LOVELY'S HAITI: ANOTHER CRISIS, ANOTHER MIRACLE
Haiti's hospitals remain threadbare five years after the 2010 earthquake. Can Lovely's mother, pregnant and desperately ill, survive the search for help?
Catherine Porter / Toronto Star Order this photo
World Bank economist
FERMATHE, HAITI—I am racing Rosemene Meristil to the country’s premier maternity hospital in my rental car, begging her not to die en route.
She sits in the back seat, eyes closed, resting her throbbing head against the car window.
Her blood pressure is 240/140 — deep into stroke, heart attack and liver-failure territory. (Normal blood pressure is 120/80.) It’s been that high, or close, for four days, since she was admitted to the mission hospital near her home.
She has a severe case of pre-eclampsia — high blood pressure during pregnancy that is a major killer of women in Haiti.
I had just dropped in, by chance, when a doctor burst into her room, chart in hand, and declared in Creole: “We can’t keep you here. We need to get that baby out, but we can’t do that here right now.”
Rosemene is seven months pregnant. Sitting up weakly in bed, she’d asked if they shouldn’t wait for the urine test results to come back. She’d just paid for them.
“Would you prefer to wait for the results and die?” said Dr. Tania Ramilus. “Or just lose that money ...”
The hospital’s single ambulance was broken. Ramilus offered to call one from the country’s new free service. But its central yard is located near the airport — at least 1.5 hours away.
“She could have a seizure at any minute,” said Ramilus.
Rosemene’s husband Enel, younger brother Arnold and I grabbed her meagre belongings and rushed toward the exit, and my rental car. But Rosemene calmly held back in the darkened, bare room.
“Jesus,” she said in Creole, closing her eyes and stretching her arms out like the cross. “Please protect me.”
It had been five years, plus one day, since the earthquake cleaved her already broken country into pieces, killing as many as 300,000 but sparing her family. Now, Rosemene was praying for another miracle.
In the car, I reach back with my damp hands to find hers.
I don’t believe in miracles. But I am praying for one now, too.
The biggest miracle in Rosemene’s life came on Jan. 18, 2010 — six days after the magnitude-7.0 earthquake.
That day, neighbourhood men slammed through the jumbled layers of her old crumpled apartment building and pulled out the dusty body of her eldest child, Lovely.
Just 2 then, she had survived the pressure of two stories of concrete, plus six days without food or water. The Greek doctors who examined her at a makeshift medical clinic were amazed: no broken bones, no gangrenous wounds, just long-term malnutrition.
Miracle child. That’s what they called her.
Since then, the miracles have continued.
Now 7, Lovely is the first in her family who can read. In Grade 3, she has already had more schooling than both her parents combined.
The family escaped the dangerous slum for the safer, cleaner mountain countryside 40 minutes southeast of the capital. There, they rent as big a home as they have ever known — two rooms, with an outdoor privy, and even intermittent (stolen) electricity that powers a single light bulb.
Like many Haitians, Rosemene’s family has clawed their way up from the ranks of the extremely poor (defined by the World Bank as living off $1.55 a day) onto the ledge of the simply poor ($2.98 a day).
But the improvements have come not from international development or Haitian government programs, but from international remittances — in this case, from Star readers and me, moved by Lovely’s story. For the past five years, we have paid for school tuition and a tutor (for Lovely, her little brother Jonathan and three cousins), the family’s rent and hospital tabs.
According to the World Bank, extreme poverty in Haiti has declined from 31 per cent 15 years ago to 24 per cent now. Lead economist Raju Singh credits most of those improvements to better-paid jobs in Port-au-Prince after the earthquake and a huge increase in remittances that last year added up to one-quarter of the country’s GDP, or $2.5 billion, according to the International Monetary Fund.
“Going forward, the big question is how much of this progress is … built on sand and will reverse quickly if things don’t go well,” Singh says.
“Most of the households are still clustered around the poverty line.”
What happened to the $8.9 billion (U.S.) pledged five years ago by the international community to help Haiti “build back better,” after debt was forgiven and the rubble cleared away? What of the donors’ promises to step off the worn path of donor-directed aid and follow a new, country-led plan?
