Catholic Transcript Article: A Young Woman’s Choice: The Village or the Road.

By Michael R. Bourque, M.D.

The passing of our most recent Mother’s Day, along with my work in poor villages in Haiti and the Dominican Republic, have made me take a fresh view of the enormous sacrifices that women make for the sake of our future children. In our country: flowers, cards, dinners out, and a special day mark the happy results of a life experience that is accepted as hard work, but with a fruitful outcome almost guaranteed. Here, with an experienced physician or midwife in charge, along with a small platoon of supporting personnel including nurses, residents, anesthesia, and nursery staff, a woman labors knowing with almost certainty that her life as well as that of her unborn is not in jeopardy. She is surrounded by her closest family, and she can fully concentrate on the physical task of birth before her.

Not so with a young woman of the same age and health who had the misfortune of luck and genetics to be born in a country where there are few resources, and the choice of where she can deliver takes on the implication of her living or dying, or forever being damaged by the physical result. Never mind that her decision will also determine the outcome of her unborn child.

You see, in most villages in the poorest of countries, there are no health facilities of any kind. A female, non-medical elder, will supervise the labor of the patient in a small dirt-floor room, or outside under the tropical sky. There may be a village shaman or voodoo doctor who is consulted when things are not progressing well, and whose answer, while not medical, carries the full weight of authority of her village. The result is then left to the whim of Mother Nature whether she will survive this most natural, but very difficult, female endeavor.

A small home in the remote village of Dame Marie, Haiti.

On a recent trip to a remote village on a mountainside in Haiti, I took a four-wheel-drive vehicle over the same roads that a woman must walk to reach the nearest health facility. It is an eight-hour walk over rocky, unpopulated roads where streams and rivers must also be forded to reach any kind of maternity care. In labor, often in the dark, and in bad weather, can you imagine the fear and the hope that tussle in that young woman’s mind as she takes step after step, hour after hour, to reach the land of Oz, where she and her baby will be safe?

Road from Haitian Mountain Villages to city of Jeremie, Haiti

I have also seen the destination where she is heading, and sadly it is not Oz. The hospital in that larger town has only one obstetrician for four hundred thousand people. Here in Connecticut, statistics are 6 per ten thousand, or 240 Obstetricians, for the same population. That is just the first problem when she reaches her destination: Will there be an experienced OB provider available? The next hurdle is whether the generator at the hospital has any fuel. If not, the operating room cannot run, and the patient is turned away, while her labor continues with no fetal or maternal monitoring of any kind. And if there is fuel, is there an anesthesiologist who can help with the pain relief needed for a caesarean section? They are as rare as Obstetricians. I was told by Bette Gebrian of the Haitian Health Foundation, who has worked there in Jeremie, Haiti, for the last twenty-five years, that a patient recently had to be sent by jeep to a further hospital that had everything working, but only after an additional ride of four hours, on top of her eight-hour trek to the larger community. The mother and the baby lived. This time.

And what is particularly troubling is that the choice made by the young woman, whether to stay in her village or to take to the road to try and reach Oz, is not a choice at all. Behind each door of choice is a tiger, not salvation.

Globally, a young woman dies of labor complications at the rate of one a minute. That adds up to three jumbo jets of otherwise healthy young women dying every day, and would fill 6 to 7 football stadiums of lost young mothers and potentially their newborns every year. What horrible images. And while good strides may be occurring on a national level in some third world countries in the bigger cities, healthy young women continue to die simply because they live and birth in a rural environment.

Being an experienced obstetrician, as well as a medical director of our hospital mission program, never mind also being a father, grandfather, and brother, I am appalled at this daily loss of life. I have witnessed it firsthand and it has left me forever changed. I had not lost a young mother in my long years of practice at Saint Francis Hospital and Medical Center, but suffered that most terrible of tragedies for an obstetrician on the very first night of my first mission trip six years ago.

On a happier note, we can save these young women if we are serving there when they go into labor. Witness the C-Section delivery and happy result of this young patient in the Dominican Republic, who would have died but for our presence.

C-Section delivery in the dark when the generator powering
the room lights ran out of fuel.

Her delivery was blocked by an obstructed labor and a C-Section was lifesaving. The smiles of the happy couple with their newborn baby the next morning was all the thanks we needed.

The happy young family the next day.

The sad part is that we can only help so few, and while you are reading this article, another half dozen young innocent women have died from complications of their labor due to bleeding, infection, toxemia, or obstructed labors.
We must do much more for these young women who are the future of their next generation; in monies to support the extension of OB facilities to outlying areas, and in training more U.S. OB personnel to make a difference by donating their skills to international mission trips.

I am proud to represent Saint Francis Hospital and Medical Center, along with the many selfless men and women who donate their time, skills, and pay their own way, to serve alongside me to make such a difference to these neglected sisters of ours. And our growing, international mission program is fully supported by the Administration, and many supporting departments of our Hospital.

If you are moved by what you have read and seen here, please go to our website: www.saintfrancisimm.org, and consider a tax-deductable donation to our cause. We are excited to announce that we hope to be breaking ground on a Saint Francis Hospital Mission House in Dame Marie, Haiti, in the fall. This will be another first in the long stellar history of Saint Francis and its commitment to its less fortunate sisters and brothers in the community. This will be a joint effort by the local community, the Antoine Family Foundation, and our mission team, to try and create a sustainable ongoing program to improve care in the largely undeveloped Western third of Haiti. Please help us to help them. 100 percent of any donated dollars goes to defray mission supplies and support.

About the Author:
Michael Bourque is a senior obstetrician who has practiced at Saint Francis for the last thirty-one years. He is one of two medical directors of Saint Francis Medical Missions, and a founding member of that organization. He has received awards for his compassionate care, excellence in teaching of resident physicians, and his commitment to international mission work.