How UNICEF Is Fighting For Undernourished Women And Children In Haiti

Maxence Bradley for UNICEF USA.
Nutritional hospital of Borgne in the Nord Department of Haiti.
Like many roads, in Haiti the path to Borgne, a town on the northern coast of the island, is a long, hot, and uneven one. In favourable weather, a sturdy Toyota 4X4 could make the westerly trip to Borgne from Cap-Haïtien, Haiti’s second-largest city, in two body-rocking hours. Deft motorbike taxis, technicolor “tap-tap” pick-ups, and massive trucks transporting construction materials stir up enough dust on dry days to make a bandana surgical mask a valuable accessory on what will still be a doable ride. On rainy days, however, the pockmarked routes fill up with water and run, leaving travellers to wade through waist-deep byways at their own risk or stay put until any floods have passed.
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When V. Simeon recently journeyed north, she didn’t have to contend with the harshest elements, but she did have to worry about how to safely transport the ill child strapped to her body from southern Haiti up to Borgne’s specialised hospital for pregnant and nursing mothers and their children in the Nord department. The trip took a toll on both of them.
Simeon’s 3-year-old son Narkendor Dorval is one of 22% of children in Haiti who suffers from chronic malnutrition. Eleven percent of children are considered underweight, and 65% of children under five years old (and 49% of women of reproductive age) have anemia. These are lifelong problems that contribute to Haiti having the highest child and maternal mortality rates in Latin America and the Caribbean.
Narkendor was born in fair health, Simeon says. He appeared jaundiced at first and always had some difficulty moving around since one of his legs is longer than the other, but she saw no obvious signs of the turn he would take by eight months old. Despite starting to crawl as he got older, Narkendor’s health began to backpedal along with his mother’s.
Maxence Bradley for UNICEF USA.
Simeon and her son Narkendor in Borgne.
Until recently, Simeon split her time between Port-au-Prince and Léogâne, a coastal city roughly 25 miles from the capital that was at the epicentre of the 7.0 magnitude earthquake that struck southern Haiti in 2010. An estimated 80% to 90% of the buildings in Léogâne were destroyed, leaving one-fourth of the local population dead or missing and crushing many opportunities for people to work or support themselves.
Simeon later moved to Port-au-Prince, where her parents lived. They helped take care of Narkendor when she went out for work, and after she was diagnosed with tuberculosis and unable to do much else. When she felt well enough to travel herself, Simeon tucked her son into an infant carrier and paid a mototaxi driver 150 gourdes (50 extra for a smoother ride) to drive them to Borgne. They left at 5 a.m. on a Monday morning, with Narkendor sore, small, and unable to walk any of the distance, as many people who go to the clinic do. The pair arrived by 10 a.m. and were seen almost immediately by the Ministry of Health nurses, who were already shorthanded.
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“Both of us are receiving treatment because I haven’t finished mine yet,” Simeon said through a translator.* “When I first arrived, I was very sick, like many other people. Some of them lost their lives but I’m still here and, aside from God, if it weren’t this group of nurses, I would have lost my life as well. Even my parents were completely discouraged, but the nurses here are intelligent and efficient, and it’s thank to them that life is continuing for me.”
Nonetheless, Simeon is realistic about her situation, even if she is increasingly optimistic. Her father died recently, making money even tighter in her family. Focusing on her and Narkendor’s health takes a toll on her ability to earn an income while she waits for him to completely recover. Simeon’s story echoes that of the other two-to-three dozen women also waiting at the clinic. The perfect storm of manmade and natural disasters has exacerbated all of their problems.
The 2010 earthquake in Haiti killed more than 220,000 people, left about 300,000 injured, and displaced 1.5 million others — roughly 15% of the country’s entire population. Later that year, thousands of people’s health conditions worsened when one of the worst cholera outbreaks in modern history emerged in Haiti as a result of improper sewage disposal by UN peacekeepers stationed on the island as part of the rescue efforts. UN Secretary-General Ban Ki-moon admitted wrongdoing and accepted fault for the epidemic for the first time last December amidst calls that the organisation compensate Haiti for the impact of the devastation, but the damage was done. Since the 2010 outbreak, 807,273 suspected cases of cholera have been reported, and more than 9,500 people have died.
