THOMONDE, Haiti — Bresa Belizaire works out of a wood hut with a raked-dirt floor. Under a wooden chair in the corner are bottles of medicine and human bones. Belizaire is a voodoo priest, or "houngan" in Creole, in Thomonde, Haiti, an impoverished area in the center of the country. He works and lives just off one of the main dirt roads, near a health clinic run by Project Medishare, a U.S. nonprofit group that is working on improving the health infrastructure of Haiti.
Voodoo is a national religion, says Dr. Serge Pintro, a consultant to Project Medishare in Thomonde and a former division director at the Ministry of Health in Haiti. The voodoo priest or priestess is not only a healing doctor, he says, but also a religious figure, which makes it difficult for people not to believe.
Belizaire and his colleague, Pierre Marie-Chantal, a voodoo priestess, or "mambo," are two of the traditional healers that Project Medishare and Partners in Health, another nonprofit health care organization, work with in Thomonde. The organizations collaborate with the healers to help identify patients who are infected with HIV.
As in many countries, traditional medicine plays an important role in Haitian society. According to the U.S. government's HIV/AIDS Country Operational Plan 2006 for Haiti, nearly one out of every three households, urban and rural, consults a traditional healer when a family member becomes sick. People often seek out healers as a first option. By the time they turn to modern medicine it may be too late.
Carolle Charles, a Haitian-American professor of sociology at Baruch College in New York, says that few people in Haiti have access to formal medicine and that they rely on traditional medicine. There is a cultural conception in Haiti of disease and illness, she says. "And it's very close to the way people see the world, the way people see relationships, their position in the world and their relationship to nature."
"There's a whole culture of illness that I'm sure must influence the way people will get access or look for health care," she says. "A lot of people do not believe that they can have AIDS. A lot of people think that AIDS is a disease sent on you, a bad thing that people do on you. It's not something that you can get."
Recognizing the significance of traditional healers to the local communities, the U.S. government has incorporated them into HIV/AIDS programs. The President's Emergency Plan for AIDS Relief (PEPFAR) is training traditional healers on HIV/AIDS counseling and testing and prevention messages in several African countries, and it is beginning to formally collaborate with traditional healers in Haiti.
That's a good thing, says Catherine Maternowska, an assistant professor of obstetrics and gynecology at the University of California, San Francisco, and the author of an upcoming book on Haiti. One of the reasons traditional healers are popular in Haiti, she says, is that they are able to provide both the time to listen and the quality of care that people in the community need and crave.
Pierre Marie-Chantal, also known as Mambo Faura, greets patients in her yard under the shaded canopy of banana and palm leaves on a circle drawn on the ground in chalk. Mambo Faura sits on a handmade chair while several assistants seated on the ground tend a fire nearby. She is a solid woman and is wearing a purple and blue traditional African dress. Townspeople drop by while she describes her work.
"I have been a priestess since I was 10," she says. "The spirit entered me then. â€¦ The spirit is from my mother, and they have chosen to work through me."
Mambo Faura started her own traditional medicine practice when she was 17. "When a person comes to me because a spirit hurt her, I can see from the physical being of the spirit what kind of illness they have," she says.
To foreign visitors, Mambo Faura smiles and says that there is nothing to fear. "Voodoo is a sacred religion. â€¦ I don't want you to think that I do bad. In short, I am part of the voodoo priests that are healers and give people good luck, not evil."
Sometimes, she says, she will see medically related cases that she can't treat. In those instances, she says, "I will assess the ailment and then give the appropriate medicines. And if there is no result, I will bring them to the hospital. Sometimes the person could have TB [tuberculosis] or HIV."
Dr. Louise Ivers, who works with Partners in Health (PIH) in the Central Plateau, says that sometimes a family may want to take a patient to a houngan from the hospital if, after a couple of days, the patient isn't visibly recovering. PIH will instead suggest that the houngan come to the hospital to treat the patient there, although the houngan is not encouraged to administer his own medicines in a hospital setting.
Because the houngan are leaders in the community, she says, PIH, which receives PEPFAR funding, has specific projects that engage the healers and train them to recognize the symptoms of TB and HIV/AIDS.
Thomonde is Belizaire's home, but it's also a city with many health problems. In addition to chronic malnutrition, HIV/AIDS and TB are widespread.
Thomonde was green in April â€” it hasn't been for months, but the rainy season has just begun. The rain has filled the potholes in the road with water. Trucks drive through slowly and children run alongside them, showing the drivers a path that is clear and not too deep.
Belizaire, 42, and the father of nine, has an intense gaze and an alert manner. Some of his children crowd around while he leads the way on the muddy path from his home to the hut where he works.
"Here we do a lot of work," he says. "There are a lot of health issues here. If there is no result from the voodoo [work], then we send people to the hospital and continue to work with them. Sometimes people go to the hospital and they don't get better so they return and are healed here."
"I see people from all religions," Belizaire says. "They might go to church too, but all the townspeople come to voodoo doctors."
Belizaire is familiar with HIV/AIDS in a city where up to one-tenth of the population is infected with the virus. He offers rum to the friends and patients in his hut as he explains how spirits tell him the composition of the herbal medicines he prepares.
If those medicines don't work, or if he's concerned that someone who comes to see him may have HIV or TB, Belizaire will refer that person to Medishare's clinic down the road.
At the end of the interview, Belizaire was asked if he had any questions for his guest. After pausing a moment, he says he has only one. "Could you tell me how to cure HIV/AIDS?"