The future of health care in.... Haiti

A pair of health professionals in Haiti are deeply troubled for the future of health care in their country. Jerry and Marlon Bitar not only established their own private practice in Haiti, but also a free clinic for those in poverty. As the medical aid from the earthquake begins to leave, the Bitars' wonder what if any health care will take it's place. Any survivors who where customers of the Bitar's private practice now use their free clinic, some even live there.

From the Washington Post, writer Lois Romano interviewed the pair on their concerns for the future.

But as the immediate crisis starts to wane, more and more patients with maladies unrelated to the earthquake are turning to international health-care teams led by the World Health Organization, raising concerns about Haiti's ability to care for its own once the relief teams pull out and need for rehabilitation and long-term care grows.

The Bitars ask what appears to be a simple question: How can the country's medical structure be rebuilt when hundreds of humanitarian teams are still providing health care for free? The surgeons say they have no income -- not from the poor and not from their private practice. For one, 700,000 people are now homeless with no access to funds. For another, the hospitals, the Bitars and others say, are finding it hard to compete with the visitors. With no end in sight, some of the nation's doctors have already left, and others are considering leaving.

"We have not been able to make payroll for two months," Jerry Bitar said.

Marlon added: "I am very worried that many of our good doctors will leave. The humanitarian hospitals, they don't ask for any money. Yesterday, I went to one and saw two of my private-paying patients getting treatment there."

Indisputably, international organizations are carrying the Haitian health-care system today -- and will continue into the indefinite future. Many Haitian health-care providers were among the 230,000 killed in the earthquake, and others have not shown up for work, dealing with their own losses. The nursing school at the University Hospital collapsed during exams and killed essentially an entire first-year class of nursing students.

"It is a very difficult situation," said Thomas D. Kirsch, a professor at the Johns Hopkins medical school and an expert in developing-world health issues who was recently in Haiti. "If these organizations pulled out, the system would be worse than ever, and as long as there is free care available, that's where the Haitians will go and the Haitian doctors will have no business. . . . There must be a well-planned transition period to subsidize the Haitian health-care system, have [nongovernmental organizations] work directly with Haitian providers, and to train sufficient providers and nurses to be able to meet the population's needs."