A little health goes a long way: Parc Acra, Port-au-Prince, Haiti

For people displaced by the Port-au-Prince earthquake, healthcare is at the same time one of the biggest priorities and one of the biggest challenges. Knowledge of risks is limited, access to treatment disrupted, and basic illnesses can become life-threatening. Children are especially vulnerable to disease; living in crowded and cramped conditions, their health symptoms often go unnoticed by adults who are focused on other aspects of family recovery or protection.

Parc Acra, a displacement camp of around 4000 residents, was hastily assembled on a hill in the first few days after the quake. Most of them have been there since. Nearly half of them are children, and new babies are being born every day. What happens in this community is a fair representation of what is happening in 600 other camps across Port-au-Prince.

But there is a difference here. World Vision’s health and sanitation interventions – a clinic, household visits from a health and hygiene team, water delivery and special services for new mothers – are facing up to the challenges. Here are some of the simple tools they use.

Nutrition
Mirjo Hyppolite returned to her home country of Haiti from the US as a newlywed in late 2009. With qualifications in nutritional health, she set up her own clinic and began happily planning for the rest of her life.

But after the quake devastation of January 12 in Port-au-Prince, she discovered that there was little point in holding onto her plans. Along with millions of other Haitians, she was facing a world that could never be the same.

“I tried reopening for a while, but of course nobody was coming to my clinic,” she says. “Then my husband told me I was one of only three nutritionists in the whole of Port-au-Prince. He said I should do something with my skills.”

Mirjo became a child nutrition advisor for World Vision, who was setting up healthcare and child support systems in camps in and around Port-au-Prince.

It’s a decision that has almost certainly saved lives. By assessing children’s weight to age ratio and height to weight ratio on household visits or through the mobile clinics, the team can recognise early if a child is dangerously malnourished. They then refer the children to organisations and hospitals that can provide supplementary, high nutrition food and help them recover.

“The single most important thing we can do to keep these children healthy is to make sure they have the right nutrition,” says Mirjo.

Early treatment
Mirjo is right. Children’s vulnerability to disease has strong links to their level of nutrition. Diarrhea contributes to malnutrition, and fever can rapidly weaken malnourished children. A malnourished child is the first to succumb to infections; vital organs are weakened. A high rate of respiratory illness in babies usually indicates that malnutrition is prevalent in communities.

At first, the children that Mirjo’s team referred for supplementary feeding were children that had been malnourished prior to the quake. But food is scarce and everyone in the camp eats less than they ought. New cases are now starting to emerge.

Barbara is the clinic nurse at Parc Acra. She says she’s already noticing an increase from week to week in child illnesses, particularly fevers. She thinks it is because of the rain and will only get worse. Malaria is affecting both children and parents, and these are not ideal conditions for a quick recovery, even with treatment. And there are plenty of rasping coughs to be heard throughout the camp.

“The children who come have diarrhea, worms, fever – all of them recover with treatment. We have not had any child deaths, but that is because we find these children and treat them.”

“They come to us, or we go to them. If we were not here, then they would find it hard to get to hospitals for treatment. Here, we have the medicines and advice that they need to recover.”

Clean water
In the camps of Port-au-Prince, dirty water is not so much of a problem. It’s the absence of any water at all that is the key challenge. World Vision is trucking in chlorinated water, safe for washing, cooking and even drinking.

“The water from World Vision comes twice a day,” says Marie, a mother at Parc Acra. “We fill our buckets until it’s all gone – but if people miss out, we share with them. If World Vision didn’t bring it, there would be no water at all.”

People need to be extremely careful with how they handle this precious resource. For children, the diarrhea caused by drinking dirty water can be life-threatening. There needs to be water by the latrines for washing hands, but it needs to be stored and used in such a way that people cannot contaminate it by using it. Bathing with dirty water can create skin conditions and sores that easily get infected, so there needs to be enough for each member of the family to use once a day.

People use whatever they can to collect the water – saucepans and pots, buckets and tins. But many of them carry 15 litre buckets with lids, or resealable plastic water bladders, distributed by World Vision. Whether by handles or by heads, the heavy loads are carried back up the hill to the tents where other family members are waiting. It’s clean, it’s protected from dirt or contamination, and it is badly needed.

Exclusive breastfeeding
Emanuelle Saint Fort gave birth to her little son Briseaux in the camp. Luckily for her, it was a normal, safe delivery, but soon afterwards she became very concerned about how weak he was.

“I didn’t know then how important breastfeeding was. I’d never done it before. So I took my sister’s advice and used formula instead. Sometimes I gave him baby cereal. The World Vision clinic was telling me that I was not doing the right thing for Briseaux but I wasn’t really listening.”

Besides the fact that breast milk has all the nutrients a child needs for at least the first six months of his or her life, breastfeeding also protects children from ingesting the germs that cause diarrhea. Briseaux was eating a lot for a newborn, but because the formula and cereal were mixed with water that was giving him diarrhea, he was receiving almost no nutrients from it.

“To tell you the truth, I was scared of breastfeeding,” says Emanuelle. “Then I went to World Vision’s Baby Friendly Space and I learned how to do it from the other mothers at the camp.”

The Baby Friendly Space is a private tent where mothers can be comfortable nursing their babies together. A session is held there every day, and if the babies are awake, then the mothers come – up to 50 at a time. Mirjo often joins them, or another of the World Vision clinic staff, but for the most part the sessions are about sharing knowledge, not simply listening.

The Baby Friendly Space was one of the first initiatives, set up in response to the discovery that many women had stopped breastfeeding due to shock. As well as the more technical aspects of breastfeeding, relaxation and stress reduction are important goals.

“The facilitators at the Baby Friendly Space really helped me,” says Emanuelle. “They helped me understand a lot of things about myself and about my son. I’m proud of myself, that I’ve been able to do this for my baby.”

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