Partners In Health Articleshttps://www.pih.orgPIH Calls for Continued U.S. Funding of WHO

U.S. Sen. Rand Paul of Kentucky has proposed an amendment to terminate all United States funds to the World Health Organization, a plan that would have disastrous consequences and further erode U.S. credibility globally.

We believe Paul's proposal comes at a disastrous time amidst the global fight against the COVID-19 pandemic. It also arrives on the heels of one of the most important World Health Assemblies in the 73-year history of the WHO, in which all 194 member states voted to promote an equity agenda supporting access to diagnostics, treatment, personal protective equipment for health workers, and an eventual vaccine in the global pursuit to contain COVID-19. This is vital work, which PIH supports and advocates for on the international stage.  

Now more than ever, we need global solidarity and collaboration to contain the spread of COVID-19 and ensure that the most marginalized and vulnerable receive preferential access to these collective global goods.

Call your elected official

Contact your state officials to voice your concern for Paul's plan and make sure this doesn't receive Congressional approval.

Look Up Your Elected Official

PIH Staff Picks: Essential Reading and Watching As You Stay At Home

As Partners In Health staff continue the organization’s vital work of strengthening health systems around the world—a mission that’s especially critical amid COVID-19—they’re drawing inspiration from a host of books and films. These stories of strength, struggle and perseverance reflect the passion for social justice that lies at the core of PIH and its work. PIHers around the world contributed to this list of recommended books and films—stories that uplift us during these uncertain times and shine a light on the challenges that they bring. We hope they can inspire and inform you, too.


Becoming
Directed by Nadia Hallgren

“An inspiring, joyful, honest, behind-the-scenes look at Michelle Obama’s book tour—this is a “must see” for all! I enjoyed reading the book. Seeing this behind-the-scenes account was even more inspiring. As we are faced with so much negativity and adversity around us, Ms. Obama brought hope and inspiration to my heart and soul!  A very inspiring & uplifting documentary. If you have the opportunity to watch, please do!”

—Mary Cooper, Accounts Payable Accountant, Finance


The Undocumented Americans
Written by Karla Cornejo Villavicencio

“I’m currently reading The Undocumented Americans—a beautiful, raw and, above all, honest account of what it means to be an undocumented person in America. Through a series of essays covering over a decade of reporting, Karla Cornejo Villavicencio tells the stories of people who are all too often absent from journalism and writing about immigration today. There are the “second responders,” undocumented workers who responded to 9/11, stories of underground pharmacies/botanicas in Miami catering to persons whose legal status blocks them from receiving adequate medical care, the struggle for acknowledgment—and clean water—via a state ID in Flint, Michigan. Through it all, she weaves her intensely personal story of struggles with mental health, love, life and hope as an undocumented American. Inspiring and highly recommended.”

—Matias Iberico, COVID-19 Strategic Planning Coordinator, Compañeros en Salud (PIH in Mexico)


LAVIL: Life, Love and Death in Port-au-Prince
Edited by Peter Orner and Evan Lyon

“Through the direct voices of residents of Port-au-Prince, Haiti, you can hear a heartwarming message of courage, hope, pride and determination. With the struggle, crises and hardship they have been through, that message that couldn’t be any more relevant for me as a reader than during this pandemic craziness.”

—Jean Claude Mugunga, Deputy Chief Medical Officer, Population Health Planning and Financing


The Worst Hard Time: The Untold Story of Those Who Survived the Great American Dust Bowl
Written by Timothy Egan

“A powerful and highly engaging narrative about the Dust Bowl, Egan’s work tells the tale of the people who stayed and survived in Oklahoma through the 1930s. A tribute to their courage and the power of the human spirit, this book is also a frightening documentary of the damage that misguided government policy can do to an ecosystem, public health, and society itself.”

Andy Wilson, Chief Development Officer, Development


Deported
Directed by Rachèle Magloire & Chantal Regnault

“This interesting documentary touches upon social justice, immigration, culture and identity. The film follows several Americanized Haitians—who have never been to Haiti and are unfamiliar with the culture and language—before and after their deportations, capturing their struggles as they try to adapt to their new environments. Deported highlights the discriminatory policies within the American justice system toward foreign residents with minor offenses. Today, despite the COVID-19 pandemic, ICE continues to deport Haitians—some who have tested positive for the virus—putting the Haitian population at higher risk for transmission. This is a growing concern among human rights advocates as the number of COVID-19 cases continues to rise in Haiti."

—Coralie Noisette, Senior Development Officer, Zanmi Lasante (PIH in Haiti)

 


On Fire: The Burning Case for a Green New Deal
Written by Naomi Klein

"This collection of longform essays by journalist and non-fiction author Naomi Klein offers a detailed, powerful, and accessible account of the climate crisis, possible solutions, and its inevitable effects upon all members of society, but particularly on the most marginalized. With an eye toward the systems and practices that have created this crisis, Klein captures the deep-seeded need to fight this issue, not just for Earth, but for ourselves.  As we face a crisis of our own that requires sacrifice, expert consultation, and broad cooperative action, Klein's viewpoint and catalyzing words hopefully will serve for inspiration to come out of the COVID-19 crisis with a mindset toward rebuilding our systems with a sustainable focus.”

—Will Cleveland, Liaison Officer and Partnership Coordinator, UGHE, Rwanda


Long Way Down
Written by Jason Reynolds

“This book simply demands that you give it your full attention and read it cover to cover in one sitting. Written in verse, Long Way Down melds the power of poetry with the capacity to cultivate compassion in a way that is unique to narrative storytelling. Touching on the themes of racial justice, courage, and resilience, this book will leave a lasting imprint in your mind and heart.”

—Lauren Spahn, Senior Advisor to the CEO


Taika Waititi, Global Stars to Read Roald Dahl Classic to Benefit PIH

Partners In Health is thrilled to announce that Oscar-winning filmmaker and actor Taika Waititi will lead a glittering line-up of global stars in a multi-week reading via YouTube of the Roald Dahl classic James and the Giant Peach, to benefit PIH’s global work and response to COVID-19.

In the 10-episode series, the Thor: Ragnorak director will lead viewers through the beloved children’s story with help from megastars, including: Meryl Streep, Ryan Reynolds, Benedict Cumberbatch, Cara Delevigne, Chris and Liam Hemsworth, Cate Blanchett and Lupita Nyong’o.

The first two episodes are now available on the Roald Dahl YouTube channel. New episodes will be released every Monday, Wednesday, and Friday at 1 p.m. EDT.


Viewers will be encouraged to donate. The Roald Dahl Story Company has committed to matching the first $1 million donated and has a history of supporting PIH’s work. Ophelia Dahl, PIH co-founder and board chair, is the daughter of Roald Dahl, who was among the organization’s first supporters.

He believed deeply in the power of imagination to fuel important change, whether a vastly better health system, a more effective vaccine, or jobs for the most vulnerable,” Dahl said of her father. “Creativity and partnership are at the root of our organization.”


The campaign will support PIH’s critical work globally in the fight against COVID-19. Having successfully confronted infectious disease outbreaks for more than 30 years, PIH is uniquely positioned to respond to COVID-19, building on deep experience in treating epidemics and responding to emergency situations around the world.

In addition to its global efforts, PIH recently announced the expansion of its national efforts to fight COVID-19 with the launch of a new unit aimed at helping under-resourced public health entities in the U.S. build and refine contact tracing programs. The U.S. Public Health Accompaniment Unit follows the launch of PIH’s Community Tracing Collaborative  in Massachusetts.

PIH knows that the best way to defeat any new disease is to rely on and invest in local health systems that deliver high-quality, dignified care. Through health system strengthening and long-term partnership, PIH offers an antidote to despair and demonstrates that injustice has a cure.

PIH to Support COVID-19 Response Across U.S.

Despite its vast clinical infrastructure, the United States’ struggle to respond to COVID-19 has exposed weaknesses in the public health system, which are proving to be particularly devastating for vulnerable populations. For the past three decades, Partners In Health (PIH) has been at the forefront of global health interventions in the most resource-poor settings around the world, including widespread response to epidemics such as HIV, tuberculosis, cholera, and Ebola.

When the novel coronavirus pandemic swept the globe in early 2020, PIH was asked by the Commonwealth of Massachusetts to mount an unprecedented contact tracing initiative to help local boards of health cope with the expected surge of positive cases of COVID-19, the resulting disease.

PIH recognized the opportunity to share its decades-long and unique expertise with many U.S. partners, who are desperately struggling to implement complex interventions such as contact tracing not only to flatten but to shrink the curve of the virus, help protect communities and health care workers, and return to normal life.

A Vision For the Future

Since its very beginning, PIH has brought the benefits of modern clinical expertise to the most resource-poor settings around the world. Over the years, PIH has built, in close partnership with local ministries of health, a vast and unique experience implementing nimble and effective public health interventions.

PIH leaders have always known that such experience could be valuable to many other governments across the globe, including resource-rich nations like the U.S. The replication of those hard-earned lessons at the global level is the ultimate step in PIH’s theory of change, which is built on the integration of direct provision of care, rigorous research, and professional training.

This moment is a perfect opportunity to shift the paradigm of global public health towards an inclusive and equitable redistribution of health resources.

And that is why PIH is launching the U.S. Public Health Accompaniment Unit, which will engage U.S. government agencies, local jurisdictions, and their implementing partners with two interrelated components: 1) direct technical advisory services and 2) a newly formed Learning Collaborative.

Caring for a Campus: Nurse Andre Ndayambaje Leading Health Services at UGHE

Andre Ndayambaje said the first baby he ever held was his sister’s—in a tragic setting that he will never forget.  

“It was during the 1994 Genocide against the Tutsi in Rwanda, and my sister gave birth in the forest,” Ndayambaje said. “It was raining and cold, and I didn’t know what to do when I held the newborn covered in blood. We were saved by the loud sounds of my crying for help. From that moment, I wanted to be a nurse or midwife, someone who could help another in times of need.” 

Ndayambaje has more than fulfilled that ambition.

Andre Ndayambaje trains a midwife in newborn care
Andre Ndayambaje teaches a midwife how to help a newborn baby breathe.

He’s worked for 11 years as a senior nurse midwife in critical care units, providing neonatal care, and has been a master trainer, educator, activist, and project manager for maternal and newborn health programs. He’s held executive positions with organizations supporting nurses, including serving as president of the Rwanda Association of Neonatal Nurses. And he’s a 2019 graduate of the master’s in global health delivery program at the University of Global Health Equity (UGHE), a Partners In Health initiative in northern Rwanda.

Now, as UGHE’s health services coordinator, Ndayambaje provides mental and physical checkups for the nearly 100 staff, students, and faculty living on the university’s campus in the rural community of Butaro.  

As the world celebrates International Nurses Day, the World Health Organization continues its ongoing Year of the Nurse and Midwife, and, of course, amid the global COVID-19 pandemic, the role and contributions of nurses like Ndayambaje have never been more important.

Ndayambaje said the pandemic has revealed the extent of nurses’ and midwives’ work, and their vital roles in health care.

“It has greatly added to the workload for nurses and midwives,” he said, of COVID-19. “Mothers are still coming for care as the cycle of life continues, and nurses are still handling other conditions (and) routine health problems, on top of caring for patients with COVID-19. It doesn’t go away in times like these.”

Personal sacrifices to keep patients safe also are increasing, unfortunately, during the global battle against COVID-19.

“There are nurses in almost every country who have lost their lives at the hands of this pandemic, nurses suffering physical and mental hardship in the face of long hours and emotionally draining patient circumstances, and nurses’ families who will suffer either the absence of a mother or father, or else risk increased exposure to transmission at home,” Ndayambaje said.

Andre Ndayambaje, center, with colleagues in eastern Rwanda
Andre Ndayambaje, center in black jacket, stands with colleagues while serving as a maternal and newborn specialist for a USAID project in Rwanda's Eastern Province. 

But that doesn’t change his dedication, or his optimism.

“As a nurse-midwife, I feel so proud of my colleagues across the world who are reaching patients where others don’t dare to reach,” Ndayambaje said. “By fostering collaboration between health workers, investing in fragile health systems, and providing the right tools to nurses on the frontline, we will beat this virus, and outbreaks to come.” 

Read more about Ndayambaje and the university’s new Center of Nursing & Midwifery, via UGHE.

UGHE Student Mothers Balancing Studies and Family, Amid COVID

Balancing full-time academics and raising a family is hard enough. Amid the global COVID-19 pandemic, student mothers at the University of Global Health Equity, a Partners In Health initiative in northern Rwanda, are facing additional pressures and difficult decisions felt by families everywhere: How to continue studies while also supporting children and spouses who live far away, including in different countries; whether to stay on campus or return home; and above all, how to keep themselves and their loved ones healthy and safe.

For Mother's Day, three UGHE students share their stories of perseverance amid the pandemic, and how they are working harder than ever to become future global health leaders. Their full profiles will be shared Sunday by UGHE. Here, we present introductions, of Sosina Dessalegn, Salome Sijenyi, and Grace Chinelo Okengwu. 

New Mom Holding Baby Daughter Close After Early Birth in Liberia

As Liberians celebrate Mother’s Day throughout May, on different dates according to different religious leaders and churches, one new mother in particular is thankful for her first child and newfound joy.

Because for Jacqueline Bedell, 23, motherhood did not come easy.

Bedell was six months pregnant when she visited Pleebo Health Center, one of the facilities supported by Partners In Health in southern Liberia’s Maryland County. Pleebo District is home to more than 55,000 people, who visit the health center for care and treatment in areas ranging from hypertension and diabetes to tuberculosis, HIV, and emergency needs.

Bedell was visiting for her regular prenatal checkup, part of the health center’s maternal and child health services. Her visit became far from routine, though, when clinicians diagnosed Bedell with preeclampsia, a condition associated with high blood pressure during pregnancy.

World Needs Public Health, Nursing to Lead Way in Global Pandemic

This is not the celebratory Nurses Week I had imagined for 2020. This being what the World Health Organization named the Year of the Nurse and Midwife, I had visons of a week filled with celebrations and social media highlights of the amazing nurses who work at Partners In Health (PIH) globally. This year will instead be remembered as the time of the COVID-19 pandemic and talk of isolation, quarantines, and a different life for all of us. 

All over the world, we are seeing people honoring and celebrating nurses and all frontline health workers. There are music, lights, horns blowing, and pots and pans making a cacophony of sounds every evening in some cities—all to pay respect to our essential workers. The word “hero” is being used a lot, fitting I think in many circumstances.

But there is also an uprising of health care workers who do not want to be called heroes; they want a safe place to work and provide care for their patients. These frontline workers make sacrifices every day. There are many things that cannot be controlled in a health care environment, but access to protective equipment is not one of them. This can happen with the right strategy, planning, and prioritization by those in power.  

We also need to acknowledge and give thanks to all of the frontline workers who are risking their lives, including those who work in stores, those harvesting and hauling our produce, firefighters, police, and countless others who make the machinery of our lives function. 

COVID-19 and health disparities

The United States spends the most per capita on health care, yet trails other countries in many health indicators, including life expectancy and infant and maternal mortality. The disparities that underlay those statistics—such as access to care along racial and economic lines—are becoming even more pronounced during this pandemic. People living in small spaces with many others are not able to safely quarantine or isolate themselves if exposed or infected with COVID-19, leading to high rates of familial transmission. Food insecurity and the reliance on public transportation are most likely increasing risk for infection, while the disappearance of many service industry jobs is further compounding the disease’s assault on communities.

COVID-19 is not the great equalizer, and those who say viruses are equal opportunity infectors are wrong. APM Research Lab is tracking mortality rates from the 38 states that are releasing that data. The existing data are deeply disturbing and reveal deep inequities by race, especially for Black Americans. The latest available COVID-19 mortality rate for Black Americans is 2.3 times higher than the rate for Asians and Latinos, and 2.6 times higher than the rate for Whites. 

patient is tested for COVID-19 at a shelter on Navajo Nation
A patient is tested for COVID-19 at St. Joseph's Shelter on the Navajo Nation. Photo by Robert Alsburg / COPE

We also know that Navajo Nation has been severely impacted. As of May 4, the Navajo Nation had reported a total of 2,373 cases and 73 confirmed deaths from COVID-19.  With a rate of 46 deaths per 100,000 people, the tribal nation has a higher coronavirus death rate than every state in the country except New York, New Jersey, Connecticut, and Massachusetts.  PIH’s sister organization, Community Outreach and Patient Empowerment (COPE), is working hard to provide support to the Navajo Nation.

For the first time, many people in the U.S. are worrying about whether hospitals have enough ICU beds, whether their loved ones working there have enough gloves and masks to protect themselves, and whether they themselves have enough food at home as income evaporates. These worries have always existed for vulnerable populations living in this country, and even more so for those who work in the PIH global sites in Africa and Latin America. 

