Global Health Delivery Fellows honored for accomplishments and leadership

The 2010 Global Health Delivery Fellows.

From implementing a PIH project high in the rural mountains of Lesotho in southern Africa to directing a rural health center in Haiti to studying as a Fulbright scholar in the U.S., accomplishments and a record of leadership distinguish this year’s Global Health Delivery Fellows.

In the midst of the tragic aftermath of the January 12 earthquake in Haiti, there was a bright spot that indeed shone hope and promise on the future of Haiti. On February 27, 2010, Partners In Health (PIH); the Brigham and Women’s Hospital (BWH); Harvard Medical School (HMS); Zanmi Lasante (ZL); and the Haitian Ministry of Population and Public Health (MSPP) held the first convocation for the joint fellowship in Global Health Delivery. Twenty physicians were honored for completing “academic training and credentialing in the delivery of health care while strengthening the public sector in resource poor settings.”

The fellowship program in Global Health Delivery is a program jointly administered by the BWH’s Division of Global Health Equity (DGHE), HMS, MSPP, and PIH and ZL.  The program was designed to train a cadre of Haitian physicians to implement and deliver programs to treat HIV and TB while improving the primary health care system within the public sector.

The three-year fellowship includes training in the use of HIV therapy; case detection and treatment of TB and other opportunistic infections; treatment of malnutrition; and innovative practices in delivering primary health care in resource-poor settings. Fellows are also mentored, “shoulder to shoulder,” by faculty at the DHGE in locations supported by ZL and the MSPP.

This graduation, held on the grounds of the PIH/ZL Socio-Medical Complex in Cange, Haiti was the first of its kind anywhere in the world. The Global Health Delivery fellows were awarded certificates for working within public structures in countries with PIH-affiliated hospitals and clinics, including Burundi, Haiti, Lesotho, Malawi, Peru, and Rwanda.

The 2010 class of fellows – with more than 150 years of clinical experience between them – is the first to receive this honor. 

Dr. Maxi Raymonville.

With music provided by the Cange church musicians, speakers referenced the struggles endured not only by the fellows, but also by Haitians more broadly. Dr. Maxi Raymonville, the laureate with the most years (19) of PIH/ZL service, focused mainly on the durable philosophy he learned in Cange. “Together, our goal is to reach the poorest, the most isolated, [those in] the toughest situations and individuals in suffering and to provide care,” he said. Read other remarks and speeches made at the convocation.

Speaking in Kreyol, with Dr. Farmer translating, PIH Executive Director Ophelia Dahl praised the graduates for their accomplishments, observing how “the road to justice is long and paved with thorns.” Now there is a bridge, she said, but only after many years of work and effort to build new partnerships, and it stands as a testament to ZL’s dedication. “This graduation was planned long before the earthquake, and was a moving tribute celebrating the extraordinary contributions our Haitian colleagues have made to improve the lives of so many,” said Dahl.

But this hopeful convocation was also, appropriately, a memorial. Two fallen collegues were honored and posthumously awarded fellowships – Dr. Josue Augustin, ZL Chief of Surgery, who was murdered in August, 2009; and Dr. Mario Pagenel, ZL Director for Training and Medical Education and the Director of the Caribbean HIV/AIDS Regional Training Center , who died in the January 12, 2010 earthquake.  

“Dr. Pagenel truly lived the term preferential option for the poor,” said PIH’s Clinical Director in Haiti, Dr. Louise Ivers. “He could have worked anywhere but he decided to work in one of the most isolated parts of Haiti to serve his people.

Also included in the ceremony were Dr. Gary Gottlieb, President and CEO of Partners Health Care and PIH board member; Dr. Betsy Nabel, the President of the Brigham and Women’s Hospital; Dr. David Golan, Dean for Graduate Medical Education at Harvard Medical School; and Mr. Rick Mills, Dean of Global Health Programs at Harvard Medical School.

