CRUDEM

CRUDEM Foundation, Inc. / Hôpital Sacré Coeur

362 Sewall Street PO Box 804 Ludlow, MA 01056

314 754-7471 Missouri 413 642-0450 Massachusetts

www.crudem.org

 

Frequently Asked Questions

What is CRUDEM?

CRUDEM (Center for the Rural Development of Milot) is a multifaceted mission dedicated to helping impoverished people in and around the village of Milot in Haiti, the poorest country in the Western Hemisphere.

What is its mission?

CRUDEM’s mission is threefold: 1) to provide accessible health care to the poor of northern Haiti regardless of their religion, economic status, or medical condition; 2) to train and nurture a competent Haitian medical staff, supplemented and supported by volunteer specialists; and 3) at all times, and in all endeavors, to practice Christian compassion and respect for the inherent dignity of every individual.

Who does CRUDEM serve?

CRUDEM serves the 225,000 people living in the Milot region of northern Haiti. The village of Milot itself has a population of about 25,000, and an additional 200,000 people live within a 12-mile radius. The area is made up of many small hamlets and rural communities, situated on rough terrain consisting of mountains and plains.

What are the demographics of Haiti?

Haiti has a population of 8.6 million. Some 80% of the population lives in abject poverty—per capita income is U.S. $480 per year (2006 World Bank Atlas Methodology). Out of the 177 countries ranked by the United Nations Human Development Index (2007), Haiti’s position was 146. In Haiti, 54 percent of people live on less than a dollar a day and 78 percent on less than $2 USD.  The life expectancy in Haiti is the lowest in the Western Hemisphere. For women, it is 54 years; for men, it is 51 years. Infant mortality before age one is 76 deaths per 1,000 (by contrast, the U.S. rate in 2004 was 6.8 deaths per 1,000 births, according to statistics from the CDC). Malnutrition affects 35% of children under the age of five, and 118 children out of 1,000 die before reaching the age of five. The incidence of diseases ranging from intestinal parasites to HIV/AIDS is extremely high. Only about 71 percent of the population has access to safe drinking water, and only 34 percent has access to sanitary sewer systems. There is one doctor for every 10,000 inhabitants. Haiti suffers from widespread unemployment and underemployment. More than two-thirds of the labor force does not have a formal job. In addition, illiteracy is extremely high: Only 54.8% of males and 51.2% of females over the age of 15 can read and write, and 46% of school-age children have never been to school.

What is the history of CRUDEM?

Founded in 1968 by the Brothers of the Sacred Heart of the Montreal Province, CRUDEM was initially started to improve the infrastructure of Milot. By 1983, CRUDEM had brought many improvements to the area, including roads, schools and potable water as well as four clinics, one in Milot and the others in adjacent hamlets. In 1986, the Brothers constructed a hospital in the area: Hôpital Sacré Coeur because of the acute need for healthcare. Since that time, the hospital has served adults and children living in abject poverty—people whose basic health needs are exacerbated by their poverty. Today, CRUDEM is focused primarily on healthcare.

 Who operates CRUDEM?

In 1993, the Brothers ended their involvement in CRUDEM and the Archbishop of Cap Haitien gave operating responsibility for Hôpital Sacré Coeur to The CRUDEM Foundation, a tax-exempt public charity established by Dr. Ted Dubuque, a surgeon, and Carlos Reese, a businessman, both of St. Louis. In January 2005, a Protocol Agreement between The CRUDEM Foundation, Inc. and the Archdiocese of Cap Haitien, Haiti, was signed to confirm this operating, fiscal, and management arrangement and to reaffirm that the organization would be focused primarily on health care provided by Hôpital Sacré Coeur.

Which services support the mission?

Hôpital Sacré Coeur has 73 inpatient beds and an outpatient clinic. It has full maternity services, a pediatric wing, and a complete laboratory. Besides the medical care facility, a Nutrition Center on the hospital campus provides two free meals daily to malnourished preschoolers. The hospital also does outreach through its Community Health Services department which includes a Mobile Clinic that travels to four villages on a regular schedule, each for five to six hours per day. Patients served are the poor and confined who are unable to make the trip to Hôpital Sacré Coeur because of illness, age, or pregnancy. Two of these clinics provide primary care services and two others offer pre-natal care. An average of 100 to 200 patients visit each clinic per week.

Does the hospital offer any special programs?

 Hôpital Sacré Coeur offers the following Community Health Services: Nine public health nurses and thirty three ‘health agents’ serve five ‘communes’ in the Milot region, each with dispensaries, and reach 150,000 people with vaccinations, pre-natal care, basic hygiene and nutrition training , and HIV/AIDS, tuberculosis, malaria, and filariasis treatment. They also train the LPN’s (called ‘auxiliaries’) who staff the dispensaries. There are currently 17 auxiliaries. The department also distributes dry food provided by the World Food Program one time per month to malnourished children, pregnant and breastfeeding mothers, and TB patients. Community Health also provides a full immunization and vaccination program (infant, early childhood, and adult) plus health education programs to outpatients with ongoing conditions (e.g., diabetes).

