Doctor Evelyne De Decker recently returned from a MSF project in the deprived area of Martissant in Port-au-Prince, the capital of Haiti. In December 2006, MSF opened an emergency room in the slum to help its civilian population, who face violent attacks from feuding groups and have no access to healthcare. Here she tells us about her experiences.
Can you describe the situation in the slum?
There is a constant threat of violence in the slum, but of course it is not permanently present with the same intensity: there are moments of acute violence and others that are calmer. These waves are linked to several factors, one of them being the immediate need for money. Back in April, for example, we saw an increase of violent acts that can be linked to the rise in food prices; in the past few months, basic food items like rice have doubled in price and this is creating tension among a population that is already very poor.
MSF staff stabilise a gunshot victim before transferring him to intensive care. Haiti, 2008.
Guillaume Le Duc/MSF
People live with the constant threat of violence. Everybody knows somebody, or has somebody in their family, who has been attacked or injured in the slum. They hear frequent shooting and hear stories of people being attacked or kidnapped, and they know it could happen to any of them. This causes a lot of distress. Yet these people can handle much more than we could, because they are used to it - they grew up in this environment.
What does MSF do to help these people?
MSF provides medical care to people who come to us with traumas and by stabilising those patients who need to be referred for surgery. The majority of the people we treat in our emergency room are affected directly or indirectly by the violence. We are talking about injuries caused by shooting and by other weapons, such as knives or machetes. Several people also come in with heavy burn wounds caused by accidents, because they do not have electricity at home and use fire for cooking.
Besides that, we also offer psychosocial care, but not all the patients respond to this offer. We have three psychologists and one social assistant in our clinic. Normally, people come through the emergency room or our mobile clinics and our doctors can refer some of them for psychological assistance. But, people do not come looking for it directly, because they are not used to getting such support and do not expect it. We might see between 250 and 300 people per month who are referred by our doctors to the psychologists for all types of traumas: women who have been raped, children who have been shot etc.
How did you feel working in such a violent environment?
So much indiscriminate violence certainly made an impression on me. However, MSF is very well known and respected among the people of Martissant. Last April, riots against the food prices were making the security in Martissant extremely volatile and nobody could move around without getting stones thrown at them – only the MSF cars could pass untouched. It was very rewarding to work in a place where you can really make a difference for those people and I felt comforted by so much respect.
The most difficult thing for me over this time was to see so many innocent people being hurt. People get wounded just because they are passing in the street at the wrong time. It happens a lot; most of the people we see in our emergency room are civilians.
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MSF has worked in Haiti since 1991, running several programmes offering support to state-run health facilities and responding to emergencies (cyclones, floods). MSF’s activities are currently concentrated in the capital, Port-au-Prince, providing a response to emergencies mainly linked to the violence affecting the city over the last few years. MSF offers specialised health care for trauma victims – at the La Trinité hospital and in the rehabilitation centre for trauma victims (Pacot) – and for women victims of sexual violence. MSF also answers to obstetric emergencies in the Jude Anne hospital, in the Delmas district. In the poorer district of Martissant, MSF offers the population basic and emergency health care. All health care in MSF facilities is offered to patients free of charge.