What Haiti can use: doctors, health care, collaborative medical education, jobs
(Read Part One of Dean Wing’s journal.)
The next morning we drove to a primary care clinic and rehabilitation facility Patrick had started. An American couple — a pediatrician named Brooke Trenton and her husband, who has expertise in management — staff it together with specialists in ophthalmology, dentistry, and ob/gyn. They see scores of patients each day. I asked her what diseases she would diagnose in a child with fever. She said pneumonia, malaria, typhoid fever, and tuberculosis. She diagnosed and treated empirically. This type of medicine is practiced the world over in tropical, poor countries. My experience in Kenya, Cambodia, India, and the Dominican Republic has been the same.
Brooke and her husband are idealistic and want to turn over the care to Haitian doctors. Patrick feels this is unrealistic. Eighty-five percent of Haitian doctors leave the country for better paying jobs in the United States and Canada. The government does not have resources to pay for medical care for the population. The average annual income in Haiti is approximately $500. Providing clean water and jobs for the population is as important as providing direct medical care. The unemployment rate in Haiti approaches 80 percent.
Our next stop was the Universite Notre Dame d’Haiti, a relatively new denominational university and medical school — 12 years old. One of the students, who had graduated from the Louverture Cleary School, gave us a tour. Medical education in Haiti is patterned after the French system, a total of eight years after high school. The first two years are sciences, including physics, chemistry, math, biology, biochemistry, and other pre-med courses. The students graduate to anatomy, physiology, and the usual medical courses. Clinical experience, which is really observation, begins in the third and fourth year, with more intense rotations in the fifth and sixth year. Students are required to do an internship and then national service for a year. They can apply for residencies afterward.
We visited a class of first-year students. They were intense and involved, frequently asking questions. The language was French, but I was told the medical textbooks were in English. Unlike American schools, the results of their entrance exams were posted outside the classroom. You could see who ranked first down to who ranked last.
The school had a classroom filled with what looked like old computers. I asked if they were Internet-based or whether they had learning software. The answer was no, the machines were simply used to teach the students how to use computers. The histology and pathology labs had microscopes and old slide samples. The library had textbooks, the most recent being a Sabiston’s Textbook of Surgery dating to 1999. The medical textbooks such as Harrison’s were published in the 1980s. I did notice a series of Chinese magazines in English about life in China.
Our first meeting was with Dr. Jean Hughues Henrys, dean of medicine at the Universite Notre Dame d’Haiti, and two of his associate deans. The meeting was very cordial in a plain room without air conditioning. We agreed that there should be a cooperative, mutually beneficial relationship between the Warren Alpert Medical School of Brown University and their institution. Students would rotate between both institutions, as would faculty. Common research would be encouraged.
We then met in a larger air-conditioned room with Msgr. Pierre-Andre Pierre, the recteur (director) of the university. The meeting was quite formal with comments by the director, several others, and myself. Pictures were taken, handshakes made, and a tacit agreement to sign the previously drafted memorandum of understanding.
We next traveled to St. Damien’s Hospital, a new Catholic church-supported pediatric hospital. As we drove up and passed the security guards, we saw beautiful grounds and new buildings. After waiting for a few minutes in the lobby, we were met by Sister Judy, a nurse from Ohio. She obviously ran the place. We met in a large room and she told us what she needed: our residents to come and cover weekends and nights — period. She claimed that many other institutions in the United States and elsewhere wanted to come and implied that we would be lucky to get a spot. After some discussion, it was apparent that she really wanted us there, that the other institutions were coming for limited times, and that she would welcome education and students as well as coverage. I became convinced that we would have an excellent relationship going forward.
Sister Judy then gave us a tour through a very well run institution. The large wards were clean and well lit. The children were usually with their moms and seemed like all children in a hospital, except for the ward for malnourished children. In that ward, the children were very sad and listless. Some were edematous with kwashiorkor, protein malnourishment. These children have a continuous characteristic cry. One child was two years old but was the size of a three month old. She didn’t move. The malnourishment is due to both a lack of food and a lack of appropriate food — i.e., protein and vitamins. Haiti should be an agricultural exporting nation. Instead, most of the food is imported from countries like the United States. Much of the food is processed, and some is inappropriate. The favorite and universally available meat is hot dogs.
The hospital also has a well functioning intensive care unit although the doctors are very overworked. A cancer ward provides therapy based on protocols from St. Jude’s Hospital in Memphis, Tenn. There is a formal relationship with that hospital, and consultations take place via the Internet. At the end, we visited a beautiful chapel that is used for the hospital. The walls are covered with Haitian art. This national art genre is colorful, dynamic, and unique. It consists of oil paintings, sculpture, and metal works that express the beauty and dynamism of the population.
We returned to Rhode Island the next day, moved by our experience, bound to start our program, and determined to return as soon as possible. Within a few days, we heard that for the first time in 50 years, the scourge of cholera had appeared in Haiti. We became all the more determined to strengthen our educational and clinical programs as soon as possible.
Read Part One of Dean Wing’s journal.