Global North learns from Global South

With the first reports of the arrival of a new virus, we at PIH looked to our global experts in Rwanda, Haiti, Peru, Liberia, and beyond for guidance in responding to this pandemic and lessons learned from others. Rwanda has an aggressive COVID-19 strategy and has had a lot of success keeping transmission under control with comprehensive public health measures. Our colleagues in Haiti treated and hunted down cholera in 2010. In Peru, our community health workers conducted contact tracing for multidrug-resistant tuberculosis cases and prevented countless deaths. And to eliminate Ebola in Libera and Sierra Leone, we employed survivors who helped track down the virus’s spread in their communities to stop transmission and end the epidemic there.

nurse puts on protective equipment before treating Ebola patients in Sierra Leone
Nurse Musa Sillah, who grew up in Sierra Leone and returned to the country to help PIH combat the Ebola epidemic in 2015, dons personal protective equipment at a treatment unit. Photo by Rebecca E. Rollins / Partners In Health

Technology is great; we push for access to the best tools to monitor and evaluate care. But these tools can only support the most crucial players in the battle against a global pandemic—human beings.  At times of stress, sadness, and fear, we all seek human connection, compassion, and empathy. There is no app for that.

In the vast majority of PIH sites, we do not have access to ventilators, but are doing the best we can while we continue to fight for more. Alongside our colleagues in the ministries of health, we are working hard to improve hospitals and make sure there is 24-hour electricity, running water, oxygen, and essential medications to try and stabilize critical patients.

But we are not there just to respond to COVID-19. We have already been there for years, in some cases decades, because PIH made a long-term commitment to the countries where we work. And we will stay there, as long as we are needed. Just as with HIV, TB, Ebola, and other challenges to the health system, we need to fight the immediate danger in front of us AND continue to build or strengthen national health systems. 

Lessons from a pandemic

When working in West Africa during the 2014 to 2015 Ebola outbreak, home was a place of refuge for me each night. This feels very different to me now, as home can feel often like a fortress to keep the world out and not a place for rejuvenation. This has increased my awareness of and empathy for my colleagues, whose homes are in the communities where we work globally. As much as I thought that I had appreciated the duality of working and living in the same place in the midst of an epidemic, I know now that my experience was surely different than my West African colleagues. Just as we turned to our colleagues to teach and guide us through large-scale contract tracing, I am also relying once again on my mentors and teachers from PIH country sites to learn how to respond to crises in my own backyard.

Dr. Sheila Davis consults with colleagues during the Ebola epidemic in West Africa
Dr. Sheila Davis (center), PIH's CEO and an expert nurse, and Dr. Anany Gretchko Prosper, who led PIH's Ebola response in Liberia, speak with an MSF colleague during the epidemic in October 2014.

As the pandemic has run rampant throughout the U.S., it is painfully apparent that this country is ill-prepared, despite spending the most on health care in the world. Our health care system has been built around high-tech solutions in elaborate hospitals that provide the most advanced level of acute care. There is no doubt that that is very much needed. But what we do not have is a robust public health system that can identify and address pathogens and illnesses where they appear—within the community. We need a system that strives to address health and illness and relies on an interdisciplinary team to provide care in people’s homes, schools, places of worship, and community gathering places.

Lilian Wald & Florence Nightingale

We need Lilian Wald. Lilian was a 26-year-old nurse who settled in the lower east side of New York in 1893 and who, two years later, opened the Nurses Settlement (later called the Henry Street Settlements). She believed that poverty was the result of societal structural forces and worked with the most vulnerable communities to connect them with health care. She saw people in their homes, saw their challenges, and fought to provide a dignified approach to care for all.

Lack of access to clean water, electricity, food, and quality health care is not just an example from Lilian’s days; it is an issue in the U.S. and globally today. We need a strong public health nursing presence today during COVID-19 and long after.

For decades our public health systems have been defunded and dismantled. If there is even a sliver of a silver lining to this pandemic, it is that a light has been shown on the U.S.’s lack of a comprehensive health care model that connects a community to a clinic to a hospital and back again. We need health care that is embedded in communities as the norm. Epidemic control is local and needs local solutions supported by a strong network at the state and federal levels. We need excellent hospitals, but as a part of a continuum of care delivery, much of which can be done more effectively, efficiently, and less expensively in the community.  

Nightingale fellows at graduation ceremony in Boston
The first graduates of PIH's Nightingale Fellowship, which provides professional development for global nurse leaders. From left to right: Viola Karanja, Graciela Cadet, Angeline Charles, and Emmanuel Dushimimana.

Nursing as a profession must answer this call. Let us lead the way and shift the locus of health care away from the hospital and bring it back into the community. Lilian would be proud.

May 12 is the birthday of Florence Nightingale, the modern-day founder of nursing, and the last day on which we celebrate Nurses Week. On that day, I will stop, remember her and Lillian Wald, and think about the PIH nurses and midwives who are working hard combatting COVID-19 and delivering all of the other amazing care they provide every day.  I will then do what nurses always do—I will go back to work. 

Q&A: Combating Sierra Leone’s Maternal Health Crisis Through COVID-19

As the novel coronavirus continues to spread, patients aren’t just at risk of contracting its resulting illness, COVID-19. They also face higher risk for all other health issues, as many facilities must divert resources from routine medicine to emergency care. What’s more, COVID-19 is preventing families from seeking the care they need. Fear of the virus is spreading alongside the virus itself—and could prove just as deadly.

Expectant mothers across the globe find themselves uniquely impacted by these new barriers to health care. Nowhere in the world is the situation more acute than in Sierra Leone, where a woman’s lifetime risk of dying in pregnancy or childbirth is already 1 in 17 during non-pandemic times—the world’s worst maternal mortality rate.

Isata Dumbuya, a nurse midwife and manager of reproductive, maternal, neonatal, and child health for Partners In Health in Sierra Leone, has been working to combat these barriers in the maternity wards at PIH-supported Wellbody Clinic and Koidu Government Hospital in Kono District. Last year, the facilities provided more than 2,200 safe deliveries—a number that rises annually.

Isata Dumbuya stands in the maternity ward at Koidu Government Hospital. Photo by John Ra  / Partners In Health
Isata Dumbuya, pictured in the maternity ward at KGH.  

COVID-19 case numbers are also rising. PIH has been preparing Kono for a possible outbreak, as well as assisting the government with national response efforts, as the number of known cases increases past 200 in the country of seven million people.

“What we don’t want,” Dumbuya said, “is fear of COVID preventing women from coming into the hospital to access normal services that would improve their health and prevent them from having other morbidities that have nothing to do with COVID.”

We caught up with Dumbuya to hear more about the intersection of a longstanding epidemic—maternal mortality—and the new pandemic of COVID-19, and the measures PIH is taking to fight even harder to protect women and infants in Sierra Leone.

What impact has the coronavirus pandemic had on maternal health at Wellbody Clinic and at Koidu Government Hospital?

Dumbuya: Like most of the departments in the hospital, we did see a reduction in the number of women who came in, primarily for prenatal care. They are probably thinking, "This is not an emergency. I'm well, and I would rather save myself a journey into the hospital." Because there was a lot of uncertainty and fear around coronavirus, there was a common misconception in communities: "Don't go to the hospital." Women who might want to come for prenatal checks were being told, "Don't come."

We also saw, in the initial periods at least, that women who did come into the labor ward were much further along in their labor than we would like, so we didn't have a lot of time to monitor them or put interventions in place to have a better outcome. Women come in late most of the time, but this was just getting to later, critical stages, and there were fewer of them. For the first couple of weeks, almost every woman who came in ended up with a cesarean section.

A delivery room at Koidu Government Hospital. Photo by John Ra  / Partners In Health

And were fewer patients arriving for care generally at the hospital?

Before, you would come into Koidu Government Hospital and there's usually a crowd of people. Some are patients, some are waiting, some have accompanied patients. That stopped. The few that had to come in were the ones that had no choice. And when they came in, they came in with one person. Usually the average rate of accompaniment is three people per patient. They were coming in with one person at a time and trying to get out as soon as they possibly could.

That was the same during Ebola, too. Most people in Sierra Leone never had Ebola, but were dying from malaria, tuberculosis, HIV, car accidents—everything that was affecting people before Ebola.

But it's getting better. We're getting more women to come in. We’re almost back to normal. In the prenatal clinics, especially at Wellbody, the numbers have started to increase. It's good to see that they're willing to come back. Patients are walking back in and seeking care, which is one of the things that we feared the most, one of fallouts: "These people are not gonna come to the hospital, and when they do come, they're gonna be critically sick, and we're gonna have more and more poor outcomes."

Pregnant women wait for their prenatal care appointments at Wellbody Clinic in 2018. Prenatal services at the clinic saw a drop in patients after COVID-19 was confirmed in Sierra Leone. Photo by Emma Minor / Partners In Health
Pregnant women wait for their prenatal care appointments at Wellbody Clinic in 2018. Prenatal services at the clinic saw a drop in patients after COVID-19 was confirmed in Sierra Leone. Photo by Emma Minor / Partners In Health

Before coronavirus, you were going out to the different chiefdoms around Kono District to educate community leaders and families about the services available at KGH and Wellbody. Have you been doing any outreach since the coronavirus pandemic started?

I was really lucky to be part of the engagements with community health workers and other community stakeholders, explaining step-by-step what coronavirus is, the impact that it's having all over the world, how we are preparing to minimize the potential for us experiencing the same level of infection and death. And also just trying to get people to understand that the hospital is still open. Having that interaction, it allayed a lot of the people's fears. It generated a lot of questions. They seemed to understand a lot more about COVID by the time we were done and were willing to take the message forward and say, "Now we know, we are also less fearful, and we will let our people know and encourage them, 'You have to come to the hospital.'"

Maternal mortality in Sierra Leone has been an emergency for decades for women and children. What would you say to those who may be worried about COVID-19’s impact on plans and strategies to radically reduce maternal mortality?

With COVID, yes, this is the foremost thing, not just in Sierra Leone, but in the whole world at the moment. But there will be life after COVID. Maternal mortality in Sierra Leone still continues to deteriorate despite COVID, until we get more and more structured systems in place.

We're still pushing forward and realigning our plans with COVID. We're getting more and more ideas about things that we perhaps hadn't thought about or hadn't put very high on the list. We need more isolation units. We need more staff trained in high-dependency care. We're going to need more equipment, so that in the future, whether it's COVID or anything similar, we need to build in more critical care intervention for pregnant women.

The maternity ward at KGH, empty of patients.
The maternity ward at KGH during an abnormally calm weekday with few patients. 

One of the biggest differences between coronavirus and Ebola times is that health care in Kono has come such a long way; patients will still have access to the care they need in a way they didn’t during Ebola. What are some of the standout improvements you've seen in the maternity wards and in reproductive and maternal and child health care in Kono since you arrived?

There's so much. I remember when I first started here in 2018—the difference from then to now with staff motivation. We've had a few new staff, but most of them I met when I started. They now come to work because they really want to. They come in determined to do a great job and to enjoy doing their job.

We recently did a weeklong training, because we're opening up a high-dependency unit in maternity. This is also something new. We are able to look after critically ill women in a dedicated space—with staff that are now happy to come to the training. There’s a higher level of motivation, of pride that they take in their work, and of interest.

A woman recovers in the maternity ward at Koidu Government Hospital.
A woman recovers in KGH's maternity ward. 

That transformation makes sense—going from having no resources and not being able to intervene to save a woman’s life to having resources, training, supplies, electricity, and a blood bank.

Women should not die in pregnancy. She should not die when she comes to give birth. This is not something that we should just take lightly anymore. This is something that we should do everything, with the resources, knowledge, finances that we have, to prevent from happening.

What's keeping you motivated and energized during this moment?

Every day I come in to work determined to support the staff I'm working with, both PIH staff and the Ministry of Health, to do the best they can in terms of patient care to help women and babies. The care that we give is intended to not just save lives, but also to improve their whole reproductive journey, to make it special and different from anything they've ever experienced.

Meet the Mental Health Warriors of Sierra Leone

At Partners In Health (PIH)-supported Koidu Government Hospital (KGH) in Kono, Sierra Leone, PIH’s mental health care team gathers in their office, the walls covered with evidence of their work: posters detail their schedules and contact information; fliers bear educational messages about the hospital’s mental health care services; and shelves reveal tomes of records for each patient they’ve treated.

Their efforts began just over one year ago, but have already made a world of difference.

In partnership with the government of Sierra Leone, PIH formally established mental health care programs through KGH and nearby PIH-supported Wellbody Clinic in February 2019. The mental health team—comprised of eight community health workers (CHWs) trained in mental health care, three psychosocial counselors, a program manager, and a psychiatrist—works to destigmatize mental health conditions within communities around Kono and provide essential therapy and medication to people living with conditions like depression, psychosis, and bipolar disorder.

Posters in the mental health office at KGH
Posters destigmatizing epilepsy--which falls under the purview of mental health in Sierra Leone--and encouraging  people to pursue care like group therapy hang in the mental health office at KGH.

Such services had never been as robustly available in Kono, an eastern district located hours away from Sierra Leone’s only dedicated mental health facility in the capital of Freetown. Beyond the biological roots of mental health conditions, which disregard history and geography, Kono’s population of 500,000 contend with ongoing trauma from Sierra Leone’s decade-long civil war, historic Ebola outbreak, and day-to-day reality of extreme poverty.

As the mental health team supports individuals and their families during regular home visits and connects patients with the district’s first and only psychiatrist, more people than ever before are accessing the care they need to live independent, healthy, productive lives. By December of last year, more than 750 patients were receiving mental health care at KGH—up from 115 patients in December 2018.

Patient records at KGH
Patient records stored in the mental health office show that 2019 was the year with the highest volume of mental health patients receiving care at KGH to date.

Alongside the longtime need for mental health services in Kono, personal experience drives the work of each PIH mental health care provider in Sierra Leone. Below, meet some of the team members, and learn about the inspiration behind their efforts to make mental health care a human right.

 

John Kamara

*John Kamara, mental health CHW at Wellbody Clinic: I was an Ebola patient. I managed to survive with help from people really caring for me, spending their time with me, talking to me, building my confidence. That kind of love, and the hope and courage they built in me—it’s the same thing I want to extend to my patients. I was run down like them. I want to give back to them the mental support that was given to me.

Kumba Judith Conteh

Kumba Judith Conteh, psychosocial counselor at KGH: I was once a refugee. When the [civil] war broke out, my family and I went to Guinea. Being a refugee, you also have mental illness, because you leave your home forcefully and go to another man’s country. But people were caring for me; there were NGOs that were going around to talk to us about how to adjust to our situation as refugees. When I came home to Sierra Leone, I found myself in the mental health program. I’m really happy about it. I’m passionate about giving care to other people, helping somebody who is in need.

David T. Mafinda

David T. Mafinda, psychosocial counselor at KGH: During the war, as a refugee in Guinea, the Center for Victims of Torture’s program trained and employed me as a psychosocial counselor. When I came back to Sierra Leone, my colleagues from Guinea and I started a local version of that program. We called it the Community Association for Psychosocial Services. During Ebola, I volunteered as a counselor at Koidu Government Hospital. And this year, PIH came and took me on board as a full-time, paid staff member. This is my field—I love giving help to my people.

Mary Kargbo

Mary Kargbo, psychosocial counselor at KGH: I was one of the refugees in Guinea. Because I didn’t have any relatives there, and because of what I saw during the war, I wanted to kill myself. But I worked with some angels who taught me how to take care of myself and others, and when I returned to Sierra Leone, I was trained by the Center for Victims of Torture as a psychosocial counselor. I was a volunteer at Koidu Government Hospital, and then PIH hired me. I see myself in my colleagues and patients. I empathize with them and know the pain they are going through or have gone through, and that compassion drives me to take care of them. I know the benefits that mental health support gave to me, so I love this work and our program.

Lansana Kamara

Lansana Kamara, mental health CHW at KGH: I feel relieved to work on [mental health care with] my fellow human being, who to me has lost his senses and cannot concentrate. I enjoy working with such an individual to regain his consciousness. I feel passionate that if I achieve that, I will be rewarded in the kingdom of God.

Cathy Conteh

Cathy Conteh, community health officer at KGH: If we think about the horrors that have happened here—from the war in 1991 to the Ebola outbreak—and looking at our people, they have really been suffering. Now, with support from PIH, people have the knowledge that mental illness is a condition, just like malaria. It can be treated. Seeing people on treatment, who now fit into their community, they are really grateful.

 

*Comments were edited and condensed for clarity.

Going on the Offensive to Stop COVID-19

Global Situation in the Time of COVID-19

Recommendations for Next Stimulus Package -- Necessary Funds to Rebuild our Public Health Infrastructure

Closing non-essential businesses and services and implementing stay-at-home orders and lockdowns has not been easy. Yet these steps are working in flattening the curve and reducing the number of contacts that each person who tests positive has had. It is essential we take advantage of the time these measures have bought us, and fully implement four key elements of a robust public health response: testing, contact tracing, supporting those of us who have been exposed to successfully quarantine, and helping isolate and care for those of us who have the disease.

Moving too quickly to re-open non-essential services without all of these four key elements in place will spark a resurgence of the epidemic, cost more lives, and wreak even more economic damage than the first wave of this outbreak. Moreover, every state needs to implement these strong public health strategies in unison: failures to contain the virus in one state will impact all states. We thus urge the federal government to provide strong incentives for all states to invest in and rapidly scale these public health measures.

1. Testing

The slow ability to increase testing capacity nationally has been our Achilles heel in our ability to contain the spread of COVID-19 in the U.S. We are happy to see provisions of $25 billion for increased testing capacity in the stimulus package approved on Thursday, April 23rd, and hope that additional testing will come online rapidly in the upcoming weeks. All positive test results must be linked to public health surveillance database so that case investigators and contact tracers can do their jobs. Moreover, testing needs to be expanded in an equitable way, such that those communities with the highest numbers of cases and most vulnerable populations are prioritized.

