Notes From the Field: Haiti (Part I.)
By Jessica Bowers, Grants Program Director
As the Grants Program Director for Every Mother Counts, I love going into the field and seeing firsthand the work that we are supporting, as well as learning what other organizations and people are doing around women’s health in the country. Haiti is also just a beautiful, historic country to visit. Haiti has been identified as one of the top countries suffering from a critical shortage of health workers, and women face serious challenges trying to access care that is nearby, timely, high-quality, and well-resourced. Since 2012, EMC has funded the work of Midwives For Haiti. Midwives For Haiti is having success helping to close the gap of skilled providers, as are a number of other small organizations in the country.
Last week I hit the road with Jessica Jordan, Executive Director of Midwives for Haiti, traveling around Haiti to visit a few other organizations working to improve maternal health in the country, hear about their challenges and approaches, and identify opportunities.
Our first stop was Les Cayes, in the southwest part of the country. There, we met up with a group of supporters and friends of Mimsi International, an organization founded and run by Dr. Winfred Tovar, a Haitian-American Ob/Gyn. Mimsi has a small, well-trained team of community health workers delivering prenatal care through 13 mobile clinics deployed to rural villages outside of Les Cayes. Dr. Tovar founded Mimsi in 2015 after his cousin in Haiti nearly died from eclampsia and hemorrhage giving birth to twins. She had limited access to skilled prenatal care and emergency obstetric care.
We tagged along to two of Mimsi’s monthly mobile clinics, the first held at a government dispensary in Les Cayes, the second at a church up in the mountains. We watched as Mimsi’s team of 17 Haitian health workers piled into the back of a small pick-up truck to trek to the next destination. At each, the team got to work with efficiency, giving women pre- and post-natal check-ups, administering pregnancy tests, vaccinations, and Depo shots, testing and treatment for sexually-transmitted infections (STIs), taking blood, testing for HIV, and providing referrals. Sixteen of the 17 workers are women, including a doctor and 2 nurses. Mimsi focuses on hiring women, and wants to build the pipeline of women health workers at all levels in Haiti.
Mimsi’s lone man — a community health agent named Pierre — travels on his moto to rural villages in the mobile clinic catchment areas to recruit pregnant women and women who suspect they may be pregnant, to come to the clinic for free pregnancy tests and services. Because of that active recruitment, they have been able to get nearly 38% of their patients to come in their first trimester — an unusually high rate for low-resource and underserved settings.
Mimsi patients have two paper records — one that Mimsi hangs on to, and a smaller pocket-sized one that patients carry with them. This way they ensure continuum of care and that wherever they give birth they will have their records. On the pocket-sized record is a hotline number that women can call in-between visits if they have questions or concerns. Mimsi workers take turns with a shared phone and are on-call to (wo)man the hotline.
Low-risk women (about 75%) deliver where they want, usually with a matwon (traditional birth attendant), and Mimsi distributes clean birth kits to the women for their matwons to use. The other 25% deliver at a hospital, which Mimsi covers. They are growing quickly — seeing 1,200 patients/month, adding 250–275 more patients each month.
(Side Note: This post would be incomplete without a huge shout-out to Madame Jeanine Tovar who generously hosted us and fed us delicious Haitian food).
Mimsi hopes to build a maternity hospital with a birth center across the street from Jeanine’s house, and wants to eventually expand their model beyond Les Cayes into other parts of Haiti and, eventually, globally.
The following day, we visited REMODEL Development, an NGO founded and run by a Haitian woman and her husband living in Canada. REMODEL is doing work in Nippes department, in the mountains near Saint Louis du-Sud, and in Carrefour. We drove far up into the mountains near Plaisance, climbing rocky dirt roads filled with crater-sized holes, to see their mobile prenatal clinic, held in a community church. REMODEL had funding from the UN to do health and nutrition outreach in underserved rural communities. As happens too often with international aid projects, the projects last a few years and then close up shop, failing to leave communities much better off than they started and instead, arguably, fostering aid dependency instead of supporting communities to realize their own self-defined long-term goals on their terms.
Since the end of REMODEL’s UN project, REMODEL has worked hard to continue the work so that women and babies continue to receive care without disruption. We watched as a community health worker handed out prenatal vitamins, nutrition supplements, and led the women in a song to educate them on identifying health risk signs in themselves and their children. Song and music are powerful in every culture, and this is particularly true in Haiti. Song can also act as a great memorization tool in places where literacy levels might be low.
Check back in over the next couple days for Notes From the Field: Haiti (Part II).