When faced with a choice of going to a public hospital where poor care is common, many women are opting to self-medicate and see traditional midwives instead. Health professionals are working to increase awareness and improve care.
PORT-AU-PRINCE, HAITI — Dressed in a blue doctor’s coat, she fidgets with the stethoscope that hangs around her neck. Medical reports are scattered on the large desk in front of her and she stares at her computer, frustrated and tired.
Michouta Lafleur, 42, head of maternity service at a public hospital in the capital city, is both overwhelmed by the number of women who have come in for prenatal care and worried about those who she knows need the care, but won’t come in.
“Large numbers of women don’t seek prenatal care during pregnancy here,” she says.
In 2005, experts estimated that half of Haitian women had access to prenatal care. But a lot has changed since then, Lafleur says. From the 2010 earthquake to rising poverty rates and a growing food shortage, fewer women are seeking medical services, she says, adding that more-recent statistics are needed to quantify the problem.
“I don’t want things to go on like this. Quite frequently, women wait to seek medical help until the very last minute,” Lafleur says. “This presents complications likely to endanger their survival and that of their babies. And yet, routine prenatal visits have the potential to avert risks.”
Challenging financial circumstances and traditional beliefs are often blamed for the fact that many women do not seek care or go for checkups during pregnancy in this Caribbean nation.
In villages throughout the country, women take herbal remedies and seek guidance from older women who have become midwives, often without formal training. But there are other causes, too.
Haiti’s health centers are few and far between, and the medical sector is notoriously unstable, with frequent strikes and low-quality care from underpaid doctors among the common complaints.
According to the 2012 “Haiti Mortality, Morbidity and Service Utilization Survey,” 63 percent of women give birth at home.
Dr. Jerry Augustin, 29, has been a general practitioner for three years. He sits on the scientific committee of the Université Notre Dame d’Haïti and works for the maternal and child health care program, Jhpiego Haiti. He says low rates of prenatal care are the result of a complicated combination of factors.
“Women’s nonadherence to prenatal care is not only a matter of education, but also relates to poor services in hospitals,” he says.
He places blame, ultimately, with the government.
“Low budget allocations to the health department appear to be at the root of all the problems,” he says. “Doctors are frustrated at work because they get low pay from the government. And pregnant women are fragile beings. So once they’ve been treated with contempt, they’ve been deterred from seeking medical help,” Augustin says.
An internal medicine doctor at a government facility earns 3,500 Haitian gourdes ($56) a month, while a resident doctor gets 7,000 gourdes ($112) a month. But payment from the government is often late, sometimes as much as four-months late, Augustin says.
Dr. Johnny Pierre, a resident doctor employed by the public health ministry, says he is hopeful that a newly introduced wage structure will boost pay for an internal medicine doctor to as much as 10,000 gourdes ($160) and that of resident doctor to as much as 14,000 gourdes ($224) a month.
But the time frame for receiving those new wages is unclear.
“Unfortunately, it’s been almost five months, and we’re yet to get our pay. In any case, there is no assurance that the promised pay raise will come true in our lifetime,” Johnny Pierre says.
Low pay affects doctors in numerous ways, Augustin says.
“If health professionals aren’t economically stable, how can they be mentally and emotionally stable? And yet, they need to be stable to provide appropriate care to some patients,” he says.
There are other challenges many pregnant women face, says Nadège Innocent, 36, who has been a prenatal care nurse for the past two years.
She says the health system has failed to live up to its mission to protect the health of the population, especially the vulnerable.
“Even if a woman attends prenatal care appointments, she will always have difficulty finding her prescribed medications,” Innocent says, noting that prescription medication is both expensive and often hard to find.
Marlene Dorestant, a 40-year-old merchant and mother of two, says public hospitals are never her first choice for care.
“Services in public hospitals are disgusting,” she says.
Woodjina Pierre, 22, recently gave birth at a public hospital in Port-au-Prince. She says women can’t be expected to rely on formal health care in Haiti because the medical sector is unstable, which makes it more difficult for women to have access to quality services, prompting them to choose to have a home birth or seek help from traditional birth attendants.
“Public hospitals are always on strike, and people travel long distances to health centers. As if that were not enough, nurses and doctors treat us as good for nothing,” Woodjina Pierre says.
She says a common attitude here is that it’s better to stay home rather than spend a whole day waiting for poor services.
“So what, then, would be the point of going to the hospital if you know full well that they will yell at you in front of everyone? And to add an insult to injury, the service is very slow. This is why I self-medicate with tablets or take traditional remedies whenever I don’t feel well,” Woodjina Pierre says.
From behind the heap of files on her desk, Lafleur acknowledges the challenges present, but says she chooses to focus on increasing awareness about the importance of prenatal visits.
“We must do everything we can to change the current situation, especially among illiterate women, because timely medical care will help save many lives,” she says.
No sources in this story are related.
Sylvestre Ndahayo, GPJ, translated the article from French.