Social Issue

A tale of two Haiti(s)

My brother Keddy and I grew up in Karenaj, a then hassle-free neighborhood in the world-renowned city of Cap-Haitien. Although our family had relatives in Saint-Michel de l’Attalaye, an Artibonite county south of Cap-Haitien, we lived far removed from rural Haiti, except for a few sporadic trips to “andeyò” which is the term Haitians use to refer to rural areas. It’s a Kreyòl word derived from the french “en dehors” translated as outside. So my twin and I, we were raised unfamiliar with most traditional food and to a greater extent, the language and culture of Haiti’s rural regions with their complexity and richness.

When our grand-mother passed away, I could feel that the few stories of Saint-Michel along with anecdotes of our elderly’s rural trips had also vanished. But now, as adults and doctors, we’ve managed to visit the entire country apart from Grand-Anse, either during professional endeavors or on personal adventures. As far as we could tell, decades later, differences still persist between how us, city-raised gentlemen, perceive and express reality and how rural populations do. Not only the rhetoric differs but the very elements of culture struggle to collide. During our trips, those gaps even impaired our ability to communicate with the locals. In terms of local tourism, this situation wouldn’t be much of an issue. But consider the heavy toll of such discrepancy when it comes to patients explaining their symptoms or when it comes to us doctors communicating health risks and treatment options.

In the 1970s, as Haiti’s agriculture sector plummeted, people massively moved from rural regions to adjacent towns in search of a better life. Throughout the decades, the dynamics of rural exodus have only made this transit skyrocket. More than half of Haiti’s population now live in cities. Needless to say that the emigrants carry what they have accumulated as a cultural background with them. The vacuum left by such demographic movement and social context leaves the rural areas very vulnerable. Which in turn often leads to city dwellers, with their own culture, to commute to rural areas for work-related projects, many of them provided by NGOs. This is how we found ourselves on a day-to-day journey trying to comprehend each other.

In rural populations, overcoming issues such as academic illiteracy or comprehending the beliefs in magico-spiritual forces is often a pre requisite for creating rapport and therefore to have impact on a patient’s health outcome. But some other concerns are subtler. I recall having examined an old woman named Annia in Saint-Antoine, a neighborhood next to Poupelard avenue, in Lalue, Port-au-prince. The old woman was from the South and had settled in Saint-Antoine less than 2 years prior to her consultation. Visibly uncomfortable, she described her pain to me in those words: as if a stack of millet was being pounded upon with a big pestle. She made it clear: – “The big ones Doc, not the small ones”. Coffee is very much engrained in every Haitian’s life and I’m very familiar with scenes of people pounding coffee roasts in big pestles, it happens in rural zones as in certain towns, but I sure had no idea as to what it feels like. And can’t obviously make the difference between the big and smaller ones, except for their size. While I was expecting her to describe her symptoms using my words, she relied on images of her daily life. As she spoke, even though we speak the same language, I could feel the gap between us widen and as if we were losing each other.

Keddy has also experienced such “language barrier” when he asked a patient from a locality near Montrouis, when she’d last had her period and she casually replied: – “On the last moon”. While he was anticipating an exact date, ignoring when the last moon was or even what that actually means.

It’s not a mere matter of language (French versus Kreyòl) as the concern is raised ad nauseum but instead a collusion between two different cultures, impairing understanding and proper health communication between two people speaking the same language.

These cultural barriers to communication stress the difficulties to assess and address health risks in patients and communities alike. I remember visiting Maniche with a team of Port-au-prince-based health agents. Most of them were hailed from this very Southern locality, and although our job was to raise concern about the safety of a water source, because they used to drink it and were actually baptized in these waters in their youth, it became harder for them to question its quality. The same goes for patients suffering from high blood pressure who dismiss any change in the way they prepare food because they’ve been taught a particular way by a parent since they were kids. Habit is more powerful than science and without the psychological tools of social and behavioral change communication the work of healthcare providers might as well be for naught.

