Four and a half years ago, the world was consumed with the earthquake that rocked Port-au-Prince, Haiti. Though most of us have long forgotten about the heartbreaking conditions and turmoil in Haiti and moved on with our lives, the country still remains in great need of both better infrastructure and health care. Last month, three classmates and I spent two weeks volunteering through the WIVP at Hospital Bernard Mevs in Port-au-Prince, where we witnessed these continual hardships and were reminded how privileged we are to have access to quality care, regardless of the faults within our own health system.
Compared to other Haitian hospitals, Bernard Mevs provides comprehensive care. It has one of three CT scanners in all of Haiti, and the only ICU, NICU, and neurosurgery practice in the country. However, to those accustomed to the level of care provided in the U.S., Bernard Mevs would appear to be a shockingly substandard facility – crucial supplies are often missing, certain lab tests simply impossible, and various specialists unavailable. Despite this, we can learn a lot from Bernard Mevs. Whatever shortcomings the hospital may have, it has done a tremendous job making the most of its limited resources.
We spent the first week interviewing the hospital administration, doctors, nurses, EMTs and medical volunteers, learning about their job-specific challenges, hospital-wide challenges and desired improvements. Through our interviews and observations, we began to understand the tension between the hospital’s desire to provide health care to everyone and its need to be sustainable. For example, we witnessed this typical scenario:
A young woman enters the triage center, walking slowly towards the EMT seated at the reception desk. Other than the large cut on her forehead, she looks fine. The EMT asks her in Creole, “What happened? How did you get the cut?” At first, she tries to hide the truth, but eventually reveals that she and a friend had an argument that turned into a physical fight. An American medical volunteer examines her cut, simultaneously explaining to the EMT (and us) the extent of the wound and recommended course of treatment – sutures, a tetanus shot, and an X-ray. He writes a prescription for this care plan and hands it to the young woman. Because the volunteer doesn’t speak Creole, the EMT explains to her that she needs to go to the hospital’s pharmacy, pay for the treatment, come back with the receipt, and then she will actually receive the treatment. She walks the 500 feet from the triage center to the pharmacy window, where she is told how much the treatment will cost. She can’t pay for it. And so, instead of receiving the necessary sutures, shot and X-ray, she leaves the hospital, with the cut on her forehead still open.
When the EMT and medical volunteer realize that she is not coming back, they (and we) are both disappointed and frustrated. The volunteer laments that although right now the cut may appear to be a relatively minor injury, without proper treatment it is likely to become infected – especially given the typically poor living conditions and commonality of hard labor in dirty settings – and cause multiple health problems. And yet, because in this moment she is medically stable, the hospital cannot afford to offer her free treatment.
As aforementioned, Bernard Mevs has the only ICU and NICU in Haiti. With an average monthly salary around 60 USD, most Haitians who find themselves in the ICU, the NICU, or even the ER, can’t afford to pay even a fraction of their hospital bills. In most of these cases, Bernard Mevs absorbs the cost of care. Health insurance as we know it does not exist in Haiti; unless you are fortunate enough to work for a large company that will cover your costs, you must pay for everything out-of-pocket. And though the concept of paying before receiving treatment may seem foreign to us, in Haiti it is standard for patients to be required to purchase everything from gloves to band-aids to medicines prior to receiving care. Having to unexpectedly find the means to pay for all of these items places a tremendous burden on the patient.
Knowing all this, the hospital consciously charges less for its services than its competitors do, in the hopes that more people will be able to afford care. But the hospital is still a business and has to remain financially viable in order to serve the community. This tension served as the backdrop for all of our work at the hospital. As we developed our recommendations, we continually asked ourselves: Will this help more patients get access to services they can afford? Will itserve to better the hospital’s financial position? Is it feasible to implement? In the end, we made recommendations that tried to address all these issues simultaneously. I hope that, even though we are no longer there to drive the process, our work will be taken up by the administration and have a positive impact.
During our two weeks there, I came to see how deeply Haitians cared for one another – from the doctors and nurses to patients’ family members. I was humbled witnessing the caregivers’ profound commitment and optimism in a context that might leave those in the first world feeling demoralized and hopeless. I am honored to have had the opportunity to contribute, even in a small way, to Bernard Mevs. And more than that, I am humbled and grateful for the life lesson the hospital bestowed upon me: even if you don’t have much, you can still make a difference.
For those who are interested in learning more about Hospital Bernard Mevs’ work, please check out our liaison Dr. Vince DeGennaro’s blog at http://doctorrwanda.blogspot.com.