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The American College of Obstetriciansand Gynecologists Recognizes Konbit Santephysicians for Research in Cap-Haitien
Haiti is the poorest country in the WesternHemisphere where women are often the soleproviders in families that survive on less thanone dollar a day per capita.Just 600 milesfrom our own borders,onein five Haitian children doesnot survive to the age of eight and the rate of maternal mortality is sixtytimes greater than in the U.S — with a ratio of 670maternal deaths for every100,000 live births.At the recent nationalconference of the AmericanCollege of Obstetricians andGynecologists,colleagues EvaLathrop,MD,MPH,a U.S.OB/GYN and head of Maine-based Konbit Sante Cap-HaitienHealth Partnership’s women’s health team,and Youseline Telemaque,MD,a HaitianOB/GYN and employee of Konbit Sante inHaiti,were recognized for their researchevaluating family planning practices andneeds in northern Haiti.Lathrop andTelemaque’s research involved extensiveinterviews with both medical providers andpostpartum patients at the JustinianUniversity Hospital,the largest publicteaching hospital in northern Haiti whichhouses one of Haiti’s three OB/GYNresidency programs.“We surveyed hundreds of postpartumwomen to garner further informationregarding their experiences withcontraception,their desired family size,barriers to achieving this,desired spacingintervals,as well as barriers to usingcontraception at all,”says Lathrop.Thesurvey also queried women about their desire for contraception in the immediateand extended postpartum period,and theresponse was overwhelmingly in favor of having access to more family planninginformation prior to leaving the hospital.Census data from Haiti shows that only 25percent of sexually active women usecontraception,and 60 percent of those notusing contraception would like to do so.Not unexpectedly,the majority of womeninterviewed by Lathrop and Telemaque alsoexpressed a desire to either space or limit their pregnancies,citing profoundeconomic hardship as aprimary reason.They alsoshared misconceptions andfears – passed on throughinformal networks of familyand friends – related to thesafety and efficacy of variouscontraceptive options.“From interviews with healthcare providers we learned thatnone had any experienceinitiating family practice
It was clear to us thatthe door was open foreducation efforts at alllevels of our systemand that this traininghas the potential tomake an extraordinaryimpact from a publichealth perspective.”
AUGUST2009
“
Konbit Sante andDirect Relief International Preparefor Hurricane Season
Maine-based Konbit Sante Cap-HaitienHealth Partnership and California-basedDirect Relief International have teamed upto preposition more than $450,000 worth of critical medical supplies – the contents of a40-foot container – at the JustinianUniversity Hospital in northern Haiti.Haiti,the poorest nation in the Westernhemisphere,has a tragic history of naturaldisasters during the June to November hurricane season.Haiti is particularlyvulnerable,not only because of its Caribbeanlocation in the path of dangerous tropicalstorms,but also because of widespreaddeforestation.The first deforestationoccurred during colonial times when vasttracts of land were cleared for sugar production.Now,because of lack of affordable alternative cooking fuels,treescontinue to be cut for charcoal production,thus creating the conditions conducive tolandslides and flash flooding.In 2004,Tropical Storm Jeanne dropped 13inches of rain on the northern mountains of Haiti,causing flooding that killed more than3,000 people in the town of Gonaives andsurrounding areas.During 2008,four back-to-back storms devastated villages,homes,crops,and livestock,causing major sufferingand loss of life.The situation was made evenworse by storm-related shipping delays.After last year’s storms,road washouts causeddisaster relief as well as basic medical suppliesto take four to six weeks to reach affectedareas,despite being immediately releasedfrom donor warehouses.The country nowbraces for the 2009 hurricane season.“Having adequate supplies to provide decenthealth care is a struggle every day in Haiti,”says Konbit Sante executive director,Nate
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(Left to right) Dr.Youseline Telemaque with a healthy baby,traditional birth attendant and communityorganizer Mme.Bois,Konbit Sante
agent sante
Odile César,and Dr.Eva Lathrop talk outside Mme.Bois’house in the Shada neighborhood of Cap-Haitien.
continued next page
Donated equipment and supplies are unloaded by hand at JustinianUniversity Hospital from one of ten shipments Konbit Sante hassent to date.Healthy baby and mom in the densely-populated Shadaneighborhood of Cap-Haitien.
