The Undermining of Haitian Health Care: Setting the Stage for Disaster

In December 2003, the dedication ceremony of Haiti’s first and only public medical school took place in Port-au-Prince. The school’s ability to provide free medical education was considered one of the most important achievements of former president Jean-Bertrand Aristide’s administration. A mere one month after it opened, however, the school became one of the many casualties of the military coup that ousted Aristide in 2004. The story of this school is both the story of the Haitian people's iron will for self-determination and betterment, and the country's constant struggle with meddling foreign powers.

February 22, 2010

In December 2003, the dedication ceremony of Haiti’s first and only public medical school, a project jointly supported by the governments of Haiti, Cuba, and Taiwan, took place at the University of Tabarre in Port-au-Prince. At the time of the school’s opening, Haiti had one of the worst doctor-to-patient ratios in the world (one to 10,000 in urban areas and one to 20,000 in rural areas), and the school’s ability to provide free medical education was considered one of the most important achievements of former president Jean Bertrand Aristide’s administration.

In a declaration full of optimism and hope, the Dean of Health Sciences, Dr. Yves Polynice stated: “The inauguration of the Aristide Foundation University is an opportunity to renew our Hippocratic Oath where each physician pledges to care for the poor, widows, and orphans free of cost. We must be conscious that any illness affecting one citizen represents a threat to us all. Today we say ‘health care for all, without exclusion.’ ” On February 3, 2004, the hospital officially opened its doors and began treating many of Haiti’s most vulnerable. For many it was their first visit to a doctor.

The mood of optimism and hope expressed by Dr. Polynice on that December day didn’t last long. Just two weeks later, on the evening of February 28, 2004, Aristide was overthrown and forcibly removed to the Central African Republic in an internationally organized coup d’état. Less than one month after its opening, the hospital and the university complex it was part of were closed down at gunpoint and occupied by U.S. Marines and the United Nations Stabilization Mission in Haiti (MINUSTAH). The 247 new medical students watched as their classrooms were turned into barracks, their instructors forced to flee from political persecution (due to threats on his life, Dr. Polynice fled to Europe), and much of their material and equipment pillaged to service the capital's private medical clinics. The school was finally abandoned by MINUSTAH and reopened to students in the summer of 2009, but with widespread budget cuts and curriculum changes that downplayed its original community service mission.

Despite the United Nations’ efforts to “stabilize” Haiti after the 2004 coup, politically motivated violence, and widespread, systematic persecution of Aristide supporters sharply escalated. In this politically charged atmosphere, the 247 medical students were never able to return to Tabarre to complete their medical education. Since the new medical facility was a collaborative project of the Haitian, Cuban, and Taiwanese governments, the Cubans extended a helping hand to the Haitian doctors and staff and allowed them to continue their medical training free of cost at the Latin American Medical School (ELAM) in Cuba.

The students from Tabarre were not the first Haitian students to study in Cuba. Since the devastation of Hurricane George in 1998, Cuba has promoted a humanitarian exchange with Haiti which provides medical professionals to the country’s remote regions and trains Haitian medical students. When the January 12 earthquake struck, there were an estimated 400 Cuban doctors working in Haiti, along with 573 Haitian doctors who were trained in Cuba, and now they are covering the entire nation.

Tabarre was not the only medical school in the country, but it was the only one that provided free education to its students. The school recruited prospective doctors from poor families from all of Haiti's nine departments. It also offered free room and board to students if they entered an agreement to serve for several years in remote regions of Haiti. These were significant agreements because some 90% percent of the nation’s doctors work in the capital, Port-au-Prince, while two-thirds of all Haitians live in rural areas. This concentration of doctors in the capital has created a situation in which the majority of Haitians—those who live in rural areas—are left without the most basic elements of health care.

At the time of the school's opening there were fewer than 2,000 Haitian doctors in the entire country. In a nation with so few doctors, this school was an ambitious, essential project. Before its closure, it was estimated that the school would train 600 new doctors during its first 12 years of operation. It was hailed as a step forward in the epic effort to provide the citizens of Haiti with a basic health care infrastructure, in spite of the ongoing aid embargo to Aristide’s administration.

After this year’s devastating earthquake, many of the medical students who had left in February 2004 returned to the site of the university and reunited with teams of Cuban doctors to provide emergency care and treatment for the disaster’s victims. Surprisingly, the medical school survived the quake intact, and by January 15 became a site of refuge for more than 10,000 victims of the earthquake. That same day Aristide Foundation spokesperson Toussaint Hilaire reported that there were many doctors on site, but critically lacking medical supplies. He emphasized that the road to the medical school was unobstructed and that supplies could be directed there. Several hundred yards away, at the newly occupied Toussaint L’Overture airport, U.S. forces were busy diverting planes bringing lifesaving medical equipment into the country in order to allow additional troops onto the island to maintain control of the on-the-ground situation.

The Aristide administration’s creation of this free medical school was a herculean achievement, contradicting the media’s claim that Aristide had abandoned his populist roots. The closure of the school has not only severely crippled Haiti’s ability to effectively deal with the barrage of hurricanes, floods, and landslides it has faced in recent years, but has also served the political purpose of erasing the legacy of Aristide and his political movement, Lavalas.

On February 10, filmmaker and activist Kevin Pina reported to the Canada Haiti Action Network that the medical school at the University of Tabarre had been once again occupied — this time by troops of the U.S. Southern Command. That a public medical school could have become a reality in Haiti despite the aid embargoes, massive debt payments, widespread destabilization, and privatization of nearly everything speaks to the iron will of the Haitian people to better themselves. Sadly, the closure and occupation of Tabarre once again reflects the equally hardened determination of others to prevent them from doing so. “While extreme earthquakes are acts of nature,” wrote Tracy Kidder in a recent New York Times op-ed piece, “extreme vulnerability to earthquakes is manmade.”

Kevin Edmonds is a NACLA Research Associate.


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