Wednesday, August 07, 2019

A Tale of Two Generations

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way--in short, the period was so far like the present period, that some of its noisiest authorities insisted on its being received, for good or for evil, in the superlative degree of comparison only.” -Charles Dickens

It was the best of times, it was the worst of times.  It was the age of Tara being foolish, it was the age of Paige being foolish. It was the epoch of flying dogs through the air, it was the season of idiocy, it was the season of shame, it was the spring of another generation of dim women, we had everything before us, especially an ass-load of stress, the period was so much like the period that proceeded it that some of its noisiest authorities insisted history was repeating itself, for good, or for stupidity, there was much to be compared.  -Tara Livesay

The Bible speaks of the sins of the fathers being visited upon the sons.  

Today we lament the poor decisions of the mother becoming the poor decisions of the daughter. In an effort to preserve history for the next generation, I bring you this story wherein my daughter Paige is doing EXACTLY the incommodious thing that I did back in Aught-Seven.  And there is nothing I can do to stop her. 

In 2007 Brittany, Paige's big sister, was 17 years old and leaving for college at Baylor University. She was to have a three month period in the USA before she began her University classes. During those three months we would welcome Lydia to the world and reside mainly in Minnesota.  Brittany played on all my Mom guilt and sorrows over the ending of her childhood and she insisted her 130 pound Mastiff be in the USA with her for three months.  

I wrote about it here.  

That decision became one of the greatest debacles and sources of shame of my life, but I learned, by God, I learned.  (Being by yourself, at the mercy of an airline employee, without a car, a home, or cash, at 5am with a three month old baby and a giant sedated dog and far too much luggage will teach you something, by-golly.) 

Sadly, my learning is not transferrable to Paige.

Paige announced to me that her dog was going to go to South Korea with them. It was over the internet and just a voice message. 

I physically cringed.  I forced my lips together and said nothing. I continued like this for a commendable time period.  (I was commended by KJ.) 

I only lamented and complained to Troy and KJ. “WHY would she do that?", I asked repeatedly.

And so, like sand through the hour glass, so are the days of our lives. History has a way of repeating itself.  She will do it because she wants her kids to have their dog.  The same reason I did it.  Mother guilt.  The strongest force in the universe.  Two generations of loving, guilt-ridden, mothers.

Paige’s dog, Cooper, is going to South Korea.  

A poorly behaved dog from the humane society in Waco, TX is moving abroad, seeing the world as it were.  

And what dog shouldn’t see the world?  What are you doing for your pet, exactly?  If your pet has not left the country in which it was born, please explain yourself.

Cooper the humane society dog cannot fly out of Texas because of course he can’t. (You may recall the Mastiff debacle of Aught-Seven included driving from MN to TX because MN was TOO COLD for the dog to fly out and return to Haiti with us.) 

Texas is too hot in the summer.  August is no joke. Just try to find a Texas tarmac that is not hotter than the center of the sun.   

Originally we were to drive all the way to Seattle.  My girlfriends heckled me and said, "My Lord, Tara, why would you do that? Haha, I guess you are a supportive Mom, but, I mean, where is your sense of pride?" 

Anna, a Heartline donor, stepped in. She couldn't allow a four year old, a two year old and a poorly behaved dog road trip of 34 hours.  She researched temperatures and weather patterns. She all but laid down her life for the cause. She booked us tickets from a slightly cooler city in the midwest. 

Later in August, we (Paige and I) will drive Cooper and his favorite boys to Kansas City, where, if God loves us, it will be under 85 degrees on the morning we fly out of that airport at 6am. We then fly direct to Seattle for a couple days before Paige, her boys, and her Humane Society dog fly away to South Korea. 

Obviously, before arriving in Korea, Cooper the poorly behaved dog has requested a chance to see the Space Needle and Pike Place Market and Puget Sound. (Der.)

The newest PETA (People for the Ethical Treatment of Animals) initiative is being headed up by Cooper. He is calling it DETA - (Dogs Enjoying Traveling Abroad).

