Credit and Health

Earlier in the week, I was talking to Bob, the credit agent responsible for one of our best credit centers, the one in Lakou Feliks. We gave a certificate and a present to its chief, Marie Ange, in May, when the Marigo office held its local assembly. At the time, it was one of only two Marigo centers who were 100% up to date with their loan repayments. “Zero delinquency,” as we say.

The center is no longer at zero delinquency. Two women, members of Marie Ange’s solidarity group, have fallen behind. But the center is handling these problems well, and we expect them to be solved by the end of the year. One of the women simply left Haiti to make her way in the Dominican Republic next door. Her fellow members are furious, even though she promises to send what she owes in a lump sum this month. They keep in touch with her to ensure her repayment, but they also say that they won’t take her back if she returns to Haiti. The other woman, a younger one named Manouchecar, has a more common problem. Shortly after she received her last loan, two of her brothers became seriously ill. Helping her mother take care of them ate up most of the capital in her business and took up the time she would normally spend making money as well.

I don’t have the data in front of me to support this assertion, but I think it likely that most of the delinquency we deal with is connected in one way or another to health issues. They are not the only problems our borrowers face. Their money and merchandise are sometimes stolen. Transportation issues can mean that women trying to bring agricultural products into Port au Prince can suffer losses when produce rots before it gets to market. Too much or too little rain can spoil their crops. The price of salami can plummet while they have a large stock in their hands. There are lots of things that can go wrong in their lives.

But very many of the women who have repayment problems tell us stories of children, husbands, siblings, or other family members who are sick or have died. They pay for doctors, medicines, or funerals. Many others talk about their own ill health. Being sick is expensive. They have to spend money to get better, and they lose income as long as they are sick.

The problems are especially bad around childbirth. About 6% of all Haitians die at birth. That’s ten times the number that dies in the States, a country with its own health problems. Over 500 Haitian mothers die for every 100,000 live births. Only about eight of 100,000 do in Europe.

So, for example, in the center at Lakou Feliks, Marie Ange convinced one of our borrowers not to take a new loan because she is pregnant. Another member is returning to the credit program after giving birth to and nursing a healthy child. Lakou Feliks is a good center, and good centers manage even difficult issues, like member pregnancies, well.

Other centers don’t. I’ve written before, for example, about the problems that started when Ivette, a borrower in Segen, took out a loan when eight months pregnant. (See: Working Out Problems.) And Ivette’s not the only one.

Bob and I were driving by a center in Lagad on the way back from Segen on Tuesday, and we decided to stop to see the center chief, Roselène. She is a young woman, still living with her parents, but she had been pregnant for several months. I’m not sure how many. We thought we’d stop by to ask her how she was, and discovered that she was in terrible shape. She had gone into labor, but the baby had died at birth. She had been bedridden ever since. We found her huddled on a blanket on the floor of her family’s outdoor kitchen, trying to stay warm. Her parents and siblings were sitting around the fire. She told us that she had been able neither to eat nor to sleep. And she was too weak to get onto a motorcycle or a truck for the long, bone-rattling ride it would take to get her to medical attention.

That’s where Job came in. His older brother is my “monkonpè”, the father of my godson. And that makes us family. I’ve known Job since he was a high school student. He’s now in the last month of his seven-year medical school education. He’s already a working doctor, scrambling to make a living and to help his older brothers support their younger sisters too, and he’s working hard to prepare for his marriage next March. But he always seems to have time to see me – or to see anyone else I ask him to see – whenever I call him. And I was worried about Roselène, so I gave him a call.

That was Tuesday, and Bob would have to return to the area on Friday, so I asked Job to come Thursday afternoon, spend the night, and then head up the mountain with Bob the next day. He immediately agreed.

He went up the hill on the back of Bob’s motorcycle. They had two credit centers to visit before they’d be able see Roselène, and I suggested to Bob that he have the women in those centers talk with Job about their health while he was collecting repayments.

Job didn’t do a lot in those centers. He wasn’t equipped to do a lot. But the women were grateful for his visit. He took their blood pressure, told them how they could fight hypertension by changing what they eat, and listened to their aches and pains. From what I can tell, the women loved having him, and wanted to know when he’d be back.

When he got to Roselène, he found that things were much less dark than they had seemed to me. She was overtired, a little undernourished, very sore, and somewhat depressed. She and Job had a long talk. It turns out that her labor was premature, brought on, he thinks, by the heavy farm work she was doing well into her seventh month. We sent her some vitamins. Job prescribed a couple of medicines: a pain reliever, an antibiotic, I’m not sure what else. Since Roselène has no way to get to a pharmacy, we’ll have to try to find them in Marigo. Job thinks she’ll be fine after some more rest.

Unfortunately, Fonkoze doesn’t have doctors it can send to the field on a regular basis. I’m lucky that I have Job. But the women we work with live in places where health care can be hard to find. An occasional visit by a doctor willing to donate his time is a very good thing.