Petit Trou de Nippes, Haiti
May 2011
By Andrew MacCalla

We arrived at the small medical clinic in Petit Trou de Nippes about five hours after we left Port-au-Prince that morning. The distance is only 75 miles but the unpaved roads, traffic, and small lakes and rivers we had to drive through to get there made the drive long. Halfway through the trip my Haitian colleague Catherine asked me if I felt like I was in a blender with all the jostling of the Land Cruiser we were driving in. We just pretended we were getting expensive lower-back massages the whole way.

Like the other clinics I’ve visited on this trip, this is the only one serving the 25,000 people who live in the area. Unfortunately, this small government clinic does not have a doctor, because he left for a training course in Port-au-Prince and they fear he’s not coming back due to the poor pay he’s receiving. A young but committed first-year resident who just graduated from medical school last year is now running the clinic. I asked her if she felt ready to be running a medical clinic just one year out of school. Before she answered yes, she hesitated and looked around at the two nurses, social worker, administrator, pharmacist, and lab technician who were sitting on the bench across from her waiting to hear what she’d say. It seemed like she wanted to reassure them that she could do it.

Like the doctor on the island of La Tortue who asked for a better boat to get his patients across the ocean to the larger hospital, the doctor at this clinic also asked for better transport. However, she needed it to get women into her clinic to deliver their babies. The only “ambulance” the clinic has is two broken-down motorcycles, but they wouldn’t want to transport pregnant women on motorcycles even if they were working. They went on to say that pregnant women usually come in on horseback, are carried in a chair, or lying on a door while their neighbors carry them like pallbearers.

Lack is a common theme. For example, nearly 100 doctors and more than a thousand nurses get their degrees every year in Haiti, but low salaries often drive them away from the country. While plenty of doctors and nurses are trained every year, many rural areas are left without the staff to care for their people.

A relatively small amount of money can solve the clinics’ problems, ones they’ve been dealing with for years. The doctor on the island of Ile-a-Vache asked if we could fix the leaky roof in his exam room so when it rained he and his patients wouldn’t get wet anymore. The doctor on the island of La Tortue needed $1,000 to dig a well so he could put running water in his hospital. The doctor in Petite Trou de Nippes said her dream would be to have an actual ambulance, but she’d be happy if they could have gurneys or stretchers so women wouldn’t have to be carried in on doors. The medical director of Beraca Hospital wants a sterilizer so wouldn’t have to disinfect instruments in a pot of boiling water on the stovetop. The nurse on Ile-a-Vache needs a raise from $300 a month to $350 a month because her parents spent all their money to send her to school and now she’s responsible for taking care of her three siblings. And the administrator in Nippes, who was extremely proud to show me the professional patient records and filing system he keeps, said he needed a new desk because the one he’s using is just a piece of plywood sitting on two oil drums. This man was working for almost no pay (and often goes months without even getting a paycheck) yet took pride in his work. He needs a real desk.

The Haitian doctor I was traveling with, who had worked in the U.S. for the last 30 years, promised to personally pay the $1,000 for the well, because of the thought of working in a hospital without running water was unbearable.

I take comfort in the fact that I work for an organization that can respond many of these requests and has a plan to help improve the health of mothers and babies in Haiti. We’re providing pre- and post-natal incentive kits for women who come to the health facility for treatment and delivery, upgrading medical equipment needed for safe deliveries, providing 5,000 rapid HIV tests to test mothers who enroll in the Prevention of Mother to Child Transmission (PMTCT) program, and providing ongoing education for traditional birth attendants. We’re targeting eight health centers strategically located in eight of the ten departments (or states) in Haiti, reaching 563,889 people, including almost 16,000 pregnant women over the course of the next year.

Sometimes it feels like we’re scratching the surface. But it still gives me hope.

A Dad’s Eye View

Drawing from his own experience as a father-to-be, Direct Relief's emergency response manager finds new meaning in maternal-child health initiatives in Haiti.