What of the Haitian government’s grand plans to transform the country’s threadbare, mostly private systems into a coherent safety net, including public housing, education and subsidized health care?
There has been some progress, particularly in education. But mostly the government plans and donor promises of co-ordination have withered. Five years after the earthquake, 89 per cent of the money pledged by Haiti’s biggest donors, and earmarked for development, has been dispersed, with no sign of more to come.
“One should not expect donors to fund programs indefinitely,” Singh says.
“The donors should not be seen as the bad guys, going out. The (country) is going back to normal assistance rates from before the earthquake.”
In other words, this is as good as it gets.
One week before, Rosemene had stepped through the rusted metal gate of her yard to find me — surprise! — sitting with her three children.
Her phone was broken, so I hadn’t alerted her to my pending arrival.
But the real surprise was for me. Her belly protruded unmistakably. During my regular phone calls from Canada, she had said nothing.
“I was embarrassed,” she explained. Two years ago, after giving birth to her third child, Ananstania, she had vowed to never get pregnant again.
This pregnancy was an accident, she said. After Ananstania swallowed some charcoal, she had rushed her to hospital and spent three days there. During that time, she forgot to take her birth control pills.
“Enel cried when he found out I was pregnant,” she said. “So did I. I didn’t want any more kids. We don’t have the means to take care of them.”
My frustration quickly turned to concern when I noticed her swollen feet. She had just returned from a prenatal checkup. There, the mission hospital nurse had diagnosed her with pre-eclampsia and told her she would need a caesarean section, which they couldn’t do.
“Did they refer you somewhere?” I asked.
“Non,” she replied.
I emailed the mission’s administrator, whom I’ve known for years, to find out if this was normal. He called me the next morning: send her back.
The Baptist Mission Hospital is set on the edge of an emerald mountain, tucked behind its impressive stone church.
Built by American missionaries to treat the region’s poor, it is equipped for basic procedures but not emergencies. There is a blood bank, an X-ray machine, an understocked pharmacy and two operating rooms used for planned procedures by private specialists.
Patients pay for medical procedures and medication, which quickly add up, even at a subsidized rate. A caesarean section, for instance, costs $372 — three-quarters of the annual rent for Lovely’s new living quarters.
After Rosemene’s 15-day-old nephew died at home five years ago, having never seen a doctor, I opened an account here for the family with Star readers’ money.
Two days later, the hospital’s medical director, Dr. Jean-Claude Bernard, briefs me on Rosemene’s case.
He plans to control her blood pressure with medication and bed rest until the baby has developed to term, so that it does not require an incubator, which the hospital does not have.
Then, he will schedule a caesarean with an obstetrician.
The only real treatment for pre-eclampsia, anywhere in the world, is to remove the baby.
“It depends on how she responds to the medicine,” says Bernard. “What worries me a bit is the baby. If there is too much pressure on the cord, (the baby) will die.”
If the situation becomes “an emergency emergency,” he will transfer her to another hospital for an immediate caesarean.
For two days, Rosemene does not respond well to the medication.
Bernard prescribes a different medication, not stocked by the hospital pharmacy. Rosemene’s brother Arnold takes local buses to the city centre in search of it. Arnold, like most Haitians, can’t read basic Creole, let alone the names of chemical ingredients written in French.
He brings back the wrong medication.
By day four, Rosemene’s blood pressure is even higher.
This is an “emergency emergency.”
The story of maternal mortality is a bellwether for the country’s progress during these past five years.
Before the earthquake, more women died during childbirth in Haiti than anywhere else in the western hemisphere. A lot more. For every 100,000 live births, 680 women perished — more than triple the number in Bolivia, which had the next worst chance of survival (200 per 100,000).
In Canada today, only 11 die.
Haiti’s rate was so high because most women gave birth at home.
They didn’t go to public hospitals to deliver babies for three reasons: there wasn’t one nearby; they couldn’t afford the fees; and, even if they scrounged up the money, the treatment was lousy.
