Why Young Doctors Leave Haiti

Despite the many efforts of the health ministry and its partners, the Haitian sanitary landscape is plagued by chronic and infectious diseases and trauma. Half of the country’s population suffers from hypertension 5 , and four years ago, a major cholera outbreak erupted killing thousands of people. Unfortunately, the level of sanitary education in the Haitian population remains among the lowest. These factors, coupled with some of the worst conditions in the northern hemisphere contribute to the 61-64 year life expectancy 6. In the midst of this catastrophic public health state, a staggering number of physicians leave Haiti year after year, further exacerbating the 2 doctor for 10,000 inhabitants ratio 7. Why is Haiti’s health sector experiencing such an exodus? This article’s aim is not to exhaustively analyze all of the reasons why Haitian physicians leave, but to discuss the reasons I  have observed among my peers.

Poor financial reward

A licensed doctor- either a general practitioner or a specialist- employed by a state health care institution, earns around 21,000 HT gourdes a month. This is the equivalent of US $5,373.13 a year, according to the national bank exchange rate. While some doctors run private clinics, it is not uncommon for many to work for more than one institution in order to earn a decent living. In this field, as in any other in Haiti, it is difficult to secure a good job, and clinics bring less and less income because people lack the means to pay private doctors. It should be noted though, that some doctors who own private practices are very successful.

Let us dare a comparison: In France, the average net salary of a general doctor is € 6, 664 a month (UNASA, 2012); which is the equivalent of US $103,958.4 a year (€ 1 = US $ 1.3 in april 2012) 8 www.freecurrencyrates.com [\ref]. As Atul Gawande stated in his book Better: A surgeon’s notes on performance, in 2003, the median income for primary care physicians in the USA was $ 156,902, and for general surgeons, it was $ 264,375. Active orthopedic surgeons, cardiologists, pain specialists, oncologists, neurologists, hand surgeons and radiologists frequently earn more than half a million dollars a year.

Inappropriate work environment

In addition to the poor financial reward of practicing medicine in Haiti, the work environment is not ideal. When it comes to the health care system, one can easily notice a significant difference between reality and what is reported. Poor governance by the ministry of health has led to a residency fiasco, where a group of state students have used intimidation and false propaganda to make the ministry withdraw previously held fair policies. The programs themselves are poorly run in terms of leadership and mentoring. A lack of proper andragogy plagues the tutoring program, and fear and brutality are frequently used teaching methods. Therefore, the results are far from what is expected; the physician, who is supposed to be the kindest human being, tends to lose his/her humanity in such a situation. This sense of humanity is also slapped on a daily basis by the uncleanliness and the unpleasant odor of the work place

The health care system is broken in so many ways, it seems like we do not have the necessary administrators to fix it. The eternal war between public and private medical schools can prove this fact. As a result of the weaknesses of the system, the hospitals lack even the basic materials like sheets for the beds, gloves for doctors and nurses and sterilized equipment. Often, the materials available are so outdated; they can not be properly used to save a life in a matter of minutes.

Lack of continuing education opportunities

For the doctor, education does not stop the last day of medical school or residency program. Practicing medicine is a lifetime commitment to study and research. It would be unfair not to acknowledge the efforts of the health ministry to provide Continuing Medical Education in Haiti. But again we are faced with the inequity issue, as these opportunities are not available for every doctor. In fact, not enough resources, mainly live events, are available for the number of physicians requiring such initiatives in Haiti. In the USA, the American Medical Association has gathered resources to help physicians meet their professional goals. These resources include things such as: live events, written publications, online programs, audio, video, or other electronic media.

Lack of Confidence

Haitian doctors are aware of the worldwide situation of the medical science. Thanks to globalization, foreign doctors can personally engage with doctors in Haiti and vice-versa, to learn from each other and improve their skills and medicine in general. On such occasions, a feeling of low self-esteem seems to conquer too often the minds of even well trained Haitian doctors. As a consequence of the previous flaws described, there is a feeling of shame that adds to the burden. The lack of confidence makes many Haitian doctors doubt their skills. As one stated in a conversation: “… [I would] rather be a good nurse in the USA or Canada instead of being an unqualified doctor in Haiti.” While Haitian doctors have shown impressive skill and judgment no matter how poor the work setting, low self-esteem remains a poison.

How is it possible that our basic conditions are so unsatisfying? Over the years, I have realized that arrogance, greed and incompetence are given the priority over what truly matters. Politicians only care about their own agenda instead of the health of the people. Therefore, bad governance leads to such unresolved crises. The status quo is guarded by people who are in position of power as long as it is profitable for them. Exclusion is then the norm. We must tackle all of these issues to prevent this massive exodus of young Haitian doctors.

I personally work with people who dream to become cardiac surgeons, army surgeons, health system designers, health care entrepreneurs, world-class professors, genetic researchers and more. I work every day with people who are motivated to pursue and conquer their dreams. The ambition is palpable. But where in Haiti can a doctor receive such training? How can a Haitian doctor lead such a fruitful career without eventually leaving one day?

