Haiti - A student's perspective on a recent experience

I looked out the plane window at the white-spotted city of Port-au-Prince, “I wish I was going home… What was I thinking?” In early May of 2011, a team of six Ontarian nurses, one paramedic, and myself, a level 3 McMaster nursing student, flew down to Port-au-Prince to run a series of mobile clinics organized through Coram Deo International Aid (CDIA). Upon arrival we began sorting medications and met with our team of Haitian translators and Dr. Ed Amos, a Physician’s Assistant from Michigan who has been living and working in Haiti for over 9 years. During our 10 day stay we set up 6 clinics, treating over 200 Haitians daily. Clinics were organized in the mountains of Fort Jacques, a tent city, schools, a church, and in the slums of La Saline, on the outskirts of Cite Soleil. Our clinics were organized into registration, whose jobs included documenting vitals, weight, age, and the patient’s chief complaint. Following registration, patients were sent to advancé to wait for a provider, who was accompanied by a translator. Once their diagnosis was determined patients would go to the pharmacy table and collect their prescriptions. As a nursing student, with limited clinical experience, I was absorbed by what I saw. The daily ethical dilemmas were unlike anything I had ever experienced.“I would like to be treated.” “Do you have a number?”“Non.”“Then I am sorry, we do not have enough medications for everyone…”Clinically I learned about assessing and treating different diseases and conditions, including goiters, worms, sexually transmitted infections (STIs), Anemia, and various skin infections. I was surprised by the vast number of young pregnancies (12-14 year olds), severe anemia, ophthalmic infections and young children with STIs. A young boy comes to mind; at 11 he was experiencing the tertiary stage of syphilis, namely the lack of vision and neurological function. The effects of the earthquake were still very evident. For instance, an elderly woman came in with constant ringing in her ears, a young boy could no longer respond to his name, read, or write; both effects of their brain damage. I also had opportunities to interact with the Haitians about their new president Martelly, how they felt about their government, and their hopes for the future. “Hope and faith,” our translator Charles told me, “is what gets me through. In Haiti, you must be so patient.” And yes, they are so patient, waiting calmly 8 hours at times just to be treated. They are just as hopeful, beautiful, and resilient as you have all heard, yet, there is a deep sense of loss and stagnation as the people patiently wait for their government to aid them out of this destruction. I am thankful to have had this experience, shocked by what I saw, and yet excited to find a role in helping work towards the future of healthcare in Haiti. I have found my passion, global health, and eager to find where this interest may lead me.

HAITI BLOG

Dr. Alezandre Dauphin.

I have been working in Haiti for the last 20 years providing health care to Haitians and more intensely since the earthquake; and I have seen the destruction of the core of Haiti, Port-au-Prince and its surroundings first-hand. The most powerful earthquake in 200 years hit Haiti on January 12, killing 200,000 people and affecting over 3.5 million. Lifelines to even the most basic health services were disrupted, especially for the extreme poor among whom access to especially maternal and child health care was already a problem.

Before the earthquake, mothers in Haiti faced catastrophic risks, with one in 200 mothers dying in childbirth, the highest rate in the Western Hemisphere. Even more disheartening is the situation for children with one in nine children dying before their fifth birthday. These children are fighting for their survival every day, most often against conditions easily prevented and/or treated, such as respiratory infections, diarrhea and malnutrition. The impact of the earthquake has left the people in Haiti with health care issues that are even more devastating. It encompasses now all genders and social strata with extended consequences for years to come.

Most of the indicators underlying mortality rates have either stagnated or worsened in Haiti over the last five years:

• Breastfeeding has fallen to unacceptably low levels
• Childhood immunization rates range from 10 – 40 per cent nationwide
• Malnutrition among children and pregnant women remains high
• Only 26 per cent of women have a skilled attendant at birth
• Haiti has one of the oldest HIV/AIDS epidemics in the western hemisphere

This week, leaders of G8 countries meet in Canada and maternal and child health tops their agenda. Will the G8 set out clear plans to tackle these problems in Haiti and other developing countries facing similar crises?

The priorities are clear: Enhancement of basic health care delivery, family planning, prenatal and postpartum care, assisted deliveries, treatment of diarrheal diseases in children, nutrition counseling and education (including promotion of breastfeeding) and vitamin A supplements. To succeed, all of these are to be done in a way that will bring changes that are truly irreversible and long lasting.

Half a million women die around the world in childbirth every year

Dr. Jean Chamberlain

“Half a million women die around the world in childbirth every year,” I tell the crowd at Wycliffe College in Toronto. For many, this fact may seem far-fetched in a nation where only an average of ten deaths occurs annually from childbirth related complications compared to Uganda with the same population where 6,000 mothers die. But for many of the world’s poorest nations, the high incidence of maternal death from preventable complications is a painful reality. Stephen Harper, on behalf of Canada, has remarked that “This is simply not acceptable,” and has made a commitment to address maternal and child health as a top priority initiative for this year’s upcoming G8 Summit in Huntsville, Ontario. Having witnessed firsthand the deaths of women during childbirth over and over in developing nations through my work as an obstetrician-gynecologist, my passion lies in questioning what we can do to bring down this intolerable number, and taking effective action.

The future well-being of developing nations depends on how the next generation of global leaders partners with those nations to tackle the scourge of maternal deaths. I believe the key action required is work with indigenous leaders, developing partnerships on-the-ground to bring sustainable change. This is the belief on which Save the Mothers International was founded in 2005 –a Canadian-Ugandan partnership offering a Masters in Public Health Leadership taught at Uganda Christian University, ultimately training community leaders to advocate for grassroots change in their culture to reduce maternal deaths. More than 120 Ugandan leaders, including parliamentarians, journalists, and educators, have entered or graduated from the program since 2005.

As founder and executive director, it is truly inspiring to witness the direct impact that Save the Mothers is having in the country. Earlier this year, four members of Ugandan Parliament, Save the Mothers graduates, lobbied to block a Ugandan national budget until more funds were allocated for maternal health. It is also very welcoming to hear of news that maternal deaths are down in some regions. However, we need to continue working diligently to ensure every pregnant mother gets the care she needs, regardless of her geographic or economic state.

And so my mission continues. There are plans to expand Save the Mothers International to other developing nations, starting across East Africa and then to countries in the Indian subcontinent and the Middle East. What a lucky coincidence it is that maternal health is being acknowledged at the top of this year’s G8 Summit agenda. As a keynote speaker at the G8 Youth Summit in Muskoka on June 24th, I am excited to meet these G8 Youth - young men and women from strategic countries with a great chance in their lifetime to save mothers and children, to reduce deaths that are preventable. I hope to make my mission theirs.

For more information on Save the Mothers International, please visit our website at www.savethemothers.org