 
discussions with patients immediatelypostpartum,”says Lathrop,who did her OB/GYN residency at Maine MedicalCenter in Portland and is currently a FamilyPlanning Fellow at Emory University inAtlanta.“At the same time,they expressedgreat concerns about the incidence of unsafeabortions and maternal mortalities and feltthese could be reduced by improvingpostpartum family planning services.”Prevention of unplanned pregnancies is oneof the most effective approaches todecreasing maternal mortality,and thusfamily planning strategies are proposed as amethod of primary maternal mortalityprevention.Focusing on the postpartumpopulation allows women to space and limittheir pregnancies during a high risk periodfor unintended repeat pregnancy.According to Lathrop,“Family planningprograms have been successfully integratedinto other services in Haiti,specificallyvoluntary programs testing clients for HIV/AIDS,so there is every reason tobelieve that a family planning program cansuccessfully become part of the postpartumservices offered at the hospital and other centers providing maternity care.”Lathrop and Telemaque have already begunusing the findings of their research toimplement family planning training for health care providers at the JustinianUniversity Hospital in both the maternityand pediatric services.To reach out into thecommunity,Telemaque has initiated ongoingreproductive health education for traditionalbirth attendants who deliver the vastmajority of the babies in the area.“It was clear to us that the door was openfor education efforts at all levels of our system and that this training has thepotential to make an extraordinary impactfrom a public health perspective,”saysTelemaque.“It will take time and careful,culturally-appropriate interventions,but it iswell within our capacity to help my Haitiancolleagues become comfortable withreproductive and sexual health education.Obviously,in a country long suffering withhigh rates of HIV infection,the impact herewill extend far beyond family planning.”
Recognition
continued 
Hurricane Preparation
continued 
HAITIAN PROVERB
Pise marengwen ogmante larivyè.
Even a mosquito’s urine increases the river.
Every little drop counts.
Nickerson.“Every day Haitian health careproviders face chronic shortages of life-saving medications,supplies,and equipmentthat limit their ability to provide care.But inthe context of a humanitarian disaster,theurgency is amplified many fold.Now,withthe appropriate medical supplies stockpiledand ready,lifesaving resources will beimmediately available when the nextemergency arises.”The container carrying the Direct Relief International resources is currently in transitfrom California to Cap-Haitien.ShouldHaiti be fortunate enough to not suffer natural disasters this year,the supplies andpharmaceuticals will be integrated into theinventory of the local public hospitals andclinic and a new container will beprepositioned for the following year.Thesupplies will be warehoused at JustinianUniversity Hospital and managed by our new staff member,Nadine Mondestin.In March 2009 Brett Williams,EmergencyResponse Coordinator for Direct Relief International and Dan Smith,Senior Program Officer for Latin America and theCaribbean for Direct Relief International,visited Cap-Haitien to meet with KonbitSante and review procedures for management and distribution of medicalequipment and supplies.“Working withKonbit Sante is a natural fit,”says Williams.“They have a proven track record,and boththe relationships and commitment that showthey plan to be there for the long run.Mostimportantly,they care about changing theway things are done.We have a thoughtfulpartner in Konbit Sante and look forward togrowing the relationship over time.”Direct Relief International,based in SantaBarbara,is a nonprofit corporation whosemission is to improve health and lives of people affected by poverty,disaster,and civilunrest.Established in 1948,Direct Relief International strengthens the efforts of itspartners through provision of financial,technical,and essential medical materialresources.Direct Relief Internationalcurrently ships containers of medicalequipment and supplies to 58 countries.To learn more about Direct Relief International,please visit www.directrelief.org.
