Travelling North

As I continue to travel around this country, I become more amazed and saddened that things actually seem to be more desperate once you leave Port au Prince. I came here to respond to the earthquake in Port au Prince but didn't imagine that things might actually be worse elsewhere.

Yesterday afternoon my colleagues and took the thirty minute flight from Port au Prince to Port de Paix in the far Northwest of the country. (A driver picked us up at the airport after driving up from the capital the day before and said it took him eight hours to get there due to the poor roads). We came to the north to visit two more hospitals in order to upgrade the conditions of their maternity wards and encourage more women to come to the hospital for pre-natal visits and delivery. As we drove down the long, bumpy and muddy road from the airport to the hospital I was struck by the fact that this town seemed to be the poorest I’d seen in Haiti. There were almost no other cars on the road (as compared to the constant traffic in Port au Prince) and the houses and roads looked to be in even worse shape than those in the capital. However, when we arrived at Beraca Hospital were greeted with a hot lunch of chicken, fish, plantains, rice and beans and a team of doctors and nurses who were eager to hear what we had come to offer.

Once again, I was struck by the eagerness and commitment of this medical staff to their jobs despite the fact that many of them had not been paid in months, their pharmacy had almost run out of stocks, and their sterilizer had broken so they had resorted to sterilizing their instruments in a pot of boiling water. This particular hospital had been funded by missionaries since it opened but funding has stopped and they haven’t received any outside support in over 10 years. Since they are not a government hospital, they do not receive any funding from the Ministry and thus have to rely on patient fees to support the hospital. That is almost unheard of in Haiti because it is simply not a model that can work here. Many patients cannot afford to pay for basic care. For example, ever since this hospital raised their fees for deliveries to 1,000GDS (roughly $25 USD), they only do 30 deliveries a month compared to the 100 they did before. So instead, the women have to deliver at home with the assistance of a matron who is often untrained and ill equipped to handle anything outside of a normal, perfectly smooth delivery.

This morning we left Port de Paix to head for La Tortue on a small boat with an outboard motor (that broke two times during the journey) and a purple velvet curtain attached to a PVC pipe that they used as a sail and boom. (The resourcefulness of Haitian people never ceases to amaze me).

When we reached the island of La Tortue I thought I might be at the end of the earth. This is an island of 40,000 people but only has 10 cars and a couple tiny boats to get supplies across. The steepness and bumpiness of the unpaved roads is astounding. A couple of times I thought for sure the Land Cruiser transporting us was going to tip over backwards due to the incline. And now, it’s 7pm and I’m sitting on the balcony of the only guesthouse in town overlooking the whole island that stretches nearly 50km long and 7km wide and there are no lights on as far as you can see in any direction. Indeed, the hospital we visited today only has power for 6 hours per day using a generator, does not have running water, and has to send patients to the hospital in Port de Paix (in that same velvet sail boat that takes nearly an hour—not to mention the trek to get to the water) if there is an emergency.

Today the doctor told us about a woman who came to deliver her baby at the hospital but he could not deliver the placenta no matter what he tried. So he sent her down the incredibly steep and bumpy road in the Land Cruiser and across the ocean in the velvet boat in order to be seen at the public hospital in Port de Paix. However, since this woman did not have the $30 for the procedure, they would not see her. So she waited outside the hospital for 4 days, meanwhile becoming infected, until finally her family was able to gather the money to get the hospital to perform the procedure.

This is an island where the hospital used to be the premier facility in the Caribbean and people traveled from all over the Caribbean to come for treatment. Today, I met the doctor at that same hospital on this same island and his first request was for a better boat so he could get patients away from his hospital and across the ocean to a different one.

This is an island where Napoleon’s sister once lived. Today, her house has been reduced to the foundation because the stones have been used to build dozens of other houses around the island by people who don’t have any other resources to use.

The sheer neglect of these areas over the past few decades has led to an astoundingly fast and extreme fall from decency.

Giving Birth in Haiti

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% chance of survival. I found that incredible given that Melissa literally just entered the third trimester last week. Obviously we hope that the baby will cook for the full 40 weeks and we won’t have to worry about an early delivery; but it is actually quite comforting to know that if he had to come out now for some reason, he’d probably be just fine.

