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Haiti: mistakes plus negligence equals death

Health clinic in HaitiRecently I passed through the high security zones of Petion-Ville and Delmas on my way to Cité Soleil, where policing is limited to the neighbourhood parameters. It’s very possible I was missing something and the police were hiding at the ready; the tap tap driver complained that he did not like coming to Cité Soleil because there were ‘bad people here’. Unfortunately, with my limited Kreyol I couldn’t understand the reason for his nervousness.

I was on my way to visit Dr Carroll at the paediatric clinic at the ‘House of the Sisters’ where he has worked for many years. The clinic is set in a large, tranquil compound with a school, a sewing training centre for women and a nutrition centre for underweight babies to attend with their mothers. There were two security guards at the entrance, but thankfully they are not armed. As usual, the shaded courtyard was filled with mothers, babies and toddlers. Many more waited patiently inside in the large, airy waiting room.

It was already 11am and Dr Carroll’s morning clinic had been running for a few hours. I opened the door hesitantly and entered. He immediately greeted me and began to tell me about 11-month-old baby Willgesta Pierre, who needs hole-in-the-heart surgery. A previous patient, baby Elie Joseph, had needed similar treatment but died after his mother failed to get her passport to enable the trip to the Dominican Republic for the operation. Elie Jospeh lived in one of the worst camps in PAP, Aviation City (a shameful reminder of the assault on human dignity and the failures of post-earthquake humanitarianism). Dr Carroll described Elie’s death as a series of failures – including his own.

Big mistakes plus little mistakes plus big negligence plus little negligence all add together and equal death. Just because his parents don’t know how it all works, doesn’t mean people aren’t at fault.

And we are all failing the hundreds of thousands of innocents living in the tents now. There is no urgency for the poor. There never has been.

I imagine Elie’s death was foremost in Carroll’s thoughts and the need to ensure that baby Willgesta did not die through a similar set of failures paramount. Repairing a hole in the heart (ventricular septal defect) is just a 15-minute operation, but it requires sophisticated medical technology to keep the blood pumping whilst the heart is being repaired, high medical expertise from a specialist paediatric heart surgeon, and also reliable electricity – a combination not present in Haiti at this time. Willgesta was admitted to hospital in April but needs her surgery quickly. Already the pressure is building up around her lungs and if this continues she will need both lung and heart replacement,which is not going to happen. So now Dr Carroll has to find a surgeon willing to operate for free in the US (this is the easiest of his tasks) and get visas for baby and mother, all in the next few weeks. In his words, there is absolutely no excuse for this baby to die – zero!

One of the biggest problems in providing appropriate and timely treatment is clinic hopping. Patients go from one clinic to the next, often without a clear knowledge of the diagnosis and or forgetting the treatment they received. The lack of documentation wastes time, with patients being retreated for the same problems. With documentation the doctor would be able to see that a particular patient has a recurrent problem and look for an underlying problem. Willgesta’s mother is an example of this. She has been to five clinics and all she has to show for it is a bag full of payment receipts. Nothing has been done for her daughter. Now Willgesta is in a critical condition, with fever and sweats and possibly TB, which is rampant throughout Haiti. How does one begin to understand any of this when the struggle to pay for doctors is pitted against the struggle to eat? Three, four hours spent travelling from clinic to clinic, each time waiting in hope that someone will care enough to do something.

The cost of maintaining UN troops in Haiti in 2012-13 is nearly $650 million. In contrast, the World Bank just announced $70 million for maternal and child health in Haiti. We are told that 1.8 million women, children and vulnerable families will benefit, though we are not told the quality and quantity of that benefit or, more importantly, how much of the money will go towards operational and staff costs. While any improvement in the access and use of health services is of course a positive step, the real cause of illness in Cité Soleil and elsewhere is largely due to living conditions. Since the World Bank money will not be used to improve these, the programme ends up as nothing more than a Band-Aid used to cover a bullet wound.

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