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Looking Back. Moving Forward. A Summary of 25 Years of Service and Progress

1996 2021 Walking the Final Mile with Borgne Haiti

Table of Contents

Part 1: Looking Back, 1996-2020 Guiding Principles of H.O.P.E


Interview with Michael Shields and Dr. Thony Voltaire


Reflections on Dr. Rose-Marie Chierici


H.O.P.E. Milestones


Spiritus Christi and H.O.PE.


Part 2: Where We Are Now, 2021 Year in Review


Running A Million-Dollar Program On $250,000/Year








Ekonomie/Economic Vitality


Effective Partnerships


Part 3: Strategic Goals for 2022


Strategic Development 2022 Fiscal Budget Mobile Clinics Form Haitian Legal Entity Cultivate Critically Important, Decentralized Health Networks


Letter from Executive Director As it was throughout the world, 2021 was a year of loss, change, and renewal at H.O.P.E. It was our first full year without Rose-Marie Chierici, our founder and Executive Director, who passed away in August 2020. On top of being heartbroken at the loss of a dear friend, mentor, and role model—and one of the most extraordinary women we have known—we were concerned as to how to H.O.P.E. would continue to be H.O.P.E., in the absence of Rose-Marie and all the energy, expertise, and direction she brought to the work. 2021 showed us that Rose-Marie’s spirit lives on, as does her work in Borgne, Haiti. Despite profound political uncertainty in Haiti, fluctuations in currency rates, the COVID-19 pandemic’s long reach, and a pressing need for those of us on the U.S.A.-end of this partnership to commit ever-more time and resources, H.O.P.E. has in fact enjoyed a renewal that reveals three truths: 1) The trust and solidarity she built within Borgne, and our partnerships with the department of health and many humanitarian agencies, have proven durable, sustainable, and essential to this community of 80,000. 2) Together we have the strength and resolve to continue building capacity in Borgne and to expand our reach and build durable and innovative capabilities to support this work from our base in the USA. 3) Our future is bright, as our Haiti operations are now recognized as among the most effective and successful in rural Haiti. Upon the strength of these accomplishments we draw upon additional resources to continue to meet the community’s needs. We honor these three truths in this Annual Report. Our intent is to provide you with a comprehensive overview — our very first such summary. To bring this work to life, we share some of our foundational stories, highlight core elements of our current program, and identify our strategic goals for the coming year. Taken together, we hope to tell this extraordinary story of learning and friendship, one that has unfolded over some 25 years and has called to service an all-volunteer Executive Committee and Board of Directors in the United States as well as a team of 30+ highly capable leaders in Borgne. Medical Director Dr. Thony Voltaire, who leads an impressive array of hospitals and programs, shared recently in our weekly call that the partnership itself is what makes us different. No other NGO working in Haiti operates with a trust as well-earned and unshakeable on both ends–in Haiti and the USA–as does ours. In the spirit of continuity and collaboration, we invite those of you who have traveled with us from the beginning to see H.O.P.E. anew. And we invite those of you who are new to H.O.P.E. to see Haiti anew through our highly productive, revelatory partnership with Borgne — the heart of rural northern Haiti and a place cherished by those who know it well. With sincere gratitude,

James Myers


Looking Back, 1996-2020


H.O.P.E. walks the final mile with the residents of northern Haiti. In this work, we honor four core principles.



Walking the Last Mile since 1996

Our Guiding Values Recognize the inherent inequalities in our global institutional order that cause real suffering. Honor indigenous knowledge and Haitian wisdom to advance social literacy, education, economic vitality, and human rights. Support a health care delivery model that meets people where they live--in extended family compounds-- to promote general well being. Acknowledge and celebrate local capabilities to promote asset-based community development.

“Social justice is not just sitting behind a desk and writing about it, but really putting your hands to work. We are moving forward because people are putting their whole hearts into what we do.” H.O.P.E. Co-Founder Rose-Marie Chierici


Looking Back, 1996-2020

An Interview with the founders of Alyans Sante Borgne (A.S.B) Shields Sundberg, Chair of the Board of Directors, speaks with A.S.B. Founders Michael Shields and Dr. Thony Voltaire How did you two meet? Michael: We had formed Alyans Sante Borgne with Dr. Ernst Jasmin who was then and remains the Minister of Health for the northern province; and we had arranged to meet at a local church with a doctor who was doing his Social Service internship in Borgne. Dr. Thony Voltaire was a local hero, having been a star student who left Borgne for Port au Prince and then Medical School in Cuba. Our goal was to see if this young doctor could lead our new partnership. We knew immediately he was the right person --humble, fiercely committed, selfless and brilliant. His passion and energy matched Rose-Marie’s. I knew that he would change this community’s failed health system. Shortly thereafter I had to convince Dr. Jasmin, the Director of the Department of Health for Northern Haiti, that Dr. Voltaire was the right choice despite his young age and lack of formal leadership experience. Dr. Jasmin ultimately agreed that “Dok Thony” (his local name) could lead the alliance. That was our first big step forward. Why and when did you create A.S.B? Michael: The conditions in Borgne were literally among the worst in the entire nation of Haiti: mountainous, remote, and far from the capital in a country where political and economic power are highly centralized: Oboy (the commune’s nickname in kreyol) had fallen off the radar. The H.O.P.E. clinic that Rose-Marie started was popular and critically important, but simply too small and understaffed to meet the needs of this population of 80,000. 6

