When she was old enough, Severe sometimes accompanied her dad on trips to work in mobile clinics in small towns across southern Haiti. She’d help manage the check-in process, queue those waiting for appointments, and so on.
“Those years of traveling with him definitely left an impression. It was the most precious gift he could have given me – keeping me close during the clinic days,” she said.
The years were short lived. In 1997, Severe’s father was returning home after a multi-day clinic trip when he was shot and killed during a robbery in Port-au-Prince. He was 50 years old. Severe, who’d not been along on that particular excursion, was a young teenager.
“After, I remember that people kept coming to the clinic at the house but there was no one to treat them. I was so helpless that I couldn’t do anything. I think that is what really solidified my interest in medicine,” she said.
Two decades later, Severe has indeed followed in her father’s footsteps, expanding on his work with the underserved in her native Haiti in ways her dad probably could not have imagined.
“He knew I was interested in his work as a kid but I don’t know that he would have guessed I would become a physician,” she said. “There was always a joke in my family that I would make a good lawyer – I was always advocating for something.”
Going beyond borders
Severe wasted no time combining advocacy and medicine, taking a permanent position at Partners in Health (PIH) immediately out of medical school. She managed clinics ostensibly set up to provide HIV treatment – but really providing broad-spectrum care – in remote communities near the Haiti-Dominican Republic border.
“I was very connected with the type of care they were providing. It reminded me so much of what my father was doing,” she said. “I was getting involved in a lot of mobile clinic work, but whereas my dad used to drive to mobile clinic, I was taking horses.”
Severe identified that continuity of care for HIV patients in the area was a big problem, as Haitians illegally crossing the border in the Dominican Republic in search of employment to support their families routinely abandoned their treatment plan. Many, if they returned at all, were coming back so sick that treatment was nearly impossible.
“They were forced to make the tough choice between treatment and financial means. Many were dying,” Severe said. “I learned that this was not new but an ongoing problem. Not just in my clinic, but in nearly all of the clinics near the border.”
Severe began her own excursions into the Dominican Republic, visiting the health clinics, building relationships with counterparts there and asking questions. How did their HIV-focused programs work? Were they willing to treat the Haitian patients who walked into their clinic? Could they set up a system to share patient records and notes? Partners in Health gave Severe a small grant for a program to help the migrant Haitians acquire the necessary paperwork (birth certificates, passports, visas) to cross back and forth legally, making it easier for patients to obtain care and maintain their health.
The pilot program led to a larger, $1.2 million USAID project, administered through Partners in Health, to develop a large-scale plan to coordinate care across both sides of the border. Severe, then only a few years out of medical school, was tasked with launching that program, Partners in Health’s first programmatic entry into the Dominican Republic.
“We restructured their program so that care on both sides of border would be similar and the teams could communicate and better work together,” she said. “It was so political. I had to closely collaborate with various entities including the police and the military. I wore different hats – doctor, lawyer, human rights advocate, to name a few.”
A turn to psychiatry
In her work in the HIV clinics, Severe saw firsthand that many of her HIV patients suffered from other illnesses and challenges that acute treatment for HIV did not resolve. Chief among them were mental health concerns. The USAID grant provided resources for Severe to begin providing basic mental health services to her HIV clinic patients, including screening for depression and suicidal ideation – another first at Partners in Health.
“We were able to demonstrate that our patients were more engaged in taking their medications when their mental health was addressed,” said Severe. “That period was what really sparked my interest in psychiatry.”
The interest led Severe to a Global Mental Health fellowship through a partnership between PIH and Harvard Medical School. Severe, whose education did not include formal psychiatry training, was not a traditional candidate. But Harvard at the time was expanding mental health research in Haiti and wanted someone who knew the country, the health systems and the culture. Severe spent a year training (both in-country and remotely) under Harvard mentors: Drs. Giuseppe Raviola, Stephanie Engel and David Grelotti. During that time, she traveled constantly throughout Haiti to help social workers, psychologists, and primary care providers administer mental health services in consultation with her Harvard mentors.
There was a research component, too, looking at the prevalence of Post-traumatic stress disorder (PTSD) among school children in the aftermath of the 2010 earthquake. What the team found was surprising.
“We were baffled because we thought these issues would be rooted in things people experienced and saw during the earthquake. But our research showed that it was anxiety based on cumulative trauma, including sexual abuse and violence,” she said. “It wasn’t really about the earthquake, although the earthquake opened people’s eyes in terms of seeing and addressing mental health. The experience solidified my desire to do a residency in psychiatry.”
Severe moved to the United States and completed subsequent residency programs at Tufts University and the University of Massachusetts, followed by a public psychiatry fellowship at Columbia University, in New York City, a program that focuses on the intersections of mental health care with broader public health, policy and systems development.
Severe’s focus was on increasing access through collaborative care, i.e., incorporating primary care doctors into mental health services delivery. She joined Michigan Medicine in 2017 as a Clinical Assistant Professor of Psychiatry. Her primary focus continues to be on improving access to mental health services by collaborating with primary care physicians and providing consultations on mood disorders, the most common mental illnesses encountered in primary care clinics.
“What attracted me to UM was that it seemed open to novel approaches to care and has great mentors like Drs. Michelle Riba and Sagar V. Parikh. Michigan as a state has issues with lack of access, but we have all of the ingredients we need here to make things happen,” she said. “I want to be a bridge to improving access, because there are so many creative ways to make it happen.”
Staying connected to Haiti
Severe remains active in Haiti as well. In 2017, she launched a non-profit, the Lovinsky Severe Foundation, named for father, which aims to support more mental health services through a Collaborative care model around the southern city of Les Cayes, where her father used to run his clinic. Prior the 2010 earthquake, there were only 15 psychiatrists practicing in Haiti and, even with a modest ramp-up in the years since, the country’s mental health infrastructure is still inadequate, with services concentrated in the city of Port-au-Prince and practically nonexistent elsewhere.
She is also collaborating again with colleagues at Partners In Health developing a new psychiatry residency programs in Haiti. Tentatively set to launch in the fall of 2020 through Hôpital Universitaire de Mirebalais, created by Partners In Health. It will be only the country’s second psychiatry residency training program. Severe has been involved in curriculum development and review and plans to teach portions of the program involving depressive disorders and bipolar disorders, topics that closely align with her work at Michigan Medicine.
“At the end of the day, I was born and raised in Haiti. I plan to remain reconnected with the country. she said. “I think my father would be proud. He would be happy.”