I went back to Karenaj recently. As I sat in furniture that feel older than the city itself, I was thinking that until we reduce the gap between urban and rural realities we will not be able to understand each other, recognize what puts us at risk and heal our common evils. As I thought of my conversation with Annia and the way many pride themselves as educated, I asked myself if we were hardly doing any good. What good is a doctor’s vast knowledge if he can’t even understand his patient, let alone help her improve her behavior? There is not a single way to resolve these differences. But if we at least stop considering distance as difference, maybe we can start learning and improving together.

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Contact, Public Health, Social Issue

Why Haitian Doctors Choose To Practice In Haiti

Three months ago, I was granted the opportunity to present the results of an epidemiologic research (scroll down to CO-057) I conducted at the latest conference of the French Society of Pharmacology and Therapeutics; a scientific institute aiming to advance research on drugs and their utilization. Being a local-trained and based doctor in Haiti, I was twice as happy realizing the many promises of medical research for the country. However at the same time, the back of my mind was still being gnawed by the many obstacles afflicting the Haitian health care system. For example, while the epidemiological threats are quickly diversifying, basic data collection and analysis are still lacking. And a flagrant misuse of local capacities is in many aspects a scourge. As the ongoing strike of residents exposes the system’s shortcomings, it is obvious that such structural inadequacies have long resulted in junior doctors’ exodus.

Read “Why young doctors leave Haiti”

But against these odds, many Haitian doctors choose to practice in Haiti, despite increasing promises of improved work environment and better opportunities for doctors in foreign countries. Even among the large community of Haitian doctors practicing abroad, the desire to come back to the motherland is often expressed.

There is no one reason for that desire to stay or come back to Haiti. A colleague told me that Haiti is the only place he feels he belongs and connected to. That regardless of the state of the healthcare sector, he is more likely to stay in Haiti, strong of his familiarization to the Haitian culture and way of life. Some doctors don’t have a choice at all, staying because of family situations such as marriage or a chronically sick child.

As a reason for their coming back to practice in Haiti, a few of my former professors evoked experiences of exclusion, discrimination and racism which have contributed to drive them back where they feel more appreciated and needed. One day, as I was in Brussels for a medical internship, as I handed my passport to an office staff member, I was startled as he shouted to me how chaotic of a country Haiti is. That experience helped me catch a glimpse of what many might be enduring abroad in regards to discrimination pertaining to their origin.

Deep inside, I know that personal reasons such as lifestyle, family situations or unfortunate experiences abroad are not sole factors to embrace Haitian medical practice. As a matter of fact, while most doctors who leave always give me clear reasons why they do, most doctors who stay never seem to be able to give me a concise reason why they do. What is for sure is that whatever the reasons given, they are almost always associated with a profound feeling of patriotism and a sense of duty when it comes to practicing medicine in Haiti.

In fact, as I described in many of my articles, factors such as a lack of capacity and initiative hold back the Haitian healthcare system. But regarding its current state, one of my mentors affirmed that Haitian doctors, as every citizen, need to redefine their relationship to Haiti instead of abandon it. According to him, overcoming our shortcomings in regards to health care is a patriotic duty. But how many doctors are there, visionary enough to make it their mission to stay or come back here and try to improve what can be? I am honored to know and work with many of them. As I was recently discussing with two senior doctors, they consented that leaving might earn them less stress but also less happiness. Their choice was motivated years ago, ever since their career started back in the 1980s, by the ambitious project to train generations of doctors in Haiti to solve Haiti’s health issues. Let me clarify that leading a health-related project in Haiti is barely an easy task. I know that because the organization I co-founded, integrAction, has long been trying to find a working strategy to accomplish its mission which is to improve health literacy in Haiti. But with the experience I gathered, I realized that an often silent sense of patriotism plays a key role in keeping people pursuing their project. For me, there is no doubt that this is the most important reason why doctors still choose to practice in Haiti over many other choices. It is a crucial driver and that’s good because the fact is that Haitian doctors are critically needed on their land.

Click to like integrAction’s Facebook page

This leads to another reason to practice in Haiti: the desire to cast a stone. Even though it’s a plausible argument for countless people, I’m not referring here to the year of service provided in exchange for the State’s investment in training doctors. In a broad sense, Haiti has nourished the personality and imagination of everyone who has spent time here. It has shaped who the people are- doctors included- through a complex net of trial and error, frustration and victories. And as the saying goes, much is often required from whom much is given. For a lot of Haitian doctors, staying in Haiti helps them to be useful and contribute where they are needed. And they all agree that politicians and those in charge of the health sector have the obligation to foster an adequate and coordinated work environment for more and better impact.