It was the best of times, it was the worst of times.  It was the age of Tara being foolish, it was the age of Paige being foolish. It was the epoch of flying dogs through the air, it was the season of idiocy, it was the season of shame, it was the spring of another generation of dim women, we had everything before us, especially an ass-load of stress, the period was so much like the period that proceeded it that some of its noisiest authorities insisted history was repeating itself, for good, or for stupidity, there was much to be compared.

Wednesday, July 24, 2019

Philosophy of Culturally Competent Care


What better place to start to address systemic and structural issues than with Moms and their soon to be born babies?

We are preparing for the upcoming three Starting Place classes being offered at the Heartline Maternity Center.   

These classes (sharing the model of care) will be offered this coming October, February and May.

Today we are focusing on the portion of our model that addresses cultural competency and how that relates to short term volunteers.

In 2016 we made a decision to invest in local midwives and medical professionals by increasing the size of our staff and pouring into them by offering continuing education and support.  Finding jobs in Haiti is VERY difficult, we are happy to provide 12 jobs at the Maternity Center, 7 of those 12 jobs are medical professionals.

We made a decision that every woman that is pregnant deserves to meet with someone during her consultation that speaks her language, understands her culture, her life, and her challenges.  When I was pregnant, I always had care providers that spoke to me in my own language, and that is what we think Haitian moms deserve too.

We believe that the best way to build trust with clients is to begin by building relationships.  We decided that relationships can't be built in a week or two or three.  

We made a decision that the Midwifery Model of Care cannot take place in a clinic or birth center where people rotate in and out and there is not a consistent and predictable face providing the clients with consultations. 

We decided that Haitian care providers are best prepared to understand Haitian clients. We decided to train only Haitian care providers because they are the ones that will likely live here for the next forty years.  

Please hear this. We did not decide we dislike North American medical professionals.  We did not decide we don't want Americans to train as midwives. We simply decided that if Haiti is ever to see any true and lasting change in the care that is provided, it is going to depend on Haitian medical professionals being excellent and ready to respond to the needs of patients, therefore we prioritize investment in local midwives.   

Cultural competence refers to the process by which individuals and systems respond respectfully and effectively to people of all cultures, languages, classes, races, ethnic backgrounds, religions, and other diversity factors in a manner that recognizes, affirms, and values the worth of each individual. 

Cultural awareness is the deliberate, cognitive process in which health care providers become appreciative and sensitive to the values, beliefs, practices, and problem solving strategies of their clients' culture.

The number one way we practice cultural awareness and competence is by remaining committed to providing Haitians with jobs and giving them a lovely work environment wherein they can serve their neighbors, the women in their own country.

Heartline Maternity Center is not closed to visitors.  We are always happy to schedule and provide tours of The Maternity Center and would love to talk more with you when you're in Haiti.  We just don't have work for you to do because the people doing the work really love it and they need their jobs. 

Friday, July 19, 2019

Love, Loss, and Ismael

In every culture, the loss of a pregnancy or newborn child or the inability to have a desired pregnancy can be indescribably painful.

If you’ve followed stories in Haiti for long, you know that far too many Haitian families have experienced great loss. Loss is more common in cultures that lack resources and medical infrastructure. 

Your continued compassion toward the women we care for and walk with at the Heartline Maternity Center has meant so much to us over the last twelve years.

Compassion is one of the greatest gifts we can offer.

In mid 2016, Celia came to the Heartline Maternity Center for care. She was early in her second pregnancy. In her initial interview, Celia shared that her first baby was born at home and had struggled to breastfeed. That precious baby girl died in the first week of her life.  

Understanding how painful loss is, we wanted Celia to have the very best chance at a healthy pregnancy.  She began attending our prenatal program and class every week.  

In December of 2016, she went into preterm labor at just 29 weeks. Sadly, just before Christmas, Celia’s baby boy died at the hospital and she and her husband, Robert, again experienced the loss of a beloved child.

To read the entire post, please visit the Heartline Blog HERE.

