We are all struggling to process the changes the COVID-19 pandemic has already brought to our lives and, even more worryingly, what might be coming in the next few weeks and months. In that context, our most important wish is that you and your families stay safe and well. 

We know that there is a great deal of curiosity regarding how things are developing in Haiti and we wanted to provide a quick update for all of you.   

Thus far, there has not been a confirmed case of COVID-19 in Haiti, but there are many confirmed cases across the border in the Dominican Republic. Haiti has closed its border and stopped almost all international flights. While these steps may slow the onset of the virus in Haiti, we know it is only a matter of time until there will be a spike in cases.  

We are using this period to prepare our staff and clinics as best as we can for what will likely be a very difficult situation once the virus becomes established. Haiti suffers from every issue (but multiplied) currently facing the United States and Europe: lack of testing kits, an extreme shortage of masks and sanitizers, as well as very few hospital beds that are equipped to handle the kind of extreme respiratory complications we saw in China and are seeing in Italy.

However, due to the worldwide nature of this crisis, it is very unlikely that international support will be available for Haiti once cases appear in significant numbers. The reality in Haiti is that many family members cohabitate in small spaces; there is almost no ability to store significant quantities of food at home; and most Haitians live in very crowded urban neighborhoods with poor sanitation. All this suggests that COVID-19 is likely to be absolutely devastating.

With great urgency, we are doing our part to prepare for the imminent arrival of the virus in Haiti.  We are working closely with the Ministry of Health as it finalizes its operational plans. And, with our clinic staff, we are putting processes in place including an extreme emphasis on handwashing, patient screening, and enhanced training on the importance of social separation. In addition to that, we are working to source supplies such as masks, thermometers, sanitizers, and medicine from as many possible sources as we can during this time of extreme medical supply scarcity.

We plan to keep you updated regarding our efforts and look forward to the date when we can all speak about this global pandemic in the past tense.    

We thank you for your support and wish you and your families the best in this difficult time.

Dear Friends, 

This past summer, we announced that we would be expanding our clinic network to a new department in Haiti. After a rocky year of civil unrest, road blockades, and fuel shortages that threatened the country’s stability, we decided to move forward and open our first clinic site in the Northeast Department of Haiti. 

Before we sought to rehabilitate government clinics in the Northeast Department, we formalized a newly forged public-private partnership (PPP) between C2C and the department’s Ministry of Health. After several meetings throughout the last few months, we decided that it was best to rehabilitate a government clinic in Roche Plate. 

Roche Plate, a communal section of Trou-du-Nord, is a small community of 13,750 people and is approximately 80 minutes from Cap-Haitien.

Although the site was already an established government clinic, it was in bad physical shape, lacked essential medications, had a very low patient volume, and overworked yet underpaid staff. We knew that by taking it on as a PPP clinic, we could infuse it with C2C’s operational excellence and ensure that patients have access to quality care in their own community, as well as a fully-stocked pharmacy that has all the necessary medications.

Stay tuned to learn more about Roche Plate’s progress and the ways it continues to serve the community! 

The last decade began with the most devastating natural disaster to strike Haiti on January 12, 2010.  We open this decade with far more hope but with the acknowledgment that there is still so much to be done.

Ten years ago, the earthquake claimed the lives of an estimated 100,000 to 300,000 people, injured countless others, left millions of Haitians homeless, and caused tremendous damage to infrastructure. Today, a decade later, the recovery effort is still ongoing. Thousands of Haitians are still displaced, many people do not have access to basic services such as healthcare and sanitation, and the country has yet to heal from the trauma it experienced. This past year alone, Haiti faced some struggles in the form of civil unrest, fuel shortages, and country lockdowns. 

A few months after the earthquake struck, C2C opened its first clinic in partnership with Grace Children’s Hospital, AmeriCares, and Management Sciences for Health in Port-au-Prince, the center of the destruction. The clinic served an unmet need in the catchment area, offering gynecological and perinatal care for women.

C2C has come a very long way in the past decade, and so has Haiti. While Grace Children’s Hospital has rebuilt its infrastructure and no longer uses our clinic, we now operate six (soon to be seven!) clinics in two departments of Haiti. Though our model has pivoted over the years to focus on rehabilitating existing public clinics and offering comprehensive, one-stop-shop primary care services, our staff remains dedicated to delivering high-quality healthcare to families and communities throughout Haiti. Even though many NGOs have left in the years since the earthquake, C2C continues to grow in partnership with the Haitian Ministry of Health, working within the greater healthcare ecosystem to deliver sustainable care.

