Executive Director of Haiti's State University Hospital, Alix Lassegue, ouside the hospital in Port-au-Prince. The French-trained gastroenterologist is hoping for a government socialized health plan within four years.

LUCAS OLENIUK/TORONTO STAR

By Catherine PorterColumnist

FERMATHE, HAITI

The newest member of Lovely’s family was born here last month, the cord yanked from around his howling throat.

He died, still unnamed, 15 days later.

No one knows why.

“Everyone’s sorry,” whispers his mother Lina Elistin, Lovely’s 25-year-old cousin, curled on a wooden chair in the family’s dirt yard. The last time I’d seen her, she was proud and pregnant. Now, she’s almost disappeared in layers of dirt-smudged clothing and sorrow. She keeps her eyes locked on the ground.

“I just stopped crying this week,” she says softly.

She had hoped to give birth in the local hospital. But her father Delius said it was too expensive. Instead, he hired a nurse to deliver the baby at home. The nurse didn’t make it in time.

Lina pushed out her thin child on Lovely’s bed, assisted only by her step-mother and a family friend. They used one of her father’s tailoring razorblades to cut the umbilical cord.

Fet ak kwaf. He arrived in a chokehold, which in Haitian folklore predicts a lucky life. But after a week, the little boy turned his head from his mother’s breast. He began to wheeze. Delius’s wife, Rosita and her sister Rosemene took turns comforting him — feeding him softened crackers and massaging his naked body with oil.

Lina was sleeping beside him one afternoon when the family discovered he’d stopped breathing.

Less than an hour later, Delius buried him in an unmarked grave. They had been waiting for his baptism to give him a name.

Everyone mourns. The weight of guilt is heavy, fueling blame. Rosita thinks Lina dropped him. Lina thinks an angry neighbour killed him with a voodoo curse.

But the real villains are ignorance and poverty. When I ask Rosita why she didn’t rush him to the nearby hospital, she says she didn’t think of it. When I ask Delius, he responds: “No money.” A bed there costs only $1.50 a day, but the lab tests and medicine are extra.

The baby’s death does not fully capture the tragedy of Haiti’s pitiful health-care system. Statistically, Lina should have died too.

Haiti is one of the easiest places on Earth to die — not from violence, although last week more than a dozen people were shot in post-election protests, but from easily treated illnesses.

Cholera, a disease cured with sugar, salt and clean water, is just the most recent example: It has killed more than 2,100 Haitians since October.

Almost six babies of every 100 die soon after birth. One in 12 won’t make it to age 5 — most succumbing to diarrhea and the flu. What child in Canada hasn’t had those?

More women die during childbirth here than in any other country in the western hemisphere. A lot more. For every 100,000 live births, 630 Haitian mothers perish — more than triple the number of mothers in Bolivia, which has the next-worst chance of survival (200 per 100,000). In Canada, only 7 die.

Most of those Haitian women bleed to death because, like Lina, they give birth at home.

“We are talking about 2,000 young women dying year after year because they don’t have the money to go to a hospital. For no other reason, they’re dying,” Christian Morales tells me from inside his small trailer-office in a barren field by the city’s airport. A naturalized Canadian, Morales has lived in Haiti for five years as the Pan American Health Organization’s health systems expert.

Haiti’s health-care system is a moth-eaten quilt of public and private facilities. Threadbare budgets mean even public hospitals charge patients for basics such as intravenous tubes and syringes, which most Haitians — living on less than $2 a day — can’t afford. Only one in 10 people here is covered by public health insurance.

Money often doesn’t buy care. A group of American doctors and nurses volunteering at the Haitian Community Hospital in Pétionville scrounged among themselves for $400 to admit Revaldo, a tiny 2-pound premature baby arriving at the hospital in the arms of his panicked father. His twin brother had died in their tin shed shortly after birth.

Two days later, I visited Revaldo and his exhausted mother, Fania Saint Juste, in a dim room they shared with two other sick babies — one with highly contagious pneumonia. Instead of being protected and warmed in an incubator, his tiny body lay under blankets on an adult gurney, warm air pumping over him from a heater. His face was tinged yellow.

Saint Juste slept slumped in a chair nearby. After prodding from Massachusetts pediatrician Gail Ryan, nurses showed her how to pump her breasts, and gave Saint Juste a rinsed-out plastic orange juice bottle to collect her milk for the baby. The bottle of breast milk was then left out, unrefrigerated, for more than a day.

“Babies this little tend to get infections. Their skin is thin, their immune systems are immature — nothing is ripe yet. That’s why breast milk is his best chance,” Ryan said, erupting in frustration. “How basic can you get?”