In the midst of a health system in crisis with no apparent short term resolve, my questioning the motives behind Haitian doctors’ choice to keep a practice in Haiti was both justified and eye-opening. It helped me determine where to look at in order to inspire the future doctors of this country. A mixture of personal preferences seem to be an important factor but patriotism and the aspiration to contribute to the community are also deeply ingrained. As Haitian doctors continue to build and struggle against all odds, the need for advocacy for an improved work environment and opportunities to live a fulfilling life in Haiti is mandatory. Human resources are the most important asset of any system and to achieve ambitious health goals, we need to maintain our precious medical work force.

SFPT2016

Presenting my research entitled “Evaluation of antibiotics self-medication among outpatients of the State University Hospital of Port-au-Prince, Haiti” on April 2016.

 

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Global Health, Public health concern, Social Issue

On the shades of violence in Haiti

When we first moved to our current neighbourhood ten years ago, the sides of our impasse was occupied by poorly maintained shrubs and houses isolated from each other. Only one car could manage to go through a narrow path left between the trees. Acquaintances often quipped about us living in such a remote place, hardly accessible and sometimes dangerous, given the numerous cases of kidnapping that had occurred there in the past. Indeed, the main avenue was not even fully concreted and huge potholes spread along the road. But ever since the earthquake hit, people from diverse and unknown backgrounds have settled on unfenced lands nearby, slowly changing the settings. Retail sale of clairin, a popular alcoholic cocktail, has flourished since then and round the clock gambling also attracts many young unemployed. Gun related and gender specific violence were quickly added to the picture, outlined by injuries, addiction and mental health issues.

Over time, we got used to the times when drunken men cause inconvenience and to the days when quarrels over money or marriage issues block access to our home. But as an extreme example of how unchecked violence has spread, three young men were recently found dead on the streets, killed by heavy gunfire heard during the night. Surprisingly when it comes to violence, young people seem to be the most vulnerable. Violence claims the lives of 200,000 young people per year worldwide and represents the 7th cause of death in Haiti.

The disastrous political context of the country during the last decades has shaped the minds towards believing that violence is inevitable. Not only have people engaged in violent acts for the smallest rewards, but many accustomed to political turmoil think of violence as a substantial part of their daily life. The general public and the policy makers consider violence more as a banal indicator or trend, going up and down but never as an issue plaguing their own personal and community health. In our communities, the trivialization of violence is in fact, the result of inaction which results in more violence, repeating a vicious cycle and accumulating into increased cases of serious injury, chronic diseases and perhaps lowered life expectancy.

The popular culture has long encouraged violence against women through apologies of machismo and the objectification of women. It goes without saying that despite women’s rights activists’ campaigns, they remain the largest target of verbal and physical violence. Misogynistic words being too often valued and praised, they somehow abound in the media, accompanied by degrading images of women and hateful mocks. Even in my youngest years growing in Cap Haitian, the tendency to disregard women and LGBT communities’ values had already been deeply rooted in most boys my age. So it was not surprising that, as a medical intern in Cap-Haitian decades later, I couldn’t keep count of the cases of gender-related violence registered in the emergency service. There were even cases where serious burns were the consequence of such domestic violence.

Besides the factors mentioned above, structural violence seems an even more important cause of physical violence. The lack of education, unemployment, social and economic inequalities, exclusion, gender-based, racial or religious discrimination and poverty among other factors stand as complex mechanisms preventing many people from defining and fully realizing themselves. In the countryside, the absence of an efficient mean to uphold justice leaves enough space for violent conflicts over land tenure, often leading to deaths. Although there are no excuses to violence, it is rooted in a highly unequal society, which leaves very little opportunities through decent jobs and an environment to realize one’s potentials. As a matter of fact, the World Health Organization referred to concentrated poverty, easy access to alcohol, drugs and guns and weak governance as main risk factors for youth violence. And as far as we know, the daily lives of most occupants of cluttered neighborhoods in Haiti consist of much of these factors.

