"Removing deadly user fees is making an invisible problem visible, " Farmer said in a telephone interview en route from Rwanda to Haiti, where his Partners in Health organization works to improve health care in the country's Central Plateau region. "Before, these women were dying at home. Now they are dying in front of you."

EFFORTS TO HELP

Earlier this year, the Canadian government with the Haitian Ministry of Health launched a $6.5 million program to fight maternal mortality. The program reimburses institutions for deliveries and transportation costs for participating pregnant women and compensates traditional birth attendants who walk clients into the doors, rather than risk an at-home delivery. Some 61 medical facilities, including Farmer's, are part of the network, known as SOG.

"Safe motherhood should be a right, not a commodity, " Farmer said.

With little access to proper healthcare, most pregnant women here rely on traditional birth attendants to help deliver their babies. But they often can't handle complications such as pregnancy-induced high blood pressure or preeclampsia, which Haitian women develop at high rates.

"They just aren't skilled or have the training, " Farmer said of the birth attendants.

The evidence is clear at Jude Anne, where a grateful Maudeline Joseph, 22, was forced to deliver two months early after she developed preeclampsia and her blood pressure skyrocketed. Six-pound Patricia, sleeping next to her, was born healthy.

Magaly Jodely, 39, however, has had two failed pregnancies. The latest left her clinging to life after she suffered a stroke, and she spent eight days in the hospital. The mother of two was forced to deliver early at five months, and the baby died. As she waited to be discharged, her arms and legs were still swollen, and her speech was slurred.

"If you get pregnant again, you will die, " a nurse cautioned while urging her to practice birth control. "Do you understand?"

Behind them, newborns slept in a makeshift neonatal ward with only heating pads to keep them warm.

Two babies -- no bigger than a stick of butter -- lay dying in a crib the size of a shoe box. A few cribs over lay a baby girl with a bleeding brain.

"We need to make sure we can link safe motherhood to family planning, " Farmer said. "We need to have bold family planning."

Haiti's new health minister, Dr. Alex Larsen, agrees the country needs to rein in its exploding birth rate. He says SOG is an excellent program but worries what the government will do when the funding runs out and whether such subsidized care also serves as an incentive for pregnancy because of the attention provided.

Farmer calls such thinking medical folklore and says the best way to encourage family planning is to deliver safe, healthy babies.

PERSISTENT OBSTACLES

Meanwhile, the ministry of health has reopened all hospitals, but strikes and a lack of resources continue to threaten operations.

For instance, the General Hospital has long been a cesspool of corruption, and its kitchen and pharmacy are still closed. At least one of the other hospitals, Larsen said, had to be temporarily closed because of unsanitary conditions caused by a mosquito infestation and hurricane damage.

"There is a lot of work to be done. I don't have a bag of tricks to just fix the health system like that, " he said of the overall healthcare issue in Haiti.

Larsen says the spike in deliveries at Jude Anne isn't solely because of closures and strikes, but because the services are free. Even the public hospitals require payment.

"They prefer to go to Médecins Sans Frontières, even if it means they have to give birth on the floor, " he says.

Van Dillen sees the Canada's SOG program as his group's exit strategy, saying free health services would allow them to increase survival rates of Haitian women and babies.

Farmer agrees but also says international agencies are handicapping Haiti by persistently treating it like a triage case. Instead, they should provide a long-term commitment that would allow the nation to build a solid foundation for healthcare.

"When you have a disaster relief mentality that has so plagued Haiti . . . that is not going to help, " he says. "It prevents the building up of institutions. If you are really serious about reducing maternal mortality, you have to stay in the game a long time."