By: Toni Cela & Olriche Fortin
The COVID-19 global pandemic has served as a wake-up call for many. With each passing day, we witness the importance of social safety nets such as education and access to healthcare, how the built and natural environments can facilitate or hinder health, and how effective leadership can save lives. Most importantly, despite the many boundaries and borders erected to separate ourselves from others, this global pandemic reminds us of the interconnectedness of humankind.
Though we are connected as humans there are clear differences in how we are experiencing this health crisis. These experiences are informed as much by biology, our individual behaviors, the configuration of our local communities, the environment in which we live, healthcare policy and systems as they are by local histories, sociopolitical and cultural processes. This crisis also reminds us how health disparities between the rich and poor are entrenched in all societies, including more affluent countries. Yet, while lack of political will may explain the failure to extend health coverage to the most vulnerable in society, nations in the global South must also contend with resource constraints, both material and human, that make access to even basic healthcare quite daunting.
However, it is crises such as Ebola, MERS, SARS, H5N1, that provide us with opportunities to challenge the idea of health as profit-based investments. It is in this moment that we must think of access to health not only as a human right but also critical to human development and human security. If nothing else, COVID-19 has placed our health and well-being in the hands of family, friends, neighbors, and strangers whose decisions to get on a flight, wear a mask or gloves, or wash their hands may determine if we become infected. However, acknowledging health as human security and human development issues requires that we extend our definitions of citizenship and what that should entail and re-examine our relationship to our natural environment. While this acknowledgement challenges conventional premises that govern health policy and health systems in many countries in the global North, it must also be adopted by leaders in the global South, where populations are either stuck in marginalized communities or forced to migrate in a quest to make a living and search for respect and human dignity.
For many migrants from the global South, the limitations of citizenship in one place and opportunities afforded to citizens and residents in another are often at the core of the decision to migrate. Migrants are searching for better educational opportunities, employment prospects, safety from political, structural, and other forms of violence and inequities, and access to social services such as healthcare. This, certainly, is the case for many Haitian migrants abroad and their families in Haiti who have endured the failed social contract between the state and its citizens over more than two centuries. The state’s failure to provide social safety nets for its people has fomented distrust among its citizens. Haitians have few, in any, expectations of their government and when that government exercises any semblance of leadership it is regarded with suspicion as has been the case with the COVID-19 pandemic.
On March 19, 2020, the first two known cases of COVID-19 infection were announced in a public address by President Jovenel Moïse, yet few details were provided. President Moïse would immediately declare a national state of emergency that would be lifted on July 20th closing all educational facilities and factories while instituting a national curfew from 8pm to 5am, effective March 20, 2020. The Haitian-Dominican border was closed, migrant circulation officially halted- though goods were permitted to circulate between the two countries, and commercial flights were suspended.
At the end of March, de facto Prime Minister Joseph Jouthe announced the creation of a 14-member scientific committee, whose official mandate is: “to collect and process data related to COVID-19, and make recommendations to the government regarding health measures.”
In addition, the Ministry of Public Health and Population (MSPP) launched an awareness campaign via social media networks, television, radio, and press releases to educate the population about preventive measures and inform them of infection and mortality rates. In early April, the President would encourage Haitians to wear masks in public while the Prime Minister would announce the distribution of 21 million masks. By June 15th, the government would announce that 9 million masks had been distributed countrywide. For those with cellular phone service from the Digicel telecommunications company a permanent message would appear across their screens that reads, “Wash your hands,” in Haitian Creole. No stay-at-home orders have been issued and social distancing has played but a minor role in Haiti’s mitigation strategies. By August 2nd, there were 7,476 confirmed cases of COVID-19, of which 165 people had lost their lives. However, the accuracy of these numbers must be questioned given Haiti’s limited testing capacity and the reticence of many Haitians experiencing symptoms to seek out testing from a healthcare system that has historically failed to adequately serve them.
In countries beset by political, social, and/or economic instability, such as Haiti, vulnerability defines one’s daily existence. Over half of the population lives below the poverty line and just under one-quarter live in extreme poverty. Twenty percent of the population is illiterate as one-third of Haitians have less than a primary school education or have never attended school at all.
Not surprisingly, social distancing as a mitigation strategy remains a challenge to enforce because for many their lives are characterized by physical proximity. The average household size is 4.3. The largely unregulated public transportation system is frequently overcrowded with no established maximum capacity levels and rarely, if ever, any enforcement of safety measures. Haiti’s most common form of transport, the mototaxi (a motorcycle taxi), can be seen transporting anywhere from one passenger to as many as four, not including its driver. Outdoor farmers markets, which sell the freshest, most competitively priced, homegrown produce are typically bustling with people; vendors, consumers, as well as socializers- engaged in pleasant negotiations, intense haggling, or gossip with comrades. Many of these markets are strategically positioned beside main thoroughfares to cater to pedestrians and passenger vehicles alike. Yet, Haiti’s poor infrastructure make them a public health threat as vehicles kick up dust from damaged and unpaved roads while emitting diesel fuel. And, compromised sewage systems are often backed up leaving putrid smells wafting in the air. From these social factors we can glean some of the challenges of enforcing social distancing measures in this context and we can also see how the spread of this disease will be difficult to contain in Haiti.
