Through walking, I learn
A mother and her twin babies I met on my first walk in the villages surrounding the clinic. There were many pregnant mothers and babies who had never had prenatal care and were happy to hear of the two new midwives from their community.
I have come here to help an organization with the set up of a comprehensive maternal health program in rural Haiti. Like many clinics, it is contained within high cement walls with an iron gate. There is always a local man who watches over things and that is true here as well. He has been here for as long as anyone remembers and his sons live here, as well.
On Saturday morning, I walk with two sons, to the nearby school and church. I ask where the nearest water pump is and they offer to take me there. As I am scrambling up hillsides, barely passable on foot, I am thinking of one WHO requirement for a safe birth- “access to a skilled birth attendant.”
I have grown somewhat accustomed to motos but this does not seem passable even on a moto. Only one moto passes us and we never see a car or truck. I had asked to walk to the nearest pump. I had not understood how far and how difficult the walk would be. I walk and walk but still we have not come to the pump. I can not imagine that they met the second WHO requirement for safe birth “access to transportation in an emergency.” Even if they could get down off the mountain, the clinic ambulance is kept in town and so it would take an hour and a half, for transport after walking to the clinic. Women in shock or seizing can not very easily be propped onto a motorscooter and bounced over rocks.
“Just a little further.” My new friends know everyone by name and we stop to say hello at every house and sit on stools in the yard as we visit.
We pass small houses with tin roofs that are mostly isolated and not clustered. There are small, harvested patches of Congo Beans that appear as sticks bare of any currently growing leaves. They tell me they will replant when the rain begins in a few weeks. Some houses are blue plywood and show that perhaps a volunteer crew had built them. Some have outhouses and the earth houses have the added benefit of the rocks for building material. There are very few animals; a very occasional goat and one cow pen but without the cow. Most of the historic mangoes were cut for charcoal. We see a young boy busy with a machete cutting down the only tree in his yard.
In some places, in Haiti, there are rivers for washing clothes and other household chores. Here, there is no fresh water at all anywhere that I have seen. I can see that they do not meet the United Nations suggestion that all people live within an hour walk of a water pump. This is at least one hour up hill, over rocks and boulders. There are no smaller stores and the main ferry town is an hour the other direction from the clinic.
We pass babies in every yard; mothers, babies and children of all ages. I wonder how anyone came to live up here, far from the sea and fertile land. There are caves everywhere; large, craggy caves. I think, a runaway slave or Taino Indian would have made their way up here rather than being a slave or killed. Perhaps these strong people are the survivors of Haiti’s genocide; tucked in caves and rocky hillsides making a life for themselves away from mainland Haiti.
When we get to the village I can see the skeleton of a market but it is Saturday and almost nothing is for sale. Market day is Wednesday. There is a well made chicken fighting ring, a small Catholic church, a school and a rice mill. There is a World Vision compound but no one is there. “They left Haiti” I am told. There are young men, children and a red, clay clearing, which is the town center. There is a clinic building but no one to run it. There are no other buildings and most of the small houses are on the outskirts of this village.
We see a young woman in early labor who slept at the clinic the night before but when she did not have have her baby, returned home. I consider that there should be a clinic up here every week as well as a small, rural birth center. Without transport this area is remote, isolated and a dangerous walk to town for a pregnant woman. She tells me she is far more afraid of the moto ride at night than birth with a familiar and loved matron at home. She has considered her odds for living and decided home, without any life saving medicine, is safer than the road.
On the way back down, we stop at a “girl friends” home and there is an older woman with a flock of children. One toddler is on the verge of dying. I know the signs; the sores, the drooping, wet eyes and lack of any sign of life. She picks him up out of the dirt and holds him. Another child drops his plain white rice in the dirt and gobbles it up; sure that there is no replacement and that he might have to soon fight off the one turkey. I ask about MedikaMamba; a program for malnourished children but no one seems to know. I tell her to bring him to the clinic on Monday but she says she has no shoes to get there. No one is wearing shoes but I am unable to continue without mine. I got them for $4 at Goodwill and someone may have them when I leave but sadly not till then.
One in four children, under the age of five will die in Haiti. I tell the community health agent to go see him and tell her again to come down but I don’t know. Everyone is running around. His mother has left him with her and he seems mostly forgotten amongst the dirt and rocks. He is not fighting for rice. He has given up.
We make faster progress on the way down the mountain and when I arrive back, I lie down. I shut my eyes and review the barriers for women and babies, I noticed on the walk:
1. An inability to get to the clinic for prenatal care or delivery and post partum.
2. Even a nominal charge may be prohibitive.
3. A lack of water and food. A lack of topsoil for gardens and farms.
4. Children spaced too closely together may mean they are not accessing family planning.
5. Perhaps a lack of men remaining with the family.
6. Women leaving children to go work in the city; a lack of jobs.
7. Communication about the services of the clinic reaching those who need it.
8. The continued cycle of poor soil, lack of clean water and poor roads caused by the cutting of trees for firewood.
When the solar power goes on, I plug in my kindle, camera and computer deciding the kindle and a book to read was most vital. I cannot bare not to have something to read. I am in a country with no books and where only 10% of the women can read. I have just finished Claire of the Sea by Edwidge Danticut. She always helps me to see. She helps me to see the song in what I see; to hear the children playing and the women singing. She helps me to notice the blue sea and the one old mango tree that has been saved.
It grows dark and someone brings me a mosquito net and hangs it in my room. They bring me a coke and some ice. I cannot tell from where these gifts are coming but I accept them with gratitude. It is getting dark and the solar power has stopped working. Everyone stays outside as long as they can; talking, joking and maybe singing. Tomorrow is Sunday and it is a day to shine.
I can help set up a prenatal clinic but there is more; there s trying to understand what the women need to be healthy over the long run. There is the trying to understand why there is not already prenatal care and if the lack of it impacts lives, in ways no one has identified. What are the stories that impact health care and what can I learn as I set out for a walk or sit by the road, beyond the clinic gates?