AMI in Haiti
Give a global, quality answer to hygienic, psychic and social needs of street children and adolescents in the city of Port-Au-Prince
Street children in Haiti are a big social issue. Indeed they are the first to suffer from the worsening national context [degradation of socioeconomic conditions, increasing pauperization of the country, continuous migrations to urban areas], 50% of them dying during the first four years of their life in the streets. That is the reason why AMI decided to start a program in 2004 to help the more fragile street children, giving access to a social contact based on mutual trust and recognition, and to primary health care for those who dare not ask for any help. AMI’s outreach policy [meeting directly children in the field without asking them to go to any given place] is unique in Haiti. Thus, 64.6% of AMI’s consultations were directly held in the streets of Port-au-Prince. AMI’s teams had to cope with the tension that was constantly plaguing the city of Port-au-Prince [demonstrations, insecurity, robberies, rapes, kidnappings, crimes, assassinations] before the presidential and parliamentary elections were held.
Parallel to the census of street children started in 2004, AMI’s mission in Haiti now focuses on four lines of activity:
Health care: giving street children and adolescents access to quality health care and adequate medical follow-up through the creation of a mobile medical clinic
Prevention: informing and raising awareness among street children about risk behavior and its consequences, particularly regarding the dangers of HIV/AIDS transmission, to which street children are much exposed [prevalence rate extremely high (5.9%) compared to the national average (3.4%)]
Two complementary lines of activity were set up in October 2005:
Risk behavior: dealing more specifically with conditions related to risk behavior, for instance in terms of reproductive health [family planning, contraception, mother and child health] and drug addiction, as well as encouraging HIV screening and treating infected children
Psychosocial assistance and education: striving for the reinsertion of street children and adolescents in Haitian society through psychosocial and educative activities [organizing focus groups, offering various art, sports or recreation activities]
2,550 consultations [among which 2,395 primary health care and 157 specialized health care consultations]
178 children treated for infections and sexually transmitted diseases
38 children taken in to hospital
555 awareness sessions on HIV/AIDS, i.e. 3,885 street children and adolescents involved, and 68,560 condoms distributed
15 peers trained by AMI then responsible for disseminating prevention messages to their peers in the street
2,160 awareness sessions carried out by peer educators
Development of partnerships [with hospitals, drop-in centers, screening centers, etc.] so as to create a multidisciplinary solidarity network for street children at risk and/or infected by HIV/AIDS
Project definition in Haiti
AMI has been working in Haiti since 1984. After various missions to train medical staff and support health structures, AMI started a street children program in 2004.
Population covered: 1,815 street children and adolescents aged from 0 to 25 years in Port-au-Prince
Direct beneficiaries: 1,450 street children and adolescents met by AMI’s
AMI’s team on the project
2 expatriates: head of mission, medical coordinator. 29 local staff: logistician, administrator, medical manager, social manager, line managers, social educators, nurses, etc
Sources of funds
Family Health International [USAID/FHI], United Nations Children’s Fund [UNICEF], Swiss Cooperation Agency [DDC], Aventis, Mission for Non-Governmental Cooperation [MCNG] of the French Ministry of Foreign Affairsconsult this article only
Testimony from Chantal AUBERT-FOURMY, the President of the organization
Chantal AUBERT-FOURMY, the President of the organization returns from a 15 days trip to Haiti, she visited a program called «the street children from Port-Au-Prince».
AMI is the only NGO caring for the Young Children from the Streets. Many other actors propose various programs of socialization, reintegration, and various assistance, but they require that these Children come to their premises, whereas the ultimate goal is to get them to leave the street. Our "outreach" policy (to directly meet the children on the ground without proposing them to go to a precise place) is unique in Haiti, and it allows the most fragile population of the street children (those who do not dare to cross any door) to reach for social contact based on confidence, recognition, and to seek primary health care.
