The Story of ASB – How two visions combined into a new health model for Borgne.
This is the story of the beginning of Alyans Sante Borgne (ASB)/The Borgne Health Partnership, which launched a powerful new capillary model of rural health in the community of Borgne. In retrospect, it shows how a small and inexperienced team with a shared vision and passion can achieve an improbable and highly important outcome. I had the good fortune to be there at the very beginning and this is how it happened.
During one of my first trips to Borgne with Rose-Marie, we had escaped the heat and the noise of the market to sit on the concrete ledge of an unfinished building overlooking the sea. We started basically dreaming out loud about expanding H.O.P.E.’s little part-time clinic in the main village of Oboy to leverage the defunct hospital at Fond la Grange. This was a large complex that had been abandoned for several years when the only physician in town had died. All that remained was one first-year intern doing mandatory social service and a public health nurse, both working part-time without electricity or running water. We had invited the intern, Martine, to work on her days off in our clinic which had both electricity and clean water, plus a small functional lab and pharmacy. Through her we learned that her replacement was to be a young local M.D. who had just completed medical school on a scholarship to Cuba.
A couple of months later we found ourselves sitting on the veranda of the local St. Rose rectory in the complete darkness as Dr. Thony Voltaire, the new intern, came to meet us. We were speaking in French and each introduced ourselves. Rose-Marie asked Thony to tell us a little bit about himself, in what is now a well-known story. At first I thought that Thony had not understood the question because there was a fairly long pause before he spoke in his quiet voice, “Je suis ne’ a le bord de la route alor que ma mere etait en train d’aller a marche’/I was born on the side of the road as my mother was walking to the market’. What followed was one of the most powerful commitments I’ve ever personally experienced. Thony walked us from his birth, through his early years and into the very improbable circumstances that led him to become a doctor. He transitioned into his promise to his home community that he would not rest or ever give up until everyone had access to proper medical care. This was coming at a time when Borgne had the lowest vaccination rate and the highest mortality rates from water borne illness in the North of Haiti. So, yes, it was an ambitious goal; but Thony stated in calmly and firmly. He explained that he had been living at his mother’s and basically working round the clock as people came by to get help for a wide range of health problems. We then explained our offer to join forces and combine our clinic, staff and equipment with his hospital. The three of us agreed that it was worth a try and started with Thony’s commitment to work in our clinic while we worked to get the more formalized structure into place.
Several month’s later, in January 2006, Rose-Marie and I were sitting around a table in a small building adjacent to the Hotel Christophe with Dr. Ernst Jasmin, The Director of Haiti’s Department of Health for the North of Haiti (MSPP/DSN), to put together our partnership. Dr. Jasmin had his key staff with him, and Rose-Marie and I had brought a small support team from Borgne. We drafted a one-page partnership agreement that basically left H.O.P.E. in charge of running this entire system and funding most of the salaries and medication budget, with critical staffing and support to be provided by MSPP. This was a very bold move on our part, because we had no idea where we would get funding, nor how to manage a health system of this scale. But we did have good guidance from Paul Farmer’s PIH organization, as Rose-Marie was a friend and advisor for that organization. One key contributor to the overall model was Dr. Hugo Jerome, who had served as Medical Director for PIH in Cange, and had worked with us on the community health assessment. I remember Rose-Marie looking directly at me in a near panic and I whispered, ‘don’t worry, we’ll figure this out later’. We signed.
Rose-Marie signed after looking at me and asking ‘how are we going to do this?’
Our first budget meeting in Borgne after the ASB Partership was signed (May 2006)
We faced enormous challenges putting this all together. The local community was suspicious of any government involvement, our clinic staff was dead-set against moving to the hospital, the building was a disaster with rodents and bats throughout, etc. We were optimistic and excited. Over the next year we raised the funding to renovate the first parts of our now expanded clinic/hospital and recruited the staff. MSPP provided a medical director; but that doctor lived in Cap Haitian and rarely showed up in this remote town with bad roads and a very poor population. Instead Dokte Thony became the driving force for the new health model. He worked tirelessly and donated his salary to others in need as he lived in a small room at the hospital. We worked together to tear down walls, get running water from a spring that we capped in the mountain a half-mile away, and got a generator working to provide electricity. I spent most of my time on Borgne visits working through people and financial issues. Rose-Marie covered the community outreach and listened to all of the underlying needs and issues. Thony won over all of the staff and ASB became a legitimate health model.
Dok Thony worked all day in the hospital and joined us in construction of the lab late into the evening.
By 2010, when both a cataclysmic earthquake killed a quarter of a million Haitians and left millions homeless and destitue, and a cholera epidemic broke out ten months later, ASB was running a staff of seventy and had the entire hospital complex up and running. Dok Thony had established mobile clinics to the remote parts of the community, and all of the key health metrics were improving. The ASB Cholera response was among the best in rural Haiti, as Dok Thony had immediately launched the preventive and treatment protocols through the active capillary health outreach. That was the turning point for an even greater expansion of services. We were a legitimate health system and received funding from Red Cross, Doctors Without Borders and later Women Strong International.
As I look back, it was truly a remarkable outcome, launched in good faith by a few of us who really had no idea what we were doing or how to do it. I feel rewarded beyond measure to have had the good fortune and privilege to work with Thony and Rose-Marie toward this end. There is still a lot of work to be done. We are not done.