Haitian Health Foundation: Going the furthest to give the most

JÉRÉMIE, Haiti — In early February, throngs of women and their children crowded together under an open tent on a hill in the village of Terre Rouge. They sat two to a chair or on the red earth, after which their village is named, waiting to weigh their babies and receive much-needed vaccinations.

Outside under the sun, another group of women sang a loud song, making charade-like gestures as if they were holding babies. They were showing the visiting Catholic journalists hosted by Cross International how they use song to learn how to healthfully deliver, nurse, and care for a child. The song conveys crucial information in a country where 500 to 1,000 women die during pregnancy; compared to the eight women who die for every 100,000 babies born in the United States.

This village is one of 104 that has food for its children and mothers who can help their babies thrive amidst famine and disease thanks to the efforts of the Haitian Health Foundation (HHF).

Dr. Jeremiah Lowney, an orthodontist from Connecticut, founded HHF in 1985 at the urging of Blessed Mother Teresa. He met her while offering his medical services several years prior in Port au Prince, where the Missionaries of Charity have a health clinic and orphanage. The story goes that Mother Teresa urged him to go to the village of Jérémie in western Haiti because of his name.

Thankfully, Lowney followed her advice and his heart. Though his intent was only to build a small chapel and dental clinic, the Klinik Pep Bondye-a now boasts a 27,000-square-foot outpatient building and residence on 10 acres of land. They can assist up to 400 people a day.

Under the capable administration of Sister Maryann Berard, a registered nurse, of the Hospital Sisters of St. Francis, HHF focuses on the neediest of the population: women and children. They have a public health program; nutritional rehabilitation; safe motherhood services; community development programs; and self-help programs to further family and community autonomy. The foundation also  responds to emergencies with humanitarian relief and works with charitable organizations like Cross International.

Recent news has focused on civil unrest in Port au Prince, but the majority of the nearly nine million Haitians lives in rural areas and they are all teetering on the brink of famine.

Haiti is the size of Maryland and has nine states. The rural income is about $300-$400 annually per capita. Haiti is the poorest country in the Western Hemisphere and exports the majority of its crops. It is located 600 miles from Florida, or only 90 minutes by plane.

The health statistics in Haiti rival the worst conditions in Africa, according to Bette Gebrian, Ph.D., a cardiac nurse who is the public health director for HHF. Gebrian, also from Connecticut, moved to Haiti because Bishop Daniel P. Reilly, then bishop of Norwich, suggested she go on a mission. It changed her life as all who work and help at HHF have been changed. She has lived in Jérémie now for 20 years, is married to a Haitian, has two daughters and speaks fluent Creole, the native language.

Gebrian is an enthusiastic and loving advocate of the HHF mission and the Haitian people. She described how health and nutrition education has had exponential results in villages where people have been starving for generations. Though the focus is on women and children, fathers and grandparents are involved also.

“We take an intergenerational approach that is 80 percent educational and 20 percent medical,” Gebrian said. “We are working to make healthcare a right and not a privilege.”

The average Haitian consumes 1,200 calories a day, even less now with inflation making the cost of rice or beans prohibitive. Currently, the cost of rice is approximately $50 for a 110-pound sack, yet most people live off $2 or less a day.

The Haitian diet consists mostly of rice, cassava, beans and maybe dried, salted cod imported from Canada. Gebrian said the cod is normally soaked and the salt is thrown away while the clean water, which also is at a premium, is kept for cooking. This process washes away the iodine and creates a deficiency that causes diseases such as goiters and developmental problems.

Virginia Polytechnic Institute developed a ground protein meal that Haitians could make out of a combination of two parts bean and one part rice or corn. It is called Akamille. When it is cooked, women will add leaves, oil and salted fish. To make it sweet, they add cinnamon, nutmeg and other spices.

“One Folgers coffee can of Akamille can feed a child for a month,” Gebrian said.

HHF established mills with funds from donors. Millers are trained to run the machinery, which cost $11,000. HHF has located mills close to larger populations of people and encouraged them to grow beans. Now, mothers’ clubs grow beans together which the mill will purchase. The foundation is currently working on distributing Akamille to outlying areas.

But the food can only go so far to sustain people.

“If you get sick you die in Haiti,” Gebrian said.

