Orthopaedics in Haiti.

On January 12, 2010, an earthquake with a magnitude of 7.3 on the Richter scale struck the island nation of Haiti, causing devastating losses of property, life, and limb. Orthopaedic surgeons from around the world responded to the mass casualty disaster and came together to treat many of the injured. That deadly earthquake focused the world’s attention on the Haitian health-care system. Despite years of developmental aid and the efforts of a large number of nongovernmental organizations (NGOs) before the earthquake, Haiti had some of the worst health conditions in the Americas, including the highest infant and maternal mortality rates in the Western Hemisphere. The public sector comprised about 35.7% of the health infrastructure, demonstrating the government’s limited capacity to provide health services. Physicians, especially orthopaedic surgeons, were largely concentrated in the capital city of Port-au-Prince and in other large towns. In some areas, there was only 1 physician for every 67,000 residents. Between 2005 and 2008, nearly 30% of all health-care professionals left the country, primarily for the U.S. or Canada. Today, these circumstances continue to negatively impact the standard of orthopaedic care for Haiti’s young, active, and struggling population. In fact, with a population of 10,924,000 and a per capita income of $1,750 U.S. (USD) (Population Reference Bureau, 2014), Haiti continues to lack many modern medical resources, including state-of-the-art hospitals and clinics; trained nurses, doctors, and other medical staff; medical devices; diagnostic technologies; and medications. Despite these circumstances, this culturally rich country has an interesting orthopaedic history. Herein, we will trace the highlights of the development of orthopaedic surgery in Haiti and describe some of the personalities who have allowed it to become what it is today; we also will describe what we would like it to be in the future. What is unknown to most people is the fact that, in Haiti, orthopaedic surgery started during the colonial period (between 1492 and 1803) when slaves were given the responsibility of reducing fractures and dislocations. These menwere known as “bonesetters.” They probably derived their expertise in part from notions acquired in Africa and through interactions with European surgeons since these surgeons were involved in the care of island settlers. After Haiti gained independence from France in 1804, foreign doctors and pharmacists who were not slave owners were the only ones authorized to remain in the country to practice. In 1817, our visionary leaders started to build medical schools in Cap-Haı̈tien under the government of King Henry Christophe, who reigned from 1811 to 1820, and in Port-au-Prince under the leadership of Jean-Pierre Boyer, who was president from 1818 to 1843. With these structures in place, Haitian medicine quickly became organized. For example, a fee for orthopaedic services was established, and a law dated May 12, 1828, fixed the remuneration for the reduction of a simple fracture at 12 gourdes (approximately 2 USD currently). About 132 years after the creation of these medical schools, the first orthopaedic department was established in 1949 under the leadership of Professor AntenorMiot, who held the orthopaedic chair at the state medical school in Port-auPrince. Professor Miot is known as the father of Haitian orthopaedics (Fig. 1). Professor Miot was born on November 5, 1906, in the small town of Les Cayes in the south of Haiti. After obtaining