May we send youoccasional E-news?
It’s easy,its’green,and it saves money.To receiveelectronic updates please send your nameand email address to info@konbitsante.org or 
info@healthyhaiti.org
.
 We Welcome Your Comments:
info@konbitsante.org or info@healthyhaiti.org.
More than 5,000 soft baby caps andhundreds of baby blankets have been createdby crafty parents,grandparents,school,scoutand church groups in 13 countries inresponse to Maine blogger Amanda SouleBlake’s call for “Caps for Cap-Haitien.”These beautiful caps and blankets have beensent to Cap-Haitien and are distributed inthe community by traditional birthattendants.Our thanks to Amanda(www.mamatomama.org) and her networkof crafters for supporting our women’shealth initiative to improve birth outcomesin northern Haiti.
From the 2009 World Health Organization Report on Health Statistics
Maternal MortalityNeonatal Mortalityper 100,000per 1,000Medical Staff per10,000 PopulationLive BirthsLive Births
PhysiciansNursesDentists
United States
114269416
Dominican Republic
1501819188
Haiti
6703231<1
 World Health Statistics 2009
World Health Statistics 2009 contains WHO’s annual compilation of data from its 193Member States,and includes a summary of progress toward the health-related MillenniumDevelopment Goals and targets.This edition also contains a new section on reported cases of selected infectious diseases.For more information about this report please go to http://www.who.int/whosis/whostat/2009/en/index.html.
Dr.Telemaque meets with traditional birth attendants andKonbit Sante
agents sante
to provide education and collect dataabout birth outcomes.Brett Williams (left) and Dan Smith of Direct Relief Internationalvisit the supply depot at Justinian University Hospital inCap-Haitien in March to discuss equipment and supply needs.Some of the hundreds of baby caps created for the“Caps for Cap-Haitien” program.
Crafters Create Caps for Newborns
 
Konbit Sante Receives Official NGO Status
Konbit Sante was recently awarded legal NGO (non-governmental organization) status inHaiti.This is a similar recognition and status as a 501(c)3 non-profit is in the US.“While theprocess was quite rigorous,we believe thatit was a very important step for theorganization,”according to NateNickerson,Konbit Sante executivedirector.“First of all,we feel that is it rightand important to recognize the laws andregulations of our host country in thisway,and it will also give us severalopportunities to increase the impact of our work.”Having NGO status in Haitiallows Konbit Sante to bring in additionalmedical supplies and equipment,and itmay open up additional fundingopportunities from organizations thatrequire this recognition within thecountry.NGO status requires us to have aHaitian board of directors,which is nowbeing established in Haiti to monitor our impact on the ground and recommendstrategic directions.
Letter from the Executive Director:
Helping the Heroes
Dear Friends,Konbit Sante’s mission is to find ways to work together,or form a
konbit 
betweenvolunteers and staff in the U.S.and their colleagues in Haiti,to build the capacity of the Haitian health care system in Cap-Haitien.Ultimately,a functional healthsystem will result in improved health status in the community.In fact,that wouldbe the measure of a truly functional system.We feel that providing supportivecollaboration and finding ways to empower people to improve their own systemrather than developing separate or parallel systems of care is the most effective,sustainable and dignified approach.Since the beginning of our partnership eight years ago,we have thought a lotabout what it takes to build capacity.Though we don’t claim to be the authority on this matter,there are a number of things that we have learned.At the mostbasic level,it seems to me,there are two things that a system needs in order tobe capable — it requires functional infrastructure,and it needs able people.Bothare essential.Indeed,if you have either one without the other,the impact will belimited.But,if I had to prioritize,I would say that the single most importantelement to success is having the right people in places where they can make adifference.A good infrastructure — good management,supply-chain,adequatefacilities,program design — is incredibly important,but trying to realize a goodresult without having the right people in place is not possible.On the other hand,if you can find and engage the people with the passion and skills to make things better,they will make progress under even the direst conditions.Konbit Sante’s approach is to try to build capacity in both of these areas,but Iwould like to take this opportunity to reflect on the human resource aspect of what we are trying to do.In the field of public health,there is a concept called“positive deviance”.I think that it provides us with an important insight.We know that in every group of people,in every community,there are “outliers”– peoplewho are not average.We often associate the word “deviant”with somethingnegative;however some people are outliers,or deviant,in a very positive sense.They have unusual skills that could help others.I was recently struck by the following quote from Paul Collier’s book,“The BottomBillion,”in which he describes his thoughts about how to improve the plight of theone-sixth of the world’s population who live in abject poverty.He wrote,
Let me be clear:we cannot rescue them.The societies of the bottom billion canonly be rescued from within.In every society of the bottom billion there arepeople working for change,but usually are defeated by the powerful internalforces stacked against them.We should be helping the heroes.
