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Background: 2013

This is an extract from our latest Activity Report, looking back on our work in the previous year.

More than three years after Haiti’s devastating earthquake, the few public medical facilities in the country do not have the resources to meet the needs of most Haitians. Emergency services are particularly lacking.

Healthcare in Haiti remains largely privatised and most people do not have the financial means to pay for it.
 In 2013, Médecins Sans Frontières/Doctors Without Borders (MSF) continued to provide urgently needed free services to help fill some of the gaps.

Cholera, a water-borne infection that can lead to rapid dehydration and sometimes death, remains a health threat where there is poorly managed water and sanitation. Overall, living conditions in Haiti have improved over recent years, but hygiene standards in camps remain extremely poor and some people are without access to affordable drinking water.

The cholera crisis that began within months of the 2010 earthquake persists, particularly during the rainy season, when the number of patients reaches epidemic levels. Since October, more than 700,000 people have been infected with cholera. One-third of these have been treated by MSF.

Teams continued to run cholera treatment centres (CTCs) in Delmas and Carrefour, in Port-au-Prince. Preventive measures included distribution of hygiene kits, water chlorination points and educational activities.

In 2013, more than 85,000 people learned about cholera prevention and 5,240 disinfection kits were distributed.

Historically there has been little emergency care available for people in Haiti unless they can afford to pay for it. MSF runs the Centre de Référence en Urgence Obstétricale (CRUO), a 130-bed hospital in Port-au-Prince providing free, 24-hour obstetric care for pregnant women suffering from complications such as pre-eclampsia, eclampsia, obstetric haemorrhage and uterine rupture.

A full range of reproductive health services, including family planning, postnatal care and prevention of mother-to-child transmission of HIV is also offered. A 10-bed unit, the ‘Cholernity’, is available for pregnant mothers with cholera within the CRUO. Teams assisted 5,450 births during the year.

Decentralising care

MSF continued to manage the 160-bed temporary container hospital in the city of Léogâne, which had originally been set up to provide emergency services after the 2010 earthquake.

Aware of the fragility of the healthcare system after the disaster, MSF decided to extend its programme in order to support the Ministry of Health’s aim of restoring services to the pre-earthquake level in the region. The hospital continued to provide basic healthcare for women and children this year, as well as specialist services, primarily for obstetric emergencies, and to run a cholera treatment unit.

MSF has begun to reduce its activities in the hospital, and straightforward deliveries and antenatal care for uncomplicated pregnancies can already be managed in local health facilities. MSF has started to identify potential partners to handle complicated cases.

Drouillard hospital

A team provides trauma care to victims of accidents, burns and violence, including sexual violence, at the 130-bed Drouillard hospital in Port-au-Prince, close to Cité Soleil slum. Surgery, intensive care, orthopaedic and burn care, and physiotherapy are offered.

Some 13,200 people were treated in 2013. More than one-third had been in road accidents, one-fifth were victims of violence (around 50 patients with bullet wounds and 100 with knife wounds were admitted monthly) and one-quarter were injured in domestic accidents. A large percentage of patients who suffered burns in domestic accidents were children under five.

Drouillard hospital is the only facility with a specialist burns unit in the country. MSF also maintains a unit in the hospital that can quickly be transformed into a 130-bed CTC, if required.

Martissant emergency and stabilisation centre

MSF provides paediatric care, internal medicine and maternity services, as well as psychological support for patients and caregivers at the Martissant emergency and stabilisation centre.

The centre is open around the clock, offering free care to people in any kind of emergency medical situation. An ambulance service transports patients to appropriate hospitals for treatment.

More than 100 patients were seen daily in 2013.

Tabarre

The Nap Kenbe surgical centre in Tabarre continued to provide free emergency and trauma services, orthopaedics, physiotherapy and post-operative care for people in eastern Port-au-Prince.

At the end of 2013, MSF had 2,324. MSF has worked in the country since 1991.

Patient story

Manise, 19 years old

I was living in Canaan camp with my cousin after the earthquake. I stayed in the tent and prepared food, while my cousin went out to work. One night, I went to collect some water. Two men arrived and dragged me into an empty tent.

I shouted so loudly one of them left. The other held on to me tightly and hit me many times. It was around 8pm and there were a number of passersby. No one came to help me.

I had no problems in my pregnancy until my feet began to swell. My health worsened and one day I lost consciousness and woke up in an MSF hospital. I saw the baby next to me but could not remember the birth … I am worried I won’t be able to feed my son once he is too old for breast milk. I am going to offer to do washing for people.

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