It was an emotional and moving ceremony for many of the honorees, their families, and for those of us who have worked closely with them. In some cases, these working relationships have lasted for more than a decade.

Below are some excerpts from remarks at the convocation:

	Dr. Joia Mukherjee with the GHD Fellows.

To accept the whole world as one home and family is to assume that we too have a responsibility to our brothers and sisters, mothers and fathers.  To bear witness to the suffering of others is to allow the truth into our lives; the truth, that our privilege, historically, as today, is connected with systems that perpetuate the cycle of poverty…mize.  And once we open our eyes, heart, mind and spirit to the pain and suffering of the large mass of humanity we call the poor, it is impossible to close them again for even sleep is tormented by facing the abyss between comfort and enormous, inequitable and unnecessary want; the wounds of those who live from day to day without food, water, shelter, without education, without medical care.

The Fellows in Global Health Delivery who we are honoring today are colleagues and friends, brothers; those my son calls ton ton. They are the men whom I have worked with, taught, learned from, travelled with, laughed with and cried with for eleven years. We have together set up a national program for the treatment of multi-drug resistant (MDR) TB in Peru, and public sector programs to improve health care and integrate HIV and TB services in 52 facilities – 11 in Haiti, and 41 in four African countries. The influence of our collective work has been felt in countries throughout Africa, Asia, Latin America and in superpowers like the US and Russia.  These doctors have, here, have made a deep commitment to community-based work, to public sector work, to make a preferential option for the poor….They represent the backbone upon which global health will be taught in the decades to come.

-Joia S. Mukherjee, MD, MPH
 PIH Medical Director
 Associate Professor, Harvard Medical School,
 Division of Global Health Equity, Brigham and Women’s Hospital

My belief that health is a basic human right embodies my conviction to reduce the barriers that deny health care to the destitute sick….Driven by this conviction, humbly and modestly I lead ZL’s efforts to incorporate interventions for clean water, food support, employment opportunities, housing, and education into the care of patients who are systematically marginalized by grinding poverty.   Because I believe healthcare should be a public good rather than a private privilege, I have committed myself to working through the public sector to deliver care to the poor. Since early 2002 when monies from Global Fund against AIDS, TB and Malaria (GFATM) were awarded to us in Haiti, I have been active in integrating ZL’s support into the government of Haiti’s public health system, as the public system is the only entity that can guarantee the rights of its citizens…we have achieved this through carefully and persistently raising awareness among his colleagues in the Ministry of Health, and by mentoring young clinicians who join the ZL team in the principles of health and human rights.

When Partners In Health was asked by the governments of Rwanda, Malawi, and Lesotho to expand its model of care to their countries, I was among the first members of PIH’s team who led the effort. I started travelling to Rwanda in 2005 to train local doctors and nurses, assuring… them that, based on my experience in Haiti, it was indeed possible to provide primary care and to treat serious and chronic disease in settings of extreme poverty and within the public sector. I quickly had an immediate credibility and a connection with local clinicians and HIV/AIDS association leaders. This Fellowship in Global Health Delivery is the recognition of our work, and the contribution of the Zanmi Lasante model to delivering health care in the world’s poorest settings. 

Today we are paying tribute to the values of engagement, humility, availability, honesty, compassion, vision, and solidarity. These values are embodied by many of the staff who have come through this program, attended hundreds of late night meetings, worked tirelessly in patient care and human rights activism. I will finish in thanking all of you who contributed to making the Fellowship in Global Health Delivery a reality… Paraphrasing Dr Martin Luther King, Jr., “Among all the human rights the lack of access to health care is the most inhumane!”

