South Florida Sun-Sentinel
February 26, 2004

Rebellion pushes Haitiís hospitals to brink of collapse

 
By Tim Collie
Staff Writer

PORT-AU-PRINCE · Widler Christophe lay bleeding in the emergency room of this city's main hospital, shot in the head at a roadside barricade, as nurses tried to determine if the facility's only X-ray machine worked on Wednesday morning.

After determining that the rusting machine was broken, his family wheeled him out of the hospital, down a dusty street and up a flight of stairs to a private X-ray clinic nearby. Once they had the X-rays in hand, they wheeled him back down the street to a musty room at the State University of Haiti Hospital, where a nurse assured the patient's family that surgery would be performed -- once a doctor could be located.

"No, no, no!" screamed the man's aunt, Mica Christophe. "You can't be serious. Look at him!" Blood and fluid flowed from his wound and onto the floor. Nearby, another wounded man begged passers-by for money to buy antibiotics for an infection.

"Once you get shot here, there's really nothing they can do for you," said Joseph Pierre, a friend who found Christophe lying in the middle of the road and took him to the hospital. "Here was a guy who wasn't doing anything, and they just shot him for no reason. But then after that, he cannot get any decent medical care."

In Haiti, few can these days, as a 3-week-old anti-government rebellion has thrown the nation into crisis. Rebels, seeking to overthrow the government of President Jean-Bertrand Aristide, have overtaken more than a dozen cities and towns, leaving more than 70 people dead in skirmishes with pro-government police since the uprising began Feb. 5.

If rebel leaders make good on their promises to take Port-au-Prince, one of the last remaining Aristide strongholds, the fighting on city streets could pale compared to the suffering that awaits the wounded in this poor nation's primitive hospitals. There are three major hospitals in the capital, and none could be described as functioning this week.

Overwhelmed by the growing number of Haitians injured in street fighting between pro- and anti-Aristide groups, hospital workers are struggling to keep up with the daily press of casualties. Fresh medical supplies, in demand during even the best of times, are hard to come by because barricades have been erected along major routes leading to the city to repel rebel forces, who now control about half of Haiti. And, out of fear, fewer health-care workers are reporting to work each day.

As Pierre and other wounded men arrived at State University Hospital on Wednesday morning, they were greeted by a handful of nurses with little more than a few bandages and some bottled water to treat them.

Most of the hospital's doctors had not arrived for work -- many were in hiding or have fled the nation -- and most of the facility's diagnostic and surgical equipment was not functioning. Most days, there is no running water, and electricity is sporadic. Dried blood covers many sections of the emergency room's floor, and dust stirred up from the nearby street blows in through the windows over the bandaged and open wounds of dozens of injured men and women.

It's not unusual for armed men to show up at this and other hospitals around the city, pull patients out of their beds and demand care for their own wounded comrades.

Most patients only get what they pay for: medicine that has to be purchased at the little drugstores just outside the hospital's gates. While there is no shortage of sophisticated weapons on the streets -- dozens of youths carry shiny handguns and elite assault rifles -- even the most basic medical technology is in short supply at the city's hospitals.

International health experts said on Wednesday that only one hospital is fully functioning in Port-au-Prince, a city of about 2.6 million people -- a private hospital primarily patronized by the city's wealthiest residents, who can afford to pay for care.

"We're just an empty box. There's no medicine here, none of the doctors have showed up, and all we really have to offer someone with a severe wound is a bit of gauze," said a State University Hospital nurse, asking not to be named.

"It's been this way for months, but nobody dares to complain or you get labeled as `opposition' by the government," said the nurse, as she stood over a man who had been shot in the abdomen at a roadblock. "If there's a bloodbath here, there's really nothing we'll have to treat the wounded. Nothing at all."

The International Committee of the Red Cross said plans are under way to take over the ward of at least one hospital in Port-au-Prince and staff it with emergency room physicians as well as Cuban doctors who make up a large portion of the country's health care system. There are about 300 Cuban doctors in Haiti, and they are an essential part of the country's deteriorating health-care system.

The ICRC's plans come in response to reports that raids on hospitals had increased in recent weeks and that wounded patients had been kidnapped by gunmen. One of the key tasks, said Yves Giovannoni, head of Red Cross operations in Latin America and the Caribbean, will be to brace for an influx of wounded, if major fighting breaks out in Haiti's besieged capital.

"Handling war wounded -- meaning people with bullets in their body or with cuts by knives, machetes -- requires a particular surgical technique, particular policies, in terms of using antibiotics," said Giovannoni.

The violence that has wracked Haiti has hit hospitals hard -- cutting off the flow of drugs and supplies and also putting health-care workers at risk. As attacks on the opponents of Aristide have increased, along with the crowds of demonstrators demanding his resignation, militant supporters of the embattled president have surrounded hospitals where protesters have fled, occasionally chasing them inside and pulling out wounded patients.

"This is a regular routine of ours: After every demonstration, we go to the hospital and care for our wounded, because there's always going to be wounded after a demonstration here," said Charlie Baker, a businessman and leader in the Group of 184, one of the moderate groups leading the opposition. "And you never know what to expect because the hospital can be just as dangerous as the street."

Alain Grimard, an official with the United Nations Development Program in Haiti, said the deteriorating conditions have pushed Haiti's health-care system to the brink of collapse.

"Even in the best of times the health-care situation in this country has been abysmal," he said. "There isn't enough medicine -- the poor have to buy their own -- and that's only for those who have a chance at affording it. The vast majority of people in this country have no real access to health care."

Chereste Auguste, 46, was brought to the State University Hospital on Wednesday after being shot when militant pro-Aristide gunmen known as chimère commandeered his taxi scooter.

"These people were base," Auguste said, as he waited to be treated for his wounds in the hospital's emergency room with about two dozen other patients nearby. "They just shot me and stole the taxi. Now I'm in really deep pain. I cannot feel my legs and I need more drugs. But I don't have the money for more drugs."

After a moment, he turned to a reporter and asked, "Can you give me anything, anything, please?"

Tim Collie can be reached at tcollie@sun-sentinel.com or 954-356-4573.

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