Haiti’s public hospitals serving the country’s poorest have gone on strike twice in the last 12 months, in the midst of a deadly epidemic. The media was still reporting on the distressing aftermath of the earthquake, when an outbreak of cholera broke in Haiti’s Center and Artibonite departments. As of last year, six years since its outbreak, approximately 40,000 people have fallen ill. In September, I visited a cholera treatment center in Belladeres, a border town in Haiti’s Central-east which was home to many cases. During this trip and our visits, I was reminded how much of a burden such outbreaks are on an already weak healthcare system. The impact is heavier in isolated towns and villages, where resources are often scarce. The route, from the epidemic’s very start to the current phase where the incidence is the lowest since 2014, has been paved with lessons that could benefit the entire system.
Improving leadership and management. As a medical student back in 2012, I found myself hanging onto every word of Dr. Junot Felix addressing an inquisitive audience during a conference. As a senior public health professional, he stated that “the biggest obstacle facing Haiti’s healthcare system is a lack of competent managers”. As both management and leadership are vital to progress, his statement hinted that Haiti needs more people who are willing to highlight the best in each other and organize to provide the best possible care to the population.
Large and inclusive conversations need to happen between actors from public, private and NGO sectors- regardless of their many differences and priorities- to create liaisons, learn from each other about what has worked in the past, how to handle the current reality and bring forth solutions for the future. This is the type of collaboration that took place in elaborating and executing the plan to battle cholera.
Gather and share timely information. When I started working as a practitioner, in a private clinic, I was forced to work while in the dark about crucial information. National health data was either unavailable to me or outdated. I could not accommodate my practice effectively to special trends, especially when it comes to transmissible diseases. This is also the case for State institutions and many NGOs, entities charged with gathering and sharing information at different stages of their programs to contribute to the management of prevalent health issues in Haiti.
Such weaknesses have also affected the war on cholera, where sharing timely information is oftentimes as crucial as setting an IV line. But thanks to the cooperation between the actors in charge of responding to the epidemic, the situation is slowly improving. Were it not for constant efforts to initiate and preserve this synergy, project management and delivery of care and services would be ineffective and resources, used inadequately.
Develop an entrepreneurial culture. I have been following Daniella Bien-Aime, a blogger who strongly advocates for an entrepreneurial culture to counterbalance the aid perspective in Haiti. In my opinion, this would also benefit the health sector which is almost entirely funded by international donors. Although international aid has been pivotal to improve health indicators in Haiti in recent past, it is not sustainable for an autonomous healthcare system. International aid leaves little to no place for innovation and competition, and kills local initiatives at an embryonic stage. This is in part why doctors, nurses, midwives, pharmacists and laboratory scientists seek NGOs jobs, abandoning State hospitals and local clinics, or simply leave the country.
Promoting local initiatives either in Port-au-Prince and outside is the first step in instilling this paradigm shift. Raising awareness is one thing but proper training and support programs intended for local healthcare professionals could also breathe new life into Haiti’s healthcare system.
Improve health literacy. Health literacy affects every element of the health care system. This observation brought my colleagues and I to create integrAction, a project dedicated to health literacy which led online campaigns during the Chikungunya and Zika epidemics in Haiti. Health literacy is the ability to obtain, understand and master the health information necessary to make advised decisions. The goal is to make the complicated health system easier to navigate, through health promotion, communication and literacy.
Such initiatives might be largely helpful to the future of Haiti as they help lower the burden of preventable diseases, deaths and consequently lower the amount of money spent on these issues.
The cholera epidemic remains an unprecedented challenge as we work towards its elimination. Almost seven years past its introduction in Haiti, Haitians can use their experiences to look at the future with tenacity and a clearer vision. “We are here, fighting…” a drinking water technician said as we left Belladeres. My short visit there did not allow me the opportunity to implement any lasting change. Neither will any quick fix resolve the problems that lead to the recurring public hospital strikes, as they are a mere symptom of a deeper issue. As I lay down these recommendations of mine, to anybody reading this, I hope that the seeds will take root to bring forth a brighter future because of our common engagement.