Joudeline Bien-Aime, 14, was just five months pregnant when she was rushed to hospital after her water broke.
CATHERINE PORTER/THE TORONTO STAR
HINCHE, HAITI—You can hear the screams from outside the rusted gates.
Shrieks and pleas to God pour out of St. Thérèse Hospital to the dirt road where the smiling guard sits in his uniform. He swings open the gate for a burstingly pregnant woman in a white nightie riding the back of a roaring motorcycle taxi with her hands cupping her pubic bone.
Follow the sound to its source, around the corner and through the doors, and you find four women lying on worn leather birthing beds, their swollen bodies exposed for all to see. The white plastic shower curtains around each bed hang limply to the side, making way for the ebbs and flows of midwives, nurses, nursing students, midwifery students and a single, tall man in a white lab coat — the only doctor.
A wall clock is stuck at 7:23, although it’s now 10:45 a.m. Beneath it lays the coiled body of Joudeline Bien-Aimé, 14. She is five-months pregnant. Her cervix is dilated to seven centimetres.
“I’m so scared, wahhhh,” she wails, tears washing down her face. “I can’t hold it any longer. Oh Jesus, Father deliver me . . . ”
Her baby was not planned. Nor, perhaps, is it wanted. Her father, a poor tenant farmer with a gaunt face and coat-hanger-thin body who waits outside, says the father is their neighbour — a grown man with two children.
Joudeline was set to be the first in their family to finish grade school, he says. The principal kicked her out of Grade 6 when her pregnancy became apparent.
Her baby wasn’t due for another 14 weeks. But this morning, while brushing her teeth, her water broke.
The baby is in a bad position. Instead of being head down, it is lying across her womb like a bridge. But it is so small, says ever-smiling Dr. Rosemont Celestin, it should have room to turn.
Another woman bursts into the room, baby in arms, the umbilical cord looping down between her legs. She clambers onto a birthing bed across from Joudeline, the flock of nurses, midwives and now Dr. Celestin settling around her.
Emergencies jockey for attention every day in the birthing room at St. Thérèse. Most weeks, 30 babies are delivered here. Most weeks, seven are stillborn and at least one dies soon after birth. Mothers sometimes die, too. The No. 1 killer is eclampsia — high blood pressure that mysteriously appears at breathtaking rates in Haiti during pregnancy. (By one expert’s estimate, one in five pregnant Haitian women will develop it, compared to one in 20 in Canada.) No one knows why. The constricting blood vessels can trigger seizures, causing both mother and baby to die. While a drip of magnesium sulfate will lower hypertension for a few days, the only real treatment is to deliver the baby. So in Hinche, the midwives regularly induce women early. If the baby is nearing term, it will likely live. If it is younger than 34 weeks, it will likely die.
Joudeline’s baby is only 26 weeks old.
There is no equipment to keep premature babies alive at St. Thérèse, and even if there were, staff couldn’t turn it on. Despite being only 40 kilometres from Haiti’s biggest hydroelectric dam, the only power comes via generators. The hospital’s main generator failed three months ago. The government has promised and promised and promised to fix it, but nothing changes. In the meantime, the operating rooms sit empty.
The taps in the hospital don’t work. There is no running water, despite a U.N.-built cistern. A truck delivers a barrel of water to the birthing room every so often, but it is nearly dry. The staff revert to hand sanitizer.
For patients, this means no bathroom. Pregnant women are instructed to bring a bucket, along with sheets, drinking water and food. Most squat over the bucket by their beds and then dump the waste in a field behind the hospital.
These conditions have nothing to do with the earthquake that shattered the country’s capital 20 months ago. Cradled in Haiti’s central plateau, three hours north of the destruction, Hinche and its public hospital were untouched. The lack of electricity and water are normal for the town of 50,000. And, believe it or not, the women who give birth at St. Thérèse are lucky.
As a public hospital, the service and the medications — when there are some — are free. The staff are professionals, trained at university and college and supported by a couple of American nonprofit organizations. Most Haitian women give birth at home, attended by matrones — untrained birth attendants — most of whom arrive equipped with only a razor blade, a piece of string and Latex gloves. The result: more women die during childbirth in Haiti than in any other country in the Western Hemisphere. A lot more. For every 100,000 live births, 630 Haitian mothers perish — more than triple the number of mothers in Bolivia, which has the next-worst maternal mortality rate, at 200 per 100,000. In Canada, only seven die.
