With the hour approaching 9 a.m. and the temperature nearing 90, the mobile women’s clinic is set to open in Nan Sab, a “habitasyon” in remote northern Haiti.
About 100 women, brightly dressed, are milling about in the hot sun. Many younger women have brought children. Others are in their 70s or older. Quite a few are ill and resting in the shade. Sick or well, most of the women have walked miles in the heat along a dirt path to see a doctor, buy medicine or get diagnostic tests.
The clinic has taken over the seaside residence of Rosie Toussaint, a gregarious 75-year-old farmer who donated her entire home for the day. Setting up the clinic is a major undertaking.
Starting at dawn, supplies are driven a short distance from the town of Borgne, floated across a small waterway and then hand-carried for miles down a long dirt road to the one-bedroom, corrugated tin roofed home. Within hours, the house is transformed into an examining room, lab, treatment center and drug dispensary.
The doors open today, as they always do, with a communal prayer and short lesson. Ben Georges, who oversees the clinics like a benevolent general, steps onto the porch to talk to the women about birth control and the importance of medication adherence. Clinic begins.
A nurse sits just inside the front door, checking the patients in one by one and taking brief medical histories.
On the front porch, Jean-Ronald Pierre accepts the fee for care, 50 cents per patient. (Those who cannot pay are still seen, but everyone seems to have the money this morning.)
Beside him is a table piled with drugs that women may receive as part of their fee – to treat HIV/AIDS, STDs, headaches, gastrointestinal upsets, blood pressure and cardiovascular disease, as well as several forms of contraception. All the women who come will be seen, and all will be treated.
Last year, about 4,500 women received care in the mobile clinics supported by WomenStrong International that rotate through the seven rural districts in the Commune of Borgne. The clinics travel out twice a week from the Alyans Sante Borgne hospital, the centerpiece of a critically important healthcare system. In a commune of 80,000, the mobile women’s clinic expect to reach even more women in 2016, but the impact of the clinics is even greater than the numbers suggest. Throughout the commune, the clinic’s regular presence has reduced the stigma attached to some diseases and encouraged more open conversations about nutrition, spacing births, reproductive health and illness. In an area where women lack much, the most important need may be for more and better information.
An elderly woman waits patiently with her friends on a bench, wearing a blue floral dress and camouflage pattern canvas hat against the sun. She has severe psoriasis and cataracts. Another woman seated nearby has brought her young son who she fears has parasites. Many children do.
An endless stream of women come into the small bedroom that has been set up with an examining table and two chairs. The room is shadowed and a curtain hangs over the door.
Dr. Herlandy Princivil, an obstetrician-gynecologist trained in Cuba with a specialization in family medicine, is doing prenatal exams with one pregnant woman after another.
Despite the heat and crush of patients, he sits a moment with each one after the examination, providing advice on nutrition and care, listening to their concerns. He tells them to stay away from sugar, carbonated drinks and suggests foods that are good for the growing baby.
He also keeps an eye out for women who may be at risk, ordering them to the hospital in Borgne where they can receive more thorough pre-natal testing and care. Experience shows that women who come to the hospital for a pre-natal visit are more likely to come to the hospital to deliver, increasing chances for a successful outcome for mother and baby.
Dr. Herlandey asks a 37-year-old woman about her plans for delivery. She has six children and has lost two in childbirth. She plans to have her baby at home.
“Why won’t you come to the hospital?” he asks.
“It’s too far,” she says, “and it’s too much trouble for my husband.”
“Well,” the doctor said, “you’re not getting any younger and each time gets harder and more dangerous.” She shrugged.
This woman had only a few miles to walk to the hospital in Borgne. Others in this mountainous area criss-crossed by steep paths littered with loose rocks must walk up to 12 miles, often in extreme heat, to reach the hospital.
A slip of a girl enters the room quietly, 16 years old and pregnant for the first time by her 17-year-old boyfriend. She is soft-spoken and frightened, but quietly defiant. The doctor tells her to come down to the hospital the following day with her parents for pre-natal testing. The following day, she does.
These mobile clinics are part of a larger network of activities run through WomenStrong partner SEE-Fanm that include Mothers’ Clubs, Girls’ Clubs, a maternity unit and nutrition center for treating malnourished women and children and a surgical unit for handling emergency and high-risk deliveries, set to open later this spring.
The clinics are an enormous success and, in a relatively short time, have begun improving the health and well-being for thousands of women, their families and their communities. The challenge now is to reach more and more women each year.