Although the population may rejoice in the brutal murder of robbers, these acts may not be more than a Band-Aid on a deep wound, if the core problems remain unaddressed. Perhaps it would be useful to keep engaging all communities proactively in order to expel the idea that violence is normal and inevitable in Haiti. Communication should counter the idea that the situation is acceptable today simply because it was worse 12 years ago, because no level of violence is suitable. It will be mandatory, to teach or keep reminding our communities the fact that women are equal to men both in their body and their mind. School children should be taught that violence makes orphans and leads to many health consequences. If young people are offered the opportunity to play a role in their country’s path to development, if they are able to support their families with dignity and respect for others’ property, it will certainly make a difference and that is definitely a worthy investment for the future.

Cluttered neighborhood

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Public health concern, Social Issue

The weight of social approval

During a short break from seeing patients, I was sitting behind the desk, enjoying an appealing novel. In the heart of the neighborhood of Jalouzi, in Petion-ville, the atmosphere was rather comforting, punctuated with laughter of children and chants of street vendors wandering outside. Betty, the nurse in charge of patients’ vital signs laid on the wooden bench in the waiting room looking preoccupied. At some point, she got closer to me and shared her concern: Ever since she started working at the center, she had gained several pounds and feared to have crossed the line of obesity, making her susceptible to the health threats associated with it (mostly cardiovascular diseases).

Betty is a short and curvy, 24 years old woman. She confessed to never doing exercise. Even back when she was at school, the court was too small and physical education wasn’t part of the curriculum. She also grew up in a family where women proud themselves on their thickness. According to her family and peers, it is a mandatory asset to attract a mate.

Generally, clinicians use the Body Mass Index (BMI) to assess the adequacy of weight in patients. This index, designated as indicator of fatness, is a ratio of the weight (kilogram) in relation to the square of the height (meter) of the person. A BMI score equal or greater than 30 is required to classify a person as obese while between 25 and 29.9, he/she is said to be overweight. In 2008, the World Health Organization reported an increase in the number of overweight and obese people, especially in developing countries where 115 million people bear the burden of disease due to obesity. It is important to note because in developing countries, including Haiti, the many health problems co-exist with poverty and a blatant lack of basic education, strengthening the vicious circle. As a consequence, the impact of obesity goes beyond the individual and also affects the State in terms of cost of related diseases.

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Betty had a BMI at 34; far along in the side of obesity. When I asked about her diet, she told me that she often consumes fried and greasy meals many times a day. Her sedentary lifestyle along with the popular culture that particularly promotes female thickness is also a factor. Other obese patients have even confessed to having resorted to self-medication and other practices to gain weight and develop a body shape, given the social standards, that is valued by most people. Bearing in mind the concept of health as defined by the World Health Organization, self-acceptance undoubtedly has an important role to play in the overall well-being of a person. But self-acceptance is sometimes too tightly dependent on social norms. Therefore isn’t it important in specific cases to question these norms and ideas of beauty that lead to self-flagellation and degradation of the body in the long term?

For instance, let’s go back to the origins of the Body Mass Index used to determine obesity. It was first described in 1832 by a Belgian mathematician and statistician called Adolf Quetelet. After the Second World War, it became crucial to develop a reliable index of normal body weight as the relation between weight and illness and death represented such a shattering concern in the medical world. But the researchers only referred to Anglo-Saxon populations to gather the data. Hence, the ideal Body Mass Index is not quite representative of the every person since African populations among other ethnics had been ignored in the studies. Another bias is that fat is not the only component of body mass. Muscle mass makes it even harder to generalize the obesity measurement standard. As a matter of fact, studies have shown that blacks have lower body fat and higher lean muscle mass than whites, so the same BMI score may lead to less obesity-related diseases. It doesn’t mean that the index per se is useless in African populations but the situation opens doors to further research which may lead to ethnic adjustments. In that vein certain groups have begun to lower cut-off points for the BMI of Asians.

After our exchange, Betty promptly acknowledged the challenge to merge her idea of beauty with her desired state of health. While the prospect of developing a perfectly objective standard for determining obesity and its health risks is still blurry, we need to keep in mind that the perception of beauty itself remains subjective. The balance between what is culturally preferred and what is healthy is also delicate and difficult to reach. Undoubtedly there seems to be a shift of consciousness among young women in Haiti. Hopefully properly designed and culturally tailored health communication campaigns are going to meet them halfway.

