The Dominican Republic has identified nearly 1,000 pregnant women suspected of being infected with the Zika virus. Haiti, which shares the same island, has identified only 22.
"There's no reason to believe that the mosquito will behave differently here [in Haiti] than in the Dominican Republic," says Dr. Jean Luc Poncelet, the World Health Organization's representative in Port-au-Prince.
Why are the numbers so dramatically different? Dr. Louise Ivers, with the nonprofit Partners in Health, which runs the largest teaching hospital in Haiti, is concerned that Zika is spreading as a silent epidemic.
Indeed, Haiti has all the ingredients for a major outbreak. The Aedes aegypti mosquito, which carries the virus, is widespread. Open sewers and ravines covered in trash provide ideal breeding grounds for the mosquitoes. A doctors strike over the past four months — it just ended — pushed the public health system into crisis, making it less likely that health care officials would pay attention to Zika.
Poncelet says part of the problem is that the country doesn't have the resources to test extensively for Zika. Haiti is also in the midst of a political crisis that has left it without an elected government since February. And it faces numerous other health issues, including a cholera outbreak that has sickened 25,000 people this year alone.
Meanwhile, the effects of Zika are apparent, even though the nation is reporting only a handful of confirmed cases.
Doctors at public, private and religious hospitals say they're seeing an increase in babies born with microcephaly — a condition that the World Health Organization has linked to Zika — as well as a spike in Guillain-Barre syndrome, a condition that can spring from Zika. Haiti has few services for people with disabilities so it's unclear how the country will be able to cope with a surge in severely disabled children.
At the Mirebalais Hospital in Haiti's central plateau, doctors say they've had four babies born this year with microcephaly — three of them in July. Dr. Ivers and Dr. Roman Jean-Louis are tracking the development of the children. Ivers checks the reflexes of a girl named Chinashama, who is on the examining table.
"So this baby has much more muscle tone than the other [microcephalic] babies," she says. "She's sort of fighting me, and the other really was not doing that much.
But the girl's legs cross unnaturally at the shins, and one foot doesn't respond when Ivers runs her finger over the sole. The baby's mother says the child cries almost all the time.
Jean-Louis says he used to see perhaps one or at most two cases of microcephaly a year, but never three in one month.
Ivers is concerned that Haiti is unprepared to care for babies suffering from severe developmental delays because of Zika.
Life is already tough in the poorest country in the Western Hemisphere. Sixty percent of the population lives on less than $2 per day, and there are few services for children with physical and neurological disabilities.
One resource is the Kay St. Germaine rehabilitation center in the Tabarre section of Port-au-Prince.
Outside the gate, a mother holds a child with twisted limbs and a floppy neck.
Inside, Annette Johansson, a volunteer from Sweden, is preparing for the start of the fall semester.
"Here we have the resource room," Johansson says as she walks through the compound. "And a speech and language therapy room. But at the moment we don't have any trained speech and language therapists."
The center provides physical therapy and basic education to children with cerebral palsy, Down syndrome, autism and other neurological disorders. Much of their work, Johansson says, is training parents to care for a disabled child.
"Because they [the parents] need to be able to change them, dress them, feed them in a safe manner," she says. "We don't have the equipment that you have in America or Europe. We can't give them feeding tubes, so it's really important that they know how to handle their kids, position them the best way possible."
Haiti is an incredibly hard place to look after a disabled child, she says.
Most of the families that bring their children to the center live in the poor sections of Port-au-Prince, with as many as four or five people in a one-room shack. The houses often aren't accessible by paved roads or sidewalks, so they aren't accessible to wheelchairs.
"So we can't provide them chairs," Johansson says. "Well, first of all we don't have any chairs. Second of all, they don't have room for chairs or they don't have anywhere to store them indoors."
Many of the parents bring their children to the center in the beat-up pickup truck taxis known as tap-taps that barrel across Port-au-Prince and serve as Haiti's main form of public transportation.
"I don't know if you've seen the tap-taps and how full they are," she says. "And then imagine you're going to try to get a disabled child into this." She shakes her head as if the very thought of it is overwhelming.
Just up the dusty dirt road from Kay St. Germaine is the St. Damien children's hospital. It's run by the same Catholic organization that runs the rehab center. The hospital administrator, Jacqueline Gautier, says disability is the leading reason children are abandoned in Haiti.
"Many times the parents just leave them," she says. "Actually we have [a] room full of 10 children like that. And all hospitals have a small unit with abandoned children."
She can usually find homes for able-bodied kids, but the disabled children will most likely stay at the hospital for the rest of their lives. Her hospital has also had three babies born recently with microcephaly. They've sent blood samples to the national laboratory to test for Zika but haven't yet gotten any results back.
"It's very hard," she says. "The last one is still hospitalized, because the mother died. The father lives elsewhere now. The baby has seizures, so the baby is still with us."
