Not unlike US healthcare, the hospital is not self-sustaining, particularly in the midst of the poorest country in the Western Hemisphere. Our largest contributor has cut funding by 42%.  The local government has inflated salaries by 26%, driving up the cost of healthcare, supplies and services. Higher salaries and relative comfort in the more developed areas of Haiti have lured surgeons, anesthetists, nurses and lab technicians away from Pignon.  We have established an endowment fund and are developing it to provide long term support.