Although Haïti has four major cities and many large towns, the majority of the population lives in small villages and mountain hamlets, even in clusters of isolated communes far out of sight and accessible uniquely via footpaths. When NOVA and Church of the Presentation conduct bi-annual one-week clinics, patients from these communities are the last to arrive for care and usually on the day the clinic is being closed down when medicines have either become scarce or have run out entirely. These sick stragglers are the ones with the least amount of education and severest amount of disease. They are the ones who should be seen first and have the opportunity for follow-up evaluation. They usually have never, ever once seen a nurse, physician or health care worker. They are treated by the local witch doctor or “medecin feuille” (literally translated leaf doctor) who apply the handed-down knowledge of homeopathic medicinals.
NOVA is initiating a twelve-month Agent Santé training program to address this dilemma. This program is nothing original, it is a model that has been handed down by the Chinese and is effectively utilized in many emerging countries in both hemispheres. Basically, young potential talent is recruited for health education from isolated local communities and trained to be the local health care provider. To insure local buy-in, community leaders are solicited to propose the names of the potential candidates. Screening interviews are held jointly with local town leaders and a written examination is requested to confirm literacy. One candidate is eventually selected for the formal government-organized and delivered one-year training program that consists of twelve one-month educational modules. Content involves both classroom and supervised fieldwork. Five-year work contracts are firmed up prior to training during which a stipend is paid to the student. Upon graduation, the Agent Santé becomes the employee of NOVA and functions as the first line of treatment for members of his/her own extended community for people who otherwise would have no medical care.
The Agent Santé is responsible for census taking, verification of vaccination status, making simple diagnoses, distribution of medicines and direct observation treatment (confirming compliance in taking medicines). If complexity of a given disease is beyond their scope of comprehension, Agent Santés are responsible for bringing the patient to the NOVA clinic for more advanced diagnostics and the care of a physician. Agent Santé continued medical education will be held monthly at the NOVA clinic in Martineau and provisions of renewed medications and supplies will be distributed to them for use during the subsequent month.
NOVA Hope for Haïti is initiating the Agent Santé program in two chosen isolated mountain communities that have been targeted on past field trips. A new national government took over Haïti in May 2011 but was not functional until December.
When the newly appointed minister of health becomes operational, NOVA will seek approval for its first Agent Santé training program at two sites and begin this operation in late 2013.