We have many developments to report.
In September 2011, our new RN joined the Santé Pou Yo clinic and the Haiti Village Health team. She trained in Cap Haitian, and brings her enthusiasm and sense of community to the team. Patients, their families and their respective communities have welcomed her with open arms. She has taken charge of the prenatal outreach program amongst many projects. She has also become the lead on our new postpartum outreach program. She has already become such an asset to our team, and I am sure she will continue to be in the months and hopefully years to come.
Prenatal Outreach Program:
Monthly visits continue to take place in each zone. These include:
1) Guiotin
2) Bord de Mer / Morne / Bouchi / Mongoio
3) Monben
4) We have expanded our program to include the region of Norman. Approximately 20 women were present at our first session in Norman. They were enrolled in our prenatal outreach program at this visit. All patients partook in an initial education session covering topics such as danger signs in pregnancy, prevention of STIs, prevention of malaria and cholera, and more. All received an extensive antenatal assessment reviewing past pregnancies, a review of past and current medical history, a psychosocial assessment, a review of current pregnancy - normal symptoms of pregnancy and symptoms of concern, a full physical examination, a urine screen test and a rapid hemogram screening test for anemia. All women were referred for HIV/Syphilis screening if not already completed in this pregnancy. All women were encouraged to complete their Tetanus vaccination if not already done so, and were referred to the nearest vaccination site for completion. All women received a month’s supply of prenatal vitamins, iron if needed, and a safe birthing kit if over 32 weeks gestational age. Every woman now carries a prenatal passport - which highlights issues raised during prenatal assessments and pertinent results such as HIV status, etc. - these passports aid in communication between Santé Pou Yo staff, patients and local traditional birth attendants. If needed, women were referred free of charge to our Santé Pou Yo clinic for physician assessment of medical conditions raised during the visit, or if needed, to a secondary or tertiary care centre, in Limbe and Cap Haitian respectively.
Fabrication of Safe Birthing Kits - Weekly by our Agents de Santé
Prenatal Visit Initial Education Session - Hosted by our Agent de Santé
Prenatal Assessment by our RN
In view of ensuring ongoing prenatal care to the entire region of Bas Limbe, we collaborated with a primary care clinic in Titoit. We were informed that many women received inconsistent to no prenatal care in this region. Despite last minute advertising of this prenatal day, approximately 50 women were present at our 8 am arrival. Initial goal of this day was not solely the provision of prenatal assessments as described above, but to train their nurses in the ongoing provision of these services. We welcomed my colleague Dr. Noor Ramji on this day - I thank you for your great ideas, input and hard work. Our lovely Santé Pou Yo nurse worked side by side with the nurse in Titoit to teach and train her in prenatal care. The Titoit clinic’s second nurse was unfortunately not present on this day due to personal illness. It was a long day, but I do believe great care was provided. We will continue to oversee the provision of ongoing prenatal care to the women of Titoit on a monthly basis, in hopes of having this institution run the prenatal program independently.
Titoit Prenatal Day Waiting Area
As some may be aware, Haiti Village Health has recently taken over the management of the Clinique Communautaire de Shada 2, in one of the most needed areas of Cap Haitian. We are currently in discussions and in the development phase of an ongoing prenatal care program at this site as well. Mme Bwa, a well renown traditional birth attendant, informs us that over 40 women are currently pregnant in this area, and scarcity of prenatal care is of great concern.
Shada 2 & Clinique Communautaire de Shada 2
Births in Bas Limbe
Having a birthing plan is key, and this is emphasized during the aforementioned prenatal outreach visits. As distances to a primary or secondary care centre are great, and as patient financial strains are ongoing, we aim to support current practices - and these include training of traditional birth attendants (TBAs), providing basic intrapartum and postpartum care, and facilitating transfers to birthing centres located 45-90 minutes away via our ambulance-truck (which consists of tricky and difficult roads to drive).
Training of TBAs includes monthly training sessions at Hopital Fort Saint Michel in Cap Haitian (CAP) and on-site training during Santé Pou Yo deliveries. Our nurse and physician welcome TBAs into the clinic. Santé Pou Yo personnel provides on site review of evidence-based practices.
HVH is currently in discussions with partners in CAP in hopes of hosting a formal TBA training curriculum for all 15+ Bas Limbe TBAs. An initial needs assessment was completed this October 2011, and we are awaiting final curriculum details and budget costs.
Bas Limbe Traditional Birth Attendants Accompanied by RN (centre) for Initial Needs Assessment
Postpartum Care
As is with most clinic visits, postpartum women and their newborns typically present when symptomatic only, rather than for preventative and regular care. As most postpartum women stay in the household for many weeks after birth, a postpartum outreach program is being implemented. Such a program is based on current in-country postpartum standards of care, and consists of 3 postpartum visits completed by an Agent de Santé. Many health concerns can arise in the early postpartum and neonatal period. We aim to reduce the incidence of these complications, and ensure their early recognition and management. Our nurse will run the program with our Agents de Santé. We are currently in its implementation phase, and hope to soon be able to provide new mothers with postpartum Vitamin A as well. Thanks to your knitted donations, new mothers will receive a baby blanket as they welcome the Agent de Santé into their household for this assessment.
Three Day Old Baby Born in Limbe, Treated for Neonatal Conjunctivitis at Santé Pou Yo Clinic (a condition we aim to reduce with the addition of antibiotic ophthalmic drops in distributed safe birthing kits)
Many thanks to all our hardworking personnel on the ground and to our partners.
May we stay strong and continue working towards improving the health of our communities.
Emmanuelle Britton MD CM, CCFP
Women’s Health Director
Haiti Village Health