I recently returned from Leogane, Haiti, where I worked with an international volunteer team run by Hands On Disaster Response, a grassroots organization that helps rebuild earthquake-stricken communities. For more information, visit hodr.org.
LEOGANE, Haiti--On stretches of sun-drenched fields crisscrossed by battered cement walls, a humble concrete building stands alone in Leogane, Haiti, the epicenter of the January 12 earthquake. The entire second floor crumbled a few months ago. But on the remaining foundation of the facility, every morning, women queue up neatly on wooden benches lining a long aquamarine hallway. Inside, behind the hand-painted logo of Family Health Ministries, or "Misyon Sante Fanme Aysyen," are a few of the only people in the world who can tell them whether they're going to be okay.
The Family Health Ministries women's clinic in Leogane, a satellite facility in FHM's network of community partnerships in Haiti (other centers are operating in Blanchard in Port-au-Prince and Fondwa in the Southern Mountain region), is a tight operation that was here long before the quake and has survived just about as well as the surrounding community.
The clinic, which runs on local staff, has managed to restore its operations over the past few months. It may seem odd that intakes for preventive medical care have rebounded at a time when people are struggling for basic food and shelter. But the women who come here know the services are vital for the community's struggle to regain some sense of normalcy.
This is one of the few facilities in the whole country that tries to fully wrap itself around the cornerstone of a community's life cycle. The Safe Motherhood Initiative seeks to whittle down Haiti's appalling infant mortality rate: about 60 of every 1,000 births (nearly nine times the United States rate and unmatched in the Western Hemisphere). FHM works with local midwives to help promote safer birthing techniques and has been interviewing traditional birth attendants for field research.
The international FHM team working here today, three American women facilitating the work of a Haitian ob-gyn doctor and locally hired staff, pointed out that the goal isn't to "professionalize" the midwife workforce per se -- these birth attendants are primarily trained through an apprenticeship system -- but rather to see how their practices differ from internationally recognized standards facilitating births outside of a hospital system. "Even just having a clean razor blade to cut the cord at home" is a step forward, said Hannah Meador, an American who works with the clinic through an affiliated Duke University program. The work with midwives is complemented by GPS health resource mapping to identify available services and gaps, as well as student-coordinated "verbal autopsies" -- documentation of maternal deaths drawn from the accounts of loved ones, to help trace what went wrong, such as hypertension that went untreated during the pregnancy.
FHM and its local partners have made necessity the mother of invention on another health obstacle for poor women around the world. Long before the quake, the group was devising grassroots systems for preventing and treating the Human Papilloma Virus, which is often a precursor for cervical cancer. According to a local survey of women over a four-year period, roughly one in five screened positive for HPV. The group reports that due to a lack of preventive care, both cervical cancer rates and related deaths are extraordinarily high. In the Caribbean, cervical cancer deaths may double in the next two decades, according to international health authorities.
The clinic has played a role in seeding solutions for the cervical cancer scourge in countries with little or no public health infrastructure. One of its major innovations has been a portable "CervisScope," a compact tool designed for clinicians working in "low-resource" settings. The model will be further developed through field testing in other parts of the Global South, with the help of online donations and NGO funding. So instead of sponsoring a hungry child somewhere, you can beam over a mini-grant of $1000 to deploy the next generation of barefoot medicine in Malawi.
The clinicians and researchers here say it's actually more cost-effective to collect biopsy samples and ship them to Maryland, where a pathologist will screen the samples pro-bono. It takes longer, but it's cheaper than sending the samples to the nearest facility in Port-au-Prince. This is how things get done in Haiti. Everything inside is somehow tethered to a distant, sometimes precarious resource. A system threaded together with grants and goodwill, hinging on the booms and busts of the global economy and the ebb and flow of natural disaster.
When asked about whether Haiti may one day achieve a truly self-sufficient public health system, Missy Owen, an American nurse and FHM coordinator who has waded through the mercurial streams of international NGO funding and donor politics, remarked matter-of-factly, "Sustainability is one of the words I don't really care for."
For the women here, as well as the dozens of local staff FHM employs, the priority right now is meeting today's needs and catching up on yesterday's; tomorrow is something no one can even hope to predict. The one constant thing about Haiti is that crisis is inevitably waiting around the corner, and there will always be some, but never enough, people on the ground to help these communities stay one step ahead of the next calamity.
Cross-posted from Colorlines.