My Love Affair with a Sh*thole Country


I first visited Haiti in 2006. It was not love at first sight, or even a like. I spent a week on a medical mission trip, missing my family and sweating in the operating room while I performed some of the most difficult surgical cases of my career, without adequate lighting and unfamiliar instruments. Climbing the steps of the airplane to return home was a welcome relief from the searing heat of the tarmac and the aroma that is Haiti (think rotting fruit mixed with exhaust fumes and burning charcoal). I’m not sure when the amnesia set in over the next few months, but I was soon planning my return visit the following year. 15 or so trips later, I look forward each visit to spending time in a country that I have visited more frequently than any other.

My  trip last week coincided with the recent comments about Haiti from President Trump. While he was ranting about the immigration of Haitians to America, I was participating in distributing microloans to a new group of 10 Haitian businesswomen. The women received $200 to help fund their small businesses and will be responsible for paying back the loan over 10 months with a low rate of interest. Each of these women has worked hard selling clothes, food, shoes and motor oil to support their families. This is in addition to the daily tasks that a Haitian woman must perform without the benefit of running water or electricity. Entitled or lazy would be the least descriptive terms that I would use.


The following day I worked with one of the Haitian seamstresses that we employ to construct reusable menstrual pads for distribution to Haitian girls. She uses a manual sewing machine and is able to make $4 a day working  5-6 hours. She also participates in menstrual hygiene instruction at area schools so that young girls will have the benefit of knowledge about their bodies and not the fear that her generation of women experienced. She has no desire to immigrate to America away from her family, but wants the opportunity to make her life in Haiti more comfortable.

I am not quite sure why this country has occupied so much of my time, energy and pulled at my heart. The opportunity to leave a frigid Minnesota in January makes the idea of sweating in the operating room more palatable. But is much more than that. Haiti is a land of contradictions – corruption and family strength, sadness and laughter, illiteracy and value of education.  There is very little black and white, rather many shades of grey. But it makes my brain think and try new ideas, something that is more difficult to do in my American job. I have been the recipient of many opportunities in the US, and although I have worked hard and been the first to graduate college in my immediate family, there were many along the way that provided encouragement and a helping hand. I would like to think that I can be that helping hand for Haitians – providing business loans for women, saving a baby’s life when her mother is suffering from seizures/eclampsia, removing an enlarged uterus so that a woman can better perform her household chores and providing education and hygiene products so that young girls are able to stay in school during their period. Yes, Haiti is a destitute country that has suffered from both outside forces and its own corruption. But its people are willing to change that – if we would only give them a fighting chance. And remarks such as those from our President don’t help to provide that chance.

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For those of you who have been following this blog over the past few years, you know that I am passionate about all things related to women’s health care. Considering that my job as an Ob/Gyn physician is intimately interwoven with this topic, it is only to be expected that my children are exposed to my opinions during conversations at home. They also hear about my experiences in Haiti and are often recruited to assist with the construction of reusable menstrual pad kits that are distributed to young Haitian girls to encourage them to remain in school after they start menstruation.

May 28th (5-28) is Menstrual Hygiene Day and is dedicated to creating awareness around an often taboo subject. The 5-28 has significance in that most women bleed for 5 days every 28 days. Although Western civilization has made great strides in the past few decades around menstrual health education, the stigma and embarrassment for young girls persists. My daughters and I were finishing a restaurant meal when we noticed that the girl leaving the table next to us had a large blood stain on the back of her dress. We looked at each other with horror while having a hurried discussion about whether it was less embarrassing to run after her and inform her of the stain vs. letting her find out herself. The decision was made as we heard the door of the restaurant close behind her and our chance was lost. Would we have wasted time in discussion if the bleeding had stained her clothes from a large cut on her leg? The blood is the same but the source so much different.

