Emmanuel François, md, mph, mba.
Original AMHE founder
If one were to wonder if this avuncular, occasionally suspenders-wearing, garrulous man, ready to smile, always present at every AMHE congress, was acting like a parent proudly overseeing the blossoming of an offspring, one wouldn’t be far astray from the truth. The truth is that this person is named Dr. Emmanuel François and as customs would have it, Manno, by his peers. The pride he is exhibiting rests on a singular fact: he is the sole founder, continuously active in AMHE affairs who has yet to miss a convention. His life story mirrors modern history spanning from the mid-sixties to present day.
Born in the shadow of the Roman Catholic Cathedral in downtown Port-au-Prince, like so many of his congeners, his formal education in the primary and secondary cycles took place at religious institutions. First at Jean-Marie Guilloux (Teyat in our vernacular), a stone throw away from his childhood residence, then at St. Louis Gonzague. He sheepishly admits to the fact that, with a certain Boris Chandler who will become his cherished friend till death tore them apart, he shared the highest score at the entrance exam for our national medical school. This was a hallowed edifice that he fondly recalls, as a member of the class of 1964. He then spent 2 years of Residency in Surgical Pathology, under the guidance of Dr. Vergnaud Péan, and along the way, he became an instructor in Histology and Histopathology at the medical school. He was one of six young physicians making the first group who ever passed the then dreaded ECFMG exam in Haiti in 1966.
He landed a position at Harlem Hospital in NY and started his training in General Surgery. Three years into the training, an abrupt interruption came when Uncle Sam rewarded him with an unsolicited offer he couldn’t refuse: a position in the US Army Medical corps as a commissioned officer. That hiatus lasted 2 years; it began in basic training at Fort Sam Houston near San Antonio, Texas, where he became a US Army Major before being shipped from there straight to Vietnam. The military assigned him first as commanding officer to a field hospital in Duc Pho where he received a shrapnel wound which led him to receive the Purple Heart Medal. Then, it transferred him to the 27th Mobile Unit Self Transportable (MUST) Surgical Hospital in Chulai, the type immortalized by the TV series “MASH”, the earlier Korean War era name for this type of hospital. Life at Chulai was more like that of a surgical Resident at a busy inner city public hospital. He dealt primarily with management of gunshot wounds.
Critical patients were to be evacuated to Japan in flying intensive care units, under the watchful eyes and care of a surgeon. Officers considered such trip as a plum assignment so much that the higher-ups put a lid of rationing on it. Imagine a beckoning package that included several nights of downtown Tokyo nightlife, right in the vicinity of Sanyo Hotel, the US Government property reserved for military officers in transit. And in the army culture where rank has its privileges, Major Francois, field grade officer with gold leaves in his hat, could sip it all in. Besides the one trip to Tokyo, he had two other memorable outings. The first and most fun-filled one was a real treat. As a true Christmas present, he spent a week-long vacation as a second honeymoon with his bride in Hawaii during the 1969 holiday season. The second one, billed as an R and R perk, ended up with a bittersweet unraveling. He did visit Hong Kong for one week but the agonizing Apollo 13 saga in April 1970 dulled the celebration.
After spending a harrowing year-long tour of duty in Vietnam and with Purple Heart in his duffel bag, he returned to the States to complete his remaining stint in the military at Fort Bragg, NC, for a tour at the Womack Army Hospital General Surgery service. At that hospital, he continued to hone his skills in Surgery although not as a resident formally in training.
Dr Francois confides that the Vietnam experience changed his life forever. As he describes it, “By going to Vietnam, I broke out of the cocoon of the protective environment of the safe ivory tower of academia. It literally plunged me headfirst into the brutal world of adult life with all its warts. Warts like the gruesome discovery of and active partaking in armed conflict. Warts like the constant stress of making split-second decisions with life-or-death consequences on young soldiers barely out of high school with baby faces. Decisions made on the fly at a warp speed far superior to what I faced in surgical units stateside. I was an officer, and part of my role was to issue orders and to follow and maintain a tight discipline. By necessity, I always had to be on the lookout for the minutest details and explained them to my satisfaction. In any environment, I was always processing impulses coming through my senses to avoid being blindsided or I could literally or morally perish at any single brief period of a slip. This attitude has stayed with me since and is still second nature half a century later. My approach in any and every situation I have confronted has been and is still to proceed after an exhaustive scanning of the environment and a thorough assessment of the risks and rewards. I don’t claim of being always right, but I stocked far fewer blunders and far fewer pitfalls than I would have otherwise. Conclusions I have reached observing several of my peers facing the same harsh and unforgiving elements of modern American life.”
