On the afternoon of Jan. 12, 2010, when the ground forever shifted under him, Dominique Joseph’s eyes were closed, his hands in the air.

He had just sat down for 5 o’clock church services in Port-au-Prince, Haiti. For an instant, the worshippers thought their prayers had set the room atremble.

” ‘Ah, Jesus is back!’ ” he quipped wryly last month, recalling the congregation’s reaction – and what happened next.

Over the next 30 seconds, a 7.0-magnitude earthquake shook Haiti’s capital, a city of about 1 million, to pieces. Buildings crumbled, and tens of thousands died in minutes.

Inside the church, Joseph watched as a wall buckled, nearly sending a balcony crashing onto a row of worshippers. But the church stayed upright – and maybe that was the answer to his prayers.

It wasn’t until he stepped outside that he saw how serious things were. Rubble was everywhere. Walking home to check on his wife and children, he passed bodies in the street. On every block, he could hear people crying.

“It was like a cemetery,” he said.

Joseph’s family was safe – his wife, children, siblings, parents and grandmother all survived – but the suffering he saw, and the eagerness of others to help, changed the course of his life.

Then 35, Joseph was working for a textile company in the area. Feeling he couldn’t sit on the sidelines of the earthquake response, he quit and returned to serve the Catholic mission school he attended as a child. Then he moved to the Red Cross and, finally, a Maine-based charity in northern Haiti called Konbit Sante.

At Konbit Sante, which works in Cap-Haïtien, a northern city of about 270,000 people, Joseph gained years of experience and specialized training, and has since risen to become the organization’s in-country director.

Medical staff operate on an earthquake victim in an operating room at the Justinian University Hospital in Cap-Haïtien in January 2010. Gregory Rec/Staff Photographer

At Konbit Sante, Joseph helped to create mobile clinics to fight a cholera epidemic that swept the country after the earthquake, and, among many other accomplishments, cut child mortality in Cap-Haïtien by supplying hospitals with portable oxygen. He now plans to get a master’s degree in public or health administration.

“Sante” means health in Haitian Creole. A “konbit” is a collaboration among equals – like a farmers’ co-op, or a community barn raising. And that’s what Konbit Sante is all about, says its executive director, Nate Nickerson, who has a home in Maine.

“When people think of people doing health work in poor countries, they have a picture in their heads: a mission group tending to patients at a clinic,” Nickerson said in a recent interview.

Nate Nickerson reviews a Justinien University Hospital resident’s research project at the Konbit Sante Cap-Haïtien office in September 2019.  Photo by Rod Harmon

“Our whole reason for being is to support the local patient health system – not to go around them or replace them or manage them, but to help strengthen what’s here on the ground.”

The 10th anniversary of the earthquake passed last month, spurring retrospectives on what progress Haiti has made, and how to rate the international community’s efforts to help.

So far, the verdict has not been positive.

Billions of dollars flowed into Haiti after the earthquake, which devastated infrastructure and killed an estimated 300,000 people. Yet today, Haiti remains the poorest country in the Western Hemisphere, ill-equipped to provide daily public services such as food, clean water and health care – let alone to respond to an emergency.

And another crisis is, indeed, brewing. A battle between the country’s president and his political opposition has brought everyday life to a standstill and spurred food shortages and violence. The standoff has lasted so long that, with elections canceled amid unrest, lawmakers’ terms are expiring without replacements, leaving President Jovenel Moise to rule by decree.

Haiti’s challenges are myriad – corruption, poverty, political division, a sclerotic bureaucracy – but it was several well-publicized failures in foreign aid that helped to cement the country’s reputation internationally as a “money pit,” a place beyond help. Investigative reporting has documented how, under pressure from donors and the public, well-intentioned charities such as the Red Cross cut corners, spending millions while reporting inflated results.

This has contributed to what Nickerson and his colleagues call “Haiti fatigue.” The idea that the country is “a lost cause,” he says, prompts people to ask, “Why throw good money after bad?”

But all the while, a handful of aid organizations have been doing things differently: working from the bottom up, hiring native Haitians, and strengthening the country’s institutions, rather than building parallel ones that disappear when aid workers go home.

“You have to involve people,” says Patricia Wolff, founder of Meds & Food for Kids, a group that has been doing grassroots work in Haiti for decades. “You have to have skin in the game. You have to go beyond ‘rescue.’ Employ people, build their skills, make it possible for them to be successful.”

Residents at Justinien University Hospital in 2018. It’s the second-largest teaching hospital in Haiti. Photo by Nicole Wolf

“Change is not fast,” Wolff said in an interview last month, “and Nate’s very patient and persistent and consistent.”

In 2001, Michael and Wendy Taylor, a dermatologist and a marketing manager from Maine, founded the Greater Portland International Health Initiative. That year they formed their first partnership – with Justinien University Hospital, the second-largest teaching hospital in Haiti – and in 2002, they changed their name to Konbit Sante to reflect their cooperative mission.

Over time, Wolff, who also works in Cap-Haïtien, saw things improve thanks to Konbit Sante.

When she first went to Haiti, 30 years ago, Wolff took many sick children to public hospitals in the city.

“There was almost nothing they could do,” she said. The hospital had trouble testing blood sugar. They were low on IV fluid and antibiotics. So Wolff and her employees brought those things with them. After 6 p.m. there was no electricity, so they brought flashlights, too.

