In this issue:
- A new home at Zanmi Beni
Dozens of unaccompanied children, most with physical or developmental disabilities, had to be relocated following the earthquake. Read about their new home--Zanmi Beni.
- Improving women's health in Haiti's settlement camps
An update on Proje Sante Fanm's work to improve healthcare services for women in Port-au-Prince settlement camps
- From HIV/AIDS to chronic diabetes
An update on the Boston-based PACT project's initiative to treat and manage diabetes using community health workers.
- Q&A: Addressing Mental Health and Trauma in Haiti following the earthquake
An excerpt from an interview with Father Eddy Eustache, a priest and psychologist who serves as director of mental health and psychosocial services for Zanmi Lasante, PIH's sister organization in Haiti.
- Opening a new pharmacy, eliminating parallel systems, strengthening the public sector
A new pharmacy in Rwanda helps merge PIH's medical supply chain with the one run by the Rwandan Ministry of Health.
- More than a support group, a support community
Patient meetings help foster a supportive community for people living with HIV/AIDS in rural Malawi.
- A family reunion just in time for Mother's Day
Helping a mother find her daughters—across country borders.
- A Mother's Day Slideshow
A photo essay celebrating mothers and their contributions at our sites around the world.
- Plus: Katie Couric reports from settlement camps in Haiti, PIH co-founder Paul Farmer's newest book, Six weeks in Haiti, Harry Potter fans help relief efforts, A three-month progress report, Social networking with PIH, and Gifts that matter.
Above photo: Mothers bringing their babies to the pediatric clinic in Malawi. In honor of mother's day, we've pulled together a photo essay celebrating mothers and their contributions at our sites around the world.
A new home at Zanmi Beni
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Three of the children living at Zanmi Beni.
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With children laughing and chasing each other, playing with balls and pet guinea pigs, the sunny courtyard could be mistaken for an ordinary afterschool daycare program. But this is no ordinary childcare program, and the children are not living under ordinary circumstances.
The Haiti earthquake injured hundreds of thousands of people and damaged hundreds of buildings throughout Port-au-Prince, including the city's only public hospital—the General Hospital. Living in one of the wards within the hospital’s pediatric unit were 48 children—ranging from two weeks to 21 years old, some without parents, many living with either physical or developmental disabilities.
In the aftermath of the quake, it was clear that these children could not remain at damaged and over-crowded General Hospital. The hospital’s medical director contacted PIH and its Haitian sister organization Zanmi Lasante (ZL) to help find the group a new home. PIH/ZL helped facilitated the children’s move to a new long-term care facility in Croix-des-Bouquets, a city located about eight miles northeast of Port-au-Prince. The facility, named Zanmi Beni – “blessed friends” in Haitian Creole, is the result of a partnership with Operation Blessing International—a nonprofit organization that provides disaster relief and community development in 98 countries. PIH/ZL also received support for this project from the General Hospital, the organization Nos Petits Freres et Soeurs, and the Haitian Ministry of Social Affairs.
With safe and sunny wards, space for the children to run and play, books and toys, and a dedicated 75-person staff to care for them, the children are happily flourishing. Some of the children who had before been bedridden are now beginning to walk—they simply needed the opportunity and a little attention to help them take their first steps. Others study their lessons in a small tent-school room. Staff ensure that each child is given special attention to help foster learning and development—from feeding themselves to speaking skills.
Read more about Zanmi Beni.
Improving women's health in Haiti's settlement camps
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Signs on the Proje Sante Fanm tent advertise, "Care to Women Offered Here."
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Dire conditions disproportionately threaten women living at the hundreds of settlement camps for homeless earthquake survivors in and around Haiti’s devastated capital, Port-au-Prince. Threats include higher rates of HIV and sexually transmitted infectoins(STIs), as well as increased risks in pregnancy and childbirth, and violence against women.
PIH and its Haitian sister organization Zanmi Lasante (ZL) are working to respond to these threats to women and their children. Last month, we reported on work to strengthen our women’s health service program at four large settlements. These efforts were organized by staff from ZL’s Proje Sante Fanm—“Women’s Health Project” in Haitian Creole.
Since then, the Proje Sante Fanm staff have joined the teams at the established health clinics at Parc Jean-Marie Vincent, Building 2004, Dadadou, and Caradeux—settlements with a combined population of roughly 88,000 people. They operate women-focused spaces separate from the general clinics, where women can seek medical care, advice, refuge, and a private and safe space for nursing their infants. Female nurses staffing these spaces also provide visiting women with information about family planning, prenatal care, general reproductive and OB/GYN-related information, testing and treatment for HIV and STIs.
