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The Maternal Health Crisis in Haiti

Nadege delivered David totally alone right here on the floor of her shack in the hills overlooking Port-au-Prince. October 4, 2013. Photo by John Carroll.

“When there are so many problems to address and the needs are great, what better place to start than with mothers and their babies?”

— Tara Livesay
Director Heartline Maternity Center
Port-au-Prince, Haiti

I have a Haitian friend in Port-au-Prince named Djongo. Several weeks ago his hospitalized full-term pregnant wife was told that she needed a C- section. However, the doctor who was to perform the C-section could not get to the hospital due to the riots that were happening in Port’s streets because of the sudden gas price increase. There was hardly any staff in the hospital at all.

Photo by Karen Bultje–July 6, 2018.

So in order to save his wife and unborn baby’s life, Djongo had to quickly leave the hospital with her and safely maneuver them through the burning tires and massive street crowds to a private hospital in another part of the city. When they arrived at the private hospital they were told that they had to come up with $1,320.00 US for the C-section.

A request was posted and Djongo’s friends on Facebook urgently raised the money and sent it to him via Western Union. The only problem with this was that Western Union was closed during the manifestations. When Djongo returned to the hospital from the closed Western Union office, the obstetrician and hospital decided to do the emergent C-section anyway, and a very healthy baby boy was delivered.

Djongo’s baby boy.

The next day the physician cleared Djongo’s wife for discharge; however, the hospital would not let Djongo and his wife and newborn leave until he paid the bill. When the danger in the streets had lessened some, Djongo was able to walk back to Western Union, obtain his money transfer, make it back to the hospital without getting robbed, and pay his bill. His wife and baby were discharged and they successfully returned to their home on the outskirts of Port.

This anecdote is simply about one poor Haitian woman who needed a C- section. The General Hospital in Port is on strike and the free Doctors Without Borders Maternity Hospital in the Delmas neighborhood just closed. Port-au-Prince has three million people, the vast majority who have little to no money. How many poor Haitian women have over 1,000 dollars sent to them from people they hardly know for emergent childbirth in a private hospital? How many women and newborns suffered and possibly died during the political unrest several weeks ago? Poor Haitian women have no good options now for obstetric care and so many more Haitian women will deliver at home with the help of the local “matron” (midwife).

Newborn baby delivered at home in Northern Haiti. Umbilical cord tied with twine. Photo by John Carroll.

 

 

 

 

On July 19, 2018, The Miami Herald’s Jacqueline Charles published an article: “Haiti’s maternal mortality rates among the highest. So why is this hospital closing?” I have (partially) summarized the article with the following bullet points:

1. The Geneva-based medical charity, Doctors Without Borders, has closed down its free round the clock maternity hospital in Port-au-Prince. It had been open since 2010 after the earthquake.

2. Haiti has more women die before, during, and after childbirth than anywhere in the Western Hemisphere–359 deaths/100,000 pregnancies according to WHO in 2015.

3. This Doctors Without Borders Maternity Hospital admitted 500 patients a day in 2017.

4. Haiti does not currently have a functioning government after the resignation of its prime minister and his cabinet last week following this month’s deadly fuel-hike riots.

5. Dr. Claude Surena, former president of the Haitian Medical Association, said the closure of the maternity hospital, which treated pregnant women with eclampsia and pre-eclampsia and was the only health facility that specialized in expectant mothers with cholera, will have a significant impact. The health ministry, he said, will need to find a way to gradually absorb such cases and improve healthcare delivery.

6. According to the World Bank, Haiti spends less on healthcare per capita than its closest neighbors. The Dominican Republic spends $180 per capita; Cuba, $781; and the Latin American and Caribbean region overall, $336. Haiti spends just $13. Maternal and infant mortality rates are also five and three times, respectively, higher than the regional average, the bank said in a report it published last year while calling on Haiti’s government to increase healthcare spending.

***

Tara Livesay sent me the following email regarding the horrible maternal health care crisis occurring now in Port-au-Prince–

“In the ten years I have worked in maternal health in Port-au-Prince, I cannot tell you how many times we have attempted to transfer women with clear and determined needs for a Cesarean Section, only to be told “Sorry, no room at this hospital.”

“We went to four hospitals on a few occasions, only to have each one say they had all their ORs packed full for hours and hours to come. What a horrible and helpless feeling, to know exactly what a woman needs in order for her baby to live and for her intense and prolonged pain to end, but not be able to find it. It is quite common to make a transfer plan as we leave the Heartline Maternity Center that has options A, B, and C. There is not a guarantee of availability (of maternal health care) for any woman in this city.

“The maternal health statistics for the country are conservative, in my opinion. It is our experience that 1 in 4 women will become pre-eclamptic before her baby is born. It is our experience that a little more than half of those women will be able to deliver vaginally but the other half will likely need a surgeon and an anesthesiologist and an operating room. The World Health Organization estimates that 10 to 15 percent of births will require a Cesarean delivery, and we find that to be true.

“Our birth center is small and very focused on high quality and holistic care. I wish this level of care were available to the entire population of this island. At this point, we would settle for far less than the high quality and respectful care we offer, and would simply be thrilled if we could just find an open operating room staffed by the right medical professionals to save a life or two.

“Motivating others to care is really hard. When I think back to my pregnancies (four of them), I can easily remember the nervous and anxious thoughts about the delivery day. Every woman feels nervous at some point in pregnancy or in the days leading up to delivery. If those of us that can immediately find care feel that fear and nervousness, imagine how much more frightening it would be to know that the day you deliver, there is almost a guarantee you’ll have to do it without a trained midwife, nurse, or doctor.”

More articles by:

John A. Carroll, M.D. is a physician working in Port-au-Prince.

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