An Uncomfortable Week in LaColline

17 May, 2010

I was awakened at 4 am by what sounded like a spliced- together sound track from every barnyard movie that had ever been made: a massed chorus of dogs, donkeys, cows, pigs, goats, and (of course) roosters was enthusiastically welcoming us to LaColline.

I zipped myself out of the mosquito netting and saw a man with a big basket of buns patiently standing at the front door. We bought some for a sunrise breakfast.

The grounds of the mission compound include not only the hospita where we were to work,l but a church, school, and a cannery. There was also a prenatal care and feeding program, where corn meal, flour, and cooking oil donated by the US government are distributed.

In the clinic area we met one of the two staff Haitian doctors. A tour of the hospital showed that not a single one of the 19 inpatient beds was occupied. The OR was stacked with boxes and supplies, and a somewhat dubious obstetrics suite was still filthy from the last delivery. In the pharmacy bottles of pills were arranged on raw wood shelves, and trash lurked in the corners. An iron-barred window to the outside was sealed with a heavy wood shutter; later we saw that the pharmacist opened it from time to time to dispense medicines.

People started slowly arriving for the outpatient clinic that Elise and I were to staff. From past experience in Uganda and Kenya, I expected a huge influx of patients. But they never materialized. Soon enough I found out why: This hospital charges fees.

A consultation with a doctor costs the equivalent of $1. Then if lab tests are ordered the patient must pay for them in advance –the rather daunting cashier, who sits in a little booth like a ticket seller in a movie theater, collects the money then stamps the lab slip. After the lab results are available, the patient sees the doctor again. If the doctor orders medications, these too must be paid for in advance. The people living in the villages near the hospital are very poor; in several cases I saw patients who had already paid for the consultation and lab tests being sent home because they had no money left to pay for their medicines. Elise and I made it a policy to give our patients medicines that we’d brought with us from Léogâne, if we had the right ones. And in several cases we paid for both lab tests and medicines, which unaccountably displeased the cashier.

That a hospital in such a poor area, particularly a mission-sponsored one, would charge patients was of course quite upsetting. I asked if there were provisions to give free care to those who simply could not pay. The answer was an evasive shrug, which I took to mean ‘no, not really.’ Why did this hospital seem so dysfunctional? Was the support of this project so limited that it wasn’t possible to make services available for free? Couldn’t a special fund be established so that the very poor could be served? Were cultural issues or unknown government regulations involved? Unfortunately there was no one who could give us answers. This was an uncomfortable week.

Later I spoke with several Haitian doctors and NGO representatives who told me a very sobering story: The presence of so many NGOs providing free care may perversely impair the health of Haitians in the long run. Many private as well as government-sponsored hospitals and clinics charge a small amount to pay staff and meet operating expenses. But when the NGOs poured into Haiti after the earthquake, poor people naturally went to them for free care rather than to the established hospitals which charge. This has resulted in the bankruptcy and closure of a number of these hospitals; such losses compound those of hospitals destroyed in the earthquake. Thus when the NGOs drift off to the next disaster, Haiti is likely to be worse off than before. Somehow, the more desperate people are the harder it seems to be able to help them.