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Cara Caskey Osborne, a certified midwife (and mother of two), has long been interested in the role of health infrastructure in developing countries. A graduate of the Harvard School of Public Health, Caskey teaches at the Frontier School of Midwifery and Family Nursing in a graduate program that trains nurse-midwives and nurse-practitioners. Earlier this year, Osborne was scheduled to take a group of students to Haiti to work with Midwives for Haiti (www.midwivesforhaiti.org), a training program founded by Nadene Brunk, a Frontier Alum. January’s devastating earthquake added another layer of urgency to the trip. Based in Hinche, a rural town on Haiti’s central plateau, Midwives for Haiti was the only organized midwifery training program to survive the earthquake. The mission of Midwives for Haiti is to decrease the alarmingly high maternal mortality in Haiti where the lifetime-risk of dying in childbirth in 1 in 44 (in the neighboring Dominican Republic, the risk is 1 in 230 and in the United States 1 in 4,800, making Haiti the most dangerous place in the western hemisphere to give birth). Here, Osborne describes her life-changing trip to Haiti, and outlines the concrete needs of Midwives for Haiti and what you can do to help.

“In early March, I booked an American flight to Haiti, brining along a back pack of personal items and two 50 pound bags of medical supplies donated by friends and family. The Port au Prince airport had been leveled during the earthquake but was up-and-running in surprisingly orderly fashion. Moliere, Midwives for Haiti’s trusted driver, met me outside of the airport with a big smile that made any travel anxiety I had dissipate. He expertly guided me through the mass of people hoping to carry my bags and receive desperately needed money in return. We drive to a pop-up field hospital run by Beth and John McHoul of Heartline Ministries (www.heartlineministries.org). Beth, who has lived in Haiti for 20 years, is studying to be a midwife and had graciously agreed to be my host in Port au Prince for the night, as I could not fly to Hinche until the next morning. I’ve never been so grateful for a layover. Beth and the volunteers working with her welcomed me with open arms and let me jump in to their work as soon as I put my bag down. It was a poignant introduction to post-earthquake life in Port au Prince. I met three-year-old Emmanuel, who had lost his parents and siblings in the earthquake and had been trapped for some time in the rubble. He is being cared for by his grandmother and by the volunteers at the hospital and was quite the charmer despite the injuries still visible all over his little body. All the patients at the hospital have survived unimaginable injuries, losses and circumstances. I was thankful for my time with them and think of them daily.

“On day two, Moliere ushered me to the charter airstrip next to the main airport, where I caught a ride with Mission Aviation Fellowship from Port au Prince to Hinche. From the air, I had a sweeping view of the tent cities radiating out from the city center. It’s hard to imagine how those tents will be able to withstand the rains that are coming and even more difficult to imagine an alternative in the midst of such devastation. Once in Hinche, the hallmarks of rural Haitian life were immediately visible. The “runway” that we landed on was populated by goats, chickens, dogs, children and men on motorcycles. Jean Louis Lefort, the founder of Maison Fortune (www.maisonfortune.org) , the orphanage that would be my home for the next week, met me at the airstrip and took me back to the orphanage to meet Nadene and Dr. Steve Eads, an obstrician and gynecologist from Richmond, VA who is a member of the Midwives for Haiti board.

“The World Health Organization has determined that an essential factor in the maternal mortality rate in such places as Haiti is the presence or absence of skilled attendants at birth. The WHO defines a skilled birth attendant as: “an accredited health professional – such as a midwife, doctor or nurse – who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns”. The Midwives for Haiti students have had 12 months of basic nursing training after high school to become Auxillares and then go through the 12 month Midwives for Haiti training program to meet this definition. By providing skilled birth attendant training in a rural area, where women are least likely to have access to skilled attendants for their births, Midwives for Haiti is changing the system and working directly to decrease the risk of maternal death.

“This is the conceptual definition of the program. It’s something that I believed in and supported without question long before my trip to Haiti. What I didn’t know was that seeing it operational—seeing the work of the program first-hand—would forever change me. Nadene and Steve greeted me warmly before we headed to St. Therese Hospital. The hospital is a sturdy structure with intensely limited resources. There is no electricity or running water. The clinicians there are doing great work under extraordinarily difficult circumstances—as I learned very quickly. Suffice to say that I assisted with four births in my first two hours—trial by fire, especially for someone who has been out of clinical practice for about three years. One of the babies had meconium-stained amniotic fluid and needed a little help in transitioning to extra-uterine life. In the U.S., we would have put the baby in an electric warmer and suctioned the sticky fluid with mechanical suction (and if necessary provided mechanical ventilation). Without electricity or oxygen, the process is quite different: we placed the baby on an empty birth table, opened the airway, suctioned as much as we could with a bulb syringe, and gave the baby a few breaths of positive pressure room air from an ambubag. Thankfully, the baby responded well to this basic intervention; not all babies do.

