Jhpiego Haiti: Madame Gourdet Wouldn’t Take No for an Answer
01/25/2010
Jhpiego in Haiti working to save women's lives in the aftermath of the quake
Jan. 26 Madame Gourdet Wouldn't Take No for an Answer
Jan. 25 At the General Hospital: Pregnant Women in Great Need
Jan. 23 From Petion-Ville: Undeterred by Crushed Midwifery School
Jan. 22 In Delmas, a Mother Mourns a Friend's Lost Child
Jan. 20 Debussy Street: Jhpiego's Own Opens His Home to Neighbors
Jhpiego’s Work in Haiti
Madame Gourdet Wouldn't Take No for an Answer
Jan. 26, 2010
She is the chief nurse overseeing women who give birth in Port-au-Prince's largest hospital. The conditions for pregnant women and newborns at General Hospital had so upset Marlene Gourdet (everyone calls her Madame) that she was determined to reopen the maternity ward today.
Some co-workers and others have been reluctant to enter the building in spite of five safety inspections by the U.S. military that found the building to be structurally sound for use. A tremor after the initial earthquake sent people running from the hospital and some who saw them flee have remained fearful despite the inspections.
Patients are being treated in tents on the hospital grounds. But Madame Gourdet believes that women in labor, new mothers and their babies aren't receiving the care they deserve because medical facilities are overwhelmed by patients with trauma injuries.
When Madame Gourdet meets Jhpiego's Willy Shasha, an ob/gyn, outside the hospital gates, the feisty nurse realizes she has an ally. He is working with his Haitian colleagues in the Jhpiego office in Port-au-Prince to reestablish maternal and newborn health services at the hospital, the main referral facility in the capital, and ensure pregnant women, mothers and newborns are properly cared for as Haiti copes with thousands of injured quake victims.
Madame Gourdet marches Dr. Lucito Jeannis, Jhpiego's Haiti Country Director, and Dr. Shasha, who came to work with Jhpiego's Haiti staff on a recovery plan, into the surgical tent where staff are performing emergency Cesarean sections and other major operations. "Can people work in these conditions? Dirt under their feet and in a tent?" she asks. "There is a building next door."
Today, Madame Gourdet, other hospital staff and Jhpiego's team - Doctors Jeannis and Shasha, Nurse Marie Jacqueline Jean, Baltimoreans Rich Lamporte and Anne Pfitzer - return to the building for the first time to start cleaning, organizing and preparing for a resumption of maternal services.
"Most important, we will now have three operating rooms with minimum standards to prevent infection, which is difficult to control in tents. We also have a sense of renewal, a sense of pride to get back to essential services," says Dr. Thierry LaPlanche, a Haitian medical resident who has been tending to patients in the tents until now.
"A lot of people across the hospital are watching us, watching the leadership of the maternity to recover services for the long term."
"I just want things to return to normal", adds maternity nurse Francois Francoinise.
For Madame Gourdet, re-opening the maternity ward in the hospital means delivering care safely, in a sanitary environment and with dignity. She understands why the tents were necessary - tremors have rattled the capital since the first quake hit two weeks ago. But she also knows that it is urgent to re-establish the quality and level of health care with improved facilities and enhanced infection prevention.
Jhpiego's team knows this too - the organization has worked in Haiti for 15 years to help Haitian health care professionals strengthen emergency obstetric care, infection prevention, family planning and HIV/AIDS programs. But the Jhpiego team recognizes that the pace of recovery will depend on the commitment of Haitians like Madame Gourdet to move the effort forward. Gourdet participated in a 2005 Jhpiego training on prevention of HIV/AIDS transmissions from mother to child.
"She is strong and gets the maternity staff to work," says Jean, a reproductive health advisor in the Jhpiego Haiti office. "Sometimes they complain, but know they can count on her. She has a kind heart. If she was not strong, she would not remain head of the ward."
As 30 to 45 cartons of supplies arrive from UNFPA to restock General Hospital's maternity ward, Madame Gourdet wastes little time rallying a group of Haitians to begin moving the boxes into the facility. Jhpiego was instrumental in getting the supplies delivered.
"She is a passionate advocate for women too easily forgotten in the stress of these times,'' says Shasha.
