Lessons from 24 years in health care: an interview with Maxi Raymonville

August 18, 2016
Dr. Maxi Raymonville

Dr. Maxi Raymonville is the Executive Director of University Hospital, a partnership between the Haitian government and NGO Zanmi Lasante.

What is your current position?

My responsibilities involve mostly leadership and management. Mirebalais Hospital is a tertiary care teaching hospital that not only provides services but also trains residents and conducts research. We have 200 beds, see more than 1,000 patients daily, and we have more than 1,100 staff members. It is a very complex operation. 

Can you tell us about your career path?

In 1995 I graduated from the Faculté de Médecine at l’Hôpital de l’Université d’État d’Haiti, Haiti’s only public medical school. At the time, every Haitian physician was required by the government to complete one year of social service in rural areas. I went to the city of Hinche in the Plateau-Central region and worked at the Hôpital Sainte Thérèse de Hinche. At this time, I met with the Zanmi Lasante group in Cange and started working with them. Zanmi Lasante is a national Haitian NGO supported by its sister organization in Boston, Partners In Health.

 After spending one year in the social service, I went to the General Hospital in Port-au-Prince where I spent two years as an Obstetrics and Gynecology resident. After my residency program, I returned to the Plateau- Central region to continue my work with Zanmi Lasante, where I have been ever since. I served initially as the Medical Director of the community hospital in Cange and then as the Coordinator of Zanmi Lasante’s Women’s Health Program tackling issues such as maternal mortality, family planning, HIV among pregnant women, and cervical cancer screening. I was working with the 12 Zanmi Lasante sites in Central Haiti and the Artibonite region. In 2013, I became the Executive Director of the University Hospital in Mirebalais at its opening.

Can you share your top career goal?

My goal is to have the capacity not only to deal with all of the staff, but to deal with the complexity of serving patients who often do not have the means to afford treatment. Managing a tertiary care hospital, you face difficulties daily in leading the team through financial situations, having the right staff, and overseeing organizational planning and infrastructure maintenance. It is really important to discuss how to address all of these issues. The hospital is always overwhelmed because of the lack of access to health care for the majority of the Haitian people. My goal is to balance these different needs.

What is the biggest challenge you face in your current position [OR, in meeting your goal]?

One of the biggest problems that we are facing is understanding how to balance the financial burden of a tertiary hospital while fulfilling our mission of serving low-income patients. Furthermore, we need to continue to look at quality improvement. I always have to ask myself, “What does this mean in terms of cost?” Having an Intensive Care Unit open 24/7, providing the right supplies, and maintaining a qualified staff costs a lot of money. The challenge is how to achieve the right balance. We must maintain the quality of care that we provide and identify the funding piece to continue our work.

What impact do you think GHDI will have on your career?

GHDI exposes me to different experiences from different perspectives, addressing many of the principal challenges to global health. Hearing examples from different programs, such as the BRAC tuberculosis program in Bangladesh, the difficulties of developing a malaria program in Zambia, and the different aspects of addressing surgical care in the poorest settings will definitely help me in terms of finding a better approach in my level of management in Plateau-Central, Haiti.

What are you most proud of?

I am most proud of my leadership and continuing to share my experiences through teaching the new generation of health care professionals. I took part in the University of Global Health Equity last year with our PIH colleagues in Rwanda and was able to share my experience of health care delivery in Haiti. It was a good experience for me, and I would like to continue to educate the next generation of global health leaders.

What advice would you give to someone just starting out in health care in your country?

Medical training in Haiti does not fully prepare physicians to address all the issues facing populations in rural areas. What they are learning at the school is different from the experience in the field in a rural area where there are many needs including difficulties in terms of access, people living on less than USD 2 per day, and low levels of education. Practitioners need to know that’s the kind of patient you are going to have sometimes. I would tell them to prepare themselves to see what health really looks like in the rest of the country.

I would also advise those starting out in health care in Haiti to look at case studies from the field because they can give you definite perspective. Even though many case studies are written about different countries, they can share important lessons in addressing the burden of disease here in Haiti.