Had he stayed in his mud shed, Revaldo’s chances of survival were zero, Ryan said. Here, in this hospital, she pegged them at 30 per cent.

“Now with the cholera outbreak, I’d make them more dismal,” she says months later, when I reach her by phone in her North American office.

Revaldo survived the 10 days she helped pay for in the hospital. What happened to him afterward, she doesn’t know.

If there was a silver lining to the earthquake, it was this: hundreds of thousands of Haitians saw a doctor for the first time.

Public and private hospitals operated in the rubble. Haitian physicians bandaged people in their back yards. Hundreds of medical groups flooded in to perform Civil War-style surgeries — no antiseptic, no electricity, charts scrawled on patients’ bandaged stumps because there were no clipboards.

Ten months later, dozens of health clinics funded by non-government organizations continue to offer free, rudimentary medical care under tarps and in buses around the broken city.

It’s what happens next that is the big question.

In April, the health ministry proposed rebuilding the many damaged hospitals, and adding others throughout the country so that every Haitian will be within 30 minutes of a health facility.

The plan describes a new universal health-care system, extended first to the most vulnerable Haitians — young children, pregnant women, the elderly, amputees and the mentally ill — and eventually, to everyone.

All this is supposed to be underway in the next 18 months.

“Everyone’s in agreement that we need a social system, even before the earthquake,” says Dr. Jean Hugues Henrys, a health ministry member and the dean of the private Catholic Notre Dame University medical school. “The problem was finances.”

That’s not entirely true. Yes, the Haitian health ministry runs on an anemic budget of $30 million. But the country receives a monetary transfusion every year — $190 million in 2008 — from international donors for health programs.

Since the Jan. 12 earthquake, health-care spending has almost doubled from 2008, with donors pouring $460 million into health services — the exact amount the government says it needs to complete its 18-month plan.

The problem is leadership. Traditionally, Haiti’s health ministry has been a junior partner of the big international donors. The result is a patchwork, incoherent health-care system. Foreign-funded programs for patients with HIV and AIDS flourished, while public hospitals slumped with neglect.

Morales, the Canadian health systems expert with PAHO, gives this example: Last year, the Cuban and Venezuelan governments built six state-of-the-art diagnostic centres. The problem: there were few places to transfer the patients once they had been diagnosed. The centres were better equipped than the hospitals.

“And nobody said, ‘You know guys, this won’t work,’” says Morales. “That’s a huge problem.”

“This is one of the few areas where there are five main actors — USAID, CIDA, Cuba, UNICEF and thousands of NGOs (non-governmental organizations). They all have their own ideas. They all think they know what’s best to do.”

Bolivia is an apt model of what leadership can do. Fourteen years ago, its health statistics paralleled Haiti’s. Then the Bolivian government directed aid money into a health insurance scheme, granting free care to all children under 5 and pregnant women. As a result, the country’s infant and maternal mortality rates have been cut in half.

“At some point, it’s not a matter of money,” Morales says. “It’s what you do with that money.”

Push through the crowded green gates into the courtyard and the smell of urine becomes overwhelming.

The once-white buildings arranged around a wilting patch of trees and mud look like they’ve been hauled up from the ocean floor. They are mottled with grey and brown spots and, since Jan. 12, long curving cracks. Metal bars curl out from one wall like eyelashes. A thin river of grey water pulses down the gutter, as half-naked people bathe from buckets outside a smattering of beige pup tents.

A man pushes his shriveled father, dressed only in underwear, around parked cars in a wheelchair that looks like it’s been fished from the trash — leather seat and backrest replaced by a white plastic chair.

This is Haiti’s top hospital, the Hopital de l’Universite d’Etat d’Haiti (HUEH). It is the country’s biggest as well as its only teaching hospital and it is the only hospital in Port-au-Prince with a 24-hour emergency room. If leading presidential candidate Mirlande Manigat was hit by a truck, this is where she would be rushed.

Haitians call it the place to come to die.

Dressed in a starched white lab coat, Dr. Alix Lassegue cuts through the chaos with purpose. A French-trained gastroenterologist, Lassegue was once a top bureaucrat in the health ministry. Today, he’s the hospital’s executive director. He’s a man of procedure, pen-scribbled notes and quiet optimism. If he notices the disarray and filth around him, he doesn’t let on.

He stops between two parked cars outside the cracked surgical building and gently nudges a mound of grey sand with the toe of his dress shoe.

“This is it,” he says. This is where a group of American and French dignitaries gathered in late September to lay the foundation of a new $53.2 million hospital. This pile of sand, now adorned with an empty juice can, symbolizes hope.

