Dr. Carissa F. Etienne
Assistant Director, PAHO

ŠArmando Waak/PAHO

Carissa Etienne was sworn in as the Pan American Health Organization's new assistant director in August 2003. A former official in the Ministry of Health of her native Dominica, she helped develop major Caribbean initiatives in disaster preparedness, HIV/AIDS, health services organization, essential drugs, health promotion and regional cooperation in health.

Today Etienne oversees PAHO's technical cooperation programs in the areas of disease prevention and control, family and community health, sustainable development and environmental health, and technology and health services delivery.

Trained as a general practitioner at the University of the West Indies, she also studied community health at the London School of Hygiene and Tropical Medicine, where she received her master's degree in 1982. A member of the Caribbean Public Health Association, she has also been an associate professor at Ross University School of Medicine since 1996.

PAHO Today recently spoke with Etienne about her first six months in office and her outlook for the future.

How did your background prepare you for this job?

Because I worked in a small country, I was forced to wear many hats. I had to deal with all the technical areas, starting with my work as director of primary health care and going on to chief medical officer. I had to deal with environmental health, maternal and child care, epidemiology, disasters, chronic diseases, communicable diseases and many others, so I had the technical background. Also, because I was involved at the regional level, I had a level of experience in working with different countries. This is a job that demands good managerial experience and knowledge, and for me this is a strong point. The position of assistant director demands that you understand human resources, how to work with people. This is one of my strengths. I'm also very conscious of the need for good communication so people who work with me understand our goals, and I am committed to teamwork.

Do you find a strong country focus in your work here at PAHO?

The majority of my experience was at the country level, but I was also involved in developing local health systems, working with HIV and AIDS, and working with many countries to develop a coordinated response. In the Caribbean we do a lot of networking and coordinating. I was involved at the subregional level in things like the East Caribbean Drug Service and in primary health care systems at the local and national level, so the country focus is not new to me. I was also very active in disaster preparedness, and we had annual meetings to improve preparedness and develop things like management of mass casualties.

How do you envision PAHO's mission and work in the future?

I would like to see health systems that ensure greater equity, with a particular emphasis on the people who are marginalized and underserved. I would like to see us address HIV/AIDS with a total, integrated response in a coordinated fashion, with access to treatment and prevention. And I think we need healthy public policies more conducive to health in things like environmental issues, food and drug legislation, laws for seatbelt use, and many others. I would like to see us empower individuals, especially the indigenous, the poor, rural residents and many others so they get support to make better decisions on their own health, with better information, with improvement of water and sanitation, with a deconcentration of services. One of my passions is the challenge of chronic diseases, which is so closely related to lifestyle choices. It's clear that we have to do more education, but it's not only that. It's also changing the environment to allow better choices. It's having healthy schools, where kids have an opportunity for physical activity, and so on. A lot of these chronic problems are seen as health problems, but they are really multisectoral in origin, and this is a big challenge for PAHO. How do we get the governments to see the multisectoral nature of health issues? How do we get them to see that they have to draw all sectors into their work to improve health? The answer is that we need more engagement at the political level. We need to sustain the level of information for them so they can make the right decisions. There have been some successes, like in HIV/AIDS, where the prime ministers have elevated the program and we have achieved a response by all sectors.

ŠArmando Waak/PAHO

Are you optimistic about the public health situation?

Yes, I am an optimist and my outlook is that it is possible. That motivates me and keeps me moving forward, gives me momentum, and allows me to motivate others, which is very important. As I joined this organization, I saw that one of my key functions is to keep units and areas motivated, helping people to work with an eye to the future.

Do you find PAHO's structure adequate for this task?

We have the great strength of having offices in almost every country and have had a strong presence for decades. We have built a structure and have gained the confidence of the region's health authorities. They trust us and we have good rapport, good knowledge and experience. The organization has to become more country-focused and establish the type of relationship between headquarters and the country offices that allows this focus, working more closely in our planning with PAHO representatives and being more responsive to them. We have to remember that we have been public health leaders for over 100 years, when there were no other players. Now there are several other players involved in international health, and we have to take cognizance of that. We have to realize that the nature and magnitude of some of the problems we deal with are way beyond our resource capabilities, so we have to learn to sustain and develop partnerships. We have to ensure that our member governments see us as their broker organization. At the country level there may be 10 donors or agencies that approach you, and we have to be more of a broker, to define needs more clearly, and learn to say "no" when that is the right answer. Our role is not as a donor agency but as a technical cooperation agency.

(At this point, the interview is interrupted by a call from a former patient of Etienne's, a woman so worried about her blood sugar level that she is compelled to call her former physician, now in Washington, to discuss her health. Etienne takes the call and talks with her former patient, then says, "I'm still in the mold of the old family physician.")

What is your typical day like?

I usually wake up at 4 or 5 in the morning, pray, read background information, and come to work at around 8, to start rounds of meetings and e-mails. I find a lot of the work I have to do is coordinating, so I often meet with my area managers, the management teams in an area, or with people who visit PAHO. One of the roles I need to play is to work with WHO and the CDC, and I have not traveled too much so far. I think it's more important to secure your base and work to get it on a good footing. I usually work a 12-hour day, then go home, prepare dinner, watch news and read. My 23-year-old son lives with me, and another of my kids is in medical school, and the third one is in Massachusetts. My husband is a civil engineer.

What do you do to relax?

In Dominica I devoted myself to my kids, and I was very involved in church-related activities, working with bishops, and I was involved in youth work. I'm really a very spiritual person and keep that part of me very much alive. I'm very flexible and don't need too much to be happy.