A Hospital in Haiti: The Rule or The Exception

Hinche, HT — In the mid-morning of October 17th, I headed towards inner Hinche with Saj Fanm Pou Ayiti’s Volunteer Coordinator, to visit one of their partner hospitals, Hôpital Sainte Thérèse. As I stood just beyond the green gates and queue of moto drivers, a wave of disbelief washed over me. And though I knew that this was the destination, my eyes looked for stronger evidence that the building erected in front of me was what I had considered for so long to be the quintessence of health.

My eyes traced the ridges of the hospital’s rusted roof. They scanned the built-up dirt on the hospital’s decorative lattice and scrutinized the concrete ground that held tightly to old and new stains, alike. Ashamed to be a tourist in a setting that renders others so vulnerable, my eyes avoided contact with the eyes of patients and guests who leaned against the railing of the hospital’s corridor — hoping, waiting, praying, something.

The proclamation that there exist severe health challenges in Haiti is not new. In the early 1980s, American fear-mongers preyed on international health institutions’ inability to conquer newly arising infectious diseases. As HIV swept through the nation, being Haitian became one of the identities attached to the viral infection.[1] Nearly 30 years later, the devastating 2010 earthquake rendered Haiti as the new project of the “developed world”. Conversations in International Development, Global Health, and Aid revolved around the island nation. Haiti plastered Western media news outlets with one infectious disease after the other. However, the conversation rarely expanded to address Haiti’s inadequate health system infrastructure — an inadequate infrastructure that far preceded the earthquake. Without these vital conversations, it is quite unlikely that population health will improve (sustainably) in Haiti.

The health facilities available, such as Hinche’s Hôpital Sainte Thérèse, are insufficient for the population they serve. Many of the hospitals, especially public, government-subsidized institutions, encounter severe limitations of space, equipment, medicine, and emergency vehicles, limiting the scope of care and exacerbating avoidable deaths. For the remainder of the hospitals, they are either inaccessible or non-existent. Following the 2010 earthquake, over 50 health institutions and hospitals in Haiti were damaged or destroyed, and of the nearly 5.5 million people living in rural Haiti, only 5% have access to paved roads.[2] The result of such a health system is all too predictable, people don’t go to hospitals, people fall ill, and people die. Just as pressing of an issue as the infrastructure, once the walls are built, there are simply not enough medical professionals to adequately treat Haiti’s population of 11 million.

According to the WHO, the minimum threshold of doctors, nurses, and midwives per 10,000 people, is 23.[3] In Haiti, this number is far below the threshold, amassing at 4 medical professionals per 10,000. When viewed regionally, per 10,000 people, there is less than 1 physician and 1 nurse or midwife per 10,000.[4] With numbers so austere, how is it possible for the country to get healthier? Further, as Haiti is one of 82 countries classifying as “Medium” or “Low” on the United Nation’s HDI report[5], and is one of 44 low-income countries not meeting the WHOs clinician threshold, it is important to not view Haiti as the exception in global health.

There is a pressing need in global health management to address inexistent and inadequate infrastructure and staffing shortages. If the conversation continues to revolve solely around relief aid, clinical voluntourism, vaccinations, and donations of American refuse, we will never address the continuum of global health needs. As an example of the changes needed, in Port-Au-Prince, Haiti, Bethesda Referral and Teaching Hospital in Haiti (BRTH) began a six-part intervention addressing the global health continuum. The six parts included implementing evidence-based interventions in the community, increasing the skills and number of health care professionals, providing affordable care to patients, utilizing technology systems in health settings, and improving patient transportation to the hospital.[6]

Intersectional, cross-cultural, collaborative approaches are needed to solve global health’s greatest challenges, both in Haiti and in the entirety of the Global South. The fields of international development, aid, and health have become far too complacent with systems of inequality. Furthermore, private sector organizations with the power, funds, and technical experience to make systems changes, are not involved enough in distributing and sharing wealth, equality, and entrepreneurial ideas throughout the Global South.

In order to expand the reach of health systems in marginalized communities, we must identify where there is room to learn, grow, and expand in our own approaches. There is ample room to look at the role public-private partnerships may play in health care management. There is ample space to ask how we, both as individuals and organizations, can sit at the table with local institutions, organizations, and individuals and generate collaborative, sustainable solutions to existing or non-existing global health infrastructure. There is ample room for low-income and low ranking countries on the HDI index to create think tanks amongst themselves and learn from each other’s international health case-studies.

Last but not least, there is ample room for inequality today to be conceptualized not as the rule, but as the exception.

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[1] Marc, Linda G. et al. “HIV among Haitian-Born Persons in the United States, 1985–2007.” AIDS (London, England) 24.13 (2010): 2089–2097. PMC. Web. 19 Oct. 2016.

[2] Jacobs, Lee D, Thomas M Judd, and Zulfiqar A Bhutta. “Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care.” The Permanente Journal 20.2 (2016): 59–70. PMC. Web. 19 Oct. 2016

[3] “Achieving the Health-related MDGs. It Takes a Workforce!” Health workforce . World Health Organizaiton, Web. 19 Oct. 2016. <http://www.who.int/hrh/workforce_mdgs/en/>

[4] Jacobs, Lee D, Thomas M Judd, and Zulfiqar A Bhutta. “Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care.” The Permanente Journal 20.2 (2016): 59–70. PMC. Web. 19 Oct. 2016

[5] “Table 1: Human Development Index and Its Components .” Human Development Reports. United Nations Development Programme, Web. 19 Oct. 2016. <http://hdr.undp.org/en/composite/HDI>.

[6] Jacobs, Lee D, Thomas M Judd, and Zulfiqar A Bhutta. “Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care.” The Permanente Journal 20.2 (2016): 59–70. PMC. Web. 19 Oct. 2016