Haiti: Debriding Wounds

As I walked into the maternity ward of the General Hospital in Port-au-Prince, I nearly slipped in a puddle of amniotic fluid. Outside, beyond heavy iron gates, women were sprawled on the ground, waiting to see a doctor.

In Haiti, most health services are provided by NGOs or religious organisations. Clinics, like the one run by the Sisters of Charity, and dispensaries are common throughout Haiti, particularly in Port-au-Prince. These clinics are always overflowing with people, with maladies ranging from scabies to abscesses to deep, gouging wounds on their limbs. Health care, what exists of it, tends to be limited to Port-au-Prince and major cities – the majority of doctors are found in Port-au-Prince whereas in rural areas, there is generally only one doctor for 30 000 people. For people who live far from Port-au-Prince, it can take a day to reach a hospital, if they can make it that far.

If you can get to a hospital, immediate care is expensive. During my stay in the Canape Vert Hospital, the best in Port-au-Prince (or so I’m told), to secure a room I had to produce a 15 000 Gourde deposit (about $682 US). During my stay, I was charged for everything from the tape that they used to attach my IV to cotton balls to the thermometer, on top of medication. In total, without doctor’s bills, my stay cost at least 7 000 Gourdes ($320 US). For me, with medical insurance and an employer to help me cover my bills, this is entirely reasonable. For the average Haitian who makes $260 US a year, it’s impossible.

The typical hospital experience in Haiti is more likely what you fine at the General Hospital (L’Hopital Universitaire de L’Etat d’Haiti, HUEH). In a recent article for La Nouvelliste, journalist Serge Philippe Pierre writes of the endless struggles to receive care at HUEH. If a patient arrives at 5 am, there will already be a line. If it’s there first visit, a file needs to be opened, which can take all day. If they’re returning, the file needs to be retrieved from the archives, which are rarely in order. In general, HUEH has 600 to 700 seeking treatment on any given day. They manage to see perhaps one quarter to one half of them. Those unable to see a doctor their first day can come back again the next, if they don’t die of their illness first. Some use the services of racketeers. Pierre writes, of a discussion with one of the doctors, “at times, the doctor tells us, they put the blame on us. “The patient says, at times, that they paid to see a doctor quickly. It’s one way of saying that it’s us, the doctors, who maintain the group of racketeers that operate in the courtyard.”

The General Hospital is a series of drab concrete buildings located in downtown Port-au-Prince, an area whose security problems increase significantly after sunset. The hospital itself has 700 beds and an occupation rate of 82% - 92 %. For these 700 beds, there are only 143 licensed doctors. Most of the work, it turns out, is done by the residents. Pierre writes, “the residents say there is most frequent need of a state doctor’s assistance with certain emergencies. “We’re left to ourselves. We consider ourselves health professionals in training (10%) and employees who provide 90% inexpensive labour.”

All of this seems typical of a developing country – extreme lack of doctors, inadequate health services, woefully under served rural population. Haiti is a country where people die frequently of diseases easily, and cheaply, cured in North America.

At the General Hospital, my good friend, a resident in his final year of studies, lives on the hospital grounds. There really isn’t any point for him to keep an apartment; he’s always at the hospital. After visiting him at the hospital, spending time volunteering in wound clinics, and a brief stay at the Canape Vert hospital myself, the General Hospital incensed me. “It’s difficult,” he admits, “but you get used to it. We always work in these conditions.” I asked him once what makes him mad. It wasn’t the hours he works at the hospital or the incredible stress of the job – that was a choice he made when he entered medical school. “The thing that makes me mad,” he tells me, “is that people steal the supplies. Without them, I can’t do my job properly.”