Nearly two years have passed since the most recent earthquake hit Haiti in 2021, killing more than 2,000 people and injuring 12,000. But many communities are still reeling from the devastation. The earthquake destroyed tens of thousands of buildings and many health care facilities, including a maternal health clinic supported by Doctors Without Borders/Médecins Sans Frontières (MSF) in the town of Port-à-Piment, Sud department. The clinic was damaged beyond repair, leaving 250,000 people in the community without access to much-needed maternal health care.
This year, MSF officially reopened the clinic after rebuilding and upgrading the facility, restoring access to maternal health care in the community. The improved clinic will have enormous impact on the wellbeing of pregnant women and newborns in the area. In 2022, MSF teams assisted 700 deliveries in Port-à-Piment at the old facility. In the improved new clinic, 347 deliveries took place in the first four months of this year, including 39 caesarean sections. In the same period, 89 babies were admitted to the hospital, 40 of them to the intensive care unit.
Depleted supplies and medical staff
While the violence plaguing Haiti’s capital city, Port-au-Prince, is far away from the quiet coastal town of Port-à-Piment—about 93 miles to the west—the ripple effects are felt. Disruptions to the supply chain have led to frequent shortages of medical supplies in hospitals and clinics, and the blockage of the main fuel terminal in port of Port-au-Prince in 2022 caused dire fuel shortages in Sud province.
Many medical staff from rural areas like Sud have gone to Port-au-Prince, and many medical staff from Port-au-Prince have left the country escape the violence. The earthquake in 2021 further exacerbated the situation. Several organizations promised financial and material support to rehabilitate damaged medical structures, but efforts have been slow to materialize and few of the damaged structures have been repaired.
These factors have left the health care system in this part of Haiti in an extremely precarious situation, without enough medical supplies, staff, and facilities to meet the needs of hundreds of thousands of people. This severely impacts the health of the community, particularly pregnant women and newborns.
Confronting high maternal and neonatal mortality rates
Haiti has the highest maternal mortality rate in the Western hemisphere, with 529 deaths per 100,000 births. The neonatal mortality rate is also very high, with 24 deaths per 1,000 births. Approximately 64 percent of women don’t give birth in health care facilities, which can have fatal consequences for both the mother and the baby if complications arise. “It is fundamental that births take place with the support of health care professionals. A swift response can save the life of the mother and the baby,” said Benoit Vasseur, MSF Head of Mission, during the official opening of MSF’s new services in Port-à-Piment, February 2023.
The facility, which Haiti’s Ministry of Health and MSF run together, now has an operating room for obstetric surgery, including caesarean sections, and a neonatal department equipped with an intensive care unit. The team there also provides comprehensive sexual and reproductive health care, including contraceptive care, prenatal and post-natal consultations, and supports six health centers in towns and villages around Port-à-Piment. By collaborating with the networks of traditional birth attendants and volunteers in the community, MSF’s team tries to overcome the first hurdle in achieving better maternal health outcomes: improving the knowledge of when pregnant women should seek medical help.
Logistical challenges in accessing medical care
Many miles north of Port-à-Piment, along a dry riverbed through the mountains, lies the village Rendel, MSF’s team of medical staff and health promoters visits once a week. “Rendel is one of the six places we support with health education and promotion,” said MSF health promoter Guerline Georges. “We talk to pregnant women about the main causes of death related to childbirth, such as eclampsia or hypertension disorder, and how to detect the symptoms in order to anticipate complications and seek treatment rapidly.”
Women living in the village of Rendel also face another hurdle: being able to reach a health care facility when they need medical care. The Sud department is sparsely populated, which means health care facilities can be far away for some women. Often the roads are in poor condition, and transportation is expensive.
In Rendel, the dry riverbed that is used as a road fills up with water during the rainy season. It can take the women living in mountain villages inland from the coast six or seven hours to reach a health care center on foot. Sadly, women in labor have died while walking to a health center, succumbing to the complications of delivery before reaching the medical facility. To address these issues, MSF teams are installing referencing committees in different villages, to facilitate transport for women in labour. MSF also runs an ambulance service with four-wheel drive vehicles converted into ambulances.
The organizational difficulties of the referral system
Alexis Leone lives in Rendel. “Four years ago, when I was pregnant with my first child, doctors told me that I should go to the hospital if I experienced any pain,” she said. “I did not feel well so I walked to Port-à-Piment for a consultation. My blood pressure was too high, and I was transferred in an ambulance to a hospital one hour away where I gave birth. They told me that I would have probably died if I had stayed in Rendel.”
The referral from MSF’s previous structure in Port-à-Piment to another hospital saved Alexis’s life, but MSF noticed that organizing these referrals had become more difficult, as health care facilities in the region were struggling to provide life-saving services due to lack of supplies, staff, and other issues. This is one reason why MSF upgraded the facility in Port-à-Piment. Now, the clinic in Port-à-Piment offers more high-level care, including caesarean sections and blood transfusions directly on site. This is a major improvement for people living in and around Port-à-Piment.
Enormous medical needs remain for women and children in Haiti
The volume of patients receiving care at the MSF facility demonstrates the enormous needs of women in Sud province. Many health care facilitiesn other towns and villages in the area, such as Coteaux and Roche-à-Bateau,were also destroyed in the earthquake but have not been rebuilt. In Coteaux, for examples, health care workers have to operate in a training center because the local health care center is still in ruins.
To reduce high maternal and neonatal mortality rates, much more needs to be done. Every pregnant woman should be able to deliver with a trained health professional in an appropriate structure with the needed supplies. Other organizations must step up their assistance, beginning by delivering on promises made after the earthquake in 2021. They must also increase their support to fund salaries of additional health care workers in remote areas. It’s the only way to improve the survival chances of pregnant women in this area of Haiti.
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