“We are going to completely rebuild the site. It will be a modern hospital. We’ll have all the specialties, more imaging, more technical approaches, oncology, radiotherapy, a CT scanner and MRI, a pediatric ICU. It will be like CDTI,” says Lassegue, referring to a swank, private hospital five minutes away where the country’s first organ transplant was done last year.

The hospital was funded like a university dorm, hence its pathetic legacy. While Toronto’s Mount Sinai spends $445 million a year, HUEH’s budget is $5 million — 90 per cent sapped by salaries, which were both low and irregular. Top doctors here make $590 a month, when they are paid, so everyone — including Lassegue — has a private clinic, where they work two to three days a week.

In principle, treatment here was free. In practice, patients were sent across the street to private pharmacies to buy everything from surgical gloves to needles.

“I remember one lady suffering from heart failure,” recounts Dr. Louine Martineau, a doctor with Partners in Health who interned at HUEH. “The medication was only 25 gourdes (62 cents) for a bottle, but she couldn’t afford it and she died.”

The earthquake came as a mercy killing. It destroyed buildings that should have been bulldozed years ago. It also infused the campus with dozens of international medical groups who established the hospital’s first intensive care unit. Lassegue says the supplies they brought will last into next year. In July, the Red Cross raised staff salaries for the year to nearly match what NGOs are paying. And the French and American governments have committed to help the hospital for five years, by which time that mound of sand should be replaced by a new earthquake-resistant building.

But what are the chances of all that happening?

Private hospitals like CDTI — the Centre de Diagnostique et de Traitement Intégré — still haven’t been reimbursed for the care they provided after the earthquake. It has since closed, going bankrupt after three months of treating earthquake victims for free.

No headway has been made on the government’s plan for universal health care. The Interim Haiti Reconstruction Commission approved a $20 million PAHO program to provide free health care for some patients, but didn’t fund it, so Morales is back to begging donors.

“It could take three or four years (to rebuild HUEH), depending on political stability,” Lassegue says. “But it will happen.”

Just across the dirt park, row upon row of babies cry and murmur from their rusty cribs in the hospital’s pediatric wing — now housed in a plywood bunker. Three of the babies were abandoned here by their parents, perhaps out of fear or poverty. “We don’t have time to hold or play with them,” explains Dr. Romy Morency, a sleep-deprived pediatric resident, rushing from the bunker in search of an IV tube. “There are so many kids here in bad shape.”

What will happen to them is beyond contemplation, Morency says.

Will the renovation plans help? Will they keep her at the hospital?

“Hell no,” she says, pulling a BlackBerry from her jeans to show a photo of her 3-year-old son. “I have a family to take care of. I’ll be long gone.”

There is a model for good health care in Haiti, for the rich and poor alike. To see it, you must leave the city, head northeast up into the desert mountains with their cacti and famers astride lumbering pack mules until you reach the dusty town of Lascahobas. At the end of the main road, lined with saloon-like stores, sits what could pass for an Oakville golf clubhouse: low-slung white buildings surrounded by manicured lawns and birds of paradise. People sit on benches under a trellis of white flowers awaiting prescriptions. No garbage, no pulsing gutter, no smell of urine. Yes, the hospital is basic, but it is clean and welcoming. Most importantly, it is free.

Officially, patients pay 25 gourdes (62 cents) as an admission fee, which covers all their treatments and medication. Most don’t pay even that.

The wards are packed with one comforting story after another: peasant women with bellies swollen from heart disease blessing the doctors; the farmer who donated his sugar cane and rice fields for the hospital contentedly recovering from malaria; 10-year-old Elmitha Felix sliding her crippled left foot up and down the hall, just like her physiotherapist taught her.

She arrived here from Port-au-Prince last March with what doctors thought was typhoid fever. Five days later, she slipped into a coma. Turns out she had tuberculosis meningitis.

“She’s the star,” says Dr. Louine Martineau, watching her do her exercises. “Here, we can actually help people. It’s not depressing.”

Most of the hospital’s $1.5 million budget comes from international grants and donations. But it is run with the approval of the health ministry, which pays a base salary for the staff.

“Rather than developing a parallel system to replace what the ministry can’t do, we’re trying to support what the ministry has the authority to do,” says Dr. Louise Ivers, the Irish-born chief of Partners in Health in Haiti who has spent seven years here. “That’s the only way to have a sustainable system.”

In nearby Mirebalais, backhoes are leveling corn and rice fields to make space for a larger version of this hospital — 320 beds and six operating rooms. It, too, will be government-sanctioned, but PIH-funded, treating the poor for free.