During Proje Sante Fanm’s first two weeks working in the camps, about 200 women sought services in these safe-spaces. Staff also travel out into the settlements to check on women who are unable to come to the clinic, and accompany women with issues too severe for the settlement clinics to medical appointments at the General Hospital in Port-au-Prince.
Read more about Proje Sante Fanm.
An update from the Boston-based PACT project: From HIV/AIDS to chronic diabetes
When “Joe” was given three new pills to control chronic diabetes, the prescriptions became just another page in an already large case file. A gregarious 51-year-old man from Dorchester, MA, Joe takes 22 different medications for a dizzying array of ailments—many of them either directly or indirectly related to his being a diabetic. One major barrier to successful diabetes management was his poor knowledge about the disease—the importance of healthy eating and exercise, and how to take his medicines.
Joe’s doctor could not give him this level of support. Fortunately, he was assigned a community health worker through the Prevention and Access to Care and Treatment Project (PACT)—a joint effort of Brigham and Women’s Hospital and Partners In Health (PIH).
The community health worker discovered that because Joe did not understand the difference between his three diabetes medicines, he was only taking two of the pills, greatly diminishing the regimen’s effectiveness. She explained how they work together and helped Joe manage the sudden drop in blood sugar that resulted when he started taking all three medicines. Joe’s clinical status improved dramatically.
The community health worker also helped him define individual goals and outline action steps to guide his success. One of Joe’s major achievements has been enrollment in a physical therapy program at the Dorchester House, allowing him to exercise for the first time in years.
An objective of health reform is to revolutionize the relationship between those receiving care and those providing it, focusing on an individual’s capabilities rather than just his or her needs. As Joe’s case illustrates, community health workers have a key role to play.
Adapting a model that PIH has so successfully used to fight HIV in rural Haiti and drug-resistant tuberculosis in Peru, PACT has for many years employed community health workers to provide home-based services to the sickest and most marginalized people living with HIV in and around Boston. The proven effectiveness of using community health workers to help treat and manage infectious diseases like HIV/AIDS and tuberculosis is now being tested by PACT to treat a chronic disease—diabetes.
Read more about this exciting initiative.
Q&A: Addressing Mental Health and Trauma in Haiti
PBS NewsHour recently interviewed Father Eddy Eustache, a priest and psychologist who serves as director of mental health and psychosocial services for Zanmi Lasante, PIH's sister organization in Haiti. Below is an excerpt from the interview. Read the full piece.
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Father Eddy Eustache is the director of mental health an psychosocial services for Zanmi Lasante.
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What are the most common mental health challenges you are seeing in Haiti at this point?
Almost four months after the earthquake we are seeing people having various kinds of emotional distress responses. These include difficulty sleeping, heart palpitations, somatic complaints, and significant sadness, worry and anxiety. Some of these can be seen as normal reactions to a highly abnormal situation. However, the level of distress for many is severe. We also see people who have developed psychotic reactions, and other more acute mental health problems, since the earthquake.
One major challenge is a general lack of services in Haiti to address significant mental health problems. Haiti had few mental health professionals, and limited organized mental health services prior to the earthquake. There was not a clear understanding of the prevalence of mental health problems in Haiti prior to the earthquake, but we can expect that the mental health dimensions of the earthquake, overlaid on the pre-existing issue of poverty, will have significant ramifications for mental health. Our hope is to further develop the services needed to assist with such problems, in a culturally appropriate way, for the long-term.
How are mental health workers trying to address the needs?
Interventions are needed that respect people’s capacity to recover from such an event, that do not pathologize normative responses to such a terrible circumstance, that do not risk harm to individuals, that have some evidence for their efficacy, and that are appropriate to the Haitian context.
At Zanmi Lasante [Partners in Health] we have expanded our team to 17 psychologists from three prior to the earthquake, and to more than 50 staff focused exclusively on mental health and psychosocial services. We have been working … to provide communal opportunities for mourning, to develop community-based supportive interventions in collaboration with schools and churches, and we have expanded basic clinical services.
This has included training of doctors and nurses in management of acute mental health problems, and planning for expansion of the system of care to include community health workers attuned to mental health, and development of effective referral networks to providers.
Read the full interview.
Opening a new pharmacy, eliminating parallel systems, strengthening the public sector
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Inside the new district pharmacy in Kayonza, Rwanda.
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A new district pharmacy recently opened in the Kayonza district in eastern Rwanda. The new facility, opened in a partnership between PIH’s Rwandan sister organization, Inshuti Mu Buzima (IMB), and the Rwandan Ministry of Health (MOH), marks a major step towards merging the MOH medical supply chain with the one IMB first established upon entering the country in 2005.
