TACOMA, Washington — Every NGO that operates across national boundaries must answer an important question: import the workforce or hire local hands? While many factors need to be considered to answer this question, the experience of many NGOs shows that hiring local workers yields greater results. There are many reasons for the difference in outcomes. Many of these reasons can be explained through Maison de Naissance’s success, a “culturally appropriate” maternal care center in Torbeck, Haiti, run by U.S.-based NGO the Global Birthing Home Foundation.
Jim Grant, the Global Birthing Home Foundation executive director, believes that Maison de Naissance’s success is largely due to its commitment to hiring and training local Haitians. “The [mother]doesn’t feel like she’s going into a typical Haiti medical institution,” said Grant to The Borgen Project, “which most rural Haitians are afraid of because they aren’t treated well—they’re looked down on.”
Witnessing Issues in Maternal Care
The maternal mortality rate of Haiti is the highest in the Western hemisphere. In 2004, the estimated rate of maternal mortality was 513 per 100,000 live births, according to the World Bank statistics. Since 2004, the rate has dropped and risen, reaching a second peak in 2010 at 506 per 100,000 live births. As recent as 2017, the rate has lowered to 480 per 100,000.
Two Kansas City obstetricians witnessed this problem first-hand while volunteering in Haiti. The first doctor was Dr. Stan Shaffer, who worked parallel to Paul Farmer. After Shaffer’s first trip, Grant shared that “Dr. Elizabeth Wickstrom went to visit the maternity ward and she saw the women who were suffering needlessly with relatively minor complications, at least from her U.S. point of view. And that bothered her a lot.” When she inquired about the problems, she found that the appropriate training was not available and the pay unreliable.
Shaffer and Wickstrom decided to address poor maternal health in Haiti. Their proposed solution was to open a midwifery-based maternal care center. With the midwife approach, explained Grant, the organization would reduce the costs incurred with the service of doctors.
Providing Rural Regions With Accessible Maternal Health
The second decision for the doctors was the location of the center. Grant shared a story about when Dr. Shaffer was touring public health facilities with graduate students. “As they were approaching the hospital, a woman was being ejected by the medical staff because her family hadn’t come back to pay her delivery fee, so she’d been in the hospital laboring in the maternity ward. But as soon as the baby crowned, that meant somebody had to deliver the baby. But her family hadn’t paid in advance, which is required for medical care, and everything has to be paid for in advance, and medical supplies also have to be provided or paid for by the family.” Dr. Shaffer delivered the baby in the hospital’s parking lot and paid the fees for post-natal care.
From this experience, the doctors knew they had to set up the center in a rural location, where care is difficult to receive because of infrastructural and transportation issues. Thus, they decided on Torbeck, a rural region of Haiti with limited access to healthcare infrastructures. Now established in Torbeck, the organization serves a population of more than seven hundred thousand people.
The Importance of Hiring Local
When Jim Grant became the organization’s executive director, the current expatriate director in Haiti “was at her wit’s end.” Grant explained that, all too often, expatriates run into a “cultural barrier they just cannot surmount.” He had seen this before—how cultural barriers can often lead to professional blocks. He also noted that expatriates are often pulled out for their own safety in times of environmental disasters, leaving local NGO programs in a state of limbo during times of extreme need.
The doctors quickly found a Haitian midwife with a master’s in public health. She was hired in 2013 and has been, as Grant puts it, “the best director we’ve ever had.” With her in charge, the cultural boundaries between staff and director were dropped and the organization developed a much more harmonious environment, particularly in times of strife in Haiti. “Once we had a Haitian director,” said Grant, “all that went away and we have been open 24/7 without fail since opening day.”
Removing Further Barriers
Maison de Naissance strives to remove as many barriers between pregnancy and birth. Such barriers can be in the form of access to appropriate infrastructure, cost of care and distrust in medical professionals and environments. As for access, Maison de Naissance’s location is critical in bringing care to those who cannot mobilize to it.
Regarding the cost of care, the center is completely free for any soon-to-be mother and thereafter. Free maternal cost of care is one of Maison de Naissance’s pillars. It should be noted that maternal care is not considered a privilege by the WHO, which recommends mothers attend a minimum of “four focused prenatal visits.” According to Grant, the local community has been so impacted by the birthing center that they have offered to start paying the center for its services at whatever rate they can. Nonetheless, Maison de Naissance maintains its pillar: no woman should go without the appropriate maternal need because of her financial situation.
Trust in medical environments was the next most important barrier to overcome when addressing maternal health in Haiti. Grant expressed the discomfort that many locals have toward established medical facilities and professionals originated from how they are treated. The caste system, explained Grant, is a significant barrier that impedes many from even seeking care. Here is where hiring local is extremely important to Maison de Naissance. By employing local midwives instead of foreign doctors, care is done in settings familiar to the patient. This has helped all women who go to the birthing center feel comfortable when they can feel very vulnerable.
“Small but mighty.”
Grant recognizes Maison de Naissance is a small operation, “small but mighty.” He emphasized that they have been open since 2004 without ever closing or denying care through earthquakes, hurricanes, financial hardships and political turmoil. Maison de Naissance has overseen the safe delivery of 7,000 babies with zero maternal fatality in rural Torbeck. “The key thing,” said Grant, “really is our staff in Haiti.”
The Global Birthing Home Foundation is currently looking to expand its services into other areas and sectors. It will be beginning a program in 2021 to provide HPV diagnosis and treatment. Depending on funding opportunities, the foundation may have the opportunity to expand its impact. However, according to Grant, many donors pass up on the organization because its operations would not yield the immediate payoff that many interested donors seek.
Nonetheless, the organization continues to have a great impact, despite its size. In fact, its model works so well that another Kansas City doctor who visited Maison de Naissance returned home and opened her own center with the same model.
In closing, Grant explained that Maison de Naissance “ensures that [the women]are treated the way they should be treated, with respect and dignity. Maison de Naissance’s dedication to caring for Haitians in a Haiti-centered manner is a lesson many organizations should learn to safeguard the sustainability of their own impacts.
– Luis Gonzalez Kompalic