Dear colleagues,

When you think of Haiti, what comes to mind? For the vast majority of us, it’s probably the 2010 earthquake and subsequent relief efforts. Haiti, in many respects, is a country synonymous with extreme devastation and poverty. But also, for those who know it well, resiliency, ingenuity and survival.

We began development work with the l’Université Quisqueya (uniQ) in Port-au-Prince several years ago. UniQ lost many faculty members in the aforementioned earthquake and most of its infrastructure. Like many of our Fellows, Dr. Lucie Brazeau-Lamontagne, FRCPC, a diagnostic radiologist based in Sherbrooke, Que., rushed to Haiti shortly after the earthquake to lend a helping hand. In addition to her clinical offerings, she saw an opportunity for the Royal College to help with restoration efforts in the way of training standards and program development. She has played a seminal role in developing our relationship and strategy with uniQ.

Our efforts to-date have focused on strengthening faculty development and continuing professional development at uniQ so that future doctors are more practice-ready and able to provide better care. This work includes helping uniQ set up a simulation centre that could serve as a national resource, using our recent donation of simulation equipment. All of this is in support of the vision of Dr. Geneviève Poitevien, dean of the Faculté des sciences de la santé de l’uniQ.

This past December, Royal College staff members Danielle Fréchette (executive director, Health Systems Innovation and External Relations) and David Piccini (advisor, International Development) visited Haiti with a small group of Fellows. I thought I’d use this month’s message as an opportunity for them to share in their own words about our progress in Haiti.

As Danielle aptly put it, “we’re beyond baby steps.”

I hope you enjoy reading this update.

Sincerely,
Andrew Padmos, MD, FRCPC, FACP
Royal College CEO


Our work in Haiti: An update
By: Danielle Fréchette and David Piccini

Medical training in Haiti is quite different than in Canada. They have a pre-med system of several years called the internship followed by a “social service” year, prior to specialization (if they so choose to specialize). While residents in Canada are practice-ready at the end of their residencies, Haitian trainees can get a license to practice after their year of social service. This year is a way to give back to the state for the benefit of the education they’ve received, whether privately or publicly-funded. Practice during this year is often under limited or no supervision in what are, at times, very difficult conditions. We are trying to help strengthen the internship in preparation for the social service year.

We have been working with l’Université Quisqueya (uniQ), a private medical school in Port-au-Prince, to help enhance their health educational system and standards. This is the desire and vision of Dr. Geneviève Poitevien, dean of the school’s Faculté des sciences de la santé. Better trained interns will have better competencies. Better competencies lead to better patient care during their year of social service and onwards. Physicians who then choose to continue into specialty training will have a stronger foundation upon which to continue their studies.

Simulation: an essential component to faculty development
The focus of our trip this December was to build upon the MOU we signed with uniQ in June 2016. This agreement lays out our joint commitment to support faculty development and continuing professional development towards our common vision of the best health for all Haitians through better-trained health professionals. Simulation is a cornerstone.

Dr. Caryne Lessard, FRCSC, presented a workshop on simulation in the context of clinical teaching — a true introduction to this theme and one that we’re committed to building upon. Parallel to this teaching, the Royal College donated extra simulation equipment we had to the university. It was a fairly exhaustive inventory, including task trainers, mannequins and some laptops to run the more high-tech equipment. This donation enables the creation of a simulation centre at uniQ to support the education of all health professionals.

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The Royal College’s strategy in Haiti is anchored in capacity-building. Teaching and infrastructure are both foundational and complementary components. We know that access to patients in the educational context is somewhat challenging. If health professionals can have some sim time, their first encounter and future encounters will not only be safer but they’ll be more productive. Simulation can also help practising clinicians perfect or learn techniques. Beyond mannequins and equipment, that first workshop we did on simulation was really about developing different scenarios.

At this juncture, we’re trying to create success at uniQ where faculty can then train other faculty, whether in their own institution or other institutions. The dean’s vision is to create a national resource by way of this simulation centre. She’s very committed to the advancement of her country and has clarity of vision. The future for her is improving competencies and expanding residency programs. She’s hoping the Royal College will accompany uniQ on that journey and we are there to work hand-in-hand responding to their needs.

On our next trip, our small team will be taking the donated simulation equipment out of the crates. We’ll show them how to handle the equipment, how to set it up, store it and some basics on how to develop scenarios using the equipment for learning and assessment of learning.

Our approach in Haiti: sustainable efforts, anchored in the cultural context
We are trying not to boil the ocean. Our goals are simple in description but large in execution because this little bit of faculty development and continuing professional development is huge. It will be one of the underpinnings of capacity-building in this country because then they’ll be able to teach others; there’s sustainability in that and we will continue to support them.

Dr. Lucie Brazeau-Lamontagne, FRCPC, deserves a great deal of credit for this work. She has been such a champion of our efforts in Haiti. She has opened doors, been an ambassador for the Royal College, promoted our contributions and built important local relationships. For example, she was instrumental in developing a new competency framework, first introduced in 2015-2016, fashioned from CanMEDS. Titled, The Hand that Heals, this framework includes all the CanMEDS Roles but fits within the local cultural context.

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For our work in Haiti to be meaningful and sustainable, we approach it with the philosophy that “it’s never about you, without you.” The thought of molding Haiti’s system to a Canadian model is so inconceivable because of the differences between our two countries. Instead, we are trying to help them build the strongest system possible that is mindful of resources and relevant to their institution and country, without jeopardizing fundamental principles of quality education.

While in Haiti, we met with the Canadian ambassador, Mrs. Paula Caldwell St-Onge. The ambassador spoke about the challenging reality on the ground, but was very supportive of the work the Royal College is doing to support the faculty at uniQ. To put it in context, we’re not going down, building a house and then leaving; we’re going down and supporting the full-functioning of that house — it’s for long-term engagement.

Haiti is showing growing signs of recovery. There are more paved roads and more consistent electricity. At uniQ, they have more buildings where there once was rubble; a brand new library and soon a simulation centre. Despite all that nature and life has thrown at them, Haitians have a steadfast commitment to bettering their community and country.

The Royal College is very much engaged at the systems-level, supporting capacity-building, faculty development and practising clinicians in gaining essential competencies (a structured approach). Royal College Fellows should be very proud.