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Haiti: Emergency Obstetrics in MSF's Jude Anne hospital
Although Sonja’s contractions had started and she was losing blood, the General Hospital refused to care for her because she could not afford it. In Port au Prince, the capital of Haiti, if a patient dosen’t have money for health care, they can forget about getting help. “I waited for more than three hours in that other hospital, standing in the hallway. I was in a lot of pain, I was losing blood and I was spitting up blood too. No one even looked at me. Then they came to ask me for money and I don’t have any. If this hospital wasn’t here…”, explained Sonja. By the time she finally arrived at Jude Anne, her baby was tired of waiting. She delivered her child right outside the hospital’s entrance, on the ground, in public. Every day there is a line-up in front of Jude Anne hospital, which is managed by Médecins Sans Frontières (MSF). Dozens of women come for a medical consultation and family members wait patiently until they are allowed to visit. Because of limited space, each hospital patient is allowed only one visitor. There are also women who are about to give birth. Wherever you look, in and around the hospital, you see and hear pregnant women kneeling, panting for breath, lying on the ground or leaning against a wall. They call out, wail, or cry. Petra Reijners, Head of Mission for MSF in Haiti: “We’ve only been open since March and it’s unbelievably busy. That’s not surprising, because the hospitals run by the Ministry of Health do not function. They lack staff and if they do have personnel, they go on strike. In the area around our hospital there are six fully equipped operating theatres that aren’t being used! You can get care in the private hospitals, but they are incredibly expensive. As a result, most women deliver at home. However, if they have the slightest complication they die because they cannot afford any medical care. That’s why we opened this hospital. We try to reach the women who live in the city’s violent neighborhoods.” At Jude Anne, MSF offers free medical care to pregnant women, but it is responding to such a great need that it may become a victim of its own success. Currently there are more than 30 deliveries a day in the operating room, as one cesarean section after another is carried out. “We try to limit ourselves to the complicated cases, those with high risk. There are many dangerous pregnancies. Many of them involve women with pre-eclampsia. If they aren’t helped, they will die,” explains Petra Reijners. Haiti has the highest maternal mortality rate in the western hemisphere. In 2004, for every 100,000 births, 523 women died in Haiti (compared to eight maternal deaths for every 100,000 births in Europe). But in the last two years, the statistics in Haiti have probably worsened due to the increasing violence. There are also women whose babies are breech and who cannot deliver normally. Without a cesarean section they will not survive, and without medical care at home they will die a certain death. Doctors don’t visit the poor, violent neighborhoods as the risk of kidnapping is too great. Women who perform a home abortion and develop an infection from it risk their lives when they can’t get any medical help. In Jude Anne they get the care they need, but they are often ashamed of having done their abortion and don’t dare come to the hospital. And there is more. Nelly’s story illustrates the biggest problems with living in Port au Prince: the insecurity and poverty. Nelly received a cesarean at Jude Anne and she is now recovering from the operation. But she is also recovering from everything she had to go through before she had the operation. In her arms she holds her newborn daughter Patricia (3300 grams), and her husband Patrick sits next to her bed. He looks just as haggard as she does. “My contractions had been going on for some time and I felt like it was time, but the baby wouldn’t come. She was too big. I couldn’t take it anymore”, says Nelly. “It was already late,” continues Patrick. “We wanted to go to the hospital but we didn’t dare go out into the street. We live in a neighborhood where there is shooting regularly. We’re used to the violence but at night it is too dangerous to go out.” As soon as it was light, Nelly and Patrick came to Jude Anne where Nelly had her cesarean section, just in time. Nelly and Patrick live in Bel Air, one of Port au Prince’s most violent areas. They live in the heart of the neighborhood, in a house made of corrugated metal sheets, together with the whole family: Nelly’s mother, her brother and his wife and their two children, her brother-in-law and his three children. Nelly’s sister died a few months ago. How it happened remains unclear, all that is known is that she was hit by a bullet. Not even the police want to enter the area and despite the presence of the UN blue helmet soldiers, the violence goes on. The gangs are in charge here. “We would like to live somewhere else where it is safer, but we have nowhere to go. We don’t have the money”, says Patrick with shame. “We live in stress”, says Nelly. “We live in fear and we are frustrated. But the birth of Patricia is a ray of light. She will bring us happiness.”
At each bedside, there is another story to be told. Again and again one hears about women who would have died without help. The consultations, as well as the selection of patients, are done on the ground floor of the hospital. This is done as not all pregnant women can be admitted for care. Only those who are at high risk gain entry. The others must go elsewhere to have their baby. Head of Mission Petra Reijners explains, “If a woman is about deliver, of course we don’t refuse to help her. But we have a limited capacity (59 beds).” On the hospital’s second floor, the women’s cries cut straight to the bone. Because the two delivery rooms and the operating theatre are almost constantly in use, many women have no choice but to deliver in the ward. “It’s like a factory”, says Sarah Senbeto. She is a midwife and seems to have no time to catch her breath: “So many women come here. We almost can’t keep up with it. It’s especially busy at night. The majority of our patients run a high health risk: they are pregnant with twins, they have pre-eclampsia (high blood pressure that is followed by an epileptic seizure). Sadly enough, we can only help a small portion of the women in Port au Prince. We can only save those who make it this far.” On the top floor of Jude Anne lie the young mothers with their babies. These are the women who have survived. You would expect to see only happy faces but the opposite is true. Most of the mothers are exhausted and they are worried about their babies. The mortality rate for children under age five is incredibly high. Catherine’s story speaks volumes. She has just delivered twins. “I delivered the first child, a son, at home. But the second one didn’t want to come out. It was lying sideways. In the General Hospital they refused to help me. Then I came here where they operated on me”. The second baby, a girl, did not start to breathe when the umbilical cord was cut. She also had a very weak heartbeat. Sarah Senbeto, the midwife, explains,“We were busy for more than an hour with that baby. We thought that she wouldn’t make it. Then the baby began to breathe on its own.” This was Catherine’s tenth delivery. From the nine previous ones, only five children remain alive. The twins, the boy Carlyn and the girl Carolyne, are her sixth and seventh children. But Catherine and her two infants won’t be given a party to celebrate their birth. In Port au Prince, only rich Haitians can celebrate birthdays. The overwhelming majority of the population cannot afford it. Most don’t have enough money to survive, let alone to organise such a party and presents. The young mothers’ only luxury is a special meal designed to help them regain their strength: vegetable soup or chicken with bananas. Then life, and the fight for survival, goes on.
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