Compounding vulnerability is lack of access to toilets and potable water. A government household survey conducted between 2016-2017 observed that only one-quarter of Haitian households had access to soap and water for hand washing, 12% had water access only while the majority of Haitians, 60%, had neither access to potable water, soap, or any cleaning agent. As only 4% of Haitians have medical insurance, the majority of the population must pay out-of-pocket severely limiting access to quality healthcare. Finally, food insecurity has become an increasing threat, a result of land erosion from environmental degradation compounded by climate change. It has made the Haitian diet less balanced while increasing the prevalence of certain conditions such as diabetes, hypertension, and cardiovascular diseases.
What will happen as the virus continues to spread in Haiti? How can we encourage social distancing in this context? What type of messaging is necessary in a circumstance such as this? Why should Haitian citizens trust a government that has failed to represent their interests or institute a viable social contract? How does a government that lacks legitimacy provide the leadership necessary to protect, and ultimately save, human lives? These are some of the immediate issues that Haiti grapples with as it tries to encourage the adoption of mitigation strategies and prevent the spread of a potentially deadly disease. Yet, months of political upheaval, several years of economic turmoil, more than a decade of destabilizing and deadly natural and manmade disasters (e.g., cholera), and environmental degradation dating back to the colonial period, serve as the backdrop to this pandemic making COVID-19 the latest in series of challenges Haiti faces. These challenges have marked the daily lives of the Haitian people: protests that close schools and businesses for months on end, hunger and food riots, skyrocketing unemployment rates, displacement and death caused by disasters, as well as numerous coup d’états. A global pandemic in which people are advised to wear masks and wash your hands- where the choice is between purchasing masks or food for that day and you may not have access to water- simply pales in comparison to the many other crises confronted by the Haitian population.
Many, unfortunately, believe the pandemic is a tactic of distraction employed by an illegitimate government. And many will become infected, and possibly lose their lives, due to such skepticism. Yet, in the end, Haitians will be credited for their resilience. As the saying goes, “Nou la pi red [We are still here]!” Resilience has little currency when survival is all you can aspire to. It can lead to complacency, if not resignation. Haiti is not unique in this regard, many nations in the global South have endured being on the losing side of modernity, capitalism, and globalization. A pandemic such as this has much less “shock value” when you have survived genocide, war, famine, structural adjustment programs, the HIV/AIDS epidemic, earthquakes, and other disasters. There is less to fear when you have so little to lose.
Yet for those in the North who have lived a life of (even relative) privilege, this pandemic has the potential to upend life as they have come to know it. For many, this pandemic has raised awareness, if not consciousness, regarding the vulnerability of their own citizenry, economic disparities, and the impact of the environment on human health. The impact of the pandemic on people’s daily lives, the disruption, and continued uncertainty has revealed some of the structural factors that make health, or a healthy lifestyle, possible for some and nearly impossible for others. Many capitalist powerhouses, such as the United States, must contend with the threat of unemployment which can very quickly lead to bankruptcy and poverty. Even among the social democracies of Europe, the lifestyle change that this health and consequent economic disaster will bring is for many utterly unimaginable.
For many in the North, it is believed that crises such as these are supposed to happen in remote, far off lands and, perhaps, in poor and marginalized communities at home that are populated by people from those same far off lands. Ironically, this is one of the few times in history in which migrants and the working poor have been acknowledged as “essential workers” despite the obvious indispensability of their labor. They have been called to duty putting their lives at risk as they do not have the luxury of telecommuting and because their work create the conditions for the privileges that others enjoy. Such crises are not supposed to happen in modern, advanced societies. Yet, here we are, North and South alike, experiencing vulnerability and uncertainty together.
This pandemic has blurred the lines between North and South. Now that disaster lies at everyone’s doorstep, it is a wake-up call for those who have benefitted from globalization but never had to reckon with its daily toll on human life. We are experiencing collective vulnerability; most of us face the threat of infection, a number of countries face Personal Protective Equipment (PPE) shortages, testing remains a challenge, and many fear their local hospitals as this pandemic has converted them to sites of risk. Months of uncertainty lie ahead as we wait for a vaccine to bring this nightmare to an end.
What lies before us all, in the North and South, is an opportunity to re-examine the paradigm of development vehiculated by the forces of global capitalism and its world order as well as our roles in it. It is in these critical, “life and death” moments that our core values are revealed. How governments respond to citizens’ needs, how we treat our neighbors (in our communities, migrants in our countries, and the nations with which we share borders), and how we inhabit the world from this moment forward will reveal our true selves. This is our opportunity to put an end to unnecessary human suffering and create a new framework for human development and the rights creed of global citizens. The consequences of doing otherwise would be unimaginable.
