Interview Date: July 31st, 2012
Interview conducted by Tarnia Green-GIS
1. Dr.Etienne you have had a long career in the field of medicine and public health for over thirty-five years. What has the journey been like? Why are you so passionate about your field of work?
“I think that I am passionate because I love people. I love people to live lives with dignity. I think it also stems from my spirituality as well. When I was age seven I knew that I wanted to be a doctor. As I progressed in my career as a doctor, I became more interested in Public Health. At first I went back to University to study internal Medicine and then Hurricane David came and I had only been gone for six weeks so I packed my bags and came back to Dominica because I thought my country needed me at that time. On my return, we began the journey to rebuild the health system and so I became more and more involved in public health system. For me I felt that was really the best way of touching people’s lives, of ensuring that people had access to care, that people understood about their bodies and how to be healthy. For me it has been thirty-five years of enjoyment. I really do enjoy what I do. It has meant sacrifices, particularly when you live in a country like Dominica; you need to combine many things. I also worked not only as a public health practitioner but I also did private practice. Because of my approach to dealing with people I did all things so I was holistic in my approach, so I took care of spiritual, emotional and mental. Importantly I feel what I have learnt of this journey is the ability to touch people where it is important.
2. Throughout your career, you obviously gained extensive knowledge and experience in various aspects of health management, health systems and health care delivery, including management of essential drugs, human resource management for primary health care and the integration of health programmes and systems. Were these areas of special interest to you?
“In Dominica at that time we had such few professionals in a field that you had to do everything. My own public health experience in Dominica spanned many areas of interest. I worked with nurses, we worked with immunization programmes, with the care of pregnant women, but I also worked with environmental health officers, I also was involved in the work that they were doing in food handling, I was involved in the work on water and sanitation and I had exposure to this, I was responsible for heading the health response to disasters and so I learnt a lot of things as I went along. I worked with HIV /AIDS at a time when it was very difficult to get our population to accept that this is a disease and a condition like any other and that these people had dignity and that we had to respect them. It was a time also when we had to do a lot of education and so in all of the opportunities that presented themselves to me in Dominica, because we were so limited in terms of human resources we had to do lots of things. This helped me as I went on to PAHO because in PAHO I had all the technical areas, so that experience that I had gained in Dominica it helped me tremendously.”
3. What to your mind were the main contributing factors to you getting thus far in your career?
“Grace of God I always want to say that. I don’t think I am the smartest person out there, I think what characterizes my work is my passion and enthusiasm. And as I said that passion is born out of the love for people. I am an extremely hard worker, I have very good work ethics maybe I don’t take sufficient time for myself but I am passionate about work, I am passionate about what I do and I strive for excellence. I am never happy with mediocrity, I want excellence and so I strive harder and harder each day. I always tell my children genius is seventy-five percent sweat, so even now if I have something to do I wake up at 4:00 a.m and I prepare. I am saying this because I really want the young people in Dominica to understand that you have to put the sweat in. Even at the global level at the WHO, I wake up at four in the morning to do the work. If I have to give a talk, I recognize that I am from some little island (Dominica) that nobody knows, I have to make sure that I do it very well and so I work on it, I write, I practice so I can come off looking good because you have to strive for excellence.”
4. You have been seeking support for the candidacy to hold the position of Director of the Pan American Health Organization (PAHO).How has your campaign been?
“Interesting…. you know Dominica as a small island developing state we have limited experience and limited resources. But our Prime Minister Hon.Roosevelt Skerrit has really been a champion. He has used his contacts and made representation at the very highest level, not only with CARICOM but also with other countries. It is a difficult election. We do have five candidates running for the position and there are thirty-eight (38) voting member states. The CARICOM vote is very important because we have fourteen (14) CARICOM countries and five Latin American countries and we need twenty votes to win. So we must continue to strive. I think we have been helped by some friendly countries and we have had to visit the Embassies in Washington accompanied by Dominica's Ambassador/ Permanent Representative to the Organization of American States H.E Hubert Charles. Our minister of health Hon. Julius Timothy has also been quite active in working with other Ministers of Health. It has been a collective effort with support from the ministry of health and foreign affairs.”
5. If you are successful in being appointed in the position as Director of the Pan American Health Organization (PAHO) come September 2012, what will be your major priorities?
“When I am Director of the Pan American Health Organization, I shall focus on ensuring that the organization continues in excellence. I think it’s important. We have many experts in countries. The organization is a hundred years during which time many countries have developed, they have developed their own technical expertise. We need to change if we are to remain relevant. We have to make sure that we have excellence of a different type, not necessarily only health technical expertise but we need to be able to harness the expertise that is there throughout the other countries. We need to be able to facilitate the South South Co-operation that would allow member states to help other member states; we need to be able to map out where that expertise is and to bring this to bear. Of course there are technical priorities that we need to ensure and many of those I think have relevance for not only Latin American countries but also for the Caribbean region. Importantly, the work that needs to be done on access to the social determinants of health, the work that needs to be done around chronic diseases and that is very important for the Caribbean as well, ensuring continued access for both prevention and control of HIV/AIDS, we need to continue the effort on communicable diseases as well some of those are vaccine preventable but some of them are not and we need this. Very importantly we need to work on the access to health systems and services. It is a growing problem with increasing privatization we need to ensure that people have access to care, that they can afford to have good care. This means also we need to look at how are we financing health care and working with countries to help them to do that. Addressing the human resource for health issues is another major priority. The Caribbean loses a significant number of health care workers that we train. We have to ensure that we can continue to service our health care system with health care workers that are relevant. We need to change the profiles as well as we need to ensure good distribution of those health care workers. I think importantly we have to look at access to safe, quality and efficacious medicines.”
6. What is your opinion of PAHO and do you think the organization is doing enough to address the region’s health problems?
“I think PAHO has really been a champion for health in Latin America and the Caribbean region. I think PAHO finds itself in a juncture whereby we have to adapt to the changing environment within which we are working, an environment where there are many other actors in public health. At one time it was only PAHO but now there are several other actors in public health. It is a situation where the agenda is increasing. Every year member states give us a number of resolutions that we need to work on in a context where our financial resources are limited. We need therefore to remain flexible and to ensure that we can adapt our methods of work if we are able to continue to help member states.”
7. What level of advocacy are you able to undertake as a Dominican in a privileged position to help Dominica and the region?
“There are not many people who work at a global and regional level that fully understand the situation of small island developing states. I bring that experience and knowledge to the work that I do, I bring the context within which we must address these issues and so I always advocate for the needs of small island developing states. I always provide the context within which we must also consider their needs. So I will continue to be an advocate for improving one, the technical support to our small island developing countries and also to help them to accessing support for their own health needs. PAHO is not a financing agency, we are a technical agency, but we can work with member states to access financing and other resources and I think I could help there as well. I think also, the question on how do you bring the technical capacity of the organization to bear on the technical issues and health problems of our countries is something that I will seek to address. It takes a special type of leadership to ensure that this happens.”
8. So you are prepared to take on this role?
“I think I have the required experience and competence to do this. I have worked at the local level, at the regional level and at the International Level. I have had the necessary exposure that would allow me to lead an organization like the Pan American Health Organization (PAHO) well into the 21st Century. So certainly I look forward to heading that Organization.”