A hospital opened in January where a year earlier cows grazed.
There were banners and bands that bright day in the tiny community of Lacolline, Haiti. Thousands of people came, singing, playing music, and giving speeches. Even Haitian President Réne Préval was there and with him a band of ministers, deputies, and other high officials.
The hospital is a modest, one-story structure. Whitewashed an eye-stabbing white that speaks of cleanliness and cures, the facility will provide care for thousands in the surrounding community who previously had to trek to a crowded clinic in nearby Lascahobas.
But more was going on that day than the commissioning of a structure, even one where doctors and nurses will work. Something brought a nation’s president and important cabinet members to a facility that boasts a modest 54 beds – less than a 10th the size of Harvard-affiliated Brigham and Women’s Hospital, whose Division of Social Medicine and Health Inequalities sponsors physicians key to the new hospital’s construction.
Hope is what brought out the people and the president that day. Hope that giving birth won’t be a death sentence in a nation with high maternal mortality. Hope that AIDS can be a chronic condition in Haiti as it is in the developed world. Hope that illnesses that have become routine in many nations won’t fester and grow until they threaten lives and livelihoods. Hope that the thick ranks of starving Haitian children will slowly thin in the decades to come. Hope that the future will be better than the past.
Hope, in many ways, is a national religion in the Western Hemisphere’s poorest nation, where so many have so little. Haitian hope, perhaps not surprisingly, is tinged with fatalism. A common saying goes: “As long as you have your head, you will hope to wear a hat,” reflecting both the hope that things will get better – you’ll get a hat – and the realization that things very well could get worse – you might lose everything, including your head.
On the third Monday in January, hope took the shape of a hospital in the village of Lacolline. It was designed and built by the nonprofit Partners In Health and financed by the charity AmeriCares. Partners In Health has close ties to Brigham and Women’s Hospital, Harvard Medical School’s Department of Social Medicine, and the Harvard School of Public Health’s Francois-Xavier Bagnoud Center for Health and Human Rights.
The $469,000 facility was designed by Instructor in Medicine David Walton, a physician with Brigham and Women’s Hospital; Partners In Health co-founder Paul Farmer, the Maude and Lillian Presley Professor of Social Medicine; and Patrice Nevil, health systems manager for Partners In Health’s Haitian partner organization, Zanmi Lasante. Though not approaching the size of Boston’s urban medical centers, the Lacolline hospital was designed with an eye to both modern medical standards and the constraints of operating in its poor, rural setting.
The high-ceilinged facility is built around a central courtyard featuring a tranquil garden and a small fish pond. To one side is a wing dedicated to outpatient care while inpatient care is centered on the other side, to address what Walton termed “a disaster” of patient flow and risk of exposure to infection at the existing facility in Lascahobas. The building has separate wards for men, women, and children, as well as a row of isolation rooms for tuberculosis patients with a simple, outward-blowing fan built into the wall to provide the negative air pressure that keeps the airborne tuberculosis bacteria from drifting into other sections of the hospital.
All around the facility, upward-facing UV lamps kill airborne bacteria. In contrast to the enclosed, narrow corridors in many existing clinics, the new hospital at Lacolline was designed to encourage airflow as a way to reduce infection.
The hospital, powered by a generator, has a laboratory, a pharmacy, a dentist’s office, and an incinerator for medical waste. Farmer said he hopes it becomes a model for hospitals in similar settings around the world.
The day before the opening, Walton and Roland Desire, director of the facilities at Lacolline and Lascahobas for Partners In Health’s Haitian arm, Zanmi Lasante, were directing a crew of workers hanging pictures and doing other final tasks in preparation for the big day. The two spoke about how far medical care in the area has come in a short period of time.
In 2002, Partners In Health first came to a small, cramped facility in Lascahobas, a small town a couple of kilometers from the new hospital. Staffed and run by the government, the Lascahobas clinic attracted just a few patients per day, seen by one of three nurses who, together with a laboratory technician, were the facility’s full-time staff. A doctor just out of medical school, serving his or her required social service residency, would periodically come to see patients.
Through a cooperative agreement with the Haitian Ministry of Health, Zanmi Lasante took over operations at Lascahobas. They added staff, stationing a doctor there full time, and ensured a steady supply of medicines, bandages, and other medical equipment. When operations began, the hospital saw 12 to 14 patients a day. Through word of mouth, however, the number of patients began to increase. Within a year, the hospital was seeing 250 patients a day and Zanmi Lasante realized the space at Lascahobas was woefully inadequate.
“When I first came, the situation was terrible,” Walton said. “After eight months, we saw already that the health center was too small.”
They tried to do more with what they had, adding a suite of inpatient rooms holding 15 beds at the back of the building.
But patient volume continued to climb. Some days they’d see as many as 400 patients. Finally, a group of local landowners offered to give Zanmi Lasante land to build a hospital. Walton and Farmer jumped at the chance to design a new facility, incorporating features to address a variety of shortcomings in the existing clinic.
They stopped short at accepting the gift of new land, however, telling the landowners that the government was the proper recipient. Farmer said later that their partnership with the government is an important one, since only the government has the ability to confer rights – such as the right to basic health care – onto its population. Further, he said, the government has the power to scale up efforts countrywide, as is needed in Haiti.
Construction started in March 2007, taking less than a year to complete.
The new hospital will have two doctors on staff, with 20 nurses, the region’s first dentist, and numerous support workers. It will be open 24 hours a day, seven days a week, and will see patients with a full range of medical conditions, from malaria and malnutrition to injuries and infections, to the disastrous linked epidemics of AIDS and TB.
The government requires that the clinics charge a nominal fee, the equivalent of 60 cents, and Walton said a patient gets a suite of services for that one fee, including an appointment with the doctor, medication, and hospitalization if necessary. Even that amount, however, is out of reach for some patients. Regardless, Walton said, nobody is turned away.
Though the facility’s official catchment area holds 55,000 people, Walton said it will likely draw from much farther away. At the tiny clinic at Lascahobas, people have walked 12 hours and even returned from the Haitian capital, Port-au-Prince, to get care. Walton said Lascahobas, and now the new hospital at Lacolline, are the only really effective health facilities around.
To Walton, who began working with Farmer a decade ago when he was a medical student, the hospital opening is yet another milestone in a job that doesn’t seem to have an end. “I don’t feel like I can leave until we fix it, but we’re never going to fix it.”