2. Contact Tracing

We recently worked with U.S. Rep. Andy Levin and U.S. Sen. Elizabeth Warren to inform their Containment Corps strategy announced on April 22, focused on addressing the shortage of public health jobs for the long term and rapidly putting community members who lost jobs due to COVID-19 back to work for the public good.

Currently there are only 2,200 contact tracers on CDC payroll in the United States. Roughly 50,000 public health jobs have been lost since the Great Recession, and public health departments simply don’t have the resources to hire the people they need; in 2019, the federal government spent $265 million less on public health preparedness than in 2002.

What we’re left with is a hollowed out public health system that knows how to beat this virus, but doesn’t have the resources to do it. Short-term surge capacity for contact tracing must work to reinforce existing departments of public health in each state and incorporate federally qualified community health centers (CHCs), and link to their existing public health data collection systems, rather than creating a completely parallel, privatized system.

This is what Gov. Charlie Baker and the Commonwealth of Massachusetts’ Contact Tracing Collaborative (CTC) commenced on April 3rd.

Tech-enabled solutions for contact tracing, such as those announced by Apple, Google, and Novid, can be strong complements to the human-to-human components of the MA CTC approach. As stand alone solutions, the technology may have limitations, especially when it comes to helping to provide psychological first aid for people learning of their positive status or that they were in contact with someone who tested positive, and in linking contacts to necessary resources to ensure they can safely quarantine or isolate.

3 & 4. Supported Quarantine and Isolation

Identifying positive cases and their contacts is essential, but it is a first step. People who have been exposed to the virus, but who are not yet sick, need to be in quarantine for a minimum of 14 days. Those who become infected need to receive medical care and remain out of physical contact with others for three days after the resolution of fever, for a minimum of 7 days.

Many people need support—financial, material, medical and social—to successfully complete stints of quarantine and isolation. It is worth emphasizing that if people are unable to adhere to quarantine and isolation, and go on to infect others, the testing and contact tracing program will be  ineffective, and the outbreak will not be brought under control. It is imperative that people be given the supports they need to be successful in this regard.

Studies from past quarantines demonstrate consistently that quarantine and isolation failures are driven primarily by food and job insecurity. We anticipate people will require a range of supports including food and cash assistance, home delivery services, medical support, and social services like dependent care, mental health and substance abuse counseling. Careful attention to the needs of marginalized communities will be necessary. Social support specialists from communities with highest need and highest case burden should be hired to add to existing social worker numbers and work to identify community resources and connect each case and contacts to these resources.

Already the MA CTC is finding that people are afraid to receive calls from contact tracers due to their immigration status. Given the inequities that exist in our society, many immigrant communities remain key hot spots for coronavirus spread. All people currently in the U.S., regardless of their immigration status, must be treated equally and provided the same access to testing, isolation and treatment if we are to succeed in stopping the spread.

A further consideration is that many people’s homes are not conducive to quarantine or isolation. They are too crowded to avoid spreading the infection to others in the household, or they are not safe. Establishing safe non-residential quarantine and isolation facilities in local hotels and universities can further reduce transmission and should be considered.

We are in the process of modeling the costs of home and non-homed based quarantine and isolation, as well as the costs of not providing these supports. We expect federal investment in these measures will be well worth the price, given the alternative of the high cost in lives and livelihoods that will result from an unchecked epidemic, especially among our most vulnerable communities where we’re already seeing the correlation between poverty and COVID-19 transmission.

Financing the Public Health Response

The federal government can provide financing for the public health response in a number of ways. For example, channeling public health financing to states through expansion of TANF, SNAP, SSI, or Medicaid or other federally subsidized programs, or creating a new one, should be considered.

War Bonds are one potential mechanism we also think has potential. War Bonds are a funding concept that have enjoyed wide popularity since they were first issued in 1917, particularly in times when citizens are motivated to show their patriotism and willingness to pull together as one nation. Using the War Bond model, “COVID Victory Bonds” would be long dated (30 years) debt instruments issued in small denominations for the retail public and backed by the credit of the U.S. Government. The bonds would be issued at below face value, with little or no annual interest, but would be guaranteed to double in value on or before maturity.

Our proposal would be for the federal government to disburse this funding to states to distribute solely for the purposes of stopping the COVID epidemic. This would entail funding state-operated testing and contact tracing programs and providing funds for individuals asked to quarantine or isolate themselves, including sufficient subsidies for food and housing, means-tested income replacement, and a range of support services.

If you believe this is a solid plan for battling COVID-19 and funding a national response, please reach out to members of Congress and share this proposal.

Look Up Your Elected Official

Keeping the Flame: UGHE Student Reflects on Rwanda's Post-Genocide Growth

Orietta Agasaro is a student in the master's in global health delivery program at the University of Global Health Equity (UGHE), a Partners In Health initiative in northern Rwanda. 

When I think about what Rwanda has surmounted in the last 26 years, I’m reminded of a passage from A Tale of Two Cities by Charles Dickens: “I see a beautiful city and a beautiful people rising from this abyss. I see the life for which I lay down my life, peaceful, useful, prosperous and happy.”

I, like many others in my generation, have the immense privilege of enjoying security, peace, and freedom in my daily life. As I reflect on this year's Kwibuka ("to remember" in Kinyarwanda), the 26th annual commemoration of the 1994 Genocide against the Tutsi, I have a heightened awareness of what was sacrificed – toil, suffering and even lives – to put a stop to the genocide.

I was born after the 1994 Genocide against the Tutsi, and am one of the post-genocide generation acutely aware of the suffering endured by more than 1 million victims, and of those who compromised their health and even gave their life to end the violence. I am also indebted to the valiant men and women who have, in the years that followed, given their all for Rwanda’s rebirth and reconstruction. 

Unity, Community in Rwanda's Rebirth

Growing up, I remember being taught about the ethnic divide that led to the genocide, but also about the concept of Ndi Umunyarwanda ("I am Rwandan"). Ndi Umunyarwanda is a national program that aims to promote unity and reconciliation by encouraging conversation about the causes and consequences of the genocide, and about how to rebuild the country by focusing on the national theme, “Remember-Unite-Renew." 

Rwanda was able to advance significantly in its pursuit of unity and reconciliation through several home-grown solutions, implemented at the community level. Those include the gacaca (local community courts); abunzi (community mediators); itorero (youth civic education camps); ingando (solidarity camps); and many more. I had the opportunity to attend an itorero camp in 2015. It not only broadened my knowledge of Rwanda’s history, but also reinforced my Rwandan values, namely Ndi Umunyarwanda. 

UGHE students are participating in this month's Kwibuka remembrances with on-campus activities, discussions, and more.
UGHE students, staff, and faculty are participating in this month's Kwibuka remembrances with on-campus discussions and activities, including lighting candles to symbolize Rwandans' hopes for a bright future. 

The national adherence to, and application of, Ndi Umunyarwanda and home-grown solutions have driven Rwanda’s rapid and impressive development.

Looking at the milestones my country has achieved, I cannot help but feel overwhelmed by a sense of pride and thanksgiving. As a young woman, I take pride in knowing that women have been, and currently are, important actors in Rwanda’s reconstruction and development. It gives me hope and confidence for my future, and for the future of my female friends and classmates.

Gender Equity

In my country, the promotion of women is one of the many milestones birthed through this focus on unity, particularly in decision-making and leadership positions. Rwanda has been recognized globally for its tireless efforts in promoting gender equity across all sectors; we are proud to have the highest percentage of women in parliament anywhere in the world.

Our health sector is exemplary in this regard, and its systems were revived and rebuilt by many strong and resilient women in Rwanda, including UGHE’s Vice Chancellor, Prof. Agnes Binagwaho.

When she gave a lecture to my master's in global health delivery class, I was inspired by her clear dedication to improving health care delivery, upon returning to a devastated country and finding innovative ways to promote health for all, and especially for the most vulnerable, in the post-genocide era. Her lecture reminded me why I wanted to study global health delivery in the first place: to contribute to my country’s efforts to improve the health and well-being of the poor and vulnerable.

I also look up to other pioneers in the rebirth of our health system, including Rwanda's First Lady, Her Excellency Mrs. Jeannette Kagame; Dr. Yvonne Kayiteshonga, the national director of mental health at Rwanda Biomedical Center and the Ministry of Health; and the many, many female health providers and community health workers on the frontlines, who tirelessly work to improve the health of Rwandans daily.

UGHE at sunset
The national flag flies over the University of Global Health Equity in northern Rwanda, with Mount Muhabura in the background. April is an annual time of genocide remembrance in Rwanda. (Photo by Nick Carney / UGHE) 

Health Care for All

Rwanda’s strong national governance, paired with leadership at the community level, has been key in finding equitable health solutions that promote health care for all.

From the examples set by these women, I’ve learned that a focus on social justice and a strong moral compass are two cornerstones to success. With scarce resources, Rwanda has managed to transform a broken health system into one that is acclaimed worldwide, through its evidence-based, community-oriented, and equity-driven approach to health.

After the complete devastation the health system experienced in 1994, some would call it a miracle that 15 years later, more than 90 percent of all Rwandans were medically insured, with the poor receiving free health coverage through Rwanda’s Mutuelle de Santé (Community Health Insurance) program.

This achievement has been paired with significant national strides in reducing HIV and malaria rates, decreasing infant and maternal mortality, and increasing access to vaccination. 

Solidarity and COVID-19

The strength and effectiveness of Rwanda’s health care system is now more apparent than ever, as the country is tackling the COVID-19 pandemic.

The multiple measures the country has taken to protect its citizens are testaments to our government’s belief in the value of strong health systems. Additionally, the commitment of Rwandans across the country to follow recommendations from the Ministry of Health and the World Health Organization speaks not only of the importance of good leadership, but also of the values of Rwandans themselves.

Each year, Kwibuka is a time of national solidarity. This year, the Rwandan people stand in solidarity with one another, and with the multiple frontline health workers, police, immigration officers, ministries and health organizations working to combat this destructive virus. 

We can surely hope that if the country continues to deploy its efforts in combating this pandemic, alongside the world, we will undoubtedly win this battle, as we have won many battles before.

I feel a surge of pride for belonging to a nation as bright as mine, and a surge of hope for what the future holds for Rwanda. My hope is greatly inspired not only by Rwanda’s good leadership but also by Rwanda’s highly motivated and socially conscious youth, including my UGHE colleagues.

I admire the audacity that members of my generation have in bringing up difficult conversations, and their ability to find creative and critical ways to arrive at solutions.

Furthermore, these past couple of months at UGHE have shown me what is possible when brilliant minds, driven by humanity, join to contend for health equity. 

I feel a deep sense of responsibility to keep the flame that was lit by courageous Rwandan men and women burning. As a young woman and future global health leader, I strive to contribute to my country’s development by being an advocate for equity and social justice, by treating all with the same compassion shown by those who’ve come before me, and by ensuring that voices long silenced are finally heard.

This reflection originally was published by the University of Global Health Equity

PIH Breaks Ground on New ER Facility at Liberia Health Center

Construction has begun on a new emergency care facility that will dramatically improve care and services at Pleebo Health Center in Liberia—so much so, Joseph Lusaka said, that it will feel like a long-held, angry stare finally is looking elsewhere.

“We are committed to giving patients the health care they need with the resources we have,” said Lusaka, PIH’s senior physician assistant at Pleebo. “But the challenges of inadequate beds for people with acute conditions; a lack of gender-friendly spaces; not enough space for standard protocols, quick referrals in emergency cases, or prevention of infection during sterilization procedures; and a shortage of patient-examination rooms, always have been glaring at us.”

Construction of Pleebo’s new emergency facility is making that glare go away.

In collaboration with Liberia’s Ministry of Health and Maryland County Health Team, PIH recently broke ground on the new emergency care block at the PIH-supported Pleebo Health Center. When completed, the facility will expand Pleebo’s capacity to provide health services and treatment in a wide range of areas, including hypertension, diabetes, hepatitis B, tuberculosis, HIV, maternal health and child health, in addition to emergency needs.

PIH previously renovated Pleebo Health Center in 2015. The health center serves Pleebo District, which is the most populated in Maryland County and home to more than 55,000 people in southeastern Liberia. Because Pleebo also is a regional commercial center, people from the neighboring counties of River Gee and Grand Kru, and from the neighboring country of Ivory Coast, also visit Pleebo frequently for health care.

Lusaka, affectionately called Joe, said the health center offers primary care in areas including maternal, newborn, and child health; adolescent reproductive health; mental health; and communicable and non-communicable diseases, while seeing about 200 patients and 20 emergency cases every day.

Patients talk while waiting for care at Pleebo Health Center
PIH-supported Pleebo Health Center offers a wide range of health services for people from Maryland County, neighboring counties, and even the neighboring country, Ivory Coast. The new ER facility will greatly expand the center's capacity to provide care, far beyond emergency needs. (Photo by Kathleen Towns/PIH) 

More than Emergency Care

Providing all of those services has been challenging without a dedicated emergency facility.

Lusaka said he and his team have been using a makeshift emergency ward to accommodate patients brought in with immediate needs such as injuries from accidents; severe hypertension; and acute respiratory infections, requiring oxygen. All of those patients need safe, high-quality spaces to receive lifesaving stabilization before referral or surgery.

The new emergency facility is designed to meet those needs.

When completed, the facility will include five beds for general admission patients, a trauma bay, an isolation room, utility rooms, storage areas, bathrooms, a reception and triage space, an inpatient ward with eight beds—four for males and four for females—an expanded outpatient consultation area, and a non-communicable disease clinic with three consultation rooms, a waiting area and storage.

Additionally, the new facility will provide outpatient services, therapy for palliative care patients, and emergency care for children, people with acute conditions, and people with emergency surgical needs such as trauma care.

All of those services will benefit patients from more than 30 vulnerable communities in Maryland County.

“When completed, the new ER block will further enable Pleebo Health Center to have adequate space, equipment and capabilities, such as ultrasounds and electrocardiograms, to improve treatment of ‘our bosses’ tremendously,” Lusaka said, using his team’s term for Pleebo patients. 

Wellington Kyane, mayor of Pleebo District, attended the recent groundbreaking ceremony along with the county health team and expressed his commitment to smooth construction of the new facility.

“Today’s groundbreaking demonstrates PIH and the government of Liberia’s efforts to strengthen health systems, through the provision of ancillary spaces, administrative spaces, and consultation spaces—including restroom facilities, a kitchen, storage, waiting areas and central waste management—to give long-term patient care to the people of Liberia,” Kyane said.

How Natural Disaster Response Links to Global Health

Clinicians and staff at Partners In Health see every day how climate change and natural disasters can have direct, devastating impacts on the lives of the most vulnerable around the world.

Severe droughts wither crops, forcing subsistence farmers to worry when, not if, their families will suffer hunger. Increasingly powerful and unpredictable rainy seasons cause flooding and mudslides, which wipe out fragile homes built along hillsides and riverbanks, leaving thousands homeless and scrambling for clean water. And more frequent hurricanes—with their gale-force winds, heavy rains, and tidal surges—multiply the number of hungry and homeless by destroying crops and homes.

At these moments, PIH’s long-term work to strengthen health systems and social support enables global teams to provide immediate relief through food packages, temporary shelters, clean water, and emergency health care at mobile clinics. These efforts help meet residents’ needs in the short-term, but are a small part of what PIH does on a daily basis.

PIH leaders and their government partners focus most of their efforts on building permanent, sustainable solutions that address the root causes of poverty. That work begins with universal access to quality health care, from prenatal appointments for expectant mothers to palliative care for the dying, and from lifesaving surgeries to cancer treatment.

Across 11 countries, PIH is working to build strong public health systems, train the next generation of health care professionals, and inspire global leaders to follow PIH’s example so that more people will benefit when empathy and solidarity join the fruits of modern medicine.

Below, and in honor of Earth Day, find examples of how PIH has responded in moments of climate crisis to ensure the most vulnerable have access to the care they need, and deserve:

patients are transferred to a dry facility following Hurricane Matthew in Haiti
Patients are moved to higher ground after torrential rains flooded the courtyard of a hospital in Les Cayes, two weeks after Hurricane Matthew crushed already fragile communities in southern Haiti. Photo courtesy of Hospital of the Immaculate Conception

Hurricane Matthew in Haiti

Zanmi Lasante, as PIH is known in Haiti, partnered with the Ministry of Public Health and Population to respond to Hurricane Matthew in the fall of 2016 by assisting with cholera prevention and response, mental health care, and aid for colleagues who had lost their homes, crops, and livestock across southern Haiti.

Floods in Peru

Socios En Salud, as PIH is known in Peru, sent at least 50 medical brigades throughout Carabayllo District, north of Lima, to deliver emergency aid and medication, distribute baskets of food, and tend to the mental health needs of flood victims in the spring of 2017.

Mudslides in Sierra Leone

In the fall of 2017, PIH in Sierra Leone partnered with the Ministry of Health to conduct a record-breaking cholera vaccination campaign that delivered two doses of oral vaccine to 500,000 people living throughout Freetown, the nation’s capital, following heavy rains and landslides that left residents susceptible to the deadly, bacterial disease.

