JÉRÉMIE, HAITI – Natache Mizene, 29, lies in a bed at Hôpital Saint-Antoine de Jérémie, the only state hospital for the Grand'Anse department. She is wearing a green, floral gown, and her whole body is swollen.

Her doctor has diagnosed her with kidney failure.

“I am diabetic, I have difficulty breathing, and I have hypertension,” says Mizene, an accounting student. “My doctor says I suffer from renal insufficiency.”

But she can’t get the treatment she needs at St. Antoine Hospital, located in Jérémie, the capital of the Grand'Anse department in southwestern Haiti.

“I was in the hospital for three months already when they sent me to another place because they could not do anything for me,” she says.

Frantz Alexis, 25, an intern at St. Antoine Hospital, confirms that the hospital can’t provide Mizene with the treatment she needs.

“Mizene should have an ionogram, a special type of blood test,” Alexis says. “But unfortunately, we do not have the equipment for that here at the hospital.”

Alexis is a third-year student at École d’Infirmières Notre Dame du Perpétuel Secours, a local nursing school.

“What makes her body swollen like that is that she has difficulty urinating, so all the salt stays in her body,” he says.

They have prescribed medication for Mizene that makes patients urinate, but it is not working, he says.

“She should see a nephrologist to look at her kidney, but unfortunately, we do not have a nephrologist here,” he says. “She needs to go to Port-au-Prince for that. In her case, there is nothing we can do for her here.”

Mizene says the hospital staff sent her to Port-au-Prince, the capital, to obtain care. But patients are responsible for paying for all their own costs, and she couldn’t afford to continue treatment away from home.

“After two weeks, I was forced to return here because I do not have the money to go to another place,” Mizene says.

Patients of St. Antoine Hospital say they suffer physically and economically because they can’t obtain the care they need locally. Staff members attribute this to a lack of specialists and resources. The directors of the hospital and the Grand'Anse delegation of the Ministère de la Santé Publique et de la Population, Haiti’s public health and population ministry, cite some progress but acknowledge that significant change is still needed.

There are 45 public medical institutions, including small clinics and dispensaries, that serve the nearly 433,000 inhabitants in the Grand'Anse, says Dr. Jean Lionel Gerôme, director of the ministry’s Grand'Anse delegation in Jérémie. But St. Antoine Hospital is the only state hospital in the department.

Dr. Jean Marie Duvilaire, 65, a surgical physician, serves as the director of St. Antoine Hospital. He says the hospital, which was built in 1923, has grown along with the population.

But patients and staff say not all medical services are available at the hospital. This hurts patients’ health. It also affects them financially if they have to travel to obtain care at a different