Konbit Sante’s Early Years: An In-Depth Conversation with Dr. Michael Taylor

In 2001, Dr. Michael and Wendy Taylor had an idea to create a nonprofit organization that would improve the healthcare system in a developing country by working within the system rather than creating a parallel system. It was a bold and innovative approach, and neither knew at the time whether it would work.

Twenty years later, Konbit Sante Cap-Haitien Health Partnership is one of the most revered nonprofit organizations working in Cap-Haitien, Haiti. It has expanded its focus from one healthcare partner facility in Haiti to four, developed partnerships with other non-governmental organizations around the globe, and earned the respect of both the Haitian government and Haitian healthcare professionals.

Dr. Taylor is a retired dermatologist in Portland, Maine, who has a career-long interest in international and community medicine. He is a graduate of Amherst College, University of Buffalo Medical School, and Harvard School of Public Health, and completed residencies in internal medicine and dermatology at University of California at San Francisco. Following medical school, he volunteered for the U.S. Peace Corps in Nigeria. He taught epidemiology at Dartmouth College, and was chief of the department of community medicine at Maine Medical Center.

In commemoration of Konbit Sante’s 20^th anniversary, Communications and Fundraising Coordinator Rod Harmon recently conducted an in-depth interview with Dr. Taylor about Konbit Sante’s founding and formative years. An edited transcript of that interview follows.

First, can you tell me a little bit about your background and what brought you to Haiti in the first place?

I’d have to go back to my folks, who were extremely generous members of their small community just outside of Buffalo, N.Y. My father was a general practitioner who charged $2 for an office visit until about 1964, when he went up to $3 and felt guilty about it. At Christmas, my parents would sit in front of the fireplace, go through the bills, look at the patients who had not paid, and decide whether they should pursue it or let it go. They knew everybody because it was a small community, so they knew who could pay and who was trying to scam them. But 90% would be discarded – thrown into the fireplace — and they’d start the new year with a blank slate.

You don’t find that kind of philanthropy in the medical industry these days, unfortunately.

It was a different time. They had both gone through the Depression, so they understood hardship. So that’s probably where I got some of my motivation.

What made you decide to become a doctor and follow in your father’s footsteps?

Truly, I had no choice. My oldest brother went to medical school, and it was always understood that if I was smart enough to get into medical school, that was my destiny. Nowadays, kids apply to thousands of colleges and grad schools. I applied to three colleges, and only one medical school, which was in Buffalo, where my dad and brother had gone. So it isn’t that I gave it a lot of thought. Thinking about life in general, that never occurred to me. I was just on a pathway.

Fast-forward to when you started to travel to other countries.

After medical school and internship, I went into the Peace Corps and was in Nigeria from 1965 to 1967. And then raising a family, starting a practice, and being a member of the community took my attention away from foreign opportunities for many years.

Can you talk about your trip to the Dominican Republic in 1998? What you experienced there really sparked the idea for Konbit Sante, correct?

Both Wendy (Taylor, Michael’s wife and co-founder of Konbit Sante) and I went to the Dominican Republic, and there was a significant example that struck both of us. There was an OB/GYN nurse who was also part of our group. She raced up to us and said, “I just found somebody with diabetes.” She had a little, battery-operated glucose meter that gave her a reading of greater than 400 blood sugar, and she was excited about how she was really going to help this fairly obese woman.

And my heart sank. There was no refrigeration for the insulin. There were very few needles and syringes. There was no public health nurse to teach her how to give herself insulin, the right dose, the monitoring. She had no choice about the diet that she was eating. And Wendy and I instantly knew that when within a month, her supplies would run out, and she’d be right back where she was.

We didn’t say anything at that time; we decided to wait until we were on the plane back home. We declared that yes, there was a great need, but in order to have a meaningful impact, we needed to find a single place, partner with that place, and continue on a regular basis.

Now when you say “place,” do you mean a healthcare facility?

Yes. And not fly into a remote village, take blood pressure, give a month supply of blood pressure medicine and leave, which is what many of them — not all — but what many charitable organizations were doing. When they leave, the need is still there, but there’s nobody there to treat them. We knew we didn’t want to replicate that. And so we came back and began discussing the fact that if we were going to be helpful, we needed to find a place that wanted us, would accept us, and had needs that we could fill.

At that time, our major medical resources were specialists, our colleagues at Maine Medical Center. We were not primary care physicians. So we tapped into the resources we had, and looked for a place that could benefit from a radiologist, that could benefit from a cardiologist, that could benefit from a urologist. … Many of the surgeons felt that they could work in partnership with their Haitian colleagues. They could teach, perform surgery, take needed equipment and supplies, and then invite their Haitian colleagues to Portland for a week or two of hands-on education.

