{"id":29551,"date":"2020-08-03T10:49:48","date_gmt":"2020-08-03T15:49:48","guid":{"rendered":"https:\/\/panamaadvisoryinternationalgroup.com\/blog\/?p=29551"},"modified":"2020-08-03T10:49:48","modified_gmt":"2020-08-03T15:49:48","slug":"way-north-pregnant-migrants-brave-harrowing-jungle-crossing-panama","status":"publish","type":"post","link":"https:\/\/panamaadvisoryinternationalgroup.com\/blog\/way-north-pregnant-migrants-brave-harrowing-jungle-crossing-panama\/","title":{"rendered":"On their way north, pregnant migrants brave a harrowing jungle crossing in Panama"},"content":{"rendered":"

\"\"<\/a><\/p>\n

Billowing dust trailed the van as it barreled down a dirt road. In the back seat, Faustin Dieumes held his pregnant wife, running the remnants of a damp napkin over her face. Her body was limp and one of her palms laid face up in her lap. The couple had gone two days without food or water before she collapsed.<\/p>\n

This road is one of two ways out of Bajo Chiquito, the first stop migrants come to beyond the Dari\u00e9n Gap \u2013 the 60-mile stretch of jungle at Panama\u2019s southern border with Colombia and one of the most dangerous places in the world. Familiar themes echo in migrant stories of crossing the Dari\u00e9n: flash floods, wild animals, thieves, smugglers and infection are among the threats that come with the jungle\u2019s diverse terrain of rocks, rivers and thick vegetation.<\/p>\n

Medical attention can be critical for migrants on the other side of the jungle, but few doctors and limited supplies in Bajo Chiquito force some to wait until their conditions worsen before continuing north.<\/p>\n

The need for health care is even more pressing for Dieumes\u2019 wife, Mircagnard Janvier, and other pregnant women who reach the camp on an almost daily basis, carrying with them the well-being of two lives.<\/p>\n

Janvier, a Haitian migrant who spent the past two years living in Argentina, is one of the\u00a0500 pregnant women<\/a>\u00a0UNICEF predicts will survive the Dari\u00e9n and arrive in Bajo Chiquito this year. The addition of pregnant migrants and unaccompanied children to an already overwhelmed medical system led the Pan American Health Organization, UNICEF and Red Cross to assist Panama\u2019s government by expanding health services in migrant camps.<\/p>\n

\u201cIt is better,\u201d said Clara In\u00e9s Luna, a communications officer for UNICEF, \u201cbut still not very good. \u2026 You still see pregnant women, eight months along and sleeping on the floor.\u201d<\/p>\n

Janvier, who was in her fourth month, emerged from the jungle after 10 days of traveling, sick with an infection she suspected originated from a fall in the jungle.<\/p>\n

Hours before her collapse, she and Dieumes gathered with other migrants at the center of the camp hoping to continue their journey to the next camp by boat. Of the hundreds of fellow migrants surrounding her, Janvier was far from alone in needing a doctor.<\/p>\n

\"\"<\/p>\n

Mircagnard Janvier, who was four months pregnant, was lifted into a SENAFRONT Jeep at the Bajo Chiquito camp in the Darie?n province of Panama on March 7, 2020. (Photo by Nicole Neri\/Cronkite Borderlands Project)<\/p>\n<\/div>\n

\u201cThere are sick children here; they have fevers, and there is no doctor,\u201d Janvier said. \u201cThere is not enough for the people here. \u2026There is nothing.\u201d<\/p>\n

Villages like Bajo Chiquito have been overwhelmed by the estimated 22,000 migrants who endured the Dari\u00e9n Gap in 2019, according to SENAFRONT, Panama\u2019s border patrol agency. Bajo Chiquito\u2019s infrastructure is equipped to serve up to 100 individuals at a time, although more than six times as many migrants flooded the camp in March 2020.<\/p>\n

Migrant campsites are nestled between weathered homes and rooftops studded with satellite dishes. Without running water or toilets, migrants are forced to relieve themselves in the Tuquesa River \u2013 the only source of drinking water for those who cannot afford otherwise.<\/p>\n

\u201cThere are big disparities,\u201d said Alejandra Carrillo Roa, a health systems adviser for the Pan American Health Organization. \u201cIt is important for everyone analyzing the situation, trying to understand what is going on there, (to) understand that we have different nationalities with different customs. Some things we see can shock us but may not be bad things.\u201d<\/p>\n