Madame Gourdet and her Jhpiego allies want to make certain that this huge relief effort creates even better services for mothers and babies.
At the General Hospital: Pregnant Women in Great Need
Jan. 25, 2010
When the Jhpiego team arrives at Haiti's largest hospital, five women have already given birth - and it's only 10:30 am. The team's obstetricians, nurse-midwife and health-care professionals are there to conduct a review of maternity services at General Hospital at the request of the Haitian Ministry of Health.
Since a massive earthquake hit Haiti last week, killing tens of thousands and injuring as many, international relief doctors and nurses have arrived to help, and the General Hospital's primary focus is now treating crush and trauma victims. That shift has left pregnant women without the expertise and specialized care they need, according to the Jhpiego review, led by country director, Dr. Lucito Jeannis.
Although women are delivering babies there, the lack of obstetricians and other personnel trained in maternal and newborn health concerns Jeannis and the Jhpiego team members, who are accompanied to the hospital on Sunday morning by a representative of the ministry of public health, Dr. Franz Montes. General Hospital is the hospital to which Haitian women with complications or special obstetrics needs would be referred.
"You've got to have those referral centers as one end of the household-to-hospital continuum. Specialized emergency obstetrical care doesn't exist there now. We have to work with the Haitians to rebuild that capability," says Rich Lamporte, a Jhpiego team member from Baltimore.
As Jeannis, Lamporte and other team members walk through the hospital, they meet two Haitian medical students who have recently returned from school in Cuba to help in the earthquake relief. They've been assigned to deliver babies.
One of the medical students is examining a pregnant woman and appears puzzled at a concave portion of the woman's belly. Jhpiego's Willy Shasha, an obstetrician, examines the woman and advises the student that the woman has a full bladder.
"A full bladder can slow the progress of labor," he tells the Haitian medical student.
The earthquake has disrupted service at the hospital in other ways. Even though the U.S. military has deemed the hospital building safe and secure, people are fearful to be under its roof and many patients are being treated in tents on the hospital's grounds, the team finds.
While touring the hospital tents, the team meets a man whose pregnant wife was injured during the earthquake and began hemorrhaging. She has been at the hospital for a day, and now doctors have decided to take her into surgery. The husband is alone and distraught.
In another case, the team approaches a woman who is complaining of pains in her stomach. The woman, who had recently undergone a C-section, vomits. The staff gives her water and tries to comfort her.
A woman who had recently delivered a baby shows clear signs of eclampsia, a high blood pressure disorder and a leading cause of maternal deaths in the developing world. Her ankles are severely swollen. Jhpiego's Anne Pfitzer talks to the woman and learns the new mother has not yet breastfed her baby; Pfitzer encourages her and gives her some tips.
Pfitzer counts six other women in labor in one of the tents.
After their tour of the hospital, the team attends a United Nations-sponsored meeting of international aid organizations that are focused on health issues. The Jhpiego representatives share their commitment to work with Haitian groups and partners to help organize and reestablish maternal and newborn health services, and provide a continuum of care from home to hospital.
"After the international relief physicians complete their important task of stabilizing the trauma victims and the trauma care ends, this is when all the primary care is needed. It is maternal health, basic health and hygiene, and prevention," says Lamporte, "and there are consequences of not addressing those issues. We work across the system to meet those needs."
From Petion-Ville: Jhpiego Team Undeterred by Crushed Midwifery School
Jan. 23, 2010
Haiti's primary school for nurses and midwives is split in two. Half of the building is miraculously intact. The other half looks like a bomb tore through it - twisted metal, blown-out windows.
More than 100 people lost their lives there when the earthquake hit last week.
"I have to tell you it's really heartbreaking,'' Jhpiego's Anne Pfitzer says, in a telephone call from Port-au-Prince. "You can see the bus - it's completely crushed by rubble."
The school's operations matter when you are trying to ensure Haiti's pregnant women, newborns, mothers and infants are getting the care and treatment they need in the aftermath of a devastating earthquake.
