In Haiti, hope amid the human toll of a deconstructed state | Opinion

Franckelie was 15, suffering from heart failure due to a degenerated heart valve attacked by his own immune system after a strep throat.

His body made antibodies to the bacterium that infected him but, like millions worldwide — especially in poor and crowded places like Haiti, where he lived — he became increasingly ill when those antibodies attacked his own heart valves, a condition known as rheumatic fever. His condition was dire. Either he would receive valve replacement surgery or he would die. That was nine years ago.

He was brought to an NGO-run clinic, one I have worked with for many years. It keeps a nationwide database of children and young adults with operable heart conditions, arranges diagnoses and treatment and matches patients to surgical teams.

In Haiti there are no pediatric cardiologists and there has never been a cardiac surgery program. As with many aspects of Haitian society, government programs for healthcare are nearly absent. NGOs have largely taken on this role. The Pan American Health Organization, an arm of WHO, estimated that only 36% of health facilities are public and that the remainder are run by NGOs.

Franckelie and his family were accompanied by NGO staff to the Dominican Republic for cardiac surgery. He was given post-op care including medications and a home monitoring machine to avoid potentially fatal clotting on his new metal heart valve.

That was 9 years ago, when the country’s services, including the Ministry of Health, were at least limping along. They are no longer.

Last Sunday, Franckelie dressed up for church. He walked a carefully chosen route to avoid the gangs that have torn Haiti apart, got to the service, prayed and sang, then walked again safely home, only to find his house ransacked, and nearly everything destroyed or stolen. That included his anticoagulation monitoring machine.

The NGO’s Haitian social worker, Ben — still working in Port-au-Prince despite perilous conditions there — told me this week that he is working to track down a replacement. He’ll risk going out to get it to Franckelie.

We’ve all read about the armed gangs in Haiti. We’ve seen pictures of body bags and burning tires; we know there have been rapes, killings and terrible atrocities. Amid that, what about the expectation of healthcare, an integral part of daily life, along with going to church, to work, to school?

The somber-toned BBC reported last week that the maternity ward in the public hospital in Cap Haitien, a somewhat safer area, was without electricity due to gang-related fuel stoppages. They reported that pregnant women have delayed or stopped coming in for fear of violence, resulting in a needlessly high toll of stillbirths and maternal risk.

Our cardiac patients tell us they must awaken at 4 or 5 A.M. to find a tap-tap (informal van kitted out as a bus) or moto (for-hire ride on a motorcycle) to transport patients sometimes 50 or more miles past gang roadblocks to be seen at the clinic. Initial talks with the hospital in Cap Haitien to start a clinic there have been tabled; such investment is deemed too dangerous now. Visiting pediatric cardiac surgical teams left and haven’t returned since gunfire erupted near ambulances carrying patients in 2019.

The country’s only pediatric cardiologist, recently trained in France, left in 2023 after doctors and nurses at her hospital were kidnapped. The main government hospital, damaged badly in the earthquake of 2010, has now closed due to gang violence.

So yes, urgent circumstances scream for an international effort, led by Haitians, to right the security ship of the Haitian people. But in concentrating on transitional presidential councils, Kenyan police forces, debating who in “civil society” should be included in the process, we must not miss the point of caring for the everyday needs of people like Franckelie.

That must include providing effective, quality health services — hopefully in conjunction with a functional Ministry of Health. This will require many millions of dollars of investment, which must be overseen by an independent international control board including Haitian stakeholders and donor country representatives.

Easy to say, hard to do, and imperative to do. USAID announced a commitment on March 11 of $29 million in total humanitarian funding for Haiti in 2024, of which $7 million is earmarked for health-related initiatives, primarily cholera prevention. This is a start, with the funds going to specific NGOs, and no clear control mechanism outlined. We must do better.

Franckelie, now 24 with a newborn son, was lucky he had his medication bottle with him that day; he has been able to continue his meds, though without the stolen machine he cannot yet monitor his anti-clotting levels.

Ben, the social worker, told me, “I’m not an orphan, but when I was 7, my father said, ‘I love you, but because I have nothing, I have to give you to an orphanage.’ In there, I read in a book that you may exist without really living. I made a decision — I want to be sure I am living. I’m living in a generation where I want to do all the positive I can. If I can stay alive, have an impact and save a life, that makes me really happy.”

Let’s do the right thing in Haiti, press for a huge investment in humanitarian aid with proper controls, and give Franckelie, Ben and their generation something to be hopeful about.

Editor’s note: The full names of the patient and the social worker are not being published due to concerns for their safety.

James R. Wilentz, M.D., is associate clinical professor of medicine and global health at the Icahn School of Medicine at Mount Sinai in New York City. He’s a co-founder and board chair of International Cardiac Alliance, which began in Haiti following the 2010 earthquake.