en English
ar Arabiczh-CN Chinese (Simplified)nl Dutchen Englishfr Frenchde Germanit Italianpt Portugueseru Russianes Spanish

A Matter of Life and Death

“I couldn’t stop bleeding. After I gave birth, I bled every day.”

“Right here,” Jenelia points to the small dark room where she lives with her husband and three children. “This is where I delivered my son.” There’s no electricity. No skilled provider. The conditions are unsanitary. It’s where you give birth when you have no choice.

When you live on less than $2 a day, how do you pay for reproductive health care? If a mountain stands between you and the nearest health facility, and there is no road and no ambulance, how do you get help in an emergency?

“My delivery went OK. But after ten days, my bleeding still wouldn’t stop.”

Jenelia grew weaker by the second. She needed to get to the hospital. But there was only one way—to climb a steep mountain path for hours.


Ten days after giving birth and still bleeding, Jenelia began her climb. She pulled her body up over large rocks, her husband hiking beside her with their newborn.

Imagine her relief—the clinic finally appearing through the trees.

Jenelia approached the door. In an instant, her relief was gone.

“No one could help until Monday,” says Jenelia. It was Saturday, so the clinic’s only doctor wasn’t there. The trip was for nothing. Worse than that, Jenelia had to make the long journey home again. To wait and bleed for two more days, then make the arduous trip again, before she finally received treatment.


No woman—no matter where she lives—should have to endure what Jenelia did.

Yet hers is a story we hear again and again. Not just in Haiti, but Nigeria, India, and Myanmar. In the world’s poorest, most isolated communities, women suffer out of sight. We can fill this dangerous gap and connect underserved communities to the doctors, hospitals, and critical care they need to survive. It starts with well-trained community health workers, like Etienne.



It’s clear by the way Etienne jumps from rock to rock that he’s sure of his footing. He knows the terrain well. This is where he’s from and where, for the last 20 years, he’s served as a community health worker. He is proud to deliver free services and information to some of the most isolated families in Haiti.

The sun blazes down by the time he crosses the river. Etienne is on his way to make an important home visit. He scrambles up rocks, then follows the path through tall fields of corn. Finally, he reaches the house and sees Jenelia cradling her baby in the shade.

After a warm greeting, Jenelia and Etienne sit together. To begin their counseling session, Etienne holds his mobile phone between them. Out of its speaker, a prerecorded audio message plays. Jenelia smiles slightly, leans in, and listens.



Pathfinder understands one of the best ways to address the preventable suffering of women like Jenelia is to improve the quality of community-based care.

That’s why we teamed up with Dimagi, Inc., experts in open-source software for use in the world’s poorest countries, to create a groundbreaking tool. Health workers can use our application—for their phone or tablet—to make decisions, record data, refer clients to health facilities, and more. Our “app” has the potential to transform the way health services are delivered to Haiti’s underserved women.

Not just for pregnant women—for all women—including those desperate to prevent another pregnancy.


Jenelia is tired. She shifts her baby in her arms then turns to Etienne. “I can’t even remember how old I was when I got pregnant the first time,” she tells him, shaking her head. “I had a miscarriage, then two more. Then I had my three children. All before turning 30.”


“I’ve never used family planning,” Jenelia says. She’d heard dangerous rumors. “People told me it would make me lose so much weight I couldn’t work. It would hurt me.” Throughout her life, Jenelia’s sexual and reproductive rights have been ignored. That ends now. Etienne stands with her. Pathfinder stands with her. Today Jenelia learns the truth—she has the power to take control of her body and health.

Etienne opens a new menu on his phone. He follows the app’s checklist for contraceptive counseling. “Jenelia,” he says, “let me tell you about your options…”

To date, the Services de Santé de Qualité pour Haiti project, funded by USAID and led by Pathfinder, has trained 309 community health workers to use this innovative mobile health application.

Other Impact Stories

explore where we work