April 13, 2009

As Haiti’s prime minister, the UN Secretary General, representatives from more than 30 donor countries, and multilateral agencies convene tomorrow in Washington, D.C., to fund strategies for Haiti’s future economic and social development, they must not neglect the country’s immediate public health crisis. MSF calls on the Haitian government and international donors to immediately implement concrete measures to improve access to health care for the Haitian population.

On the call is Paul McPhun, MSF’s Operation Director for Haiti, Brian Phillip Moller, head of mission, MSF’s Trinite surgical trauma center, Hans Van Dillen, head of mission, MSF’s Jude Ann emergency obstetrical hospital, and Gaëtan Drossart, field coordinator, MSF’s hospital in Martissant.

Paul McPhun

Listen:

Thank you to those on line for giving your attention to the health crisis in Haiti. Doctors Without Borders is making this call today because our medical teams on the ground in Haiti are confronting a health emergency even as the country has enjoyed nearly two years of respite from intense urban conflict.

As Haiti’s Prime Minister, the UN Secretary General, US Secretary of State, key donor countries, and multilateral agencies convene tomorrow in Washington, DC, to fund strategies for Haiti’s future economic and social development, they must not neglect the country’s immediate public health crisis. Doctors Without Borders calls on the Haitian government and international donors to immediately implement concrete measures to improve access to health care for the Haitian population.

We are making this public call after weeks of advocacy towards a number of key actors in Haiti raising the attention of the unmet public health needs for Haitians: the Haitian government, donor governments such as the US and Canada, UN agencies, the UN Economic Social Affairs Council, and donor institutions such as the World Bank. Much of the focus of donors has been on hurricane reconstruction and infrastructure projects. These are all laudable endeavors. But hidden in plain sight are the emergency health needs of the population, which donor strategies have for the most part ignored. The proposed plan for the health sector development in Haiti calls for $65 million for two hospitals and medical supplies and equipment for the next two years. Right now, Doctors Without Borders is spending $17.5 million each year on our emergency health programs. And we are far from meeting the needs with this contribution to the health system.

The medical needs for Haitians today are striking. As many of you know, Haiti has the worst health indicators in the western hemisphere. Pregnant women die at a rate estimated at 630 deaths per 100,000—50 times greater than in the US or Canada. Government surveys have revealed that 72 percent of the population does not have access to any kind of health care, according to a recent International Crisis Group report.

Port-au-Prince, a city of 3.5 million people of which half live in slums, has 21 public health facilities including four hospitals. These fee-for-service facilities hardly function due to a lack of paid medical staff, equipment and supplies.

Despite improved stability in the last two years, Port-au-Prince’s poorest residents are still highly dependent on MSF’s free emergency health-care services. Fees charged by public and private health structures make care unaffordable for most people. Public hospital and clinics are often plagued by management problems, strikes, and shortages of staff, drug, and medical supplies.

There are numerous private clinics throughout the capital, but most people in Haiti cannot afford to pay for health care in private facilities. If you can pay, the level of care in these private facilities is quite impressive. But if you cannot, preventable and treatable illnesses can amount to a death sentence—even if you can reach a public hospital in time. With the World Bank estimating that between 50 and 60 percent of the population lives on less than the equivalent of $1 per day we know tens of thousands must be going without any health care.

Let’s be clear. Just a few years ago, the situation was catastrophic in terms of violence in the capital. Doctors Without Borders scaled up its operations in Haiti in 2004 and 2005 following the upsurge in urban violence. Our medical facilities were established to fill the vacuum in accessible and quality emergency services during a period of acute crisis.

Now, the violence has for the most part abated in Port-au-Prince. However, the existing efforts to strengthen the health system are far from meeting the needs of the majority of Haitians who cannot afford care in private facilities and don’t trust other public facilities.

Today, Doctors Without Borders medical facilities provide the ONLY free 24 hour a day, 7 days a week emergency room services for trauma, obstetrics, burn victims, and survivors of sexual violence in the capital.

This is an unacceptable situation for the population. This is why we are making this call today. The government of Haiti and its supporting donor governments and institutions must prioritize accessible and quality health care for Haitians today.

Thank you. Now I am going to pass the call to my colleague Brian Phillip Moller, our head of mission for the Trinite trauma center in Port-au-Prince.

Brian Phillip Moller:

Listen:

Thank you Paul.

Before I tell you about the situation today in Port-au-Prince, it is illustrative to look back to when I first worked in the Doctors Without Borders trauma center here—then St. Joseph hospital—in the summer of 2006. Those were days of incredible violence for the city’s inhabitants. Our emergency wards were filled with gunshot and stabbing victims. We had two operating rooms working around the clock, 7 days a week. In July 2006, Doctors Without Borders treated more than 200 gunshot victims at three of our medical facilities in Port-au-Prince. We had built what amounted to a war hospital. We could only admit violent trauma.

Today, our wards and beds are still filled beyond capacity. However, they are filled with the everyday cases of a city of 3.5 million—automobile accidents, domestic violence. Of our current admissions to Trinite hospital, just 3 percent of the cases are for gunshot wounds and 22 percent overall related to violence, predominantly domestic violence. This is compared to the period between December 2004 and April 2005, when 30 percent of admissions were for gunshot or machete wounds.

