Webcast: Ten years after Haiti's earthquake, medical care is in crisis

Good evening and thank you for tuning in to the Doctors Without Borders webcast. Ten years after Haiti's earthquake, medical care is in crisis. I'm Nico D'Auterive, senior press officer for Doctors Without Borders, USA and communications advisor for MSF in Haiti. I'll be serving as your moderator this evening. Thank you very much for joining us.

Just some housekeeping before we proceed, throughout this evening's discussion, you'll hear us referring to MSF. MSF is Doctors Without Borders' official acronym and it stands for our French name, Médecins Sans Frontières. The discussion will last about one hour and then we'll move into the Q&A. For viewers watching on Livestream or the Doctors Without Borders' website, we encourage you to use the chat function which you can access by clicking the icon in the upper right hand corner of your video screen.

Please note, you may need to create a Livestream login. Once there, you can type and post your questions, which will be answered by MSF staff monitoring the chat. Selected questions will be handed over to me for the Q&A session. For those of you joining us on Facebook live, you can post questions in the comment section and we can respond to you there or pass the question onto our panel here. First, let me introduce our panel.

Vania André is a first-generation Haitian-American media professional, born and raised in New York. Vania has covered the Haitian community for almost 10 years and worked with major media outlets, including NBC and ABC news. She is board chair for the Haitian Times, one of the oldest publications in the Haitian community and the leading media outlet covering the Haitian Diaspora in the US.

In April 2016, she received the Excellence in Journalism award from the Society for Haitian Research and was named one of 40 Under 40 by the Star Network. Next, Anne Chatelain, is MSF deputy operations manager for Haiti based in New York. She first worked with MSF in Darfur in 2005 as a nurse.

Since then, she has worked for MSF primarily as a project coordinator, head of mission and emergency coordinator in the DRC, Central African Republic, South Sudan, Pakistan, Nigeria, Cameroon, India, Libya, Syria, Liberia, and Lebanon. In 2010, Anne was the project coordinator for MSF's Saint Louis project in Haiti. She holds Master's degrees in public health and public policy.

Lastly, Jane Coyne, was recently head of mission in MSF in Haiti. She began working with MSF in 2003, leaving behind a career in the corporate world. She was based in MSF's Paris office as the program manager responsible for MSF's activities in Sudan, South Sudan, Central African Republic, Kenya and Georgia. Jane has also served for three years on the board of directors for MSF, USA.

In fall of 2019, she spent three months as head of mission in Haiti and oversaw the opening of MSF's Tabarre trauma hospital. Thank you to all of our panelists for joining us for this important conversation. As our viewers will remember, 10 years ago, on January 12th, 2010, a magnitude 7.0 earthquake devastated Haiti. MSF, which had been present in Haiti for 19 years prior to the earthquake, lost 12 employees that day.

And two of the three MSF-supported medical facilities were seriously damaged. Before we begin the discussion, we have a short video we would like to share with you featuring two of our local staff members retelling their experiences during the earthquake.

Vania, you had family living in Haiti during the earthquake. Can you recall for us what it was like... Where you were when you learned of the earthquake and what it's like watching it from the US.

Sure. So I actually was still in school when I found out about the earthquake. I was coming from class and I got to my dorm. I turned on the news and I just saw Haiti plastered all over CNN. And for me, a lot of emotions were going on all at once. For me, it was a lot of shock and awe because it was the first time that I had ever seen Haiti on the national news landscape. While this is not the first time, it was the first time for me when Haiti had been making the news rounds decades before I was a child.

So for me, that was the first thing, was like, wow, this thing is happening in my country and my family's country and the world is taking notice. And then also, it was this lack of communication that you were cut off as someone that's been a member in the diaspora. You have family, there's real no way to communicate, lots of confusion in the days after and where to go for information, who has the right information and just overall sense of confusion and fear.

But one thing I will say that really sticks out to me about that experience and finding out about the earthquake was that in a way coalesced a generation of Haitian-Americans that didn't have a relationship with Haiti before or had grown up in a country where I feel like our culture or our background was put to the back seat because it was really just more about integrating yourself into American culture or just not really being cognizant or being aware of your cultural ties and how important that was.

So out of that earthquake and having conversations with other friends and people like we always knew were Haitian-American, it wasn't such an important part of our identity.The earthquake brought that all about and it really spurred a generation of Haitian-Americans that were inspired to learn more about their country, especially because now, it was being talked about on the world stage and people were looking to you as some pseudo ambassadors to know all this information in a and to be able to guide people.

And we were learning with everyone else. So learning about the earthquake and just being here in this country while it happened, you felt very removed or still very attached and in this weird limbo area of not really knowing where your places and how you can really help.

Anne you were actually working in Haiti for MSF in 2010. Following the earthquake, MSF mounted one of its largest ever emergency responses, helping 350,000 people in the first 10 months. What were the main priorities there in the field directly after the earthquake?