Rose Marie and I made a great team: she was a radical anthropologist who loved her homeland and was committed to addressing the suffering in this community. I was a systems thinker and entrepreneur who believed it was possible for H.O.P.E. to grow without losing Rose-Marie’s ethic. Thus our goal was for us to reopen the hospital and gain access to the other funding sources that were being lost due to the lack of a formalized health system in Borgne. We also needed Haitian Ministry of Health (MSPP) support to find professional medical staff to grow our services. ASB, which we started in 2006, was our partnership to meet those objectives. With MSPP support we have access to their staffing and funding sources. This partnership legitimizes our health systems and in turn we provide valuable data and insights on how best to meet holistic health needs of rural Haiti. What makes ASB so successful in Haiti? Thony: ASB is successful due to the sincerity and enthusiasm on all sides, those of us who work for H.O.P.E. in Borgne, the U.S.A. Board of Directors, and M.S.P.P. Rose-Marie never agreed to reach out to someone to only “help her up.” She was able to go further to find the cause of the fall. Her humility allowed her to consider all humans equal with values and dignity to be respected. She was able to blend in with the community, understand the problem, and join people together to find solutions. There, her humble and ingenious manner compelled one to persevere and flourish.

She shaped our unique approach; we place an enduring partnership at the center of all we do. No other NGO I see is doing that, or really listening to one another to promote innovative, locally-derived programs. What are you most proud of about this longstanding partnership? Thony: I'm proud of our model: treating the roots of the tree to produce better fruits. Michael: I am proud of the strength and resilience of this partnership through 15 years, and the recognition that we have literally moved from the worst health care in northern Haiti to its best rural health system. The data speaks for itself but equally important: this model has been recognized and replicated by many organizations as one that works well for rural Haiti. You two have always seemed like brothers to me. What holds your profound friendship together? Michael: We have bonds that can only be built through perseverance and trust during hardship and adversity.

“ We have built trust in Borgne, walking as we have with this community through ups and downs, over many years. Our deep understanding of the community informs all decisions about programs and actions, in health, education, and economic well-being. All we need are the means — the opportunity to put all that we’ve learned and know into practice – to keep pace with the committed, inspiring experts who work every day in Borgne.” – Mike Shields, Founder Alyans Sante Borgne and Chair of Strategic Development Committee

Thony: We share the same vision. We believe in a better world for everyone, and we work everyday for that.



Looking Back, 1996-2020

Rose-Marie, Medical Anthropologist by Tim Dye, PhD

Rose-Marie Cassagnol Chierici melded with anthropology so deeply that it became impossible to separate her intellectual work understanding and interpreting culture (especially, though not solely, Haitian culture), her lived experience as a woman from Haiti living mostly outside of her homeland, and her compelling vision to put anthropological design and thinking into action, from her ever-present, overarching humanity. Rose-Marie not only became an anthropologist, she lived anthropology, crossing a science-life

I cherished conversations with her that wove anthropological thinking and theory with peoplecentered action, always underscored by the notion of doing something to help balance the inequities imposed upon people and communities by exploitive systems and histories.

barrier that could well have (and very often does) objectify and dehumanize the people among whom she worked and learned. Throughout the years I knew Rose-Marie, I cherished conversations with her that wove anthropological thinking and theory with people-centered action, always underscored by the notion of doing something to help balance the inequities imposed upon people and communities by exploitive systems and histories. During a visit to Borgne, I had a particularly memorable experience that anyone who spent time with Rose-Marie, in that wonderful part of the world, could likely relate. We went for a meandering walk toward town, early in the morning with the sun shining, reflecting about life and experience, seamlessly weaving anthropological thoughts and theories, grand notions of ecology, human society, and dynamics, with on-the-ground ideas for action that would support communities. I distinctly recall the tranquility of that morning, and how I admired her ability to weave thoughts – big and small – into specific plans. “I have come to realize that through sharing the pain of our informants we begin to understand the suffering we observe and write about…” (RoseMarie Cassagnol Chierici, Demele: “Making It”, Migration And Adaptation Among Haitian Boat People In The United States, 1986)


