“It’s not easy,” she says, rubbing her stomach while looking off into the distance at the suffocating traffic on Delmas in Port au Prince. “It’s not easy to feed yourself and your family. I am afraid to go to the clinic sometimes, even when I am supposed to. What happens if I am robbed? I work every day. But I worry about myself. I worry about my baby. What if I contract COVID? What if my baby gets COVID? Should I wear a mask? What if the midwife gets COVID? What happens then? My sister lives in an area of Haiti where she cannot even access a doctor. She sees a Matrone. If anything happens, the matrone cannot help her. If something happens, my sister knows she might die.”

— Anonymous, May 2020

It’s Haiti. It’s January. It’s hot. The mood around Port au Prince is heavy. The news is grim. There is traffic congestion. The dangers are constant. Mostly theft. Sometimes more violence. The ambient stress is everywhere. And infectious. We are warned to stay clear of ATMs and are not allowed to visit certain areas. Occasionally, expats are victims of violence but, for the most part, it’s locals. We don’t hear much about violence against locals in international media. “Just last week eight people were kidnapped near here,” one midwife tells us in the ground floor office of the Association des infirmières sages femmes en Haïti (AISFH). “Really?” asks another. The First Midwife shrugs. She doesn’t know for sure. Sometimes, it’s impossible to be sure of anything at times here.

In the office downstairs, we look at a series of logos spread out on the conference table. Several members of the board of directors are present, as are about 15 midwives. Some are here for a project meeting, four for the communications and call centre training (with board members as back up). In just a few short weeks, AISFH will be the hub of Alo Saj Fanm, a new, innovative response to the need for more maternal health care in a country where health care resources are limited or not easily accessible. Alo Saj Fanm (“Hello Midwife” in Creole) is a call centre that offers services to Haitians who are seeking information on maternal and child health and family planning. Callers can access a series of pre-recorded messages or speak to a live midwife during specified hours. And in the Age of COVID‑19, the need for socially distanced medical support is increasing. The centre launches early this summer 2020 in the Department of Nippes, followed by le Sud Est, Grande-Anse and later Nord-Ouest with the hope of going nationwide in 2021. Alo Saj Fanm is part of the Saj Fanm Pou Fanm (“Midwives for women” in Creole) project, which aims to strengthen the profession of midwifery, reduce maternal mortality rates, and promote the health and well-being of women, girls and newborns in Haiti.

“The aim of the Alo Saj Fanm telephone line is to enable women, especially in remote areas, to obtain reliable and free information related to pregnancy and childbirth, and to strengthen their links with health institutions so that they can go there for follow-up,” says Veronique, Project Co-ordinator of Saj Fanm Pou Fanm (SFPF). “The maternal mortality ratio is very high – 529 per 100,000 live births,” adds Marie Juliana, Field Officer for SFPF.

Today’s training covers a variety of techniques and processes all designed to make sure callers receive the information they need. We’re also discussing options for the new Alo Saj Fanm logo. Marthe Elvire, a registered midwife in Haiti and communications point person, looks on intently. There is discussion. AISFH aims for consensus so members feel they have a voice in the decision‑making process. Marie Juliana looks on before she takes us upstairs to show a largely empty space and a series of rooms. The space is warm and colourful. She smiles. The air is quiet. Peaceful. She points out where the desks will go, where the phones will be. She shows us the room where the staff can rest if call volume allows. The veranda where one can enjoy a tea, a moment with social media. Port au Prince is one of the most beautiful cities in the world, nestled in and around a series of hills with stunning views of the Gulf of Gonâve and nearby hills. There is a great art scene, dedicated health care workers, social activism, generosity. But its ambitions and beauty are constantly undermined. Its political situation is complex and layered. The challenges are real and everywhere.

“In the current context of COVID‑19, we have a population of people that are nervous, getting tons of inaccurate information, and major distrust in the ability of the health care system to absorb these cases,” says Regine, project coordinator for Viamo; a telephone platform that specializes in public engagement and behaviour changes services and operates in nearly 30 countries. “We are able to provide women info about the pregnancies in relationship to COVID‑19. Give them a place with accurate and empathetic information during a time of uncertainty.”

The call centre structure is simple and effective. When someone calls in, they have the option of going to the info line or going to the call centre. The info‑line is full of information for pregnant and post-natal women, from the beginning of their pregnancy to the first few weeks after the baby is born. It covers prenatal care, miscarriage, postnatal care and even contraceptive care. The info‑line also has information for future midwives, fathers, and the Haitian equivalent of a community matron. Pregnant mothers also have the option of signing up for weekly updates sent to their phone that provide basic information from foetal development all the way through to the child’s first birthday. Of course, it is not designed to replace in‑person medical care, but this service can fill in some of the gaps that are ever growing.

“Most definitely, it’s a much‑needed service, to be able to provide people with the same amount of information that we have available online despite their remoteness or literacy levels,” explains Regine.

Back downstairs, Marthe Elvire decides on which logo she feels best represents Alo Saj Fanm. “I like this one. If I was a woman seeking information about maternal health… it makes me want to call.”

AISFH is working towards the goal in the hopes many other women agree with her.

Saj Fanm Pou Fanm (SFPF) project, aims to strengthen the profession of midwifery, reduce maternal mortality rates, and promote the health and well being of women, girls and newborns in Haiti. The overall budget of this five year project (2018‑22) is 15 million CAD. SFPF is led by the United Nations Population Fund (UNFPA) and is funded by the Government of Canada. It is a collaboration between AISFH, the Canadian Association of Midwives (CAM), Université du Québec à Trois Rivières (UQTR), and Haiti’s Ministère de la Santé Publique et de la Population (MSPP).

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