EFFECT OF POLITICALTURMOIL ON PEDIATRIC DISEASE AND PREVENTION IN PORTAUPRINCE

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EFFECT OF POLITICALTURMOIL ON PEDIATRIC DISEASE
AND PREVENTIONIN PORT-AU-PRINCE

• DR JESSY COLIMON ADRIEN
• Director of Pediatrics
• HUEH
• October 4-6

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INTRODUCTION

• Haiti is a beautiful Caribbean island
• The poorest country in the western hemisphere
  one of the poorest in the world.
• Population 8.3 million inhabitants.
• Per capita gross national product 480
• Since January 1, 1804, history of political
  turmoil, dictatorship, and 30 military coups.
• Political chronic turmoil, bad socio-economic
  conditions badly influence health system,
  particularly, pediatric disease and prevention in
  Port-au-Prince

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OBJECTIVES

• Present the health indicators before February
  2004 in order to understand the impact of the
  violence in a country with a very weak public
  health infrastructure .
• Explain how this situation affects the delivery
  of Curative and Preventive health care to
  children In Port-au-Prince and particularly in
  some vulnerable areas.

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Health Indicators
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Mortality Indicators

• Child Mortality under 1 year of age
• Haiti 1995-2000 80.3
• Child mortality less than 5 years
• Diarrheic diseases 11.5
• Acute respiratory infection 9.4
• Maternal Mortality 523/100.000
• Life expectancy 54.4 years

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Resources IndicatorsDisponibility and Coverage
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Immunization coverage of children lt 1y.o. (2003)
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Nutritional Data

• Protein-Energetic Malnutrition 60.1
• Under 5 years
• low birth weight 17
• Acute malnutrition
• kwashiorkor-Marasm 5
• Vitamin A deficiency 2.5/00
• Iron deficiency
• under 5 years 60
• under 2 years75

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Causes of death 0-5 y.o.
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Infectious Etiologies
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Impact of violenceon health care system

• February 29th 2004 HUEH (Main hospital of 700
  beds) and other major clinics such as Maternity
  Isaie Jeanty were closed
• Fear of health care provider for their safety
• Attack on ambulances and private cars by street
  gangs with bullets.
• Shortage of energy supply
• Loss of vaccines interruption of cold chain

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Consequences of the violencefor delivery
services

• NGO Red cross CRS Care - UNICEF
• Food Trucks were looted
• Decrease of medical supply and Drugs
• Development of no mans land Bel-air
  Saint-Martin, Delmas 2, Cité-Soleil etc
• September 30th 2004 New development in the
  violence With Baghdad Operation

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Impact Handicapped Children

• Monfort Institute School for deaf and muted 250
  children located in Saint-Martin , the
  headquarter of gangsters was attacked on
  September 29th, day of Baghdad operation
• The children and teachers were stocked in their
  rooms.They couldn't go out for 45 days.
• No food or water, no cooking gas, no medical care

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Children in Cite-Soleil

• Hospital Sainte-Catherine (45 pediatric beds) in
  cite-soleil, the heart of violence, was closed
  August-September 2004
• Now they receive only daytime emergencies
• Actually ambulatory clinic frequentation has
  dropped from 50 to 10 patients a day
• Decrease of services immunization and nutrition
  clinic

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Medecins sans frontieresNew Strategies

• At the end of the year 2004 in Port-au-Prince
  because of the problems of HUEH
• Opening of traumatology center of 56 beds in
  Saint Joseph Hospital
• 3100 patients were treated
• 1112 were war wounded
• 600 were children, women and old people

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Medecins Sans Frontières(French doctors)
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Impact on ongoing care and prevention
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Tetanus coverage 2004

