The morning breeze filled the room, warmed up by the first rays of the sun. That day, Jacqueline was the patient who kept my attention the most with her story. She was shambling as she entered the room, tightly holding an iron cane. The purpose of her appointment at the clinic was a monthly follow-up examination for diabetes and high blood pressure. A sixty-four-year-old mother, Jacqueline is suffering from obesity. She spends her days selling retail fabrics on the bare ground at the “Marché du Port”, familiarly called Gerit in Haitian Creole. Most of the time, her business doesn’t do well and she has to count on her daughter’s generous help. During history taking, as I asked her when did she become aware of her cardiovascular diseases, she started telling me about her life. This is how I seized the power of the determinants of health, these social and economic factors that influence individual and group differences in health status.
As far as her memory goes, it started on a 1987 Sunday morning. This sad November 29, marked by ruthless massacre, was the first Election Day in Haiti after the Duvalier regime. Gendarmes crowded the streets. On her way through the “Ruelle Vaillant”, seeking comestibles to feed her family, Jacqueline brought herself to the bloodbath. To avoid the gunshots, she jumped in the nearest canal and broke her leg bone as she fell. The effects of her broken leg remain to this day prompting her handicap. But on another level, the aftermath of the tragedy was so strong that it triggered emotional disorders in Jacqueline. Shortly after the event, she was diagnosed with high blood pressure.
Jacqueline stared at the ceiling as the memories streamed in front of her eyes. As she counted, the Hyppolite market was her main station back in the 80s. In these times, merchants only had to contribute a small fee to occupy a decent place. Under the mayor’s term, a hygiene service regularly cleaned the place, thanks to the occupants’ contributions. But since 1990, she moved to the Gerit following the orders of a new administration. The aging woman experienced since then, the precarious sanitary conditions and successive arsons which stain the history of the Gerit. Nowadays still leading a hectic way of life, her stress levels have skyrocketed. As the years passed by, she hasn’t even noticed how hastily the country was regressing. When I told her that the general hospital didn’t admit women to give birth for a mere 5 gourdes anymore, she couldn’t help but laugh.
Then, came the January 12. When the earthquake ripped her four-piece house, Jacqueline was left with nothing but courage. She never saw a home in the shelter an NGO provided her, but she still lives in it. Some days, she manages to make it on a 10 gourdes budget, hoping her daughter collects a decent paycheck in the USA. Diabetes hit in late 2010. She confessed: “As age and disease pile up, I don’t plan to rebuild the house. Medications are way too expensive and health is to be guarded like a precious gift”. The day I examined her, she was struggling with a sore foot which is oftentimes an indicator of bad compliance to an appropriate lifestyle and medications in diabetes patients. Her story was written on her foot.
Why does it matter? She did not predict the earthquake nor did she expect the many adversities she went through. But they acted as social, economic and environmental factors which have an important impact on her life and health. Many times, a single factor cannot determine the health issues a person or a community strives with. They prevail as the results of a cascade of events and behaviors which are deeply rooted in history and the way the society is organized. In Haiti, political instabilities and natural disasters played a pivotal role in the onset and development of many health issues. More than two decades after the “Ruelle Vaillant” massacre, the months following the 2011 elections, the cholera epidemic peaked in Haiti. One of the many reasons is the fact that Port-au-Prince was home to many cases and as rioters barred the roads, patients couldn’t arrive at the Cholera Treatment Centers on time.
The story of Jacqueline is similar to Jean’s, a 24-year old patient at the clinic. During a conversation, he affirmed: “I can’t explain why cholera struck me because I thought I was safe.” As scientific data show, the source of the epidemic lies in the unsafe disposal of Nepalese soldiers’ waste. Considering the persistent lack of sanitary infrastructures and the weak health care system, Haitians are more vulnerable than ever. This is factual because the social and political choices and events bear major impact on the population’s health.
For a prosperous future, a stable society and the improvement of the living conditions represent the key stones. As a matter of fact, it is arduous to deal with bigger challenges like climate change, in a situation dominated by uncertainty, even though it also plays an important role in the health of tropical populations. By influencing the determinants of health, the next generation will be more likely to build a strong nation and plant a seed of reparation for Jacqueline and Jean.