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HAITIAN EARTHQUAKE RECOVERY

Mary Bliss history

From the Ground Up:

The Evolution of a Hospital in the Third World

  Medicine and Health / Rhode Island   Mary J. Bliss  Vol 82 No. 4 ApriI 1999

       With 160,000 people, La Romana, a tourist-oriented city in the Dominican Republic, boasts the largest sugar cane company in the world. However, a poverty-stricken population of sugar cane workers receives little or no health care.   Some key people in the local community and multiple volunteer American medical and construction workers have together spearheaded the creation of the Good Samaritan General Hospital in La Romana.

            Reverend Jean Luc Phanord, a leader of the local Haitian community was the hospital's founder: he recognized that the most extremely impoverished, who are primarily Haitian immigrants, could not afford services at the other hospitals in La Romana; hence, they were not receiving treatment.

            Reverend Phanord initially raised money to buy an eight acre plot of undeveloped land in a run-down area adjacent to the city.  The building of the hospital began in 1989. It has been funded and constructed entirely by American volunteers, and with every visiting American construction team the hospital has grown. Institutions such as Rhode Island Hospital and the

  Lahey and Mayo Clinics have donated and shipped all equipment and supplies. At this point the first floor of the hospital has been completed. The ambulatory clinic officially opened on November 9th, 1997.

Editor’s Note  -  Pastor Jean Luc Phanord was killed in the tragic crash of American Airlines Flight 587 in Queens NY on November 12, 2001.

  THE BATEYS

            "Bateys" are the small villages where the sugar cane workers and their families live on a subsistence level. Men are recruited from Haiti to come work in the cane fields, since the cost of manual labor is less than that of machinery. (About 90% of the twenty-five thousand people living in the bateys are Haitian. ) The immigrants, almost all of whom are illegal, arrive with their  families and sign on to a life of brutally hard labor. They live in tiny, filthy, make-shift shacks  without electricity or running water. The communal latrines are shallow trenches, often located  next to the primary water supply. Most of the inhabitants do not have access to medical care.  There are over one hundred bateys in the La Romana area alone, each one having between  500 - 1500 residents.

            The GSGH was created with this population in mind.  One service provided by GSGH is  a mobile clinic that travels to these rural areas several times per week. A fundamental source of  the health care comes from volunteer American medical workers. Medical teams from RI have been involved with the project since 1992. A team of 40-50 medical and construction volunteers from RI travels annually to La Romana and works for up to two weeks.

            My first trip to the bateys was with Reverend Phanord's wife Elza, a public health worker,in 1996. We drove for about an hour and a half along bumpy dirt roads in an old family jeepearly one morning to visit two of the villages.

                Outside of the city are endless rolling fields of blue-green sugarcane that shimmer against the expansive, deep blue sky. We passed many weathered-looking people along the way, with most of the women balancing impossibly huge packages on their heads. We also passed several garbage dumps where starving horses and pigs foraged for food.

            The first batey we stopped at was called "Lima." As we drove up we heard a swelling chant of "Americana, Americana!" which referred to me in the back seat. When I stepped out of the jeep I was instantly surrounded by children. They were pointing at me and laughing and all wanted to touch my white skin, which would make them shriek and laugh even harder. A few reached up to touch my red hair, which made them squeal with disbelief. Any attempt on  my part to speak Spanish was relentlessly mocked and then mim-icked in a silly voice. Every child wanted to hold my hand, so when I walked anywhere I had a different child attached to all ten fingers! Some of the children surprisingly had blondish-reddish hair, similar to the Aborigines in Australia. (This is a sign of severe anemia.) Most of the children were barefoot and wore only the remnants of donated American clothes.

            The GSGH oversees the monitoring of the growth rate of the babies and toddlers to determine who is malnourished. Each month the babies get weighed. We placed them in a little sack and put them up on a scale on the wall. None of the toddlers weighed over 17 Kg. Most weighed under 10. Many had distended bellies signifying nutri-tional deficiencies.

            "Batey 203" seemed even worse off than Lima. One half-naked little girl was sitting on a tiny chair in the middle of a footpath, holding a loudly crying baby. The girl could not have been more than three or four herself. An emaciated woman emerged from a tiny hut and brusquely pulled the baby out of the girl's thin arms and brought the still crying infant over to us. I held her for a few minutes and by what must have been pure coincidence she stopped crying. She felt as though all she wanted was some warmth and security. Her little nose was running and I detected a rasp in her tiny chest when I patted her back. The delicate little creature turned out to be six months old .  I have seen bigger two month-old infants.

