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Haiti Is Facing a Humanitarian Crisis. This Doctor Is on the Front Lines.


Humanitarian Crisis

Father Rick Frechette and staff tend to a patient at St. Luke's Hospital in Port au Prince, Haiti. (Photo courtesy of St. Luke Foundation)

Haiti is in the throes of a humanitarian disaster provoked by months of violent protests. Demonstrations have blocked supply routes, choking a nation already crippled by poverty. Accessing health care in these conditions is challenging, if not impossible, exacerbating existing health problems. As medical care grows more scarce, preventable disease becomes more deadly.

On this episode of our podcast, we speak with Father Rick Frechette — a priest-turned-doctor treating patients at one of Haiti’s few operational hospitals. He gives us an on-the-ground look at the situation in Haiti, and a prediction for what lies ahead.

A warning to listeners, some may find the following descriptions disturbing.


An alarming email came in last month.

It spoke of burning barricades and decaying bodies.

“I won’t press your imagination,” Father Rick wrote, “but I’ve never seen so many maggots in my life.”

Father Rick is an American priest turned doctor that’s been working in Haiti for more than 35 years.

I spoke to him over the phone with Direct Relief’s Andrew MacCalla.

He’s not an easy person to get a hold of, for good reason.

MACCALLA: He said I’m trying to organize a surgery for gunshot victims. Tomorrow would be better.

Father Rick is the founder of St. Damien’s Pediatric Hospital and St. Luke Foundation — an organization that provides medical care to over 60,000 patients a year.


RAFANELLI: Hey, Father Rick?

RICK: Yes. Hi, how are you?

RAFANELLI: He’s no stranger to the civil unrest that mars Haiti’s history.

Father Rick witnessed the coup that ousted President Aristide in 1991 and precipitated a flood of political persecutions.

In 2004, he cared for victims of political violence after Aristide was overthrown, yet again.

And now, he’s tending to Haitians caught up in the chaos of the country’s most recent political upheaval.

RAFANELLI: Can you tell us what’s happening in Haiti right now?

RICK: Hold on one second. I’m going to go outside. OK. It’s just quieter outside.

Well, there’s lots of demonstrations every single day against the President. Two days ago, we were rushing two gunshot victims downtown because they had vascular injuries and we can’t do vascular surgery at our hospital. So, I took them in my own truck, in my own ambulance, down to a private surgeon and, of course, whenever we do that, we always have those bills later to pay because they’re not free. Trying to get there with those two people that were hemorrhaging, we had to go through two or three different manifestations of people, some of whom have sympathy and compassion and let you through and others who don’t and wind up screaming obscenities and hurling rocks and blasphemy. You’re dodging cars that people have set on fire and dodging flaming barricades and everything else. I mean, that’s what it’s like. Rushing to save two lives and coming up against a lot of hostility and frustration that’s far beyond negative, shall we say, frustration that erupts into a lot of vengeful and hateful, divisive sentiment. That’s how it is when these manifestations are happening.

RAFANELLI: The demonstrations are the latest in a bout of anti-government protests that erupted last year. Protesters are calling for the resignation of President Jovenel Moise over corruption allegations, soaring gas prices, and food shortages. The president denies any wrongdoing and has refused to step down. In response, the opposition has vowed to continue demonstrating.

RAFANELLI: So, Father Rick when you have gone out to retrieve these patients have you been stopped by these protests with patients in your vehicles that are in need of…

RICK: Yes, all of our ambulances have. I think anyone that has an ambulance has had the same problem. They want to search you and make sure the President’s not laying down on the cot.  They’re convinced the President can’t get around the country because he’s kind of a prisoner of where he is and that he is using ambulances to move around. It’s absurd, but that’s the thinking. And so, a lot of times they make everybody get out and make sure the President’s not in the ambulance and then you can get back in. Sometimes it’s just, you know, they’re hungry. They tell you, look, we’re hungry, we have nothing to eat, nothing to drink and you give them $5 and they let you through and you’re on your way.

RAFANELLI: Haiti is the poorest country in the Western Hemisphere. More than 60 percent of the population lives on less than $2 a day, and half of the country is undernourished. Within this setting, preventable disease runs rampant. The island nation has the highest incidence of tuberculosis in the Americas and diarrheal disease ranks among the top 10 causes of death. Civil unrest only complicates this challenging health landscape. Hundreds have been injured since protests intensified in September and at least thirty-five have been killed.

RAFANELLI: Can you tell us about the kinds of health problems that you’re addressing right now? What are the most pressing health concerns?