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Public Health, Public health concern, Social Issue

Let’s change the rules to save women’s lives in Haiti

Fairly called Poto Mitan in Haitian Creole, women account for 50.49% of the Haitian population and represent the center pillar of most households. From commerce to education, their contributions to the society are undeniable. As the prosperity of the nation relies on its citizen’s well-being, it is no surprise that women’s health is a public health priority when it comes to the national health policies. But despite the efforts, unsafe abortion remains unfortunately a scourge as prevalent as poorly addressed.

I recall my last shift at Chancerelles’ maternity ward where a 16 year-old pregnant girl presented with intense abdominal pain and massive vaginal bleeding. At first, she did not admit any medication ingestion prior to the onset of her symptoms. But as we pursue the medical investigations, her 30-year-old boyfriend confessed that he had provided her with 4 pills of an over-the-counter drug known to provoke abortion in pregnant women. For the gynecology residents, it was a routine and classic case. Yet openly discussing unsafe arrest of pregnancy in Haiti is controversial since it’s so much of a taboo.

The World Health Organization (WHO) defines unsafe abortion as a procedure for terminating a pregnancy performed by persons lacking the necessary skills or in an environment not in conformity with minimal medical standards, or both. Every year, 50.000 women, mostly from Latin America and Caribbean countries, die from consequences of unsafe abortion. According to the article 262 of the Haitian penal code, induced abortion no matter where or who performs it, is a criminal act and legally punished nationwide. But regardless of the law (or maybe because of it), complications of clandestine abortions are common motives of visit in general and obstetrical care facilities.

SDG3

Target: By 2030, ensure universal access to sexual and reproductive health-care services.

Carole, the latest patient I examined, was going through her second abortion experience and presented with severe anemia after 15 days of bleeding. When she got pregnant, economic difficulties arose, urging her to take the decision with her husband’s consent. But the specialized hospital she visited wouldn’t provide the desired services as forbidden by the law. So she turned to a clandestine clinic, even when the fees were high. As we shared our opinions, she said that it would be beneficial for women to abort safely with optimal medical assistance because the absence of a legal framework for safe abortion and technical capacities almost took her life away.

A few days later an obstetrician and HIV care specialist told me that to alter the perilous consequences of unsafe abortion in Haiti, it would be best to decriminalize it. Among the 530 women deaths per 100.000 inhabitants per year in Haiti, 120 are attributed to unsafe abortion. Fortunately, in the last quinquennium, the Ministry of Health has debated the subject and elaborated a new bill with several social groups to allow abortion for medical purpose and in rape cases. This is one step forward in the modernization of women’s health in Haiti even when it hasn’t reach the parliament yet.

But the main causes of induced abortion being socio-economic status, maybe the bill should also include women who desire to arrest their pregnancy for any reason other than congenital malformations or rape. It would be better if every woman could openly  discuss it with their doctors.

Because it is the State’s duty to guarantee optimal health care to the population, and health is not restricted to the body. It includes mental and social well being.

It would be valuable to couple activism with effective health communication. Because often, the barriers to improving women’s health in Haiti are some erroneous traditional beliefs. My intention here is not to downplay any religious or cultural values, as some have actually improved women’s health. My advocacy is to conduct proper scientific studies on this public health issue and clearly communicate the best ways to prevent the consequences. After all, prevention costs exponentially less than complication management and as the recently published statistics show, the State’s funds have long been depleted.

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Social Issue

Beneath the Beautiful Bright Paint Covering Jalouzi

This story first appeared on WoyMagazine – Design by EBMD 

I still remember that November morning, Moise Street in Petion-ville was under reconstruction. Dust filled the air and provoked my nose to sneeze multiple times. It was my first day of work as a doctor in Jalouzi. I decided to walk to get there; that was my way of getting to know this colorful neighborhood I knew very little about. All I had in mind were my brother’s quips likening Jalouzi to Kabul by day and New York City by night.