Near the heart of the camp stands a yellow building with a sign that reads \u201cMinistry of Health\u201d above its door. Not equipped to offer more than surface level solutions, the clinic provides just enough treatment for patients such as Janvier to reach a larger health care checkpoint at the next stop on their journey: La Pe\u00f1ita.<\/p>\n

Migrants travel one of two ways to the next camp beyond the jungle, the most favorable being by boat at the cost of $25 each, a business led by Indigenous locals. Janvier and her husband knew that the alternative \u2013 a six-hour walk \u2013 was not an option in her condition.<\/p>\n

Janvier and other migrants requiring expedited medical attention were placed on a priority list for the boat trip to La Pe\u00f1ita. She received an injection to subdue the pain in her abdomen and was advised not to drink from the river while she waited for the next available seat on the boat, but several days passed in Bajo Chiquito before the couple set out again.<\/p>\n

A rotation of two doctors and a handful of nurses staff the Bajo Chiquito clinic during weekdays, tasked with serving the flow of migrants, who inhabit the camp for an average of two weeks at a time.<\/p>\n

\u201cI am in so much pain, I don\u2019t sleep,\u201d Janvier said. \u201cWe sleep on the ground, there isn\u2019t any water. \u2026 Here they don\u2019t give anything to anybody.\u201d<\/p>\n

Shortly thereafter, she collapsed near the river that would have carried her to La Pe\u00f1ita. Nearly unconscious, she was lifted into the back of a SENAFRONT van with her husband and driven to La Pe\u00f1ita for immediate attention by a Red Cross doctor.<\/p>\n

\"\"<\/p>\n

Toussaint Pina Casimie records her journey at the Centro Materno Infantil in Meteti. \u201cMy goal is to arrive in Mexico City to cross the United States because of the crisis in Haiti where I lost my mom,\u201d she writes. (Photo by Haillie Parker\/Cronkite Borderlands Project)<\/p>\n<\/div>\n

For expecting migrants, the clinic at La Pe\u00f1ita is the first step in receiving anything beyond what most Americans would consider a checkup. From there, migrants move to other medical facilities until they obtain the sufficient medical resources.<\/p>\n

SENAFRONT agents wait alongside migrants through their hospital stays, transporting them by car, collecting prescriptions, translating their stories to doctors and, in extreme cases, acting as the equivalent of a family member if need be.<\/p>\n

After seeing the Red Cross doctor in La Pe\u00f1ita, Janvier was driven 45 minutes to the Centro Materno Infantil, a women\u2019s clinic in the town of Metet\u00ed.<\/p>\n

The clinic dedicates a portion of its facility to pregnant women, mothers and newborns, said Clara In\u00e9s Luna of UNICEF, \u201cbut it is not a hospital.\u201d<\/p>\n

Medical resources gradually become more comprehensive as migrants\u2019 medical journeys take them closer to Panama City, although the Panamanian government provides this care as a means to an end. At each facility, migrants repeat their story to the best of their abilities, meeting new doctors who can provide more advanced treatments than the last, until they are deemed healthy enough to return to La Pe\u00f1ita and complete the transit through Panama.<\/p>\n

The patchwork of migrant care offers only what is necessary to continue through Panama\u2019s \u201ccontrolled flow\u201d migration system and keep hospital waiting rooms clear for Panamanians who use the same health care process as migrants. Coincidentally, Luna said, this aligns with many migrants\u2019 desires, especially for pregnant women who are hopeful and determined to reach their destination before giving birth.<\/p>\n

\u201cSometimes, they don\u2019t want to wait to recover (in Panama) \u2026 they just keep going,\u201d she said.<\/p>\n

The likelihood of pregnant women reaching Centro Materno Infantil has increased since the Red Cross and UNICEF stationed a doctor at the migrant camps, Luna said. Attention from medical professionals and collaboration with SENAFRONT agents provides migrants an ally who can speak for their health and help them benefit from a health care system that requires \u201cadvocacy and getting vocal,\u201d she said.<\/p>\n

Yet migrants still struggle to receive care, particularly those who reach Bajo Chiquito unaccompanied and unable to speak Spanish, the common language of Central America.<\/p>\n

