Jude Anne Hospital has been functioning at over-capacity since inception
Haiti 2007 © Julie Rémy
Located on one of the busiest street corners of Port-au-Prince, Haiti, the 75-bed Jude Anne Hospital has been operating well beyond its capacity since Doctors Without Borders/Médecins Sans Frontières (MSF) opened the facilities in March of 2006. It was not unusual to come across a woman giving birth on the floor, in a stairwell or in the bathroom during the months of 2008 when patient numbers were at their peak. Designed with one delivery room to accommodate five women in labor at a time, Jude Anne Hospital was before long bursting at the seams—as many as 1,600 deliveries per month, more than 50 a day—at its peak, or 35 babies a day during regular times.
The building is small and three stories high, with a tiny stairwell that cannot easily accommodate stretchers or weak patients needing to walk from one floor to another. According to Hans Van Dillen, head of mission for MSF, “Jude Anne has become a totally inadequate structure to manage the number of pregnant women who need our care. The cramped building caused substandard care, complete lack of privacy for patients and unacceptable working conditions for the staff.”
In order to be able to provide more adequate healthcare to the women of Port-au-Prince, the MSF team has undertaken the large task of moving Jude Anne Hospital to a new, more spacious location. Planning started in late 2008, and the move is taking place this February. The new hospital will be in an area called Cité Solidarité, which was until 2007 one of the most insecure zones in the city. It is about a five-minute drive from Jude Anne.
Haiti 2007 © Julie Rémy
Van Dillen concedes that while the security situation has improved dramatically throughout Port-au-Prince in the last year, it remains volatile. The advantages of this new location are the additional space for patients and its proximity to the slum communities, communities which MSF targets for free obstetric care. Working with MSF, Dr. Wendy Lai is excited about the move and says the extra space will be most welcome. Nurses will be able to walk between beds to do patient care, says Lai—currently beds are jammed together. Staff will not be tripping over one another or over patients, and babies won't be piled next to each other or sleeping on the scale for lack of cradle space.
MSF's goal is not to take responsibility for all deliveries in Port-au-Prince
The increase in space in the new facility, however, will not mean an increase in capacity over the current 75 beds. Hans points out that if MSF were to increase its capacity, “We could easily take over the responsibility for all the deliveries in Port-au-Prince and that’s not our goal.” Haiti has the grim distinction of having the highest maternal mortality rate in the western hemisphere. MSF’s goal is not to replace the current healthcare system in Port-au–Prince, but rather to have an impact on the maternal mortality rate.
According to Van Dillen, the best way to do this is by “targeting women with high-risk pregnancies who have no access to free healthcare. All women outside of this target group can continue to be referred to other institutions. With our resources, we can manage about 800 to 1,000 deliveries per month and we want to stay within that ratio in order to ensure we are delivering high-quality care to our target population.”
Haiti 2007 © Julie Rémy
Lai adds: “We focus on complicated pregnancies: mostly pre-eclampsia, eclampsia, third-trimester hemorrhage, and incomplete abortions. We have chosen the most serious diagnoses so that we can prevent maternal deaths. The purpose of our move, then, is to better care for these serious cases, because they are most likely to die. Since the time that Jude Anne opened, the number of these cases has been fairly stable. I don't want them to be lost in a crowd of normal deliveries.”
Normally, Jude Anne operates far beyond full capacity. As soon as one patient vacates a bed or a delivery table, it is cleaned and immediately another patient climbs on. Lai admits she is most worried about having to move a hospital full of patients while still trying to provide medical care. “Ít’s hard for logistics to carry a bed out the door if there is still a patient in it. Since we only do emergency obstetrics, it is difficult to predict who will arrive at our doors in serious condition. We cannot ignore women with severe complications who would otherwise die. So, we cannot close the hospital to move it. We can only try to decrease our activities and manage services to minimize patient risk.”
The team will move one operating room to the new hospital, for example, while the other operating room remains functional. For a time, two hospitals will be open, so MSF can continue to triage patients and treat extreme emergencies. According to Lai this means juggling staff and materials. It also means the logistics staff face incredible challenges; it is hard to move half a water system and half a generator. But the medical team requires water and electricity at both sites.
Despite the complications associated with moving an entire hospital and its patients from one location to another, MSF hopes the new hospital will result in better working conditions for the staff and more privacy for the patients. It should also mean more space to be able to involve families, something which can have a positive impact on a patient’s mental and physical health. The current facility only allows for one family member to accompany each woman in labor. The new structure will also mean a centralization of all hospital services and activities, such as the outpatient department, office, and warehouse. The move will take place during the first two weeks of February 2009.
MSF has been working in Haiti since 1991. In the capital Port-au-Prince, MSF provides emergency obstetric care in Jude Anne hospital; organizes mobile clinics in the slums of Martissant, Pelé Simon, La Saline, and Solino; offers emergency and stabilization care in Martissant hospital; and provides trauma care and physiotherapy in La Trinité and Pacot hospitals, including counseling for victims of sexual violence. North of the capital, in the Gonaives, MSF set up a water and sanitation program and mobile clinics, and manages an 80-bed hospital to provide emergency, maternity and pediatric care, in response to the destruction caused by tropical storms and hurricanes.