Looking Back, 1996-2020

Rose-Marie, Mother and Activist by Monica Chierici

Sitting down to write this is difficult. Not only because I miss my mother dearly, but because I am afraid the words that I use to capture just how magical it was to know her would be insufficient. I won the mother lottery, and it was such an honor to grow up witnessing her step into her power while simultaneously uplifting others as she ascended herself. It was not long after I was born that my mother started working towards her Doctorate. I was like her little sidekick that went everywhere with her. I would go with my mother to school and to work at the University of Rochester, at one point I started to consult international students coming in to file their visas, which must have been very peculiar to see. We went on a big adventure when I was about six. I joined her on a visit to an apple orchard, which I was very excited about. This visit was different from the typical American child’s outing to the apple orchard, like mine who go and blissfully grab apples, take bites and toss them on the ground while searching for the perfect pick. On this day, my mother was interviewing Haitian migrant farm workers for her dissertation. I remember seeing very small, dingy, box-like buildings, which I would find out housed the people working in the orchards. I remember her having several lively conversations with people and occasionally stopping to explain to me what was said- she always had a knack for keeping everyone engaged. At one point she showed me a giant container full of apples and she told me the workers had to fill it very carefully because if they bruised a certain number of apples, they would


lose pay. This felt to me like a very impossible and unfair task for anybody. And, just like that, very simply, a six-year-old learned about social (in)justice. She was good at teachable moments, and she would always say, “you have to look at the roots of disparity!” My mother, Rose-Marie Chierici, passed away fulfilled, inspired, and still full of passion for H.O.P.E., her students, and her family. She loved her work, “the work”, as she would say. She loved Haiti and its people. She loved her family and friends. She loved against all odds and that was the most marvelous thing about her.

Rose-Marie, Mentor by Pierre Min, PhD

It's been just over a year since Rose-Marie passed away, and not a day goes by without my thinking of my beloved friend and extraordinary mentor. I first traveled with Rose-Marie to Haiti in 1997. I was a sophomore in college and had a vague idea that I was heading to Borgne in order to "help" or "make a difference." Rose-Marie chuckled when she heard my intentions and told me that I should spend the summer learning Kreyol and seeing how people lived and worked. If eventually I wanted to take actions that could improve living conditions for rural Haitians, I would at least know something about the challenges they face. More importantly, I could work to support their own initiatives rather than coming in with imported solutions. Twenty-four years later, having followed in her footsteps to become an anthropology professor myself, I continue to be challenged and inspired by Rose-Marie's and H.O.P.E.'s approach: social change across inequalities come about through relationships, and relationships take time and trust. Witnessing poverty and injustice in her home country was always painful for Rose-Marie, as it should be for anyone who believes that tout moun se moun (every person is a person). I will always be inspired by her courage in confronting difficult situations, her delight in witnessing big and small successes, and in her unshakable conviction that all people should be able to live decent and fulfilling lives.


1996 Looking Back, 1996-2020

25 Years Strong | H.O.P.E. Milestones


Following Rose-Marie Chierici’s doctoral research in community development, she partnered with members of the Spiritus Christi spiritual community in Rochester, NY and local leaders in Borgne, Haiti to open a small health clinic in her homeland. Shortly thereafter, Rose-Marie and Spiritus co-founded Haiti Outreach Pwoje Espwa (H.O.P.E.) as an NGO devoted to working with local leaders from the peasant, church, and school communities to promote general well-being.


H.O.P.E expanded beyond health to include education and economic development 2001 initiatives as a more holistic approach to community well-being. These included a water and sanitation technology center, a grain mill, a bakery, a solar project, and several tree nurseries.


Dokte Thony operates a four-tier health intervention program that remains the heart of H.O.P.E.’s efforts in Borgne. Central to his vision are mobile 2008 hospitals and grass-roots community health care, or a “capillary model of indigenous health” with ASB at the center pumping care, medicine, knowledge, and rights-based health initiatives into the commune of Borgne via local markets and churches. H.O.P.E partnered with PEPFAR to initiate a massive HIV education, prevention and treatment program.


Following a 2005 community-wide health assessment showing alarming statistics, H.O.P.E. launched–with the assistance of Dr. Hugo Jerome of Partners in Health– a new initiative to reach beyond the local clinic into the more remote regions of the community. The goal was to establish a partnership with Haiti’s Ministry of Health (MSPP/DSN) and USAID to address the failed health system. This new 2006 Borgne Health Alliance (Alyans Sane Borgne, or ASB) brought global funding and a broader network of support. Spiritus Christi and a small group of private donors provided the funding for H.O.P.E.’s financial commitments to operate this system. MSPP provided staffing, including ASB’s new medical director,Dr. Thony Voltaire who has built the capacity of this organization on the ground for the past sixteen years.

Spiritus Christi and H.O.P.E.

The catastrophic earthquake forced ASB to dramatically increase capacity, expand the size of the hospital (adding 30 new beds at ASB), and add a health clinic in the mountainous village outpost of TiBouk. Additionally, Dr. Thony led a cholera-response that was 2010 recognized by the Haitian Red Cross and Doctors Without Borders (MSF) as the most effective rural response in the nation of Haiti. Awarded a $250,000 grant by the Red Cross, H.O.P.E. added clean water, sanitation, oral rehydration therapy and greatly expanded maternal health capacity. Between 2011 and 2015, the Red Cross awarded H.O.P.E. more than $250k in grants.


