Poor Pay the Price for Haitian Medicine Shortage : Embargo: Medical supplies are officially exempt from sanctions, but drugs are scarce for all but the rich.

Louis Saint-Dominique fell the other day and cut his leg. The two-inch scrape didn’t seem much of a problem and it shouldn’t have been, but it could have cost the young man his limb or even his life.

At the same time, a reporter from the United States got something in his eye. This too didn’t seem much of a problem, and in the end it wasn’t.

The experiences of the two young men testify to a basic contradiction in the international economic embargo of Haiti: The poor and ordinary suffer greatly, while the well-to-do and connected lead normal lives.

Drugs and other medical supplies are officially exempt from the sanctions imposed to force Haiti’s ruling military to step aside and permit the reinstatement of Jean-Bertrand Aristide, the president driven from office in September, 1991.

But bureaucratic delays by the United States and United Nations, the difficulty in finding transportation to bring in the drugs and a slipshod distribution system have created intense shortages and high prices.

“No boat will come here just to bring a few boxes of medicine,” said Dr. Franz Large, a U.S.-trained ophthalmologist. He said independent peddlers who once went to the United States to buy non-prescription drugs for sale to the lower and middle classes can no longer make the trip because of a ban on air traffic.

“We’ve never had a good health system. It was not caused by the embargo,” Large said. “But this last (embargo) really hurts and has made the problems even worse.”

He listed vaccines, nearly all antibiotics, hypertension drugs, malaria medicine, ulcer drugs and eyedrops as among the worst shortages, in addition to X-ray machines and spare parts for his ophthalmology equipment.

The lack of drugs and equipment is exemplified by the experience of Saint-Dominique, a 27-year-old auto mechanic. He was lifting a battery from a car when he slipped on spilled oil and fell against some scrap metal littering the garage where he worked in downtown Port-au-Prince.

The resulting cut, more of a scratch, according to Saint-Dominique, barely bled and didn’t seem much different from the rest of the bruises and nicks on his legs and arms. So he left it untreated.

“Besides,” he said, “I don’t have any money to go to a (private) doctor and I can’t take the time from work to wait at the national (public) hospital.”

While the shortage of adequate medical supplies and equipment has endangered many of Haiti’s 7 million people, those who can pay fare fine.

The owners of pharmacies had enough money to stock enough medicine to last for months, as did hospitals that cater to the rich. One such facility, Canape Verde Hospital, makes sure it has enough funds to serve its upscale clients by charging cash in advance.

The system worked fine for Matt Marshall, a 27-year-old free-lance reporter from Washington, D.C., who discovered an irritation in his right eye recently.

His affliction appeared insignificant until the eye began to swell. Marshall visited a private physician in the wealthy hillside suburb of Petionville and received a prescription for antibiotics. Within a couple of days, the swelling was gone and Marshall was back to normal.

In Saint-Dominique’s case, the scratch turned first into a slight bump on his left shin and then an angry, bloated swelling that he said became so tender and painful he couldn’t work.

He found a doctor who examined him for $1 and prescribed an antibiotic. But several pharmacies were out of the drug and, for that matter, any other antibiotic. So he let the festering wound go untreated.

When the pain became unbearable, Saint-Dominique went to the national hospital and was told he needed an operation to have the swelling lanced and cleaned out. But the hospital was so short of medicine, antiseptics and even sutures that only emergency surgery was being performed.

His first doctor was able to convince the hospital that the case was an emergency, arguing that the risk of gangrene and blood poisoning could lead to amputation and even death. The operation was performed and the swelling went down, but Saint-Dominique is still worried.

The incision is being held together by ordinary Band-Aids because the hospital said it had no sutures, and he never could find the antibiotic he needs.

“I am afraid,” he said. “It still hurts and I think it is getting bigger again. The doctor says I have to use the medicine, but I just can’t find it.”

Some doctors in Haiti resist the embargo’s impact, but often at great personal expense and with limited results.

Just outside the impoverished seaside city of Grand Goave, about 35 miles west of Port-au-Prince, Dr. Rene Saint-Leger runs a clinic that serves about 40,000 people. Except for occasional help from a public doctor, Saint-Leger is the only physician in the area.

He built the clinic with his own money, earned during 20 years of private practice as an internist in East St. Louis, Ill. Not only does the 70-year-old Haitian native pay for the clinic’s operation, he flies to St. Louis every two or three months to bring back the drugs he can’t find here.

“I hope I can keep going back,” he said during an interview in his beachfront home near the clinic. “I hope Air France keeps flying.”

Air France has defied U.S. pressure to shut down and has three flights a week to the Dominican Republic and Martinique. “If they stop, I will find another way,” he said.

His effort shows. In his clinic pharmacy and in his home, Saint-Leger has nearly every drug unavailable to Haiti’s other public doctors--medicine for heart patients, antibiotics for infections, morphine, treatments for eye disease, even balm for chafed skin.

But even with his well-stocked pharmacy and his generosity (no patient pays more than $1, and most are treated free), the doctor thinks he is losing ground because of the embargo. “We used to be crowded every day, 40 and 50 patients a day,” he said. “But now you see less and less because transportation costs are so high” that the people can’t get to the clinic.

He also bemoans the things even he can’t get. “What I would give for an X-ray. Can you imagine diagnosing tuberculosis without X-rays?”

“Haiti has never been a paradise,” Saint-Leger said, “but now . . .”

His voice trailed off.

In Port-au-Prince, Dr. Large finished the thought. “Before the embargo, Haiti was the second circle of Dante’s hell. Now we’re in the first circle.”