Other Community Health Services are:

• Mobile Clinic—Because Hôpital Sacré Coeur is the only reliable medical provider in the Milot region, it is responsible for providing public health services to the entire region’s population of 225,000. To fulfill this charge, it also operates a Mobile Clinic which has approximately 100-200 patient visits per week. Started in October 2003, the Mobile Clinic serves a large number of the poor and confined in the area who have not been able to take advantage of on-site hospital services because of illness, age, pregnancy coupled with the rough terrain that must be traveled. There are two mobile clinic teams; one consists of a nurse mid-wife and public health nurse that provide pre-natal care and HIV testing and counseling. The other includes a nurse practitioner, family practice resident and health promoter that provide primary care services. The Mobile Clinic teams cover eight sites on a regular schedule for 5-6 hours per day.
• Blood Bank—In the spring of 2005, the hospital began operating a blood bank, serving patients from area dispensaries and a smaller area hospital. The Red Cross provides the hospital with the necessary equipment, supplies, staff training, and funds required to pay the salary of one technician.
• HIV/AIDS Prevention—A program to prevent the transmission of HIV/AIDS from mother to child, as well as provide voluntary counseling and testing programs, began in September 2005 in conjunction with the Catholic Medical Mission Board (CMMB). In August 2005, Hôpital Sacre Coeur began participating in the anti-viral treatment program called the AIDS Relief Project to treat entire families affected by HIV/AIDS. Under this grant program (funded by Catholic Relief Services and the CMMB), Hôpital Sacré Coeur’s is serving thousands of individuals. In 2008, 5,073 people received HIV testing and counseling services for HIV/AIDS, 2,499 of those were pregnant mothers. There were 12,840 visits to the Antiretroviral Clinic in 2008.
• Nutrition Center—If they show signs of malnourishment, children visiting the hospital as outpatients are referred to this program by a physician or nurse professional. Each child receives two balanced meals plus nutritional snacks and vitamin supplements. On Fridays, the children are sent home with a small provision for Saturday and Sunday. There are organized games, physical exercise, singing, dancing, and storytelling; children are also toilet trained and coached in proper hygiene. Progress is tracked closely and regularly to prevent any recidivism, and mothers or guardians take part in monthly health education programs. The program serves an average of 23 children per day in the center. Over the past four years more and more children referred are from outside the village of Milot. Approximately 52 children each month receive weekly dry rations of food as they are not able to travel to the nutrition center on a daily basis.
• Immunization and Vaccination—The hospital conducts an immunization and vaccination program (infant, early childhood, and adult) plus health education programs for outpatients suffering from specific medical conditions (e.g., diabetes).

How is the organization staffed?

The CRUDEM Foundation, Inc. has an administrative services employee and also an executive director who is responsible for overseeing the foundation’s operations, fund raising, and serves as the board’s liaison with the hospital.  In Haiti, the hospital currently employs 247 people: 215 full-time and 32 part-time. The AIDS Relief project covers the salary of 22 employees, the Department of Health for the North of Haiti covers 5% of the total cost of salaries and the Red Cross pays for the salary of one nurse and one technician for the blood bank. Nonmedical staff number 97. There is a Haitian physician who is the executive director of the hospital and a Haitian obstetrician who is Medical Director. There are also two full-time internists, two general practitioner, two family practitioners, two full-time and one part-time pediatricians, one part-time and three full-time obstetricians, one part-time ophthalmologist, two part-time surgeons, three anesthetist nurses, three pharmacists, a dentist, psychologist and three full-time residents. There are 90 people on the nursing staff, 78 of whom are full-time, including the nursing services director, 5 nursing services managers, 44 staff nurses, 11 midwives, 9 Public Health nurses, 16 nurse auxiliaries, and 4 nurses’ aids. In addition, the laboratory has a staff of 13 technician.  The CRUDEM Foundation also recruits medical volunteer teams from the U.S. who travel to Milot at their own expense. These teams help the Haitian medical staff provide both primary and specialty medical care, including surgeries, from September through June. The hospital hosted 187 medical volunteers and 83 non medical volunteers in 2008. In recent years, not only do the visiting medical teams perform surgeries and treat patients themselves but they also spend a lot of their time teaching and mentoring the Haitian staff.

What are the hospital’s results?

