In a country where no insulin is produced locally, people managing diabetes have few options, limited further by violence and instability. These health providers are changing that.
By Paul M. Sherer
First published September 23, 2024 by Direct Relief
Every couple of weeks, a child arrives in a diabetic coma at Haiti’s Hôpital Sacré Coeur. Some are experiencing the initial onset of Type 1 diabetes, while others have run out of the injectable insulin their bodies need to keep them alive.
“Their family cannot afford to buy their insulin, and very often we have witnessed them come to the hospital in a coma,” said Dr. Harold Previl, CEO of Hôpital Sacré Coeur, the largest private hospital in northern Haiti. “In a country where people are struggling for food, they are bearing a disease whose treatment [must be continued] for their entire lives.”
A child in Haiti diagnosed with Type 1 diabetes at age 10 has a life expectancy of 13 more years, compared to 57 more years of life for a similar child in the United States, according to a study in The Lancet Diabetes & Endocrinology. Many die before even learning they have the disease; 35,000 young people around the world died at the onset of Type 1 diabetes in 2021 without being diagnosed, according to the T1D Index.
Insulin isn’t manufactured in Haiti, leaving Haitians who need it entirely dependent on imported medicine. (All people with Type 1 diabetes and an estimated 7.5% to 15.5% of those with Type 2 diabetes require insulin.) Years of severe political instability and civil disorder have stretched Haiti’s already-fragile medical supply chains to the point of snapping.
Violence Disrupts Medicine Imports and Distribution
Haiti’s primary international airport and seaport in the capital Port-au-Prince were shut down for nearly three months earlier this year by heavily armed gangs. The land border with neighboring Dominican Republic has been periodically closed, and with gangs controlling the capital’s streets, local distribution of medicine ranges between very dangerous and impossible.
“With air and sea ports closed amid mounting violence in Haiti, access to critically needed supplies came to a sudden halt – including medicines, food, and basic necessities,” said Genevieve Bitter, Senior Director of Program Operations at Direct Relief. “For months, the only source for medicine was local vendors within Haiti.”
Successfully delivering insulin and other cold-chain medicines is especially challenging. Cold-chain medicines must be kept within a specific temperature range from the moment of manufacturing until the time they are administered to the patient. If the temperature goes above the required range for long enough, the medicine is considered potentially unsafe for patients and must be destroyed.
Getting access to insulin and other medicine under these circumstances has required creativity and persistence. Hôpital Sacré Coeur has never completely run out of insulin. “We never let that happen,” Dr. Previl said. “We look everywhere, we have to knock at the doors of everyone, and if we have to purchase it, we purchase it.”
Testing New Delivery Channels
Direct Relief is testing new transportation channels, successfully delivering two shipments of insulin in recent months into northern Haiti, which has been less disrupted by violence. The deliveries have been made possible by working with the Haiti Health Network, or HHN, a collaborative group of healthcare providers and support organizations who meet regularly to discuss current needs, share knowledge, and coordinate resources.
In July, Direct Relief and HHN flew a test shipment of insulin, donated by Eli Lilly and Company, on a small plane from Miami into the northern Haiti airport of Cap-Haitien, where it was delivered to healthcare providers including Hôpital Sacré Coeur. An earlier test shipment of insulin made it through in May, days before heavily armed men set fire to Cap-Haitien’s customs office.
HHN’s support for the insulin deliveries was driven by what it heard in monthly meetings of its members. “For a number of meetings in a row we heard first-hand crisis stories from HHN members about children in diabetic comas, patients dying needlessly from the lack of available insulin, and the stress that searching for insulin was having on healthcare providers and families,” said Rachel Bernard, Haiti country director for the Dalton Foundation, which helped launch the Haiti Health Network and continues to support its activities. “We couldn’t listen to these stories over and over and not do something to help.”
Direct Relief is working on a third test delivery of cold-chain medicines and large pharmaceutical refrigeration units, with the hopes that it can restart regular shipments of insulin to Haiti with its global diabetes partner Life for a Child, said Kelsey Grodzovsky, Direct Relief’s Director of Global Programs. The shipment is intended for La Fondation Haïtienne de Diabète et de Maladies Cardiovasculaires, or FHADIMAC, whose clinics provide care to thousands of Haitians with diabetes.
The third delivery will be sent through the Port-au-Prince airport. Because it isn’t feasible to ship large volumes of aid into the northern airport in Cap-Haitien and transport it by road to Port-au-Prince in south-central Haiti, increasing the volume of medical aid to the country will depend on being able to reliably ship through the Port-au-Prince airport, Grodzovsky said.
Beyond Security: Long-Term Challenges in Getting Medical Aid to Haiti
While Haiti’s need for donated medical supplies is high – it is the poorest country in the Western Hemisphere, and little medicine is domestically manufactured – bureaucratic hurdles have long made it a very difficult country to get medicine into. The challenges predate the security breakdown of the past three years.
The process of getting medicine through customs can be difficult and unpredictable. Shipments have gotten stuck in customs for months. Licenses to import medicine expire every three months, and renewing those licenses can take six months.
“Many businesses reported difficult and slow customs clearance processes, resulting in long waits for imported products to become available,” said the U.S. State Department in a 2024 report. And customs clearance is only the first challenge. “The proliferation of gangs in the metropolitan area of Port-au-Prince and persistent roadblocks put in place by the gangs along the main north and south access routes to the capital create major challenges for goods to freely circulate in the country.”
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