A conversation with Dr. Wiener Leblanc, emeritus professor of clinical pediatrics, Columbia University College of Physicians and Surgeons

To be an expectant mother in Haiti or her soon-to-be-born child is to face – unwittingly or resignedly – the greatest risk of maternal and infant death in the Western Hemisphere, and one of the four highest in the world outside Sub-Saharan Africa.

Particularly if she is from a poor rural family – like many of those living near Aquin, a southern coastal city in one of the micro-regions on which the W.K. Kellogg Foundation is focused – an expectant mother in Haiti has no easy access to health care. In fact, she may have to travel several days – on bad roads or no roads – on the back of an animal or on foot – to visit even a modestly equipped and staffed health care facility.

She may feel relieved that she only has to endure one such trip and one prenatal exam, unaware that – even with a routine pregnancy and no complications – her counterpart in the U.S. will likely have 10 or more such exams.

To be an expectant mother in Haiti is not to know that families can be planned, and that her children’s health could be improved by doing so. It’s to be unaware, for example, that the greater the time between a woman’s pregnancies the better the probable health outcomes for her babies.

To be an expectant mother in Haiti is to face a three-times-in-four chance that you will have to deliver your child at home, or someplace else far from a health care facility.

“This is a life-threatening complication that can be minimized or avoided with a drug that costs about 30 centers per dose.”

And it’s to face the likelihood that you will be assisted in your delivery – not by a physician or nurse-midwife – but by a matrone – a birth attendant who may have had no formal medical training, and who might not know what to do if you or your infant experience a common obstetric emergency such as excessive post-partum bleeding or asphyxia, when your infant fails to breathe during the first minute after birth.

Dr. Wiener Leblanc knows all these things. Leblanc, emeritus professor of clinical pediatrics at Columbia University College of Physicians and Surgeons, was born and raised in Haiti and earned his medical degree from the National Medical School of the University of Haiti. Even at age 82 – and, as his wife reminds him, retired – he remains vitally interested in the state of maternal, prenatal and neonatal care in that country and actively engaged in efforts to improve it.

To do so, he wants to begin with fundamentals, with accurate record-keeping and a system for accessing medical data. Neither is common in Haiti.

“If births and deaths aren’t registered,” says Leblanc, “if you don’t even know the number of stillborn births, how can you reduce mortality, and how will you know when you’ve succeeded?”

From fundamental and general improvements, Leblanc quickly shifts focus to the particular. He believes that solutions – even to serious, life-threatening problems – can often be relatively straightforward and inexpensive.

Imagine, he suggests, an expectant mother, likely a teenager pregnant for the first time, or a woman over 40. Her only symptoms are high blood pressure and protein in her urine. But if she has preeclampsia, as may be indicated, she and her infant face profound risk. Preeclampsia can lead to eclampsia, with the potential for stroke and seizures in the mother, and premature birth and other complications in her baby.
The treatment includes medication for hypertension plus magnesium to prevent seizures. As Leblanc puts it, “This is a life-threatening complication that can be minimized or avoided with a drug that costs about 30 cents per dose” and with the care of personnel trained to recognize and treat the condition.

A similar approach to the problems of maternal and neonatal mortality overall – also based largely on fundamental, low-cost solutions – is at the heart of Aquin Hospital’s planned project to improve birth outcomes.

Their work calls for a multi-phase effort starting with capacity-building for the hospital, including updated data collection and access and increased training for hospital and community caregivers such as nurse-midwives and matrones.

The second phase is for what Leblanc calls “continuity of care,” the substance of the potential project. It divides the Aquin community into three groups – preconception adolescents, pregnant women and newborn infants. For each group, the project will address basic needs – nutritional guidance and supplements, physical examinations, vaccinations and – for pregnant women and infants – greater availability of care for medical emergencies. Education will be essential for both the preconception adolescents and pregnant women.

Leblanc hopes the combination will remove some of the challenges to being an expectant mother or her soon-to-be-born child in Haiti. “There are quite a number of ways to address these problems without costing a lot of money,” Leblanc says. “My vision is to do so and, in this one area, to decrease mortality as a result.”