In this issue:
- PIH mourns the loss of a surgeon and "a driving force"
Bringing access to surgery to some of the world's poorest communities was Dr. Josue Augustin's mission—one that will outlive him or any other one person.
- Save the date: PIH Annual Symposium
Paul Farmer, Nicholas Kristof, and the PIH family will celebrate "Accompaniment: Solidarity in Action" at PIH's 16th annual Thomas J. White Symposium on October 3.
- Partners in Profile: Dr. Guilavogui Seydouba, MSF trainer, Haiti
How a surgeon from West Africa ended up teaching nurse anesthetists in Central Haiti.
- Impact x 4 vs. drug-resistant tuberculosis
For a limited time, matching grants will quadruple your support for PIH's efforts to fight drug-resistant tuberculosis in Lesotho.
- Impressions on visiting Rwinkwavu Hospital in Rwanda
Few people get a chance to see the work of PIH's partner project in Rwanda first hand. Read the impressions of one recent visitor to Rwinkwavu Hospital.
- Sending out an SMS in Malawi
A pilot project using cell phones and open-source software cuts the miles between patients, village health workers and health clinics.
- A commitment to action: PIH finds partners through the Clinton Global Initiative
As the Clinton Global Initiative Annual Meeting convenes in New York this week, PIH's partners in Haiti reflect on the actions resulting from last year's meeting.
- Hot Heads: Calling all knitters!
Are you a knitter? Learn how you can help PIH's partners in Rwanda prevent hypothermia in newborns.
- Plus a partnership in Rwanda on PBS, Jim Kim's thoughts on health care reform, discussing Mountains Beyond Mountains, happy birthday to charity: water, OpenForum blog, Twittering, and PIH's move.
Above photo: A panoramic view of the new training center in Rwinkwavu, Rwanda.
PIH mourns the loss of a surgeon and "a driving force"
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Dr. Josue Augustin
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Dr. Josue Augustin, the director of surgery for PIH's partner organization in Haiti, Zanmi Lasante (ZL), was killed on August 31. Reeling from the loss, the PIH family remains committed to Josue's life work of building a surgical program to provide life-saving operations to some of the poorest communities in the world and to working with authorities to ensure that those responsible for Josue's death are brought to justice.
Since joining the PIH family over a decade ago, Josue focused his work on building a surgical program to provide life-saving operations to some of the poorest communities in the world.
Hundreds of ZL staff and supporters traveled several hours to attend the service on September 12, joining a crowd that overflowed the First Baptist Church in Petionville, Haiti. Louise Ivers, PIH's clinical director in Haiti and a long-time colleague and friend of Josue's, delivered a eulogy at the funeral.
"In our anger and in our frustration, I wish that today we will remember Josue’s life and not just his death," Ivers said. "Let us remember what he said with his life. He took a stand for the destitute poor – and he did so with grace and with humility… Dr Josue was a rare jewel in our midst – he never wanted people to pay for surgery. He didn’t want to sell health. He didn’t want people to die because they were poor…." Read Louise Ivers's eulogy.
PIH co-founder Paul Farmer remembered Dr. Josue as “a level-headed and thoughtful surgeon and the driving force behind our collective efforts to make sure that surgery did not remain the “neglected stepchild” of our work in Haiti.”
“Josue combined a rigorous pragmatism with a broad vision of what could be done to improve complex medical services, and surgery especially, in settings in which such endeavors are too often dismissed as impractical, not cost-effective, or even (absurdly enough) unnecessary," Farmer wrote in his eulogy.
“What this means for us, beyond our grief, is that we must fight hard to make sure that Josue’s vision of equitable surgical services for the poor is one that remains front and center, not just in Haiti but in those other regions, regions full of people in need, too readily written off as unsuitable for surgery. We honor Josue by making sure that such an important mission outlives him or any other one person." Read Paul Farmer's eulogy.
Josue leaves behind his wife and two daughters, in addition to his PIH family. His second daughter was born three weeks after his death. She comes into a world made better and more humane by her father, said Paul Farmer. “It is not fair that she will never meet her father,” he added. “And this is another reason, surely, that we must honor Josue's memory and mission.” Read full article.
If you would like to contribute to a memorial fund to support Josue’s family and the legacy of his work, please visit: https://donate.pih.org/page/contribute/josue.