Six years later, while a mix of national government institutions, private enterprises, and international organisations continued to rebuild the country, southern Haiti was struck again by Hurricane Matthew, a Category 4 storm that left an additional 175,000 people homeless. 70 to 90% of the livestock and crops in affected areas were destroyed. It is a loss that may be extended for another decade, and will be felt much sooner than that.
The price for food and produce in local markets has skyrocketed in recent years. Nearly 75% of Haitians live on $2 USD per day (about 63 gourdes), however, the majority of marketplace prices are unregulated by the government, leaving vendors to sell the foods people need most at the cut-rate prices they choose. Meanwhile, a vast number of Haitian business owners earn their revenue in dollars, but pay their employees a less-than-liveable wage in gourdes, further compounding inequality across the country.
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After the earthquake, UNICEF Haiti implemented two consecutive programs to help stabilise the country, focusing on emergency relief, recovery, and development. In 2014, UNICEF USA launched the Kid Power program, which links global initiatives that combat malnutrition with domestic work that centres on children’s health. For example, research has shown that only one-third of children in the United States are physically active each day, which can lead to a number of juvenile, and eventually adult, health problems. With the Kid Power program, participants buy Fitbit-like bands online or at Target that serve as a watch and a pedometer. (They can also download the Kid Power app for free and link it to the pedometer on their iOS or Android phone.) The more active users are throughout the day, the more points they rack up in the Kid Power app, unlocking funding from friends, parents, partners, and other donors. Some of the program's participants include students in traditionally underserved areas like like P.S. 5 Ellen Lurie School in Inwood, New York.
"Parents love that their kids want to walk more and go to the park more," says Kristen Sabatini, a fourth-grade teacher who applied for and received a grant to bring Kid Power to her students at P.S. 5 as they learn about Uganda. "We are a Title 1 school in an underserved community, but things like respect and being helpful are all free, and are things that that kids universally can do."
UNICEF’s current programs in Haiti will run through 2021 and focus on issues such as health (vaccination, immunisation, paediatric and postnatal care), child protection (decreasing children’s exposure to violence and abuse, neglect, and abandonment), education (improving enrolment, sanitisation, safe access to water), and nutrition. The latter is an area that could have a tremendous impact on children like Narkendor, but that UNICEF says is drastically underfunded. That is especially true given the massive impact that malnutrition can have on populations for generations.

"The consequences of insufficient nourishment continue into adulthood and are passed on to the next generation as undernourished girls and women have children of their own."

In 2008, medical journal The Lancet issued a series of reports on maternal and child undernutrition, which indicated that the first 1,000 days of a child’s life (and the first 1,000 days of motherhood) play a crucial role for individuals and whole communities.
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“By the time children reach their second birthday, if undernourished, they could suffer irreversible physical and cognitive damage, impacting their future health, economic well-being, and welfare,” the researchers wrote. “The consequences of insufficient nourishment continue into adulthood and are passed on to the next generation as undernourished girls and women have children of their own.”
If left unchecked, undernutrition in pregnant women can result in low birth weight postpartum, stunting, chronic restriction of growth height, micronutrient deficiencies, and more. Many of these are issues from which Narkendor suffers.
The researchers explained that rapid weight gain after ages 2 and 3 could lead to a spate of chronic illnesses and result in permanent cognitive impairment. “Children who are stunted or born with IUGR are also shown to complete fewer years of schooling and earn less income as adults, hindering their cognitive growth and economic potential,” the researchers continued. “Lower income, poor health, and reduced access to proper nutrition then continue to impact the health of children born into the next generation, establishing a repetitive cycle.”
And if children don’t build the cognitive foundations necessary to learn, retain information, think critically and creatively, or even simply concentrate — no number of donations of textbooks will make the difference necessary to help young people develop into self-sustaining and self-advocating adults. It’s one of the reasons so many researchers continue to look into the impact of school lunches and performance. It is also a reason that other researchers have started to consider the impact that ingesting poisoned water can have on children’s families even two generations from now.
Maxence Bradley for UNICEF USA.
Marie Rhudnie B. Angrand, an MSPP representative in the Nord Department, points out a nutritional diagram that is used to instruct mothers.
