Haiti: Between denial and fears in the face of COVID-19, health promotion on the front line | Doctors Without Borders
PORT-AU-PRINCE, Haiti, July 6, 2020–Amid the COVID-19 outbreak in Haiti, rumors of the disease and mistrust of health facilities are causing people to delay seeking care. Nathalie DestinÃ©e Charles, supervisor of the health promotion team of MÃ©decins Sans FrontiÃ¨res / MÃ©decins Sans FrontiÃ¨res (MSF) in Martissant, and Julie rolinet, MSF’s health promotion manager in Port-au-Prince, today provided the following story:
In Haiti, there have been many rumors since the start of the COVID-19 epidemic. One of the most widespread rumors is that a deadly injection is being given in hospitals to increase the number of deaths linked to the epidemic, in order to receive more international aid. Another is that healthcare facilities are testing a vaccine against the coronavirus on people without their knowledge.
We work day in and day out to counter rumors and provide correct and factual information to the public as part of the MSF health promotion team in Port-au-Prince. But some beliefs are hard to change. At the MSF emergency center in Martissant, a district of the capital, patients have become more reluctant to receive an injection when necessary, and sometimes they refuse it.
In the streets, people often tell us that they would rather die at home than go to the hospital. Beyond the mistrust it shows towards institutions, this is a very worrying trend because it affects the behavior of people seeking care. At the COVID-19 care center opened by MSF in the Drouillard district in Port-au-Prince, we see that people tend to delay treatment and arrive in serious or even critical condition. Out of 132 patients admitted to the center between mid-May and mid-June, 12 died on arrival or within the first 24 hours.
Many people we meet are expressing conflicting things about COVID-19. On the one hand, they don’t believe in it but at the same time they fear it. Some fear that the health system, already fragile in Haiti, could not cope with such an epidemic. Indeed, the repercussions of COVID-19 are increasingly evident in the general health system. Several health facilities in Port-au-Prince have already been forced to totally or partially suspend their activities due to the lack of protective equipment or the capacity to implement triage and isolation to ensure the safety of patients. patients and staff.
Fear and stigma are linked: for fear of being infected, people do not want a patient near them. It is a means of protection. This is why before the opening of our COVID-19 care center in Drouillard, MSF health promotion teams went to community leaders and neighbors to listen to their concerns and try to respond to them. They were also invited to visit the structure before it opens to understand the path taken by patients and see all the precautionary measures in place to avoid contamination.
The denial of the disease is, however, probably linked to the fact that the number of officially registered deaths in the country remains low so far, compared to what can be observed in other countries. In some neighborhoods, residents tell us about a “fever epidemic” affecting a large part of the population, but they do not see it as COVID-19.
Due to COVID-19, we cannot organize large gatherings to share health information. Instead, we adapted our methods and encouraged training and awareness raising in small groups. For training on COVID-19, we have targeted certain key groups such as community links, school principals and neighborhood associations. We have already trained more than 120 people, which is the basis of our community involvement. Then they can share the information more with those around them to help people protect themselves from the virus.
We have also stepped up our door-to-door activities to make residents aware of the existence of the disease, the prevention measures to adopt and the need to seek treatment before it is too late. Obviously, we manage to educate fewer people than if we could have large gatherings, but we have more in-depth discussions with everyone. In the current context where many rumors circulate, this exchange is fundamental because it allows to understand the concerns of people, and it allows them to ask questions. It is when people ask questions without finding adequate answers that rumors have a place to spread.
If everyone understands how the disease works and how it is transmitted, this allows everyone to identify the most risky situations in their daily lives and to take precautions according to their situation. Preventive measures such as wearing a mask, physical distancing, or even hand washing are very difficult for part of the population in Haiti. They may have to choose between feeding their children or buying a mask, or they may not have adequate access to soap or water. Physical distancing is very difficult in a neighborhood like Martissant which has one of the highest population densities in the world. With the local populations, we try to think of alternatives adapted to their living conditions such as collective hand washing points for example.
The fact that MSF has been present in Haiti for nearly 30 years and provides free health care, especially in the very difficult neighborhoods of Port-au-Prince, known for their insecurity, has allowed us to create a solid relationship of trust with population. . In the face of rumors, confidence is an asset. As health promoters, our role is to actively listen and dialogue with people in the communities where we work, to preserve this bond of trust.
An MSF patient in Drouillard, Port-au-Prince, also provided the following account:
“If I hadn’t come to the hospital, I probably would have died”
My name is Sid and I am 49 years old. I work as a driver in Port-au-Prince. I had a fever for almost a month before going to the hospital. My wife and one of my two children also had a fever, but they recovered faster than me. I took traditional medicines made from oak leaves, lilac and aloe vera to cure myself at home. At first, I didn’t think I had COVID-19 because I hadn’t been in contact with people from overseas, so I didn’t think I could catch it.
When my condition did not improve, a friend told me to call an ambulance to go to the hospital, but I refused. Today, as soon as people see an ambulance pass by, they immediately think the person inside has COVID-19. Some people have even been threatened because of it. Over time, my condition worsened; I was coughing up blood and couldn’t get up. Finally, I asked a friend if he could drive me to the MSF COVID-19 center in his personal vehicle, to avoid creating panic in the neighborhood. If I hadn’t come then, I would probably be dead!
In my neighborhood, there are a lot of people who complain of having a fever. They say they would rather die at home than go to the hospital because they are convinced they will be injected with a deadly vaccine. Since I was hospitalized, several friends called me here, to tell me not to accept the injections. This vaccine-related rumor is deeply rooted in Haiti. Recently a man I played football with was hospitalized with heart disease. He died two days later and everyone thinks it is because he was injected with a vaccine.
I have been treated here for 14 days now. I feel better and hope to be able to return home soon. It is important that people feel confident to come for treatment as soon as they have a fever or difficulty breathing. They should not be afraid of going to the hospital or being stigmatized by those around them.