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Wednesday, November 14, 2012

Ask Wednesday: Dr. Jean Ramses Rouchon on his life in public health (so far)

We are honored to interview Dr. Jean Ramses Rouchon, a naturalized citizen of the United States who has in the course of his varied educational and work experiences become a skilled practitioner in public health. He earned his Doctor of Medicine degree in Port-au-Prince, Haiti in 1992.
    Dr. Rouchon recently came to our attention when our editor in chief was copied on an email stemming from his own role in Dr. Rouchon's education. Morris Dean had, in his capacity as North Carolina's state coordinator for the Academic Common Market, approved Maryland's certification of Dr. Rouchon as a resident of that state to pursue a Master of Science degree in Public Health at the University of North Carolina at Chapel Hill. [The ACM is a regional program coordinated by the Southern Regional Education Board in Atlanta through which the southeastern states share their unusual degree programs at in-state tuition rates with residents of participating states that don’t have the degree programs. Unfortunately, North Carolina’s legislature has put a stop to North Carolina’s participation. If Dr. Rouchon were applying today, he would not be able to study in North Carolina at affordable rates through the ACM.]
    The email from Maryland was a happy connection. [Our questions of Dr. Rouchon are in italics.]

Dr. Rouchon, you were born in Port-au-Prince, Haiti forty-seven years ago. Please tell us about growing up in Haiti.
    My father died when I was eight years old. My two older sisters and I were raised by my mother, who was the principal of her private elementary school. Pertaining to my high school education, I attended the Institution Saint-Louis de Gonzague, a well-known college that was led by French Catholic priests. At the end of my studies, I decided to become a physician and enrolled at the main faculty of medicine that existed in Haiti at that time: Faculté de Médecine et de l’Université d’Etat d’Haiti.
    Generally speaking, I had a very happy childhood and adolescence, and my mother and teachers targeted excellence for me. However, not everyone has been that lucky.

We suppose that you became fluent in Haitian creole and French early. When did you learn English?
    Haitian creole is spoken by most Haitians. I mastered French as everyone does who holds a high school degree in Haiti or speaks French at home. I started learning English in high school. I was able to practice more while I was working at the Comité Bienfaisance de Pignon, a non-governmental organization founded and led by Dr. Guy Theodore, my mentor, and supported by the United States Agency for International Development (USAID) in Haiti and American missionaries. I later refined my spoken and written English at Johns Hopkins University.

How did you become interested in medicine?
    I was always interested in alleviating people’s pain or health problems. It became obvious to me to choose this path when I was offered the opportunity.

What was the state of public health in Haiti in those days?
    To be honest, I had no idea about public health in 1984. In my third year at the school of medicine, a class on the topic caught my attention and I found my vocation later at Comité Bienfaisance de Pignon.

You studied and worked in Haiti until 2007, right? You were a health manager in the district of Pignon and medical director for the Comite Bienfaisance de Pignon. What or where is the district of Pignon?
    Pignon is a municipality that provides virtually the only clinical care and public health assistance in the northern department of Haiti, within a catchment area of nearly one hundred forty-two thousand people. It has one central hospital and five satellite clinics.

We imagine from what little we know of life in Haiti that your work in Pignon was challenging. What main challenges faced you as a senior member and medical director there?
    It provided me with a distinctive opportunity to collaborate with Dr. Theodore and the Community Health Director and their staff, partners, and stakeholders, in helping to better the population by providing clinical care and public health interventions. I helped design, implement, and manage activities toward our Millennium Development Goals, especially in the areas of maternal and child health, combating HIV/AIDS, and promoting gender equality and universal education.

How well qualified were the doctors and nurses assigned to provide health care?
    Doctors, nurses, and nurse-assistants are well trained in Haiti and consequently very qualified. Most of Haiti’s health schools are in fact accredited in the United States of America, and health professionals can work in the U.S. after passing the exam for foreign students. Hundreds of physicians and nurses originally educated in Haiti are practicing in the U.S. today.
    More concretely and regarding Pignon, USAID-Haiti, through Management Sciences for Health, promoted a program of continuing education. American physicians and nurses visit the system on a regular basis, which allows reinforcing competencies. Dr. Theodore was trained as a general surgeon in the U.S., is board certified, came back to Pignon where he is from, and still gives direction to young practitioners offering their services in the system. He was my supervisor and is a dear friend.