If you would prefer to donate by mail, send a check with "Dr. Josue Augustin" in the memo line to:
Partners In Health
P.O. Box 845578
Boston, MA 02284-5578
Save the date: PIH Annual Symposium
Partners In Health will hold its 16th annual Thomas J. White Symposium on Saturday, October 3, at Harvard University's Sanders Theatre in Cambridge, MA. The theme of of the symposium will be "Accompaniment: Solidarity in Action." Speakers this year will include New York Times columnist Nicholas Kristof, PIH co-founders Paul Farmer and Ophelia Dahl, as well as speakers from PIH partner projects from around the world.
Although tickets to this free event are no longer available, some tickets may be released on the day of the event, but please keep in mind that space is limited.
Also, a live webcast of the event will be available at www.pih.org beginning at 3:00pm on October 3.
Partners in Profile: Dr. Guilavogui Seydouba, MSF trainer, Haiti
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Dr. Guilavogui Seydouba teaching the certification course for nurse anesthetists.
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Sitting in a class room in Cange, high in the central plateau of Haiti, six Haitian women listen as Dr. Guilavogui Seydouba reviews the elements necessary for good oxygen transfer in the human cardiovascular system. The women have traveled from across Haiti, leaving behind family and loved ones to participate in this challenging 18-month course, which will culminate in their certification as trained nurse anesthetists.
Dr. Gui (as he is known) has also left behind family and loved ones—his wife and five children, including a two-month-old child whom he has never met—to teach the course. A surgeon from the Republic of Guinea in West Africa, he has come halfway around the world to help PIH's partner organization in Haiti, Zanmi Lasante (ZL), teach nurses. Why? Because his biography bears a strong resemblance to the patients he treats in rural Cange.
The child of a poor family in the Nzerekore region of Southern Guinea, Dr. Gui grew up surrounded by poverty. It left a lasting impression. He completed his medical degree in Guinea, and with the help of Médecins Sans Frontières (MSF), he spent a year in Belgium for training in anesthesiology. The only stipulation: He must commit to working for five years in rural Guinea. “For me, this was not a problem at all,” said Dr. Gui. “The rural poor are the people for whom I have wanted to work.” True to his word, Dr. Gui has dedicated his life to treating the rural poor—whether in Guinea or in Haiti.
In Cange, he is currently working with ZL, MSF, and the Haitian Ministry of Health to do whatever it takes to ensure that his pupils complete the training course, which is a crucial component of ZL's efforts to roll out accessible surgical care across Haiti’s impoverished Central Plateau and Artibonite regions. (Read a memorial to the driving force behind this rollout, Dr. Josue Augustin.) As new surgical facilities come online, nurse anesthetists are especially needed for emergency c-sections, a basic surgery that saves lives every day and has the potential to save thousands more.
The trainees’ schedule is demanding. Their day starts promptly at 7:00am with a 90 minute class on theory. Then they report to the surgical ward for practical training, and don’t head home until all surgical cases for the day have been seen, whether that is 6:00pm or after midnight. After finishing their workday, the students use the time remaining to study for their weekly written exams.
Dr. Gui strives to match their dedication with his own—spending his scant personal time to tutor an individual student or arranging for a more intensive mentorship for another. His approach is to build solidarity among his students. “I let them know that we are in this together, and that none of us will advance until all of us understand the material and training.”
Read more about Dr. Gui and the MSF/ZL/Ministry of Health partnership to train nurse anesthetists.
Impact x 4 vs. drug-resistant tuberculosis
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Curing MDR-TB requires an intense drug regimen.
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Community health worker checks on a patient in his home.
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Over the past two years, PIH's project in Lesotho, in partnership with the Lesotho Ministry of Health, has achieved remarkable success in the fight against deadly strains of multidrug-resistant tuberculosis (MDR-TB). In a desperately poor country that suffers from one of the world's worst TB epidemics, we have built a program that has become a model for the rest of the world.
With funding support from the Open Society Institute (OSI), we renovated and staffed a state-of-the-art TB hospital and a new national TB laboratory, and established an innovative treatment program in all 10 districts of Lesotho. This model is community-based—using community health workers to treat patients in their homes, as opposed to in a hospital. (View PDF for more info about the Lesotho MDR-TB program.) As of this month, we are treating 339 MDR-TB patients and recording cure rates comparable to those in wealthy, industrialized countries. We have also begun to share our model by providing training to teams of clinicians from other African countries. But there is still much work to do.
