In Haiti, Pregnant Women Flee Melissa’s Devastation through Gang-Controlled Roads

At a community clinic in Montegrande, Haiti on Tuesday, midwives treated a new patient: a woman halfway through her pregnancy who'd fled the catastrophic damage of Hurricane Melissa for the country's safer north.

She told midwives her house was likely destroyed. If it's still standing, she explained, it's been looted by now.

"She is resigned to starting her life entirely over," said Jane Drichta, executive director of Midwives for Haiti, a nonprofit health organization whose clinicians care for women displaced by violence and disaster, living in what Drichta described as 23 different temporary camps.

Another woman whose home had been destroyed by Melissa, sheltering with a three-week-old infant, "seemed to be in shock," Drichta said.

"Even though we didn't get a direct hit like Jamaica" from Hurricane Melissa, Drichta said, "the lack of infrastructure and political instability" led to Haiti's high death toll. Forty-three deaths have been reported in Haiti thus far.

Like every displaced woman Midwives for Haiti's staff care for, the two evacuees had braved gang-controlled roads where violence is rampant, and the danger to their lives extraordinary, to seek shelter in northern Haiti. Even in the dozens of camps for Haiti's displaced, who have fled gang violence - and now a Category 5 hurricane that caused widespread destruction in southern Haiti - there are so many gang members that Drichta won't allow clinicians to care for patients in the camps. Instead, pregnant women in the camps are transported to a nearby community clinic by ambulance.

For thousands of Haiti's internally displaced women, many of whom fled their homes in Mirabalais, Lascahobas, Sodo, and other areas overtaken by armed violence in recent months, circumstances are desperate. One patient with severe intellectual and physical disabilities was raped in the camps and became pregnant, but was unable to understand what that meant. Drichta reported on Tuesday morning that the woman had just undergone a scheduled C-section and was recovering at Midwives for Haiti's high-risk maternal waiting home. Another pregnant woman, recently arrived, was doing her daughter's hair when gangs suddenly invaded her town. She grabbed her two children and ran - barefoot - from her home.

After walking 15 miles, "she found her way to us, and is due any day," Drichta said.

When the city of Mirabalais fell to gang control earlier in March of this year, an estimated 22,000 people became newly displaced. Drichta calls that a "conservative estimate." Mirabalais was a devastating loss from a healthcare perspective: The city had a well-equipped hospital and a number of highly skilled providers. Now Drichta said the hospital is "shut and looted."

While it's impossible to tell how many have been displaced from their homes by Hurricane Melissa - there simply isn't enough capacity in Haiti to keep close track - she notes that she's seeing similar increases in the number of pregnant women urgently needing care. The average recent clinic has seen numbers of patients about 45% higher than usual - comparable to the numbers associated with displacement earlier this year. A Monday clinic that normally tops out at 50 pregnant women saw 120 patients in need of maternal health care.

"Our midwives didn't get home until eight p.m., and one of my greatest rules is no one on the roads after dark" due to the danger of violence, Drichta said. Safety precautions, such as transporting pregnant women from the camps for care and restrictions of travel, are intended to keep clinicians and staff safe.

But midwives are often so concerned about patients - they know that the care they provide every day is lifesaving - that they can be careless of their own safety. "Nobody listens to me," Drichta said, with a humorous note in her voice.

It's far from just an abundance of caution. A senior midwife at Midwives for Haiti's training school was kidnapped two years ago. "It was the worst three months of my life," Drichta recalled. On a recent call with Direct Relief, she mentioned calmly that she'd passed two dead bodies on the road on her way to work that morning.

But Hurricane Melissa brings new dangers. Haitian women are fleeing the south, but Haitian women who have lived for years in the Dominican Republic have also been deported or been forced to flee the hurricane's impacts. Many do not speak Haitian Creole. "It's a complex disaster," Drichta said.

Midwives are also reporting an increase in patients with heavy bleeding from placental abruption, which Drichta thinks may be due to the stress of Hurricane Melissa and the continuing violence. "We've had an extraordinarily stressful event and we're seeing it more now," she said.

Nutritional deficiencies and a lack of medical oxygen threaten many of her patients. Patients at camp clinics receive two daily meals, staff give packets of food to families, and Midwives for Haiti distributes therapeutic food for children with acute malnutrition. But Drichta said it's common for babies to be born prematurely because of malnutrition and need acute care, which isn't always available: "A lot of them are dying due to a lack of medical oxygen."

Widespread flooding from Hurricane Melissa has made cholera and malaria all but inevitable, Drichta reported: "One hundred percent, we're going to be seeing an uptick" in water- and vector-borne diseases.

An increase in sexual violence, too, is all but inevitable. Drichta feels confident she'll see more cases like the woman who received a C-section Tuesday morning. Increases in the pregnancy complications that are already too common in Haiti - hypertension, eclampsia, and preeclampsia - are highly likely as well.

"It's not just what happens in an emergency," she said of Hurricane Melissa's destruction. "It's what happens after. These people are now high-risk pregnancies."

Direct Relief supported Midwives for Haiti with 30 full midwife kits and 30 resupply kits - enough equipment, medicine, and supplies to support 3,000 safe births - and a $50,000 grant to secure additional medicines last year. The organization has allocated an additional shipment of midwife kits to support Midwives for Haiti's ongoing work.

For the clinicians of Midwives for Haiti, earning these women's trust will be the first step.

"The weather has betrayed them. The gangs have betrayed them," Drichta said of her patients. "Luckily most of midwifery care is done with the heart and hands, and not just with medications…Our midwives are very good at this, at building these relationships."

But she stressed that a disaster with Hurricane Melissa's magnitude has consequences for everyone.

"With the influx of people we're going to have even more [patients] and we're going to need to do more camps," Drichta explained. "My midwives will be overworked, and they will go out into the field" when they're needed, whether it's safe or not.

"No one is coming, so we have to do it ourselves," she said.