Care on the margins

Grace Children's Hospital and International Child Care bring health and care to Haiti.

NILE SPRAGUE with TARA BARNES
UMW Response Magazine

When I arrived at Grace Children's Hospital in Port-au-Prince, Haiti, the open air waiting room was filled with waiting patients. Most were women and children, with occasional men mixed in. Access to quality health care is still a struggle for those living in the most impoverished country in the Americas.

Grace Children's Hospital is a project of International Child Care and supported by United Methodist Women. The organization provides services such as vaccinations, birthing kits, hospital care and counseling as well as community-building programs of integrated community health, nurses training, micro-enterprise programs and education on childbirth, hygiene, sanitation and clean water. Instead of shipping supplies from other countries, International Child Care prefers financial gifts that can be used to stimulate community economy by purchasing products locally. United Methodist Women Mission Giving supports International Child Care in this way.

A large part of International Child Care's work is going out into the community to provide care. Along with Keith Mumma, U.S. national director, and Kirsten McIlvenna, communications director for International Child Care, and a translator, we left Grace Hospital and went out into a nearby community outside Port-au-Prince. We parked the car and walked down a narrow, eroded dirt path inaccessible by vehicle or even motorbike. After a couple hundred feet we turned into a courtyard near some buildings, where a large collection of women were clustered. A group of young nurses were weighing babies and taking records.

"Many parents are unable to afford health care," said Aldones Anitchi, age 28. She has three children ages 12, 3 and 6 months, whom she'd brought to receive care. "The economic situation is a struggle. Many people in the neighborhood will bring their children for vaccinations."

The nurses are trained and supported by International Child Care, which is about to celebrate its 50th anniversary.

"My children received vaccines, and babies are weighed," Ms. Anitchi said. "They do home visits. They help us learn how to prevent disease. As parents, we apply what health workers tell us. This helps us stop our babies from getting sick."

Alberta Monpremier, International Child Care community health director, echoes Ms. Anitchi when asked about the essential services the organization provides.

"A number of health agents and nurses go into the community," she said. "They offer vaccinations, weigh babies, offer recommendations. They hold regular meetings with people in the community.

"The education they provide helps prevent diseases. Fewer children die from 

preventable diseases thanks to the vaccines. Children born from the women educated from the program are healthier because of what they learned, such as nutrition, hygiene and how to breastfeed," she continued.

Health in Haiti

International Child Care has established programs to help face the most pressing health issues in Haiti, including preventable child disease, HIV and AIDS, contaminated water, women and poverty, infant and maternal mortality, tuberculosis and malnutrition. UNICEF ranks Haiti as the country with the highest rates of infant, under-5 and maternal mortality in the Western hemisphere. International Child Care trains traditional birth attendants, also known as midwives, to help reduce mother and infant deaths not only through safe child birthing practices but through preventative care and teaching nutrition, hygiene and knowing the signs of complication in pregnancy or delivery.

"The mothers take better care of themselves. They wash hands and food before eating," said Ms. Monpremier. "The health workers teach a healthy diet and which activities to avoid when pregnant. Pregnant women learn the signs of complications."

"They encourage me to see a doctor regularly and to know what kinds of foods to eat to help me stay healthy and to help the baby develop," said Ella Lionel, 25, pregnant with her first child. She lives in Jolitrou, a village in northern Haiti about two hours from Cap Haiten. Visiting Jolitrou requires multiple river crossings, which makes it inaccessible during high water. "I learned the importance of drinking a lot of water — treated water."

Like Clara Swain, the very first health worker supported by United Methodist Women predecessor the Woman's Foreign Missionary Society, International Child Care health workers go into the community to provide care, especially where traditional health care doesn't reach or is inaccessible to residents.

Viergene Duvot is a health care worker in Jolitrou. She's been a health care worker for 20 years working with nine towns, where she sees similar problems that keep repeating.

"Being a health agent is very important because it helps save people's lives," she said. When she visits children she also checks on the mothers' health and well-being. "I do home visits and mobile clinics. Without the mobile clinics women have to get up really early and wait in line at the general hospital. My role in the community is large."

She takes people's needs to heart, she says, and makes sure she receives proper education to meet their needs. International Child Care training programs help with both supplies and training.