By Andrew MacCalla

Haiti, April 15, 2011

Halfway through my trip to Haiti this week, my wife sent me an email saying that if our baby was born today, he would have a 90 percent chance of survival. I found that incredible, given that Melissa just entered the third trimester of her pregnancy last week.  Obviously, we hope that we won’t have to worry about an early delivery, but it is comforting to know that if our baby had to be born now, he’d likely be just fine.

The day she sent me that message I was visiting a hospital Direct Relief is supporting in Marchand Dessalines, a town named after one of Haiti’s first leaders after its independence from France, about two-and-a half-hours north of Port-au-Prince in the Artibonite mountains. I learned from Dr. Fequirere, the young Haitian obstetrician/gynecologist who works at the hospital, that if a child is born in Haiti at the start of the third trimester it would have practically no chance of survival.

Haiti has the highest maternal and infant mortality rate in Latin America and the Caribbean. Pregnancy and its complications have become the leading cause of death and disabilities among women of childbearing age. Out of every 100,000 births, 630 women die giving birth. Roughly 77 percent of Haitian mothers give birth at home, and nearly 100 babies out of 1,000 die during their first year of life. The thought of my wife giving birth in what is now a typical home in Haiti--a battered tent or tarp without running water or sanitation--makes me queasy.

Since the earthquake, Direct Relief has focused on addressing immediate medical needs. We’ve supplied wound dressings, sutures, and wheelchairs after the earthquake; IV solutions, oral rehydration, and antibiotics after the cholera outbreak; and bleach, soap, shampoo, and toothpaste to address the poor hygienic conditions in the camps.

Now, 15 months after the earthquake and seven months since the outbreak of cholera, Direct Relief is taking a step back to focus on the ongoing medical issues facing the country. The one that takes my breath away is the number of women and babies who die unnecessarily every year in childbirth.

The eight hospitals Direct Relief is supporting throughout the country (all with trained doctors, nurses, and midwives), will ideally become centers of excellence in Haiti with new equipment and supplies to save more lives and encourage more women to come in for prenatal care. Over 50 percent of women in Haiti don’t ever see a doctor before they give birth—partially because of the state of the medical facilities.

Our plan takes a four-pronged approach:

1. Provide pre- and post-natal "incentive kits" to give to mothers who come in for pre-natal care and delivery. We'll also pay for their transport to the facility and pay the traditional birth attendant to bring them in.
2. Upgrade the equipment and supplies at eight facilities to help them better care for women having complicated deliveries.
3. Provide rapid HIV tests to pregnant women who come in for prenatal care. They'll receive antiretroviral treatment if they test positive.
4. Train traditional birth attendants to better recognize complications and encourage women to visit the clinic.

Dr. Fequirere at the hospital in Marchand Dessalines told me that they deliver about 80 babies each month, 10 of whom will die. While the hospital is staffed with five well-trained doctors, 18 nurses, and an anesthesiologist, it lacks the material resources to save these babies. There is no blood bank in the hospital. Often they don’t have the medications needed to treat the women, and they don’t have any incubators, let alone a neonatal intensive care unit to deal with premature deliveries. The doctor said the hospital must refer pre-term labor cases to a hospital over an hour away. The road between the hospitals is impossibly bumpy and winding, and the woman is transported in the back of a truck. Imagine any woman in your life--your wife, mother, daughter, or sister--having to endure that journey.

Bringing life into the world should not be a death sentence. We have the technology and knowledge to treat babies who are born three months (or more) early.

Sometimes it takes a personal experience, or the ability to put yourself in someone else’s shoes, to relate to these issues that affect so many people on our planet. Now that I my wife and I have a baby on the way and know what care pregnant women receive in the United States, I’m shocked by what most women in Haiti go through in bringing a new life into the world. Direct Relief is going to help change that for nearly one million women in Haiti. I’m glad I can be a part of it.

By Genevieve Bitter, Direct Relief's director of international operations. Genny is traveling in St. Vincent & the Grenadines on assessment visits, where she has met with Mr. Lanceford Weekes, Permanent Secretary for the Ministry of Health, and several of his associates.