Let me be clear, I do not wish to judge the quality of medical training in Haiti. I do not have the competence required to do so. This is what I do know, doctors who refuse to settle for the Haitian system are searching for an inclusive system, better work environments, open opportunities to learn more and greater financial reward. Correct me If I’m wrong, in any well-functioning society, these factors are any professional’s most basic rights.

Photo Credit: Kenny Moise

Kreyòl translation coming soon.

Notes:

  1. EMMUS V (2012)
  2. Op. citat.
  3. Site de l’Institut Haïtien de statistique) http://www.ihsi.ht/pdf/projection/POPTOTAL&MENAGDENS_ESTIM2 009.pdf
  4. EMMUS V (2012)
  5. Op. citat.
  6. Site de l’Institut Haïtien de statistique) http://www.ihsi.ht/pdf/projection/POPTOTAL&MENAGDENS_ESTIM2
    009.pdf
Kenny Moise

Kenny Moise

Dr. Moise is a medical doctor, currently living and working in Haiti. He is the co-founder of IntregAction. He can be found on twitter @KennyMoise, where he tweets about his interests in public health, politics, social development and art.

6 Comments
  1. Well done. We need to improve the system. However the situation is the same for all other fields and professions in the country. If every other professional had to leave because of those factors what would happen to the country current situation? Should financial conditions be the first variable in the medical profession?
    In other countries such as US and other European nations, the associations that support the profession, that creates journals and training have not been created by the State rather by member of the profession themselves.
    Furthermore, you highlight the salary of those working in the public Sector ( state) but you ignore the salary of those working for private hospitals, not-for-profit institutions and NGOs. We all know those institutions provide a lot of (if not more) well paid jobs to young doctors and they are in places where state health infrastructure is lacking. Therefore, the salary highlight here is not the average salary and cannot be compared to salary provides in the US or France or even Dominican Republic because of external validity issue.
    Another thing is that we (the middle class) don’t trust the average Haitian doctor because of well known medical malpractices and mistakes that they commit every day. We would rather pay much more money to send a member of our family in the Dominican Republic or the US rather than let Haitian doctors provide them with care. There is a trust issue going on. Those who can pay for care and help improve doctors overall financial conditions would rather go elsewhere. As the saying goes now : In Haiti you cannot trust those two groups: Politicians and Doctors.
    Why Young Doctors Leave Haiti? Is leaving Haiti the solution? It can be a personal and individual one but the country will not benefit from it..Imagine what would have happened if those who trained you had left after graduation? The State has invested in you, you have used its infrastructure, you have used some other advantages and now you are ready to serve you decide to leave. Is it the kind of behavior we would like to teach the next generation? Leaving is not a solution, it is just a choice made by free riders and cowards.

    1. Well done Dr Moïse. By writing this article you just wrote for me. Like you were talking about me. It’s all about the truth in this article. (Je monte à bord)

  2. Thank you for your brilliant inputs. First, I have to say that I share your idea. Leaving is definitely not “the solution”. In this article, my aim was to point the main reasons that explain this exodus. I think that the future of Haiti can’t be better than the present if Haitians don’t work to make it better.
    Please, note that I didn’t ignore the fact that some doctors gain more money because of private practice. In other countries like the USA or France, the health care system is different. It’s one of the factors that explain the difference between what doctors gain. Money shouldn’t be the first concern. But we all know that people need money in order to have a decent life and take care for family. And a decent salary is a good place to start. Another system issue.
    And yes, we are aware of the limits of the medical science and the confidence issue also exist even among doctors. As I mentioned, it’s another reason for some to leave.
    Definitely, we as Haitians, have a long way to go to improve our health care system and prevent doctors exodus. Doctors will need leadership, political will and a sense of patriotism and sacrifice to change things.
    If we don’t recognize the problems, we can’t bring solutions. Thank you for your inputs one more time!

  3. Thank you for your great inputs. I am happy that you contribute to this debate. First, I should say that I totally share your point. Leaving is definitely not “the solution”. Haitians are responsible for the future of Haiti. We cannot afford to lose all these professionals. The Haitian health care system can’t be better if we don’t improve it. But let’s be honest, some may need to go for continuing education and come back later until we figure out new ways to improve the system (especially education). To prevent the exodus, we need values of leadership, patriotism and self-sacrifice among professionals of all fields. I’m not supporting the exodus. I’m just explaining why it is happening. This way, we can find together the solutions.
    Please, note that I mentioned that doctors succeed financially with private practice and multiple jobs. I also think that Haitian people will have to work together with doctors in the process of care. The confidence issue- another reason of departure- is a consequence of a lack of communication and manipulation of under-educated people by some groups. Education and sincere communication are the keys in this particular case.
    And even when profit is not the primary concern of the doctor, we cannot ignore the fact that everybody needs to live a decent life in order to perform his daily duties. To live a decent life can start with a decent basic salary. That’s another system issue to improve. We cannot ignore it. But as I said it, we will need value of self-sacrifice for a better future for all.

  4. I’m the one of the haitian doctors who leave haitian for the same reasons above … I’m glad I can find you who write this article Just to awake health care responsible conscience on haiti… I was often frustrated when ppl leave haiti to search better Heath care in Dominican republic even for the basic cares!!! Hopefully the next generation should work about that matter only God knows how haitian health care situation is so bad !!!

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