So just after the earthquake, the main priority was to look for our colleagues, the team, because as you said, some MSF facilities collapsed during the earthquake. Some of our colleagues passed away. So it was really the first things that we have tried to do. Then it was... We are trying to organize medical care the best we can do in the worst condition because again, our hospital collapsed.

And so, we were trying to find innovative solution to be able to do surgical procedure and in the respect of the high chain rules to provide the best care as we can in the worst condition. So this was just after the earthquake. Then the challenge was more a logistical challenge with supply, because when you have the patients, you need to have medicines to be able to provide care. So the challenge was to import goods, so medicines, gauzes, surgical sets.

But the airport was closed. So the plane, the five planes landed in Santo Domingo, and then it was to organize the movement for the trucks from Santo Domingo to Port-au-Prince and it was quite complicated. Then as our hospital collapsed, we open what we call an inflatable hospital. So it's a hospital under tents. So it was again, the objective was to be able to provide good quality of care in a basic working condition.

So it was quite challenging as well, but we did manage to do that and to do some really technical and specialized care. So we had the capacity to do internal fixation to be able to... It's a specialty of trauma surgery, but a complicated one. Another challenge, because now, we're speaking about the medical care, but then the Haitian people lost their houses. So a part of the job of MSF is to provide care, but as well to provide what we call non-food items, so like tends to provide that decent living condition to the population.

So we are trying to do that, but it was difficult because as any organization, we have our limits, meaning that we did not have enough tents for all the people who lost their houses. So we organized non-food item distribution in buses. So meaning that we were taking people in a bus, we were organizing the distribution and then when the distribution was done, we were dropping the people in other location to avoid security incident, because when you have this kind of goods, it's a scarcity, so anyone wants this item.

So this was another challenge. Another challenge was to hire the people, medical staff, non medical staff, between by memory. Before the earthquake, MSF was managing four or five health facilities and we increased our medical offer to 26 health facilities. And we increased the number of staff from 800 to 3,000 employees, so colleagues. So this has to be organized as well. And again, to organize this kind of recruitment is complicated because anyone is looking for a job. So this is what we had tried to do just after the earthquake.

Thank you. And in the years following the earthquake, I know MSF continued to work in Haiti and expand its projects. Can you explain some of the additional work we did in those years and some of the major health crises that we faced in that time?

So after the earthquake, Haiti had been affected by another crisis, which was the cholera outbreak. So MSF was involved in the response to this massive outbreak. Then Haiti was affected by a hurricane. So the same MSF provided support. We were, in addition to these emergency responses, MSF was involved in maternal health care because we were running a maternity and we were running I mean, hospital with surgical capacity.

So we were involved in the medical offer, generally speaking, and other organization over time. We decreased our medical offer for good and bad and bad reason. One of the reason was to focus on other crises because the situation was coming back somehow to the normal in Haiti at that time.

Thank you. Jane, since you just came back from Haiti a couple months ago, maybe you can explain what MSF is doing now and how the health needs have developed more recently in Haiti.

Thanks. Today MSF has five projects in the country and the projects range, they cover a variety of medical areas, some more general than others. So there's a hospital project in the South that focuses on maternal and child health care. There's a project in the neighborhood of Martissant that focuses on response to urgent care.

We have a burns hospital in Cité Soleil and a trauma hospital in the neighborhood of Tabarre, the last three projects in Port-au-Prince. And we also have a sexual violence program that's based in Port-au-Prince and Gonaïves. And so, what you can see from that is that the activities of MSF are relatively specialized and that reflects the fact that thankfully, the crisis that we had in 2010, things are considerably more stable.

And so, the kinds of medical problems that people have in Haiti are the same kinds of medical problems we have here in the United States, a combination of chronic diseases and infectious diseases and then other acute needs like the need for a burns hospital or the need for trauma care.

I think one of the things that's particular to Haiti and is important to at least... I'm sure we'll get it at some point is the reason that the trauma hospital was opened is because there's been a great deal of violence in Haiti and that is deeply affecting the population. And so, we know that that violence is real.

The day we opened the hospital, the first day, we had five gunshot wound victims. And in the first five weeks, I think something over 50% of the patients that required care were gunshot victims. And so, I would say that the needs of the population are very similar to all places that we work.

And one of the realities is that the health system had stabilized and improved. And one of the things I think we'll get to in the conversation is how access to health care has changed recently, but maybe I'll toss it back to you and you can lead us onward.

Sure. Thank you. Speaking of other things that you were talking about, I recently returned from Haiti myself and I was there in December and January for the 10-year anniversary of the earthquake. And the media asked a lot of questions about what NGOs had done since the earthquake, what went wrong, there was a lot of focus on these negativities.

And the focus was really on the efforts done by NGOs related to the earthquake, but as far as the violence narrative. Other stories that maybe would be to tell a lot about life in Haiti and are interesting were left out of these conversations. And so Vania, I wanted to ask you, since you work in journalism, what you want people to know about the situation in Haiti that maybe isn't being said in the media and hasn't been heard.

