Partners In Health Articleshttps://www.pih.org PIH Staff Safe, Facilities Open But Struggling During Unrest in Haiti https://www.pih.org//article/pih-staff-safe-facilities-open-struggling-during-unrest-haiti Partners In Health staff and patients remain safe and health facilities open despite more than eight consecutive days of strikes and civil unrest that have broken out throughout the country.

The situation is growing ever more dire as food, clean water, and fuel for generators and ambulances become increasingly difficult to transport from the capital to PIH’s 12 clinics and hospitals across the Central Plateau and lower Artibonite. If the situation continues, bedside oxygen and medications will run short as well.

According to the Miami Herald, at least eight people have died since Feb. 7 in violent clashes between police and demonstrators. Schools, businesses, and public transportation have been shut down in the wake of the political and economic crisis, largely sparked by skyrocketing prices, a rapidly devalued currency, and chronic fuel shortages. Blockades prevent travel, and residents are reluctant to leave their homes.

Hospitals throughout the country have closed, including the Hospital of the State University of Haiti—the largest public hospital in the country, as staff do not arrive for shifts and supplies have become scarce. 

The unraveling situation has made it particularly difficult for staff with Zanmi Lasante, as PIH is known in Haiti, to get to and from facilities and transport supplies. And patients are being turned away at road blocks when seeking emergency and routine care.

To help us prepare for emergency response in Haiti, please DONATE HERE.

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Fri, 15 Feb 2019 12:53:38 -0500 https://www.pih.org//article/pih-staff-safe-facilities-open-struggling-during-unrest-haiti
UGHE Alumni Spotlight: Benjamin Ndayambaje https://www.pih.org//article/ughe-alumni-spotlight-benjamin-ndayambaje Benjamin Ndayambaje is a Rwandan who grew up in a refugee camp in Uganda. A trained veterinarian and former veterinary surgeon, he graduated in the University of Global Health Equity’s inaugural Class of 2017. While earning his master’s of science degree in global health delivery, he focused on one health, which involves the integration of health for people, animals and the planet. 

Can you describe where you grew up? What were your aspirations when you were younger?

I was born and grew up in Uganda, in a refugee camp. Life there wasn’t easy for people from foreign countries. There were long distances to school, or to a clinic for medical checkups and treatments. The scarcity of resources created bottlenecks for most refugees. Environmental and hygienic conditions were not good in the camp. As a child, I aspired to be a medical doctor to save lives—especially for those in need. 

As I grew up, my aspirations and interests changed, particularly as I spent time with my grandpa during school holidays. I enjoyed looking after my grandpa’s herd of cows. My grandpa taught me how to milk, and how to take care of young calves. He couldn’t treat some of their diseases, though, and we lost quite a number of cows to curable diseases. We couldn’t get enough milk for home consumption and selling. From that experience, I became determined to work hard and save our animals from diseases. My interest in saving animals for the benefit of people’s wellbeing has grown since then. I aspired to be a veterinarian to treat and protect animals from diseases. 

Can you give a brief overview of your professional background? What were you doing before you began attending UGHE?

I hold an undergraduate honors bachelor’s degree in veterinary medicine from the University of Rwanda. I am a registered veterinarian, and practiced for one year as a private veterinary surgeon. Early in 2013, I worked as a manager for the Institute of Livestock Research and Development (ILRD). I managed the Innovative Program for Enhancing Milk Production (IPEMP) in the Umutara region, to help address the multitude of challenges for farming communities in northeastern Rwanda, primarily through research and outreach activities.

Later in 2013, I was recruited as a junior faculty member in the department of veterinary medicine at the University of Rwanda. I co-founded a One Health Students Club, which was later named “Students’ One Health Innovative Club,” as a platform for university students from various disciplines to collaborate on the most pressing community challenges. In the same year, I acted as managing director of Hobas Ltd. With support from USAID and the Land O’Lakes dairy and agriculture company, Hobas trained 500 farmers in dairy-related enterprises, to improve milk production for both home consumption and surplus sales in Rwanda’s Eastern Province.

In 2014-15, I won a competitive fellowship with Global Health Corps, and was placed in a senior position with the food security and livelihoods program with Partners In Health, known in Rwanda as Inshuti Mu Buzima. Moreover, I joined an online learning initiative through Harvard University and took a course titled, “Improving Global Health: Focusing on Quality and Safety,” and earned a certificate upon completion.

What inspired you to apply to UGHE?

I strongly believe health is a human right! Since childhood, I’ve wanted to save animals to improve people’s health and wellbeing.  Life in the camp in Uganda, as the son of a refugee, and my Global Health Corps experience with Partners In Health inspired me to apply for UGHE. Moreover, the UGHE mission and vision were stepping stones for me to acquire more skills and knowledge to participate in the global health arena.

Can you describe your studies at UGHE? What did you focus on?

Studies at UGHE focused on shaping future global health leaders capable of identifying and defining global health pathologies, and knowing how to address them effectively and strategically. At UGHE I explored strategic problem-solving; experiential and hands-on learning; leadership and management training, focused on defining the role of global health leaders in addressing intertwined health challenges; and one health, which encourages multi- disciplinary collaboration to address health challenges facing humans, animals and the environment.

My focus was on one health. My capstone report focused on the use of pesticides and their effects on human, animal and environmental health in eastern Rwanda. Results of the study revealed the effects of improperly applied pesticides on humans, animals, and ecosystems. Moreover, the study recommended a multidisciplinary approach to address such health challenges, which are always multi-faceted in nature.

What was the most valuable thing you learned at UGHE? What was your favorite class?

The most valuable thing I learned at UGHE is that health is a human right, and global health is a complex web of challenges. Leadership plays a vital role in managing and strengthening health systems. 

Favorite classes: 
1.    Principles of Global Health (first class by Dr. Paul Farmer, PIH co-founder and chief strategist) 
2.    One Health (by Dr. Hellen Amuguni, of the Cummings School of Veterinary Medicine at Tufts University) 
3.    Leadership and management (by Cloe Liparini, senior advisor for leadership development programs)
How did UGHE prepare you to work in global health? What have you been doing post-graduation?

Global health challenges are multi-faceted, and thus require a holistic approach. UGHE prepared me to think systematically and strategically when approaching global health challenges. Biosocial analysis is paramount when addressing global health. Using human-centered design skills gained at UGHE, my current project is designed to address root causes of health challenges and meet the needs of a targeted group of people. 
Because the one health field encourages multi-disciplinary collaboration in addressing global health challenges, my project involves a diverse group of professionals.

Since graduation, I've taught at the University of Rwanda—applying global health tools acquired at UGHE—while working on global health projects. I'm now pursuing my PhD in applied ecology and one health, at the University of Nebraska's College of Agricultural Sciences and Natural Resources

Benjamin Ndayambaje at UGHE graduation in 2017
Benjamin Ndayambaje addresses his peers during commencement for UGHE's Class of 2017, in the master's of science in global health delivery program. (Photo by Zacharias Abubeker / for UGHE)

What inspires you to work in global health?

What inspires me most is giving back to my community, and giving a hand to the most in need. It always feels great. Helping people who need a hand, without expecting a reward or gain of any kind, give me peace of mind.  

What are the biggest rewards of working in global health? What are the biggest challenges?

The biggest reward is giving the voiceless a chance to speak up, by listening to them and helping them figure out better ways to move out of poverty and improve the health of themselves and their families.  

The biggest challenges include leadership and management, accountability, and humility among others in the global health arena. Also, understanding global health as an intertwined set of problems and learning how to approach them effectively. Collaborative efforts to solve challenges are still minimal at local, national and global scales. Experience with numerous global health threats—outbreaks, pandemics and epidemics—such as HIV, H1N1, Ebola,  and others, shows that collaboration, leadership and management all play a vital role in containing, preventing, predicting and fighting against these threats.

Furthermore, as Dr. Paul Farmer said: "The idea that some lives matter less is the root of all that's wrong with the world.” I strongly agree with him. We as global health leaders need to fight for global health equity, while promoting humility, advocating for the voiceless and making the world a better place for all human beings.

What do you hope to achieve through your career in global health? Why is this work important?

I hope to play a role in improving the health and well-being of many people, especially those in need. This will be done through advocating for the voiceless and poor families, and designing human-centered research and development projects (likely involving food security and livelihood), especially in the developing world. I envision becoming a global health leader as a researcher and consultant.

I was born in a refugee camp. My personal hardships and experiences have laid the ground for me to strive for progress, and make the world a better place for everyone. It’s not only rewarding, but also a great feeling and accomplishment to help those who can’t help themselves. I always aspire to make a difference in the lives of those in need, and give them hope for future. 

What advice would you give to young global health professionals?

The best advice I can give to young global health professionals is to work hard with humility, collaborate among themselves, and bring the best out of themselves by fighting for global health equity. 

Today, more than ever, we have the best global health experience and tools—such as technological knowhow, skills and knowledge—to address these challenges. We need global health leaders who are optimistic and not afraid to confront these challenges, with the mission of health for all and health care as a human right. 
 

Watch Ndayambaje explain his capstone project on pesticide safety for Rwandan rice farmers, in a UGHE video here.

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Wed, 13 Feb 2019 14:50:59 -0500 https://www.pih.org//article/ughe-alumni-spotlight-benjamin-ndayambaje
UGHE Alumni Spotlight: Titus K. Koikoi https://www.pih.org//article/ughe-alumni-spotlight-titus-k-koikoi Titus K. Koikoi is a program director for global health nonprofit Population Services International, in his home country of Liberia. In November 2016, he was one of 25 health care leaders to attend the inaugural Executive Education course through the Global Health Delivery Leadership Program (GHDLP), at the University of Global Health Equity in northern Rwanda. The two-week course was designed to help leaders develop skills to deliver value-based health programs. 

 Can you describe where you grew up? What were your aspirations when you were younger?

I grew up in a small town of about 3,000 people, called Fissebu, in Lofa County, northern Liberia. Both of my parents were teachers, so we lived in staff quarters on the campus of the Zorzor Rural Teachers Training Institute (ZRTTI), where my father had been working, primarily training other teachers. We had electricity and pipe-borne water in our homes on the ZRTTI campus, and I could clearly see the disparity between marginally poor people and those who could afford basic social services. The campus is located about a mile away from the town. Fissebu is still there today, and is pretty rural. People live in huts and mud houses, with a few concrete houses. There are a few hand-pumps for water, plus a lot of hand-dug wells. Most of the town’s residents use a small creek for washing clothes and bathing. Most people use the forest for defecation. The town has one clinic and two senior secondary schools, and a computer training institute was recently opened about two miles from the heart of town. The basic means of survival for people in Fissebu is subsistence farming.

Can you give a brief overview of your professional background?

I’ve worked in global health programs and project management for more than eight years. My work has usually focused on grant management; health systems strengthening; capacity building; service delivery; data management and usage; community engagement and advocacy; government and civil society coordination; and water, sanitation, and hygiene (WASH). I’ve managed budgets of up to US$9.5 million, and currently work as program director for Population Services International (PSI) in Liberia, where we implement the USAID-funded Partnership for Advancing Community-based Services (PACS), and a Global Fund HIV project focusing on key populations. I have a master’s degree in public health and have worked as a public health professional for more than 10 years. 

What inspired you to apply to the GHDLP?

GHDLP’s program curriculum was very interesting. I could clearly see how participating in the program would allow me to apply my program management skills to real-life situations and learning. I saw that the program was modeled to bring together experts from diverse backgrounds and expertise, to discuss challenges and find ways to make implementation/service delivery better and more efficient. UGHE’s interest in rethinking health service delivery, so that the ultimate goal is quality service delivery to the beneficiaries, stood out for me. I was fascinated by such a unique training model.  

Can you describe your experience at the two-week GHDLP course? 

My time at the GHDLP program was rewarding. I had a mix of both rural and urban experiences. I expanded my professional network and used the opportunity to discuss practical solutions around the many global health challenges we’re currently facing. I learned about innovative ways in which lessons from program implementation can enhance learning in the classroom. 

What was the most valuable thing you learned at UGHE? What was your favorite class?

UGHE has begun a movement that seeks to encourage everyone involved with global health delivery to begin rethinking health care and looking into more efficient delivery models. This was the most valuable thing for me. I also enjoyed the case studies. While the case studies touched on very pivotal global health issues and highlighted smart solutions in some cases, they were also an eye-opener to demonstrate that some of the problems in global health have been there forever, and because we continue to do business as usual, those problems are still there. There is more than sufficient evidence to justify the need to innovate, rethink and be more efficient.

Please explain what types of mentorship you received. 

My team from Liberia developed a breakthrough project, and after the training in Kigali, we received mentorship in implementation, follow-up, mobilizing resources, writing reports and presenting the project. A team of experts from UGHE’s core faculty provided the mentorship remotely.  

Can you give an example of a time you used something you learned at UGHE in your workplace at PSI?

I was able to immediately set up an efficient feedback system on my return to work at PSI. Feedback can mean different things to different people. Most often, we feel feedback should only be negative, or should only flow from supervisors to their staff. I learned a different way of providing feedback while at UGHE, and I was able to utilize this learning appropriately. Feedback can be both negative and positive; feedback should flow from supervisors to their staff, and vice versa. This is one way to build a more transparent workplace and maintain a highly motivated and confident workforce. 

How has PSI benefited from your participation in the GHDLP program?

I returned from the GHDLP training course in December 2016, re-energized and with a lot of great new ideas. I’ve been able to transfer new skills and techniques to other managers, and I’ve shared various learning tools and materials with other colleagues for their professional growth. Overall, the GHDLP experience helped me contribute more and better to the awesome work PSI does in Liberia. I’m happy to have had the opportunity. 

Titus K. Koikoi
Titus K. Koikoi said he wakes up "every day remembering that service to humanity is the proudest engagement ever, and that health is an integral component of a more just, safe and better society." (Photo courtesy of Titus K. Koikoi)

What inspires you to work in global health?

I’m passionate about service to mankind. I get inspired every day knowing that the decisions I make, the actions I take, and the networks that I build, support and join, all go toward ensuring that a child somewhere receives timely vaccinations, a sex worker is tested for HIV, someone living with HIV is enrolled in care and treatment, someone in a village is treated for malaria, children learn in safe and healthy environments, people in villages have access to safe and clean water, and more. 

What are the biggest rewards of working in global health? What are the biggest challenges?

I wake up every day remembering that service to humanity is the proudest engagement ever, and that health is an integral component of a more just, safe and better society. I feel humbled that my work in global health gives me an opportunity to plan and manage service delivery for my fellow Liberians, and by extension, the world’s population in general. I feel challenged on a daily basis to give back to society, and to be a critical voice that advocates for access to health by all. I feel challenged and encouraged to contribute to local and global health care policies that ultimately affect health care and service delivery at the very peripheral level, and for the common person. 
There are manpower challenges in global health, and that is one reason why there’s a need for training more global health leaders. As a result of this challenge, I’ve seen little or no impact come out of huge health care investments over time. My home country is an example. It will take a great deal of innovation and rethinking, using models like the one developed by UGHE, to change the current paradigm. There are also huge disparities in terms of wealth distribution and access to care, and poorer people continue to feel the pinch of expensive health care across the globe, while the rich can afford to pay for foreign health care services. This must end now!

What do you hope to achieve through your career in global health? Why is this work important?

My hope is to see a more robust, efficient and resilient health care delivery system not only in Liberia, but also in countries where health service delivery to people in need is still a huge challenge. I hope my work always allows me to add my voice and hands to efforts that ensure under-served and under-privileged populations have frequent access to health care services. This remains one of the most critical things to supporting global security, fostering economic growth and maintaining political stability. 

What advice would you give to young global health professionals?

UGHE is an ideal platform for improving the skills and expertise of young global health professionals. Take up a course as soon as possible! While we all strive to prioritize efforts in global health and make the world a better place, we must now begin to innovate and rethink health care delivery. We cannot continue to do business as usual and expect different results. UGHE has practical solutions through the programs they’ve designed. I would recommend all young global health leaders and professionals apply to UGHE today. 

Read more from Koikoi in a 2017 interview with UGHE, here.

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Wed, 13 Feb 2019 14:19:09 -0500 https://www.pih.org//article/ughe-alumni-spotlight-titus-k-koikoi
UGHE Alumni Spotlight: Dr. Grace Dugan https://www.pih.org//article/ughe-alumni-spotlight-dr-grace-dugan Dr. Grace Dugan is an Australia native who graduated with UGHE’s Class of 2018. She earned her master’s of science in global health delivery while working for Partners In Health, known in Rwanda as Inshuti Mu Buzima, in the pediatric oncology ward at the Butaro Cancer Center of Excellence in northern Rwanda. 

Can you describe where you grew up? What were your aspirations when you were younger?

I grew up near Warwick in Queensland, Australia. This is a rural, farming area two hours away from a big city (Brisbane). My main aspiration throughout my school years was to be a novelist, though I did have an interest in social justice and formed an Amnesty International club at my high school. A school careers counselor actually sent me to a rural health careers workshop that was aimed at encouraging rural students into medicine, nursing and allied health. She thought it would be a good fit for me because I had good marks in sciences and it would be a way to do good in the community, but I was completely uninterested. I just wanted to write books.

Can you give a brief overview of your professional background? What were you doing before you began attending UGHE, and what inspired you to apply to the university?

I’m a medical doctor and I had been working in Australia and New Zealand for 3.5 years before getting a job in global health. When I applied for a spot at UGHE I was working in Papua New Guinea in multidrug-resistant tuberculosis (MDR-TB), which was an extremely challenging but deeply rewarding and, without exaggeration, life-changing experience. I had basically jumped ship from the normal career pathway for Australian doctors and figured out that I wanted to work in global health forever, but had no idea what to do next. Just before going to Papua New Guinea, I discovered Paul Farmer’s books and read most of them, so that led me to PIH and then to UGHE. At the time I applied I was in a bad patch in my job, and I wanted something to look forward to in the future. I didn’t expect to get in, and when I did get in I at first decided to ask for a deferment because I felt really bad about leaving my patients. But when I told my wonderful boss, Stenard Hiarsihri, he gave me his blessing and encouragement, and I decided to go.

Can you describe your studies at UGHE? What did you focus on?

It’s a diverse program, which I really liked. We started with a semester that essentially was about the history and politics of global health, then we did research methods, then management, and a practicum. We also had shorter courses in political economy, leadership, and management and communications, which were all great. Everyone is working full time, and I was very lucky to be offered at job at Partners In Health, known in Rwanda as Inshuti Mu Buzima, where I worked in pediatric oncology at Butaro Hospital in northern Rwanda. I based my practicum on one of the huge challenges we faced at Butaro: how best to treat acute lymphoblastic leukemia, which is a common childhood cancer with very challenging treatment. In high-income countries, it is almost always curable, but the treatment is complicated, lengthy and with potentially fatal side effects, so finding the best way to treat it is not easy.

Dr. Grace Dugan participates in a class at UGHE
Dr. Grace Dugan participates in a master class at the University of Global Health Equity. (Photo by Amani Hatangimana / for UGHE)

What was the most valuable thing you learned at UGHE? What was your favorite class?

I don’t have a favorite class, there was so much of it that was so wonderful. We were lucky to have a great faculty with an amazing array of practical experience. There were some challenges for our cohort, but I always felt so supported, encouraged and valued. It was so great to be in an institution which shared my values, and it made me feel like the sky’s the limit for what we could accomplish.

How did UGHE prepare you to work in global health? What have you been doing post-graduation?

I was already working in global health prior to and throughout the course, but in largely clinical roles. The master’s of science in global health delivery program gave me more confidence to take on managerial and leadership positions, and to potentially start my own project. A month after graduation, I was working in the Marshall Islands in the central Pacific Ocean, in an ambitious project which involved screening 22,000 people for TB and leprosy, as well as treating 4,500 people for latent TB. The project was led by a CDC doctor, Dick Brostrom, who has been a real leader in working to give TB patients in the Pacific access to high-quality treatment. It was a real privilege to work with him.

What inspires you to work in global health? What are the biggest rewards of working in global health, and the biggest challenges? 

I think of the work as an expression of solidarity with some of the world’s most vulnerable people. I find it inspiring to work with others who share a sense of the injustice of how global resources are distributed. It’s also wonderful as a doctor to be able to relieve suffering, though to be able to relieve it you first have to be able see it, and seeing it can be overwhelming. I’ve met doctors from rich countries who’ve told me they couldn’t cope with what they witnessed in poor countries, and didn’t want to work in those environments. For me, I remind myself that incredible suffering is taking place whether I’m witnessing it or not, so I may as well try to lend a hand.

What do you hope to achieve through your career in global health? Why is this work important?

One of my goals is to return to working in Papua New Guinea, where things are really terrible in terms of health care. When I was working there I noticed a sense of fatalism and a desire to blame the people or the culture for their health problems, but in my experience, patients sacrificed an enormous amount to receive treatment and it was possible to accomplish a lot.

Dr. Grace Dugan checks a patient in the pediatric ward at Butaro District Hospital.
Dr. Grace Dugan examines Frank Mugisha (pseudonym), then 6, in March 2017 in the pediatric ward at Butaro District Hospital. Frank had just completed 30 months of treatment for acute lymphoblastic leukemia. (Photo by Cecille Joan Avila / Partners In Health)

What advice would you give to young global health professionals?

UGHE students come from very different backgrounds, and I can only really give advice to those who are like me and come from high-income countries. Working in global health usually involves poor job security and you may want to do unpaid work, as well, so it’s helpful to avoid debt if you can, either from study or from a mortgage. It can be socially isolating so it’s important to look after your friendships, with people who support you and who understand your drive. There are a lot of people who like to complain about how difficult the work is, and that’s not a productive discussion to be having all the time. I get a lot of strength from staying in touch with friends in Papua New Guinea, Rwanda, Peru and the Marshall Islands, who all are really passionate about improving the health of their people.

It’s also good to remember that a lot of people who would really like to do this work are unable to because of other responsibilities, or because they don’t have the skills or the opportunity, so if you want to and you can, then you probably should. It doesn’t matter if it doesn’t lead to anything else or advance your career, the point is to do the work that needs to be done. And if you do one job and find that it didn’t work out, like you didn’t agree with the values of the organization or you didn’t feel you were accomplishing anything, don’t give up. With a bit of reflection and research, you might figure out what you’re hoping to achieve and find the right way to do that.

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Wed, 13 Feb 2019 13:26:20 -0500 https://www.pih.org//article/ughe-alumni-spotlight-dr-grace-dugan
Surgery, New Home Empower Young Mother in Malawi https://www.pih.org//article/surgery-new-home-empower-young-mother-malawi Wearing a “Feeling Lucky” T-shirt as she held her children close, Rose Kapeni* gently opened the front door of her new home and leaned forward to look inside. 

She smiled, and sighed in happiness and relief. Then she walked in to check out her new surroundings—with an excited group of friends and supporters right behind her. 

