A market last week in Port-au-Prince, Haiti, where doctors are preparing for an outbreak of coronavirus. Photo / Chery Dieu-Nalio, The New York Times
The virus has been slow to hit the country. But as laid-off Haitians return from hard-hit areas, doctors are preparing furiously for an outbreak they fear will strain the nation's threadbare health care system.
The man stood in line, shaking with fever, one of countless others trying to cross the border and return to Haiti.
A doctor screening them for coronavirus infection pulled him aside. Like thousands of Haitians, he had been laid off in the Dominican Republic, which has been hit hard by Covid-19, the disease caused by the coronavirus.
Now he and the other Haitians were returning home, threatening to bring the virus with them.
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The coronavirus has been slow to come to Haiti, partly because protests and political violence virtually shut down tourism and drove away the foreigners who could have brought the disease to the country.
A month after the first case was announced, there have been only 58 confirmed cases and four deaths. Prime Minister Joseph Jouthe last week congratulated the country and announced that factories would reopen at reduced capacity, a rare bit of encouragement for a nation that has been lashed by tragedy — with a deadly hurricane, a cholera outbreak and a horrific earthquake in just the past decade.
But with the influx of workers returning from the Dominican Republic, where there have been 5,044 cases and 245 deaths from Covid-19, the odds are stacked against Haiti and its weak health system, warned a presidential panel run by Dr. Jean William "Bill" Pape, a widely respected doctor who is racing to set up centers to treat Covid-19 patients.
"This monster is coming our way," said Pape, who runs Gheskio, a large Aids and tuberculosis clinic in Port-au-Prince, the capital. "If a place like New York can be so overwhelmed, how is Haiti going to deal with this?"
Most Haitians lack access to clean water, let alone soap, and many live in tightly packed slums where self-isolation is physically impossible. Protests over government corruption shut down the country last fall, barricading roads and crippling the already fragile economy, leaving even fewer people with enough resources to quarantine.
The nation's health care system is so threadbare that Haitians regularly die of easily treatable ailments like diarrhoea, and public hospitals often have to charge patients for basics like syringes and gloves.
The sick man pulled aside at the border crossing had to be quarantined at a vacant building because an adequate area had not been set up yet.
Dr. Daniel Fitzgerald, who works with Gheskio and is the director for the Center for Global Health at Weill Cornell Medicine, said he expected tens of thousands of people to become sick in Haiti.
"It's just a question of time," he said.
Pape's team has been feverishly drafting a treatment protocol that is both effective and realistic for a country like Haiti. Learning from the experience of the United States, where the majority of patients on ventilators have died, Pape is focusing on treating hospitalised patients with oxygen.
Pape estimates that the country will need 6,000 beds dedicated to Covid-19 patients. "Now, I have not even 100," he said.
But the plan, which requires trained staff, personal protective equipment, as well as oxygen, is costly. Pape estimates the first month alone will cost about US$30 million — about half of what the Haitian government spends on health care a year. Pape and panel co-chairman Dr. Lauré Adrien, who is the director of the Ministry of Public Health and Population, are sorting out details and funding.
The International Monetary Fund announced US$111 million in financing to help Haiti with "health-related expenditures and income support" to ease the impact of Covid-19. The State Department and the US Agency for International Development committed US$13.2 million.
Local businesses have donated, and some foreign nonprofit organizations are raising money that, given the recent US ban on exporting medical supplies, and the increase in costs that followed, needs to stretch further.
"It's more expensive, but it was the only way we could do it," said Geoffrey Boutros, a Miami-based broker who arranged for masks and gloves to be shipped to Gheskio directly from China.
A big challenge is convincing Haitians the epidemic poses a real threat.
A month after Haiti's president announced an emergency, banning gatherings of more than 10 and closing schools, tap taps — the converted pickup trucks that run as private buses — are still jammed with people.
And while the upscale supermarkets that cater to Haiti's elite now offer customers hand-cleaning stations and demand they wear masks, the open markets that serve the country's poor remain a cacophony of jostling humanity.
"People don't believe it because it's coming from the government," said Karl Jean-Louis, a Haitian entrepreneur who interviewed workers and vendors along Port-au-Prince's crowded streets. Some claimed the epidemic was a ruse for the government to make money from aid agencies. Others said staying home was impossible, as they had to work to feed their families.
More than half of the population lives hand to mouth, earning less than US$2.41 per day, according to the World Bank.
While recovering from Covid-19, a couple in Haiti's rural south became so stigmatised that Dr. Inobert Pierre, director of St. Boniface Hospital, sent a car with loudspeakers blaring: Covid-19 is not a crime; it can strike anybody; prevention is the best cure.
To his own scared staff, Pierre explained "this is like a war" and "we are the soldiers."
Pape has trained more than 1,000 people to go door to door, seeking out anyone with symptoms and urging them to go to the hospital. Crews are delivering tubs of water and hand soap in the slums, where people normally buy water by the bucket. And through loudspeakers, they're asking: Wash your hands, or lave men in Creole.
Experts say Haiti's low number of infections partly reflects the country's dysfunction. Protests and gang warfare drove away would-be visitors and with them the potential of importing the virus. Kidnappings have become so chronic that the United States issued a "do not travel" warning in early March.
But those conditions are changing. Over recent weeks, thousands of Haitians have flooded back home each day from the Dominican Republic, said Giuseppe Loprete, chief of mission for the International Organization for Migration in Haiti. Doctors have been screening at four official border checkpoints but not at dozens of illegal crossings.
As Pape and his team prepare a countrywide response, hospitals have been left to their own devices.
In Port-au-Prince, a century-old French hospital that had been caught in the crossfire of gang warfare for two years shut down altogether after the first suspected case hit the emergency room.
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"The situation created a panic," said Dr. Jean Venèse Joseph, medical director at the hospital. "Coronavirus came and worsened a situation that was already bad."
Not far away, the founder of St. Luke Hospital, Father Richard Frechette, converted an old hospital building — last used to treat cholera patients — into a 40-bed Covid-19 ward. Instead of face shields, he outfitted staff with the snorkels and welders' masks he found at a local market. He has commissioned tailors to fashion 15,000 masks out of bathrobes for use in the hospital's non-Covid areas.
"Rich countries are hoarding all the stuff," said Frechette, who is also a doctor and built the country's only children's hospital.
Until recently, he hoped the country would be spared by the unpredictable virus, which seemed to strike rich northern countries and was said to not flourish in the heat and humidity of countries like Haiti.
But watching it erupt in the Dominican Republic next door, he worries it could become comparable to the cholera epidemic that, starting in 2010, ripped through Haiti's slums and burgeoning tent camps, infecting more than 820,000. That came months after an earthquake that left between 220,000 and 316,000 people dead.
Although billions of dollars and aid workers poured into Haiti, vowing to "build back better," the dreams of planned communities, public health care and free schools remain dreams 10 years later, leaving many Haitians bitter and skeptical.
This time, as countries around the world fight their own battle against the virus, Haitians do not expect aid.
"We do not have hundreds of (nongovernmental organizations) here and there, doing things. It's not the same," said Franck Généus, president of the association of private hospitals that provides about 40 per cent of Haiti's health care. The group has offered 300 beds to coronavirus patients, at a cost of US$200 a day.
"Basically we are alone," he said. "For once, we need to solve this ourselves."
Written by: Catherine Porter and Ianthe Jeanne Dugan
Photographs by: Chery Dieu-Nalio
© 2020 THE NEW YORK TIMES
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