So one of my main frustrations when it comes to covering Haiti is that I find that it's an all-or-nothing approach, that a lot of the coverage and we at Haitian Times also sometimes we are guilty of this as well and we have to take a very intentional approach on our editorial strategy for this reason is that it's very easy to add to coverage of a narrative that's already there.

So for example, around the earthquake, a lot of the coverage was really watchdog reporting, accountability coverage, and really taking a look back at what had transpired over the past decade and highlighting what was not working, which is important. That's very important and Haitian people want that. So that is part of the reason why that coverage exists.

But at the same time, one of the things that was very striking to me in my conversations with people, especially when I went to Haiti and speaking to people who were still working in Haiti after the earthquake, was this real sense of disappointment because the narrative is about how things are not working, how the country has been plagued with scandal and fraud and it's from everyone, from the government to international actors to personal relationships.

And all of that for them, they really felt like it put this dark cloud over the work that they've done, which is important that it's still highlighted because these people are still on the ground, still trying to help provide services that... To be quite frank that the population would not have access to because the government isn't able to provide certain coverage.

So for me, it was really important and when thinking about our coverage of the earthquake of looking for success stories. And one success story that we did come across in healthcare was mental health. So there was a lot of attention, which I'm happy to see that after the earthquake, it wasn't just about physical ailments and helping people with physical trauma, but there were also very concerted efforts to help people deal with the emotional and psychological trauma that comes with dealing with something like this.

So that was a story that it was important for me to highlight, that the perception of mental health in Haiti changed drastically over the past decade. People are more open to speaking about some of their issues. As someone, I'm Haitian-American, a lot of the sentiments that you would find when talking about mental health, it's like, well, you just leave it to God or there are more important things to worry about and it all works holistically cause physical and mental, it's all one.

So I can understand this coverage that was there about accountability and really trying to get an understanding of why things are the way they are in Haiti, but at the same time, it was really important to highlight voices of people that were still doing valuable work, which is why I was particularly pleased to come across your colleagues and the report that you shared to be able to see like, wow, all of this was still happening while we were also having conversations about the scandal with the Red Cross and Oxfam.

So all of these happen together and not in a vacuum. And I think that's really important for journalists to think about when they cover Haiti.

I'm glad you mentioned mental health. That's definitely something that's really important to MSF and to our projects in Haiti, both with the burn victims who face a great deal of discrimination and stigma, as well as for people who have been victims of violence, including sexual violence.

So it's definitely something that we work on quite a bit and you saw our colleague in the video who works on mental health and is doing an amazing job there. So one thing we mentioned a little bit was the violence in Haiti. And this is something that I think a lot of people maybe don't know about or don't realize the effect that's having on daily life.

There's both the urban violence and then also, more recently, we've seen a lot of political violence as part of the political crisis that's happening. So Haiti has been in a political and economic crisis for the last a year and a half since 2018. I was wondering if someone could give our viewers a little bit of understanding of what is happening in Haiti and how daily life has been affected in Haiti recently by this crisis that they're experiencing.

So just to give you a concrete example of the situation, schools were closed from September to December, just because there were no yeah... Schools were closed, for instance. Then it's difficult for people to move from a location to another one because of the violence. Then we had, on our side, to develop some strategy to make sure that we have nurses and medical doctors who reach in our hospital. Maybe you could describe what we did.

Sure. So I'm just going to introduce the term “peyi lok”. So that's in Haitian Creole and it means essentially locked country. And in the Fall, the political opposition implemented this strategy of peyi lok to try to shut everything down with the objective of getting the president to stand down. And the impact of that was really practically.

They didn't want anything to function, so no government services, they didn't want people to be able to circulate on the roads, they were blocking public transportation and that has lots of ripple effects. So as Anne was saying, practically speaking, it was almost impossible for our staff to get to the hospital and home safely.

And so, what that meant for us in managing medical activities is that we would send our ambulances out in the morning to collect staff and bring them back to the hospital, which is logistically complicated. But when you think about doing that in the context of Haiti, October, 2019, we were moving more on the roads than probably almost any other organization. And that is a risk. And it was a risk principally for the staff that were in the cars.

And that was of great concern to us. But the trade off in that was, was that we were able to continue to care where lots of other medical structures really struggled to function in the Fall last year because of, number one, the staff not being there, but in addition, if trucks are not moving on the road, you don't have things like fuel and you don't have gas to heat the sterilization and you don't have oxygen to provide to your patients.

And so practically speaking, the security concerns and the economic issues resulted in a dramatic decrease in access to healthcare and in the fall that certainly preoccupied us and is something that in response, MSF has increased its medical activities in the country.

I know when I was in Haiti, some of the projects mentioned, they'd had an increase in certain types of patients during the peyi lok periods. So for instance, we had an increase in children who had been burned at home at our burns hospital because school was out for months at a time. And as well, we had some patients who had been burned in street fires that were used in protest or with Molotov cocktails which were used.

I met one patient who... He was just taking the bus to school and a Molotov cocktail was thrown into the bus and he was injured very severely. But at the same time, some of our projects really suffered and were... There was a shortage of patients as a result of the fact that the patients couldn't reach other facilities. So in the case of a patient with burns, if they don't reach treatment within the first couple of days, they can develop a life-threatening infection.

