Prenatal outreach at the market

Prenatal outreach at the market

The midwife helps a mother lister to her baby's heartbeat at the weekly market

I could see, last week that there were many pregnant women at the market.  The question is why none of these women were not coming to the clinic for prenatal care.  It has been my experience, in Haiti, that women like and want prenatal care.  I have seen hundreds of women walk for hours and wait in line all day for care.  The question is why do these women not come to the clinic for prenatal care.   What are the barriers and how can they be overcome? 

I decided that perhaps going to them might help and so we pack up some supplies and head to the weekly market.  We find a tin market table and cover it with rice bags and a sheet.  We arrange the educational charts I made and begin to do blood pressures and hand out a weeks worth of prenatal vitamins.  I find baby heartbeats with a stethoscope and try to let them listen.  There are brochures that say the care is gratis and when it is. 

I watch the pregnant women flock to the table.  The newly graduated midwife, who is from the community and was a health agent, is hesitant.  I know enough Kreyol to know she is not telling them it is free.   They tell the translator they cannot afford to come.  They are far poorer than the women who currently come to the clinic.  She is not telling them to come in a week for more vitamins and a complete check up.  I encourage her and model enthusiasm but she is quiet.   Does she not want them to come in?  Is she shy?   Is there pressure to not have non -paying prenatal mothers at the clinic?   There are lines of women all around us.    The matrons come up and kiss me and introduce themselves.   The midwife smiles at me.

The pregnant women clearly do not know about the clinic and did not know about prenatal care.  Many are eight months pregnant and have never had a blood pressure taken.  They have had no prenatal vitamins, have had no testing for serious diseases and have no emergency plan.   They live in small villages, get pregnant, and have no birth control and no money to pay for food let alone medical care.   They know if there is a serious problem, to go the hospital, which will cost them a year’s income.  

There has been no common understanding of why prenatal care saves lives, prevents long-term disability and disease and why it is a keystone to more prosperous communities.  Orphaned children, motherless children and disabled children are a challenge for any community. The cultural, geographical, historical barriers are many nut there we are.  The new midwife is passing out vitamins, the volunteers can hardly breathe for all the people wanting their blood pressure taken, and we laugh and listen to baby heartbeats.   There is a sweet excitement; a hint of possibility and hope.  

A nurse from Atlanta, Georgia buys two new brooms from the market for us to hang in the new birth room.  In Edwidge Danicott’s Claire book she describes a new broom at the birth of a baby for good luck and to sweep the mother’s belly to help the baby come out.  I had not heard this before, but I love to know these traditions and am thankful for the gift.   It is difficult to set up a room that reminds the mothers of home.    

The volunteers walk around the market looking for pregnant women and watching the heart of the community’s economy.  Someone buys cassava bread. I give the cook $10 to shop for fruits and vegetables.  Another volunteer buys the two brooms.  We pass out vitamins from Vitamin Angels and many blood pressures are taken.   The women laugh, shove, shout and shake their heads.   They listen for heartbeats and the results of their blood pressure.  Life has been hard for the oldest amongst them.  Their life expectancy is about 62.  I want to say that good, education based prenatal care will prolong their lives and make them stronger.  They can watch children so parents can work and their community can grow strong. 

At noon, we pack up and make our way down the mountainside to the clinic, passing small houses, women cooking and children returning from school.  

In the evening, after my English class, I rest on the roof with some children and watch night settles in.  There is no electricity.  Mother’s call and children try to play outdoors for as long as they can.  The burro’s call and the night sky fill with stars.  The children rest and nearly fall asleep on my lap. It has been a long, good day.

Later, I sit in the dark and make a list of why prenatal care is important.   I tell myself, “start over, go back, review, don’t take things for granted, don’t assume, walk slowly, imagine you too never had the possibility of prenatal care, be creative, be patient.”    I wonder at times if I made it all up.  I am sure that it is a standard thing that is well accepted but here I am with a solar lamp writing my list, which is accompanied by thanks for the day and a prayer for the next one.

Why prenatal care

1.     It is an important opportunity to introduce and teach positive health habits.

2.     It is an opportunity to teach women about their bodies.

3.     It allows women to benefit from essential health screenings that may impact their own health, their partners and their children including HIV, syphilis, honoree, chlamydia and many others as cost allows.

4.     It may be their first complete physical exam.

5.     It is a place to get prenatal vitamins which helps prevent anemia and birth defects.

6.     It screens for anemia and helps prevent death or disability from hemorrhage.

7.     It provides women with worm medicine to prevent anemia and malnutrition.

8.     It screens for hypertension and pre-eclampsia, which may lead to death and orphaned children.

9.     It screens for diabetes, which leads to life long health problems.

10. It prevents health problems in newborns.

11. It supports breastfeeding.

12. It helps women create safe birth plans including an emergency plan.

13. It provides malaria screening; a leading cause of maternal death and disability.

14. It screens for possible high-risk birth situations that require a mother to stay with relatives in town such as twins, breech or high blood pressure.

15. It screens for physical abuse of women.

16. It helps parent’s transition into parenthood.