As we enter a new decade, we must celebrate the moments that show that Haiti will still stand tall. We are optimistic about the future of Haiti and believe in the resilience of its people. We look forward to sharing more updates soon about our progress, including our newest clinic opening this month!

Happy New Year & Happy New Decade! 

Thank you to all of our supporters for an amazing year at C2C!

While widespread protests and fuel shortages across Haiti made 2019 a year of many challenges, we also have so much to be grateful for. This year, we have served over 33,000 patients (up from 23,000 last year) and our imbedded social enterprise model recovered clinic operating costs at 80% across the entire network, further validating our sustainable health-delivery model. We secured significant new support from foundations and individuals and were recognized by the Innovations in Healthcare Initiative at Duke University in March and as a finalist for the Concordia P3 Impact Award in September. Even during very challenging times, we continued to provide high quality, sustainable primary care to communities who desperately need it. None of this would have been possible without your support!

Thank you again from all of us at C2C. Happy Holidays!

At Care 2 Communities, our main focus has always been to provide quality primary health care to communities in Haiti. Through our network of six clinics, we are able to treat approximately 3000 patients per month. In addition to primary health care, we offer different specialty programs, including our malnutrition program, which has operated for the past three years thanks to generous contributions from our supporters.

Through our malnutrition program, we have been able to save the lives of hundreds of children by providing nutritional aid in order for them to reach an adequate weight and maintain healthy growth. We admit children between the ages of 6 and 59 months with moderate and severe malnutrition, providing them each week with a peanut paste fortified with 13 vitamins and 10 minerals called Ready-to-Use-Therapeutic-Food (RUTF), also known as “Plumpy Nut,” or as Haitians call it, “Medika Mamba.” A moderately malnourished child will stay in the program for 6-8 weeks and a severely malnourished child will remain for up to 12 weeks. Children come once a week with their caregiver and are seen by a malnutrition nurse where they are weighed and their progress is assessed. The children are given a certain quantity of Medika Mamba sachets depending on the nurse’s evaluation. Only when they reach a desirable weight will a child be discharged from the program. 

On top of assessing every child in the program, our nurse gives educational talks about malnutrition on dedicated days and has a one-on-one conversation with each parent or caregiver. The educational lessons tackle different matters which are adapted to the general Haitian population. The nurse discusses subjects such as eating habits, Haitian food groups, vitamins and minerals, health issues, treating water, hygienic practices, diarrhea prevention and treatment, along with many other topics. The educational part of the malnutrition program is extremely crucial. The lessons offer caregivers the opportunity to improve their practices at home and deliver beneficial information that not only will help their child during the program, but also after reaching an ideal weight. In addition, the lessons can be passed on to other members of the household, friends, and neighbors. 

Another vital aspect of the malnutrition program is the community health workers, who ensure we reach as many children as possible. Due to parents often being ill-informed of the severity of their child’s malnutrition, our community health workers go into the field and screen children. This way, we can find these children at an early stage and be able to put them back on a healthy track. 

The vast majority of the children enrolled in the program come from some of the poorest households in remote areas every week to attend the malnutrition program. To help them with the burden of transportation, C2C gives each household a stipend. This gesture helps reduce dropout rates, ensures children come to the weekly weigh in, and eases stress on the caregiver accompanying the child.

Overall, because of this program and its dedicated staff, hundreds of malnourished children get the chance to have a brighter future.

Being pregnant in Haiti is not easy, and in fact, can be very dangerous. Access to antenatal care is complicated and expensive. The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere and are comparable to the rates found in sub-Saharan Africa and Afghanistan.

The majority of pregnant women in remote areas only have access to maternal care through a nurse or an auxiliary nurse and may never see a doctor throughout their entire pregnancy. It is also typical for pregnant women to pay for services individually, meaning they pay for each separate lab test and medication or vitamin. Since many lab tests are necessary throughout the pregnancy to screen for infections, preeclampsia, and other complications, prenatal care can be expensive and most women will choose to do only certain tests or purchase only some of the medicines prescribed. Furthermore, ultrasounds are typically only performed in urban areas, requiring transportation, time, and money. They are also expensive, ranging from $10 to $20 per ultrasound, in a country where more than half of the population lives on less than $2.50 a day. As a result, most women will go their entire pregnancy without even one ultrasound.