\"\"<\/p>\n

From the Centro Materno Infantil, Toussaint Pina Casimie writes her journey thus far. (Photo by Cronkite Borderlands Project)<\/p>\n<\/div>\n

Casimie, 29, seven months pregnant and mourning the sudden loss of her mother, left her home in Haiti to seek a better future for her child. Casimie\u2019s sister, her only remaining family, stayed behind in Haiti. Although Casimie hopes her sister will make the journey one day, Casimie set out alone.<\/p>\n

Although her sights originally were on the United States, conditions in the Dari\u00e9n gave Casimie doubts about reaching her destination. With her head in her hands, she repeated between sobs, \u201cI don\u2019t know, I don\u2019t know.\u201d<\/p>\n

Casimie was less than halfway through the six hour trek from Bajo Chiquito to La Pe\u00f1ita when the van transporting Janvier to Meteti zoomed passed her. Robbed in Colombia, Casimie did not have the $25 boat fare to La Pe\u00f1ita, forcing her to make the journey in thin sandals, her feet swelling over the straps.<\/p>\n

Formerly a nurse in Haiti, Casimie came prepared with anti-inflammatory medication and iron supplements to protect the development of her unborn child to the best of her ability. She left Haiti on Feb. 5 and had traveled for just more than a month \u2013 through Brazil, Peru and Colombia \u2013 before reaching La Pe\u00f1ita. She had shared her scarce resources with other pregnant migrants she met, but now she was down to her last two red, oblong iron supplements.<\/p>\n

Her last few steps to La Pe\u00f1ita were completed with the help of strangers. Speaking only Haitian Creole and French, Casimie was unable to communicate with SENAFRONT agents or advocate for the health of her fetus.<\/p>\n

A fellow migrant whom Casimie had never met translated for her in Creole as others helped her into the van that had transported Janvier to Meteti earlier that day. Upon Casimie\u2019s arrival at the Centro Materno Infantil, she and Janvier\u2019s SENAFRONT spokesmen greeted each other at the door. At the center, the same doctor treated them, and by the next morning, both Janvier and Casimie were back in La Pe\u00f1ita.<\/p>\n

The risks Casimie took to make her journey while pregnant are indicative of the unwavering determination and commitment that hundreds of displaced pregnant women embrace each year while embarking on the same journey. According to Luna, UNICEF estimated that number reached 111 in the first two months of 2020 alone.<\/p>\n

\u201cNow, SENAFRONT believes what we say \u2013 we are talking about humans,\u201d Luna said. \u201cNow they understand why we are talking about primary services for children and pregnant women.\u201d<\/p>\n

Commissioner Alexis Betancourt of SENAFRONT said the agency prides itself on its humanitarian approach, and although the \u201ccontrolled flow\u201d system is not without its flaws, recognition by the Panamanian government to implement a migrant health care system at all is unusual, especially for a country that\u2019s small and quite diverse.<\/p>\n

\u201cControlled flow begins with humanitarian help, so people can stay alive and be healthy \u2013 be fed,\u201d Betancourt said, although there is still more he hoped SENAFRONT could do.<\/p>\n

\u201cThere are many piercing stories involving children and pregnant women,\u201d he said, \u201cbut I think that the feeling of the man in uniform is that we have to keep doing more, we can\u2019t do it all.\u201d<\/p>\n

By Panamanian standards, the process is robust. It sets Panama apart from other Latin American countries that migrants pass through en route to Mexico and the U.S., Betancourt said.<\/p>\n

\u201cIt\u2019s possible to execute security measures while deploying a humanitarian approach,\u201d he said, adding that SENAFRONT has proven itself adept at both.<\/p>\n

\u201cThe government has been doing a very good job with the medical services,\u201d said Santiago Paz, chief of mission of the International Organization for Migration in Panama, especially for a country with a significant portion of its population living in poverty. \u201cThey have been assisting pregnant women, bringing them to the hospital in Metet\u00ed.\u201d<\/p>\n

\"\"<\/p>\n

Toussaint Pina Casimie rests at the La Pen?ita migrant camp after a six-hour walk from Bajo Chiquito. On her other side, two SENAFRONT agents collect names and passports of fellow migrants entering Panama\u2019s controlled flow migration system. (Photo by Lidia Terrazas\/Cronkite Borderlands Project)<\/p>\n<\/div>\n