Jalouzi is an impoverished, overpopulated neighborhood, or what the international media would call a slum, in Port-au-Prince with countless houses stacked on top of each other. It is not unlike many other neighborhoods in places like Carrefour feuilles, Carrefour, la plaine etc. The only thing special about Jalouzi is its proximity to Petion-Ville. The view from Petion-Ville’s hotels and bustling restaurants occupied by tourists, expats and the wealthy is none other than the stacked houses of Jalouzi. Ever since the beginning of Jalouzi en couleurs, a government project to paint the houses of Jalouzi in bright colors, a couple of years prior, the slum had caught the world’s attention. So my heart was filled with excitement to experience this side of Haitian life. Almost a year after my experience there, the memories are still vivid in my mind. Yet Jalouzi remains the media’s cherished story, to the extent that RYOT has recently shot a 5-minute documentary short called “The Painter of Jalouzi” for the release of the iPhone 6S Plus of the mega brand Apple. Much to my disappointment, the movie conveys a good bit of misinformation and heavily clashes with the daily reality of Jalouzi.

It took a visit to the archives of Petion-ville’s Town Hall and to the bureau of the civil protection while researching for a book I am writing about Jalouzi to learn that nobody knows the exact number of people actually living there. I realized then that while the bright colors provided the slums with more visibility, the people remained invisible to the State. The people of Jalouzi welcomed the Jalouzi en couleurs government project simply because these people have nothing; they have no choice but to welcome whatever is offered to them. It is no surprise then, that for many of the patients I discussed the project with, healthcare and running water would have been their top priorities if they were given a choice.

Along the Stenio Vincent street in Jalouzi, three health care centers could be counted as of December 2014. But since my first visit, the one that belongs to the Ministry of Health has been closed. Today, its driveway is occupied by vendors, making it difficult to even be noticed. One of the private centers has packed up and the building has been rented to other businesses. Yet the need for healthcare itself has not diminished one bit. On the contrary, in the midst of this situation, various illnesses have arised. Why? Because poverty leaves people extremely vulnerable.

There is no reliable running water in Jalouzi. On the days I reached Jalouzi by foot, I climbed along the slippery steep stairs where women and children carry buckets of water on their heads. Unfortunately, they can only get this water from trucks with water tanks that come once or twice a week, depending on how business is. In the rainy season, there is no clear distinction between the trash and the walkways. Therefore, the soles of people’s feet become public transport for germs which end up straight inside their homes, the stacks of chaotic construction. In the marketplace, food is sold on the floor, meat is covered with flies, the sanitation conditions are dire and precarious.

A mother confessed one day, in the examination room: “All the problems I have go beyond the bright color of my house.” As her issues accumulated, she ran out of money to pay the rent, solely relying on family based in the United States. Her problems, which are closer to the rule rather than the exception, could not be alleviated nor transformed by a paint job. Just as her constant headache did not go away with the makeup she wore that day. Throughout its narration, RYOT’s documentary depicts a delusional image of what life is in Petion-ville’s Jalouzi, which is far from being Haiti’s largest slum, contrary to what they report. Its transformation is only superficial, and the ultimate beneficiaries remain the spectators, foreigners or locals, enjoying the view of Jalouzi’s brightly painted houses from a distance.

In spite of its worldwide reach, “The Painter of Jalouzi” has failed to call for real transformation in people’s lives. To be more accurate, the short film might as well had depicted the real painter of Jalouzi as an outsider. Someone far from the reality of the neighborhood, working in the slums during the day, and returning to relax in his suite at the Royal Oasis Hotel in Petion-Ville at night. This is a missed opportunity to raise awareness on the very real issues of healthcare, education, clean water, energy and human dignity. The government’s Jalouzi en Couleurs project has failed the people of Jalouzi. Why don’t we build schools in the name and memory of Préfète Duffault? Why don’t we push the Ministry of Health reopen its health center? Does it help to apply lipstick to a pig, or to disguise the misery and hunger of the most vulnerable? By blinding ourselves from the suffering of others, one day we might end up being the victims of our own farce.