Wednesday, June 12, 2019

By Isaac Livesay

Hello folks! This is Isaac writing to spill the tea on what my family and I are going to be up to this summer! You ready? It is exciting for us.
To start things off everyone, including KJ but excluding my Dad, will head to Florida. From there we fly to Tennessee and spend a week at friend’s cabin in the Great Smoky Mountains. I am so happy about being in Tennessee, not only because of the people I will get to see but also because of the environment. I love a change of scenery, and Tennessee’s change of scenery is definitely a good one. I also enjoy photography so I’m hoping to take a lot of pictures on that visit.
After our trip to East Tennessee comes to an end Hope, Noah and I will break away from the group and head our own ways. Hope will be heading to Minneapolis, Minnesota to hang out with our oldest sister Brittany. Not only will she be there to hang with Britt, but she will also help with caring for Gideon and Eleanora (Brittany’s young children) while their mom is away at work.
Noah will be traveling to Colorado to stay with his godfather and godmother for a week. They are friends we made in Haiti and Noah told them he wanted them to be his Godparents and that was that. While there in the Denver area he will see and do many things including ice skating for the first time in his life.
Lastly I will be venturing to Michigan for two weeks. I will be staying with Lee Ann, my amazing and brilliant veterinary medicine professor, and her husband at their little farm house. While I am there I will helping them around their farm with whatever they need. I will also be going on a few adventures with Lee Ann. I’m not exactly sure where yet, but I know that it will be awesome. Here’s the big catch about going to Michigan; other then getting to spend time at the farm with Lee Ann, I will also be shadowing her at her work. What this means is while she is doing her thing at the clinic I get be by her side and watch and maybe assist her. It sounds so exhilarating and I cannot wait.
When my time at Lee Ann’s is done I will fly to El Paso, where by second oldest sister Paige lives, and meet up with Hope, Noah and the rest of the fam just in time for the Fourth of July. We watch fireworks at Fort Bliss, it is very fun. After all that action and excitement my Mom will leave with the two little girls to go back to Haiti and its pretty much just going to be hanging out with Paige and her two boys for the rest of the summer. To me that’s a summer well spent.

Monday, June 03, 2019

Story Time: The Joy&Frustration of Cross-Cultural Communication

Lydia - 3 years old
Mastiff Marley,
quite old at that time
Living cross-culturally means that we are entertained half the time - and enraged the other half of the time and the good folks we live among and work with feel the exact same way about us. 

It's good times, I tell you. GOOD TIMES.

I am keenly aware of my bent toward ethnocentric thinking. I call that out here and now and I say to you this:  I know there is more than one way to skin a cat.  (That's a weird expression.)

I know that because I VERY MUCH think driving in an orderly fashion with rules and systems is FAR better.  However, that does not mean it is the only way.  Obviously.  People are doing the opposite thing here every damn day.  Generally, they get where they are going.  (They are much much angrier than if there had been just SOME rule, but I digress.) 
So, I know ... There are two or more ways to do most things.  

Okay.  That is established.

Friday afternoon the security guard that works at our house 6 of 7 nights per week had a big emergency.  We know him, he has been with us a year.  He was responsible and awesome and he called the security company we contract with, that he works for. Then he called us, he called Geronne too. He made sure we all knew he could not make it to cover the night at our house.  

Troy called the contact we have right away too.  They said they would bring out another guard.  That was around 4pm.  The shift begins at 6pm.  This is a service we pay for and want. We love that we know our two guards and it gives us a sense of security to know the man walking around our yard all night. If it is false security, we don't want to know that.   Shhhh. 

Back in the days of TWO Mastiffs, Peanut has gone on to a better place.
Hazelnut on the left.

Around 9:30pm a bunch of noise was happening at the gate.  Troy went to answer.  It was a group of guys saying that they were dropping off the agent to cover the night. The dog was mad and barking. (She has never bit anyone except a goat but she sounds mean.) 

