Fieldset
From a natural disaster to urban violence: how this team adapts to care for patients in Haiti

A devastating earthquake, armed groups, political tensions, fuel shortages, COVID-19. These are the crises that people in Haiti's capital faced in the span of just a few months. Nurse Nicolas Broca writes...

In Haiti, the context is constantly changing. One of the major things that struck me is that there's always something that you don't expect. You have to adapt continually.

Magnitude 7.2

Three days after I arrived, the August 14 earthquake struck southern Haiti. While the capital, Port au Prince, was not directly affected, our hospital soon filled with patients who had been injured in the regions to the south.

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Devastation in Haiti after the August 2021 earthquake
Destruction in the commune of Les Cayes following the earthquake

Because of difficulties getting around after the earthquake, some people with complex injuries only reached our hospital three or four days later, by which time their wounds had become infected. Some had even developed antibiotic-resistant infections, which are particularly difficult to treat.

Violence

In the week after the earthquake, the level of violence in Port-au-Prince was much lower than usual, as the city's various armed groups let people move more freely. But by the following week, that had changed.

Sometimes an armed group would attack people by setting their house on fire

People who had been hurt through violence started to arrive at the hospital in just as high numbers as before, while our wards were already full of earthquake survivors.

Burns

As head nurse, I was managing the nurse supervisors, nurse aides and the hygienists in each hospital unit. The hospital includes the only specialised ward for patients with severe burns in Haiti, which MSF relocated from the Cité Soleil neighborhood earlier this year because of armed clashes there.

People continued to arrive grave condition...

Burns patients have very fragile health, and caring for them requires a large number of staff. You always have to have someone monitor their vital signs, and the smallest problem can become a very big problem for a burns patient's body.

They are very vulnerable to infections and need repeated dressing changes, which means staff are needed to provide clean linens and sterilise medical instruments. Alongside the treatment for their physical injuries, with burns patients there is a strong need for mental health workers who can help them face the challenges.

Political tensions

Staffing the hospital became more difficult when transportation was shut down in Port-au-Prince. Political tensions, strikes and a fuel shortage prevented hundreds of staff members from commuting to work as they normally do.

At one point we had to reduce our admission criteria, accepting only patients who would not survive if they were referred elsewhere...

The city was completely blocked, and even though strikers allowed MSF vehicles to pass through their demonstrations, it was very stressful for staff members to be out in this environment.

Fuel shortages

Our logistics team told us they were struggling to obtain more fuel for our vehicles and generators, and at the hospital we only had enough to last us 15 days, so we had to do everything we could to limit our consumption while maintaining vital medical services.

Our staff all started working 24-hour shifts, to reduce everyone's movement in vehicles. We reduced the number of administrative and logistical staff, and at one point we reduced our criteria for admission, accepting only patients who would not survive if they were referred elsewhere.

However, people continued to arrive in grave condition, and there was generally nowhere else to refer patients with severe burns. In times of fuel shortages, people would stockpile fuel at home in unsafe containers, such as plastic bottles, and this led to accidental burns. Sometimes an armed group would attack people by setting their house on fire.

The pandemic

You don't hear a lot about COVID-19 in Haiti, but it creates challenges too.

We test all new patients, and to limit potential transmission of the virus we have a very strict limit on people visiting the hospital. But it's impossible to cut this completly: we must still allow children to have a family member present, for example. And this creates risks for patients and staff.

When a staff member tests positive, they must stay at home, and when a patient tests positive, they must be housed in a separate area of the hospital, and given oxygen therapy if needed. Fortunately, we have not so far seen COVID-19 deaths among our patients there.

I found my assignment in Haiti to be exhausting but rewarding. The staff are very competent and committed, and the level of medical care we provide is something to be proud of. It is very intense work in the midst of a crisis.

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