The joyous home-handover ceremony for Kapeni and her three children was filled with singing, dancing and laughter Feb. 7 in Neno District, Malawi, where friends, community members, and Partners In Health staff gathered to formally present and open the newly built home. The ceremony culminated a long period of illness and recovery for Kapeni, and showed how community-based health care can help provide healing that is far more than physical. 

“I’m beyond grateful that I was found and supported during this very difficult time,” Kapeni said. “I hope and pray PIH can continue to do this work, as there are many others in the community who are struggling.”

Kapeni, 25, went through more than her share of struggles.

A longtime HIV patient, she began suffering severe health problems in June 2016, when a persistent skin condition became debilitating. Her attempts to have surgery for the condition at Queen Elizabeth Central Hospital in Blantyre, Malawi’s second-largest city, failed. Twice, she was unable to have surgery because the surgeon wasn't there; a third time, the hospital did not have blood available in case she needed a transfusion. Travel to the hospital was long and difficult. 

Because of her condition and associated stigma, Kapeni’s husband left her and much of her family abandoned her. As money ran short, Kapeni almost gave up on having the surgery. 

When staff with PIH—known locally as Abwenzi Pa Za Umoyo—visited her home last September, they found Kapeni bedridden, essentially unable to move. 

The PIH clinical officer visited Kapeni to find out why she was missing follow-up appointments for HIV. Kapeni had been dedicated to antiretroviral therapy (ART) since 2014, so it was concerning that she was not taking her medication, and was missing checkups. 

The clinical officer discovered that Kapeni was no longer able to leave her home due to the skin condition, which by that time she had been living with for more than four years. Her HIV viral load was very high. She and her children lived in a small, crumbling structure with no solid walls, an incomplete thatched roof, and very limited food. Her condition made it painful for Kapeni to sit, or even to move. Motorbike rides to visit health facilities had become too painful. 

Rose Kapeni's former home
When PIH clinical staff visited Rose Kapeni in September, they found her bedridden in this unstable home, suffering from a debilitating skin condition and struggling to care for her children. (Photo by Mark Chalamanda / Partners In Health)

PIH’s clinical HIV team quickly mobilized, along with community health workers and the program on social and economic rights, or POSER, which addresses social and economic causes of poor health. The close coordination between all those teams ensured Kapeni quickly got comprehensive care, and soon resumed her ART. 

POSER staff provided a large bag of maize, along with emergency financial support for her hospital stay. POSER also coordinated transportation to Neno District Hospital, where, at the end of September, PIH’s medical director and a visiting surgeon successfully conducted Kapeni’s long-awaited surgery, fixing her condition. Her community health worker, Ida Simion, cared for Kapeni’s three children while she was hospitalized. 

Recovering at the Neno hospital last fall, Kapeni explained that throughout her ordeal, her only strength had come from her children: her son, 9, and two daughters, 6 and 2. All three children are HIV-negative. Kapeni knew she had to be there for them, so she persevered through the pain and stigma. 

“Problems come to anyone in life, and you just have to stay strong,” she said. 

After four weeks in the hospital, Kapeni returned to her home in Tiyese Village and, finally, began the long process of starting anew. 

Her vitality was evident in December, when Kapeni buzzed with energy while visiting PIH’s main office in Neno. She laughed as she talked with staff, joking and carrying herself with a renewed confidence. 

She and her children now have an additional source of strength.

Rose Kapeni and her children at their new home, February 2019 in Neno
Rose Kapeni, center and holding her three children, receives the key to her new home during a joyous ceremony Feb. 7 in Neno District, Malawi. The ceremony and new home, funded by a private donor, culminated a long, grueling period of illness, recovery and resilience for Kapeni and her children. (Photo by Elise Mann / for Partners In Health)

The POSER team worked with the community and Kapeni’s family to buy land for a new home. POSER had built 109 homes in Neno District since PIH’s arrival in 2007, and it was clear that the 110th could be for Kapeni, if funding could be found. Thankfully, a private donor provided money for the permanent, two-bedroom home for Kapeni and her children. 

John Living Munthali, infrastructure manager for PIH in Malawi, said construction of the home started in December and took six weeks. Crews molded bricks right on the site, nestled in a small community in Neno's Matandani area.

“We believe that treatment alone is not enough,” said Victor Kanyema, POSER program manager. “Working in collaboration with clinical teams, we make life better for all the people we serve in Neno.”

*Name changed

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Tue, 12 Feb 2019 11:10:31 -0500 https://www.pih.org//article/surgery-new-home-empower-young-mother-malawi
Eliminating TB, One Van at a Time https://www.pih.org//article/eliminating-tb-one-van-time The imminent launch of two vans equipped with state-of-the-art technology to test for tuberculosis (TB) and multidrug-resistant tuberculosis (MDR-TB) marks a major milestone for PIH’s and Peru’s fight against TB, the leading infectious killer of adults in the world. Within coming weeks, these trucks will enable PIH to carry out a new screening program called TB Móvil, which will search for, diagnose, and refer TB and MDR-TB cases in the three northernmost districts of Peru’s capital, Lima.

TB Móvil is one of various strategies that comprise a new ‘TB Elimination’ campaign, led by a coalition of PIH and partner organizations in northern Lima, which aims to rapidly drive down TB rates. It is the first time PIH is launching such a campaign. The TB Móvil component focuses on bringing testing closer to where people live, in order to search for and promptly treat TB and MDR-TB. The goal in 2019 is for the vans to drive through northern Lima and offer 100,000 people a free, fast way to be tested for the disease and gain access to treatment.

Once inside the truck, volunteers will receive a chest X-ray and—if necessary—a sputum test, the results of which are delivered in mere minutes thanks to advanced automated radiography and GeneXpert machines—two technologies that would otherwise be unavailable to poor patients. A clinician will evaluate the results and, if they test positive for TB, connect them to public health centers for a quick start to lifesaving treatment.

By actively searching for patients and bringing rapid testing, PIH, community organizations, and Peru’s Ministry of Health will ensure that more TB and MDR-TB patients receive early treatment. In so doing, we will halt the spread of the disease and save more lives, now and into the future.

PIH Co-founder Dr. Paul Farmer was in Peru in December to celebrate the program’s first steps. “I marvel at how much the Peru team has accomplished over the past 23 years,” he said. “Seeing former patients who two decades were so sick and are now flourishing, and seeing nurses and health workers and lab techs still working with compassion and conviction after years—these are the best gifts we could ask for, especially in front of these new tools. This novel community screening program is a symbol of shared commitment to do more to address one of the world’s most trenchant public health dilemmas.”

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Fri, 08 Feb 2019 12:35:36 -0500 https://www.pih.org//article/eliminating-tb-one-van-time
'It Felt Like the End of the Road': Bizinde Elyse Reflects on Beating Cancer in Rural Rwanda https://www.pih.org//article/it-felt-end-road-bizinde-elyse-reflects-beating-cancer-rural-rwanda One morning in July 2014, Bizinde Elyse noticed that his right knee was painful and swollen. 

A native of Nyamasheke District in Rwanda’s Western Province, Elyse brushed it off, assuming he had played football too roughly with friends at school and the swelling soon would go down. To his alarm, his knee kept swelling over the next few days, while becoming itchy and hot to the touch. His parents grew concerned and urged him to go to the nearest health center. He was about 20 years old at the time. 

At the health center, clinicians could not immediately diagnose the swelling’s cause. They gave Elyse some medicine and told him to come back in a few weeks. But his condition continued to worsen, as the swelling increased considerably and he became feverish. Elyse quickly went back to the health center, well before the few weeks were up, but clinicians again could not give conclusive results. They referred Elyse to the district hospital, which promptly referred him to University Teaching Hospital of Butare, in southern Rwanda. Butare is more than 100 miles—or three-plus hours, by car—from his home district. 

Doctors at the teaching hospital diagnosed Elyse with rhabdomyosarcoma, an aggressive and highly malignant form of cancer in skeletal muscle cells. 

Elyse remembers feeling shell-shocked. 

“I had always heard of cancer affecting other people, and I never thought I would ever be one of those people,” he said. “It felt like the end of the road for me. I was even more sad because my parents took it very hard. My mother was very distraught. I hated seeing her that way and it added to my own sadness.”  

Fortunately, doctors told him that since they had discovered the cancer in its early stages, it was still operable. They recommended a swift course of action, beginning with amputation to stop the cancer from spreading. Surgeons amputated Elyse's right leg in early 2015. Following that surgery, doctors transferred Elyse to Butaro District Hospital in northern Rwanda, for chemotherapy. The Butaro hospital and its Cancer Center of Excellence are supported by Partners In Health, known in Rwanda as Inshuti Mu Buzima. 

Elyse said the compassion of Butaro staff was as important to his full recovery as the treatment.        

“Everyone was really kind to me. It made me feel less lonely, as I had made the journey from Nyamasheke to Burera (District) alone, without my parents,” he said. “My treatment, lodging, and meals were all covered by Partners in Health. I would also get transportation from where I was staying to the cancer center, for treatment, and had access to counseling services, which I received regularly.” 

Partners In Health also provided Elyse with a prosthetic leg, so he could transition from using crutches. 

Today, Elyse is 25 years old, healthy and cancer-free. He decided to move to Butaro permanently to make checkups easier, and now runs a small variety shop near the cancer center. He sells everything from airtime data and mobile money transfers to small snacks and everyday items. 

Bizinde Elyse helps customers at his stall in March 2017
Bizinde Elyse, who had one of his legs amputated as part of his treatment for cancer found in his knee, has become a healthy, familiar face in the Butaro community in northern Rwanda. Here, he helps customers at his small stand in March 2017. (Cecille Joan Avila / Partners In Health)

His customers range from caregivers to first-time visitors to the Butaro hospital. He speaks gently as he serves his customers, and has become a beloved, familiar member of the community.

“If you could have asked me two years ago what I would be doing now, I would not even have told you—I would’ve assumed I’d be dead,” Elyse said. “Now, I am an entrepreneur and am contributing to my community and my country.”  

Elyse added that he is incredibly grateful for his recovery and new outlook on life. He also is able to think about his future. In 2017, Elyse graduated from high school, earning second-class honors in math, biology and chemistry. He said he hopes to be a doctor one day, so he can help people in the same way he was helped.

“I would like to thank everyone who helped me get better, from the doctors, nurses and care providers at Butaro, and the government of Rwanda, to Partners in Health, who covered the cost of my medication and also supported me with a prosthetic leg,” he said. “I have been able to go back to my normal life because of their intervention and support.”
 

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Fri, 08 Feb 2019 11:12:23 -0500 https://www.pih.org//article/it-felt-end-road-bizinde-elyse-reflects-beating-cancer-rural-rwanda
Op-ed Urges New Focus on ‘Crushing Burden’ for Poorest Billion https://www.pih.org//article/op-ed-urges-new-focus-crushing-burden-poorest-billion The director of Partners In Health’s NCD Synergies program is calling for a dramatically overhauled approach to cancer, heart disease, mental illness, and other non-communicable diseases, saying in a Bangkok Post op-ed that detection and treatment have “largely failed to reflect the experience” of the world’s poorest, jeopardizing efforts to achieve universal health coverage and leaving countless people without care. 

“NCDs have long been a crushing burden for children and young adults living in extreme poverty in rural Sub-Saharan Africa and South Asia: hundreds of thousands will die each year before the age of 40 from an NCD,” Dr. Gene Bukhman writes in the Wednesday op-ed, co-authored with Dr. Gina Agiostratidou of the Helmsley Charitable Trust. 

“In addition, the out-of-pocket expenses necessary for treatment can be catastrophic for families already living on next to nothing,” they continue. “And that's if these conditions are diagnosed at all, which is far from guaranteed.” 

Bukhman helped launch NCD Synergies in 2013, and in 2016 became a co-chair of the Lancet Commission on Reframing NCDs and Injuries for the Poorest Billion. Agiostratidou is the director of Helmsley’s Type 1 Diabetes Program. Their op-ed coincides with the 2019 Prince Mahidol Award Conference, held this week in Thailand’s capital and focusing on the political economy of NCDs, which kill an estimated 41 million people a year globally. 

Despite that alarming rate, they write, “NCDs among the poorest billion have gone under the radar of the global health community,” particularly regarding young patients.

“Childhood conditions among the poorest billion, such as type 1 diabetes, rheumatic heart disease, or sickle cell anemia, often have genetic, infectious, or environmental determinants,” they write. “Because these NCDs are diverse and relatively uncommon, they have so far failed to garner needed health policy attention: they don't easily fit into a traditional public health agenda, structured around highly standardized approaches to preventing disease or minimizing risks. 

“Now is the time for that to change.”

Bukhman and Agiostratidou lay out a three-pronged approach to revamping NCD policies, including: a greater focus on the world’s poorest, research on integrating health care delivery for non-communicable diseases and injuries, and partnerships to boost financing and integrated solutions. 

Read the full op-ed, here.
 

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Fri, 01 Feb 2019 14:03:05 -0500 https://www.pih.org//article/op-ed-urges-new-focus-crushing-burden-poorest-billion
Dr. Binagwaho to POLITICO: UGHE Aims to “Radically Change Education” https://www.pih.org//article/dr-binagwaho-politico-ughe-aims-radically-change-education Dr. Agnes Binagwaho, vice chancellor of the University of Global Health Equity, recently told POLITICO that UGHE’s new campus in northern Rwanda reflects its “mission to radically change education” and build a 21st-century model for better health equity.  

“Our vision is a world where every individual no matter where they are, who they are and where they live can lead a healthy and productive life,” Binagwaho told the international politics and policy website, in a story published Sunday. “Our mission is to radically change education, health education, so that we impact the way health care is delivered around the world.”

Binagwaho was one of several UGHE and Partners In Health leaders quoted in the story, which followed Friday’s inauguration of the Butaro campus, UGHE’s first permanent home

The university is an initiative of PIH that was launched in 2015. Construction of the campus began a year later, with classes and part-time studies temporarily based in Rwanda’s capital, Kigali. 

Though UGHE is a private, nonprofit institution, the government of Rwanda has played an important role in its development. In addition to providing financial resources and donating the land for UGHE, the government is paving roads that link Butaro with Musanze and Kigali, and has increased access to water, electricity, and internet connectivity throughout the region.  

In addition to providing an overview of UGHE, its mission and the new campus, the POLITICO story also speaks with UGHE’s founding dean, Dr. Abebe Bekele, about his innovative approach to curriculum, and tells the story of UGHE alumni Crispin Gishoma and Arsène-Florent Hobabagabo, who graduated last May and now run a diabetes clinic in Kigali. 

Read POLITICO's full story here.
 

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Tue, 29 Jan 2019 10:10:06 -0500 https://www.pih.org//article/dr-binagwaho-politico-ughe-aims-radically-change-education
UGHE Campus Intertwined with Butaro Community https://www.pih.org//article/ughe-campus-intertwined-butaro-community Jean Claude Niyonzima laughed when asked about his average workday in recent weeks, as he helps prepare the University of Global Health Equity in northern Rwanda for the Jan. 25 inauguration of its new, permanent campus. 

“Oh, my goodness,” said Niyonzima, UGHE’s 29-year-old facilities manager. “I’m moving all day.”

His days start at 5 a.m. and quickly become a blur of contractor meetings, equipment and furniture orders, mechanical plans, and check-ups on everything from final coats of paint to ceiling fans. By the time he responds to the day’s last emails, it’s usually 10 p.m.  

Construction of the UGHE campus has transformed the surrounding community of Butaro over the past two years, in ways large and small. There now are streetlights. Vastly improved public infrastructure for electricity, potable water, and internet access. The first elevator in Burera District. A future paved road to the capital, Kigali, that will drastically reduce travel time for the 80-mile trip. Construction-related jobs for more than 1,500 people, with more than 90 percent of the workforce local, and more than 30 percent women. Many workers are learning new skills—such as masonry, welding, plumbing and landscaping—that could help with future employment. 

Like Anne Marie Nyiranshimiyimana. A mason on the campus project, Nyiranshimiyimana initially faced criticism—“They told me, ‘No woman builds, no woman climbs,’” she said—but she has since risen to the rank of master mason. She’s also become a source of inspiration for women and girls in her community. She’s known around Butaro by her nickname, Kankwanzi, which loosely translates to “rising star who refuses to conform to society’s expectations.”

Nyiranshimiyimana is one of many people on the construction crew who also worked on Butaro District Hospital, which opened in 2011 about two miles away. Nyiranshimiyimana began her masonry training on that project. Both the university and the hospital are initiatives of Partners In Health, a global health nonprofit that works in Rwanda through sister organization Inshuti Mu Buzima. The hospital and the UGHE campus sit atop scenic hillsides, visible to each other across a lush valley. The hospital is one of several teaching facilities that will collaborate with the university and provide hands-on training for students. 

The new campus will eventually span almost 250 acres and is home to six academic buildings, housing for 200 students and staff, a dining hall, administrative spaces, and more. Though UGHE is a private, nonprofit institution, the Government of Rwanda has played an important role in its development. In addition to providing financial resources and donating the land for UGHE, the Government of Rwanda is paving roads that link Butaro with Musanze and Kigali, and has increased access to water, electricity, and internet connectivity throughout the region.  

UGHE construction brought more than 1,500 jobs to the area
UGHE worked closely with the Burera District local government and community not only to hire and train local workers, but also to spur economic development by using Butaro-sourced goods and services whenever possible, including cement, sand, gravel, cured bricks, and more. (Photo by James Martin/CNET, for UGHE) 

These changes have had many impacts locally, but the greatest has been on the 115 households moved to make way for construction of the campus. Many families sold their land as part of the relocation process. All of them were compensated by the government. More than 40 households have moved to a new, government-constructed model village about a mile away, called Mulindi.

Niyonzima, the facilities manager, said the relocation process began with community meetings and explanations of the campus project, which has been universally welcomed by the community. That sounds somewhat unbelievable, but Niyonzima—who grew up in Rwinkwavu, in southeastern Rwanda, and has lived and worked in Butaro for more than six years—said residents quickly saw the benefits of the new university. 

”Where they were, they didn’t have potable water. They didn’t have electricity. They didn’t have a health center. They didn’t have a school or a nursery,” Niyonzima said. “The Government of Rwanda has committed to providing all of that.”

Additionally, he said, many Butaro residents are farmers, who now will have a new, growing market and customer base for their produce. 

Construction of the hospital, and IMB’s resulting strong reputation in the region, also paved the way for the community to welcome UGHE. 

“After hearing the university project was connected to IMB, they didn’t even really ask much more,” Niyonzima said. 

UGHE and the government collaborated to make the relocation process transparent and accessible. 
Guided by Rwandan land laws, UGHE worked with government officials to take a full inventory of land and property. Compensation was distributed before families moved. Families were given advance notice to move, and local leadership helped several families identify and buy land elsewhere in Burera District. 

When asked if any families opposed the relocation, Niyonzima answered unequivocally: “None of them. None.”  

The model village of Mulindi, completed in August 2017, is not unique in Rwanda. Every district in the country has at least one model village, funded and built by the government to connect rural communities to roads, schools, electricity, water, health posts, and markets. Mulindi eventually will house more than 200 families. 

Emmanuel Kamanzi, UGHE’s director of campus development, oversaw planning and construction of the campus, managing the more than a dozen contractors on site. The project actually brought him back to Rwanda, and Butaro--Kamanzi has worked for PIH and IMB in several capacities over the years, including as director of development for Butaro District Hospital during its construction almost a decade ago. Following that project, Kamanzi moved to the U.S. and worked in PIH’s Boston office, as program officer for Rwanda. But his familiarity with large-scale projects in Butaro made him a natural fit for development of the UGHE campus, so he moved back early in 2016--with a clear vision in mind, and work that won’t end with construction.   

“We wanted to design and build a campus that is inspirational, durable and easily accessible, while fostering a strong sense of community and high quality of life,” Kamanzi said. “We made sure that everyone involved understood these principles, and was aligned with them. Now that construction is complete, our major focus will be to make sure that the function follows the form we’ve achieved.”

UGHE's administration building
Wavy clouds form a scenic backdrop for UGHE's administration building, days before the landmark campus inauguration Jan. 25. (Photo by Emmanuel Kamanzi / UGHE)

Dr. Abebe Bekele, UGHE’s founding dean of health sciences, said families will be connected to the campus community—and vice versa. 

“The campus is going to be dependent on the community in Butaro—for food supplies, for services, for advice and safety, and most of all, to help us teach our students—so we will be creating an opportunity for the community to work with us,” Bekele said. “We are working on different programs that can engage Butaro residents. One is community-based education, where our students will directly learn from the community, and in turn help them while doing so.”

Bekele sees UGHE as a point of pride not just for the community, but for the region as a whole. 

“This is owned by Partners In Health,” Bekele said of the university. “But, truly speaking, the people who own this are the people of Rwanda and the people of Africa.”

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Thu, 24 Jan 2019 14:06:56 -0500 https://www.pih.org//article/ughe-campus-intertwined-butaro-community
Ophelia Dahl on Optimism in Difficult Times, for Boston's NPR Station https://www.pih.org//article/ophelia-dahl-optimism-difficult-times-bostons-npr-station Ophelia Dahl, a co-founder of Partners In Health and the board chair, reflected recently about the organization's early days in Haiti and on how deeply she and other co-founders wished to "make a dent in the extreme poverty faced by thousands of Haitians," in partnership with local colleagues. 

Some 30 years ago, their team built a clinic in rural Haiti that had a positive impact on countless lives. That clinic grew into a hospital, which served as a reference point for patients from across Haiti. Their work spurred a movement that leapt to Peru and Russia, expanded to Mexico, and also has taken root in the heart of Kazakhstan and five countries in Africa.

All of this was possible, Dahl says, because they chose optimism over apathy. Here's is the beginning of her essay, as published on WBUR's Cognoscenti, the opinion page for NPR's Boston-based affiliate:

"There’s a well-loved Haitian proverb I often turn to during challenging times: 'Piti piti, wazo fe nich li.' It translates to, 'Little by little, the bird makes its nest.' My friends and colleagues offer it up as words of consolation and hope when a challenge seems overwhelming. I bring it up now, as I often do during difficult times when so much seems uncertain, because it also reminds me of a specific moment from my first trip to Haiti in 1983 as an 18-year-old volunteer."

Read more here.

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Tue, 22 Jan 2019 10:58:28 -0500 https://www.pih.org//article/ophelia-dahl-optimism-difficult-times-bostons-npr-station
UGHE’s New Campus a Beacon for a Brighter Future https://www.pih.org//article/ughes-new-campus-beacon-brighter-future The University of Global Health Equity will be celebrating so much more than a new campus at its landmark Jan. 25 inauguration in northern Rwanda. 