The temporary security agent was too afraid of our large Mastiff, Hazelnut to enter our yard.  Troy said to the men, (In Creole)  "You know what, it really does not do me any good if you are afraid of the dog and won't move around the yard.  Why don't we just forget tonight. Also, it is 9:30 now and it is dark and I don't know you and it doesn't really help anyone here feel safer for you to come in at this time. You're late! Thanks but no thanks, as the customer we will decline your services this evening."   

To our American way of thinking, this is perfectly reasonable.  The dude fears our dog. We don't know him from Adam (that's an expression too) and he has annoyed us by coming 3.5 hours late.  

We set off a bit of a storm with this decision. Phones were ringing all over town and the guys would not leave our area and everyone was arguing about whether or not Troy could just decide that - Boom, just like that. 

To our host culture Troy was being unreasonable and inflexible and they wanted a compromise.  They wanted Troy to accept that they were late and let that go and then to agree to lock our dog up for the night inside the house.

This went on for a good hour or two. Troy dug in, they dug in.

I just stayed in my room reading and relaxing and laughing at it all. (That is where entertained half the time comes in. Laughing at Troy.)

Living cross-culturally means that we are entertained half the time - and enraged the other half of the time and the good folks we live among and work with feel the exact same way about us. 

Sunday, June 02, 2019

The Table

With the recent tragic passing of Rachel Held Evans, my husband Troy and I have been reflecting upon a moment in the last year that moved us both to tears.  

We were at a conference that Rachel co-founded with our friend, Sarah Bessey.  At the end of the two day event communion was made available to those that wished to come to the table. 

That moment felt like an intentional whisper of love and a promise of light from God. It happened last October in what was for us a year of relative darkness.

As we stood to receive communion we chose the station nearest to our seats. We stood in line a short time. When we reached the table we looked into the faces of three beautiful reflections of the image of God.  (Genesis 1:27)

We were offered the cup and the bread by: 

Author, Nish Weiseth

Spoken word / Hiphop artist, Jason Petty (known by most as Propaganda),  

Author, Jeff Chu.  

The three of them come from entirely different backgrounds and upbringings and religious traditions.  Their lives, struggles, hurts, joys, and experiences are quite different, save one thing. They all call Jesus their Lord and follow hard after Him. The all believe that God is love.

When we were served the cup and the bread by these three, we wondered if we were experiencing our own personal peek at the Kingdom.  (On earth as it is in Heaven.) 

Perhaps you read or heard of William P. Young's book, The Shack.  If not, it is a story written about a very human God.  

The book forces the reader (well, it forced me) to look at the nature of God. 

In the book, written 12 years ago, Young dared to picture God as female. Beyond that the author intentionally developed the Trinity into the characters of 

"Papa" a large welcoming and always beaming African woman 

Jesus, a Middle Eastern man wearing a belt of tools; ready for physical labor, 


the Holy Spirit, an Asian woman in the clothing of a groundskeeper or perhaps a gardener.  

The book was controversial because it did not play by the rules and some of the thought police felt it sacrilege.  

I loved it.  

If God is Love and we are created in God's image, then we are also created to love God and one another with the same compassionate and intense love exemplified between the Trinity in The Shack.

The day I was served communion by Prop, Nish, and Jeff, I felt closer to God's heart than I had felt in a very long time.  

I won't ever forget it. 

"This is what the kingdom is like: a bunch of outcasts and oddballs gathered at a table, not because they are rich or worthy or good, but because they are hungry, because they said yes. And there's always room for more."  
-Rachel Held Evans

Thursday, May 09, 2019

Smaller than a Fart ... Life with Paige

Paige left me with her kids at an
insane kids museum-
she went and bought and ate
a rice-crispie bar so she would not have to
share with me or her little minions.
But she sent me a photo.
Mothers of young children need
rice-crispie bars alone sometimes.

The last time Paige visited us in Haiti we were all playing the game 'Catch Phrase' together.  

It was very heated competition and everyone in this family is a jerk except for Isaac so there was a lot of smack-talking and cocky behavior.  