            Various medical teams from the U.S. volunteer their services to the GSGH and the bateys throughout the year. When the medical teams visit, an average of 150 - 200 people are seen  each day. A large batey will have approximately 350 children (age 0-18) while a smaller one will have on average 170. The most common complaint for children and adults is stomach pain, which is generally due to parasites, gastritis, or simply hunger. Many of the women, especially of childbearing age, are severely anemic, with hemoglobins of 6-10 Hg range. Diabetes is also common, with subsequent visual deficits. Most of the children are underweight and lethargic,often due to not consuming enough calories.

  THE HOSPITAL

  In January 1998, the GSGH hired one local Haitian doctor to work in the clinic half time, six  days a week. On average 25 -  30 people are treated each day. Like the population in the bateys, the most common complaints are of non-specific gastritis, anemia, and hypertension.

  The most generic consumables received by all patients treated are anti-inflamatories, antihypertensives, parasite medicine and vitamins.

            In addition to the resident physician, the current staff includes the Hospital Administrator, Chief Accountant, two secretaries, and one pharmacy worker. Local doctors and nurses are commissioned separately to work in the bateys. The projected salary for clinic physicians at the  hospital is approximately $4500 annually. The goal is for the hospital to pay these salaries and those of the doctors hired to work in the bateys with money earned in the ambulatory clinic.

  The cost of a general consult at the hospital is $3.20 (50 pesos) while in the bateys patients are charged between $0.19- $1  (3 - 15 pesos), depending on the relative poverty status of the batey.

            Presently the primary source of income is derived from medications donated from the U.S: the hospital sells them at a maximum of 1/3 of the current rate found at any of the local pharmacies. For example, if a 50 pill bottle of aspirin is donated, 30 pills are marked for the bateys while the remaining 20 are sold at the hospital pharmacy. This system has been able to  almost meet the costs of running the clinic, although the GSGH continues to rely on American donations.

  1999 BUDGET

  In 1999 it is projected that between the visiting American groups and the local doctors at the hospital, 2635 patients will be seen in the hospital clinic and 38,751 in the bateys. An additional 234 patients will also be treated by American doctors outside of the hospital £,r surgical  procedures at a separate clinic. This gives a total of 41,620 patients treated in connection with  GSGH. The projected annual budget for 1999 totals $80,140  (1,242,176 pesos). The  projected income totals $93,048. However, this figure includes an expected
$22,279 in U.S.  donations in addition to the volunteer medical help and donated supplies. Without these extra  funds the hospital would only expect to gross
$70,769 - $9371 short of the projected income.

  FUTURE PLANS

  In 1999 GSGH plans to open its laboratory which is close to being fully equipped. Within the

  next two years the hospital hopes to add two surgical suites. There also are plans to add a  pediatrician, a cardiologist and a gynecologist as  well as a part time (weekly) ophthalmologist and dentist. Eventually the hospital hopes to grow into a Hill care facility with at least three additional floors for inpatient stays.

  CONCLUSION

            The sugar cane workers and the indigent of La Romana live under appalling conditions.

  The GSGH is the first hospital in the Dominican Republic designed with the primary goal of providing health care to the people in the bateys. It is unusual because it does not rely on government funding but is supported solely from American donations. Right now the hospital is in a critical growing stage. It wants to develop into a full care facility.  Once the hospital is fully  operational, it hopes to be financially independent, no longer tied to United States aid.

  The public hospitals in the Dominican Republic arc generally of poor quality, medically and administratively. Patients are expected to provide their own bedding, food, and often their own medicine. Hospital management information in developing countries is also difficult to obtain  due to a lack of standardized information systems. Results from a study on public hospitals in the Dominican Republic showed all surveyed to be grossly inefficient, chaotic, and poorly  managed. The authors found the budget of the Aybar Hospital in Santa Domingo to be over 50% higher than the actual service costs, demonstrating terrible waste and inefficiency.

            The GSGH is a small, modest institution, but as it grows it will have to eliminate some of the inefficiency common to other health institutions in the Dominican Republic.  The GSGH is an example of a community that has taken the initiative to provide its own non-governmental system of health care, to help a population that needs it the most. If the GSGH is a success, the knowledge gained from the growth process can be shared.

  Mary J Bliss is a second-year student at Brown University School of Medicine.

 Editor Note:  This was submitted by Mary ‘Molly’ when she was at Brown.  She now works in the Emergency Department at Providence Hospital, RI