Health care in Panama is a layered issue that often is characterized by its disparities, Paz said. The quality of medical care is almost exclusively dependent on the hospital\u2019s proximity to Panama City, and with Panama\u2019s dual health care system, many in the city choose a combination of public and private health coverage to meet their needs.<\/p>\n

Eugenia Rodriguez, a social anthropologist at the University of Panama who specializes in gender and ethnicity studies, said lack of quality health care is particularly apparent among women in rural and Indigenous communities who still suffer from maternal mortality at a much higher rate than in Panama City. The situation is acute in Bajo Chiquito and other villages that share land with migrant camps and use the same systems for emergency medical care that migrants do.<\/p>\n

Poverty is historically the way of life for rural communities, Rodriguez said. These populations have never known life to be any different, and are therefore unaware of the modern health services they live without, unless they leave their native lands, she said.<\/p>\n

For Sally Edwards, an environmental adviser for the Pan American Health Organization, \u201cgood enough\u201d by Panamanian standards is far from adequate in more resourced countries like the U.S. and the United Kingdom.<\/p>\n

\n

RELATED STORY<\/strong><\/p>\n

<\/a>Torn between humanitarian ideals and U.S. pressure, Panama screens migrants from around the world<\/a><\/p>\n<\/div>\n

\u201cI\u2019ve done lots of emergencies,\u201d said Edwards, who visited La Pe\u00f1ita in July 2019, \u201cand the conditions (there) were dire.\u201d<\/p>\n

This visit encouraged the Pan American Health Organization to take steps to improve the overall health of the camps, such as adding first aid kits, a rotation of doctors from UNICEF and Red Cross, and a plan to complete an additional migrant camp, Lajas Blancas, to house women and children exclusively.<\/p>\n

The flow of migrants through Panama rises with the dry season from April through November, putting pressure on camps and increasing the need for additional resources. During the wet season, when rain falls in the Dari\u00e9n 85% of the time, some migrants still press on.<\/p>\n

\u201cIn that time of year \u2026 it\u2019s a part of the country that is impenetrable,\u201d Edwards said.<\/p>\n

When it rains nearly every day in an area only accessed on foot or by boat, Bajo Chiquito becomes even more dangerous.<\/p>\n

\u201cYou can\u2019t keep people there, especially not pregnant women and people who need medical attention,\u201d Edwards said.<\/p>\n

The push for improved living conditions at the new camp of Lajas Blancas made an unexpected pivot in May when the spread of COVID-19 pressured SENAFRONT to open the camp before it was completed. A shelter exclusively for women and children now is occupied by those showing symptoms of the novel coronavirus that causes COVID-19, isolating migrants to slow the spread within local communities.<\/p>\n

\"\"<\/p>\n

After they see a doctor, Faustin Dieumes and his wife, Mircagnard Janvier wait in el Centro Materno Infantil until they can be transported back to La Pen?ita and continue through Panama on their journey to Mexico. (Photo by Haillie Parker\/Cronkite Borderlands Project)<\/p>\n<\/div>\n

The virus presents yet another roadblock for expectant migrants. In Panama, one of about 30 countries honoring birthright citizenship, pregnant migrants can have their newborn child naturalized as a Panamanian citizen and apply for visas created for migrant parents \u2013 although few choose this course. With most migrants equating a life in Panama to a life lived in villages like Bajo Chiquito or La Pe\u00f1ita, staying is not an option.<\/p>\n

From La Pe\u00f1ita, Casimie continued north on her dream to one day reunite with her sister in a place they both can be safe, but for fellow Haitians Janvier and Dieumes, the immediate future was still unclear.<\/p>\n

Away from the chaos of Bajo Chiquito, hydrated and looked after for the first time in weeks, Janvier and her husband considered other options within the quiet walls of the women\u2019s clinic in Metet\u00ed.<\/p>\n

\u201cIf we can live and work legally,\u201d Dieumes said, \u201cmaybe we\u2019ll stay.\u201d<\/p>\n

Cronkite Borderlands Project is a multimedia reporting program in which students cover human rights, immigration and border issues in the U.S. and abroad in both English and Spanish.<\/em><\/p>\n

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    Billowing dust trailed the van as it barreled down a dirt road. 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