Since the inception of C2C’s Maternal Health Program in 2015, it has undergone several different iterations. Currently, the program is available at two of our six clinics, in Acul du Nord and in Camp Coq. For a small fee (varying from $2.50 to $3.50 USD), pregnant women have access to a complete prenatal visit with a certified midwife as well as a consultation with an OBGYN if the situation requires it. Pregnant women are encouraged to attend a minimum of five visits during their pregnancy and receive at least two ultrasounds. A complete prenatal visit includes preventive and diagnostic lab testing, essential prenatal vitamins containing folic acid and iron, and all other necessary medications to treat any infection or issue that may arise during pregnancy. We provide personalized education and counseling at every visit, encouraging each future mother to give birth in a health facility rather than at home.

In 2019 alone, we have performed more than 1500 individual prenatal visits for over 400 pregnant women. On average, 80% of our patients complete at least four prenatal visits during their pregnancy, as recommended by the WHO, compared to Haiti’s national average of 67%. 66% of women who receive prenatal care and counseling at C2C choose to give birth in a health center rather than at home, a much higher rate than the national average of 39%.

At C2C, we aim to provide high-quality prenatal care in remote areas by bringing medical expertise to communities that previously did not have access. Pregnant women in our Maternal Health Program can see an OBGYN in the event of any complications and have access to as many ultrasounds as needed for their specific pregnancy. Because our low bundle price offers comprehensive services for just one small fee, all of our patients get the lab tests and medications they need in order to have a healthy pregnancy, and ultimately, a healthy baby.  

Because we believe so strongly in our program and because maternal and neonatal complications and deaths are still extremely prevalent in Haiti, we are prioritizing the expansion of our program to more clinics to reach more people and increase our impact.

To support C2C as we expand our Maternal Health Program to another clinic, please visit our campaign site. Thank you!

C2C is joining the Global GivingTuesday Movement to expand our Maternal Health Program to another C2C Clinic. 

GivingTuesday, taking place December 3rd, is a global day of giving that harnesses the collective power of individuals, communities, and organizations to encourage giving and to celebrate generosity worldwide. Every year, on GivingTuesday, millions of people across the globe mobilize to show up, give back, and change their communities. The goal is to create a massive wave of generosity that lasts well beyond that day, and touches every person on the planet.

As we focus on expanding our scope of care in Haiti, one of our main priorities is to also expand our Maternal Health Program as part of our primary care services that we offer to every community we serve. Too many women in Haiti do not have access to essential maternity care, which explains why Haiti’s maternal mortality ratio, at an estimated 521 deaths for every 100,000 live births, is the highest of any country in the Western hemisphere.

By partnering with GivingTuesday, our goal is to launch this program at the next C2C clinic at the start of the new year. We need your help in making this program a reality at one more C2C clinic through a financial donation of your choosing. Any contribution that you can make would be greatly appreciated and will help us achieve our goal of improving maternal and infant mortality rates in Haiti, one community at a time.

Stay tuned for next week when we will share the inner workings of C2C’s Maternal Health Program and provide an inside look at what a typical visit looks like. We hope you join C2C’s GivingTuesday initiative by visiting our campaign page!

This week, C2C was honored as a P3 Impact Award Finalist at the Concordia Annual Summit in New York. Founder & President Elizabeth Sheehan and Executive Director Scott Schroeder presented C2C’s Public-Private Partnership (P3) with the Haitian Ministry of Health to deliver high-quality primary care at rehabilitated government clinics. C2C was considered among a very diverse set of five finalists.

It was a wonderful opportunity to outline the model we have developed in partnership with the Ministry of Health. We emphasized that the challenge in Haiti wasn’t access to healthcare, it was access to quality care. While 90% of the population lives within 5 kilometers of a primary care facility, only 23% lives near a clinic that offers high-quality care. Through years of studying the data and market research behind this gap, we saw that the pathway to a healthcare revolution in Haiti is the rehabilitation of the community clinic network controlled by the Ministry.

This is exactly what our Public-Private Partnership does; C2C works with the Ministry to identify the clinics most in need and upgrades the entire health support platform by introducing the systems and technology that are needed for efficient, high-quality healthcare delivery. The Ministry of Health provides the existing clinic buildings, clinical staff salaries, and centralized support. C2C uses revenue from very low patient fees and services and reinvests it back into the clinic network, resulting in 80% cost-recovery, even with patient fees 20% lower than under government management.

