While visiting Haiti you will see that the United Nations’ presence is palpable across the country especially in the capital Port-au-Prince where the United Nations Stabilization Mission in Haiti (MINUSTAH) is housed. During rush hour it is not uncommon to see countless UN vehicles with peacekeepers and leaders in berets (mostly men) among the many motos and cars driven by locals, buses, and NGO SUVs.
Roseline had delivered her baby during the chaos of our first day at Mama Baby Haiti, a birthing center for women near CapHaitian, Haiti. Mondays are the busiest day at the center, located on a dirt road just off Highway 1, as it is the intake day for expectant mothers that are new to the program. Three of us had arrived the night before from the early spring of Minnesota weather to be greeted by unseasonable warm Haitian weather – 95 degrees and high humidity.
While we were teaching 10 Haitian nurses and physicians asked about cervical cancer screening in a low resource setting and Roseline was laboring with the aide of a Haitian trained nurse midwife to deliver her healthy baby girl. She graciously agreed to be interviewed only hours after the birth of her child and shortly before she was to depart for her home (patients stay at the center for only 4 hours after an uncomplicated birth).
As is true for many of the 30-40 women who deliver at Mama Baby Haiti each month, she had heard of the program through a friend. She lives 20 minutes away and had been seen for five prenatal visits. She was appreciative of the nurse midwives that seemed to listen to her concerns and the cleanliness of the birthing center. This was Roseline’s first child. The father of her baby was sick and unable to work and she supported herself with side jobs and help from her family. The cost of her care at the center was much reduced from what her care would have cost at the local hospital. Without the services of Mama Baby Haiti, she would have had to deliver at home, either by herself or with an unskilled birth attendant.
Inside the child malnutrition unit at Hôpital Albert Schweitzer, the largest regional hospital in Haiti’s Artibonite region, colorful murals have been painted over the beds. They were specifically designed to teach parents, especially mothers, how to keep their newborns and children healthy and well-fed.
This mural in Hôpital Albert Schweitzer Haiti shows mothers the importance of breastfeeding their newborns as well as the importance of taking their babies to the Centre de Santé (health center).
Haiti has a 53 percent literacy rate making it imperative that health messaging at the hospital is conveyed through art as well as through color-coded words. For example, the hospital’s social services are all written in red so those who cannot read can easily find that department. Additionally, for those who can read all signs are written in French as well as in Creole as language politics in the region are quite heightened.
Mothers instead of fathers are more likely to tend to their children in the malnutrition unit like the mothers I saw when I visited. Some mothers were feeding their children and others were sitting with their children who were too weak to be awake.
Haitian women have a lower literacy rate than men in Haiti making messaging through art critical to driving home nutrition education in this unit.
Casimer Dieuvela, 24 years old and five months pregnant, lives two to three hours walk from her monthly health post in Deschappelles, Haiti, but she goes despite the distance to receive her tetanus shot.
It’s her third time coming to the health post run by health agent Junior Exanthus and arranged by Hôpital Albert Schweitzer (HAS). Dieuvela brings her daughter to receive her full course of vaccinations. HAS also immunizes pregnant women for tetanus. Last year there were 1,332 first doses and boosters administered.
“I heard through a neighbor about the health post,” Dieuvela said through translation. “I come because it is good for my health. It is important to me.”
Maternal and newborn tetanus (MNT) is an extremely deadly disease, but can be prevented through immunization, proper cord care, and hygienic birthing practices. Without care and immunizations, tetanus has a 100 percent death rate. In Haiti 1.3 million women between the ages of 15 – 49 are at risk of contracting tetanus.
The World Health Organization effectively started initiative campaigns to eliminate maternal tetanus in 1999 with a goal year of reaching the goal by 2015. Thus far, 36 of highly affected countries have reached their goal to eliminate maternal tetanus. Haiti is not one of those countries. In fact, Haiti accounts for 50 percent of all maternal and newborn cases of tetanus in the Western Hemisphere.
Since 1999, 129.5 million expectant women have been immunized against tetanus. According to the WHO, MNT remains a major public health problem in 23 countries.
In 2013, Minister of Health of Haiti Florence D. Guillaume said during a vaccine drive in Port-au-Prince, “Vaccination has always been a priority for prevention and improving health and today we are reaffirming that commitment.”
In order to eliminate maternal tetanus, more women in remote areas need to be vaccinated. GAVI has committed to over $20 million dollars in vaccines and health systems strengthening through 2020. As of Feb 28, 2015, a little over $10 million has been disbursed.