Petite Rivière, Haiti: medical tents in the shadow of events

© David Baar/MSF
The health zone of Petite Rivière is situated in the Artibonite district - a three-hour drive from Port-au-Prince - and counts some 80,000 inhabitants, almost half of whom live in the village itself. MSF started to work in Petite Rivière three years ago to improve the general health condition of the population and, in particular, to fight maternal mortality - one of the main causes of death in Haiti.

There is currently a team of three international staff working there: medical doctor Evi Eggers, architect David Baar and logistician Stéphanie Barban. "The main health problems here are skin diseases, wound infections, typhus fever and malaria, and acute respiratory infections or diarrhoea in children aged under 5," explains Dr. Evi while she takes us to one of the places where MSF is working. The Petite Rivière health zone has three hospitals in total. However two of them are public and therefore so are state-funded and they simply do not have resources.

These hospitals have no medical staff and subsequently no patients. The private Albert Schweitzer Hospital on the other hand, a referral hospital with 150 beds, is properly managed thanks to its annual 3 million US dollar donation from the Bill Gates Foundation.

The hospital offers all kinds of medical services, including a Prevention of Mother to Child Transmission (PMTCT) HIV/AIDS programme. In the near future the hospital wants to start treatment with antiretrovirals as well. Since 2001, MSF has concentrated its work on the Charles Colimon Health Centre and dispensaries of Segur and Jean Denis.

In total, the three health facilities provide some 4,200 medical consultations per month. Patients pay an average of 15 Gourdes (less than 0.5US$) per consultation, plus between 20 and 100 Gourdes for medication. "At both dispensaries we provide supervision and drugs supply," Dr. Evi explains. "At the health centre, however, we play a far more active role - both in terms of medical work and rehabilitation of the facilities."

The urgent need for the latter becomes immediately clear when we enter the gate of Charles Colimon Centre to find an empty building under construction and a tent camp. "The roof of the centre collapsed some six months ago," Dr. Evi continues. "Since then, all medical activities have been housed in separate tents. There are tents for TB treatment, dressing, maternity, medical consultations and pharmacy. The situation is far from ideal, but it's the best possible alternative for now." Charles Colimon Centre counts five medical doctors, six nurses, four pharmacists and two maternity nurses. MSF is mainly involved in medical consultations, drugs supply and reconstruction.

The team of international staff will increase soon with a midwife to train the maternity nurses and improve quality of care to reduce maternal mortality. There are some 45 deliveries per month at the centre. Architect David will be responsible for the construction of a new maternity building as soon as the health centre is ready. "We are starting an HIV/AIDS programme with two counsellors," explains Dr. Evi. "One will provide voluntary counselling and testing (VCT) and the other one concentrate the Prevention of Mother to Child Transmission programme for pregnant mothers.

The PMTCT programme also involves providing one tablet of antiretroviral medication (Nevirapine) to the mother during delivery, which considerably reduces the risk of transmission of HIV to the child at birth". The HIV/AIDS programme also involves "Information, Education and Communication" activities (IEC), to increase awareness within the local community of HIV/AIDS prevention and treatment. So far, several youth organisations have shown interest in working together on this.