HHF combats this problem with education. The staff trains volunteers from the villages to become health agents. Gebrian said they have trained 3,500 adults and teenagers since 1999. The agents learn about health issues particular to their area. The leading cause of death for children under age five in Haiti is diarrhea, so mothers are taught how to rehydrate their babies using fluids mixed with salt that costs only pennies.

Health agents learn to recognize the signs of bacterial pneumonia and can give a child 50 cents worth of Bactrum to help cure it. This has cut the death rate by pneumonia in half, according to a 1997 Center for Disease Control study.

Potential agents are tested by putting on a show for their village where they sing and perform skits about healthcare. The whole village has to approve the person’s ability before he or she can graduate. The agents are given a cell phone in case of emergencies and to call the male nurses, who have been given motorcycles to reach remote areas.

Gebrian said that Haitian education focuses on rote learning and not problem solving. That is why health agents use song to teach people. She translated one song about diarrhea, “When a child has diarrhea they are dry, dry, dry, but I know how to fix it with Pedialyte,” followed by the recipe.

Teaching Haitian women a different way to care for their infants in the first few months of life has been a priority.

“Everybody wanted to bottle feed their babies because they see fat babies on cans of formula, but babies were not getting enough nutrition that way,” Gebrian said. “They didn’t mix enough formula in and it ended up being only white water.”

Traditionally, mothers discarded the nutrient-rich colostrum and stayed inside for 30 days after a baby was born. The mother and/or child often died. Through donors, HHF purchased a maternity emergency vehicle that has saved 200 women’s lives so far. The nurses offer prenatal and postpartum care and see about 5,000 women a year.

When Gebrian first arrived in Jérémie, she estimated that only five percent of the women breastfed their children. When she gave birth, she breastfed and showed the women how to do it. She arranged for donations of breast pumps, nursing bras, and maternity clothes, which has helped.

Gebrian said the average family has about five living children. “They have a lot of children and half may die,” she said.

The women usually give birth at home assisted by midwives since obstetricians are rare. A midwife is a respected position, but they are not formally trained because they are called to their vocation in dreams.  Often the midwife is called in from working and will have dirt on her hands. Through HHF programs, midwives are now taught to cover their hands with plastic grocery bags to deliver the infants, use shower curtains to cover the dirt floor, and use a clean knife to cut the umbilical cord instead of a dirty knife or worse, a broken Coke bottle. The bags are in lieu of plastic gloves which often tear.

Changes like that have saved thousands of lives, Gebrian said. Another life-saver has been the nail clipper. Teething babies put their hands in their mouths and get diarrhea from dirty nails. Gebrian said one U.S. church donated 10,000 nail clippers to HHF.

“You don’t know how much diarrhea that prevented,” she said.

They also teach natural family planning, which has reported a high efficacy. Health agents  teach boys and girls fertility awareness as part of a sexual responsibility program.

“No Haitian dies alone,” Gebrian said. “Everything is in your face whether its birth, death, or mental illness. If you don’t come here spiritual, you don’t stay that way very long.”

HHF sponsors 60 health fairs each month in the four counties. The woman in charge in Terre Rouge was Maude St. Rose, a health agent and determined advocate for her community. In addition to keeping her community well, St. Rose, 37, provided another important resource: she took a census. In 1997, St. Rose walked from house to house in her village to register each family in her care and keeps the list updated. Now HHF can see whether life has improved in Terre Rouge.

Education in Haiti is not free nor is it mandatory. HHF purchased L’ecole St. Pierre in urban Jérémie with money from donors. The building was formerly used for education by day and to make coffins at night. Currently 407 students attend kindergarten through seventh-grade. One class has 72 children. Students receive tuition, books, uniforms, shoes and one meal. The school costs $3 a year except for kindergarten and seventh-grade, which are $14 a year.

The foundation started a welding school for street boys to make them employable; helped found a nursing school in Jérémie and provides a clinical practicum in nutrition and public health.

“Everything HHF does involves mutual development,” Gebrian said. “We go the furthest to give the most care to people who have no care. HHF tries to strike a balance between health and development. It is community based. HHF is in it for the long haul and the development of the people. They have no expectation that anyone will do anything for them. In Creole there is a saying that it takes three rods to hold the cooking pot: the community, the providers and the donors.”

For more information about the HHF, visit www.haitianhealthfoundation.org.

For information about Cross International, visit www.crosscatholic.org or call 800-391-8545.