It is impossible to talk about healthcare in Haiti without mentioning the January 2010 earthquake and the subsequent cholera epidemic which to date has affected 630,000 people and taken the lives of 7,500. It would be easy to believe that cholera was a direct result of the devastation of the earthquake and the heavy rains of the following June, July and August. Some two million people were forced to take shelter in overcrowded internally displaced camps [IDPs] where living conditions were appalling.
Yet prior to October 2010 there had been no cases of cholera in Haiti for nearly a century. The first hospitalized case was on 17 October in Mirebalais, the region through which Haiti’s longest river, the Artibonite, flows. By 22 October cholera was confirmed and the outbreak in the coastal areas of St Marc was established. The disease was able to spread rapidly due to initial misdiagnosis, lack of oral rehydration treatment and an already overstretched medical infrastructure. Cholera was not the epidemic in waiting. The first responders to both the earthquake and the cholera outbreak were the Cuban Brigade, which had been in Haiti since 1998, along with the well-established Médecins sans Frontières (MSF) also in Haiti for many years. At the start of 2013 these are the only two sizable medical teams left from those first 12 to 18 months.
Cholera is an acute dehydrating bacterial infection spread through water and food contaminated by human faeces and the illness is exacerbated by heavy rains; poor sanitation; and limited clean water and associated poor hygiene, such as failure to wash hands after going to the toilet. Treatment for most people is surprisingly simple: oral rehydration treatment and, in severe cases, an intravenous rehydration with antibiotics.
The problem with healthcare in Haiti is that there is no system, no structure, no plan – at least, not one that has been implemented. What healthcare facilities exist are wholly inadequate – insufficient medical staff, support staff, equipment and treatment. It is left to medical NGOs such as MSF, the Cuban Brigade and a few faith-based and charity clinics to provide what they can. For example, there is one MSF hospital in Carrefour with 275 beds serving about 400,000 people. In Cité Soleil, the figures are similar. In addition to the MSF hospital there is public hospital, St Catherine’s, which, like most government hospitals, is staffed by excellent Haitian doctors but is rundown and under-equipped. The Charity Mission runs a small hospice for HIV/AIDs patients and a few other small clinics serve at least 250,000 people. Finally, there is the Centre de Nutrition et Sante Rosalie Rendu, which has a paediatric clinic and sees up to 300 under-fives a day, with many mothers travelling across the city to reach the clinic. The round trip from, for example, Delmas to Cité Soleil can take up to four hours and three tap taps (pick-up trucks that serve as share taxis) at a cost of about $2 – a long and costly journey. But the Haitian and US doctors are excellent and the clinic includes a nutrition centre for malnourished children who attend every day for six months or until their weight and overall condition has improved.
The public hospitals, including the country’s main teaching hospital and clinical and trauma referral centre, L’Hôpital Université d’Etat d’Haïti (Haitian State University Hospital or HUEH), are in a terrible condition and have effectively been abandoned by all those involved in running the country – the government, the UN, USAID and other country donors, and the NGOs. HUEH was partially damaged in the earthquake – 150 nursing students were killed and two-thirds of the buildings destroyed. Even before the earthquake, it wasn’t in great shape; the rebuilding of HUEH was supposed to be a priority according to a 2010 proposal by Partners In Health.
One medical improvement at HUEH which is indicative of how things happen in Haiti is the TB clinic set up in 2010 by US volunteer Dr Coffee and a group of Haitian nurses. The clinic, which initially operated under tents, is now housed in a building. It has cared for over 1,000 TB patients since 2010.