When my daughter informed me that she was combining both of the above experiences into one argumentative essay for her final AP Composition Essay, I had to smile and then pity the male teacher who was to be subjected to her strident opinions. This same teacher (late 30’s) admitted that he has never purchased feminine hygiene products for his wife and had no advice for sources of information to help support her argument that luxury taxes should be abolished on tampons and pads. Because of the work of humanitarian organizations such as WASH in developing world countries and women’s health advocates in this country, resources for information were plentiful.  I have included the first part of her essay below.

Luxurious Taxes

Toothpaste, sunscreen, chapstick, shampoo, condoms, viagra. All daily items, all exempt from taxes. Daily essential items that are categorized as a necessity and aren’t taxed. Items thought to be a luxury, however are taxed. Flowers, cell phones, nail polish, TVs, computers, and jewelry. They add pleasure to your life. Those items are bought by choice and personal interest. What defines whether an object is declared a necessity or a want? Does the gender of a buyer for an object affect the tax, non-tax ruling? Tampons are taxed, but females need them to tend to their monthly periods. Taxes should be removed on tampons in every state. They are looked upon too lightly and assumed to be more of a extravagance and less of need. They are the “pink tax”.

My mom is an OBGYN and she sees female patients on a daily basis that revolve around period defects. Patients are suffering from heavy streaming periods and other dysfunctions that are uncomforting. They have to change tampons more frequently than an average person. Changing tampons every hour is inconvenient and costly.  My mom works with women to try and assist them in feeling more comfortable with the unnatural feeling periods and other dysfunctions of being female and save them time and money from buying so many tampons. However seeing a doctor about menstrual issues becomes even more costly when trying to fix your awkward period malfunctions. Women are feeling embarrassed and uncomfortable.

Tampons. They are declared a luxurious item in thirty-eight states of the United States. On holidays, taxes are removed on some everyday items, however, tampons and pads are still taxed on those special occasions. Tampons are still looked upon as a non-essential item, as if they are used by choice. As if women choose to go out and buy a $7 box of wonderful cotton plugs. As if women choose to have periods every month for an average of thirty-six years of their life. As if women choose to spend close to $2,000 on such a “luxurious” item as a small cylindrical object made of cotton. As if women are being spoiled with an item to protect their blood from leaking out. What a treat.

Tampons aren’t flowers. People wouldn’t buy a box of tampons for their friend’s birthday. Tampons are a common piece of feminine hygiene that keep blood from spilling out uncontrollably and make periods a little less worse. Periods are a naturally occurring part of a female’s life that they can’t prevent, not to mention the berserk side effects of mood swings, cramps and cravings. Tampons and pads have to be used to prevent blood from pouring out and leaking everywhere, time after time after time.  Every second you feel uncomfortable blood shedding; every minute you’re hesitant of leaking; every hour you’re contemplating if you need to change tampons; every day you’re in fear of the current of your flow; every week you wonder when it will be done. Periods aren’t a choice. Tampons aren’t a choice. They are a need. Tampons are calculated to be needed for 456 periods, 38 years, and 2,280 days (2015, Kane) of a female’s life. Tampons are a female necessity.  

Although her grade for the entire essay was high, the one critique by her teacher is evidence that we still have some work to do in this country when it comes to education around menstrual health. He penned ” too graphic”.


The work that needs to be done in developing world countries is even greater.  There is a growing awareness that less stigma around menstruation results in better lives for both boys and girls. Girls that stay in school beyond the age of menstruation because they have access to a private bathroom as well as menstrual pads, also have fewer children and are better able to secure a job to support their family because they have obtained a higher level of education. My involvement with the sewing center at Helping Haiti Work has reinforced what I have seen researched. The need for menstrual protection supplies in schools is recognized, but the thirst from teachers and students for education is even greater. Our Haitian seamstresses have been provided with women’s health training and given charts and pelvic models to use in their educational sessions. For $16 a day they will assist in the distribution of the reusable menstrual pad kits and provide 3-4 hours of education to teachers and students.


My hope is that a future granddaughter will pen a similar essay to the one above for her ancient history class and use our current experiences as the beginning of the end when it concerns the menstruation taboo.




