PORT AU PRINCE, FEBRUARY 18, 2022 (MIC) -
In this instalment from correspondent, Cyrus Sibert in Haiti, he interviews Dr Ernst Robert Jasmin, North Departmental Director of the Ministry of Public Health. The interview was conducted in Haitian Creole.
Dr Ernst Robert Jasmin
The current situation
In early January, the US Centers for Disease Control and Prevention (CDC) adopted a Level 4 Travel Warning against Haiti advising that travellers avoid the country “due to kidnapping, crime, civil unrest, and COVID-19”.
This was a very high-level advisory widely expected to impact the economy of the country.
Since December 2021, Haiti has been facing what has been described as a “fever epidemic” that affects the majority of the population. According to testimonies, the whole country is affected by this disease which seems seasonal but whose symptoms curiously resemble the Coronavirus.
Due to the small number of people tested, the statistics on this latter disease remain low. It should be noted that this wave of fever corresponds in timeline to the spread of the Omicron variant.
Accustomed to fever epidemics, the majority of the Haitians people see nothing new and continue to go about their business without being worried.
It is in this context that the Ministry of Public Health reported recently: 153 new cases for 577 new tests, 0 deaths; 12 new hospitalisations; 89% of people are already cured.
Overall, a total of 176,038 tests have been administered, there have been 30,162 confirmed cases, 814 deaths, 5,408 people hospitalised and 25,152 people cured. In percentage terms: positivity rate 17.13%, fatality rate 2.70%.
By mid-February, 149,814 people have received a first vaccine dose; 81,790 received their 2nd dose; 341 had a single dose vaccine and 99,237 people were fully vaccinated.
According to our observations, based on the statistics, between the report of January 2022 and that of February 14, 2022, statistical differences in confirmed COVID-19 cases coincide with the so-called “fever epidemic.”
Over this period, there have been 20,233 tests, 3,358 new confirmed cases, 34 deaths, 377 people hospitalised and 1,375 new people who have recovered from the virus.
The low medical coverage and the insignificant quantity of tests carried out, combined with the scepticism of the Haitian population regarding the existence of COVID-19, have prevented experts from having a real idea of the scale of the impact in Haiti.
It should also be noted that February 4, 2022, marked the third year since a case of cholera was first recorded in Haiti. Public authorities are now celebrating what they consider to be a victory over a disease imported into Haiti by MINUSTAH soldiers.
Since its introduction in 2010, cholera has infected more than 819,000 people and claimed nearly 10,000 lives.
The impact of the Coronavirus on the Haitian health system.
If COVID-19 has since its appearance caused an overflow and extreme pressure on health and hospital care systems around the world, in Haiti it has had the opposite effect and there is even a claim that it have been certain positive aspects. This can be surmised from an interview with Dr Ernst Robert Jasmin, North Departmental Director of the Ministry of Public Health.
Translation of our interview with Dr Ernest Jasmin:
“The appearance of COVID-19 caused a lot of stress at the beginning, taking into account what we observed in developed countries and big cities like New York. Because our capacity of care is modest, we had to cancel a lot of activities and direct our resources towards the management of COVID-19.
In a context where we did not have enough equipment and the health personnel were afraid of the disease, there was a form of fear. The population was worried and expected the worst. But, with what we have, we had to face it. Thus, the Ministry of Health provided some support and some of our institutions were 60% ready to deal with the disease.
Dr Ernest Jasmin agreed to be interviewed by MIC
The Haitian Ministry of Public Health's Coronavirus Preparedness and Response Plan gives a detailed idea of the preparations.
Unlike other countries, paradoxically, we have recorded a drop in patients at the level of healthcare institutions. At the beginning the population had (avoided) the health institutions in order not to be tested.
Why?
People were afraid that their illness would be called COVID-19. So many of our compatriots preferred not to know their real condition.
In addition, the epidemic caused a drop in attendance for other programmes such as: Child Health, Maternal Health, Routine Vaccination, HIV/AIDS, Tuberculosis. Patients of all kinds fled hospitals for fear of contracting the disease in health centres.
Later, scepticism around COVID-19 vaccines caused a lot of fear. People were afraid of being vaccinated without their knowledge. All injections were refused. This has negatively affected traditional vaccination campaigns against other diseases. We had to insist and convince the patients that it had nothing to do with COVID-19.
Health workers had to innovate to be able to continue to provide HIV/AIDS and tuberculosis patients with their drugs, without forcing them to enter hospitals. Rumours about COVID-19 and fake news significantly diminished patient confidence.
At the level of medical personnel, the rate of absenteeism is high, especially among the elderly or those at high risk.
The most common illnesses for which people go to hospital more easily, such as acute respiratory illnesses, have also seen a considerable drop. Still, health officials hope to observe these specific cases to assess and study the presence of the COVID-19 virus in the country.
There was a refusal to undergo tests.
Also, COVID-19 has caused the death of some health workers. Usually, we do not publish the list, but we have lost several co-workers.
On the positive side, this epidemic has strengthened the capacities of the systems. The epidemiological surveillance system is strengthened. Border control has improved.