For the 12 months ending December 31, 2008, Hôpital Sacré Coeur served 56,701 people on an out-patient basis. It had 4,182 hospital admissions and 1,268 newborn deliveries, performed 1,227 surgeries, filled 136,517 prescriptions, completed 77,128 laboratory tests, and performed 3,192 other diagnostic tests (EKG, Radiology, Endoscopy). In addition, it served on average 24 children per day in its Nutrition Center program and provided 1,190 patient visits through its Mobile Clinic project. A comparison with the same time period in 2007 yields the following statistics: overall in 2008 there was a decrease in adult and pediatric inpatient and outpatient visits. There was a decrease in newborn deliveries of 4%.  There was also a 10.2% decrease in clinical visits in 2008. These decreases in 2008 were primarily due to the effects of the worldwide increase in food and fuel prices which have affected Haiti badly. Some people postponed or skipped medical consultations because they may not even have had the cost of transportation to the hospital. This resulted in the arrival of patients in a more critical state which in turn also puts a greater strain on the hospital. It is worth noting that in 2008 there was an increase of 9.8% in emergency consultations.  However the total number of surgeries performed increased by 6.8% (with 62% of surgeries performed by the hospital’s Haitian physicians). The number of specialty clinic consultations by visiting medical teams increased by 11.2%. We are very grateful to our dedicated medical volunteers (187 in 2008) who continue to travel and share their time and expertise with our local staff. Prescriptions were down 7.9% on 2007 figures with an average of approximately 11,376 filled per month while the number of laboratory tests completed increased by 6.4%. The Community Health department has experienced remarkable growth.

The following chart provides detail:

                                                                                       2002     2003     2004     2005     2006     2007     2008

(Patients, Patient Visits, &/or

Units of Service)

Outpatients                                                             29,692   37,267   53,223   60,463   55,694   57,142   56,701

 Inpatients                                                                  2,419      2,939      2,821      3,675      4,270      4,198    4,182

Newborn deliveries                                                    580          581         832       1,257      1,526      1,322    1,268

Surgeries                                                                          846      1,149          859      1,096      1,190      1,148    1,227

Prescriptions                                                           68,418   83,757   106,992 158,030 159,765 148,164 136,517

Lab & Radiology                                                     34,110   52,891     73,527     76,884     76,031   74,263   78,769

Community Health                                                   1,750    1,664       3,256        6,279        6,846       6,950    10,075

 

What is the financial status of the foundation?

• The CRUDEM Foundation, Inc. is a federally designated tax-exempt 501(c)(3) organization.
• The annual audits of the corporation have resulted in unqualified opinions without management letters.

What is the fundraising responsibility of The CRUDEM foundation?

For fiscal year 2009, the hospital’s annual budget is US$1.74 million (the 2008 actual expenditure was $1.76 million), excluding the $9.78 million in donated supplies, medicines, and equipment that were acquired. In 2008 the annual salary expense at Hôpital Sacré Coeur was $957,865, a decrease of 3.1% on the 2007 amount of US$ 957,865. Of that total, 67% was paid to the hospital’s physicians, dentist and nursing staff. Patient fees, though nominal, covered 38.16% of CRUDEM’s operating expenses in 2008. For 2009 patient contributions are projected to cover approximately 41.8% of total operating expenses. In 2009, The CRUDEM Foundation is responsible for raising a minimum of $777,000.00 in operating funds to support the hospital’s operating needs. The CRUDEM Foundation has additional expenses of $413,962, over 90% of which directly support hospital operations in Haiti. The Foundation also identifies and solicits the $9 -$9.5 million in donated supplies, medicines, and equipment through partnerships with organizations such as Americares and the Catholic Medical Mission Board.

How is the CRUDEM board structured?

CRUDEM has a volunteer board of directors responsible for all aspects of governance, including operations, fiscal, and fund raising. The board convenes three times per year. Board terms are three years, and board members may serve two consecutive terms.

What strategic planning has the board undertaken?

The CRUDEM Foundation has begun to explore the hospital’s need for renovation and expansion over the next years. This need is due to the following:

• The significant numbers of people seeking outpatient services (for example, primary care, maternity, pediatric, and laboratory services).
• The growing need for upgraded hospital facilities for outpatients, inpatients, storage of supplies, medicines, & records.
• The critical need for adequate housing for hospital physicians with families.
• In 2006, the Haitian Ministry of Health declared Hôpital Sacré Coeur a reference hospital (an official referral site) for 5 large communes in the North of Haiti. The lack of space at Hopital Sacre Coeur is evident and it is necessary to expand inpatient capability to a minimum of 100 beds. However, no Haitian government funding is accessible to help with the costs of this expansion.

In response, the board of The CRUDEM Foundation began a strategic planning process that encompasses:

• A comprehensive review of the hospital campus and its physical capabilities, including land availability, condition and potential use of current buildings, water drainage, septic system issues, and ample electricity generation.
•  A plan to reorganize and renovate the present buildings on campus and increase space availability.  Currently professionals in engineering and architecture are providing recommendations and cost estimates.
• The critical need for ample, affordable housing for staff physicians and their families.

Concurrently, discussion at the board level continues to ensure:

• Quality and adequacy in planning and design.
• Efficiency of development costs and any additional operating costs.
• Adequate levels of funding.
• Continued support of the basic and very necessary services Hôpital Sacré Coeur currently provides.