And as well, our sexual violence project, it's not that sexual violence decreased during this time, we don't think, but the number of patients who could actually make it to a facility really decreased. I know, you were telling me a personal story about your father when he had a health problem more recently in Haiti. Maybe you share that.

Sure. I think this is a really good real life illustration of what acts, but not having access to health care, depending on where you are in the country is really important. So my father usually spends about half of the year in Haiti. And last February, he called me kind of in a panic on a Saturday night saying, he needs to come to back to New York immediately tomorrow, as soon as possible because he was having trouble breathing and just really wasn't doing well.

And he wants to go see a doctor and the doctor told him, you need to call your family and tell them to buy you a ticket to come to the US because there's nothing we can do for you. And for me, it was again another eye opening moment where it's unfortunate that you cannot go and really have a life in Haiti and not know that you have access to healthcare.

And there are simple things that can be treated, but just because you just don't have the access to, it becomes life-threatening. So we pay up and bought a ticket for my dad, he came. And literally, the ambulance was waiting for him as he got out of the flight and come to find out it was blood clots all over and the doctors just were like, we cannot help you. You need to just go to the US or go to the ER. And that was the answer.

I know in some of our projects, we've had trouble referring patients to hospitals because many of the hospitals have been closed. They're not taking patients since the crisis started. Maybe Anne or Jane, you can speak to why the hospitals aren't operational or how the hospitals have been affected by the crisis.

As Jane was saying previously, to be able to provide care, you need nurses, you need medical doctors. So just basically, if people cannot reach the hospital, you do not have care providers within the health facility. If you do not have oxygen, you cannot care a patient. So just this kind of examples, but I would like to go back to our medical offer in Haiti, which is quite specialized.

So because MSF is running the stabilization center, a burn hospital, a trauma center, and sexual violence care plus a support to smaller maternity. But in Port-au-Prince, we are providing specialized care. And we made the difficult decision to target lifesaving... I mean to provide care to a really acute situation, so to life saving surgery because we have as well our limits.

So today, we do not have the capacity to do primary healthcare while it would be needed. So it's a difficult decision for us to do that.

Yeah. And maybe just to add to that, because we haven't talked much about the economic crisis. So I think it's really important to understand that I think the overall purchasing power in Haiti is deteriorated by on the order of 50% in the last few years in a combination of inflation and the exchange rate between the Haitian gourde and the US dollar.

And so there was huge economic pressure. During the peyi lok, many, many people that had jobs in the formal economy lost their jobs. So we saw notices of hotels and restaurants and the big soda factory shutting down and firing people. So the economic impact of the peyi lok and the state of the country today is tremendous. And frankly, I think that has a huge impact on access to healthcare.

And the reason it has such a dramatic impact is because, and this is the same whether you're going to a private hospital or public hospital, you need to pay fees and the hospitals need those fees in order to be able to function properly. And so, one of the things we really saw in the second half of 2019 was that there were hospitals that you basically had to pay at the door to get in and you had to prove that you had the capacity to pay.

And they generally didn't have very many patients because fewer and fewer people were capable of paying. And then there were hospitals that were taking in patients without respect to whether they'd capacity to pay and they were completely overwhelmed. So there was a maternity hospital in the Capital in Port-au-Prince that was doing maybe an average of 150 births a month in the beginning of 2019 and it crept up to 220, 250 in the summertime.

And then it was 320 in September and 400 in October. No hospital can... That's a really steep increase in capacity that they were trying to manage. And they were confronted because patients couldn't find anywhere else to go and they were willing to take them in. And so, there was a real challenge with access that you mentioned.

And I think I'd just like to touch on one other thing that we haven't talked about in this health access is, during the Fall with these waves of violence, it wasn't just in the Capital, it was in many cities and even rural areas around the country. And one of them that I think provides an interesting example is the area called Les Cayes, which is in the South of the country.

And there, the hospital didn't function because in fact, during the waves of protest, the hospital had been looted. And so, the hospital couldn't physically function because it didn't have all of the equipment it needed. And so, I think from all of these aspects, the security constraints, the material constraints, the looting and the economic side, the result was that there's been just a dramatic decline in access to healthcare in Haiti in the last 60 months.

Yeah. You mentioned that sometimes you have to, you have to pay for a service before coming in, which is very difficult with such high unemployment rates. As well, I mean, even in some hospitals you have to buy your own supplies and bring them with you to the hospital because the hospitals have such a shortage.

I know in Les Cayes, like you're referring to, we often find you actually have to bring your own blood donors with you before you'll be admitted because there's such shortages of blood due to looting that happened during peyi lok. So for sure, there was a real difficulty for people today to be able to access healthcare.

Vania, I'm wondering, from your perspective, I'm sure you've heard from the communities a lot about how the economic situation is affecting them. If you could speak a little bit about just what that looks like for people living in Haiti.