Kingstown, St. Vincent
May 5, 2010
I am so impressed with the health system implemented in this tiny country. There are 39 health centers which offer basic primary care services; these centers are regional and are no more than three miles apart. There are five district hospitals in addition to Milton Cato Hospital, which is the largest and acts as the referral facility. The Ministry of Health is in the process of opening three polyclinics to ease the pressure on the emergency room and trauma center at Milton Cato (visibly labeled as “Fresh Wounds”).

Milton Cato Hospital offers a wide range of services including surgeries, lab tests, radiology, dental, ophthalmology, maternity, and geriatrics. It is equipped with three operating theaters, but it is by no means a state-of-the-art facility. These are the tropics, so things are rusty and dilapidated but the services the hospital provides are consistent. The fact that there is always a radiologist available impressed me when so many facilities only offer part-time access to such services.

Another unique component of the hospital is its commitment to and treatment of asthma patients, which is how Direct Relief first came to know the facility. The hospital holds an asthma clinic once a week where the staff can see returning patients--mostly children--and adjust their medication if necessary. In the emergency area, there’s a bench with built-in nebulizer stations where patients can sit and receive treatment when having a respiratory attack.

Mr. Emmanuel Jones is a trained nurse and pharmacy technician who now manages the inventory system at the Central Stores. He showed me how he logs and distributes our product and pointed out our supplies in the hospital. From his nursing perspective, he knows how desperate they can become for hospital necessities, so he works very hard to get the goods out swiftly and accurately. Our donations not only go to Milton Cato, directly across the street from the main Central Store, but they are delivered to all of the hospitals and health centers as needed, so we are really helping to equip the entire country. Emmanuel also showed me in their log records that they were down to just five IV sets when our donation was received, boosting the stock to more than 2,000.

What I like best about Direct Relief’s relationship with St. Vincent and the Grenadines is that we are the primary source of medical donations for them, they know the quality of our goods on a personal level, and our donations have literally saved lives and also enabled them to use their budget for drugs for chronic conditions--diabetes and hypertension are widespread here. Allowing people to have piped water in their homes is a good thing but also took away daily exercise. The shift away from backyard farms to eating more convenient refined foods has clearly contributed as well.

From the clerks in the Medical Stores to the nurses to the Ministry level, all were deeply grateful for our relationship and are eager to continue. I am leaving here very proud of our work and have seen direct results of the quality donations we provide...and with a list of what they'd like to see in the future. 

Saturday, January 23, 2010 at St. Damien Hospital, Haiti

Working in Port-au-Prince to facilitate logistics in Haiti and help our partners there, Brett Williams took this photo at St. Damien Hospital, a pediatric facility that has been treating a large number of adults and children injured in the January 12 earthquake. “The staff is treating patients under tarps,” Williams reported today. “They had so many patients the only place they could treat them was in the courtyard.”

Listen to a radio interview with Brett Williams from Haiti, broadcast this morning on KGO-AM, San Francisco

January 18, 2010 - 2 pm

Direct Relief staff members Brett Williams and Nate Brock are in Haiti coordinating logistics and relief efforts there. Williams' comments from Port-au-Prince follow:

We have been able to organize the piles of medical supplies for the tent hospital that has been established in two large tents at the UN compound, where dozens of volunteer physicians from the States and several from France are working nonstop. Staff from the University of Miami, and a team from New Jersey were among the many who had been at it for days – sleeping onsite on crates.

Sunday evening, patients with serious injuries, including open compound fractures, were still arriving to be seen for the first time.

As we work to organize the resources already here, we are receiving site level assessments and reports from our partner health facilities – all of them are draining supplies fast and need replenishment. The in-country logistics for distribution, essentially from the airport outward, are pinched. We are focusing on the medical-supply channels, but food, water, fuel, patient transport, and every other type of transport and distribution function also is urgent.

Former President Clinton is here today, and we were with him at the hospital in Port-au-Prince. We have connected with Partners in Health and will work together to assist St. Damien Children’s Hospital. The pre-positioned emergency medical supplies we provided to St. Damien months ago in anticipation of an emergency (which we thought would be a hurricane), was a good call. But they need more, as do other partners, just to keep up.