We were several rounds in when it was Paige's turn.  She was on my team - I was highly tuned in and ready to dominate.

Paige began a new word. She said, "Not a fart, smaller than a fart".

Within a few guesses those of us on her team yelled, "Toot"

"YES YES", she excitedly said.

Then she said, "Okay, now this is harder, it's a thing you go down into in a storm."

We shouted out guesses and she kept lamenting how hard this word was and that she did not know what it meant.  The buzzer sped up and eventually went off in her hand.

She was hoping we would guess the word hatch. (Storm hatch -- which is an old-timey thing that these kids that have lived in Haiti for 13 years have no idea about - do we do storm hatches in the modern day times?Talk to me.) 

She was ticked at her bad fortune.  There was dramatic lament about why she always gets the WEIRD words. 

She said, "What the heck is a toot-hatche?"  

I was instantly rolling with a side ache laughing, "TOOTHACHE?  As in your tooth hurts?  Is that what it said?"  

We grabbed the game out of her hand to look for ourselves.

We all love when somebody is a dingbat because then we can mock them for the rest of their lives.  

Forevermore when one of has a sore tooth we will say, "Not a fart but a ???"  Toot-hatche.

Tuesday, May 07, 2019

A Chance To Honor Women & Mothers - Don't Miss It !!

Courage. Love. Sacrifice.
From the daily selfless acts of motherhood to stories of women facing incredible challenges, we don’t have to look far to witness these universal characteristics of a mother’s heart.
Time and time again, mothers around the world astound us with their courage, love, and sacrifice. This is certainly true in Haiti.
Give a special Mother’s Day gift to the Heartline Maternity Center 

in honor of a courageous woman in your life and make a lasting

impact for mamas and babies in Haiti.
Prenatal care is hard to come by in Haiti. Respectful and thorough prenatal care is nearly nonexistent. 
Muraciene knew there were limited options for maternal healthcare in her community, but she was determined to provide the best start for her precious baby. At 11 weeks pregnant, Muraciene made her first hour-long trek to the Heartline Maternity Center. She was overjoyed to have a spot in the program and knew the care, education, and nutrition she received would give her baby the best chance to thrive. 

Prenatal Class Heartline Maternity Center Haiti

Every Thursday throughout pregnancy, Muraciene rose early to make the journey to the Maternity Center. Though the trip was bumpy, long, and required her to change tap taps three times, she relished the opportunity to learn of her baby’s progress and how to remain healthy.
In her 35th week of pregnancy, Muraciene was awoken by contractions at 4am. At first she wondered if this was really labor, but the waves of pain continued to intensify. She knew her due date was still several weeks away and worried about her unborn baby. 

Woman walking in Port au Prince, Haiti.

Lately, everything felt especially tense and unsettled as civil unrest gripped Haiti. Political demonstrations and roadblocks were making travel throughout the city increasingly difficult. She knew this trip could be especially challenging, but feared what might happen if she waited and couldn’t make it to the Maternity Center in time for her baby’s birth. 
Muraciene chose courage and began making her way to the Maternity Center. 
As the tap tap rumbled over potholes, Muraciene clutched her belly and hoped for the best. She arrived at the Maternity Center later that morning. With her labor intensifying by the minute, she felt relieved to have made the journey safely and was certain that her baby would be coming soon.

Muraciene's labor with the Heartline Maternity Center midwives, Haiti

The Heartline Midwives gently prepared Muraciene that her baby would likely need some assistance breathing because of his early arrival. Once again she chose courage by trusting her midwives, body, and baby through the labor and delivery process. 
Two hours later, Muraciene gave birth to her second son, Kenneth. Those first moments were excruciating as she watched her baby struggle to take his first breath. The Midwives quickly intervened and Kenneth began to turn a perfect pink and let out a mighty cry. Joy washed over the room. 