When leaders from  the Government of Rwanda, Partners In Health, international academic institutions and other global health organizations gather at UGHE’s brand-new cluster of sparkling white buildings, surrounded by the Butaro region’s green hills, they’ll be celebrating an institution that is dedicated to improving health care services and delivery for underserved populations around the world. They’ll be celebrating UGHE’s innovative focus on equity and social determinants of health, which pairs education in human rights and social justice with rigorous, community-based medical training.

The university is an initiative of PIH that was launched in 2015 with catalytic funding from the Bill & Melinda Gates Foundation and the Cummings Foundation. Construction of the campus began a year later, with classes and part-time studies based in Rwanda’s capital, Kigali. The campus already is transforming infrastructure, accessibility, and employment—not to mention health services—in the Butaro community. Butaro District Hospital is just two miles away, across a valley, and will serve as one of multiple teaching hospitals for university students. The hospital and its cancer center are supported by Inshuti Mu Buzima, PIH’s sister organization in Rwanda.

Though UGHE is a private institution, the Government of Rwanda has played an important role in its development. In addition to providing financial resources and donating the land that UGHE is situated on, the Government of Rwanda has paved roads that link Butaro, Musanze, and Kigali, and increased access to water, electricity, and internet connectivity throughout the region.    

All of that synergy empowers UGHE with opportunity—for students, staff, and partners; for patients, communities, and countries. Opportunity for a brighter future, and for aspiring doctors who otherwise would not have the chance to pursue their dreams. For people who thought medical school would never be within their reach. For patients who thought high-quality care would never reach them, and who thought their disease was a death sentence. 

Dr. Agnes Binagwaho, UGHE’s vice chancellor, said the realization of UGHE’s vision will affect far more than academics, and far more than Rwanda alone.  

“Together we are assembling the building blocks of a university that will contribute to the transformation of health service delivery, through education, mentorship and research, in every corner of the globe,” she said. “This year, the University of Global Health Equity has progressed further and faster than any of us could have imagined.”

Construction on the UGHE campus in March 2018.
Construction progresses on the UGHE campus in March 2018. More than 1,000 workers joined the construction crew over the two-year building process. (Photo by Barb Kinney for UGHE)
Construction on the UGHE campus in March 2018.
Facilities Manager Jean Claude Niyonzima walks in March 2018 through one of the main academic buildings on UGHE's new campus in Butaro. (Photo by Barb Kinney for UGHE)

UGHE’s growth comes at a time of severe need for qualified healthcare workers across Africa. The WHO estimates the continent will have a shortage of more than 6 million healthcare workers by 2030. 

With that need firmly in mind, UGHE’s new campus will provide a permanent home for health sciences education grounded in the belief that health care is a human right. The university so far has graduated two classes of part-time students who earned master’s of science degrees in global health delivery, through a two-year program. Those students gathered in Kigali for several weeks each semester, with the remainder of their studies conducted remotely or on trips with classmates and staff. 

The 250-acre (100-hectare) campus is about 80 miles north of Kigali and, in the first phase of construction, includes housing for up to 200 students and staff, a dining hall and six academic buildings. The state-of-the-art academic buildings will include a clinical simulation center; a science laboratory; a 6,700-square-foot Information Commons, providing e-learning tools, tech support and a medical library; a configurable Studio Classroom, and more. 

The campus’ setting in rural Butaro directly reflects the university’s mission and values. 

“It’s no accident that our campus is not in an urban city-center,” said Dr. Paul Farmer,  co-founder and chief strategist at Partners In Health and global health department chair at Harvard Medical School. “We want our students to understand what it’s like to deliver care in rural settings, yes, but more importantly to look beyond what they can learn in the classroom and the clinic. Some of the key lessons learned in the delivery of equitable care have been learned right here in rural Rwanda, and some of these lessons are broadly applicable in cities and many disparate settings. 

“The students who study here will be encouraged to learn clinical skills while also learning how to think about the world beyond the hospital,” Dr. Farmer added. “If we’re ever going to see a world where every person, no matter who they are, receives quality health care, we need to transform the way we think about training our future leaders. Opening this beautiful, state-of-the-art campus in Butaro signals our commitment to improving care delivery not only in this region, but across the world.”

UGHE’s founding Dean of Health Sciences, Dr. Abebe Bekele, joined the university’s leadership in June. He is a highly regarded thoracic and general surgeon, former dean of the School of Medicine at Addis Ababa University in Ethiopia, and former CEO of Tikur Anbessa Hospital in Addis Ababa. 

Bekele will oversee the launch of UGHE’s first medical degree program, which will give students the opportunity to earn bachelor’s degrees in medicine and surgery, jointly known as MBBS, along with the master’s in global health delivery, over six and a half years of study. All together, the program will be known as the MBBS/MGHD dual degree. 

The first cohort of 30 students will begin the program in July, after the university receives accreditation by Rwandan and international governing standards. In 2025, those students could become the first graduates of UGHE’s comprehensive medical school.  

“By the time they graduate, they will be doctors, with a master’s of science degree in global health delivery,” Bekele said.

Construction progresses
Beautiful views abound on the UGHE campus, in the green hills of the rural Butaro region in northern Rwanda. Many buildings are adorned with geometric designs, in traditional Rwandan patterns known as imigongo. (Photo by Danny Kamanzi/UGHE)

They’ll undergo a unique course of study along the way. Butaro District Hospital will provide a clinical location that essentially is on-site, just a 15-minute walk from the UGHE campus. Lessons will be tailored to address the continent’s greatest burdens of disease and gaps in care.

“Our students will learn and think about research from day one,” Bekele said. “We will pay specific emphasis on health needs that the continent demands at the present moment—that is, emergency care and safe surgery and anesthesia.”

Bekele said graduating doctors “will be able to handle emergency care medicine in all settings, and to perform, at least, essential surgical procedures” in settings with limited resources. 

In their first year of study, UGHE medical students will be introduced to an education outside of medicine, to help them better understand the conditions, history and contextual realities of the patients they’ll serve. 

“We are an equity-based global university,” Bekele said. “A health professional who has no idea about human rights, gender, injustice—a health professional who does not understand the history and political economics of Africa,  a health professional who is not prepared in critical thinking and scientific reasoning— probably has no place in tomorrow’s Africa.”

Bekele emphasized that students will take advantage of the numerous health facilities supported by Inshuti Mu Buzima, for hands-on learning and experience in community-based education.

“We will teach the students at health posts, health centers and hospitals, as they develop through the six and a half years,” Bekele said. “Gone are the days when doctors are expected to only treat sick patients. The doctors of today need to connect with and understand the communities that they serve."

UGHE also offers Executive Education programs. The customized short courses are designed for global health executives and so far have included partnerships with the Global Fund to Fight AIDS, Tuberculosis and Malaria; George Washington University’s Health Workforce Institute; and Yale University’s Global Health Leadership Institute, among others. The courses focus on health system strengthening, leadership, management, strategic problem-solving and more.

A third pillar of UGHE education is One Health, a concept stressing the integration of human health, animal health and the environment. An advanced program in that discipline could be about a year away, but eventually will be one of UGHE’s “signature programs,” according to Bekele. 

“One Health is new to Africa,” Bekele said. “UGHE is strategically placed to play a pivotal role in representing One Health on the continent.”

The University of Global Health Equity's first class, of 24 students, graduates in May 2017 at a ceremony in Kigali. (Photo by Zacharias Abubeker for UGHE)
The University of Global Health Equity's first class, of 24 students, graduates in May 2017 at a ceremony in Kigali. (Photo by Zacharias Abubeker for UGHE)

Graduates of the MGHD program already are making impacts. UGHE’s alumni community includes 37 global health leaders, who now are working in public, private and nonprofit sectors. 

One of those leaders is Dieudonne Hakizimana, who graduated in 2017 as a member of UGHE’s first group of MGHD students. He came to UGHE with a master’s in epidemiology from the University of Rwanda and 10 years of experience in the health field, including four years at Inshuti Mu Buzima’s Rwinkwavu District Hospital in southeastern Rwanda. 

His studies at UGHE prepared him for a leadership role in global health, with training in management, health financing and more. He is now a teaching and learning officer at UGHE, where he’ll help students reach goals of their own. 

Applications to be among the next wave of UGHE students are coming from all over the world. UGHE received more than 300 applications across 26 countries in 2018, for the 24 spots in the current cohort that began studies in September.  

Bekele said offering classes online soon will help meet that global demand. 

Accepted students also get significant financial support from the university. All enrollees in UGHE’s global health delivery program get scholarships, which cover an average of 91 percent of the $54,000 charge for tuition, room and board. UGHE has awarded more than $1.8 million in financial aid so far.  

UGHE’s alumni community already is bringing lessons from the university into their professions, and communities. 

Titus K. Koikoi, a Liberian who is program director for global health nonprofit Population Services International, took an Executive Education course at UGHE, through the Global Health Delivery Leadership Program. He said the course continues to affect how he approaches his work in Liberia. 

“UGHE has begun a movement that seeks to encourage all involved with global health delivery to begin rethinking health care and looking into more efficient models for health services delivery,” he said. “I feel humbled that my work in global health gives me an opportunity to plan and manage service delivery for my fellow Liberians, and by extension, the world’s population in general. I feel challenged on a daily basis to give back to society, and to be a critical voice that advocates for access to health by all.”
 

UGHE's new campus greets a new dawn in January 2019, just days before students arrived.
UGHE's campus greets a new day in January 2019. Leaders from the university, the Government of Rwanda, Partners In Health and academic institutions around the world will gather on the campus Jan. 25 for a formal inauguration. (Photo by Emmanuel Kamanzi/UGHE)

 

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Fri, 18 Jan 2019 13:24:03 -0500 https://www.pih.org//article/ughes-new-campus-beacon-brighter-future
Make Social Justice Your New Year’s Resolution https://www.pih.org//article/make-social-justice-your-new-years-resolution Host a birthday fundraiser: Make your birthday meaningful by asking your friends and family to contribute to a Facebook Fundraiser for PIH! Start yours by signing into Facebook here.

Claim your sticker: Sign up here and we’ll send you a free “Health care is a human right” sticker to put on your laptop, water bottle, or notebook! It’s an easy way to spread the social justice message. Claim yours here.

Become a Paul’s Partner: Partner with PIH year-round by signing up for a monthly gift. Each month your donation will go towards helping communities in need around the world, from providing monthly HIV medications to supporting regular postnatal visits for new moms. Start your monthly gift here.

Post on social: Tell your friends and followers why you support the right to health care! Share a PIH post or make one of your own. Don’t forget to tag PIH in your post and we will share some of our favorites. And be sure you're following us on Facebook, Twitter, and Instagram.

Share the social justice story: Want to inspire your friends and family to get involved in social justice? Mountains Beyond Mountains is the perfect introduction to PIH’s work. If you’re looking for something new, here’s a list of some of our favorite inspirational books.

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Tue, 08 Jan 2019 12:33:22 -0500 https://www.pih.org//article/make-social-justice-your-new-years-resolution
Most-Read Stories of 2018 https://www.pih.org//article/most-read-stories-2018 Partners In Health is proud of what our friends and colleagues accomplish every day, in every community where we work. Each year is filled with new challenges and innovative solutions that help us deliver high-quality care in some of the poorest, most remote regions of the world.

We often share these stories of struggle and success on our website and social media. In case you missed them the first time around, we've compiled our top 10 stories from 2018. These are the people, places, and programs that caught your eye, from Lesotho, Sierra Leone, and Malawi to Haiti and the Navajo Nation.

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Kamohelo Phoofolo and her daughter

10. Safe Deliveries, Big Smiles at Lesotho Health Center

Kamohelo Phoofolo, 8 months old, was born safely at a facility revitalized by Lesotho's national health care reform, one of nearly 4,000 more safe childbirths in 2017 than in years prior. Read more.

Gladys, a Sierra Leonean midwife

9. Gladys: Trailblazer, Midwife, Feminist in Sierra Leone

Boyama "Gladys" Katingor, the head midwife at Wellbody Clinic in Kono, Sierra Leone, ensures every expectant mother receives the best possible care and advocates for her patients' both in and outside the clinic. Read more.

Malaria cases rise in Malawi

8. Malaria Cases Rising in Malawi as Peak Season Nears 

Flora Tigone worried when her infant son, Chisomo, suddenly became lethargic and feverish. A month ago, an older child had battled malaria. Fearing that was the case with Chisomo, Flora knew she had to act quickly. Read more.

First graduates of Nightingale Fellowship

7. Graduates "Paving the Way for Global Nursing Leadership"

The PIH Nightingale Fellowship was designed to provide support and training for nurses in senior or executive leadership positions, and ultimately to improve patient care. The first four fellows graduated from their yearlong program in June. Read more.

Dr. Marta Lado discusses her book on Ebola

6. Dr. Marta Lado on Ebola, and its Aftermath, in Sierra Leone

Dr. Marta Lado, chief medical officer for Partners In Health in Sierra Leone, talks about the lessons she learned while treating patients for Ebola, and why she stayed to help rebuild the public health system. Read more.

Teen HIV Club gathers in Malawi

5. Teens with HIV Find Support, Friendship at Malawi Club

On Saturdays in Neno District, Malawi, teens living with HIV can find friendship, games, snacks, HIV education and, most importantly, support. Read more.

Breast cancer survivors share stories in Haiti

4. Breast Cancer Survivors in Haiti Share Their Stories

In 2018 alone, PIH clinicians and staff in Haiti have been caring for 450 women diagnosed with breast cancer. Five survivors shared their stories in honor of Breast Cancer Awareness Month in October. Read more.

Single mother cares for kids, handles HIV

3. Single Mother in Malawi Caring for Kids, Handling HIV

Agnes Paulo's expression was somber as she held her infant son, Ulemu, in her lap. Paulo, 35, is a single mother and living with HIV. Her four older children are HIV-negative, but Ulemu had not yet been tested. Read more.

Mental health work expands across PIH

2. Mental Health Team Expanding Innovative, Pioneering Care

Dr. Giuseppe “Bepi” Raviola, PIH’s director of mental health, oversees a growing program that is caring for thousands of people in Haiti and Rwanda; developing safe houses for women with chronic mental illness in Peru; working to treat common mental disorders in communities across eight countries; and much more. We caught up with him for an eye-opening chat. Read more.

Eating well in the Navajo Nation

1. Eating Well: Grocery Program Takes Off in the Navajo Nation

Doctors give patients, usually mothers, “prescriptions,” or vouchers, for a month’s worth of free fruits and vegetables for their families. The mothers spend the vouchers at their local store. And PIH reimburses the stores for the cost of the produce as part of the Fruits and Vegetables Prescription Program, or FVRx. Read more.

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Fri, 21 Dec 2018 18:01:32 -0500 https://www.pih.org//article/most-read-stories-2018
PIH Staff Pick Inspiring Reads for 2019 https://www.pih.org//article/pih-staff-pick-inspiring-reads-2019 Many people discovered Partners In Health after reading "Mountains Beyond Mountains," Tracy Kidder's 2003 book that followed the trajectory of PIH's early days and chronicled the lives of the nonprofit's co-founders, Dr. Paul Farmer, Ophelia Dahl, and Dr. Jim Kim.

With inspiring reads in mind, we asked a selection of staff if they could recommend other social justice-minded books, either fact-based or fiction. Here's a short list of what they had to say:

“Nickel and Dimed: On (Not) Getting By in America”

Barbara Ehrenreich

I read this book when I was just out of college. The author effectively goes “undercover” in various jobs in America—as a Merry Maid cleaner, Walmart employee, etc.—disrobing herself of any social capital or safety nets that she had come to take for granted. 

She applied and survived without academic credentials, insurance, a savings account of any amount, or even a car. As a product of a white, scrappy middle-class family who ensured education for my siblings and myself, I had been raised thinking people who worked hard would excel, and those who didn’t lacked personal character. This book shattered that perspective, and informed how I would pursue my career. 

Professionally, I worked to ensure context-sensitive admissions to universities and thoughtful financial aid packages before turning to my current work at PIH. For both, I attempted to understand how institutionalized barriers prevented hard work alone from equating to similar outcomes for all—a strand that runs throughout Ehrenreich’s book. The book lingers with me still, 15 years later, as I explain to my young children that, for example, some people with multiple houses did not work hard for them, while other people who work incredibly hard—much harder than some wealthy people would ever need to—can barely make rent.  

—    Katie D. McDonnell, senior director of development


“No Ordinary Time: Franklin and Eleanor Roosevelt—The Home Front in World War II”

Doris Kearns Goodwin  

It’s a phenomenal book, looking at the years leading up to WWII, through the lens of Franklin and Eleanor’s relationship. Of note for global health enthusiasts, there are some great behind-the-scenes details around the founding of the United Nations. It’s a dense read, but endlessly fascinating and enlightening. 

—    Joan VanWassenhove-Paetzold, senior program development officer


“White Fragility: Why It’s So Hard for White People to Talk About Racism”

Robin DiAngelo

This book provides white folks with the skills to better accompany people of color in the fight for social justice, truly reflecting PIH’s fundamental value of accompaniment. 

The timing of this book could not be more important for white people in the U.S. As white Americans continue to struggle with how to engage one another and folks of color in difficult discussions about race, racism, and systematic oppression, DiAngelo provides a framework for white people to begin these conversations from an honest, open, and empathetic place. 

The author delivers a thought-provoking history about the construction of race in America and how that system functions to provide power and privilege for those born with white skin. Moving past the narrative of racism being confined to individual acts of hate and discrimination, DiAngelo allows the reader to understand how whiteness affords white people with untold and unseen benefits in American society. DiAngelo challenges fellow white folks to engage in the difficult work of dialogue, action, and accountability to deconstruct whiteness in America. She identifies the barriers that she and other white people use to shut down conversations about race, racism, and unearned privilege, while providing tools for creating authentic dialogue about these critical issues.

—    Jarrod Chin, director of diversity and inclusion


“Last Night I Dreamed Of Peace”

Dang Thùy Tram

“Last Night I Dreamed of Peace” is the wartime journal of a young Vietnamese doctor named Dang Thùy Tram. Her journal and life were taken by an American, but after decades, her writing returned to her family, and was recently made available for translation. 

Barely out of medical school, Dr. Thùy volunteered to set up a semi-mobile field hospital for National Liberation Front guerillas in the middle of the most intense fighting of the American war. Facing impossibility, this young doctor wrote of resilient hope. Her words are raw and clear as she describes saving some lives, failing to save others, and her intense battles with the love and hatred in her own soul. Dr. Dang Thùy Tram’s sentences astonish and inspire me every time I read them. 

—    Reilly Hay, donor support coordinator


"Cutting for Stone"

Abraham Verghese 
 
As a writer, I find “Cutting for Stone” inspiring because of the seamless way the author weaves together the story of identical twin brothers—born, interestingly, to an Indian nun and a British surgeon—with the weighty topics of civil war, racism, and inequity in health care. 
 
The story is largely told through the eyes of Marion, who grows up with his identical twin, Shiva, on the campus of Missing Hospital in Addis Ababa, Ethiopia. The boys, who are raised by adoptive doctors, wish to become physicians themselves, but their paths diverge sharply in adolescence. The rift is spurred by a single rash act that has lifelong repercussions for both twins, and brings to mind that old adage of how a butterfly flapping its wings in China causes ripples of changes on the other side of the world. 
 
A physician and writer himself, Verghese masterfully unravels his story, which at the core is about family, love, and the pain and joy wrapped into a single act of sacrifice. I would recommend this book to anyone looking for a good read, but especially to those social justice warriors frustrated by the way the world’s resources—food, housing, security, health care—are unfairly split between the haves and have-nots. 
 
Early on in the book, I came across the following passage and wondered if, secretly, Verghese was a Partners In Health supporter. Or at the very least, I thought, he must have drunk the PIH punch before penning this novel. It’s something Matron, the nun who runs Missing Hospital, says to Mr. Harris, whom she hopes will provide a significant donation to support her ailing facility:
 
“We aren’t even fighting disease. It’s poverty. Money for food, medicines…that helps. When we cannot cure or save a life, our patients can at least feel cared for. It should be a basic human right.”

—    Leslie Friday, interim direct of content

 

"Homegoing"

Yaa Gyasi

If you haven’t read Yaa Gyasi’s 2016 novel, "Homegoing," do yourself a favor and request a copy from your local library or bookstore immediately. While tragic, the novel unravels the tales of two sisters and weaves together the stories of each generation of their separated families, all tracing back to their ancestor, an Asante woman.

Starting in Ghana during the slave trade, the complex story features richly developed characters who span 250 years of history, and examines the implications of colonization and slavery. Each chapter acquaints the reader with a different descendant. Gyasi's tale is at once devastating and beautiful, and explores the ripple effects of violence and trauma, as well as family and love. It’s impossible to put down and will have you thinking about it for months.

- Elise Mann, Global Health Corps fellow, Malawi

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Thu, 20 Dec 2018 16:59:00 -0500 https://www.pih.org//article/pih-staff-pick-inspiring-reads-2019
How an HIV Diagnosis Inspired Friendship in Sierra Leone https://www.pih.org//article/how-hiv-diagnosis-inspired-friendship-sierra-leone Upon learning she was pregnant in early 2017, Aminata Kebbie couldn’t stop smiling as she walked around her village in rural Kono District, Sierra Leone. Her joy turned to concern just a few months later when the 28-year-old felt something was off. Although it was her first pregnancy, Kebbie knew the way she felt wasn’t usual. She would awake in the night freezing cold, covered in sweat, and gasping for air.

“I was panting all the time,” she recalls. “The tiredness made my whole body feel heavy, like a stone.”

With each day that passed, Kebbie lost weight and her lethargy increased until even getting out of bed or leaving the house became a mountainous task. She had no money to see a doctor and, an orphan since she was a teenager, had no one she could turn to for financial support.

Ultimately, Aminata would get better and deliver a healthy baby girl, thanks to two things she couldn’t have imagined back then. First, free high-quality health care. And second, a network of neighbors and strangers who are part of the well-oiled machine that is PIH’s maternal and community-based care in Kono District.

The tiniest glimmer of hope first appeared in Kebbie’s fifth month of pregnancy. Kumba Soyama, a PIH community health worker, noticed that her neighbor had been staying in her house more than usual. When Soyama visited, she saw that Kebbie was clearly sick, and told her to get a checkup at the PIH-supported Koidu Government Hospital.

“She insisted everything was free for pregnant women,” says Kebbie. “I couldn’t believe it.”

SierraLeone_1017_KGHdrone_JLascher_04.JPG
Koidu Government Hospital, one of several facilities PIH supports in Sierra Leone. (Photo by Jon Lascher / Partners In Health)

Soyama accompanied Kebbie to the Hospital, offered moral support during the consultation, and encouraged her to agree to further medical tests after the nurse shared tough news. The new mother had HIV.

Kebbie felt devastated. After discussing it with doctors, she understood that her HIV could be suppressed through antiretroviral therapy, but she worried that friends and neighbors would treat her badly if they found out, and that her baby might not be strong.

