Partners In Health e-Bulletin, November 2009

In this issue:

1. Fighting MDR-TB in Peruvian shantytowns ... and on a world scale
   From the dedication of a nurse working to cure tuberculosis patients in poor Peruvian communities to the participation of clinicians and researchers in developing and demonstrating the effectiveness of community-based treatment, PIH and its partners take on drug-resistant TB.
2. Solar energy brings light to Boucan Carré Hospital in Haiti
   Sustainable and practical, solar panels help power hospitals while preserving our planet.
3. Operation: operating room
   A new operating room opens its doors to life-saving surgeries in central Haiti.
4. World AIDS Day
   PIH and our partners around the world will commemorate World AIDS Day on December 1. Find out how you can participate.
5. Twins
   How a shared birthday can help bridge the distance between Beverly Hills and the hills of Malawi – but only so far.
6. A year in the life
   A volunteer with PIH's partner organization in Peru shares his experiences upon first arriving in Lima ... and on his departure a year later.
7. Plus a Calendar, Summer internships, Forgiving children, Connecting and acting with Tracy Kidder, an OpenForum, and Social networking with PIH.

Above photo: Lesotho's military lends a hand to PIH by transporting a generator that now provides electricity to the Lebakeng Health Clinic. High in the mountains of Lesotho, Lebakeng is so remote that it is inaccessible by road. See how the clinic commemorated this special delivery.

Fighting MDR-TB in Peruvian shantytowns ...

Next week, staff from PIH and its partners around the world will be attending the 40th Union World Conference on Lung Health in Cancun, Mexico. A main focus of PIH's participation in this meeting centers around our community-based programs to combat drug-resistant tuberculosis, a treatable disease that every year infects more than 500,000 people and kills an estimated 120,000. To shine a light on these programs, below is a profile of one of the thousands of partners who work with us each day to fight this deadly, yet curable disease.

Hortencia Campos Sembrera supervises MDR-TB treatment in six regions for Socios En Salud (SES), PIH's partner organization in Peru. The following is her story, as told in her own words.

I’m the type of person who loves taking on life’s challenges; I’ve already spent almost an entire year traveling from one part of the country to the other. It’s been a wonderful, unforgettable experience for me, and I’ve come to love my country more and more every day. I’ve been able to see and experience firsthand the extreme poverty afflicting our brothers in forgotten communities.

My patients are like my family to me, I have a great love for them and I do what I can to make sure they trust me and consider me a friend… Seeing their joy and excitement in working with me is my greatest reward. It keeps me going without needing a break.

Sometimes, getting to patients’ homes is very difficult. There are places where cars can’t go, and if there is no way to get to or from these places you have to figure out on your own how to do it and find a way to get there: walking long distances with a basket of supplies, crossing a river walking over a narrow log or sometimes traveling by horse. In other places in the country, where there are districts which are 20 or 30 minutes apart, I decided to use a motorcycle in order to finish on time all my daily home visits and food basket deliveries.

It doesn’t matter who or what made me the person that I am, all that matters is that I can help the most forgotten people of our country and, why not say it, of the world too… I feel proud to be part of SES. Thanks to timely interventions, SES has supported many patients and saved thousands of lives and that is without comparison.

– Hortencia Campos Sembrera
 Nurse technician, Socios En Salud

... and in the conference halls in Cancun

For more than a decade, PIH and our partners at Harvard Medical School and Brigham and Women’s Hospital have been developing and demonstrating the effectiveness of community-based strategies for combating MDR-TB in resource-poor settings. From December 3-7, representatives of PIH and our partner organizations will be sharing lessons from our work and conferring with leaders in treatment and management of drug-resistant TB from around the world to map out strategies and mobilize resources to fight the deadly epidemic.

To read more about the International Union of Tuberculosis and Lung Disease World Conference on Lung Health, please click here.

Solar Energy Brings Light to Boucan Carré Hospital in Haiti

	The newly installed solar panels at Boucan Carré.