So again, just tilting back to media coverage, a lot of the stories that have come out of Haiti about how peyi lok and the economic crisis has impacted daily life in Haitians has really been geared toward pèp la, the masses. But there's also a small middle-class community in Haiti that touches on what you spoke on that has been severely impacted in a way that I think may be a little bit harder for them to deal with and rationalize, just off of this simple strength that if you were accustomed to a certain condition, you know how to deal with it.

What we're seeing in Haiti are patient professionals that are a part of the formal job market, that are being impacted in a way that I don't think that they've ever experienced or seen. So you have everyone from just average small business owners who now cannot have... They don't have customers. So now, that trickles down and they have to lay off their employees.

You have people who may have been making their income by rental property in Haiti, whether they were living in the country or not, they are now people not able to pay their rent because they no longer have their jobs. And one friend of mine that was a situation that had not even occurred that essentially, he took a pay cut because the value of the Haitian good went down, so went down so much compared to the US dollars.

So it's these little things that I don't think we think about when considering how it impacts daily life that really does add to this overall doom and gloom feeling in Haiti that really has a lot of people feeling hopeless and unaware of what the future is going to look like.

About that, I would like to add one point, that there are some comparison done between the current situation on the crisis of 2004. According to my, because I was in Haiti in September, so I met some colleagues, and we're working with in 2010. And they are telling me that today, the situation is worse than in 2004 and because today, the middle class is affected as well by the economic crisis, which was not the case 15 years ago.

Yeah. And I think actually, an example we have within MSF, maybe Jane you can mention, you can talk about the number of applicants we received for our most recent opening in the Port-au-Prince.

Yeah. So during the period, I was in Haiti, MSF opened a new 50-bed acute trauma hospital called Tabarre. And their legal requirements when you're hiring a bunch of new people, you have to post the jobs publicly and of course, you want people to come, so you have to. And we were completely overwhelmed. So in the end, I think we received more than 37,000 applications for about 300 positions.

And that not only is something MSF has never dealt with, but I actually talked to people that work in big corporations in Haiti and they had never heard of anything like that either. And I think that it reflects... First and foremost, I think it's great that people want to come work with MSF. So that's terrific. But it certainly reflects the depth of the economic crisis.

And interestingly for us, when you looked even inside the numbers, there were lots of really well qualified people. And maybe this is a good time to say that one of the great joys of working in Haiti is the fact that unlike many other countries that MSF works in and that I've worked in, we've all worked in, in Haiti, you can find surgeons and anesthetists and really qualified, well qualified specialized medical staff.

And when you look inside that 37,000, it wasn't just some of the less skilled positions, it was also the highly skilled positions that we had a lot of applicants for, which was really... It was sad. It was hard for the team that had to go through all those files.

One thing I want to add to that comment, so one statistic that you hear often when talking about Haiti and diaspora is this 80% brain drain in the country, that all of the skilled labor professionals, they leave. But a lot of that has to do with exactly what you're talking about. This is the case and it's unfortunate and we talk about it as a problem and how do we fix it?

But the main issue is that there's political and economic instability in the country that prevents people who have the knowledge and skills to contribute to Haiti in a formal way, there is no opportunity. So they are forced to leave. I mean, I remember I was in Haiti I think this was January, 2019 or 2018 and one of our drivers, he was saying how he literally... His plan is to leave and to go to Chile. Everyone he knows, they are going to the Chilean embassy.

There are lines wrapped around because everyone is just looking for a way out. And people that I do know that are part of that small middle-class, for them, it's a constant struggle of thinking, do I stay here? Do I stay here? Do I try to give? because staying in Haiti within itself unfortunately is a political statement, especially if you have a certain means, when you know you can technically live elsewhere and make a life elsewhere, it's a very intentional political statement to stay in the country and try to live throughout all of this.

So one message I really want to impart on the audience and whoever's listening is that we can't talk about these problems like, there's 80% brain drain in the country when there is nothing conducive in Haiti, the majority of the time that allows for opportunity for that population to stay there.

Yeah. I know with our staff and with a lot of the medical staff in Haiti, many of them are trained either in Haiti, at great institutions, but also, many times in Cuba or the United States or Canada. And so, you do have these extremely skilled professionals, but unfortunately, just not enough jobs for them.

We're actually receiving quite a few questions online right now about recruitment. So if I could pivot to that, one question that was asked is, how does MSF recruit during a large scale emergency like the earthquake? If someone could maybe answer that?

So the way we do a recruitment during larger emergency is the same as the way we do recruitment in case of a non-emergency situation, meaning that we open position, we organize written test and then oral interview.

The difference between an emergency mission and a regular mission is that you will provide more resources to be able to organize in the quickest way to recruitment. But then the process is really the same and the recruitment are based on competencies.

Thank you. We have another question here from Dawn on Livestream. He says, I help oversee a clinic in Gonaïves and getting supplies to the clinic in a timely manner is always an issue and he's curious how MSF manages to get our supplies, especially during these crises, these issues.

