Université d’Etat d’Haiti- Pre-Earthquake

The origins of the Université d’Etat d’Haiti date back to King Christophe’s creation of the Royal Academy in 1815. The faculty of science that exists today was first established in 1902 as a private institution and then recognized as a public university in 1905. Its final official incorporation under the current legal framework for the State University of Haiti occurred on August 4, 1920. Up until 1995, when a new private Catholic university admitted its first class of medical students, the State University of Haiti was home to the only medical school in the nation. It continues to be the center of medical education for the country’s doctors and nurses and is the headquarters of every medical and surgicaltraining residency program in the nation. Trainees from the Université d’Etat d’Haiti’s medical and nursing programs are considered in Haiti and abroad to be well qualified to practice their specialities. Despite the relative strength of the educational experience at HUEH, even the most experienced faculty are paid less than $6,000 per year in income. Prior to the earthquake, the country’s largest hospital and only 24-hour public trauma facility had a meager 5 million US dollar budget per year. Contrast this to the largest major teaching hospitals in the United States, where expenditures can be as much as 2 billion US dollars per year. Currently, the field of academic medicine is not well valued or even a viable profession within the Haitian medical system. Due to a lack of emphasis on academia and economic support for clinical staff, scenarios of frequent strikes of faculty, students, and residents have led to a chronic shortage of staff, medicines, and supplies to the facility and for patients seeking medical care.

Haitian public healthcare system, on a national level with a budget of less than 2 United States dollars per citizen per year for public health, the impoverished public health sector in Haiti, has never been an attractive career opportunity for young and talented healthcare professionals. 70% of the population of Haiti lives outside of Port-au-Prince, almost half, 46%, of the medical professionals of the country are concentrated in Port-au-Prince and most, including the vast majority of HUEH’s teaching faculty, work in private, for-profit practices to support themselves. Considering the huge challenges to the health system in Haiti, it is unfortunate that a staggering 80% of all physicians trained in Haiti leave within five years of graduation to practice abroad. The Haitian government, therefore, educates many talented healthcare professionals, but fails to retain its graduates and integrate them into the national system that serves the rural and urban poor. The key to keeping talented healthcare professionals in the pubic health system is to provide them with living wages and the tools of their trade. It will be part of the long-term goals and sustainability models of ORSI to help in this regard, hoping eventually to turn over the increased wages to medical staff to the Ministry of Health and government of Haiti. ORSI’s mission will be to improve clinical, educational, and infrastructural services to the public health system in Haiti and particularly concentrate its efforts on HUEH. It is a crucial objective of ORSI to heavily involve our efforts in educating the future orthopaedic surgeons of Haiti and work in concert with the orthopaedic surgical residency program to, hopefully, improve the quantity and extent of training for those residents looking to serve their country. Currently, there are approximately 45 to 50 orthopaedic surgeons in Haiti, 15 of which are trainees in the orthopaedic surgical residency at HUEH. The scope of orthopaedic maladies is enormous, and subspecialty representation in fields outside of adult reconstructive and trauma surgery are minimal. As if the quality of orthopaedic clinical services was challenged before the earthquake, the Hopital de Université d’Etat d’Haiti was decimated after the earthquake.

Université d’Etat d’Haiti- Post-Earthquake

100_0177The severe damage to HUEH, the incredible loss of life on the campus itself, and the inability of many surviving staff to return to work, combined with the influx of tens of thousands of patients in dire need of care, created a perfect storm for health service breakdown in the public sector. NGOs, surgical teams, and international government relief entities arrived at HUEH in the days and weeks after January 12 to assist the hospital’s general director, Dr. Alix Lassegue, and head administrator, Miss Marlaine Thompson, in doing everything possible to stem the suffering of the patient’s indesperate need of treatment and care. Many NGOs, including Partners in Health, Doctors Without Borders, Red Cross International, and others, agreed to support the Ministry of Health and HUEH to provide emergency medical and surgical care. In the weeks that followed, NGO staff and local physicians and nurses spent 24 hours a day setting up operating rooms to address the huge surgical and trauma burden, restoring electricity to the hospital campus, and assessing the structural integrity of the buildings, pitching large medical tents for ward space in the hospitals, courtyards, and roads, triaging, treating and caring for patients, and reestablishing essential hospital functions in surgery, medicine, pediatrics, ob-gyn care, critical care for adults and children, pharmacy services, nutrition, etc.

While much has improved at HUEH due to the generous donation of time and supplies by others, many lifesaving supplies and personnel remain at dangerously low levels. Many, many patients are in need of daily care, and medical volunteers and supplies have diminished with the passing of time since the earthquake. With reference to orthopaedic surgical services, priority near-term interventions require deployments of clinical and educational teams and the supply of much equipment and supplies to provide infrastructure and functionality so adequate orthopaedic surgery can be accomplished.

In conclusion, HUEH is the largest public health facility in the country and trains the vast majority of Haitian health professionals that go on to serve throughout Haiti and abroad. Significant ongoing strategic improvements to the comprehensive infrastructure, staffing, training, operations, and clinical practice of this central public health facility are a mandatory investment in the future of all public health throughout Haiti. At the time this document is written, HUEH is undergoing a deconstruction reconstruction process that will increase its annual budget hugely and allow for short-term remedies and long-term sustainability models to take hold.