The leaders of H.O.P.E offer our profound and enduring gratitude to Father Jim Callan, Reverend Mary Ramerman, Reverend Myra Brown, and the entire Spiritus Christi community. While the health clinic that originated as part of Spirtus Christi’s ministry has grown in ways that were hard to imagine in 1997, our work remains rooted in the idea beautifully expressed by Reverend Myra Brown that “power should be used to help lift the powerless, to level the playing field, and to create equity and justice for all.” Indeed “Spiritus and H.O.P.E have walked with each other along life’s journey for over 25 years, committed to each other and the relationships that we have formed. The Spiritus community sees the Borgne community as an extension of our family. We are always carrying one another in our hearts.” You are true friends to H.O.P.E. and Borgne.



Dr. Thony launched Sante Nan Lakou, or “health in the yard” as a truly unique and indigenous response to healthcare needs in Borgne. 2013 And H.O.P.E. Board Member Dr. Steve Burgart created a world-class dental clinic at ASB, providing equipment, training, and a foundation for a massive oral community health initiative.

2021 After two decades of successful capacity-building and innovative programs, Borgne has been widely recognized as the best rural health system in the North of Haiti. In a new initiative sponsored by the Pan American Health Organization (PAHO) and the Haitian Ministry of Health, Dr. Voltaire and ASB were selected 2021 to lead a multi-community health association that extends H.O.P.E’s model and programs beyond Borgne to neighboring communes in northern Haiti. At the same time, H.O.P.E. won a competitive USAID “Investor Tank” Grant of $150,000 to expand mobile health clinics and add community health workers. H.O.P.E. is the largest and most successful employer in Borgne today.

2021 Partnering with WomenStrong International (WSI), H.O.P.E. expanded its capacity to address the crucial shortfalls in women’s health, literacy, and economic vitality. The financial support 2015 and expertise resulted in a series of highly successful programs such as trained birth attendants, micro-lending for economic initiatives, and community-wide maternal and child health education through traditional means.


We stand at an important crossroads, with decades of ethical, effective partnership at our backs and a bright future ahead of us. Here are some highlights of our year in review.

Where We Are Now



725 patients treated for acute RESPIRATORY INFECTIONS


Residents of Borgne


51 52 BEDS




available to


space, and vaccination-in-the-street program.




112 new incidences

and treatment


11 ANAMATRIS (gender-equity trainers)

LIVE BIRTHS including one

set of triplets

patients treated at

Alyans Sante Borge for



48 689 1,162



(health agents)


$70,000 15 RAISED FOR COVID-19 RELIEF EFFORTS including training, education, PPE, quarantine


new incidences


H.I.V TESTS administered


visited Alyans Sante Borgne



treated for arterial

1152 GASTRITIS treated for


patients treated

692 TYPHOID cases treated

725 treated for intestinal


Where We Are Now, 2021

We Run a Million-Dollar Program on $250,000/Year In the past year, H.O.P.E. has reorganized our leadership structure, appointed a new Executive Director, instituted new Board norms, and submitted grants to the NIH, Haiti Renewal Alliance, the Dorothea Haus Ross Foundation, and International College of Dentistry. Additionally, PEPFAR awarded H.O.P.E. over $50,000 for COVID-remediation, owing to the highly successful model we have relied upon to spread awareness regarding acute health concerns. We also responded to a number of critical situations in Borgne including a comprehensive COVID response—constructing and outfitting a quarantine area at the hospital, providing personal protective equipment (PPE) and necessary supplies for staff, and orchestrating COVID-19 vaccinations (in addition to the vaccination campaigns we run annually for Tetanus-Diphtheria, Polio, Measles, and others). The urgent need to respond to, and contain, COVID in the community also led to our relaunching the S.E.E. Team (learn more about this innovative indigenous program on page XX), or trained Borgne community members. They lead outreach and education efforts related to health and well-being, including COVID prevention measures such as masks, social distancing, and hand washing. Borgne also experienced an outbreak of scabies— an extremely contagious skin condition caused by a parasite called the human itch mite. Though often a relatively minor condition in wealthier regions, in areas such as Borgne, where sanitation and hygiene resources are inaccessible, scabies


– Carrying supplies to remote mobile health clinic (left)

can quickly lead to secondary infections and complications, and can be life-threatening. H.O.P.E.’s response to the scabies outbreak included the distribution of hygiene kits with soaps and detergents, outreach and prevention education, along with medication and treatment at the hospital and clinics. We have responded to other significant challenges including the abrupt shift in Haitian to U.S. currency exchange rate, and the assassination of President Moise with the resulting political turmoil and uncertainty his death brought to Haiti.