So Gonaïves is along one of the national roads that was particularly blocked in the Fall and really, really basic supplies were unable to get there. There wasn't fuel delivered for weeks and weeks at a time. And so, I have sympathy for their problem. In general, MSF organizes all of the transport ourselves.

And I know that during the peyi lok, MSF was able to get the required supplies to our project in the South instead of using big trucks, which were quite vulnerable and harder to move, we used only MSF vehicles to transport what we needed to the projects. And so, but that in and of itself was challenging as it can be in many places, not just in Haiti.

But during the peaks of violence throughout the Fall, there’s kind of a constant negotiation for with the people that are manning the barricades or the barriers to provide access. And that's a long-term negotiated space that you're trying to create to make sure that MSF vehicles can continue to move.

And so, I don't think there's any magic bullet with that, it's having the resources available, the trucks and the capacity to be able to move things, and then having patience, cause not every day, you can take that road, and just negotiating with people, explaining what you're trying to do.

Yeah. I know MSF has really been fortunate that due to the relationship we have with the communities in Haiti, we have still been able to move during some of these crises. I know I met a patient who was in a very large bakery fire explosion that happened in Les Cayes, probably while you were there.

And our ambulances had to bring these patients all the way to Port-au-Prince cause we're the only burns hospital in Haiti that can treat these kinds of severe burns. And so, he said it was like five, six hours in the ambulance and constantly being stopped by barricades and having to negotiate access all along the way.

And as well, our maternal healthcare project has the same problem. We used to be able to go, when we had patients that needed to be referred to hospital, we used to go one hour away to the nearest hospital and now, we're looking at going up to five hours. And sometimes we've faced barricades along the way and had to negotiate access. And-

Maybe just one quick comment on the explosion in Les Cayes because I think it's important to be clear that that was quite a collaboration. So the patients came to the MSF burn center, but there were a lot of different people orchestrating their arrival. So the Haitian national ambulance service actually transported many of the patients.

There was an air transport that several other organizations were involved in. And so, that was coordinated through the ministry of health. And I think is a good example of collaboration in order to do the right thing, to take care of patients.

Thank you. I think actually that answers another question we have here from Elizabeth on Livestream was asking, how MSF partners with other local or international organizations in Haiti. And I think there's definitely these examples of when we work together to share resources. I know we've also done some work in the hospitals to help rehabilitize the areas.

I don't know if there's other organizations that we're working with, but yeah, I think that's a great example of collaboration. Let's see. Oh, one other example I actually wanted to give about the supply issue is that when I was in Drouillard in the burns hospital, they pointed out that they've been stocking up on fuel, though we now have like twice the stock that we used to just because we're so afraid that we may not be able to get fuel again.

So I think that's really important to keep in mind that even the most basic supplies, oxygen, fuel, everything is hard to get at this point in time. Let's see. I think that's all the questions we have right now. So I have a couple more questions for you. We focused a lot on the negative points of what's been happening in Haiti.

I'm wondering if there's some positives we can take from this conversation, some positive things that are happening that you've seen there. Maybe Vania, if you have any examples.

Sure. One thing that has been surprising and refreshing, that has come out of the political and economic crisis in Haiti at the moment is that I'm seeing a lot of interests in the diaspora being more politically engaged in Haiti. So when you think back about this past decade, there are a few things that stick out to me. And one really is the push that the mortality administration made to encourage tourism in Haiti.

And I find that that was a very attractive appeal for a lot of people in the diaspora because again, going back into that generation of Haitian-Americans that were removed, but finding their Haitianness again after the earthquake, that was a specific appeal that we could help share and amplify that message Stateside or in Canada. So for us, it was really like an opportunity where we could have events, conferences.

For example, there was like the Haiti Tech Summit, there was spring break in Haiti, a lot of things that were very foreign to us as a generation because we grew up with this very strict narrative of, you don't go to Haiti, it's super dangerous, it's just not somewhere you go. So we saw all of that change within that 10 years. And then you see within the past year, year and a half, all of that has been undone.

And what that has caused is a lot of questioning within the diaspora, around a lot of people around my age. And some of that has to do because not being aware of history of patterns and things that may have happened before, but then also really trying to understand how is it that we had a very unique moment where Haiti had the attention, the hearts and pockets of the world and that's still was not enough to help lift the country in a way that we had all hoped and anticipated.

And one of the things that really sticks out to me when I was in Haiti last, I think it was end of October, beginning of November, was this sense from people that what Haitians are experiencing at the moment is another type of earthquake, but one that they can't really conceptualize because before, it was a natural disaster, but now, it's like man made in their perception.

So what we see in the Haitian diaspora is this strong interest to A, try to become more politically active in Haiti and assert our influence there, especially because the diaspora contributes such a large portion of the GDP in Haiti. But then also I see a lot of strategy happening where people are thinking of, okay, we may not be able to have a voice in Haiti, but how do we put pressure on our elected officials here? How do we put pressure on friends of Haiti here to maybe move the needle on what's going on in Haiti?