The day she happened to send me that message I was visiting a hospital we’re supporting in a town called Marchand Dessalines, named after one of Haiti’s first leaders after independence, about two and a half hours north of Port au Prince in the mountains of the Artibonite. I learned from Dr. Fequirere, the young Haitian OB/GYN who works at the hospital, that if a child is born in Haiti at the start of the third trimester, there would be practically no chance of survival.

Haiti has the highest maternal and infant mortality rate in all of 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% of Haitian mothers give birth at home and nearly 100 babies out of 1,000 (10%) die during the first year after birth. The thought of my wife giving birth inside what’s become the typical home in Haiti, a battered tent or tarp help up by 4 sticks without any running water or sanitation, makes me queasy.

In this year after the earthquake, Direct Relief has been focusing on addressing the immediate medical needs of the population. 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. However, now 15 months after the earthquake and 7 months since the outbreak of cholera, we’re taking a step back to look at the ongoing and ever-present medical issues facing the country. And the one that jumps out and takes your breath away is the number of women and babies who die unnecessarily every year in Haiti due to complications with childbirth.

The doctor at the hospital in Marchand Dessalines told me that day that they deliver roughly 80 babies per month, 10 of whom will die. While this hospital has 5 well-trained doctors, 18 nurses, and an anesthesiologist, they lack the material resources to save these babies. There is no blood bank in the hospital. Often times they do not have the medications needed to treat the women. And they do not have any incubators, let alone a neo-natal intensive care unit, to deal with premature deliveries. In fact, the doctor told me that they have to refer these 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 your wife or mother or daughter or sister having to endure that journey.

Bringing life into the world should not be a death sentence in 2011. As I know now, we have the technology and knowhow to treat babies who are born three months (or more) early. The eight hospitals we’ve selected throughout the country (that all have trained doctors, nurses, and midwives), will ideally become “centers of excellence” in Haiti with new equipment and supplies we’ll provide them to save more lives and encourage more women to come in for pre-natal care. My wife Melissa has now had nearly a dozen hospital visits and will double that by the time this baby is born; yet over 50% of women in Haiti don’t ever see a doctor before they give birth—partially because of the state of the medical facilities.

Sometimes it takes a personal experience, or just the ability to place yourself in someone else’s shoes, to relate to these issues that affect so many people on our planet. In fact, I think one of the biggest problems we face today is many people’s inability to walk a mile in another’s shoes. (Think healthcare for the poor and elderly, welfare for those who cannot find jobs, and the state we’re leaving our planet for our grandchildren. But that’s a topic for a totally different blog.) I remember when I broke my first major bone and couldn’t walk for over three months; I discovered a newfound respect for people with physical disabilities.

And now that I have a pregnant wife, a baby on the way, and know what we can do with complicated pregnancies in the United States, I’m shocked by what the majority of women in Haiti have to go through just to bring a new life into the world. But we’re doing what we can to help change that for the nearly 1 million women in Haiti who receive care at these facilities.

Working Together

Once again, I'm blown away by the coordination effort that groups in Haiti are pulling off. Now it's in response to the cholera epidemic and not immediate earthquake response, but it's still happening nonetheless.

Direct Relief brought in an unprecedented amount of supplies to respond to the cholera outbreak thanks to the support of corporate donors who make these essential supplies. However, we were then stuck with the challenge of figuring out how to deliver these supplies to the over 100 hospitals and clinics we support in Haiti. Many of them are dozens of hours away along bumpy, unpaved roads and some of the clinics are actually on the islands off the coast of Haiti. Getting the supplies to these areas would require a huge logistical effort and would be extremely costly.

However, out of no where, we were put in contact with a group from Germany who provide helicopter ambulance transports for patients in the rural areas who need to get to a larger, more sophisticated hospital. Well with a sickness like cholera, patients don't necessarily need to be transported--they just need to receive immediate oral re-hydration and possibly an IV and antibiotics. So this group has been generously providing their helicopter for groups like DRI to use to get these supplies out to the rural areas where the people are being treated.

This past week we've made a number of deliveries and hope we can continue to do so in the future as this saves crucial time (and money).

So thanks to German Help One for providing this valuable service!