University Hospital of Mirebalais’ Residency Program Fuels Next Generation of Doctors in Haiti
Social Medicine, Listening Skills Key Elements of Training
Posted on Oct 1, 2020
In January, University Hospital of Mirebalais in central Haiti, achieved a major milestone: international accreditation as an institution of graduate medical education. This milestone placed the 300-bed health facility firmly on the map of global teaching hospitals that meet the highest standards in medical education.
To Dr. Giovanni Bordes, a third-year resident in the program at Mirebalais, the news didn’t come as a surprise. “It’s a big step and a proud achievement,” he says. “Even before we learned about the accreditation, this was the best place for a young doctor in Haiti to do their residency. Since I graduated medical school, my biggest dream was to get into the residency program here.”
The teaching hospital’s global accreditation by the Accreditation Council for Graduate Medical Education (ACGME)—making it the only ACGME-accredited hospital in the Caribbean and the only in a low-income country—is just the latest evidence of its impact on current and future medical professionals in Haiti.
'There's Always Someone To Learn From'
Zanmi Lasante, Partners In Health’s sister organization in Haiti, and the Haitian Ministry of Health opened University Hospital of Mirebalais in April 2013. Since then, the hospital has rolled out 6 residency programs, including in emergency medicine, surgery, and obstetrics and gynecology. So far, 123 residents have graduated, and 98% of them have opted to stay in Haiti, contributing to building a stronger health system.
University Hospital is the culmination of three decades of PIH’s work in Haiti, where PIH has partnered with Zanmi Lasante since the 1980s to provide health care to a population of more than 1.3 million people. PIH employs 6,300 staff in Haiti, including 2,500 community health workers, and provides primary care, maternal and child health care, HIV and tuberculosis services and more, in partnership with the Haitian Ministry of Health.
The hospital’s residency programs offer residents access to opportunities and resources that are hard to find elsewhere.
Bordes, whose specialty is obstetrics and gynecology, values the program for its access to medical equipment, such as ultrasounds and fetal monitoring systems as well as the mentorship opportunities it provides.
“In Mirebalais, we have attending [physicians] specialized in gynecology as well as in obstetrics, so we learn skills and procedures that other public hospitals don’t teach,” he says. “There’s always someone to learn from and there’s always someone who has your back.”
Bordes also appreciates the focus on physicians’ well-being. The program offers residents accommodation, hot meals, reliable Wi-Fi and, crucially, for those with a high workload, a work-free, 24-hour period to relax and reset each week.
That set-up is intentional.
“Along with training, one of our priorities is resident wellness,” says Dr. Ornella Sainterant, the hospital’s continuing education coordinator.
Sainterant, a palliative care physician, is a former resident herself who was part of the first family medicine cohort in 2011 Now, she is responsible for coordinating the residency program, where she advocates for improving health systems—starting with patient/physician communication.
“In our residency program we teach residents about the health system and Haiti’s national health policy,” Sainterant says. “We also focus on physician communication skills, because when you listen to your patients, that can also help you to improve the system.”
Listening might once have been seen as a soft skill but, as Sainterant says, in a busy clinical setting it can be one of the hardest parts of the job.
In the palliative care department, she takes residents under her wing, equipping them with the tools and language to lead difficult family meetings with empathy, break bad news to patients and their families, or navigate situations in which patients are experiencing anger.
“When the residents work with me in palliative care, they can see me in action, and then they can carry out the work in practice,” she says.
One of the key pillars of the program is social medicine—the idea that clinicians must understand the social and economic factors underlying their patients’ wellness and overall health.
“Social medicine is unlike anything I had previously learned in medical school in Port-au-Prince,” says Bordes. “You learn to listen to the patient and what the patient has to say. Now I always ask my patients, ‘What do you expect from me? What would you like? What would suit you?’ and then together you make a decision about the next steps.”
In addition to teaching social medicine in the hospital, the program immerses residents in nearby communities to study the relationship between health and environment—something that serves the dual purpose of building greater trust between doctors and patients and addressing health system gaps.
Between working and teaching on the ward and supervising the residency program, Sainterant spends much of her time thinking about the ways in which clinical care and health systems strengthening intersect. She would like to see new generations of Haitian research doctors emerge, contributing to national and global knowledge bases through their expertise and experience.
Both she and Bordes hope to be role models for future cohorts of residents, inspiring them to commit to building a future in Haiti, using their skills to contribute to strengthening the health system.
“I hope that in the coming years we will have more health professionals staying in the country, and that they can be the leaders for others,” Sainterant says.
The program has already had that deep and enduring impact on at least one resident.
“I could have left Haiti a long time ago, but I decided to stay because I think I can make a difference,” says Bordes, whose parents live in the United States. “Everything I’m learning in the residency program is setting me up for that.”