promises are yes: Community Health Evangelism in Haiti

Report prepared by Osse St Juste, Coordinator of Medical Ambassadors Haiti

Community Health Evangelism (CHE) first started in Haiti in 1993 in the area of Labruyere, in the north of the country. A team was trained at a Training of Trainers 1 (TOT1) in the Dominican Republic and started implementing the CHE principles in the following villages in the North province (“Nord” in French – see map): Milot, Grand Ravine, Labruyere, and Bayeux. Out of those four communities, CHE really got started in Labruyere and a little bit in Bayeux. Through contacts that were made, CHE began to be implemented in trainers' hometowns of Monben Kwochi (in the Northeast province, or Nord-Est), Lenbe, and the area of Lakil (both in North). There are several ways that the program can expand: through churches, partner organizations, clinics, or other local organizations. There are some programs in Haiti that receive direct support from Medical Ambassadors International (the original organization which started CHE in so many countries). There are other international organizations and churches that ask the local team, Ambassadeurs Medicaux d'Haiti (AMDH, or Medical Ambassadors Haiti) to accompany them.

As of today there are around 80 communities in Haiti that use the CHE tools. About 35 of those programs are overseen by different partner organizations. Of the over 40 CHE programs overseen directly by AMDH there are a total of 72 trainers, 350 committee members, and 1152 community health evangelists (CHEs, the house-to-house volunteers). There are even more communities that are hoping to start the first training, a TOT1. The CHE communities have gone through several stages: the awareness seminar, committee training, training of the CHEs, then often Women's Cycle of Life and Children's CHE. The majority of the CHE communities in Haiti have already reached the stage of doing home visits. As we begin seeing CHEs start to visit homes and small local projects planned and executed, we start to see changes in communities. We often have a party to celebrate the beginning of home visits, and everyone who went through the training gets a certificate. We call this the “Change Party.” We perform evaluations to verify that people have retained what they learned. The trainers also evaluate the homes that are visited.

Different missions and organizations plan and partner with AMDH when they see that we have common goals. AMDH then accompanies these organizations as they organize and plan trainings. We do a vision seminar for the communities involved and then offer a series of trainings: of these trainings, TOTs 1 and 2 are critical. A TOT 3 is done if there are several active CHE programs that are working well and expanding. Together with our partners we have CHE programs now in multiple provinces (“departments” in Kreyol): North, Northeast, Artibonite, Central Plateau, and now some new programs starting in the West province. In the southern part of the country (in the West province in particular) the programs are led by church and mission organizations. (Click here for a map of Haiti showing the provinces.)

We see success in the physical and spiritual realms with this program because the training is holistic and participatory. In each meeting the trainers teach a physical and a spiritual subject. Behavioral changes and belief changes are seen in people who are in the program. People's mentality starts to change – they think more about sustainable development and they want to participate in it (as opposed to waiting for handouts).

Activities Accomplished
After the trainers complete a TOT 1 they share the CHE vision in their communities, typically through awareness seminars. The community members elect a committee which is then receives 18 training sessions. Once the committee is trained they select between 25 and 50 CHEs, who will be trained in different lesson modules such as: basic lessions, sanitation and hygiene, agriculture, health, etc. The CHEs then visit 6 to 10 families regularly, once per week. Water sources are improved, water is treated so that it is potable, they organize seedling gardens and plant trees (for reforestation), start vegetable gardens, raise chickens and rabbits, dig fish ponds. They also do evangelism and have small group Bible studies. The entire process is facilitated by a group of master trainers who are responsible to supervise two or three CHE programs, as well as a team of two to four local trainers who volunteer in their community, training the committee and the CHEs.

What are some reasons why are there challenges implementing CHE?

The trainers weren't well chosen.
No local community leaders open doors or integrate into the process.
The community is very used to receiving relief work.
People are not motivated to work voluntarily toward holistic development.
They want to start with projects rather than receiving training.
They think more about the way to resolve problems rather than thinking about the resources they have that can help them advance.
Non-governmental organizations with a lot of money give gifts and do relief work in the community.
Natural disasters or political crisis.

Needs

Reinforce the capacity of the trainers, committee, and CHEs in order to have both quantity and quality of programs.
Ensure that there are models for people to grow under, particularly spiritually.
Increase the spiritual training that is done in the home visits, in order to truly see a holistic change.

Practical Advice

The vision seminar should be done with the principle leaders of the mission or organization – the decision makers must be there.
The choice of the trainers who are invited to the TOT 1 is critical. They must:
Have a good witness in the community.
Live in the community or live no further than 45 minutes away.
They must be able to read and write.
Have the ability to share what they learn.
Available to volunteer around four hours of time per week.
Start to put into practice what they learn and model what they teach.
Christians who are faithful.
Interested in both the physical and spiritual aspects of people.
Participate and accompany the community members in their activities.