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 鈥� 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 reports that some 5% of Haitians are now internally displaced 鈥� 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-Aim茅鈥檚 time these days is consumed with coordinating logistics.
For instance, last Tuesday, he spoke with the manager of a screening program in southern Haiti. 鈥淪he has diagnosed someone with cervical cancer,鈥� he says, 鈥渁nd was calling me to decide, 鈥極K, we need that person to find care.鈥� In the south, she doesn鈥檛 know of any places where she can send her.鈥�
Fils-Aim茅 directs strategic planning for , 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. 鈥淢irebalais becomes her only option now,鈥� Fils-Aim茅 says matter-of-factly.
鈥淪ome people take the road [there] even if it's controlled by armed group[s],鈥� he continues. 鈥淭hey take the risk because they need health care. They desperately need the care.鈥�
But he and his colleague weren鈥檛 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鈥檇 need to have her diagnosis confirmed and her treatment started.
Fils-Aim茅 admits they can鈥檛 make those highly personalized arrangements for every patient 鈥� so Zanmi Lasante gives priority to women in precarious situations, including those with risky pregnancies. In addition to moving patients, they鈥檙e also considering transporting medication and other supplies on a boat that will travel from port to port to avoid the risky roads.
Here鈥檚 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鈥檚 become a deadly obstacle course. 鈥淭his is very, very鈥︹�� Fils-Aim茅 pauses before concluding: 鈥淭his is tough.鈥�
Mobile medicine
Every Monday to Friday from 8 a.m. to 3 p.m., a couple of Toyota Landcruisers from the 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. 鈥淚t鈥檚 very busy,鈥� says Dr. Abdoulaye Ousmane, ALIMA鈥檚 medical coordinator in Haiti.
The mobile clinic is equipped to handle minor cases 鈥� 鈥渙utpatient consultation, antenatal care, postnatal care, family planning, psychological support,鈥� says Ousmane.
Anyone who shows up with an emergency is brought by ambulance to one of the hospitals still open. 鈥淏ut of course, the issue become[s] the day we are not there and they have emergency cases,鈥� he says. That鈥檚 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. 鈥淥f course we are [making a difference],鈥� he says. 鈥淲e feel proud.鈥�
And yet it鈥檚 possible to view these mobile clinics as a partial effort to plug the holes of a health system that鈥檚 falling apart. 鈥� are suffering from acute hunger and nearly are at a risk of severe hunger,鈥� 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. 鈥淲e still record a lot of security incidents, a lot of attacks,鈥� he says, adding that he鈥檚 seen no improvements in health care or security since the street gangs first took control six months ago. 鈥淵ou have a higher rate of mortality at the community level.鈥�
鈥淎ll the hospitalization, all the surgery鈥� all those services are not available because of this insecurity,鈥� he says.
Ousmane agrees that women are the most vulnerable population in Haiti currently. 鈥淲hen one woman need[s] to give birth,鈥� he says, 鈥渁nd she cannot because there is no place to give birth, it becomes something very dangerous for her 鈥� and for the children.鈥�
The day-to-day work of treating a country with a health care system on life support is a hefty challenge. But Ousmane isn鈥檛 blinking.
鈥淭here is hope,鈥� he says, that 鈥渕aybe in the coming months or weeks, we will see change.鈥�
鈥淲e hope that the security situation and political situation,鈥� he adds, choosing his words carefully, 鈥渋t will resolve soon.鈥�
And until that resolution comes, Fils-Aim茅 says, 鈥渨e are trying to do whatever we can.鈥�
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