History | Health | Education | Economic Sustainability | The Stories of Ayida and Brigitte | The next chapter: A Bridge across Fonlanfè

The Story

On the banks of the Fonlanfe: life and death in "The Deep Hell"

In the village of Boucan Carré in the heart of Haiti's Central Plateau, Partners In Health (PIH) and their Haitian sister organization, Zamni Lasante (ZL), run a public clinic where an average of 200 patients receive free health care every day. To reach the clinic, vehicles and pedestrians must often cross a river called Fonlanfè, which literally translates from Haitian Kreyol to English as "Deep Hell." During the dry season, the typical peasant travels on foot and must wade through waist-deep water across a very rocky and uneven riverbed. But when the rains come, the waters of Fonlanfè swell, a condition that combined with severe flash flooding, makes passage virtually impossible.

Because of Fonlanfè's raging waters, urgent deliveries of medical supplies and food have been delayed or denied altogether. Patients and staff members, whether on foot, horse, motorcycle or SUV, have been stranded for hours on either side of the river waiting to cross. Vehicles, including PIH/ZL ambulances, have been swept away by sudden floods. People have drowned while seeking medical care, and others still have died on the banks, waiting for the waters to recede.

In a country where 80% of the population lives below the International poverty line (CIA 2003), Haiti's Central Plateau lies at the bottom of the economic ladder. Massive barriers to adequate healthcare, education and economic sustainability exist for these people who strive daily to meet the basic demands of life. In this struggle, Fonlanfè stands as a literal roadblock to those living in the Central Plateau, as well as to anyone trying to provide assistance.

History

Since Haiti’s discovery by Columbus in 1492, the rules of social and economic justice have not applied to its people. Early on, indigenous tribes were eradicated, European colonization dominated social and economic development and slave ports were established throughout the island. Even after slaves united and drove the French out in 1803, creating the first free black republic, Haiti struggled to establish itself domestically and abroad.

Today, Haiti continues to see the effects of its troubled and often violent history. Once-thick forests have been stripped clean, a practice that began as European plantation owners cleared land for larger plantations and has only continued as Haiti’s own impoverished people search for cooking fuel. As a result, the hills and mountains of Haiti have become rocky surfaces hardly capable of supporting vegetation. In addition to making subsistence farming difficult, the raw mountains no longer support natural storm-water run-off which in turn causes massive flash floods throughout the annual rainy season. This reality has devastating effects on the thousands of people living in Haiti’s Central Plateau, making the simple act of survival a daily struggle.

Health

PIH/ZL funds, staffs and manages clinics and hospitals throughout rural Haiti, including a clinic in Boucan Carré, where vital medicines, procedures and emergency assistance are made available to more than 20,000 people. But even with the best efforts of PIH/ZL staff, the ability to provide and sustain life-saving begins on the other side of Fonlanfè. Without suitable travel routes to replenish supplies and reach more advanced facilities for emergencies, PIH remains bound by the very rules of social inequality and inadequate infrastructure they are dedicated to overcoming. In recent years, Fonlanfè caught an ambulance laden with medical supplies as it attempted to cross. As ZL staff and the ambulance's driver struggled to dislodge their vehicle, a flash flood washed the ambulance and its valuable cargo away. This event and many others like it underscore the fact that until a bridge is built, crossing Fonlanfè remains a guessing game dictated by the whims of nature.

Education

For many people living in resource-poor communities, education stands as a vital means of overcoming generational poverty. In Haiti, many dedicated teachers, school administrators and students seek educational enrichment as a means of bettering themselves, their communities and the future of their country. Currently in Boucan Carré, small village schools provide education to more than 1,100 local children. Those able to afford secondary school have the option to travel approximately ten miles to the town of Mirebalais, which lies on the far side of Fonlanfè. Travel is difficult during the best of times, but often rendered impossible when the rains come. Children often remain stranded, cut off from their families and friends by the torrential waters. For those who stay in Boucan Carré, resources and supplies are limited. While children attending schools in the United States climb aboard buses or get into their parents' cars without a second thought, students and teachers like Gerrard "Bronk" Maxime must contend with a temperamental river that can completely block them off from school, family, friends and supplies at any time.