Earthquakes in Mexico 

Leadership and staff at Compañeros En Salud, as PIH is known in Mexico, mobilized across 10 communities in rural Chiapas to assess damage from two earthquakes in the fall of 2017, helping residents clear roads, find temporary housing, and connect with care in the midst of the crisis.

Floods in Malawi 

Abwenzi Pa Za Umoyo, as PIH is known in Malawi, partnered with local and national governments to bring emergency relief to residents following particularly devastating rains and floods in the spring of 2019, delivering food, financial support, and temporary shelter to those affected.

If you believe climate change advocacy is global health advocacy, sign the PIH pledge.

Need to Know: WASH

The world is seeing now more than ever, how washing hands with soap and water has become one of the most important ways to prevent the spread of infections leading to illness. However, in lower-income countries, access to clean water is a luxury that most cannot afford. This is an incredible shame, because when people have regular access to potable water, it can lead to increased productivity, healthier communities, and decreased spread of water-borne and diarrheal diseases. That is why WASH—or water, sanitation, and hygiene—is such a vital part of improving people’s quality of life.  

For more than three decades, Zanmi Lasante (ZL), as Partners In Health is known in Haiti, has worked in close collaboration with the Haitian Ministry of Health to improve the lives of the less fortunate in the Central Plateau and lower Artibonite regions. In addition to clinical care, ZL started a WASH program to educate the public, provide clean water treatment, and conduct a variety of community projects to improve water and sanitation.

doctor provides care to cholera patient in Mirebalais, Haiti
A doctor provides patients with care in a cholera treatment center in Mirebalais, Haiti, in 2012. Photo by Rebecca E. Rollins / Partners In Health

Since the cholera epidemic began in October 2010, ZL established 12 cholera treatment centers to care for the sick and help stop the spread of the bacterial infection. Staff also disinfected homes, distributed hygiene kits, which included soap and water purification tablets, and made patient referrals to local cholera treatment centers. ZL trained teachers and community health workers on how to communicate about and encourage proper hygiene. And ZL staff led the construction or rehabilitation of dozens of public water sources, including protecting natural springs, covering wells, and repairing pumps.

At University Hospital in Mirebalais, ZL built a sanitation block—called Kay Liz—where an average of 500 people each day access bathrooms and showers, where this a regular stock of clean water and soap. This was key considering many patients arrive with family members or friends, who sometimes travel from far away to stay and accompany their loved ones through care. The sanitation block ensures they will remain healthy themselves throughout their stay.

Below, Saskya Vitiello, ZL's partnership relations officer, provides a definition of WASH, explains its importance in quality health care, and talks about its link to climate change:

community education on proper handwashing outside Mirebalais, Haiti
Rose Marie Renati (center), a local PIH health agent, teaches children at an orphanage in Fond Michel about the importance of handwashing to prevent illness. Photo by Cecille Joan Avila / Partners In Health
  1. What is WASH exactly?

WASH is the intersection of access to water, sanitation, and hygiene. A complete WASH program ensures individuals have access to safe water to drink, bathe in, wash clothing, and perform all bodily care. It means people have access to a toilet, where fecal waste is properly disposed of and cannot contaminate individuals or water sources.  In addition, it means that everyone has basic hygiene knowledge, including the importance of washing hands thoroughly with soap and water.

  1. Why is WASH important in places like health care facilities?

Just as there is an intersection among the three components of WASH, there is an intersection between WASH and health care. According to the British Medical Journal, the invention of sanitation is the greatest medical advancement in 150 years, surpassing the inventions of antibiotics and anesthesia.

Health facilities should exist in an environment that helps individuals recover from illness not makes individuals sicker. As such, a health facility cannot properly function if infection is not controlled. Health care professionals cannot control the spread of infection without clean water to wash their hands and clean surfaces, nor without toilets for proper disposal of human waste. Moreover, when health facilities do exist in the absence of good WASH, patients and health care workers suffer.

  1. What are the positive impacts of strong WASH programs in health facilities?

Having access to adequate WASH services in a hospital creates environments that are safer for both health care workers and the patients who visit facilities. This includes reduced risk of infection in surgical spaces, safer labor and deliveries—including cesarean sections, and reduced transmission of infectious diseases among patients.

  1. When WASH is not in place properly, what are the negative impacts?

Infection can spread among health care workers and patients. Patients can spread disease to other patients. Surgery cannot take place safely. In addition, labor and delivery can lead to complications for the woman and child, even leading to higher mortality rates from uncontrolled infections.

  1. How is WASH linked to environmental and climate change issues?

A poorly planned or executed WASH project can negatively impact communities and ecosystems when, for example, improperly collecting and disposing human waste—especially when that waste contaminates public water sources. This is most important in countries where open defecation due to lack of sanitation facilities is the highest.

Water-related climate change, such as more severe and frequent droughts or floods, will have the greatest impact on the most vulnerable. During those droughts and floods, the lack of water and sanitation in emergencies leads to increases in diarrheal diseases, such as cholera, and other health problems.

Facing COVID-19, Preparedness is Key in Sierra Leone

In mid-March, when Dr. Chiyembekezo Kachimanga stood in front of a hushed crowd of Partners In Health (PIH) staff members and began talking about COVID-19, the disease had not yet made its way to Sierra Leone--but he knew it soon would, and time was short.

“It’s a very difficult pandemic; countries that are richer, that have more resources, are struggling,” Kachimanga said to PIH clinicians, community health workers (CHWs), and administrators, based in the country’s rural Kono District.

“This disease is real, it’s spreading fast, and we are all trying our best so that it doesn’t come to Sierra Leone.”

Known as Dr. Chembe, Kachimanga is PIH’s director of clinical programs in the coastal, West African nation. Sierra Leone, of course, is no stranger to pandemics—the country and its neighbors battled Ebola from 2014 to 2016.

The most recent battle began in early April, when Sierra Leone confirmed its first case of the novel coronavirus—one of the last nations in the world to do so. The news was expected, given that the virus had presented elsewhere in West Africa weeks before. Yet it was jolting, nonetheless, in a country with limited ICU capacity, very few ventilators, and a majority of people whose incomes and lives would be direly affected by the strict social distancing measures seen in other countries.

That’s why Dr. Chembe and PIH’s entire Sierra Leone team stressed preparation and proactive measures from the start, weeks before COVID-19 arrived. In Kono and nationwide, PIH’s efforts have included clinical training and community engagement, system building for specialized triage and isolation at PIH-supported Koidu Government Hospital (KGH) and Wellbody Clinic, long-term ordering of necessary medical supplies, and government accompaniment.

Dr. Chembe trains CHWs
Dr. Chembe answers questions from community health workers during one of their first trainings on COVID-19, held in late March at PIH's administrative office in Kono. Photo by Maya Brownstein / Partners In Health

All those measures mean that Sierra Leone, even with its socioeconomic vulnerabilities, is uniquely prepared to halt further spread of the novel coronavirus.

“Though the resources we have are more scarce than other countries’, the steps already taken across Sierra Leone point to how seriously the country takes the outbreak,” said PIH-Sierra Leone Executive Director Jon Lascher. “And for those of us who fought Ebola, the memory of that struggle and the lessons we all learned can help.”

With approaching 30  confirmed cases as of mid-April, Sierra Leone is still in the earlier stages of the global COVID-19 pandemic, though case numbers continue to steadily rise. Throughout the country, the goal has shifted from preventing the virus’ introduction to preventing a serious outbreak. But PIH’s mission remains the same: working with the Ministry of Health to support Kono District and all of Sierra Leone with the resources needed to care for all patients, coronavirus or otherwise.

Training, Information, and Compassion

A foundation of PIH’s COVID-19 response in Sierra Leone is training and education—making sure clinicians, CHWs, and communities have the information they need to protect their health.

In Kono, PIH is providing coronavirus trainings at KGH and Wellbody Clinic. Clinicians and other health workers know the epidemiology of COVID-19, when to use personal protective equipment (PPE), and how to manage patient care. The trainings are not only about science and health systems; they also are about compassion, as anxiety runs particularly high in the midst of an infectious disease pandemic.

Dr. Marta Patino
Dr. Marta Patiño leads a COVID-19 training for Koidu Government Hospital staff--from clinicians to cleaners to community health officers. Photo by Maya Brownstein / Partners In Health

“We are health care workers—we must be examples,” Dr. Marta Patiño, an internist at KGH, encouraged staff during one such training. “This is our role: Kindness. Patience. Information. Empathy.”

Training sessions in communities throughout the district are filling in potential knowledge gaps between households and health facilities. Driving long distances over bumpy roads, PIH staff have been making their way to all 14 chiefdoms in Kono to set up handwashing stations, deliver informational posters, and meet with community leaders on virus prevention methods. These gatherings have been limited in attendance in accordance with national social distancing regulations; the goal is for local leaders to share information with their communities, supplemented by PIH coronavirus prevention broadcasts on Kono radio.

A community training session in Kono
In Kainkordu, one of Kono's 14 chiefdoms, community leaders gathered for a COVID-19 educational session led by PIH clinicians. Photo by Doug Miller / Partners In Health

CHWs, meanwhile, have received specific training on how to more safely make their regular home visits and accompany patients to care. New guidelines include meeting with patients outside of homes and using PPE when accompanying people at risk for COVID-19. As trusted sources of health information in the communities they serve, CHWs also have received briefings on how to dispel rumors about coronavirus and, like clinicians, how to help address patients’ fears.

“In situations like this, with a lot of information going around on social media, patients need us to make sure we’re giving them the right information in how they can protect their families,” said Community Based Program Manager Kumba Tekuyama.

And PIH’s impacts are extending far beyond Kono.   

Dr. Marta Lado, chief medical officer for PIH in Sierra Leone, recently traveled to Brazzaville, Congo, for a World Health Organization training on COVID-19 patient care. She’s since been supporting Sierra Leone’s government on coronavirus case management and provided training to clinicians at Military 34 Hospital in the capital city of Freetown, where all of the country’s coronavirus patients are being monitored and treated.

Strengthening Sierra Leone’s National Response

Lado remains at Military 34 Hospital this month, as one of the clinicians caring for the country’s handful of patients who’ve tested positive for coronavirus. None of them are in critical condition.

“All are doing amazingly well,” she said. “Most of them are completely asymptomatic.”

Chief Medical Officer Dr. Marta Lado trains clinicians at Military 34 Hospital in Freetown, where all of the country's current COVID-19 patients are being monitored and treated. Photo by Jon Lascher / Partners In Health
Chief Medical Officer Dr. Marta Lado trains clinicians at Military 34 Hospital in Freetown, where all of the country's current COVID-19 patients are being monitored and treated. Photo by Jon Lascher / Partners In Health

For now, all positive COVID-19 cases are being transferred to Freetown, and national mandates—border closures, a three-month shuttering of Sierra Leone’s airport, and periodic countrywide lockdowns—are aiming to control the potential spread of the virus. Plans for additional treatment centers, for both mild and severe cases, are in the works.

“Mild cases have no need to be receiving hospital-level care, but we have to set up some facilities where those patients can be separated from the community while they are infectious,” Lado explained.

She added that severe cases, meanwhile, will be taken to “treatment centers with modern technology and all the systems we need to deliver critical care to the 5 or so percent of people who are going to get quite sick.”

As Lado helps inform infection prevention and control strategy for the government, PIH is also represented at national- and district-level Emergency Operations Center meetings run by the government.

“Feedback and engagement with the Emergency Operations Center helps embellish and feed into our PIH preparedness plan,” said Momoh Jimmy, director of government relations for PIH-Sierra Leone, one of the staff members ensuring a symbiotic relationship between the national response and PIH’s. “Coordination here and with the Ministry of Health ensures our plan is aligned with government priorities and international standards in the fight against COVID-19.”

As government response efforts feed into PIH’s, the organization offers technical assistance in areas like clinical training, contact tracing, and supply chain, as well as other granular forms of assistance. A PIH driver, for instance, recently took Ministry of Health officials around the country to inspect health facilities’ isolation capacities.

Signs at the entrance of PIH-supported Wellbody Clinic  tell patients in Krio to wash their hands and get their temperature checked upon entering the facility. Photo by Maya Brownstein / Partners In Health
Signs at the entrance of PIH-supported Wellbody Clinic  tell patients in Krio to wash their hands and get their temperature checked upon entering the facility. Photo by Maya Brownstein / Partners In Health

Triage, Testing, and Treatment in Kono

In Kono, KGH had seen three suspected coronavirus cases by early April, but all had tested negative. PIH’s work has focused on preparing supply chains and essential triage and isolation systems, in case of community transmission and a resulting outbreak in the rural district.

Aligning with national protocols, staff at the hospital and at Wellbody have set up a separate triage system for all patients with COVID-like symptoms, who will be admitted in an area that’s separate from other patients, then isolated and tested for the illness. Patients who test negatively remain at the facility for care, while patients who test positively are taken in an ambulance to Military 34 Hospital, in order to contain the disease’s spread as much as possible.

Both PIH-supported facilities recently have seen reductions in the number of patients arriving for care—indicative of patients’ fears, with roots in the Ebola epidemic, of health facilities during the time of a potential epidemic. But with more community education efforts, and the continuation of quality essential health services and accompaniment from CHWs, staff expect patient attendance to soon return to its usual high level.

PIH’s supply chain team has been placing orders with that in mind. Since the majority of medical supplies, equipment, and drugs are shipped to Sierra Leone from other countries, the global COVID-19 pandemic poses threats to all forms of health care. Shipping is limited and more expensive, and items as simple as surgical gloves and aspirin are increasingly unavailable.

PIH staff unload supplies, including PPE.
Staff unload supplies, including PPE, at the PIH warehouse in Kono. Photo by Doug Miller / Partners In Health

But Sierra Leone, luckily, is equipped with comfortable amounts of PPE that are left over from the Ebola outbreak. And one of the first measures in PIH’s COVID-19 response was to order of six months’ worth of stock for pharmacy shelves, surgical trays, and supply closets, for the treatment of coronavirus or any other illness.

Indeed, maintaining routine health services is a key aspect of PIH’s COVID-19 response, as an unintended global consequence of the virus could be diverting resources away from non-COVID health areas in need of equally urgent attention.

“We are committed to making sure our patients have access to the same services they had before coronavirus,” Lascher said.

Tekuyama echoed this message on behalf of PIH’s force of CHWs.

“We’re still going to continue with patient care—because I feel like patients need us even more now,” she said.

As COVID-19 is proving to be not just a new, emergent health problem, but also a reminder of the necessity of holistic health system strengthening, PIH-SL is working hard to ensure every Sierra Leonean’s right to health care.

In one of his recent trainings, Dr. Chembe stressed that message—and the necessity of direct, compassionate measures—to a crowd of community health workers. 

“I want you all to be doers of these things,” he said. “If you are doers, you protect yourself, your family, and the community.”

FAQs: Hiring, Process Behind PIH's Efforts in MA COVID Response

Interest from the public has boomed since Partners In Health announced last week that it is joining the state of Massachusetts’ COVID-19 response, by implementing a contact tracing initiative in collaboration with the office of Gov. Charlie Baker that will require hiring nearly 1,000 additional staff.

The Massachusetts COVID-19 Community Tracing Collaborative (CTC) is designed to not just flatten the curve, but bend the curve downward to more rapidly reduce the number of cases in Massachusetts.

The CTC is a partnership of four groups: MA COVID-19 Command Center, Commonwealth Health Insurance Connector Authority (CCA), Massachusetts Department of Public Health (DPH), and PIH.

PIH is hiring contact tracers, resource coordinators, and case investigators to reach out to those individuals who have been in touch with COVID-19 patients, counsel them on testing and quarantine, refer them for testing, and connect them to necessary resources throughout their quarantine. This is in tandem with statewide efforts to increase testing, improve communication, and implement isolation and quarantine.

As that hiring process begins this week, PIH teams are doing all they can to answer questions and provide additional information. As part of that effort, here are some of the most common inquiries related to hiring and contact tracing, with responses from PIH’s human resources department, Community Tracing Collaborative leaders, and more.

PIH will update this list frequently to provide the most current information. Job descriptions and hiring links are available online. 

Hiring/Job Details 

Are these full-time or part-time positions?

Full-time is preferred.

How much do they pay?

Compensation will depend on the position. Contact tracers, for example, will receive $27 per hour.

When will interviewing start?

Interviews are starting this week, which began Monday, April 6.

I submitted an application, but I didn't get any kind of confirmation email. Was my application received?

Someone will follow up as soon as possible. We've seen very strong interest, and have received several thousand applications.

Are you eligible for this position if you're from out of state?

Everyone can apply. However, Massachusetts residents with knowledge of state communities and geography are preferred.

Will there be limited volunteer positions available for those that want to help out in their spare time?

Not at this time.

Is an iPad sufficient for new employees to use?

Unfortunately, no. The job description includes specific requirements for computer technology, including: PC with Windows 10, Antivirus Protection: Windows Defender and Windows Firewall; or Mac with Apple OS X 10.13, Antivirus Protection: Sophos; and a personal mobile device to use for this job. A headset also is preferred.

What is a good email address for Contact Tracers to reach out to if they have questions about their position?

Contact Tracers can email HRHelp@pih.org with their questions. 

Can an international student, in the U.S. on an F1 visa, apply for a position?

