Jenna and Brittany are holding the dossiers of  the 16 students who will get the call that they have been admitted to our training program this year. Sometimes it is mind-boggling to think how this will change their lives and the lives of their families. The sad thing is that 109 applicants have to be turned down.

Why do we continue training skilled birth attendants even after the government midwifery school  reopened last fall? There were several things that helped us decide to continue to train. One is that we think it will be a long time until there are enough graduates from the government program to meet the need for around 1600 skilled birth attendants in the country.

Another is the history of brain-drain.  Every nurse-midwife we have hired to teach has left the country within one to two years. We do not think it is the nursing degree that got them to Canada. It was the money. Anyone who makes enough money in Haiti dreams of going to the U.S. or Canada. So the drain will continue to happen.There are only about 100 obstetricians in Haiti. And around 100 nurse-midwives. More than two-thirds of the obstetricians and midwives have left the country. That leaves a total of 200 skilled birth attendants left to deliver about 250,000 babies a year in Haiti. So most women do not ever see a doctor or midwife or even a nurse.

Another is that we are uncertain of the willingness of others to work in rural areas of great poverty for the same income that our graduates work. Most will want to work in the urban areas where food is less work to produce and entertainment and friends are nearby. Well, wouldn't you chose a place with electricity over one without?

The International Confederation of Midwives has decided that nursing is a necessary ingredient in the education of midwives. Because so many countries do not have a high quality nursing educational system they have recommended at least a three year program for students with no nursing background and 18 months for nurses.

Because of the recommendations, although Midwives for Haiti is the name of our organization and we accept only auxiliares and infirmieres, we mostly use the terms "skilled birth attendant" when we talk about our educational program and training. The "Core Abilities of Skilled Birth Attendants" are defined by the World Health Organization and the International Confederation of Midwives and include both the abilities to care for normal pregnancies and skills to treat and care for complications and emergencies that can occur in the childbearing year.  So even though we refer to our graduates informally as "midwives", the ICM would not approve of us using that term.

Currently our mobile clinic offers the same testing that is available at most government facilities for pregnant women. Plus education about signs of danger, breastfeeding, nutrition, dehydration, etc. And we will add Tetanus vaccinations this year. So far our graduates are working at 10 birth centers and two hospitals in Haiti.

So the most important reason we will continue our educational component one more year is that currently 49 graduates of our program are doing over 60,000 prenatal visits a year and over 11,000 births per year . Until there are enough skilled workers to take over their work with the poorest women in Haiti we will keep training. And who cares what they are called? Not the women who walk for miles to see them. Not at all.