The e-mail arrived in Baltimore with the headline: “Emmanuelle bébé precieux.”

Jhpiego’s staff in Haiti had good news to report today.  A pregnant woman arrived at the General Hospital in Port-au-Prince with serious complications. She was 37 weeks and bleeding. This was her first pregnancy and she appeared to be about 45 years old.

Dr. Lucito Jeannis, Jhpiego’s Haiti Country Director, and his colleague, Dr. Jean Bernard Fevrier, examined the woman and found that the placenta was lying too close to her cervix– dangerously close. She also had many fibroid tumors in her uterus.The doctors recognized the severity of the situation immediately.  “If you don’t do something quickly,” Dr. Jeannis said in a telephone interview today, “the woman is going to die and the baby is going to die.”

The doctors rushed the woman to an operating room that supports the maternity ward, which Jhpiego helped reopen and supply following the recent earthquake.  Jeannis and Fevrier, assisted by a Swiss anesthesiologist and a third-year medical resident, delivered by cesarean section a 5-and-a half pound. healthy baby girl. In her first minute of life, the baby scored a personal best: a 9 out of 10 on the APGAR test. She was named Emmanuelle, the French version of the biblical “God is with us.” “Exactly,” says Jeannis.  In recounting Thursday’s successful delivery to Jhpiego colleagues in Baltimore, Jeannis signed off his e-mail with two words: Bonne journée.

A good day indeed!

The flight to Baltimore would leave soon.

The Baltimore team, Jhpiego’s Country Director, Dr. Lucito Jeannis, and the other Haitian staff had been successful in helping administrators at the General Hospital reopen the maternity ward and restock it with basic supplies and essential medications to serve pregnant women who were delivering their babies in medical tents. The ward had begun seeing patients for prenatal care and performing emergency Cesarean sections inside the building.

It was a good start, but some patients and staff still feared entering the building. They saw how a massive earthquake can collapse a house, a church, a government palace in minutes.

While we have confidence our Haitian colleagues are fully capable of supporting the maternity patients at General Hospital, part of me would have liked to be there as the reintegration of all maternity services takes place.

Of course I wish we could do more for those new mothers. I would like to assign one or more Haitian, Creole-speaking nurses to provide breastfeeding support, help organize more clean water for postpartum moms and give those newborns a fighting chance by at least making sure they can breastfeed.

We also discussed putting in a counselor who can connect homeless moms and their families with clean and safe shelters and other support services, including tent visits to check on mom’s and baby’s health, by neighborhood.

On Sunday, we spent a little time again driving through Port-au-Prince, taking pictures and videos. The Eglise de Sacré Coeur was a sad sight. And when we paused there, several young men approached us individually to ask about our mission and inquire about jobs.

One young man, Garry Janvier, is a teacher whose school is closed. Yet he recently took a two-month USAID course in water and sanitation. He was particularly interested to help educate people in Jacmel. So I e-mailed his phone number to a couple of organizations and hope someone will call him.

There was another, Samuel Saint Jean, who was just about to finish his accounting degree when the quake hit. He lost his mother, little sister and brother. His school is closed. He has no place to live and wants to use his skills.

At Lucito’s house, we saw the devastation of the two neighbors’ houses in the cul-de-sac and heard from Ferni, his wife, the incredible story of how Lucito rushed out after the quake, entered one of those houses and got an elderly couple and boy to leave the building only to have it collapse right after they stepped out.

Or the boy from across the street, who survived because he was outside but saw the building collapse and kill his father.

Stories like that are on everyone’s lips.

Quettly Chevalier, a midwifery instructor who was with 102 students on the ground floor of a three-story school, was the last to exit as the upper floors collapsed behind her. She lunged through a crack in the wall to the street. Her prescription glasses were left behind on a desk and now she can barely read.

As we travel back to our comfortable homes, our families, we carry those stories in our hearts, as well as a commitment to do more for our brothers and sisters, friends and colleagues in Haiti. May the rains be a bit late this year to allow all to get a roof or a good tarp over their heads, and let them be gentle so as not to cause any more damage or pain.
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Rich Lamporte, Jhpiego’s team leader, arrived at the airport with little time to spare. Once he and colleague Dr. Willy Shasha boarded the plane, he too had some time to reflect on the road ahead for the dedicated Haitian medical staff with whom he had worked so closely  —  Madame Gourdet, the chief nurse in the maternity ward, and the others — and the pregnant women arriving daily for care.

How long will it take for the hospital workers to trust going into safe buildings? The same for moms in labor? Services across the spectrum, a continuum of care, from homes/tents to hospital, still have to be fully integrated. But we are committed to helping Haitian doctors, nurses and other health workers return to work to improve and support the health of women and their families.

The midwifery student we met, “one of the best” at the school that’s now in ruins, has the talent that can help rebuild Haiti’s health care services better than before. She doesn’t know when her final classes will begin. But Haiti’s pregnant women and new moms need her. How can she best use her talents?

Seven thousand pregnant women—all expected to give birth in the next month. After the earthquake, will they make different decisions about their family, the size of their family, healthy choices? Will they know where and when to seek care? Can men help, how can they be effectively involved?

Now with the rescue over, will international aid donors be willing to invest in efforts that will benefit Haiti in the near term and set a course for its future? Will a critical mass of donors decide to invest in Haitian leaders who can drive the country’s recovery? Haiti can emerge stronger from the quake.

And baby Edeline, what about her future? Is she still at the temporary orphanage? Is her toe healing? Is she still sleeping through the night? Eating as ravenously? Will she be treated as well as the boys are treated in the same clinic on the same day? Will I actually get the phone number for the pediatrician caring for the kids in her orphanage? Will she find a loving home?

