Welcome to those of you who are visiting our site for the first time!  As you may have noticed from recent posts, we are now focusing our efforts heavily on the establishment and operation of our new community health center. Below, I discuss why we believe this is so important, and what we hope to accomplish with it in 2009.

The Problem:
In the communities of immigrant Haitian sharecropping families living in the southwestern Dominican Republic, the vast majority of people live in destitute poverty and no institutional safety nets exist to prevent the hunger, illness, and mistreatment endured by this population.  One of the most deplorable consequences of this demographic group’s marginalization and poverty is the high rate of maternal and child death associated with pregnancy and labor complications.  Because of malnutrition, poor sanitation, and inability to pay for prenatal care or delivery in a hospital, rates of premature birth, miscarriage and birth defects are very high and routine complications often become life-threatening emergencies when a woman goes into labor on the dirt floor of her hut, miles from the nearest medical center.

The Solution:
This year, Children of the Border plans to establish a “Casa de Salud,” a community health center, in the town of Pedernales, Dominican Republic.  The house will serve as a base of operations for our community monitors, and will allow us to provide multiple services aimed at preventing much of the unnecessary suffering endured by many mothers and children in the border region.

Steps to Achieving the Solution:
1.    Finish our census of the community. In order to measure the change that the Casa de Salud aims to bring about in the coming year, we must complete our comprehensive census of the community.  In the coming two months, our Community Monitors will be working hard to visit each and every family in CotB’s catchment area to determine the exact size of the population we serve, the breakdown by gender and age, the number of pregnant women, the potential demand for provision of family planning services, and the prevalence of certain health and welfare problems in the community.
2.    Provide family planning options to every woman that requests them. The benefits of birth control in this setting cannot be overestimated.  Most families already support between six and ten children, and most women say that if they could choose to stop having children, they would.  Allowing women freedom from the repetitive cycle of pregnancy and labor gives them time and energy to work and to focus on caring for the children that they already have.  The bottom line is that the cost of providing oral contraceptive medication, condoms, and even more complicated solutions like fallopian tube ligation surgery is negligible compared to the potential health and economic benefits to the families we serve.
3.    Provide prenatal care services to every expecting mother. Once our census is complete, and we have made all families aware of the Casa de Salud’s services, our next job will be to start every pregnant woman on a program of prenatal care.  This will involve taking each woman in for an ultrasound examination, establishing the expected due date of the baby, and setting a schedule for regular check-ups. We will also provide folic acid and other nutritional supplements for the purpose of preventing vitamin deficiencies and other effects of malnutrition that can lead to birth defects and low birth weight babies.
4.    Provide a clean, safe, and comfortable home for women on the days approaching and immediately following their due dates. Three days before a pregnant mother’s expected date of delivery, she will come to stay at the Casa de Salud, where she will be fed three nutritious meals per day, receive a final ultrasound examination, and sleep every night in one of the Casa’s beds.  When she goes into labor, she will be taken promptly to the Pedernales hospital, where she can give birth, and any complications can be dealt with quickly and effectively.  After her delivery, she can expect to spend another three nights in the Casa de Salud, resting with her baby, eating nutritious food, and getting ready to return home with her new, healthy child.
5.    Provide neonatal care and childhood immunizations to all babies born in our catchment area. All children born within CotB’s catchment area will receive the necessary prenatal care, including care for low birth weight babies, to ensure that they can return home healthy.  Additionally, all children should receive the routine course of vaccinations provided free by a government program.

Thanks to everyone for your interest in, and support of the Casa de Salud project.

With a donation from Dr. and Mrs. Yee and the Roxbury Foundation, we bought 800 packs of contraceptive pills at NGO prices from the local affiliate of Planned Parenthood, PROFAMILIA. The cost per pack (a one-month supply) was less than US$0.57! They were out of condoms for the year, but we still have US$600 earmarked for purchasing condoms, which they told us would be available by the second week of January. Our volunteers in Santo Domingo will make the purchase and shipt them to our Human Rights Monintors in Pedernales.

Here is a video of our Haitian Human Rights monitor, Estela, explaining to a small group of women from the community about contraceptive use before distributing the pills.

The Roxbury Foundation, a Humanist organization based in Boston MA, just donated $1,000 to our project.

This donation will allow us to immediately start providing access to birth control methods to those women who have so insistently asked for them.

We are able to get a one-month supply of birth control pills for just US$0.57 from another NGO based in the Dominican Republic. We just placed an oder for 800 months of pills, or enough to cover every woman who has asked for birth control for a whole year.

During the past two weeks our field staff has been very busy with babies and mothers. We asked our Human Rights monitors to make sure everyone received the critical medical care they needed, regardless of our current funds.  We refuse to allow preventable deaths to occur just because we are waiting for grant money, and have promised our workers on the ground that we will do all the necessary fundraising to catch up with them if the costs of emergency care delivery should exceed our operating budget.

Well, they’ve been working very hard and we have a lot of fundraising to do or we could run out of operational funds.  Here are some pictures.

Last month we had another emergency. Friends of Mme. Mesina approached us with the news that she had been bleeding for almost a week after having miscarried on the dirt floor of her home.  We took her to the doctor and paid for ultrasounds and emergency lab work. She had lost so much blood that now she needed an emergency transfusion to survive. Unfortunately, there is no blood bank in the area, so we broadcast over the local radio station that we were looking to pay for blood, and were contacted by a few volunteers.  After testing the safety of the blood, doctors performed the transfusion and she started to improve.

The next day we took her by public bus, still bleeding, to another hospital 3 hours away, where she was hospitalized. We again covered for all her medical costs, including further blood transfusions.

Two days ago we returned to pick her up. She was very happy to see us, and her husband was waiting for her at our Human Rights monitor’s house. We gave her the new medicines the doctors prescribed and paid for her transportation back home.