Bringing high quality health care to remote rural areas requires not only essential medicines and medical staff to deliver it, but equipment and lighting to see by. In addition, Partners In Health’s work with people living in poverty means that we bear witness to the dramatic impact of environmental degradation and climate change on people living in poverty. As a result, PIH is constantly looking for energy sources that are accessible in remote regions and that reduce our impact on the environment. Our partnership with the Solar Electric Light Fund (SELF) and Good Energies Foundation has made both of these goals a reality.

Until this fall, Boucan Carré Hospital in Haiti's central plateau relied on a diesel generator for its electricity. Then, over the course of three weeks, SELF installed a 10,000-watt solar panel system on the roof of the Boucan Carré Hospital. As part of the project, SELF also conducted an intensive two-week course, training local technicians to install and maintain solar systems. The advanced hybrid system integrates the solar panels with the existing generator, enabling the facility to run off batteries charged by the solar panels most of the time, with the generator as a backup.

In the short time the system has been in operation, the results have been dramatic. In the month of August 2009, prior to the installation, the Boucan Carré facility consumed 11 barrels of generator fuel. One month later, with the system operating, the facility used just four barrels of fuel.

We look forward to working with SELF on the installation of solar systems at other PIH-supported facilities throughout Haiti. SELF has also completed installations at PIH supported facilities in Rwanda, Lesotho and at a Village Health Works facility in Burundi.

Operation: operating room

At 1:00 pm on November 12, Dr. Eddy Jonas and his team performed the first surgery in a brand new operating room at the hospital at Petite Rivière de l'Artibonite in Haiti. The operating suite, funded by Deerfield Partners, is the latest achievement for Zanmi Lasante (PIH's partner organization in Haiti) and its program to bring life-saving surgical services to the poorest communities in Haiti.

The first surgery was to remove a fibroid in a patient's breast (see photo on the right). This month, they've also performed several gynecological surgeries, including a cesarean section.

Celebrating World AIDS Day 2009 –
Everyone deserves to live their rights. Stop AIDS. Keep the promise.

Twins

	Roads surrounding Neno, Malawi. ©Jamil Simon

Ivy Kuperberg worked for a year for PIH's partner organization in Malawi, Abwenzi Pa Za Umoyo, as the assistant to the project's Country Director. The following is excerpted from an article in which Ivy describes an event that revealed both how much she shares with her closest Malawian friend and colleague (her "twin") and how wide a gulf separates the experiences of those born in the United States from their peers in poor countries like Malawi.

That snake does not look friendly.

It’s 6:00am and I’m doing my daily run through the African bush. Jay-Z pulsing through my iPod, I round the corner of the maize fields and come upon something distinctly green and succinctly unhappy. I take half a second to let my life flash before my eyes and then whip around and sprint back into the village. I bang on the door of the mud and thatched roof dwelling of Magdalene Johnson.

There’s no answer. Where in the world is Maggie? Maybe she ran to fetch water?