There have been additions of equipment at the private or public level, training for staff who have become more experienced. The preparations and aid received to deal with COVID-19 have led to the strengthening of the hygiene and sanitation system within health institutions.
It's like cholera. This epidemic has considerably changed some hygiene habits which has a considerable impact on the spread of other diseases contracted by microbes in the intestine.
For example, the rate of cases of typhoid, intestinal parasitosis has dropped considerably. This is to explain certain correlations that exist between epidemics.
So, even when there are not many proven and certified cases, the preparations and changes brought about by information, education and communication campaigns can have effects on the spread or dissemination of other diseases.
Between December 2021 and the end of January 2022, the country has experienced a seasonal flu epidemic. Among those sick with this flu, the Ministry of Health has observed a modest increase in cases of COVID-19. Modest in number compared to other countries but serious in rate.
Unfortunately, if the fight against cholera had caused a change in behaviour, for COVID-19 we observe resistance on the part of the population.
The recent flu epidemic is proof of this. For instance, all Haitian families have had a member who has been a victim of flu or fever during the last two months.
But people do not quarantine themselves. There is no provision to protect people in their environment. The refusal to wear a mask is a real problem. People consider the mask as an obstacle to free speech including Creole expression "babouket" (knot around the mouth of horses or donkeys to easily dominate them). Haitians don't like it. So, if there is a serious variant of the COVID-19 virus, there would be carnage in Haiti.
Mask wearing is the exception rather than the norm.
Are you sure it is not the new OMICRON variant?
Doctor Jasmin replied:
There is a testing problem in Haiti because it is not systematic. In Haiti, the test rate is extremely low. Therefore, the number of cases identified is also low. And it surely gives a false appearance of reality. The population's refusal to undergo a COVID-19 test is one of the major obstacles for the health system to accurately determine the overall reality of COVID-19 in Haiti.
The aid received by the Haitian government has made it possible to strengthen health centres with protective equipment for staff, hospital beds, and oxygen. Above all, an oxygen generator to fill the oxygen tanks was provided by the Ministry of Health.
Insecurity posed a problem in terms of supply. Sometimes trucks had to face difficulties related to gangs and political unrest. Therefore, being able to produce oxygen on site was essential.
The Ministry of Health has hired additional technicians to deal with the epidemic.
All other services continue to provide health care to the population. Patients have begun to return to the health centres for the usual cases: high blood pressure, diabetes, dialysis, cardiology, maternity, childcare, other chronic pathologies or general medicine.
There was no discrimination between private and public institutions. They are all part of the care system. Even when there were not specialized care centres for COVID-19, the other centres received the necessary monitoring equipment with instructions to refer patients to hospitals.
In terms of overall lethality, he claims to have observed an increase in funerals in some cities across the country. The Ministry of Public Health has statistics on deaths in health centers. Other deaths can be traced through municipal records. But there are still many undeclared funerals in remote parts of the country. He pointed this out to funeral directors who confirm that they have observed an increase in non-violent deaths in the country.
There is no H1N1 epidemic in Haiti. Only a flu epidemic that seems to be seasonal, and we cannot say specifically that it is H1N1.
Even without a high number of recorded cases, COVID-19 has changed several medical practices in Haiti. Preparations, staff training and observation of the behaviour of the population allow us to say that we are better prepared than before.
He reported that herbal medicine serves as a means of defence for the population. There is a kind of community solidarity that allows the population to share their experience and knowledge in terms of using herbs against the symptoms, to strengthen their immune defence.
It is a pity that we will not have carried out a study on this aspect in order to list the leaves and the recipes used during this period. We could verify their chemical composition in the laboratory and document their method of use.
Still, the population believes in the medicinal capacity of these herbs and has made them an object of exchange and solidarity.
An empty isolation room at the Justinien Hospital in Cap-Haitien
Regarding the vaccination programme against COVID-19, it's still ongoing. There was a shortage of Moderna vaccine stock in December. The government just received new doses of Pfizer and Jenssen which are available. WHO has approved interchangeability between vaccines. People who had their first dose with Moderna can receive their 2nd dose with Pfizer or Jenssen.
However, my concern is that the COVID-19 vaccination will affect other vaccination programs. Because, contrary to the criticisms of the sceptics, humanity has made a lot of progress thanks to vaccination. Serious epidemics are brought under control thanks to vaccination. Considering the fear that exists against COVID-19 vaccines, I would hate to see this drive people away and decrease the number of children vaccinated for other diseases.
This interview with Dr Jasmin allowed us to understand the refusal of other health centre managers to be interviewed. He said:
“As a Hospital Manager serving the population in the centre of the country, I do not see how I can say COVID-19 has negative consequences on my hospital. We do not provide care, we only test people with symptoms, in the vast majority of cases, they are negative. The few proven cases have been referred to the care centres.”
COVID-19 has impacted the Haitian health system by the invisible nature of its shadow hanging over Haiti and the refusal of its population to believe in it. All ofthis is in contradiction with international recommendations.
Video recording of the interview with Dr Jasmin:
Aucun commentaire:
Enregistrer un commentaire