The private hospital in Haiti’s capital had done everything to try to keep the coronavirus at bay.
It had capped the number of patients at no more than 35 a day for social distancing, limited visitors to one per patient and put tailors to work making masks — obligatory for everyone who stepped into the building.
Then an 18-year-old stumbled through the emergency room earlier this month, displaying signs of meningitis. The staff didn’t think they had reason to worry.
“He didn’t show any symptoms” of the coronavirus, recalls the hospital director. The Miami Herald is not identifying him or his hospital because of continued threats that hospitals treating coronavirus patients will be burned down. “And now you have a block of rooms that’s out of service … because of one patient, and twenty-something doctors, nurses and auxiliary staff who are all in quarantine.”
As COVID-19, the respiratory disease caused by the novel coronavirus, spreads in Haiti, the risk of health care workers and hospitals falling victim to the pandemic grows. Every patient walking into a medical facility is a potential spreader who can knock an already fragile health system on its knees.
“People with this disease can be shedding (the) virus while asymptomatic,” said Dr. Jean William “Bill” Pape, the founder of GHESKIO, a leading HIV/AIDS treatment center and co-president of a Haitian presidential commission charged with overseeing management of the pandemic. “Health workers in Haiti and all over the world should take extra precautions whether they are a primary COVID-19 center or not.”
The teen with meningitis had been at the hospital for 13 days before doctors decided to transfer him to another hospital because they could not help him.
Days later, one of the director’s nurses shared a rumor she had heard: There was a death related to COVID-19 at a not-for-profit hospital in Port-au-Prince not designated for coronavirus patients. After additional digging, she discovered that it was their former patient, who on Friday became Haiti’s sixth — and youngest — coronavirus fatality after he had problems breathing and fell into a coma.
That the church-run hospital found out about the case through the medical rumor mill — and not from the Ministry of Health or other official channels — is bad enough. A bigger problem: Nearly 10% of its medical staff is out on quarantine and more than two dozen hospital rooms are out of service, highlighting the challenges facing Haiti as it prepares for an onslaught of coronavirus cases.
With a population of more than 11 million, Haiti has over 900 health institutions, of which 38% are public, 42% are private and 20% are mixed government and nonprofit, according to the World Health Organization. More than half of the health facilities, which include primary care centers, community referral hospitals and 10 departmental public hospitals, are located in metropolitan Port-au-Prince.
A 2017 World Bank study noted that there are 1.2 health centers per 30,000 inhabitants and Haiti had significantly more hospitals than many similarly poor countries. But its hospitals, the majority of which charge user fees, are often underequipped.
The director of the church-run hospital in Port-au-Prince, which is among more than 36 private hospitals in the capital, doesn’t yet know if any of his staff is infected.
After confirming Friday that the teen had died from COVID-19, he quickly shut down the internal medicine unit, pulling 24 beds in a common area and four others in private rooms out of service until the unit is properly decontaminated. He ordered doctors, nurses and nurses’ aides who may have had contact with the teen to self-quarantine for two weeks, and asked the ministry of health to run tests on three staffers who had close contact with the teen. The earliest they could send someone, the ministry told him, was Monday.
The operators of the second hospital, which is a private nonprofit, have not responded to repeated requests from the Miami Herald about what measures have been taken, including whether hospital staff has been properly notified of possible exposure to the deadly disease. That hospital, like the first, was not equipped to receive COVID-19 patients and there are concerns that both a hallway and operating room next to the intensive care unit where the teen had been on a ventilator, near other patients, could have been contaminated.
Haiti currently has 76 confirmed cases of COVID-19, but few believe it’s an accurate count. Few people outside Port-au-Prince have access to testing. Many Haitians still do not believe in the existence of the flulike virus and see it as a government ploy to get international aid. Others, frightened by what they do not understand, view the disease as a death sentence and anyone with it as tainted. That makes contact tracing difficult if not outright impossible in some instances.
The Pan American Health Organization, which has been urging countries in the region to expand testing and accelerate their preparation for COVID-19, said it remains concerned about health systems collapsing under the weight of the pandemic as community spread and fatalities continue to escalate in Latin America and the Caribbean.
“The backbone to fight this epidemic is a strong health system, and strong health services in hospitals,” said Marcos Espinal, PAHO’s director of the Department of Communicable Disease for the Pan American Health Organization.
For weeks, Haiti has been trying to come to some agreement with its private hospitals over increasing the number of COVID-19 beds, as officials expect as many as 432,000 infected Haitians would be in need of hospitalization, according to health officials’ latest projections.
But the private hospitals, several sources told the Herald, want reimbursements of $336 per patient per day, a sum Haiti’s cash-strapped government says it can’t afford.
“We met with private hospitals several times to establish a memorandum to see how we could help them financially … . But we must admit, to date, we cannot find an agreement,” said Dr. Lauré Adrien, the director general of Haiti’s Ministry of Public Health and Population and co-chair of the coronavirus commission.
The head of the Association of Private Hospitals in Haiti, Dr. Franck Généus, declined to be interviewed for this story.