“I need to make note here of the water issue: anyone who has ever seen a baby born knows that it can be messy business. At this Haiti hospital, water is scarce. The staff runs water from a cistern once a day that is used for cleaning. When this is gone, you have to do the best you can with towels. Hand sanitizer becomes your best friend but often seems inadequate. There is no drinking water; the patients’ families bring them water as they are able. “After lunch and a brief rest, I visited the Azil feeding station, a residential feeding program for malnourished children run by the sisters of Missionaries of Charity (www.cmswr.org), the international society founded by Mother Teresa in Calcutta. Dr. Mark, the pediatrician on the team, was my guide. He has spent a great deal of time at the Azil and is much-loved by the children and sisters. We were there to treat wheezing and difficulty breathing in a particularly ill little boy. We brought along an inhaler that would help him breathe, but in order to get him to inhale the medication, we had to get creative. In the U.S. children who need inhalers use devices called spacers that allow them to inhale the medication without having to coordinate their breath with the spray. In order to accomplish the same objective at the Azil, we crafted a “spacer” by putting the inhaler through a Dixie cup and attaching it with Duct tape. Dr. Mark then used his hands to create a seal around the child’s mouth so that he could inhale the medication. Believe it or not, it worked.

“It was big first day. I was exhausted. After dinner and a shower, I settled down to sleep on my mattress out on the porch of the orphanage under my mosquito net and fell fast asleep disturbed only occasionally by crowing roosters and barking dogs. he days that followed are a bit of a blur. I spent my second day in Hinche with the 11 Haitian Midwives for Haiti students, learning about them, listening to their stories and telling them mine in turn. The students are an amazing group of women. They are all auxiliary nurses who work in hospitals, as well as outpatient settings. Many of them have also served their communities as traditional birth attendants called Matwones. I was impressed with the dedication and poise that they brought to the discussions. I am sure that I learned much more from our day together than they did. They taught me about traditional birth practices, commonly held beliefs and the barriers that women in the area face in seeking prenatal care and delivery by a skilled attendant. At this point I was 48 hours in and I could feel something happening. I had bonded quickly with both the American and Haitian members of the Midwives for Haiti team and was already beginning to feel a part of it. By day three in Hinche, I was trying to plan my next trip.

“On my last day, I got up early to see one of the new volunteers off to a mobile prenatal clinic with two graduates of the program, then made my way to the hospital to meet with Dr. Prince and hear his hopes for improvements at the hospital. Dr. Prince showed me the over-flowing prenatal, vaccination and child nutrition clinics and introduced me to Dr. Cruff the Zanmi Lasante/Partners In Health program director to hear more about the HIV and TB programs. I finished just in time to make my flight back to Port au Prince. I headed from the airstrip up the hillside of Port au Prince to Petionville. If you’ve been following the earthquake footage, you’ve seen it: it is one of the “wealthiest” sections of the city and one of the hardest hit by the earthquake. Getting there for my meeting to discuss midwifery education with consultants to the central Ministry of Health, and then back to the airport, gave me a real sense of the extent of the devastation. It felt post-apocalyptic, like something from a Mad Max movie.

“I spent my final night with Beth and John McHoul, talking midwifery until the last moment. During my flight home, it took me a while to organize my thoughts. What Nadene has created in Midwives for Haiti is nothing short of amazing. I am in awe of her effort. For the first time since those first couple months out of midwifery school, I felt very certain of my place in the world. I am sure that I am meant to be a part of this work. The details of what I am to do are not clear but I’m sure that it starts with getting the word out.”

HOW YOU CAN HELP: There are some big things that Midwives for Haiti needs in order to keep up the work and donations to the group will go directly towards these goals. They are:

• A permanent Hinche location. Midwives for Haiti has been hosted by various faith-based organization but the program has grown to as size that requires a home base. There are buildings available in the area that could be suitable.

• Trucks for mobile clinics: Due to the road conditions, it takes a special truck to withstand travel in Haiti. The organization is working with a Jeep dealer/modifier in Pennsylvania who has worked in Haiti and is familiar with the needs.

• Water for the hospital. Reliable access to water is a problem in most parts of Haiti. Midwives for Haiti is in the process of identifying a partner to address the water situation. However, as with most large-scale projects, it will take a significant financial investment. If you’re interesting in donating or getting involved directly please see the Midwives for Haiti website: www.midwivesforhaiti.org. For more information on how to donate or become involved, email midwivesforhaitico@gmail.com.