On a busy day, the Rosalind Rendu Pediatric Clinic deep inside Cite Soleil, a densely populated slum in Haiti's capital, Port-au-Prince, is crammed with about 300 patients by 7 a.m. Mothers come with babies and toddlers with various illnesses any symptoms, among them coughs, fevers, skin infections and malnutrition.
Even so, these children could be considered lucky. The clinic is private, run by the Catholic missionary group Daughters of Charity, and the youngsters might have the opportunity to be treated by two veteran Haitian pediatricians and Dr. John Carroll, an internist from West Peoria, Ill., who regularly travels to Haiti.
"They are the fortunate ones because they are being seen that day and treated that day, and there is a pharmacy right there at the clinic," Carroll said.
The reality is far grimmer for patients seeking help from public facilities, especially now that a strike that has ground on since March is exacerbating the already dismal and desperate state of health care in the impoverished Caribbean nation.
Carroll, who recently returned from his seventh visit to Haiti in 18 months, offered firsthand accounts of the strike's effects. Few of the other international humanitarian organizations that work in Haiti were willing to comment on the general effects of the walkout for fear of jeopardizing their status in the country.
According to news reports, at least four public hospitals are closed, and others hobbled by the strike are limping along without the mainly young doctors and interns who have walked off their jobs.
The physicians, who earn the equivalent of about $140 a month, according to international medical staff acquainted with Haitian doctors, are demanding better pay, improvemed sanitary conditions and more medical supplies, including basics such as surgical gloves and gauze.
"The public health care system is just deplorable in Haiti," said Carroll, who founded Haitian Hearts, a nonprofit group that since 1995 has facilitated surgery for about 200 Haitians, mainly pediatric heart surgery that is not routinely performed in Haiti. "It was bad even before the hospitals went on strike. But it's the only thing the majority of poor people had to turn to."
The doctors had originally demanded a pay raise to $500 a month but have now agreed to accept $360, the Associated Press reported. The government's latest offer of $200 a month was rejected.
The conditions at public facilities are not only bad for patients but also for physicians, Carroll said. Some of his Haitian medical colleagues describe being overwhelmed by the number of patients, getting threatened by patients' relatives, working without running water and performing operations under the glow of hand-held flashlights because of the lack of regular electricity.
About 40 percent of Haiti's population lacks access to essential health and nutrition services, and only 45 percent of all children 12 months to 23 months old are fully vaccinated, according to the U.S. Agency for International Development. Public spending for health represents only 10 percent of all health financing for the country, and there are as few as four health professionals per 10,000 people, according to the agency.
With the strike dragging on, "the Haitian public hospitals are now more dysfunctional than usual," Carroll said.
At St. Catherine Laboure Hospital, a public facility with a three-stretcher emergency room not far from the clinic where Carroll works, there were only four infant patients at the pediatric ward in early July, he said, "a horrifyingly low number for the high population of the slum."
"When I go into that hospital, I am depressed," Carroll said. "I see beds with no mattresses on them, just springs, and no babies."
The ward "should be overloaded with pediatric patients," he said.
During the last 15 years, Carroll said, he had referred babies he had examined at the clinic to St. Catherine, and many of their lives were saved with "simple medicine," such as intravenous fluids and basic antibiotics. Haitian doctors have delivered thousands of babies there, Carroll said.
"If the hospital were correctly run, it would be one of the best teaching hospitals in the world for young resident physicians," Carroll said. "But the hospital has now become so dysfunctional and too expensive for the person in the slum to afford."
It is unclear when the strike might end. Past walkouts have dragged on. And for the poor, strikes "are frequently a death sentence when they become ill," Carroll said.
In an interview with the AP, Dr. Gabriel Thimothe, director general of Haiti's Health Ministry, called striking doctors "radicals" who had trained in Cuba.
"We're open to negotiations," he told AP. "But we can't give everything they demand due to the economic situation of the country."
Thimothe said at least three deaths, including a pregnant woman who died outside the State University hospital's gates, have been attributed to the strike. But Carroll said the toll was probably much higher.
"I would say there have been many, many deaths since the strike started due to no medical care for the poor," he said.
When he questions Haitian medical colleagues about their professional obligation to patients, Carroll said they typically respond as follows: "What are the ethics of giving very poor treatment in public hospital when we frequently send these patients away because we can't treat them?"
Without public health care, the poorest Haitians have few options. Most cannot afford to pay the equivalent $1 fee charged for a basic medical consultation, much less the cost of prescription medicines or private treatment from noncharitable organizations, Carroll said.
"If you're a poor Haitian, you can do very little," Carroll said. "They are really up the creek right now."
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