By Dominique Kerouedan, MD, MPH, PhD
It’s very hot outside, the sun is burning, and the light is violent at noon. I walk alongside my sister on an earthy red path through sugar cane fields, on our way home from school. We are thirsty; the sugar cane is refreshing and delicious. This is Africa. This is Bouaké in the early 1960s when it still is in the middle of nowhere, a big village in the bush. Côte d’Ivoire has just become independent from France’s colonial powers. My sister is 4 and I am 3 years old. Our brother is not yet born, but he will come soon, after we arrive in Dakar, where we will spend a few years too. I love going to school.
This is my first childhood memory of Africa. Ever since, I have felt I belong to this continent and am so happy each time I land there to work with colleagues, putting our efforts and energy together to improve people’s lives, their health and human rights, in a place where economics and politics are driven by the interests of wealthy leaders and nations.
I was fortunate to have completed my medical studies at one of Paris’s best medical schools, despite some unexpected challenges. After I began my studies, I was confronted with the dreadful suicide of my father. Following his death, I worked much harder to finance my studies. I wanted to specialize in Tropical Infectious Diseases, to travel around the world, discover other people, and feel useful to those who might need me.
On a leave during my internship, I spent two years in delicate humanitarian situations with “French Doctors” NGOs. Once, when working in southwest Colombia, I was evacuated by the Colombian Army from M19 and FARC guerrilla-occupied zones during a civil war in Cauca. I later served as a medical doctor in an Afghan refugee camp close to Quetta in the Baluchistan desert of southwest Pakistan, in 1986, when the Russian troops occupied Afghanistan. I recall sharing wonderful time with refugee children who came with their mothers to the dispensary on their days off from the Koranic schools. This camp was close to Pakistan’s border, not far from Kandahar. Many of these children, I imagine, became the Taliban…
Next, I worked in Karen refugee camps in northwest Thailand, providing care to Burmese refugees along the Salween River. As we vaccinated and treated their mothers and younger brothers and sisters, child soldiers stood with Kalashnikov rifles in the jungle all along the river on the Burmese side. It seemed as if no one in the world cared about them.
Returning to France in 1987, I met my husband, Thierry, a pediatrician who was planning a clandestine medical mission to the Panjshir Province in Afghanistan, at the request of Commander Ahmad Shah Massoud through an NGO in Paris, Aide Médicale Internationale. Thierry spent almost six months in Afghanistan monitoring health medics trained in Peshawar. He reached villages by walking at night to avoid stingers that targeted the Russian army’s helicopters. We met again in Paris and decided to finish our internships before moving around the world together. I was very interested in the work conducted by the Medical Commission of Amnesty International in Paris. In 1988 the office had organized a world conference on the involvement of health professionals in torture and death penalty procedures. We invited MDs from Pakistan, Brazil, Argentina, South Africa, Mauritania, and other places who testified about their situations. I wrote my thesis on their experience and how to prevent this from happening again. I studied law to better understand how the sovereignty of nations could be such an obstacle to protecting people from human rights violations. There has been slow but significant changes with respect to this in the world over the last 20 years.
At that time, HIV/AIDS was spreading rapidly throughout Haiti and the West Indies, as well as Central Africa. I spent my internship conducting epidemiology research on HIV/AIDS mother-to-child transmission in Africa and the Caribbean. I also gave birth to our first son, Theo, who was born at Christmas in Paris!
Thierry and I knew that we wanted to specialize in Public Health, so we chose Berkeley’s School of Public Health. It was a great decision. The years at Berkeley were among the best times of our lives together. The place was just lovely, and everything was perfect for our son, too. He enjoyed the childcare center and learned English quickly; he was one year and a half when we arrived; his first word was “cookie!” We carried him all over Berkeley on our bikes. He loved to watch the squirrels as they ran all over the lawns and trees on campus and listening to the carillon.
