HAS’ surgical service is well-recognized for its excellence; during the post-earthquake period, many patients came to HAS from the impact zone, most of whom required surgical interventions. With a core of full-time Haitian surgeons and a rotating international staff of specialists, HAS can offer a high level of surgical services to the immediate HAS district, and, increasingly, to other parts of Haiti. In recent months, one-third of all surgical admissions came from outside the HAS primary service area.
On average, 27 of the hospital’s 120 occupied beds are allocated to adult and pediatric surgery (one-third of the surgical volume is pediatrics). Many of the cases are related to vehicular accidents, in addition to a variety of soft-tissue ailments.
The core elements of the surgical services include the salaries of the clinical and support personnel in both the operating suite and the surgical ward ($477,300), pharmaceuticals and medical supplies ($195,000), and infrastructure costs ($94,000)
In order to provide essential care to the hospital’s patients, either on an ambulatory or impatient basis, it is necessary to be able to support the diagnosis of the source of the clinical condition. The primary resources for diagnosis are laboratory tests, electrocardiograms, X-rays, and ultrasound. While equipment is essential for effective diagnostics, the skills of the technicians and those who interpret the assays are also very important. HAS is highly regarded in the region for its ability to support an accurate clinical diagnosis.
In recent months, the laboratory has provided approximately 4000 tests per month, or about 190 per day. The radiology service averages 600 studies monthly, or approximately 30 studies each day. Five percent of these are ultrasound examinations.
The expenses related to the diagnostic services include salaries for the technicians in the laboratory and radiology suite ($85,000), the costs for materials and supplies ($70,000), and infrastructure costs ($45,000).
HIV/TB Inpatient Ward
Each week, patients arrive at HAS with a complex of presenting complaints including weight loss, fever and discomfort. Their condition is sufficiently serious to require admission, and they are reflective of conditions associated with major infectious diseases such as HIV/AIDS and TB. Such patients are admitted to the medicine unit, and if their diagnosis with HIV and/or TB is confirmed, they are provided with initial treatment in a ward with specially-trained staff. Once their condition has been stabilized and they can be discharged, they are referred to local institutions where Partners in Health maintain outpatient management and monitoring of their conditions.
This unit is supervised by a specialist physician, and is supported by experienced clinical personnel. The total salary costs are $65,000, and medical supplies and equipment represent a cost of $35,000. Infrastructure costs are an additional $30,000.
Evaluation, Diagnostic and Stabilization Unit (EDS)
The EDS unit is a new service at HAS; designed by the Internal Medicine physicians, it offers a short-stay service in which the underlying cause of an illness can be determined, and initial treatment can be offered, with a return appointment or referral to another primary care facility in the HAS service area. Normally, patients remain in the unit for less than 24 hours; patients who are determined to require inpatient clinical care are admitted to the appropriate ward.
This special care unit is directed by a physician and a physician extender and a variety of clinical support personnel with annual salary expenses of $145,000. Clinical supplies and materials represent an expense of $75,000, and infrastructure costs are $65,000.
Most children in the HAS service area are born at home, supported by a traditional birth attendant (matrone) who have been trained by HAS. The matrones have basic skills of monitoring the growth and development of the unborn child, and refer women with high blood pressure other danger signs, to the nearest dispensary which then determines if a referral to the hospital is necessary. The HAS high-risk obstetrics unit evaluates these referrals and tries to support a normal delivery. If this is not possible, caesarean section deliveries are available on a 24-hour basis.
An average of 60 women are admitted to the unit each month; in a number of cases, they are able to be discharged to continue their pregnancy with a home delivery, or remain in the unit for delivery or C-section.
The High-Risk Obstetrics unit is supported by a full-time physician, nurses and technicians for a total personnel cost of $125,000. Medical supplies and materials require an expense of $30,000, and infrastructures are $45,000 per year.
Community Health Centers (Dispensaries)
HAS operates four freestanding health centers in its service areas, which provide preventive care, such as growth monitoring and immunizations, and primary health services. These centers provide valuable clinical services close to where many of the population live, and they are a valuable resource, especially for the residents of remote mountain communities.
Costs associated with the operation of each of HAS’ four health centers include personnel expenses of $85,000, which includes the salaries of Community Health workers who are assigned to specific zones surrounding the health center. In addition, the expenses for medical supplies and materials are $35,000, and infrastructure costs are $35,000.