Doctors Without Borders closes the first of two hospitals in Haiti

PORT-AU-PRINCE, Haiti – In a country where more women die before, during and after childbirth than anywhere else in the Western Hemisphere, poor women in Haiti with high-risk pregnancies now have one less option for lifesaving care.

The Geneva-based medical charity, Doctors Without Borders – known as MSF, its French abbreviation – has closed its free, round-the-clock maternity hospital in Haiti’s capital. The facility, called CRUO, an acronym for its French name, was opened after Haiti’s catastrophic 2010 earthquake. It admitted its last expectant mother last Sunday – three months ahead of its scheduled closing.

“It was a temporary structure that has a life span that already has been surpassed, and requires significant investments to turn it into a permanent, more long-term structure,” Michelle Chouinard, MSF’s head of mission, said about the prefabricated structure that was built from shipping containers. “It’s not MSF’s role to remain indefinitely.”

The hospital closing is the first of two for MSF. The organization opened them after many of Haiti’s health care facilities collapsed in the earthquake, and a deadly cholera epidemic hit 10 months later. The charity’s 122-bed trauma hospital in Tabarre, which receives a large number of head trauma cases and broken bones related to the country’s motorcycle culture, is scheduled to close permanently in June 2019.

But other medical facilities run by the charity will remain open.

“People are saying MSF is leaving. MSF is not leaving,” Chouinard said. She said the group’s 40-bed severe-burn center, 24-hour sexual violence center, 24-hour emergency clinic in a Port-au-Prince slum and a facility in Port-a-Piment, which was opened after 2016’s Hurricane Matthew in southern Haiti, will all remain.

With the number of conflicts and other humanitarian crises increasing around the world, demands are up for the charity’s emergency medical aid, Chouinard said. Also, the situation in Haiti is not the same as it was in 2010, when the charity was in the midst of handing over some projects to the government when earthquake forced it to put plans on hold, she said.

“MSF does have standards of care for our patients,” she said, noting that running the maternity hospital, which admitted an average of 500 patients a day last year, is expensive. “We do believe that health care is important and should be free. Most of the times we work in areas where people can’t afford to pay for health care.”

In Haiti, that has meant not only providing life-saving care to women with complicated pregnancies and babies with low birth weights, but also being on the front lines of the cholera epidemic. At cholera’s height, MSF was often the first to dispatch emergency response teams to far-flung reaches of the country affected by the deadly water-borne disease. In 2016, when a strike crippled the country’s public hospitals, the Tabarre facility was the only respite for those unable to afford private care. That year, it treated 15,228 patients in the emergency room and performed 8,088 surgeries.

Despite the care, MSF has not been immune from criticism in Haiti, where nongovernmental organizations, or NGOs, are often accused of undermining the government because of their ability to provide services free and pay top dollar for staff. That has led to a complicated – and sometimes contentious – relationship between governments and NGOs. It is especially so in Haiti where this year President Jovenel Moise, after a sexual misconduct scandal involving the staff of British charity Oxfam, singled out Doctors Without Borders.

In an interview with Reuters, Moise called for an investigation of the medical charity saying “it had to repatriate about 17 people for misconduct which was not explained.”

A Doctors Without Borders spokesman at the time said it was unclear what Moise was referring to. Chouinard, in an interview with the Miami Herald after the president’s comment, said MSF takes allegations of abuse and harassment “very seriously,” and over the years has developed policies to address such situations, but declined to address the allegations directly.

Haitian leaders have long been harsh critics of NGOs, while also enjoying the comfort of knowing that they fulfill a need. But critics say the reliance on NGOs weakens governments, which often don’t consider the fact that funding often runs out and programs go away.

In the case of Haiti, the end of MSF’s 12-year investment in battling Haiti’s childbirth crisis, and the eventual closing of the trauma hospital, couldn’t have come at a worse time. The country currently doesn’t have a functioning government after the resignation of its prime minister and his Cabinet after this month’s riots over fuel prices.

The new government, when it is formed, will have to figure out how to absorb MSF’s services and costs while addressing Haiti’s dysfunctional health care system. Chouinard and others say MSF had long warned Haitian health ministry officials that the maternity and trauma hospitals were temporary.

“They had discussions with the ministry, and because of the weakness of the system, the ministry kept asking for a delay,” said Dr. Claude Surena, former president of the Haitian Medical Association, who was part of the Health Ministry’s team that led Haiti’s response after the earthquake.

Surena said closing the maternity hospital, which treated pregnant women with eclampsia and pre-eclampsia and was the only health facility that specialized in expectant mothers with cholera, will have a big impact. The Health Ministry, he said, will have to find a way to gradually absorb such cases and improve health care delivery.

Chouinard acknowledged that the timing isn’t great.

“We understand the limits of the Ministry of Health, but we have been trying to work with them to be able to hand over some of our equipment so that some of these services at CRUO can continue,” she said, noting that the aid group ended its cholera response program last year after others stepped in to help with the dwindling numbers.

According to the World Bank, Haiti spends less on health care per capita than its closest neighbors. The Dominican Republic spends $180 per capita; Cuba, $781; and the Latin American and Caribbean region overall, $336. Haiti spends just $13. Maternal and infant mortality rates are also five and three times, respectively, higher than the regional average, the bank said in a report it published last year while calling on Haiti’s government to increase health care spending.

With 359 deaths for every 100,000 pregnancies, according to the World Health Organization’s 2015 statistics, “Haiti remains the country in the Western Hemisphere with the highest maternal mortality,” Chouinard said.