Today, our 60-bed structure is still under tremendous pressure though to meet the medical needs of patients. We must rapidly turnover beds in the hospital to make room for new patients. As a result of saturation of the hospital, the poorest patients—who have nowhere else to turn for reliable care—are definitely going without care.

The kinds of injuries we are treating today should be handled by the public health system. Trinité hospital treated close to 17,950 trauma cases in 2008, and has the only adequate “burns unit” in Haiti. This cannot go on. The absence of any improvement in emergency services these past two years of relative calm is made painfully clear by the inability of the public health system to care for these routine cases.

Now, I will turn it over to my colleague Hans Van Dillen, head of our Jude Ann emergency obstetrical hospital.

Hans Van Dillen: 

Listen:

Thank you Brian.

Emergency obstetric care is among the most neglected health services in Haiti’s capital, despite a new policy by the Ministry of Health, to offer free obstetric care in the country. Since March 2006, MSF has provided obstetric care to more than 25,000 pregnant women. Almost 60 percent of these cases involved complications, presenting life-threatening consequences for the mother and child.

These figures only represent the women who can actually reach our hospital. Hundreds of women do not receive the appropriate medical care they need because of lack of money, insecurity, rejection by health workers in other health facilities, and occasional hospital strikes

Indeed, hospital strikes in Port-au-Prince in October, turned MSF’s 65-bed emergency obstetrics hospital into a frontline general maternity hospital. Women, regardless of their condition, came from as far away as 120 km to Jude-Anne hospital. The result was that the quality of our medical care was severely compromised. For example, most of our patients who have undergone a cesarean-section must leave our hospital within 24-hours of the operation, due to lack of beds. At the time of the strikes, women were giving birth in the hospital’s stairwells, rooftop, parking lot and washrooms. In some cases, patients’ lives have been lost because our staff was overwhelmed and was not able to always provide medical care quickly enough.

The October strikes put our facility beyond the breaking point. But the day-to-day caseload, even with other hospitals open, is unsustainable.  MSF’s Jude Ann hospital normally covers only risk pregnancies.

Women that we refer to other facilities are refused upon arrival or face financial demands when hospitals have run out of supplies During the October and November strikes, the MSF hospitals were the only health facilities in town to provide emergency services. This is an untenable situation for and emergency organization with limited financial capabilities.

Thank you. I will handover to my colleague Gaëtan Drossart, field coordinator of our emergency health center in the Martissant slum of Port-au-Prince.

Gaëtan Drossart:

Listen:

Thank you Hans.

Martissant25 is an emergency center opened two years ago due to the high levels of violence in the Martissant slum and its immediate surroundings. More than 300,000 people are living in this area without any health facility.

We are a facility set up to stabilize patients with life-threatening conditions so they can be referred to other medical structures for care. The problem we face today is that we have no reliable public facilities to refer these patients. As already has been said, the other Doctors Without Borders facilities are overrun with patients and struggle to meet the needs already on their doorsteps. In this context, we have been forced to increase our capacity to treat more patients. Today, we have an observation room of 14 beds, but we are increasing it to 35 in the next two months. We are doing this so that we are able to refer fewer patients to other public health structures, as we know of the enormous problems they will face upon referral.

Nonetheless, our capacities are still limited and we have no other choice but to refer about 10% of our patients anyway, to public health facilities. For them, it amounts to Russian roulette. Indeed, the facilities will often lack basic capacities such as oxygen, blood transfusion, sterile surgical material, or other critical supplies… And even if everything to treat the patient is available somewhere in the hospital or outside the structure, they may be forced to pay for these materials before the medical staff will attend to them. Many times, they can’t afford it. Also, imagine if you are patient who is unable to walk but has to find a way to leave the hospital to purchase the medical supplies for your treatment. Most of all, it will be a huge problem for someone in need of lifesaving care and thus in need of a very quick response from a medical team.

I will tell you two recent cases to give you a sense of the dangers for patients referred to public health facilities.

A one-year-old boy with burns injuries was admitted to our facility in February. His haemoglobin began to fall and he needed a blood transfusion. We transferred him and his mother to a public hospital with a medical kit for his burn wound dressings. The kit was stolen on the ward of the hospital. The next day one of our staff personally arranged the blood transfusion and brought another kit. The second kit has been “lost” and the blood transfusion was not begun until the following day. The child died the day after receiving only 40CCs of blood.

Another day, a pregnant woman came to the emergency center with an ambulance of the Haitian red-cross. She was to the point to deliver but with complications. We had to send her to a public hospital with the ambulance and they were refused in three different public hospitals because no place was available or because there was no doctor. Finally they took her to a private hospital. While they were discussing the price of the intervention, she delivered in the ambulance. She lost the baby…

Sometimes also patients are coming from far away to our structure, losing days because they have to find the money for the transport and finally when they arrive in Martissant, it can be already too late. It happened 2 weeks ago with a mother coming from the surrounding area of Jacmel in the south of the country with her acutely malnourished baby who was also suffering from a complicating disease. She took 2 days to arrive and her baby died in the following hours of his arrival in the emergency center. The little girl was 4 years old and she was called Celestina.

These stories are sadly all too common. And these are the patients who can make it to our facility… These experiences shed light on the suffering Haitians endure in absence of quality and affordable care. Thank you.

Paul McPhun: The situation my colleagues have told you is completely unacceptable. The government of Haiti and its supporting donor governments and institutions must prioritize accessible and quality health care for Haitians today.

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