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.