Konbit Sante Program Manager a Champion for Change in Haiti

Adrien Demes remembers the moment when he decided he wanted to become a doctor. He was 15, one of five children in a family living in Mole Saint-Nicolas, a poor community on Haiti’s northwest coast. He wanted to inspire change in Haiti, but his activism against the corrupt Duvalier regime was increasingly putting him at risk.

Then his father had a heart-to-heart talk with him. “I see that you love helping other people,” he said. “Maybe you should become a doctor.”

Thus began a lifelong mission to alleviate the suffering of Haitians by changing the health system, one small part at a time. A mission that he is now tackling as Konbit Sante’s program director in Cap-Haitien.

It’s a multifaceted role that requires the wearing of many different hats. Demes facilitates coordination with Konbit Sante’s four partner facilities (Justinien University Hospital, Fort Saint Michel Health Center, Haitian Convention Baptist Hospital, and ULS Health Center), the Haitian Ministry of Health, and other non-governmental organizations (NGOs). He is also responsible for the oversight and supervision of KS programs and staff, coordinating traveling volunteer activities, co-teaching research seminars and mentoring residents, helping to organize community outreach clinics, and more.

He readily admits that it sometimes can be overwhelming. But he also embraces the task.

“I like challenges,” he said. “When I wake up in the morning, I come here and think, ‘I will do some challenging jobs,’ and that motivates me. And when you face some key difficulties and you’re getting people to help solve them, that is very rewarding.”

Demes came to Konbit Sante with years of educational and hands-on field experience. After graduating from the state university in Port-au-Prince in 1997, he started his medical career as a general practitioner in the Centre department of Haiti. As commune director at Saut-d’Eau, a remote area in the Centre department, he was responsible for coordinating health care to the area’s entire population of about 40,000 people, which often meant grueling four-hour walks up Montagne Terrible (French for “Terrible Mountain”).

“The mountain is very high, and it is very difficult to get there. I could spend three, four days there providing health care to people,” he said. “And I say to myself, ‘It’s the best way to give back what I received, to help those poor people in the area get quality health care.’ … Because these people, they are completely forgotten. They have no good schools, no health centers. When I go there, that’s the only access to health care that they have.”

Demes’ time at Saut-d’Eau also introduced him to voodoo culture and the impact it can have on the delivery of health care. Famous for the annual Our Lady of Carmel voodoo festival, the region draws thousands of Haitians from hundreds of miles, and the community’s voodoo priests are often viewed as the primary source for health care. Patients would refuse to receive care from Demes unless they first got permission from their voodoo doctor, so he not only had to overcome his prejudices as a trained physician, but as a Baptist pastor.

“I had to learn to negotiate with the voodoo priests,” he said. “We are of two worlds, but we need to find some negotiation for the betterment of the population.”

Demes’ work caught the attention of Concern Worldwide, an NGO based in Ireland, which hired him as a project manager in Saut-d’Eau. At the advice of a CW supervisor, he obtained a master’s degree in public health in 2003 from the Prince Leopold Institute of Tropical Medicine in Antwerp, Belgium. He then went to work for the International Medical Corps (IMC) in Burundi, Africa (because “Haitians have African roots”), where he ran a community health program and a child health program, and helped the state health system respond more quickly to epidemics. That led to a stint in Democratic Republic of the Congo as a health manager for International Rescue Community (IRC).

In 2005, Demes decided to focus his career on quality improvement of health care. He began working for I-TECH (International Training and Health Education Center for Health) at the University of Washington, first as a training coordinator and then as a quality improvement specialist in the I-TECH Haiti program. The following year, he became an ad hoc professor at the State University of Haiti’s School of Medicine and Pharmacy, which led to a scholarship from the Canadian government to pursue a Ph.D. in public health at the University of Montreal.

All of this work and training would eventually lead Demes back to his home country, as his doctorate research focuses on quality improvement in the context of Haiti’s health system. He spent the next several years alternating between working toward his Ph.D. and working for various NGOs in Haiti, including CARE, the American Red Cross, and Catholic Medical Mission Board (CMBB), as well as Deloitte Consulting Group.

In 2017, Demes came across an online job posting by Konbit Sante for a program director based in Cap-Haitien. Intrigued, he called a friend, Dr. Jean Geto Dube, who is executive director at JUH and a close collaborator of Konbit Sante. Dube gave Konbit Sante a glowing review. That, coupled with some research on the organization’s work and mission, convinced Demes to apply.

“The philosophy of Konbit Sante is to strengthen the health system instead of creating a powerless system,” he said. “… I think Konbit Sante has really supported the health system (to a degree that) Justinien Hospital could be the center of excellence in the (state) health department.”

Demes became Konbit Sante’s program director in February 2018. In his first year, he has helped shepherd numerous programs and initiatives, including a research program for JUH; the Leadership Circle, a monthly gathering of medical professionals from the Cap-Haitien area to promote the exchange of ideas and experiences; and collaboration between JUH’s maternity and pediatric departments to reduce problem deliveries and neonatal deaths. He is especially proud of the latter accomplishment.

“Sometimes when you are working in a complex bureaucratic system, getting people to work together as a team to solve a common problem can be challenging,” Demes said. “They had been trying to do that for months and months. Finally, they agreed to discuss the work, to do something together to reduce neonatal deaths. … Now, every time we analyze neonatal deaths, we look at cases that have connections with maternity and pediatrics, and we can then review those cases and address those issues.”

Haiti’s health system still has a long way to go before it is sustainable in terms of both resources and quality of care. But Demes is confident it will get there. And he intends to continue doing his part in this “konbit” to help make it happen.

“Change cannot happen with one person,” he said. “You need to mobilize a group of leaders to make that change.”