I look around wildly for a Plan B. The sun is just starting to rise over the mountains, a beautiful sight if I wasn’t so terrified. It’s morning in Neno, Malawi, one of the poorest districts in one of the poorest countries in the world, and instead of celebrating my one year anniversary at Partners In Health, I’m becoming the poster child for Ophidiophobia [fear of snakes].

~~~

My house is right across the street from the hospital, and I quickly skip across the dusty road to the main entrance. I pass the Emergency Room and peek into the Rehab Clinic my Malawian roommate, Claire, is running.

“Bo bo (what’s up)?” I shout into the room.  

Claire looks up. “Bo bo.” She grins.

“Hey, have you seen Maggie? She wasn’t at home this morning.”

“Your twin?” Claire asks, shaking her head. “Haven’t seen her.”

Maggie is not really my twin; my birth in Beverly Hills and her concurrent birth here in Malawi makes that physically impossible. But it’s not the birthdays that earn us the nickname-rather, it’s our affinity for high heeled boots in the middle of rural Africa, and our penchant for watching music videos of Rihanna and Chris Brown together at sunset. Both of us hail from the city (Maggie’s originally from Blantyre, Malawi’s financial capital), and have both found out that while you can take the girl out of the city you can’t take the... well you know the rest.

	Pediatric clinic at Neno District Hospital. ©Craig Bender

I step outside again, and am met with a throng of people at the pediatric clinic. The crowds are especially thick today, the veranda flooded by mothers with babies and toddlers tied to their backs. I peek into the throng to see if I can spot Maggie. Her youngest brother, Thomas, wasn’t feeling well last night.  Between eating French fries and watching Disturbia, Maggie had mentioned taking Thomas to the clinic. Maybe she’s in line? Lost in my thought, I run smack into Dr. Jay, who’s about to climb into a car. “Sorry!” I say and then remember that he was the doctor on call last night. “Hey,” I say to him as he sticks one foot into the car. “Have you seen Maggie at all?”

“Yeah, she came in last night with her brother-we referred him to the main hospital.”

I decide to call the city hospital just to see how Maggie’s doing. The nighttime rides can be pretty long, and bumpy. When the patient registrar answers, I ask whether they have an 8 year old named Thomas Johnson in the wards. The registrar tells me to wait a second while she checks the rooms, and five minutes later she comes back on the line.

“There’s no one here by that name,” she informs me.
 
I’m very confused.

Read the rest of Ivy and Maggie's story.

A year in the life

Last fall, Geoff Gusoff arrived in Lima, Peru. As a volunteer with PIH's sister organization Socios En Salud (SES), he saw firsthand the poverty and barriers to healthcare that faced the shantytown communities surrounding Lima. Over the course of his year with SES, he also observed how the organization – and his role in it – made a difference in the lives of the poor patients served by SES.

October, 2008:

	Geoff Gusoff hiking to visit patients in Lima. ©SES

After two weeks of accompanying Socios health promoters in visiting patients' homes ("Socios En Salud" is the Spanish equivalent of Partners In Health), I've made a few observations. The first is that if you made a topographical map of Lima by using household income instead of meters to measure altitude, that map would be almost a direct inverse of the actual topographical layout of Lima. That is to say the poorest people seem to live in the hills, and the higher up you go in the hills, the poorer people are. As it was explained to me, during Lima's population explosion in the last generation, droves of people moved from the country into the city (again, often a trip downhill from the Andes but seeking higher socio-economic ground) and began these squatter settlements or pueblos jovenes in the unclaimed, unaccommodating hillsides. As new families move in, they simply build higher and higher up the hills. The cruel irony of this arrangement is that the people with the best views of the grandeur of the city have the least access to its resources. Read more.

November, 2009:

	Houses on the outskirts of Lima. ©SES

The vast majority of the people I worked with lived in these cerros [hills surrounding Lima], including two who lived in the very last houses on a massive hill affectionately referred to as Machu Picchu [the famed "Lost City of the Incas," perched on a mountain ridge 8,000 feet above sea level]. When I would trek to their homes two or three times a month to check on their micro-businesses, I’d always wonder, between panting breaths, how seriously ill patients made this trek everyday.

My main job in Lima was to help run a micro-enterprise program, which provides small loans to former patients so they can establish small businesses and have a sustainable income after their treatment ends. The program was something of a radical experiment: to create a micro-enterprise program with a preferential option for the poor. Unlike other micro-finance organizations, we took on many clients considered high-risk because of their history of illness and we committed resources to intensively train each participant. We also provided no-interest loans because we found that for many patients paying interest would mean drawing from the food budget or other necessities, raising their risk of becoming re-infected with TB.

I was responsible for making regular visits to mentor and collect loans from thirty-five (roughly half) of the businesses. Through these visits, I gained a deeper appreciation for Lima’s economic landscape. I learned how precarious it was to live in the hills, with many residents suffering injuries from terrible falls or from carrying heavy items. I also learned that the landscape was not completely static. People occasionally moved downhill to higher economic ground, and employment was a key factor in making that transition. Through the success of their businesses, the two residents of Machu Picchu were both able to move lower down on the cerros. Others were able to make improvements on their homes, adding a bathroom or a roof. Perhaps most importantly, many used their business revenues to pay their children’s educational fees to help break the cycle of poverty. Read more.

Final shot

A helicopter carved into the stone walls of the building housing the generator at Lebakeng Health Clinic commemorates the generator's special delivery.