Dr. Thony Voltaire was born one morning on the side of the road as his mother was on her way to market in the northern seaside town of Borgne. Raised by his mother and grandmother, both farmers, Dr. Voltaire attended medical school in Cuba. Today, back in Borgne, as Medical Director of Haiti Outreach Pwoje Espwa (H.O.P.E.), Dr. Voltaire manages the medical and administrative operations of a health network serving 80,000 people, most of whom subsist on less than $2 per day. But he has never forgotten his roots.
Dr. Voltaire’s driving passion for more than two decades has been service to his community. In addition to being a brilliant doctor, he is known as an innovator and advocate for the people of Borgne. He often can be seen riding a motorcycle across a thigh-deep river en route to a mobile clinic, and he is known to be equally adept at fixing the hospital electrical system as he is at fixing broken bones. With his remarkable background in the community and his expertise in public health, Dr. Voltaire believes his work will not be done until every person in Borgne has access to quality medical care and a chance for a better life.
Under his leadership, H.O.P.E. has implemented a three-tier health system praised by Dr. Paul Farmer, founder of Partners in Health, as one of the best in rural Haiti. “Doctor Thony” manages a community hospital and health center, as well as weekly, daylong mobile clinics and week-long mobile hospitals accessible only on foot. H.O.P.E. relies on a network of community health and outreach workers to serve people in the most inaccessible corners of rural Haiti, as well as a staff of 140 health professionals and support staff, all of whom look at Dr. Voltaire as a model of tireless dedication, professionalism, resourcefulness, and heart. Colleagues say he has the mind of a scientist and the heart of a humanitarian, able to deal with a dire medical emergency with complete calm and well-honed skill, then to weep once the crisis has past. Dr. Voltaire may be a leading Haitian authority on health and development, but he remains an eager student, taking ideas from other WomenStrong Consortium members and adapting them to meet the needs of his own community.
WomenStrong sat down with Dr. Voltaire recently to discuss the vision and passion that have guided his work and his plans for the future as a #WomenStrongWarrior.
When you were studying to be a doctor, did you imagine that one day you’d be doing what you’re doing today?
When I was studying to become a doctor, I always thought about how I could be most useful to my community. I studied family medicine in Cuba, where they stress a community medicine approach that prepared me well for the work I do today. I never wanted to be a doctor in a traditional practice. I wanted to live close to the people, to really understand their health problems and the social conditions that impact health.
I knew there were many health problems. In the first month after I returned to work in Borgne after graduation in 2005, I was troubled by many challenges. I knew I wanted to work to empower women, but how? And, who would accompany me, collaborate with me, support me, as I tried to improve the health of women in the community? At the time I never thought that I would meet H.O.P.E., which shared the same philosophy, or that I would develop a career with H.O.P.E.
What did you see and learn in those early days after medical school?
When I arrived, there were no doctors in the community at all. There was the H.O.P.E. clinic, but it only provided basic care. There was the MSPP (Ministry of Public Health and Population) community hospital, which was in a very poor condition. At that time, roads were really bad; you could say there weren’t roads at all! It took 8-9 hours to travel about 40 miles from Borgne to Cap-Haitian….People had to travel great distances to find care.
I didn’t sleep in the days after I returned to Borgne. News spread quickly from person to person that a doctor had come to take care of them. I saw all kinds of cases: pregnant women, injured people, children ill with fever, malaria and typhoid, and more. I worked from 5 a.m. until midnight, because I was the only doctor. I was often tired, but I couldn’t sleep, because I knew that while I was sleeping, a patient could be dying. I was forced to face that responsibility. And I had to come up with a system to organize my day [and to] triage patients according to the severity of their symptoms just to get through the day. When I lay down for a rest, someone would call with an emergency. So it was very difficult.
You can imagine the path that we have traveled to arrive here today.
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 Rose-Marie 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. That was a turning point-a very difficult moment, yet a critical one.