Here again, her neighbor played a pivotal role. “Kumba told me something: She was also HIV positive. I was so shocked,” says Kebbie.

According to UNAIDS, there were 67,000 Sierra Leoneans living with HIV in 2016, 26 percent of whom had access to ART. And among pregnant women living with HIV, 87 percent were on treatment to prevent transmission of the virus to their children.

As in other countries where PIH works, clinicians in Sierra Leone incorporate HIV testing into the normal flow of outpatient care. By the end of 2018, staff will have conducted 17,800 HIV tests across PIH-supported clinics and hospitals. As a result, there are now 1,630 HIV patients enrolled in HIV care.

Among them are Kebbie and Soyama. Knowing their common bond, the two women became close friends, supporting one another wherever possible. Kebbie felt inspired by Soyama to do everything she could to stay strong and healthy. “Kumba visited me almost every day,” she says.

In her seventh month of pregnancy, Kebbie’s biggest challenge was adhering to her medication. Though PIH made sure she had enough, and for free, she had a difficult time swallowing them. HIV medications are notoriously harsh on the stomach in the early stages of treatment, and especially difficult to tolerate when hungry—as Kebbie often was.  

Unknown to Kebbie, Soyama had reached out to a colleague for help, namely Mohammed Bundu, a member of PIH’s Acute Needs Program team, which provides qualifying patients with financial support for food, housing, and transportation. Half of HIV/TB patients in Sierra Leone receive financial assistance through the program. After familiarizing himself with her case, Bundu followed up with Kebbie to see how PIH could ensure her recovery.

Kebbie remembers their first meeting. “I was sitting on my veranda, as I always did in the afternoon. My baby had grown quite large in my belly by that point, and the midday sun made me very hot,” she says. “Mohammed parked his bike near my house and came over to sit next to me. He asked me a series of questions, which I answered happily.”

A few days later, Bundu returned with 200,000 leones, around $25, so that she could buy groceries, prepare meals, and have a full stomach with which to take her pills.

“I couldn’t believe my eyes,” remembers Kebbie. “It was then that I knew everything was going to be OK.”

And it was. Kebbie’s health continually improved, and her baby daughter, Susan, was delivered at Koidu Government Hospital safely last June. Further still, initial tests reveal that Susan does not have HIV. Mother and daughter now have a small, but thriving, business selling cakes and breads around town.

All that’s left, in Kebbie’s mind, is to pay the kindness she received forward. She’d like to help others the way Soyama and Bundu helped her.

“Without their help, I’m not sure I would have regained my strength,” she says. “No one should suffer at home until they can’t stand up anymore. Everyone deserves to be healthy.”

 

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Thu, 20 Dec 2018 08:09:55 -0500 https://www.pih.org//article/how-hiv-diagnosis-inspired-friendship-sierra-leone
Dr. Joia Mukherjee writes about Universal Health Coverage in Devex https://www.pih.org//article/dr-joia-mukherjee-writes-about-universal-health-coverage-devex We know what universal health coverage looks like. We know how to get there. And we know the cost of inaction.

So argues PIH Chief Medical Officer Dr. Joia Mukherjee, in a recent op-ed for online development journal Devex. In the piece, she personalizes the fight for universal health coverage through the tale of a Liberian taxi driver, who broke his leg and suffered greatly due to the absence of a functioning health system in the post-Ebola, war-torn West African country. The young man’s story would have ended quite differently, she says, had he arrived at a hospital equipped with the right supplies, staff, space, and systems.

Achieving universal health coverage is not an impossible goal, Mukherjee says. It requires global health experts to define local burdens of disease and then to seek funding for proper treatment. This sounds straightforward enough, except that many schemes for arriving at equitable health coverage now work in reverse by nailing down funding and then seeking patients.

If we want to achieve universal health coverage, she says, we need to financially support local governments. Vast sums of money can’t be routed around ministries of health, but must be injected directly into the public health system.

On these and other points, Mukherjee’s recommendations may sound commonsensical, but true to PIH form, they often cut against the grain of the global health establishment.

Read the full piece here.

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Wed, 12 Dec 2018 15:51:24 -0500 https://www.pih.org//article/dr-joia-mukherjee-writes-about-universal-health-coverage-devex
Q&A: Dr. Abera Leta on the March to Universal Health Coverage https://www.pih.org//article/qa-dr-abera-leta-march-universal-health-coverage Dr. Abera Leta is executive director for Partners In Health in Lesotho, where a national health care reform is revamping how care is delivered and making incredible progress toward universal health coverage. The mountainous, landlocked country is surrounded by South Africa and has the world’s second-highest rates of HIV and TB, some of the world’s highest rates of maternal and infant mortality, and significant barriers to delivering health care in rugged, remote settings with limited resources.

The reform began in 2014 and is meeting those challenges head-on in four of Lesotho’s 10 districts. Broad upgrades to 72 health facilities; improved district management; and a strengthened network of 4,000 village health workers, who provide health screenings and resources door-to-door in their home communities, are just some of the strategies that are yielding stunning results. 

PIH, known locally as Bo-mphato Litsebeletsong Tsa Bophelo, is supporting the reform as the primary technical advisor to Lesotho’s Ministry of Health. A comprehensive evaluation of the reform’s first four years was released in October and showed impressive impacts. For example, 1,300 more women completed at least four prenatal care visits in 2017, compared to before the reform; health center staff transferred 1,100 more women to hospitals during complicated childbirths; 1,700 more children were fully immunized; thousands more people per month were tested for HIV; health center staffing, supplies and structure were dramatically improved; and much more. 

The reform’s successes are gaining international attention and positioning Lesotho as a global model for achieving universal health coverage in poor countries. Ahead of World UHC Day on Dec. 12, we caught up with Leta to talk about the reform’s progress, providing care in remote communities, and future goals as PIH prepares to help the government scale nationally, to all of Lesotho’s 10 districts. 

How did the reform come to be? Can you give a quick overview of what led the government to take on such sweeping changes?

Partners In Health has operated in Lesotho since 2006. We began with the Rural Health Initiative, which supported HIV care in seven clinics in some of the country’s most isolated, mountainous areas. Before we arrived in those areas, care was provided through an outreach program with doctors who would visit sites by small plane or helicopter. 

When we arrived, we began establishing programs that could provide comprehensive primary health care—including maternal and child health, TB screening, and more, in addition to HIV treatment—by engaging communities through the village health worker program. 

We also worked to improve the availability of all the required supplies for primary health care, including essential drugs and human resources. We also expanded facility infrastructure, to make sure that we had enough space to provide care that met the burden of disease in our catchment areas.

MASERU, LESOTHO - FEBRUARY 15, 2018: Sebolelo Makhoathi, 28, has been an MDR-TB patient for about 11 months. She is also on first-line ART for HIV. Her treatment supporter is Mapontso Mapheelle (right), who lives about a 30-min walk down the hill from Makhoathi's house. She comes to SeboleloÕs home every morning at 6 a.m., then returns every afternoon.
Sebolelo Makhoathi, 28, has been an MDR-TB patient for nearly two years. She also is on first-line antiretroviral therapy for HIV. Her treatment supporter is Mapontso Mapheelle (center), who lives about a 30-minute walk down the hill from Makhoathi's house. Mapheelle visits her friend twice every day, in the morning and afternoon. (Photo by Cecille Joan Avila / Partners In Health)

We gradually were able to demonstrate good coverage in hard-to-reach areas, through the mountain clinics, where we are still operating. 

When one of those clinics, Bobete, was visited by Lesotho’s prime minister, he was surprised and impressed by the scope and quality of services, and asked PIH to support the government by expanding our approach into other districts. That was how we began our involvement with the national health care reform. 
 
Tell us about the scope of the reform now, and what strategies have created the success we’re seeing. 

We’ve been supporting the reform over the last four years. It now encompasses 72 health facilities across four districts and reaches about 40 percent of Lesotho’s population, of about 2.2 million. 

In each reform district, we created a model where we can link communities to health centers, and health centers to district hospitals. We also boosted the local capacity of each district management team so they can improve their governance and leadership, properly plan their needs for service delivery, supervise the quality of services, and train their staff. 

Nurse Mahali Lethetsa uses an i-STAT machine.
Nurse Mahali Lethetsa checks an i-STAT machine, used for bedside blood tests and other analysis, at Botsabelo Hospital in Maseru, Lesotho. (Photo by Cecille Joan Avila / Partners In Health)

At the community level, we recruited more than 4,000 village health workers, trained them, and paid them. We created a program whereby they will be supervised and coordinated, while also developing monitoring tools to track their work. We also expanded the capacities of health center staff by increasing training and supervision. 

We ensured that health centers have enough supplies, in terms of essential drugs, and we established maternal waiting homes, where mothers can stay before delivery to avoid traveling during labor. 

Women nearing childbirth stay at the waiting homes, and we provide their food. We recruited a PIH-funded cook for each waiting home. In addition, in health centers that have occasional power outages, we supplied disposable, sterilized delivery packs, so they can provide safe deliveries regardless of the power supply. 

The other thing we created was a good referral system, contracting with local drivers to bring women to hospitals for complicated deliveries, because ambulances are not available everywhere. That gives health facilities confidence to admit mothers into maternal waiting homes. In case of complications, it is easy for them to refer women to the district hospital. 

All of this has created big, remarkable improvements in capacities at the district level, and in clinical outcomes. 

What have those improvements meant for patients and the use of health facilities?

More people are coming to outpatient departments for care. There is a huge improvement in women completing prenatal care, for example. There also is widespread availability of services that previously were not available. For example, only 2 percent of the 72 health centers could accommodate deliveries before the reform. Now, almost 100 percent of them are providing deliveries.  

This has increased facility-based deliveries by 30 percent. Facility-based deliveries are much safer than giving birth at home. And much of that increase comes from new users, who didn't have access to a health facility before. 

Ntlele
Malieketso Ntlele holds her 7-month-old son Tlala Ntlele at Pontmain Health Center in Leribe District, Lesotho. Maternal and child health are key focuses of the national health care reform, which has significantly increased prenatal visits and facility-based deliveries. (Photo by Cecille Joan Avila / Partners In Health)

At the national level, Lesotho’s Ministry of Health has recognized this huge improvement, and the effective approach to implementing comprehensive primary health care to achieve universal health coverage. The ministry now is planning to expand the reform. They already have expanded some components, like the village health worker program, into the country’s remaining six districts, where resources allow.  

But they need more resources to really scale up the whole package to the remaining districts. 

You’ve spent much of the past year traveling to forums, events, and conferences to talk about the reform and raise interest. As you've made this international tour, what do you hear from people when you tell them about the transformation in Lesotho?

We’ve done a lot of presentations at local and international levels, especially since we’ve had data from the evaluation. In Lesotho, we presented to national stakeholders and government officials. They’ve been amazed with the results. And there is a huge commitment from the government to support the health reform, and also to join PIH to mobilize resources for scaling up the health reform nationally. 

Internationally, PIH and the government jointly planned and gave a presentation in Astana, Kazakhstan, in October, at the WHO’s Global Conference on Primary Health Care. The event commemorated the 40th anniversary of the Declaration of Alma-Ata. 

People were really excited to see this remarkable change through our approach and model of care. 

We also presented in Washington, D.C., to our donors and several agencies. Everyone was very appreciative of what PIH is achieving in hard-to-reach, difficult areas, by creating a delivery strategy to achieve universal health coverage. 

You mentioned hard-to-reach areas. For people who aren't familiar with Lesotho, what do you mean by that?

In Lesotho, the majority of people live in rural areas. But the rural areas are very difficult to access, because of the rugged terrain and mountains. People are very scattered and they live in the mountains. To reach facilities, there is no road access, so they have to walk for hours or ride horses. 

home visit
Daniel Masupha (center), village health worker coordinator for Mapheleng Health Center, and Makena Ratsiu, primary health care coordinator, walk toward a patient's house in Berea District, Lesotho. (Photo by Cecille Joan Avila / Partners In Health)

That makes it really, really difficult. So we need to have a delivery strategy by which we can make lives easier in those areas. For example, the maternal waiting homes that enable pregnant women to come to health facilities earlier, like a week or days before their expected delivery, and stay in the maternal waiting home instead of having to travel while in labor or deliver at home, which is risky.

The reform is based on health system strategies that PIH has successfully employed in Haiti, Rwanda, and around the world. Why has it also been successful in Lesotho?

We have been doing direct service delivery in hard-to-reach areas, and providing quality services to people in the catchment areas of health facilities that we are supporting. But we also have developed strategies, such as providing technical assistance and logistic support, that enable the government to do the same things that PIH is doing. Through this approach, with a modest amount of funding, we are able to reach large numbers of people and many health facilities. 

Where do you see the reform in five years? 

I hope we will have the health reform scaled up across the country in all remaining districts, and that the results from these districts will be similar to the results we've already seen. 
 

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Fri, 07 Dec 2018 15:34:31 -0500 https://www.pih.org//article/qa-dr-abera-leta-march-universal-health-coverage
Gladys: Trailblazer, Midwife, and Feminist in Sierra Leone https://www.pih.org//article/gladys-trailblazer-midwife-and-feminist-sierra-leone Walking around her clinic in the muggy heat, Gladys, 52, attracts a lot of attention. During the morning’s whirlwind of activity, people rush up to her from every direction: uniformed midwives, women with newborn babies strapped to their backs, heavily pregnant women. She speaks to everyone in a gentle, encouraging tone and goes out of her way to offer advice wherever possible. This is how Gladys starts most of her days as head midwife at Wellbody Clinic in Kono, Sierra Leone.

“I’m always on my feet, educating my staff, and saying, ‘Let’s not let any danger occur to our patients,’” says Gladys.

Known as Gladys to friends and colleagues, Boyama Gladys Katingor joined Wellbody, a Partners In Health-supported clinic, in 2014, and has since been trail-blazing female empowerment. At the clinic, Gladys strives to standardize a modern approach to women’s health care. And in doing so, she tackles a number of universally debated and politically charged issues—including teenage pregnancy, abortion, and female genital mutilation—by listening, loving, and, when necessary, lecturing.

Regina Korgbendeh, a traditional birth attendant at Wellbody, reflects fondly on Gladys’s approach to leadership. “There are often many people present during a woman’s delivery—from midwives to traditional birth attendants to family members,” she says. “Gladys will say firmly to the room, ‘Let us all work in harmony to keep this woman safe.’ She’s always calm, supportive, and strong.”

Gladys grew up in Longie village, roughly 30 miles from Koidu, Kono District’s capital. She is one of the few girls from her village cohort to complete her education. Following high school, Gladys trained as a community nurse for the nonprofit organization, International Rescue Committee. Her role with IRC involved coaching new mothers on how to administer basic medicines, such as anti-malarials and tuberculosis medication, to their families. After gaining significant experience there, Gladys made the decision to resume her studies and train as a midwife, leading to her current role with PIH.

Sierra Leone had the seventh highest rate of teenage pregnancy in the world, with 38 percent of women delivering their first baby before the age of 18. At Wellbody, expectant mothers under the age of 18 are invited to stay at a birth waiting home for the month preceding their labor. Here, they receive free prenatal care and meals, and enjoy a supportive environment.

Women waiting
Pregnant women relax outside the antenatal care center at Wellbody Clinic.  (Photo by Emma Minor / Partners In Health)

“Most of these are school-going children. The girls are very shy when they arrive and feel like they’ve committed a crime,” says Gladys. “I bring them closer to me, like a mother, and ask them how they are feeling.”

Postnatal classes are also available at Wellbody following a birth, and Gladys makes sure new mothers are supported in a number of ways, including through family planning services.

“We offer approved contraceptive methods, but many women are discouraged from using them by their families,” Gladys says. “Everyone is happy to listen though, especially the young girls, and we’re now seeing an uptake.”

Abortion is another tough reality Gladys confronts. They are illegal, but not uncommon, in Sierra Leone. “They’re performed on girls in villages who come to Wellbody Clinic afterwards in very bad health,” she says. Many even face death. One-fifth of global maternal deaths result from unsafe abortions, and Sierra Leone is no exception. Gladys quickly refers them to the local hospital. 

Perhaps the most challenging, and familiar, situation Gladys deals with is female genital mutilation, or FGM, a procedure commonly carried-out on adolescents. In Africa, around 3 million girls undergo FGM each year; Sierra Leone is one of the only countries where the rate is over 90 percent. 

Staff
LEFT: Sister Boyama Gladys Katingor (far right) invests time training her midwifery team at Wellbody Clinic. RIGHT: 
Sister Jenneh Dakowah (center), who has worked as a midwife at Wellbody Clinic for more than three years, outside the maternal ward. (Photos by Emma Minor / Partners In Health) 

FGM often takes place in a small hut, in an area known as “the bush,” on the outskirts of a village. Multiple girls will stay in the hut at any one time, while the procedure is performed on each of them.

“When I was a child, I became part of this. It was not my choice, but something my parents wanted. It was an excruciating procedure,” Gladys recalls. “When the cut is done, veins are tampered with, and you can sometimes bleed a lot. If you bleed like this, which I did, the whole village will call you a witch. It feels horrible to be called that.”

What should a girl do if she’s encouraged to go through FGM? “If a girl confides in me at Wellbody, I will tell her of the hazards and advise her against having it done,” Gladys says.

Her advice can’t always be heeded, but her overall message to female patients and staff is hard to ignore. “I tell them, whatever happens you must reach some heights. Whatever your family says, keep going. I say don’t lie down, wakeup and keep moving. You are not just here to give birth; you are our leaders of tomorrow.”

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Tue, 04 Dec 2018 11:21:34 -0500 https://www.pih.org//article/gladys-trailblazer-midwife-and-feminist-sierra-leone
Teens with HIV Find Support, Friendship at Malawi Club https://www.pih.org//article/teens-hiv-find-support-friendship-malawi-club At school, Promise says, none of her friends know about her HIV status.

“No one talks about it,” she adds, shrugging her shoulders while sitting on the edge of a stage in a large community hall in Neno District, Malawi.  

Promise’s somber expression implies that talking about HIV is just not done at her school. That kind of silence can be found across the East African nation, where nearly 10 percent of adults are living with HIV and social stigmas run deep. 

Silence likely doesn’t come easily for Promise, who laughs and interacts enthusiastically with other teens running around the hall. The friendly, outgoing 17-year-old lives with her grandmother in a nearby village, lists math and English as her favorite subjects and hopes to work in a bank one day. Moving her hands like she’s riffling through a stack of bills, she jokes that she gets inspired when she sees tellers counting money.

She was diagnosed with HIV at age 7 and has been dedicated to antiretroviral therapy, or ART, for several years. She gives Promise as a pseudonym, in a region where discrimination is common. 

But on this Saturday afternoon, at a Teen HIV Club event near the Partners In Health-supported Ligowe Health Center, she was more than able to talk freely with peers about her condition, her treatment, her community involvement, and more.  

Because at Teen HIV Club, everyone talks about it—that’s the point. 

“As manager of the program, your health is my responsibility,” Dr. Dimitri Suffrin, HIV and TB program manager for PIH in Malawi, tells the 48 teens attending today’s event. “Any problem that you have, I am here to listen and find a way to help you.”

The teens stand in a circle as Suffrin speaks, part of introductions and songs before activities begin. Chisomo Kanyenda, an HIV program officer for PIH, translates Suffrin’s remarks into local Chichewa. PIH is known in Malawi by a Chichewa name, Abwenzi Pa Za Umoyo.  

PIH, Malawi’s Ministry of Health, and like-minded groups such as the We Care Youth Organization—whose Peer Power project is working to raise HIV education and awareness in Malawi—organize the regular Saturday events for teens living with HIV. They offer Teen Club in five locations across Neno and work with more than 200 children and young adults, most of them 10 to 19 years old. 

The program is part of a growing HIV program that is turning the tide in Neno District. PIH has nearly 8,000 people enrolled in HIV treatment in Neno. That number equates to 90 percent of all adults living with HIV in the district—a benchmark goal set by the World Health Organization. Moreover, about 86 percent of people in the HIV program have suppressed viral loads, meaning treatment is working and impacts of the virus are greatly reduced. 

But only about 50 percent of Neno teens have suppressed viral loads, creating a need for more education about the importance of adhering to treatment.  

Reaching youth through Teen Club is intended to meet that need and bring effective treatment much closer to 100 percent for youth—even in the most remote areas of Neno, where dirt roads wind over boulders and up steep mountain slopes, where electricity and water supplies can be unreliable, and where food scarcity is an epidemic in hot summer months, if not year-round. 

Teen Club also can be a respite from those challenges, and a place where kids can just be kids.

"I strongly believe that being a teenager is difficult," Suffrin noted. "With HIV, it's even worse."    

Participants find friendship, games, snacks, HIV education and, most importantly, support—from their peers and from adult mentors, clinicians and educators, some of whom are living with HIV themselves. 

Staff at Teen HIV Club
Left to right, PIH teen coordinator Wedson Khoviwa and PIH clerk Mphatso Chammudzi stand with peer educator Mphatso Chimangeni of the We Care Youth Organization and Ministry of Health teen coordinator Gertrude Daluni. The four regularly lead Teen HIV Club events in Neno District, Malawi, to provide education and support for youth living with the virus.  

One of those mentors is Ministry of Health teen coordinator Gertrude Daluni, who has been HIV-positive since 2002 and on antiretroviral therapy, or ART, since 2004. 

Daluni greets nearly every teen who walks in the door. Her booming voice, friendly laughter and boisterous demeanor would be instantly recognizable to anyone who has attended a summer camp—her smiling presence fills the spacious community hall. Kids run up to Daluni for hugs, while sunlight streams in large windows and other kids jump rope or play keep-away with a basketball, running and sliding on the cement floor before the programming starts. 

Later in the afternoon, Daluni bounced that basketball loudly while standing in the middle of the teens, again gathered in a circle. She asked questions about ART, viral loads, nutrition and more—punctuating each question with the “BAM” of a dribble—and tossed the ball to teens whom she wanted to give answers. 

Teen educator Kenneth Mangani also led the group in several games, including a call-and-response activity similar to “Simon Says.” If teens misheard quickly changing instructions and moved the wrong way, they were out, eliciting rowdy yells every time. 

Lessons are interlaced with the laughter. Mphatso Chimangeni, a teen educator with the Peer Power project, organized a short skit in which she and some of the older teens played roles to show how different treatment levels affected viral loads. Even that activity took on a light-hearted note, as Chimangeni, playing HIV, theatrically tumbled to the ground in defeat. 

“We play a lot of games and things like that, so the knowledge is instilled,” PIH teen coordinator Wedson Khoviwa said. 

One of the best ways to retain knowledge is to hear it from peers. And at today’s Teen Club, the most senior peer is 23-year-old Caroline Kapalamura. She’s been coming to the events for about five years, after an HIV-positive diagnosis at age 13. While nearly every youth at Teen Club—including Promise—contracted HIV from their parents, Caroline is an exception. She got the virus from a boyfriend who didn’t tell her about his HIV status.

