16773: (Hermantin) Miami-Herald-Boston Globe-Haiti Villagers get medical training (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: leonie hermantin <lhermantin@hotmail.com>

HAITI
Villagers get medical training
A Boston-based nonprofit is on a mission: making sure people in remote areas
with no doctors can fill the gap.
BY RAJA MISHRA
The Boston Globe

CANGE, Haiti - In the stifling dark, they rushed Elmanie Joseph from room to
room, poking and prodding her, and finally left her in a frosty suite with
glaring white lights.

She prayed: ``If God gives me life, I'll take it. And if He gives me death,
I'll take it, too.''

The doctor had told her: We must cut out your baby now. In all the
commotion, he'd mentioned words like post-term pregnancy, vaginal bleeding,
cesarean section. But the shy, girlish 25-year-old from a remote village in
the poorest region of this dirt-poor country did not understand. She had no
clue her baby could not fit through her narrow, malnourished hips. That they
both might die without surgery.

Had it not been for a simple suggestion from a specially trained fellow
villager -- go see the doctor -- she might now be lying in the dark of her
ramshackle home, on the verge of hemorrhaging. Her father had helped her
make the seven-hour trek to the clinic, where doctors raced to save her life
-- and her baby's.

CLASSES IN SESSION

In hundreds of villages like Elmanie Joseph's, community health workers
armed with the most rudimentary medical training teach neighbors how to stay
healthy -- and help get them to clinics if they need a doctor. The community
health agents have been trained by Partners in Health, a Boston-based
nonprofit that runs the clinic in Cange.

In a sweltering classroom on the clinic grounds, nearly 50 Haitians --
mostly older, mostly female -- listened one recent day to nurse Cynthia
Orlus, who held up a cartoonish drawing of a man's chest.

''With tuberculosis, you need to remember that every organ in your body can
get infected,'' she said.

Some students nodded. Others stared blankly. One patted the stray tan
mongrel wandering between the desks.

A man raised his hand.

''I have a family in which many people are coughing,'' he said. ``Should I
bring them for screening? How do I know if they have tuberculosis?''

''For tuberculosis, there are many signs and symptoms and treatments,''
replied Orlus, jotting a list of terms on the blackboard. ``Now we're going
to study the signs.''

These villagers from around the Central Plateau are training as ajans sante,
or community health agents, skilled enough to give basic advice and
recognize when something is seriously wrong.

''The program is absolutely vital for treating treatable diseases in the
Third World,'' said Partners in Health executive director Ophelia Dahl in
Boston. ``This is the model for the Third World.''

Partners in Health started the program in 1987, and since then has trained
more than 600 villagers. The trainees must be literate and trusted by local
villagers; often, they are elders or those with leadership positions in
their towns. The Haitian government supports the effort but gives no
financial assistance.

The villagers initially spend three months learning the basics of health
care at a training center near Port-au-Prince. Partners in Health pays for
the classes, room and board. Back in their villages, they earn $100 monthly
salaries and go to the Cange clinic monthly for a day of further training.

THE MEANS TO SERVE

The health workers are given a kit with equipment like thermometers, blood
pressure gauges, painkillers and antimalarial pills. Some receive training
that focuses on women's health issues, including prenatal care, family
planning and pregnancy complications. Others focus on delivering HIV and
tuberculosis medications to patients -- sometimes the same type of expensive
drug regimes administered in wealthy nations -- making sure patients
maintain a strict pill-taking schedule.

They are all trained in nutrition, hygiene and prevention of infections. And
they learn the warning signs of serious illnesses, when a villager needs a
doctor. In essence, these community health agents fill part of the role
played by primary-care doctors in the United States. Haiti has a severe
doctor shortage, and they will help fill the gap.

LIFE AND DEATH

In the training classes, the students are taught to check pregnant women for
bleeding, pelvic pain, and other indicators of trouble, and to send those
with problems to one of the five clinics in the Central Plateau. For
pregnant women, getting this sort of basic guidance can make the difference
between life and death, for the mother and the fetus, according to numerous
studies.

It did for Elmanie.

Back at the Cange clinic, Elmanie lay on her side, her skinny legs a
silhouette beneath a thin white sheet. From time to time, she glanced at her
boy and smiled. And she gave him a name: Samuel.

''I see my baby, and I'm happy,'' she said. ``I like him so much. He is my
life.''

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