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.

In 2008, four tropical storms severely ravished the country. On January 12, 2010 a 7.0 magnitude earthquake with its epicenter near Port au Prince inflicted a atastrophe of incredible proportions on the already impoverished nation. With 250,000 estimated dead and a further 1.25 million homeless, it is one of the most lethal natural disasters on record.

What is the history of CRUDEM?

CRUDEM, an acronym for (Center for the Rural Development of Milot) was founded in 1968 by the Brothers of the Sacred Heart of the Montreal Province. The brothers built roads, schools, wells and several co-operative ventures. In 1986, the Brothers constructed a hospital in the area: Hôpital Sacré Coeur. However, they had an operating room with no equipment and no surgeons. Around that same time, Dr. Ted Dubuque, Jr. KM, a surgeon from St. Louis, Missouri, became fatally ill and he promised God that if he recovered he would go to work in the missions. He had a complete recovery and true to his word he traveled to Hôpital Sacré Coeur and spent 6 months there performing 250 surgeries. His family and his local community, particularly his friend Carlos Reese, supported him in fully outfitting the operating room. As word spread about Hôpital Sacré Coeur and the needs of the people in Haiti, more and more people, both medial and non-medical, expressed an interest in helping and becoming involved.

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, Jr., 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?

Before the earthquake in January 2010, Hôpital Sacré Coeur had 73 inpatient beds, an outpatient clinic, 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. In the aftermath of the tragic earthquake, over 500 victims received critical surgical care at Hôpital Sacré Coeur. This was achieved as a result of the well established infrastructure, highly trained staff and long standing network of volunteers which allowed expansion to a 420 bed hospital in 2 weeks. The US Navy, US Coast Guard and various other hospitals and NGOs sent many of the most critically injured to Hôpital Sacré Coeur because of its capacity and expertise to treat them.

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 now serves 8 sites, the poorest of the poor, those that are not able to take advantage of the hospital services onsite because of distance or due to  illness, age, or pregnancy. 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. In 2009, it served 1,231 patients.

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 2009, 5,735 people received HIV testing and counseling services for HIV/AIDS, 2,315 of those were pregnant mothers. There were 11,632 visits to the Antiretroviral Clinic in 2009.

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 41 children per day in the center and weekly dry rations of food are provided for those unable 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 two full time staff. 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. Non-medical 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 technicians.

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. The hospital hosted 270 medical volunteers and 75 non-medical volunteers in 2009.  Between January and September 2010 over 1,500 volunteers had already visited. Not only do the visiting medical teams perform surgeries and treat patients themselves, they also spend a lot of their time teaching and mentoring the Haitian staff.

What are the hospital’s results?

In 2009, Hôpital Sacré Coeur served 49,161 outpatients. There were 4,643 hospital admissions, 1,316 surgeries and 1,226 newborn deliveries. There is no pharmacy or laboratory in the area so last year the hospital filled  134,330 prescriptions and completed over 82,000 laboratory and other diagnosistic  tests. It also proveids HIV/AIDS services that include a prevention of mother-to-child transmission program. The Nutrition Center has an average of 41 kids a day for meals.

The following chart provides detail.

• 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 2010, the hospital’s annual budget is $2.2 million.  The CRUDEM Foundation has additional expenses of $1.4 million, over 90% of which directly support hospital operations in Haiti. The Foundation also identifies and solicits the budgeted $15 million in donated supplies, medicines, and equipment in 2010.

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?

Hôpital Sacré Coeur was an extremely busy place and operating over capacity before the January 12th earthquake. Preliminary plans for expansion and renovation were underway after a comprehensive review of the hospital campus and its physical capabilities. As a result of the earthquake, it was necessary to temporarily give up the primary care space within the main hospital and convert that into a third OR suite and related services. Currently there are outpatient and inpatient facilities within the tent hospital extension and therefore it is not a viable option to return to a 73 bed facility. A contract is currently being negotiated for land purchase adjacent to the hospital buildings to enable permanent expansion of the hospital to 120 beds.

Hospital Expansion and Renovation:

On the first floor would be an all new surgical area which would include 2 OR s for visiting and general surgeons, 2 labor and delivery rooms, a 3^rd OR for C-sections, a central supply area with 2 sterilizers, a prep room, a pre-op waiting area, post-op recovery and ICU, surgeon and nurse dressing rooms, 2 on call rooms, 2 bathrooms.  The second floor would be a 50 bed addition to the hospital.  The main floor of the hospital would house outpatient and exam areas.  The present surgical area would be used as a procedures room and emergency care.  The second floor of the present hospital needs some remodel to better utilize space and improve plumbing.  New construction is calculated at $100 sq. ft. and with furnishings the total would be $1.2 million.

The need for CRUDEM and Hôpital Sacré Coeur, its Haitian medical staff, its operating staff, and its services is now more evident than ever before in our 24 year history. We are acutely aware of the role that we are playing in Haiti as a referral center and also as a prototype for improving medical care in Haiti.  However, there are other renovations, upgrades and expansion needed to ensure that we can meet the acute needs of our patient population. For example, the radiology department, a new storage and inventory control system, a general services and maintenance building, upgraded communications, water system and electrical system. These require significant investment and we are aware that this can only occur with the continued support of our volunteers, advocates and generous donors.