Working Together for Change in Haiti

By Louisamène Joseph Alionat¹

To thrive, a child needs nutrition, healthcare, early stimulation, and affection, four key elements that form the basis for ATD Fourth World Haiti’s Welcome Babies program. Targeting parents and their young children under three years old, this community-based family promotion initiative operates through a team of five individuals. The team comprises two Volunteer Corps members and three young women with several years of experience working with ATD Fourth World in Haiti.

The program originated in the heart of the densely populated Martissant neighborhood, Port-au-Prince, Haiti, amid the wooden shacks where families live. Due to the political unrest and conflicts between armed gangs, it temporarily relocated to a safer space in 2006 at the Saint-Michel Health Center — a partner organization. Later on, with the establishment of a new ATD Fourth World Center, we provided a pleasant, spacious, peaceful space for the program. Nearly two decades later, many families participating in the program still come from the original area, which remains deeply impoverished. Some participants walk an hour to the center, but we also make regular home visits. This approach enables the team to familiarize themselves with the communities, reinforce connections, and engage with new families.

The Program

Program enrollment occurs in September, yet the door remains open throughout the year to receive children from the most vulnerable families, particularly those suffering from malnutrition. One morning per week is dedicated to one of three age groups: toddlers, intermediate, and older children. A fourth morning, called the Welcome Babies Nutrition Program, focuses specifically on children suffering from malnutrition, irrespective of age. They receive tailored nutrition plans and an enhanced personalized learning program, which is fundamental to their personal development.

Upon entering the center, parents find refreshments and a place to relax and wash their hands — an essential practice, given that the cholera outbreak after the earthquake in 2010 has not been entirely eradicated. Subsequently, parents and children are welcomed into a room furnished with soft mats and age-appropriate toys. Facilitators encourage children and parents to incorporate the toys into their learning. Every child progresses at their own pace. First-time participants undergo an intake process to assess their needs, expectations, place of residence, and how they became aware of the program.

Among our team of five, we share various responsibilities: preparing the room, greeting people, weighing the babies, listening, facilitating, observing, taking notes, supporting learning, preparing snacks, and cleaning the toys and the room. At all times throughout the activities, one facilitator attends to the needs of the children on the play mats. Once a month, on average, children are weighed using a hanging scale, a process of particular concern for parents when their children are underweight.

Our interactive approach with parents and children and our collaborative working methods are conveyed to the young facilitators. They are trained in motivating the children based on their age and developmental stage and, if appropriate, assisting them in reaching a healthy weight. Developmental cards featuring stimulation exercises (developed by the Center for Specialized Education (CES)) are employed for this purpose. Weekly team meetings are held to share insights from family interactions, including their challenges and coping strategies.

The story of Cecilia

In 2008, when Welcome Babies was held at the St Michel Health Center, a distressed mother arrived with her one-year-old daughter, Laura. Observing the child’s severe malnutrition, a health worker at the center asked us if we could include this mom and her child in the program. This was not the first time he referred a child in a difficult situation.

Prior to Laura’s birth, Cecilia and her husband relocated to Port-au-Prince with their three older children. Settling in a shantytown without a garden and struggling to find employment, they faced hardships. Far from their extended families, they lived a hand-to-mouth existence, finding it difficult to feed their children. The father’s health declined steadily, and they received no assistance from their unsupportive neighbors, who looked down on them.

“My child was very ill,” Cecilia² recalls. “I searched everywhere for help; I did not know where to turn. A cousin of my husband who had a child at Welcome Babies advised me to go to the St. Michel Health Center.”

We immediately invited Cecilia to join the program. Initially, she was shy and afraid. During parent introductions, Cecilia hesitated to speak, merely mentioning her age as 25 but appearing older. Some parents laughed, but we gave these parents a stern look to ensure Cecilia could continue expressing herself.

From that day on, Cecilia and her child regularly participated in Welcome Babies and the nutritional program. We provided individual and group support to Cecilia, consistently reassuring her to share her challenges and thoughts.

Encouraging parents to openly discuss topics such as self-esteem, cholera, and women’s and children’s rights, among others, involves initiating conversations that begin with seeking the parents’ perspectives and understanding on these topics. We adopt an attentive listening approach without interruptions. Our goal is to highlight points of consensus and, for certain subjects, identify the correct answers.

Gradually, Cecilia felt more comfortable. Reflecting on her journey, she expresses gratitude, “I learned to prepare a balanced meal with limited resources. Thanks to the program, I gained insights into the different types of food groups and benefited from the advice shared by the other parents. I changed because of Welcome Babies. I appreciate the facilitators showing me how to care for my child better and the parents for our mutual understanding. I learned how to treat water and the importance of washing my hands before eating. I also learned to use the toys and play with the children.”

