Category Archives: In the Field

C2C RESPONDS TO CIVIL UNREST IN HAITI

Photo Courtesy of The New York Times

Today is the celebration of Carnival in Haiti. The Carnival of Haiti (otherwise known as “Mardi Gras” or “Kanaval” in Creole) is one of the most anticipated events in the country. This cultural event kicks off the day before Ash Wednesday to usher in the season of Lent, with colorful celebrations throughout Haiti. But, unfortunately, this year, Haiti’s Minister of Culture has announced that official carnival celebrations have been canceled in light of recent protests and unrest across the country.

Photo Courtesy of Associated Press News

As you may have heard from the news or from personal connections in Haiti, major demonstrations have been occurring across the country since February 5, when citizens and opposition politicians began to demand the resignation of President Jovenel Moise.

That same day, our clinic managers were leaving our Cap Haitien clinic to attend a staff meeting at our Acul-du-Nord clinic when they were stopped on National Road 1 due to political unrest demonstrations. They tried to urge the demonstrators to allow them to cross the road to get to the clinic but there was no way convince demonstrators to allow them to pass the road blocked with cement blocks. Our staff from other clinics also were forced to cross the roadblock zone on foot to get home. The following day, the road was cleared and the staff was able to get to work easily. Unfortunately, the demonstrators blocked the road again later in the day, and, again, the only way the staff could pass through closures was on foot.

On February 7, due to the rising unrest (protests, huge roadblocks and barricades, and burning tires), we were forced to close our clinic network to protect our staff and the patients. Our staff in Haiti stayed in communication at all times to evaluate the situation in order to make a decision regarding the opening or closure of the clinics. For two weeks, our HR manager would send a message to all the staff every morning to instruct them to stay home if the roads and conditions did not allow travel. For most of this time however, one of our more remote clinics remained open and continued to serve the community since it is located in an area away from the political unrest and most of the staff lives in the same community the clinic serves. We also made a conscious effort to try and keep our main clinic in the center of town (Cap Haitien) open to patients who needed timely access to care.

Beyond the demonstrations, another challenge has been lack of fuel, which has made traveling difficult not only for our staff but patients too. Transportation prices have more than doubled to account for the shortage of fuel options in the country.

Encouragingly, in the last week, things have started to return to normal, but the political and economic situation in Haiti is still delicate. There is no telling whether or not the protests will restart. So, there will certainly continue to be challenges but this is what encourages us to keep doing the work we do. We hold on to (and continue to be energized by) the fact that we are providing vital healthcare services to communities that need them desperately.

Thank you for your continued support and, as always, onward!

The Lancet Revisits Maternal Health

“Every woman, every newborn, everywhere has the right to good quality care.”

This is the guiding message of the 2016 Lancet Maternal Health Series. More than a decade ago, The Lancet published their first report focusing on maternal survival. The new series is made up of six papers discussing maternal health, its successes and current failings.

In 2015, 216 women died of reported maternal causes per 100,000 live births. In order to meet sustainable development goals (SDG), the global target is to reduce maternal mortality to 70 per 100,000 by the year 2030. The series offers a five-point action plan for local, national, and global communities to achieve the SDG vision: quality, equity, health systems, financing, and better evidence.

Women and children under 5 are uniquely vulnerable to health threats and C2C believes in providing them with specialized, subsidized care. As part of our free antenatal care program, our physicians saw more than 1,000 pregnant women so far in 2016. We employ an OB/GYN specialist in each clinic two days per week, and pregnant patients have access to local, community-based care: pre-natal exams, diagnostics, medicine and vitamins, and ultrasound. 75% of our pregnant patients receive the WHO-recommended minimum of 4 prenatal visits and we’re determined to get that number to 100%. In 2017, C2C will expand our maternal health program to focus on keeping enrolled patients in the care system and supporting them through safe deliveries and a healthy post-partum period.

Updated Technology Ensures Accurate Data and Response to Community Needs

C2C believes accurate, timely data are vitally important to our provision of the best possible health care to families in Haiti. In the spring of 2014 launched an electronic medical records system at our Camp Coq clinic. The system was an enormous upgrade from the paper systems our clinical team had used previously. As our clinic opened in Acul du Nord clinic, the system was already in place for the new team, and will also roll out with each new clinic opening in 2016.

