A little less than two years after the 2010 Haitian earthquake, Marie entered the delivery room in a small hospital in Port-au-Prince, afraid and alone—without the baby’s father or any other family members at her side to support her. After several hours of difficult labor, Marie died due to complications, but her tiny baby, Jeremie, survived.

It is not uncommon for a mother to die in childbirth in Haiti. The cost of proper health care is beyond the resources of many residents and visits to a clinic usually require payment before treatment. This deters many from seeking care, under any circumstance. The level of poverty and lack of education experienced by many pregnant women also makes it difficult to maintain their health and the health of their unborn child. For impoverished fathers left with a newborn, formula is out of their reach because of its high price. Most fathers don’t have the education to care for the child without help or guidance. Those left to care for a motherless newborn are routinely approached by orphanage workers who promise that the child will have a better life in the orphanage because the child will have access to medical care, food, and education. Of course, the parents and the family of the newborns wish to keep and care for the child themselves; but they feel they have no other choice. With no social services to speak of and low literacy rates among the residents of Haiti, compounded by little or no knowledge of their rights, the overwhelmed parents and family members often sign away their newborns to the institution.

Recent scientific studies have shown that situations like the one in Haiti have significant consequences for the society. In most institutions, children are left without stimulation or personal attention for the majority of the time every day. They share a living space

with other boys and girls up to age 18. Their meals are often scant and lacking in nutrition. The quality of education is extremely poor. Scientists have found that these conditions negatively affect the child’s brain development, which can lead to serious health and behavioral problems.

Over 30,000 children are currently cared for by 800 or more institutions in Haiti. Many local residents believe that these well-established private institutionsare the best place for a child whose parents can’t afford to care for them or don’t have the resources or help that they need. The funding for these institutions is often foreign aid that is based on how many children the institution cares for, or funding provided to help the children move through the international adoption process. The Haitian government lacks resources to provide meaningful supervision of these institutions. Unfortunately, it has become an accepted and thriving practice among Haitians to depend on these institutions as a safety net. Social services, if they existed, would actually help parents in dire need avoid giving up their children and stabilize the family unit at the same time, but institutions that separate families and destabilize and stunt the development of these children are seen by the public as their only hope.

Despite their reputations among Haitians, institutions do not provide the care and the education needed by these children in order to develop healthy bodies and minds. Typically, the infants are left in a crib or other holding area while a handful of workers make the rounds to change diapers, feed, and occasionally bathe the children, roughly three to four times a day. With a staff of only a few individuals caring for dozens of children, staff members provide little to no personalized attention. For school-aged children, education is provided between meals by a single teacher inside this same building. There are no opportunities for individual attention, even in the case of children with disabilities.

Decades of studies conducted in Europe show that children who are removed from their biological families and placed in large residential facilities have reduced brain development, specifically in relation to physical and social-emotional development. One study found that young adults raised in institutions are 10 times more likely to be involved in prostitution than their peers, 40 times more likely to have a criminal record and 500 times more likely to take their own lives.

About 90 percent of schools are private institutions in Haiti, and families are charged for their services. School fees for tuition, uniforms, books, and materialsfor one child add up to almost 25 percent of a working parent’s yearly salary. The prospect of educating a child can be a serious burden on the family’s already strapped resources. In a typical home with multiple children, only one child, if any, is able to attend school. Therefore, when institutions present struggling parents with a promise that a child will receive an education in the institution, the parents may be convinced that there is no better choice for that child.

John was 7 and Dave was 4 when they were left at an orphanage. The institution promised that John and Dave would have better opportunities than what their parents could provide for them at home—including a good education. However, over the weeks that followed, John and Dave had a hard time adjusting to life in the orphanage; living with dozens of other children, all suffering their own maladies—post-traumatic stress disorder, separation issues, malnourishment, mental impairments, learning disabilities, and infectious diseases. Children of both genders, from birth to age 18, lived under the same roof exposing the brothers to bullying, abuse, and other factors that severely reduced the children’s ability to learn. Even worse, John and Dave often questioned why their parents who lived less than a mile away would place them in an orphanage.

Ali and Jamie McMutrie—two sisters from Pittsburgh—first went to Haiti intending to work in an orphanage. Jamie stayed there for eight years, then co-founded Haitian Families First (HFF) with Ali during the aftermath of the 2010 earthquake. They wanted to help nurture and empower families in despair through emotional, social, and financial support enabling them to keep their children. They wanted to ensure that children remain with their biological families and out of institutions by working closely with the local communities in Haiti.

"Families who approach us are in desperate need, ready to turn their child over to an orphanage because they think they have no option. We help them find options so they can keep their child with them. Over 90 percent of children in institutions in Haiti have a living relative — a parent or other family member willing to care for the child, but unable due to poverty. If more social services like those we provide existed in Haiti, orphanages would not," said Ali McMutrie.

