Coronavirus has affected every aspect of life for people all over the world. It has not only affected those infected with the virus, but it has also left many without work and livelihood. Disruption of global trade has affected the price and availability of goods people rely on daily. Furthermore, the disorder brought by the virus has affected the global healthcare system’s ability to treat patients with other illnesses. Over the last week in Haiti, we have seen these realities firsthand. In our outpatient clinic, we generally send 3-4 children to the hospital per month. In the past 3 days, we have sent 6. I want you to know their stories.
On Tuesday, we saw three patients who needed hospitalization. The first such patient was a 29-month boy with a fever and confusion. I know his mother well (I take care of the boy’s sister in our nutrition program). His examination showed that his neck was stiff and that he had intense pain when any light was shone into his eyes. With effort, we were able to waken him, but after a minute of consciousness, he started to doze back to sleep. Our medical diagnosis was clear; he was displaying the classic signs of meningitis. In a country with spotty vaccination, this illness is more common than we see in the U.S.—but it is just as deadly. We quickly triaged him to the pediatric hospital near the U.S. embassy for treatment.
The same morning, my colleague Dr. Valdema and I saw a young boy with abdominal pain so intense that he struggled to walk. Again, the differentiation was clear; we sent him to the local hospital for appendicitis. We knew he would require surgery as soon as possible.
Later Tuesday, one of our nutrition nurses, Ms. Jonkat, pulled me aside to help with a child she had identified as critical. He was a 3-month-old with severe malnutrition. Given his young age, we had no choice but to recommend that he start his treatment in the local hospital. He would need around-the-clock monitoring to ensure that rapid weight gain would not cause excessive stress on his small, weakened body. We have a positive working relationship with the hospital and work together to make sure children get the care they need. We wrote out a referral and directed them across town. After this child is finished with his inpatient stay, we will see him again and work with the mother weekly to nurse him back to health over time.
On Wednesday, my colleague called me in to help with a 9-day old child. Upon entry into the exam room, I thought the infant was deceased. I had never seen a child so withered and weak. His legs were wrinkled from dehydration and his forehead was deeply sunk at the point where his cranial bones had not fused. On closer examination, I could detect a faint respiration and a feeble but rapid heartbeat. We conferred and sent him to the hospital. It was his only chance.
Every Thursday, we have a nutrition program for the most malnourished children being treated by Lespwa TImoun. It is both a stressful and rewarding day. Some weeks our children are making great strides; other weeks, it feels like everyone is falling behind. This was one of those Thursdays. My 10th patient was a new child with normal weight and arm thickness. These are the signs we look at to determine if a child is malnourished. However, as soon as his mother brought him close, it was very clear why these signs were “normal”. He was severely swollen, from his ankles to his thighs all the way to his arms. His normal weight was solely from many pounds of fluid. This swelling is a sign of end-stage malnutrition. Before I came to Haiti, malnutrition conjured up images of a lack of vegetables, or perhaps missing your daily vitamin. As I have come to see, the word malnutrition often appears to be a euphemism for what could more accurately be described as starvation. As starvation worsens, children are not able to produce the necessary proteins to keep fluid in their blood vessels. As a result, their stomachs protrude from retained liquid, while their body withers away underneath.
Our patient was in this final stage. His mother was from a faraway mountain village and needed to be convinced that she would need to leave her other children to stay with her son in the hospital. My driver, Smyrne, waited and waited as the family discussed. Eventually she acquiesced and allowed us to take them across town. This boy will need to stay in the hospital for close to a week before his swelling improves enough to return to our program for the next step in his rehabilitation.
Later the same Thursday, my favorite patient came. She is 2 years old and has suffered from epilepsy since birth. I have seen her seize many times in past visits. She is, and has long been, severely malnourished. Her mother does everything she can for her. She takes her daughter to the pediatric hospital every two weeks, walking miles and then catching a public bus known as a “tap-tap” to get there. She patiently feeds her peanut-based supplements to help her gain weight. She does not become fatigued when her daughter is unable to eat due to her constant seizures. Each week the daughter fails to gain weight; however, I can see that it is not from lack of effort. This week, the patient was much worse. She was seizing and feverish when I saw her. For the next three hours, she did not stop convulsing. I told her mother she needed to go to the hospital. She started crying; she understood.
Getting to the hospital is not easy in Haiti. A child with persistent seizures in the States would be taken immediately by ambulance to the closest emergency room. In my mind, this is how things are supposed to work. However, the car was already in use taking our other patient to the hospital. The only viable option other than a lumbering tap-tap was a motorcycle. However, this would hardly work with a constantly seizing child. We waited for Smyrne. All the while, the seizures continued. When Smyrne got back, he immediately headed back out again with the child and mother. This time, I decided to join him. We made the drive to the pediatric hospital and we both walked her in. We said goodbye at the door—no visitors are allowed with Coronavirus.
This week feels different in Haiti. Yet, this is not the first time Haitians have faced a difficult time. Crisis after crisis seems to rack the country—violence, political impasse, natural disasters, famine. Perhaps it is just the first time I have seen the grim results of sterile, distanced words like inflation, trade imbalance, food insecurity, and lack of sustainable agriculture first hand.
The price of corn has doubled in the last month as food shortages worsen. Disruption of global trade has affected food imports. The local currency continues to fall against the U.S. dollar as exports have all but ground to a halt. What little local trade was present has again faltered as coronavirus has thrown the country into chaos. Families that were on the brink from a turbulent 2019 find themselves with no viable options to feed their families.
In the days after Coronavirus was first discovered in Haiti, many of the largest public hospitals in the capital closed their doors. This was followed in short order by hospitals in other departments of the country doing the same. The reason? Doctors and nurses, long underpaid (if paid at all) and under protected without sufficient PPE, had gone on strike. Do I blame them? Maybe not. What I know is that the country has been left without a functioning healthcare system in a time of great need. Coronavirus is far from the only medical issue that we are seeing.
I spoke with the meningitis patient’s mother today. He is starting to improve. His fever has broken and he is more alert. Our swollen child still has several more days of comprehensive inpatient care ahead of him. One of our nurses spoke with the hospital about the 9-day old. With fluids and antibiotics, she is holding on. In much of the world, we are doing this today—holding on. We must all continue to do this. I am so grateful to the many people who support Lespwa Timoun and Light from Light and continue to provide hope for the most marginalized people of Haiti each day.
Tram, I keep you and Hannah in my prayers, but now I will also include the children that are mentioned in your post. Little children are not supposed to suffer like that! Love, Mimi
The hopelessness of these situations is overcome by the selflessness and faith of those like a Tram who do the work of Christ, daily, as each situation arises. May God protect you, Tram, and all who labor with you. I pray for COVID-19 protection for Haiti.
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