For a limited time, donations made to this program will receive a quadruple match, thanks to the generosity of the OSI and an individual donor, who believe strongly in the importance of our work and the impact of our program. Through the end of December, every dollar contributed will be matched by the individual donor. Then OSI will match this combined amount. So a $10 donation will become $40 to fight MDR-TB. We need to raise $150,000 to receive the full match, so please consider donating what you can to help us make full use of this opportunity.
This funding will help us reach our goal of expanding the program to annually treat 1,000 patients. Enrolling more patients on treatment will also allow us to strengthen the community-based program as a model for replication by proving that our outstanding adherence and retention rates can be maintained on a larger scale. It will also help us to share our treatment model with more clinicians and community health workers throughout Lesotho, across the continent of Africa and around the world.
Your donations can help us accomplish this—quadruple fold. Donate today!
Impressions on visiting Rwinkwavu Hospital in Rwanda
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The entrance toRwinkwavu Hospital.
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Few visitors get a chance to see the work of PIH's partner project in Rwanda first hand. Below is an excerpt of a piece written by Jodi Mikalachki of the Mennonite Central Committee in Burundi, who recently visited Rwinkwavu Hospital and jotted down her impressions. Read her full essay.
Leaving the well-maintained highway from the capital city, turn left after a gas station in Kabarondo onto a dirt road. Rwanda is mostly a lush country, its celebrated hills covered in banana trees, tea plantations, and fragrant (if soil-deadening) eucalyptus. When you turn left after the gas station, however, it's as though you've suddenly entered a desert country. This savanna has its own austere beauty, but limited water and dry winds that sweep away topsoil have made it one of the poorest areas in Rwanda. This is Rwinkwavu, where Partners In Health chose to begin its work in the heart of Africa.
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Inside a ward at Rwinkwavu Hospital
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Outside on the grounds of Rwinkwavu Hospital.
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As with most structures in Rwanda, Rwinkwavu Hospital is built up the side of a steep hill. The higher you climb, the more you are convinced that it really isn't possible to go any further. One wonders whether similar doubts crossed the minds of the PIH visionaries who raised the funds, developed the programs, and forged the partnerships with local and national officials that now bring world-class healthcare to this impoverished corner of Rwanda. We can only be grateful for their continuing perseverance.
The hospital, reclaimed and transformed after the devastation of the genocide, is a series of single-story houses containing wards for women, men, children, and people suffering from tuberculosis. Although they are open wards, there is a homey feel to them. Parents and children in Icyumba cy'abana ("the children's room") chat amicably between beds and gladly engage with visitors who pause to greet them. Outside, patients stretch out in gardens of drought resistant trees, vines, and ground cover that have the shaggy look of someone's backyard, rather than the sharp lines and angles that characterize most institutional gardening.
The healing of a human being—the restoration of an emotional body that allows a soul to accomplish its unique purpose in the universe—is an end of complete worthiness in itself. Yet PIH does not stop there…
Read more about what Jodi discovered on her trip to Rwinkwavu.
View a slide show of Rwinkwavu Hospital.
Sending out an SMS in Malawi
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Village health workers learning to use their new phones.
© Josh Nesbit, FrontlineSMS:Medic
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Village health workers (VHWs) are the backbone of Partners In Health's comprehensive health care model in Malawi. They visit patients daily, walking with them to the clinic, supporting them in the community, and getting them to the health center if there is an emergency. Frequently, hours of travel separates patients, VHWs, clinics, and doctors. A new pilot project at Abwenzi Pa Za Umoyo (APZU), PIH’s sister project in Malawi, utilizes cell phones, an inexpensive laptop, and free software called FrontlineSMS to create a direct communications link between the clinic, VHWs and ultimately, the patients.
FrontlineSMS is free, open-source software that enables two-way communication between groups of people using text messages. A team of students and recent college graduates have adapted the software for medical use in a resource-limited setting and they have formed an organization called FrontlineSMS: Medic. This past August, Josh Nesbit, the Executive Director, traveled to Malawi with funding from Stanford University (his alma mater) to assist with the implementation of a pilot project. He arrived with 130 cell phones, an Acer laptop, and a GSM modem that enables a computer to send and receive text messages over a cellular network.