What was your most memorable contribution to public health in Haiti? And what was your saddest disappointment?
    In Pignon I was involved in the training of fifty special midwives (Vanguard program initiated by Pignon around 2002) specifically for working in the rural areas, and I have participated in the training of more than two hundred nurses and physicians in Haiti as an instructor for the Advanced Life Support of Obstetrics (ALSO) program. This endeavor resulted in a significant decrease in both in-hospital and out-of-hospital maternal mortality in the immediate ante-partum and post-partum period as well as in neonatal mortality.
    I am strongly positive by nature and by choice. As a result, I truly do not have saddest disappointments in my career.

You've worked most recently with Earth Institute at Columbia University. What are you most proud of there?
    My proudest work there, this very year, was participating with other partners on the ground in the southern part of Haiti in launching a new class of community health workers there who use special cell phones to collect data. They represent the main health workforce in some developing countries, given the deleterious effects of "the brain drain" and the remote areas often involved that have no access to health care.

What factors led you to seek United States citizenship, and when were you naturalized?
    My citizenship epitomizes the outcome of a love story. Indeed, I was doing a fellowship in laparoscopic surgery at Inova Fairfax Hospital [in Virginia] when a beautiful and delicate nurse anesthesiologist and I met. She was from the District of Columbia. We fell in love at the right minute, like in the movies. Almost one year later, we married and went back to Pignon together. She spent one year at Comité Bienfaisance de Pignon, where she taught anesthesia to three nurses. Two years after our marriage, I joined her in Maryland where she began working for Johns Hopkins Hospital. I was naturalized in Baltimore, Maryland three years later.

Since coming to the United States, you have of course continued to focus on issues of public health. What contributions have you made so far here, and what contributions would you like to make in the future?
    After my graduation at Gillings School of Global Public Health at the University of North Carolina at Chapel Hill [2010], where I met only heartfelt, competent, and wonderful professors and classmates, I became consultant for University Research Co., LLC. I participated with a team in the replication of quality standards for Orphans and Vulnerable Children (OVC) at a national level in Haiti on behalf of the President’s Emergency Plan for AIDS Relief (PEPFAR) and subsequently initiated the implementation of the USAID Health Care Improvement Project in the country.
    Later, as a Senior Health Advisor with Earth Institute at Columbia University, I technically supported a team and partners on the ground in health interventions in a Millennium Villages Project in Port-à-Piment, Haiti, for a catchment area of thirty thousand inhabitants. Areas of endeavor included family planning, reproductive health, malaria, HIV/AIDS, materials development, and maternal, newborn, and child health.
    As for the future, I will be waiting to see what it has to offer me.

What is the situation in Haiti?
    The current Minister of Health established new policies for Haiti’s health system in January 2012. I attended a workshop where diverse organizations, institutions, and agencies were represented. The Minister has extensive experience and is determined to modernize the system.

What question or questions haven't we asked that you wish we had?
    I would like to add that whatever we undertake, it is always more efficient and effective when it is the result of teamwork.

9 comments:

  1. I thoroughly enjoyed this interview and felt the warmth of Dr. Rouchon's humanity in it.

    I'm curious about the reference to the brain drain. It suggests that academically gifted young Haitians must be pessimistic about their future. What solutions does Dr. Rouchon see that would convince Haitians not to emigrate?

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    1. I thank you Ken for your comments. First, I will not be so formal in asserting that young Haitians need to be pessimistic pertaining to their future. A lot of initiatives are currently undertaken for a sustainable change and many young Haitians have succeeded in Haiti in the past. Second, offering a quality work environment including availability of materials, relevant management and decent salaries can motivate a professional to remain in his country. I have found these conditions at Comité Bienfaisance de Pignon, which explains my long career in this organization as so many other employees and colleagues did. Lastly, the decision to emigrate belongs obviously to someone and his /her close relatives. Once again, I express my thanks for the opportunity given to clarify this point.
      Jean Rouchon

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  2. Dr. Rouchon is truly an American success story! It's heartwarming to know that through SREB's Academic Common Market program, the State of Maryland's and Maryland Higher Education Commission played an important role as well in facilitating Dr. Rouchon's educational goals.

