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.''
