While Healing Art Missions’ (HAM) Dumay primary care clinic began serving the community in 2000, we only began offering a comprehensive Safe Birthing Program in 2018. Despite offering pre- and post-natal care from the beginning, there have been many obstacles to managing actual births at the clinic; funding, physical space, the need for 24-hour care, and cultural hurdles being primary. However, in 2016 we decided the need was too great to wait any longer, and so our journey to create such a program began.
Midwife Marie Flaure with the first baby born at the Dumay Clinic.
We’ve learned over the years, when it comes to childbirth, beliefs and traditions complicate trust, and sensitive communication is key to a successful program. In rural Haiti most women give birth in the mother’s home, attended by local birthing assistants steeped in traditions, that often oppose medical science. Realizing the key to earning the trust of the community must involve locals, working with birth attendants, we decided to support the training of local nurses. As with all things medical in Haiti, there is a distinct shortage of such trained professionals such as midwives.
Fortunately, we had discovered another NGO, Midwives for Haiti based out of Richmond Virginia, that employed Haitian midwives to train Haitian nurses under the supervision of licensed American midwives in the Central Plateau city of Hinch. Our partnership with Midwives for Haiti meant the year-long training would be free of charge, but the nurses enrolled had to pass an entrance exam, and live in Hinch for their training year. This meant HAM would need to pay for a year of housing and food for the two licensed nurses we selected. Upon completion of the program the nurses would officially be allowed to function as midwives by the Haitian government.
Midwives Marie Flaure and Joel Saint-Cyr, fresh from Midwives for Haiti graduation.
Training began in 2017, and in early 2018 our two newly graduated midwives, Marie Flaure and Joel Saint-Cyr, began setting up and working out of a small office at the clinic. They took over care for the pre- and post-natal patients, using their newly learned protocols and reaching out to the community and local birthing assistants to develop trust. We also recruited the services of Dr. Emmanuel, an OB-GYN working in Croix-des-Bouquet, the closest city with 24-hour hospitals. With Dr. Emmanuel, we developed an agreement with the hospital he practices in to manage patients with complications, including those needing caesarean sections.
By the end of 2018, the newly created Safe Birthing Program had seen 488 visits and 2 deliveries. As trust developed between the midwives and community, 2019 saw a major increase to 1048 visits and 31 deliveries, and in 2020 the program continued to grow with 1113 visits, 49 deliveries. In just the first two months of 2021, the Safe Birthing program has seen 195 visits and 7 deliveries. It has become obvious that the small office dedicated to the Safe Birthing Program is insufficient to handle the patient and birth load and we need to expand.
Current workspace supporting pre and post-natal exams, ultrasound exams, Gyn exams by the weekly Ob/Gyn visits, and deliveries.
With the expansion of necessary services and programs we offered to the Dumay community since moving into the current clinic facility in 2010, we have outgrown space available inside the existing clinic and cannot fully support the needs of the Safe Birthing Program. However, several years ago we had created a large covered open-air pavilion next to the clinic, replacing the large tent put up in 2012 to address the overwhelming patient load we experienced when we became the hotspot of Cholera. The tent had since disintegrated, but we realized how important it was to have some sort of additional support space on the property to be prepared for future and emergency needs, and so we built the pavilion on the tent’s footprint. Realizing that the structural bones of pavilion would support a conversion into an enclosed space, we decided to convert a portion of the pavilion’s footprint into two delivery spaces, a consultation room and a bathroom. The remaining pavilion space will function as a waiting area and meeting space.
Construction of exterior walls for the new Safe Birthing Program space.
Construction of the Safe Birthing Program facility began earlier this year and much of the structural and exterior work has been completed, although we are still looking for funding to complete the interior work, as well as electrical, plumbing and finish work. We are hoping that by the Fall this project will be completed and ready for use.
Exterior work continues.
We are delighted at the success of the Safe Birthing Program, an extremely important and necessary addition to the overall health of the Dumay community. According the World Health Organization, Haiti has the worst health indicators of the Americas: the highest infant and maternal mortality rates. In 2013, the most recent count, only 43% of health care facilities offered delivery services and 10% provided caesarean section. Nearly two-thirds of births are unassisted by qualified obstetrics staff. Based on the number of maternal deaths reported by health institutions, the Haitian Ministry of Health estimated the maternal mortality ratio at 157 per 100,000 in 2013.
As mentioned earlier, we are currently looking for additional funding to finish construction. Completing this project will enhance our ability to safely support births in Dumay. As always, we are ever so grateful to our community of supporters in North America who have enabled HAM to successfully collaborate with the communities where we work in Haiti to provide healthcare, education and clean water.