And I think that's very important in just in an overall context, because the narrative around millennials is that we do slacktivism. We think if we slap a hashtag on something that were being involved and we're not as engaged as we should be and I've actually seen the complete opposite within my community and a lot of my peers are very engaged and they are becoming even more so now on a level that I hadn't even anticipate because of this crisis.

Thank you.

Maybe one other bright spot is, I think it's a really interesting perspective that you bring up this. I think there is a stirring of engagement and I do think it's coming from more youth youthful place and I think that's really powerful. Speaking medically since we are MSF, I think it's important to mention cholera. So cholera was a devastating epidemic.

Hundreds of thousands of people were affected by it, but it has been a year since the last confirmed case of cholera in Haiti. And that is distinctly a bright spot and we hope that Haiti will continue to be cholera-free. So that's a good note.

Thank you.

And I would say again from medical perspective, as Jane said already, the positive point of Haiti is to, as Vania has said, the positive point is the people because in Haiti, you can find qualified people, surgeon, anesthetists, nurses, finance people, log, etc. So this, it's really the trends of Haiti.

Thank you. And then also, I was wondering what could both diaspora, other people outside of Haiti who are interested in what's happening in Haiti, the international community, what can they do to support this time and in this time and help Haiti move towards more positive future? What do you think?

Just what to realize that we would like that other organization pay more attention to Haiti because as we described the situation, today was this economic and political crisis. The situation is complicated, it's difficult, access to care is limited. So this, it would be an objective per se.

Maybe just to add on that, I don't have all the numbers in my head, but at the peak, I think something on the order of $2 billion went into Haiti in a single year, and then it carried at more than a billion dollars a year for the first five or six years after the earthquake. That's a lot of money that fueled jobs and non-governmental organizations and other actors into the country.

And one of the questions that I frequently got asked mostly by people outside the country of who else is working there? What are they doing? What are they working on? And I think it's really astonishing and important to note that there's just so much less funding for development activities and even emergency response activities that there aren't other international.

So in the health side, there are very few other international actors working in Haiti. So partners in health is a notable exception, but there really are very few others. And so, I think when we say more people need to pay attention, I think there's tons of unmet needs that other actors could play the part.

And then I would just add, and this goes more along with what Vania is saying, is that the solution has to come from Haitians and it's a political and economic crisis. We're a health organization. We're not going to solve those problems, but I sure would like to see a strong and vibrant solution come out of the Haitian community in Haiti or in the diaspora.

I would just really encourage, the audience, anyone who's ever had just even a little interest in Haiti to really be purposeful in trying to hold back cynicism when it comes to Haiti, which can be very difficult for a number of reasons.

And I'm speaking to people who are Haitian, who are not Haitian, who have personal business stakes in Haiti, all of it, because what I found the most troubling and disheartening in our reporting, again, where the voices of people who were still working in Haiti that really were starting to feel unmotivated because the conversation has only been about scandal. So you see a direct resolve that people are not giving money anymore, people are not donating their time because the perception is that nothing works in Haiti, and if you do, it's a scam and you're going to lose your money.

And there's no accountability. That exists to a certain degree, but it also doesn't. And I just really would urge people to resist that urge to have Haiti fatigue and to look at everything at Haiti in a cynical way because there is still a lot of urgent need. And the simple truth of the matter is that the government is not able to provide all of the services that the people need. And this is a necessity for the country and the people.

Is there a way that you think the media can also help with bringing more attention to Haiti?

Yeah, it's well-balanced coverage. And it's tough because I understand as someone being in the media that a lot of what journalism about is about democracy-building and watchdog reporting and making sure that you are holding people's feet to the fire about what is not going wrong. But also, a part of that and it's because I work for a news organization that represents a community that I am a part of. So I have a double viewpoint.

So for me, it's important that the media also highlights success stories to help change this perception and this narrative, because I feel like when I go out into the world and I had to talk about Haiti, I feel like I'm fighting two fights. I feel like I am fighting this perception that everything goes wrong in Haiti and having to admit that there is, that comes from somewhere, but then also trying to show that Haiti is so much more than that, but having to put that narrative against a lot of cynicism, which is hard.

Well, I have another question. I have another question here. Eby on Livestream is saying that it was mentioned a few times tonight that mental health services have expanded during the time after the earthquake. And he wants to know or she wants to know, sorry, what worked well in expanding mental health services to the public?

I will say MSF's projects, quite specific communities that we're reaching with mental health. I know you mentioned that it's become more popular through, would you say that was due to media, social media, just the work of NGOs or...

So my direct experience really was just through some of the reporting that I did for the mental health story and talking with partners in health and really seeing how with Zanmi Lasante, how they really did a very community-based approach.

And a lot of it was just really interpersonal and also bringing in faith leaders, whether it was on Christianity side or bringing in traditional, voodoo practitioners or priest, priestess to really help give a well-rounded approach and showing that there isn't a right or wrong way to approach mental health and using language that people were accustomed to help explain what they were going through.

I think that has a lot to do with it was that cultural sensitivity that they paid attention to and figured out how to work with established people in the community that everyone trusted to help change this perception that mental health or mental wellness.