Caroline
Caroline Kapalamura, 23, has been coming to Teen HIV Club events for five years, after an HIV-positive diagnosis when she was 13. She said her favorite part about the events now is working with younger people, and doing outreach to find new members who could benefit from the club's invaluable peer support and education. 

Kapalamura said she struggled with weakness and fatigue for a long time, without understanding what was wrong. She thought that maybe she had malaria. She eventually visited PIH-supported Neno District Hospital, explained her symptoms and got tested. She began ART in 2015. Grace Nyambi, a senior clerk at the hospital’s integrated chronic care clinic, told her about Teen Club. 

“My health has been much better since I have been on treatment. I feel very strong,” said Kapalamura, who is studying to become a nurse. “My favorite part of Teen Club is teaching, and doing outreach.”

Outreach to find new members is one of the most invaluable aspects of the program. Nyambi, the hospital clerk, introduced Promise to Teen Club, too, in 2012. Promise has been attending events regularly since then.  

“She is very active,” Khoviwa said. “Ever since she joined Teen Club, she has been here every time.”

Promise now joins Khoviwa on outreach visits, encouraging other teens to come to events. She also advocates within Teen Club for more funding, more resources and more connections with other clubs, in Neno District and throughout Malawi. 

Turns out, Promise has a knack for it—and is a strong, outspoken voice in efforts to decrease stigma and fully support her peers with HIV.  

“Five other teens have joined because of her,” Khoviwa said.
 

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Fri, 30 Nov 2018 14:17:42 -0500 https://www.pih.org//article/teens-hiv-find-support-friendship-malawi-club
November Conference Call with Dr. Paul Farmer https://www.pih.org//article/november-conference-call-dr-paul-farmer Listen now for the latest conversation with Dr. Paul Farmer, PIH co-founder and chief strategist, and Leslie Friday, interim director of content, as he looks ahead to 2019 and reflects on his most formative experiences in global health. Farmer discusses PIH’s struggle to combat Ebola and efforts to holistically strengthen health systems, the climate justice movement, and how certain patients have shaped his outlook on global health.

Download

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Wed, 28 Nov 2018 12:45:13 -0500 https://www.pih.org//article/november-conference-call-dr-paul-farmer
Safe Deliveries, Big Smiles at Lesotho Health Center https://www.pih.org//article/safe-deliveries-big-smiles-lesotho-health-center Kamohelo Phoofolo, 8 months old and bundled in a soft pink, hooded fleece, smiled happily as she sat on her mother’s lap at Mapheleng Health Center in Lesotho. 

Her mother, 27-year-old Marefiloe Phoofolo, matched her daughter not only in clothing color, but also in disposition. She was all smiles as she talked about the maternal health care she had received at the Partners In Health-supported Mapheleng facility.

Phoofolo lives in the village of Ha Matoeba, where homes dot hillsides surrounded by steep ridges. The terrain is so rough, and the region so remote, that doctors from Mapheleng ride horses to the most hard-to-reach communities. Phoofolo doesn’t live quite that far away—her village is within walking distance of the health center—but she stayed at Mapheleng’s maternal waiting home for five days before she gave birth to Kamohelo, to make sure she was close to care when labor began. 

While there, she received three meals a day, water for bathing and around-the-clock prenatal care. All of it was free.

Most importantly, Phoofolo had a safe, healthy childbirth at the health center, where she continues to have postnatal checkups and Kamohelo receives care as a toddler. Her birth was one of more than 30,000 facility-based deliveries—including 6,000 life-saving cesarean sections—provided at PIH-supported facilities around the world in 2017. Globally, PIH provides about two-thirds of its entire services to women and children, with the goal of reducing maternal deaths and ensuring healthy futures for the next generation. 

That effort is especially vital in Lesotho, a rural, mountainous country surrounded by South Africa. The remote location of many communities, rugged dirt roads and scarcity of resources create enormous health care challenges, including for expectant mothers. One in 61 women in Lesotho will die from pregnancy or childbirth. By comparison, women in Sierra Leone face a 1 in 17 lifetime risk of dying in pregnancy or childbirth—the worst rate in the world—while women in the U.S. face a risk of 1 in 3,800.

Lesotho’s ongoing national health reform is changing that dynamic, and has fueled transformative improvements in just four years. PIH, known locally as Bo-mphato Litsebeletsong Tsa Bophelo, is supporting the reform as the primary technical advisor to Lesotho’s Ministry of Health.  

photo
Mamakalo Mohatle, 42, a village health worker at Mapheleng Health Center in Berea District, Lesotho, leaves the health center with three mothers: Maitumeleng Semamo, with her son Mokete Semamo; Maitumeleng Mosele with her daughter Itumeleng Mosele; and Marefiloe Phoofolo with her daughter Kamohelo Phoofolo. (Photo by Cecille Joan Avila / Partners In Health)

Mapheleng is one of 72 health centers revitalized by the reform. Mapheleng serves about 6,200 people across 28 villages, and—with more nurses, maternal supplies and medicines—has provided facility-based deliveries for hundreds of women like Phoofolo.

Facility-based deliveries have increased by 30 percent since 2014 in the reform’s initial four districts. That equates to nearly 4,000 more safe deliveries in 2017 than before the reform.  

Kamohelo was one of them. On a sunny, clear February day, Phoofolo talked with two other new mothers in Mapheleng as she held her second child. All three of the women had been referred to Mapheleng by village health workers, who provide health resources and access to care in their communities. 

Phoofolo said she, too, would encourage pregnant women to use the health center for prenatal care and delivery—to help ensure more safe childbirths, and more newborn smiles, like her daughter’s. 

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Wed, 28 Nov 2018 12:14:17 -0500 https://www.pih.org//article/safe-deliveries-big-smiles-lesotho-health-center
PIH's Parvannah Lee Reflects on Food Access in the Navajo Nation for Teen Vogue https://www.pih.org//article/pihs-parvannah-lee-reflects-food-access-navajo-nation-teen-vogue Parvannah Lee has a clear picture in her mind of what hunger looks like. It's of her mother walking miles through a snowstorm to the nearest grocery store.

So begins Lee’s essay about families in the Navajo Nation struggling to eat well and stay healthy. Published in Teen Vogue on November 22, the piece shares a glimpse of what it was like to grow up on the reservation—a 27,000-square-mile area that straddles Arizona, Utah, and New Mexico. It touches on the shameful history of the United States government toward the Diné people, and the forces that created one of the largest food deserts in the United States. And it celebrates a grocery program, created by PIH sister organization COPE and for which Lee used to work, that is successfully improving health on the Navajo Nation, one family at a time.  

Lee is optimistic. Next month, she will start working for the Indian Health Service in South Dakota. She greatly admires her mother's dedication to keeping her family healthy and hopes that “some of my mother’s magic has rubbed off on me.” 

Read the full piece here: https://www.teenvogue.com/story/im-from-the-navajo-nation-and-i-want-to…

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Tue, 27 Nov 2018 13:52:13 -0500 https://www.pih.org//article/pihs-parvannah-lee-reflects-food-access-navajo-nation-teen-vogue
Toddlers Growing, Gaining with Help from Malawi Clinic https://www.pih.org//article/toddlers-growing-gaining-help-malawi-clinic Violet McDonald has an expressive, thoughtful face that belies her age of just one year.  

As several adults crowded around her in a small, noisy room at Matope Health Center in Neno District, Malawi, baby Violet sat on the floor in her onesie, quietly looked around and held a MUAC strip against her arm, as if she knew how to measure her own Mid-Upper Arm Circumference, a primary gauge of malnutrition in small children.

She actually might have. Lydia McDonald, 20, had been bringing her baby daughter to the Matope facility since late June, for regular checkups through the program known as CMAM, or Community Management of Acute Malnutrition. Violet’s weight had increased from 7 kilograms at her first visit to 7.9 kilograms at this visit, in early October. That equates to growing from about 15 pounds to 17.4 pounds.  

It was a significant gain, but there was plenty of room to grow. CMAM facilitator Jessie Chizumo carefully recorded Violet’s health information in large paper files, and checked her weight on a chart that showed a corresponding amount of RUTF—ready-to-use therapeutic food, or nutritional meal supplements known locally as chiponde—that Violet would need for the week ahead. 

For 2-year-old Stella Alfred, also in the CMAM clinic that morning, the number of needed meals was 23, or three-and-a-quarter RUTF packages per day. Chizumo explained the recommendation—one package in the morning, one for lunch, a snack, and one for dinner—to Stella’s mother, 27-year-old Jennifer Andrea. 

Photo
Jessie Chizumo records health information in the malnutrition clinic at PIH-supported Matope Health Center in Neno District, Malawi. Seated behind her is Jennifer Andrea, 27, holding her 2-year-old daughter, Stella Alfred, who was having a checkup that morning.  
Photo
Stella Alfred, 2, clings tightly to her mother, Jennifer Andrea, as Jessie Chizumo uses a paper strip to measure Stella's mid-upper-arm circumference, or MUAC, a primary gauge of malnutrition in small children.  

Stella’s weight—at a full year older than Violet—was just 8.4 kilograms, or about 18.5 pounds. She cried throughout her checkup, as Andrea rocked her gently. 

Violet and Stella are two of the 11 children enrolled in the CMAM clinic at Matope Health Center, which serves 11 nearby villages and is supported by Partners In Health. On this particular morning, an integrated chronic care clinic also was underway, with lines of people waiting for screenings, talking with staff or resting in the shade of a huge baobab tree. The malnutrition clinic was toward the rear of the health center, away from much of the bustle. 

Known in Malawi as Abwenzi Pa Za Umoyo, PIH supports malnutrition care for more than 2,400 children younger than 5, across Neno District. 

This was the hardest time of year for them and their families. 

September and October are Malawi’s hottest months, known colloquially as “hunger season.” Riverbeds are dry, fields are dustbowls, the harvest is weeks in the past and new rains have not yet arrived. Dry heat turns bent, picked-bare cornstalks into crinkly brown matchsticks. For Neno District’s population of about 170,000, it’s a time of food scarcity and corresponding high prices for corn and other staples—especially this year, when many people around Neno cited a weak harvest.

Robert Jackson, supervisor for Matope’s community health workers, said the 115 CHWs based at the health center do all they can to screen every child for malnutrition, and refer children and parents to the CMAM clinic. It’s a busy job. Just nearby Tchenga Village, where McDonald lives with Violet, has more than 600 households. 

But the need is vital.

“By screening all children at the household level through visits by community health workers, our goal is to catch malnutrition earlier and refer children quickly to treatment, to avoid hospitalization or significant illness,” said Emilia Connolly, chief medical officer for PIH in Malawi. “This will improve the health of children and families overall, thanks to the invaluable work by the community health workers—our foot soldiers.”

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Tue, 20 Nov 2018 10:56:49 -0500 https://www.pih.org//article/toddlers-growing-gaining-help-malawi-clinic
PIH's 2018 Annual Report https://www.pih.org//article/pihs-2018-annual-report Communities, clinics, hospitals, ministries of health, and global thought leadership. This year, PIH has had an impact in all of these spaces, from providing high-quality health care in impoverished communities, to pushing the world closer toward universal health coverage.

Our 2018 Annual Report serves as a record of these accomplishments—and as a thank you to all of our invaluable partners who make this lifesaving work possible.

Inside, you'll find details about where we work, a note from Chief Executive Officer Dr. Gary Gottlieb, patient and staff stories, and data showing last year's impact in cancer care, HIV treatment, maternal health, and more.

Read through the report here.

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Mon, 19 Nov 2018 16:13:09 -0500 https://www.pih.org//article/pihs-2018-annual-report
Support PIH with a Facebook Fundraiser https://www.pih.org//article/support-pih-facebook-fundraiser We know you’re with us in the fight to provide health care for all. This Giving Tuesday is your opportunity to make a lasting impact. We’re challenging our supporters to launch 50 Facebook Fundraisers between now and Giving Tuesday to encourage friends and family to join the cause. Help us spread the word and encourage others to join the fight to provide health care for all.

To make your contributions go even further, we’re pledging to match all donations that come in via Facebook Fundraisers on Giving Tuesday, November 27, up to a grand total of $5,000!

Together, we can provide more lifesaving health care to those in need. Will you join us?

Here’s how:

Start your fundraiser

  • Go to https://fb.com/fund/partnersinhealth/, where you will be prompted to start your fundraiser.

  • Name your fundraiser, set a goal, and choose an end date. Be sure to include "Giving Tuesday" in your fundraiser title, and make sure your fundraiser runs for at least one week. 

Customize your fundraiser

  • Choose a goal: Commit to raising $200 or more to support health care around the world. If you meet your goal, increase it!

  • Share your story: In the description of your fundraiser, tell your friends why you support Partners In Health.

  • Choose a cover photo: You'll be prompted to choose between several PIH photos by clicking the "Edit" button. Pick whichever you like!

Promote your fundraiser!

  • On the morning of Giving Tuesday, November 27, share your fundraiser link with your Facebook friends and ask them to give.

  • Facebook Fundraisers don’t have to be just on Facebook! Tweet a link to your fundraiser, call your mom, send an email letting your friends know you’re participating in this challenge, or share any other way you know how.

  • And remember, the fundraisers don’t stop when Giving Tuesday ends! Be sure to keep encouraging friends to donate until the fundraiser ends.

Feel free to direct message Partners In Health on Facebook with any questions. Thank you for thinking of us this giving season!

And don’t forget: Any gifts that are made to Partners In Health via Facebook Fundraisers on Giving Tuesday, November 27, will be matched, up to a total of $5,000!

 

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Mon, 19 Nov 2018 13:34:34 -0500 https://www.pih.org//article/support-pih-facebook-fundraiser
Director Honored for Years of Vital TB Work in Russia https://www.pih.org//article/director-honored-years-vital-tb-work-russia Oksana Ponomarenko, longtime country director for Partners In Health in Russia, was honored with a prestigious public health award during an international tuberculosis conference at The Hague in October. 

Ponomarenko received the Karel Styblo Public Health Prize from the International Union Against Tuberculosis and Lung Disease, a Paris-based scientific organization known as The Union. 

The award is named after Karel Styblo, a pioneering TB doctor,  and “acknowledges a health worker or a community organization for contributions to TB control over a period of 10 years or more,” according to The Union. 

The organization added that Ponomarenko was chosen this year, at the 49th World Union Conference, for her “outstanding contribution to TB control on a local, national and global level, with a focus on hard-to-treat, drug-resistant TB among vulnerable patients through her role” with PIH in Russia. 

Ponomarenko has been a TB researcher for decades and country director for PIH in Russia since 2001. She is the only person to have held that position, overseeing a staff of 17. 

Known locally as Партнеры во имя здоровья, PIH has worked closely with Russia’s Ministry of Health and the Division of Global Health Equity at Brigham and Women’s Hospital in Boston, to combat multidrug-resistant TB (MDR-TB) in Tomsk Oblast, a Siberian state about the size of Poland.

In 2006, under Ponomarenko’s leadership, PIH-Russia launched the Sputnik Initiative, a model of patient-centered accompaniment that focused on providing daily care for patients who were at risk of stopping treatment, which can happen for any number of reasons. The program’s treatment success rate for MDR-TB patients was greater than 70 percent, which PIH leaders called an “incredible achievement” in nominating Ponomarenko for the award.  

The Tomsk program overall, PIH added, “resulted in significant decline of TB incidence and mortality, punctuating Tomsk Oblast as a leader in TB control in Russia and neighboring countries, and prompting policy changes that increased access to care for the most vulnerable patients.” 

Tuberculosis rates in Tomsk declined from nearly 117 per 100,000 people in 2000 to less than 68 cases per 100,000 in 2013. Mortality among patients dropped from about 28 percent in 1999 to less than 6 percent in 2013, leading to changes in Russia’s national policies for drug-resistant TB management and care.

Ponomarenko said she was honored to receive the award, which “recognizes PIH-Russia’s contribution to TB control in Russia and on a global level." 

Above all, she added, the recognition means that programs delivered for the patients.

“This award is not only for me, but for all of us—the entire Partners In Health family,” Ponomarenko said. 

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Fri, 16 Nov 2018 11:03:03 -0500 https://www.pih.org//article/director-honored-years-vital-tb-work-russia
A Safe Birth, and Welcome Relief, in Sierra Leone https://www.pih.org//article/safe-birth-and-welcome-relief-sierra-leone When 18-year-old Fanta Karoma found out she was pregnant, she was scared. It was her second pregnancy—her first child had been stillborn, after a complicated birth—and it was also bad timing. She was training to become a seamstress in Kono, eastern Sierra Leone, and enjoyed stitching patterns from lapa fabric, learning to design stylish outfits for customers.

Before long, Karoma’s boss noticed her growing baby bump. Annoyed, he pressured her to have an abortion. Karoma contacted a backstreet abortion provider, someone who lived in her village. 

Because her neighbors, who had heard horror stories, told her it could be unsafe, Karoma decided to go through with the pregnancy. Her dad, with whom she lived, was angry. She briefly moved in with the baby’s father, but “he kicked me out shortly after, and didn’t want to take responsibility” for her and the new baby.

Like many women in Sierra Leone, Karoma thought she was out of safe options. Sierra Leone has one of the highest maternal mortality rates in the world, at 1,000 per 100,000, and about half of all women give birth at home, far from skilled clinicians should emergencies arise.

After Karoma told her story to a clinician at her local health facility, she was referred to Wellbody Clinic, a Partners In Health-managed facility in Kono. There, a midwife met with her, reviewed her files, and, she says, “invited me to stay at the birth waiting home.” Karoma realized that it wasn’t the first time she had heard the idea. “I had already been told about it by another pregnant woman in my village. She had visited me at my house to tell me about the birth waiting home when she heard I was pregnant again.”

The birth waiting home—a whitewashed house on a hill—provides a tranquil environment where at-risk expectant mothers, including those who live far from clinics, receive three meals a day and regular checkups. There are shaded porches to rest out of the hot midday sun, and everything, including food and accommodation, is free.

Zainab
Zainab Kalokeh, a midwife who cared for the young mother, holds Karoma's son during a regular visit. Photo by Emma Minor / Partners In Health

“The great thing about the birth waiting home is that it’s built specially for the pregnant women,” says Zainab Kalokeh, a midwife who cared for Karoma. “The rooms are convenient, with bed nets and everything, as well as a water supply. The place is comfortable and nice.”

Even better, the home is a short distance from the maternity ward at Wellbody Clinic, where despite the national statistics, there hasn’t been a maternal death in two years. That’s half the amount of time that PIH has been working in Sierra Leone, initially responding to the Ebola outbreak in 2014, then staying to focus on Kono district in the country’s far east, and partnering with the Ministry of Health and Wellbody Alliance to strengthen the health system.

Reducing Sierra Leone’s sky-high maternal mortality rate is a priority, and the birth waiting homes are a cornerstone of PIH’s approach.

Karoma moved in. “I felt gladi,” she says, in Sierra Leonean Krio. “I knew I would get the best possible medicine and care at the birth waiting home. When I was there it felt like my family. I made friends with the other women and I wouldn’t worry about being hungry.”

At the birth home, Karoma had help drawing up a birth plan. Because her first pregnancy had resulted in a frightening, prolonged labor that lasted for three days, the team recommended a planned cesarean section for this pregnancy.

Night was falling when Karoma felt the first pains of labor. Kalokeh accompanied Karoma in the ambulance to Koidu Government Hospital.

“I was scared and in a lot of pain, but everybody was helping me,” Karoma says. “I had confidence that it would be alright this time.”

“We managed to talk to her, calm her down,” Kalokeh says. “We gave her confidence that when she will go to the hospital, she will have a baby. And she was so eager to have that baby.”

Her baby, John David Karoma, was born by c-section soon after.   

Kalokeh says that Karoma’s case is not uncommon, and that she sees many women with complicated and at-risk pregnancies. “While some of those admitted to the birth waiting home come because they live far from a health facility, others have conditions like pre-eclampsia. Our aim is to make sure they have safe deliveries, and to save lives.”

Karoma has now returned to her home village with John. “If I hadn’t heard of Wellbody or gone there, I think I would have died this time,” she says. “I know many women who have died trying to give birth at home this way. I’m looking around now, wherever I can, for pregnant women, to tell them to go to Wellbody Clinic.”

Best of all, she is still excited about continuing to train as a seamstress. Once John learns to crawl, she hopes to get back to work. “I want to learn to be a seamstress so I can support him,” she says. Her chosen career will have an added bonus: new clothes for the little one.

Fanta and John
Karoma holds John in the doorway of their home on a recent morning. Photo by Emma Minor / Partners In Health

 

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Tue, 13 Nov 2018 11:02:42 -0500 https://www.pih.org//article/safe-birth-and-welcome-relief-sierra-leone
Malaria Cases Rising in Malawi as Peak Season Nears https://www.pih.org//article/malaria-cases-rising-malawi-peak-season-nears Flora and Thomas Tigone said they knew something wasn’t right when their 7-month-old son, Chisomo, suddenly became much less playful than usual. 

Their worries increased when Chisomo grew feverish, and began vomiting and breathing heavily. It was a Monday in late September, in Luwani Village of Neno District, Malawi. Chisomo is the youngest of the parents’ six children. Just a month before, their second-youngest, a 7-year-old, had contracted and recovered from malaria.

Malaria is a mosquito-borne illness that can cause fevers, chills, muscle aches and fatigue. If left untreated, symptoms can escalate to nausea, vomiting, kidney failure, seizures, coma and death.

If malaria was the case again—and this time, with an infant—Flora and Thomas knew treatment would have to start quickly, to prevent complications. They brought Chisomo to Lisungwi Community Hospital at 5 a.m. the next morning. 

Lisungwi is one of two hospitals that Partners In Health supports in Neno District. PIH, known locally as Abwenzi Pa Za Umoyo, has worked in Neno since 2007 and also supports 12 health centers there. The rural district borders Mozambique and is home to about 170,000 people. 

Malaria is one of the most consistent, severe diseases afflicting the population, and Neno health workers are concerned about the peak season, now just weeks away. During the dry season, from May to September, PIH and Ministry of Health staff conduct about 17,500 malaria tests a month across Neno’s 14 PIH-supported health facilities. 

But that number rises to about 30,000 tests a month—equating to nearly one-fifth of Neno’s entire population—in the rainy months from January to April, breeding time for mosquitos. 

About 55 percent of malaria tests across Neno District show a positive result—meaning, positive for malaria, not for the patient. Subsequent treatment and care can place a heavy load on PIH and Ministry of Health staff in hospitals, health centers, and communities. 

“To cope with the uptick in demand mostly requires more health care workers—medical assistants, nurses, clinical officers, and physicians—to diagnose and treat patients effectively,” said Emilia Connolly, chief medical officer for PIH in Malawi. “But the need also is great for rapid malaria tests, reagents for lab testing, blood transfusions, medications for malaria and its complications, and other hospital supplies.” 

