The Walrus

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Birth in the Americas’ poorest country

by Jon Evans
Field Notes · From the May 2008 magazine
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port-au-prince—There are babies everywhere, babies like tribbles, babies galore. Nine exhausted mothers and their wrinkled newborns lie sprawled across the eight cots of the recovery room. In the salle de couchement upstairs, four infants lie swaddled on a shelf while five women on five very un-private beds strain to add to their number. A dozen more mothers-to-be wait out their labour pains in a tarp-covered courtyard formerly used as a parking lot and even (in a pinch) a delivery room. The women’s moans are drowned out by a thunderous, car-sized generator. A high steel fence protects them from a street choked with diesel fumes and dust, street vendors selling sugar cane and bags of clean water, and a stream of gleaming four-wheel drives, ancient Toyotas, and public-transit taptaps painted in retina-searing patterns.

In the recovery room, Elda Cicéron, a pretty young woman in a blue dress, lies on a cot, holding her hours-old daughter, Mamaika, close. Cicéron’s eyes shine with joy. She came to the hospital this morning, delivered a healthy baby, and will depart in a few hours’ time. She looks like a poster child for development efforts in Haiti, the poorest country in the Americas, but is in fact an example of how complicated the desire to do good can become.

Médecins Sans Frontières (msf) Canada opened this facility, the Jude Anne Hospital, in March 2006. It stands in the seething heart of Port-au-Prince, Haiti’s capital, where hundreds of thousands live in cramped seas of corrugated iron shacks and harrowed, garbage-strewn dirt. The clinic’s goal at the outset was to handle 400 births per month. Within eighteen months, it was delivering almost fifty babies per day. (Mount Sinai Hospital in Toronto, which boasts Canada’s largest obstetrics program, is less than half as busy.) msf now finds itself struggling to keep up with demand at the same time as it tries to reach out to more of the women who most need its services.

“All beds are occupied every day,” says Nancie St-Preux, a thirty-seven-year-old nurse from the coastal city of Cap-Haïtien, as she makes the rounds of the hospital’s seventy-five beds for women with complications from their pregnancies. Coolly professional, she checks blood pressure, palpates abdomens, spreads gel on distended bellies, and listens to fetal heartbeats with a hand-held Doppler ultrasound machine. St-Preux is one of more than 200 medical staff performing such duties, including forty-five midwives, nine gynecologists, and four anaesthetists.

Jude Anne is so full that women such as Cicéron who have uncomplicated deliveries get only four hours to rest and recover before being discharged. When the hospital is overloaded, some women are transferred to other, fee-charging facilities. Government hospitals, for example, typically follow the American model, charging patients for every service and every medicine; few women from Port-au-Prince’s shantytowns can afford it.

“We offer free care to a vulnerable population,” says Sylvie Savard of Gatineau, Quebec, who works as msf’s financial coordinator in Haiti. It seems a simple goal, but the task is complex. In the shantytowns, home births with a local matron, less safe and sanitary, are cheaper than a trip to Jude Anne. And while the hospital doors are open to all, women from the slums can have enormous trouble getting there, particularly at night, when few vehicles dare enter their neighbourhoods. In an effort to encourage expectant mothers, msf reaches out with obstetrics education campaigns and mobile prenatal clinics, but the slums are riven by street gangs, and attempts to help are sometimes seen as taking sides.

Cicéron isn’t from the shantytowns, but rather the wealthy suburb of Pétionville, home to Haiti’s only gourmet restaurants and modern supermarkets. She could simply have gone to her local hospital, but there is terrible poverty in Pétionville as well, and the fees might have been crippling. No one begrudges her the care she received.

With demand for the hospital’s services rising, St-Preux points out that it is starting to need more space. But msf specializes in crisis response — it can’t replace Haiti’s medical system, nor does it want to. In fact, the organization is actively seeking a way to get out of the baby-delivery business. Ideally, the Haitian government — assisted by Canada’s recent aid commitment of $555 million, our largest such allocation outside of Afghanistan — would start providing free obstetric care, and indeed a plan is in the works to do so. Another option is to have a different organization take over. But in case none is found, most of Jude Anne’s medical staff are keeping second jobs.

Despite the compromises and uncertainty, the hospital remains a rare beacon of hope for Haiti’s poorest. Savard remembers the first delivery she witnessed: “I was holding the mother’s hand, she was crying and wailing, and then the baby just came out. The mother started praying, both Catholic prayer and voodoo, and then the baby started crying . . . it was just beautiful.”