Describe your job today?
Today, my job is more complex, more varied. Our health system, Alyans Sante Borgne (Borgne Health Alliance), is expanding in partnership with the Health Ministry. We have more doctors and more nurses. Since 2006, we’ve evolved from the worst health system (among the 13 communes that make up Haiti’s North Department) to the second best public institution in the north. I’m responsible for managing the health system for this commune, and our approach to health involves much more than caring for patients.
Our approach rests on three pillars: health, education, and economic wellbeing, and working on all of these has changed the community. I don’t see patients as much as I used to or would like to, but I am still very engaged in their care. I participate in discussions and consultations with the other doctors; they call on me, and we share ideas. But I’m responsible for much more.
Can you tell us more about this other work?
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 and norms can change. It is through education that the economic situation can improve. Improving education, creating livelihoods, creating the environment for better health, this is our vision.
We also must reach the most vulnerable, the ones most affected by poor conditions. They are at the heart of the problem.
Problems usually begin in childhood. Suppose you give birth to a baby girl: we live in a community where too many girls have to leave school early to do house chores, or never get to go to school because they have to take care of their siblings. Before you know it, she is 10 years old, she begins to develop, and she becomes vulnerable. By the time a girl turns 12, she could be pregnant and must drop out of school. Any plans or dreams she had must be abandoned. She becomes a mother without support from the adolescent father of her child, and so you can see why nothing can change in the community without improving the lives of little girls, young girls, mothers, and women.
We must educate girls, empower girls to think for themselves, make their own decisions, and not to be swayed by others. They must be taught, and believe, from an early age, that they are equal to boys and to any other person in society. They must learn to avoid pregnancy and continue their studies. We must create conditions that support positive change for girls, and in this way, create positive change in society.
Our Mothers’ Clubs and adolescents’ clubs, as well as the animatris (community organizer) programs are critically important. Women are the most important group in bringing about change, not only because they are the ones who give birth and raise families, but because they are the most vulnerable, the ones with the most to lose, if nothing changes.
What do you like most about your job?
My greatest joy is when we save the life of a gravely ill child, or when we can help a pregnant woman experiencing serious complications deliver her baby safely and see her smile while she looks at the baby for the first time. Nothing beats watching a mother holding her child, and there’s no more beautiful day than when your work is done and a life is saved.
What are your future plans for H.O.P.E., the healthcare network and the hospital?
We’ve walked a long way, accomplished a lot. We have listened to understand the community. This deep understanding of the community informs all decisions about programs and actions, in health, education, and economic wellbeing. All we need are the means — the opportunity to put all that we’ve learned and know into practice, to further develop our model of Sante Nan Lakou (health at the household level).
We’re still learning. When I accompany a mobile hospital, walk six or eight hours to reach the site, I can see firsthand the reasons for so many health problems in the commune. We see unusual cases, conditions we’ve never seen before, and we learn from this, too.
I feel we are just beginning. We will continue to work so that women do not die giving life, so that children don’t die through no fault of their own before they start to live. We will continue to build a better community, a better country, and a brand new, better world.
If you could say one thing to all the women and girls participating in H.O.P.E. programs, what would you tell them?
I’d say “congratulations” to them for their determination and courage. I am proud of them. They are the real heroines in Borgne.
What would you say to people, including donors, who look at Haiti and the poverty there and find the problems overwhelming?
I would like to tell everyone that in our 12 years of experience, I have seen many things, I have experienced some hard times, but I have also had beautiful moments. I think that our work has the potential to make a huge difference in the community. To ensure that any change is sustainable, you must develop programs in health, education, and economic empowerment that serve people in the town or larger villages, and those at the margins of our community. For a tree to be healthy, the roots must be healthy, and it is the same with a community. That’s why we work at the grassroots. As for myself, despite the difficulties, I am always hopeful. And, if I were to have a message for others, it would be: let’s not be discouraged. We’ll reach our goal.