Economic Sustainability

Limited healthcare and educational opportunities serve as the physical symptoms of an even greater disease - economic failure. In an area like Boucan Carré, which relies heavily on agricultural trade, jobs are scarce. For many, farming serves as a primary source of income - but once again, Fonlanfè stands in the way. Even when Fonlanfè allows for passage, many local farmers must wade the waist-deep waters on foot, bringing with them only the produce and goods they are able to carry by donkey, horse or on their own backs. In addition to making exportation of goods difficult, imported items often arrive with inflated prices due to difficult travel. Even with hard work and ambition, farmers, laborers and those seeking more lucrative jobs outside of Boucan Carré can do only as much as Fonlanfè allows.

The fact of the matter is that until Boucan Carré gains access to life on the other side of Fonlanfè, thousands of men, women and children face increased health risks, limited educational opportunities and stagnant economic conditions. And sadly, for all those that have waited patiently to reach opportunities on the other side of Fonlanfè, there are others that have not been so lucky.

The Stories of Ayida and Brigitte

The following stories bear witness to the harsh realities faced by rural peasants in Boucan Carré, particularly women. While the stories are true, the names have been changed to Haitian names that translate from Kreyol to English as "the spirit of love" (Ayida) and "keeper of faith" (Brigitte). These names have been chosen to represent the thousands of nameless, faceless women in Haiti and around the world who share a similar fate.

Fortunately for most women giving birth in Boucan Carré, the local PIH/ZL clinic offers facilities where women can deliver their babies safely. However, when complications arise, Fonlanfè can mean the difference between life and death.

Such is the story of Ayida and Brigitte. After going in to labor, both of these women experienced complications beyond the scope of the Boucan Carré clinic. For Ayida, the problem was hypertension and pre-eclampsia, a condition requiring an urgent cesarean section in order to save both mother and baby. Brigitte, on the other hand, gave birth, but developed a post-partum hemorrhage due to a condition known as placenta acreta. These types of medical conditions are considered manageable in the United States, but in Boucan Carré, they required surgical intervention available only at the PIH/Zamni Lasante hospital in Cange on the far side of Fonlanfè.

Ayida and Brigitte went into labor at different times, on different days, but unfortunately both of their babies came during the rainy season. As they attempted to cross Fonlafè to reach the hospital in Cange, flash floods thwarted their attempts. Ayida waited in the ambulance for Fonlanfè to recede, but her pre-eclampsia worsened, she developed seizures and despite the best efforts of PIH/ZL doctors and staff, both she and her unborn baby died. Brigitte, too, was forced to wait. As she continued to hemorrhage, the blood loss became too great and she died, leaving her newborn infant motherless.

Stories of childbirth complications are not uncommon, but thanks to modern medicine, such stories often have happy endings, even in Haiti. What separates the stories of Ayida and Brigitte from their counterparts is something as simple as a river. Their complications were no more severe, their lives no less valuable. And while the PIH/ZL doctors and staff did everything they could for their patients, these women and babies were lost for lack of a simple bridge.

The next chapter: A Bridge across Fonlanfè

With your help, we can ensure that PIH/ZL's invaluable healthcare facilities remain accessible and sustainable. We can broaden educational opportunities available to children and teachers on both sides of the river. We can create reliable transportation infrastructure that allows for year-round market trade and higher export volume as farmers use handcarts or animal-drawn carts to carry their goods to market. With your help, we can build a bridge that rewrites the stories of Ayida and Brigitte as part of a tragic past and promises hope for the future.

Together, we can help change the future for Boucan Carré.

How will you make a difference?

The rains have already begun this year and still without a bridge, the people of Boucan Carré and their dedicated friends at the PIH/ZL clinic continue to fight for social and economic justice. Your support is vital. Today, you can help us build a bridge - a simple structure of concrete and steel - that will change the lives of more than 20,000 men, women and children in Boucan Carré.

Please donate today.

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CIA. 2003, "CIA-The World Factbook--Haiti", Retrieved 4 April 2008, (https://www.cia.gov/library/publications/the-world-factbook/geos/ha.html).
Goodman, Amy. 2004. "Getting Haiti Right This Time: The U.S. and the Coup." Monroe, Maine: Common Courage Press.