Great was his unpleasant surprise when he returned to the States on this May 3, 1970, made infamous by State troopers having fired at and killed college students, at Ohio Kent State University, protesting against the Vietnam war. This was the toxic brew mix that Vietnam Vets returning home were confronting. “Instead of being welcomed with open arms as heroes, we were to hide our tour of duty there. Some of us had literally spilled our blood for the country, but we were to hide it, by fear of being looked down as villains, or even worse, of being attacked in the streets for being responsible of the fighting of ‘an unjust war’”. In his own case, as a black man, but educated immigrant, he was fighting on a double front.
On one hand, he became entangled in the Vietnam conflict not of his free will, ergo he was a bystander forced to participate in a war without any kinship to the casus belli. On the other hand, the prejudices held against black men, an ego-deflating practice embedded in the military as a microcosm of the larger social fabric, ensconced him in a tight corner. Had he not been of a different cloth, he would have fallen as a casualty of so many pitfalls afflicting Vietnam Vets of that period: drug abuse, PTSD, violent behavior and so on. For that he is grateful and thankful to his lifelong companion, Edda, who stood strongly by him when the blues showed up. Incidentally, he reminds everyone that this past June he celebrated his 57th wedding anniversary and almost sounds mawkish, regaling one with the story of the classic encounter between a nursing and a medical student.
He separated from the military in February 1971 and returned to Harlem as a Junior Chief Resident, while his former classmate and competitor friend, the late Dr. Boris Chandler was the Senior Chief Resident. As such, his duties entailed rotating in the different surgical specialties without a formal training on their own, such as Pediatric Surgery, Neurosurgery, Plastic etc. Right at his reentry in civilian life, Dr. Chandler paired him with two young Haitian physicians who needed special support: Dr. Lionel Lainé, graduated from Lille, France, School of Medicine and Dr. Laurent Pierre-Philippe from Haiti Medical school. They did their three months rotation in Peds together. Fresh from his Vietnam experience and their senior, in an unbidden gesture, he decided to take them under his wings and to teach them the ropes, the harsh realities of the junior residents’ life in a big inner-city hospital. A recurring theme of their conversations that he relished centered on the concept of “giving back”, inherited from his father the Haitian politician of yesteryear.
In Dr. Lainé’s case, he had to go out of his way to have him accommodate to the American way of life. Educated in France, Lionel had espoused the bourgeois customs common there, where society treated physicians as demigods perched on pedestals. A city hospital and more so a black one at that, didn’t exactly hold all the amenities he had grown accustomed to. For example, it would have been unheard of in Lille, to have a physician transport a patient on a stretcher to have a chest X-ray, or to carry the blood samples to the labs. Well, at a city hospital in an indigent area where there always seems to be a shortage of everything, getting the task done meant doing this type of scut work. He became close to both physicians, and they stayed in touch even after they moved on to other rotations. Dr. François finished his training at Harlem in December 1972 and moved with his family to Columbia, Maryland, to take a position as Associate Chief of Surgery at Baltimore’s Provident Hospital, the then beautifully rebuilt, century-old black hospital there. He has resided in Columbia since, preferring the slow pace of life of a small hamlet to the full tilt of a large city.
Because of his relationship with Dr. Lainé, he was involved from concept to action, in every step of AMHE creation. Dr. Lainé had asked him for his advice and guidance in birthing this construct because of his previous managerial experience in the military. At the same time, Dr. Lainé had previously participated in this type of assembly back home. He once was a very active member of the Cercle des Étudiants under the leadership of Père Georges. The latter would join Papa Doc’s first government as Minister of Education and would become his opponent later. Dr Francois advised Dr. Lainé to embrace inclusivity and cast a wide net for recruitment. That started with physicians from other New York area hospitals for the launching committee. Hence, Dr. Lainé reached out to Dr. Pierre-Philippe who had left Harlem to go to Jacobi and Dr. Pierre-Philippe brought in Dr. Roger Dérosena from Columbia P&S Medical Center.
Later, after the first AMHE meeting that he presided in November 1972 at Harlem Hospital, according to the first AMHE Bulletin, words went viral. One would then see the first outsiders’ faces of Drs. Janin Raoul and Dougé Barthélémy from Chicago and of Dr Joseph Verna from Montreal. Dr. François suggested to Dr. Lainé to make the tactical decision to hold the first official large meeting, that of the Conseil de Direction, in Chicago in the spring of 1973 and the first AMHE Convention in Montreal during the 1974 Labor Day weekend. In that same year, AMHE incorporation papers were drafted and signed on February 7th, and NY State registered them 12 days later. Truth be told, the official AMHE birth certificate goes back to February 19, 1974. The signatories then were Lionel Lainé, Roger Dérosena, Laurent Pierre-Philippe, and a dentist Joseph Dorsainville. The major hurdle at hand turned out to be growth of membership.
