Mirebalais University Hospital
Haiti Program Highlights, 2012
The purpose of this report is to provide a general update on the progress of Partners In Health's ongoing work in Haiti since the earthquake in January of 2010. Thanks to your generous support, Partners In Health has raised over $140,000.00 via globalgiving for our Haiti Earthquake Recovery project. We extend our deepest gratitude, on behalf of all of our patients and colleagues, for your commitment to and belief in helping poor people access quality health care.
Partners In Health and our Haitian sister organization, Zanmi Lasante (“Partners In Health” in Creole, or ZL) provide medical care at 15 health centers and hospitals across Haiti’s rural Central Plateau and Lower Artibonite regions. As well as improving access to care, PIH/ZL is dedicated to raising the standard of care in rural Haiti by introducing new diagnostics and treatment regiments for both common and complex illnesses.
Hôpital Universitaire de Mirebalais (Mirebalais University Hospital)
Haiti has long been the heart of PIH’s work, and today PIH/ZL is the largest healthcare provider in Haiti. By investing in public health infrastructure and the local workforce, PIH and ZL are rebuilding the health system in rural Haiti and ensuring the long-term sustainability of our efforts. In 2010, PIH/ZL conceived of Mirebalais University Hospital (HUM) in response to an urgent request from the Haitian Ministry of Health following the destruction of the national referral and teaching hospital in Port-au-Prince in the January 2010 earthquake. Beyond delivering life-saving care to a poor and underserved population of 3.3 million in Mirebalais and central Haiti, HUM will allow us to embark on an ambitious strategy to develop the capacity of Haitian clinicians (doctors, nurses, and specialists) to provide care.
As of July, hospital construction is fully complete, and the hospital will open at partial capacity in spring 2013. Additional specialty services will be rolled out over the following two years. Upon opening, HUM will offer the following services:
- Community health services, including vaccinations, treatment for malnutrition, and preventative care
- Outpatient services, including TB/HIV, general adult and pediatric care, and non-communicable diseases
- Women’s health services, including family planning, reproductive health and comprehensive emergency obstetric care
- Inpatient care, including internal medicine, pediatrics, and intensive care
- Surgical care, including Caesarean sections and emergency surgeries
- Emergency medical services
- Advanced diagnostics, including digital radiology, ultrasonography and computed tomography
- Mental health services
- Laboratory and pharmacy
As a national teaching hospital, HUM is designed both to provide a new standard of healthcare in the public sector and to take a leading role in training and retaining an expanded workforce of well-trained and highly motivated doctors, nurses, and other health professionals.
Cholera prevention and treatment
The cholera epidemic had affected 553,270 people and killed 7,238 nationwide between October 2010 and June 2012. From January 2011 to May 2012, PIH/ZL treated 70,582 suspected cases of cholera at our facilities, 56,506 of whom were hospitalized, and 282 of whom died. Nationwide in Haiti, the case fatality for cholera is 1.3%; at PIH/ZL facilities it is 0.4%. After a year of fighting the outbreak with treatment, we added an additional tool to our arsenal: in April, PIH/ZL launched a pilot cholera vaccination campaign which reached nearly 50,000 people with the two-dose vaccine. Though these achievements are substantial, we are additionally buoyed by the international attention we were able to draw to the epidemic and ultimately the World Health Organization’s recommendation that a stockpile of vaccines be available in Haiti
Building upon PIH’s existing health programs and partnership with the Haitian Ministry of Health, PIH/ZL launched the first comprehensive and integrated breast cancer program in Haiti’s Central Plateau and Artibonite Departments. Currently our breast cancer program is based out of Cange. When the Mirebalais National Teaching Hospital begins operating at full capacity, the program and clinical team will transfer there.
Because breast cancer is not yet a widely recognized disease in Haiti, most patients with cancer present in very advanced stages, necessitating some combination of mastectomy, chemotherapy, and/or palliative care. For women whose cancer results are positive, ZL provides chemotherapy and surgery (mastectomies, quandrantectomies, and lumpectomies) in Cange. Our current caseload includes 10 patients that are on active chemotherapy for breast cancer, and an additional 30-40 patients receiving Tamoxifen alone.
To encourage a greater awareness of breast cancer in our catchment area, our staff also coordinate extensive education initiatives at the community and clinical levels. Community awareness events held on World Cancer Day and International Women’s Day shared information about breast cancer with a broad audience. Community health workers, who frequently visit patients in their homes, also receive information on breast cancer to pass along to their patients. We have already seen an increase in caseload as a result of these community outreach efforts, and expect that trend to continue as breast cancer awareness in our catchment area increases.
Following the January 2010 earthquake, PIH/ZL marshaled the resources of academic and medical partners to treat the thousands of victims who lost limbs and mobility in the tragic event. We have since built upon this emergency response to develop and implement a community-based model of rehabilitative medicine that continues to provide care to earthquake survivors as well as a number of other patients who have suffered strokes or other catastrophic illnesses that have resulted in limited mobility.
Patients who have been injured or ill are evaluated and referred to the rehabilitation team where they are comprehensively managed by an interdisciplinary group of professionals, which includes physical medicine and rehab physicians, therapists, rehab technicians and rehab educators. Awareness and sensitivity to each patient’s unique socioeconomic needs, personal goals, and social support is paramount in the formation of a plan that ultimately facilitates maximal community reintegration. Community-based rehabilitation and long-term accompaniment by specialized community health workers called Rehab Educators account for a significant portion of the clinical care delivered and is essential in combating harmful stigma and maximizing quality of life and reintegration.
Currently, rehabilitative medicine is offered through PIH/ZL’s two largest hospitals: L’Hopital Bon Sauveur in Cange and L’Hopital Saint Nicolas in St. Marc. During FY12, PIH/ZL supported two rehab technicians, six rehab educators, and one administrative assistant who carried out 455 new consultations and 1,520 inpatient, outpatient, and community-based patient visits.
These clinical care initiatives continue to revolutionize the treatment course following catastrophic illness or injury and address the harmful notions of stigma around disability. It is through the demonstration of what is truly possible that we practice daily disability advocacy. As a ward full of onlookers stands in amazement as someone takes their first steps after injury or a community realizes what a profound impact a ramp can have on individual autonomy and access, it is apparent that this work makes an impact beyond the clinic doors. In 2013, PIH/ZL will expand rehabilitative medicine to Mirebalais University Hospital, which will include inpatient, outpatient, and community-based service delivery as well as an emphasis on clinical rotations for medical residents.
Cholera vaccine distribution