Today is the first opportunity for Jhpiego's Haiti Country Director, Dr. Lucito Jeannis, to brief his Baltimore colleagues on the state of maternal and newborn health clinics, hospitals and related sites in Port-au-Prince. Pfitzer, Rich Lamporte and Dr. Willy Shasha, an ob/gyn, arrived Friday to help the Haiti staff organize a network of services to treat and care for pregnant women, newborns, mothers and infants who often are forgotten in disaster situations.
Jeannis offers heartfelt thanks for the support of his colleagues. His childhood home has been destroyed and he isn't sure just how safe his current home is. In his neighborhood alone, he says, at least 22 children have lost their parents.
"I do not know how we are living right now,'' he says, referring to the weight of sadness bearing down on Haitians.
At the meeting, the Jhpiego staff sits close to the door in the office in Petion-Ville. Tremors continue to rattle the Haitian capital and Jeannis worries that the office building in which they are located isn't structurally safe.
Marie Patrice Honoré, a nurse-midwife in the Haiti office, tells her Baltimore colleagues that she doesn't believe pregnant women are being served. "There is no primary care for them; the priority is on the wounded," she says.
"I ask myself, what if I was in labor, what would I do? I would have no answer. It's the same situation for newborns,'' she confides.
That reaffirms the reason the Baltimore team came to Haiti - to help their colleagues reestablish services for some of Haiti's most vulnerable citizens, its newborns, infants and their mothers. On their way into the capital, the team learned that the main maternal ward in a general hospital in Port-au-Prince was appropriated for crush and trauma victims. Pfitzer, a senior program manager for Jhpiego, is on her computer, trying to download a special disaster map with the locations of the hospitals and facilities so the team can identify areas most in need of mobile maternal health clinics.
Shasha is working on identifying nurses and midwives, who can be mobilized. In the 15 years Jhpiego has worked in Haiti, the organization has trained more than 1,200 health care professionals. But he is also looking for help from a local training organization whose offices are in the same building.
"They don't know who is alive and who isn't and we're going to have to work from the ground up,'' says Lamporte in a call from Port-au-Prince. "This is about helping Haitians reestablish primary care for pregnant woman and newborns."
Jeannis has been attending daily meetings of international aid groups and organizations that provide health services to help coordinate reestablishing care for the thousands in need. In those meetings, the Jhpiego team learned that the government plans to open a camp for displaced persons about 45 minutes from Port-au-Prince. It's near a maternity clinic that Pfitzer and the others visited on their way into the city with a member of the Haitian Society of Ob/Gyns.
"That clinic is sounding like it could be a really good mobilization point,'' she says.
Helping restore health-care services to pregnant women, mothers and infants is why Pfitzer and her colleagues traveled to the earthquake-shattered capital.
Tomorrow the team begins narrowing the search for the right location for a maternal mobile health clinic.
"Amidst the rubble, life goes on. Women will give birth. Children will be born," says Shasha.
In Delmas, a Mother Mourns a Friend's Lost Child
Jan. 22, 2010
They still cannot find my friend's little girl. She is under the rubble. She is two years old, the same age as my son. Last night I dreamed that the little girl was still alive. I'm hoping, but there is no hope. It was a five-story building and they only found the body of the grandmother. How can I comfort my friend, how can I comfort her?
Marie Flore Trevant, Jhpiego's office administrator in Port-au-Prince, is camped out in the courtyard of her mother's house in Delmas. Her immediate family survived last week's earthquake that rocked Port-au-Prince. Her home in a nearby community received minimal damage. She has food and a generator to help the family cook but they are sleeping outdoors because they fear the next tremor will engulf them as the first engulfed thousands of their fellow Haitians.
In a conversation on Skype with a French-speaking colleague at Jhpiego's Baltimore headquarters, Flore asks about the team that is due in Port-au-Prince to help set up a clinic for pregnant women, newborns, mothers and children. She talks about the loss of close friends, the bodies in the street and the fate of Haiti's children.
When is the team coming? Tell the team to be careful because of the dead bodies in the streets. They have to be sure to protect themselves.
I get water at a camp ground at the United Nations and I have a stock of food . . . We sleep in the streets. When there is a tremor everybody runs. My little boy is very afraid. You can see it in his face and the way he acts. He is 26 months; he does not really understand. My nephews are a little older and they are always telling me, "I'm afraid to die." I tell them it's over now, it's over now.
Privately, Flore worries if it is really over.
