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The cost of glaucoma treatment often means Haitians have to choose between their sight or food on the table
For many in industrialized countries, developing a preventable disability is barely fathomable. But as the second cause of blindness worldwide, especially in developing countries, glaucoma is taking a major toll on affected patients’ quality of life. Numerous are the stories of loved ones who have lost their vision due to glaucoma; a parent, a relative, a friend. Because this often-painless disease progresses silently over years, its public health, social and economic burden also goes unnoticed. Back in 2016, when Dr. Jessica Nestor embarked on a journey to study how glaucoma is impacting Haitians’ wallets, I rushed to join her.
Glaucoma is a chronic disease, meaning that it cannot be indefinitely cured, but only controlled if managed properly. It is more prevalent in people of African descent, especially if there is history of it in their family. In rural and urban areas in Haiti, 14.2% of a population suffered from glaucoma according to a recent study, compared to the global rate of 3.54 %. These numbers suggest that glaucoma is affecting Haitians at an alarmingly high rate. Even in a US-living Haitian population, glaucoma was also found to be highly prevalent, no matter the age group. As in other chronic illnesses, early detection using very simple tools is vital in preventing the worst outcome in patients; complete blindness in this case. In Haiti’s main public hospital where Dr. Nestor conducted the study, patients are prescribed eye drops to limit glaucoma’s progression, and/or benefit from available surgeries when necessary. But here lies the problem, nothing comes free, especially health. In Haiti, where patients are often not in a financial position to afford the bill, people are paying the ultimate price.
At the time of our research, when the U.S. dollar was still worth less than 45 Haitian gourdes, glaucoma treatment using eye drops swallowed between 15% up to more than half of the average Haitian’s salary if working minimum wage (3.750 gourdes at the time of the study equivalent to 35.88 USD). With associated surgery, the costs go from almost half up to more than 3/4 of their salary. Today, the U.S. dollar is worth 85.50 Haitian gourdes. Considering the national average Haitian household income, the financial toll ranges from 12% to 41% if using only eye drops, and up to 62% if surgery is needed. Low income and lack of health insurance are the main barriers. The cost of glaucoma treatment often means Haitians have to choose between their sight or food on the table. When Dr. Nestor and I presented these heartbreaking findings at Université Notre-Dame in Haiti, and later at Yale University at a major global health conference, we advocated for national health coverage to protect the less fortunate.
On July 2017, Haiti’s president Jovenel Moise announced a national commission for health system reform. He concluded the inaugural speech saying: “The entire population must receive services that meet their needs and not according to their wallets. This reform will put the patients out of the spectrum of ruinous health spending.” This promise echoes a pledge to advance comprehensive care coverage nationwide. But as Ministry of Health official Jean-Patrick Alfred pointed out in a publication naming different options available to Haiti, the main question regarding universal health coverage is to define how to finance it. Almost two years after the launch of the presidential commission, as the cost of living is spiking, Haiti’s healthcare system has not yet known the magic shift this commission promised. Strikes in public hospitals over unpaid salaries for the staff and lack of materials remain a common occurrence, with no sign that this will change any time soon.
As researchers, clinicians,and public health specialists join efforts to fight glaucoma worldwide and in developing countries such as Haiti, the ultimate battle to keep patients away from financial ruin because of long-term treatment and/or surgery cannot be forgotten or put on hold. Currently, low insurance coverage makes glaucoma treatment unsustainable in Haiti. In the meantime, although the tools for early detection and long term treatment are relatively simple, Haitians continue to lose their sight at alarming rates. Unfortunately, this is only one of many in the long list of threats that Haitians are facing daily.
*The full text of this study mentioned in this piece can be found in the library of Université de Notre Dame, Port-au-Prince, Haiti.