The task of recruiting members was an act of devotion that he is now very proud of because it reeks of pure commitment. As he tells it, “I contacted the AMA’s office in Chicago and made the request to give me access to their mailing list because, I told them, we were in the midst of launching a sister medical society. The person at the other end gave me the telephone number of a New Jersey outfit to get in touch with. I did and the deal was to pay in advance a dollar for each name culled from the list. The next morning, I called. They had picked up 337 Haitian graduates’ names, so I had to pay $337.00 for that list if I wanted it. That was more than my monthly salary at the time. I paid it from my own pocket out of savings stashed away during my military years.” From then on, Dr. François became part of the budding AMHE, well woven into its quilt. He ran only once for the office of President of the CEC and lost to Joseph Verna, an older friend. Dr. François had campaigned for him back home, when the latter was a candidate for the Presidency of ADEM (Association des Étudiants en Médecine). This he thinks, only shows that democracy has its price, and he is fine with that. But he learned later that some leveled criticisms at him for his lackluster effort to fight for the post. He holds no regrets since this is meant to be a collegial endeavor and not a fight or a polemical exercise, a flaw of ours.
One of his plum creations at AMHE is the AMHE Foundation that has a somewhat checkered history, going through twists and turns to its present form. The 1975 New York convention placed Janin Raoul as the “Animateur” (a word from our cherished Dr. Wesner Fleurant) to make a reality of a foundation to be appended to AMHE. We all understood that it was a reward for Janin who showed a keen interest to the whole AMHE experience since the beginning. Further, Janin would have to continue to organize the Chicago chapter. In that same meeting, he proposed to christen the foundation with the name of a recently lost classmate who was mutilated in a US Highway car accident. But the original five who didn’t really know Janin’s method, decided to tag me along, so the goal would be accomplished by the next year’s convention. And, indeed on June 4, 1976, the AMHE sponsored foundation was incorporated in Illinois under the name of Ménélique Roland Foundation. A terrible snafu because the family had not granted any such permission. Thanks to a name change in August 1986, it then morphed into Medical Relief International and finally in March 1996, it took its present name. He feels somewhat bemused by some of our colleagues who don’t seem to grasp the concept of a foundation doing the humanitarian works of a medical society à la AMA that does the very same thing. He is definitely proud that the AMHE Foundation nowadays supports at least 10 projects in Haiti. He has a special place in his heart for the AMHE-GRAHN project that he has been part of from its early conception. He was instrumental in awarding an outright grant of $20,000.00 by the Foundation to help in the construction of the first wing. Now, he is elated that this project will cement forever the AMHE name on Haiti’s soil.
As for his professional life, when he left Harlem Hospital, Provident Hospital in Baltimore, MD, hired him to organize a training program in Surgery that the hospital wanted to start. He held the title of Associate Chief of Surgery. Unfortunately, the project fell due to the economic realities that hampered inner cities black health care institutions, an unintended consequence of the Medicaid program enacted in the 60’s. That century-old black hospital would close its doors a few years later even after receiving a temporary lifeline from the city Lutheran Hospital, a center with religious affiliations, that absorbed it. The appointment at Provident Hospital would last but a year and then he would start his own private practice and has been running it since.
His involvement with AMHE and AMHE Foundation would lead him to develop a keen interest for the non-medical side of healthcare delivery. Hence, as a self-imposed apprenticeship, he became active in the running of the Baltimore City Medical Society. There again, he got chewed up by older black physicians of the city, because in a not-too-distant past, blacks were not admitted in the city AMA branches. Furthermore, to acquire a formal knowledge in the field, he enrolled at the George Washington University MPH program. He was among the first group of students who clinched that degree from GWU, in 1989, and the following year, he completed the MBA curriculum from the same institution with Major in Economics and Finance.
Dr. François, Entrepreneur.
He was among the founding members of an investment bank created with the mission to “shovel” capital into Haiti, the Promo Capital Investment Bank to be affiliated with the Promobank in Haiti. A million dollars evenly split among venture capitalists from the US and well-heeled businessmen in Haiti were to be raised. Although the investment bank didn’t last long, one can list among its stellar accomplishments
- Hospital CFDT created in Turgeau, Port-au-Prince (now defunct).