Haiti also holds the regional record for infant mortality. More than 60 of every 1,000 babies born die soon after birth, compared to five in Canada.
The baby who has just arrived is fine — her umbilical cord cut, she is swaddled in a blanket and left on a scale on the counter behind Joudeline as Dr. Celestin massages her mother’s belly to deliver the placenta.
“Oh me Jesus, Jesus,” howls Joudeline, twisting her mouth into a knot. Sweat drips down her nose. The ceiling fans don’t budge. The room is hot. A nursing student dressed in a little white hat and pleated white skirt reluctantly fans Joudeline’s face with a piece of paper, checking over her shoulder at her giggling classmates.
Nurses in Haiti are technicians, putting in intravenous lines and needles. They are not trained to comfort. Family members are expected to bathe, feed and soothe their loved ones. But since no family members are allowed in the birthing room, a girl like Joudeline will confront her body’s breaking point without so much as a kind hand on her shoulder. A dozen people surround her but she is utterly alone.
Finally, a midwife appears and pours water from a pitcher over Joudeline’s face and neck. Another administers a needle to slow her contractions. “Don’t worry. You won’t die,” she says.
But she might. Something has changed. “There’s a chance she won’t be able to deliver the baby,” Dr. Celestin tells me. Her uterus could rupture. She needs a caesarean section.
“If I had an operating room ready, I’d let her stay here to the last point. . . .” Before the generator died, he averaged 30 C-sections a month. They tried to continue without air-conditioning or fans, but during the first surgery a nurse fainted from the heat. “If I faint, I could kill someone,” Celestin says. “I’d give her a 60- to 70-per-cent chance she’ll make it,” he says, before heading out to the garden to find Joudeline’s father.
St. Thérèse doesn’t have an ambulance. To get Joudeline to the closest hospital capable of surgery, in Cange 40 kilometres away, her father will need to hire a taxi for about $40 — his month’s earnings growing corn and beans.
“Pas gan kob.” I don’t have enough money, he says, pressing his wet eyes into a cloth. He sets off to beg the regional public health director, whose office is across the street, for help.
A miracle: the director agrees to loan his personal car — a white SUV with USAID stamped on the side. Joudeline is changed out of her bloody skirt into a clean, black cocktail dress. Two midwives walk her to the hospital gates and pull her into the back of the vehicle onto the lap of a friend. We roar down the road at 100 kilometres an hour, kompas music blaring from the stereo.
The hospital in Cange, called Bon Sauveur, is famous in Haiti. Built over the past quarter-century by American doctor and anthropologist Dr. Paul Farmer, it is the model of what health care in Haiti could be. The buildings are clean and cool beneath giant trees. There is art on the walls. The toilets flush. There are guest rooms for family members and three hot meals a day. Most importantly, the hospital offers treatments normally reserved for rich Haitians who can pay — chemotherapy, plastic surgery, neonatal incubation. Recently, a child with a cancerous Wilms’ tumour was flown from here to Massachusetts General in Boston for a successful operation, and then flown back — all for free. The hospital’s $2.65 million annual budget is funded by Farmer’s non-governmental organization, Partners In Health.
We pull through the gates after 35 minutes. Joudeline emerges, wide-eyed and crying. She lies on a stretcher — two wooden handles on each side — and is carried up a steep, shaded staircase and along a winding path to the maternity building. A doctor greets her and says the operating room is full but she is next. She is taken to the birthing room to wait. Five minutes later, her baby slips out — purple feet first — surprising everyone.
A little boy. So small he fits on Joudeline’s outstretched hand. She holds him for two minutes before the cord is cut and he is whisked to the neonatal intensive care unit.
Those are the only two minutes Joudeline will ever hold her baby. Pediatricians work on her son for hours. Through a glass wall, I watch them press his chest with two fingers and hold an oxygen mask over his tiny face. He was declared dead at 9 that night, just seven hours after being born. The nurses called him a little mouse, he was so tiny.
Even in Canada, a baby born at only 26 weeks faces enormous challenges — eye damage, asthma, incomplete intestines, a weak heart. In Haiti, nothing could be done, not even at Bon Sauveur hospital.
“His lungs were not developed enough to live,” Cate Oswald, Partners In Health’s lead program manager, tells Joudeline the next morning. “Maybe God had a different plan for the baby and for you.”
Joudeline’s mouth twists into a knot, as it did during labour. She sobs. Her son’s body has left for the morgue. She can’t say goodbye. She can’t remember what he looked like. The only photo she has is the one I snapped.