The general hospital in Port-au-Prince.

The first time that I brought my now 12 year old son to Haiti, he wrote an essay titled, “Help, but Don’t Help Too Much.”  Within this essay, he explained how assisting people in ways that were not sensitive or relevant to their problems was really hurting, not helping.  At the time, I was impressed, but also a little shocked, because this was not a line of thought that I had previously pondered.  Now, after seven service trips to Haiti, advocating for human rights, organizing efforts for clean water and fresh food, coordinating medical service trips, supporting refugees in transition, and delivering school supplies, I would have to say that I wholeheartedly concur with my preteen son’s opinion.  

A major catalyst for this change of perspective is the current public hospital strike.  At least 5 public hospitals across the country are currently on strike, with the goals of receiving higher wages and better safety standards.  While their demands are worthy, their methodology lacks regard for the thousands of ill or injured people who have been unable to receive affordable care for the past 3 months.  While nonprofit and private hospitals are still open, their costs are prohibitive to the impoverished Haitians who normally frequent the public hospitals.  For example, it may cost around $20US for a visit to Bernard Mevs (part of Project Medishare), whereas it would cost less than $2US for a visit to the Port-au-Prince general hospital.

As of 2015, a general practitioner doctor employed by a government funded health care institution only earned around $5,400US per year, and resident doctors could earn as little as around $1,200US per year.  Nurses serving the same institutions typically earn even less.  There have been several articles written on this phenomenon, comparing Haitian doctors pay to garment workers and dock unloaders.  While it is sad that the Haitian government either cannot or will not allocate more funding to the pay of medical staff, does it warrant doctors and nurses allowing innocent people to die for want of care?  Also, can NGOs and medical volunteer trips solve Haiti’s healthcare problems, or do we make things worse?

To address the first question, no, the innocent sick do not deserve suffering and death in the name of higher pay for medical personnel.  There has to be another way.  Friday, June 9, 2016, my pre-med student team from the University of Houston visited the general hospital in Port-au-Prince out of curiosity, expecting to find closed doors and empty rooms.  Instead, as we walked through the halls haunted by silence, we saw a number of patients still occupying beds – coincidentally, all women –  writhing in pain from lack of treatment.  The janitorial staff was still working despite the strike.  We asked one janitor, “Who is taking care of these people?”  He replied, “God.”

Several women that we met on Friday needed insulin, several needed dialysis, and almost all needed some type of medication to dull their agony.  Since we did not have our MD with us that day, we prayed with the women and left them some money for food and medication.  In another ward of the hospital, we found one doctor still working on one specific patient, but it was uncertain whether he had a good heart or had received his desired level of payment for this client.  He quickly left the hospital after treating this patient.  

Through interviewing the janitorial staff, we found that they were angry with the doctors for abandoning the poor through the strike, yet are still working in private hospitals and clinics.  One member of the cleaning crew stated that the doctors are still receiving pay from the general hospital, although they are not reporting to work.  However, he claimed that the cleaning staff had not been paid in six months, yet are still showing up everyday.

Out of respect for the ill, I only took photographs of empty rooms.

And what of the NGOs and medical volunteer trips in this crisis?  Do we make it better or worse?  In preparation for hosting two days of clinics next week, we discussed pay with a couple of doctors this week who we are considering hiring.  One doctor quoted $75US per day, while another agreed to slightly less.  While this is not much compared to what doctors earn in the United states, if doctors are earning only a little over $100US per week in the public hospitals, $70 – $75US per day is a great improvement.  However, my group, like many other US based volunteer organizations, is only going to be seeing patients in Haiti for 2 weeks out of every year.  Thus, we are not solving the pay issue long-term.  More importantly, while we can preserve lives in the immediate sense through providing free or affordable care, consistency and continuity is absent in comparison to a state hospital open 365 days a year.  

There are other shortcomings, as well.  We do not have accurate up to date files on the patients.  We have limited capacity to assess illnesses accurately.  For example, we do not have an X-ray or CAT scan machine with us.  Also, our doctors are not in one region long enough to take blood cultures to understand the deeper cause of symptoms.  While the pre-med students with me are gaining valuable experience by working with medical doctors and registered nurses to serve an impoverished population, our solutions, like our trip length, are short-term.

