“If it wasn’t for this hospital, I would be finished.” Saint Koeur François sugar cane farmer

PORT-AU-PRINCE, HAITI—If you want to be inspired by progress in Haiti, drive 1.5 hours north to the new University Hospital of Mirebalais.

If you want to be depressed by the dismal state of affairs four years after the 7.0-Richter earthquake, go downtown to the old University Hospital of Haiti.

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I visited both last month. At the first facility, I found bright new buildings covered with solar panels, patients wandering around clean leafy courtyards with trickling fish ponds, and an American technician teaching employees how to work a gleaming new $700,000 CT scanner — the first in a public hospital in Haiti.

There was a sewage treatment system, a machine that looked like a giant furnace compressing oxygen and sending it through copper pipes directly into operation and recovery rooms, and a pharmacy stocked with expensive chemotherapy drugs — another first for a public hospital.

At the second, known locally as the general hospital, I watched the body of a young man be wheeled down a urine-soaked brick lane between broken buildings and then hoisted onto a jumbled pile of cadavers inside a shipping container. That is the hospital’s — and city’s — current morgue.

Patients were getting blood tests outside in a canvas tent. Abandoned kids sat tied to their rusty cribs inside a series of plywood buildings that for three years now have served as the hospital’s pediatric unit.

The contrast between the two hospitals was even more jarring when I spoke to patients.

In Mirebalais, I met Saint Koeur François, a 57-year-old sugar cane farmer, weakly sitting up in his private room. He’s about as complicated a medical case as you can get in Haiti. First, he’s been an HIV patient for 14 years. Then, 28 days ago, he woke up with a locked jaw and violent body shakes. He was diagnosed with tetanus, a deadly disease that requires intubation, nasal feeding tubes, myriad medications and intense physiotherapy — all costly treatments that a rural farmer like him would never manage to pay. His total bill? $1.15 for a hospital registration card.

“If it wasn’t for this hospital, I would be finished,” he said, wiping tears with towel on lap.

At the general hospital in downtown Port-au-Prince, I met bright-eyed, smiling 8-month-old Naisha Laurent sitting on her grandmother’s lap outside the plywood pediatric unit. She was brought here 15 days ago with one of the most common, easily treated diagnoses — malnutrition.

The hospital’s policy is to not charge children under 5. But machines are regularly broken and medical supplies regularly run out. Laurent’s grandmother, Lucienne, told me she had spent more than $500 on lab tests and medication, as well as food for her and Naisha’s mother, who hadn’t left the baby’s side since she was admitted. To pay for it all, she’d sold out the entire stock of her little business, selling rice and beans on the street.

“Write down my number,” she told me. “I need you to find me an adoptive mother for her. We can’t take care of her. I can’t send my 9-year-old to school as it is.”

Promises, promises

These two hospitals are 60 kilometres and worlds apart. One is a postcard for the world’s promise to “build back better.” The other is an advertisement for cynicism and broken promises.

Looking into Naisha’s smiling face, I wondered what lessons could be found in their stark differences?

Both hospitals, made modern and new, were promised soon after the earthquake.

The Boston-based non-profit health-care organization Partners in Health had proposed a small hospital in Mirebalais, but the Haitian government asked it to expand the plans.

Partners In Health has a long, celebrated history in Haiti and a dynamic leader, Dr. Paul Farmer, who by then had been named the United Nations’ deputy special envoy for the country. He has a fat Rolodex. His team managed to raise $23 million — including $5 million of in-kind donations — and broke ground in a rice field six months later.

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The hospital opened last spring, with 171 beds but room to expand to 300.

Sixty kilometres away, Haiti’s general hospital was promised a much-needed rebuild after the earthquake. Sixty per cent of its buildings were destroyed, and the ones remaining were ancient and decrepit. The American and French governments vowed $25 million each to rebuild the hospital and outfit it with modern equipment. The job would obviously be more complicated than starting from scratch in a farm field — there was rubble to remove, buildings to take down, all while continuing to treat thousands of patients.

Years passed with nothing to show for it.

“If we had gotten the money directly, we would have done it,” Prime Minister Laurent Lamothe told me in an interview. “Let me tell you, the other day they got a contract after a four-year bid. And by the other day, I mean three or four months ago.”

His government vowed to boost its commitment to the hospital’s rebuild from $3.2 million to $33.2 million.

It also committed $8 million to the first year’s operating costs of the new University Hospital of Mirebalais — a huge expense, given that the hospital controls less than $60 million of its own health budget.

But that’s still inadequate. Guelph General Hospital, which has only 169 beds, runs on $109 million a year.

Partners In Health has committed to raise another $3 million to pay for salaries and medication.

Meanwhile, the general hospital has more than double the beds (475 still in use now), and it is forced to run on $6.3 million a year. Most of that goes to staff salaries, which are paltry. Doctors here make only $630 a month — eight times less than their counterparts in Mirebalais. Understandably, most of them are largely absent, earning a living in their private clinics.

There has been no commitment by the Haitian government to boost that, the hospital’s executive director Dr. Maurice Mainville told me.

How could it? It controls only 9 per cent of the $635 million spent on health care in Haiti every year. More than 85 per cent is directed by foreign donors.

“Everyone knows what we need to do,” Mainville told me. “We just lack the means.”

For me, the lesson of these two hospitals reflects the country’s greater lesson of development and aid.

Great things can happen, but only with one strong leader in charge. And that leader must be directed by the country’s own government.

“It’s absurd to think you can’t do what we did at Mirebalais anywhere in the country,” Farmer said over the phone. “We have to do more to help the general hospital. Every health NGO in Haiti should take it on as our problem.”