Sustaining Health Care as Crisis in Haiti Escalates

Four decades of collaboration with HMS and beyond laid the groundwork for resilience and hope amid violence and insecurity

Woman with infant in hospital in Haiti
Women and their newborns receive care and support throughout pregnancy and the first year of the baby’s life in the Journey to 9 Plus program based at PIH-supported Mirebalais University Hospital in Haiti. Image: Mélissa Jeanty/PIH

The local staff of a dozen hospitals with deep ties to Harvard Medical School are still providing crucial health care to some of Haiti’s most vulnerable people during the current escalating violence, political chaos, and crushing economic downturn that has led to a state of emergency in the island nation, according to Joia Mukherjee, associate professor of global health and social medicine in the Blavatnik Institute at HMS.

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Borders in Haiti are closed, ports occupied, airports under attack, and main roads blocked, leading to severe shortages of food, water, fuel, and medicine. The United Nations says more than 5 million Haitians need humanitarian assistance because of displacement, famine, and other privations.

Harvard Medicine News spoke with Mukherjee — who is also chief medical officer for Partners In Health, a global health care equity organization founded in Haiti four decades ago by the late Paul Farmer — about the long-term collaboration between HMS, PIH, Brigham and Women’s Hospital, and Haiti’s Ministry of Health and the lessons the world can learn from Haiti about how to provide health care in times of crisis.

Harvard Medicine News: How would you describe what’s happening in Haiti right now?

Mukherjee: We want people to understand two things. First, the level of urgency: There is a tremendous need for humanitarian assistance in Haiti right now.

This is the worst violence we’ve seen in the 40 years that we’ve been working in Haiti. Most of the violence is taking place in Port-au-Prince, but since that’s the main entry point for the supplies people in Haiti need to survive and the economic center of the country, that means the suffering spills over throughout the countryside.

I wish things were easier, but I’m also proud to be able to continue to accompany my Haitian colleagues, and the people of Haiti, supporting them however I can.

Joia Mukherjee

I was just on a call with our team in Haiti trying to figure out how to make sure that we can provide IV fluids, medicines women need if they’re in labor, and all the other supplies you need for medical care. Even with the crisis, people are still living their lives, which means they’re still getting sick and they’re still delivering babies.

The second thing people should know is that there are amazing people on the ground in Haiti who are willing and able to help. As precarious as the situation is, we have some of the best, most dedicated colleagues working to provide care to as many people as possible. They just need support.

HMNews: Even with that solid foundation of personnel, it doesn’t sound like a recipe for a quick fix.

Mukherjee: This kind of work takes time and a long-term commitment. But investing that time in recent decades has helped us build a health system that has the kind of flexibility and resilience that Haiti needs right now.

The staff running PIH’s operation in Haiti is fully Haitian. As tough as these times are, it’s a great consolation to know that the Harvard medical community had a role in building that capacity.

Working with faculty, students, and staff from HMS and Brigham and Women’s over the last 40 years, we’ve focused on enriching the Haitian team’s skill set. People from the Harvard medical community have also helped develop training and residency programs in Haiti. So now there are home-grown specialist nurses and doctors who are really committed to being there for the people of Haiti.

HMS faculty, students, and trainees have also supported PIH’s work in Haiti by conducting research that helps document successes and identify areas for improvement.

HM News: How has what you learned in Haiti informed your work at Harvard?

Mukherjee: We’ve faced many challenges in Haiti over the years, including learning how to deliver care for people with HIV in rural villages hours away from the nearest hospital, vaccinating people against cholera in the midst of an outbreak, and helping people heal and rebuild after earthquakes and hurricanes. Some of those lessons inspired us to create a new kind of master’s program in global health delivery, which launched at HMS in 2012.

We wanted to give people who work in places like Haiti the skills to answer complex questions about how to create and maintain a health system on their own. We also wanted people to share and build on their own experiences and perspectives from living and working in those settings.

The program is now 12 years old, and some of our graduates are in top leadership roles at PIH in Haiti. They include Maxi Raymonville, the head of Mirebalais University Hospital, which opened in 2013 as a partnership between PIH and the Haitian Ministry of Health; Christophe Millien, the chief medical officer at Mirebalais; Ralph Blondel Charles, who is now leading the emergency response for the organization, and Kobel Dubique, who leads the research efforts for the team.

Partners In Health supports 12 public hospitals in Haiti, and they are among the only ones in the country that are open right now. Having leaders who can plan, implement, manage, analyze, and improve complex systems on the fly is a big part of what’s enabled us to keep the doors open during this emergency.

And these aren’t only trauma centers or scaled-back emergency operations. We do provide lots of urgent care, but we’re also still doing surgical, mental health, maternity, pediatric, and other kinds of care.

HMNews: It must be even tougher to keep people healthy with growing food insecurity and hundreds of thousands of people who have lost their homes due to the ongoing violence.

Mukherjee: That’s something else we teach our master’s students — an emphasis on what we call the social determinants of health.

What are the social, historical, environmental, and economic forces that make people sick and make it harder for them to get well? Food insecurity, water that may be contaminated with cholera, lack of safe housing, and overall insecurity — all of those things, of course, make people sicker.

So it’s not only that they can’t get the care they would otherwise need; they also need more care.

Long-term solutions are important here too. That’s why, many years ago, PIH built a factory in Haiti to make a ready-to-use therapeutic food to treat malnutrition.

We make a nutritionally fortified peanut butter using peanuts that we buy from local farmers. We don’t have to rely on imported peanuts, and we can provide those small farmers with a livelihood. Some of the ingredients, like vitamins, we have to bring in from abroad, but so far we’ve been able to keep that going.

Our supply isn’t enough to feed the whole country, but we can provide kilotons of food for children in two very large catchment areas in central Haiti who have severe malnutrition.

HMNews: The team on the ground in Haiti clearly has their work cut out for them. What can people on the outside do?

Mukherjee: The key is to hold on to hope. With all the awful headlines about Haiti lately, people tend to throw up their hands and say there’s nothing they can do. But we don’t believe that.

One way people can improve health for those most in need in Haiti is by giving money, if they have the means, or by using their voices to call for humanitarian support. Plenty of Haitians are doing the hard work to help their neighbors; they just need the resources to pay for health care supplies, safe housing, food, fuel, and other materials. If the ports are closed and the roads are blocked, we’re going to need airlifts to get food and keep the supplies of medicine flowing.

HMNews: How do you see the next chapter in Haiti’s story playing out?

Mukherjee: I have a hard time looking too far ahead when we’ve got so much work to do right now.

The current political situation and the violence on the streets of Haiti are obviously very serious problems, and they will take some time to solve.

But there are things we can do today to make the lives of ordinary people in Haiti much better.

Our team is already working on them, every day.

I wish things were easier, but I’m also proud to be able to continue to accompany my Haitian colleagues, and the people of Haiti, supporting them however I can.

The news media tend to focus on the violence and the chaos, which paints a picture that Haiti is ungovernable, the kind of place where there’s nothing anyone can do to help. I hope our work can be an antidote to all the despairing news.

Our department at HMS, and the whole world of global health equity and social justice, have been so enriched by the Haitian people we have worked with — our patients, students, colleagues, faculty members, friends, and neighbors. They have a spirit that combines grit, resilience, and a passionate desire to help one another. My greatest teacher has been Haiti and my Haitian friends.

After all these years there’s still more we can learn and more we can do to help one another.

This interview was edited for length and clarity.