The maternity ward at St. Therese Hospital in Hinche.

On the front lines with Midwives for Haiti

Where childbirth is “women’s war”

Story and photographs by Michael Matza

HINCHE, Haiti _ Rain pummeled the ragged dirt highway outside the walled compound of Midwives for Haiti.

Inside the non-profit’s headquarters, a handful of staffers and volunteers on a medical mission from Florida thought they were in for the night after a long day providing care.

That’s when MFH education director Cindy Siegel’s cell phone rang. It was clinical director Perrine Stock, calling from the rundown public hospital a mile away where women deliver on bare gurneys unless they bring bed sheets. Buckets are their only toilets. Electricity is sporadic, and the maternity ward lacks running water.

A day earlier, a 26-year-old with soaring blood pressure gave birth to a very premature baby that died in delivery. A few hours later the woman suffered a seizure associated with eclampsia _ a major killer of women in Haiti. As her grieving relatives stood vigil outside the ward, her condition worsened.

Stock monitored her into the night. But now in this hospital that lacked even a defibrillator, her heart was failing, and Stock, who had begun CPR, desperately needed back up.

The rain had grounded the pennies-per-ride motorbike-taxis on which the midwives rely, but a Haitian staffer with connections arranged a car for Siegel and Kaleen Richards, a volunteer on leave from her clinic in Orlando.

The two joined Stock at the stricken woman’s side, but it was too late to save her. On hearing that she had died, her bereft relatives broke down wailing.

In the span of 24 hours, an expectant mother and her newborn were lost, a sadly common scenario in Haiti, where midwives liken the rigors and risks of childbirth to “women’s war.”

The country has the highest rates of infant mortality (52.2 per 1,000 live births), and maternal mortality (359 per 100,000 live births) in the Western hemisphere. By comparison, infant mortality in the U.S. is 5.6 per 1,000 live births, and maternal mortality is 24 per 100,000.

Rising to the challenge of those grim statistics is Midwives for Haiti, a 12-year-old NGO that operates on an annual budget of $750,000.

It trains Haitian nurses in maternal, neonatal and infant care; operates a mobile clinic at 22 remote sites across central Haiti; pays the $4,000-a-year salaries of 18 nurse-midwives who work at St. Therese Hospital, and administers a program that uses “teaching songs” to help matwons, Haiti’s traditional, lay birth attendants, many of whom can’t read, to memorize the protocol of safe birth practices in a country where voodoo cures are common.

Midwives for Haiti was founded by Nadene Brunk Eads, a certified nurse midwife who lives and works in Richmond, Virginia. She had visited Haiti on a one-week medical mission in 2003, during which it became clear that much more than volunteerism was needed in a country where 65 percent of births happen in dirt-floor shacks with no access to obstetric care for complications.

   In 2006, inspired by the force-multiplier effect that comes from providing an education, not just spot services, Eads started MFH. Her first class of nine student-nurses met around a blackboard under a tree.

MFH is among hundreds of non-governmental organizations delivering aid in Haiti, providing medical care, restoring the environment and helping to build schools, among other essential services.

   By 2017, 155 Haitians had graduated from the 12-month program of what came to be called the Nadene Brunk Eads School. Classes are held at the compound in this gritty town of 50,000, high on Haiti’s Central Plateau.

Thirty-two students are enrolled in the class of 2018. Their curriculum is tailored to the competencies expected of a “skilled birth attendant” as defined by the World Health Organization. It includes 800 hours of classroom instruction and 600 hours of supervised clinical training.

MFH estimates that each graduate _ almost all are women _ will care for about 2,000 babies in the course of her career.

Historically in Haiti, midwives have trained at a government school in the capital Port au Prince. The Brunk Eads School is different.

The government school attracts candidates with more resources, many of whom wish to remain in a city, or leave the country after their training, said Stock.

   By contrast, MFH candidates are selected from rural communities, with the goal of sending them back to their villages to become advocates and practitioners of skilled maternity care, she said.

   Of the first 124 MFH graduates, just two had left Haiti by the end of 2017; of 425 graduates who held diplomas from the government school in 2017, more than half had emigrated, MFH says.

MFH students pay no tuition; foundations and private donors cover their costs.

Every mother counts

   Early and continuing support has come from Every Mother Counts, the New York philanthropy founded by former supermodel Christy Turlington Burns, whose commitment stems from having had a complication that was manageable when she gave birth in America, but likely would have been fatal in Haiti.

Karen Nassi, director of programs for Every Mother Counts, calls MFH “an all-around powerhouse of an organization.” Her group began donating to MFH in 2012. Its contributions have helped pay for the training of 69 midwives, each of whom delivers about 200 babies a year in the most underserved areas of the country.

Traveling for hours on rutted dirt roads, and crossing streams in a high-clearance SUV, MFH brings its mobile pre-natal care to the remotest parts of Haiti.

It’s a bumpy 90-minute drive from Hinche to the twice-a-month clinic in Fombrun. Examinations take place in a two-room cement blockhouse that is located down a quarter-mile path over three winding brooks.

MFH staff and volunteers carry the heavy supplies and a folding table for pelvic exams to a small clearing where more than a dozen pregnant women, some of them teenagers, already are waiting. Often, more than 100 are waiting. Some are from families that grow sugar cane in small hamlets high in the mountains. It is not unusual for them to begin the hours-long trek to the clinic the night before.

The clinic begins with a recitation of the Lord’s Prayer, followed by a talk about maternal nutrition and the warning signs of problem pregnancies.

   Then one by one the women come forward, kick off their muddy sandals and step inside the blockhouse for measurements of their heart-rate, blood pressure, and weight. They squat behind the building to provide urine samples. They are tested for STDs.

After a pelvic exam, or a wellness check of a newborn, the women leave with folic acid, medication and vitamins.

Nonssant Rosemene, 23, brought her one-month-old daughter Albeth Phelanda to the clinic to be checked for a small rash on her right forearm. Back in Rosemene’s village, a matwon had treated it with a shirt button tied with thread around the baby’s wrist.

The midwives were not concerned about the classic, splotchy newborn’s rash. In all likelihood, they told Rosemene, it would clear up on its own. Culturally sensitive to the new mother’s traditional beliefs, however, they left the button tied to the baby’s wrist.

   Mobile clinic nurse-midwife Philomene Thelemaque was already an experienced mother when she graduated from the MFH program in 2009. Her youngest child is three; her oldest are 19-year-old twins.

Despite all that she knew about childbirth from personal experience, she said, her MFH training was transformative.

   “Right now,” said Thelemaque, “I am a person who can save a life.”

—The Haitian Times, May 29, 2018