becomes something very dangerous for her — and for the children.”
The day-to-day work of treating a country with a health care system on life support is a hefty challenge. But Ousmane isn’t blinking.
“There is hope,” he says, that “maybe in the coming months or weeks, we will see change.”
“We hope that the security situation and political situation,” he adds, choosing his words carefully, “it will resolve soon.”
And until that resolution comes, Fils-Aimé says, “we are trying to do whatever we can.”
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