In Neno, 130 VHWs were trained to use a cell phone to send and receive text messages; while select clinicians, data clerks and VHW coordinators were trained on the FrontlineSMS software.
For evaluation purposes, APZU is using the system to follow up with patients listed as defaulters—patients who have either missed their doctor’s appointment, or who may have run out of medicine. Every Monday, Dyson Likoma, APZU data manager, generates a report with a list of patients. The report is checked for accuracy and then text messages are sent to the VHWs responsible for the patients needing follow-up. The VHWs then visit their patients and send a text message response with their patients’ status, typically within 24 hours.
Traditionally, when a patient misses an appointment, a staff member from the clinic is dispatched on a motorbike to try and find the patient's VHW. To maintain high patient follow-up, clinic staff must dedicate precious time and travel to reach the remote areas where VHWs and patients live. The introduction of FrontlineSMS has the potential to save staff time and enhance patient follow-up.
Read more about this project.
A commitment to action: PIH finds partners through the Clinton Global Initiative
The Clinton Global Initiative (CGI) is holding its annual meeting this week in New York City. A collaboration between world leaders, governments, the private sector, non-profit organizations, the media, and philanthropists, CGI matches funding sources with development projects, creating defined and measurable commitments to action. Commitments made at the 2008 Annual Meeting are expected to impact almost 160 million people. Among those commitments were several supporting PIH’s work in Haiti.
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The new Boucan Carre bridge.
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- Construction will soon start on a new public hospital in the town of Mirebalais, thanks to a partnership between the Pierre and Pam Omidyar Fund, Haiti’s Ministry of Health, and PIH.
- The telecommunications company Digicel partnered with PIH to provide 8,573 children with a quality primary school education. The partnership also supplied 9,793 students with a daily hot lunch. For many children, this was the only regular substantial meal they ate each day.
- The Boucan Carre health center now has electricity, thanks to a newly installed solar-power system, provided by a partnership with Good Energies and the Solar Electric Light Fund (SELF).
- The community of Boucan Carre will also soon be able to safely cross a swift river separating their town from the rest of the Central Plateau and cutting off the town’s access to hospitals, markets, and schools. Digicel, Haiti’s Ministry of Public Works, the UN, and the Boucan Carre community all partnered with PIH on this project.
- To help communities devastated by the 2008 hurricanes, Proctor & Gamble donated 500,000 PUR water treatment sachets to families left without access to safe, clean water sources. The Clinton HIV/AIDS Initiative (CHAI) helped feed families displaced by the flooding with 7,000 kg of high energy biscuits, and 3,000 kg of Ready-to-Use Therapeutic Food (RUTF).
- 33,333 people in poor rural communities who are at risk of tungiasis (sand fleas) infecting their feet will soon receive a new pair of shoes, thanks to TOMS shoes. TOMS is also providing PIH’s army of community health workers with 12,800 pairs of rain boots to help make their daily treks to visit HIV and TB patients a little easier during the rainy season. 19,200 more pairs of boots are also on their way to PIH’s projects in Rwanda, Malawi, and Lesotho.
The 2009 commitments promise to bring even more funding to vital projects in poor communities around Haiti. Stay tuned for updates!
Hot heads: Calling all knitters!
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Baby born at the Burera District Hospital--kept warm with a stylish beanie cap.
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In the chilly mountains of rural Rwanda, where last year PIH's partner organization began working with the Burera District Hospital, resources are very limited and the temperature often drops into the 50s. Newborn babies, particularly those born prematurely, often struggle to keep warm. In a country where one in 10 babies dies before her first birthday, hypothermia is a serious threat.
A simple solution that can help save some of these little ones is to provide them all with beanies to keep them warm.
We are looking for knitters to help us put a warm beanie cap on every baby born in Burera—as is done in American hospitals. The Burera District Hospital welcomes about 100 new babies into the world each month, so our current goal is to provide 100 caps per month.
All beanie styles and colors are welcome. Hats can be made to fit either premature babies (head about the size of an orange) or full-term babies (head about the size of a grapefruit). We will arrange shipping from Boston to northern Rwanda.
Hats and donations may be sent to:
Jesse Greenspan
Partners In Health, Attn: Baby hats
888 Commonwealth Ave, 3rd floor
Boston, MA 02215
More information about this initiative and pattern samples can be found at: http://hotheadknitters.blogspot.com/
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