Run as a semi-autonomous organization, the new district pharmacy will supply the MOH hospital and health centers in the district with medicine and equipment. Different from our previous pharmacy, IMB staff will not manage this facility. Responsibility will instead be handed to MOH staff hired from the region surrounding the new district pharmacy, new employees trained by IMB to operate this independent facility.
When PIH launched Inshuti Mu Buzima —“Partners In Health” in the Rwandan national language, Kinyarwanda—in the spring of 2005 at the invitation of the Rwandan government, we established an independent supply chain and pharmacy system, one that primarily dealt with PIH/IMB hospitals and health centers.
Over the last five years PIH/IMB has expanded services such that we are currently supporting or operating more than 20 hospitals and health centers in three of Rwanda’s thirty districts. As we grew larger, a problem arose. PIH/IMB and the Rwandan Ministry of Health were each developing their own health care-related supply chains—with separate providers, warehouses, and distribution systems.
To reduce redundancies, save money, and help streamline Rwanda’s health care system, the Ministry asked PIH/IMB to consolidate distribution systems with the government. The result is a new system that eliminates the parallel IMB system, which will in turn help strengthen the public sector system. Having a single system will allow for better forecasting and increased transparency.
Read more about the new pharmacy.
More than a support group, a support community
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Dancing and singing at a patient meeting.
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In many of the communities that PIH serves, HIV/AIDS patients must carry the physical burden of the disease as well as the psychosocial burden of stigma.
PIH’s partner organization in Malawi, APZU, is working to combat this stigma and create a supportive space for patients living with the disease. Each month, APZU helps organize a patient meeting, which brings hundreds of patients together to laugh, sing, dance, support each other, and learn from each other about coping with the daily challenges and issues caused by living with HIV. Moreover, they leave with a sense that they are not fighting the disease alone, but as a community.
"These meetings are a place where people living with HIV/AIDS in Neno District can meet to organize, strategize and discuss about alternative ways to address their disease and poverty," said Dr. Paul Pierre, APZU Director of Community Programs.
The meetings are organized and run by a committee of patients elected by their peers, and focus on inspiring and positive messages. Regular features of these meetings include information about how HIV/AIDS is transmitted, and methods for preventing the spread of the disease, as well as local dance crews, musicians, and comedians. Over 400 patients attended a meeting last month.
Read more about the patient meetings in Malawi and watch video footage from a recent meeting.
A family reunion just in time for Mother's Day
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Katia (left) and Gina on their way back to Haiti.
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Mimose Maurice's home collapsed around her during the January 12 earthquake. With her leg and foot seriously fractured, and the medical centers in Port-au-Prince either overwhelmed or lying in ruins, she was transported to a hospital in the rural Central Plateau of Haiti run Zanmi Lasante (ZL), by PIH's sister organization in Haiti. Though she was safe and receiving top-notch medical care, she was devastated. In the post-earthquake chaos that enveloped Port-au-Prince, she had been separated from her family--daughter Gina, 16, and niece Katia, 14.
The two girls found themselves in the middle of a massive disaster zone. Without Mimose, they were all alone. Mimose had become Katia's guardian and new mother just hours before their separation. Katia's previous guardian--her aunt and Mimose's sister--had died in the earthquake.
The two girls had also been hurt by the earthquake. Gina's injuries were not serious, but Katia had open wounds covering her back, arms, and face, and a deep cut in her lower back.
Like Mimose, the girls headed out of Port-au-Prince to seek medical care. They hitched a ride in the back of a pickup truck and endured a long, bumpy drive to a town near Haiti's border with the Dominican Republic. At the clinic, they were told to cross the border and try their luck in Santo Domingo.
The girls found their way to Hospital Dario Contreras-the capital city's trauma hospital. After receiving initial medical attention, they were sent to Hospital Robert Reid Cabral, a nearby pediatric hospital.
As the week progressed, Katia's list of injuries expanded: she developed a urinary tract infection and complications with her kidneys.
Weeks went by. During all of this Gina had to take on the role of parent, friend, and caretaker to Katia as she slowly recovered. While local volunteers looked out for the girls generally, they were ultimately alone in a foreign country, and anxious to learn what had happened to Mimose.
Find out what happened to Gina, Katia, and Mimose.
A Mother's Day Slideshow
Sunday, May 9, is Mother's Day. In honor of mothers everywhere, we've pulled together a photo essay celebrating mothers and their contributions at our sites around the world.
Click here to view.
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