Muraciene and Kenneth recovering after delivery - Mom and Baby - Heartline Maternity Center Haiti

A few hours later, Kenneth began showing signs of respiratory distress. His premature lungs weren’t quite ready for the world outside of his mother’s womb.
Thankfully, the Midwives had access to an infant CPAP machine that provided Kenneth’s lungs with continuous pressure to remain open. This treatment, along with his mama’s devoted love and attention, worked wonders for Kenneth. His breathing improved and he was able to wean off the machine 48 hours after birth.

Baby Kenneth, born prematurely at the Heartline Maternity Center in Haiti, gets help breathing from an infant CPAP.

Without access to the Maternity Center, Muraciene and Kenneth’s story would have been drastically different. 
It’s true that the power of a mother’s love is an incredible – even miraculous – force. But the harder truth to face is that sometimes even a mother’s love, sacrifice, and courage cannot alone save her child. 
Muraciene loves her baby boy deeply, she made numerous sacrifices for her child, and courageously faced frightening situations in order to give him the best chance to thrive. Still, her baby was born prematurely and was unable to breathe on his own. Without access to quality care, Muraciene could have lost her beloved son. 

Mama Muraciene and her baby boy, Kenneth, spend time skin to skin at the Heartline Maternity Center in Haiti.

The majority of Haitian women receive little to no prenatal care and give birth at home without the help of a skilled birth attendant. This lack of access to care makes it extremely dangerous to be pregnant and give birth in Haiti. For far too many mothers and babies, the situation faced by Muraciene and Kenneth would have resulted in tragic outcomes.
Will you give today to ensure that mothers and babies in Haiti have access to the quality, life-saving care we all desire for our own families?
When you donate for Mother’s Day, we’ll send a personalized ecard to a special woman in your life letting her know of your thoughtful gift.
After six days of rest, recovery, and breastfeeding support at the Maternity Center – Muraciene and Kenneth were ready to return home. But the situation surrounding their homecoming was anything but typical. 
Safely tucked inside the Maternity Center walls, Muraciene listened to news reports about the current situation in Haiti. The political protests that had threatened her journey to the Maternity Center had intensified. Large parts of the city were essentially shut down due to roadblocks.
Muraciene was given the option to wait out the days of civil unrest at the Maternity Center. But her older son was eagerly awaiting the return of his mama and new baby brother. She knew it was time for her family to be together again. 

Muraciene and her husband take their baby boy home after receiving care at the Heartline Maternity Center in Haiti.

Muraciene’s husband arrived by motorcycle. She courageously climbed on the back and held Kenneth close while they weaved through the side streets. 
As they were leaving the city, the family came upon a large group of demonstrators who were not allowing travelers to pass. Muraciene and her husband explained that they were taking their new baby home. The news spread amongst the protestors who began to shout, “Let the baby through! They’re taking their new baby home. Let the baby through!” The family was allowed to peacefully pass through the demonstration and made it home safely.
The following week, protests began to quiet and public transportation resumed. Muraciene once again climbed into a tap tap to make her way to the Maternity Center. She was grateful to be holding her healthy baby boy in her arms as they bounced over the potholes. Over the next six months, Muraciene and Kenneth will return to the Maternity Center each week for community, child development class, and check-ups.

Baby Kenneth, born prematurely at the Heartline Maternity Center in Haiti, is growing and thriving!

Kenneth is thriving thanks to the support of generous friends like you and the love of his fierce mama!
This Mother’s Day, we celebrate the love, sacrifice, and courage of mothers around the world. Will you honor a special woman in your life by caring for Haitian mothers who mean so much to their families?
This Mother's Day, give a thoughtful gift that makes a lasting difference for Moms in Haiti.
When you make a donation to the Maternity Center, we’ll send a personalized Mother’s Day ecard to the woman you wish to honor. Your thoughtful gift will ensure that Haitian women and babies receive the highly skilled and compassionate care they deserve.

Friday, March 22, 2019

Slow and Steady Wins the Race

(Picking up where I left off on my recent Instagram/FaceBook post...)
Waiting for Ultrasounds

The Process of Growth

All new endeavors are overwhelming at the beginning. Growing at a slow, but steady pace can help you become well established as you begin to provide women with excellent maternal healthcare. There are many ways to build a maternal health program, no one way is correct. In order to make it less overwhelming for you as you dream of your future impact, we want to talk about the slow and steady way the Heartline Maternity Center model was built.