The Power of Globalization

While many of my friends were participating in the Women’s March on Saturday, I was proud to be working with a group of seamstresses who were busy demonstrating the power of globalization and how it can be used to benefit others. 30 women and 1 man showed up to construct reusable menstrual pads for distribution to school girls in Haiti, as well as prepping fabric for our Haitian seamstresses to construct the same kits and earn a livable wage. We were our own march for the equality of women throughout the world, signifying that Women’s rights are Human rights. Helping others less fortunate causes all of us to rise; attempting to divide women by country, sexual orientation or race will only make us more resolute and determined.

Help me to Help Haitian Women


Helping Haiti Work, a non-profit that I started in 2012 to provide microcredit loans for Haitian women, is nearing the end of its third year. I am very proud of what we have accomplished.

  • A total of 203 loans in 2 different locations with 100% payback rate
  • 65 of those loans were originated in 2015
  • Women starting their third loan cycle will receive an extra $100 for business growth
  • Establishment of 2 sewing centers that will be constructing reusable menstrual pads and reusable diapers for sale in the community.

The loans have empowered these women to become leaders in both their communities and in their homes. Because we continue to fund more loans each year, other women are starting to dream of the possibility that they could successfully start a small business.

In 2016 our goal is to fund 65 new loans as well as continuing to add $100 to each loan that has been successfully paid back twice. This totals $18,500, nearly twice our 2015 budget.   The women in these communities have worked hard to ensure their loans are paid back on time. We would like to  honor this hard work with our continued support. Please consider making a contribution to Helping Haiti Work as part of Give to the Max Day.


Menstruation Sensation


February 2014 was when I read my first article about the need for feminine hygiene products in the developing world. My blog post, The last taboo – Menstruation, written in April 2014 has been the most viewed of my posts as well as the post that has generated the most traffic from international viewers. There has been an explosion in international awareness of this problem for girls and women and this awareness has driven incredible innovation in a short amount of time. Along with an increase in feminine hygiene products for the developing world has come a breakdown of barriers around the discussion of this taboo subject. Both of the organizations described below provide an educational component to their work, teaching young girls about their bodies and how to safely care for themselves.

Aakar Innovations in India has developed a disposable pad using agricultural waste. This pad is biodegradable as most rural villages lack proper sanitation. Aakar has recently expanded to a “business in a box” model in which others can purchase the equipment needed to set up their own small business. Twenty one such small businesses are now operating in India and one in Kenya. This business can provide employment for 15 women and produce 2000 pads a day.

SHE in Rwanda has been using the refuse from banana growers to create absorbent, biodegradable disposable pads. In the past  growers had no market for the used banana trees, but now they are being paid for their waste. The factories are locally owned franchises that employ local woman and sell a superior, less expensive product.

So what does all of this mean for Haiti? It allows us to collaborate with these organizations as well as other NGO’s already in Haiti to bring women choices for feminine hygiene. Just as in a developed country, not all women use the same product throughout their reproductive life. Haitian women may not have as many choices as the aisle in Target, but they should have a choice between reusable and disposable. And the disposable product should not be an environmental problem (it can take hundreds of years for a plastic pad to decompose).

Helping Haiti Work, a non-profit I started in 2012 to give Haitian women microloans, is exploring the possibility of starting a new venture that would produce these disposable pads. We are using nursing students to trial both the reusable and the disposable pads and give us feedback.  Hoping that we are the first menstrual pad factory franchise in Haiti!

I’m Back from Haiti and Need Your Help!

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This trip to Haiti was much different in many ways from my previous travels. We stayed in CapHaitian rather than traveling to Limbe, we taught Haitian providers about cervical cancer screening rather than performing surgery, we rode local tap-taps for transportation, we “camped out” in a partially finished house and slept on mattresses on the roof because it was unseasonably hot (95 degrees) and we attempted to market reusable diapers and menstrual pads to start a business for our microfinance women at Helping Haiti Work.