She's hoping Haiti will be spared from Zika, that maybe it won't be as bad here as in some other places.
But she shrugs and says they'll just have to wait and see.
ARI SHAPIRO, HOST:
Haiti officially says it's had just a handful of confirmed cases of Zika. Doctors suspect there are many, many more. They're seeing an increase in babies born with microcephaly. As NPR's Jason Beaubien reports, Haiti's not well equipped to deal with the emerging virus or with a potential surge in disabled children.
JASON BEAUBIEN, BYLINE: If the Zika virus was looking for an ideal place to flourish, Haiti would certainly be a top candidate. I'm standing here in downtown Port au Prince next to a large, open drainage canal that's half full of water and half full of garbage. There's old tires in there. There's plastic bottles. There's a pig rooting around. This is the type of place that the Aedes aegypti mosquito which carries Zika loves to flourish in. And there are spots like this all across Port au Prince.
Yet Haiti has only identified 22 pregnant women suspected of having Zika while the neighboring Dominican Republic has identified nearly a thousand.
JEAN LUC PONCELET: There's no reason I think to believe that the mosquito will behave differently here than in the Dominican Republic.
BEAUBIEN: Dr. Jean Luc Poncelet is the World Health Organization's representative in Haiti. Poncelet says part of the problem in Haiti right now is that the country doesn't have the resources to test extensively for Zika. Haiti's also in the midst of a political crisis that's left it without an elected government since February, and it's got numerous other health issues on its plate, including a cholera outbreak that sickened 25,000 people this year alone.
PONCELET: Zika is definitely a problem. Fortunately it is a problem that is affecting a bit less than other disease in the country.
BEAUBIEN: But to what degree Zika is affecting Haiti is unknown. A doctors strike that stretched from March to August shut down much of the public health care system and has made the country's Zika statistics highly unreliable. In the middle of August, Haiti was officially reporting 20 suspected Zika cases per week while nearby Puerto Rico was tallying nearly 2,000.
UNIDENTIFIED BABY: (Crying).
LOUISE IVERS: Oh, oh, sorry.
BEAUBIEN: At the Mirebalais Hospital in Haiti's Central Plateau, Dr. Louise Ivers and Dr. Roman Jean-Louis are following three children born in July with microcephaly. Microcephaly can be Zika-related birth defect which causes a smaller-than-normal skull and an underdeveloped brain. Dr. Ivers with Partners in Health, a non-profit that runs the hospital, is checking the reflexes of a baby named Chinashama.
IVERS: So this baby has much more muscle tone than the other babies. She's moving around more. She's kind of fighting me. And the other baby was really not doing that much.
BEAUBIEN: But the girl's legs cross unnaturally at the shins. One foot doesn't respond when Ivers runs her finger over the sole, and the baby's mother says the child cries almost all the time. Dr. Roman says they'd expect to see one or two cases of microcephaly at this hospital per year.
ROMAN JEAN-LOUIS: (Foreign language spoken).
BEAUBIEN: But he says it's highly unusual to get a cluster of three babies with microcephaly as they did in July. Life is already tough in the poorest country in the Western hemisphere. Sixty percent of the population here lives on less than $2 per day, and there are very few services available for children with physical or neurological disabilities.
One of them is the Kay St. Germain rehabilitation center in the Tabarre section of Port au Prince. Outside the gate, a mother holds a child with twisted limbs and a floppy neck. Inside, Annette Johansson is preparing for the start of the fall semester.
ANNETTE JOHANSSON: And then we have a resource room and then speech and language therapy room. But at the moment, we don't have any trained speech and language therapists here.
BEAUBIEN: The center provides physical therapy and basic education to children with cerebral palsy, Down syndrome, autism and other neurological disorders. Much of the center's work, she says, is training parents on how to care for a disabled child.
JOHANSSON: Because they need to be able to address them, change them, feed them in a safe manner. We don't have the equipment here that you have in America or Europe. We can't give them feeding tubes. So it's really important that they know how to handle their kids and position them the best way possible.
BEAUBIEN: Most of the parents, she says, bring their kids to the center in the beat up pickup truck taxis known as tap taps.
JOHANSSON: I don't know if you have seen the tap taps, how full they are. And then you're going to try to get the disabled child into this as well and lifting them onto it.
BEAUBIEN: Just up the dusty dirt road from Kay St. Germain Case is a children's hospital run by the same Catholic organization as the rehab center. The administrator of the hospital, Jacqueline Gautier, says disability is the leading reason kids are abandoned in Haiti.
JACQUELINE GAUTIER: Actually we have a room full of 10 children. We have like that, and all hospitals have a small unit with abandoned children.
BEAUBIEN: The abandoned, disabled kids, she says, will most likely stay at her hospital for the rest of their lives. Jason Beaubien, NPR News. Transcript provided by NPR, Copyright NPR.