Amid Ongoing Unrest, Caring for Covid-19 Patients in Haiti

At the height of Haiti’s current Covid-19 wave, Father Richard Frechette got on the phone with a local gang leader.

For the priest and medical doctor, it was a matter of life and death. His staff, caring for a ward full of Covid-19 patients, needed to be able to get oxygen canisters safely to St. Luke’s Hospital in Port-au-Prince, where Frechette works. Gang warfare was making the trip increasingly dangerous.

So Frechette made an impassioned plea: How would you feel, he asked the gang leader, if it were your mother or grandmother who was in the hospital? What would you do if it were your family or friends?

The response? The man said he didn’t control all the people currently fighting in the neighborhood. But they would probably leave the St. Luke’s staff alone if Frechette dropped off a keg of beer.

Frechette did as he suggested. It’s far from the first time he’s gone above and beyond to make sure his patients receive care.

Even before the assassination of Haiti’s president, Jovenel Moïse, on Wednesday morning, Haiti’s surge of Covid-19 was disturbing, and likely made worse by instability. Violence made it harder to transport oxygen and other medical necessities, and decreased the likelihood that sick people would seek care at local hospitals.

On Wednesday, after the assassination took place, Frechette described empty streets and closed stores. Hospital staff, unable to go home – public recommendations were for people to avoid going out – were planning to work for 72 hours, three times the normal length of a shift. It was impossible to make the trip to replenish oxygen stores, although Frechette was optimistic that oxygen would be available the following day.

And staff were struggling to find food for patients, who are generally fed by family members. “This is a very communitarian country, so people bring food to their loved ones in the hospital. That’s how we’ve always done it,” he said. Eventually, requests to local small businesses yielded bread and coffee to be served the following day.

Frechette was concerned that the assassination would cause further unrest. “If the streets turn into looting and riots, we’re not going to be able to get oxygen,” he said. “That always happens when there’s instability.”

A changing situation

Although Haiti has been promised Covid-19 vaccines, Frechette said, only about 20% of his staff members – those with United States visas – have been able to receive them. Among the general population, vaccination against the coronavirus is all but nonexistent.

For Haiti, dealing with a Covid outbreak this widespread and severe is new. Although the virus broke out in Haiti last year, it faded relatively quickly, doctors said. At St. Boniface Hospital in southern Haiti, according to Director General Dr. Inobert Pierre, a dedicated Covid treatment center was built – only to sit empty for months on end.

Now, he said, he has more severely ill patients than ever before: “We’ve been receiving patients in more critical condition than the first time. They need more oxygen and they need more care to get back to health.”

While St. Boniface still had some beds available for Covid-19 patients, Pierre was concerned about beds filling up in the coming days, as the virus continued to spread.

Before Covid, Pierre said, a patient who needed oxygen might need as much as five liters per minute. A severely ill coronavirus patient might need 15.

As was the case for St. Luke’s, St. Boniface was having trouble getting supplies due to the violence and unrest. “Sometimes we have supplies in Port-au-Prince but we can’t get them to the hospital,” Pierre said. “Sometimes we have to buy locally what we already have sitting in Port-au-Prince.”

In addition, Pierre explained, there are people who have Covid-19 and need medical care, but aren’t seeking it out because of the unrest. “The insecurity issue is killing people silently as well,” he said. “They’re running the risk of being shot, so they just stay at home and the don’t go to hospitals.”

Stigma is also playing a role, according to Pierre. “Many people are dying from Covid, most of them silently. They never get tested, never go to the hospital, nobody hears about them,” he said. “The family will make up another reason” for their death.

During the first wave of Covid-19, even one of St. Boniface’s own employees tried to hide his illness from his employer when he came down with Covid-19. “It’s sad to say, but he was dying,” Pierre said. “He lives 10 minutes’ walk from the hospital.” The employee was successfully treated, and “today, he’s the best advocate against stigma.”

Ongoing challenges

Like St. Boniface, St. Luke’s has some empty beds that Frechette attributes to the violence, although he said the Covid-19 wave itself is also beginning to decline.

The gang conflicts themselves have changed in recent years, he said. Gang members used to be local – “We’ve known those guys since they were in diapers. We’ve taken care of their grandmothers and their children and them” – but are increasingly from outside the community. That means that Frechette and his staff are less well-known – and more at risk.

The violence isn’t the only threat. Haiti was also at risk from the recently dissipated Tropical Storm Elsa, and Frechette’s staff was forced to move all of their Covid-19 patients from the open-air treatment ward inside the hospital.

When designing the treatment ward, “we wanted to be heavy on light and air” to keep the disease from spreading, Frechette said. “Nature is also nice, for the people to look at trees and things like that.”

An additional source of frustration is the lack of treatment options. Frechette and his staff have steroids, anticoagulants, and antibiotics to treat the complications of Covid-19, along with oxygen and vitamins. They recently received enough vials of the medication remdesivir to treat 33 severely ill Covid-19 patients. “This is brand-new to us and wonderful to us, and we finally have something advanced to offer at least a few people,” he said.

But monoclonal antibodies and vaccines, two important tools in the fight against the pandemic, are still absent.

Overall, Frechette said, he’s seen less stigma rather than more. Last year, there were mobs of angry people at the gates of the hospital, and patients received threatening text messages telling them not to go home. This time around, his patients have been left alone: “It’s a very pleasant difference from last time.”

The assassination of Haiti’s president is a complicating factor, prompting a closure of the airport at Port-au-Prince and a declaration from the country’s interim prime minister of a “state of siege.”

“Regarding the assassination of the president, we’re…anticipating troubles, but the close future is mostly woven of unknowns,” Pierre said. “At this point, we stay put and try to keep our staff and properties safe.”

Direct Relief is providing ongoing support to hospitals and other health organizations in Haiti during the Covid-19 pandemic, including supplying oxygen for hospital patients and PPE for staff. Since January of 2021, the organization has sent $21.6 million in medical aid – more than 148,000 pounds’ worth – in 20 shipments to 14 Haitian partners, including St. Luke’s and St. Boniface.