I believe the heroes that he is talking about are the “positive deviants”in thehealth system.With your help,we hope to continue to help some local heroes besuccessful in positions where their presence can make a real impact.In thisnewsletter I hope you will notice that the stories are not just about what the U.S.members of the Konbit Sante team are doing in Haiti,but also about the amazingwork of the Haitian team members and facilitators we have the pleasure to knowand support,and who make these programs work.Nathan M.Nickerson,RN,MSN,DrPHExecutive Director 
Florida FirefightersProvide Fire SafetyTraining at JustinianHospital
 Justinian University Hospital has sufferedtwo major fires during the past few years – one that burned the
Salle Privee 
(privateward) and nearby buildings.The second firedestroyed the cardiology ward and theshared office of Konbit Sante and theUniversity of Miami-Haiti Project.Fortunately,no lives were lost,but these firesresulted in significant loss of property andinterruption of patient care.Through contacts with former Haiti PeaceCorps volunteer,Chris Beyer,Konbit Santewas fortunate to be introduced to hisorganization,The Florida Association of Volunteer Action in the Caribbean andAmerica (FAVACA),which agreed tosponsor fire safety training for the staff at Justinian Hospital.FAVACA in turnpartnered with volunteers from Florida-based International Firefighters Assistance,Inc.(IFA) to accomplish the project.Thethree-day training was led by LieutenantNathan Lasseur,a firefighter/paramedic fromWest Palm Beach Fire Rescue withvolunteer instructional staff membersCaptain Robert Belizaire from Davie FireRescue,retired firefighter/paramedic GayleNye and Haitian Creole translator GinaLasseur from Florida.According to Dr.Marie Leconte,head of anesthesiology and fire safety participant,thistraining is the first of its kind during her 26 years at Justinian Hospital.The team’s review of the hospital facilityand procedures highlighted the need for protecting electrical wiring from tampering;establishing procedures for early warningand patient evacuation;installation of smokedetectors generously donated by West PalmBeach Fire Rescue,Davie Fire Rescue andDania Beach Fire Rescue;and training infire extinguisher operation and maintenance.The highlight of the training was a hands-on opportunity for 24 hospital staff topractice using fire extinguishers donated byMaine Medical Center to put out ademonstration fire set behind the hospitalbuildings by IFA instructors.Our thanks to FAVACA (www.favaca.org)and IFA (www.IFArelief.org)for their generosity and expertise.
Emmanuela Béliard (center),Konbit Sante’s in-country programmanager,receives the official NGO certificate in Port-au-Prince.Also pictured are (from left) Mme Preptie Carole,Chief of service at UCAONG (
Unité de Coordination des Activités desONG 
or Coordination Unit for NGO Activities),and MrBeaudelaire Petit Frère,Coordinator at UCAONG.(Left to right) Florida fire safety team members Robert Belizaire,Gayle Nye,Gina Lasseur,and Nathan Lasseur in Cap-Haitian.Dr.Marie Leconte demonstrates the proper technique forextinguishing a fire.
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