A traditional Haitian Kreyol proverb says, ‘Zafè Kabrit pa Zafè Mouton’ or in English, ‘The Goat’s Business is not the Sheep’s Business’. Each individual should focus on their life and not interfere with the lives of others or in other words, what you do is your concern and I should not interfere, regardless of how your actions may affect those around you. Unfortunately, this way of thinking encourages individualistic behaviors and limits social accountability. This can be problematic in a country where epidemic cholera will continue to pose a threat until the underlying structural, social and behavioral conditions that led to its spread are addressed. When it comes to water, sanitation and hygiene (WASH) related diseases, such as cholera, each individual’s business or behavior does impact their neighbor; my neighbor’s feces, garbage and water management practices can increase or decrease my family’s risk for diarrheal diseases. As such, collective action is one component of any strategy that will be successful in mitigating the continued spread of cholera and other preventable WASH-conditions. In an effort to alter community norms around WASH behaviors and encourage collective action to reduce the threat of epidemic diarrheal disease, the Center for Medical Humanities & Ethics has collaborated with the Pan American Health Organization and the Eco-Eau et Jeunesse (Water and Youth) grassroots movements to implement Community Health Clubs (CHC) in urban communities in Port au Prince. Between March 2012 and January 2013, 6 CHCs comprised of over 250 Registered Members were established in 6 urban communities in Port au Prince, Haiti and in February 2013, over 130 of these Club Members were honored for completing the curriculum during a vibrant graduation ceremony. Thereafter, an additional 20 CHCs were created with over 600 current members (we now have close to 1,000 members across Port au Prince) and we plan to celebrate with close to 500 of these members in February 2014 at the next graduation ceremony.
The CHC model of health education is a community-based, participatory methodology first developed by the Zimbabwe AHEAD organization and has had great success throughout Sub-Saharan Africa during the past 10 years. This approach is considered ‘best practice’ for community-based participatory health education because it not only encourages the participation of entire communities, but also achieves measurable WASH behavior change. By combining time-tested adult education activities and culturally adapted educational materials with weekly health promotion sessions for a dedicated group of learners, this approach catalyzes sustainable behavior change through social pressure and alters community WASH norms. Where implemented, the ‘Common-Unity’ approach engenders increased Social Capital and establishes a sustainable culture of health that can be leveraged to lead the organized community down a path of empowerment and economic advancement.
Social Capital refers to the connections among individuals, including the social networks and the norms of reciprocity and trustworthiness that arise from them. As described by L.J. Hanifan, an early social reformer in the United States, the strength of social capital is that, “the community as a whole will benefit by the cooperation of all its parts, while the individual will find in his associations the advantages of the help, the sympathy, and the fellowship of his neighbor.” However, if each individual is only concerned with their ‘business’, then rapport can be difficult to establish and it is hard to imagine neighbors engaging in collective action to address problems within their community. This was the situation that most, if not all of the communities where CHCs were established in 2012 faced, due to population displacements and a history of disempowerment in urban Port au Prince. As one Club Member in the community of Simon-Pele explained, prior to the Club being formed in this community, he ‘knew’ his neighbors by the fact that they lived in proximity to each other, but their interactions as a community were limited to the occasional greeting on the street. However, after the Lakou Lapè (rough English translation: Courtyard of Peace) Club was formed, this neighborhood was transformed. While learning about personal hygiene, diarrheal disease transmission and how individual behaviors impact community health during the weekly Club meetings, the Members came to ‘know’ each other. Rapport was established and weak social bonds were strengthened as the Members held each other accountable to attend the weekly meetings, actively participate, and respect each other’s opinions. This has led to an increase in trust and the creation of new norms of reciprocity, which have been used to ensure the implementation and maintenance of the newly agreed upon hygiene practices, such as the use of home-made hand washing facilities and the maintenance of a waste (feces and garbage) free environment. In short, these Members have succeeded in creating a ‘Courtyard of Peace’ in their neighborhood, where Social Capital has been leveraged to create ‘Common-Unity’; increased communal cooperation and enhanced fellowship amongst neighbors.
The slogans of the Haitian CHCs reflect this desire to achieve a new sense of ‘Common-Unity’ and the important role that health plays in maintaining a community. The Lakou Lapè CHC in Simon Pele says, ‘San Sante pa gen Lavi’, or ‘Without Health, There is no Life’, while the Members of the Sarth Germain CHC say, ‘Sante Chak Moun Konte’, or ‘The Health of Each Person Counts’. These slogans, which are mission statements for each Club, reflect the understanding that health is tied to development and that development cannot be achieved unless the entire community works together to ensure a healthy environment. In response, the CHC coordinators in Haiti took the initiative to alter the old Haitian proverb to reflect this newfound sense of ‘Common-Unity’, and to help diffuse this message more widely amongst the Haitian population. ‘Zafè Kabrit se Zafè Mouton’, or in English, ‘The Business of the Goat IS The Business of the Sheep’, has become the unifying slogan for the all of the CHCs in Port au Prince, including the 26 new Health Clubs to be formed this year. From Canaan, a new settlement of earthquake-displaced families and individuals in the north, to Cite Soleil, the oldest and largest informal settlement in the Northern Hemisphere, 2013 will be the year that the Goats and the Sheep are brought together through Community Health Clubs so as to raise their collective voices and say: ‘Sante pou tout Moun’ (Health for Everyone)!
For related content, please check out Jason Rosenfeld’s TedxSanAntonio talk and visit the UT Health San Antonio Mission Magazine story about our Community Health Club program in Haiti. We also welcome you to visit the program website where program updates, stories and other content will regularly be updated.