COVID-19 could devastate Haiti’s health system
■ Haiti’s healthcare workers say hospitals will close if they do not get personal protective equipment like masks and gowns to treat COVID-19 patients. They also want access to rapid testing like in the Dominican Republic.
The fragility of Haiti’s healthcare system in the face of the coronavirus pandemic came into focus this week when the French Hospital of Haiti announced that, after more than 100 years of providing medical care in the capital, it will shut down its emergency room and quit admitting patients on
May 1.
The hospital’s medical director, Dr. Jean Venèse Joseph, said the final straw was when it took government officials 48 hours to test a 70-year-old pneumonia patient for COVID-19, and staff realized they had neither the equipment nor medical gear to confront the highly contagious respiratory disease.
“You can imagine the panic that took place inside the hospital,” he said in a telephone interview from Port-au-Prince. “We realized that we are not prepared to confront the reality that exists.”
Private hospitals and nonprofit healthcare providers like the 60-bed French Hospital are the backbone of Haiti’s healthcare system. But those key players say they’re being undermined by the Ministry of Public Health and Population, which is leading the national response to the pandemic.
According to some healthcare providers in Haiti, the government is dragging its feet on rapid testing, contact tracing, and involving non-government healthcare facilities in its response.
Haiti’s official statistics tell a troubling story. The nation of 11 million has only tested 200 people and has 18 confirmed cases. By comparison, the Dominican Republic, which has roughly the same population as Haiti, has run more than 4,000 tests and reported 1,488 cases and 68 deaths. It has also said it’s seeing community transmission.
Dr. Franck Généus, the head of Haiti’s association of private hospitals, said the decision by the French Hospital is a sign of things
to come if the government doesn’t get its act together. He has publicly accused the ministry of not doing enough to involve private hospitals in its COVID-19 response plan.
“In two, three weeks, the healthcare system in Haiti will be brought to its knees,” Généus said.
For weeks, nonprofits like Zanmi Lasante, which runs the country’s largest functioning hospital, the 320-bed University Hospital of Mirebalais, and Innovating Health International have been asking the ministry whether they can use 15-minute tests to help detect COVID-19, the respiratory disease caused by the flu-like virus. They have received no response even though both have access to testing kits.
“Haiti desperately needs testing and rapid testing because half of all cases are asymptomatic,” said Dr. Vincent DeGennaro, founder of Innovating Health International. “The USA failed miserably in testing and understanding our epidemic. We can’t let Haiti repeat those mistakes. Rapid tests should be used for screening and surveillance, neither or which is practical or feasible with swab tests.”
The issue of rapid testing remains controversial, with some doctors arguing that the lack of accuracy and knowledge over how and when to use them could create more problems than they solve. Others say that given that a significant portion of all COVID-19 cases are asymptomatic, rapid testing allows for massive screenings of the population and for quickly detecting the depth of the epidemic in the population.
Ashley Baldwin, a spokeswoman with the Pan American Health Organization, said rapid testing still “needs to be evaluated and is not currently recommended for clinical diagnosis pending more evidence on test performance and operational utility.”
But some countries are using the tests to try to figure out the prevalence of the disease in their societies. Carlos Suero, the spokesman for the Dominican Republic’s Ministry of Health, said the country has 12,000 rapid tests. While not relying on them as the principal diagnostic tool, health officials are hoping they will have some use in monitoring and controlling the spread of the outbreak.
Since they first received the rapid tests on March 27, they’ve been using them on first responders who have already been tested using the slower but more accurate tests.
“Starting Saturday we’re rolling them out nationally and concentrating on the hot spots,” he said.
Dr. Lauré Adrien, the director general of Haiti’s Ministry of Public Health and Population, said officials are proceeding cautiously so Haiti avoids getting counterfeit tests, which have been identified in Spain.
The ministry, he said, is willing to go the route of rapid massive screenings, but “it is first necessary to ensure the specificity, the sensitivity,” and accuracy of the tests.
“It’s a new virus, therefore with new tests, we must be vigilant,” Adrien said. “In addition, we must also ensure the ability of laboratories to perform reliable (quality control). We hope very soon to have more tests and especially more screening points in the country.”
Adrien pushed back on criticism by Généus and others that private institutions are not part of the response. Généus, he said, “knows that the response plan includes everyone” and has been part of the meetings as head of the association of private hospitals.
Adrien said some private hospitals in Haiti have an expectation that the health ministry will be giving personal protective equipment to all healthcare workers. But this will not be the case. The government first needs to know which hospitals are in position to receive and care for COVID-19 patients, and then the institutions need to provide an inventory of their needs.
“The country does not have a huge amount of PPE; our orders are not yet fully met,” he said.
Haiti, which recently ordered $18 million in medical equipment and gear from China, according to its prime minister, will distribute the equipment as soon as it is available, Adrien said.
He said another problem with the private hospitals is that while they have nurses and administrative staff, they rarely have doctors assigned to them, further complicating care and the ability to respond to the pandemic.
“These hospitals must also tell us how many nursing staff they have and the estimate of their needs,” said Adrien. “We must know the operations of private hospitals in Haiti . ... The state does not want to repeat the experience that private hospitals lived after the [2010] earthquake where most were decapitalized or even closed. So we need a support plan and to ensure the feasibility and compliance with this plan.”
But time remains of the essence, say healthcare workers in Haiti. Even before the first case of COVID-19 was confirmed in the hemisphere, Haiti was facing challenges with its weak health system.
Ten years after the deadly earthquake that killed more than 300,000 Haitians, the largest public hospital still hasn’t been completed and most of the existing public facilities are poorly equipped. Strikes are also common.
The health ministry, meanwhile, has been criticized for its lack of transparency in relaying the information on COVID-19 cases and whether they are travel-related or from community spread. It has also been slow on contact tracing — a key component in stopping the spread of the virus.
Last week, for example, two people were contacted almost two weeks after returning from Miami to be told that fellow airline passengers tested positive for the virus and they needed to be screened.
The day after the phone calls, the mayor of one of Port-au-Prince’s most populated suburbs, Carrefour, took to the radio to blast health authorities after a pastor, who tested positive after arriving from Miami, fled one region of the country amid threats and showed up in his city with nine family members. The health ministry, Carrefour Mayor Jude Edouard Pierre said, needs to do a better job of communicating.