Our P3 has created some incredible results: 30,000 patients served annually across six clinics, quality assessment scores doubled in healthcare delivery post-C2C intervention, and a quarter of a million dollars in earned revenue infused back into the healthcare system.

The Concordia Summit gave C2C the opportunity to share our catalytic partnership with a broad and influential international community. It was also a time for incredible learnings and insights into P3s around the world, as well as other urgent topics such as climate change, global health, and women’s empowerment. It was a very busy week as Concordia coincided with the UN General Assembly and other important gatherings, and C2C is honored to have had the opportunity to learn from inspiring voices in our field and beyond. 

We are grateful to Concordia, the UVA Darden School of Business, and the US Department of State’s Office of Global Partnerships for selecting C2C as a finalist for this prestigious award, as well as to our team in Haiti and in the US, including our Board of Directors, for all of their hard work that made this possible.

Electronic Medical Records systems (EMR) are promising and have the potential to bring many benefits for healthcare in the developing world. However, they also present many obstacles, from implementation to reporting. At C2C, we have employed an EMR system since 2014 and we have had to find creative and innovative solutions to face these challenges.

Benefits of EMR systems: 

One of the first and most important benefits of an EMR system, especially in the developing world, is the increased ability to identify patients from visit to visit. Usually, healthcare practitioners in resource-constrained settings have a hard time identifying existing patients due to inconsistent name spelling and lack of identity cards. Our EMR system permits us to access a patient file with all its relevant information, whether a patient last came to the clinic two days or two years ago, which improves the continuity of care. Our EMR system also improves our efficiency of some time-consuming or error-prone tasks such as writing down all lab results. Some specific features, such as mandatory fields for staff members ensure that all the correct information is recorded adequately. 

A truly effective EMR system provides our doctors and nurses with tools for effective case management proving speedy access to past patient records, including lab results and medications purchased helping them to make better decisions for the care of the patient. Our increased availability of good quality data also contributes to decision making and allocation of our limited resources. Planning and management go hand in hand with an effective EMR system. Having all our patient data as well as our inventory data centrally stored and easily accessible facilitates supply chain management and helps us reduce medication stock-outs. Thanks to our EMR report-generating capabilities, complying with the Ministry of Health reporting requirements takes our staff significantly less time, leaving them more time to focus on education and care for the patients. Overall, our EMR system helps our staff to provide better, more personalized patient care.

Challenges of EMR systems:

With that being said, most organizations trying to implement an EMR in a low-resource, low-connectivity setting face many challenges similar to what C2C has faced in the past. The first challenge is low internet connectivity in most communities we serve. Internet connectivity is key to backing up clinical data to the cloud for reporting and decision-making purposes. To overcome this obstacle, we have had to take time to train non-tech staff to do manual backups of the data to ensure timely information syncing. The second biggest issue that we faced is in regards to our staff of healthcare professionals. Cell phone and computer penetration is still low in Haiti, and some staff members had never worked with a tablet or a computer before working in our clinics. This requires spending extra time on training, offering continuous support for the staff and doing frequent data quality analysis to course-correct mistakes quickly. This issue is compounded by the fact that our clinics sometimes face staff turnover, requiring us to repeat this process. Finally, low-computer literacy, as well as occasional bugs and glitches, often contribute to limited trust in the system by the staff. For now, most clinics find it necessary to retain some kind of paper-based workflow to reassure the staff that data will not be lost but also to serve us in case of a bug or unexpected system shutdown.

The key for an EMR system to fully provide all its potential benefits to an organization is staff engagement and participation. Involving users (staff) from the conception of the system to the deployment and updates ensures that they will better understand, trust, and use the system efficiently. This process is time-consuming and requires constant supervision and follow-up, but an EMR system is only as good as its user inputting the data. We know that it’s the C2C staff who is at the core of the success of our EMR system.

C2C’s health services are not only offered in our clinics; community health education is an extension of our clinical activities into the community. One of the activities provided by our community health workers (CHWs) is a rally post in a different community once a week. 

At this week’s rally post, the CHWs discussed hypertension and checked the blood pressures of community members. The first half of the rally post is dedicated to education, while the other half is spent doing blood pressure checks. This service is completely free. It is an opportunity for people to easily access blood pressure checks without having to go to a clinic. Our CHWs also use this time to inform community members about C2C’s clinical services. 

At our latest rally post, we had a great turnout of about 100 people. These are popular events in the community, where people can come together to get their questions answered and check on their health.