An Assessment of Health Care Needs and Barriers in a Rural Community of Haiti
World Health Student Organization
Justin Gerard1; Dr. Jeffrey Van Laere2; Nabil Othman1; Terrie Ahn1; John Dawdy1; Priyanka Singh1; Lea Monday1; Amy Li1; Dr. Diane Levine3
1Wayne State University School of Medicine; 2Detroit Medical Center Department of Emergency Medicine; 3Detroit Medical Center Department of Internal
Medicine
INTRODUCTION
During a medical missions trip to Morne L’Hopital in Haiti, a
needs assessment was conducted to obtain information
regarding the healthcare needs of the local population.
The goal was to determine obstacles to healthcare, as well
as perceived healthcare needs.
A qualitative survey was administered individually to clinic
patients to determine the most prevalent healthcare needs,
obstacles to obtaining healthcare, most frequent point-ofhealthcare access, perceived best and worst aspects of
Haitian healthcare, and finally needs for improvement.
METHODS
The survey was conducted by a two person team,
consisting of a medical student and a translator.
Participants were selected at random from a group of
patients whom were waiting to be triaged.
All medical students involved in the study were required to
complete CITI training.
The survey was adjusted in response to difficulties that
arose while conducting the survey. Question 1.a. was
excluded from the survey. Participants had a difficult time
discerning the meaning of the question, or providing a
response. Participants were also providing similar
responses to questions one and seven. A greater emphasis
was placed on problems with the healthcare system when
question seven was asked.
RESULTS
Symptoms
Pain
Headache
Abdominal Pain
Fever
HTN
Vision/Eye Irritation
Infection
Vaginal Infection
Cold
Anemia
Diarrhea/GI Complaints
Rash
Dental Problems
Cough
GERD
Palpitations/Heart Problems
Asthma
Dizziness
Weakness
Shortness of Breath
Diabetes
Thyphoid
Malaria
Dyspnea
Gas
Hemorrhoid
Cholera
Cyst
TOTAL Response
Best aspects of Healthcare
Total
% of Responses
19.28
13.33
8.83
8.83
7.57
5.59
5.59
4.14
3.96
2.88
2.7
2.52
1.98
1.8
1.62
1.62
1.26
1.26
0.9
0.9
0.72
0.54
0.54
0.36
0.36
0.36
0.36
0.18
99.98
107
74
49
49
42
31
31
23
22
16
15
14
11
10
9
9
7
7
5
5
4
3
3
2
2
2
2
1
555
# of Responses
35
50
This clinic
18
25.71
Doctors (when available)
5
7.14
Seen during emergency
3
4.29
Local Clinic/Hospital
3
4.29
Access to medications/Medications
3
4.29
Nurses
2
2.86
Transportation
1
1.43
70
100.01
# of Responses
213 patients were enrolled in the study.
% of Responses
Permanent Clinic
87
30.21
More Trips
48
16.67
More Medications
38
13.19
Clean Water
28
9.72
More Doctors
27
9.38
Electricity
19
6.6
School
11
3.82
Better access to healthcare
7
2.43
More Clinics
Better roads
6
5
2.08
1.74
Eye Specialist
More follow up
3
3
1.04
1.04
Soccer balls/toys for kids
3
1.04
More notification
2
0.69
1
0.35
288
100
More collaboration
Total
Worst Aspects of Healthcare Responses % of Responses
Cost
32
41.56
Not Enough Doctors
10
12.99
Distance
6
7.79
Inadequate Clinics
6
7.79
Access to Medications
6
7.79
Transportation
5
6.49
No Clinic/Hospital
4
5.19
Access to Clean Water
4
5.19
Access to Surgery
1
1.3
Hunger
1
1.3
Cholera Tx
1
1.3
Leadership
1
1.3
TOTAL Responses
77
99.99
% of Responses
Nothing
Total
Needs/Improvements
DISCUSSION
Access Point
Obstacles
Responses % of Responses
Finances
126
56.76
Access
65
29.28
None
10
4.5
Distance
9
4.05
Transportation
6
2.7
Not Enough Doctors
5
2.25
Sanitation
1
0.45
TOTAL Responses
222
99.99
# of Responses
% of Responses
General Hospital
45
64.29
Community Health Center
18
25.71
Private
6
8.57
Pharmacy
1
1.43
70
100
Total
MATERIALS
Needs Assessment
Site/Clinic:
Respondent’s Age:
Respondent’s Gender:
Relationship to patient: self____ parent_____ grandparent_____ spouse_____ other relative______ non-relative_______
1. What are the 3 most pressing healthcare concerns you have about adults in your home? About children?
a. What are different healthcare concerns you have at different times of the
year, e.g., the rainy season?
2. Who in your household makes decisions about healthcare (e.g., where to go, when to go)?
3. Where do you normally go for healthcare for adults? For children?
4. What are the biggest obstacles to getting your healthcare needs met?
5. What is required to help you improve the health of adults in your household? Children in your household?
6. What are the best aspects of healthcare available in your community?
7. What are the problems with the healthcare available in your community?
8. How could we (US medical students) improve the healthcare we provide when we are in country?
56.8% stated that cost was the largest obstacle to obtaining
healthcare.
41.7% expressed problems regarding healthcare access
(not enough doctors and/or lack of transportation).
A large majority accessed healthcare via large general
hospitals; the exact reasons for this are unclear, although
we hypothesize that this is because there are limited other
options.
These findings support the importance of maintaining a
clinic in the area to circumvent the obstacles stated above.
Our free clinic provides an opportunity for patients to access
healthcare for primary care conditions that would likely go
untreated otherwise. While our clinic is temporarily able to
address many of the concerns brought up by this
assessment, more must be done to provide sustainable and
self-sufficient solutions.
FUTURE STUDIES
A need for more accessible healthcare clearly exists in this
community. It is the hope of the WHSO that a more
permanent and sustainable clinic be established to meet
the needs of the Morne L’Hopital population.
In order to accomplish this, a more thorough assessment
regarding the strategic, legal, and financial barriers that
exist must be conducted.