By Souley Boubacar, Niger

Independent from France since 1804, Haiti has a quite remarkable history. It’s the first and only slave colony to gain national independence and is the second free republic in the Western hemisphere after the United States of America.

 

But more than two centuries after its independence, Haiti is still struggling to emerge from poverty.

Comparative social and economic indicators show Haiti falling behind other low-income developing countries of the Americas since the 1980s. In the United Nations’ Human Development Index, the country now ranks 146th of 177, while the neighboring Dominican Republic ranks 79. Compared to other Caribbean countries, Haiti is still underperforming and its rank in the Human Development Index falls far below that of all its neighbors.

Yet, Haiti is potentially rich with well-trained human resources, and lots of natural resources and minerals such as bauxite, copper, calcium carbonate, gold, and marble. Agriculture that accounted for 27% of the GDP in 2007 includes products like coffee, mangoes, sugarcane, rice, corn, cacao, sorghum, pulses, fruits and vegetables. If developed, tourism could also be one of Haiti’s major sources of income.

Despite its natural resources and its potentialities, Haiti is in a deep economic stagnation. Centuries of slavery, poor governance, endless political violence and social instability are to blame, according to many experts. Commenting on his country’s situation, the Chief Editor of “Le Nouvelliste” (Haiti’s leading daily newspaper) recognized that “decades of political turmoil and mismanagement have dramatically plunged Haiti into an economic disaster.” The World Bank also recognized that Haiti’s path to economic development has been hampered by decades of political unrest.

As they struggle to survive, in the wake of worldwide soaring food prices and new political turmoil (two Prime Ministers have been removed from office by the Senate since 2006), Haitians face another challenge: the country’s healthcare system is dying, due to the shortage of health workers, and the lack of good infrastructures, medicines and other health supplies in many parts of the country, especially in the rural areas. Today, “most of Haitians have no access to modern healthcare, and the current system is desperately inefficient” acknowledged Dr Gaston Deslouches, Director of Health Services for the South-East region. According to him, the weakness of the Haitian healthcare system is at all levels, primary, secondary, and third.

There is no place that better illustrates the failure of Haiti’s healthcare system than the coastal city of Jacmel, the capital of the South-East Region. The only reference hospital in the entire region (“Hôpital Saint-Michel”) lacks almost everything: from ambulances to medical supplies, qualified health workers, and specialized personnel (especially surgeons and anesthetists). In fact, it’s impossible in the current conditions to perform surgeries at Saint-Michel because there is no electricity in the hospital. A temporary solution could come soon from the United Nations Stabilization Mission in Haiti (MINUSTAH) who promised a power generator to Saint-Michel. According to the Minister of Public Health and Population, Dr Robert Auguste, the political instability that Haiti went through over the last decades is the main cause of the country’s current healthcare chaos.

For now, no short term solution to this healthcare crisis seems to be in sight, not even at the Ministry of Public Health which receives, each year, a very small portion (10%) of the national budget. In a country where 80% of people live under the poverty line, where there is only one(1) doctor for 10 000 inhabitants, where 11% of children have never been vaccinated, where 23% of children live in chronic malnutrition, where infant mortality rates are 87 out of 1 000 (for children under 5) and 53 out of 1 000 (for children under 1), and where tuberculosis, malaria, pneumonia, and other infectious diseases are widespread, it’s very easy to imagine how tough life is for most of Haitians living in the country.

As result of the modern healthcare crisis, Haitians, especially those living in the rural areas, tend to rely more on “Oungans” (Voodoo Priests) for their treatments. Beyond the lack of financial means, at least two major factors make the traditional medicine very attractive to Haitians. First, it’s more convenient and more accessible. Second, it’s more adapted to the local culture (it is generally admitted that Haitians believe more in Voodoo than in modern medicine). 

The general failure of the modern healthcare system in Haiti has been worsened by the phenomenon of medical brain drain which, in turn, is fuelled by both the political turmoil and the economic crisis. Over the last decades, large portions of skilled health workers fled Haiti in search of better employment opportunities in Western countries. Most of them migrated to Canada and United States. A study conducted by the World Bank in 2007 revealed that 83% of Haitian Medical Doctors live out of the country. This massive “exodus” has taken a heavy toll on the already under-funded and fragile health system in Haiti.

The similarity between Haiti and Sub-Saharan Africa on all aspects of healthcare is quite surprising. Like in Haiti, a large number of African children die each year from easily treatable diseases. Like Haiti, most of the countries in Africa are facing a health crisis, mostly driven by poverty as well as under-funded and underperforming healthcare systems. Like in Haiti, traditional medicine has become nowadays the alternative for millions of Africans who cannot afford modern treatment.

Like Haiti, Africa is also facing an unprecedented exodus of its healthcare professionals. As the Vice-President of Uganda, Pr Gilbert Balibaseka Bukenya, emphasized in his presentation at the Geneva 2008 Health Forum, Sub-Saharan Africa has 11% of the world’s population; yet it has 24% of the global disease burden, and only 3 % of the global health workforce.

For various reasons, the African health professionals are leaving the continent. Figures from the World Health Organization indicate that on average one in four doctors trained in Africa is working in the Western countries. Taken individually, some African countries are hit more severely than others by the medical brain drain phenomenon. Thus, according to the International Organization for Migrations, 34% of Zimbabwean nurses work abroad, so do 7 000 South African nurses and 29 % of Ghanaian physicians. According to some international medical sources, Ghana alone lost more than 12 000 health workers in brain drain since 1993.

In Haiti and in Africa, the causes of the “medical exodus” are the same: the search for better working conditions and career opportunities. In both cases, political instability and war are also considered to be very instrumental in stimulating the medical brain drain phenomenon.

Souley Boubacar

Freelance Journalist, Niger

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