It was 1 am in the emergency room, and I had been on duty since 8 am the day before. As an intern at the emergency department, my job consisted of assessing the patient's emergency to then refer them to the right department.
As I was setting up a venous route for a patient, there were cries in the hall, as always. Then, I saw a 30-year-old man arrive, his face wrapped with a bloody shirt. His relatives could not handle the sight of his jaw injury; the buccal cavity was visible from the outside. It was the first time that I witnessed such terrible facial trauma. He was silent, keeping the pressure on the bleeding site, looking so lost in thought; maybe he didn't realize his situation yet. Unfortunately, facial trauma is a frequent consequence of road traffic accidents because we still do not have adequate preventive measures. Meanwhile, a referral had to be made.
There is an immediate need for increasing the number of ENT providers in Haiti. According to the Chief of ENT at State University Hospital, Dr. Jean Gilles Patrick, there are only around 21 ENT practitioners for a population of 12 million, about 0.18 providers per 100,000 people. However, there are about 3023 ENT doctors in France (1) and 12,887 ENT doctors in the United States (2), equating to 4.5 and 3.8 doctors per 100,000 people, respectively. In Haiti, the ENT unit in the public general hospital has a unique training structure that has only produced about 3 residents since 2000.
In addition to our ENT practitioner shortage, Haiti is facing a multitude of issues that increase our burden of head and neck pathology. Haiti has a high rate of road traffic accidents, the main cause of facial injuries that require surgery. Political instability, mostly in poor areas, is responsible for many bullet wound cases. Not to mention the panoply of infectious diseases of the head and neck such as parotitis, otitis and sinusitis. Those patients arrive every day while our system is struggling to deliver best possible care with limited means.
“What is the next step doctor?” asked the patient. Then, I suddenly remembered, the ENT unit in the hospital is closed due to the destruction of its facilities resulting from government-sanctioned road work. This has resulted in foregone surgical consultations for more than 70 patients per day and the cancellation of numerous head and neck surgery cases, bringing complications and death for would-be patients. This situation has affected the training of the 12 residents at the only public ENT center for the entire country, and it is having massive repercussions on ENT care for the country.
A few protests about this situation were drowning under the ocean of issues Haiti must deal with. It has been more than 2 months now since the ENT unit was closed, and there has been no governmental response, no propositions, nor donations to get the unit back on track. The more time passes, the more we were forced to adapt and accept this reality.
Urgent action must be taken. We must alert the population to the seriousness of the situation by calling for help from individuals and medical associations to converge their strengths and achieve concrete results so that these events never happen again.
According to Dr. Jean Gilles the consultations have started again. However, the surgical interventions remain difficult to carry out as they are now housed in a suboptimal facility with minimal ENT equipment.
Reopening the ENT unit at the State University Hospital is urgent, but it should be only the first step into addressing the burden of ear, neck and throat diseases and facial trauma in Haiti. Future steps should include the creation of a new residency program to mitigate the workforce gap.
In the meantime, patients have been returning home with the firm idea that we let them down. This reality weakens the fight for access to health care in Haiti.
Olivier Mortel
Medical Student, Université d'État d'Haïti (State University of Haiti)
Twitter: @Olivier_Mortel
References
https://www.profilmedecin.fr/contenu/chiffres-cles-medecin-orl/. Accessed January 29, 2021.
Hughes CA, McMenamin P, Mehta V, Pillsbury H, Kennedy D. Otolaryngology workforce analysis. Laryngoscope. 2016 Dec;126 Suppl 9:S5-S11. doi: 10.1002/lary.26238.