The Haitians were naturally cautious, because they had seen this before. They’d seen generous Americans come down and say that they would come back and never did. So it wasn’t an immediate embrace. In fact, I would say that it took a good two years for them to understand what we thought we had to offer, which was not a lot of money. It was going to improve patient care with education, systems development, and connections with other professionals.

Why did you choose Cap-Haitien, Haiti, as the area to focus on?

We wanted to find a place that could not only use our resources, but where they would mesh with what their needs were. We went to Haiti, because a friend in Portland had medical school classmates in Miami who had a program in Haiti. They were eager to take us to Haiti to see what was there, and they already had a link through the family practice program at Miami. I went down with Art Fournier, who was head of family practice at Miami and head of their outreach programs, and he escorted me to three sites in Haiti. Two of them, for different reasons, I didn’t think would work.

And then we got to Cap-Haitien, and there was a hospital, some infrastructure, a history. And they seemed if not eager, at least willing to work with us. It was somewhat difficult, because groups coming into Haiti usually brought money, and it was difficult for us to explain what we had to offer, which was not money. But we were able to establish a relationship by visiting on a fairly regular basis. The first day we were there, we would visit the Minister of Health and had a half hour or 45-minute meeting, telling him what resources we had and what we intended to do, and get his blessing.

We had become a U.S. nonprofit before choosing Cap-Haitien.  After choosing Cap-Haitien, we reviewed the purpose of Konbit Sante — the mission statement. That really took an inordinate amount of time to talk about what it was we wanted to accomplish and how to go about it. In retrospect, spending months on the mission statement was time well spent, because it’s now been 20 years since the inception, and the mission statement still stands with possibly one word changed over the years. Early on, when we were questioning what to do or how to do it, we would refer to the mission statement and see if it was compatible.

One of the key aspects of the mission that I’ve always been struck by, and that I haven’t really seen in practice anywhere else, was that you were willing to work within the system rather than establish your own hospital and manage from afar, which is what a lot of nonprofits do.

Yes. And make it sustainable and to lift the Haitian professionals enough so that they felt confident, assuming the responsibility for taking some risks, trying some new things.

There’s been a tumultuous relationship between the United States and Haiti ever since Haiti gained its independence in 1804. Slavery was still legal in the U.S., so it refused to recognize Haiti’s independence or trade with it. In the early 20^th century, the U.S. occupied Haiti country for almost 20 years. When you first went to Haiti, it was not long after a 1991 military coup had temporarily ousted (former Haitian President Jean-Bertrand) Aristide, and the U.S. had placed an embargo in response that presented a great many hardships for Haitians. What challenges did that pose, and continues to pose, for Konbit Sante?

I think that we’ve learned that we can’t change the government. Because if we tried to pay attention to the Haitian government, it’s always going to be frustrating, or inadequate, or whatever you want to say. And if we tried to pay attention to the United States’ involvement with Haiti, it would be the same thing.

I’d like to go back to your first visit to Haiti. Can you describe your thoughts, your first impressions?

On my first trip with Art Fournier, my impression was that it was going to be extremely difficult. Haiti had been over-missioned. There were so many NGOs, and those folks, while well-meaning, would come in with money and gowns and then leave. In some cases, they would build some nice clinics, so that was the expectation from Haitians.

It was a year between the time that we had the original notion until we went down (with the first Konbit Sante group). … When the first 13 people from the U.S. visited, we met with some physicians, who had already had experience with Americans. We met with the minister of health, who was baffled. (Laughs). We met with the mayor of Cap-Haitien, and toured the hospital (JUH) and a clinic. We called that the “pre-nuptial trip.” The purpose of that trip was to evaluate whether or not the assembled group thought that this was a doable situation.

There’s something magic about being in Haiti and being with the Haitian people. They’re generally upbeat, happy, and outgoing, so they’re easy to like. When we returned to the United States, people felt really warm toward the Haitians. I don’t know anybody who thought we shouldn’t continue – there may have been, but those people didn’t speak out. So the consensus was that we should do it.

You mentioned that after your first site visit, you thought it was going to be extremely difficult. Why did you decide to do it; what made you go forward?

Anyplace that was worth going to was going to be difficult. The amount of poverty and infectious disease was significant. We knew that it wasn’t going to be a walk in the park, that we would have to work at it. Every one of us agreed that it would require not just an organization, but individual long-term commitments.

Why did you decide to change the name from the Greater Portland Health Initiative to Konbit Sante?

The Greater Portland Health Initiative was a place-holder. We had to have a name when we incorporated, for legal purposes. We became very friendly with the Peace Corps volunteers (in Haiti) and vice versa, until they had to leave because of a coup (the second coup to oust Aristide, in 2004). A Peace Corp volunteer, Bryan Schaaf, who has since gone on to work for nonprofits in D.C., was fluent in Haitian Creole, and he suggested “Konbit Sante.” It made sense.