Lisungwi Community Hospital, and the Tigones’ home in Luwani, sit on parched flatlands that formed broad, paintbrush swaths of brown and yellow in late September. Grassfires seemed likely. Even the cooler, breezier mountainsides were dotted with smoke plumes, as farmers used controlled burns to clear land ahead of the coming rainy season.  

But the rains had not yet arrived, and dry heat remained dominant. Thirsty, malaria-bearing mosquitos were seeking bites everywhere they could.  

“Each and every day,” said Audings Winga, a Ministry of Health nurse at Lisungwi, describing the frequency of malaria-related visits at the hospital. 

Fifty to 70 a day, to be more specific. That’s the daily amount of malaria tests cited by Allan Chimpeni, a Ministry of Health lab scientist at Lisungwi who works down the hall from the ward where Winga cared for little Chisomo, as Flora and Thomas stood by. 

Chimpeni did Chisomo’s malaria test that morning. Malaria tests take about five minutes, he said, and require a blood sample placed on a small test strip. 

The entire lab team at Lisungwi consists of Chimpeni and three technicians: Davie Chabwera, Yohane Ngwira, and Cidreck Murameya. In addition to malaria tests, their work includes blood counts, urine analysis, parasitology, tuberculosis screening, and more. 

Lab scientist Allan Chimpeni prepares TB samples for Gene Xpert at Lisungwi Community Hospital, where he has worked since 2013. Chimpeni completed school in May 2018 at the College of Medicine in Blantyre.
Lab scientist Allan Chimpeni holds a malaria test at Lisungwi Community Hospital. Chimpeni said he and his team of three technicians conduct 50 to 70 tests a day during dry months, but he expects testing to reach 120-150 a day when the rainy season begins in December. 

“The workload is very high here,” Chimpeni said. 

It will soon get even higher. When the rainy season arrives in December, he expects the number of daily malaria tests to double. 

“Severe malaria can happen any time of the year, but we see it much more in the rainy season, with more cases overall,” Connolly said.

Children are hit especially hard. 

“I would say, on average, the number of children admitted to the hospital triples during the rainy season, mostly for malaria,” Connolly said.

On this September morning, the results of Chisomo’s test confirmed his parents’ fears. Despite the fact that they had placed a mosquito net around his bed, the 7-month-old’s diagnosis was severe malaria. 

Winga quickly put Chisomo on medication, initially through an IV. By early afternoon, about eight hours after the family had arrived at the hospital, Chisomo was quietly breastfeeding, appearing much healthier and acting happier. 

Relief was evident on the faces of Flora and Thomas, who sat next to each other on a hospital bed while holding Chisomo. Thomas, 45, is a bricklayer who has lived in Luwani all his life. The community is about a 10-minute drive from Lisungwi Community Hospital. Flora, 37, was born in Blantyre, Malawi’s commercial center and second-largest city, and sells vegetables in a local market. 

They planned to stay at the hospital overnight with Chisomo, in case any complications arose. 
Winga said Chisomo should be healthy the following morning. His free treatment would continue for four days, with a dose every 12 hours. Chisomo was just large enough to take pills orally, Winga said, so the initial IV would not be needed again. 

The Lisungwi staff that screened, diagnosed and treated him so quickly had great news to confirm the next day: Chisomo, indeed, had been discharged in good health, and his parents had brought him home. 

Chisomo Tigone, 7 months, sits with parents Flora and Thomas Tigone during his treatment for severe malaria. Despite the family's use of bug nets, this is their second case of childhood malaria in a month.
Chisomo Tigone, 7 months, smiles with parents Flora and Thomas Tigone during his treatment for severe malaria. Flora and Thomas brought him to the PIH-supported hospital at 5 a.m., after he had been feverish and sick the day before. By early afternoon, after diagnosis and an initial dose of medicine, he was eating and playful. 

 

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Thu, 08 Nov 2018 10:53:54 -0500 https://www.pih.org//article/malaria-cases-rising-malawi-peak-season-nears
Single Mother in Malawi Caring for Kids, Handling HIV https://www.pih.org//article/single-mother-malawi-caring-kids-handling-hiv The rural compound where Agnes Paulo has lived since she was born sits atop a ridge that, in the dry season at this time of year, is dusty and brown. Steps away are downward slopes dotted by agricultural fields, including her family’s. The view across the valley is hazy through the heat of a late-September morning, weeks after what many people called a weak harvest. 

Dogs and goats amble through the cluster of small houses and outbuildings, beneath clotheslines that stretch from one roof to another. Several young kids play excitedly together, while older kids are off at school. There is a tangible feeling of shared community and extended family in this corner of Chinyani Village in Neno District, Malawi.

Agnes Paulo sits on a mat with her back against a wall of her home, and gazes at the view absent-mindedly. She’s holding her infant son, Ulemu, in her lap. Her expression is somber. Ulemu was born in August, and is her fifth child. The other four—two boys and two girls—are 5 to 14. 

Paulo, 35, breastfeeds Ulemu while talking about the struggles facing the entire community, and her immediate family. She’s a single mother and living with HIV. All four of her older children are HIV-negative, but Ulemu had not yet been tested, meaning his status remained unknown.

Preventing mother-to-child transmission of HIV is a vital goal for Partners In Health, which has worked in Neno District since 2007, as a partner to Malawi’s Ministry of Health. Nearly 1 in 10 adults—and more than 70,000 children—are living with HIV across Malawi, an East Africa nation facing some of the world’s most dire challenges in HIV, maternal health, malnutrition and other health areas. 

Neno’s arid flatlands and rugged mountains increase the barriers to health care for its roughly 170,000 residents. PIH is working to bridge those gaps, one home at a time, through a network of community outreach and regular, one-on-one visits, like this morning’s checkup with Paulo and Ulemu. 

Paulo is one of nearly 8,000 people in Neno who are living with HIV and enrolled in antiretroviral therapy, or ART, programs supported by PIH. Her commitment to treatment dramatically increases Ulemu’s chances of being HIV-negative. Mothers without ART have a significantly higher rate of transmitting HIV to their children—up to 45 percent—than mothers like Paulo, who are able to access and stay dedicated to ART, and have a much lower risk.

Paulo has taken a pill every evening for several years, regularly getting free refills at PIH-supported health facilities, including Neno District Hospital, more than an hour’s walk away on rugged dirt roads. 

Additionally, she has a team of PIH staff supporting her. Several members of that team are sitting with Paulo this morning, including Rose Zingwani, a senior community health worker for Abwenzi Pa Za Umoyo, as PIH is known locally. Zingwani is 35, same as Paulo, and lives just down the road. 

Zingwani decided to volunteer for the village’s health committee, and then become a community health worker, after seeing the challenges facing the remote Chinyani area. She’s worked with Paulo and her family for more than three years. Zingwani visited frequently in recent months while Paulo was pregnant with Ulemu, to provide education, support, and access to care.

Today’s visit is a regular monthly checkup for Paulo and little Ulemu. Zingwani kneels on the mat beside Paulo while talking about danger signs for infants, such as diarrhea and jaundice, and the importance of breastfeeding, ideally for six months after childbirth. It’s crucial to remain on ART and keep a low viral load during breastfeeding, Zingwani says, as mothers can transmit HIV to newborn children through  breastmilk. 

Zingwani shows Paulo educational materials she’s brought along, and records Paulo’s and Ulemu’s health information in a large binder. 

CHW site supervisor John Kaiya (left), CHW program manager Benson Chabwera and CHW Rose Zingwani review health documents for Agnes Paulo, a single mother living with HIV, at Paulo's home in Chinyani Village. 
CHW site supervisor John Kaiya (left), CHW program manager Benson Chabwera and CHW Rose Zingwani review health documents for Agnes Paulo, a single mother living with HIV, at Paulo's home in Chinyani Village. 

John Kaiya, a community health worker supervisor, and Benson Chabwera, a community health worker program officer, talk with Paulo about other needs, such as the upkeep of her home—because supporting someone’s right to health means supporting their right to healthy living conditions. 

Food is her greatest challenge, she says. Paulo feels that there is nothing she can do to improve her family’s food supply. She grows corn when she can on the nearby plots, but fertilizer often is too expensive. This year’s weak harvest has increased the price of corn amid short supplies, as well.

Also joining the visit is Sam Msiska, Malawi coordinator for PIH’s Program on Social and Economic Rights, or POSER. The program provides support including financial, food, home, and education assistance to patients who have needs beyond health care. 

Those needs can span a broad range in Neno, where Paulo has seen decades of changing seasons, ebbs and flows. She smiles rarely this morning—even when chatting with Zingwani, a friend and neighbor she’s known for years—indicating times have been harder lately. Chabwera promises to advocate for housing help, and Msiska discusses the potential for immediate food assistance. 

Above all, Zingwani emphasized the importance of Paulo maintaining her ART and her regular checkups at the central Neno clinic, to ensure the best possible future for Ulemu and her four older children.  

They would have to wait a little to learn Ulemu’s HIV status. Soon after that visit, Zingwani enrolled Ulemu in the Early Infant Diagnosis program at Neno District Hospital's integrated care clinic. He had his first HIV test there, but results would take a month or more to come back from Blantyre, Malawi’s second-largest city. Henry Makungwa, community health worker manager for PIH in Malawi, said the Early Infant Diagnosis program usually extends over two years, as infants are tested multiple times as they continue breastfeeding. 

With the team supporting his mother and family, Ulemu’s chances of living a healthy life are strong, whatever the results of his HIV tests. 

As the morning’s visit concluded, Paulo stood up, Ulemu still in her arms and wrapped in a bright green, patterned cloth. Zingwani embraced Paulo as good-byes were said, and then Zingwani and the PIH team departed—they were off to the next home.

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Wed, 07 Nov 2018 14:37:45 -0500 https://www.pih.org//article/single-mother-malawi-caring-kids-handling-hiv
Breast Cancer Survivors in Haiti Share Their Stories https://www.pih.org//article/breast-cancer-survivors-haiti-share-their-stories Five days a week at University Hospital in Mirebalais, Haiti, dozens of patients flow through the oncology ward for doctors’ visits, chemotherapy, and consultations with the team’s social worker or psychologist. The vast majority are women, and many—450 in 2018 alone—are in various stages of battling breast cancer.

For Breast Cancer Awareness Month, staff at Zanmi Lasante, as Partners In Health is known in Haiti, asked five survivors to share their journeys with cancer. Some of the women started receiving care in Cange; others first went to University Hospital, which opened in March 2013 and is still the only facility in Haiti that provides free cancer care and psychosocial support. Each woman comes with a different perspective and background, but all share the scars of the same disease. Here are their stories.


The lump in Laurie Dorce’s breast never hurt, so it was easier to push its existence out of her mind. But one day, she noticed the lump had become much harder, and her concern grew. In 2011, she visited a doctor in Léogâne, near her home in southern Haiti. A biopsy revealed she had breast cancer, and her doctor recommended she visit the PIH-supported hospital in Cange.

Dorce was still scared and in shock by the diagnosis when she arrived. But PIH staff and clinicians “explained everything to me, provided me with information, and eased my mind,” she says. She underwent a series of chemotherapy treatments to shrink the mass, then had her first surgery in 2014.

Despite taking tamoxifen to prevent a recurrence, Dorce found another lump and has had two more surgeries since 2016—all while under PIH’s careful watch. She continues to travel to the hospital regularly for follow-up care.

“By the grace of God,” she says, “I feel good these days.”

 

Del
Oldine Deshommes (left), University Hospital's oncology program social worker, stands outside the oncology ward with Suzie Del (right), a breast cancer survivor.

Suzie Del* was watching television on a Friday night in 2012 when a commercial captured her attention. An actress was explaining the importance of breast self-exams, especially for women over 40, and gave a demonstration. Del had never done such a thing. She raised her arm, draped it over her head, and felt for lumps in her breast. She found some.

The following Monday, 59-year-old Del visited a doctor at Bernard-Mevs Hospital in Port-au-Prince. Tests revealed that she indeed had a tumor, and that it was cancerous. She had surgery to remove the lumps, then took her first course of chemotherapy. She lost all her hair and reacted so strongly to the powerful medication that she required an IV.

Knowing she could no longer afford care at the private facility, Del traveled north to the PIH-supported hospital in Cange, where cancer care was free. Dr. Ruth Damuse, the oncology program director for PIH in Haiti, met with her, reviewed her files, and said she no longer needed chemotherapy. Instead, Damuse recommended a mastectomy, which Del agreed to undergo.

 “When I first learned that I had cancer, I thought I was going to die,” Del says. But after speaking with PIH clinicians and staff on the oncology team, she felt renewed hope, as do many fellow cancer patients. “They told us we shouldn’t worry and encouraged us to continue with our activities as much as possible.

“I never told anyone that I was sick,” she adds. “No one knew I was sick because everyone saw that I continued with my life as normal.”

Following her last surgery, tests revealed no further signs of cancer. Del has been on preventive medication and follow-up care ever since. She says she feels very well now, and thanks God—and PIH—she’s alive.

 

Cherie
Cita Cherie was among University Hospital's first breast cancer patients when the facility opened in 2013.

Cita Cherie is a single mother of seven who has seen a lot in her 49 years. When she found a lump in her breast, it was one of several worries was juggling at the time, including occasional homelessness. She visited doctor after doctor and got no relief, just more bills.

Then, one day, someone told her about University Hospital, where cancer care was free. She visited shortly after it opened and met Dr. Damuse. After a biopsy and several exams, Damuse informed Cherie that she had an advanced stage of breast cancer. The doctor didn’t recommend surgery, but advised her to start palliative chemotherapy, which could prolong her life. 

Five years later, Cherie rarely misses her chemotherapy appointments. Damuse has shifted her to different lines of palliative treatment over that time, with occasional recovery breaks in between. Inevitably, she arrives with a huge smile, and is always in good spirits. 

“If it were not for the Mirebalais hospital, I would not be alive today,” Cherie says. “I get all my medication for free, and when I come to the hospital, the doctors take really good care of me. They welcome me and they really value me.”

 

Adriana
Desameau stands with Adriana Jean, another breast cancer survivor, in the courtyard outside University Hospital's oncology ward. 

Adriana Jean had a similar reaction to many women when they first learn that the lump in their breast is cancer. She was terrified and prayed that she would stay alive, for her family’s sake.

“I have six children,” Jean says, adding that there are four boys and two girls. “My last one was in sixth grade, and I was worried that I would not be able to help him advance in school.”

The hospital she visited in Tabarre, not far from her home on the outskirts of Port-au-Prince, referred her to another facility for surgery. But she knew she couldn’t afford the procedure. A friend recommended she visit the PIH-supported hospital in Cange, where she could get free care.

Following her advice, Jean traveled to Cange in 2010 and got the surgery she needed. But her cancer was persistent, and tumors reemerged. In 2012, she underwent a mastectomy, recovered from surgery, and began taking tamoxifen to prevent a recurrence. She remains in follow-up care at University Hospital.

 “I used to say: ‘As long as the girls are young, I would not want to die before they get married,’” Jean, now 62, remembers. “Today they are older, and if I die now, I am relieved that I would not leave young children behind.”

 

Philomena
Fadhmaelle Pierre (from left), an assistant social worker with the oncology program; Maria Destin, Philomena's daughter; Philomena Moise, a breast cancer survivor; and Deshommes spoke about Moise's journey through care at University Hospital.

Philomena Moise, 77, had a long journey to get the care she needed after discovering a mass in her breast more than eight years ago. It took a while, but she eventually got an appointment at the General Hospital in Port-au-Prince, where a clinician took a biopsy and sent the breast tissue away for testing. Months passed before she got results. When she learned she had cancer and would need surgery, she felt a pang of despair.

“I told Jesus I did not understand what was happening,” she remembers.

Again, Moise waited months for her next appointment at General Hospital, while the mass grew and formed a painful abscess that eventually burst. Desperate for help, she followed another doctor’s recommendation and turned to the PIH-supported hospital in Cange.

There she met Dr. Damuse, who wasted no time. Moise had her first appointment in February 2010, and by April, she was scheduled for surgery to remove the mass. She began chemotherapy in Cange and continued her care at University Hospital in Mirebalais. She has been in follow-up care ever since.

*Patients' and family members' names have been changed.

Every day, women in Haiti go without the breast cancer care they need to survive. If these five women's stories inspired you, please help more women fight back with a gift today. Make your lifesaving gift>>
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Fri, 19 Oct 2018 18:45:48 -0400 https://www.pih.org//article/breast-cancer-survivors-haiti-share-their-stories
Mental Health Team Expanding Innovative, Pioneering Care https://www.pih.org//article/mental-health-team-expanding-innovative-pioneering-care Tell us a little about the progression of mental health programs across PIH sites in recent years. 

Over the past seven to eight years, we’ve developed a lot of experience delivering mental health care in Haiti and Rwanda. In each of those countries we have several thousand people receiving care. And over the past five years, we’ve been working with all the other sites to support further integration of mental health care within existing primary care platforms.

A lot of that work has focused on care of severe mental disorders—psychotic disorders, schizophrenia, bipolar disorder—because those are the people who tend to present to our hospitals in crisis. But we have also wanted to address common mental disorders, such as depression, post-traumatic stress, anxiety, and somatic disorders.

Over the past year, we’ve increasingly moved a number of sites toward thinking about how to address common mental disorders with non-specialists.

 

Home visit with Paul Mainardi
Dr. Giuseppe Raviola (right, back) speaks with Paul Mainardi (far left), at his home in Haiti following his mental health treatment in 2015. (Photo by Rebecca E. Rollins / Partners In Health)

 

Those conversations have really accelerated recently. 

What has tended to happen with our small mental health teams at the sites is that they’ve at times been so overwhelmed with the care of people living with psychotic disorders. It’s been difficult to give time and attention to common mental disorders, which are a significant burden in communities and societies globally. The challenge of providing clinical supervision for common mental disorders is also a challenge we face at our sites.

A year ago, Dr. Vikram Patel, who is a preeminent thinker in global mental health, became a new professor at Harvard, in the Department of Global Health and Social Medicine, where I also am on the faculty. He has been a leader in research on the mobilization of community health workers for care of common mental disorders. He is a founder of Sangath, which is a community-based organization in India that has both mobilized community health workers for mental health care and done significant research on that process.

As he and I put our heads together, we thought it would be great to bring together implementers and researchers on the topic of community-delivered care for common mental disorders, and the bottleneck that affect groups like PIH who are at the front line. We had a significant meeting at the Harvard Center for Global Health Delivery-Dubai to support this aim.

 

That led to a lot of groundbreaking ideas on best practices, supported by everyone from community health workers to academic researchers. What was one concrete result?

We are working toward an important consensus statement from that meeting, with recommendations for best practices in community-delivered care for common mental disorders. This month, we will be announcing a new initiative at PIH called the Many Voices Collaborative in Community Mental Health at PIH.

Our cross-site mental health team will provide support, including seed funding, to eight sites in deepening community health worker-delivered care of common mental disorders.

 

How else has academia shaped PIH’s global mental health work recently?

We have a fellowship in global mental health delivery at PIH, shared with Harvard Medical School. It’s called the Dr. Mario Pagenel Fellowship in Global Mental Health Delivery. We have fellows in Haiti and Rwanda, and we’re expanding the fellowship to West Africa, southern Africa, and Latin America. The West Africa fellowship will be shared between Sierra Leone and Liberia, southern Africa will be shared between Lesotho and Malawi, and Latin America will be shared between Mexico and Peru.

So our cross-site team is growing, and mental health care delivery is expanding. We are also increasingly engaged in advocacy for the need for greater commitments to global mental health delivery. Paul Farmer and I published a commentary on October 10, World Mental Health Day, in support of the Lancet Commission on Mental Health and Sustainable Development.

 

Can you share a sense of the need for mental health care in low- to middle-income countries, particularly regarding depression?

Mental disorders represent the greatest collective cause of disability today. Depression is the most common mental disorder. It affects 350 million people globally, it represents the leading cause of disability around the world—more than ischemic heart disease, road traffic accidents, cerebrovascular disease, and chronic obstructive pulmonary disease. 

Although mental disorders significantly impact people in low- and middle-income countries and 80 percent of the world’s population live in these regions, greater than 90 percent of mental health resources are spent in high-income countries.

 

Wow.

And furthermore, the treatment gap for people with mental disorders—that is, the gap between how many people have disorders and how many are receiving care—exceeds 50 percent in all countries worldwide, but it approaches rates as high as 90 percent in the least-resourced countries. And 75 percent of lifetime cases of mental health conditions begin by age 24, which tells us that we need to be thinking about prevention and early intervention as well as treatment.

 

Olivier Kayitsinga
During a 2017 visit from PIH's mental health team in Rwanda, patient Olivier Kayitsinga points out different areas of the house that he is building. (Photo by Cecille Joan Avila / Partners In Health)
 Carabayllo, Peru.
Mental health team members coordinate before a house-to-house intervention in Carabayllo, Peru, in 2016. (Photo by William Castro Rodríguez / Partners In Health)


How do community health workers begin to address these problems?

Community health workers can provide basic psychosocial and psychological interventions, both clinical and preventive. In Haiti, for example, we have developed a toolkit for community health workers that starts with basic information about the origins of mental illness and human rights; the role of culture and traditional belief systems; and basic skills in delivering psychological interventions that are helpful and effective. Also, it includes information on how to talk about mental health with people in the community. Helping people understand that mental disorders are highly treatable—and linked to human rights, as well as to stigma and potential discrimination—is really important.

 

Let’s talk more about the Many Voices Collaborative, what it is and what it might mean for country sites. 

The Many Voices Collaborative will provide seed funding and implementation support to the sites, to either build a basic level of management capacity and care delivery capacity that they haven’t had, with a focus on common mental disorders, or to enable sites to deepen their engagement on a range of mental health conditions in the community. 

For example, in Liberia, for two years, a small, local mental health team has been delivering care to hundreds of people. Mostly people are living with psychosis and are homeless on the streets of Harper. The team has been getting incredible results and the work has been very well-received and very important in reducing stigma in the community. For many people served, it’s been lifesaving. But the team has been limited in its ability to address common mental disorders, so we’ll be hiring additional community health workers and build this other component into the work in Liberia.

 

In the countries where PIH works, how often are mental health problems seen as shameful or disgraceful, and how do you address that?

Stigma can be embedded not just in communities, but also in the health system. It’s a huge barrier. What we’ve found is that possibly the most effective counteraction to stigma is delivery of care. Often it’s remarkable, the degree to which providing people with effective care dramatically improves lives, and eradicates stigma.

 

We’ve talked about a lot of growth in mental health programming and support: the Many Voices Collaborative, new staff, new funding. What’s helping us turn the corner?