It's not something that's purely regulated to some of the extremes that we would think of, but it's something from making sure that you know how to cope with tragedy, how to deal with grief in a healthy way to dealing with mental illness and everything in between.

Thank you. Jane would you...

I guess I would just add that the Drouillard burns hospital for me was the first time that I felt like MSF did a great job of really integrating the mental health care into the overall patient and caregiver experience. Like, burns treatment is long and hard and it's hard for the staff, but most importantly, it's hard for the patient.

And I think that helping our patients understand what they're going through and helping them through this long, hard process, I thought we did a good job of that. And I think it's a really interesting part of the project. I think it's really well integrated. I like it.

Yes. So in 2010, it was already the case because so due to the trauma, we had mental health activity. So I was the project coordinator for one hospital in Saint Louis. So it was a trauma hospital. And in a hospital, you have the medical warrant in the morning, like medical doctor, nurses are going to check the medical condition of the patients at that time.

Mental health was part of the medical one. So surgeon were having discussion with the psychologist to be able to explain then to the patient what would be the best medical decision. And I remember some cases because just after the earthquake, there were many electric burns. So the two... And in this case of situation, to be able to save the lives, you have to do amputation. So you can really imagine that a life without two hands is more complicated.

And to be able to explain the medical decision to the patients, surgeon were working with a psychologist. And then I would say within MSF practice, having mental health today, it's really integrated to our medical office, so in trauma center, but as well, outside trauma center and more and more. We are developing a strategy and community-based approach.

So for instance, this is what we are doing in Liberia. And yes, so now, I would say generally speaking, mental health disease are more accepted within the community, even if it’s still a stigma worldwide.

Now, I'll say part of the community approach, I know when I was in Haiti, we had our open door days at Martissant emergency center where all of our projects came. We invited people from all of the community to come and visit the center and to meet our different projects. And we had the national staff was doing a play that they do.

It's more a health promotion to teach about some basic themes, but it's great, they have a staff member there who dresses as a baby. I don't know if you've met him. He's always there to help people who are in the emergency room. And so we have this adult man who dresses as a baby, talks as a baby. And there's also another man who dresses as an old man.

And so they did a skit, but they're also there every day just to take some of the tension away from patients who are waiting in the waiting room with these major injuries and everything. And so I think just having that approach of not just thinking about the medical side, but also thinking about the patients' mental experience.

So I think is really important. We've received another question. This one's from Wu. Wu asks, how did MSF maintain community trust amid all of the scandals that came out with other NGOs since the earthquake?

So the specificity of MSF is that we are funded by private donors. And so this, it's really a specificity which allows us to develop activities based on our own assessment. So I would say that our activities meet the needs of the people and it's maybe a part of the explanation. Maybe it's why we still have this distrust, this acceptances within the community.

Yeah. I don't know that this is necessarily specific to Haiti, but I think that as Anne was saying, the activities are relevant. But also, in general, working on health is maybe an easier place to work, to achieve trust. And MSF's approach is to provide excellent quality medical care.

And as Anne was saying, we have the resources, we identify the projects, we have the budget, we do what we need. And I think we're quite good at delivering on what we say we're going to do. And I think that fundamentally helps build trust.

Yeah. And just to go back to your experience in the Gonaïves, the way we negotiate our access to the road, to the community, it's because all the time, we are trying our best to engage with the community, with our patients.

So we are trying to discuss with our patients to understand their situation and know what we can do more and as well, to try to explain our limits. And by saying that, by being honest, it helps to develop trust. And this is what we do.

I think another thing worth mentioning is, in Haiti, just as everywhere in the world, most of the MSF employees are from the country where we work. And I think that's really important for trust and for being able to communicate in language and to really connect with the communities and understand the experiences of the communities.

And so, as you've already mentioned several times, our national staff there, our local staff is amazing and really, they do a lot of this work to make sure that we stay connected to the communities.

Wu has one more question, which is, looking into the future, what is MSF's strategy in Haiti? I know we can't speak. We don't know what's going to happen in five years or 10 years, but maybe in the near future,

No, we don't know what's going to happen, but for sure, given the context, our objective is to continue this trauma care, stabilization, emergency care, in Haiti.

Thank you. I think it's also worth mentioning here, we've just expanded with this new sexual violence project in Gonaïves and for now, continuing to treat sexual violence, maternal health care, trauma and burns. I think we may have one more question coming through. All right.

I think that's it from the Q&A. So thank you very much everyone. That's going to conclude our evening. Thank you to our panelists and thank you to everyone who's been watching. A very special thanks to all of you. And you can find this recording of the discussion at doctorswithoutborders.org/HaitiTenYears.

Also to learn more about MSF or to read our new report that came out called Haiti Ten Years On, please go to our website where you can sign up for our monthly newsletter or find us on Facebook, Twitter, or Instagram. And this evening's discussion is part of MSF broader efforts to raise public awareness about underrepresented humanitarian health crisis worldwide. So I want to thank everyone for your time and I think that would be it. Good night. Thank you.

Good night.

Thank you.

Thank you.