- OnePhone Mobile phone company reorganized later as Digicel.
- E Power, a thermal electric generating company still going strong.
As for the reason for the demise of an investment bank that caters to investors ready and willing to pour money into the country, he feels that in Haiti, the transparency we are accustomed to, as the norm in the US, has plenty of room to grow, before it becomes an accepted practice over there.
He was also involved in nurturing a relationship with movers and shakers on both sides of the Atlantic. As a founding member in 1982 of NOAH, the National Organization for the Advancement of Haitian Americans, he became seriously involved in trying to shape the US Government policy toward Haiti. He was a frequent visitor at the State Department and at the Capitol Hallways, lobbying congressmen connected to Haiti. He became acquainted with Mr. Walter Fauntroy, the Washington, DC, Congressman who was then Chairman of the Congressional Black Caucus Haiti Subcommittee. Representative Fauntroy was his special guest at the AMHE Convention in Norfolk, VA in 1986, and was awarded an AMHE plaque by Dr. Marie Claude Rigaud the Executive Committee President at that convention.
In 2004, he created the Alliance of Overseas Haitians, with the mission to force the Haitian political system to recognize Haitians in the diaspora as full-fledged citizens, with rights to vote and to hold office, rights that had been denied to us, due to an erroneous and self-serving interpretation of the 1987 constitution by Haiti political elite. A pincer attack consisting of the candidacy of Mr. Dumarsais Siméus, a Texas businessman affiliated with PromoCapital dovetailing the organization of the Haitian vote on foreign soil, mainly US and Canada, failed due to the fierce opposition of the US-anointed, Haitian Prime Minister Gérard Latortue. But the struggle was not totally lost, because the idea followed its circuitous route in Haiti’s social landscape, emulating a water stream that meanders the terrain on its preordained rendezvous with the sea. In 2011, overseas Haitians’ rights were restored, and enshrined in constitutional amendments voted at the end of Préval’s presidency.
How does he marshall the strength to juggle the responsibilities of family life, full time medical practice and all these other activities mentioned here, without even adding social obligations? “First, I was and am still blessed with a robust health. Safe for a brush with demise about 10 years ago, when a nasty disease put me on life support, I may not be pristine, but I am good enough to function, thank you. Anyway, what living body with moving parts, or inert entity stays pristine with passing time?”
Next, it is a legacy from my father. The old man had emigrated from his native Port-de- Paix to seek fortune in Port-au-Prince to follow the common practice of his time. He quickly embraced politics and had his baptism of fire in the early thirties, when he was a high ranking official in Seymour Pradel’s election, opposing the latter to Sténio Vincent for the presidency of Haiti. We know that my dad’s side lost, but that had instilled in him, and he passed it on to us, that one has always to strive to reclaim territory from dark evils by doing the right thing. I can still hear echo of his voice telling me, “You have to give back because you are blessed”. And being blessed in these post-World-War-II days in Haiti, was just being able to have three square meals a day. Last year, I’ve learned from a resurfaced publication, that Saturnin François, my father, was among the young disciples of Jacques Roumain, a former Columbia University Haitian graduate, “trying to apply Marxist principles to Haitian politics” in the 30’s.
But as he explains health and upbringing are great underpinnings. But they can carry you just so far. In his mind, the true support came as a trophy for the battle he won hands down. That of successfully raising and molding to his own image, the family unit he created with his erstwhile sweetheart nursing student. They gave birth to two boys and a girl. The second son, a successful Wall Street financial executive and his daughter, a Harvard-graduated Doctor in Education, have constantly peppered the family name on academic papers published. Yet Mammy earned her right to address the AMHE convention in Absecon, NJ, by organizing and being active within the AMHE Auxiliary in the early days of the association. Although still busy seeing patients, the prized assignment for him nowadays more than anything else, is to baby-sit on weekends his third grandchild, the 5-year-old son of his daughter who gave him this joyous task he would gladly pay to indulge in. The two older grandsons are presently attending colleges and should soon follow their father’s footsteps in the world of business.
Looking to the future, besides having front row seat to watch the blooming of his grandsons, his main project now, is to assure the survival of the AMHE Foundation, beyond the passing of the present directors. The foundation’s survival will depend on applying sound management skills. By necessity we must raise more capital to reach the wherewithal of hiring professional staff with competency to carry the torch forward. And that is the penultimate challenge and the concern keeping me awake at night at times.
Reynald Altéma, MD.