RICK: Well, there are the usual ones, except the baseline is more malnourished, which means recovery is jeopardized.They’re the usual ones,except the illnesses have delayed a lot because of inability to get care. Ability to get care is not just the streets. I mean, most places, if you don’t have money, you’re not seen. Money is what people don’t have anymore. But when I say the usual things, most of them are from living in filth. In other words, gastrointestinal disorders, parasites, typhoid, a lot of these things can become deathly, deadly. For example, typhoid can perforate your intestines and then your intestines spill into your abdomen, the contents of your intestines, and then you go septic and then you die. Other kinds of things besides the parasites and gastrointestinal diseases, from even the difficulty in finding clean water anymore to drink, all the usual pneumonias—viral, bacterial—which cause a lot of compromise to children. They’re very dangerous—pneumonias in children—and in adults, too, that are malnourished. Malaria, of course. I mean, there’s plenty of rain, there’s plenty of mosquitoes. Malaria is always a problem here. So, it’s the things we’re used to seeing, but delayed and in a more malnourished body. So, in other words, it’s like a garden with no fertilizer. You can plant whatever you want, but if there’s no organics in the soil, it doesn’t work. So, it fights against treating illness quite a bit if the person is malnourished as a baseline.

RAFANELLI: So, in addition to treating an increased number and trauma related injuries now you’re also seeing a worsening of bacterial infections and viral diseases.

RICK: Yes. Because of the circumstances.

RAFANELLI: What are your patients saying right now? What are they most worried about?

RICK: They’re most worried that the country is just going to collapse on top of the ball. In other words, that there’s no future in the way things are now, that there’s absolutely no future for them. And if there aren’t huge changes and,of course, most of the people associate the President with the problem, but the President, of course, inherited the problems and maybe made them worse or maybe didn’t do anything about them. I mean, I’m not saying he’s above criticism, but the people are focusing mostly on the President as the problem. But of course, it’s the enduring poverty. The poverty endures because of corruption. The corruption endures because no one has any control over any branch of any department or police here anymore. You know, to be honest with you, the solution is very easy. It’s work for everybody at a wage that is not exploitative. That’s the solution. If people had money and, in a country like this, for people at the level of the peasant, if that were eight hundred dollars a month instead of a year, that would be phenomenal progress with what people would be able to do with eight hundred dollars a month instead of eight hundred dollars a year. But I mean, that would be hard to imagine such a pay scale. I think that if people could work for even $400 a month in a non-exploitative way, you’d see a lot of the problems here would solve themselves. People would find completely different ways of living than what they’re obliged to accept because of their lack of circumstances. They’re not looking for handouts. They’re looking for work. I think this is a big tragedy of the country. And, in any developed country like the United States, when unemployment rises, it’s a concern for everybody. It’s an indicator of national well-being. So, when unemployment is over 50 percent, you can imagine what a mess it is. And similarly, the solution is finding work for people.

RAFANELLI: Can you tell me a little bit about the challenge of getting medical supplies into Haiti right now? I know that getting supplies to St. Luke’s has been difficult. And I was just I’m just curious if you could tell us more about this challenge.

RICK: Well, when there are no roads, supplies can’t move. And if supplies are in a hot custom’s warehouse, that’s bad for perishables and it’s bad for medicine. So, there’s damage to the products when they’re sitting for a long time and get released sporadically and then taking even longer to be able to, on a better day, go across the roads to the delivery sites. So, there’s shortages of lots of medicines. There’s pretty much a national shortage, for example, of seizure medicine, Carbamazepine. This is really, really a disaster. With the epileptics that we follow here at St. Damien’s, and in the clinics that I do with Mother Teresa’s sisters and in our field hospital in Cité Soleil—a lot of people with epilepsy—it’s dangerous where they’re living. There’re canals everywhere. People have fires going everywhere. They’re living along water and mud at the sea. So, unfortunately, in those kinds of settings, when somebody has a seizure, they often fall into fires or water or in front of traffic. It’s more tragic because the settings are already so dangerous. It’s not like you fall to safe. You know what I mean? Like somebody in an office at home in the states with epilepsy would be sitting in an office chair and slump or else fall onto the floor, but they wouldn’t be falling off the roof of their house where they’re sleeping or falling into a fire or falling into the water. So, the lack of medicine, the effects are very wide from the lack of medicine. That’s one example.

RAFANELLI: Before the conflict escalated, Direct Relief had emergency medical supplies stationed in Haiti. They were stored in a warehouse only a few miles from St. Luke Hospital, where Father Rick has been treating patients. They were stored in a warehouse only a few miles from St. Luke’s Hospital, where Father Rick has been treating patients. But the protests have made traversing even just a few miles difficult. Father Rick had to plan it just right.

RAFANELLI: Can you tell us a little bit about what retrieving those supplies was like?

RICK: Um, what it was like?


RICK: Ok. You mean physically like going down there?


RICK: Well, we went early in the day and there weren’t too many problems on the street.We took a covered truck so people wouldn’t know necessarily what was in it. We were able to get back here before there were any blockades. So, it went pretty smoothly. And the staff at the depot were very, very fast and very efficient. So, thank God, it went smoothly.

RAFANELLI: So you had you weren’t able to access those supplies previously because of roadblocks?

RICK: Yes. Yeah. It was going to be delivered here,but it was taking it was getting so delayed that I finally said, we’ll just come and get it because we needed it so badly. So then we made our own plan to go down and get the supplies.