Report From Haiti -
By Brett Williams, Director of Emergency Response
January 18, 2010

We have been able to organize the piles of medical supplies for the tent hospital that has been established in two large tents at the UN compound, where dozens of volunteer physicians from the States and several from France are working nonstop. Staff from the University of Miami and a team from New Jersey were among the many who had been at it for days – sleeping on-site on crates.

Sunday evening, patients with serious injuries, including open compound fractures, were still arriving to be seen for the first time.

As we work to organize the resources already here, we are receiving site level assessments and reports from our partner health facilities – all of them are draining supplies fast and need replenishment. The incountry logistics for distribution, essentially from the airport outward, are pinched. We are focusing on the medical-supply channels, but food, water, fuel, patient transport, and every other type of transport and distribution function also is urgent.

President Clinton is here today, and we were with him at the hospital in Port-au-Prince (right). We have connected with Partners in Health and will work together to assist St. Damien Children’s Hospital. The pre-positioned emergency medical supplies we provided to St. Damien months ago in anticipation of an emergency (which we thought would be a hurricane), was a good call. But they need more, as do other partners, just to keep up.

Haiti: Babies Don't Stop for Hurricanes
Traveling through Haiti to finalize plans for Direct Relief’s Third Annual Hurricane Prepositioning Project, Senior Program Officer Dan Smith and Emergency Response Coordinator Brett Williams discovered that in the north, new mothers and their babies are most affected by last year’s hurricanes.

March 24, 2008
On Haiti’s northern coast there has been a spike in premature births—a trend you wouldn’t immediately attribute to the storms that struck six months earlier. Those disasters are long forgotten by everyone except those still struggling with their lasting effects.

Haiti’s northern departments are the country’s poorest and most vulnerable, where about 75 percent of people live on less than $2 a day. The northern departments are dependent on commodities from the capital, Port-au-Prince, and are linked by one low-lying road on the coast that passes through Gonaives. It repeatedly bears the brunt of hurricane damage.

In St. Louis du Nord, we visited North West Haiti Christian Mission’s Birthing Center, which averages about 85 births a month. The clinic receives nutritional products from Abbott, which are critical for these mothers and babies.

At the clinic we met Rose Cardene. Rose had recently given birth to a beautiful baby boy, Standley, days before we arrived. Standley was premature, born weighing less than 3 pounds.

Premature birth is increasingly common in northern Haiti, where a food crisis lead to violent protests last spring and hurricane damage to crops caused the price of food to skyrocket. This left adequate nutrition out of reach for many pregnant women, placing additional stress on their already stressed bodies. Donated nutritional products become a lifeline for these women and their babies to be.

Adding insult to injury, aid delivery was severely hampered following last year’s four consecutive storms in as many weeks that killed more than 800 people, causing massive flooding and damage in their wake. With roads and bridges completely washed out, people in the north were forced to fend for themselves.

Now, in late March, a full month before the start of the rainy season, daily rains are making people in the north very nervous; memories of last year’s storms are all too vivid. It’s hard to image life in rural Haiti getting harder than it already is, but all you need to do is add water.

We are here planning our Hurricane Module distribution for the 2009 season, which will include Haiti. Clearly the need here is great.

Last year, hurricane modules were prepositioned in Texas, Louisiana, Mississippi, and Alabama in the U.S., and in Jamaica and the Dominican Republic in the Caribbean. The modules contain essential antibiotics; nutritional products for children and adults; oral rehydration solutions; and supplies for wound-care and water purification, all selected to help local healthcare providers meet the surge of additional patients while also caring for existing patients.

Having these modules in place before hurricane season starts will help protect vulnerable populations like pregnant women and their babies should a hurricane strike. Nutritional products give premature babies a chance at survival, despite challenging circumstances. 

Direct Relief provided more than $2.3 million (wholesale) in aid to Haiti following last year’s hurricanes. The organization is committed to providing essential medicines and nutritional supplies as long as needed following an emergency—because pregnancy doesn’t stop for hurricanes.