H.O.P.E.’s work is not simply reactive, responding to one crisis after another, but rather a proactive approach. Based largely on the expertise, approach, and vision of Dr. Thony, we strive to approach problems holistically, considering the economic, educational, equity, and environmental implications of our actions over the long term. This includes opportunities related to sustainable community development, local resilience and self-reliance, and capacity building. We seek to recognize local assets—human, social, natural, institutional, and capital—and their crucial role in realizing the community’s vision for Borgne. Committed to community assets since our inception, we were keen this year to catalog and amplify the wealth of talent, ideas and resources in Borgne and the wider global H.O.P.E community strengths. Beginning in Spring 2021, we launched a livelihood study, which will identify available assets in the community, and help us understand barriers to making use of them. The results of this survey, or anko, will help us support local initiatives based on local wisdom and resources, including the hearts, minds, and hands of the people of Borgne. In the pages that follow, we highlight our core programs, and the ways we have prioritized them in the past year, even as, in some cases, we have not had funds to fully support them at the level they deserve.


Where We Are Now, 2021

Alfasosyal Alfasosyal is our “alpha” program; it is at the foundation of every one of H.O.P.E. 's programs in Borgne. Roughly translating to “social literacy,” Alfasosyal instills a sense of pride, a personal commitment to change, and a sense of self-determination within the community. It promotes these critical values through a community education approach that places emphasis on community assets and social networks that sustain wellbeing. Patrick Bernard Pierre, board member and longtime community leader in Borgne, devised the word to explain a “participatory dynamic” that fuels change and promotes dignity. Alfasosyal, however, is more of an attitude or a steering mechanism that promotes an ethic in all other efforts. It is a Haitian concept whose absence from other global efforts to “help Haiti” explains why so many aid programs fail to generate enduring change. Alfasosyal works because it is a Haitian concept which places local individuals at the center of conversations about anything from how to share seedlings to how to fight parasites. Through Alfasosysal, community members become aware of the resources at their disposal and the ways in which they share and make use of the indigenous knowledge and wisdom.


One cogent example of Alfasosyal’s programmatic necessity is the success of our Animatrice program, which cultivates the inherent leadership capabilities of women to self-determine their goals for community health, education, and economic well being (animatrice translates roughly to “animator”). Specifically animatrice: • Increase literacy among women in the community through establishing and ensuring proper functioning of lekòl alfa classrooms; • Assist young pupils who are having difficulty in their studies and in learning trades; • Educate and train girls and women on topics related to pregnancy, breastfeeding, and nutrition; • Help girls and women to choose and practice income-generating activities; • Encourage and channel women to practice or learn a trade; • Increase women and girls’ understanding of the importance of saving and help them set aside some of their income; and, • Organize and promote economic activities in the community (community markets, savings accounts, etc.)











Where We Are Now, 2021

Sante/Health At H.O.P.E., we love to share the story of Dr. Voltaire’s birth: he was indeed “born on the side of the road.” Though his mother did not know it at the time, her youngest child would grow up to be a champion of maternal health, providing a multi-tier, full service, and free health delivery system as the Medical Director of ASB in the community where he was born. As he explained, returning was an education: “It felt like the seven years I spent studying medicine in Cuba were just the beginning of my medical education. In reality, I learned medicine in the community. To practice medicine is to understand the context of a problem and to find the solution to that problem. I was trained in a country with a well-organized medical system, but I was shaped as a physician by the needs and conditions of this community. I had to rethink everything I knew, to adapt it all to the reality that this community lives. But it was also an auspicious moment, because H.O.P.E. and the government at that time decided to form an alliance to better address the health problems of the community. I met RoseMarie Chierici (Executive Director of H.O.P.E.) and Michael Shields (Deputy Executive Director) in 2006. From that very first meeting, I have felt that we shared the same ideas about how to resolve the health problems of the community.” Dr. Thony has guided H.O.P.E. to create a model of health care in Borgne that is rooted in this understanding of the impact geography can have on a person’s health. Our model prioritizes the delivery of care and dignity of all community members over maintaining preconceived ideas about how care should be delivered.


Dr. Thony manages what is both the only health system in this commune of 80,000 and an impressive system by any standard. The fourtiered system includes: 1. ASB – a high-capacity, expertly staffed hospital just outside the town of Borgne. The hospital provides basic services, such as an inpatient facility, internal medicine, women's health, maternity, delivery, and prenatal and postnatal services, as well as a dental clinic, TB and HIV/AIDS programs, a lab, and pharmacy. This hospital moves nimbly to respond and provide large-scale interventions (from a cholera outbreak in 2012 or a global pandemic in 2020).

Whether we are supporting ASB or funding training for the S.E.E. Team, H.O.P.E. prioritizes the needs of families over institutions through an orientation and through-line we call Sante Nan Lakou, or “health in the yard.”

