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An Innovative & Effective Model:
Sante Nan Lakou

We focus our disease prevention and health outreach efforts at the level of the lakou, where we can make the most impact and reach those who would otherwise never receive medical care. 

H.O.P.E and A.S.B Hospital have worked together to develop a novel multi-pronged, four-tiered public health model referred to as Sante nan Lakou—“health in the lakou.”  Lakous are the basic social structure in rural Haiti, comprising an aggregation of family members who live together—typically in multiple dwellings—and share responsibility for child rearing, providing food, and familial tasks.  Women and girls are central to the functioning of the lakou and, likewise, are central to our holistic health intervention programs, as is our team of trained community health agents, lab techs, nurses, and doctors. 

Community surveillance and health screening at the lakou level allows us to provide a holistic approach to health, beginning at the grass-roots level and flowing up to Alyans Sante Borgne Hospital.  This four-tier model is our innovation, and it gets proven results.

We wish it were simple to explain what we do!  The truth is, we do a lot, and we do it all “in community” with the residents of beautiful, rural Borgne--a commune in northern Haiti that stretches from the beaches of Fond La Grange to the mountainous communities in Milot. 

A Holistic Community Health Model

TIER FOUR

In The Lakou

TIER THREE

Mobile Health Clinics

TIER TWO

TiBouk Clinic

TIER ONE

Alyans Sante Borgne Hospital

TIER FOUR: In the Lakou

 

Principle: 

Build on existing community networks and social institutions to extend the reach of medical treatment and preventative services for people in rural northern Haiti.

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Community Health Agents Assigned to Specific Habitasyons and Sections:


We employ community health agents who are embedded in specific villages and deeply familiar with the lakou in their area, and are trained to assess basic health problems, such as preeclampsia in pregnant women and early signs of malnutrition in infants and children, and then refer them for clinical follow-up. Community health nurses, who are more skilled at patient assessment and health education, support the community health agents. The community health agents help promote upcoming mobile clinics scheduled for the area. They also promote participation in mothers clubs and other peer support groups we have established. Pregnant mothers, mothers with infants and small children, and the elderly are encouraged to attend one of our mobile clinics, or referred to either the hospital in Borgne, or the clinic in Petit Borgne. Community health agents are responsible for a specific geographic area, and serve as the front-line of our lakou- level surveillance and screening efforts.




S.E.E Team (Sante (Health) , Edukasyon (Education), Ekonomi (Economy) Team):


To address the environmental and behavioral factors influencing public health, we have created a health outreach team focused on community education. This team is comprised of 3-4 individuals trained in the prevention of malaria, cholera, parasitic infection, and typhoid as well as basic nutrition interventions and methods for assessing community health. This team works across the commune to synthesize commune-wide surveillance data provided by the community health agents and nurses. Together with the health agents, the S.E.E team supports our peer health support groups and provides epidemiologic data and surveillance information to the medical staff. Our medical team is then better able to target interventions and treatment programs and schedule focused mobile clinics in areas where certain diseases or conditions are most prevalent.




Peer Health Support Groups:


Peer support groups such as mothers clubs and girls clubs are a critical aspect of our program. We have established mothers clubs in each of the rural sections of the commune. The clubs provide peer support networks both pre- and post- partum. Our network of mothers clubs has had peak participation of over 460 women across the seven sections. Community health agents and community health nurses support the mothers clubs.





Programs: 

 

TIER THREE: Mobile Health Clinics

 

Principle: 

Mobilize services and resources to better connect with, and truly understand, the community in the socio-economic context in which people live.

