For more than a decade, the Brigham has partnered with health care colleagues in Haiti to improve the island nation’s fragile health care infrastructure through medical education, operational guidance and emergency assistance. In collaboration with Partners In Health (PIH), Brigham faculty and staff have worked alongside Haitian colleagues on disaster relief efforts and long-term projects aimed at strengthening the country’s health care system.

In the wake of the magnitude 7.2 earthquake that struck Haiti on Aug. 14, Brigham Bulletin spoke with Joia Mukherjee, MD, MPH, of the Brigham’s Division of Global Health Equity and PIH chief medical officer, about what this latest tragedy means for the country.

Haiti has experienced several devastating events in a short window of time — a worsening pandemic, a wave of political violence and now another tragic earthquake. What do we know about the situation on the ground there right now?

Joia Mukherjee

JM: What we know is that all of these tragic factors intersect. The constitutional crisis, which has led to widespread protests and violence, has made the response to COVID more difficult. Haiti was among the last countries in the world to receive the vaccine, just vaccinating some health workers only a couple of weeks ago. There is limited oxygen or ICU beds in the country, and Haiti, like other countries, is experiencing a surge based on the Delta variant.

The unrest was further exacerbated by the assassination of the president on July 7. And the combination of roads made impassible due to political violence, plus a beleaguered health system inundated by surging COVID, has made even getting an accurate assessment of the destruction of the recent earthquake very difficult.

How does the fallout from this earthquake compare to the earthquake that struck Haiti in 2010?

JM: The 2010 earthquake was particularly devastating because it hit a very densely populated, urban area — one many times larger than the area currently affected by the quake. But the advantage for the Haitian people was their proximity to air and seaport, allowing materials and staff to be transported. In addition, major roads out of Port-au-Prince meant that other areas could be used to attend to the sick.

We do not know yet what the scope of this tragedy will be, and while it is likely to be smaller, it will be very significant.

What do these events mean for Haiti’s health care infrastructure?

JM: Many decades of political manipulation from within and outside of Haiti have led to the hollowing out of the institutions within Haiti to respond to crisis. However, after the 2010 earthquake, Zanmi Lasante, the Haitian sister organization of Partners In Health, with the government of Haiti built a large tertiary care hospital, University Hospital Mirebalais, which has trained over 70 surgeons and hundreds of internists, pediatricians, family and emergency medicine doctors, and advanced nurses.

Doctors from the Brigham’s Department of Medicine, Department of Emergency Medicine and Department of Orthopaedic surgery have provided significant support of these training programs, as has the Dana-Farber Cancer institute and Boston Children’s Hospital.

As a result, highly trained Haitian specialists have been dispatched to the affected area to respond to the crisis and help reinforce the public facilities in the region.

How else are Brigham faculty and staff helping support the people of Haiti at this time?

JM: Faculty from several departments are already involved supporting our colleagues on getting needed supplies in countries and making plans to send physicians and nurses to support our Haitian colleagues.

As you mentioned, the COVID vaccine only recently became available in Haiti. How do we expect recent events to affect vaccination efforts and the trajectory of the pandemic there?

JM: The number of vaccines was very small — just 500,000 doses (that is, enough for 250,000 people) for a population of 13 million people. These first vaccines when to health workers and some vulnerable people.  It is unclear how the earthquake will disrupt the vaccination efforts of these groups. What is clear, however, is that Haiti needs millions of doses — not only to combat the virus in general but also because the displacement of people due to this earthquake will cause more COVID transmission.