Five years after Haiti’s massive earthquake, the health system is only partially reconstructed and specialist services remain out of reach for many people.
Médecins Sans Frontières (MSF) has continued to fill gaps in the Haitian healthcare system (gaps it has been filling since before the catastrophic earthquake in 2010), and has been helping build local capacity by training national staff. Haitians need better access to emergency services, including obstetrics, neonatology, surgery and trauma care. Cholera is an ongoing health threat but there is a lack of available finances to tackle it and no effective response plan in place. MSF is regularly stepping in to treat patients and prevent major cholera outbreaks and loss of life.
Drouillard burns unit
Domestic accidents and poor living conditions are the main causes of burns in Haiti, and victims are predominantly women and children. MSF continued to run the only facility treating burns patients in the country, in Drouillard hospital, close to the Cité Soleil slum in Port-au-Prince. Equipped with three operating theatres, the hospital increased capacity from 30 to 35 beds. To focus on the treatment of burns patients, MSF closed the trauma unit it was running inside the hospital. There were 481 patients hospitalised for burns in 2014.
Emergency services in Port-au-Prince
Responding to more than 45,000 emergencies in 2014, the Martissant emergency and stabilisation centre is a free, around-the-clock resource for people experiencing any kind of medical emergency, caused by violence, accidents, burns or obstetric complications. There are eight beds where patients can remain under observation and an ambulance service for referrals to appropriate hospitals. MSF’s specialists provide care in paediatrics and internal medicine. Staff treated more than 25,000 patients with accidental trauma, 13,250 with violent trauma and more than 3,700 people with cholera.
MSF provides emergency services including surgery and trauma-related care around the clock at the 121-bed Nap Kenbe centre in Tabarre, eastern Port-au-Prince. The centre has three operating theatres, an intensive care unit and an outpatient department that is open six days a week. Since mid-2014, MSF has been running an orthopaedic surgery training programme at the centre.
To ensure a high standard of care, MSF has installed onsite technical services, including an X-ray machine, a laboratory and a blood bank, sterilisation facilities and a pharmacy. Social and mental health support and rehabilitation through post-operative care and physiotherapy are all available to patients to maximise their recovery after emergency treatment. Teams responded to more than 9,880 emergencies and performed more than 4,200 surgical procedures in 2014.
Specialist care for obstetric emergencies
Located in the central Delmas 33 neighbourhood of Port-au-Prince, MSF’s 140-bed Centre de Référence en Urgence Obstétricale (CRUO) continued to provide 24-hour, free obstetric care to pregnant women experiencing serious and life-threatening complications such as pre-eclampsia, eclampsia, obstetric haemorrhage, prolonged and obstructed labour and uterine rupture. CRUO offers a range of reproductive healthcare services, including ante- and postnatal care, family planning and prevention of mother-to-child transmission of HIV, as well as neonatal care and mental health support. There is also a 10-bed ‘Cholernity’ ward for pregnant women with cholera. There was an average of 17 births a day in the CRUO in 2014. Some 10,400 patients were admitted to the facility.
Following the January 2010 earthquake, MSF constructed a temporary container hospital to conduct surgery in Léôgane, an area that was 80 per cent destroyed by the disaster. The programme has evolved to handle emergencies, focusing mainly on complications in pregnancy and road accident victims. Basic medical care is also provided to pregnant women as well as children under five.
In keeping with the plan to shut the hospital in 2015, MSF has been progressively reducing activities at Chatuley since 2013. In February, a cholera treatment unit that had been running since 2010 was closed. As of November, only emergency services for pregnant women, newborn babies and children under five were being provided. There will be no formal handover of the hospital to the Haitian authorities, and so teams have been reinforcing the capacity of other medical facilities in the area in preparation for the closure.
In 2014, MSF admitted 6,782 patients to Chatuley hospital, carried out 2,617 consultations for children under five, provided 6,162 antenatal consultations and assisted 3,298 births.
Four years after cholera’s first appearance in the country, the Haitian health system is still facing a shortage of funds, human resources and drugs. Many Haitians continue to lack access to clean water and adequate latrines, resulting in regular outbreaks of cholera, a potentially deadly communicable disease. Outbreaks today can mostly be predicted, yet the authorities remain unprepared. There are insufficient public cholera treatment centres (CTCs) in Haiti and reduced international funding has limited the delivery of medical care and the provision of clean water and sanitation services. When the number of people contracting cholera spiked in October, MSF set up CTCs in the Martissant, Delmas and Carrefour neighbourhoods of the capital. Teams also focused on preventive measures, including distribution of disinfection kits (chlorine, buckets, etc), and awareness and education activities. More than 224,600 people were reached via these activities and 1,640 disinfection kits were distributed. Overall, more than 5,600 people received MSF-supported cholera treatment.
No. staff in 2014: 2,159 | Expenditure: €35.2 million | Year MSF first worked in the country: 1991 | msf.org/haiti