Mobile Clinics and Hospital Referrals:


H.O.P.E. began supporting mobile hospitals and clinics in 2006 as it was apparent that the new hospital alliance we built would only ever reach about 15% of the people who need medical care in Borgne. We actively bring medical care into remote areas through mobile clinics and mobile hospitals. Mobile clinics are day-long clinics, involving 2-3 doctors and multiple nurses, technicians, and volunteers, which typically serve 200-400 people. The clinics include community health education programs focused on diseases that are common in the particular area hosting the clinic. All clinics include HIV/AIDS and STD screenings. Some clinics target pregnant women and well-child visits. We have also conducted specialized mobile clinics for cervical cancer screenings. The clinics have significant impacts on community health. Mobile hospitals are multi-day clinical encampments taken to the most remote areas of the commune. Mobile hospitals allow us to serve and treat those who might not ever come to a hospital for treatment. Other groups working in the Caribbean have replicated our mobile clinic model. Working at the level of the lakou, and collecting health surveillance data at this level, allows us to construct a picture of community health from the ground up. It affords us the opportunity to observe and document behaviors that contribute to disease within families and across communities. Our approach has led to early interventions in thousands of potential high-risk pregnancies; enabled a rapid and highly effective response to cholera; and is credited with successfully reducing HIV/AIDS infection rates and STD infection rates across the commune. This is one of the most expensive and most beneficial elements of our holistic health program. Funding more mobile clinics, which cost about $3,000 each, is our number one funding priority as they reduce suffering as well as slowly, methodically improve general health levels in Borgne.




Mobile Health Screenings:


Mobile health screenings (cervical cancer screening using VIA, anemia screening, well-child and maternal clinics, HIV/AIDS and STD testing, etc.) help us to further target treatment programs.





Programs: 

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TIER TWO: TiBouk Clinic

 

Principle: 

Counter the highly centralized nature of Haitian structures.

Program: 

About 10 years into our partnership with the Haitian government, we independently rebuilt a health clinic in the market town of TiBouk, the second largest population center in Borgne.  This secondary level provides the only medical care in the mountainous rural areas of the commune and offers families who live too far from the village of Borgne access to testing, treatment, and vaccines as well as maternal care and nutrition. This clinic serves as a literal and symbolic bridge from the farthest corners of this mountainous commune to the administrative center in the town of Borgne, --which is at sea level and near to paved roads that lead to Cap-Haitien.

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TIER ONE: Alyans Sante Borgne Hospital 

 

Principle: 

Promote a holistic vision of community health by integrating the physical, environmental, social, cultural, psychological, and economic dimensions of community well-being.

Program: 

A.S.B., or the Health Alliance of Borgne Hospital, is a high-capacity, expertly staffed hospital just outside the town of Borgne that H.O.P.E. has built and assumes high levels of responsibility for funding-- in partnership with the Haitian government. The hospital provides basic services, such as an in-patient facility, internal medicine, women's health, maternity, delivery, and prenatal and postnatal services, as well as a dental clinic, TB and HIV/AIDS programs, a lab, and pharmacy. This hospital moves nimbly to respond and provide large-scale interventions from a cholera outbreak in 2012 or a global pandemic in 2021. The medical team who runs this hospital sees over 20,000 patients a year and we estimate that this addresses only about 15% of the medical needs in the commune of Borgne, even as it is the only no-cost health care system in northern Haiti.

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Progress In The Last 12 Months:


  • 80,000 residents in Borgne
  • 51 staff at Alyans Sante Borgne, including 23 Ajan Sante (health agents) and 11 anamatris (gender-equity trainers)
  • 52 beds available to patients
  • 21,734 patients seen
  • 1,162 new pregnant women visited Alyans Sante Borgne for maternal care
  • 285 live births including 1 set of triplets
  • 689 H.I.V tests administered
  • 48 new incidences of H.I.V. treated with counseling and ARVs
  • 112 new incidences and treatment for Syphilis
  • 725 treated for acute respiratory infections
  • 811 treated for arterial hypertension
  • 692 treated for Typhoid cases treated
  • 725 treated for intestinal parasitosis treated
  • 1,152 treated for Gastritis
  • 3,017 patients treated for scabies
  • $70,000 raised for COVID-19 relief efforts including training, education, PPE, quarantine space, and vaccination-in-the-street program
  • 1,720 COVID-19 vaccines administered
  • 15 patients treated at Alyans Sante Borge for severe COVID-19
  • 0 deaths owing to COVID-19





 
 
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