QUO VADIS AMHE?
During our lifetime, we have seen quite a bit of upheavals among industry behemoths. Venerable institutions that have been around for decades are falling by the wayside. This alphabet soup includes Pan Am, Life, Ebony, Sears, numerous hospitals and so on. It seems like the advice that past success is no guarantee of a rosy future rings true as time goes by. As we are in the midst of celebrating AMHE’s jubilee, we need to ask a germane question: will it be around for another 50 years or for that matter for the next 10 years?
Lest there be some misunderstanding, let’s say this loud and clear as rule #1: reaching jubilee status is a major accomplishment and one to be proud of. Having said this, let’s also add this proviso as rule #2: any constructive criticism thereafter doesn’t negate rule #1. Moving forward, it’s important to remember both rules.
I have been around AMHE since the early nineties when my first ever participation at a conference was a cameo appearance in Absecon, NJ. Since then, I have gravitated all the rungs of the ladder, short of the presidency, by choice. I therefore have had a front-row seat and I feel comfortable sharing my thoughts. Unbidden, of course, but honest and wishing that AMHE can survive us and remains relevant.
The success of AMHE in a sense is a surprise because it always had to fend off quite a few headwinds, some stronger than others but the sum total has always been a matter of concern. Suffice it to cite: schedule dilemma because our annual powwow is so close to the NMA’s, a fleeting membership, internal quarrels, the issue of the lingua franca and so on. Usually, such obstacles have resulted in the death knell of many Haitian organizations. Amazingly, AMHE has survived. If truth be told, it has not escaped unscathed and it remains scarred. Many former Chapter presidents for one reason or another no longer participate in any activity. Same can be said about some former CEC presidents.
The urge to write a paean for the commemoration of the jubilee, strong and appropriate as it may be, carries the risk of being heavy on unbridled exuberance and light on necessary autocriticism. A better approach is to winnow away the weak links of the chain. Just like a piece of silverware that has accumulated tarnish over time, we can remove the layer of grime, polish it so the luster can return and shine anew. Ignoring this phenomenon would be to our detriment. What are some issues that need our attention?
The first one and always a thorny issue is the language. Although by statute AMHE represents Haitian health providers outside of the homeland, in reality it has always been a North American entity and make that a continental American entity primarily. Because French wasn’t a mother tongue but a borrowed language, many of us once immersed in the American milieu become more comfortable with English and not infrequently forget French and veer completely toward English. This reality is pitted against the fact that our colleagues who have emigrated north of our border have remained fluent in French and many never acquired the command of English. So, this had always been a headwind at our congresses, i.e. which language should be used, only English, English and French? I remember the uproar of my colleagues when I dared make a presentation in Kreyol! Yes Kreyol, the language spoken by all of our brethren and not a patois as some of us like to call it but would never dare classify Afrikaans the same way. Comme on le dit en français, c’est un cas de deux poids, deux mesures. Why language should even be an issue is a microcosm of the peculiar nature of our culture. Open mindedness is not our forte. A practical solution should be the following: one should feel free to use any of the three languages spoken in North America: Kreyol, French, English. Translations should be made available so that it is not an issue. If the goal is to corral support from our professionals from the North, then we need to accommodate them and not make them feel uneasy. Sterile discussion about the use of Kreyol or any other language for that matter is not consistent with good scientific inquisitive disposition. For those ready to slam the door shut about my making an argument for Kreyol because it supposedly is not sophisticated enough to allow the expression of abstract ideas, please be reminded of the seminal works of Professor Alfred Noël. A tenured faculty member at the University of Massachusetts, he wrote a two-tome advanced math book in…Kreyol! I had written about the publication of the first one in the very pages of this Newsletter a while back.
The cost of attending a congress has always been a sizable bite in one’s budget. At the same time the one feature that had made our congress attractive was its appeal as a family affair. So long as the health care climate was advantageous for physicians, the concern about cost became secondary to the allure of the social benefit of our annual gatherings. As time went by, the concern for cost of attending a congress became more and more of an issue, especially when college tuition had become part of the equation and HMOs had declared assault on physicians’ reimbursements. The appeal of fashion shows styled by the ladies from Montreal and choreographic performances by folks from NY, as well as artistic performances by our members have become nuggets of our lore. However, we have been witnessing for the past few years a dearth of such entertainment. Lately, everything being equal, the cost issue seems to have become a deal-breaker. What else seems to be at play?
The strongest headwind that so far that we have not been able to get a good handle on is the graying of the membership. Our sons and daughters who grew up coming to our annual gatherings, even if they go in the medical profession don’t seem to have the same gordian knot or carry any keen commitment to join. Not infrequently, they refer to us as a gerontocracy congregation. This lands us into a double whammy. Graying means retirement with less disposable income, illness, change of priorities. Whereas heretofore it was automatic to consider attendance at the congress as a family annual outing, now spending time with grandkids takes precedence. It also means the young is not replacing the old. This lack of constant infusion of new blood remains a festering issue and likely its resolution or lack thereof looms as an existential matter. Is there any model that we can follow?
Universities do offer a method worth emulating. Absent intermittent reports of the slower ascendance of women and African Americans, meritocracy is at play. Young members are moving up the ladder. We need to mirror this pattern. We can dub our existing template as a recycling of the same folks. We need to start pulling back and let the new generation take over. We also need to recuperate as many of the members that have strayed over the years to ensure we still have a critical mass because our effort to attract the younger folks will take time to succeed. Where do we go from here?
After attending this last congress, it seems to me that AMHE’s lot is not yet irrevocably set on the downslide. There were enough young academics to imagine that we can leverage them to start a common process for institutions that want to remain relevant: reinvention. Instead of timidly dwelling with the digital world, we ought to embrace it and take advantage of its convenient features. Offering CMEs by remote is a great idea and we need to expand it. In fact, this is an arena that we should open to the younger set and let them run with it and run it. Hopefully having ownership of a program will translate into a vested interest and status as a stakeholder. Instead of wallowing in self-pity reminiscing about yesteryear events, we ought to look forward and start working on goals stated in our mission statement that we have not yet been able to accomplish in a sustainable manner. We have enough good academicians that we could start tele instructions for medical students, residents, and postgraduate classes. Again, we should let the young handle this and not go about it the old-fashion way by recycling the same old guard in new suits. The digital revolution is creating quite a few victims; we need not be one of them. I remember being part of the first cohort of physicians going to L’Hôpital Général to do volunteer work. It was then a USAID-sponsored activity that fell by the wayside due to insecurity. Nowadays with the advent of Zoom, that can become part of our tools and we need not be concerned about personal security.
These reflections should be considered as the first volley of a series of conversations that we ought to have to create a path forward, to ensure that we keep singing a siren song for AMHE instead of listening ruefully to a drab, forlorn, disappointing, swan song. It’s best to be proactive than to fall behind the curve and try to be reactive in the face of a continuously moving goal post.
This congress turned out to have been a super spreader. Quite a few of us have caught Covid as attendees. I was surprised to be among them. As a hospitalist and taking care of Covid patients routinely, and as the oldest person in my department of more than 30 providers, I had escaped the infection until just now. Of course, my symptoms were mild- I am fully immunized- but nonetheless it’s not pleasant to have myalgia, rhinorrhea, sore throat. In future conventions, strict adherence to mask wearing should the rule. Otherwise, we will acquire the unfortunate reputation as being a place for germ propagation. This would really scare folks and they will stop coming altogether.
Reynald Altéma, MD.