They would need to consult with an immigration attorney. Unfortunately, PIH cannot give legal advice.

COVID-19 Information

When should people expect to start receiving notifications or phone calls about possible contact with COVID-19?

The MA COVID Team started making calls to individuals and contacts on April 11, and will continue to grow its staff to meet the needs of the state.

I tested positive for COVID-19 or recently exhibited symptoms. What additional resources are there, if I have not yet heard from a contact tracer on the MA COVID Team? 

Local boards of health across Massachusetts are responsible for contact tracing in their areas.

People who believe they might have COVID-19 can reach out to their local boards of health, or call 211, the state's non-emergency assistance line. If there is an immediate medical concern, please call your health care provider, if you have one. In emergencies, call 911.

What kinds of social support will be provided to people who need to quarantine?

The MA COVID Team will work to assess the needs of individuals and families and connect them to community, local, and state services.   

Haitian Clinicians, Staff Resilient Through Unrest, COVID-19

Anti-government protests in Haiti began in July 2018 and persist to this day. The civil unrest—which has led to violent protests, roadblocks, and fuel shortages—has negatively impacted the economy and placed undue burden on Haitians, who now face 30 percent inflation on basic goods and services.

Despite the political and socio-economic turmoil, public health centers supported by Zanmi Lasante (ZL), as Partners In Health is known in Haiti, have remained open to provide critical care to Haitians across the country. As one of the Ministry of Health’s longstanding partners, ZL became the frontline responder to the first confirmed COVID-19 cases and remains the only organization with a health facility actively treating patients who test positive. While providing the best quality of care to its patients, ZL is following the ministry’s strategy to establish networks for contact tracing at the community level to ensure early detection of cases and to stop the spread of the virus.

Care continues in Haiti, despite civil unrest, violence toward health care workers, and global pandemic. 

As in past emergency situations, ZL will continue to ensure that essential routine health services are not impacted during the COVID-19 outbreak preparedness and response efforts. That work includes reinforced community monitoring of patients receiving care in other programs, such as tuberculosis and HIV, maternal and child health, and noncommunicable diseases, such as diabetes and hypertension.

ZL clinicians and operations staff are working closely with ministry colleagues to ensure preparedness at our facilities for anyone who requires care for COVID-19. Six doctors and nine nurses are working around the clock to ensure care is effective, efficient, and patient-centered, while they also ensure they remain safe themselves. Meanwhile, staff have trained on how to use COVID-19 rapid diagnostic tests and started testing at a border crossing with the Dominican Republic and at various ZL facilities.

PIH staff in Haiti meet at the border with official from the Dominican Republic
Zanmi Lasante staff meet at the border with government officials from the Dominican Republic to discuss COVID-19 preparedness. 

Although ZL has a strong reputation across Haiti and excels at community education and awareness, staff have become victims of unwarranted threats and violence in the communities they serve. More security personnel are now positioned across all sites to ensure that staff and patients remain safe while providing and seeking much needed care.

Today, ZL staff face the challenges of COVID-19 and are at the frontline of care and support for those receiving treatment now, and for individuals who will be impacted in the future. Tomorrow and every day after, they will work together to take on this battle. Haitian health care workers and staff at University Hospital and across all ZL-supported facilities will do whatever it takes to provide emergency and essential care to patients—despite all odds and obstacles.

Donate to COVID-19 Response

Vital Maternal Care Continuing Amid COVID-19 Response

One thing every mother knows is that babies arrive on their own watch. Labor is unpredictable. In the best of times, labor begins when the expectant mother is mentally and physically ready to give birth, and the hospital to which she is admitted is fully staffed, stocked, and ready to help her deliver a new life into the world.

That’s the ideal situation. But, of course, it’s not always the reality—especially not now, during the global COVID-19 pandemic.

Expectant mothers now are forced to worry about whether they will have access to what they and their babies need throughout labor and delivery, or whether staffing, beds, and necessary supplies will be rerouted to care for the crush of patients arriving at hospitals and health facilities with symptoms of the novel coronavirus and its resulting disease, COVID-19.

This is true for women in the United States, which is considered to have one of the most advanced medical health systems in the world. But it is ever more true, and urgent, for expectant mothers in countries where the public health system is weak or non-existent. Well-trained staff, adequate supplies and medication, and ample, clean space for delivery and recovery are not guaranteed during normal times, much less during a global pandemic.

In collaboration with national governments, Partners In Health has worked steadily for decades to ensure women have access to the right staff, stuff, space, systems, and social support as their families grow. In 2019, PIH-supported facilities provided more than 58,000 safe, facility-based deliveries, including more than 10,150 lifesaving cesarean sections. Clinicians also provided more than 134,600 prenatal care visits to ensure expectant mothers remain healthy throughout their pregnancies.

Maternal Care in the times of COVID-19

As hospitals and clinics are pivoting in the U.S. and Europe to meet the everyday needs of patients alongside those testing positive for COVID, health care facilities across the 11 countries in which PIH works are doing the same juggling act. Here are some examples of how they are accomplishing this work, while maintaining vital care for pregnant women and new mothers, from Haiti, Mexico, and Sierra Leone:

Haiti on the frontlines

COVID-19 rapid diagnostic test training in Haiti
Zanmi Lasante staff receive training on how to use COVID-19 rapid diagnostic testing in Haiti. Photo courtesy of Zanmi Lasante.

Haiti was the first country in which PIH clinicians provided care to patients testing positive for COVID-19. Staff working for Zanmi Lasante, as PIH is known locally, have been trained in the proper use of rapid diagnostic tests and are employing them at one border crossing and key facilities across Haiti’s Central Plateau. Those patients who test positive are provided direct care and support, as appropriate, while those who have been exposed to the virus are placed in quarantine and observed for symptoms.

All of these activities occur on top of day-to-day care. Pregnant women staying at Kay Manmito, a maternal waiting home, have been moved to another safe location to receive care so that the facility could be converted to an isolation ward for COVID-19 patients. When expectant mothers go into labor, they are escorted to University Hospital for delivery and recovery.

Preparing in Mexico

In Mexico, Compañeros En Salud—as PIH is known in Mexico—continues to welcome expectant mothers to Casa Materna, a maternal home that offers prenatal services and assists women through labor and delivery. PIH-supported Jaltenango Hospital abuts this facility and has provided Casa Materna patients with C-sections in the past, when their deliveries turn complicated.

To ensure those services continue for all patients, hospital leadership has supervised the conversion of a section of the hospital into an isolation ward for patients arriving with COVID-like symptoms.

isolation wards at Jaltenango Hospital in Chiapas, Mexico
Compañeros En Salud and Ministry of Health leadership collaborated to establish isolation wards at the Jaltenango Hospital to tend to patients who test positive for COVID-19. Photo courtesy of Compañeros En Salud.

Sierra Leone remembers Ebola

In Kono District, Sierra Leone, clinicians at PIH-supported Wellbody Clinic and Koidu Government Hospital have prepared separate triage and isolation spaces for patients with symptoms of COVID-19. This is all while maternal health care continues in labor and delivery wards, and expectant mothers stay at a nearby waiting home.

Sierra Leoneans starkly remember the time of Ebola, when expectant mothers feared coming to clinics and hospitals, thinking they might contract the virus from other patients or find facilities unstaffed. Many women chose to deliver at home and risk the odds. When complications arose, as they sometimes did, traditional midwives were unable—despite their best efforts—to save the lives of mothers and their newborns.

No one wants to repeat those conditions. PIH clinicians and community health workers are reaching out to women to assure them that health care will continue to be available throughout the pandemic. They encourage their patients to attend their regular prenatal appointments, to utilize the national ambulance service to be transferred to necessary secondary care, and to deliver at the facility.

COVID-19 community outreach in rural Sierra Leone
PIH staff in Sierra Leone conduct COVID-19 community education sessions in rural Kono District. Photo by Doug Miller / Partners In Health

Meanwhile, in partnership with local government, PIH staff are working with clinicians at health facilities throughout Kono to help send the message that caregivers will be there for pregnant women when they need them most, with or without a global pandemic.

Supply chain and logistics staff in Sierra Leone have also ordered six months’ worth of necessary items to stock pharmacies, surgical trays, and supply closets, in anticipation of spikes in general demand and pricing for drugs and medical supplies, as simple as surgical gloves and ibuprofen.

Globally, though, supply and logistics teams continue to face challenges to stock adequately as the pandemic deepens and broadens around the world, disrupting traditional manufacturing schedules and international trade.

And yet, all of these efforts combine to ensure pregnant women and expectant mothers continue to receive quality care, whether for COVID-19 or for the many other reasons they have come to rely on PIH-supported clinics and hospitals around the world.

expectant mothers awaiting prenatal care in Sierra Leone
Expectant mothers await prenatal appointments at Wellbody Clinic in Kono District, Sierra Leone. Photo by Emma Minor / Partners In Health

 

Climate Change Advocacy is Global Health Advocacy

When Earth Day arrives on April 22, the annual day highlighting action on climate change undoubtedly will be shrouded in the smog of COVID-19.  

But that does not mean the health of our planet and the health of its people are two separate issues, or that one obscures the other.

They are inextricably intertwined.

That’s why Partners In Health, more than ever in this time of global pandemic, is recognizing Earth Day by urging greater global collaboration for climate justice and mitigation strategies that prioritize the world’s most vulnerable communities and address health concerns that extend far beyond clinical care.

“All rights and social justice issues are interdependent and therefore require collective action,” said Joel Curtain, PIH’s director of advocacy. “Achieving health equity also requires environmental, social, racial, and economic justice.”

As a social justice organization that strengthens health systems, provides and supports medical care, and trains local health care workers in 11 countries around the world, PIH has a firsthand view of how the global climate crisis affects human health—from the increased frequency of devastating natural disasters to rising air pollution, food insecurity, and clean water scarcity.

PIH staff and clinicians see the evidence through cholera outbreaks after devastating floods; HIV and tuberculosis epidemics fueled by malnutrition and air pollution; and rampant malaria amid severe rainy seasons, floods, and deadly storms.

And now, as the world battles COVID-19, it has never been more evident that pandemics highlight inequality and injustice on a global level—and the communities that bear the greatest burdens are those that systemically have received the least support.  

In recognition of Earth Day, PIH strongly believes that we can cure the world's worst injustices, together, by addressing planetary health as essential to humanity’s health—and ensuring health as a human right.

Action on climate change is critical for health. Health is a human right, one that climate change threatens directly.

Join our movement as we work to combat climate change and ensure care for all.

Sign Our Pledge

PIH Shares PPE Conservation Strategies Amid Local, Global Shortages

The first thing Cory McMahon will tell you is that shortages of personal protective equipment (PPE) for caregivers responding to COVID-19—and the conservation strategies that are emerging as a result—are not situations that anyone would hope for.

“I think my hope instead would be that we have enough PPE and don’t have to do something like this,” said McMahon, director of nursing and midwifery for Partners In Health (PIH). “These are not ideal situations for anyone.”

As hospitals and health facilities in Boston, across the U.S., and around the world are handling surges of COVID-19 patients while facing critical shortages of PPE—the vital masks, gowns, gloves, and eye protection needed by frontline caregivers—medical staff are making difficult decisions and doing all they can to ensure safety while providing high-quality care.

"Our nurses and doctors are always innovating to provide the best patient care possible," McMahon said. "This situation has forced everyone to develop creative solutions to ensure the safety of our health care workers." 

To support those efforts, PIH is sharing the strategies and guidelines that clinical staff and colleagues are developing during the COVID-19 response. Staff will post the guidelines at PIH-supported hospitals and health facilities in the 11 countries where PIH works, and make them available for health organizations anywhere. The guidelines include PPE recommendations from the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and from local hospitals in Boston, where several PIH staff and colleagues are working and providing care for COVID-19 patients. These clinicians have already had to improvise and innovate with PPE to ensure the safety of caregivers.

McMahon said the pandemic’s impacts are unprecedented. 

“The level of patients that we’re seeing at one time is not something that we’re used to absorbing, at a global level,” McMahon said. “What we’re seeing locally, whether it’s Boston or New York right now, that is going to be the same thing for us, in the countries where PIH works, if we’re not able to stop the spread. And possibly even more so, because they have less capacity to absorb” surges of patient numbers.”

McMahon added that hospitals everywhere already were functioning at capacity, in terms of both staffing and equipment, before COVID-19 began to spread.

“So it’s not like there is extra capacity waiting in the wings for this kind of pandemic,” she said. “Because of that, hospitals everywhere have started to think about their strategies, in order to absorb this.”

Details of PIH’s strategies continue to evolve, as patient and supply levels change. But at the strategies’ core are bedrock principles for conserving and—when appropriate—reusing PPE: reduce individual PPE use through careful planning, and minimize the number of people using PPE.

PPE Conservation Strategies

Caring for Caregivers

PIH also will continue to stay updated on new and emerging data for decontamination methods that may extend the use of PPE, and other safe reuse options.

The PPE guidelines are part of PIH’s unyielding dedication not only to care, but also to caregivers.

“I think as frontline people fighting this…they’re always putting the patient first, and emphasizing that patient care isn’t suffering because of this,” McMahon said. “To me, that’s why it’s our responsibility to make sure that our people who are on the frontlines are protecting themselves—because they’re always putting the patient first, despite whatever risk is coming their way. And that is so important.”

ICYMI: PIH Experts Address COVID-19 Questions

A panel of four Partners In Health experts responded to a wide array of audience-submitted questions about the novel coronavirus during a live webinar last week.

PIH CEO Dr. Sheila Davis; Dr. Joia Mukherjee, chief medical officer; Daniel Orozco, director of clinical operations; and Emily Dally, director of impact, participated in the hour-long discussion.

Questions ranged from how the United States is confronting COVID-19, the disease that results from the virus, to how PIH is collaborating with national governments to test, treat, and support the most vulnerable communities as they confront this global pandemic.

Viewers submitted questions beforehand and during the live session April 2. 

Watch the webinar

Check out the link below to watch the full webinar. The original video has been edited and condensed for clarity.


PIH Calls for Immediate Stop to Deportations

UPDATE: 11:30 A.M. APRIL 7, 2020   

A flight carrying some five dozen deportees departed the United States this morning and is scheduled to land in Haiti today. Partners In Health—or Zanmi Lasante, as we are known in Haiti—stands ready to assist them.

 

BOSTON – Partners In Health calls on the Department of Homeland Security to immediately stop all deportations, including the flight scheduled to depart the United States for Haiti today, April 7. People scheduled for deportation face heightened risks of contracting and unknowingly spreading COVID-19, thanks to conditions like overcrowded detention centers, and deportations not only needlessly accelerate the spread of the coronavirus, but undermine deportees’ and recipient countries’ right to health.

Please contact director of external relations Eric Hansen, at ehansen@pih.org, with any questions.

 

PIH Partners with Mass. Governor's Office on COVID-19 Response

Massachusetts Gov. Charlie Baker announced a new initiative today to accelerate the state’s efforts to contain the spread of COVID-19, by dramatically scaling up the state’s capacity for contact tracing through a new collaboration with Partners In Health (PIH).

The Massachusetts COVID-19 Community Tracing Collaborative (CTC) is designed to not just flatten the curve, but bend the curve downward to more rapidly reduce the number of cases in Massachusetts.

The CTC is a partnership of four groups: MA COVID-19 Command Center, Commonwealth Health Insurance Connector Authority (CCA), Massachusetts Department of Public Health (DPH), and PIH.

“We are living in a difficult and unprecedented time, and it is imperative that all of us in the Commonwealth contribute to controlling this epidemic,” said Partners In Health CEO Dr. Sheila Davis. “We’re humbled to be part of the team selected by Governor Baker to fight COVID-19, and hope that PIH’s experience fighting pandemics around the world will help stem the grim tide of the COVID-19 epidemic in Massachusetts.”

PIH will coordinate closely with the state’s Department of Public Health and Department of Health and Human Services to support the state’s efforts by training and deploying hundreds of contact tracers, who will call people who have been in close contact with confirmed COVID-19 patients. The CTC’s work will be combined with the state’s response initiatives and will provide support to people in quarantine to contain the spread of COVID-19.

“Enhanced tracing capacity is an enormously powerful tool for public health officials to rely on in their battle against COVID-19,” Baker said at the State House in Boston during a Friday afternoon press conference announcing the collaborative. “By monitoring and isolating through an enhanced community tracing program, our state can be positioned to reduce the number of cases in the long run.”

Baker said that while local health boards in Massachusetts already are contact tracing, the collaborative will bring “a much more robust, targeted approach” that is “working toward a goal of getting staffed and ready to go…by the end of this month.”

The collaborative is part of the state’s multi-faceted preparation for an expected surge of COVID-19 cases in coming weeks.

“When you start getting into numbers like the types of numbers we’re talking about in our projections, you need a larger organization with a much larger infrastructure,” Baker said. “The difference is between doing this for a few thousand people, and doing it for tens of thousands of people.”

Dr. Joia Mukherjee, PIH chief medical officer
Dr. Joia Mukherjee, PIH’s chief medical officer, said at the State House that expanded contact tracing in Massachusetts will help "shine a light" on the COVID-19 epidemic. Looking on is Massachusetts Gov. Charlie Baker. (Photo courtesy of Massachusetts Governor's Office)

Dr. Joia Mukherjee, PIH’s chief medical officer, cited the organization’s experience in responding to disease outbreaks around the world.

