Last August, Garry Pierre-Pierre spent three weeks in Haiti chronicling the services and impact health clinics had in the communities they served. The International Planned Parenthood Federation had approached Pierre-Pierre with the idea to do a series on their work in Haiti. He found this opportunity exciting and interesting given that few journalists have reported on this issue.
Part 2 in this 5-part series, focuses on Profamil’s health promoters, who work in sometimes dangerous situations to provide health information to numerous neighborhoods in Haiti.
PORT-AU-PRINCE, Haiti — Like a soldier en route to the battlefield, Josue Brunard stuffed his backpack with ammunition for his mission. But instead of guns and bullets, his armament consisted of condoms and other contraceptives. Brunard’s fight is to save lives, and lower the rate of sexually transmitted diseases in Haiti.
On a recent outing, Brunard and a few of his colleagues at Profamil hopped on the back of an early model white Toyota Land Rover as they set out to address a community group. After a 45-minute drive navigating rocky and dusty terrain, the staff disembarked and set up for their presentation at Ti Marche, a hamlet outside Croix des Bouquets.
They set a small table under a large shaded tree, and slowly, the women and a few men began assembling. In less than 10 minutes more than 60 people had gathered to listen to the presentation. Brunard began his demonstration by talking about the various birth control methods. He went through the options and methodically explained the pills, condoms, depo-provera shots, vasectomy, diaphragm and tubal ligation options.
For most of the women and men who had finished absorbing this information, it was the first time they had heard a thorough explanation of birth control and their effects. Questions were lobbed at the crew like missiles.
“How effective and reliable [are these] birth control methods?” one woman asked.
“Can a man take the pill?” a male participant asked sheepishly.
“Can I take multiple birth control methods?” another woman asked.
Yanick Morose, an RN at Profamil, stepped up to answer all of the questions. She put special emphasis on the one about the pill.
“No, a man can’t take the pill. It’s not made for him. The pill affects the ovary and a man doesn’t have an ovary. The man can wear the condom or he can have a vasectomy. But he has to be sure that he’s done having children because it’s permanent and difficult to undo.”
The staff of four had planned to stay for about 30 minutes. But the crowd was particularly engaged and the session lasted more than an hour. Besides the obvious medical questions, Nurse Morose received queries about myths people had heard about family planning. For instance, some people had heard that planning caused cancer. Others were told that the body’s metabolism changed for the worst and that one could get sick constantly.
“This is important for us to know,” Fernande Silien said. Silien is a mother of two who signed up for a visit after listening to the presentation. “It empowers the women so that we have time to work and not spend our entire time raising children.”
Dr. Ernest Desir, the director of Profamil’s Jacmel’s clinic, said that while family planning is at the heart of Profamil’s mission, the organization has to be much more than that. Population growth and Haiti’s declining agriculture production have created a complex set of problems that spills beyond health care.
“It’s a vicious cycle,” Dr. Desir said. “The poorer they are, the more children the women have. The old adage that children are poor people’s wealth doesn’t apply anymore.”
Profamil deploys a staff of 30 peer counselors and health promoters in its effort to inform each neighborhood of sexual reproductive and family planning. The number of the promoters doing this job is miniscule in order to educate a population where too many people lack formal education. The outreach in sexual education is not limited to adult women. At Profamil, the youth — particularly young girls — are a top priority. At each clinic, there is a group of girls from 9 to 19 years old who attend weekly meetings. The conversations range from sexual education to financial education and the benefits of doing well in school.
Wendy Jasmin is the leader of The Friendly Youth Club of Jacmel. At 20 years old, she has developed her political identity, a better appreciation for her country and sexual maturity, through her interactions at the club. Her mother worked two jobs to make ends meet. Her father died five years ago.
The younger girls learn the dangers of being sexually active at a young age and the importance of doing well in school from the youth club.
“It’s a center of information,” Jasmin explained. “We learn among ourselves. We’re not here to waste our time. It helps us bring changes in ourselves. It’s psychologically healing. We’re able to touch our inner selves.”
But the job of community health promoter can be complex and at times dangerous. The task requires a certain level of dexterity in human interaction. You have to deal with a farmer, a teacher and a street vendor, said health promoters interviewed for this article.
“You have to know how to approach people,” Brunard said. “If you approach them the wrong way, they refuse to open the door.” Brunard is a university student who began as a member of a youth group and eventually became a health promoter. “That’s the key to our mission. No matter how important our message is, if we can’t get to people, then we’re not effective.”
At times, the promoters have witnessed police raids while they conducted workshops, and some of them have been assaulted at gunpoint by bandits roaming the tents. Thugs have stolen their cell phones, jewelry and purses.
“It can be dangerous, but that’s part of the job,” Brunard said. “You learn where to go and not to go. That’s the trick.”
In addition, many of the promoters say that they lack basic items like enough bright color T-shirts to wear on their outings. They say that for instance, it would be helpful to have at least watched some of the procedures they are describing to people so they can speak more authoritatively. In many occasions, there are no nurses with them in the field.
Dr. Gardner Michaud, profamil’s executive director, is all too familiar with the challenges facing his staff of health promoters. He knows that a large media campaign can significantly amplify their message by galvanizing residents on the issue of family planning and reproductive health.
“Too often too many people are hearing about family planning for the first time from us,” Dr. Michaud said, adding that a media campaign is out of their reach at this time. “That means we have to return to that same group many times before the message can resonate clearly with them. The population is large. It’s really a race against time.”
Garry Pierre-Pierre is the founder of Haitian Times. He is currently the executive director of the Center for Community and Ethnic Media at CUNY’s Graduate School of Journalism.