We learned much about how business works in Haiti and the Haitian medical providers learned  about the causes of cervical cancer, how to screen for the disease and methods of treatment. More about the cervical cancer program in another post. This is what I learned.

1. Haitian women work hard and maintain long hours at their market stalls in order to clear $3-4 a day.

2. Haitian women are skeptical about new products, especially when marketed by white women. A side-by-side comparison to the local product (diaper or menstrual pad) using water was much more effective than talking.

3. Haitian women are born to bargain when negotiating price.

4. Most Haitian women have not seen an electric sewing machine in action and all want to try to operate it, usually going way too fast.

5. Haitian women are quick to learn a new task because many of them are illiterate or only partially literate and learn by doing.

After multiple conversations with women, assessing the current market price of our product and estimating the cost of supplies to make a reusable diaper or menstrual pad kit, we have realized that the profit margin is too narrow to make this program fully sustainable. But that does not mean that we have given up. Put 5 white women together on a roof with a bottle of wine at 9 pm and much brainstorming happens.

camping out with ipads

camping out with ipads


We have created the concept of CUTTING PARTIES or PINOT AND PADS. For $20 a person, you collect a group of your friends together and for 2-3 hours cut out diapers and menstrual pad kits. We will supply you with patterns and fabric purchased thru the $20 donation. No sewing needed as the unfinished kits will be sent to Haiti and the women will purchase them for a small cost, construct the item and market it for a profit. This employs many of the ideas from my previous post When Helping Hurts. We are working to create a culture of self-sufficiency rather than a culture of dependency. We are also in the process of making a video that you can download from YouTube which gives a visual education in what we are trying to accomplish.

The next shipment of kits will be traveling to Haiti in mid June. The Haitian women are depending on us to help them help themselves. Please contact me at if you are interested in hosting an event.

Seamstresses Without Borders in Haiti


You may have heard of Doctors Without Borders or Engineers Without Borders, but you have probably not heard of Seamstresses Without Borders, as we have just started the first branch in Limbe and Ranquitte, Haiti. Ellen Schreder and Abbie Ahner traveled to Haiti this week to work with Haitian women who are interested in a microfinance loan thru Helping Haiti Work, but do not have a pre-existing business. We have been collecting fabric over the past few months and 6 – 50 pound suitcases followed the women on their journey over potholed and washed out roads to the rural village of Ranquitte. Ellen and Abbie are helping women with basic sewing skills develop a business plan for constructing and marketing the items that they sew. We will be continuing to encourage the women to use the reusable menstrual pads that I have written about previously, in addition to reusable diapers and mens and womens underwear.

The board of Helping Haiti Work has had numerous discussions about how we can make this business sustainable but also profitable for the women. Too many projects that are started in the developing world falter and break down when funds to sustain the enterprise dry up. Using donated fabric and supplies, purchasing remnants of fabric and using used flannel sheets has allowed us to keep the cost of each item low enough so that a profit can still be made when the women sell the items in the local market. Unfortunately, flannel fabric is difficult to find in Haiti so most of the fabric will need to be brought in by volunteers.

The first day of the project went beyond our expectations. The sight of an electric sewing machine (the norm in Haiti is a treadle machine as electricity is variable) generated much excitement when women saw it in operation the first time. During a teaching session about business models, women brainstormed new ideas building on the sewing program. One woman wants a loan so that she can purchase fabric in Cap-Haitian and then sell to the sewers so that they can focus on sewing. Women wanted to teach their sons and daughters to sew to increase production. Although cooking is considered women’s work in Haiti, many of the tailors are men.

Free handouts to those who are poor are easy and make the giver feel fortunate and superior. The recipient, however, does not benefit to the same degree and is left waiting for the next handout. Programs such as this are much more difficult to implement, involve more time on everyone’s part but create a sustainable business that will be in place long after the Americans have left. Haitian women also benefit by realizing that they have the power within themselves to make a better life for their family and their community. They no longer need to rely on handouts and can replicate this same business in neighboring communities.