International Fellowships For Recent Graduates: Rural Healthcare In Haiti

Sep 16, 2013

The Medical Missionaries Global Health Fellowship is a fully funded one-year professional fellowship, offering fellows the opportunity to gain first-hand field experience in rural Haiti. As this year’s Fellows, Mary Davies and Samuel Ware share their personal experiences. Mary graduated from Harvard in 2013 with a degree in Social Studies. She hopes to start medical school next year and plans to keep up her Creole until she can come back to Haiti. Samuel Ware graduated from University of Pennsylvania in 2013 with a degree in Health and Societies. After his year in Haiti, he wishes to continue working in global health and eventually pursue a Masters in public health.

Global Health Fellows Mary Davies and Samuel Ware with the Bok Banik Water Committee in Thomassique, Haiti

By Mary Davies and Samuel Ware

The Medical Missionaries Global Health Fellowship places two Fellows at St. Joseph’s Clinic, a primary care clinic in Thomassique, Haiti. For the last seven years, Medical Missionaries has been managing and supporting the clinic, located in a small town about four hours northeast of Port Au Prince, near the Dominican border. As Global Health Fellows, we coordinate a wide variety of community health programs – we manage community health workers, malnutrition interventions, water purification systems, maternal health promotion and transportation stipends, and many other activities. In addition, we work to support the clinic’s daily operations. We track supplies and medication, help out in pharmacy, and even occasionally fit eyeglasses during mobile clinics. Our other main responsibility is to liaise between the clinic’s Haitian staff and the U.S.-based support team. One of the best parts of the job is that we get to work with a huge variety of stakeholders. To solve any given problem, we work alongside doctors, clinic administrators, community members, and the Medical Missionaries management team. It’s never a dull job!

The fellowship is an incredible opportunity to throw yourself into the everyday challenges of rural healthcare. It’s a very different experience from working for a large NGO in an urban area in Haiti, like Port Au Prince. Here in Thomassique, we’re the sole blan (foreigners) in the community and represent the only NGO in the area. Instead of living in an expat community, you’ll develop close relationships with the all-Haitian staff (we live in the same residence), improve your Creole (since almost no one speaks English, you’ll find yourself learning quickly), hone your domino-playing abilities, and receive dumbfounded looks when you go for long walks in the countryside. The “Republic of Port Au Prince”, where the vast majority of NGOs and government services are located, feels like a world away.

Essentially, the fellowship year is a crash-course in what it means to actually work on the ground in global health delivery.  We grapple with big picture questions – like how global socioeconomic forces lead to unequal health outcomes, or the complications of NGO interventions. But instead of just talking about them in a classroom, we see all of the ways that they impact the communities we serve.

We both came from academic backgrounds where we had the chance to study global health interventions all over the world and spend time in the field. With this job, however, you’re suddenly the one actually running those programs. It’s your responsibility to troubleshoot, improve outcomes, anticipate consequences, and respond when things aren’t going well. We’re learning to navigate the myriad challenges that arise every step of the way – from planning and implementing to managing, and evaluating health programs.

We’ve learned, for example, the difficulty of making sure the whole clinic staff is on the same page when it comes to properly filling out medication tracking forms, at the risk of running into medication shortages. When we tried to revamp our infant malnutrition program, Medika Mamba, by bringing it into rural communities, we unexpectedly stumbled into problems with transportation when the seasonal rains washed away roads. We hoped to send a nurse out to do home visits for children enrolled in the program, but realized she was more urgently needed in the cholera treatment center due to an upswing in cholera patients.

Troubleshooting these problems gave us a newfound appreciation for the complexity of implementing just one program (among many) and an ability to always think on our feet. Although we’ve only been here for three months, the Fellowship has honed our ability and confidence to navigate competing demands and situations among donors, patients, staff, community members, and government officials. It also provides a unique perspective on global health and NGO work. You’ll never be able to fully grasp the system’s complexity and nuances from an office or classroom. Although we’re only just starting our careers, we hope that we’ll leave Haiti with the experience and expertise to confront complex global health issues around the world.

So what does an actual day on the job look like? We start work around 8am, to the smell of coffee and the morning’s breakfast. (Favorite: Tuesday’s cheesy spaghetti. Least favorite: Thursday’s goat intestines.) We catch up on emails with the U.S. management team and work on data collection and evaluation, whether tracking medication or following up on community health workers’ progress for the month. Afterwards, we’ll often head out to a community meeting in one of five outlying villages where we work with community health committees. We hop in the car with the clinic driver and bump our way over muddy roads until we reach the community health center. During meetings, we’ll talk with committee members about ongoing projects (like mobile clinics or vaccination campaigns), their goals and vision for the next few months and how we can improve the services we provide to these communities. Then it’s back to the clinic, maybe to meet with our maternal health care team on ways to improve our training for traditional birth attendants. When we’re done with work for the day, we usually go for long hikes in the hills surrounding the clinic – one of the best parts of working in a rural area.

Who should apply to the Fellowship? Any college graduate (including those graduating in Spring) and graduate students interested in global health may apply. The only other requirement is a willingness to learn Haitian Creole. The application committee looks for candidates with experience working in under-resourced areas; a strong sense of ethics; a demonstrated commitment to social justice; and the ability to troubleshoot problems, adapt to challenging settings, and coordinate among diverse stakeholders.

The Fellowship lasts for one year, starting in June. All expenses for the year are covered by Medical Missionaries including room and board, medical evacuation insurance, and travel costs (including two trips back home during the year, ideal for those applying to medical or graduate schools).

© Victoria Johnson 2013, all rights reserved