Haiti: Between denial and fears about COVID-19, health promotion on the front line

Fighting COVID-19 in Haiti amidst denial and fear

Haiti 2020 © Lunos Saint-Brave/MSF

PORT-AU-PRINCE, Haiti, July 6, 2020Amid the COVID-19 epidemic in Haiti, rumors about the disease and distrust of health facilities are causing people to delay seeking care. Nathalie Destiné Charles, Doctors Without Borders/Médecins Sans Frontières (MSF) health promotion team supervisor in Martissant, and Julie Rolinet, MSF health promotion manager in Port-au-Prince, provided the following account today:

In Haiti, there have been many rumors since the start of the COVID-19 epidemic. One of the most widespread rumors is that a fatal injection is administered in hospitals to increase the number of deaths linked to the epidemic, in order to receive more international aid. Another is that health facilities are testing a vaccine for the coronavirus on people without their knowledge.

We work day after day to counteract rumors and provide correct and factual information to the public as part of the health promotion team for MSF in Port-au-Prince. But some beliefs are hard to change. At the MSF emergency center in Martissant, a neighborhood in the capital, patients have become more reluctant to receive an injection when necessary, and sometimes they refuse it.

On the street, people often tell us that they would rather die at home than go to the hospital. Beyond the distrust it shows of institutions, this is a very worrying trend as it affects health-seeking behavior. At the COVID-19 care center opened by MSF in the neighborhood of Drouillard in Port-au-Prince, we note 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 of the people we meet express contradictory things about COVID-19. On 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, cannot 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 capacity to set up triage and isolation in order to ensure patients’ and staff safety.

Fear and stigma are linked: for fear of being infected, people do not want a sick person 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 see the community leaders and neighbors to listen to their concerns and try to answer them. They were also invited to visit the structure before it opened to understand the path that patients take and to see all the precautionary measures in place to avoid contamination.

Denial of the disease, however, is likely linked to the fact that the number of deaths officially registered in the country remains low so far, compared to what can be observed in other countries. In some neighborhoods, residents tell us about an "epidemic of fever" affecting a large part of the population, but they do not see it as COVID-19.

Because of COVID-19, we can't organize large gatherings to share health information. So instead we adapted our methods and encouraged training and awareness-raising in small groups. For training on COVID-19, we targeted certain key groups such as community liaisons, school directors and neighborhood associations. We have already trained more than 120 people, which is the basis of our community engagement. Then they can further share the information with those around them to help people protect themselves from the virus.

We have also strengthened our door-to-door activities to make residents aware of the existence of the disease, the preventive measures to adopt and the need to go for treatment before it is too late. Inevitably, we manage to educate fewer people than if we could have large gatherings, but we have more in-depth discussions with each person. In the current context, where there are a lot of rumors circulating, this exchange is fundamental because it allows us to understand people's concerns, and it allows them to ask questions. It is when people ask themselves questions without finding adequate answers that rumors have a place to spread.

If everyone understands how the disease works and is transmitted, it allows everyone to identify the situations most at risk in their daily lives and to take precautions according to their situation. Preventive measures such as wearing a mask, physical distancing, or even handwashing are very difficult for part of the population in Haiti. They may have to choose between feeding their kids or buying a mask, or they may not have adequate access to water or soap. Physical distancing is very difficult in a neighborhood like Martissant which has one of the highest population densities in the world. Together with the local people, we try to think of alternatives adapted to their living conditions such as collective handwashing points, for example.

The fact that MSF has been present in Haiti for almost 30 years and provides free healthcare, especially in very difficult areas of Port-au-Prince, which are known for their insecurity, has allowed us to create a solid relationship of trust with the population. When dealing with rumors, trust is an asset. As health promoters, our role is to actively listen and speak with the 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 would probably 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 I went 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, lilacs and aloe vera to treat myself at home. At first, I didn't believe I had COVID-19, because I hadn't been in contact with people from abroad, so I didn’t think I could catch it.

When my condition didn’t 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, they immediately think the person inside has COVID-19. Some people have even been threatened because of this. As time went by, my condition got worse; I was coughing up blood and I couldn't get up. Finally, I asked a friend if he could drive me to MSF COVID-19 center in his personal vehicle, to avoid creating panic in the neighborhood. If I hadn't come then, I would probably have died!

In my neighborhood, there are many people who complain of having a fever. They say they would rather die at home than go to the hospital because they are convinced that they will be injected with a deadly vaccine. Since I have been hospitalized, several friends have called me here, to tell me not to accept injections. This rumor related to vaccines is deeply rooted in Haiti. Recently, a man I used to play soccer with was hospitalized with a heart condition. He died two days later and everyone thinks it was because he was injected with a vaccine.

I have been treated here for 14 days now. I feel better and I hope I can go home soon. It is important that people feel confident to come for treatment as soon as they have a fever or breathing difficulties. They should not fear going to the hospital or be stigmatized by those around them.