Under The Mango Tree: Reflections on Haiti - Midwives For Haiti

Under The Mango Tree: Reflections on Haiti

People often ask me “Is Haiti getting better?” My answer is alway a resounding “Yes!” Granted, Haiti still has severe struggles with bad driving, poverty, pollution, a countryside stripped of its tropical forest, people at all education levels working hard at escaping to another country, a social mindset of violent reactions, it’s own set of human rights problems, and more. But, Haiti is catching up.

For 25 years, I have been able to witness slow, but sure, changes. The political climate seems to be at least neutral in terms of good and bad; a definite improvement over regimes that had plundered Haiti of so much over the past 70 years.  More children are going to school and staying in longer. The once prevalent four-legged bourik is giving way to the noisier motorcycle. There are efforts at reforestation, with fast growing eucalyptus and fruit trees for the near future and, also, with mahogany hardwood that will take two generations to mature. Fish farming projects are increasing. As I write this from a balcony overlooking rural Hinche, other infrastructure advances are apparent. Paved roads cover the once muddy and often impassable “interstates”. Electricity is reaching farther and the land is dotted with modern solar panels. Safer community water sources and a growing number of clean cisterns are evident. A generation of technology has been bypassed as the people have gone from few communication options to cell phones for all. And there are electronic medical records in the hospital! Surely, there is much more, but this is a start.

And speaking of Hinche – wow! The tiny “suburb” of Naran is a microcosm of many individuals and outside organizations working together to create a remarkable transformation. Individuals in this remote outpost had a vision. In days past, they would sit under the great mango tree at the “mayor’s” house (and where we once held medical clinics) and dare to dream. The seeds were sown. So,with a little help from outside friends, a village has blossomed with strong community involvement. The school of 120 students was once just a few children homeschooled under a tarp tied to trees. Now, there is a block schoolhouse, full time teachers, and a hot meal everyday. More regular healthcare has arrived through a rotation of visiting medical teams. This includes monthly prenatal care so that good health can start at day one. A rudimentary road has been carved into the hillside. What was once a 40-minute hike is now a 5-minute ride, albeit a bumpy one and with the aid of a good truck.  Solar power is here, too, operating a water pump in the deep and clean well to fill a community water tank. That mango tree is still there and continues to be a place where the people of Naran can wonder “What if…?” These changes have not just been given to them. They have worked hard to make this their own – to sustain and grow.

This brings me to Midwives For Haiti (MFH) and its role in the changes in Hinche – and, indeed, in many other parts of Haiti. I have been a part of MFH since its earliest days and delight in witnessing its growing impact over just a short eight years. A seventh class of skilled birth attendants is soon to graduate. What a difference this is making! The maternity ward at the local hospital was once a shell of a unit. With MFH, admissions have increased over 15-fold, and the graduates now deliver over 140 babies a month. (An exciting sequel created by this is the development by another organization of a Neonatal ICU.) Maternal and infant morbidity and mortality are down dramatically, as are seizures from high blood pressure. What is being taught and modeled is a more compassionate and comforting approach to delivery – a departure from the witnessed, more chaotic scene of the past. And, now, post delivery care and follow up evaluations are offered for each newborn.


A mobile midwives project now visits a rotation of 20 villages each month. The main purpose is to offer prenatal service. They see about 500 ladies each month. (Although, yesterday they saw 118 alone!) Exams and measurements are done each time, vitamins are supplied, a Doppler stethoscope is used to asses fetal heart rate, and medications for malaria and worms are given. But, there is more. While one midwife see the mothers-to-be, another engages in a spirited discussion with others on public health concerns – clean water, nutrition, infant care, STD prevention, home violence, family planning, etc. These mobile midwives have now taken it on themselves to develop the next step.

Matrons are local village birthing attendants who may have much wisdom, but little formal training. Our graduates reach out to them with regular meetings to discuss safer home births, how to recognize labor complications that need hospital care, having transportation options in place, and, then, supply them with simple, but highly effective, birthing kits.


MFH is also an employer. Including cook, security guards, laundress, drivers, interpreters, and graduate midwives, there are more than 35 people on staff. Even the political climate is changing – at least locally – as expectations, accountability, supervisory skills, and administrative needs are negotiated at all levels of the project.

Healthcare is changing in Haiti because of MFH. Well-educated graduates are working throughout the country in hospitals and rural clinics. With better prenatal care and safer deliveries, there are now healthier infants. Other organizations are stepping in to take on the next step of increased pediatric care. There is active discussion about developing a birthing center in a remote area with difficult hospital access. 24/7 obstetric care will be available. And this would lead to wider medical services being available to the community. This would be the start of one of the long term visions of having many such centers located in less accessible areas. A yearly conference is held as a teaching and open forum for other healthcare professionals. Within MFH and with other organizations, discussions are on the table about replicating this teaching project elsewhere in Haiti (and – do we dare dream under our on “mango tree”- elsewhere in the world). With curriculum written that meets World Health Organization standards and a great education model, it is ready.

MFH has done its small part to draw more good attention to Haiti. Over 400 volunteers from around the world have offered their services. Many of these passionate volunteers return, and they all take home stories filled with tears and determination to do more. International organizations are investing in Haiti because of MFH. Belief is so strong that one way we, collectively, can break into the cycle of the world’s troubles is with genuine attention to women’s health and that of the unborn child.

Other individuals and organizations see the worth of MFH ‘s mission and readily offer support. The ripple effects of MFH mingle with those of many other organizations, Haitian and international. We are grateful to learn from the wisdom of those who have been here long before us. In turn, others are learning from our “new age” approach to maternal-infant care. And all are here with the will of making good things happen.


Haiti’s history has put her in the position of needing a measure of revitalization. The country, with intention, has started this process on its own. There is certainly much global interest as well. (And, yes, I realize this same outside world has also been responsible for much past and ongoing suppression of Haiti and needs to change many of its ways. But, as a whole, the balance is shifting to the good.) So, are good changes happening in Haiti? Is Haiti “getting better?” My answer continues to be “Men wi!” (For sure!)

-Ken Heatwole, MD, Board of Directors, Midwives For Haiti