Community Health
Program - Haiti
Program changes in 2008
Since 1994, AFSC has been providing health and reproductive services in rural Grand’ Anse, Haiti. During this time, the level and scope of services has grown, and the program is an established and valuable community resource, staffed entirely by Haitians and supported by AFSC. The next major goal for the program is that it be independent of AFSC, thus strengthening of Haitian civil society as well as the Haitian health infrastructure. During this process, known as “devolvement” or “localization”, AFSC will continue to provide significant administrative and financial support. Devolvement is consistent with the belief that the most valuable and sustainable support AFSC can provide is to help communities develop their own systems of self reliance and sustainability. A large public meeting and ceremony took place in the Clinic on December 14, 2007 to mark the transfer of responsibility to a new organization, the Association for Health and Community Development (ASADEK). ASADEK intends not just to continue and expand the program, but to work towards having the health center Lespwa grow into a full-fledged regional hospital and public health institution. The descriptioin below gives more information on the program up to the end of 2007.
Background on health program to 2007
The
health component of the AFSC Haiti program operates on
the premise that improving the physical health of the people
is crucial to improving their economic, social, and political
conditions and that, conversely, improving these conditions
is essential to improving their physical health. The community
health program aims to prepare health committees, mothers’ clubs,
youth clubs, volunteer collaborators, and traditional midwives
to manage the health problems of their community by intensifying
their training in preventive and curative care.
The program first began
with the understanding that there was a severe shortage
of trained health professionals in the area and that the health program could
only be successful if it group of nurses received a great deal of community
involvement. Based on this understanding, the program was centered on
local health committees; from each committee, one or two
members would receive training as a community health worker
(agent de santé). The agents de santé give vaccines,
monitor children for malnutrition, and conduct seminars on issues of public
and preventive health, such as prenatal care, good nutrition, and oral rehydration.
In response to the overwhelming
demand for adequate health services in the region, AFSC
built its own health center in Irois in 1997. The Center
meets the basic needs of the curative program and has space
for meetings on health promotion and disease prevention.
The staff at the Center consists of nurses, a laboratory
technician, nurse auxiliaries, a pharmacy aide, an archivist,
and the agents de santé. AFSC has expanded the health
work into Anse d’Hainault where health committees
have been formed to work on local projects.
The
most common health problems seen in the area are malnutrition,
malaria, diarrhea, intestinal parasites, scabies, arthritis,
and gastro-intestinal ulcers. Tuberculosis and typhoid
fever are two of the severe illnesses seen and AIDS is
a growing problem. AIDS, sexually transmitted infections,
tuberculosis, and malaria are currently the biggest health
concerns in the target communities and the work against
them is being reinforced. Other priorities for the health
committees include the elimination of childhood malnutrition
and an improvement in the local water supplies leading
to a reduction in the incidence and prevalence of diseases
caused by contaminated water.
An estimated 10% of
children under five years old seen in the program are
in a moderate or severe state of malnutrition. Currently,
parents are supplied with a porridge made of rice, corn,
beans, and milk to be given to the children to address
their protein and calorie shortage. Parents also receive
educational information on child nutrition.
The water supply in
all but one locality in Irois is in bad condition. The
bad water is the cause of many
of the diseases and childhood deaths from diarrhea. Almost
everyone in the area carries intestinal parasites. People
use springs that are not protected, where they and others
stand in and in which or near which animals often defecate.
Further, there are few latrines in the area, meaning
that human feces often remain on the surface and also
drain into the water supply. The community, with assistance
from AFSC, has protected some water springs and provided
them with faucets, although many more still need attention.
Another short term
priority of the health program is the improvement of
reproductive services through two major components—the
availability of high quality contraceptive options and
childbirth services. Most childbirth services continue
to be provided in unsanitary conditions due to the limited
training and physical resources available to the midwives.
In Irois, several cases of neonatal tetanus are still
seen per year. The condition, from which the infant almost
always dies, can be prevented by either immunization
of the mother or by proper delivery techniques. Thus,
it is important that the midwives are trained and are
provided with simple safe delivery kits. The program
has also made advances in women’s health with its
pre and postnatal clinics, tetanus vaccinations for women
who are of childbearing age, distribution of iron pills
to anemic pregnant women, family planning, and deliveries
at home or at the clinic.
Information, education,
and communication (IEC) activities are another important
part of the program. Past workshops have included discussions
on tuberculosis and sexually transmitted infections and
AIDS. This is an especially important area of work because
of the high frequency of these illnesses. IEC also focus
on topics such as the care of children, reproductive
health, personal hygiene, environmental clean-up, and
infectious diseases.
In the 2002 fiscal year, five mobile clinics traveled to
the areas in the region with the most difficult access to
health care: Dady, Malette, Galette St. Aubin, and Galette
6. In the mobile clinics, the field staff of Irois and the
medical staff conducted pre and postnatal consultations
and vaccinated pregnant women and children aged five and
under. Four rooms for tuberculosis patients, which were
completed in 2003, have allowed AFSC staff to offer more
help to the population suffering from TB.
AIDS
in the Communities of Irois and Anse d’Hainault
The first cases of
AIDS in Haiti were detected in 1978-1979,
which is consistent with the hypothesis
that AIDS originated in Africa, spread
to Europe and the US, and came to Haiti
either by tourists or returning Haitians.
While the disease emerged in urban regions,
statistics over the past ten years have
shown an increase of the disease in rural
areas as well.
AIDS in
Haiti:
- 2001 population of Haiti: 7,063,722
- Adult prevalence rate of HIV/AIDS: 5.17%
- People living with HIV/AIDS: 250,000 (2001 est.)
- HIV/AIDS deaths: 30,000 in 2001
- Children under 15 who have lost one or both parents to AIDS: 200,000
(2001 est.)
(Source: UNAIDS/WHO
Epidemiological Fact Sheet on Haiti:
2002 Update)
The situation
is no different in the communities
of Irois and Anse d’Hainault,
where communication is difficult and
85% of the population is illiterate.
Despite the efforts of AFSC-Haiti,
ignorance, taboos, and a lack of information
increase the incidence of the illness
in this impoverished region of the
country. An estimated 10% of the children
in the region are AIDS orphans. There
continues to be a great need for rapid
tests, counseling, and medication.
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