Our mental health team is small, but what we are doing is quite innovative. We have an essential focus on building systems of care that are safe, effective, evidence-based, and culturally sound. Our work integrates research evidence from science, but at our core we provide accompaniment to local teams implementing needed services at the front line, where not many people work. We’re having success because our teams have real-world experience with the challenges of delivering care in difficult circumstances. And when you meet the people we serve, you’ll see that people’s lives are greatly improved.

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Wed, 10 Oct 2018 13:17:49 -0400 https://www.pih.org//article/mental-health-team-expanding-innovative-pioneering-care
Dr. Marta Lado on Ebola, and Its Aftermath, in Sierra Leone https://www.pih.org//article/dr-marta-lado-ebola-and-its-aftermath-sierra-leone Best known among Partners In Health colleagues for her love of exclamation marks and good cheese, Dr. Marta Lado, chief medical officer in Sierra Leone, bursts with energy. The 39-year-old infectious disease specialist from the small town of La Coruna, Spain, completed her medical training in Madrid and then worked in a number of roles across Africa and Asia. Her compassionate spirit led her to Sierra Leone during the height of the Ebola epidemic in 2014, where she helped set up and operate one of the first treatment units in the country. In 2016, at a time when most medical professionals were withdrawing their support, Lado stayed put and soon joined PIH.

Most of Lado’s work now involves collaborating with the Ministry of Health to rebuild and sustain Sierra Leone’s public health system. Still, she can’t quite escape her connection to Ebola. Last month, she published a book, Ebola Virus Disease, that provides an overview on the management of the deadly infectious disease, details historical outbreaks, and shares expertise gained while working in treatment units in Sierra Leone. And this month, she is taking a brief leave to help a World Health Organization team fight the latest outbreak, this time along the border of Uganda and the Democratic Republic of Congo.

We sat down with Lado to discuss what drew her to Sierra Leone in 2014, her experiences working with the Ministry of Health, and patients for whom she wishes she could have done more.

Where did you get your drive to work in countries like Sierra Leone?

My dad comes from a family of farmers who lived in a really poor, rural part of Spain. He was incredibly fortunate when someone offered to pay for his studies, which allowed him to train as a doctor. Because of this, a duty has always been instilled in me to help others if I can. In my view, no one deserves what they’re born with, it should be shared wherever possible.

What’s the best part of your job?

I feel useful. My job makes a difference to others around me, whether that’s through treating someone in the clinic or teaching and mentorship of junior medics.

Of course, I have rollercoaster days with huge ups and downs, but I’ve been here for five years now. What I see is a completely different story to when I arrived. That’s what gets me out of bed in the morning.

An Ebola survivors' tree, adorned with ribbons tied on by survivors as they were discharged from the clinic.
The Ebola survivors' tree in front of the Maforki treatment unit, now weathered and worn, marks the passage of time since the outbreak ended. (Photo by Aubrey Davis / Partners In Health)

You played a prominent role in controlling the spread of Ebola in Sierra Leone. What do you feel you did well at that time?

I stayed. I showed commitment. That has definitely helped show the Ministry of Health that I’m serious about working together now.

On the whole though, I’m not proud of what happened during Ebola. Nobody had the resources to adequately treat anyone, and thousands died needlessly. Often I felt like I was only making a horrific death more dignified.

That’s an incredibly honest answer. Do you feel you could have done anything differently?

For a long time, the international medical community denied it was an alarm situation. Normally it’s possible to contain infectious diseases like Ebola, because they mostly affect villages. This was different, though. Cases reached cities and went out of control. The first patient in Sierra Leone was identified at the end of May 2014. Within six weeks, the disease had spread all over the country.

Sometimes I’ll sit and think about it. Perhaps I should have anticipated its scale of terror sooner and pushed harder for the Ministry’s attention. And internationally too. Everyone just fled. It felt like no one was listening.

What was your day-to-day role during that period?

No one had a clue how Ebola spread or how to properly identify a patient. There were no guidelines whatsoever apart from some developed in 1997, which I followed like my bible. I worked with the Ministry to set up the National Task Force, a group that met weekly to review new Ebola cases and develop guidelines.

Over that period, we collected all sorts of information, like: How should we disinfect patients’ beds? What kind of protective clothing should medical staff wear? How should we dispose of waste? Should we use chlorine, or is soap and water enough? My book expands on this information, highlighting all of the Ebola symptoms and guidelines we identified.

Health workers in protective garments at work in an Ebola Treatment Unit (ETU) during the 2014 crisis.
A view inside the Port Loko Ebola Treatment Unit in November 2014, at the height of the epidemic. (Photo by Jon Lascher / Partners In Health)

Patients must have felt so angry about what was happening to them at that time. 

Sierra Leoneans have an amazing ability to just accept that things are bad for them. They can’t picture what a high standard of care is like, so they never expect it. It’s really heart-breaking.

If a disease like Ebola threatened Sierra Leone again, would we be prepared to combat it?

Yes. Definitely. Our prevention control is better and, most importantly, there has been a shift in mindset among health care workers. Juniors are coming in with a real thirst to make a difference.

But we’re still in trouble. It’s not just about health care; it’s also about society. The basics still need to be addressed: poor hygiene, crowded housing, bad water systems, no gloves in hospitals—the list goes on.  

What do you most cherish and need to do your job well?

Staff. We need more expertise here, especially through local hires. We can’t always fill positions with international placements. We should be working with the Ministry to recruit local clinicians who can support the longevity of health care in Sierra Leone.

Great steps are being made already. Last year, PIH got approval from West African College for the first medical training course here in Sierra Leone. We’ve since been able to establish a teaching suite at Koidu Government Hospital in Kono.

If you could snap your fingers and change one thing about health care in Sierra Leone, what would it be?

Make health care free for everyone. Even if it didn’t work properly at first, or ever, it would change a really damaging mindset that Sierra Leoneans currently have around health care. They’ve had too many disappointing experiences of spending money they don’t have, only to receive terrible medical care. People just don’t think to go to the hospital if they get sick. 

Are there any patients who stick in your memory most?

It’s all the stupid deaths. If we’d had the very basics, that person wouldn’t have died. They’re the ones who stay with me.

What advice would you give to someone starting out in a similar line of work?

Doing this kind of work, in a culture often different to your own, requires maturity, good training, and a willingness to adapt to situations respectfully.

I’ve often found there’s no right or wrong way to do something. There’s just a way, and it’s important to be flexible to that. Making assumptions on things will disengage colleagues and stunt change. I’m learning that every day.

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Thu, 04 Oct 2018 22:30:12 -0400 https://www.pih.org//article/dr-marta-lado-ebola-and-its-aftermath-sierra-leone
Dr. Paul Farmer Calls for Action on Tuberculosis in STAT and on NPR https://www.pih.org//article/dr-paul-farmer-calls-action-tuberculosis-stat-and-npr Last Wednesday, the United Nations held a high-level meeting on tuberculosis. Presidents, prime ministers, and other international leaders were invited to publicly commit to ending the world’s deadliest infectious disease, one that kills 1.6 million people each year.

Was the meeting, which was the first of its kind, a cause for hope? Or was it an exasperation, a symbol of just how little has been accomplished in the decades since a cure for tuberculosis was discovered?

In an opinion piece in The Boston Globe’s health and science publication STAT, PIH Co-founder Dr. Paul Farmer and Lelio Marmora, the executive director of global health funder Unitaid, suggest the answer is “both.”

History has shown just how indifferent the world can be to diseases that affect primarily low- and middle-income countries,” they write. “It’s also shown what a difference we can make when indifference is replaced by concern.

Dr. Farmer echoed that sentiment in an interview on NPR’s Morning Edition.

I have been a skeptic about the relevance of yet another meeting about a problem that really hasn't been addressed ever," he said. Then he tempered his skepticism by remembering that a similar meeting years ago led to massive investment in the fight against AIDS.

And maybe therein lies the big point. Global meetings are inspiring and enervating, but most importantly, they need to be followed by action.  

Read the STAT article here

Listen to the NPR Morning Edition story here

 

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Tue, 02 Oct 2018 18:23:41 -0400 https://www.pih.org//article/dr-paul-farmer-calls-action-tuberculosis-stat-and-npr
For His Mother: Sierra Leone PIHer Reflects on Career https://www.pih.org//article/his-mother-sierra-leone-piher-reflects-career In September 2014, as the largest Ebola outbreak in history was devastating West Africa, Alusine Mark Dumbuya was struggling with an additional, very personal concern in a rural region of Sierra Leone. 

“I know it sounds bad to say, but I didn’t care all too much about Ebola,” Dumbuya said. “At that time, my mum was getting really sick with cervical cancer, so I just wanted her to get better more than anything else.” 

Dumbuya, 33, is now operations manager at Koidu Government Hospital, for Partners In Health. The hospital is in Sierra Leone’s Kono District, and less than 100 miles from where Dumbuya grew up. His experiences during the Ebola outbreak, trying to find cancer treatment for his mother amid the international crisis, motivated him to apply to PIH. And at the hospital, he continues to honor his mother. KGH, as it's often called, has a strong focus on maternal health, in a country where 1 in 17 women dies during pregnancy, delivery, or its aftermath—the worst rate in the world.   

Dumbuya remembered the Ebola outbreak solemnly.  

“The hospitals were so overwhelmed by Ebola patients that other illnesses kind of got ignored. At first, mum was misdiagnosed with a growth, but my family knew something was wrong because she felt more and more unwell,” he said. “Many hospitals closed their doors because the doctors had either died or were too scared to go to work. By the time a doctor figured out what was wrong with her, she desperately needed morphine to control her pain, but it wasn’t available anywhere in the country.

ETU
PIH staff prepare to receive patients at the Maforki Ebola Treatment Unit in Sierra Leone in 2015. (Photo by Rebecca E. Rollins / Partners In Health)

“I was so desperate to help that I ran around the big pharmacies in the area, pleading and begging to buy morphine from them,” Dumbuya continued. “The pharmacists all looked at me so funny.” 

Sierra Leone’s government implemented a nationwide, three-day quarantine amid the outbreak, ordering people to stay in their homes from Sept. 19-21.

“It was total shutdown,” Dumbuya said. “When we were finally allowed to leave and go back to the hospital to visit mum, her condition was much worse. She died the next day. We think her oxygen machine must have been taken away by someone else staying there, but I guess we’ll never know.”

His mother’s death changed Dumbuya’s life.  

“After months of insight into how flawed my country’s health care system was, I decided I should try to help if I could. So, I made that my focus,” he said. “I started a job as operations assistant at the Wellbody Clinic in December 2014.”  

Wellbody Clinic is a primary care facility in the small town of Koidu. PIH has supported the clinic since 2014, when it was just one building. It now has six buildings and round-the-clock electricity and water—precious commodities in Kono District. Since 2015, PIH also has supported nearby KGH. PIH collaborates with Sierra Leone’s Ministry of Health to provide support including medical training, supply chain management, community outreach programs, data system innovations, and more.

Jon Lascher, executive director for PIH in Sierra Leone, said Dumbuya "represents the best of PIH" through his work at the hospital.  

“Mark’s commitment to PIH’s mission exemplifies the type of team we have in Sierra Leone," Lascher said. "He works tirelessly, often behind the scenes, to ensure life-saving clinical work is possible at KGH. Since I met Mark, he has never mentioned a task was too small.” 

Longtime PIHer and Sierra Leone native Dr. Bailor Barrie, strategic adviser to Lascher, echoed those sentiments.

"Mark is a smart, passionate and dedicated staff member," Barrie said. "He strives to make work easy for PIH and Ministry of Health staff at KGH. He also is a great mentor."  

Dumbuya said his nickname, “Fire-jumper,” relates to his job as KGH’s operations manager, because of the daily need to tackle problems head on. 

He has been tackling problems—and overcoming extraordinary challenges—since childhood. 

Dumbuya grew up in the town of Makeni, near the Liberian border. Makeni is also near the majority of Sierra Leone’s diamond mines, making it a hotspot for rebel soldiers during the civil war.  

Conflicts escalated in 1991, when Dumbuya was 6, and continued for more than a decade. Rebel soldiers conducted much of the fighting, and looting, in small communities such as Makeni.  

“I still remember my family arguing in the kitchen about whether to stand our ground in Makeni or flea to a nearby village,” Dumbuya said. “On the day we finally decided to leave, in December 1998, I saw a government troop’s vehicle drive past my house. It was covered in blood on one side. It was then that I couldn’t believe we were still in the house. I thought we were going to die.” 

Over the coming months, Dumbuya’s family would travel from village to village in search of somewhere safe to settle. 

“We would walk between 4 a.m. and 7 a.m., because this was when the rebels were quiet,” Dumbuya said. “These were difficult journeys because we had to walk in complete silence, and my sisters were young so they couldn’t walk very far.” 

Old Photos
Dumbuya (second from left) with family; classmates (center); and colleagues (second from right). (Photos courtesy of Mark Dumbuya)

His family found safety for a few months at a village called Foryeahun. But safety could disappear in a moment—like one day, Dumbuya recalled, when he was with a few friends. 

“We were fishing when about 15 rebels jumped out on us from nowhere,” he said. “The other boys ran off quickly, in different directions, but one of the rebels ordered me not to move or he would shoot. The group of rebels circled around me, pointing their guns at me and demanding to know where the village kept their cattle. One of the men behind me began to beat my shoulder with a sharp stick. I’m not sure what would have happened at this point if it hadn’t been for a familiar voice suddenly shouting out in recognition—one of them knew me. It was a boy I had known when I was younger. He was my age. Luckily, they let me run back to my family unharmed and left the village alone.”

Not long after, when rebels occupied much of the country, Dumbuya’s family managed to get him to Freetown, Sierra Leone’s capital and the home of his uncle. Dumbuya was able to finish secondary school there.   

“I feel lucky to have gained the qualifications that I did, because they’ve allowed me to do the work I do now,” he said. “During the years I spent studying, I would think about my family every day and whether they were still alive out there. I vividly remember the day I was reunited with them, after the rebels finally ceased fire in 2001, two years after the Peace Accord was signed on 7 July, 1999. It was truly the best day of my life.” 

Dumbuya said he still thinks about all the other people who were running from rebels in rural districts, like he was. He wonders if their outcomes were as fortunate as his own—and he knows there is more he can do to help heal his country’s wounds. 

“My history led me to PIH and, in a way, I feel I’m now helping communities like the ones I grew up in and experienced so much with,” he said. “I’ll jump over all the fires I have to, with PIH at my side, to ensure that the future’s as bright as I know it can be for us here in Sierra Leone.” 

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Tue, 18 Sep 2018 12:53:40 -0400 https://www.pih.org//article/his-mother-sierra-leone-piher-reflects-career
Building a Passionate Team: HR Manager Tholoana Mohapi Marks a Decade of Hires in Lesotho https://www.pih.org//article/building-passionate-team-hr-manager-tholoana-mohapi-marks-decade-hires-lesotho Tholoana Mohapi said that when she was very young, she wanted to be a nurse one day. 

Instead, her career has led her to more than a decade of hiring nurses and other health professionals, as a leading member of the human resources team for Partners In Health in Lesotho.  

The 38-year-old Mohapi has worked since May 2007 for Bo-mphato Litsebeletsong tsa Bophelo, as PIH is known locally. She joined the team as PIH was beginning its operations in Lesotho, where now—just a decade later—PIH works with the Ministry of Health to reach 40 percent of the country’s 2.2 million people through a national health reform, plus 90,000 more people through a program supporting seven health clinics in remote mountain areas. Additionally, PIH provides treatment and support for people with multi-drug resistant tuberculosis, with an outreach team that reaches patients in communities across all 10 of Lesotho’s districts. 

Dr. Abera Leta, executive director of PIH in Lesotho, praised Mohapi’s dedication to helping build the tireless, passionate team that has led that growth. 

"Tholoana is one of our longest-serving staff members, and lives a life committed to PIH’s mission of helping the poor,” Leta said. “As human resources manager for PIH in Lesotho, she has invested her talent to develop staff who are providing health care services in hard-to-reach places. She is truly selfless and committed to bringing social justice to the most disadvantaged people.”

Mohapi began as PIH’s office administrator in Maseru, the capital, and became an HR coordinator a year later. She became HR manager, she said, “in 2014 or 2015”—and not immediately knowing the exact year could be a sign of just how hectic those years have been. 

“We’re busy,” Mohapi deadpanned on a recent day in the office.

About 50 employees work in Maseru, and about 250 more work in the seven remote clinics and the health reform’s initial four districts. About 125 other people are PIH-supported government employees. All in all, it’s a lot to manage for Mohapi and the two members of her team: HR coordinator Mojela Masupha and HR assistant Liako Lerotholi.

Mohapi handles it all with a steady hand, while focusing on building a strong team for PIH. 

“What I like the most is to get the most competitive employees, that are passionate about what they do and about bringing change to patients’ lives,” said Mohapi, a warm, personable colleague who’s known around the office as “Thully,” pronounced similar to “Too-Lee.” 

Mohapi knows what it means to be a patient. She’s from a small, Berea District village called Ha Phoofolo, north of Maseru, and was diagnosed with tuberculosis at age 15. She believes she got the disease from an uncle, who came home very sick after working in mines in South Africa. 

When Mohapi began having night sweats and rapidly losing weight, family members became alarmed and took her to a doctor. The quick intervention allowed Mohapi to stay stronger than later-stage TB patients and begin medication early—with motivation and encouragement close at hand.  

“Since we had a very sickly uncle in the house whom we supported and had observed him slowly recovering, I got courage to take my meds daily,” Mohapi said. “The only fear I had back then was the fact that most people who were diagnosed with TB were not recovering. Most were dying, and I think adherence to medication was a challenge.” 

Grueling side effects from TB medications can be a deterrent for many patients, who sometimes stop treatment when they start feeling better but before the disease is entirely eradicated. Mohapi said she was able to overcome those challenges because of the people around her, even as her treatment stretched from the usual six months to eight. 

“I can say a strong family support system helped me to beat the disease,” Mohapi said. Her uncle beat TB, as well, and remains healthy today.

Ultimately, TB didn’t slow Mohapi down—she went on to earn an honor’s degree in industrial and organizational psychology at the University of South Africa, and a degree in human resources development at Vaal University of Technology in South Africa.

She’s now a mother of three children, and lives in Maseru with her family. Her role at PIH is vital to the organization’s growth and success across Lesotho. 

“I may not be directly helpful in assisting patients, but I believe we are all working as a team,” Mohapi said. “I believe that’s what has kept me here—doing what is fulfilling.”
 

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Wed, 15 Aug 2018 11:37:19 -0400 https://www.pih.org//article/building-passionate-team-hr-manager-tholoana-mohapi-marks-decade-hires-lesotho
Mojela Masupha Rides the Extra Mile for PIH https://www.pih.org//article/mojela-masupha-rides-extra-mile-pih When Mojela Masupha was a site administrator for two rural health clinics in Lesotho, he needed a way to travel over steep mountain trails and rugged terrain. 

It wasn’t easy to meet village leaders, collect blood samples, carry medical supplies, and more, in some of the most remote areas of Lesotho, a high-altitude nation surrounded by South Africa. Cars weren’t feasible. Neither was walking the long distances between villages, or flying frequently by small plane or helicopter.  

So, Partners In Health trained Masupha to ride off-road motorcycles—and a new passion was born.

“It was my first time riding a bike on my own, and it was a dream come true,” Masupha recalled. “It has since become a lifelong habit—so much so that in my spare time, I teach people how to ride with discipline.” 

Masupha, 36, now works in the Maseru office as a human resources coordinator for Bo-mphato Litsebeletsong tsa Bophelo, as PIH is known locally. Along with his supervisor, Human Resources Manager Tholoana Mohapi, he is one of the longest-serving members of PIH’s team in Lesotho. Masupha was hired in 2008, about a year after PIH began supporting Lesotho’s Ministry of Health.  

Mohapi said Masupha’s personality makes him a natural fit for human resources.   

“He is passionate about the work we do, and once he is convinced about any new intervention or strategy, he runs with it, with strong commitment,” Mohapi said. “He’s a people person. He interacts with people with ease and is able to disseminate needful information to staff and other partners skillfully.”

Masupha began his PIH service at the mountain clinics, spending two years at Nkau and a year at Nohana before joining the Maseru staff in 2011. Getting around in Maseru, Lesotho’s capital, is a little easier than it was in the mountains. But Masupha still has a bike parked outside the office, and another one at home. 

He especially enjoys riding with his two sons, ages 5 and 12. 

“I ride my bike almost every day to work and my youngest son is thrilled by bikes,” Masupha said. “I take him on short rides. My older son has just recently shown interest, after I took him for a good rough-terrain ride.”

Mohapi has worked with Masupha since he joined PIH. She said he gained far more than motorcycle experience during his time in the mountains. 

“That was where his leadership skills were groomed,” Mohapi said. “He proved himself to be an excellent, remarkable leader.”

Masupha also honed valuable skills in handling finances, supplies, transportation, scheduling and hiring, while supporting staff and community outreach. 

And he gained some memorable stories. 

Like when PIH staff in Maseru asked Masupha to travel to a remote village, about four hours from the Nohana clinic by horseback, to get a letter from the village’s leader. When presented to government officials in Maseru, the letter would enable a sick patient from the village to get a passport and cross the border into South Africa for specialized treatment. 

Co-workers who knew the area told Masupha that no one had ever reached the village by vehicle, including motorcycles. Nonetheless, he decided to ride his Honda. 

Moto
Mojela Masupha rides through the gate of PIH's office in Maseru, Lesotho, early in 2018. (Photo courtesy of Mojela Masupha)

The ride back turned out to be the problem. 

After reaching the village and getting the necessary papers for the patient, Masupha was returning to Nohana when the bike got stuck between boulders in a small stream at the bottom of a ravine, known as a “donga.” 

“I wrestled the bike with no luck, until I was sweating profusely,” Masupha recalled. “I had to climb out of the donga on foot and seek help.” 

Fortunately, some boys tending herds nearby agreed to lend a hand, and with much effort—and a few falls into the stream—they all were able to push the bike out of the ravine.  

“When I got back to the clinic, many were in awe that I made it,” Masupha said. “But in my head, I was just remembering that at PIH, we have a saying: We do ‘whatever it takes’ to see someone get the medical attention they need.”

Masupha said he thinks about that trip sometimes, when he’s riding along the paved roads of Maseru. It makes him think of how far PIH has come with supporting health care for all, over the years. 

Masupha has come far, himself. He was born in Maseru but his family is from Berea District, just to the north. He said he “grew up in a hospital setting,” as his mother was a nurse and he volunteered during high school at Queen Elizabeth II Hospital in Maseru. 

Masupha said when he saw the opportunity to join PIH, he jumped at it. 

“I thought, ‘This is what I’ve wanted to do for a long time,’” he said. “Even if I’m not a doctor, at least I could touch sick people somehow, and help them. It really satisfies me when I see a patient who is happy, who is healed, and know I had a stake in that.”

