A typical January morning in Haiti, the 12th of the year 2010 greeted a bright sun and the usual bustle of the island life. While the majority of schools and churches were functioning as usual, traders crowded the pavements, carelessly dealing with their routine. Hope warmed up the hearts of the Port-au-Prince population, following the sweet Christmas of 2009 whose memories were still fresh. But on this day, a magnitude 7 earthquake was registered as a painful page in the life of the people, definitely changing the course of history by taking the lives of hundreds of thousands of Haitians. Countless people have suffered serious injuries, including those who have seen their mobility limited overnight or the ones amputated one or more members in order to survive. In all minds, fissures are still present today either as post-traumatic shock disorder or severe depression. Since then, new sets of questions have punctuated our daily lives, especially related to our way of embracing the future. This catastrophic event opened the way for new conversations about the Haitian health system. Words and ideas are far from exhaustion as the wounds are still slow to heal.
In March 2011, one year after the unfortunate event, Dr Jean Hugues Henrys, current Dean of the Faculty of Medicine of the University Notre Dame of Haiti, gave a speech at the Bloomberg School of Public Health. Through the course of his lecture, he has drawn the profile of the existing Haitian health system before the earthquake, compared to a set of decentralized health microsystem, in transition between infectious and chronic diseases. In the aftermath of the disaster, it was imperative to adapt according to Dr Henrys, because the many amputees were considered a priority, while hardly enough resources were available to support them. He also emphasized the urgent need to provide mental health services to the people while the subject was sparsely considered in the past, forsaking many to discrimination and stigma. This has revealed the lack of disaster preparedness that existed in the healthcare system on many levels: logistics, human resources and education.
For Dr Henrys, a partnership between public and private institutions would contribute to ensure a better future. Inaugurated two years after the earthquake, the university hospital of Mirebalais born of the partnership between the Ministry of Health and Partners In Health (US-based NGO operating in Haiti), treats patients through its various services and largely contributes to educate the new generations of nurses and Haitian doctors. It is among other projects that have emerged in an effort to better equip the country with capabilities to respond to eventual catastrophes seen as a constant risk.
But the lack of preparedness which patients were the victim following the January 12 concerned not only the psychological and medical care themselves but went well beyond. The Haitian health system was evolving in a chaotic situation and also deserved attention. The fear of a “phantom epidemic” of diphtheria fueled the minds for weeks following the disaster while a true epidemic was unlikely and coordination between NGOs was poor. In an article published in 2013 entitled “The celebrity as Hero: When Sean Penn has Fought Phantom Epidemic“, the American journalist Jonathan Katz counted the panic caused by the death of Oriel, aged 15 years, blaming the lack of a competent system which the teen’s parents could have used days earlier. The infrastructures already shaky before the earthquake, had completely disappeared on January 12, leaving the country in the most complete desolation when a cholera epidemic erupted by the end of the year 2010. More than infrastructural and organizational issues have been raised in the debate around the Haitian healthcare system after the earthquake.
Talea Miller quoted in her article “Haiti’s Health Care System Faces a Defining Moment” published in June 2010; Minister Alex Larsen said that the state of New York has more Haitian doctors than Haiti itself. While the exodus of health workers already afflicted the health system before the earthquake, it worsened after January 12 following numerous personal losses and the deaths of many doctors and nurses whose proportion in number was highest in Port -at-Prince. This chronic haemorrhage of medical staff also nourished the debate around the health system. With only 3.5 health professionals for 100,000 inhabitants, Haiti lies behind the standards stated by the World Health Organization. Paradoxically, the broken state of the Haitian healthcare system drives away its most important assets, while they are needed to fix it.
As reported by Talea Miller, Dr Larsen believed that human resources were more important than physical infrastructures in the wake of the earthquake and advocated the benefits of conjoined educational programs between Haitian and foreign universities. Since 2010, volunteer medical teams from the United States and Canada regularly participate in mission trips at the Hospital Bernard Mevs at Port-au-Prince and largely benefit the healthcare system in terms of services and education of emergency care physicians and pediatricians.
Six years after the earthquake, the Ministry of Public Health still faces much trouble in order to pursue its core mission. One of the major difficulties lies in the financing of the system. Despite their meager resources, the households finance 96% of their health needs in spite of the minimum package of services offered by the state. We must recall that the budget allocated to the health sector does not exceed 6% of the national budget. Regardless, new structures and programs are emerging across the country, primarily financed by donor countries. But in spite of this, health indicators remain alarming and the system statistically inefficient. At a conference on health financing in 2014, Dr. Jean Alfred Patrick mentioned that there is a weakness in the regulation and coordination of health financing systems in Haiti. In other words, bad governance plagues any sustainable progress in the health sector. Instead of motivating more Haitian doctors, this context contributes to push them towards immigration.
Today, January 12, 2016, as the Haitian people commemorate the lives of the earthquake victims, they consider the path already travelled and the long road ahead. Over the past 6 years, they have discussed on many platforms the best ways to redirect the public health priorities and goals, increase capabilities in disaster preparedness, enhance the mental health of citizens, reconstruct the many destroyed health facilities, retain qualified health professionals and promote good governance in the healthcare system. From the debates, tangible solutions have been considered and implemented. And as long as the conversations keep going, there’s hope that Haitian lives will stand on unshakable ground.