    Genny Segura, Ph.D.
    Maryland ACM Coordinator
    Maryland Higher Education Commission

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  3. Dr. Rouchon seems an amazing person and an outstanding example of a success story for an American outreach program. Can you tell us why the North Carolina legislature has ended the state's participation in the program that enabled him to attend UNC?

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    1. motomynd, I'm glad you asked, because I think North Carolinians should know why North Carolina pulled out. In my opinion, it was a direct result, not of the difficult financial times themselves, but of the fact that a Republican-controlled General Assembly had been elected in 2010. Other southeastern states were also going through hard times financially, but they didn't end their participation in the ACM. They continue to support a program that is nothing but good, in making unusual degree programs affordable for each other state's certified residents and, in the process, of attracting good students from other states to support the degree programs in their own institutions.
          No, it is abundantly clear that the General Assembly in North Carolina has an anti-public education agenda, one that I think is determined in part by the huge influence wielded by a very wealthy and active conservative individual by the name of Art Pope (and his Pope Foundation and John Locke Foundation).
          I need to explain what "hard times" has to do with it. Each state that hosts ACM students "subsidizes" their degree education as though they were in-state students (the students don't pay the out-of-state tuition rate). Very myopically, the North Carolina Legislature viewed North Carolina's ACM participation as a cost (to subsidize the incoming students), failing to weigh against it that North Carolina students were also benefiting by being able to afford degrees in other states that were not offered by any UNC institution and that the UNC institutions themselves were very much in favor of the ACM in order to attract good students from other states who would not come if they had had to come up with out-of-state tuition to do so. (North Carolina's out-of-state tuition rates are generally a lot higher than those of the other southeastern states.)

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    2. Morris, thank you for the information. You have unfortunately confirmed Suspicions I have developed since moving here from Virginia. Do you happen to know if this anti-public education agenda extends to grades 1-12 as well as college? Are they taking money from public schools to fund charter schools, and diverting tax dollars away from education to be used elsewhere?

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    3. motomynd, yes, cuts to public education include cuts to grades not just 1-12, but K-12. Remember Governor Perdue's several vetoes of bills cutting funding for education, all of which, I believe, were successfully overridden by the Republican-controlled legislature? I am almost certain that the cuts were/are not "to fund charter schools," and I can't comment on what's happening with charter-school funding. Nor can I quote any numbers from memory, but The Real News Network (TRNN, at http://therealnews.com/t2/) provides a quick overview in the article "Students and Teachers Fight Education Cuts in North Carolina" (from May): "On Tuesday, May 3, thousands of demonstrators gathered in front of the North Carolina state legislature in the capital of Raleigh to oppose budget cuts to public education. Proposed education cuts are expected to total up to $1 billion, targeting K through 12 schools, community colleges, and state universities. The 'One Voice' rally was organized by the NCAE, or the North Carolina Association of Educators, which is the largest teachers union in the state. There are concerns that cutbacks could cost thousands of state employees like teachers, bus drivers, janitors, assistants, and many others their jobs. Textbooks, elective and arts programs, school bus services, and financial aid are just a few examples of the many areas to be targeted by the budget cuts. Students and teachers formed a strong presence in the mobilization, voicing their concerns over the potential social costs of budget cuts in education spending."

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  4. Name Withheld But Morris Knows Who I AmWednesday, November 14, 2012 at 2:15:00 PM EST

    Thank you Morris for sending me your valuable Blog site...I am pleased with what you are doing with your life now. It feels like liberation in a way... for you to sit back and write what you feel like with no one to manage you or your time :) Amazing work! I am looking forward to reading many of your articles and I have to tell you this is the first blog that I have actually felt any inclination to even explore. Within five minutes...I should say, I am Hooked! I will be reading and re-reading many of your articles. It is intelligent and humorous and down right brilliant!

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  5. My late mother,a teacher, was a colleague of Dr. Rouchon's mother. PL Bonny

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