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ready to extend our work throughout the center of the country. Indeed, we’d already started and had a crackerjack Haitian team led by Fernet Léandre, Maxi Raymonwille, Loune Viaud, and many others. It was about that time that Louise Ivers, David Walton, Evan Lyon, and Joia Mukherjee, introduced earlier, joined the Haiti team to scale up our efforts within the public sector health system. With support from the Global Fund, we designed our effort to help not only AIDS patients but all patients, and to focus on prevention at the same time. The idea was to work in public facilities (such as the General Hospital, which is where Clinton made his announcement), rather than competing with or supplanting them. The Haitian government was squarely behind the plan. I was as enthusiastic as I’d ever been about linking direct service to training (at Harvard and in Haiti) and research that might inform health policy.
    We’d also launched, with Cuban colleagues and the Aristide Foundation, a new medical school that would focus on improving the health of the Haitian poor, especially in rural areas. 9 (The great majority of Haiti’s health professionals worked in Port-au-Prince.) We were set for a good decade, I thought, and so did our students and trainees at Brigham and Women’s Hospital (the Harvard hospital where I trained and where we’d launched training programs for young doctors committed to global health).

    But then came the February 2004 coup in Haiti, which further weakened the public health infrastructure. 10 Haiti’s president and his wife, our staunchest advocates in the fight against AIDS, were spirited away to the Central African Republic in a way that resembled nothing so much as the “extraordinary renditions” of suspected terrorists described in the popular press. Haiti’s elected government was replaced by a group of unelected officials (unelected by Haitians, in any case), and the Prime Minister, Yvon Neptune, was tossed in jail without charges. It was a dispiriting time, in large part because of the lies and distortions that figured prominently in many official policies, including some of my own country.
    Although the Global Fund efforts went forward, the Clinton Foundation declined to work in Haiti under the régime installed after the coup (an honorable gesture, which made absolutely no impression on the de factos, as they were called). Instead, the Clinton Foundation urged Partners In Health to launch a major rural health initiative in Rwanda with the national government’s health authorities. I’d visited Rwanda before and admired its governance, born of horrible circumstances and still subject, at the time, to legitimate critique and negative propaganda (some of which came from France, some from surviving architects of the 1994 genocide, but also some from more credible voices in human rights circles). In the fall of 2004, we made a long-term commitment to begin a comprehensive rural health initiative in Rwanda.
    From 2005 on, we continued to expand our work in the public hospitals across central Haiti, while some of us, including leadership from our Haiti team and Harvard Brigham colleagues, began setting up shop in southeastern Rwanda. We were first dispatched to a longabandoned hospital in an area of former national parklands where as many as 60 percent of the population had been displaced, at one point or another.
    It was satisfying work. By the summer of 2008, it was easy to see the power of good public health governance when linked to funding and to decent implementation capacity. Working with the Rwandan Ministry of Health (which had also received support from the Global Fund) and the Clinton Foundation, Partners In Health recruited and
trained two thousand health workers, rehabbed a dozen clinics, rebuilt two hospitals, and broke ground on a third. (We’d been sent to three of the four districts in Rwanda that lacked any working district hospital;