On my first day at St. Therese Hospital I enter the postpartum room with Gladias, my interpreter. Although I am in a foreign country, I feel completely at home in maternity wards. I pick up my camera and get to work. I am there for only three hours when a pregnant woman in labor is carried – literally carried by two men holding on to her arms and legs - into the room having eclamptic seizures. She is laid on a bare, plastic-covered mattress while the Skilled Birth Attendants (SBAs), students, and infirmieres auxiliaires (licensed practical nurses) rush over to start an IV and administer magnesium sulfate. The young woman's mother remains at the bedside fanning her daughter's face in the tropical heat of the afternoon. Thankfully, this woman continued in active labor and a healthy baby was born several hours later. Eclampsia can be deadly.

The SBAs work very hard. A quiet interlude is a welcome respite from a pending emergency. It is not overdramatic to say that birth and death are constants here. Through it all, Excellente St. Rose, a janitor at St. Therese Hospital for the past 16 years, drifts amongst the rooms, cleaning as she goes, contributing to the upkeep and conversation within. Before the SBAs started working at St. Therese, the janitors caught babies. I asked Excellente how many babies she had delivered back in the days and she laughed, "… many, many!" Once, she delivered three around the same time.

Haiti has the highest maternal and infant mortality and morbidity rates in the Western Hemisphere. The lack of skilled childbirth attendants is the primary cause of needless suffering and deaths of these mothers and babies. Midwives for Haiti located in Hinche, the capital city of the Central Plateau, is an organization founded by Nadene Brunk, Certified Nurse-Midwife (CNM), and her colleagues to address this need. After traveling to Haiti in 2003 as part of a medical team, Nadene witnessed first hand the lack of resources and skilled care for pregnant women. Determined to provide a long-term solution, she formed a small team of volunteer midwives and medical professionals and soon returned to Haiti. At the request of a Haitian community leader, she established a rigorous 12-month, culturally appropriate training program for Haitian nurses in Hinche. Graduates are empowered with the knowledge and experience to save the lives of mothers and babies. They are employed at St. Therese Hospital and other health centers throughout Haiti and provide prenatal and postnatal care in remote rural locations. Midwives For Haiti has graduated 95 Skilled Birth Attendants with another 30 students in Class 8 beginning their course in the summer of 2015.

Media attention to the needless and devastating deaths of women and infants, particularly those in developing countries, has recently increased largely driven by the United Nation's Millennium Developmental Goals #4 and #5. Since 2011, I have made three trips on behalf of Midwives for Haiti, recording what I have learned through my lens and writing. The spirit of the Haitian people and important work done through Midwives for Haiti are what compel me to return.

More about Midwives for Haiti can be learned here: https://midwivesforhaiti.org My blog from my initial trip in 2011 is here: http://hannatruscott.blogspot.com

Spiritual care is an essential element of health care in Haiti.

Always a welcome site, a healthy mother holds her healthy newborn.

Yvanese Jean Louise, Midwives for Haiti student, works in a postpartum ward. One woman breastfeeds her newborn while another mourns her stillborn.

Claudie Exume, Midwives for Haiti student, cares for a pregnant woman with very serious complications.

Collateral Damage: a fatherless eight year old girl stays in the hospital with her mother who is suffering from a severe disease of pregnancy.

This mother remains entranced by her newborn in spite of postpartum burns following a traditional herbal sitz bath at home. Midwives for Haiti graduates treated her second-degree burns.

Auntie admires her nephew while the mom takes a little break.

Excellente St. Rose, a janitor at St. Therese Hospital for 16 years, used to help deliver babies before there were Skilled Birth Attendants.

Born at home, this baby bled from her umbilical cord so was brought to the hospital. I couldn't find her on the wards the next day. I will never know if her life was saved.

The simple skill of clamping the umbilical cord can make the difference between health or infection, life or death.

Pierre Salnave is one of several male Skilled Birth Attendants.

Ronel, driver and mechanic extraordinaire, navigates through river crossings, steep hills, and rough rutted roads. The jeep carries SBAs, volunteers, supplies to clinics.

Elene and Adrienne walk to and from prenatal clinic for the reassurance that care from Skilled Birth Attendants can give.

Skilled Birth Attendants divide the tasks of giving care to women in a rural clinic. One woman anticipates being poked for a blood test!

Magdala, a beloved graduate of Midwives for Haiti, attends to charting while working in a rural prenatal clinic.

A woman waits her turn for prenatal care offered at a monthly mobile clinic staffed by Skilled Birth Attendants educated through Midwives for Haiti.

Many women give birth at home with local matrones because of difficulties in transportation and costs of going to the hospital. Prenatal care can encourage women at risk to deliver at the hospital.

A smiling SBA organizes medications and supplies. The back of the jeep becomes a make-shift exam room with privacy afforded by a sheet curtain.

Prenatal care includes education, maternal and fetal health assessment, lab testing and treatment for anemia, worms, malaria, HIV, and sexually transmitted infections.

Miladege rests with her six-month old daughter before undertaking the hour-long walk home. She remarks, "They come every month, give good care, and talk to us nicely." Jonald is in the driver's seat.

Leaving a rural midwifery clinic, women walk two or more hours each way for care that provides education, preventive health, community, and respect.

Ismerilda and her three daughters. I met her when she was in labor with her second daughter.

Graduation Day! Class of 2011 with hospital administrator and instructors.

Jesula Louis is a matrone (Traditional Birth Attendant, or TBA) in Fort Resolu, a village near Hinche. She has assumed a leadership role in the group of matrones.

Felicia Atemour shows her certificate having completed the Matrone Outreach Program taught by Midwives for Haiti. The program teaches recognition of complications requiring transfer to hospital.

Hopeful candidates for the upcoming class stand outside the closed door waiting for their interviews. Many state passionately, "I want to save lives of mothers and babies."

Midwives for Haiti Founder, Nadene Brunk, CNM with Dr. Steve Eads, Medical Director.

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