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.