By Melinda Tuhus
Friday, May 6, 2005
As the latest maternal mortality statistics show, great numbers of women are still dying in childbirth and never making it to Mother's Day. A small aid group's work in Haiti shows how a few simple, inexpensive interventions could improve that picture.
JACQUESYL, Haiti (WOMENSENEWS)--Haiti, the poorest country in the western hemisphere, has health, education, and mortality statistics rivaling those of countries in sub-Saharan Africa.
But in the village of Jacquesyl on Haiti's northeast coast, a happier story is unfolding. While its residents are very poor, they're better off than many of Haiti's 8 million people, thanks to a partnership with Marycare, Inc., a small woman-to-woman nonprofit based in New Haven, Conn.
Most of the village's 1,200 residents live in tiny, cement block, tin-roofed houses that lack electricity, sanitation and running water. Women cook their family's meager daily meal of corn mush over charcoal fires outside their homes. Whatever fruit is in season completes their diet.
Still, signs that the village is benefiting from Marycare's work are widespread. There is a new well for drinking water that is accessible to all villagers, though it doesn't fill the entire need. There is a propane-gas refrigerator to keep medicines stored in the clinic, which employs a nurse and community health educator.
There is also an invisible but even more remarkable sign of progress: Women in the village are surviving child birth like never before.
"In the past two years, no mothers have died in childbirth," says Diada Angrand, a community health educator funded by Marycare who has helped improve health care for women in Jacquesyl. "And the only baby who died was born to a mother who had attempted a self-abortion."
Marycare was founded in 1996 by three women who knew from their experience working with poor women in the U.S. that women must be at the center of programs to improve health and education and increase family income. They knew each other through their participation in the liberation theology movement in Haiti. One of the founders is Sherman Malone, a mother and social worker who first came to Haiti in 1994 with a project that matched her Catholic parish in New Haven, Conn., with that of Our Lady of Mercy in Jacquesyl.
Malone has come back at least twice a year ever since, learning fluent Creole along the way, working through the church with the village's health and education committees and the women's market cooperative.
"In 1996," Malone says, "I learned there had been 35 babies born in Jacquesyl and 10 of the babies had died and three of the mothers had died. And so it was clear that that was an emergency and the first thing that needed to be addressed."
The most recent global statistics on maternal mortality, released last week by the United Nations Population Fund, underscore how remarkable it is for the village to have lost no women to childbirth in two years.
Half a million women die every year in childbirth, according to the U.N. report. In Haiti, 7 women die for every 1,000 giving birth, or about 1,700 annually.
Marycare's work in Jacquesyl also proves the well-worn adage among public-health workers that it's relatively cheap and easy to reduce maternal mortality.
In Haiti, only 24 percent of women give birth with the help of a trained attendant. Most deliver at home, where dirt floors and no running water make home births dangerous.
With an annual budget for Jacquesyl of between $25,000 and $35,000, Marycare couldn't afford to build a hospital for all the women who give birth at home, so it put together a "safe birth kit," consisting of a receiving blanket, a new razor blade for cutting the umbilical cord, a shoe lace to tie it off, alcohol wipes and sterile gauze pads.
These inexpensive items, along with tetanus vaccination for all women of child-bearing age, have been credited with helping to prevent infections and reduce the incidence of tetanus, which many women contracted when rusty knives or broken bottles were used to cut the cord.
Marycare, according to the village health committee, is so needed because international aid to the country doesn't get to a remote village like Jacquesyl without the help of other organizations that can work in partnership with the local people.
These small successes have occurred in the context of an international aid system that, from the perspective of the supposed beneficiaries, is inconsistent and capricious. Aid from institutions like USAID and the World Bank is not always delivered as promised, or is sometimes withdrawn due to corruption or political unrest. And dollars for debt repayment flow out of Haiti faster than aid flows in. For most of the past decade, Haiti got no new aid from big international and bilateral lending institutions because it was in arrears on repayment of previous loans.
Now, after the second overthrow of democratically elected President Jean Bertrand Aristide, with an unelected interim government in power, the World Bank in January approved three new projects totaling $75 million in grants and loans for each of the next two years. USAID has also resumed aid to Haiti, pledging to provide up to $300 million over the same period for "security, budget support, immediate employment generation, elections support, democracy and human rights programs, technical advice and assets recovery," according to USAID.
But, as Malone says, "such aid is rarely focused on improving the quality of life for women and children."
Nurse Elirose Joseph says the most common health problems in the village are diarrhea, parasites, malaria, typhoid and vaginal infections.
"No one really knows how many people are HIV-positive," she says, "because very few people get tested."
On Malone's most recent trip in February, she brought test kits for HIV, malaria, syphilis and tuberculosis. AIDS treatment is available at a couple of clinics in Haiti, but they are inaccessible from Jacquesyl.
Marycare pays Joseph's salary. "To have a highly competent Haitian nurse working in the village makes all the difference in improving maternal health," Malone says.
Still, Marycare cannot address all the needs of this village.
Three women interviewed in their homes--mothers of 6, 8 and 10 children--seemed squeezed dry by life. They all told Women's eNews they're very happy that a doctor arrived in Jacquesyl for the first time last November, fresh out of a Haitian medical school.
But they said that they themselves rarely go to see him with their own complaints. Each visit costs the equivalent of 15 cents and they can't afford it.
Marycare has a fund that pays for children's visits. But so far, mothers here cannot afford to see a doctor.
Melinda Tuhus spent 10 days in Haiti in February researching this story.