After several months in the Nutrition Program, Cecilia’s baby fully recovered, enabling them to participate in all the activities.

Later, Cecilia had another child, a baby girl whose development differed significantly, and she could apply the knowledge she obtained from the program with this child. For example, when she went to the market, she made informed choices regarding the most appropriate foods to feed her children.

Cecilia often confided in us, sharing the challenges and humiliations she endured in her neighborhood, mainly because of the reaction of others, especially when her baby was suffering from malnutrition. At Welcome Babies, we took these accounts seriously, dedicating time to listen and understand, as we do with all parents. In support, we visited Cecilia in her neighborhood, a corner of the shantytown we were unfamiliar with. On the road, not far from her home, we sought directions from locals who expressed surprise to see people unaccustomed to the neighborhood looking for Celia’s family, “Cecilia receives people? I did not think she had friends!”

When we arrived at the courtyard of her house, we were struck by the cleanliness of the space around her small tin hut. Cecilia and her children warmly welcomed us, and this visit marked the beginning of a positive shift in her relationship with her neighbors. Our presence demonstrated to them that she had friends, was part of a program, took part in regular meetings, and actively worked to improve her baby’s health.

In 2011, we sought a location to revive the Festival of Learning³ previously held in Haut-Martissant. Due to ongoing unrest, we limited our activities to home visits and emergency response to the earthquake for several years. We wanted to be in a neighborhood that was significant to the ATD team, so we chose Cecilia’s community. The three-day event aims to bring the community together through various workshops and activities. The festival also serves as an opportunity to engage isolated families, mobilize young people, and promote inclusivity. Home visits were made to the district’s families to inform them of the festival.

During the festival, Cecilia’s children interacted with children in the community. It also became a space for children who were often isolated and kept at home to attend. A girl with Down Syndrome was thrilled to participate, and this moved us because often, children with disabilities live in hiding. After the festival, the neighbors showed increasing respect for Cecilia’s family. Before, children avoided Cecilia’s daughters, but after the festival, they played together.

As time passed, Cecilia’s confidence grew, leading her to enroll her two daughters in the ATD Fourth World Seeds of Hope” preschool program to prepare them for the start of primary school. The preschool staff acknowledged Cecilia’s positive transformation, noting her newfound willingness to engage with them.

In 2018, Cecilia said about her daughters: “They have become young ladies. They attend a reputable school and are progressing well. I have always ensured they do not miss school and that their uniform is clean! Even if we have nothing, we spend good times together, and [because of this] the sadness disappears. They take care of me, arguing over who’s doing my hair. I love my daughters, and they love me back.”

During a meeting that year, we asked Cecilia how she could help her neighbors. She responded, “Even if I do not have money, I can explain to my neighbors how to prepare medicine for rehydration, provide health advice, or encourage someone to seek medical attention. Now, my neighbors perceive me differently. Before, they criticized me instead of offering support.

Today, Cecilia is still in contact with our team, and her daughters participated in the ATD Fourth World youth group. Now it’s Cecilia’s turn to offer support to her neighbors, sharing her know-how and connecting them with services if needed.

Lessons from Welcome Babies: feedback from the seminar “We can all learn if…”

Together with Louisamène, seminar participants analyzed the actions that led to a change in the lives of Cecilia and her children. They also identified the principles of action that guided these transformative steps — undoubtedly, numerous other aspects can be recognized!

Reach out to the most impoverished families: welcome and encourage them, maintain high ethical standards and professional rigor; and be open to unforeseen challenges.

The Seminar attendees underscored the importance of carefully considering the reception of new arrivals, particularly those with urgent needs, such as Cecilia and her daughter. Cecilia arrived partway through the year, and the team could see immediately that the family was very vulnerable.

They noted that Welcome Babies pays meticulous attention to all aspects of the welfare of both mother and child. Beyond monitoring physical indicators, the team examines overall development, the child’s interaction with the environment, and the mother’s engagement with the child, other parents, and the community.

Parents’ progress is documented and updated daily. The facilitators discuss and incorporate what they have learned into their Welcome Babies sessions. This is a way to boost parents’ self-confidence and self-esteem.

