JEAN DENIS, Haiti -- At the health clinic here, three hours northwest of Port-au-Prince, a crowd of mostly women and girls linger in the shade away from the afternoon sun, waiting to see a doctor. This is one of the least developed areas of the poorest country in the Western Hemisphere. For miles around, this clinic is the only place people can come for modern medical attention.

"You are standing at the edge of the heartland of the rural area," said Francoise Peak, a translator who frequently works with the United Nations and joined a group of reporters at the clinic. In rural Haiti, she said, people can blame even simple health problems on spiritual disturbances rather than a medical matter: "Out there, if you're sick, it's not because of a health issue. It's because someone cast something on your family. A spiritual problem. Serious business, voodoo."

Five years after a devastating earthquake hit the island and leveled towns and infrastructure, providing care out in the rural part of Haiti remains a monumental challenge, especially when it comes to women and children.

Medical workers must overcome the limitations that extreme poverty imposes on the vast majority of this area's residents, as well as many peoples cultural and religious aversion to modern medicine. Health care providers are overworked. Many clinics, few and far between, are understaffed and poorly equipped.

At the hot and sparsely furnished compound in Jean Denis, goats outnumber employees. A corner of the waiting room serves as the ER, walled off by plywood that doesn't reach the ceiling. The whole place is run on a single diesel generator. Nevertheless, Fabiola Coqmard, the head of the clinic, and a small staff manage to serve an estimated 44,000 people living in over 50 villages in the surrounding countryside.

Coqmard explained one of the major hurdles she faces is a lack of "modern" education in nearby communities. "They have some customs and beliefs that make them reluctant to accept modern medicine, she said.

So-called health agents -- there are 26 of them at the Jean Denis clinic -- roam through nearby communities, vaccinating children and teaching women about breastfeeding and family planning, among much else. They are particularly vital as they are often the only link between rural communities and modern health care. They go out on home visits, encouraging pregnant women to try to make it to the clinic to give birth instead of staying at home in the care of a traditional birth attendant, most of whom arent formally trained. They vaccinate children against polio, tetanus and rotavirus, among other common illnesses. They weigh newborns and check for malnutrition. Even Coqmard does her share.

She goes into the field. She pulls up the legs of her trousers. She goes into the mud, said Haumanet Occeus, one of the health agents at the Jean Denis clinic. She's never stopped by that. She's never held back by any situation.