Haiti’s Hope in Saint Rock
A partnership for excellence in maternal healthcare delivery
Sitting in the bed of a pick-up truck driving through the bustling capital of Port-au-Prince, Haiti, I watch as street vendors carry skewers of fried plantains parading between cars stuck in miles of traffic. Hogs sift through pyramids of trash next to decrepit buildings of equal height; brightly colored school buses repurposed as public transportation beep and holler above the hubbub of the city. The heat is abrasive — and coupled with the unregulated car exhaust fumes — forces me to breathe through my mouth as sweat starts to build at my hairline. As we exit the city and begin the ascent into a more rural part of the country — the landscape shifts to depict one-room houses with families gathered around, and surrounded by greenery, I breathe more deeply. Despite the captivating views, it is challenging to focus on anything except clinging to the metal grate that stands between me and the sidewall of a cliff.
The fifteen-year-old vehicle heaves over boulders and into potholes as it navigates up the unpaved track through the mountains. Men, women, and children watch as I pass; they are making the same journey to a small medical clinic on foot; some wear tattered footwear while others are barefoot. Upon completing the most treacherous portion of the drive, we pull into a parking lot in front of a welcoming one-story building: The Saint Rock Centre de Santé. This clinic is owned and operated by the Saint Rock Haiti Foundation, a Boston-based nonprofit, and has become a cornerstone of the community. While the exterior of the clinic is modest, its presence in the community since 2002 has facilitated monumental improvements in its members’ health and wellbeing.
On any given day, patients start to arrive at the clinic between five and six in the morning. Some will wait until eight at night because the demand for health services is so high. The small but effective medical team at the clinic consists of three physicians, two dentists, four nurses, one lab technician, one pharmacy technician, and one receptionist. The on-site services that the clinic offers stay within the realm of primary care; patients who present more serious or emergent symptoms are often referred back down the mountain to larger hospitals. Since 2002, the number of registered patients served at the clinic has increased from 100 to almost 50,000 people, expanding its reach while also underlining the ongoing challenges of accessing care in rural Haiti.
Non-medical volunteers, like me, hand out snacks and drinks to the throngs of patients waiting to be seen. Much of this waiting occurs on the clinic’s wrap around porch or in the clay driveway which is often congested due to the high volume of patients in this space. While surveying my surroundings, I try to conjure up the feeling of running a fever while sitting for hours with the tropical sun beating against my back. I similarly try (and fail) to imagine going to the doctor’s office not knowing whether I will be able to have a broken wrist x-rayed because the office may not have electricity at that time.
Given the growing necessity for services, the Saint Rock Haiti Foundation knew it would be critical to scale up the clinic in order to effectively meet the intense need within the surrounding communities. Situated on a steeply-sloped site in the region of Carrefour, the 1,800-square-foot Centre de Santé depends on a generator for electricity, receiving 4-6 hours of reliable energy on any given day. The increases in demand for services have also led staff to rethink how to better handle patient volume and flow to accommodate the need for primary care, maternal health, and HIV treatment as community members increasingly look to them for support.
That is where Build Health International (BHI) comes in. A nonprofit dedicated to improving access to high-quality infrastructure, BHI’s team has been designing and building hospitals and clinics in Haiti since 2010. BHI has partnered with Saint Rock Haiti Foundation to construct a new 14,000-square-foot primary care hospital that will address the current clinic’s limitations in temperature control, reliable energy, and physical space.
Located down the road from the current clinic, the new hospital will include a dedicated emergency receiving area; a new maternal center of excellence; mental health counseling; a dental ward; expanded facilities for in- and out-patient care; HIV treatment; and hospital administration. For the community of Saint Rock, the current clinic already represents a true-to-form lifeline. This new hospital will substantially grow Saint Rock Haiti Foundation’s current caregiving capacity, particularly when it comes to maternal and child care.
According to UN estimates from 2015, a woman in Haiti has a one in 80 chance of dying due to pregnancy or childbirth, compared to the region-wide risk of one in 510 and to one in 5,000 in the United States. Most of these deaths are preventable with access to trained birth attendants, prenatal care, and critical health infrastructure such as emergency surgery and blood transfusions. Still, approximately 60% of women deliver at home in Haiti. Many face impediments to receiving care, including lack of transportation and funds, or fear that they will be neglected or mistreated in a hospital setting. At the present time, there are four hospitals in the Carrefour region that receive and treat pregnant women, two of which are private institutions and require payment for treatment. That payment is a limiting factor for many women seeking care whose options are then restricted to just two public hospitals. These hospitals are typically concentrated in urban settings and therefore are difficult to reach on foot — the only mode of transportation for many women in rural areas.
Operating one of the few healthcare facilities in Carrefour, the Saint Rock Haiti Foundation is at the forefront of navigating those issues. Approximately 10% of all patients received at the Centre de Santé are there for pregnancy-related appointments; women are encouraged to visit at least four times throughout their pregnancy, and more frequently if their pregnancy is considered high-risk. High risk categories include pre-eclampsia, hypertension, young age (14–20), those seeking to give birth at home, and poor nutrition. Approximately 60% of women in the Centre de Santé catchment area are vulnerable to a high risk pregnancy, making it paramount that women have access to an appropriate delivery facility in their community.
That is why the new hospital will include a Maternal Center of Excellence, with a labor and delivery ward and neonatal intensive care unit beds, as well as a postpartum ward with three beds and two recliners for breastfeeding. The facility will have air conditioning, internet connectivity, and two electrical generators — one for all current needs and one for back-up in case of emergency. Additionally, the campus will include on-site dormitories for both the staff and the volunteers during their stay. There will be additional room to scale up and add a solar panel electrical system as well as overnight capacity — the ability to house patients overnight — upon the completion of the first phase of construction. The new hospital will treat up to 200 patients per day, a 400% increase from the clinic’s current capacity of 50 patients per day.
An outsider looking in might be tempted to use misinformed stereotypes — “The Poorest Country in the Western Hemisphere,” “A Hopeless Cause” — in conversations about Haiti. Lying beneath the surface of these connotations is a history of destructive and disempowering occupation on behalf of both France and the United States; the colonization of the country until 1947 crippled Haiti’s ability to fund education and healthcare systems as well as develop public infrastructure. These simplified descriptions risk eclipsing the ample amounts of progress being made and shift the blame away from external actors.
The Saint Rock Haiti Foundation and BHI are two examples of international organizations working to push the progress forward in Haiti. Over the course of the past eighteen years, the Saint Rock Haiti Foundation’s presence has remained steadfast in the community. The new hospital will proliferate the caliber of care that medical staff and volunteers can deliver and that the surrounding communities can receive, ultimately bolstering the holistic livelihoods of countless Haitians. The new partnership between BHI and SRHF will simultaneously work to decentralize the equitable healthcare options in Haiti while providing an increased quality of care over a broader range of services on an environmentally friendly and efficient campus.
Gina Goldenberg Build Health International’s Development and Communications Intern (summer 2020). She is a rising senior at Wake Forest University majoring in English and minoring in Anthropology and Bioethics.