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Thu, 09 Aug 2018 15:39:25 -0400 https://www.pih.org//article/mojela-masupha-rides-extra-mile-pih
'That’s Where the Journey Begins': Data Specialist Starts Fellowship in Malawi https://www.pih.org//article/thats-where-journey-begins-data-specialist-starts-fellowship-malawi Themba Nyirenda was lying in bed at about 7 a.m. one morning this May, checking email on his laptop, when he got news he’d been hoping for since 2015. 

He immediately called his girlfriend, despite the early hour.

“You cannot believe what I’m looking at,” said Nyirenda, a 26-year-old data analyst who was living and working in Nairobi, Kenya, at the time. 

He was looking at an acceptance letter. And it was one that could be a game-changer, in terms of Nyirenda’s career, personal values, and life path.

The letter said Global Health Corps had named Nyirenda as a Fellow for its 2018-19 class. He’d join more than 130 other dynamic young professionals in the yearlong leadership development program, which focuses on providing health care for all and places fellows with partner organizations in Rwanda, Uganda, Malawi, Zambia and the U.S.

The letter meant Nyirenda would have to resign from his job, apply for a visa, travel to the U.S. in a month, and move back to his native Malawi for a year. 

He accepted right away.

Nyirenda will work with Partners In Health in Malawi’s rural Neno District, where PIH provides comprehensive care for more than 160,000 people through a network of hospitals, health centers and clinics. 

As part of the medical informatics team for Abwenzi Pa Za Umoyo, as PIH is known locally, he’ll help develop software to better track and manage patients’ medical records and data. 

Nyirenda has been working in informatics for several years. He’s from Karonga in northern Malawi, near the Tanzania border, and has a degree in business information technology from the National College of Information Technology in Lilongwe, Malawi’s capital. 

He was working for an IT service provider in Lilongwe in 2015, he said, when he became disillusioned with his professional track. Learning about Global Health Corps around that time gave him a broader view of career options.  

“I just came to realize that there should be more to my skills than just going to work and making profits for someone else,” Nyirenda said. “I didn’t really believe in it. I decided that I was never going to work for a private company again.” 

He decided to leave his job and go to the University of Malawi, for a master’s degree in informatics. He started the degree in late 2015 and expects to complete it by the end of this year.  

Nyirenda also applied for Global Health Corps in 2015. He wasn’t accepted—competition is steep; the nonprofit had more than 5,500 applicants for this year’s group of 134—so Nyirenda said he worked on his studies and continued to look for fulfilling professional opportunities.

He moved to Nairobi to check out the IT industry, in the bustling tech hub that’s been known for a decade as “Silicon Savannah.” An internship at an information technology company turned into a full-time job, mining social media data to help clients raise their brands’ profiles online. 

“Data is what I’m passionate about—to see the way everything comes together,” he said. 

But, of course, that was another private company. Nyirenda still was not satisfied with his work, and decided to reapply for Global Health Corps.

This time around—after two shortlists, three interviews and some nervous waiting—he made the cut, and got an email that May morning. 

“That’s where the journey begins,” Nyirenda said. 

Although his job in Nairobi wasn’t fulfilling, Nyirenda said, his co-workers there felt like family. That made it difficult to leave, especially so quickly. 

“The last days were not easy,” he said. 

Nonetheless, he packed up and took a bus from Kenya to Tanzania, then got a rental car. He had a tight schedule for a visa interview at the U.S. Embassy in Lilongwe, and drove hundreds of miles in two days to reach the Malawi capital. 

Some logistical hurdles arose, as can happen with international travel. But about a month after that fateful email, Nyirenda found himself in New Haven, Conn., in the U.S. for the first time, attending a three-week leadership training on the campus of Yale University. 

The training included community service work, group discussions and plenty of motivation.  

“I realized that leadership is not about the skills. It’s about the values that are in you,” Nyirenda said. “I was really inspired by the speakers that were there.”

Emily Wroe, chief medical officer for PIH in Malawi, said Nyirenda will help create positive change in Neno District. 

“He’s joining the team during a huge and key time for growth. Very exciting work is happening with informatics,” Wroe said. “I just emailed the team today on what a big difference in patient care some of the recent improvements made. Themba looks ready to go.” 

Ellen Ball, a software engineer on PIH’s medical informatics team, said she was very impressed by Nyirenda’s desire to work for social justice and determination to be part of Global Health Corps.

“He kept wanting to do more for the people of Malawi,” Ball said. “I love the persistence, and am looking forward to all we will learn from him.”

Nyirenda visited PIH’s Boston office in early July, just a few days before flying back to Malawi to begin his fellowship. 

“I feel that this is the beginning of my career in this field,” he said. “As for what comes next, I do not know. But what I hope to be doing is continuing what I do with PIH.”

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Thu, 02 Aug 2018 09:14:05 -0400 https://www.pih.org//article/thats-where-journey-begins-data-specialist-starts-fellowship-malawi
PIH Model Transforms Health Care, Saves Lives in Rwanda, Madagascar https://www.pih.org//article/pih-model-transforms-health-care-saves-lives-rwanda-madagascar The movement toward universal health care is growing—no matter the setting. 

Two new studies highlight incredible improvements in child and maternal health in Rwanda and Madagascar in recent years, showing repeated success, in very different environments, for Partners In Health’s ground-up model of building health systems and supporting universal care.  

Deaths of children younger than 5 dropped by nearly 20 percent in just two years in a poor, rural district in Madagascar—despite the island nation having the world’s lowest public health spending, per capita. Under-5 mortality in Ifanadiana District dropped from 104 deaths per 1,000 live births in 2014, to 84 per 1,000 in 2016.  

A similar transformation happened in Rwanda, which has seen a nationwide reduction in child mortality. This reduction was very notable in a region of about 400,000 people in Eastern Province, where Rwanda's government worked in collaboration with PIH. Deaths of children younger than 5 dropped 60 percent between 2005 and 2010 in the region, which includes Kirehe District and southern Kayonza District. Specifically, under-5 mortality fell from nearly 230 deaths per 1,000 live births in 2005, to about 83 per 1,000 in 2010.

Both studies also showed corresponding increases in births that occurred in public health facilities, rather than mothers’ homes; in prenatal care visits; and in postnatal care visits. All three of those gains represent lifesaving improvements for new and expectant mothers. 

Tahiri
Tahiri, a nurse on PIVOT’s Health Center team, measures the upper arm circumference of a child at Kelilalina Health Center, as part of the malnutrition screening that every child younger than 5 receives when visiting a PIVOT-supported health center. (Photo courtesy of PIVOT)

The results in Rwanda and Madagascar are detailed in two papers recently published by BMJ Global Health.

While Rwanda has been boosted by strong government support and a vast infusion of international resources since its 1994 genocide, Madagascar has been politically unstable and largely forgotten by the international donor community. 

Global health nonprofits PIVOT, in Madagascar, and Inshuti Mu Buzima, as PIH is known in Rwanda, led the efforts, in partnership with each country’s Ministry of Health. 

“The positive health outcomes in both Rwanda and Madagascar document our collective progress in reinforcing universal coverage, as both a moral imperative and an achievable reality,” said Dr. Paul Farmer, PIH co-founder and chief strategist, and a co-author on the Rwanda study. “PIH and PIVOT, in partnership with the Harvard Medical School Research Core and its affiliated faculty, are charting stronger, more equitable, mechanisms for improved care delivery.” 

A leader of that affiliated faculty is Dr. Megan Murray, who also is director of research for PIH and an example of how the teams behind the studies are interconnected. 

PIVOT is a mission partner of PIH, and was founded in 2013 by Drs. Michael Rich and Matthew Bonds. Both doctors were leading PIH’s work in Rwanda between 2005 and 2010, and later applied lessons from those years when starting work in Madagascar. 

Before they began that work in 2014, through PIVOT, questions arose in global health circles about whether a community-based, long-term model for building a health system could succeed in a southern Africa nation like Madagascar, which didn’t have strong government resources like Rwanda.
 
PIH and its partners have heard those kinds of doubts before. Similar questions arose years ago, when PIH began working toward expanding its model from Haiti and Peru to African nations including Rwanda. 

Dr. Joia Mukherjee, PIH’s chief medical officer, said questions about whether Haiti and Rwanda were exceptions to the usual barriers facing public health improvements are not helpful, ultimately, for conversations about creating a real, viable model for universal care. 

“What is helpful is to say: What can we learn?” Mukherjee said. “Why has Rwanda been so successful, and what pieces of the model are portable and can be adapted to other settings?”

PIH began working in Rwanda in 2005, at the invitation of the Ministry of Health. PIH’s initial efforts were focused in southern Kayonza and Kirehe districts, which had some of the worst health outcomes in the country, including high child mortality rates. 
Actions included renovations of health facilities; recruitment and training of local health staff; development of a medical record system; increasing child vaccinations and prenatal care for pregnant women; financial support for patients; and implementation of a community health worker system to help patients with HIV, tuberculosis and other chronic conditions, through daily home visits. 

Professor Agnes Binagwaho is a senior author on the new Rwanda study, and was Rwanda’s Minister of Health from 2011 through 2016. She also is on the faculties of both Harvard and Dartmouth Medical Schools, and is the vice chancellor of the University of Global Health Equity, a Rwanda-based university and PIH initiative that trains global health professionals from across the globe. “Through Rwanda's commitment to a universal right to health, we have continued to witness transformation that has rendered our country's health system an example for not only Africa, but for the world,” she said. “We embrace the shared vision and work of our partners in Madagascar. Together, we can pave the way to inclusive health systems that advance equity and health for all people.” 

BUTARO, RWANDA
Dr. Agnes Binagwaho (center) helps plant a tree commemorating the start of construction at the University of Global Health Equity in Butaro, Rwanda, on Dec. 10, 2016. (Photo by Aaron Levenson / Partners In Health)

About 1,600 miles south and across the Mozambique Channel, the island nation of Madagascar has a population of about 25 million, with low rates of HIV but significant health priorities including malnutrition, maternal health and tuberculosis.  

Results in the new Madagascar study cover PIVOT’s work from 2014-16, in the rural district of Ifanadiana, and represent the organization’s first batch of data-driven outcomes. 

Dr. Alishya Mayfield, senior clinical advisor on strategy for PIH, worked with PIVOT as a consultant for two years, and frequently traveled to Ifanadiana between 2015-17. 

“The challenges that PIVOT faced when they started working in Ifanadiana District in rural Madagascar were similar to the challenges that PIH has faced in most of the countries we’ve worked in,” Mayfield said. “They had some of the worst child and maternal health outcomes in the country.”

Mayfield said PIVOT took steps similar to steps PIH has taken in several countries, such as developing human resources by training and retaining staff, improving public health facilities and infrastructure, building reliable stocks of essential medicine, and reducing financial barriers to care. PIVOT and Ministry of Health teams worked primarily with four health centers and the district’s one hospital. 

In addition to fewer deaths of young children, they also saw a reduction in wealth-related inequalities, while overall use of the health system tripled.  

PIVOT and the ministry also developed the first public ambulance network in Madagascar. 

Ambulance
A PIVOT ambulance team responds to a referral call, transferring a sick patient from Kelilalina Health Center to the district hospital to receive a higher level of care. (Photo courtesy of PIVOT)

"A lot of these health centers in Ifanadiana are very remote. It's quite hilly, it can be dense jungle, there are large rivers, they have flooding and big storms, so it's difficult to get to a health care facility, for a lot of people,” Mayfield said. “So, early on they set up an ambulance system, and they worked with health centers they weren’t supporting to have a mechanism where those facilities could contact PIVOT and say, ‘We have a woman who's going into labor and she's having some complications,’ or, ‘We have an acutely ill child we needs a higher level of care.’”

The network includes designated meeting points on local roads. Patients whom an ambulance can’t reach directly can go to a meeting point and be picked up in emergencies.

“That's part of how they had a larger, district-wide impact, even while focusing on a small number of health facilities,” Mayfield said.

She added that the majority of health staff put in place through PIVOT are Malagasy.

“I think that has profound ripple effects over time, when you build capacity of the local staff,” Mayfield said. “And once the word gets out that you’re providing better care, and that services are being offered at no charge to people who can’t afford them, then more and more people come to the facilities for care.”

The success of that model is spreading beyond PIH and PIVOT sites. 

Mukherjee said shared lessons from empowering community health workers and strengthening care are also reflected in Mali, where health nonprofit Muso used a community-based model to drop child mortality from 154 deaths per 1,000 children to seven between 2008 and 2015. Those findings also were published by BMJ Global Health, in March.

“We have many groups around the world that we support,” Mukherjee said. “This is not an isolated phenomenon.”

Rich said the collective results are realizing a fundamental PIH vision, of working to achieve universal care.
 
“I think, all along, the overall goal of PIH has been to create a movement in global health equity,” Rich said. 

PIVOT Co-CEO Tara Loyd agreed.  

“PIVOT and Partners In Health ascribe to the same, unshakable philosophy – that no one should die of preventable illness,” said Loyd, who worked for PIH in Lesotho and Malawi before helping launch PIVOT in 2013. “Partnering with communities and governments, we have seen that it is possible to transform health care in some of the most challenging environments in the world.”

Rich added that while, globally, child mortality has fallen by half over about 25 years, Rwanda’s corresponding drop took just five years, in the catchment areas identified by the new study. 

“We actually can make a difference in the world and solve these problems,” he said.

Mukherjee described PIH as, “uniquely positioned to support countries in the delivery of care, to progressively achieve universal health coverage,” which is one of the United Nation’s Sustainable Development Goals. 

“A lot of people are talking about financing of universal health coverage. Many fewer people are talking about the delivery of care,” Mukherjee added. “We feel like we have something really important to add about delivery of care.”

Bonds said the studies reflect the broad scale and impact of PIH’s global work to improve health care for all. That work is poised for future collaboration between PIH, PIVOT and other partners. 

"This is equally about the culture of the global health movement and the practical tactics for impact,” Bonds said. "We will continue to build systems of care that work for everyone and prove that it’s possible and effective to provide care at the last mile. These papers have shone a light on the cumulative scale of what we have already accomplished, and the promising work we have yet to do.” 

 

PIVOT
The road to PIVOT's office in Ranomafana, Madagascar. (Photo courtesy of PIVOT)
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Mon, 30 Jul 2018 11:59:15 -0400 https://www.pih.org//article/pih-model-transforms-health-care-saves-lives-rwanda-madagascar
Treating Mind and Body: Mental Health Care Expanding in Lesotho https://www.pih.org//article/treating-mind-and-body-mental-health-care-expanding-lesotho It was a story no doctor wants to tell. 

But at Botšabelo Hospital in Maseru, Lesotho, during a recent training on mental health care, a doctor related the story of a man who had successfully completed two grueling years of treatment for multidrug-resistant tuberculosis, or MDR-TB—only to succumb to a different, devastating illness, that far too often goes unseen.   

That illness was mental, rather than physical, and likely involved severe depression. After beating MDR-TB by taking thousands of pills and enduring frequent, painful injections along with side effects including nausea, the patient was discharged by doctors at Botšabelo and returned to his home. 

It was only there that, unemployed and lacking a support system of family and friends, he took his own life. 

One-fifth of Lesotho’s 2.2 million people suffer from mental illness, according to a 2016 study led by Dr. Daniel Vigo of the Harvard School of Public Health, in work supported by PIH. That’s the highest rate of mental illness of any country in which Partners In Health works—but mental health is a need that crosses every border.  

Lesotho also has one of the highest HIV rates in the world, affecting one in four people. Infectious diseases such as HIV and TB, and their treatments, are significantly affected by mental health, and mental illness. 

“Mental health is the biggest total burden of disease, globally,” said Dr. Bepi Raviola, PIH’s director of mental health. “And diseases such as HIV and TB cannot be treated most effectively without considering mental health.”

That’s why PIH is ramping up its mental health programs in Lesotho and at PIH sites around the world, by training more providers to incorporate mental health into primary care and improving diagnosis and treatment for illnesses including depression, schizophrenia, epilepsy, and more.

Dr. Melino Ndayizigiye is clinical director for Bo-mphato Litsebeletsong tsa Bophelo, as PIH is known in Lesotho. He said the integration of care is vital in a country where the only mental health professionals are psychiatric nurses—usually just one or two for every 200,000 people, he added—and where many communities are in remote areas far from the nearest health facility. 

“We cannot separate treatment of mind and body,” Ndayizigiye said. 

Melino Ndayizigiye
Dr. Melino Ndayizigiye (left) speaks on a panel at a PIH meeting about non-communicable diseases in Beverly, Massachusetts, in October 2017. Ndayizigye is at the forefront of raising mental health awareness and treatment in Lesotho. (Photo by Zack DeClerck / Partners In Health)

The May mental health training in Lesotho, during which a doctor shared the tragic story of a patient’s suicide, was one part of an ongoing effort to bridge that gap, and followed a previous training there in August 2017. Dr. Stephanie Smith, associate director of mental health for PIH, led the first training session, while Dr. Todd Holzman, a Boston-based psychiatrist, led the second. Doctors and nurses participated at Botšabelo Hospital in Maseru, Lesotho’s capital, and at a regional hospital in the district of Mohale’s Hoek, south of Maseru. 

The trainings’ goals included raising clinicians’ awareness of mental illness among  patients and improving their diagnostic skills. They learned to screen patients and monitor progress, identify symptoms of depression during pregnancy, and recognize common mental health concerns among different age groups. 

Holzman said that, ultimately, much of the work is rooted in listening to patients, asking them how they’re feeling, and understanding the social and familial scenarios that can affect their health. Some people might show signs of depression that actually stem from medical conditions. 

“Be sure you eliminate that possibility before you initiate treatment,” Holzman said. “A depressed mood can be caused by a number of medical conditions, such as hypothyroidism, early pancreatic cancer, or Parkinson’s disease—to name just a few.” 

Dr. Lawrence Oyewusi, MDR-TB program manager at Botšabelo, said his staff appreciated the sessions.  

“It was an intensive training but interactive, where people were able to discuss, share their experiences and ask questions,” Oyewusi said. 

Staff at Botšabelo said some MDR-TB patients can exhibit severe depression or even psychotic behavior as a side effect of the powerful drugs, and depression also can affect patients’ families. Several doctors emphasized the need to strengthen mental health training and extend care not only to patients, but also to family members and caregivers. 

“Given that patients suffering with MDR-TB and HIV/AIDS are desperate, often depressed, and already taking more than a dozen medications daily, it is essential that we raise the capacity of health care providers at all levels to screen for psychiatric disorders, especially depression,” Ndayizigiye said.

Dr. Lawrence Oyewusi
Dr. Lawrence Oyewusi, shown at Botšabelo Hospital in April 2016, said his team will screen all of the hospital's multidrug-resistant tuberculosis patients for mental health disorders, which can accompany TB treatment. (Photo by Rebecca E. Rollins / Partners In Health)
File
Professional counselor Matseko Mokhamo looks for a file in Mohale's Hoek, Lesotho, in February 2018. Medical staff in Mohale's Hoek have participated in two extensive mental health training sessions over the past year. (Photo by Cecille Joan Avila / Partners In Health)
TB Drugs
Medications related to the treatment and side effects of MDR-TB sit on a shelf at Botšabelo Hospital in April 2016. Staff at Botšabelo say the long, grueling treatment for MDR-TB, along with high risk for co-infection, can create a significant risk for mental health disorders, such as depression. (Photo by Rebecca E. Rollins / Partners In Health)

Oyewusi’s team has a plan in place to screen all patients for mental health. He said that, anecdotally, depression is the most prevalent mental health disorder at Botšabelo, where patients struggle with two years of treatment coupled with high co-infection rates for HIV, diabetes, renal failure and more. 

He said the screening process will provide stronger data for rates of depression and other mental health disorders. 

More successful treatments and broader awareness about mental illnesses also could go a long way toward changing societal perceptions.

Smith told Botšabelo staff that stigma and discrimination against people with mental illness can create significant barriers to treatment.  

“Stigma can lead to neglect, physical abuse, denial of access to help and a violation of an individual’s human right to quality health care,” she said. “It’s important that we address stigma on all levels. Getting people the treatment they need, including successful reintegration into the community, demonstrates that mental disorders are treatable. That is one of the most important stigma-busting activities that we can support.” 

PIH is spreading that message on an increasingly large scale. 

PIH’s largest mental health programs are in Haiti and Rwanda, which each have more than 3,000 patients. Socios En Salud, as PIH is known in Peru, has expanded its program significantly in recent years and is piloting a safe house program, for example, that the government has adopted and is scaling nationally, to 350 locations. Compañeros En Salud, as PIH is known in Mexico, has incorporated mental health care since 2011, when it began operating in the mountainous region of Chiapas, and also has expanded its program in recent years. 

Mexico Training
Community Health Workers Elma Clara Salas Roblero, Celmira López López and Ernestina López Pérez (left to right) attend a mental health training with Dr. Fátima Rodríguez (not shown) in Chiapas, Mexico, in March 2017. (Photo by Mary Schaad / Partners In Health)
Rwanda visit
Members of the mental health team walk in Burera District, Rwanda, after visiting a patient at home in March 2017. Inshuti Mu Buzima, as PIH is known in Rwanda, has more than 3,000 mental health patients. (Photo by Cecille Joan Avila / Partners In Health)

PIH also is supporting growing mental health programs in Liberia, Sierra Leone, and Malawi. 

Often, that growth is from the ground up. Raviola said in most countries where PIH is supporting the development of mental health care, the field is not taught in medical or nursing schools. Nearly all patients have few, if any, options for treatment.  

“In the countries where we work, we’re often starting from scratch, but, in collaboration with local Ministry of Health teams, we’re making rapid progress in piloting effective, community-based mental health care delivery systems,” Raviola said. 

Additionally, in collaboration with a new Harvard University initiative called GlobalMentalHealth@Harvard, PIH is bringing together front-line organizations who are proving that mental health treatment can be delivered in low-resource settings. In June, Raviola and Professor Vikram Patel of Harvard Medical School— supported by the Harvard Medical School Center for Global Health Delivery-Dubai—led a meeting focused on increasing the role of community health workers in mental health care. Representatives from all PIH sites participated, along with leading researchers and members of nongovernmental organizations in India, Bangladesh and Pakistan. 

Oyewusi said that in Lesotho, improving the availability and quality of mental health care comes down to a universally common need: more resources. Specifically, he said, more “staff, space, supplies and systems.” That PIH mantra applies to health care delivery across the board, whether it’s for TB, HIV, maternal health or mental health. 

And the same motivation for that care—that health is a human right—applies to mental health as much as any other condition.

“People get better,” Raviola said, “and it has a truly remarkable and transformative effect on attitudes and beliefs.” 

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Tue, 24 Jul 2018 10:38:42 -0400 https://www.pih.org//article/treating-mind-and-body-mental-health-care-expanding-lesotho