Two Reports on Medical Emergency in Haiti

Actor Sean Penn and Toronto Star columnist Catherine Porter on the urgent medical and health situation in Haiti:

Diptheria Outbreak Threatens Haiti

Anderson Cooper of CNN interviews Sean Penn and Dr. Sanjay Gupta about the threat of epidemic disease in Haiti and the failure of international organizations to adequately organize innoculation programs and access to medicines.

Sean Penn says in the interview that the threat of disease is a bigger threat than the earthquake itself. He speaks very harshly of the failure of many international agencies to recognize the health threat facing the Haitian people and acting accordingly.

"Right now, if I were putting my money on an agency that is actually ready to act, it is the government of Haiti."…

First they amputated patients, now Haiti’s health care system is under the knife

By Catherine Porter
May 7, 2010, Toronto Star


If you look closely, you can see her sunken belly rise and fall. The skeletal woman in an abandoned tent on the main path through the hospital grounds is breathing. She is naked, bangles on her wrists and rings on each finger resting by her groin. A green plastic bin sits on her chest — the kind doctors throw dirty scissors into after cutting a person open. You can barely see one side of her face behind it. What you can see is a hole where an eye should be.

American and Canadian doctors in scrubs rush by, struggling with oxygen tanks or flipping through patient files, oblivious to her. They’ve seen a lot of death here. But I am lured back, time and time again, to peer through the plastic window at the other, broken bed in one corner, the mound of garbage in the other, and her rising and falling belly, thinking that with all medical aid and expertise gushing into this country, health care in Haiti still equates to this. A naked woman in a tent with garbage, dying unattended.

The earthquake that flattened much of this city and snapped so many lives in two happened more than three months ago. Many of the hospital tents have folded up, with doctors moving back into emergency rooms propped up with metal posts and scaffolding, tending to patients who are sick with illnesses that have nothing to do with the earthquake — motorcycle crashes, tetanus, cerebral malaria.

Last week, the executive director of the country’s biggest hospital declared the medical emergency to be over. But from what I can see, Haiti’s medical emergency is only just beginning.

We’ll start here, at the Hôpital de l'Université d'état d'Haiti, the sprawling public teaching hospital that was ground zero after the earthquake. The parking lot became a morgue, the dead in piles bloating in the sun. The little park in the middle of the complex became the waiting room, wounded patients lying on spread-out clothing, many carried from the nearby nursing school, which collapsed.

Before the earthquake, this hospital had a reputation for utter dysfunction: broken pipes, filthy rooms, limited electricity, no supplies. Ask any Haitian nurse and she’ll tell you it’s been seven months since she was last paid. Seven months because that’s how long it takes for the government bureaucracy to pay people, the hospital’s executive director, Dr. Alix Lassègue, tells me from his closet-sized office.

For the university hospital, the earthquake was a boon. Many of the buildings here were left standing, so it became the main triage centre for the wounded. More than 60 non-profit organizations rushed in to help, bringing expertise and modern medical equipment never seen before — ventilators and hand-held i-STAT devices, which run blood tests in minutes rather than days. The hospital received its first two ambulances.

“The care we are providing is now better than before the earthquake,” says Californian Dr. Adam Kawalek, looking over his patients in the hospital’s newly created intensive care unit, which just last week moved indoors. Kawalek is one of 40 medical volunteers with the International Medical Corps here on two-week rotations, helping to run both intensive care and the emergency room, along with 25 volunteer doctors and nurses with Boston’s Partners In Health.

They’ve graduated from the best American medical schools. But still, they can’t combat years of neglect and a system overwhelmed with people who, each morning, crowd the gates to receive free American health care. The hospital supplies only half of their medical needs, says Gabriel Novelo, IMC’s medical coordinator here. So, while the IMC is overstocked with donations of some items, the shelves for other basics — such saline fluid — are completely bare.