“Whether fighting Ebola in West Africa, tackling HIV and tuberculosis for a generation, or facing the sudden emergence of cholera in Haiti, we at Partners In Health know that even as we prepare the hospitals in the Commonwealth to provide safe and effective care to all the people who are sick, … we must simultaneously stop the ongoing spread of COVID-19 if we are to end this terrible pandemic,” she said at the State House.

Mukherjee spoke about how effective contact tracing can help people learn their COVID-19 status, or possible risks, and take appropriate steps to care for their families.

“Access to this information helps contacts to know how to protect their loved ones, and to get tested or cared for themselves,” she said. “Without knowing our own status, without being able to specifically protect our loved ones, we are all living in the dark. (And) we know that there is significant anxiety in this darkness.”

Mukherjee spoke about her own experience, sharing a home with her elderly mother and wanting to keep her free of COVID-19.

“We believe that people want to know if they have been in contact with this disease,” she said. “Knowing one’s status will shine the light on this epidemic and make it possible for Governor Baker’s great vision—of having the Commonwealth lead on stopping transmission—to happen.”

Dr. Paul Farmer at the State House
Dr. Paul Farmer, PIH co-founder and chief strategist, said at the State House that he is grateful to join the state's fight against COVID-19, citing the need for humane care and expert mercy. Behind him, left to right, are Secretary of Health and Human Services Marylou Sudders, Lt. Gov. Karyn Polito, and Gov. Charlie Baker. (Courtesy of Massachusetts Governor's Office.)

Mukherjee and Dr. Paul Farmer, PIH co-founder and chief strategist, both spoke about how the collaborative will approach contact tracing with love and compassion, to humanely inform people of their risks and provide access to social support and resources.

“I am grateful as a citizen, I am grateful as a Brigham & Women’s physician and Harvard Medical School professor, to join this effort … with the expert mercy that is called for in these times,” Farmer said. 

Read more about PIH's response in Massachusetts, and what PIH co-founders Farmer and Dr. Jim Yong Kim have to say about this unique partnership.


Join the COVID Community Team 

 

Partners in Health is hiring Contact Tracers, Resource Coordinators and Case Investigators to reach out to all Massachusetts contacts of COVID patients, counsel them on testing and quarantine, refer them for testing, and connect them to necessary resources throughout their quarantine. This is in tandem with Commonwealth-wide efforts to increase testing, improve communication, and implement isolation and quarantine. Apply now to work with PIH to fortify efforts to control the pandemic in Massachusetts.

Apply

COVID-19: Fact Vs. Fiction

There suddenly is so much information circulating about the new coronavirus that it can be hard to know what is fact or fiction. 

To provide and share reliable information, Partners In Health consulted with its infectious disease experts and trusted global health resources to break down prevailing myths related to COVID-19, the disease resulting from the novel coronavirus.

The following is not an exhaustive list of all the myths out there, but it does set straight some of the misinformation that's currently circulating among the public.

MYTH 1: People living in tropical regions don't have to worry about catching the new coronavirus, because such viruses don't survive in warmer climates.

FACT 1: COVID-19 virus can be transmitted in areas with hot and humid climates.

Source: WHO Myth Busters
 

MYTH 2: The only people who have to worry about contracting, or dying, from COVID-19 are the elderly. This virus doesn't infect children or healthy adults.

FACT 2: Early research in the United States shows that COVID-19 can develop and result in severe disease among people of all ages. Social distancing is universally recommended to slow the spread of the virus.

Source: CDC 

 

MYTH 3: The U.S. has developed a vaccine against the new coronavirus. 

FACT 3: The director of NIAID (National Institute for Allergy and Infectious Disease) has estimated that this process will take 12 to 18 months from March 2020, and that a commercial vaccine would not be available until after that.

Source: Dr. Megan Murray, PIH's director of research

 

medication stocked on shelves in a rural pharmacy in Malawi
The pharmacy at a clinic inside Neno District Hospital in Malawi. Photo by Zack DeClerck / Partners In Health

 

MYTH 4: There is a cure for COVID-19. I've heard that people who take Vitamin C, gargle with hot water, salt and vinegar, or take antimalarial medication get better.

FACT 4: While some western, traditional, or home remedies may provide comfort and alleviate symptoms of COVID-19, there is no evidence that current medicine can prevent or cure the disease.

Source: WHO

 

MYTH 5: Antibiotics are effective against the new coronavirus.

FACT 5:  No. Antibiotics do not work against viruses, they only work on bacterial infections. COVID-19 is caused by a virus, so antibiotics do not work.

Source: WHO
 

Staff gather for a training on COVID-19 rapid tests in northern Lima, Peru
Staff with Socios En Salud gather for a training on COVID-19 rapid tests in northern Lima. Photo courtesy of Socios En Salud

 

MYTH 6: We're all going to get this virus anyway, so there's no point in taking drastic measures.

FACT 7: Hospitals around the world, including New York City hospitals, are already straining under the onslaught of novel coronavirus cases, even as state officials say the real peak of the outbreak is nearly a month and a half away.

Doctors at the largest public hospital in New York say equipment shortages have resulted in them wearing the same masks for as long as a week. Emergency-room physicians at another hospital are having to reuse gowns. Some large hospitals already have exceeded the capacity of their intensive-care units.

“I’ve seen more cases in the last 10 days of severe respiratory illness than we’ve seen in years,” says Dr. Mangala Narasimhan. “I’m very worried.”

Source: Wall Street Journal
 

MYTH 7: The virus can live for at least 12 hours on a metal surface.

FACT 8: The novel coronavirus was viable up to 72 hours after being placed on stainless steel and plastic.


Source: CNN Health / New England Journal of Medicine
 

MYTH 8: Drink plenty of water! If the virus is in your throat, you can wash it into your stomach, where it will be killed by digestive acids.

FACT 9: Infections often begin after we’ve been exposed to thousands or millions of viral particles, so sweeping a few down the throat is unlikely to have much of an impact. 

Source: London School of Hygiene and Tropical Medicine

a public water pump in rural Malawi
Children collect water from a public water pump in rural Malawi. (Photo by Zack DeClerck / Partners In Health)


UGHE Kitchen Manager Merges Culinary Arts with Sustainable Agriculture

Three hours from Kigali, atop a remote hill hugging the Ugandan border, a small kitchen is having a big impact on agriculture and sustainability in the surrounding community. 

The kitchen is a campus hub at the University of Global Health Equity (UGHE), a Partners In Health initiative in northern Rwanda and home to nearly 200 students and faculty. Step inside on any day of the week and find a hive of hairnets, chefs’ hats, and culinary activity. There could be pastry chefs icing an enormous birthday cake, multiple vats of sweet-smelling sauces bubbling on stoves, and the hum of several industrial-size ovens counting down to lunch hour. 

At the heart of the activity is Bella Twizerimana, UGHE’s kitchen manager—and much more. Born in nearby Musanze, a northern region known for beautiful lakes and its proximity to Volcanoes National Park, Bella is a former teacher and bank manager who now is a leader in the regional hospitality industry.

She’s been leading UGHE’s kitchen for more than a year, and employs nearly 70 people on campus.

Most of those people are from local areas, and all of them—sous chefs, food preppers, caterers, and kitchen cleaners—have been personally trained by Bella. That training starts outside of the kitchen walls, with a focus on growing local fruits and vegetables and rearing livestock for sustainable meat options.

The kitchen’s mission goes hand in hand with that of both PIH and UGHE: to ensure that everyone, everywhere, has a healthy and productive life. Food, after all, is vital to good health.

“The things you eat are what you become,” Bella says. “The customer first eats with his eyes, and then thinks about the taste, and then health. You must mix all of them.”

Mixing it up is what Bella does best. Her kitchen is a swirling, bustling part of UGHE’s plans for expansion, and a key player in UGHE’s mission to support its neighbors in the surrounding communities of Butaro. 

While UGHE’s faculty trains Rwanda’s next generation of medical leaders, Bella and her kitchen team are nurturing its next generation of restaurateurs.

On a recent day in February, experts in both fields—medicine and hospitality—were stationed at Bella’s stoves and cutting boards. 

paul farmer in chef hat
Dr. Paul Farmer and guests joined in on recipe preparations, guided by Jody and Bella. (Photo by Nick Carney / for PIH)

Visiting UGHE was acclaimed chef Jody Adams, owner of multiple Boston-based restaurants and a member of PIH’s Board of Trustees. She was on hand to explore the campus, meet the kitchen staff, and demonstrate some new dishes, using local ingredients. The meeting between Jody and Bella—two extraordinary female leaders—had been in the works for some time. 

“One of my dreams for Bella was to have her meet Jody,” says Dr. Paul Farmer, another guest of honor that day. 

For a few hours, under Bella’s watchful eye, Paul switches roles from PIH co-founder and chief strategist to UGHE sous chef, looking just the part with a rolling pin and chef’s hat for the day’s kitchen demo. 

“I wanted Jody to meet our network of chefs here and Bella was part of that. Her staff are fantastic. The people who serve meals, who clean up—there is something special about this kitchen,” Paul says. 

Jody agrees. 

“I’d been told about the kitchen and Bella’s food,” she says. “I was prepped to have high expectations, and they were met. The ingredients here in Rwanda are amazing.” 

two chefs pour item into a large pot
Jody and Bella spend the day in Butaro kitchen prepping a number of different recipes for staff and students. This is the prep for ‘Saloniki Spanakopita’, a Greek recipe made with local Rwandan ingredients.(Photo by Nick Carney / for PIH)

In addition to lunch service, Bella and Jody prepare fresh gnocchi and spanakopita—a flaky Greek pie, filled with spinach—for a taste-testing later in the day, kneading locally grown, cooked potatoes into a thick dough with eggs, flour, and salt. They select and slice generous handfuls of dodo, a basil-like plant that grows in the surrounding fields of Burera District. 

two chefs cut vegetables
Key to their preparation is Dodo, a Rwandan plant similar to basil, sourced from the surrounding fields and grown by local farmers. (Photo by Nick Carney / for PIH)

For all of the food that comes out of her kitchen, Bella prioritizes locally sourced ingredients, including meats, eggs, cream, honey, fresh fruit, and vegetables. This, she explains, supports the income of local farmers, encourages the diversification of crops grown in the area, and, subsequently, boosts the nutritional value of what people eat on campus and in the community.

Explaining that philosophy, Bella moves her hand in a circle on the table. 

“Our kitchen works in a cycle—from farmers to food to farmers,” she says. “Whereas some restaurants use supermarkets, we have a big community garden, and it is UGHE’s role to support what it offers.” 

When ingredients can’t be locally sourced, Bella looks further afield—but only as a short-term solution. Channeling efforts back into the community, Bella has been identifying “food gaps,” and how to address them with the simplest, age-old solution: seeds. 

“We want to help farmers grow the vegetables we need,” Bella explains. “The variety is not enough. We have already bought many seeds, and are preparing to plant them locally in collaboration with local farmers.” 

The local growing efforts will run on a house-to-house basis, as Bella and her team meet with local families to match the right seeds with the right land, develop knowledge about their growth, and support the diversification of crops in the area. 

For Jody, seeing this passion firsthand was striking. 

“Being around Bella and getting to know her philosophy for food, her commitment to local ingredients and community education—it was so impressive,” Jody says. “It got me excited about planning my next trip back.”

chef place tray in oven and sets timer
The spanakopita is nearly complete- time for the oven! (Photo by Nick Carney / for PIH)

Jody said she also was struck by a feeling of solidarity—women helping women in the culinary world. 

“We have always had to fight and advocate for ourselves and other women. I don’t know if that will ever end,” she says. “Women will always have to do more and they need to support each other. Entering Bella’s kitchen was a wonderful experience—to see firsthand the people who she mentors through the process of cooking. I felt very comfortable there. We didn’t speak the same language, but we spoke the same language of food."

chef look over a table filled with food
Jody and Bella present their final dishes to hungry students, staff and faculty. (Photo by Nick Carney / for PIH)

 

University Hospital Cares for Haiti's First COVID-19 Patients

Haiti very often has been the first country where Partners In Health operates to try a new course of action, whether it is a new HIV medication, TB protocol, or community health worker training.

On March 20, this rang true once again.

That morning was when Haiti’s Ministry of Health and Zanmi Lasante, as PIH is known in Haiti, received the country’s first two patients who were positive for COVID-19. Since then, three more people with positive tests have come to the isolation ward at University Hospital of Mirebalais for treatment and care. Clinicians are also supporting people associated with those confirmed patients, by providing a safe, private space for them to be quarantined and monitored for signs of the disease.

Six doctors and nine nurses at University Hospital—which is internationally accredited and PIH’s flagship facility in Haiti—are working around the clock to provide effective, efficient, and patient-centered care, while ensuring the safety of patients and caregivers. There are concerns for what is to come, but the team has pulled together incredibly during this stressful time.

No other PIH-supported facilities, across the other 10 countries where PIH works, are currently providing direct care to patients who have tested positive for the new coronavirus. But all are collaborating with national and local governments to prepare to test, treat, and trace contacts, while continuing to collaborate with colleagues across all ministries of health.

Responding to COVID-19 in Haiti requires extraordinary efforts, with a team approach that includes dedicated cleaning crews, and hard-working logistical staff who are ordering necessary personal protective equipment (PPE), medications, and other supplies required to run an isolation ward.

But it is not a new effort—the Haiti team has been here before.

The 2010 cholera outbreak that killed more than 10,000 people in Haiti and inflicted suffering on more than 1 million is still fresh in the minds of Zanmi Lasante staff. Many of these same staff members also answered the call to support PIH’s Ebola response in West Africa in 2015.

Today, they face the challenges of COVID-19. They are the frontline of care and support for those receiving treatment now, and for those who will be affected by this novel coronavirus in weeks and potentially months to come. 

Today, tomorrow, and every day after, the Zanmi Lasante team will work together to take on this battle. Haitian health care workers at University Hospital and beyond will do whatever it takes. And the global PIH network will be there, as well, at our patients’ sides for this fight.

This article was written by Elizabeth Campa, senior health and policy officer and chief of staff for Executive Director Loune Viaud for Zanmi Lasante, as Partners In Health is known in Haiti. She has worked for the organization since 2013, and is a second-year graduate student at Harvard Medical School’s department of Global Health and Social Medicine.

Care for All During COVID

While passing this bill was an important first step, it is not sufficient. We must take further action, as the bill:

What you can do

Sign our pledge: Health Care is a Human Right

We believe that every single person—regardless of where you were born, or how much money you make—has a right to receive high-quality health care.

During COVID-19, we’re seeking global health advocates to join our movement as we work to ensure care for all.

Add your name

 

Call your elected official

Urge your elected officials to support or draft legislation that:

  1. Provides paid sick leave to all Americans:This includes supporting bill >S.3415 - Paid Sick Days for Public Health Emergencies and Personal and Family Care Act to expand the availability of paid sick leave.

  2. Is responsive to the needs of Native American communities including:

 

  1. Covers individuals for all medically necessary services in connections with COVID-related testing, treatment and recovery: All Americans, regardless of whether they are covered by private insurance, Medicare, Medicaid, or uninsured should have the cost of any COVID-19 related treatment and recovery covered, including treatment for complications and other health conditions arising from COVID-19. This should be provided with no cost share to ensure Americans foremost seek early treatment and are protected from catastrophic health expenditures associated with COVID-19.

  2. Expands access to home- and community-based service provision to reduce the burden on the health system: As the health system becomes overburdened and Americans avoid seeking care for non-COVID related illnesses, it will be imperative to cover and pay for care and treatment furnished in off-site settings that can supplement the capabilities of desperately overstretched hospitals. In order to ensure there is continuity of care for all patients with chronic illnesses and other health complications do not go untreated during the outbreak, the government should authorize temporary payment increases to provide home and community-based care, including additional nursing assistance to deal with intensive patient needs.

  3. Protects those on the frontlines providing care: Our health care workforce is putting themselves at substantial risk and personal sacrifice to respond to this outbreak. Ensuring that all health care workers have access to sufficient occupational health equipment and supplies (including most critically PPE), have paid sick leave, and are prioritized for testing is critical. Moreover, infrastructure investments, including establishment of additional health facilities and capacity, will be essential to enable a safe space for both providers and patients.

  4. Collaborates and provides ongoing resources to international partners to curb the global spread of COVID-19 and provide care, including support to S.Res.505.  (A resolution expressing the sense of the Senate that the United States will continue to provide support to international partners to help prevent and stop the spread of coronavirus.) We cannot forget that this pandemic was driven by the interconnected world we live in. The CDC and USAID must now be given the funding necessary to support critical public health and health care capacity in countries with far weaker health systems and fewer options in terms of fiscal stimulus and other policies.


Look Up Your Elected Official

 

What TB Can Teach Us About COVID-19

For more than two decades, Partners In Health has treated and prevented tuberculosis (TB) and its severe, drug-resistant variants in some of the poorest and most vulnerable communities in the world. Our community-based approach to care has resulted in some of the highest cure rates and lowest treatment default rates ever recorded.

Today, on World Tuberculosis Day, the planet is grappling with another infectious respiratory sickness. With case numbers rising daily in countries beset by the COVID-19 pandemic, a powerful question looms: What can we learn about COVID-19 care, treatment, and prevention from years of fighting TB—the world’s deadliest infectious disease? 