RAFANELLI: Working in these conditions isn’t easy. Defeat is likely. Death is constant. Persevering through these challenges can feel impossible. Father Rick has been doing it for decades. I asked him how the last 30 years has affected him.

RICK: It makes you face challenges, intellectual, emotional in the world of meaning. Also, you have to change yourself, what you hope to accomplish, what you expect, what would satisfy you. There has to be a huge shift inside of yourself. You know, in other words, you develop to be very grateful for a very small success. And I think that especially that rather than focusing on, you know, you saw 80 people in the morning or 100 people in the morning, instead of kind of focusing on what you crank out with your work, that you kind of treasure nuances with the people in front of you—the smile of a child, the feeling that a senior feels assured because of the way you’re listening and trying to help. You know, you appreciate very much the effect that you’re having on the human heart and what people’s experience of life is that it’s not just nasty and brutish. But there are a lot of people that are trying to help change it in solidarity and companionship. And, after a while, those things, they help you. You get a lot of energy from them.

RAFANELLI: How does this situation now compare to the last 30 years that you’ve been in Haiti?

RICK: The situations are all unique. For example, we had really drastic years 2004 to 2007. They were god awful years. But for example, at that time, the kidnappings were unbelievable. 200, 300 people kidnapped every month and with brutal, often brutal results and we were involved with almost 100 cases of liberating people from kidnapping. But that had a whole different color to it, the violence of that time. Within the last year, for example, we’ve had cannibalism. We’ve never had that before. It’s gang-related cannibalism. But I mean, I never saw that before in my life. I think that something that’s different now is a problem all countries are having with their young people because of social media and almost a retardation, when it comes to relating with people and, you know, relating through a screen and through media where you don’t have to be face to face, you don’t have to take direct responsibility for what you’re saying, where you’re saved from intimacy in both directions—the intimacy of somebody’s anger or the intimacy of somebody’s love. So, this is a big difference now than before. The younger generations—they seem to be virtual people. They don’t seem to be real. There’s something else going on in their mind, but it’s not what’s right in front of them. And that’s a hard thing to fix, because if they’re deficient in knowing how to talk and relate, they’re not going to all of a sudden learn that at a barricade. So, it’s a big difference right now. I think some things that are the same are—we see this around the world—where a lot of people will team up either for or against a leader. And the leader comes to represent a lot of very deep things in them. And so, the leader becomes like the focus of all the unspoken problems. So, there’s kind of a group mentally and a group thinking that catches fire. This is probably typical in all of them. You know, for Aristide, against Duvalier, against Jovenel Moise, kind of pinning it on one person and fighting for that person to stay or leave and then taking full advantage of the violence of the occasions to plunder and pillage so that you go home with a flat screen TV besides having supposedly stood up for your political opinion. Those kinds of things are the same. I could always count on before, I was always sure before, I never had a doubt that I would work my way through any opposition on the streets, but I’m not anywhere near as sure of that anymore.

RAFANELLI: So does the current conflict feel more dire than past conflicts that you’ve lived through in Haiti?

RICK: It feels more dire, so long as nothing gives way. If it’s going to stay like this, yes, it’s terrible. But I would say this. It’s well known that, for example, military nurses, military doctors, emergency doctors, emergency nurses, intensive care doctors, intensive care nurses start can become very blunted just because it’s constantly too much to take what they’re dealing with and can be removed and blunted. What happens to the people is that no matter what break they get, something terrible happens before long. So. when Aristide was finally elected again, he was thrown out of the country and then he was thrown out a second time. And then we had all those terrible periods that I was telling you about, 2004 and 2007. Then the U.N. really clamped down on a lot of crime and the country looked more hopeful and what they called the Diaspora, the Haitians outside were starting to come back and invest. It looked like things were finally shaping up. And then we had the earthquake that knocked all of that flat. And then we had the cholera, which knocked it even flatter. And then when people were starting to recuperate, then we’ve had a number of massive hurricanes ever since. So, it’s kind of like, for the people, this is part of the direness, of just becoming fatalistic that there’s no way, that it’s not even worth trying, that our lot is never going to be better no matter what we do. The accumulation of all these tragedies has that effect.

RAFANELLI: Do you think that Haiti will be able to move forward from this?

RICK: Yes, with honest leaders who provide jobs. That’s all it’ll take. Honest leaders who provide jobs. That’s it.

RAFANELLI: Do you see that happening?

RICK: I don’t see who. I don’t see who right now. But that’s what has happened.

RAFANELLI: Okay. We’re gonna let you go. We know you’re busy, but thank you so much, Father Rick, for taking the time to speak with us.

RICK: You’re welcome. And thank you for all the support from Direct Relief. We really appreciate it.

RAFANELLI: Last week, an additional shipment of supplies arrived in Haiti. Direct Relief staff are working to get these supplies from the main port to St. Luke’s Hospital. Roadblocks continue to make transportation a challenge.

For Direct Relief, this is Amarica Rafanelli.

 This transcript has been edited for clarity and length.

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