Erica is a 28-year-old mother, residing in the Canaan neighborhood on the outskirts of the Haitian capital, Port-au-Prince. She survives on an informal income, selling fruit and vegetables in the city, earning between US$1.25 to US$2-a-day, depending on whether there are political protests blocking the streets or the safety of the area, which are patrolled by gangs.
She doesn’t speak of a partner or a family. She is alone lying in a hospital bed at St. Damien Pediatric Hospital, although nurses come by to monitor her condition and try to boost her morale. A few days ago, she had to have an emergency caesarean to give birth to a 35-week premature baby. The baby is currently in critical condition, while Erica awaits further surgery after a painful labor which has left her emotionally and physically exhausted.
At her last sonography, a doctor informed her about the baby’s anomaly and advised her to give birth at St. Damien where she would receive good care from experienced doctors capable of performing the labor. It turned out that the child suffered from atresia, one of the birth defects due to a stroke in an undeveloped part of the intestine. The condition needed immediate surgery. Without it, the child would die.
“She is in recovery,” says Doctor Osnel Louisma, head of the surgery ward. “Nurses are monitoring her and the baby, but things are touch and go. It is like this on a daily basis. We have dedicated staff to cope, but sometimes not enough beds.”
Usually, mothers arrive at the Rita Merli Maternity Unit to give labor. The unit delivers approximately 3,000 children per year: roughly 250 monthly, with some mothers arriving as young as 14-years-of-age. However, where complications arise such as the case with Erica, mothers have to be taken to the surgical ward to be receive specialist treatment.
St. Damien is the only hospital in Haiti with the technical platform to sufficiently treat, manage and monitor newborns and the potential pathologies, often common in Haiti. The multidisciplinary treatment involves: prenatal diagnosis, appropriate hospital delivery, admission to the neonatal care unit, resuscitation, antibiotic therapy, gastric decompensation, biological and radiological assessment, placement of venous catheter for total parenteral nutrition, surgical interventions according to the type, management post-operative and possible complications (volvulus, wound infection etc.).
“With correct and timely treatment, more than 80% of our cases are successful,” says Doctor Osnel Louima, but those diagnosed late or suffering from premature birth and carrying other malformations often leads to a bad prognosis. After the operation, these children can be fed and grow properly, but economic problems may be the cause of their malnutrition. According to World Bank, with approximately 6 million of the 11.26 million population living in poverty, poor diets and a lack of nutrition are common problems in Haiti.
The cost of maternity operations like those performed by St. Damien Hospital is out of reach for the vast majority of the Haitian population, including the upper-middle class, since the cases are not covered by local insurance companies. Doctor Osnel estimates an operation might cost between 350,000 and 600,000 Gourdes – approximately US$4,640 to US$7,955 – “Although the costs continue to increase as the devaluation of the Gourde spirals out of control, making it even more impossible for the majority of families, especially single mothers without employment, to afford such an operation.”
“We have an influx of patients which most often exceeds our current absorption capacity and adds to our very long waiting list for surgery. Patients in addition to having surgical needs also have other problems that complicate cases like malnutrition. We are absorbing more human and material resources for the treatment of illnesses and have a shortage of personnel, hence our inability to function 24 hours-a-day. For example, urgent cases received in surgery after 5pm must wait until the next day, which affects the prognosis for the children.”
Erica is devastated. Like all parents, she was hoping to give birth to a healthy child. Furthermore, she did not think the baby’s illness would be so complicated. A nurse explains that Erica hasn’t yet had time to name the baby, but for now, the surgical team have named the boy Armani, which means “warrior” in Italian.
She is sad that the child is suffering so much, but thanks to the staff at St. Damien, Erica holds hope that Armani will survive, despite the abnormality. “I don’t know when I shall be able to return home, but for the recovery of my child, I am willing to endure everything, even the toughest ordeals.”
Erica had never been to St. Damien before her arrival. She is amazed at how well the pediatricians take care of the children. Doctor Osnel reiterates that he believes Erica and Armani will pull through, but it doesn’t take away the everyday problems that the unit faces, especially during COVID-19.
“We receive a lot of requests; the needs are enormous. St. Damien is the only pediatric hospital in Haiti and we receive cases from all over the country, while the majority of the population does not have the economic means to take appropriate care of their children to ensure a clean bill of health. This is why St. Damien is so vital for the Haitian population. We represent the main, not to say the only recourse, so if special care is needed, we need adequate equipment. Unfortunately, we do not receive much help from the state, which often does not have the capacity to do so anyway,” explains Doctor Osnel.
“We appreciate all the support from donors, but your continued help is still needed. We thank you for your help, but please keep helping parents and children at St. Damien Hospital,” concludes Doctor Osnel. “You can make a difference.”
*Names of patients have been changed to protect their privacy