The medical part The local team is composed of two doctors, two nurses and two teachers. They are all motivated by the quality of the relationship with the street children. They speak about it with so much enthusiasm, love and humour. The four women express their difficulty when confronted to completely unforeseeable aggressiveness from some youngsters. They mention the necessity to support stone throwing, threats, even though some of these children excused themselves afterwards (the best socialized or the least mislaid). All that is compensated by the richness of the exchanges. No team member proposes the "to do good" concept, they all speak about listening, observation, to act "according to their requests", "gradually". Standard pathologies are well managed and the partnership with the Pétion-city hospital goes well. On the other hand, there ia a large deficit in family planning (Girls must refer to Geskhio for contraception, but they never go there), HIV training request, and drug-addiction.
Prevention and psycho-social part Nine members of the local staff take part in the meeting. The humane engagement appears strong and authentic. Urbens (teacher with AMI for the past 2 years) seems particularly militant, just as Hector, the new psychologist with AMI 1 month ago. We speak about the HCDRC (the Haitian Coalition of Defense of Rights of the Children), and the network of associations (including AMI) intervening for the street children. Each one knows its role, its sphere of activity and connections with the other services. Many talks about the pleasure they have to work with these children, rather than working in the traditional civilian society. It is sure that no one is likely to get bored! They are attentive with the world of the street children and want to make emerge other forms of expression.
Mobile private clinique Finally, the team gave up from going to the "cemetery", which was considered to be too dangerous. They are a little anxious concerning the reception which will be reserved. They decided to go to the «Champ de Mars», knowing to be more quiet. I presente myself as being the trainee of Dr CASSION who pratices consultations. Although this consultation is improvised, the mouth-to-ear goes quickly and there are many people around our truck called "Klinik mobil health louse timoun lari" (mobile private clinic of health for street children). Dr. FRANTZ makes collective sensitizing under a tree, not far from there. He has pretty STI pictures that fascinate the kids: pustules and bubos, ulcers and warts, all is there… The truck is surrounded: At the entrance, Carline makes the sorting, registers the «basic» children, evictes the other ones, contains the overflows with good mood and firmness and supervises that the weapons remain outside (one confiscates a particularly sharp-edged lead pipe the time of the consultation, for the guns, they must have a buddy keep them). Outside, some fight, others laugh… the driver and a teacher discreetly look at what is going on. In the truck, Dr CASSION sees the children one by one. They are from age 13 to 20, they are very few girls. It is ordered that contraception is not yet available on board. The principal pathologies are traditional: respiratory infections, dermatoses, diarrhoea and STI, the traditional quartet + wounds and various wounds + lots of somatization. Many spontaneous request for HIV tracking. Dr. CASSION listens, reassures and prescribes. The children remain calm, they are a little bit impressed but obviously in trust: an "important" adult listens and devotes his time for them, only for them. During a few minutes, they feel as being "somebody". Sherley, the nurse prepares the drugs, Shela, the HIV teacher gives advises and distributes condoms. That particular day, more than forty children have been consulted.
Groups of peers - the Delmar room
AMI gathers three times per week, a group of approximately 25 street children, "peers" which will be charged to relay the prevention messages to their alike and peers in the street. The AMI "Delmas room" in downtown, makes it possible to comfortably accomodate groups of about 30 young people, with an entry where the guard stores the weapons during the activities, and a small room for individual talks if necessary. Marie-Joe, Hector and David distributed themselves in advance the roles and the interventions. Today’s talk will be about AIDS and condoms. 20 boys and 3 girls are there, (all the three prostitutes, with two having a baby). Hector starts with a reminding of the basic rules: listen one to another, to accept different opinions without being annoyed, respect, tolerance, etc. Marie-Joe begins with the topic of the day, AIDS, starting from the poster that they already carried out on this subject. This poster was printed and widely diffused in all the demonstrations concerning the street children. Someone turned the tv on (which makes a hellish noise) and hid the remote control. After the incident being closed. Each one speaks and expresses his/her feeling: the idea of death, suffering, thinness, visible lesions are mostly brought out. But also the "sometimes, one is not sick" and "it is extremely mentally necessary to be strong , if not, the drugs do not work" ideas. Marie-Joe goes on with: * - the necessity of tracking - prevention: abstinence, faithfullness, condom * - contamination: sex, syringe, sharp objects, mother-child * - the necessity of the PTME * - not-stigmatization * - what does not transmit HIV: mosquito, shower, etc.
