5 Ways PIH Disrupted Global Health

How a global health and social justice nonprofit challenged the status quo

Posted on Nov 30, 2021

Ms. Esther Mahotiere, a nutrition program coordinator in Haiti, feeds Nourimanba to 8-month-old Wisline Sauvene at the malnutrition clinic in Boucan Carré.
Ms. Esther Mahotiere, a nutrition program coordinator in Haiti, feeds Nourimanba to 8-month-old Wisline Sauvene at the malnutrition clinic in Boucan Carré. Photo by Cecille Joan Avila / PIH.

In the late 1990s, Partners In Health delivered a message that no one in the global health establishment wanted to hear: thousands of miles away, in Peru, people were dying of a deadly infectious disease—and world leaders had turned their backs.

It wasn’t the first time PIH had challenged the status quo. And it wouldn’t be the last.

For more than 30 years, PIH has pushed for a simple yet radical idea: health care is a human right. No matter where people live, how much money they have, or what their background is, they should have access to world-class health care—for free.

Our mission, which is both medical and moral, has strengthened and inspired us, from the early days treating HIV in rural Haiti to the ongoing fight against COVID-19.

We focus on the needs of the most marginalized, providing a “preferential option for the poor,” and care for patients as if they were members of our own family. We do this because, as Co-Founder and Chief Strategist Dr. Paul Farmer put it: “The idea that some lives matter less is the root of all that is wrong with the world.”

Since 1987, PIH has been caring for some of the world’s most neglected patients and speaking truth to power—because we stubbornly believe a better world is possible. Our defiant optimism has changed global health policy and strengthened the movement for health equity worldwide.

Here are five ways PIH disrupted the status quo in global health:

1. MDR-TB

In the 1990s, a deadly, airborne infectious disease—multidrug-resistant tuberculosis (MDR-TB)—was sweeping through Carabayllo, an impoverished community just outside of Lima, Peru. But despite mounting deaths and suffering, the World Health Organization advised not treating these patients, dismissing the disease as too complicated and costly to fully address in impoverished settings.

That was a status quo that PIH founders refused to accept. Directly challenging WHO policy, the PIH co-founders and Peruvian clinicians began treating patients with MDR-TB—saving hundreds of lives neglected by the global health establishment and leading the WHO to revise its global treatment recommendations for MDR-TB—a story captured, among many others, in the award-winning documentary, Bending the Arc

2. HIV/AIDS

Amid the AIDS epidemic, PIH co-founders saw ripple effects of a longstanding injustice: even as awareness, action, and treatment began to spread in the United States, patients in rural communities around the world were being left behind. As PIH began caring for patients with HIV/AIDS in Haiti, global health experts said treatment wasn’t a sustainable option and advised to focus on prevention instead—a mindset that would have left millions of people worldwide without care.

PIH decided to treat patients anyway—launching the HIV Equity Initiative, providing anti-retroviral therapy, and hiring and training hundreds of Haitians to deliver basic health services in their communities, which helped pioneer the community health worker model. Our approach saved millions of lives and helped inspire the Global Fund, PEPFAR, and the WHO to fund HIV/AIDS care in rich and poor countries, alike.

3. Cholera

In the wake of the devastating 7.0-magnitude earthquake in Haiti in 2010, millions of people were left without housing, food, or access to health care. PIH immediately sprang into action, using our deep ties to the community—our staff in the country is 99% Haitian—to mount an emergency response. As we worked around the clock to care for patients, another crisis began to emerge in hospital wards: an influx of cholera patients.

The infectious disease had arrived in the country with a troop of United Nations peacekeepers and spread in a makeshift camp with poor plumbing. As contaminated sewage leaked into the Artibonite river, a water source for countless Haitians, an outbreak took hold. In response, PIH cared for the sick, taught communities how to prevent the disease’s spread, and—despite opposition from the global health establishment—vaccinated thousands of people against cholera. The innovative campaign saved thousands of lives and convinced the WHO to stockpile oral cholera vaccines, which have since been used to control outbreaks in Yemen and Sierra Leone.

4. Non-communicable diseases

In the early 2000s, PIH clinicians in Rwanda began to see a pattern: hospital beds filling up with patients living with chronic diseases such as diabetes and coronary heart disease—known as non-communicable diseases (NCDs). But connecting these patients with chronic care was a logistical challenge, as most lived in rural communities and such care required specialized staff and medical equipment.

That dilemma led to a solution that would change NCD care—training nurses and other health workers to provide chronic care at district hospitals. This approach, called PEN Plus, has since inspired WHO Africa to change its policy on NCD care in rural settings and has provided a model for other countries, such as Liberia.

5. Ebola

As Ebola began to spread in West Africa in 2014, patients in Sierra Leone weren’t receiving quality care. Instead, they were put in isolation rooms, given oral rehydration solution, and largely neglected due to fear of the little-known and deadly disease, a lack of training and resources for health workers, and decades of civil war and colonialism that had weakened the country’s health system. Due to this poor quality of care, the death rate from Ebola was 70%. PIH was one of few organizations to sound the alarm.

That set in motion a years-long effort to improve Ebola care in Sierra Leone and beyond, as PIH partnered with the Ministry of Health and local clinicians to build intensive care units, procure lifesaving resources, and train clinicians and community health workers to provide the highest standards of care. PIH’s response has since inspired the WHO to update its clinical guidelines on Ebola care for patients and survivors, which were used in recent outbreaks in the Democratic Republic of the Congo.

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