The Berkeley courses were great and prepared us for our careers in international health. I especially enjoyed working on the technical and policy aspects of health and development, through relevant case studies and publications shared by my professors Dan Perlman and Nap Hosang. Thierry loved James Robinson’s course on Health Economics and our Professor Art Reingold was a delight! I still remember examples he gave which suddenly made Epidemiology seem so easy. We learned from the faculty and also from other students we met in class or at our professors’ homes. We were invited to evening potlucks, and for the first time in our academic lives, we found professors who believed in us. Their doors were open, which was so different from our student years in Paris. Today we still enjoy so much spending time with our friends from Berkeley, Cheryl living in Kenya, and Giorgio in San Francisco, who is our second son’s godfather!
Berkeley impacted us for life. The university name seems to be a kind of a global password: a degree from Berkeley helps so much in the job market. The name also gives you credibility and legitimacy in the professional world, as does your field experience. If you have studied at Berkeley, you find that you belong to the international community, you have a voice in decision-making, you are listened to, which is key in the field of public health.
“The years at Berkeley were among the best times of our lives…The Berkeley courses were great and prepared us for our careers in international health.”
After Berkeley, Thierry and I were hired by the French Government Technical Cooperation to provide technical support for almost six years to health authorities at national and regional levels in Côte d’Ivoire. We also managed the funding for joint European Commission-French Government projects in Madagascar. In Côte d’Ivoire, we had two more sons, Johann and Gaëtan.
In Africa our work has been both fascinating and difficult. There I served as an adviser to the National AIDS Control Programme Director in Côte d’Ivoire. In Abidjan, I saw young men, women, and babies who were dying of AIDS. My colleagues and I have felt so frustrated having to implement such unadopted international strategies against HIV/AIDS. I wrote my PhD dissertation on ten years of failure of HIV/AIDS international strategies in Africa and published an article two years ago on “20 years of the failure of HIV/AIDS strategies in Africa”…unfortunately. I am now involved at the Global Fund level and do believe that public-private partnerships involving civil society and universities and the private sector, are definitely the right way to go. I have also served the regional director of the poorest region of Tulear in rural southwest Madagascar, where I found mothers who didn’t know whether they were going to be able to feed their children on any given day and couldn’t afford to seek hospital care when confronted by emergencies.
In 2001, Thierry passed a competitive examination to enter the European Commission and was posted to Brussels. After almost 15 years abroad, we were returning to Europe. To keep our family together, I became an independent short-term expert. Over the past eight years, I have learned so much in providing technical support and evaluating international agencies’ support to health sector development in the Caribbean, Algeria, Eritrea, Mali, Senegal, and Niger, and other places. I’ve also done policy evaluations of France and the European Commission involvement, as well as contributed to the fascinating work of the Global Fund against HIV/AIDS, TB and Malaria 5-year Technical Evaluation Reference Group. Thierry is currently Geographic Coordinator and Administrator of the European Development Fund to 16 West African countries.
Our thoughts often return to Berkeley and how it continues to shape our work. While I was working with a French Parliamentary committee evaluating France’s contribution to the implementation of health MDGs, I discovered that the men in our Foreign Ministry Administration knew little about health and, worse, showed little interest. I decided to sensitize them before they became civil servants and diplomats, and so on. At Sciences Po in Paris, I founded a course called “Health and Politics in North-South Relations,” an elective in the Master of Internal Affairs or the Master in Public Affairs. My students love the course because it’s about real life, because providing health care is so much about politics. My teaching methods are inspired by my studies at Berkeley. Believe it or not, Berkeley-like comprehensive international public health studies still don’t exist in France. In an effort to bring change, I am in touch with the Director of the Ecole des Hautes Etudes en Santé Publique, recently founded in Paris, to suggest developing an International Health Department and training, especially in the field of history, management, and evaluation of international health and development strategies and policies.
Last Christmas, our son Theo turned 20 years old. He is now studying Law at King’s College, enjoying so much his life in the U.K. He’s particularly interested in International Public Law, Human Rights Law and European Law. His brothers Johann and Gaëtan, are at the European School in Brussels, learning as much from students from all of the European Union Member States as from their teachers! My children miss Africa, and probably will go back…