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.”