Photo by John Carroll, MD.
I had the opportunity to sit down with a young Haitian resident physician yesterday. He is one of 450 Haitian resident physicians who has been on strike since March 18. This physician strike has closed down Haiti’s three main public hospitals: General Hospital (University Hospital-HUEH) and Hopital Universitaire de la Paix (HUP) in Port-au-Prince, and Hopital Justinien in Cap Haitien. It is the longest physician strike in Haiti’s recent history.
I told him I would not name him and I would refer to him as RP (Resident Physician).
John Carroll—Thank you for sitting down with me and answering questions about the resident strike in Haiti.
RP—You are welcome.
JC—Is there a resident physician union in Haiti? Like a factory worker’s union for example?
RP—No we don’t have a union but a committee has been set up composed of resident physicians from the three hospitals.
JC—Would you tell me exactly why you are on strike?
RP—Of course. We are striking for an increase in salary, health insurance, improved sanitation and structure within Haiti’s public hospitals, and increased security.
JC—Would you discuss the salary problem and explain where you are at in the negotiations with the Haitian government?
RP—I have three kids and have not received a paycheck since February of this year. My usual paycheck is $140 US per month before taxes are taken out. The resident physician salary has not changed in Haiti during the last 20 years even though the cost of living in Haiti has skyrocketed. As you know, 20 years ago one US dollar equaled one Haitian dollar. Now one US dollar equals 12 Haitian dollars. And I work an average of 110 hours per week.
We have asked the interim government to increase our salary to $500 US d per month. Right now the government has doubled our salary if we come back to work, but that is not enough.
JC—Explain the health insurance that you are asking for.
RP—Resident physicians in Haiti have no health insurance. A young colleague of ours, a resident physician in Cap Haitien, recently died of an unknown illness…the physician didn’t have enough money to seek effective medical care.
JC—What is the sanitation and structural issues you mentioned?
RP—The public hospitals are very dirty for the patient and the staff. We frequently do not have electricity and the hospital generators are frequently broken. We perform surgery sometimes using hand-held flash lights. Anesthesia machines are broken and leaking.
The dorms for the resident physicians don’t have flushing toilets or they are clogged or there is no running water. And the resident physicians who work in the TB Sanitarium in Port sleep in tents with rats scurrying around.
JC—And you mention security. Security for who?
RP—Security for us, the resident physicians. We are accosted now and then by angry family members with drawn guns demanding that we care for their family members. We frequently don’t have supplies to take care of their family members. We need Haitian Police in the hospitals to protect us.
JC—Has this strike created stress in your family?
RP—Yes, of course. I haven’t had a paycheck since February. My wife is selling second had clothes. We are in financial trouble as we try to keep our kids in school.
JC—When your hospital was open, how much did an outpatient consult with a resident physician cost the patient off the street? For example how much would it cost to have your baby examined for fever?
RP—One dollar US. We were seeing approximately 1,000 out patients per day in the clinics at the hospital.
JC—Tell me about the obstetric care in your particular hospital when the hospital was open and you were not on strike.
RP—There were approximately 60 normal deliveries and 20 C-Sections per week. A C-Section cost the patient $100 dollars as opposed to approximately $1,500—2,500 dollars in a private hospital in Port-au-Prince. Of course most people don’t have that type of money including the resident physicians.
Now the patients have nowhere to deliver except MSF (Doctors Without Borders) and MSF can’t take more patients…they are full up all the time.
JC—So what you are telling me is that the woman and the baby can die due to a lack of appropriate obstetric care?
RP—Yes, they can die and I am sure they do die under these circumstances. Our government just doesn’t care.
JC—Do you as a physician have any trouble with the ethics of not taking care of people who you know are going to suffer morbidity and mortality because of the physician strike?
RP—Let me ask you, “Where are the ethics when people come to our hospital and we have nothing to offer them accept suboptimal or no care. Sometimes all we can do is refer them away for our public hospitals which are broken. Where is the ethics there?”
JC—What about orthopedic problems? What does the person do who is hit by a car or who has a motorcycle accident and has a broken leg?
RP—MSF on Airport Road has a 150 bed trauma center which cares for open fractures (the bone is exposed). But MSF does not care for closed fractures (bone not exposed). MSF splints the patient with closed fractures and sends them out the door. Now MSF can’t send them to us because we are closed. So people with broken extremities that have not been set are healing improperly.
JC—This is really bad.
RP—Yes it is.
JC—What does the private physician community in Port-au-Prince say about this healthcare crisis?
RP—The private physicians don’t really want they strike to end because they use us now.
JC—What do you mean?
RP—They hire us (the striking resident physicians) to take call for them at night and pay us $10 US which is a lot more than we would make at one of our public hospitals. So the private attendings are happy for the strike because they get night coverage at a low price for them.
JC—I have heard that Interim President Privert is asking your attending teaching physicians to start working in the public hospitals in place of you to keep the hospitals going. What are your thoughts on this?
RP—Privert’s wife is a physician and she should know better. He is a business man and does not understand doctors. He calls us students but we are licensed physicians.
If attending physicians started in the public hospitals today they would be accosted physically and their cars would have their windows smashed. it would not be a good idea for them to try. This puts us (resident physicians) in a bad position with our teachers. And if I decided to “break the strike”, I would be physically harmed too.
JC—What if Cuba or France opened their doors to all 450 striking residents and said come to Cuba or come to France and we will train you. What would happen?
RP—You would not see even one resident physician left in Haiti. In fact we are all going to sign a petition to attempt to leave this country.
JC—Do people in your church community agree with the fact that you and the other physicians are on strike?
RP—The majority of my own church members are not in agreement with me for striking. But they don’t understand the horrible conditions in which we work.
(At this point in the interview it was dark out in Port and RP got a message on his cell phone that the brother of the head of the orthopedic department at one of the public hospitals was just shot and killed today after he made a Western Union wire transfer. He was shot three times just several blocks from where we were sitting for this interview. RP quietly told me, “I have to go.”)