Nearly six months after a magnitude 7.2 earthquake rattled the south of Haiti, killing more than 2,000 people, many NGOs have gone home and the displacement camps have broken up. But according to organizations still working on the ground in communities around hard-hit Les Cayes, the problems haven’t gone away – they’ve simply evolved.

“What we’re really confronting now are the ongoing effects of the earthquake,” said Conor Shapiro, president and CEO of the nonprofit Health Equity International, which provides health care and other vital services in Haiti.

Shapiro explained that, while the camps have disappeared and people have returned to their homes, it would be a mistake to think that life is in any way back to normal. Wounds and other earthquake trauma have been replaced by unmanaged chronic diseases and malnutrition – that last, particularly in children. The damage or destruction clinics underwent meant that many people lost their health care sources. Families whose houses were damaged are living under tarps.

“A lot of these towns have been completely leveled, and that’s housing, that’s physical infrastructure like schools and clinics and markets,” Shapiro said.

Before, many people walked miles to a nearby clinic, said Jenna Green, development director at Project Medishare for Haiti, which is also continuing to work on the ground in the wake of the Haiti earthquake. “Now, if you wanted to walk an hour to the closest health facility, it’s completely gone…People may be six hours away” from a clinic or other health care provider.

Most recently, on January 24, a smaller magnitude 5.3 earthquake struck Haiti’s southwest, killing two people and causing more damage, making people afraid to return to their homes, the Independent reported.

Facing impediments

Ongoing unrest, difficult-to-pass roads, and other issues have also stalled recovery. “We’ve had so many problems it’s hard to know where to start,” said Father Rick Frechette, founder of St. Luke Foundation for Haiti and a priest and medical doctor at St. Luke Hospital.

Late last year, Haiti was struck by a fuel shortage that made headlines. Although fuel is now widely available, Frechette said that it’s twice the price it used to be – devastating for a country where the electrical grid is unreliable and many facilities, including hospitals, rely on diesel-run generators.

Frechette described closing the hospital’s lab and some departments, cutting the lights, and turning off aid conditioners to “try to lower the pressure on the grid” during the fuel shortage.

Omicron also seems to be sweeping through a primarily unvaccinated population; Frechette said: “The labs here can’t distinguish [variants of Covid-19], but delta had finally died down, and we’re a month or two behind what’s happening in the States.” At the same time, droves of doctors and nurses are leaving the country, he explained.

The road to the south is controlled by gangs at Martissant, a huge neighborhood in the south of Port-au-Prince, Frechette and other sources said, which makes it difficult to get supplies and aid workers to the earthquake-struck southern half of the island.

That block at Martissante works both ways, keeping residents of southern Haiti from accessing help in the capital.

And sources described a weak international response to the August 2021 earthquake, further impeding long-term recovery.

“So many organizations came in and did their thing and then went home,” rather than focusing on increasing resilience in southern Haiti, Green said.

Shapiro is concerned that Covid-19 has distracted people from thinking about international needs. In addition, “Haiti has had so many disasters, from the earthquake of 2010 to Hurricane Matthew,” he said. “I worry that people didn’t pay attention to how devastating this was…because it was a disaster in Haiti again.”

Working on the ground

Health Equity International provides daily mobile clinics in remote communities in southern Haiti, where care is hard to access. When they come to a village or town, they’ll typically set up in a school or church or another public facility and work with community leaders to make sure people know their services are on offer.

“They’re crossing through rivers, dirt roads, just to be sure they’re reaching people,” Shapiro said. Asked what providers are treating most often, he explained that “this is a patient population that has no other access to care, so it could be a wide variety of things: infectious disease, chronic disease, malnutrition.”

For Dr. Inobert Pierre, Director General of Health Equity International, and the affiliated St. Boniface Hospital, lack of healthcare access has led to a disturbing decline in patients’ health. “Many of those people don’t see a doctor on a regular basis, so many of them are seen by our team in really bad shape,” he said.

That also includes an increase in mental health issues. The mobile teams have a rotating psychologist who goes from community to community to meet people.

In addition to medical care, the team provides food, multivitamins, and access to nutrition services for patients with malnutrition. They’re outfitting clinics with medical support. And patients who require more intensive treatment are referred to St. Boniface Hospital.

And despite widespread Covid-19 vaccine hesitancy in Haiti, Pierre said they’ve had good luck convincing people to get vaccinated, thanks to close ties to community leaders and the work of trusted community health workers.

Project Medishare is also providing mobile clinics, emergency food and hygiene kits, and birth kits containing clean, safe supplies to care for pregnant women.

In addition, they’re providing training modules for local health workers to help them care for patient needs. One training module is for community health workers; the other is for nurse-midwives and matrons – a Haitian birth attendant – to care for pregnant women who otherwise would lack access to a skilled birth attendant.

“The goal is to boost up this community, empowering them to continue providing this care,” Green said.

To get medical and other supplies down to the south, Project Medishare’s driver continues to make the journey through Martissant – and thus far, he’s done so safely. Asked how the organization manages such a feat, Green explained that they keep close tabs on local logistics and gang activity and never make the trip at night. “It’s a miracle” that it keeps working, she said.

To support Health Equity International, St. Luke Hospital, and Project Medishare in their vital work, Direct Relief is providing emergency grants of $200,000 to each organization.

For Frechette, the funding means having enough fuel to care for Covid-19 and other patients. “We’ve budgeted the price of gas, but it’s double,” he explained.

For Shapiro and Green, the primary benefit is the flexibility of the funding, which allows them to meet needs as they encounter them in the ways that best serve their patients. “To get this grant now…it’s a really incredible thing for us to continue to help,” Green said.

Interviewees said the resilience and work of the people affected should not be overlooked.

“People are so resilient, and all they want to do is have jobs and opportunity, and take care of their families,” Green said.

“Rural poverty is a very hard poverty, because there’s nothing to hang onto,” Frechette said. Still, “we always see heroism: people who are carrying their children in…facing thieves to get here with their children when they’re sick.”

Dan Hovey contributed reporting to this story.