“Slowly, slowly, (Konbit Sante) started meeting with all the right people and engaging with the authorities and employing their own doctors – Haitian doctors and nurses – to talk to the authorities,” she said, “never giving away a lot of stuff but demanding a system and accountability before they would actually agree to putting money into it.”

That work is slow, and piecemeal, and demanding, which makes jobs like Nickerson’s and Wolff’s hard to fill.

You have to be a servant leader, and you have to be not worried about your next job,” she said.

After 15 years of full-time work in Haiti, two bouts of dengue fever and countless nights spent away from his family in Portland, Nickerson is looking for his successor.

After the earthquake in 2010, Nate Nickerson, executive director of Konbit Sante, talks with Pierre Chevannes, executive director of Justinian University Hospital. They were coordinating plans to take in more casualties from Port-au-Prince. Gregory Rec/Staff Photographer

“It has been pretty all-consuming and exhausting,” he said in a recent email. “So, I would like to pass that mantle to someone with new ideas and maybe more energy.”

By 2010, the organization was also supporting a clinic in Fort St. Michel, a poor neighborhood in Cap-Haïtien. In 2012, they expanded to Fort Bourgeois, helping a group called Unité de Lutte pour la Santé run a small clinic out of a family home.

Maudelin Mesadieu, the doctor who founded the Fort Bourgeois clinic, said Konbit Sante’s support had been just that – support – and not a set of commandments from above.

“They’re not there to tell you ‘this is what you need to do,’ ” he said last month. “They’re there to help you do it yourself.”

In recent years, Konbit Sante has expanded to a total of four Haitian caregiving partners. It operates mostly out of Cap-Haïtien, where all seven full-time employees are native Haitians. The group also supports the salaries of 37 Haitians working in health facilities or community programs not directly run by Konbit Sante.

Konbit Sante brought in about $798,000 in revenue in the year ending September 2019, according to an annual report produced by the organization. Roughly half of that came from grants and foundation support, and the other half from donations and non-monetary contributions.

Nickerson has kept costs down in part by limiting his own compensation. According to Konbit Sante’s tax filings, he made between $25,000 and $27,000 a year between 2015 and 2017.

Much of Konbit Sante’s work is less tangible than buying supplies or building a clinic, however. Nickerson is constantly working to connect people and institutions to the resources and networks that will help them to thrive. Later, the Haitians whose skills and careers Konbit Sante has built will move on and contribute to other organizations.

One such person, Dr. Youseline Telemaque, was a resident gynecologist at a local hospital in 2005 when Konbit Sante enlisted her to conduct a survey on women’s health care needs.

At the time, this information was scarce, and to Telemaque the results were surprising. She already knew that women often returned home after treatment and never followed up. But many more weren’t coming in at all, discouraged by cost or the trouble of navigating the system. Some were illiterate and couldn’t read signs inside the hospital telling them where to go.

After the earthquake in 2010, Dr. Youseline Telemaque, right, Miguelle Antenor and Mansenat Goacialia, Konbit Sante employees, walk through the Petite Anse neighborhood in Cap-Haïtien. Gregory Rec/Staff Photographer

“You might tell them to go to the lab for a test,” she said in an interview, “and they go back home because they cannot read what is written on the wall. That is crazy.”

That problem was easily addressed – they put helpful pictures on the signs, like a woman holding a big belly – but there were many more gaps in resources and communication. Telemaque decided to join Konbit Sante full time.

By the time of the earthquake, she was in-country director, the position Joseph now holds. In response to the cholera epidemic, Telemaque organized a network of community health workers who trained the public how to wash their hands, prepare drinkable water and rehydrate sick people. She worked with Vodou priests who believed that spirits were causing the cholera, reconciling their methods with mainstream medicine.

Telemaque left in 2012 to join the government health ministry, where she felt she was needed, and in 2014 worked on a family planning campaign with the United Nations Population Fund. Since then, she has moved on to other nonprofits, where she works to give girls information about family planning and their overall health.

But she remains on the board of Konbit Sante, which still holds a special place in her heart.

“They respect people,” she said. “They treat them with dignity. You are a partner. You are not down, you are up.”

The Haitians and aid workers interviewed for this story took pains to note that change ultimately will need to come from within. Haiti’s political problems require a domestic solution, they said, and foreign nonprofits like Konbit Sante can’t reform health care by themselves.

The Cap-Haïtien overlook in Haiti. Photo courtesy of Konbit Sante

Nor is Konbit Sante the only organization with collaborative, grassroots ideas – or the biggest.

The best-known by far is Partners in Health, an organization co-founded by the celebrated physician Paul Farmer that has 18,000 employees and branches in several countries. Among many other initiatives in Haiti, Partners in Health built a hospital roughly 40 miles outside Port-au-Prince after the earthquake leveled the city’s health care facilities, and continues to run it today.

Still, bit by bit, Konbit Sante presses on, working to help people like Joseph to help their neighbors.

That work has been going on for a long time, Joseph said: “I was a kid, and now I’m 45, and I still hear that the U.S. government is providing money to support Haiti.”

Considering how much is left to do, Joseph and his colleagues believe that Americans ought to take stock of their efforts in Haiti, and think about how best to help.

“If you keep supporting a country,” he said, “you should want to see progress – to see things getting better.”

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