Sometimes I swear I feel like the quakes continue all the time. Where I live there is a crack in the wall as if the earth is splitting in two and the house is lifting off the ground.
Beyond concerns for their physical safety, Flore and her family are fearful for the children. Rumors are circulating about child abductions, trafficking in orphans and desperate people using someone else's child to parlay their way out of the country.
At night, parents cannot close their eyes to sleep. They must check on their children, to keep an eye on them. On the street, I heard a woman say, she lost a child who was sleeping next to her. Ils volent les enfants! They steal children!
But the loss of life remains overwhelming for her.
Where my mother lives in Delmas it has been less touched but most houses have cracks and are ready to fall. There is a building with 10 apartments that collapsed after the quake. There are decomposing bodies in the street. We have to eat food quickly so the flies don't get to the food. Some of the bodies are picked up, other people are burning them. The ones who are under the rubble, you can't get to them. . . Where we are, in the street, the smell . . .
From time to time, we have to get out of this neighborhood. But to go where? It's everywhere the same thing.
On Debussy Street: Jhpiego's Own Opens His Home to Neighbors in Need
Jan. 20, 2010
After the earth shook violently and houses broke apart, the living walked into the street. Dr. Lucito Jeannis was among them, and thankful for it. The doctor's house on Debussy Street in Port-au-Prince was still standing but his mother's home and the house across the street and the one behind his were all damaged.
Dr. Jeannis gathered his neighbors close - they had survived the worst earthquake in a century and together they would survive its aftermath.
The risk of aftershocks - one rumbled through at 6 am Wednesday - and the fear of being buried alive under rubble kept the neighbors in the street for a week - 17 in all, pooling resources, watching out for one another, sleeping under the stars to stay safe.
"We are alive,'' said Dr. Jeannis plainly in a telephone call from Port-au-Prince. "I'm living here with my neighbors on the street. We can't live inside the houses. The houses are shaking from time to time. We are eating together; we are sleeping together; they are washing themselves at my house. My wife is cooking for all of the neighborhood. We share everything we have."
An expert trained by Jhpiego, Dr. Jeannis oversees the organization's programs in Haiti. He works with the health ministry and alongside midwives to improve the health of women and newborns in sustainable ways. In its 15 years in Haiti, Jhpiego has trained more than 400 health-care providers in maternal and child health, infection prevention and emergency obstetrics care; it has developed family planning and reproductive health initiatives and designed public health campaigns to prevent HIV/AIDS.
But since the earthquake decimated his city, killing as many as 250,000 by one official estimate, neighborhood people had sought out Dr. Jeannis because he is a medical doctor. He helped those he could and assisted a neighbor, a government doctor, who was seeing patients at her home. With few supplies and limited water, there was only so much they could do. Medication for a back ache or stomach pains, and for those more seriously injured, a referral to the local hospital.
Dr. Jeannis knew how lucky he and his newfound patients were; in the streets of Port- au-Prince, people were dying or already dead, and that was one image Dr. Jeannis could not forget, would never forget.
See a video of Dr. Jeannis at http://abcnews.go.com/Video/playerIndex?id=9607030
Jhpiego's Work in Haiti
Jhpiego has worked in Haiti for more than 15 years. During that time they have worked with local experts and trained more than 1,200 Haitian health-care workers in maternal and child health, including infection prevention and emergency obstetrics care.
Jhpiego had six Haitian staff members on the ground when the earthquake struck. All members have been found safe. A team of 3 additional Jhpiego personnel are now on the ground in Haiti to support the existing staff and work with Haiti's Ministry of Health, local experts and other governmental and non-governmental groups to organize, supply and redeploy health care professionals who can tend to the needs of pregnant women, women and newborns throughout the stricken capital. A pregnancy complication with no resources endangers two people. Jhpiego is accepting monetary donations to their Haiti Relief Fund. Help support Jhpiego's work in Haiti.
Its hard to believe that this happening in that part of the world. I am a MIDWIFE from the Gambia, studying my MPH at University of Oslo currently. My heart goes to all my coleagues in the frontiers of RCH, I WISH I WAS THERE TO DO SOMETHING….read this infromation just before my morning lectures.
— BABA NJIE on 2010-01-27