2. The secondary level includes a health clinic centrally located in Tibouk, the second largest population center. The clinic is near to the largest public market in the commune, and it provides a physical and symbolic bridge from the farthest corners of this mountainous commune to the administrative center in the town of Borgne. 3. Mobile health clinics to remote areas of the commune. Historically, mobile clinics go out four times a month and rotate among different localities of the seven communal sections. Approximately 200-300 people attend each mobile clinic, and these events serve as opportunities for community health education. 4. At the end of this four-tier system is the lakou, or “yard.” During the cholera outbreak of 2012, we created the S.E.E. Team in order to expand our efforts yet further in the community, ensuring we reach every home during moments of crisis. The S.E.E. Team (or Sante, Edukayson, Ekonomie Team) consists of trained community leaders who collect data from families throughout the commune to help ASB leadership respond to emerging needs in the commune. Additionally, the S.E.E. Team is the front-line response during any crisis in Borgne, going as they do from lakou to lakou (or home to home) to provide anything from water purification systems in a cholera spike, to hygiene kits during a scabies outbreak. Much work remains to reach “last mile” communities and respond to their needs, and H.O.P.E. is committed to this Haitian model of health care, and the doctors, nurses, and community health workers who walk the last mile every day in Borgne.

– Nursing staff at Alyans Sante Borgne Hospital

“ We are not interested in building a big hospital, but a health system that remains focused on, and is adapted to, local challenges. In Borgne, low levels of education and literacy contribute to poor health and enduring poverty. To change our community, it is imperative to attend to health, but education is even more critical. It is only through education that attitudes can change and the economic situation can improve. Improving education, creating livelihoods, creating the environment for better health, this is our vision.” – Dr. Thony Voltaire 21


Where We Are Now, 2021

Edikasyon/Education In the early years of H.O.P.E.’s partnership with Borgne, we focused our education efforts on “schools.” Schools matter, and we remain committed to institutions that provide learning -- to the bricks and mortar buildings in Borgne students attend. Watching children walk to school in matching uniforms, talking to one another, and holding hands is a heart-warming sight on any weekday in Borgne. Further, students who excel in government-funded schools tend to contribute economically and intellectually to communitydevelopment efforts. We also know now, however, that traditional classrooms are not the only locations where learning can take place. In 2012, H.O.P.E. conducted a survey which found the literacy rate in Borgne to be roughly 34% among adults. In response to these findings, H.O.P.E. established Lekol Alfa. The objective of the program was to provide basic reading and writing training for adults, thereby enabling them to engage in everyday tasks, including reading signs and medical prescriptions, signing their names on legal and other documents, tutoring their young children, and generally enhancing their capacities to provide for their families. The Lekol Alfa pilot program offered free daily classes to 35 people living in a small "Habitasyon," or neighborhood, in Borgne. The results of the pilot program were heartening; students who began the course not knowing a single letter of the alphabet were, after eight months, familiar with all the letters, able to write their own names, and reading and writing simple Kreyol words and sentences. Over the next two years, the Lekol Alfa team expanded the program

to seven more districts, including five centers in Molas, the most rural district of Borgne. In 2015, the Lekol Alfa team developed a new curriculum that would provide “social literacy” (Alfasosyal) lessons in addition to reading and writing training. The social literacy classes include lessons on health, agriculture, domestic violence, and community engagement. Social literacy is included in the everyday curriculum taught by the Lekol Alfa teaching staff. Additionally, each literacy center is visited by two professionals per month, each of whom teaches a special class in their discipline; doctors teach about preventive health care, lawyers teach about accessing legal help, etc. The objective of the social literacy curriculum is to provide students with an opportunity to implement their reading and writing training as they learn about ways to improve their lives and their communities. Lekol Alfa only asks that each district provides a space in which students can congregate to learn. Many of the classes take place in makeshift classrooms people have built for Lekol Alfa and are no doubt simple by the standards of schools in the United States. Each classroom looks different from one lakou to the next. What remains consistent is that all staff members are local Haitians who participate in teacher and supervisor trainings both before and throughout the program. There is a Program Director and a Community Outreach Coordinator who monitor the reading, writing, and social literacy components of the program respectively.



Unfortunately, the Lekol Alfa program was put on hold in 2018, due to lack of funding. There are people who continue to keep the spirit of Lekol Alfa alive, and it remains a key priority for H.O.P.E. in 2022 to raise the $25,000 a year needed to support Lekol Alfa. Thankfully, our Community Library Project remains funded and strong. Not even COVID-19 stopped construction on a second Library Resource Center. These two centers provide access to books, and they also operate as might a Town Hall, providing spaces for people to gather and hold meetings.