As our clinics and services grow, C2C ensures our technology grows with us. Various updates to the system have included tablet surveys and GPS capabilities for our Community Health Workers, inventory updates to manage the pharmaceutical and laboratory supplies. These updates allow our staff to respond efficiently to community needs, understand patient satisfaction and challenges, and prevent stockouts in our pharmacy (thereby saving patients time and travel).

According to C2C’s Global Programs Manager, Julia Maxwell, “We always strive to ensure we are responding to community needs, and we count on our technology to provide accurate data on our patients as well as our business metrics. Additionally, clinical staff have the opportunity – rare in Haitian clinical settings – to receive computer and business management coaching and practice.”

C2C Provides Free Maternal Health Care to Increase Safety for Moms and Babies in Northern Haiti

Maternal health is a critical component of community health care in any part of the world. In developing regions, however, the maternal mortality rate in is still 14 times higher than in developed regions (World Health Organization. Trends in Maternal Mortality: 1990-2013. Geneva: 2014, online). To combat this reality and give babies the healthiest start in life, C2C has rolled out a new program offering free care for moms-to-be in Northern Haiti.

Dr. Chanlatte, a gynecologist and obstetrician, visits our Camp Coq and Acul du Nord clinics twice weekly to offer prenatal and ob/gyn services. Pregnant women receive all prenatal lab tests, pharmaceuticals, and an ultrasound for free. They are encouraged to come for four visits, as recommended by the World Health Organization – or more, if necessary. All patients work with clinicians to create a safe birth plan that addresses any identified irregularities, each will receive follow-up care, and all are encouraged to bring their infants (and all children) to the clinic for free immunizations.

Since this program began in mid-August, more than 200 pregnant women have participated, receiving check-ups, counseling, lab tests, and prescriptions, free of charge. C2C expects to provide more than 500 maternal care visits in the coming year.

Social Marketing: Building C2C’s Patient Base One Household at a Time

It’s a common misconception that poor families in Haiti don’t have any options when it comes to healthcare services. But most people living in populated areas like cities or towns do have options and the options run the gamut of low and high cost to low and high quality.

C2C clinic’s fill a central gap: low-cost and high-quality. Still, the decision to seek out health services can be complex: household finances are tight and patients can decide to visit traditional herbal medicine healers, or to travel long distances to government hospitals, or – even worse – to wait, and hope that one’s condition improves.

C2C’s social marketing efforts seek to make these decisions easier for poor families. Our community-based staff members (called Community Health Agents) go household to household, providing health education and answering questions about the C2C clinic’s services, pricing, and the “C2C patient experience”.

Recently, we’ve been experimenting with a community coupon promotion, which we hope will entice new clients to try C2C!

Community Health Screenings Bring Primary Care Directly to Families

At C2C we aim to reach as many people in the communities we work in as possible. Our Community Health Workers (CHWs) visit households on a daily basis, and our clinic staff see all patients who visit the clinic each day. To continue increasing the number of community members we can help, we’ve added a new feature through our Haiti clinics—community health screenings.

Once a week, our CHWs, along with our nurses and auxiliary nurses, set up a station at a local neighborhood spot, to serve women, children, and families. Community members can purchase a glucose test, and receive free blood pressure screenings, vaccinations, family planning materials, and water purification tabs.

Radio campaigns and local advertisements help spread the word for the service, announcing a different neighborhood each week. Locals can come at any time, pick up free materials, and learn more about the services offered at their nearby C2C clinic. At our Camp Coq clinic alone, there were over 240 participants in the first two weeks.

“Participants were already crowding around the venue when we arrived. People have really appreciated this initiative. Some people even asked when the next visit to their area will be,” said our Camp Coq nurse, Herlande Duvot.

These screenings will allow C2C to provide quality health care to even more members of the Camp Coq and Acul du Nord communities!

C2C Solicits Community Feedback to Location for First New Clinic in 2015

C2C has been conducting market research in northern Haiti for the past 6 weeks to identify a community for our next clinic. The feedback loop between patients and C2C is strong at our Camp Coq clinic, and we’ve learned what patients value most about the care they receive from us: quality services, caring and attentive staff, and affordable pricing.

We’re asking the same questions of our prospective clients: What do you look for in a health facility? What services do you and your family need? How do you know that the care you are receiving is good? This information is the foundation for C2C’s social business model. Community-based research is a combination of art and science. For that reason, C2C devotes a significant amount of time to the research phase. We ensure that we are hearing and integrating feedback from families across the social-economic spectrum as we make decisions.