The Maternity Center began 12 years ago. (2007)

At the beginning we simply met occasionally with 15-20 pregnant women to talk about pregnancy and basic health issues. It was similar to a support group and was meant to be a supportive and friendly learning environment.  About a year into the meetings we started distributing Prenatal Vitamins and Iron supplements. We began taking vitals each week as the women arrived and started recording their weight, pulse, and blood pressure each week before class. About two years into the weekly class gatherings, two certified midwives moved to Haiti to begin doing full prenatal visits. We were careful not to offer anything beyond the training and experience of the staff. The two midwives began seeing the women for prenatal care after program each week on the same schedule an OB/GYN or Midwife would do visits in North America. Prenatal care and regular consultations were provided at Heartline, but the client still needed to deliver at home or find a hospital.

During the first two years we also offered a class for women to attend after they delivered. We began holding classes for pregnant moms on Thursdays and postpartum moms and new babies on Tuesdays. The evaluation of the postpartum class created a deep sense of community amongst new moms who were perhaps doing things differently than their own mothers had.

About three years into the program we began to offer labor and delivery services. Before we could offer these services we needed to be sure we could cover the Maternity Center with a staff member 24/7 365 days per year. Sadly, many clinics and hospitals in Haiti don't deliver babies on weekends or at night. We think that's nonsense! We made sure to have two skilled and trained midwives on staff before we began to offer that service.

About four years into the program we realized that we needed to keep women after delivery for longer than the six hours that is customary in low resource countries. We added postpartum care with around the clock care providers for as many days as each individual mother and baby needed.

In the fifth year we began offering a birth control program. Prior to that we provided education on child spacing and methods of contraception, but had yet to provide contraception at our facility.

In our sixth year we were gifted an excellent Ultrasound machine. Several staff members received training to perform U/S. We began to use U/S during interviews of newly pregnant women. This allowed our due dates to be very accurate. Often times LMP (last menstrual period) is uncertain.

As we continued to grow, we added approximately 10 pregnant women a year to the prenatal program. As we increased the number of prenatal program participates, we also increased staff. This brought us eventually to our max number of 70 to 75 pregnant women in our care at one time. As one woman delivers, a newly pregnant woman takes her place and begins the weekly classes and prenatal care in her first trimester.  

As we became more experienced and hired more medical professionals we also began to take on slightly more complicated pregnancies. In the early years all women with pre-existing hypertension, asthma, or gestational diabetes were risked out of our care. As we have grown we have been able to take on more of those clients and we risk out less women than we did at the start. (Of course, there are still women that must be referred to higher level care with a Doctor.)

As we grew, we established both medical and practice protocols. We hired more staff and went from zero Haitian medical professionals (just two Americans) to seven Haitian medical professionals, employed full time with insurance and benefits.
Five newly pregnant women receiving contract to join the Prenatal Program
 Overall, it has taken us 10+ years to hire and build up a staff that is fully on board with the mission and vision of the maternity center, and to grow into what we believe is our full capacity as a maternal health program.

Prenatal Class March 21, 2019

We don't aspire or plan to grow our numbers to more than 70 to 75 pregnant women at a time (this ends up to be about 120 babies born in a calendar year). The high quality care, education, and focus on building trusting relationships is part of the reason we have such great outcomes. We believe the high provider to client ratio is an essential part of the model of care. In order to provide excellent care we know we cannot keep adding more women. We believe quality over quantity ascribes dignity and honor to each woman we care for.

Because we don't plan to grow, we know the only way to keep reducing maternal and newborn mortality is to share the model and equip others to take it and run with it.

Please let everyone you know (that is working at an organization that is attempting to help with women's health) know that we are offering a class and manual about how to build this program and save Moms and Babies from PREVENTABLE death.