Thirty-Two Year Old Man Lying in Emergency Department Waiting Area of St. Catherine Laboure Hospital in Cite Soleil–July 22, 2013 (Photo by John Carroll)
In the mid 80’s I had never been to the largest public hospital in Port-au-Prince. It is named L’Hôpital de l’Université d’Etat d’Haïti and referred to as the General Hospital. One afternoon I asked a physician friend of mine to show me the hospital but he refused. He said the hospital was so dysfunctional and in such disarray that he did not want me to see it.
Since that afternoon 30 years ago I have been to the General Hospital many times and it is safe to say that it has not improved. In fact during the earthquake on January 12, 2010, in a matter of seconds half of its buildings were destroyed. A revamped 500 bed $82 million General Hospital was planned and was supposed to be finished by now. However several “multinational bureaucratic snarls” from financial backers — France, the United States and Haiti has slowed the work dramatically and workers are still putting up the basic frame.
And in addition to the construction problems, the General Hospital’s employees are currently on strike.
Closed Pediatric Hospital, General Hospital Port-au-Prince (HUEH), August 21, 2011–Photo by John Carroll
During the past three decades, when I visited the General Hospital I spent most of my time in the Pediatric Ward. Pediatrics was located in a building constructed in the mid-1940’s with the help of the American Red Cross. However, the earthquake in Haiti fissured this building to the point where it was not safe and the patients were moved to a large tent just down the street on the General Hospital campus. (The old Pediatric building pictured above was later demolished.)
While it was standing the Pediatric Ward accepted hundreds of thousands of children for care. Many baby’s lives were saved in the structure but many were unnecessarily lost as well. Their mothers tended to their children’s hygienic needs and made sure their sheets were washed. Since there is no food service in the Hospital parents were responsible for bringing in food for their children. Mothers and other family members slept on the floor beneath the baby’s cribs.
When babies were prescribed IV’s their families were responsible for buying the IV catheters and fluids. If they had no money, they borrowed it. A Haitian physician friend told me that the night Baby Doc Duvalier got married in the mid 80’s he was on call in Pediatrics at the General Hospital. Baby Doc’s wedding was just several miles away and held in a very lavish setting replete with women in fur coats and many many bottles of champagne. During that single night my Haitian friend pronounced eight babies dead of dehydration….all preventable deaths in his opinion.
The Pediatric building also had a room for abandoned children who were found on the streets. Many of the children were handicapped in one form or another. Staffing in this room was minimal. On morning rounds it was not uncommon to find a baby who was dead in his crib.
Over the years Haitian pediatricians led me to the cribs and bedsides of many children suffering from congenital and rheumatic heart disease. Haitian Hearts was able to transport some of them to the States for heart surgery.
The employees of Haiti’s public hospitals have gone on strike a number of times. It is usually due to the fact that they have not received their salaries for many months from the Haitian government. And for Haiti’s poor the strikes are frequently a death sentence when they become ill.
I sadly remember a few years ago during a Hospital strike that employees of the maintenance department lined the sidewalk outside of the hospital in a public display with the bodies of babies who perished to let people know of the catastrophe occurring inside.
During the last several months, employees of the General Hospital and four other public hospitals in Haiti have been on strike again. These hospitals are largely run by young resident physicians. These physicians are demonstrating against the poor sanitary conditions and lack of medical supplies in these hospitals. They are also striking because their salaries are so low. After six years of higher education, interns make less than half the minimum wage, which is set by law at $3.80 US for an eight-hour workday. Residents physician in hospitals receive the equivalent of $123 per month. The medical staff is earning less than Haiti’s textile workers who sew T-shirts for Hanes.
Several weeks ago a bleeding pregnant woman dropped dead at the gates of the General Hospital. A crowd gathered and covered her body in a blanket and carried her body to a radio station in protest.
And recently the Haitian health ministry delivered a truckload of medical supplies (gauze, gloves, basic materials) to the hospital. However, resident physicians said that would not end their strike because the quantity of supplies was deficient and the physicians said that they would only last a couple of days if the hospital was functioning normally. The delivery was described by the striking physicians as an “empty gesture”.
During the last several months I have wondered what I would do with a someone who showed up at the gates of the General Hospital bleeding to death. Would I turn my back on the person? If there was a patient in the Hospital with a broken leg and sepsis, would I care for this patient? I know for sure that I should treat every patient. But would I have the courage to do that knowing that I would be working against the intentions of the striking hospital staff which could put my life in danger?
A recent AP article reported:
“Haiti’s public health sector, which primarily serves the poor, has long been woefully under financed. The health ministry receives less than 5 percent of the national budget.
“Health should be getting at least 15 percent recommended by the World Health Organization” said Dr. Joseph Donald Francois, coordinator of the country’s cholera unit. The operating costs of Haiti’s public hospitals are simply not covered.
“The health ministry said recently that it is trying to satisfy demands made by the resident doctors but that the government can’t address salary complaints until the next fiscal year begins in October.
“Douyon said that until the government addresses the salary demands, the medical staff strike will keep going on strike.”
The General Hospital in Port-au-Prince could be an outstanding resource for Haiti’s poor and could also be an excellent teaching hospital for young Haitian doctors and nurses. It literally could do so much good for so many people if given the chance.
The State of Haiti is in chaos as I post this now. The current interim government does not want to take responsibility for this medical disaster. And the construction of the new General Hospital is going very slowly for many unnecessary reasons.
Public hospitals all over Haiti are dirty and dangerous and have been known for years as places where people go to die. Aside from a few patients here and there, the General Hospital in Port-au-Prince is all but abandoned now. I am sure people are choosing to die properly in their own homes.
General Hospital–2012 (Photo by John Carroll)
John A. Carroll, MD
I am a physician from Peoria who gets to live my dream in Haiti.