In Haiti, there are various plans of action in the works. From June 2011 to April 2013, a Haitian NGO called FONDEFH and UNICEF worked together in collaboration with the Ministry of Public Health and Population (Ministère de la Santé Publique et de la Population, or MSPP) to establish triage-based systems across the country to handle cases of moderate malnutrition through severe acute malnutrition.
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Their reach previously extended to areas in the north and remote locations where resources were more limited, to help people like V. Simeon and Narkendor. One level focused on children with cases of moderate malnutrition to prevent them from worsening. The children were evaluated by height and weight, and then given a variety of supplements and medicines, chiefly iron, vitamin A, and Albendazole for parasites. A second component involved ambulatory patients making regular visits to clinics every eight days for four to six weeks. The third focused on treating cases of acute malnutrition that required hospitalisation and regular doses therapeutic medicine and supplements until patients were healthy enough to be discharged.
The nurses instruct all of the women on proper breastfeeding methods, and about the foods that consist of a well-rounded diet. They also give out therapeutic milks supplied by UNICEF, as well as Plumpy’Nut, a peanut butter paste high in calories that is fortified with powdered milk, sugar, oil, vitamins, and minerals. The packets have a shelf-life of about two years and are far less susceptible to contamination than food options that might need to be mixed with unclean water or require intense storage methods. All anyone has to do is knead the sachets until the paste is smooth and pliant, similar to agitating organic peanut butter when the oil separates from the base. Older babies can easily squeeze the Plumpy’Nut up the sachets themselves (think Go-Gurt with the flavour and consistency of a peanut butter cookie dough), or mothers can help them along after tearing the packets open.
Maxence Bradley for UNICEF USA.
A nurse holds RUTF (ready-to-use therapeutic foods) milk and Plumpy'Nut packets.
On a wider scale, the Plumpy’Nut factory in Cap-Haïtien, which opened in 2012, employs 65 Haitians and works with farmers in an extensive agricultural program to help them produce better, healthier yields. UNICEF buys 80% of the world’s Plumpy’Nut stock and supplies it free of charge to clinics across the world like the one in Borgne so that patients don’t have to worry about the cost.
Additionally, UNICEF uses funds generated from the Kid Power program to distribute more therapeutic packets including Plumpy’Nut (6.4 million through Kid Power to date). The sachets range in price depending on product type, from $49 per box to $80 per box for a full course of treatment. (A full course is considered to be one full box of sachets — 150 — consumed across eight to 12 weeks.)
Unfortunately, funding for the MSPP/FONDEPH program has largely dried up now that UNICEF’s contract has expired. The Haitian government has yet to fill that gap, in terms of financing, personnel, materials, or medicine. Even so, dedicated staffs of nurses and health agents — often unpaid and working on a volunteer basis — continue to try to find women and children in their local communities who need help, resources, and information, and direct them to clinics like the one in Borgne where they can make some progress. Inter-community efforts like that can make a difference in the lives of people like Simeon, who was referred to Borgne herself when a health agent met her and learned about Narkendor.
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The majority of the health agents working on the day Simeon and Narkendor arrived were from arrondissements in Côtes-de-Fer, another coastal town near Port-au-Prince. Two agents, Pierre Solis and Lafleur Josean, say that their work has become more difficult over time as funding has diminished. Fewer parents are willing to make the five-hour (or more) journey to Borgne when there is less medication available, and less staff on hand to see them. If they have more than one child, someone would need to be left behind. If they are working, missing out on pay would be another burden. If they bring their children only to find out that treatment will take days or weeks, they might have to leave their child behind under the care of pre-teen or adolescent relative and staff, as was the case with Darling, a 12-year-old girl charged with staying with her severely malnourished baby brother.
Maxence Bradley for UNICEF USA.
Health agents Pierre Solis (far left) and Lafleur Josean (third from left) stand at the hospital in Borgne with their colleagues.
Despite the difficulty of their assignments, all of the agents feel passionate about their work and are doing their best to continue it, even under-or-unpaid, on a skeletal organisational budget, and with dwindling numbers of new recruits.
“What keeps us doing this work is that these kids are from our neighbourhoods, and when we see them dying, we accompany them and try help,” Solis said. “Helping them encourages us.”
*All quotes interpreted through translator.
Editor's Note: Refinery29 traveled to Haiti in early June as a media guest of UNICEF USA. The organisation paid for travel and accommodation.
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