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Pwoje Espwa ClinicPublic_Health.html

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From May 2008-February 2010, I’ve worked as the public health director for an organization called Pwoje Espwa. Espwa, as it’s better known, is located just outside of Les Cayes, Haiti in the southwestern region of the country. Home to over 600 children and teenagers who are either orphaned or from families that can no longer take care of them, the 130 acre campus has a primary and secondary school, nearly 40 houses, a clinic, a library, arts and crafts room, carpenter shop, mechanic shop, tailors and the list goes on. 1,200 children benefit from the free education at Espwa and thousands of mouths are fed every day.

I came to Espwa for one reason, to improve the quality of life for the 1,400 plus children and adults who benefit from Espwa every day, whether they live here, work here, eat here or just come for school. It wasn’t always easy…actually, it was never easy.

I came with a plan and a large award from Brown University, to develop and implement an effective and sustainable malaria and tuberculosis prevention program that could be used as a model system for TB & Malaria control throughout Haiti, where the diseases are endemic, and that would be applicable to both children and adults. I realized my second day here that I needed help. This was the beginning of what has now become Espwa’s public health department. 

I needed helpers, responsible, dedicated, diligent young adults who would work for free. Using several medical texts and drawing largely on the expertise of the Hesperian Foundation and their books “Where There Is No Doctor” and “Helping Health Care Workers Learn,” I designed a 3-month public health training course that would cover everything from how to treat and prevent malaria, to how to wash your hands, to how to brush your teeth, to what foods are good for your health, to how to take care of a sick person. I graduated my first group of 5 public health workers and before I knew it, we had taken off like bullets. We started our TB testing, treatment and prevention program and have 122 children on treatment. We sprayed the children’s homes for bugs and eliminated the bed bug infestation. We put up screens on all the windows and surrounded the houses with rock buffers to keep away the mosquitoes and have seen incredible drops in malaria incidence on campus. We’ve increased the vitamin intake of the children by adding fruit and veggies to their diets and providing multivitamins. We hold monthly home inspections and bed inspections, weekly kitchen inspections and daily bathroom inspections for increased hygiene and sanitation. The water sources which were once full of dangerous bacteria are now safe to drink thanks to our weekly testing and treatment program. The children receive a continual deworming treatment and are healthier than they’ve ever been.

It was common knowledge in the villages that education regarding one’s health is necessary for survival but even today, the majority of Haitians receive no formal education, and only a small minority are educated beyond primary school. In Haiti, private schools are the only schools and very few families can afford even the most modest tuition.

According to the US Agency for International Development, of Haiti's 9.4 million inhabitants, the literacy rate of 70.9% is the lowest in the region. Haiti counts 15,200 primary schools, of which 90% are non-public and managed by the communities, religious organizations or NGOs. The enrollment rate for primary school is 67% in the cities and as low as 19% in rural parts of the country, and fewer than 30%  country-wide reach 6th grade. Secondary schools enroll 20% of eligible-age children. Free public education is something most of us take for granted.

Vaccine Fridge

Examination Room

Examination Chairs

Pwoje Espwa Clinic workers and volunteers

Supply Storage/Pharmacy

The Pwoje Espwa Clinic

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