What is tuberculosis (TB)?

Tuberculosis is an airborne, infectious disease that can be passed from person to person and causes progressive destruction of the lungs. 

Symptoms can include a chronic cough, weight loss, and shortness of breath, which in severe cases can affect a person’s ability to walk even short distances, or conduct physical activity.

If left untreated, or if treatment is unsuccessful because of drug resistance or other factors, it can be fatal.

How is it treated?

TB can be treated by antibiotics, but the treatment process traditionally has been long and grueling for patients, often totaling two years and thousands of pills. However, the emergence in recent years of new drugs for treating TB—including severe forms such as multidrug-resistant tuberculosis (MDR-TB)—has shortened treatment times and significantly decreased side effects, showing positive results in clinical trials around the world. 

Why Is TB relevant?

TB kills 1.5 million people annually, an average of nearly 4,000 people a day. It has been the world’s deadliest infectious disease since it surpassed HIV in 2015, according to the World Health Organization.

What are key things to know about TB and COVID-19?

 

On World Tuberculosis Day, the global TB community stands with vulnerable populations fighting COVID-19, and Partners In Health continues to advocate for a comprehensive approach to TB, including prevention, treatment, and contact tracing—the basis for our #StopCOVID response plan

Donate to StopCOVID

Family Struck by TB for Decades Finds New Hope, Cures in Lesotho

When Matankiso and Moholi Moleko learned in 2018 that three members of their family—two of their daughters and one granddaughter—had been diagnosed with a severe form of tuberculosis, they were devastated. 

They had been down that road too many times before. 

Over the span of several years in the early 2000s, the parents lost three of their 10 children to TB, the world's deadliest infectious disease. 

As Matankiso, 62, talked about those years, her face grew somber. She sat in the kitchen next to Moholi, her husband since 1974. Their family's home is in the village of Ha Rasekoai, Lesotho, in a rural, arid region ringed by mountains and more than two hours by car from the capital, Maseru.  

Views from Ha Rasekoai, outside of Maseru, Lesotho
Sweeping views are everywhere in the village of Ha Rasekoai, Lesotho, home of the Moleko family. 

Moholi, now 69, had personal battles with TB himself, catching and overcoming the airborne disease three times as a younger adult, while working in mines in South Africa.  

All of that history meant the 2018 diagnoses, one after another, struck the family incredibly hard. 

But only a year later, on that day sitting at their kitchen table in October 2019, Matankiso and Moholi were able to smile. This time, the results have been much, much better.

With the support of Partners In Health-Lesotho, all three family members diagnosed in 2018 are now healthy and in recovery. They received treatment at PIH-supported Botšabelo Hospital, the only facility in the country dedicated to multidrug-resistant tuberculosis (MDR-TB), a severe strain of the disease.

Additionally, all three family members have benefited from new TB medications, which PIH-Lesotho is using as part of the #endTB partnership and have shown positive results in clinical trials across several countries. 

Pulane Matsuma, 14, with her grandmother and her treatment supporter
Pulane Matsuma, 14, smiles outside the family home with her grandmother, Matankiso Moleko, who had smeared allergy cream on her face to fight seasonal discomfort. At left is Makhojane Ngoanapoli, 52, the TB treatment supporter for Pulane and Pulane's aunt, Tseleng Matsuma. 

For Pulane Matsuma, 14, the new medications have meant nothing less than a new outlook on life. The engaging, outspoken Pulane said she "was very, very scared" in June 2018, when she was diagnosed with MDR-TB. 

Shortly after her diagnosis, Pulane spent a week at the PIH-supported Malaeneng treatment center in Maseru, not far from Botšabelo Hospital. Malaeneng provides housing for patients receiving extended care, who live far from the capital. Pulane began taking MDR-TB medicines orally, twice a day. While she lost her appetite and battled a persistent cough, symptoms never became severe enough to warrant a stay at Botšabelo. Soon, Pulane returned home to her family in Ha Rasekoai. 

On this day in October, she had no sign of a cough as she talked about her household chores, her love of newspapers and magazines—especially gossipy or celebrity relationship-oriented magazines—and how one day, she hopes to be a nurse or a policewoman. 

First, she'll have to return to school. Pulane will finish her two-year treatment regimen in June, and said she hopes to return to school when the next academic year begins, in January 2021. 

When that day comes, one of the happiest people in Ha Rasekoai will be Pulane's treatment supporter, Makhojane Ngoanapoli.  

Pulane Matsuma receives TB medicine from her treatment supporter
Pulane Matsuma receives TB medicine from her treatment supporter, Makhojane Ngoanapoli. 
Pulane Matsuma and Tseleng Matsuma sit with their treatment supporter
Right to left, Tseleng and Pulane Matsuma sit with their TB treatment supporter, Makhojane Ngoanapoli. 

Treatment supporters are an aspect of care that, for PIH, is unique to tuberculosis. While PIH teams around the world utilize community health workers to screen multiple neighbors and communities for numerous ailments, ranging from HIV to high blood pressure, treatment supporters for TB only care for one patient at a time.

Or, in this case, two. Ngoanapoli has been the TB treatment supporter for Pulane and for Pulane's aunt, Tseleng Matsuma. The role has meant that Ngoanapoli, 52, visits Pulane and Tseleng every day, to help them take their medicines, check up on them, and provide support and access to care. 

Ngoanapoli, who also lives in Ha Rasekoai, said this was her first time as a treatment supporter. She has known Tseleng, Pulane and their family for a long time, and knows their history with TB. She said that knowledge motivates her every day.    

"I became a treatment supporter because of the compassion I feel for this family," Ngoanapoli said. "I know that I have to give good care to them—because these people have to live."

Matankiso and Moholi Moleko, at home in Lesotho
After enduring years of heartache during their family's multi-generational battles with TB, Moholi and Matankiso Moleko smile, together from inside their home in Ha Rasekoai, Lesotho. 

The third member of the family to be diagnosed with TB in 2018 was Mamots'oane Taole, 32, also a daughter of Moholi and Matankiso. Like her sister Tseleng and her niece Pulane, she also is on the way to recovery. 

Matankiso said the personal, compassionate care the family received from PIH was instrumental in the positive outcomes for her family. 

"It's the kind of care that has follow-ups," she said. "In my honest opinion, this is the best kind of care we could have received."

Now married for 45 years, Moholi and Matankiso have 16 grandchildren, several of whom are playing outside in gray school uniforms while their grandparents talk in the kitchen. Matankiso said these days, when the entire family gathers, the biggest problem they have is a happy one. 

“When they are all home for holidays, there is nowhere to sit, because it is so crowded,” she said.

COVID-19 Conference Call with Clinical, Logistics Experts

A panel of Partners In Health experts provided an update on the organization’s global plan for combatting the novel coronavirus and answered a broad range of questions from donors during a recent conference call.

PIH CEO Dr. Sheila Davis; Dr. Joia Mukherjee, chief medical officer; Dr. Patrick Ulysse, chief of operations; and Dr. KJ Seung, an infectious disease expert, participated in the hour-long discussion.

Each provided a summary related to their area of expertise and spoke about PIH’s plan for testing and treating patients, the importance of contact tracing and the accompaniment of local and national governments in the response to COVID-19.

While some donors submitted questions beforehand, others called in to have their queries answered live by the PIH panel. Questions covered a variety of topics, such as PIH’s plan to protect patients and staff, whether and how PIH is engaged in advanced planning with countries that have not yet been affected, and whether PIH will need emergency funding during the pandemic.

Listen to the experts

To hear responses to these questions, and many more, check out the link below. The audio has been edited and condensed for clarity.

Q & A: How COPE is Raising Clean Water Awareness, Access on Navajo Nation

Across the 27,000 square miles of Navajo Nation in the southwestern U.S., one of the biggest health issues is something many people elsewhere in the country take for granted: access to clean, potable water.

The Navajo Nation’s Department of Water Resources has estimated that 30 percent of nation residents lack access to running water, and must haul water to their homes after driving miles to a pickup location, which is often a community well. The scarcity can be heightened during extended dry weather, and many of the Nation’s 300,000 residents need water not only for themselves and their families, but also for gardens, livestock, and household uses.

Carmen George, COPE research & MEQ manager
Carmen George

And in the arid southwest, surface water is also a dwindling resource. The amount of surface water in Navajo Nation—which includes parts of New Mexico, Arizona and Utah—dropped by about 98 percent over the last century, as temperatures warmed and precipitation declined.

Water scarcity has been compounded by environmental issues, including pollution from more than 500 abandoned uranium mines in the region.

All of those concerns are why Community Outreach and Patient Empowerment, or COPE, a sister organization of Partners In Health, is working to expand access, awareness, and education about clean water and its effect on health across all of the Navajo Nation communities that COPE supports.

Shine Salt
Shine Salt 

In honor of World Water Day, which is March 22, two COPE staff members talked about social factors that affect water use, how better marketing and fewer sugary drinks can improve health, and a new program called Water is K'é, which is reminding residents to choose water when making decisions about which beverage to buy for themselves and their families. 

The name of the program translates in Diné bizaad, or Navajo language, as “Water is Kinship.” And to these two COPE staff—Research & MEQ Manager Carmen George, and MEQ Coordinator Shine Salt—kinship is exactly what promoting clean water and healthy communities is all about.   

 

What are some of the factors that affect whether people choose water as their beverage of choice? Have you and your team identified different factors or influences for elders, compared with young people?

We understand that COPE developed its Water is K'é program to increase water consumption. Can you describe the program's goals, and what it entails?

COPE has developed a culturally based and community-informed program to promote healthy beverage choices in Navajo Nation. This program, which we call “Water is K'é,” has a multi-faceted approach:

Can you describe how COPE worked with community partners to develop this program?

COPE did a community assessment around people’s thoughts and attitudes on water. This is how we tailored the program to meet the community’s needs. Initial funding included a capacity-building grant with eight grantees; this is how we learned together, by understanding approaches to the community. We shared the types of strategies we were implementing with Native communities and best practices for a successful initiative.

This is how we learned together, by understanding approaches to the community.

What progress or impacts have you seen from the Water is K’é program?

The initiative is gaining much more attention now than when we initially started – people are doing a 30-day water challenge on their own, and COPE partners are creating small environmental changes by only serving unsweetened tea and water at their family events. Past participants of the 30-day water challenge have mentioned that since making water their first choice, they have lost weight and are making healthier beverage choices for their family.

COPE Annual Report

Globe Op-Ed: Dr. Paul Farmer Urges “Merciful and Humane” COVID Responses

Dr. Paul Farmer stressed the importance of social support for COVID-19 patients and the critically ill Thursday, writing in The Boston Globe that “outbreak responses must be merciful and humane” in order to be effective, particularly in resource-limited settings around the world.

“People must have food, supplies, safe shelter, of course, but also help with home-bound children as well as paid sick leave,” Farmer wrote in an opinion piece. “Social support includes safe and rapid transportation to hospitals for the critically ill, since COVID-19 can be a disease with a strong and unpredictable course. Strong social support, including the assurance that one’s loved ones will have access to quality care if they do fall ill, is the secret sauce of effective outbreak control.”

Dr. Paul Farmer
Dr. Paul Farmer, PIH co-founder and chief strategist 

Farmer is co-founder and chief strategist of Partners In Health, and the Kolokotrones University Professor and chair of the Department of Global Health and Social Medicine at Harvard Medical School.

Describing what he called “expert mercy,” Farmer said responses to the global coronavirus pandemic must combine interventions to save the sick and slow the spread of disease with compassionate, humane care, across cultural and societal settings.

“We learned during the West African Ebola outbreak (2014-16) that social distancing is almost impossible in settings of food insecurity or crowded slums,” he wrote.  

PIH works in 11 countries around the world, working with national governments and international partners to strengthen health systems, from local communities to district hospitals. As PIH mobilizes and implements its COVID-19 response plan, Farmer’s Globe piece noted that strong medical infrastructure will be paramount.

“When you’re coughing and short of breath, expert mercy is an oxygen mask or a mechanical ventilator,” he wrote. “Much of this care requires hospital beds, and their availability varies substantially even in affluent countries. South Korea has 12.4 hospital beds for every 1,000 people; in the United States, 2.8. If we’re short on ICU beds in the United States, what will that mean for such places as Haiti or Rwanda or Lesotho or Sierra Leone?”

Strong social support...is the secret sauce of effective outbreak control. 

PIH’s four-pronged COVID-19 plan includes widespread testing; free, dignified, high-quality treatment of the sick; accompaniment of government partners through comprehensive, nationwide responses; and contact tracing to control spread of the disease, advise those who have been in contact with COVID-19 patients, and provide the support they need to stay healthy.  

“We know strong health care systems can help manage the surge by slowing the pace at which we need beds and, more important, nursing care,” Farmer wrote. “We know that expert mercy, and the sentiment of fellow feeling that underpins it, will be sorely needed in weeks to come.”

Read Farmer’s full opinion piece here.

Video: Dr. KJ Seung Explains Rapid Testing for Coronavirus

Dr. KJ Seung has nearly two decades of experience in curbing the spread of infectious disease in countries around the world. He has been fighting tuberculosis with Partners In Health since 2001 and is a co-leader of the Expand New Drugs for TB partnership, or endTB, which spans 17 countries.

 

As PIH prepares to implement rapid testing kits for the novel coronavirus— launching PIH’s four-pronged COVID-19 response plan—Seung is at the forefront, working with PIH teams overseas, national governments, and local colleagues.

“This is really unprecedented—so we’re planning an unprecedented response,” Seung says. “It’s going to take mobilization of everybody in our PIH countries to try to prevent this virus from spreading.”

PCR tests

The U.S. and many other countries are using a test known as PCR. That test detects the actual novel coronavirus through a nasal swab, oral swab, or sputum. But it requires advanced laboratory facilities, which aren’t readily available in many of the 11 countries where PIH works.

“In a lot of our countries there is only one national laboratory in the entire country that can do that test,” Seung says. “Some of our countries don’t have any laboratories that can do that test. So, we’re going to have to think of something different. We’re going to have to think outside the box.”

Rapid tests

That means the use of rapid tests, like those deployed widely in countries including South Korea.

PIH ordered 100,000 of those tests last week. The rapid tests detect coronavirus antibodies and can be done at bedside, with an answer in as quickly as 15 minutes.

While questions remain about the best ways to use the rapid tests, Seung said time is not a luxury that responders around the world have.

This is really unprecedented—so we’re planning an unprecedented response.

“We don’t have time for studies to be done. The countries need something right now, so that’s what we’re going to do,” Seung says. “We’re going to distribute these to eight countries and work really closely with their ministries of health to figure out how best to detect the coronavirus, see how far it’s spreading, and respond to it.”

PIH teams plan to implement the rapid tests as soon as possible, potentially within the next two weeks.

“We’re working like crazy to figure out the best way to implement them in the (given) country, and get people trained up, get nurses trained up, and community health workers who will have to do the mobilization and the contact tracing, the community education,” Seung says. “Everybody in the health care system, from the very top to the very bottom, is going to have to be involved in this coronavirus response.”

How to Help

To begin tracing and breaking chains of infection, we need to ship at least 100,000 rapid COVID-19 diagnostic tests to our teams around the world—just to start. These new tests are about $5 a piece, which mean the potential impact of your gift is immense. 

No matter how many tests you send, you’ll be supporting an essential operation in the global battle against the COVID-19 pandemic—an operation that’s absolutely necessary for the strategy’s success.

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10 Mental Health Tips for Coronavirus Social Distancing

Dr. Giuseppe (Bepi) Raviola, director of mental health at Partners In Health, put together a list of key practices to maintain good mental and emotional health for those asked to stay at home in efforts to prevent further spread of the novel coronavirus, or COVID-19. 

As we enter this new and unprecedented phase of the pandemic, we are inundated with guidelines about how to keep ourselves and our families healthy and virus-free. Yet a key item on the list—social distancing—poses unprecedented challenges to our mental and emotional well being, and requires consideration. The risk may be especially high for our children, who are suddenly cut off from school and friends.

How do we as individuals and parents cope without driving ourselves and each other crazy?

It’s a question that mental health professionals such as myself are being asked multiple times a day and that urgently needs addressing. This introduction and list was written with the help of people with whom I work, trying to gain steady emotional footing in this strange new scenario we together are in:

girls jump rope outside their home in Malawi
Alice Kanjinga (left), 6, jumps rope at her family's home in Kamdzandi Village, near PIH-supported Lisungwi Community Hospital in Neno District, Malawi. Photo by Karin Schermbrucker for Partners In Health

Top 10 Practices:

  1. 1) Social distancing does not mean emotional distancing; use technology to connect widely;
  2. 2) Clear routines and schedule, seven days a week, at home—don’t go overboard;
  3. 3) Exercise and physical activity, daily if possible;
  4. 4) Learning and intellectual engagement—books, reading, limited internet;
  5. 5) Positive family time—working to counter negativity;
  6. 6) Alone time, outside if possible, but inside too; but remember, don’t isolate;
  7. 7) Focused meditation and relaxation;
  8. 8) Remember the things that you really enjoy doing, that you can do in this situation, and find a way to do them;
  9. 9) Limit exposure to TV and internet news; choose small windows and then find ways to cleanse yourself of it;
  10. 10) Bathe daily, if possible, to reinforce the feeling of cleanliness.