-Fernet Renand Leandre MD,
 1997-present, Director STI/TB/HIV and Public Sector Partnership, Zanmi Lasante
 2005-present, Chief Consultant for Inshuti Mu Buzima, PIH, Rwanda
 2007- present, Consultant, Village Health Works, Burundi

My first day at Zanmi Lasante, I was greeted by Dr. Maxi and Dr. Leandre and to be honest, I thought they were nuts.  They spoke to me about everything except medicine – such as transport costs, income-generating activities, construction of houses, compensation for community health workers. In fact I stayed lost, I wasn’t even sure they were doctors.  But, I needed to learn, I needed time to live this reality. …(Later) in my first year, I was annoyed, I did not think doctors should do home visits. I remember one of our faculty asked me to go find a TB patient, who had left without finishing his therapy…the attending insisted that any doctor taking care of a patient has a responsibility if the patient leaves the hospital. After returning to the hospital with the patient from the village of Kayi Pin, I began to think differently about the doctor-patient relationship; about how my talking with and spending time with the patient changed his outcome.

We decided to stay in a rural place, not to return to the city, or to do a residency – but to become “Dokte Mon” – a mountain doctor. You must understand, that we were among the best students in our classes in medical school, each of us was expected to do a residency. Generally, those who are called “mountain doctors” are surrounded by rumors of incompetence…but for us, choosing this path is our core engagement to join this determined team, Haitian and foreign, who in a noble mission, serve the Haitian poor. It is not easy to be devoted to this mission, there are sacrifices in these rural places, far from the lucrative and prestigious jobs in the capital that garner a private clinic or a car. But you all have accompanied us to a much greater goal, to see the medicine in a community way, medicine in service to all those who require it…I will summarize key points of our training, concepts that our mentors have inculcated among us

• To work to constantly improve health indicators.
• To disseminate best practices.
• To practice medicine which respects human dignity even in the face of humiliating poverty; poverty in which access to drinking water, food and health represent a luxury.
• The belief that health is a right and that only the state can guarantee that right, that each individual must have access to the health care in regardless of their ability to pay.
• A commitment to working with and for the state as the entity responsible for assuring the right to health.
• A holistic, a comprehensive package, in which the patient is the center of all our interventions.
• The belief in lasting partnerships—in working with the state, we do not set forth an exit strategy. Rather, we accompany the state and the community in a long-term commitment to empower public institutions and communities in the capacity to deliver the benefits of medical technology to the poorest. 
• The refusal to accept the medical double standard which is the status quo…where the largest needs are accompanied by the fewest resources which assures that the rich person and the poor person get different treatments. 
• The belief that medicine is also a source of development, not only by assuring a health population, but by through job creation at the community level. Our projects are the examples of this approach. In Haiti today, more than 6000 people are employed through the Zanmi Lasante-MSPP partnership. In our work in Rwanda, in less than three months, we trained and employed 200 people. There are many stories like this, stories of transformation.

So, dear colleagues, if this is what it means to be a “mountain doctor” then I congratulate all of you on your title of mountain doctor, and I am proud to be among you.

-Charles Patrick Almazor MD, MPH
 Director of ZL-Public Sector Partnership, Artibonite Department, 2007-2008
 Director IMB-Public Sector Partnership, Burera District
 Fulbright Scholar 2006, MPH University of Alabama, Birmingham

Full list of 2010 Global Health Fellows: 