Généus has been a vocal critic of the government’s failure to include privately owned medical facilities in its plans from the outset. Last week, he submitted a proposal to the presidential coronavirus commission. The proposal does not cite a cost, which Généus has said was originally raised only as a basis to begin deliberations, and based on a “World Health Organization forecasting tool” on the cost of caring for a patient in Haiti with COVID-19.
While both sides stand their ground, a crisis looms.
“Cases are increasing and an increase in the number of cases is very likely expected for the month of May,” said Adrien, the health ministry director. “I cannot say that Haiti is sufficiently ready, equipped at this stage to deal with an influx of cases … We are preparing with our means.”
The government has ordered $18 million worth of equipment from a Chinese supplier including face masks, ventilators and respirators for each of the country’s 10 regions along with hospital beds. But a month after the order, the equipment has yet to arrive.
In March, the health ministry estimated that it would need between $30 million and $35 million a month to respond to COVID-19. The estimate has since grown significantly.
“It’s a race against time, and more needs to be done now, not tomorrow, as the epidemic is starting to progress with community spread,” said Bruno Lemarquis, the United Nations’ resident coordinator in Haiti.
Lemarquis, who also serves as deputy special representative of the United Nations Integrated Office in Haiti, said Haiti is facing “a perfect storm, with two back-to-back tsunamis — a health crisis followed by a severe socioeconomic impact.”
“This comes on top of an already very concerning humanitarian situation, itself generated by Haiti’s chronic vulnerabilities but exacerbated by the series of crises the country went through in 2019,” he said.
The Haitian government needs to do more to quickly designate health structures across the country to treat COVID-19 patients and to ensure that the necessary personal protective equipment is available to health workers, Lemarquis added, so they aren’t sidelined before the spike.
Adrien said the ministry is currently designating buildings around the country that can be repurposed as COVID-19 treatment centers. Ideally, it would also like to have charity and privately run hospitals provide at least 40 beds for infected patients. It is more than most hospitals, however, are willing to provide.
“To date we can count on approximately 3,000 beds that have already been identified, with a capacity to quickly put 1,500 to 2,000 more beds with certain adjustments,” he said.
While welcoming the church-affiliated hospital’s measures after learning of the 18-year-old’s death from COVID-19, there is one unfortunate reality, Adrien said.
“By quarantining a large part of the staff, the hospital is unable to provide services as usual,” he said. The incident shows that “it is imperative to continue with the training of staff on prevention and precautionary measures, and especially to begin to have enough protective equipment for staff.”
But the main challenge he believes Haiti faces “is raising public awareness to limit the community spread of the virus.”
Several recent incidents — including the escape of a recently returned U.S. deportee from government quarantine after he learned he had COVID-19, and later, five individuals in the city of Hinche also escaped while awaiting test results — are all linked, Adrien said, to Haitians’ fear and lack of knowledge about the pandemic.
The stigma surrounding COVID-19 and the lack of protective equipment have left health care workers and hospital staff feeling vulnerable and exposed, as some Haitians threaten to burn down facilities caring for patients with the coronavirus.
Last week, a crowd forced its way into an isolated coronavirus treatment center opened by the Bishop Joseph M. Sullivan Center for Health in the southeastern town of Cote-de-Fer. In the dead of night, they took their dying pastor, who was in a coma after testing positive for COVID-19, from his hospital bed. Not believing he had the disease, they transported him in the back of a pickup to Aquin, another southern town, where he died.
Counting down the days since the incident, some of those who were part of the crowd have warned the hospital’s staff of imminent protests if no one in the group dies during the 14-day incubation period since contact was made with the infected pastor.
“For them, it’s as if the ministry of health is making up cases and the cases are not real,” said Dr. Jean Daniel Laguerre, the hospital’s medical director, who filmed the incident. “The population doesn’t believe.”
“Even in a country of affluence like the United States, it’s evident there wasn’t preparation given the amount of deaths,” Laguerre said, “so just imagine for Haiti, which is truly limited economically and human-resources wise, and we are really limited in terms of equipment.”
The director of the church-run hospital in Port-au-Prince said they were in the throes of preparations for the coronavirus pandemic when President Jovenel Moise confirmed the virus’ arrival in Haiti on March 19.
“Everything just collapsed,” said the director, describing the announcement’s impact. “It was as if an airplane was flying and then it just crashed.”
In the month since, the flow of patients seeking medical care has slowed immensely, he said. The pediatric clinic, which used to see as many as 90 patients a day, last Thursday only saw 10. While some people aren’t coming because they can’t afford care, others aren’t coming because of the virus.
“People are afraid to come to the hospital,” the director said. “They are afraid of the coronavirus. They are afraid of crossing paths with anyone who has it and if you tell them that they have it, it’s a catastrophe for them … . With this coronavirus, we truly cannot function. It’s a huge hit.”
Still, the hospital has responded to the health ministry’s call, committing to provide a block of rooms consisting of 24 beds separated by curtains in a common space and four private rooms, plus another eight beds for isolation.
But concerns remain.
“If we don’t have equipment to protect us, if there is no possibility to provide it to us, then it is increasingly possible that you will find among those who are working those who will say, ‘It’s my life before everything else,’ ” the director said. “I have to always have at the back of my mind that some may quit.
“Whether we like it or not, whether we create a space for COVID or not, whether we find the means to have it function as a COVID space or not, COVID is coming here.”
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