And while short-term solutions are not inherently negative, they can become detrimental when they are applied as a long term plan.  Medical nonprofits stationed in Haiti that offer higher pay for Haitian doctors, but also a higher fee for the ill and injured, inadvertently benefit from the strike.  Volunteer clinic groups from foreign countries such as the  US and Canada also benefit – we gain ease of access in securing the best Haitian doctors to work with, a sense of heightened pride through being the heroes during a crisis, and the ability to garner more fiscal and material donations to support our efforts during this time of greatest need.  But is it best for the Haitian people to be dependent on outside organizations?  I would have to say no.

So, how can we better support Haiti during this crucial time?  By following my son’s advice and helping people based on how they actually desire to be helped.  The medical staff of Haiti’s public hospitals need funding.  This is not the first time that they have gone on strike.  There was a strike in 2010 after many doctors had not received pay in 6 months after the earthquake.  Who can the doctors serve if they are not able to eat and provide for their families?  At that time, the Red Cross made a rare cash donation of $3.8 million to the general hospital in Port-au-Prince.  A donation like that for the public hospitals would be great right about now.  Some may argue that it not the responsibility of foreigners to assist in paying Haitian doctors, but if foreign NGOs are going to continually collect billions of dollars in the name of helping Haiti, do they not have a responsibility to help in ways that support long term sustainability?

Last week, I also spoke with two leading members of the UN in Haiti, who named the strike “irresponsible” and suggested the solution was to “fire the doctors”.  Their mission branch included health care, yet they dismissed their roles of responsibility in supporting the needs of Haitian doctors.  While they cited deaths linked to the hospital strike, they did not realize their possible corroboration in these deaths by not advocating for the medical staff to receive fair pay and better safety conditions.  Again, if a person or group is in Haiti, away from their home country, claiming to help Haitian people, should they not be considerate to the needs of the people, including health care professionals?

Entering the country and financially or otherwise benefiting from the poverty, using the political disarray as a platform to build our egos and careers, and then dismissing the people’s stated needs as irrelevant or impossible, is irresponsible on the part of all foreigners associated with Haiti.  Such an attitude speaks to feelings of inherent superiority, rather than a commitment to working together for the good of all.  If a US based health-centered NGO can collect half a billion dollars with almost nothing to show for it, I think with a little effort, they could organize assisting with long-term funding for Haiti’s public hospitals.  

In conclusion, the US, France, and many other countries have gained immeasurable wealth through Haiti’s enslavement and subsequent neo-colonization.  Many multi-billion dollar corporations that we support with every paycheck are majorly fueled by Haitian imports and labor.  If you are in a “developed” nation, you are already involved deeply in the perpetuation of Haiti’s impoverishment, whether you like it or not.  So, this human rights issue as relates to Haiti’s public hospital strike, is a global issue that deserves global attention.  

I’m no celebrity.  I’m just a mother from the ‘hood with a degree, lots of experience, and a passion for making the world better.  My voice may not have the same reach as Oprah’s or Angelina Jolie’s.  However, I urge you, if you do have any influence over donations channeled to Haiti, or you are in conversation with Haitian medical staff, amplify my voice with yours.  Tell the NGOs and small groups to find ways to support grassroots Haitian clinics that provide free or low cost services rather than being focused on only their own initiatives.  Tell them if they have the funding, to help support pay for Haitian doctors to return to the public hospitals.  And tell the Haitian doctors that they must return to work at the public hospitals.  Tell them that there must be a better way to achieve their goals than striking, that they must not be inhumane in their plan execution, and that they must win with love.  

Thank you for taking the time to read my article and may God continually bless you and your family.

Nikala Asante – Author, Educator, Human Rights Advocate

About the Author: I currently serve as Coordinator for an annual medical service trip to Port-au-Prince with the University of Houston.  Each year since 2014, we set up 2 weeks of pop-up clinics in communities within and around Port-au-Prince, such as Lillevois, Ganthier, and Terre Noire.  We are also working to set up long-term relationships with these communities, by providing water filters to help prevent parasite recurrence, planting fruit and vegetable gardens with organic non-GMO seeds, giving non-perishable food donations (purchased locally, to support the economy), and keeping data on the overall health of each location to compare year by year.  We are currently in the planning stages for a possible Winter 2016 medical service trip, which will incorporate long-term initiatives such as planting.  To donate towards medical supplies and medicines for the winter trip, please visit the UH Friends of Haiti GoFundMe.  My work in Haiti is largely volunteer, outside of the occasional grant that I am able to receive to cover my trip costs.  If you would like to contribute any amount to my continued international service work, click here.  Outside of my commitment to international service work, I am a homeschooling/roadschooling mother, an active community member in Third Ward, Houston, a self-published author, and a graduate student in the Education department of the University of Houston.