But what happens if, after the hospital opens in a couple years, Partners in Health can’t raise the $8 million it will cost to run it every year?

“There’s a Haitian proverb,” Ivers says, when I ask her if she is hopeful. “It says ‘As long as your head is not cut off, you have the hope of putting on a hat.’”

I am not hopeful. Health care will continue to be what it’s always been for most Haitians, I fear — a gift bestowed on the lucky and the rich. At least for the foreseeable future.

How many women like Lina will die for no reason? How many more babies will die from poverty? It is unconscionable.

I visit the Baptist Mission hospital in Fermathe, where Lina should have taken her baby, had she the foresight and the cash. Set behind an impressive stone church, it was built by American Christian missionaries as part of a complex of schools, a tree nursery, a 1950s-style American diner and a small museum with dusty displays of Haitian history and the perceived evils of voodoo.

The hospital is there to treat people’s souls as well as their bodies, Jean Angus, its business administrator, tells me. “Many of our patients meet with Christ at the hospital.” The chaplain runs a social assistance program, waiving fees for a handful of patients each year.

Had Lina brought her son here, he might have been among those lucky few.

But, given the cool reception the family received in June when I accompanied them here, he might also have been turned away.

“If we make a big publicity about our assistance program, we will go out of business because no one will have the means to pay,” Angus admits.

I take a tour. The hospital is small, but clean, and its two operating rooms look modern and well-equipped. There are four full-time doctors, a blood work lab, a dental clinic, a busy maternity ward and a small, quiet pediatric ward.

Compared to CDTI, a bed at the Fermathe hospital is cheap. But, like most private hospitals in Haiti, every service and treatment costs extra. When we came here in June, the consultation, blood work and medication for Lovely and three of her family members — they suffered urinary tract infections and Uncle Delius had his perpetually sore back X-rayed — cost me more than $50. That’s six months’ rent in a nearby apartment.

You can see why Lina’s family didn’t bring the child here. For them, the hospital might as well be in Canada, it’s so far out of reach.

But not anymore. After reading about Lovely, many Star readers sent me cheques for the family. So, I opened an account at the hospital and deposited $1,000. That’s a lot of money in Haiti. It should support all 12 family members for at least five years — covering lab tests, medication, dental work, even surgery.

The first family member who plans to go is Lina. She’s anemic, and has been light-headed and chilled since giving birth.

>via: http://www.thestar.com/article/905566--death-and-decay-in-haiti-s-hospitals

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December 9, 2010

Epidemics and Revolt in Haiti

Burning Tires in the Time of Cholera

By SASHA KRAMER

Wednesday morning, the day after the election results were announced, and the streets of Port au Prince are covered in a blanket of tire smoke. From Delmas 33 the sounds of gunshots and tear gas canisters ring through the air every few moments and on every street corner loud political discussions echo through the rubble which has been arranged to form road blocks. On the main streets, dumpsters have been overturned and converted into roadblocks. Public transportation has slowed to a standstill and businesses are shuttered.

Imagine the implications of several days without sanitation services in Port au Prince. An example, in downtown Port au Prince and Petionville the camps of Place Boyer, Place Saint Pierre and Champs Mars (home to over 15,000 people) rely on approximately 450 portable toilets for sanitation. These toilets are cleaned and emptied daily by a private company. With a small holding capacity and extremely heavy usage, many of these toilets will fill in 1-2 days if not emptied. Two days without desludging and the toilets of Champs Mars could be overflowing with over 5000 pounds of poop per day. Also, recent reports indicate that in downtown Port au Prince portable toilets are being overturned and used as roadblocks, some spilling their contents into the streets where tens of thousands of people have gathered to express their discontent with the CEP and the UN troops.

>via: http://www.counterpunch.org/kramer12092010.html

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MIAMI HERALD WISH BOOK

Haiti earthquake survivor's wish: independence

A Haiti earthquake survivor who was trapped for two days beneath a collapsed building -- and who is now a paraplegic -- wants to reclaim her independence.

Sandrise Vital spent two days beneath the rubble of her office before she was rescued after the January 12 earthquake in Haiti. Vital sustained numerous injuries and was transported to Memorial Heath in South Broward. As a result of her injuries she is a paraplegic. She does not qualify for medical aid or any assistance because she is here on a tourist visa. For the holidays, Vital would like a new wheelchair. At 30 years old, she simply wants to reclaim her independence.

PETER W. CROSS

BY NADEGE CHARLES

NCHARLES@MIAMIHERALD.COM

>via: http://www.miamiherald.com/2010/12/11/1969540/rising-from-the-rubble.html

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