"It's been with the help of International Child Care that we are able to provide vaccines and reduce the loss of infant lives," Ms. Duvot said.

The need for support

Some programs in Jolitrou were recently reduced due to lack of funds.

"The loss of funding has had a big negative impact, one that has left a scar," said Ms. Duvot. "There are fewer mobile clinics, and the ambulance that International Child Care was at one time able to provide is also missed. Without the ambulance, motorcycles do their best to take people to the general hospital. We feel like a tire stuck in the mud."

Marie Huguette Charles is the nursing supervisor at Hospital Grand Riviere du Nord. Babies' cries and sounds of a busy hospital punctuate our conversation. With the help of International Child Care, the hospital was able to help train midwives, but funding for this program was recently cut.

"Because of lack of funds we no longer have the same amount of materials to provide to the midwives. They are discouraged," said Ms. Charles. "We used to meet every month, and now it's every three to four months. The midwife program saves women and children's lives, and the hygiene program helps children grow up in a safe environment."

She hopes the program will continue to be supported, and, like Ms. Duvot, hopes International Child Care will be once again able to provide essential ambulances.

"We have difficulties keeping the programs running and keeping the funding," said Josette Bijou, a physician and Haiti national director for International Child Care. "Many public hospitals are now closed. International Child Care tries to serve this population especially."

United Methodist Women members' Mission Giving helps support these essential programs.

"The resources are diminishing while the needs are increasing," Dr. Bijou said. "I thank United Methodist Women, and I consider you my sisters in the work of Jesus Christ."

Caring in and for community

The health workers I spoke with were passionate about their work and its importance.

"When I finished high school I went to nursing school to be a nurse, but I felt that wasn't enough," said Ms. Monpremier. "I decided to go to school to become a community health worker. Since I was a child I was passionate about helping the poor of my country."

"I am a physician and a specialist in public health," said Dr. Bijou. "There is a need to help. If I didn't work at International Child Care, I'd be volunteering."

A repeated theme was the need for care to go to the community, not the community to come to the care. Dr. Bijou spoke of the closing of public hospitals in Haiti. This leaves Haitians with only private hospitals as care options.

"Most of the time to go to the hospital you have to have good clothes and money," said Ms. Monpremier. "Bringing care the community helps bridge this gap."

"I see the health workers often," said Ms. Lionel, "but not always only at home — I run into them on the streets." She also trained as an International Child Care health worker for a period of time until attending school in town made it too difficult to do both. A neighbor invited her to the program.

The community health workers live up to the first word of the title.

"I have to continue the work because I cannot see my neighborhood perish," said Ms. Duvot.

International Child Care trains the workers who then educate the communities with which they work. For women, the health workers are there before, during and after giving birth.

"One of the reasons my baby is healthy is because I have been able to breastfeed with help from the clinic," said Ms. Anitchi, a single mother who has been unable to find work. Her oldest daughter must stay home because school fees are too expensive.

Preventing crises

"In the time of cholera not a lot of people in this village were affected because long before the outbreak they learned to wash their hands and use treated water," Ms. Lionel said.

Because International Child Care lives and works within the community, it knows what needs must be met as needs change or to adapt efforts to better meet needs. International Child Care collaborates with Haiti's Ministry of Health on women and children's health and has become one of its main partners, according to Dr. Bijou.

"The mission of International Child Care has evolved over the years," she said. "It is no longer just a clinic to prevent tuberculosis in children but now a general clinic for maternal and child health.

"As Haiti faces the spread of HIV, we are involved in the treatment," she continued. The organization also helped end and prevent the spread of cholera and works to prevent blindness and other pathologies, she said. It also teaches family planning.

"International Child Care listens to the health patients in the community. Because they listen they know what the community needs," said Ms. Monpremier.

This work of mutuality helps make the International Child Care and United Methodist Women partnership just one more way United Methodist Women members truly put faith, hope and love into action for women, children and youth. Listening and learning helps effect positive change, for when you educate women you educate communities.

"We are thankful United Methodist Women members care about helping those on the margins," said Dr. Bijou. "The things you do for the children you do for God."

Nile Sprague is a photojournalist based in Mendocin, California. Tara Barnes is editor of Response, the magazine of women in mission.