• Pregnant and Childbearing Women 15-49 years
• Haiti 25
• The west department 8

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Impact on well baby clinic

• Many pediatricians report a diminution of the
  consultation in downtown of Port-au-Prince
  because of the violence in some areas
• Many families left the capital for the
  countryside or the united States or Canada or DR
• Consequences Decrease of immunization and close
  monitoring of the Growth and nutritional status
• Patient arrive late in bad condition in hospital

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HIV Clinic

• Many infected women who live in some chaotic
  areas deliver at home without prevention.
• Children enrolled in ARV treatment cannot respect
  their appointment because of the turmoil.
• Sometimes they left the capital for more quiet
  towns.
• New strategies developed by doctors for adequate
  treatment

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Economic and Nutritional Impact

• Haiti lost 20.000 jobs
• Business closed in No mans land
• Unemployment worsens
• Higher rate of malnutrition

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Malnutrition

• HUEH Department of Pediatrics
• March to December 2004 82 patients with severe
  malnutrition
• Saint-Damiens Hospital
• January to June 2005 159 patients with severe
  malnutrition

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Epidemiological surveillanceHUEH department of
pediatrics

• Neonatal tetanus
• 2004 09
• 2005 14
• Diphteria
• July 04 to July 05 15
• Severe Malnutrition 11.56

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Culminant Violence in Port-au-Prince

• Political violence causes
• physical violence
• sexual violence
• Department of OBGYN of HUEH
• July 04 to June 05 358 raped women
• URAMEL
• Feb. to Oct. 2004 306 sexual abuse cases
• 98,6 Female
• 01,3 Male (child abuse)

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2004
2005
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Sexual abuse in female (URAMEL)
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Political Violence and psychological trauma

• Many reasons explain this situation
• In Port-au-Prince since September 2004 the
  Violence was increasing day by day.
• The noise of the bullets and the continuing
  shooting during schooldays and the week-end
• The highest rate of kidnapped Parents and
  Children were concerned
• Cars Robberies
• Murder in the streets
• Fire

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Psychological Consequences

• Many psychologists reported some symptoms most
  frequently seen in those children
• Anxiety
• Nightmare
• Fear
• Insomnia
• Abdominal pain

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Armed conflicts and medical carein
Port-au-Prince

• Many parents are separated from their children
  Because of the moving population especially in
  the no mans land such as Bel-air Saint Martin
  Cité Soleil who have
• No access to medical care.
• In the Department of Pediatrics many discharged
  patients can't go home

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Armed conflict and MedicalCare

• At the Hospital Saint-Damien AKA Little Brothers
  and Sisters.
• From June 2004 To June 2005
• Many Children were not visited during their
  Hospitalization

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Non visited patients July 04 June 05
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Impact on Health care providerIn Port-au-Prince

• Demoralized staff Nurses and Doctors also
  victims of armed conflicts
• They cannot respect their schedule
• Cannot take care of the patients in some areas
  because of personal attacks on their families
• Continuing education Many meeting were canceled
  because of the political turmoil

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Children rights violation

• Children Living in the street of Port-au-Prince
  were enrolled by armed groups to Participate in
  those crimes and kidnapping..
• Many people reported to have seen children with
  guns and participating in the violence in the
  community
• Drug Abuse by children living in the streets.

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Summary

• The present Political turmoil in Port-au-Prince
  has an important impact on pediatric disease and
  prevention. Because of the violence, some
  children, have no access to Medical care. Bad
  socio-economic conditions in the poorest country
  make the primary care worse
• After 200 years of independence we need unity and
  peace to improve child survival.We need to build
  a country without violence in order that
  pediatricians can assume their noble mission
  Loving and Caring Children

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REFERENCES

• EMMUS III
• Data Saint-Damien Hospital
• Archives OBGYN Department HUEH
• Archives Pediatric Department HUEH
• Report DPEV July 2005 8Performances Pev 2004
• Le Nouvelliste No 37186 Report of Press Meeting
  Medecins sans Frontieres.
• Institute Monforts ReportFourth-Trimester
  report October-December 2004
• Data URAMEL