During that time, the reflexes of the street are perceptible: a kid takes refuge under the table, others discreetly put on their personal stereo, another one puts on his yellow hood, mean mimicry and signs of intimidation towards another child brutally appear and disappear quickly when they crosses the glance of the teacher… The exchanges continue * - How to make a baby when the couple is using a condom? * - The Difficulty of keeping the condoms in an adapted place * - Lubrication of the condom * - The necessity of tracking, Marie-Joe demonstrates the use of a condom on a wooden phallus: technically, it is perfect, but there is no anticipation of problems: tighteness, there is no feeling of the girl’s body, what happen when it remains in the girl’s vagina (how far can it go? How to recover it ?), How to avoid these kinds of accident ? All these questions that they don’t dare to ask if we don’t mention them ourselves. The teachers are not at ease with this speech. However remarks emergent timidly "I do not find condoms my size", "they are too fragile" etc… The team tries to respond with relevance. Afterwards, the children have to test it themselves. The girls are the first volunteers. Everybody applauses. When it is the boys’s turn, they act silly, simulating masturbation by hanging the wooden phallus on their zipper, everyvody has fun. Good thing because, the condom is completely demystified. It is breaktime, David comes in (Marie-Joe is exhausted). Jokes are being made: David tells a story of condom (obviously very funny, but I did not understand anything), then each one also tells a joke, in the middle of the assistance, each one has his/her minute of glory and makes everyone laugh, we all applaud. Then we play a game on the Fidelity-Condom-Abstinence topics in the good mood, after 15 minutes, the girls won, but they cheated, while the boys were looking after the babies when they were too busy; the babies observe all this agitation peacefully. Afterwards, those who wish it to sing in front of the assistance can do it. There are some excellent rap singers, giving astonishing liberating messages by the degree of development and the richness of the vocabulary. Although most of them are almost illiterate, they correctly expressed their conviction either orally, throught dances or songs. Then we all had lunch while watching a bad romance movie on tv which seems to have captivated their attention. It is calmer, the teachers breath a little. The pressure falls down and each one goes back to his/her own life… A day at the beach with the children 17 young boys have travelled by bus with Dr. CASSION and 4 teachers. The team is a little bit disappointed because we had envisaged 25 to 30 children. The communication will have to be improved for the next time. We (Dr. SIDY, the coordinator, Sebastien, and myself) followed them by car. We are going to Jacmel, located in the South of the Island, by the sea. It is a small town, very quiet compared to Port-Au-Prince, this town is known for its dance, music and painting schools, and its metal architecture borrowed from England and Belgium. from the end of the 19th century Its greatest pride is above all to the fact to have gained its independence in 1803, 1 year before the remainder of the "free" island, itself the first «free» island of the Caribbean. The children were very proud to belong to such a glorious history, told by an enthusiastic lecturer. Then, we visited the city hall where we were received by the Mayor in person who improvised a small speech for the children, again proud that such an important person speaks to them. They visited old houses, painting and photography museums, they had such exemplary behaviors, only looking with their eyes. I was surprised by their interest for the beautiful houses, their respect for the craft industry and the beautiful things, their relevant remarks and the pride expressed while they listen to the lecture (even thought after fifteen minutes many of them were «out») and the Mayor had the good idea to make it short. For the second time, and with a different group, the quality of their co-operation and their reflexion challenged me. Then we had lunch on the beach, in a restaurant. The fish was very good, with leek and lemon grass. Unfortnatelly, there were some completely rusted frameworks of boats, plastic bottles and other waste a little bit everywhere, but the beautiful blue sea, the rymthes of the waves and the fresh wind made a delicious environment. They wanted to go swim, but it was too risked, we decided to return home.consult this article only