Monday and today I rode a small 3-passenger plane to and from Jacmel. Three of us were in Jacmel to buy art for our art show this summer in Richmond. I am not overly fond of flyng - let alone in 3-passenger planes. But this morning we left Jacmel at 8:30 am and arrived in Hinche 30 minutes later and had the whole day to get some work done. Without the flight we would have had a 5-6 hour car ride and would have lost the day and been exhausted.
Landing in Hinche is always a bit nerve-racking because people, motocycles, goats, donkeys, cars, and children still use the runway to shorten their trip from the road on one side to the road on the other and there is no one to clear the strip before the plane lands. Barbed wire that was placed to create a barrier was gradually stolen. The pilot has to depend on people's ears working well and that they will hear the plane circle and get out of the way before it lands. I pray every time that no one gets killed. There are too many close calls.
During the flight I thought about how lovely Haiti looks from the air. During the rainy season it is greener than usual. It was fun to see places we have been, including the new hospital in Miribilais with its 1800 solar panels on the roof. But the reality of living in Haiti is more like the landing in Hinche - it is risky and scary. It does not matter if they build a new hospital if you would have to walk an hour to get to it and there is no midwife in your village to tell you that your blood pressure is too high and your family has no transportation but a makeshift stretcher to take you there when you start seizures.
Sometimes I feel the same way about our program. It looks good from the distance but in reality we have so many problems to solve before it is truly a model of a way to get skilled care to the women who do not live near hospitals. We have our mobile prenatal clinics but have no birth centers in those villages. Most women we see for prenatal care are still going to deliver without skilled care. We will prevent many seizures, preterm births, and post-partum hemorrhages by the preventive care and screening for risk that we do in these clinics. But the reality for pregnant women in rural Haiti is that the landing, the birth, is scary and risky. In rural Haiti 83% of women will not have skilled care for their delivery- even with a state of the art hospital one hour away.
What good does it do to build a hospital with state of the art equipment and well-trained staff with an ambulance parked outside unless you have established rural clinics around it that screen for risks and teach danger signs? You can offer free care for HIV positive pregnant women but who is going to test the women just down the road and over the mountain unless they walk to the hospital for a half a day or two days for HIV testing?
Research has shown it takes 3 very important things to save the lives of mothers and babies: 1) a skilled birth attendant during pregnancy and birth, 2) transportation when things are not going well to 3) a well-staffed and equipped hospital that can deal with emergencies. Partners in Health and their many generous donors have built the hospital. Now we have to work on the first part- training skilled birth attendants and putting them to work in rural villages. This is where "the rubber hits the road". Without this mothers and babies will continue to die in rural Haiti.