What we hear most often is that the quality of health care services in Haiti varies widely. So often, clients are disappointed in their health service providers because the facilities do not have adequate equipment or inventory and because they are not treated well. A positive patient experience is at the heart of the C2C clinic model and we listen closely to the perspective of our partner communities. This week, C2C is conducting more than 500 household surveys (using tablet-based technology) to capture feedback from Haitian people directly about what they most want in their healthcare experience. The thoughts and opinions these families are sharing will directly impact the location of our next clinic as well as the services we offer. We’re looking forward to sharing with you once our new location is determined!

Camp Coq Clinic Turns 1!

Happy birthday to C2C’s newest clinic in Camp Coq, Haiti! We had a wonderful time celebrating with members of the Camp Coq community, our patients and local Steering Committee included. Everyone was invited to take part in health education sessions tailored to address concerns we see most often in the clinic, games, and – of course – medical consultations.

The clinic staff wanted the anniversary festivities to be equal parts fun and educational. Dr. Youveline Preval and Nurse Herlande Duvot lead two education conferences: one on the importance of immunizations, and the other on family planning. In addition to the primary care that is always offered, our visiting OB/GYN was also on site for pre-natal consultations.

Following the information sessions, the birthday party continued with a C2C-sponsored soccer match, held near the clinic. Area children enjoyed games of musical chairs, trivia challenges, and racing!

Clinic staff gathered feedback from many community members who said that the C2C clinic has become their first choice when seeking healthcare. They’re confident that when they visit C2C they’re going to be feeling better right away.

The good news is that our fabulous birthday party didn’t tire us – it inspired us! C2C loves hearing from the community; how they feel is so important to us and informs every decision we make. As Dr. Preval said, “C2C participates in community activities so they know us and we understand their needs. We are hearing from the community that they are happy they get better care here.”

Our teams in Haiti and the US absolutely cannot wait to see what Year Two brings in Camp Coq.

C2C Partnership With Namibian Ministry of Health Benefits Resettlement Community

It’s winter in Namibia and at C2C’s clinic in the informal Democratic Resettlement Community (DRC) near Swakopmund, increasing numbers of women are seeking health services. In July, over 650 women visited our clinic— many received pre-natal or post-natal check-ups, others attended health education sessions on family planning and sexual health (one of which is pictured above).

An important component of our work in Namibia is our relationship with the local Ministry of Health office. This partnership was designed to increase the government’s capacity to offer health services to women and children in the informal squatter community of DRC. Indeed, the population of the settlement continues to grow as migrant workers flock to the area in the hopes of securing work at local mines.

The growth of the population is not only from those seeking work, however. As the migrant worker population surges, so too does the rate of teenage pregnancy. Over the course of the next year, we aim to assist in the lowering of this rate.

Through a grant from the Izumi Foundation, C2C will work with the Ministry of Health to promote a health campaign to curb teenage pregnancy. Partnering with schools, parents, and community leaders we’ll work to help young people make healthy decisions about their futures, delay having children and complete their schooling.

Attention to Community Feedback Ensures Quality Care

How can C2C ensure our patients have the best possible experience at our clinic? We work toward that goal every day, most recently sending our Community Health Workers (CHWs) to talk with past patients as well as Camp Coq community members who have not yet been to the clinic. Their goal was to identify what we are doing well and where we can improve.

CHWs interviewed more than 60 patients and potential patients; half had visited the clinic and half had not. The results were truly encouraging: 97% of users said that they will visit the C2C clinic next time they or someone in their family is sick, and 100% said they would recommend the C2C clinic to family and friends. Why? A good pharmacy, quality care, and kind staff were the top three reasons patients mentioned for choosing or recommending C2C.

Interviewees who had not yet visited the clinic said they had heard from friends and neighbors about the quality care and good pharmacy. The number one reason for not having gone to the clinic was simply that they had not been sick, and 94% of non-users questioned said they would choose the C2C clinic next time they or a family member need to see a doctor.

Allison Howard-Berry, Director of Global Operations and Partnerships, said, “Our clinic staff and U.S.-based team will use this data to examine how we can achieve our goal to offer the highest-quality experience. Patient feedback is essential to C2C clinic operations, and we’re very pleased that after less than one year in Camp Coq, almost 100% of our patients are satisfied with the care they receive.”

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