If they made it to the country’s general hospital in downtown Port-au-Prince, let’s say, they would find broken equipment, no medication or supplies, and often few doctors, since they were paid terribly and irregularly. Patients had to pay for everything from surgical gloves to Tylenol, fetched from a private pharmacy. (Only 10 per cent of the population had health insurance.)
When the earthquake destroyed much of the general hospital, many Haitians considered it a mercy killing. They had long considered it the place you went to die.
The country’s post-earthquake health-care plan was ambitious. It aimed not only to build modern facilities but to establish a universal health-care system, starting with the most vulnerable Haitians.
Donors would have to stop funding only their pet projects, and direct money into a government co-ordinated plan.
“That hasn’t happened,” says Dr. Jean-Luc Poncelet, head of the World Health Organization in Haiti. “The trust in government is not there.”
Five years later, donors have built many new public hospitals around the country, including one in Gonaives constructed with $10 million from Canada.
But the government cannot afford to operate them, and certainly not for free. According to the Ministry of Health’s budget, during 2011 and 2012, the ministry had only $58 million to cover salaries, supplies, electricity ... There was one prominent standout.
In 2011, the Canadian government committed $20 million for free health-care services for pregnant women and their babies at 17 public Haitian hospitals. That money covered the operating costs for some 71,000 deliveries over three years.
By 2012, the country’s maternal mortality rate was cut almost in half to 380 per 100,000 live births.
The UNDP and WHO credit the Canadian-funded program.
However, the three-year program ended last year, and the Canadian government did not renew it — despite our government’s much-publicized commitment to improve maternal health in the developing world.
Since then, most of the hospitals have stopped offering free services.
St. Catherine’s hospital in Cité Soleil went from delivering 400 babies a month to 15, says Oliver Schulz, chief of mission for the emergency medical organization Médecins Sans Frontières.
“That was such a great program,” he says. “It’s such a pity it ended.”
Asked why Canada stopped the funding, Ambassador Paula Caldwell St.-Onge offered this explanation: “Canada is reviewing its long term strategy in Haiti, ensuring we have sustainable results and it’s accountable to taxpayers.”
The review was launched two years ago by then-International Cooperation Minister Julian Fantino, who stated he was concerned about lack of progress and corruption in Haiti. The review has also included aid coordination, according to staff in the Canadian Department of Foreign Affairs, Trade and Development.
But aid has not been frozen: 3 projects were launched by Canada in Haiti in 2014 for a total of $50 million.
Haiti’s premier maternity hospital, run by Médecins Sans Frontières, is located in a busy inner suburb of Port-au-Prince called Delmas.
To get there, we descend the winding, two-lane highway, which skirts cliffs and giant mansions protected by barbwire-topped walls and armed guards.
Five years after the earthquake, Haiti continues to be one of the most unequal places on the planet. While 60 per cent of the population survives like Rosemene on dollars a day, the rich live like Donald Trump — drivers, servants, pools, vacations in France. The richest 20 per cent of households reap 64 per cent of the country’s income, says World Bank special envoy Mary Barton-Dock.
They own the country’s scant factories and businesses, few of which pay for electricity. According the International Monetary Fund, only 42 per cent of the country’s electricity output is billed, and less than one-third is paid for — sapping the government of about $249 million a year.
The disparity, most days, is infuriating. But this afternoon, as we stop behind one dump truck after another, it seems criminal. The trucks are hauling construction material for new mansions. As we wait for them to turn, the minutes march by dangerously.
Finally, the car reaches Petionville, the Rosedale of Port-au-Prince, where midday traffic is perennially at a standstill.
We nose forward, my hand still gripping Rosemene’s behind me. “Breathe,” I say aloud, mostly to myself.
We nudge past the newly expanded Kinam Hotel, where President Michel Martelly held frantic meetings with political opponents for a week. The talks failed, parliament folded and Martelly is now ruling by decree.
The instability is scaring away investments and tourists, the two key planks of Martelly’s economic strategy.
“We risk years of progress in Haiti to be once again rolled back,” former prime minister Laurent Lamothe wrote in a January op-ed in the Miami Herald.
That progress, however, has not helped people like Rosemene.
