From all appearances, Theodore doesn’t look sick. The tall, lanky 14-year-old smiles easily as he polishes a miniature table and chair set he made as a gift for me by flattening bottle caps. He lives in a primitive building with 30 other children, all Haitian orphans. After several bouts of heart failure as a result of rheumatic fever, Theodore is hopeful that money will become available to send him to the United States for surgery to fix his heart valves. Until then, he amuses himself with bottle caps that he gathers from the street behind his shelter. Like so many children of the Third World, his future without surgery is very poor.
Located to the west of the Dominican Republic on the island of Hispaniola, Haiti is the poorest country in the Western Hemisphere. Ninety percent of the Haitian people live in extreme poverty. Most homes, like Theodore’s, have no piped-in clean water for drinking or bathing. Raw sewage is everywhere in the streets of Port-au-Prince. Often families of six to ten people have to sleep in shifts in one-room cinderblock shacks with dirt floors and no more than a tin roof over their heads. Under these conditions, the poor health of these children is not surprising.
RENMAN, a childcare center in Bon Repos, just north of Port-au-Prince, helps more than 200 disadvantaged children from birth to ten years and provides schooling, health care, and food. Florence Thybulle, its director, is responsible for the program’s success and does much in so many ways for the health and well-being of these children whose basic needs are immense. She started the program out of the goodness of her heart several years ago. With the support of Philadelphia Yearly Meeting, I have tried to provide some clothing, bedding, and food. Florence also provides a shelter in her backyard for over 30 homeless children. Occasionally a parent from the neighborhood will hear of her kindness, drop a child off, and not return. She readily takes such children into her care. She is also a foster mother to several teenage girls, even though the concept of foster care is not well known in Haiti, and she provides care for a mother and infant infected with aids. The mother is pregnant again, and unless she gets AZT early enough in her pregnancy, she may have a second child infected with aids.
The needs of these children influenced me to use my professional skills alongside Haitian doctors to try to improve the health of a small group of children in a country where the infant and maternal mortality rates are the highest in the Western Hemisphere. We started a basic health-screening program including physical exams and blood studies, as well as a primary effort to treat the children’s acute and chronic health problems. Polaroid photographs of each child were included in a basic medical record.
I was not surprised to find that almost 40 percent of the children had iron deficiency anemia. This can cause cognitive delays in one- or two-year-olds that may not be completely correctable with iron therapy alone. Some of the children with anemia, the result of low iron stores in their mothers while pregnant, were born prematurely. This could have been prevented with better prenatal care, which is often beyond the reach of poor Haitian mothers.
The best way to treat this anemia is with iron-rich foods such as fortified cereals, green vegetables, eggs, and meat. The chance of poor Haitian children getting enough of these at home is unlikely. Some of the children had blood counts that were 1/3 normal. We also measured a sample of the children and found that their height for age was below commonly accepted standards indicating mild to moderate chronic undernutrition. Our impression is that they are growing better now as a result of Florence’s program.
We also tested for malaria, parasites, and HIV infection. Probably the most important thing we can do on an ongoing basis is to screen for cognitive delays. Then we must try to do something about the problems that we uncover.
The Haitian pediatrician who donates his time to the project continues to be a critically important resource for health maintenance including immunizations that the children would not otherwise receive. He also provides in-hospital care for children who have become seriously ill.
I have tried to use personal, professional, and Philadelphia Yearly Meeting resources to strengthen this project. Our funds supported building projects for new classrooms for 35 children in a beginners’ class, improving the nutritional meals, and monitoring the quality of food purchased and served to the children. It is likely that the meals they receive at the center are the only nutritional meals they get each day.
We are involved in a continuous assessment of the general health of the children. We have supplied school materials for the different classes in addition to packets provided by children in the First-day school of Haverford (Pa.) Meeting. We have provided pediatric consultants and a Haitian consultant in public health for long-range planning in order to make the project self-sufficient. We have helped to make the new classrooms an improvement over their previous condition: no roofs, flimsy walls, and crude and unfinished floors. Now there are waterproof roofs, cement floors, and, in some cases, painted plaster to lighten the interior walls.
This program is not unique. There are many similar health projects all over the Third World. But our "right sharing" may have made both short- and long-term differences for these children.
It is amazing how these children with all their health and social problems have such energy and vitality. In presentations to Friends meetings with photographs, I have tried to show examples of how adorable they are, and how much their attendance in this program means to them.
While our efforts have been significant, many improvements still need to be made in RENMAN. There are needs for a small refrigerator for medicines and vaccines, a continuous supply of vaccines, a variety of basic medicines, and support for a good nearby clinic to help with problems beyond the scope of the nurse.
We have not improved the center’s kitchen facilities, which are rather primitive—outdoors and exposed to the environment. We have not provided reasonable play equipment that the children so sorely need. But it is very possible that, with the attention given to the children through our efforts, additional resources may be made available for other basic necessities.
Our goals for the project have been to try to introduce child health and nutrition services to a small group of disadvantaged children in Haiti. The children continue to appreciate the generous support of the toys, clothes, and education materials kindly provided by members of Haverford Meeting.
What sustains the soul of the Haitian people? For many, life is a celebration despite poverty. If Roman Catholicism is the official religion of Haiti, then vodoun (the Creole word for voodoo) is an important belief system. But even voodoo specialists cannot appease Haiti’s continual political unrest.
The return of President Aristide was a joyous occasion for many Haitians. His promise to bring change to Haiti may be hindered by lack of international support, most importantly from the United States, which used Haiti’s tainted elections as an excuse for withholding aid. Millions of dollars could be released to the Haitian people. Some of it could go toward this project when the money from the Quakers ends.
My hope is that Aristide will also be able to make some important changes to benefit the large number of disadvantaged children. Aristide has been the only Haitian leader to demonstrate real concern for the well-being of his people. Theodore is counting on him and on us, too.