In addition to educational programs on the ground in Borgne, we know that the learning goes both ways. H.O.P.E. focuses on the education that our Board members, partners of H.O.P.E., and the United States media must attain regarding Haiti. People speak often about changing the narrative. For us, what that means specifically is centering Haitian knowledge and operating from a place of openness. In practice, this often looks like reflecting on challenges facing Borgne through Haitian proverbs. One such proverb captures this element of our partnership: Woch nan dlo pa konnen mizè woch nan soley, or the rock in the sun does not know the experience of the rock in the water. Haitian concepts of development and partnership place community, patience, and humility at the heart of every decision. We have come to be hyper-aware that we need our own “social literacy” program like Alfa Sosyal when it comes to partnering with Haiti. H.O.P.E.’s new “education and awareness” committee is designed to promote this dual-track of learning simultaneously, reducing any notion that our friends in Borgne need anything from us other than trust and financial support when it comes to education. We remain dedicated to bringing these lessons of community, patience, and humility back to our U.S. and global partners, as we clearly have much to learn from Borgne.

Where We Are Now, 2021

Ekonomi/Economic Vitality Dayo Olopade, Nigerian economist, suggests that “global institutions [...] as well as macroeconomists, philanthropists, and journalists [...] look away from the figures walking to work, the green shoots in an urban clearing, or the potholes and kiosks that can provide useful orientation. Instead we focus on formal organizations and their formal solutions [...] It turns out we have been throwing a party in an empty ballroom [...] the most economically significant interactions are between individuals and decentralized groups.” (Olopade, 8) At H.O.P.E., we see the reality of Olopade’s insight in all areas of our work, but especially when it comes to economic vitality programs. We do not fund economic development in Borgne; instead, we aim to support locally-designed and culturally relevant projects that will neither disrupt regional patterns in a negative way nor prove overly complex. People in Borgne do much with the resources they have, and H.O.P.E. actively engages in conversations with leaders in Borgne about small-scale, sustainable, and locally relevant economic vitality programs that make use of local assets. In June 2021, we launched a Community Survey to take a household-by-household account of development assets. This work is tied closely to Alfasosyal and will not merely count monetary assets but will focus broadly on what strengths, knowledge, skills, and passions exist in Borgne as van nan vwèl, or wind in your sails. One of H.O.P.E.’s most successful programs in this arena is the Boukoulou, self-help groups who use traditional forms of collaborative savings and

borrowing techniques with a goal of enabling women to be more economically independent through capacity building, the formation of self-help groups, and development of income generating activities such as fruit and vegetable drying, community gardens, mother’s clubs, and women-centered markets. This program’s chief goal was to address the conditions that keep women and girls in poverty by building on familiar traditional forms of group saving. This model valorizes local culture, local assets, women’s leadership, and local problem-solving strategies to create a model that is innovative and easily understood and applied in Borgne. Similarly, leaders of the community survey, like Patrick Bernard Pierre, have worked in the past with gwoupman peyizan (Borgne’s peasant collective, formally called KGPB), to develop saleable goods for sale in local markets. Such goods -- honey, soaps, juices, chocolate -- have potential to breathe new economic life into this rural, mountainous, and green region, as well as provide independence and income, most especially for women.


“ Community development is voluntary action, but everyone benefits from it. Not everyone has to participate in it. For community development to work, it needs organization and to raise people's awareness. Development is not about building things; it requires you to change the ideas and thoughts of people. . . You can't do community development from a distance. If I am sitting in town, I am not able to imagine the kinds of development that needs to happen in remote places. I need to go there to work. I need the support of the people to work with me. I cannot impose development.” – Patrick Bernard Pierre, Community Organizer and Board Member


Where We Are Now, 2021

Partnering Effectively: Low Administrative Costs Means Your Donation Has Direct Impact H.O.P.E.’s sole financial purpose is to provide funding and technical support to our friends in Borgne. As such, we maintain minimal administrative overhead in the United States. We have a small office and employ part-time administrative support in Rochester, NY. These expenses account for less than 3.5% of 2021 our annual operating budget. Legal fees, audit expenses, and other requirements associated with being a registered U.S. non-profit raised our 2021 total U.S. based administrative costs to approximately 16% of our annual budget. In years where our donations are greater, our administrative costs can be a little as 10% of our annual budget. We rely heavily on our very engaged, all-volunteer board of directors to support the fund-raising and organizational development work necessary for our work. Our board members have been incredibly successful in raising both funds and awareness of our work. For example, Dr. Steve Burgart has secured thousands of dollars of in-kind donations in the form of equipment and expertise to establish our dental clinic, and Wynne Graham has worked tirelessly to secure funding for our Lekol Alfa programs. In 2021, all of H.O.P.E.’s operating budget was generated from personal donations and gifts from friends of H.O.P.E. and our generous board members. We know of very few organizations who so effectively combine low overhead costs and volunteerism to ensure this kind of high impact social return on donations. Alyans Sante Borgne/Borgne Health Alliance is a partnership between H.O.P.E. and the Haitian Ministry of Health (MSPP). Established in 2006, this partnership leverages an average of $200,000 annually in funding that flows through MSPP

We take our stewardship of donation and grant funds very seriously. We simply can not afford to waste a single dollar. The needs in Borgne are great, and we have limited resources. Every action we take ensures that donations are used effectively and efficiently.

and other local Haitian partners to support community health programs in Borgne. These programs include our USAID-PEPFAR funded HIV/AIDS prevention and treatment programs. For the period between October 2019 and May of 2021, more than 15,000 people benefited from our PEPFAR funded programs. In addition, because of this partnership, ASB is eligible to receive both funding and technical support from the Haitian Ministry of Health (MSPP) and other international multilateral donors such as UNICEF, Red Cross, USAID, PEPFAR, and Catholic Medical Mission Board (CMMB). Throughout our time working in Borgne, we have effectively engaged a range of partners who provide both funding and technical support for a range of programs.



