The Power of Accompaniment as Practiced by Haitian Health Workers in Times of Violence

The COVID-19 pandemic abruptly disrupted global life. As the physiological health of millions came under attack by a virus, so too did the political health of dozens of nations as already struggling governments descended further into chaos. As a global event, the pandemic has caused a ripple effect of exposing the vulnerabilities of political institutions that were unable to manage the virus well, resulting in increased vulnerability of already marginalized communities.

One of the nations to suffer from both physiologic and political disruptions is Haiti. Approximately eighteen months after the onset of the pandemic, Haiti’s president, Jovenel Moise, was assassinated in his residence by mercenaries in July 2021. His widow, prime minister, and chief of police were indicted three years later for involvement in his death and the overthrow of his government. In the absence of a clear leader, the country has devolved into rampant gang violence, rape, murder, and kidnapping of citizens and international volunteers alike. One of many negative results has been the ongoing displacement of thousands of Haitians fleeing persecution.

Viral and physical violence continues to marginalize a country in dire straits, especially in the arena of health. Not only have Haitian health workers had to battle COVID-19, but they now face threats of kidnapping by gangs who view them as pathways to large ransoms. Unable to consistently report to work and provide care, Haitian health workers are witnessing the near collapse of the national health care system. Gunshot wound victims increase in number each day while medicines and medical supplies run low with each passing minute. Gangs, having gained control of most of the country’s entry and exit points, have limited the amount of aid and number of aid volunteers able to provide additional resources to an encumbered workforce.

Despite the severity of these circumstances, they operate as a backdrop to the liberation theology-informed medicine that guides the health workers of Partners in Health (PIH). The partnership centers on three pillars: preferential option for the poor, notions of structural violence, and accompaniment, the most practiced of the three pillars. Advocated fiercely by the late Dr. Paul Farmer, accompaniment requires that you “go somewhere with [a person], to break bread together, to be present on a journey with a beginning and an end…There’s an element of mystery and openness…I’ll share your fate for awhile, and by ‘awhile’ I don’t mean ‘a little while.’ Accompaniment is much more often about sticking with a task until it’s deemed completed by the person or person being accompanied, rather than by the accompagnateur.”[1] PIH has continued to find ways to bring health services to as many Haitians as possible, regardless of the political climate because they believe these political obstacles contributing to national ill health can be overcome.

Using the model of accompaniment as practiced by PIH and the late Paul Farmer, this paper will begin with an analysis of the very real threats that COVID-19 and political instability have brought to the nation of Haiti. This sociopolitical contextualization will ground the role that violence has played in bringing attention to the nation’s plight and the particular wielding of violence this latest period has witnessed that goes beyond the comprehension of the Haitian citizenry. As a case study, the role that violence currently plays in Haiti has the power to serve as a model for other nations on the brink of unending political chaos.

Upon setting the stage that viral, political, and physical violence has wrought, I will explore the model of theologically informed accompaniment advocated by PIH as a guiding force for health workers in violence-ravaged regions. By examining the ways health workers have accompanied patients and suffering communities amid violence, I will explore ways supporting communities can accompany health workers continuing to serve on the front lines of political and health fallout. Such opportunities for patient and health worker accompaniment can serve as tools for stronger health promotion in settings overrun by violence, as well as the promotion of human dignity among marginalized communities fighting to meet basic standards of health and wellbeing. Most importantly, the theological and philosophical implications of these models of accompaniment have the power to heal communities that have been treated as underserving of the Western and global Northern bioethical gaze.

[1] Paul Farmer, “’Accompaniment’ as Policy,” Harvard Magazine (May 25, 2011), https://www.harvardmagazine.com/2011/05/paul-farmer-accompaniment-as-policy.