• Charles Patrick Almazor M.D., M.P.H. – Haiti (2002-06, 2009-present); Rwanda (2007-08);
  Fulbright Scholar, University of Alabama, Birmingham (2006)
  Director IMB-Public Sector Partnership, Burera District (2007-2008)
  Director, ZL-Public Sector Partnership, Artibonite Department (2009-present)
• Junior Bazile M.D., M.P.H. – Haiti (2003-07); Burundi (2010-present)
  Fulbright Scholar, M.P.H., University of Alabama, Birmingham (2008)
  Medical Director, Village Health Works, Burundi (2010-present)
• Renard Cruff M.D. – Haiti (2004-present)
  Director, HIV/TB Program, St Therese Hospital, Hinche, Haiti (2004-present)
• Johny Denis M.D. – Haiti (2007-present)
  Director, Program in Chronic Care, Petite Riviere, Haiti (2007-present)
• Jean Roland Désiré M.D. – Haiti (2004-2008, 2010-present)
  Director, Lascahobas Clinic, Haiti (2005-2008)
  Consultant, Inshuti Mu Buzima, PIH Rwanda (2008)
• Leopold Fenelon M.D. – Haiti (2004-present)
  Director, HIV/TB Program, Thomas J. White Pavillion, Cange, Haiti (2007-present)
• Jaime Bayona Garcia M.D., M.P.H. – Peru (1994-present)
  Director, Socios en Salud, Peru (1994-present)
• Jean-Gregory Jerome M.D., M.P.H. – Haiti (2003-06, 2007-present)
  Fulbright Scholar, M.P.H., Boston University (2007)
  Deputy Director, Monitoring and Evaluation, Zanmi Lasante, Haiti (2007-present)
  Consultant Inshuti Mu Buzima, PIH Rwanda (2007-present)
• Wesler Lambert M.D., M.P.H. – Haiti (1998-present)
  Director, Unité Communale de Santé # 3, Central Department, Haiti (2002-present)
  Director, Monitoring and Evaluation, Zanmi Lasante, Haiti (2006-present)
  Consultant, Inshuti Mu Buzima, PIH Rwanda (2006-present)
• Fernet Renand Leandre M.D. – Haiti (1996-present)
  Director, HIV/TB/STI Program and ZL-Public Sector Partnerships, Zanmi Lasante Haiti (1997-present)
  Chief Consultant, Inshuti Mu Buzima, PIH, Rwanda (2005 present)
  Consultant, Village Health Works, Burundi (2007- present)
• Mario Pagenel M.D. – Haiti (2006-January 12, 2010 – posthumous award)
  Director, Caribbean HIV/AIDS Research and Training Center, Haiti 2009-2010
• Paul Pierre M.D., M.P.H. – Haiti (2004-07); Malawi (2009-present)
  Fulbright Scholar, M.P.H., University of Arizona (2008)
  Director, Community Programs APZU, PIH Malawi (2009-present)
• Jean Aine Pretanvil M.D. – Haiti (2005-present)
  Director of the Thomonde Hospital, Haiti (2007-present)
  Smith Scholar, Harvard School of Public Health and Brigham and Women’s Hospital (2009)
• Anany Gretchko Prosper M.D., M.P.H.-student – Haiti (2005-2009)
  Director, ZL-Public Sector Partnership, Artibonite Department, Haiti (2008-2009)
• Max Raymond, Junior M.D. – Haiti (2006-present)
  Director, HIV/TB Program, San Nicolas Hospital, Saint-Marc, Haiti (2006-present)
• Maxi Raymonville M.D. – Haiti (1991-present)
  Director, Women’s Health, Zanmi Lasante, Haiti (1997-present)
  Chief Consultant, Women’s Health, PIH African Initiatives (2005-present)
• Jonas Rigodon M.D., M.P.H. – Haiti (2002-04); Lesotho (2006-08); Malawi (2009- present)
  Director of Nohana Rural Initiative, Lesotho (2006-08)
  Director, APZU-Public Sector Partnership, Malawi (2009-present)
• Mackinley St Louis M.D. – Haiti (2008)
  Director, Haitian National Referral Center for MDR- TB, Thomas J. White Pavilion, Cange, Haiti (2006-present)
• Ralph Ternier M.D., M.P.H.-student – Haiti (2003-present)
  Director, Belladere Hospital, Haiti (2003-present)
  Chief Consultant APZU, PIH Malawi (2008-present)
  Poorvu Fellow, Division of Global Health Equity, Brigham and Women’s Hospital (2008-present)
  Director, Haiti-Dominican Republic Cross Border HIV program (2009-present)
• Patrick Ulysse M.D. – Haiti (2006-present)
  Director, HIV/TB Program, Petite Riviere, Haiti (2007-present)