Notes From the Field: Haiti (Part II.)
By Jessica Bowers
Continued from Notes From the Field: Haiti (Part I.)
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 seeing what others doing to improve women’s health at the community level.
Recently, I hit the road with Jessica Jordan, Executive Director of one of our grantee partners in Haiti, Midwives For Haiti, traveling around Haiti to visit a few other organizations working to improve maternal health in the country.
Jessica and I made our way toward the Artibonite district, close to Saint-Marc, to the town of Deschapelles and the site of Hôpital Albert Schweitzer Haiti(HAS). Hôpital Albert Schweitzer Haitiis one of the oldest hospitals in Haiti. It was founded by Larry and Gwen Mellon in 1956 on a former banana plantation donated by the Haitian government. Despite being named for Albert Schweitzer and inspired by his philanthropy, Schweitzer himself never set foot in the hospital.
The HAS Haiti campus is lovely – among the trees, and not walled in so it’s very lively with people walking throughout. It feels very much IN and part of the community. There are beautiful old stone houses left over from the plantation located on the grounds, unusual to see in Haiti.
HAS employs nearly 500 Haitian people, and only a small number (in the single digits) of ex-pats, so it is very much run by Haitians. We toured the campus with HAS’s community outreach person, Leah Steele, who kindly took time out to show us around.
Accompanied by Dr. Pierre, who oversees all of the health clinics, we visited the nearest of HAS’s four health centers in the hospital’s catchment area, in Deschapelles, just up the road from the hospital. HAS’s health clinics provide primary care, vaccinations, HIV/STI testing and treatment, a nutrition program. They are starting to do hemoglobin testing at each clinic to test for anemia. They also provide pre- and postnatal care and run a robust family planning program.
Each HAS Health Center has a network of community health workers (CHWs), who administer vaccinations and are also very involved in maternity care. The CHWs help ensure that every pregnant woman has a birth plan, and visit pregnant women at home to encourage them to go for all four of their prenatal visits and ensure they have a postnatal visit within 72 hours of giving birth – a critical time for both mother and baby. Their postpartum care includes a mental health screening as part of postpartum. A dedicated family planning nurse, Nognane, sees each postpartum woman privately for a consultation where she explains the various methods, answers questions, and counsels women on the method that is best for them. Depo shots are the favorite among the women at this clinic.
HAS trains matwons monthly on danger signs in pregnancy and when to refer women who need a higher level of care. CHWs also distribute clean birth kits to the matwons (traditional birth attendants) who deliver most babies in Haiti. After a woman delivers the matwon calls the CHW to ensure they know the woman has delivered and the status of her and the baby, and troubleshoot any concerns.
After we saw the health clinic, we visited the hospital, which is one of the nicest I’ve seen in a developing country. It is deceptively small from the outside. Like most hospitals in low-resource settings, they are crowded with people needing and receiving care. HAS emphasizes the importance of primary care, and works to incentivize people to first use the primary care system of health centers and community health workers, instead of coming straight to the hospital with a health concern. HAS charges very low fees (though they will not turn anyone away who can’t pay, and will work with people on payment plans if needed), and patients pay slightly more at the hospital if they are not referred, to incentivize them to use the primary care system.
They hospital has a psychology department, laboratory, X-rays, operating theatres, maternity ward and neonatal unit, blood bank, and a chronic malnutrition program for children and mothers. The maternity is intended for high-risk pregnancies and usually a last resort but they end up with low-risk births as well. HAS delivers 1,500 babies each year and does 500 C-sections (the rate is high because they mainly receive high-risk patients).
After the visit with HAS, Jessica Jordan and I split off and I traveled up to the northern part of the country to Terrier-Rouge outside of Cap-Haitien, to visit Ninotte Lubin and Grace Birth Center.