Few countries in the world have been as devastated by AIDS as Haiti. The Caribbean nation is the poorest country in the western hemisphere and suffers from the highest rate of AIDS infection in the region. For years Haitians suffered and died from AIDS in poverty and isolation. However, an innovative program started a few years ago has begun to reverse that trend, surprising health experts around the world. VOA's Jim Teeple recently traveled to a small town in rural Haiti where there is now hope for those suffering from AIDS.
The crowd forms early at the Medishare dispensary and clinic in Thomonde, a town of about 30,000 people in Haiti's central plateau. Until just over two years ago there was no clinic and little hope for the sick in Thomonde, a market town about 100 kilometers north of Port-au-Prince. Now, however there is hope for the sick in Thomonde, and especially for those suffering from HIV and AIDS.
Two years ago, an experimental program to administer anti-retroviral drugs to AIDS patients was begun in Thomonde. About 150 residents of Thomonde now receive anti-retroviral drugs to treat AIDS. Dr. Patrick Almozar, a young doctor at the Medishare clinic, says to make sure his patients take their drugs the clinic relies on workers known as accompagnateurs.
"So in Thomonde we have someone called an accompagnateur. The accompagnateur is someone who has to give the medication one or two times a day," he explained. "So when they [patients] have a problem with complications, the accompagnateur accompanies the patient to us, and we see if we have to change the medication or stop it. So most of the time we do not have a lot of problems with complications."
Dr. Almozar and his colleagues in Thomonde are on the front lines of a medical revolution. They are pioneering new ways to treat some of the estimated 40 million people around the world, most of them poor, who are infected with HIV, the virus that causes AIDS. Roughly 22 million people have died from AIDS, but few countries have suffered more than Haiti where an estimated 30,000 people die from the disease every year.
Beginning in 1998, Harvard University Medical School Professor Dr. Paul Farmer began administering anti-retroviral drugs to Haitian peasants at his clinic in Cange, about 20 kilometers from Thomonde. Dr. Farmer who runs the organization "Partners in Health" was defying conventional wisdom, which held that anti-retroviral drugs that control HIV and AIDS were too expensive and too complicated to administer to rural poor people who live in countries like Haiti.
The antiretroviral drugs have had a dramatic effect on the lives of those suffering from AIDS.
Just over one year ago Jeanette, a mother of five, had seen her life destroyed by AIDS. She and her husband, both suffering from AIDS had lost their life savings as they sought cures from a local Hougon, or voodoo priest. Jeanette's husband, who had refused to accept medical treatment, died from AIDS. Pregnant and desperate, Jeanette went to the Medishare clinic in Thomonde where Dr. Almozar quickly put her on anti-retroviral therapy.
Now, one year after she began taking antiretroviral drugs Jeanette says her biggest problem is gaining weight. She has a new job working at the Thomonde clinic helping others like herself. Jeanette, who asked that her last name not be broadcast, says taking the drugs is not always easy, and the person who keeps her alive is her accompagnateur, who is always there to make sure she takes her medication.
"Sometimes I may feel very depressed. Other patients feel very depressed taking the medication, and when you have the accompagnateur it gives you encouragement," she said. "We need to take the medication twice a day, and sometimes we may be negligent, we may fail to take the medicine. When we have the acompagnateur, it gives us the strength and the encouragement to continue with the regimen."
When Jeanette started taking antiretroviral drugs, Dr. Almozar gave her a list of accompagnateurs in the Thomonde area. Seeing the name of her old friend Ermancie Desernes on the list, Jeanette chose her friend as her accompagnateur. Ermancie Desernes, who works with several other AIDS patients, says the key to being a good accompagnateur is discretion.
"I go to their houses, we sit around, and we joke around, even if there are a hundred people sitting around, I do not expressly tell everybody what I am there for," she explained. "I will pick a moment in time where I will discreetly go to the side and administer the medication and then be on my way."
Ermancie Desernes says sometimes her patients are distraught over the social stigma associated with AIDS. She tells them to ignore their neighbors and focus on taking their medication and getting on with their lives. She also says she can usually spot people in the community who might need her help.
"I cannot just see somebody and say right away that they have the disease. But, if I suspect somebody has the disease, I just try and encourage them to go the clinic and see the doctor," she added.
Ermancie Desernes says she has referred a number of people to the Thomonde clinic who are now receiving anti-retroviral drugs like her friend Jeanette. She says she does not mind the long days, which often begin before dawn and end late at night. Accompagnateurs receive three weeks of training and are paid about $40 a month. They often deliver their drugs on horseback or walk several hours to remote areas around Thomonde.
For patients like Jeanette, the drugs have meant the difference between life and death. But Jeannette says the drugs not only saved her life, but also the life of the child she was carrying when she discovered she had AIDS. Because she began her antiretroviral treatment while she was pregnant, her infant has so far shown no sign of HIV infection.