Haiti’s health system collapsing under weight of doctors’ strike

In Haiti a medical residents’ strike, hospital closures, and a lack of basic medical supplies have left millions of patients with no realistic treatment options.

Most of the country’s public teaching hospitals have shut down and many staff are downing tools in sympathy with the striking residents, who earn just 7000 Haitian gourdes a month (£85; €100; $111) at the outset of residency, rising to a possible 9000 gourdes.

Among the closed hospitals is the country’s largest, Port-au-Prince’s Hospital of the State University of Haiti (HUEH), known locally as the General Hospital. Strike action began there in March when the hospital’s administrator allegedly slapped a resident during a dispute over a delayed test for a patient.

“None of the public hospitals around the country are functioning and no one is saying anything. Everyone is walking around like it’s no big deal,” HUEH’s executive director, Maurice Fils Mainville, told the Miami Herald.

The strike soon turned into a nationwide residents’ walkout, with strikers demanding pay rises, safer working conditions, and a reliable supply of basic medical equipment, such as syringes and oxygen.

Heavy foreign investment since the 2010 earthquake has produced few concrete improvements in the health system, with donors focusing on single disease campaigns or prestigious building projects rather than primary care and sustainability, local doctors said.

A new $30m public hospital built by Canada was known locally as a white elephant before the strike closed it down, and a new $83m general hospital being built by France and the US faces an uncertain future since no funds were set aside for its operating costs.

The work of the American Red Cross in Haiti was also criticised in a US congressional report last month that accused the organisation of having little to show for its spending because of poor accounting and excessive claims for overhead costs.1

With most of Haiti’s health budget already consumed by doctors’ pay, the gap between the residents’ demands and the government’s capacity to pay looks unbridgeable. Two weeks ago health minister Gabriel Timothée, himself a doctor, offered to double the salaries of all residents. But the salary offer of 14 000 to 17 000 gourdes a month was only half of the lowest of the residents’ demands, and less than a fifth of the 80 000 Gourde starting salary demanded by strikers at most hospitals.

“This rotting system is either going to totally collapse or it’s going to have to improve,” resident Rishkord Juin, a strike leader, told the Miami Herald. “We don’t want the hospital to turn into a morgue. If we’re going to work there, it has to be under good conditions.”

Doctors are also demanding medical insurance for themselves and for police to patrol hospitals to protect them from often violent, armed patient relatives.

The Haitian Medical Association has asked the parties to resume dialogue, but said in a statement two weeks ago that “all the bridges seem to have been burned.”

Since last month, the country has been leaderless, as the mandate of interim president Jocelerme Privert expired and lawmakers have refused to meet to extend it. Haiti has been deadlocked in a contested election process since last year.

Initial public support for the doctors has waned. The death of a pregnant woman who pleaded for entry at the gates of Port-au-Prince’s general hospital led to a public demonstration, with the crowd chanting “Medicine must work” as they carried the woman’s body to a local radio station.

Citizens later staged a sit-in, telling residents that their salary demands were unreasonable. The incident also drew a rebuke for the doctors from the local representative of the World Health Organisation, who said that even striking doctors were obliged to provide emergency care.

Two hospitals run by non-governmental organisations (NGO) have been flooded with patients since the public system broke down. Médecins Sans Frontières runs an orthopaedic trauma hospital in Tabarre, and, in view of the health situation, the group recently decided to extend its stay in Haiti by 10 years. They are now limiting care to open fractures, in which bone projects from the wound, only. Patients with closed fractures are splinted and discharged with referrals for public hospitals that will no longer take them.

The University Hospital of Mirebalais (HUM), founded in 2013 by the US NGO Partners in Health, is considered Haiti’s best. Doctors are paid twice as much as those in public hospitals, and the hospital weathered the strike’s early days well—even opening the country’s first advanced diagnostic laboratory, able to perform tissue biopsy. Previously cancer diagnosis and many other tests had depended on waiting until someone was travelling to Boston then asking them to carry a suitcase containing up to 300 biopsy samples.

But as more public hospitals closed, and more Haitians heard that treatment was available at HUM, the hospital was overwhelmed by demand. All of the hospital’s chairs, wheelchairs, and beds have been occupied, while hundreds of patients camp in the grounds outside.

“Haiti is not the place to be sick,” the hospital’s director, Maxi Raymonville, told the Haitian Times.