The earthquake destroyed the Offices of the Health Ministry, and as a result employment records for hospital staff were lost in the rubble. Doctors and nurses have not paid for 8 months, with the exception of 150 who are part of 800 individuals under contract. There are 1800 total health care workers in the HUEH system.
A volunteer American Emergency Room doctor, Sonia Winslett, working with an international medical NGO, told us she felt guilty when she realized her airfare and per diem costs for meals would pay the salary of a Haitian surgical resident for up to five months.
Possibly enhanced by the devastation of the January earthquake, house staff have not been paid for months. As a result, some (Haitian) staff have continued to perform work and some have not. For example there was no OB/GYN service and deliveries were performed by volunteer medical teams in the emergency room (ER) or, if stable, near term women were transported to another hospital with OB personnel. Volunteer medical staff also provided a significant amount of pediatric care. Volunteer medical personnel mostly staffed the ER and ICU with some scattered presence by the Haitian house staff of physicians, nurses and maintenance. In one instance, the Miami Hospital team came to HUEH to perform a craniotomy yet opted to perform the surgery in the ER because the OR (operating room) at HUEH was determined to be too dirty.
Most private hospitals were either destroyed or closed after the earthquake, and so the burden to treat a population of 500,000 has fallen on HUEH, which was the equivalent of a county hospital here in the States before the disaster, providing health care to anyone, regardless of financial ability. Like the fictional ER on American television, HUEH is a teaching hospital and depends upon rotating medical students from a nearby university.
Dr. Telemaque explained conditions before the quake.
Prior to the earthquake, HUEH had an indoor emergency room, but no ICU. The patient load included mainly HIV, tuberculosis and malaria cases. Because Haiti received a lot of international aid before the quake, the hospital was limited in service and international aid stopped at our doors. We were a public hospital and not considered a priority.
Then the earthquake happened, and much of the medical infrastructure in Port-au-Prince was destroyed. This put the trauma burden on HUEH. "Sanitation was poor before the quake and now it is more important than ever," Telemaque said. "We are not doing quality surgery now and we were not doing quality surgery before the quake."
Why? "Because all of the aid is in the wrong place." We had heard this refrain in all areas of the earthquake zone when we questioned why conditions had not improved with the huge influx of NGOs and dollars. The USAID website reports that the U.S. Department of Health and Human Services has given $36,196,000 to "health affected areas."
So where is the money? Dr. Telemaque has not seen any of it. "We can only say we received help from some organizations during the immediate aftermath of the quake, otherwise the situation would have been more catastrophic."
There is "no doubt," Telemaque said, that without international aid after quake many more patients would have died. Haitian doctors, nurses, paramedics and medical students tried to save lives with limited resources "We operated on 25-30 trauma patients a day, on the ground, with no anesthesia and no sterile conditions."
Initially foreign medical teams came with a staff and put Haitian medical workers out of business, Telemaque explained. The Swiss teams were a notable exception, asking that Haitian medical professionals to work with them on teams. "Putting Haitian medical workers out of work meant that we did not have a lot of Haitian doctors and nurses for 45 days after the quake and only 25-30 % were working," Telemaque said. "Now that international aid organizations are leaving, Haitian medical workers are coming back."
Telemaque gave us an article, OU SONT NOS MEDECINS, written by a Haitian doctor who tried to work in the aftermath of the earthquake as foreign doctors literally took over the Haitian health care system.
Vous imaginez des mà ©decins haà ¯tiens dà ©barquent en Floride, en rà ©publique dominicaine ou a cuba, posent tentes, et sans s'adresser a personne commencent à travailler? Impossible! Et ceci mà ªme en pà ©riode d'urgence svp. On a vu un nombre incalculable d'ONGs arrivà ©es avec leurs cortà ¨ges de mà ©decins en terre conquise! Ah l'ordre des mà ©decins haà ¯tiens n'existe pas!Imagine if Haitian doctors landed in Florida, Dominican Republic or Cuba, pitch tents, and without addressing a person start working? Impossible! And this even in times of emergency please. We have seen countless NGOs arrived with their attendant physicians in a conquered land! Ah, the order of Haitian doctors does not exist!
The current situation?
"We are rats," Telemaque said as he described the horrendous conditions HUEH staff still faces, while foreign medical teams are underwritten by USAID and "charitable" organizations.
The Chief of Surgery explained that two months after the quake, people started coming for regular health problems. But, the needs at HUEH had increased "twenty-fold," including more patients, more acute patients, post-traumatic stress, other psychological problems, and the needs of 20,000 amputees who require prosthetics, reconstructive surgery and rehabilitation.
Current needs are critical and include, nutrition, water, sanitation, general surgeons, pediatric, reconstructive, and brain surgeons, as well as a burn facility, dialysis and chemotherapy.
We confirmed what Dr. Winslett witnessed.
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