A Clinic in Conflict: A Political
Economy Case Study of
Family Planning in Haiti
M. Catherine Maternowska
Perhaps the most critical transaction of all in family planning programs is that between the program and the client, for all others ultimately revolve around that nexus. If this transaction fails, the program will fail with it. Warwick (1982: 183)
There had been no electricity in Haiti for month-long stretches during the embargo of 1994; 30 March was no exception. I am visiting clients and staff at a family planning centre built for the residents of Cité Soleil, a desperate slum community in this, the poorest country in the western hemisphere. Inside the clinic it is a typical afternoon: hot, sticky and very still. The staff sit on their metal folding chairs, staring blankly, waiting for the doctors to arrive. The nurse, preparing cotton balls and alcohol, exclaims that it's too hot to move. Nine women from the community, referred to by the staff as kliyan (clients), sit on hard wooden benches in the waiting room. Some are dressed in clothes reserved for Sunday mass and doctor's visits. Others are too poor and they wear rags. All have come to the clinic for more pills, another DepoProvera shot, or relief from irregular bleeding or itching and burning ‘down there’. Each hopes that the doctor will allay her discomfort.
Upstairs is where the doctors see clients. The two Haitian doctors are tall and heavy by national standards. They always look neat and cool when they arrive in their crisp clothing and inevitably they too comment on how hot the clinic is. They speak impeccable French. Their Creole, unlike that of the poor women who attend the clinic, is studded with French phrases, confirming that they are both urban-born and educated. One of the doctors marks his clients' charts with a fancy gold pen.
The two examining rooms are small and sparse. The rooms are filled with the din from Route Nationale 1, Haiti's major thoroughfare.