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Public health concern, Social Issue

Helping Haitian Futures: A focus on health

This op-ed article was originally published in the Carribean Journal 

Across the globe, the number of migrants has risen in the recent years. This phenomenon is exacerbated by the growing poverty in regions like Sub-Saharan Africa and wars in others like Syria. We can recall the images of Aylan, the 3-year-old Syrian boy drowned in the Mediterranean sea while his family attempted to flee their war affected country. Closer to us, the story of Sonia has been related, fleeing deportation threats and intimidation in the Dominican republic where she lived.

She was not alone on her journey. As of July 2015, a significant number of Haitians and Dominicans of Haitian descent fled the Dominican Republic for similar reasons. A large part gathered in cardboard-made tents, at Anse-a-Pitres, southeastern commune of Haiti. With a minimal assistance, these migrants are left vulnerable to important health risks in a hostile environment, considering the promiscuity, lack of resources and medical assistance. Let’s go around some of these health risks.

Young boy at the migrant camp of Anse-a-Pitres Source: Etant Dupain. Twitter @gaetantguevara

Young boy at the migrant camp of Anse-a-Pitres
Source: Etant Dupain. Twitter @gaetantguevara

In Haiti, the rainy season extends from April to November. As the millimeters of rain accumulate, the risks of cholera outbreaks also rise since this infectious disease is evolving towards an endemic one in the country. At the Anse-a-Pitre’s camp, an adequate sanitation system to prevent the occurrence and spread of a cholera outbreak is definitely nonexistent, thus an exacerbated risk. However, cholera is not the only infectious disease to take into account as a health threat in this particular situation.

Tuberculosis- also endemic in Haiti- is spread by the means of promiscuity and enhanced by a poor nutritional state. In reference to the testimonies of Etant Dupain and Roxane Ledan, this describes precisely the catastrophic living conditions of the migrants. The context of promiscuity and lack of preventive medical care also stands as a large ground for the occurrence of HIV/AIDS and other sexually transmitted infections.

Simultaneously, potential women’s health issues can develop. In general, the pregnant women are exposed to countless pregnancy-related illnesses like anemia because an appropriate medical examination during the pregnancy is minimal, nay, totally unavailable. Plus, the context is favorable to high-risk delivery since an adequate medical equipment is absent.

On another side, unwanted pregnancies may result from the absence of birth control initiatives in the camp, such as an adequate education coupled with effective contraceptive tools. In the worst cases, women may arrest their pregnancy, in precarious conditions as it is often the case in Haiti where voluntary interruption of pregnancy is not supported by the law. These women’s health issues are not isolated from the risks of infectious diseases discussed above. They might come also in interactions with other health risks or propel their occurrence.

Among them, depression and substance abuse are rarely emphasized. No matter the cause of migration, whether forced or voluntary as for Aylan’s family and Sonia, the process remains traumatizing. The migrant or deported status itself carries a pejorative connotation, impairing the dignity of the person. For many, the current situation may appear like a defeat or a torturing humiliation, especially if the process involved the separation of family members or loss of material goods. This emotional pain is opportune for the development of neurosis and abuse of drugs, alcohol, cigarettes and sleep inducing medication. As consequences, violence against girls and women may occur and infections may be sexually transmitted, perpetuating the vicious circle. Unfortunately, the living conditions at the migrant camp can only worsen the risks of mental ailments.

Women and children at the migrant camp of Anse-a-Pitres Source: Etant Dupain. Twitter @gaetantguevara

Women and children at the migrant camp of Anse-a-Pitres
Source: Etant Dupain. Twitter @gaetantguevara

Despite this alarming situation, these health risks ultimately refer to the future, even if it means the next minute, hour or day. Therefore, they give us the possibility to act upon them. As organized social groups, as the government, let us come together to reinvent the future of a growing number of Haitians, desperate and abandoned. A safe environment  where food, water, adequate shelter and medical assistance are available is a must to begin with. Based on these assets, an oriented and appropriate education should pave their way into a complete integration of the social life. In the face of this mighty challenge, we are left with little choice but unity and compassion.day. t upon them. As organized social groups, as the government, let us come together to reinvent the future of a growing number of Haitians, desperate and abandoned. A safe environment  where food, water, adequate shelter and medical assistance are available is a must to begin with. Based on these assets, an oriented and appropriate education should pave their way into a complete integration of the social life. In the face of this mighty challenge, we are left with little choice but unity and compassion.

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