We have never been closer to achieving our overarching goal for Borgne – to provide an ethical, locally-driven model of essential services through a strong and well-funded partnership. Our future is bright, as this work is now being recognized for its efficacy and cost-effectiveness when compared to other forms of aid and investment in community development.


Strategic Goals, 2022


Strategic Development As outlined in this report, our success over these many years has begun to put H.O.P.E. in a strong position for funding and partnerships. Our strategic goals are to more fully leverage these successes and the broader recognition to advance our work. Our strategy is clear: to ensure the stability and sustainability of our operations in Borgne through a Three Year Development Program to generate $960,000 USD to be allocated at $320,000 annually. Our objective is to build this capacity through a combination of private contributions, private grants, and federal grants. The amount guarantees support for the organization’s core needs and avoids the potential for shortfalls and disruptions that would cause undue suffering and undermine the staff and community’s sense of security in vital services.

Our Objectives Have Been Prioritized Into Three Categories:

Critical Important Desirable

“Our Strategic Development Goal is to ensure that funding is secure for the CRITICAL and that we work toward securing programmatic funding for all of the IMPORTANT objectives.”


Strategic Goals, 2022

2022 Fiscal Budget Increase our general operating budget to $320,000 from the current level of $260,000. This increase is needed to fully cover core services and related operational budgets which have been running at a deficit in 2021. Our Board of Directors has conditionally approved this budget increase subject to securing funding at this increased level. We need to demonstrate a 12-month income stream before making this change.

Mobile Clinics At the core of our health model is the preventive and educational component that is realized through mobile clinics. These clinics bring the staff, labs/diagnostics and treatments to address the most common causes of more severe health problems. By early detection, raising education and awareness levels, and treatment of the less severe cases we lower the need for the higher cost interventions at our community hospital. These clinics are the core of our Sante Nan Lakou model of health and have been proven to work. Due to budgetary constraints in 2018, we were forced to reduce these mobile clinics to one per quarter, which is woefully short of what is needed to reach each of our sections/habitations over this 80 square mile mountainous terrain. Our objective is to return to a minimum of one mobile clinic per month, ensuring coverage of all sections at least twice per year.


Form Haitian Legal Entity There has been a well recognized need to establish a legal entity in Haiti to reach sources of aid that are restricted to development countries. To date we have relied solely upon sources that are available to U.S. based entities. H.O.P.E. is a 501(c)-3 organization. This new legal entity entitled SEE AYITI will be headquartered in Borgne and operated by our leaders in Haiti. It will be independent of our current legal operations but will operate through a strong partnership with H.O.P.E.

Cultivate Critically Important, Decentralized Health Networks • Haiti Ministry of Health Partnership (ASB) – Continue to leverage this key partnership that we formed in 2006 in collaboration with H.O.P.E., Haiti’s Department of Health for the North (MSPP/DSN) and USAID’s Haitian Health Consulting Partner (MSH and more recently CMMB). This partnership has leveraged the full force of all three partners to improve health in Borgne from the lowest rating in that area to one of the best in rural Haiti. • Department of North Union Arrondissement du Nord Sante (UANS) – Our medical director, Dr. Thony Voltaire and the ASB organization were selected to lead this new partnership that links several of the communes in the Department of the North. Pan American Health Organization (PAHO) is a key sponsor for this new organization.

•C ommunity Oral Health with Port-au-Prince Dental School – Through a recently submitted grant application to National Institute of Health, this project will bring together funding, resources and staffing from universities in Haiti and the USA (University of Rochester Dental School) to launch a comprehensive preventive dentistry program and treatment protocols across the entire commune of Borgne. • North-South Mental Health Program with Capracare. Together we are building these capacities on the strength of a proven model, a long-standing and respected partnership, and the contributions of others who believe in our work! As our founder, RoseMarie Chierici used to say to celebrate a job well-done: Ayibobo!!!


OUR VISION FOR BORGNE H.O.P.E. supports "Haitian solutions for Haitian challenges." We partner with leaders of – and residents in – Borgne to create sustainable solutions that address community needs. We practice revolutionary generosity, learn from the residents of Borgne, and support programs the community prioritizes: health, education, personal empowerment, and economic growth.

Get Involved • Donate • HOPEHaiti.org