Doctors Without Donors
One doctor’s vision to provide working-class Haitians with affordable health care
Charlemagne Woolley could have gone to Canada. If Haitian doctors are known for anything, it’s for not staying in Haiti. Woolley is an internal medicine specialist, and as he was finishing up his medical studies nearly a decade ago, he and his family completed all the requisite immigration interviews and applications. They were approved to move to Montreal, where he has family and where doctors make much better money than they do in Haiti.
He couldn’t bring himself to leave. Part of him was anxious about what life abroad would be like, but he also wanted to test a strategy that he could try only in his home country: provide working- and middle-class Haitians with affordable health care.
Woolley finished med school and started an internship at the under-staffed and under-funded General Hospital in downtown Port-au-Prince. Every day he saw scores of people come into the hospital suffering from late stages of disease, most cases too late for doctors to do anything. “I asked them why this was happening,” Woolley says from behind a dark wooden desk in his office, a modern and pristine clinic. A stethoscope hangs over his sky blue plaid button-down. “You could see it was because of a lack of access to specialists. They would go to charlatans or houngans” – Vodou priests – “and didn’t think they could afford to see a specialist.”
It costs about $50.00 for a private doctor’s consultation in Haiti. Woolley wanted to provide lower-cost access to a clinic with specialists. “The idea was to charge a low price,” he explains, “but see a lot of people to make it viable.” He convinced a small network of doctors – a pediatrician, a gynecologist, a few orthopedic surgeons, among others – to get on board and figured he could subsidize some of the cost through the private clientele he was establishing as an internist. Woolley started Clinique Santé Pour Tous in 2006, out of the small house that he grew up in, with one central idea: 500 gourdes, about $11.00, would allow an entire family to see a network of doctors for an entire year.
Faustin Woosbenley went to high school with Woolley, and they studied medicine together at Haiti’s State University. He now works at a public hospital in Port-au-Prince and, like many Haitian doctors, also has a private clinic. “In Port-au-Prince,” he explains, “where we have more than 2 million people, we have like two general hospitals that can receive every kind of patient. It’s not enough for this population.” In theory, the public hospitals exist to serve anyone with need. But in practice, Woosbenley says, “there is not enough doctors, there is not enough space to see everybody at the same time, so people have to wait a long time to see a doctor. People who can pay go to private clinics.”
In a country with average yearly income of $700, that constitutes the upper class: professionals like lawyers and engineers, government staffers, and salaried employees of international NGOs. Woolley’s strategy depended on scale. He wanted to charge a modest fee to buy into the system but make it sustainable by enrolling a large number of families who couldn’t normally afford care at private clinics. Bundling the 500 gourdes enrollment payment with children’s school fees seemed like a relatively frictionless way to sign up a lot of families quickly, so he started lobbying school directors. That was anything but frictionless.
Woolley calls the first two years of operations “catastrophic.” His wife, who’s also a doctor and works for the global health NGO Médecins Sans Frontières, supported him by covering the family finances. Woolley got a foot in the door with one school director, demonstrated over the first year that the plan could work, and the first director introduced him to a second one. Momentum built gradually, and today Santé Pour Tous has 17 schools in its network with approximately 15,000 member families.
“They pay 500 gourdes even if they come 500 times a year,” Woolley says of each member family. Each specialist works only two or three days a week, which keeps costs down. After consultations, members do have to pay for procedures and treatments, but the doctor’s network provides them with services at roughly half the market rate. The clinic also has a lab that charges half the sticker price of an average Haitian lab for blood tests, EKGs, and ultrasounds. “Our structure is not depending on outside help,” says Woolley. “We are really self-sufficient economically,” even though he estimates that 30 percent of his clinic’s business is private – patients who pay full-price and help cover the other costs.
Some families in the school-based system could probably afford to pay for private care, Woolley says. But he says that many members are working-class families that scrape together money for their children’s school fees each term. He believes that the clinic offers them reliable and consistent health care that wouldn’t otherwise be available to them in Haiti.
“It was like a miracle when we got the first school,” he says. “It was the beginning of what would be after that a really good adventure.” The business broke even in its fourth year and now makes a small profit, which allowed them to get financing to open the new, modern building last November. He plans to add a second-story hospital with an operating room eventually but estimates that would require 10,000 more member families to make it financially viable.
“Most people told me at first that if I want to do this I should start an NGO,” Woolley says. “In the country you have those structures that are really depending on help,” – outside funding from donors, he says – “and then when that help leaves, the structure goes away. It’s not viable. In this country we need structures that are self-sufficient, so they can be here in 50 years.”
“It is possible to give basic health with not so much money,” Woolley says. “That’s what I am proving here.”