She is not simply the victim of poverty and a weak state, though.
She was the one who got pregnant, after all.
And, her husband bungled the family’s best chance to get out of poverty. Two years ago, he got a motorcycle, a month of driving lessons, plus some cash to start a motorcycle taxi business, all from Star reader Paul Haslip. Had he succeeded, he might have earned $36 a day — five times the country’s minimum wage.
Instead, he crashed the motorcycle three times, and he has returned to irregular jobs, working on construction sites for $5.30 to $8 a day.
Neither he nor Rosemene takes responsibility for the failure — they think a neighbour put a voodoo curse on the bike.
This upsets me, because I expected them to be financially independent by now. But I realize, again and again, development is not a science and humans are not perfect. And also: what well-paying jobs can two illiterate people hope for? Rosemene has always said her life is tethered to poverty. It’s Lovely she hopes will rise.
I crane my head from the car’s front seat to watch Rosemene. She is praying silently to herself, eyes still closed.
In my head, I offer my own plea bargain to the cosmos: Take the baby, but please leave Rosemene here. She is the family’s poto — central pillar. If she dies, her family, including Lovely, will be lost.
Finally, we pull before the brown gate of the MSF maternity hospital — its sign so weathered, I can hardly make out the agency’s familiar logo.
It feels like we have been driving for days. I check my phone: 49 minutes.
A guard waves us through the gate into the hospital courtyard. Rosemene steps out of the car and slowly walks through the entrance.
“She’s lucky to be alive,” an intake nurse tells my translator.
The MSF maternity hospital, called CRUO, is another reason Haiti’s maternity mortality rates have recently declined.
From the outside, it doesn’t look like much. It’s built entirely of shipping containers.
Inside, it is the exact vision of the Haitian government’s now-defunct health-care plan.
Arrayed around an inner grass courtyard are operating rooms, a stocked pharmacy, a neonatal intensive care unit full of incubators and patient rooms. Some 350 people work here full-time, including 13 surgeons. All services are free.
Each month, on average, 600 pregnant women arrive, most in dire condition, like Rosemene.
She spends the night crying, vomiting and being checked by doctors.
By morning, when I visit, her face is terribly swollen. She has two IVs dripping medication, one in each arm. A mask covers her mouth and nose, pumping oxygen.
“It’s touch-and-go,” her husband Enel tells me quietly by her bedside.
“The doctors say they have to choose between her and the baby.
Happily, that doesn’t happen.
The afternoon after she’s admitted, Rosemene gives birth to a boy.
He is her latest miracle.
The doctors were able to reduce her blood pressure and induce labour with Pitocin, so she didn’t require a caesarean.
She names him Zachary, after the biblical character and Roman Catholic saint. He weighs only 3.1 pounds. Rosemene holds him for only a few seconds before he is whisked to intensive care, where he will stay for likely a month.
Peering through the glass into the neonatal intensive care unit, I see his little heart beating through his tiny rib cage. Miracle.
But miracles cannot build a family or a country. Haitians need jobs. They need a stable government, and international donors that follow one co-ordinated plan for long-term development.
“One thing we constantly forget — why Haiti is in this situation — it’s not because of lack of funds. It’s because there is no state,” says Poncelet of the WHO. “The best health protection is a functioning state.”
Even this glorious hospital is not permanent. Médecins Sans Frontières is an emergency organization, flying doctors in and out of conflict zones. It could pull out at any time and has no long-term plan to shift operations to the Haitian government, which couldn’t maintain the hospital’s $7-million (U.S.) annual budget anyway.
Perhaps we were the ones expecting miracles. With just $1 billion more than what Toronto city hall spends in a year — $10 billion — we expected this poor, destroyed country to assemble the social safety net Canada took decades to construct.
And with a little money and some free schooling, I expected a poor, illiterate family to bounce into the middle class.
In its most recent report on Haiti’s reconstruction, the IMF cites more “realistic expectations” for the country’s transformation from fragile state to one with “moderate institutes.”
Best-case scenario: 15 to 30 years.
Worst case: 59.
In the meantime, I count Rosemene’s life and that of her new baby as a blessing.