“We had to take one guy off oxygen this morning, to give his tank to those three patients,” says Kawalek, waving over to one side of the room. There are a half-dozen patients requiring oxygen and only two tanks, so choices had to be made. The man whose oxygen was taken away, who was suffering from advanced tetanus, died within two hours. “It sucks to have to make those rationalizing decision,” Kawalek says.

And these are at the best of times. What will happen when the last of these volunteers leave? Who will take over the newly formed ICU? After two days at the university hospital, I can say categorically: If I ever get sick in Haiti, please don’t bring me here.

Where would I want you to take me? A few blocks away, to the hospital near the destroyed Sacré Coeur church called CDTI — the Centre de Diagnostique et de Traitement Intégré. It opened three years ago as the medical gem of Haiti — a place with clean walls, running water, CT scan machines and no chance of picking up tetanus off the floor. Doctors performed the country’s first kidney transplant here last year. But step through the metal gate today, and you’ll be greeted by a lone man sitting behind a desk in an otherwise empty parking lot, telling you the hospital is closed.

It shut down last month. The problem? It’s a private hospital, and after two months of treating earthquake patients in tents on its grounds for free, it has run out of supplies and can’t pay its staff.

“In order to pay them, we need income,” says Dr. Michel Théard, a cardiologist who helped found the hospital. To get income, you need paying patients. Most of those have either left the country or are getting free health care down at the university hospital or the University of Miami tent hospital near the airport.

“The system is in agony,” Théard says. “The NGOs are killing the private system. It’s like giving out free rice, then the famers can’t sell their rice. It’s the same thing for medicine.”

Up the hill, the administration at the Canapé Vert hospital is facing the same problem. It’s the country’s biggest private hospital. The earthquake damaged two wings, including the renovated obstetrics and gynecology ward, and crumbled the perimeter wall. Thieves ransacked its rooms, stealing curtains, beds and medications from the abandoned pharmacy.

Still, the doctors returned, and alongside volunteer medical teams from Martinique, performed 1,700 operations on injured patients for free.

“They did a fantastic job,” Dr. Richard Salnave says of the foreign doctors. “It was really nice.” Most of them offered to help the hospital get back on its feet after the emergency was over, he says. But none have delivered on those promises.

“The problem is, usually, those organizations don’t want to help a private hospital; they prefer to help non-profit hospitals,” says Salnave, a surgeon and the hospital’s vice-president.

Since it returned to offering private care, barely one-third of Canapé Vert’s remaining beds have been full. Salnave hasn’t had one paying patient.

As a result, the hospital laid off half of its staff last month.

Two emergency-room doctors have left for the Dominican Republic.

“What is the message we’re sending young doctors?” says Théard. “We’re telling them there is no place for you.”

I’m not a fan of private health care in most circumstances. But faced with these options, I would rather pay. And Théard raises a very good point. The doctors with non-government organizations like Médecins Sans Frontières are paid to offer free health care. Why shouldn’t Haitian doctors be?

The Haitian government is intimately familiar with the problem. But it is at a loss for a solution so far.

“We have to continue to share different ideas with the World Health Organization,” says Dr. Claude Surena, the coordinator of the country’s public health commission. “Even the president is concerned about this.”

The commission’s track record isn’t great. It promised to cover the first month of expenses for all the city’s private hospitals that offered free care after the earthquake. That money hasn’t arrived yet.

The sole voice of optimism comes from Dr. Lassègue, the university hospital’s patient executive director. He looks up from his desk, where he’s been writing a letter by hand, and tells me not to worry.

When the foreign doctors leave, “we’ll replace them with our doctors,” he says simply. “Tomorrow, 55 new first-year residents are coming to the hospital.”

Last fall, he presented the government with a plan to boost the hospital’s annual budget by $7 million — enough to remodel the sprawling facility into a modern institution, he says. His vision includes two sterile operating rooms, a skin graft lab, laparoscopic surgical equipment, ECG machines, ventilators and new incubators for babies….

The French government has already promised to pay for the reconstruction, he says.

“I will have it this year.”