Mme. Mesina when we picked her up at the hospital.

She came very close to dying from the hemorrage, so her husband was very happy to see her back!

New medicines.

The membership of the American Humanist Association just sent us a check for $2,400. These funds are earmarked for the Casa de Salud, the house near the hospital where we will have pregnant women stay, so that we don’t have to rush them down from the forest at midnight when their labor pains start. The plans are to establish the house this December!

Here are some pictures from the babies and mothers we’ve been attending in the past couple weeks. All of the babies you see were delivered at the hospital by our Human Rights Monitors’ efforts, and all of them had their necessary vaccinations. Children of the Border was able to cover the costs of all necessary procedures and medications, and in a few cases we provided food for the mother during her post-delivery convalescence. One of these women is still in the hospital in Barahona, and we visit her every two days. She had a miscarriage and bled from the placenta for a week before we learned about her and by then she needed multiple blood transfusions.

The couch you see pictured is in the home of one of our Human Rights monitors. Her house is the de facto clinic, from where she takes people to the hospital and has them wait for appointments, until we open our own community health center.

The Human Rights monitors have been very busy. They now have a new digital camera to document their work, and we now receive regular updates from the field, complete with digital images.

In the meantime, we are doing end-of-year fundraising to establish the Casa de Salud, a house near the hospital where we can house pregnant women close to their due dates.  This will allow us to host women in a clean, comfortable community health center, located minutes away from the ultrasound clinic and hospital facilities before their labor or any complications associated with it begin. If we had such a house, we could have avoided the death of Antonie’s baby and the emergency of the 7-month premature baby that almost died on our hands.

A group of students at Harvard is repairing abandoned bicycles and reselling them to raise money for the project. They expect $4,600 in sales. The Roxbury Foundation has pledged $1,000. The Harvard Graduate Student Humanist Association is doing a party for the benefit of the project. We just received a donation from Dr. Edgar Yee and Mrs. Pamela Yee of $1,000, another from Cathleen and Brendan Randall, and many more from others. The American Humanist Association also just started a new campaign with their members on our behalf.

Our goal is to have $10,000 by January, and with the continuing support of our donors, we could soon meet that goal.

Just as we were celebrating that Jemena had taken back her baby and was successfully breastfeeding her, and Mme. Nono’s recent healthy birth, our Human Rights monitors got called to see a woman who had been bleeding since noon. It was almost 5:00pm then, so we got on our motorcycle and hurried to her place. She was there on the dirt floor of her house, on a makeshift stretcher.

Mme. Antonie on her stretcher as we take her to the truck for the hospital.

We immediately contacted the only man in the community with a truck, and hired him to bring Mme. Antonie to the hospital. Getting him and bringing the truck took about an hour. We later found that it was during this time that the baby inside Antonie stopped moving and died, probably drowning on her mother’s blood.

This is what we have for an ambulance.

Everybody around helped us put Antonie in the truck. She had been bleeding for more than 6 hours now, and lost 4 units of blood.

At the hospital, we got past the usual hurdles of bringing in a Haitian woman, and she was eventually attended to. The doctors could not hear the baby’s heartbeats, and she was bleeding, so she had to ahve an emergency C-section.  There was no anesthesiologist in town, so she had to be transported to the hospital in Barahona, 135km away.  Our project does not have a car, the hospital’s ambulance was already in Barahona, and the firemen’s ambulance was broken down, so the situation looked very dire.  We finally found an ambulance at the Dominican Red Cross’ headquarters, and paid all the costs up front. These ambulances are just vans with a stretcher — they don’t include any paramedics, or equipment — so we had to get Antonie on the stretcher, load her on the van, and take her to Barahona.

Our Human Rights monitor, Estela, and Antonie as we bring her to the Barahona hospital.

Once at Barahona, we had Antonie taken in immediately.  Again, we had to do everything, as this other hospital is just as understaffed. The doctors performed a C-section and removed her dead baby.  We were brought in to see the body. It was a full-term baby, and the doctors and nurses told us that she had probably died just a few hours earlier, meaning that if we had arrived earlier or had better transportation, we could have saved her.

Antonie needed 4 units of blood, and her severely damaged uterus had to be surgically repaired. Her prognosis is bad. As for the body of her baby, the hospital asked if we were going to purchase a casket to take her back to Pedernales. With just enough money left to pay for Antonie’s blood, we had to leave the body of the baby for the hospital to dispose of. The nurses put the baby on a cardboard box taken from the garbage and put the box on the floor to be removed later.

It hardly needs to be said that we desperately need to have our own transportation and a house in Pedernales where we can lodge women when they are close to their due date.  Such basic facilities would allow us to prevent another unforgivable death like this one.  We will continue to do our best given the circumstances, but we desperately need to secure the funding for an ambulance and a community health house.  These are the two top priorities for emergency care now.

Antonie already has 8 children, and was on our list of women who wanted birth control urgently. We are still trying to procure funding for this. Our list now includes over 60 women from the community who would like to have birth control.  Continue to watch this blog space for more information on the development of our Borderlands Community Health Initiative.

Our Human Rights monitors have been monitoring one pregnant women in the community, Madame Nono, for several weeks as the due date for her baby approached. When the day came, Children of the Border had a truck driver ready and paid to drive her to the hospital for delivery.

Still, we arrived a little too late, and Mme. Nono gave birth as we tried to carry her to the car. We didn’t have the facilities to cut the umbilical cord from the placenta (not that anybody in the community has the training for that procedure), so we brought her to the hospital as she was. The baby was fine and Mme. Nono was discharged.

The baby is a boy, and Mme. Nono feeds him constantly.  You can see how healthy he looks in this photograph.

Mme. Nono and her healthy baby.