Evaluate existing community support, utilize it, and develop it further

Every key stage in the family’s progress resulted from efforts made by the team to ensure that Cecilia received maximum community support. The team is always cautious not to take the place of pre-existing community connections for fear of compromising them. The delicate balance between reinforcing community ties and avoiding interference with pre-existing connections is a constant consideration. “It’s an effort because sometimes we’d like to act, to do things to be useful. But our actions could prove problematic for the person later on.”

On the other hand, the team works to amplify and strengthen this community dynamic around the children. Based on this story, the seminar participants reinforced their understanding of the connection between a child’s education and the family’s place in the neighborhood.

Frequently, in the narratives shared during the seminar, a community member guides the person towards appropriate resources. In this case, the health worker recommended the Welcome Babies program. This outcome is a product of the dedicated efforts by the Welcome Babies team to cultivate relationships and collaborate with various organizations, thereby reinforcing the support network available to families.

“In 2009, when Cecilia brought her severely malnourished daughter to the health center, Welcome Babies conducted two sessions weekly at that location. The health worker promptly referred Cecilia and her daughter to Welcome Babies, enabling seamless integration into the ongoing session. Even after Welcome Babies relocated to the nearby ATD Fourth World center, the health center continued to refer children to us.”

Additionally, fellow parents contribute support. “It is clear that in addition to partnering with their children in their education, parents also have a role in creating connections between the program and their communities. They share their experience with other parents, encouraging them to enroll.”

Cecilia’s integration into the Welcome Babies sessions emphasized creating a nurturing atmosphere, ensuring her active involvement, and preserving the freedom of expression for all participants. The broader strategy involves empowering parents by fostering a culture of shared experiences, advice, and mutual encouragement. “The fact that no one at Welcome Babies judged her was key. Joining the program allowed her to meet other parents struggling almost as much as she was. Little by little, she gained confidence. Knowing that interaction between parents is important, we ask them to share their knowledge and advice. Sometimes, we deliberately put certain people together so that within a group, a parent who is making progress can encourage others and boost their morale with a few well-chosen words.”

While Cecilia established relationships with some of her peers at Welcome Babies, the team remained conscious of the exclusion she suffered in her neighborhood. In 2011, when searching for a location to revive the Festival of Learning, ATD Haiti specifically chose Cecilia’s neighborhood. The three-day celebration, open to all, focused on ensuring Cecilia’s family felt included. Invitations were extended to all Welcome Babies participants, and community engagement was actively sought to promote openness, discovery, sharing, and enjoyment. The event aimed to forge new bonds among children while instilling a sense of pride in the community, ultimately leading to a positive shift in attitudes towards Cecilia’s family among her neighbors. “This collective action succeeded in changing attitudes to Cecilia’s family amongst her neighbors.”

Maintain a continual presence in neighborhoods and conduct regular home visits

Key moments in Cecilia’s journey included the team’s initial home visit and the decision to hold the Festival of Learning in her neighborhood. Both actions stemmed from implementing one of our essential principles: “We never shut ourselves away behind our own four walls; we get out and about frequently and visit families in their homes, in their neighborhoods. That is part of our commitment to the families we support; we visit them even if they live far away. And that is what we did in Cecilia’s case.”

Home visits enable us to see families in a new light, to get a better feel for their personalities, to understand their circumstances better, and thus establish their needs more accurately.

“The most marginalized families often experience isolation, even in their neighborhoods. No one ever visits them. Our visit demonstrated to the local community that Cecilia had connections. Her neighbors could observe that she had enrolled in a program, attended regular meetings and that her baby’s health was improving. They started to acknowledge her and, more importantly, allow their children to play with her children, which had not previously been the case.”

“We support a baby’s parent or guardian for the first three years of the child’s life. Children from the most disadvantaged families can enroll in the ATD⁴ preschool at the age of four. Over time, the parents gain more self-esteem and acquire knowledge of child development, which they can share with other parents — many do. Cecilia explains, “Sharing with others shows that you have gained confidence and makes you feel useful.” Another mother reflecting on her Welcome Babies experience, “Here, I am always shown respect. I can make friends with other mothers and laugh, which calms me down. My life is very difficult, with lots of problems to deal with. But here I find only joy!”

[1] Louisamène is a qualified community health nurse who has been working for Welcome Babies in Port-au-Prince since 2000.

[2] not the mother’s real name

[3] The Festival of Learning takes place during the school holidays in areas where we are working with impoverished families (in one or two neighborhoods concurrently). Everyone, is welcome. Lots of workshops are organized and contributions are encouraged, be they a song, a game, some personal knowledge or experience, etc..

[4] A forthcoming article will be devoted to the success of family preschool initiatives in Port-au-Prince