By Sam Bojarski
Governments around the world have recommended social distancing to stop the spread of coronavirus. That’s a tougher sell in Haiti, where millions must venture out to public markets each day to buy food.
In a country where over half the population lives on less than $2 dollars per day, the spread of coronavirus has made life even more precarious, months after anti-government protests ground normal life to a halt.
“Haitian people live daily,” said Kerventz Sylus, a 25-year-old foreign language instructor who lives in Thomassin, a mountainous suburb outside Port-au-Prince.
“As a teacher when school is closed now, I’m not going to get paid, I stay home. And the government doesn’t tell what it’s going to do for the private (school) teachers,” he added, in response to government-mandated school closures due to coronavirus.
Even before the first coronavirus case was diagnosed in Haiti, people began stocking up on food. Earlier this month, Sylus recounted seeing long lines at a public market in the Delmas 95 neighborhood. Vendors, he recalled, were completely sold out within six hours.
The worst fears of many Haitians were realized when the country recorded its first two positive cases of coronavirus on March 19. By March 24, the number of confirmed cases had risen to six and climbing daily.
Food prices began skyrocketing well before then, aggravating the country’s economic circumstances, as people used whatever means they had to purchase essentials. Large sections of the diaspora, which sends about $2 billion per year in remittances so Haitians can buy basic goods, have seen their own livelihoods impacted by the economic slowdown coronavirus has wrought in the U.S. and elsewhere. In addition to cost-of-living increases, coronavirus is “laying bare the existing gaps within Haiti’s current health system capacity” and demonstrating the need for more investment in social services, according to Franciska Lucien, executive director of the Institute for Justice and Democracy in Haiti (IJDH).
Medical professionals have cited shortages of the equipment necessary to contain the virus and treat patients.
Haiti’s government closed its border with the Dominican Republic ‒ a major source of food imports ‒ before recording its first coronavirus cases and halted all commercial air travel after March 19. President Jovenel Moise ordered all schools, factories and airports to halt operations. He also issued an 8 p.m. to 5 a.m. curfew and banned gatherings of over 10 people.
Sylus said he has noticed some people in his “zone” developing a cough and even walking around with masks. But government orders to stay home have been met with skepticism by some. On March 22, many people in Thomassin still gathered for Sunday church services.
Sylus also said in a March 22 interview that he anticipated government measures to stabilize food prices, and Moise announced food distribution measures for some districts the following day.
The price of a can of rice, which increased to about 100 gourdes, or $1.25, during the fall 2019 protests, has skyrocketed even further. “It’s about 600 gourdes for right now,” Sylus said.
Many in the diaspora also face uncertain circumstances. As of March 20, Leonie Hermantin was still witnessing lines at Western Union counters in many Haitian neighborhoods of Miami. Gepsie Metellus, executive director of the Sant La Haitian Neighborhood Center, which provides job placement, health care enrollment and other services to the Haitian community in Miami, said she anticipated that many Haitians in South Florida would send remittance money as soon as possible, for fear that government orders would close wire transfer locations in both the U.S. and Haiti.
Throughout the U.S., closures of restaurants, hotels, barber shops and beauty salons stand to impact millions of workers. Metellus estimated that Haitians comprise about 40% of the Miami chapter of UNITE HERE, a labor union representing hospitality industry workers.
With many in the diaspora tending to their own situations, Hermantin, who serves as director of development and communications for the Sant La center, said the flow of remittances to Haiti could eventually be impacted by the economic downturn in the U.S.
“People are panicking about having to buy food,” she also said. “Miami is very concerned about Miami right now.”
According to Metellus, the coronavirus crisis has exacerbated an already impossible challenge Haitians face when it comes to food access. She cited Clinton-era policies from the 1990s as a major contributor to Haiti’s underlying food challenges.