Many families who enroll in one HFF program often find they need assistance in more than that one area. Families who reach out to HFF in a desperate situation searching for alternatives to relinquishing one or more of their children go through an initial counseling and assessment process to identify their needs. HFF staff discuss the family’s situation and evaluate possible options and resources aiming toward self-sufficiency in the long run.

Around the same time in the same delivery room where Marie died giving birth to Jeremie, another mother was also preparing to give birth. Because she was enrolled in the Health & Wellness Program offered by HFF, Junia, an HFF outreach worker was there to provide support to the mother through the delivery of her child. Knowing that Jeremie would be destined for an overcrowded and understaffed orphanage, Junia called HFF founder, Jamie McMutrie to discuss options that would set baby Jeremie on a path to a healthy life with a family in Haiti.

A few years back, Junia had lost her job as a cook at one of Haiti’s few beach resorts when the company unexpectedly downd. With no one to help her, she thought she would have to place one of her two daughters in an institution while she looked for work so she could support her other daughter. She thought she had no other choice. But thankfully, Jamie and Ali intervened. They met with Junia, evaluated her situation, and discussed her options. Junia expressed an interest in social work, and after some training they found Junia to be a perfect fit for an open position with HFF as an outreach worker. HFF also helped her locate childcare service during work hours.

Like many other mothers who have been supported by HFF, Junia was able to find a way to become selfsufficient and stabilize her family. HFF also helped her raise the money she needed to send her daughters to school—which is extremely challenging for many local families. But, unlike other women and families, Junia also did something unheard of in Haiti. She adopted Jeremie, the fragile little boy whose mother, Marie, had died while giving birth. Jeremie weighed less than 2 pounds at birth and needed very special care. Junia accepted the challenge because she felt it was time for her to help someone else in need.

Based on many years of field research, Jamie and Ali McMutrie have developed three distinct programs currently offered by HFF—Education, Nutrition, and Health & Wellness—which encompass the social services most often needed by families in crisis in Haiti.

The Education Program provides assistance to families who wish to send children to school. This program works with schools in the child’s community to keep children close to home. Tutors and additional help are also made available for students who are struggling to keep up.

The Nutrition Program serves pregnant and nursing mothers and their children with vitamins and nutritional education that will enable them to live healthy lives. For new mothers struggling to breastfeed, HFF offers education and assistance, and for fathers or other family members without the ability to provide breast milk, HFF provides formula designed to help a baby develop in a nutritionally sound manner. HFF outreach is not limited to the mere provision of product. HFF also offers consulting and education related to each product, proper administration, and routine checks on the outcomes of services.

The Health & Wellness Program provides assistance to families who struggle to receive medical care due to cost. This enables HFF families to see a doctor when needed. HFF provides assurance of responsibility for the bill should the family need assistance. These relationships also help families with newborns who need immediate assistance for a number of reasons. Hospital staff members routinely call on HFF to provide help or guidance to families in need of HFF program enrollment. Families who live in five communities are referred to HFF, almost daily, by doctors from a dozen clinics.

Edanson was abandoned at a hospital at 2 years of age, severely malnourished, weighing only 10 pounds. Knowing that most mothers only abandon a child when they are afraid, desperate, and feel they have no other options, Haitian Families First asked hospital staff and members of the community to help them find Edanson’s mother.

The next day HFF staff members found Clamene, who said that she had searched for help for a long time and did not think Edanson would live. Because she had no money, she left him at the hospital, hoping doctors would care for him. If she had stayed with him, she would have been forced to pay, otherwise, doctors would not have treated him at all. Leaving him at the hospital seemed like the only way to get the medical care that he needed to survive.

With HFF’s promise to help her, Clamene went back to the hospital bringing along her infant daughter Nashka. Doctors took care of both children during their hospital stay because HFF helped with the bill. Edanson spent close to a month in the hospital recovering from illness surrounding malnutrition. During this time, doctors discovered that Clamene was suffering from pneumonia and anemia. This explained why her infant daughter Nashka was not receiving proper nutrients from Clamene’s breast milk and was not growing adequately.

With the help of Haitian Families First programming, Edanson and Nashka recovered and are now home with their loving mother, and their older brother Esteven. Nashka is breastfed and growing every day. Edanson recently started his first year of school.

"Helping a family steady themselves encourages them and gives them a feeling of hope that everyone can see. Once a family learns smarter and better ways to be and remain self sufficient, they tell their neighbors and soon the entire community is benefiting. Helping a family and a community grow together is what is helping Haiti thrive. A strong and stable family unit is what will give the next generation the ability to make change and keep the country moving forward," said Jamie McMutrie.

—Jamie McMutrie