People who work in developing countries often describe the experience as one step forward, two steps back – there are just so many challenges. What personally kept you going on this endeavor as the years went on?

Nate Nickerson (Konbit Sante’s executive director from 2005 to 2020). Without Nate, I’m not sure that a lot of us would have hung in there. He works hard; he’s direct, he’s honest, and he’s honorable. He’s an easy person to follow, a good leader.

We all have special talents. Some of us are innovators and connectors. Before I retired, I was a supreme connector. I know a lot of people, I have respect from many of them, and I have the ability to contact folks whose ability could be useful. When we formed Konbit Sante, we had Don McDowell, who was president of Maine Medical Center; Jim Moody, who was president of Hannaford, the National Grocers Association and the Bates College board of trustees; and Don Nicoll, who had been (former U.S. Secretary of State) Edmund Muskie’s chief of staff. We purposefully chose people who weren’t necessarily physicians but had some experience in business and health care. We had nurse practitioners. We had four returned Peace Corps volunteers, including myself, so they brought perspective on expectations of working in a different culture. So we had a very powerful, hands-on, working board of directors. I was able to put that together, and not everybody can do that.

Then Nate came along. I could never have done what Nate accomplished. We all have our strengths.

Was Nate the natural choice for Konbit Sante’s first executive director?

Yes. We didn’t look; we asked Nate. Nate and I didn’t know one another well, but I knew him well enough to invite him to lunch so that I could explain what we were doing before he joined the board. I was told, “Nate’s too busy; he won’t have time for this. He’s really focused on the City of Portland (where he was director of public health).” And I replied, “Well, do you know that for sure?” It was a time in Nate’s career where he said, “You know, I’ve been thinking about doing something different.” I said, “Why don’t you come down with us for a visit and see what’s it like?” He did, and he got hooked very early on.

What were the biggest challenges facing Konbit Sante in the early days, and do you think those challenges are the same today, or have they changed?

They’re different. The first challenge was obviously gathering a committed group who were paying their way to Haiti to see if they might contribute something. We didn’t have a budget, we were forming our legal nonprofit and generating enthusiasm – not just for people on the board, but people in the community. So those were the challenges.

What about the challenges of working in Haiti? Do you think Konbit Sante has built trust over the years, and that has made the work easier?

We had to demonstrate that we were reliable, that we would do what we said we would do, and that we wouldn’t do what we said we wouldn’t do. We didn’t distribute funds or so forth. We helped write grants early on, so they knew that we could be helpful in getting them money, but we were not giving them money. So we laid the groundwork for Nate and others. I don’t want to take any credit from Nate, so don’t misunderstand that, but he had a little base upon which he could build, and he did. The program now is quite different from the initial concept; it’s much better than what we could have imagined.

How many trips to Haiti did you personally make?

Twenty or 21. Then I got dengue fever. It was my second episode of dengue; I had my first episode in Nigeria when I was in the Peace Corps. The dengue I acquired in Haiti affected me significantly. I came back from Haiti early, because I was still running a dermatology practice at the time, and then I came down with this terrible weakness. I developed hemorrhagic spots with itching all over. I was so weak, I could barely get out of bed. … Soon after that — not a cause and effect, I believe — I started to develop multiple sclerosis, a slowly progressive kind. It’s not really life-threatening, but my right side is weak. Because of that and fear of getting dengue for the third time, I stopped going to Haiti.

When Nate assumed the leadership, I stepped away from day-to-day operations almost completely. I did remain on the board for a little while, but things were going in a slightly different direction than what I would have taken with the organization, so I assumed the right thing to do was to step away. And it was.

What was the slightly different direction?

A direction it should have gone, which was public health outside the Justinien Hospital focus. We started primarily because we had specialist physicians and nurses, and if that were existing today, we would still have that as the major driving force. It no longer is, and it shouldn’t be. The way it has gone was the right way.

When you think about your favorite memories of Haiti, what comes to mind?

Teaching dermatology. The (JUH) residents and the staff used to like to come to my talks. I always tried to focus on skin problems that they were going to see, or at least that they could recognize. I would put a slide up, and I would ask someone to describe what they were looking at. Then I would ask another person to mention two or three possible diagnoses. The third, I would ask to make the diagnosis, and the fourth, the treatment for that. I always wore a tie that I wanted to get rid of anyway, and at the end of the session, I would award the tie to the person I thought did the best job. It was usually one of the senior residents, but I remember giving one to a member of the staff, and they were quite happy with that. That was always fun.

What are you most proud of concerning Konbit Sante?

There are so many things, but if I had to choose one, it’s the mission statement. It described us and kept us in the right direction from the time we adopted it until now. Six to nine months seemed like a long time to form the mission statement, but it really has held up well.