Haiti’s investment in health has dropped from 16.6 percent in 2004 to 4.4 percent in 2017 despite everything its people have been through since then - unrest, cholera, natural disasters, the earthquake, COVID-19, gender-based violence, and grinding poverty. Opportunities to consult formally trained mental health workers rmeain rare. For a country of nearly 11 million, Haiti also only has 23 psychiatrists and 124 psychologists. Some alternatives, such as hotlines, are beginning to emerge in response. Linked and below is an article by Jessica Obert in the New Humanitarian about the mental health situation in Haiti.
Haitians have long worked in the Dominican Republic due to the lack of opportunities at home. With the Dominican economy contracting due to the pandemic, many Haitian migrants are returning home. The World Health Organisation's western hemisphere branch (Pan American Health Organisation) has established screening and quarantine centers at border crossings in the region but with 269 informal crossing points and only four formal crossing points ensuring the health needs of returning migrants is a daunting task - especially when they fear their own communities may stigmatise them. The full article by New York Time journalist David Waldstein follows.
In the New Humanitarian, Jessica Obert writes that Haiti never fully recovered from the earthuqake let alone cholera, political instability, and subsequent natural disasters. While Haitians themselves are resilient their government and the systems that are supposed to be in place to ensue their health, safety, and well being are not. Haiti's ever-fragile economy had already contracted 1.2 percent last year due to protests and the pandemic could result in a contraction of 2.7 percent this year according to the Haitian Ministry of Finance. Physcial distancing does not work well in settings where people are living day to day due to economic hardship. If there are positives, Haiti's population is younger and it has a history of working together with the Dominican Republic on infectious diseases. As with other countries, Haiti will be living with the pandemic for a long time to come.
Haiti's health care system, a patchwork of public and private facilities, was struggling prior to the pandemic. Instability and its root causes of poor governance, corruption, and poverty have resulted in poor access to health services for most Haitians. BBC journalist Will Grant writes below that will every country in the Americas will be impacted by the coronavrius (COVID-19) pandemic, Haiti lacks the capacity and financial resources needed to increase its preparedness. As has long been the case, the hard work of addressing growing health needs falls upon non-governmental organisations such as Partners in Health who received Haiti's first cases.
Haiti has long had a sanitation problem, being one of a very small number of countries where sanitation worsened over the last twenty five years. Port au Prince, its largest city, has no central sewage system and is unlikely to ever have one. There are other models for sewage management but implementing them without good governance, the rule of law, and a well-informed public is, as with anything else, challenging. However, there are champions for improving sanitation both within and outside the Haitian government. The full NPR article by Rebecca Hersher follows.
It is no secret that services at public health care facilities in Haiti are generally poor. However, these facilities are important in that they are used by Haitians who have no other alternative. Konbit Sante is a small organization based in Maine that has partnered with the Justinian University Hospital in Cap Haitian for many years. With their support, newborn and pediatric care is being moved into a new facility – but $25,000 is still needed for materials, equipment, and staffing. If you are looking for an accountable organization that is serious about capacity building, consider donating to Konbit Sante in support of the Justinian University Hospital.
On December 1st, outgoing United Nations (UN) Secretary-General Ban Ki-moon offered an apology of sorts, expressing reget for not doing enough to respond to cholera while not admitting that it was caused by the poor sanitation practices of UN Peacekeepers. Had this apology been made five years ago, coupled with a committment to bring an end to the outbreak no matter how long necessary, it would have meant something. Coming months before he leaves office, one has the impression that the outbreak was not a priority until recently, that he is seeking to tie up the loose ends of his legacy before stepping down, or both. The full article by IRIN writer Samuel Oakford is below and information on efforts to hold the United Nations accountable can be found at the Institute for Justice and Democracy in Haiti (IJDH).
In Haiti and other countries around the world, mental health problems cause significant suffering by decreasing a person’s ability to complete daily tasks, work, learn, and/or build supportive relationships with others. Discussing mental illness in Haiti can be sensitive – but it is a very important and often overlooked aspect of public health.
As one of the few countries in the world where sanitation had gotten worse over the past twenty years, Haiti was highly vulnerable to the cholera outbreak in 2010. After years of obfuscation, the United Nations has finally admitted that the epidemic was imported by UN peacekeepers. That it has happened at all is testament to the efforts of Haitian civil society and the advocacy of organizations like the Institute of Democracy and Justice in Haiti. The UN intends to release a response plan in two weeks. More information from AFP follows.
Haiti is in the midst of a cholera outbreak, the origin of which is and may remain unclear. We live in a mobile world and the source could be Africa, Asia, South America, or it may have already been in the environment. Where it came from is less important than the fact that Haiti, and especially the poorest of the poor, will always be vulnerable without clean water, adequate sanitation, and good hygiene. This is an update on the current cholera emergency and a reflection on actions that can prevent this from happening again.