What kind of Haiti might she face?

Dr. Lucito Jeannis of Jhpiego talks with a patient at the recently reopened maternity ward at General Hospital in Port-au-Prince and also confers with staff.

Today is Day 18 since the earthquake struck Haiti. Lucito Jeannis and his family still haven’t slept in their house on Debussy Street. He remains encamped outside his home, with his wife, 3-year-old son and a multitude of neighbors; aftershocks are still a concern. In the beginning Jeannis was providing for 17 people and then 22, including two brothers, 15 and 10, whose father died in the January 12 quake.

Now, as then, Jeannis, Jhpiego’s Haiti Country Director, shares whatever he has with his neighbors. Two families who lost everything are completely dependent on him. There are a few living in the Jeannis compound whom the doctor didn’t know before the earth shook.

But they survived the worst earthquake in a century and that is a bond they will share for a lifetime.

“This is a new life,’’ Jeannis tells his Baltimore colleague Rich Lamporte. “You have to try and understand and be a little more patient and caring for one another. We have to prepare for a new life.”

Jeannis and the Jhpiego team in Haiti have been working to restore health services for pregnant women, new mothers and newborns at the largest public hospital in Port-au-Prince. The maternity ward at General Hospital has reopened with Jhpiego assistance. But some doctors and patients are uneasy about entering the building because tremors continue to rattle the Haitian capital.

Jeannis understands their concerns as tremors continue. Helping provide food, water and necessities for his neighbors isn’t what concerns him. What bothers him more is “not knowing when the next aftershock is going to hit.”

Jeannis is less worried about finding enough diesel to power the generator so his make-shift compound will have lights and a measure of security to keep robbers away. Or that he and the others will be able to buy enough water, pasta, meat, beans, fish, and milk for the kids. Stores are opening up slowly, and if it means driving to four grocery stores to find enough food, so be it.

Jeannis’ son Gaetan doesn’t understand why his home is off-limits. Before the earthquake hit, the child was told he couldn’t play in the street — now he lives in the street and can’t go inside his home.

Everyone is having to adjust to a new reality, but Jeannis is thankful that he has the strength to care for his family and those who are now depending on him.

“There are so many dead. There is so much family pain. I am sad for my country,’’ says Jeannis.

A bright spot for Jeannis is that the Jhpiego team has been able to help reopen and resupply the maternity ward at the General Hospital so that pregnant women and newborns can have safe and quality health care. Jeannis has been the liaison to hospital administrators, health ministry officials and other NGOs providing health-related services.

Jhpiego staff have examined 17 women, providing prenatal and postnatal care, in the maternity building. Five emergency Cesarean sections were done and soon, they hope, their first natural deliveries.

“We need all health care workers, those who are skilled to help, to return to work,” he says.

Too many Haitian women deliver their babies at home as it is, Jeannis says, without skilled birth attendants at their side. It’s a reason Haiti has the worst maternal mortality rate in the Western Hemisphere.

According to the United Nations Population Fund, an estimated 7,000 women in Haiti are expected to give birth in the next month; of those, 15 percent may have complications, UNFPA says.

Jeannis wants to be sure these pregnant women are delivering their babies in a safe place with skilled obstetric care available to them. Haiti will need this new generation more than ever.

But there’s another nagging concern. With officials estimating that a million people are without permanent shelter, Lucito says, “If the rain comes, we are done for.”

Administrators at the General Hospital in Port-au-Prince thank Jhpiego's Dr. Lucito Jeannis, Haiti Country Director, for the organization's support in reopening the maternity ward there.

They arrive first thing in the morning at the General Hospital and meet with nurse Marlene Gourdet who is organizing and overseeing the re-opening of the maternity ward, and offer to help.

Jhpiego’s Willy Shasha, an obstetrician, assembles an autoclave acquired by Jhpiego from UNFPA (United Nations Population Fund) and makes sure this critical piece of sterilization equipment is ready to go. “Such equipment is essential for this high level referral center, which needs to care for the most critical cases,’’ says Shasha.

Baltimore colleagues Rich Lamporte and Anne Pfitzer also get to work. Lamporte puts on a pair of scrub gloves and demonstrates purifying gallons of water for the sterlization process, using a donation of Pur water tablets from Proctor & Gamble.

Pfitzer prepares nutritional supplements for pregnant women and later volunteers to hand-write health records when patients arrive.

Dr. Jean Bernard Fevrier, a Jhpiego employee in the Haiti office, is giving prenatal care and gynecological exams to women who arrive at the maternity building. He is helped by Haiti Country Director, Dr. Lucito Jeannis, and Marie Jacqueline Jean, a nurse on Jhpiego’s Haiti staff. The team is encouraged that women feel confident to seek help indoors after the earthquake and subsequent tremors.

In all, the Jhpiego team sees 16 patients today.

“It was a gift not to get hurt in the quake. It warms me inside to help my people,” says Fevrier.

Jhpiego is supporting the hospital’s “return to work” effort so the maternity ward can operate with a complement of doctors, nurses, and midwives trained in obstetrics care. Until now, pregnant women brought to General Hospital were delivering their babies in tents on the hospital grounds; a small contingent of overworked nurses and birth attendants were providing care.

Madame Gourdet, as she is known at the hospital, estimates tent temperatures hit 100 degrees. Patients in the tents complained of constant thirst and staff had to leave their posts to search for water.

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.

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 Jhpiego 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.”

Nursing and midwifery school bus crushed

“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. Jhpiego has spent 35 years doing this kind of work.

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.

Marie Flore Trevant, Jhpiego’s office administrator in Port-au-Prince, is camped out in the court yard 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 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.

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 a.m. 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.

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