In 1995, at the behest of the International Monetary Fund (IMF) and World Bank, Haiti lowered import tariffs on rice from 50% to 3%, as part of a structural adjustment program. The following year, President Bill Clinton’s Federal Agricultural Improvement and Reform Act directed subsidies to U.S. rice farmers. By 2013, a nation that once grew most of its own food was importing 80% of its rice from the U.S. The policies eventually led to job losses in Haiti’s agriculture sector and swelling of the urban population.
“I cannot say that I am independent, and then my belly depends on another country,” Sylus said. “Now if we had national production, the government could stock those goods to respond to the needs of the population. National production is important because there is no development without agriculture,” Sylus said.
Health care and coronavirus in Haiti
Structural adjustment programs, promoted by the IMF starting in the 1980s in response to the growing debt of developing nations, have prompted decreased investment in Haiti’s health sector, Lucien said. These programs incited many nations to devote more of their budgets to debt service and decrease social spending, as a condition for IMF aid.
In addition to reduced tariffs on imports, the short term impacts of structural adjustment in Haiti included cuts to government expenditures in health and education, according to a 2011 paper published in the journal of the Japan Medical Association. National health care spending has dropped dramatically in recent years, from 16.6% of Haiti’s budget in 2004, to 7% in 2019.
Dr. Youri Louis, a physician in Haiti and leadership committee coordinator for the nonprofit EqualHealth, which supports medical and nursing education, said both international policy and government inaction are to blame for Haiti’s lack of investment in health services. By 2013, he noted, 64% of Haiti’s national health budget came from international aid, including NGOs.
“Health care professionals are complaining about what they always complained about, lack of materials and health care infrastructure. They know what the risk is with no appropriate equipment, and there is a lot of disengagement,” he told the Haitian Times in a written statement on March 24.
When it comes to coronavirus response, he estimated that Haiti ‒ with a population of nearly 11 million ‒ has about 39 physicians available for the management of infected patients. Citing a 2019 study published by the Research and Education Consortium for Acute Care in Haiti (REACH), Louis said Haiti currently has 124 ICU beds, with the capacity to ventilate 62 patients within ICUs. Ventilation is needed to treat patients with severe complications due to coronavirus.
The REACH study identified 51 health facilities across Haiti’s 10 administrative departments, and 39 of these facilities completed the survey. Of the facilities with ICUs, only one-third reported formal critical care training for physicians.
Louis also cited shortages of protective equipment, including respirator masks and gloves.
“We don’t have enough, and the government is not able to say when (it) will provide that equipment,” he said.
Haiti’s Ministry of Health has released coronavirus preparation plans, which called for the installation of 577 hospital beds across 59 locations, to manage mild symptoms of coronavirus. The plan also called for 143 beds in 15 hospitals to manage severe cases requiring intensive care.
When it comes to coronavirus response, Sandra Wisner, a staff attorney at IJDH, said some lessons can be gleaned from the response to the cholera epidemic that began in 2010. She mentioned the importance of working with trusted civil society organizations and empowering communities with clear, consistent information on how to stop the spread of disease.
“This includes access and ensuring services are available to communities ‒ so having testing available where people are, tracing, treatment; health facilities resourced with the necessary supplies, and ensuring front line workers have the resources and tools they need to provide safe and effective care and treatment for patients,” Wisner said in an email.
Despite Haiti’s lack of health care capacity, Louis said that serious management of suspected and confirmed cases could limit the spread of the virus. He recommended practices like confinement and social distancing. However, he noted the challenging circumstances that could limit the efficacy of confinement measures.
In Haiti, “the majority of people have to go out to eat every day,” Louis said. “Confinement will not be effective if the government can’t provide basic needs (food, water) to the population.”
Faced with a government that lacks legitimacy, Sylus said many Haitians do not trust the warnings about coronavirus, even though medical professionals know enough to be fearful.
“Doctors are afraid. They say, ‘we don’t have enough equipment, we don’t have enough materials to take care of you, because you never know.’ They are afraid, it’s panic,” he added.