 

community health worker guides a family through interactive play in Peru
Community Health Worker Inela Espinoza Cadenas (left) works with Andrea Milagros Pacheco Diaz and her mother, Lourdes Diaz Tamayo, during an interactive play session at the family's home in Carabayllo, Peru. Photo by William Castro Rodríguez / Partners In Health

Remember: 

 

Solidarity for a Healthier World

This strategy is grounded in evidence, decades of transformative global health experience, and in fulfilling the right to health for all, in global solidarity. By leading global investments to strengthen health systems, the US government could help prevent 97 million premature deaths, including 50 million deaths of infants and children and 20 million deaths from non-communicable diseases, and dramatically increase life expectancy in low- and middle-income countries. The current COVID-19 outbreak is a reminder of what we already know, that health emergencies know no borders and that strengthening health systems globally is the best defense against international public health crises.

Background

U.S. Government Engagement in Global Health

The U.S. Government invests in a number of global health programs, notably the President’s Emergency Plan for AIDS Relief (PEPFAR), the President’s Malaria Initiative (PMI), and the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund). Through global health programs, the U.S. Government can display global leadership in a bipartisan manner, works towards the fulfillment of the Sustainable Development Goals (SDGs), prevents and prepares for pandemics, builds diplomatic ties, demonstrates values of humanitarianism and solidarity.

Sustainable Development Goals and Universal Health Coverage

The SDGs, which “seek to realize the human rights of all” and the UN Political Declaration on Universal Health Coverage (UHC), both adopted by all 193 countries of the UN General Assembly, enshrine the principle of health as a human right and the responsibility of all duty global bearers for its realization. The SDGs fundamentally redefine the objective of international development, with for the first time a genuine international consensus based on universal goals, applying equally to all countries and people. By significantly advancing the attainment health-related goals of the SDGs to “ensure health and well-being for all, at every stage of life” and achieving universal health coverage by 2030, the US has the unique opportunity to advance unprecedented global diplomacy based on solidarity and the realization of human rights, which is of enormous reciprocal benefit to the US and the world. This requires a bold new vision and commitment for the US’s role in global health, including taking the required decisive action for the achieving the SDGs and addressing structural factors that prevent their realization.

The Challenge

Funding is Insufficient

Funding is often inefficient and misaligned with government priorities and population needs

The Solution and Opportunity

Funding and Health System Strengthening

International cooperation beyond global health

Conclusion

The U.S. Government can build upon bipartisan successes like PEPFAR and the Global Fund, which have saved millions of lives, by significantly increasing investments in global health system strengthening towards UHC. The need for this contribution is urgent—to continue progress of lifesaving programs, make headway on non-communicable diseases, and prevent future pandemics. It is also the best foreign policy investment the US can make.

Global Coronavirus Response

The World Health Organization (WHO) is urging countries to improve efforts to contain the disease and protect health care workers, and notes that a solution calls for “aggressive preparedness,” all around the world. On March 11, 2020, the WHO officially declared COVID-19 a pandemic.

Partners In Health (PIH) knows that COVID-19 , the disease resulting from novel coronavirus, will disproportionately affect the most vulnerable and hit countries with weak health systems the hardest. The currently reported case fatality rate cannot be used to predict how this virus will devastate many areas globally, where there are not high-functioning and well-resourced health systems that can respond to an aggressive infectious disease, and where the population suffers from conditions such as malnutrition, HIV, and tuberculosis. Mortality is anticipated to be far worse in the places where PIH works, and it is unclear if the current global response accounts for these factors.

PIH has launched a comprehensive effort to support this response across its network of supported countries around the world to:

 

PIH is uniquely positioned to respond to COVID-19, leveraging deep experience in treating infectious disease outbreaks and responding to emergency situations around the world. PIH’s approach is successful because we: 

 

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An underestimated outbreak is now a pandemic that must be controlled

This virus will disproportionately affect developing nations

If not PIH, then who?

What’s our plan?

PIH has already put a plan in motion to address the massive threat poor countries face. Our plan will surely evolve as the pandemic continues. Currently, the plan is divided into 4 prongs:

1. Testing

 

2. Provision of Care

3. Assist Local Government Response

4. Mobilize Community Health Workers

 

See the Full Plan

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PIH’s Partnership with Massachusetts's Government in COVID-19 Response

 

Our Massachusetts’s Response

 

ICYMI: Reddit AMA on Coronavirus with PIH Co-Founders

Partners In Health Co-founders Dr. Paul Farmer and Ophelia Dahl reflected on decades of experience Tuesday while urging a Reddit audience to fight disease outbreaks with the model of strong health systems, prevention, and pragmatic solidarity that PIH employs in 11 countries around the world.

“Remaining optimistic and hopeful about the promise of your own engagement is much, much better than being or becoming cynical,” Dahl wrote in the live, two-hour Ask Me Anything, in which scores of participants asked about a variety of topics, including COVID-19, social justice, health education, marginalized communities, and more.

The online event commemorated what would have been the 100th birthday of late Boston philanthropist Tom White, a PIH co-founder, committed donor, and longtime friend of Dahl and Farmer.  

Farmer spoke about the power of friendship in global health when responding to a leader of a non-governmental organization in Indonesia, who works with children facing stunted growth and asked how Farmer deals with feelings of hopelessness.

Farmer framed his answer in the grief he and colleagues felt in Haiti, after the country’s devastating earthquake in January 2010.

“We were always more than the sum of our parts in those weeks and months right after (the disaster). That’s the lowest I’ve been, and friends always shore each other up,” Farmer wrote. “But the real reason I distrust hopelessness is because when we’re talking about things like childhood stunting, in Indonesia or elsewhere, we’re talking about hopelessness on behalf of others, which they can ill afford.

Dahl and Farmer reflected on past experiences throughout the question-and-answer event, showing the composure and lockstep principles crafted over decades of building health systems and responding to crises in challenging, low-resource settings.

Those challenges now include COVID-19, which the World Health Organization declared a global pandemic a day after the co-founders’ AMA. One question dealt with how PIH approaches such situations.

“Very much the same way that we have approached the other epidemics in our midst, which is to say to make sure you have a robust health system in place,” Dahl said. “Having supplies, health professionals, and access to care. In areas where there isn’t that, make sure you work hard to put it in place.”

Farmer added a complementary perspective as an infectious disease doctor.

“Communicable pathogens almost always have some treatment and (COVID-19) would seem to have several. We’re not talking about the specific therapies, but rather the nonspecific ones, supportive and critical care,” he said. “Since this is a communicable pathogen, protecting the caregivers is a prime concern. Once we link this to our mission to make a preferential option for the poor, we’re going to find ourselves needing more staff, stuff, space and better systems. And that’s what our colleagues are doing from Haiti to Rwanda to Russia.”

Read the full AMA on Reddit, here.

Dr. Paul Farmer to Axios: ‘Remember the Caregivers’ Amid Coronavirus Response

Dr. Paul Farmer told the news website Axios on Monday that the people most at risk for exposure to disease from the new coronavirus are those providing care, citing his experience with the Ebola outbreak in West Africa from 2014 to 2016.  

“Always remember the caregivers,” said Farmer, Partners In Health’s co-founder and chief strategist. “The caregivers need protecting, too, and sometimes the caregivers are going to be family members. This is another caregivers' disease like Ebola.”

In the brief, wide-ranging interview, Farmer talked about how COVID-19 could strain capacity in intensive care units, particularly in rural or low-resource settings around the world; shared his thoughts from a recent visit to Rwanda, and the COVID-19 response there; and talked about how, despite uncertainty about the disease, health resources in the United States give reason for confidence.

“Our public health professionals are really good, and our scientists and researchers are the best in the world,” he said. “If you are critically ill with this disease, even though we don't have a specific treatment, we do have nonspecific treatments — they're called supportive and clinical care. And these nonspecific treatments are lifesaving.”

Read the full interview via Axios, here.

Harvard Professor Issues FAQ on Coronavirus

Dr. Megan Murray is the Ronda Stryker and William Johnston Professor of Global Health at Harvard Medical School and director of research at Partners In Health and at the Brigham and Women’s Hospital Division of Global Health Equity in Boston. She has decades of experience as an epidemiologist and infectious disease specialist and has managed multidisciplinary research teams whose work has spanned continents.

Below, Megan provides valuable insights on how the new coronavirus spreads, whether a vaccine is in the works, and what everyone can do to reduce their risks of infection. Her answers have been condensed and edited from this original version of the FAQs.

Dr. Megan Murray, PIH's director of research
Dr. Megan Murray is the Ronda Stryker and William Johnston Professor of Global Health at Harvard Medical School and director of research at Partners In Health and at the Brigham and Women’s Hospital Division of Global Health Equity in Boston. Photo by Zack DeClerck / Partners In Health

How is it transmitted?

COVID-19 is a respiratory virus (like the common cold) and is spread through respiratory droplets, meaning drops of fluid from the nose or mouth that are emitted during coughs, sneezes, or even talking. It is possible that some of the viral particles emitted this way end up on surfaces (door handles, subway poles, coins) where they might remain viable. These objects then become “fomites,” inanimate objects that can transfer infection between people.

It is also possible that COVID-19 can be transmitted as an aerosol—in other words, airborne, through direct inhalation of the virus—but so far, there is no conclusive evidence of that. The virus also has been identified in stool and, less often, in other body fluids such as blood or urine, raising the possibility that other routes of transmission are possible, although it is not clear if that has contributed to the outbreak.

What are the symptoms and clinical course of the disease?

COVID-19 disease usually begins with mild fever, dry cough, sore throat, and malaise. Unlike the coronavirus infections that cause the common cold, it is not usually associated with a runny nose. In the early phase of the disease, illness is usually mild. Most often—in about 80 percent of cases—it remains mild and may not require direct medical intervention.

About 14 percent of people develop severe pneumonia accompanied by hypoxia (lack of oxygen) and 5 percent are considered critical, meaning they experience respiratory failure requiring mechanical ventilation.

Although we know that older people and those with heart problems or diabetes are at especially high risk for severe effects, it is not yet confirmed why these people experience these outcomes.

We’ve heard a lot about the widespread public lockdown in Wuhan, China, travel restrictions, and other measures intended to slow the spread of disease from COVID-19. Can you describe some of those measures, and for example, the differences between quarantine, isolation, and social distancing?

There are several different approaches to restricting movements to control epidemic disease. One approach, isolation, safeguards people with the disease and keeps them away from other people, to try to prevent them from infecting others. But this will only be completely effective if they are diagnosed with the disease at or before the time that they become infectious. If people are infectious before they have symptoms or if some infectious people never develop symptoms at all, transmission can take place before a person is diagnosed and isolated.

For diseases with significant asymptomatic spread, quarantine is used to separate and restrict the movements of people without signs of illness who may have been exposed to an infectious case so that they do not infect others during that period.

A less extreme measure is social distancing—asking people to avoid group settings such as schools, workplaces, or large gatherings. The Wuhan “lockdown” is an example of fairly rigorous social distancing.

All of these methods can have specific downsides. Patients who are isolated within health care facilities may receive suboptimal care if isolation measures make it more difficult for health care workers to attend to them. Quarantine can result in the housing of uninfected people with infectious people who aren’t showing symptoms, and can lead to much higher rates of spread within the quarantine facilities.

If social distancing measures involve loss of employment, education, or routine medical care, they, too, can have serious negative effects on individuals’ physical and mental health, as well as on the economy. In the case of COVID-19, it is unclear whether school closures would be helpful, since few children develop the disease, although we do not yet know if they can be carriers of the infection while not showing symptoms. 

Dr. Epifanio Sánchez sees TB patients in Carabayllo, Peru.
Dr. Epifanio Sánchez wears a mask while seeing tuberculosis patients at a hospital in Carabayllo, Peru.

Are masks effective in preventing transmission?

First of all, the World Health Organization and Centers for Disease Control are urging the general public not to buy surgical-style or N95 masks, as they are needed by health care workers and patients and are in short supply.

That said, clinicians and patients use several types of masks to prevent infection or slow the spread of the disease. Surgeons use simple masks to prevent themselves from contaminating a surgical site with respiratory droplets, for example. Surgical masks are designed to protect others, but not necessarily the wearer.

Masks known as “N95,” in contrast, are much more heavy-duty and fit tightly around the nose and mouth, blocking most transmission of even small airborne particles. These are worn by patients, or by health care workers who come into close contact with known cases. They are quite uncomfortable and very expensive, but likely reduce transmission of infections through the respiratory route. 

Many rumors have been circulating about the disease, including rumors about impacts being seasonal. Will COVID-19 go away with warmer weather?

Some respiratory viruses—such as influenza, RSV, and the coronaviruses that cause the common cold—are seasonal, meaning that they tend to peak during winter months and decline in summer. This seasonal pattern is due to multiple factors. In temperate climates, schools tend to be in session in winter and people tend to congregate in warm buildings in cold weather; these behavioral factors mean that the contact rate is often higher in winter than in summer.

Humidity is known to play a role in the transmission of influenza, as well, with higher rates of transmission during periods when the air is drier—which tends to be the case in winter, in many areas. Some evidence exists that there are seasonal differences in people’s ability to respond to disease with their immune systems.

This is often attributed to vitamin D levels, which are higher in summer because of greater exposure to UV light. This theory is supported by at least one recent analysis, which showed that vitamin D supplementation modestly reduced the occurrence of acute respiratory infections. One study of two other novel coronaviruses—SARS and MERS—found that these persisted on inanimate surfaces for longer periods of time in colder and drier conditions.

In contrast, multiple observers note that COVID-19 has already circulated widely in Singapore, where temperatures are routinely above 80 degrees Fahrenheit. Several studies have compared the epidemic growth rates in different areas in China with differing levels of absolute humidity, and found that changes in weather alone would be unlikely to reduce COVID-19 incidence without the implementation of public health interventions.

Also, of course, seasons are not the same the world over. Even if COVID-19 transmission declines as temperatures rise in the Northern Hemisphere, the virus has already been detected in the Southern Hemisphere, and transmission in those regions could intensify as the weather there cools down.

a nurse in rural Mexico provides a flu vaccination to her elderly relative
Nurse Flor Nolasco Reyes (right) prepares to administer a flu vaccination to her mother-in-law, Isabel Perez Roblero at the rural clinic in Soledad, Mexico. Photo by Cecille Joan Avila / Partners In Health

How long until a vaccine is available for widespread use?

Vaccine development has proceeded at an unprecedented pace. A number of companies and research teams already have candidate vaccines that are either ready or close to ready to trial in humans. However, new vaccines require a complex set of trials to establish safety, immunogenicity, optimal dosing, and more. This process can take more than a year.

There usually are three steps to the clinical trial process needed for vaccines to be commercially available.

Phase 1 trials are usually conducted in small groups of healthy volunteers and are designed to establish whether serious adverse effects occur with escalating doses, and whether the vaccine produces the expected immune response.

Phase 2 trials are designed to replicate Phase 1 results in more diverse populations of volunteers, and to test different vaccine schedules.

Once safety, immunogenicity, and optimal dosing are established, Phase 3 studies are conducted to determine a vaccine’s effectiveness. Phase 3 studies are usually much larger than Phase 1 or 2 studies, and are conducted among people at risk for the infection. During the 2014 Ebola outbreak, however, novel vaccine trial designs were proposed and carried out that allowed reduced sample sizes and a faster trial process.

The completion of all three steps is required for a vaccine to be approved by the Food and Drug Administration. The director of NIAID (National Institute for Allergy and Infectious Disease) has estimated that this process would take 12 to 18 months, and that a commercial vaccine would not be available until after that. The first Phase 1 clinical trial is scheduled to begin in the next two months.

Is it likely that the United States will experience an epidemic?

Most experts believe it is inevitable that COVID-19 will spread in the U.S. It may be possible to slow transmission with some of the isolation methods listed above, but it is unlikely that a vaccine will be available in the near future.

Several factors could make controlling an epidemic especially difficult in the U.S. We are in the midst of a particularly bad influenza season, and it will be difficult to know if one has seasonal flu or COVID-19. This could increase the number of people who need to be tested, making tests more expensive and more logistically challenging. Many patients may be reluctant to get checked for what they consider a mild illness, because those who are uninsured or under-insured may need to pay for testing or for a doctor’s visit. Sick individuals may also be reluctant to stay home from work if they do not have sick leave or paid time off.

What are other consequences of the COVID-19 epidemic?

One of the consequences we’ve seen so far, in Wuhan, is that people who need medical care for other conditions have not been able to obtain that care because hospitals and medical staff are at full capacity dealing with the virus. 

News reports describe people in the Wuhan region who have been unable to get dialysis or chemotherapy for the past month. So far, we have been unable to obtain data on whether general mortality has increased in Wuhan as a result of this lack of access to care.

student washes her hands after recess at school in Mirebalais, Haiti
A student washes her hands with soap and water after recess at her elementary school in Mirebalais, Haiti. Photo by Aliesha J. Porcena / Partners In Health

What should I do to reduce my risk of infection?

There are many practical suggestions available from the CDC and WHO on ways to protect oneself from infection, and to prepare for the possibility of an epidemic.

Some of these are obvious:

Others are less obvious: