Partners In Health Articleshttps://www.pih.org
Family Medicine Program Cultivates Patient-Centered Doctors in Liberia

The medical landscape in rural Liberia has undergone a remarkable transformation in recent years as doctors have shifted their approach to patient care. This shift is particularly evident at Partners In Health (PIH)-supported James Jenkins (J.J.) Dossen Memorial Hospital, where health care professionals increasingly focus on patient-centered care. This means treating the whole person, not just their disease, by providing holistic treatment and addressing the underlying factors contributing to illnesses.

Dr. Robert Sieh Jr., a medical resident at J.J. Dossen Memorial Hospital, says he has experienced a profound perspective change and gained a deeper understanding of the psychological and social forces—such as culture, housing, and income level—that may contribute to a person’s illness. These forces, known as “social determinants of health,” are a key part of social medicine, an approach that guides PIH’s work across 11 locations.

Sieh is enrolled in the Family Medicine Residency Program, a partnership between the Liberian College of Physicians and Surgeons and PIH Liberia. Originally launched in July 2017, the program was officially handed over to PIH Liberia earlier this year and relocated to Maryland County.

Dr. Robert N. Sieh, Jr., family medicine resident, at J.J. Dossen Memorial Hospital on September 23, 2024. Photo by Ansumana O. Sesay / PIH

The primary goal of the residency is to equip physicians with the necessary knowledge and skills to effectively address health care needs in Liberia. Based at J.J. Dossen Memorial Hospital, the program prepares doctors to work in remote, underserved regions, such as Maryland County—some 250 miles from Monrovia, the country’s capital. Through a hands-on approach, participants learn how to care for individuals of all ages, from infants to older adults.

“We are training the residents not only to provide care to the patients but to communicate and treat them with respect, empathy, and dignity,” says Dr. Paul Gueilledana, PIH Liberia’s family medicine residency lead.

Patients are noticing the compassionate care, too. “The doctors can talk to the people [politely],” says Tebanyene Huskin, a 45-year-old mother who received care at J.J. Dossen Memorial Hospital, speaking in Liberian Kreyol translated into English.

Continued success, empowerment

Since the program’s inception, 19 specialists have graduated and continued working in various regions across Liberia. The current cohort has five resident doctors: Flomo Cole, Mitchell Risk-Dragba, Robert Sieh Jr., Kangar O. Diggs, and Beyan Gweama. They rotate in core clinical areas such as pediatrics, obstetrics and gynecology (OBGYN), surgery, and internal medicine. All residents work in the inpatient ward at J.J. Dossen Memorial Hospital and serve as primary doctors during pediatric and OBGYN rotations at PIH-supported Pleebo Health Center, the largest primary health center in Maryland County.

The comprehensive, three-year course follows the curriculum of the West African College of Physicians, which is an association of medical specialists that promote professional training of physicians in West Africa to improve standards of practice and specialty training. In addition, PIH Liberia cultivates partnerships with international universities and accredited teaching hospitals to strengthen their workforce and develop the next generation of health care professionals.

Rapid Response Saves Lives After Deadly Attack in Haiti

On the night of October 3, 2024, the small town of Pont-Sondé was the scene of one of the deadliest massacres Haiti has seen in recent history. An armed gang, arriving by canoe to catch unsuspecting residents by surprise, opened gunfire and set fire to homes and vehicles, causing widespread panic and despair. The attack claimed the lives of at least 115 people, including women and children, and forced thousands to flee the community.  

 

Faced with this tragedy and a growing number of forcibly displaced people, the Saint-Nicolas Hospital in Saint-Marc, supported by Partners In Health’s sister organization in Haiti, Zanmi Lasante (ZL), immediately provided lifesaving care to those affected. In the first 24 hours following the attack, the hospital admitted 23 victims who suffered gunshot wounds: five died upon arrival and another succumbed during a surgical procedure. 

 

Despite challenges posed by an overwhelming influx of victims with severe injuries and a critical lack of resources, medical teams acted quickly, treating 42 patients, five of whom required emergency surgery.  

 

"We received a large number of patients suffering from serious gunshot injuries, most of whom arrived in critical condition,” said Dr. Ernsot Jean Marc, head of the emergency department. “We had to reorganize resources, mobilize our staff, and coordinate efforts to welcome these victims."  

 

Prime Minister Gary Conille visits Saint-Nicholas Hospital the day after the massacre perpetrated by armed gangs in Pont-Sondé. Photo by Thierry Bozile / PIH

 

Medical Director Dr. Alexis Frantz applauded ZL for supplying medical equipment and strengthening the hospital's emergency response teams. "We were able to mobilize three surgeons, two orthopedists, and 10 residents in family medicine, as well as receive help from doctors from other health centers in the city," he explained.  

 

Local solidarity also played a vital role in effectively managing the crisis. Community members supported both staff and patients, providing water, food, and supplies.  

 

“The camaraderie between the hospital teams and the help of the people of Saint-Marc allowed us to hold on in these uncertain times,” Jean Marc said.  

 

On October 4, Prime Minister Gary Conille traveled to the hospital to thank the medical teams for their exemplary response. He recognized ZL’s far-reaching efforts, highlighting their continued commitment to improving health care in Haiti, even in crisis situations.  

 

Zanmi Lasante is currently supporting the operation of a mobile clinic in Antoinette Dessalines to provide care for survivors located outside of the Saint-Marc region. Organized by Saint-Nicolas Hospital with the support of UNICEF, the clinic offers prenatal, general, and pediatric consultations to those who fled from the attack on Pont-Sondé. This initiative aims to provide essential care to pregnant women, children, and others affected by the crisis, meeting the most urgent needs of the displaced population. 

How Dr. Paul Farmer Revolutionized Tuberculosis Care

Three decades ago, Partners In Health’s Co-founder Dr. Paul Farmer and global colleagues embarked on a journey to combat multidrug-resistant tuberculosis (MDR-TB) in low-resource settings, such as the rural Central Plateau in Haiti and densely populated neighborhoods surrounding Lima, Peru. 

Farmer championed a model of community-based TB treatments that kept patient concerns at the center of care, forever transforming global health delivery, research, and policies. This approach addressed the underlying factors that contribute to disease spread, ensured marginalized populations received the medical support they deserved, and laid the foundation for sustainable solutions that have improved TB outcomes worldwide.  

Although Farmer passed away in February 2022, his legacy remains strong. The work he started decades ago continues to bear fruit and inspires innovations that have revolutionized TB care. His example inspired new generations of TB experts to follow in his footsteps, at PIH and beyond.  

The timeline below highlights Farmer’s pivotal role in the fight to end TB, driven by a vision for equitable health care that lives on today. 


1989: Reimagining TB treatment in Haiti

Farmer and colleagues at Zanmi Lasante established community-based tuberculosis treatment in Haiti by ensuring patients received medications, food packages to improve nutrition, and a community health worker, who provided emotional support and resources along patients’ care journey. 

PIH Archives

 


1991: Community-based care increases cure rates

Farmer conducted and reported the results of a first clinical trial in which a group of Haitian patients living with TB received community-based care and social support in rural areas. Compared to a group that received only free care, those receiving the full support package had substantially better treatment outcomes: no deaths and a 100% cure rate. The study revealed the benefits of accompaniment and helped establish PIH’s signature approach for managing complex diseases in impoverished settings. 

PIH Archives

 


1996: MDR-TB fight moves to Peru

Following visits to Peru, PIH Co-founder Dr. Jim Yong Kim helped uncover an MDR-TB outbreak among patients living on the outskirts of Lima. He, Farmer, and other Harvard colleagues found common cause with Peruvian clinicians and researchers and formed Socios En Salud, as PIH is known locally, to fight the disease. 

PIH Archives

 


1998: New model improves MDR-TB patient outcomes

Farmer and Kim introduced the idea of DOTS-Plus (Directly Observed Therapy, Short-Course) to expand the WHO recommendation for treatment of TB beyond first-line therapies—and beyond just watching people take their medication—to include other drug regimens coupled with supportive care for MDR-TB patients. After successfully piloting a small community-based treatment program for patients living with MDR-TB in Lima, Peru, they argued that such programs could not only achieve excellent treatment outcomes but could be cost-effective if such interventions reduced disease and disability and prevented ongoing spread of MDR-TB.  

PIH proved this model of MDR-TB care in Haiti and Peru and then expanded it to Russia—and beyond. 

PIH Archives

 


2001: Global Fund to Fight AIDS, TB and Malaria is born

Farmer and PIH’s work in Haiti inspires pressure from the global access community, and he and others sign statements of support for global funding to treat infectious diseases. The United Nations General Assembly endorses the creation of a global fund to fight HIV/AIDS in June 2001, which holds its first meeting in January 2002. Since that time, the Global Fund to Fight AIDS, Tuberculosis and Malaria has provided 76% of all international financing for TB, investing $9.9 billion in TB programs and an additional $1.9 billion in TB/HIV programs.  

Photo by Mark Rosenberg for PIH 

 


2002: A worldwide initiative for AIDS and TB relief 

Farmer is one of four doctors invited to the White House by Dr. Anthony Fauci, then the director of the National Institute of Allergy and Infectious Diseases, and presents PIH’s outcomes data from treating AIDS in rural Haiti with community health workers. PIH’s work is a key part of the evidence that convinces President George W. Bush to announce at the 2003 State of the Union address the President’s Emergency Plan for AIDS Relief, which has provided antiretroviral treatment for 20.5 million people and TB preventive therapy for 13.4 million people on ART. This was especially important funding in the fight against TB, given the disease was the most frequent infection among people living with HIV globally. 

PIH Archives

 


2003: Evidence of success in MDR-TB treatment

A study published in the New England Journal of Medicine about the DOTS-Plus program in Peru demonstrated that 83% of properly treated and supported MDR-TB patients could experience good treatment outcomes; this countered the prior narrative that it was not possible (or worthwhile) to treat MDR-TB in poor settings. This study ignited WHO support for the uptake of DOTS-Plus and the adoption of global policies to directly address drug-resistant TB. The paper has been cited in medical literature over 500 times.  

This same year, Farmer testified on Capitol Hill before the United States Senate Committee on Foreign Relations stressing the urgency of a growing health care crisis in Haiti. Increased TB deaths were due in part to U.S. policy affecting the country and the total amount of aid being reduced by two-thirds since 1995. 

Photo by Ophelia Dahl / PIH 

 


2005: Transforming WHO's TB care guidelines

PIH’s model of care for MDR-TB and accompanying studies informed WHO’s 2005, 2008, and 2011 guidelines on the programmatic management of MDR-TB.  

Farmer and Kim summarized PIH’s influence on international MDR-TB policy in a 2005 article, in which they were optimistic about the future of global health and challenged everyone to be more ambitious: “The world is now poised to move beyond minimalism and think about the full range of tools and interventions that will be necessary to meet the most pressing global health challenges.”

Photo by Justin Ide for PIH 

 


2010: TB tied to global poverty

Through a publication in The Lancet, Farmer and fellow activists with Treatment Action Group, an independent and community-based research and policy think tank fighting to end HIV, TB, and hepatitis C virus, called for “a bold new vision at the Stop TB Partnership,” a UN organization established in 2001 to eliminate TB.   

“Tuberculosis control and elimination need to be more closely aligned with the general economic development of afflicted communities. The natural history of tuberculosis clearly shows that to achieve tuberculosis elimination there needs to be some degree of poverty alleviation,” Farmer and authors wrote.  

Dr. Farmer and Doctors Chiyembekezo Kachimanga and Noel Kalanga (left to right) discuss Rose Kaliwo, a patient later diagnosed with TB and HIV, during teaching rounds at Neno District Hospital in Malawi. Photo by Rebecca Rollins / PIH

 


2013: Grassroots advocates fundraise for TB

Farmer helps launch the PIH Engage grassroots volunteer network, with hundreds of individuals fundraising in their communities for PIH’s TB work and advocating for billions of dollars in U.S. government funding of multilateral and bilateral TB programs, such as the Global Fund.  

With his encouragement and guidance, this network contributes annually to growing the global funding pie, through thousands of calls, letters, and meetings with congressional offices. As a result of continued advocacy, U.S. bilateral TB funding grew from less than $100 million in 2006 to $233 million in 2013. 

Dr. Farmer speaks with participants of the PIH Engage Training Institute in Boston, Massachusetts. Photo by Sheena Wood / PIH 

 


2015: Launching the endTB project

PIH, Médecins Sans Frontières, and Interactive Research and Development launched the endTB project, which aimed to find shorter, less toxic, and more effective treatments for MDR-TB through access to new drugs (delamanid and bedaquiline), clinical trials, and advocacy at national and global levels.   

Farmer’s influence was intentionally woven into every aspect of endTB: through the accompaniment of national TB programs as they introduced new drugs into care regimens, advocating for lower drug prices, ensuring patients benefitted from advancements in research and quality care, and supporting patients beyond medical treatment to address other needs, such as food, housing, and financial assistance.

Visiting Port Loko Government Hospital in Sierra Leone, Dr. Farmer reviews a sample of cells from the lungs of a 9-year-old patient living with TB. Photo by Rebecca Rollins / PIH

 


2019: Congressional support for equity-driven TB solutions

Farmer and the PIH Advocacy team are tapped by congressional leaders to integrate equity-focused TB elimination strategies into annual U.S. funding of TB programs. He and his PIH colleagues also provide technical advice to Congress on the TB reauthorization strategy bill, the End TB Now Act 

Dr. Farmer consults with Dr. Marta Patiño about a 22-year-old patient suspected and later confirmed to have TB in the men’s ward at KGH in Sierra Leone. Photo by John Ra / PIH 

 


February 21, 2022  

Farmer passed away in Rwanda, but the work he inspired continued.

PIH Sierra Leone staff recognize the first Global Day of Action outside the Maternal Center of Excellence in Kono District. Photo by Tappiah Sesay / PIH

 


2023: New MDR-TB regimens revealed

In November, endTB clinical trial results were presented for the first time at the Union World Conference on Lung Health with evidence to support the use of three new, improved regimens to treat forms of TB that are resistant to rifampin, the most important drug in standard TB treatment.

 


2024: WHO approves three, new MDR-TB regimens

In August, the WHO approved new, safe, and effective tuberculosis treatment options, including three new shorter regimens for multidrug- or rifampin-resistant tuberculosis, which were studied in the PIH-led endTB clinical trial 

The resulting recommendations, which for the first time offer novel, shortened regimens universally to children, adolescents, pregnant and breastfeeding women, represent the culmination of nearly a decade of scientific research and patient care across 18 countries.   

Janki Moneni, a 61-year-old MDR-TB patient, receives care in an ICU at Botšabelo Hospital in Maseru, Lesotho. Photo by Justice Kalebe / PIH

 

How Politics Influence Global Health

Public health has a long history: from inoculation practices in early India, to aqueduct sanitation systems in ancient Rome, to the sprawling public hospital systems we think of today. Since its early days, the field of public health has evolved alongside the governments that help establish public health policies.

In the modern world, global governments influence health care by setting goals and standards, enforcing laws, contributing resources, providing services, building infrastructure, and involving the public in decision-making processes regarding health care. This influence is part of the reason Partners In Health (PIH) works so closely with local governments to help improve health systems and expand health programs globally.

Despite governments globally contributing to global health policies and dictating local health care services, some of the largest influences in health care around the world lie in one country. The U.S. government is the world's largest donor to global health, providing $12.3 billion in funding for global health in 2024. However, while the U.S. may lead in the overall dollar amount, the country’s relative contributions to global health are some of the lowest when considering overall national income—meaning that the U.S. has the capacity, and the responsibility, to increase its global health spending. Many different U.S. government departments and agencies, congressional committees, and funding streams are involved in shaping global health policy.

U.S. Government Shaping Global Health Policy and Programming

Take tuberculosis (TB) for example. The executive branch takes the lead on programming and budgeting. The White House sets the agenda by appointing agency leaders, and by suggesting budget amounts to Congress with the combined President’s Budget Request each spring, which is released with the annual State of the Union address. Through the State Department, the bilateral country-to-country funding of the President’s Emergency Plan for AIDS Relief and the U.S. contribution to the multilateral Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund) support a significant proportion of global HIV-TB and TB programs. Through the U.S. Agency for International Development (USAID), the U.S. government funds global TB efforts, as well as malaria, maternal and child health, vaccines, nutrition, and other specific disease areas. The Centers for Disease Control and Prevention (CDC) has a global TB program, and the National Institutes of Health (NIH) is the world’s largest single funder of TB research.  

Chart courtesy of KFF

The House and Senate of Congress are also responsible for allocating funding to TB programs through the annual discretionary appropriations process. For example, the State, Foreign Operations, and Related Programs appropriations subcommittee allocates funding to the TB programs under USAID and the Global Fund. Equally important are the House Foreign Affairs Committee and the Senate Foreign Relations Committee, which have jurisdiction over the policy guidelines and goals for global TB programs—for example, the End TB Now Act. All members of Congress have an opportunity to weigh in on the appropriations process, including how much funding is allocated to TB programs. Funding for domestic TB work, including through the CDC and NIH, is allocated by another appropriations subcommittee, and governed by separate authorizing committees. It's worth noting, however, that mental health, surgery, and non-communicable diseases like cancer and diabetes receive little or no funding, and PIH is continually working to change this. 

While the U.S. government may hold the purse strings to help advance health policy, PIH recognizes that partnering with local governments to implement health programs is vital to their sustainability and success.  

PIH and Government Accompaniment

Since the beginning, PIH leaders knew that real advancement toward a universal right to health would only be possible through strong partnerships. Our goal is not to expand across the globe, but to partner with governments and organizations who invite us to work together. PIH's collaboration with national governments, local districts, organizations in the private and public sectors, and civil societies helps drive all our health system strengthening work, everywhere.

“What makes PIH unique is that we provide clinical care and provide evidence to the Ministry [of Health] of our impact through a system strengthening model,” Danielle Sharp, director of policy and partnerships for PIH Lesotho, said. “And through that accompaniment model, [we] are then able to transform the health system.”

PIH’s approach to accompaniment includes working side-by-side with our friends and colleagues at all levels, whether they are community-based, state health authorities, or global health advocates, to deliver the highest quality care. We call on those in power, from local legislators to world leaders, to advance equitable health care.  

“Health care is a human right and a public good that is best designed and delivered at scale through government,” Ashley Damewood, director of policy and partnerships for PIH Liberia, said.

Through accompaniment, PIH teams around the world aim to influence legislation, funding, and programmatic decisions to support the movement for global health equity.

Advocating for Public Health Advancements

In both the U.S. and globally, PIH works to improve health equity and address disparities by improving public policy. Through coalition and grassroots advocacy, PIH has successfully co-authored and spurred the introduction of important new legislation—such as the Community Health Worker Access Act—and opened new financing at the state and federal levels.

“We work daily to grow a foundation of strong bipartisan and bicameral congressional and agency support for critical global and domestic health programs, regardless of who may be in elected or appointed roles at a given time,” Vincent Lin, associate director of health policy and advocacy, said.

Thinking again of TB, the PIH advocacy team worked with Congressional leadership to integrate lessons from PIH's care delivery work across sites and lay out an ambitious strategy for ending TB in the End TB Now Act.  

As a result of this dedicated advocacy focused on global health funding, the U.S. has continually increased funding for global health programs. PIH’s grassroots network of volunteer organizers, known as PIH Engage, has contributed to this national movement through more than 1,500 meetings, calls, and letters to elected policymakers over the last year. PIH supporters far and wide have taken action from all 50 states and Washington D.C., with more than 40,000 calls made and letters written to Congress on important health access topics from addressing Tribal health disparities to TB spending.

The Public’s Role in Influencing Global Health

Each year, executive and congressional staff seek input from the public. By design, congress is responsive to the desires of their constituents. For example, congressional staff will meet face-to-face with constituents, take phone calls, read emails and handwritten letters, and hold town halls to better understand the interests of the communities they serve. 

Aside from engaging with their representatives, another way constituents have power to influence the public health priorities of our government is through voting. During an election year, the phrase “healthy voter turnout” takes on a new meaning when we view voting as a public health priority. According to the Health & Democracy Index, communities with higher voter turnout rates have better health outcomes. Voters also have the power to influence policy decisions that impact health care, both locally and globally.  

 

Q&A: Meet New Executive Director of PIH Sierra Leone

After about eight months as interim executive director, Vicky Reed was appointed Partners In Health (PIH) Sierra Leone’s new executive director in August.

A dedicated nurse and leader, Reed grew up in Freetown and moved to the United States when she was 15, during the beginning of Sierra Leone’s 11-year civil war. While in the U.S., she earned degrees in international business and Spanish, then spent seven years in banking.  

Inspired by her mother and grandmother, Reed made a career change and enrolled in nursing school. After several visits to Sierra Leone —including for the funeral of her beloved grandmother, a respected nurse—Reed was drawn to move home. A PIHer since 2019, Reed was first hired as PIH Sierra Leone’s director of nursing. In that role, she mentored nurses, developed protocols to improve care, and participated in the Global Nurse Executive Fellowship. In December 2023, she transitioned into the interim executive director role.

We spoke with Reed about her background, new position, and the road ahead. Below, edited and condensed, are her responses: 

Describe the moment you learned you were selected as executive director. How did you feel?

It depends on which time. After the leadership transition in December, it was overwhelming because this is not something I aspire to; I just came here to do my job. The fact that I was considered for the role is a huge honor and privilege. I think the second time around when the position was confirmed in August, I felt some sort of validation because I didn't expect the news. Being appointed into the permanent position made me feel that I am doing something right.

How have your life and professional experiences uniquely positioned you to successfully lead PIH Sierra Leone?

Growing up, my dad always taught us that when you work hard, you'll be recognized for your hard work. Don’t point out the things that you're doing. You work hard because that's what you're supposed to do, and then anything else that happens afterwards, you deserve it. In terms of my career, this is just how I've always been. I've never been one to be in the forefront and have always preferred to be in the background.

My career as a nurse really prepared me for this role. Nurses are always thrown into the fire and the unexpected. You try to juggle different things with competing priorities. When I started my career in nursing, I worked in the medical surgical unit where you had to take care of five or six patients, or even sometimes seven or eight. Even if you were short-staffed,  you had to provide the best possible care. 

What are some of the challenges in health care delivery that you, and PIH Sierra Leone, face as you look ahead?

Most people can’t afford health care, and we don't have a free health care system in Sierra Leone. In collaboration with the government, we at PIH are trying to fill the gap and address many health care needs. We are focusing on providing care and meeting the needs of the most vulnerable patients.

Many PIHers in Sierra Leone know you; however, many others haven’t had the pleasure of meeting you. With that in mind, what is something that most people don’t know about you that you’d like to share?

Most people know I have three kids: two daughters and a son. Maybe one thing they don't know is that my oldest daughter is in her last year of high school, so she'll start college soon. And when I look back at it, I can't believe that I almost have kids in college!

Do your kids want to follow your path?

I did not push any of my kids into health care. However, my oldest daughter, 17, wants to become a neonatal nurse. And my youngest daughter, 12, wants to be a midwife. I don't know where she got that from either because that's not something we even talk about in the U.S. When they came to Sierra Leone in 2022, they shadowed Dr. Naphtal while he was feeding babies in the special care baby unit. They wanted to pursue health care even before they got that exposure.

PIH Sierra Leone Executive Director Vicky Reed (third from left) with staff during a tour of the female ward at PIH-supported Sierra Leone Psychiatric Teaching Hospital in Freetown on January 17, 2024. Photo by Sabrina Charles / PIH

Reflecting on your time at PIH, what is your most memorable moment and why?

There are so many memorable moments. There's one patient who had issues with gastrointestinal (GI) bleeding and was often in the emergency department. We once sent him to Freetown to undergo a procedure at a private hospital. Then, a few months later we were planning a computer training session for some of the nurse mentors, and it turned out that the patient was one of the instructors.

The fact that he was teaching our nurses was a full circle moment because this is somebody who we can't view as just a patient. Patients are people who have lives outside of the hospital. And the impact that we had on him to where he's still able to go out, make a living, and now teach PIH staff, is special.

You’ve previously discussed the tremendous impact that your grandmother, a nurse, had on your life and career. Who else inspires you and why?

My dad inspires me because he has always been a very humble person, displays humility, and respects people regardless of their stature in life. He was a professor, deputy minister of foreign affairs, and minister of tourism. He knows the value of hard work and always instilled that in me.

When I think about things, I don't get worked up or worried about different positions or what I believe I deserve because I feel like whatever you deserve is going to come back to you. The way he approaches things and handles different situations in life is inspiring. 

Which PIHer is a mentor or go-to person for you and why?

Right now, Patrick Ulysse because he is supportive and pushes me to come out of my shell; however, all staff inspire me in some way. There’s a woman who has worked at PIH’s guest house since 2014, the year PIH began working in Sierra Leone. She really willed herself and joined PIH’s adult literacy program. While I was at the office last week, she was using a laptop and sending emails. This is huge because this is someone with no formal education who couldn’t read or write. She’s self-motivated, puts herself out there, and always wants to learn. She’s somebody I really look up to. 

What do you want people who aren't familiar with PIH (both nationally and globally) to know about PIH Sierra Leone and the country’s history?

Sierra Leone has had a very tough history with the decade-long civil war, Ebola, mudslides, and Covid—all of which have impacted our health system. At one point, Sierra Leone had the worst maternal mortality rate in the world. The numbers are much better now, but there are still challenges.

We have very poor health outcomes nationwide in many different indicators. But at PIH, we are not just going to focus on one thing, rather we are going to address everything in terms of the 5 S’s model.  It's not an easy feat, but we've made that commitment to stay and improve the health care system. Personally, I want people to understand that this is very challenging, but if we continue to get support from people, this is something feasible for us to do.

PIH CEO Dr. Sheila Davis (left) and PIH Sierra Leone Executive Director Vicky Reed (center) during a community health worker's visit with Aiah Fornah Yofari (right) in Kono District, Sierra Leone on January 19, 2024. Photo by Chiara Herold / PIH

What has been the biggest change in pivoting from director of nursing to executive director?

As director of nursing, I was focused on clinical work. As executive director, I have responsibilities beyond that. Since I started this role, I've been trying to better understand finance and operations because those are not my strong suits. However, those areas are very important for the organization because if we strengthen financial and operational systems, then we can improve our clinical work. Expanding beyond the clinical side has been one of the biggest changes for me and has allowed me to more deeply understand what’s going on within PIH.

Is there anything you’d like to share that I didn’t ask you about?

This has been an interesting time in my life and for the organization. It has been a challenging year with many transitions, but I think this is the start of something better. I'm looking forward to steering the organization to make sure that we are a site that others can learn from and gain insights, just like we are doing with other PIH sites now. I want PIH Sierra Leone to become a model for the rest of the organization.

PIH Opens New Maternal Waiting Home in Lesotho

Maternal mortality remains a daunting challenge in Lesotho, with a rate of 566 deaths per 100,000 live births, surpassing the Southern African regional average of 545 per 100,000, according to the World Health Organization. This alarming statistic has driven Partners In Health (PIH) Lesotho to take decisive action, particularly in remote areas where access to prenatal care and safe delivery services is limited.

In a significant stride toward reducing maternal and neonatal deaths, PIH Lesotho built and opened a new maternal waiting home. The facility is designed to provide expectant mothers with a dignified environment as they approach their delivery dates.

The former maternal waiting home, which sits adjacent to the new one at Lebakeng Health Center, recently became overcrowded. This forced many women to endure risky home deliveries or undertake arduous journeys while in labor. To address space constraints, the new building is larger and has 32 beds, a significant increase from the original 8-bed home.

In collaboration with the government, PIH Lesotho officially opened the facility in June during a ceremony led by Prime Minister of Lesotho Ntsokoane Matekane. He lauded the initiative, noting the challenges many expectant mothers face, such as long distances to health care facilities, poor road conditions, and the adverse effects of climate change on health services. These factors often prevent safe deliveries, leading to unnecessary deaths. Matekane emphasized that the new facility would allow mothers to stay at the clinic both before and after childbirth, providing a healthy and supportive environment that significantly improves health outcomes.

More Than a Building

Since 2009, PIH Lesotho has included maternal waiting homes at its seven mountain clinics, located in some of the most remote, underserved regions of the country. The facilities are part of a comprehensive effort to increase facility-based deliveries and reduce mortality.

In addition to a safe space, “we provide social support, including food, linen, and baby clothes, ensuring the mothers are comfortable while waiting at the clinic,” says Dr. Melino Ndayizigiye, executive director of PIH Lesotho.

Mookho Lefikanyana, a nurse at PIH-supported Tlhanyaku Health Center, assists ‘Makefuoe Kabai and her daughter Kefuoe Kabai. Photo by Justice Kalebe / PIH

Health care workers at the homes conduct regular check-ups, offer nutritional guidance, and provide emotional support, ensuring that women are well-prepared for childbirth. Each of those efforts align with PIH’s belief that five key elements are needed to strengthen health systems: staff, stuff, space, systems, and social support.

About 100 miles north of Lebakeng Health Center, another maternal waiting home is under construction at Bobete Health Center. For years, the clinic has struggled with limited space. To maximize space, staff removed all bed frames and placed mattresses directly on the floor. This adjustment, while not a perfect solution, created room for more mattresses, accommodating the increase of pregnant women admitted to the home.

There are “...only four bedrooms available in the existing maternal waiting home. One room is allocated to new mothers, leaving three rooms to accommodate an influx of 25 to 38 women each month,” says Palesa Khomonngoe-Moea, Bobete Health Center’s nurse-in-charge.

Looking ahead, she believes the facility will have a transformative impact, particularly for women who often walk for hours to reach the clinic. Once complete, the new building will also have 32 beds.

The construction of maternal waiting homes is more than an infrastructure project; it is a symbol of hope for the future of maternal health in Lesotho. 

Between January 2021 and August 2024, a total of 11,691 women received care across PIH Lesotho’s maternal waiting homes. 

Through continued efforts, in partnership with the government, the journey to motherhood is becoming safer, and the goal to achieving a healthier future for Lesotho’s mothers and children is gradually becoming a reality.

Celebrating Latin American Leaders in the U.S.

In the United States, September kicks off Hispanic Heritage Month, a national observance celebrating the histories, cultures, and contributions of Hispanic, Latin American, and Afro-Latino communities, running from September 15 to October 15. 

Although the annual celebration is confined to these dates, PIH-US acknowledges that elevating the voices, stories, and histories of these communities is crucial year-round. Today, and every day, we honor the work of Hispanic, Latin American, and Afro-Latino individuals in shaping a future where everyone can thrive. 

Below, we highlight the incredible contributions and achievements of some of our community partners in Florida, Massachusetts, and North Carolina.


Monica Luna, Community Health Worker, Healthcare Network, Florida

Monica Luna has been working as a community health worker (CHW) for the past two and a half years with Healthcare Network. Her certification as a CHW allows her to connect individuals in her community, Immokalee, Florida, to health services. She finds great satisfaction in educating and advocating for her community members at outreach events.

Monica also has a passion for maternal health initiatives. She has helped shape those initiatives by facilitating focus groups on improving WIC programs and assisting women in applying for and understanding their WIC benefits. She has even taken women to the grocery store to teach them in Spanish what items are WIC eligible. Monica also ensures newborns attend their well-baby checkup by calling recent mothers to ensure they have a pediatrician. If they don’t, Monica helps establish the newborn and mother as patients at Healthcare Network so they can see providers. Learn more about Healthcare Network here.


Marifrans Castillo de Estrada, “Pan de Vida” Program Coordinator, Misión Peniel, Florida

Marifrans Castillo de Estrada is one of the visionaries behind the “Pan de Vida” (translated to “Bread of Life” in Spanish) program within the respected food pantry and church, Misión Peniel. After studying at culinary school in her native Guatemala and immigrating to Immokalee, Florida, in 2007, Marifrans applied her passion for cooking at Misión Peniel by cooking for families in need of a hot meal. The program quickly expanded to a mobile van that served more than 350 people weekly. After Marifrans wrote an essay about her dream to expand the community food service, Misión Peniel worked with her to design and found the “Pan de Vida” program in 2019. This program now operates two days a week by offering free culturally specific meals and cleaning supplies to the elderly and to people with disabilities. Today, Marifrans works as a program coordinator in which she manages kitchen volunteers and organizes school supply and clothing drives. Learn more about the “Pan de Vida” program here.


Luz Ortega, Program Director, City of New Bedford Health Department, Massachusetts

Since 2014, Luz Ortega has been a dedicated public health professional in the city of New Bedford, Massachusetts, with a profound commitment to her community and a focus on providing equitable, culturally, and linguistically appropriate services. She began her career as a CHW, and her early experiences continue to inform her work as she has advanced professionally. As the Program Director for FR-CARA, a harm-reduction grant initiative, Luz works to reduce drug overdoses through prevention and training. Additionally, she leads the Southeast United Network, which offers training, mentorship, and education to CHWs across the region. Luz also lends her expertise and advocacy as a board member of the Massachusetts Association of Community Health Workers. Through these various roles, Luz’s passion and dedication shine through, reflecting her commitment to improving public health outcomes and supporting the well-being of those she serves. Learn more about Luz’s collaboration with PIH-US here


Nikita Valencia, Deputy Director of Public Health, City of New Bedford Health Department, Massachusetts

Nikita Valencia is a passionate leader of public health in New Bedford, Massachusetts. Nikita, a certified diversity, equity, and inclusion professional, uses her expertise to inform her work in hopes of making a more equitable society. Nikita has consistently invested in youth throughout her career, creating opportunities for youth and young adults of traditionally underrepresented communities. Previously, Nikita worked at Bristol Community College as the Director of College Access where she worked directly with urban high schools to engage high schoolers from traditionally underrepresented communities in taking college courses. She has also served on boards, including the Vocational Technical Education Board with the Massachusetts Department of Education, focusing on youth advocacy and equitable outcomes for all students. She is committed to building a strong network of women of color in public health to ensure that people of diverse cultures are driving public health change. Learn more about the New Bedford Health Department here.


Yesenia Cuello, Co-founder and Executive Director, NC FIELD, North Carolina

Yesenia Cuello is a grassroots organizer and the co-founder and Executive Director of NC FIELD (North Carolina Focusing on Increasing Education Leadership and Dignity), a grassroots non-profit organization that utilizes a social determinants of health lens to both streamline and deliver essential resources to rural marginalized communities. Yesenia has been advocating for environmental justice and the rights of farmworkers for over fifteen years. As a former child farmworker, Yesenia's advocacy journey began as a teenager working in tobacco fields and organizing youth for Human Rights Watch to combat child labor. Her efforts contributed to regulatory changes that now protect child workers from pesticide exposure, a key issue in the fight for justice for agricultural communities. 

Throughout her time at NC FIELD, Yesenia was the president of the youth group, Poder Juvenil Campesino, Public Relations Chair, Program Manager, and in 2019 took on her current role of executive director. She leads initiatives aimed at addressing the health challenges faced by farmworker communities across a 14-county region in rural Eastern North Carolina. With a deep commitment to equitable access to health care, she helped launch Sembrando Salud, led by the community and focused on mitigating the health impacts of pesticide exposure, extreme heat, and unsafe working conditions exacerbated by access barriers and climate change. Her leadership has expanded NC FIELD’s capacity to meet communities where they’re at. Yesenia’s vision is rooted in empowering agricultural workers with the tools and resources needed to effectively address systemic issues and advocate for what they need in order to live happier, healthier lives. Learn more about Yesenia in this 2022 interview.


José Infanzón Chávez, Regional Coordinator, UNETE, North Carolina

José Infanzón Chávez is the Regional Coordinator for Unmet Needs in Equity vs. Transformational Empowerment (UNETE), where he plays a vital role as a certified CHW. He uses his expertise to deliver critical wellness and health resources to the community, while his CHW train-the-trainer certification enables him to mentor and empower other CHWs in the region. Originally from Mexico, José is a dedicated father to two children and has been happily married for 20 years. 

In addition to his leadership at UNETE, José serves as an ambassador for the North Carolina Community Health Worker Association and is a board member for Mountain BizWorks. José is an alumnus of the Racial Equity Institute, reinforcing his dedication to equity and inclusion in all facets of community life. Through his work, José strives to uplift and support those around him, creating a healthier and more equitable future for all. Learn more about UNETE here.


Norma Durán Brown, Executive Director, UNETE, North Carolina

For over two decades, Ms. Durán Brown, an Argentinian native and former attorney, has actively engaged with service providers to foster cultural humility and community-based programs. She is renowned for creating initiatives like MANOS (Mentoring And Nurturing Our Students), a high school Latinx after-school program, FAROS (Freedom, Advocacy and Resilience for Our Students), a middle school weekly club, and De Mujer a Mujer NC, a grassroots community group. These programs emphasize holistic wellness for individuals and communities by collaborating with health care agencies, educational organizations, and faith groups to provide parenting strategies, resources, positive communication, and comprehensive approaches to health, academic achievement, family literacy, and violence prevention. As the Executive Director and founder of Unmet Needs in Equity vs. Transformational Empowerment (UNETE), Ms. Durán Brown believes her role as a community health worker allows her to serve justice in a more comprehensive way than in her previous career as an attorney. Learn more about UNETE here

Indigenous Data Sovereignty: A Path Toward Equity in Pima County

In the 1950s, federal policies like the Indian Relocation Act coerced Native communities off reservations with unfulfilled promises of housing, education, and jobs in nearby cities. While the act touted opportunities, it led to the dissolution of federal support for reservations, leaving urban Native Americans to face high poverty rates, job discrimination, and limited opportunities.

For the more than 70% of American Indians and Alaska Natives (AI/AN) living in urban areas, these harmful policies continue to exacerbate inequities. Despite enduring significant challenges, Native communities seldom have a say in or control over the policy decisions affecting their lives, or the data that drives these decisions.

To address this gap, Native communities in Pima County, Arizona, are stepping up to reclaim ownership of their data and reshape the policies that affect them.

Last year, Partners In Health United States (PIH-US) and the Tucson Indian Center (TIC), which offers health and other essential support services to urban Indigenous residents of Pima County, co-launched the Pima County Indigenous Health Equity Coalition to oversee the development of a Native-led and owned data ecosystem. Traditional research and data collection methods often exploit Native communities, leading to inaccurate data that results in underfunding, limited access to services, and increasing health and poverty issues for Native populations, both on and off reservations. 

While TIC already collects data on their programs, they don't currently have a unified system to fully understand and track the breadth of community strengths and needs. This new coalition will create an ecosystem that captures the urban Indigenous community's assets and needs, while also developing a shared language and vision to guide collaboration on database design, data protection, and analysis, connecting the community's platform, processes, and people. By building on traditional knowledge systems and transferring power and decision-making about data systems back to the urban Indigenous community, TIC and PIH-US aim to help shape policies and increase public funding allocations aligned with the needs of the Indigenous community. 

“In current data sets, there is often a disconnect between definitions and meanings of words. How [Indigenous] communities define health might be different than the general population,” said Dylan Baysa, Social Services Director at the Tucson Indian Center. “The data ecosystem will enable us to develop shared language and bridge the gap. We are creating something that is not only for the Native community but informed by them.” 

More accurate insights will help Dylan and his team improve access to primary care, behavioral health, and social support services for off-reservation Indigenous community members in Tucson. The data from the ecosystem will also be used to inform long-term collaboration with local government partners, including the Pima County Health Department (PCHD).

Since 2020, PIH-US has collaborated with PCHD and TIC to improve health outcomes by enhancing community engagement and creating programs that center equity and are data-driven. With PIH-US support, PCHD established an Office of Policy, Resiliency and Equity and hired a dedicated Tribal Liaison. Similarly, PIH-US is supporting TIC to establish an advisory council, which brings together diverse stakeholders to guide the creation of the data ecosystem and ensure the principles of Indigenous data sovereignty are upheld.

And this is just the beginning. 

“The health department already collects data on Native Americans, but there are gaps between the data they are collecting and what might be needed to inform policy,” explains Dylan. “By bridging the gap between the community and the health department, we’ll be able to collectively align with community priorities and use this information to develop legislation and policy.”

Intentional redistribution of power and inclusion of the community narrative are necessary to meaningfully affect change. Cross-sector collaborations like those in Pima County can yield improvements in health outcomes that no single organization or institution would have been able to achieve on its own. By centering community members’ lived experience, agreeing on shared priorities, and pooling resources, knowledge, and skills, organizations can build a collaborative infrastructure that tackles both immediate and long-term inequalities in the region.

“Having community members be a part of the community advisory council and giving them a seat at the table with the health department, I am hopeful we will build trust and start to repair some of this historical trauma,” explains Dylan. “I think [this work] is a huge step toward the future.”

Reviving Hope: Lifesaving Cardiac Care for Patients in Malawi

Cardiovascular diseases (CVDs) are among the leading causes of death in the world, taking an estimated 17.9 million lives each year, with one-third of deaths occurring in people under the age of 70. These diseases, including coronary artery disease, rheumatic heart disease, pulmonary embolism, heart valve disease, and more, encompass a range of conditions that affect the heart's structure and ability to function.  

 

In sub-Saharan Africa, the prevalence of risk factors for CVD is high, and access to specialized care is limited. With a staggering ratio of just one cardiothoracic surgeon for every 14.3 million people, options for managing heart conditions in countries like Malawi are few.  

 

Two Worlds Collide  

 

Promise Douglas, a 9-year-old from Nyaiyaye Village in Malawi’s Neno District, and Vitalina Chaona, a 49-year-old from Gochi 2 Village in the Ntcheu District, had lost hope after years of struggling with severe heart diseases.  

 

Douglas, suffering a congenital heart defect, and Chaona, battling rheumatic heart disease, received inadequate treatment for their conditions until Abwenzi Pa Za Umoyo (APZU), as Partners In Health (PIH) is known in Malawi, stepped in. 

 

 

Vitalina Chaona and her family share moments together during a medical home visit at their residence in Ntcheu following a successful heart surgery in Tanzania. Photo by Innocent Nyambaro / PIH

For Chaona, a shortness of breath and discomfort in her chest coupled with a general feeling of weakness prompted a visit to the PIH-supported Neno District Hospital in September 2021. There, she was examined by Medson Boti, a clinician specializing in chronic care for severe noncommunicable diseases. After thoroughly assessing Chaona, Boti diagnosed her with rheumatic heart disease, a condition that begins with a bacterial infection and leads to complications that affect heart valves. 

 

Chaona recalled, “When I was first informed that I had been diagnosed with this heart condition, I was initially worried; but I was relieved that at least I could be put on pain relief medication, refilled every month from Neno District Hospital. PIH Malawi also supported me with transportation during my monthly visits to the facility.” 

 

“We immediately started treating the symptoms on Vitalina,” Boti said, “then consulted a cardiologist who conducted a further assessment on her and concluded that she could benefit from surgery.” 

 

Around the same time and within the same country, another patient experienced frightening symptoms as well. Diagnosed with Tetralogy of Fallout at Lisungwi Community Hospital in February 2022 and again at Queen Elizabeth Central Hospital in January 2023, Douglas experienced difficulties breathing and eating, blue-tinged skin, fainting, an inability to exercise, and heart palpitations. Doctors concluded he had a rare condition caused by a combination of birth defects that change the way blood flows through the heart. 

 

 

Promise Douglas and his grandmother Crea Karedzera in Malawi. Douglas was diagnosed with Tetralogy of Fallot, a rare heart condition. Photo by Innocent Nyambalo / PIH

“We facilitated further assessments with cardiologists and a recommendation was made for him to undergo surgery,” Boti said. “Cardiac surgeons from Tanzania who were in Malawi visiting at the time made similar recommendations, and he was immediately put on list of those waiting to go for surgery.”  

 

Seeking Treatment Abroad 

 

Both Chaona and Douglas were treated with medications to manage their symptoms. However, due to limitations in cardiac care available in Malawi, the two required further treatment outside the country.   

 

Boti explained: “Currently, we are unable to conduct open heart surgery in Malawi. We only have medications that improve the symptoms of heart diseases. Patients with heart conditions are sent outside the country for surgery.”  

 

APZU identified Jakaya Kikwete Cardiac Institute in Tanzania as the most suitable facility for the lifesaving surgical procedures both patients needed, and a carefully planned trip was arranged.   

 

Accompanied by Nurse Dester Nakotwa for support, the hopeful pair set off for Tanzania by way of Chileka International Airport in Blantyre in November 2023.  

 

Uncertain of the procedure's outcome and desperate for relief from the ongoing pain her condition inflicted, Chaona nervously anticipated her surgery. 

 

“When I was informed about the surgery in Tanzania, I was excited but scared at the same time,” she said. “I was reluctant as I was not sure of the outcome of the procedure; however, I needed to be free from the pain I had been feeling for over three years. When we arrived, I was scared after some assessments, but I was assured that I was going to get better after the treatment.”  

 

Medson Boti, a clinical officer, conducting a check-up on Vitalina Chaona at Neno District Hospital in Malawi. Photo by Joseph Mizere / PIH

The patients stayed at the health facility for about a week before their procedures, as doctors conducted tests in preparation and to ensure readiness. Afterward, they remained in the hospital’s intensive care unit for an additional two weeks before returning to Malawi. Each surgery lasted an estimated six to eight hours, and both were successful.   

 

Recovery and Ongoing Support 

 

Five months after surgery, APZU continued monitoring Chaona and Douglas, who showed significant progress. Boti, who is keeping a watchful eye throughout their recovery, is hopeful that the two will live normal lives.  

 

“Overall, there has been great improvement on the condition of the patients following the treatment in Tanzania,” Boti reported. “For Promise, there is a lot that is expected of him as a child, and we are hoping that he will be able to grow healthy and reach his maximum potential.”  

 

“On the other hand,” he continued, “I have personally examined Vitalina since her return from Tanzania and I can see some great improvements. She is now able to walk [and] breathe properly as compared to the period before surgery. I believe she will be able to resume some household chores as a woman in her home.”  

 

According to Neno District's noncommunicable disease (NCD) coordinator, Haules Zaniku, heart conditions are relatively common in the region, where facilities register at least three to five new patients every month. Frequently reported heart conditions include: cardiomyopathy, hypertension, and rheumatic and congenital heart diseases, normally caused by rheumatic fever, alcohol use, HIV, and other infections.   

 

Dester Nakotwa, an NCD Nurse, counseling Vitalina Chaona during a home visit at her residence in Ntcheu. Photo by Innocent Nyambaro / PIH

Zaniku applauded PIH for its role in facilitating high-quality care for patients with complex health conditions, saying: “The efforts of PIH in ensuring that patients have access to treatment outside Malawi is of very great importance, as we don`t have more advanced facilities that are able to perform heart surgeries including advanced laboratory services currently in Malawi.”   

 

Expanding Cardiac Care 

 

In 2018, PIH, in partnership with Malawi’s Ministry of Health, opened PEN-Plus clinics at Neno District Hospital and Lisungwi Community Hospital. These clinics provide decentralized care for severe NCDs through the integration of health services.  

 

Both facilities address heart-related conditions through outpatient care, offering medication to help manage symptoms. People requiring surgery rely on government assistance and partner sponsorships to access treatment centers outside of the country.  

 

The two facilities also treat type 1 and type 2 diabetes, asthma, sickle cell, stroke, deep vein thrombosis, and occupational lung diseases, among other conditions.  

 

The success of the PEN-Plus clinics led to their expansion to Karonga and Salima Districts in December 2023, giving local health care providers the capacity to manage and treat both simple and complex NCDs at primary and secondary health care levels. 

 

As of April 2024, there were 595 patients enrolled in Neno’s PEN-Plus clinic receiving advanced NCD care. Among them, 86 were seen through home visits due to physical challenges associated with their illnesses. There are four patients on the waiting list for cardiovascular surgeries abroad.  

 

Oxygen Production Center in Haiti Transforms Health Care for Underserved Communities

A new chapter of hope is being written in Thomonde, where Zanmi Lasante (ZL), as Partners In Health is known in Haiti, opened its first oxygen plant in collaboration with the Ministry of Public Health and Population (MSPP) in August.  

Bringing new infrastructure and innovation to the Central Plateau and lower Artibonite regions, the Thomonde Oxygen Production Center marks a significant step towards improving health care delivery in Haiti, providing a reliable and sustainable supply of medical oxygen to communities with limited access to critical resources.  

Hospitals and clinics across Haiti have experienced dire shortages of medical oxygen, preventing them from administering lifesaving medical treatment. Fuel scarcity, blocked roads, supply chain issues, and broken oxygen generators have all made the availability of oxygen when and where it is most needed significantly more challenging. 

ZL health care facilities in Central Plateau and the lower Artibonite previously relied on the costly purchase and transport of about 850 oxygen cylinders per month. Too often, however, patients with severe respiratory conditions and other critical illnesses endured long waits for oxygen supplies, and at times, faced shortages and delays that put their chances of survival in jeopardy.  

With the capacity to produce up to 100 cylinders of oxygen per day, the Thomonde Oxygen Production Center puts an end to troubling uncertainties. Local oxygen production eliminates the dependence on external oxygen supplies and will significantly improve emergency response, the quality of neonatal care, the ability to treat chronic and acute conditions, and reduce mortality rates. 

The center also reduces the costs and logistical hurdles associated with importing oxygen from distant locations, allowing ZL to reallocate resources to other critical areas. 

Pierre Louis Wilson, an oxygen plant operator, at the facility’s inaugural event in August 2024. Photo by Thierry Bozile / PIH

Operating 24 hours per day, the facility offers new employment opportunities to the community, staffed by three rotating teams of plant operators and technicians who perform daily procedures, including maintenance and repairs.  

Reporting to Plant Manager Jean Marie Aneus, staff are trained by PIH in partnership with Build Health International to maintain oxygen infrastructure, complete future upgrades, and ensure long-term function. 

Roosevelt Jean, the Thomonde Health Center administrator, was integral to the success of the project, actively participating in the planning and development stages. Community involvement, while also promoting a sense of ownership and sustainability, is vital to assure the oxygen plant addresses regional needs. 

"This center will play a crucial role in providing oxygen first to the Thomonde Health Center and the health institutions in the Central Plateau, thus strengthening our ability to save lives and improve the health of the communities we serve," said Dr. Wesler Lambert, executive director of ZL, at an inaugural event for the facility.  

Dr. Wolve Irvens Charles, an MSPP representative, added: “This new oxygen plant clearly demonstrates the sincerity and transparency of the collaboration between the MSPP and Zanmi Lasante. In keeping with the principle of partnership, let us make sure that together this new oxygen production center will contribute to a high proportion of oxygen production that can meet not only the needs of the department’s regions, but other regions of the country too.”  

ZL plans to establish other oxygen production centers at key sites, increasing its ability to provide essential health services and making its network fully autonomous in terms of oxygen supply. A long-term investment in improved infrastructure and quality of life, the oxygen infrastructure is certain to help people living in Haiti breathe easier. 

From the Hospital to the Halls of Congress: Advocacy at PIH

Partners In Health (PIH) was founded in 1987 on the principle that health care should be a human right for all—a somewhat radical belief, even today. Increasingly over time, PIH staff, colleagues, and supporters became advocates for people around the world as they fought for accessible, equitable health care, particularly in settings of poverty.  

Advocacy within PIH has evolved over the years. From our beloved late Co-Founder Dr. Paul Farmer writing books and facilitating congressional briefings and hearings to share his personal beliefs and professional experiences, to now: a robust, dedicated Advocacy team with a strong network of grassroots supporters.  

To build sustainable health systems, PIH is advocating every day, both behind the scenes and by the bedside, to advance global health equity.

To learn more about this part of PIH’s work, we spoke with Joel Curtain, PIH Director of Advocacy; Vincent Lin, PIH Associate Director, Health Policy & Advocacy; and, Carole Mitnick, PIH Senior Research Associate and Harvard Medical School Professor, Global Health & Social Medicine. Below, edited and condensed, are their responses:

What does Advocacy mean at PIH?

Lin: Advocacy is an umbrella term that we use as an organization to talk about a lot of different work we do. PIH builds the evidence base for changing policy and uses that evidence coupled with our technical expertise to advocate with intergovernmental decision-makers in policy-setting organizations—like the World Health Organization (WHO).

We also integrate what we’re learning from our work around the world in co-writing legislation with U.S.-based policymakers, and dedicated grassroots and coalition-based legislative advocacy. With our grassroots PIH Engage network, we’ve trained thousands of volunteers in federal legislative and appropriations advocacy, generating hundreds of meetings and thousands of contacts with Congress.

In broad coalitions, we advocate alongside community health workers (CHWs) for CHW funding in the U.S. at the state and federal levels, with Tribal leaders and providers for sustained financing to address Tribal health disparities, and with TB survivors to increase tuberculosis (TB) funding. We work to accompany and empower the communities most directly affected by injustice. We also mobilize a broad base of supporters in advocacy campaigns through calls to action like our latest push for passage of the End TB Now Act of 2023, where over 12,000 letters have been sent by constituents to their members of Congress.

We’ve also seen the power of coalitions of activists over decades who have won increases in funding and reductions in the prices of necessary medications and diagnostic tools.

Curtain: Eliciting structural change is core to PIH’s history and mission. We’ve all been inspired by how PIH’s care delivery work can create new political possibilities. This is why Bending the Arc is such a compelling film. However, there are many, many steps between care delivery and meaningful policy change, which require building and leveraging power meticulously and tenaciously. This is what our team is tasked with. So, to us, advocacy is a deliberate process of developing and executing strategies to build and leverage power to change specific policies and conditions that improve people's lives. All advocacy is based on power relations.

“[Advocacy] involves developing and executing strategies to build and leverage power to change specific policies and conditions that improve people's lives.”

Mitnick: I think accompaniment is key to the PIH approach to advocacy. We advocate for what the population we serve needs, generating more resources or changing policy for the diseases of importance to those communities. And then it goes all the way up the chain to bring the needs of the patients we serve into the halls of power.  

Lin: It’s pretty amazing to have seen Dr. Paul Farmer constantly working to span multiple arenas—from huts in Cange to the White House, from local clinics to the WHO in Geneva, and from the medical classroom in Rwanda to the halls of Congress. Now, as an organization, we’re scaling such efforts in tandem with partners at Brigham and Women’s Hospital (BWH) and Harvard Medical School (HMS) and colleagues around the world.

Mitnick: And we take our advocacy to ministries of health in the countries where we work and to entities that define what’s permissible or supported in global health projects. Locally, in countries and regions where PIH works, the teams are now organizing formal efforts to keep governments accountable. To me, that’s another form of PIH’s advocacy.

How has advocacy at PIH evolved?

Mitnick: When I started at PIH in 1996, there was deliberately no advocacy strategy, as the focus was on direct service and bringing the best-known standard of care to the most marginalized. But through involvement in certain initiatives—for example, the treatment of HIV in Haiti—we realized that without a parallel advocacy effort to change the policies and the underlying assumptions that led to those policies, we weren't going to be able to effectively deliver care.

“We realized that without a parallel advocacy effort to change the policies and change the underlying assumptions that led to those policies, we weren't going to be able to effectively deliver care.”

Lin: Historically, PIH programs on the ground have served as an example of what’s possible. Back in the early 2000s, Dr. Paul Farmer was one of four physicians brought to the White House to inform the Bush administration on the treatment of HIV/AIDS. Paul described what PIH had achieved in impoverished, rural settings, and PIH’s work demonstrated what could be later scaled through PEPFAR.  

Paul always talked about growing the pie for global health equity funding overall. We've taken that mandate from him and applied it to our grassroots and coalition-based advocacy work. One thing that is unique today versus 20 years ago is that we have experts on training advocates, writing legislation, and federal and state budget cycles on our staff. We're trying to mobilize thousands of people, supporters and volunteers, to collectively and effectively improve public sector decision-making in an evidence-based manner.  

Curtain: That it is evidence-based is so important. PIH has developed this work to be very specific, targeted, rigorous, and robust—intervening in specific processes along the way, knowing when to intervene, with whom to intervene, knowing local pressure, and doing so with an enormous grassroots constituency is something that makes PIH different from other global health organizations.

Are there other aspects that set PIH’s advocacy efforts apart from similar organizations?

Lin: Our volunteers are pretty unique. PIH has attracted many people to the cause by operating from a framework of social justice: “Injustice has a cure.” We’re trying to give folks who already care about these issues a way to be active and effective in advocacy through formal training and organizing work.  

“We’re trying to give folks who already care about these issues a way to be active and effective in the advocacy space through formal training and organizing work.”

Mitnick: PIH’s approach to advocacy is unique in that it is informed by theory and rigorous evidence, both on the clinical care side and from a social justice foundation. Coming from the perspective that there actually are plenty of resources in the world if they are reallocated intentionally, in conjunction with a delivery model that prioritizes marginalized populations and uses advocacy to support them, using the research that comes from partnerships with BWH and with HMS as well as other partners... PIH does all that and advocacy is a core pillar of the whole model.

How does Advocacy help grow the health and social justice movement?

Mitnick: Our advocacy work helps bring people along who were very invested in the mission of PIH, but who weren’t going to go to medical school or public health school. They weren’t ever going to work in this space, but the advocacy work and having the opportunity to change things fundamentally also created a way for people to get involved with PIH.  

It’s been so important for us to form alliances with affected populations and other organizations to work toward some of these changes, including reductions in the price of necessary treatment and diagnostic equipment, like the GeneXpert TB diagnostic test.  

Can you give an example of how PIH advocacy has changed over the last 30 years?

Mitnick: I think our work in TB is such an incredible example because it goes all the way back to the beginning of PIH, in Haiti in the late 1980s, and the very first “randomized controlled trial” that PIH conducted studying the delivery of TB treatment. Unsurprisingly, it showed that, in an impoverished population in rural Haiti, TB treatment delivered with treatment support led to much better outcomes than TB treatment without support.

It was the first thing that was intentionally done by PIH to show the rest of the world and say, ‘Hey, this is something that needs to be adjusted.’ We didn’t define this as “advocacy” at the time, but, in retrospect, it clearly was. It used an example from PIH’s work as a model for how quality care could be delivered in impoverished settings.

In ‘98 and ‘99 we started to present results from our experiences treating TB to the WHO to try to revise treatment guidelines. Our efforts evolved from just doing the work, to doing it and trying to persuade global policymakers to think about how to reach those in need. This year, evidence from our endTB clinical trial has now informed treatment recommendations from the WHO.

Now we're on the other side of that guideline process—where there's still a lot of work to do to scale up these innovations—but we have a much more robust evidence base than we ever had before.

Lin: In August 2024, we led 130 congressional meetings between constituents and their elected officials on global and domestic TB legislation and funding. This year, a record 131 members of the House signed on in support of increasing global bilateral TB funding by 250%. That's a result of many volunteers—not just our supporters, but TB survivors and policy experts—going to Capitol Hill to specifically talk about TB.

It's been tremendous to see people picking up the phone and calling congressional offices and saying to the interns and staff there on a daily basis, ‘I want to see TB funding grow.’ I think that it’s cool to see growth in the movement over the last five years, and how many more people know about and care about TB, and are willing to put their time and energy into advocating for it.

And this has paid off: On September 19th, the U.S. Senate passed the End TB Now Act. PIH supporters alone are responsible for 12,000 messages to Congress in support of the bill, a massive effort that we are so grateful for. However, we still need your help to get it through the House of Representatives. 

Q&A: Why New WHO-Approved Tuberculosis Treatments Matter

New, safe, and effective tuberculosis treatment options were recently approved by the World Health Organization (WHO). These treatments—which were studied in the Partners In Health (PIH)-led endTB clinical trial—and the resulting recommendations represent the culmination of nearly a decade of scientific research and patient care across 18 countries.

The new treatments will benefit people with some of the most difficult to treat forms of the infectious disease, including multidrug-resistant tuberculosis (MDR-TB) and rifampicin-resistant tuberculosis (RR-TB). Combined with prompt diagnosis, these regimens can improve the lives of countless patients.

For more insight about this major advancement in tuberculosis care, we spoke with Carole Mitnick, PIH’s director of research for the endTB project, co-principal investigator of the endTB trial, and professor of global health and social medicine at Harvard Medical. Below, edited and condensed, are her responses:

How would you summarize the recent news announced by WHO to a non-clinician who is not familiar with tuberculosis, but is eager to learn more? 

For the first time ever, virtually everyone with MDR/RR-TB—no matter their age, whether they’re pregnant, whether they have HIV—can get a novel, all-oral, shorter and effective treatment. These new guidelines overcome three major barriers to universal care: 1) With the old standard—a long, toxic, expensive regimen that involved shots every day for six months or longer—health systems could only deliver this complex regimen to a handful of people with MDR/RR-TB each year; 2) the first, shorter, novel regimens had been recommended only for subsets of patients (e.g., adults who weren’t pregnant); 3) because of prior work done by PIH and partners also through the endTB project, there is much more familiarity and comfort among doctors and patients with the drugs in the newly recommended shorter regimens than there was with the first. For all these reasons, the new recommendations should help shorter, effective treatment reach many more people. 

Why does this news matter?

Without treatment, MDR/RR-TB transmits in homes and communities and kills people often after a long, debilitating illness. It frequently strikes young adults in the prime of their lives. The number of new cases each year has stubbornly held at roughly half a million. Without these new treatments, we had no hope of ending this scourge.

The endTB project is a collaboration among PIH, Médecins Sans Frontières, and Interactive Research and Development, and funded by Unitaid. What, specifically, was PIH’s role in this work?

PIH led the grant from Unitaid and the endTB project. In all parts of the project, PIH instilled social justice principles, which drives our everyday work. Specifically, PIH enacted these principles through: accompaniment of participants in the endTB clinical trial (and the other studies); provision of social, nutritional, and other forms of support to trial participants; use of modern methods for diagnosis and comprehensive care for side effects; and linkages to other services as needed for other illnesses or economic or social challenges. Essentially, PIH brought the five S’s (staff, stuff, space, systems, and social support) to a clinical trial! PIH led the implementation of the endTB trial in Kazakhstan, Lesotho, and Peru, where the organization has a longstanding presence and critical history of collaboration with each country’s ministry of health.

The new WHO-approved TB drug regimens included children, adolescents, pregnant and breastfeeding women. Why is that important?

These groups are usually excluded from clinical trials to “protect them,” so we don’t know if treatments work the same in them or cause harm. But the reality is that they get MDR/RR-TB and other illnesses that need treatment, so providers are reluctant to use innovations. In the case of MDR-TB/RR-TB, this means they continue to receive older, more toxic regimens that contain many more pills and sometimes injections. Ironically, for pregnant people, many of the drugs used in the old regimens are not known to be safe during pregnancy. So, it’s a terrible situation and vicious cycle.

The endTB regimens used only drugs that are recommended for use in any age group and during pregnancy. Adolescents could join the trial (with permission from a parent or guardian) and people who became pregnant could stay in the study if they chose to. This contributed to the evidence base for the safety of the drugs in pregnancy.

Why is this news especially important for patients with MDR-TB in countries where PIH works, such as Lesotho and Peru, with some of the highest burdens of the disease in the world?

Peru was one of the last countries in the world still using older, injectable-containing, longer regimens. The fact that nearly 40% of endTB participants were enrolled in Peru allowed the Ministry of Health to immediately act upon seeing the results and change practice in October 2023. Even before the WHO recommendation was released, a couple hundred MDR/RR-TB patients in Peru had started an endTB regimen.  

Lesotho and Kazakhstan, while quicker to eliminate the injectable agent, had not yet fully adopted shorter, all-oral alternatives. Their participation in the endTB project broadly, and the endTB trial specifically, gave health leaders and providers comfort with the emerging endTB regimens.  

Lesotho has a very high rate of HIV infection, which makes people more vulnerable to transmitted MDR/RR-TB. So, interrupting transmission of MDR/RR-TB sooner and more fully with these shortened, effective regimens is key to protecting this vulnerable group from getting sick.  

Kazakhstan has one of the highest burdens of MDR/RR-TB in the world. Shorter, effective regimens could allow them to deliver more care in outpatient settings (rather than the norm of hospitalizing them) and, again, contributing to reduced transmission. 

How do we hope this news will impact global TB care and financing?

Two of the recommended endTB regimens are the cheapest to purchase on the market. They can be delivered for roughly $300 per treatment course. Using shorter regimens poses less of a burden on health systems and shortens the time people are suffering with the inevitable side effects.

Freed up money used to pay for the other treatments and the additional health services required can be repurposed toward rapid diagnostics. The high price of diagnostic tests limits their use, which, in turn, leaves many people undiagnosed and without treatment. Buying more diagnostics and treating more people will ultimately drive down the burden of disease.  Plus, people can go back to work, school, or to taking care of their families sooner. 

What are the next steps?

There’s still a lot of work to do to ensure that adequate resources are available to deliver these treatments successfully. The five S’s are more important than ever to ensuring that people can receive a timely diagnosis and complete treatment. PIH is fully invested in initiatives that increase access to even more proven innovation, like the 1/4/6x24 campaign, which draws its inspiration from PIH’s late Co-Founder Dr. Paul Farmer’s commitment to medical science and health as a human right, and PIH Co-Founder Dr. Jim Yong Kim’s aspirational 3x5 initiative for scaling up access to HIV care in low-income countries.

PIH’s involvement in advocacy efforts to squash efforts to create “patent thickets” or “evergreen patents” means that critical drugs, like bedaquiline, are much cheaper than they would otherwise be. And the Time for $5 campaign, in which PIH is a partner, has also yielded a key win in a 20% reduction in the price of the key diagnostic tool to establish the presence of RR-TB. Our work isn’t done there as the price is still not set at a level equivalent to cost plus a reasonable profit, which is $5 as estimated by our friends at MSF.  And many other tests made by the same manufacturer at the same cost, which are key to improving health in the places we work, are still priced much too high. We are also working to increase funding for TB in the U.S. budget.

What else should the world know about tuberculosis and the work PIH is doing to treat patients with this deadly but curable infectious disease? 

Exactly that: TB newly affects 10 million people each year and close to 1.5 million die. But TB is curable and preventable. PIH is at the forefront of bringing all the available tools (the 5 S’s) to bear on this scourge to stop stupid deaths in the places we work. Through efforts like endTB, PIH is also pioneering research to improve the available tools. And, PIH doesn’t stop there, it makes sure that these new tools are taken up by countries and providers who see a lot of TB.  PIH works tirelessly to increase the pot of resources available to those facing this disease. 

9 Resources for Global Health Advocates

Editor's Note: This blog was originally published on November 2, 2022 and was updated with new resources and information on May 28, 2024.

At Partners In Health (PIH), it is our moral imperative to expose social injustice and to work toward correcting those systemic forces that create inequalities. Strategic partnerships and actions targeted at those who have direct control to change systems are essential to our global impact.

Below are resources to help you learn about and advocate for health care for all.

Take Action

1. Connect over shared values.

Share a story over coffee with a friend about why health equity and social justice matter to you. Pass along an inspiring book or film with a personalized note of why it made you think of the recipient. Build a relationship with those who engage with your social media posts about your favorite causes. 

2. Contact your representatives and voice support for important causes.

One first step could be encouraging your US representative and senators to co-sponsor global health-related legislation, such as the End TB Now Act. State and local governments have a significant role to play in local health systems, so consider contacting them about health inequities in your community.

Dr. Paul Farmer addresses Massachusetts State House
Dr. Paul Farmer, PIH's late co-founder, addresses the Massachusetts State House in April 2020.  © Joshua Qualls / Governor's Press Office

3. Write a letter to the editor of your local newspaper.

This guide details the importance of such letters and gives tips on how to write one. Elected officials and government agencies routinely clip and circulate such letters around their offices as proof of what matters to constituents. If you reference an elected official, it's likely that your published letter will end up on their desk!

4. Open browser tabs and support your favorite cause.

Tab for a Cause is a free, secure browser extension that allows you to raise money for PIH and other causes with every tab you open.

5. Volunteer in your community.

Consider social justice-minded organizations or grassroots groups such as PIH Engage, which recruits and trains volunteer community organizers on how to take meaningful action in the global right to health movement. There are more than 700 PIH Engage members across 85 communities. Join an existing PIH Engage team or apply to start your own.

230 PIH Engage volunteer leaders gather on Capitol Hill in Washington DC preceding their 2024 Hill Day to advocate for a better standard of tuberculosis care globally. Photo by Jessey Dearing / PIH

Stay Informed

6. Watch How To Survive a Plague.

It is a documentary about the early years of the HIV/AIDS pandemic. The film serves as a reminder that the road to systemic change usually involves struggle, but that—ultimately—the results can be life-affirming.

7. Read Why David Sometimes Wins: Leadership, Organization, and Strategy in the California Farm Worker Movement by Marshall Ganz.

The book details the story of the United Farm Workers and how “rethinking relations of power can lead to structural change determined by the exploited, rather than the exploiters.”

Possibly most notable for future advocates, Ganz highlights three elements that lead to organizers’ success: motivation of the movement’s leaders, their diversity of approach, and their creative decision-making.

8. Read An Introduction to Global Health Delivery: Practice, Equity, Human Rights (Second Edition) by Dr. Joia Mukherjee, PIH’s chief medical officer.

Dr. Mukherjee’s book is a valuable resource to become a more informed advocate for global health equity. And John Green, a bestselling author, vlogger, and PIH supporter, found it key to his own education as an advocate.

9. Enroll in online courses to further your education about a favorite cause.

PIH Engage’s Crash Course, updated in 2024, not only provides an overview of the history and current state of global health inequities, but also demonstrates how committed individuals can work together to address those inequities. To access PIH Engage's Crash Course, register as a new member for free, then login.

Examples of Successful Advocacy

Since PIH's inception in 1987, social justice work—which requires understanding the harm done to communities and working to remediate that harm—has played a key role in our clinical care.

Together with partners around the globe, PIH advocates for policies and practices that lead to stronger, more just health care systems in impoverished communities. From advocating for access to treatment for patients living with HIV/AIDS in the 1980s to more recently pushing for equitable access to COVID-19 vaccines, advocacy helps drive change to save lives. It takes many different forms: grassroots organizing, congressional calls and emails, fundraising events, educating the public, and more.

Longtime PIHer Retires In Lesotho

Partners In Health (PIH)-supported Botšabelo Hospital looked vastly different when Paul Soko began working there in 2010. The roads throughout the campus were gravel with minimal landscaping. And the warehouse and retaining wall weren’t built yet.
 
Upon being hired as a clerk of works assistant, Soko immediately began envisioning ways to make the buildings and grounds more attractive, healthier, and easier to access. For nearly 15 years, he dedicated his career to achieving that.
 
Today, it’s difficult to point out a structure on campus that Soko wasn’t involved with in some way.
 
He oversaw the team who built the warehouse, a massive building that stores food and other lifesaving necessities for patients with tuberculosis. He helped construct the hospital’s oxygen plant and dug a trench to bring piped oxygen to bedsides. He designed and laid hundreds of pavers, causing less dirt and debris in the air and making the road more accessible for wheelchairs and vehicles. He planted flowers and trees to make the atmosphere more welcoming. The list goes on.

 “In my opinion, the surroundings can heal a sick person,” says Soko, PIH Lesotho’s infrastructure and maintenance coordinator.

At PIH, we believe the surroundings—or “space”—are one of the five essential elements for strong health systems. By renovating existing facilities and building others from the ground up, PIH creates spaces to meet clinicans’ needs and provide a healing environment for sick patients across the 11 sites where we work.
 
Since 2010, Soko has played a key role in improving Botšabelo Hospital as well as PIH Lesotho’s seven Rural Health Initiative (RI) sites located in the most remote areas of the mountainous country.  He supervised maintenance staff at all RI sites and addressed any needs, such as roof repairs and electrical issues.
 
“Whenever they have a problem, they call me,” says Soko. “I’m happy all the staff understand the importance of saving lives. If people at RI sites are happy, it’s going to be easy for them to do their job well.”

Always Helping

Mary Lesesa, PIH Lesotho nurse-in-charge and program manager, first met Soko while working at Nohana, an RI site, in 2010. Soko would stay at the hard-to-reach clinic for days at a time to address maintenance problems.  

“He’s very helpful and very ready to assist, even if something is beyond his scope,” says Lesesa.

Back then, Soko would often express his ideas to Lesesa. She says he’d always eventually make them a reality. Reflecting on their long time working together, Lesesa is most impressed by one of his recent projects outside of the intensive care unit (ICU) building, which opened at Botšabelo Hospital in 2023.

“He designed the picnicking area, the flowers, the trees,” says Lesesa. “It was wonderful because I wanted those trees, but I didn’t say anything to him. He just volunteered. The place is very nice.”

Paul Soko on the campus of PIH-supported Botšabelo Hospital in Maseru, Lesotho in April 2024. Photo by Caitlin Kleiboer / PIH

Soko's Next Chapter

Soko’s last day at PIH Lesotho was on August 30. He’s transitioning into retirement due to the country’s law regarding mandatory retirement age.

“It's so unfortunate I have to leave, but at the same time I'm so interested [in] helping our fellow countrymen and to improve their lives as well. I am interested in farming and I want to help those people as much as I can,” says Soko.

He plans to dedicate his time to supporting his son and two brothers with their farming business. They aim to plant 120,000 apple and peach trees. While those are growing, they’ll plant cabbage and other vegetables.

A seemingly lofty goal for four people, Soko notes his objective is to expand their operation and ultimately create jobs in Lesotho, where there is a 16.4% unemployment rate.

“You don’t have to keep people suffering,” he emphasizes as he reflects on PIH patients and more broadly, the people of Lesotho. 

Pursuing Dreams: Tuberculosis Patient Remains Hopeful, Chases Career Goals

Sarafina Makashane, 30, has always been driven by her dual passions: fashion design and software development. Instead of choosing one career path, she persistently pursues both, determined to make her mark in the seemingly disparate fields.

In 2023, Makashane began establishing herself in the fashion industry in South Africa. Her designs were gaining recognition, and she was excited about her future. Simultaneously, she was enrolled in a software development course.  

Then, her journey took an unexpected turn when she began experiencing what she thought was simply a sore throat. Believing it was a minor illness and hoping to alleviate the discomfort, she purchased over-the-counter cough syrup and flu medication.

A Sudden Health Crisis

Within a few days, Makashane's symptoms escalated to severe breathing difficulties and relentless vomiting. Alarmed by her rapid decline, she sought medical attention at a health center in South Africa. There, she received the devastating diagnosis: multidrug-resistant tuberculosis (MDR-TB). She was immediately put on treatment; however, her condition continued to worsen.

As her health declined, Makashane made the difficult decision to return home to her family in Lesotho. She knew she needed their support as she faced the biggest challenge of her life. While in South Africa, she was referred to Partners In Health (PIH)-supported Botšabelo Hospital, which is Lesotho’s only facility equipped to handle severe cases of MDR-TB.  

“Getting MDR-TB is life-threatening. I didn't think I'd still be alive considering how difficult it was,” Makashane recalls. “My life was horrible. I couldn't even walk. I watched my entire life flash before me.”

Upon admission to Botšabelo Hospital, Makashane was placed on an 18-month treatment plan involving a combination of drugs. The side effects were harsh, with severe nausea, fatigue, and pain becoming part of her daily life. Tuberculosis (TB)—known to attack the lungs—caused a blockage in Makashane’s left lung, which required complex surgery. The procedure was necessary to save her life but added to her distress, leaving her with chronic pain and constant worry.

During her stay at Botšabelo Hospital, Sarafina Makashane received intensive daily care for MDR-TB, a deadly but curable infectious disease. Photo by Joshua Benson for PIH

Being in the hospital meant missing exams for her software development course, delaying her progress, and causing significant setbacks in her studies. Although frustrated, Makashane remained determined to continue her education as soon as her health allowed.

After three months at Botšabelo Hospital and two weeks in a PIH-supported MDR-TB halfway house, the time finally came for Makashane to head home.

Road to Recovery

Although well enough to leave the hospital, Makashane continues to recover. Every day, she follows a strict schedule to regain her strength and restore her health. Part of this routine includes walking to the nearby shopping mall; a simple, but significant activity. These walks are not just about exercise; they are also a source of fashion inspiration. As she strolls past store windows filled with the latest trends, her passion for design is reignited, motivating her to continue pursuing her dreams.

Since becoming ill, Makashane’s love for both software development and fashion design never waned. She is continuing with her online software development course, which is self-paced, allowing her to balance her studies with her ongoing treatment.

 “After I've fully recovered, I plan to completely embark on a journey to fortify my fashion designing skills,” she says with a hopeful smile.

Treatment Supporter Litlhare Matlole, who received training at the halfway house, visits Makashane at least twice daily to ensure she is taking her medication. Matlole also provides much-needed companionship and emotional support, helping Makashane navigate the long and often lonely road to full recovery.

With the right care and treatment, TB is curable.  

“Awareness, early diagnosis, and adherence to treatment are crucial. Sarafina's journey is a reminder of the importance of these elements and the incredible strength it takes to endure such a battle,” says Dr. Ninza Sheyo, PIH Lesotho’s intensive care unit specialist and a key member of Makashane’s care team.

Sarafina Makashane (center) with members of her tuberculosis care team at her home in Maseru, Lesotho. From left to right: PIH Lesotho Chief Medical Officer Dr. Afom Andom, PIH Lesotho Intensive Care Unit Specialist Dr. Ninza Sheyo, PIH Lesotho Executive Director Dr. Melino Ndayizigiye, and Treatment Supporter Litlhare Matlole. Photo by Mpho Marole / PIH

TB typically affects adults in their most productive years, according to the World Health Organization; however, people of all ages are at risk. Lesotho, with a population of around 2 million, has one of the highest TB incidences globally, with an estimated 661 cases per 100,000 people. Despite being treatable and preventable, TB remains a leading cause of death in low- and middle-income countries, with more than 1.3 million people dying in 2022 alone.

PIH Lesotho plays a critical role in combating TB, providing not only medical care but also social support to patients. This support includes food for patients undergoing taxing treatment regimens, temporary housing at the MDR-TB halfway house for those who cannot travel to the hospital daily, and stipends for transportation. The goal is to treat the whole patient, not just their condition.  

“Every day I feel a bit stronger,” Makashane says. “I'm grateful for the support I've received from PIH and the chance to chase my dreams again. MDR-TB tried to take my life, but it won't take my spirit.”

Vocational Program Empowers Teens Living with HIV

Malawi, one of the most impoverished countries in the world, has among the highest HIV infection rates and is home to a growing population of adolescents who are HIV-positive and facing challenges that go beyond physical health.  

Burdened by poverty, social stigma, and lack of education, young people in the region living with the virus are often isolated from their community, less likely to take medications as prescribed, and discouraged from accessing vocational opportunities. 

Recognizing that health is deeply intertwined with social and economic factors, Partners In Health (PIH) prioritizes the development of programs that go beyond modern medical care and address patients’ needs, including access to food, transportation, housing, and regular employment.   

For Abwenzi Pa Za Umoyo (APZU), as PIH is known in Malawi, social support—meaning care that goes beyond clinical—plays a crucial role in building a stronger public health system. Grappling with significant health care challenges, like the HIV epidemic, has required an emphasis on community engagement and capacity building.  

Building Economic Independence

In December 2022, APZU launched the ASPIRE project, a program aimed at equipping teenagers living with HIV with education and skills that would enable healthy decision making and economic mobility.  

Supported by the Malawi Ministries of Health, Labor, Youth Development, Gender, Community Development, Social Welfare, Agriculture, and Education, ASPIRE implements a redesigned Teen Club curriculum in the Neno District’s 14 health facilities that ensures the support patients are provided extends beyond quality medical provision to include mental wellness support, vocational opportunities, and networking activities. 

Through ASPIRE, teenagers in Neno ranging from ages 17 to 19 are trained in skills that include brick laying, tailoring, plumbing, and mechanics. Along with vocational education provided through Teen Clubs, program participants receive funding to start their own businesses in the areas they are trained.  

According to Jimmy Harare, APZU’s associate director of community health, the goal of the ASPIRE project is to achieve long-term improvements in health and socioeconomic conditions for teens living with HIV in Malawi’s Neno District.  

“For us to attain this,” he explained, “we’re looking into two thematic areas. The first one is to ensure we are improving access to quality HIV treatment services through the decentralized services we provide in Neno. The second thing is also ensuring that we are creating a socioeconomic opportunity for the adolescents that are living with HIV, so that at the end, they should be self-reliant and improve their economic pathway.”  

Breaking the Cycle of Poverty

Nineteen-year-old Patrick Francis from the Tsoka Village in Neno is among several teens who have benefitted from the project. In 2023, Patrick was trained in tailoring. After completing his training, APZU provided him with business start-up capital, a sewing machine, 50 meters of cloth, measuring tapes, needles, scissors, and thread among other items to help kick-start his entrepreneurial journey.  

Today, Francis is bringing convenience and craftsmanship closer to home, operating his business in the village, where residents previously travelled long distances for tailoring services. He currently earns around $40 each month through his business and is able to support his grandmother. This level of income is out of the ordinary for most people living in Malawi, where over half of the population still lives below the poverty line – earning less than $1 per day. 

“Through the tailoring skills I attained with support from Abwenzi Pa Za Umoyo,” he said, “I am able to earn a living and look after my granny. This season I have managed to buy 15 bags of maize, which I want to sell. My aim is to buy a motorcycle to ease my mobility to and from Mwanza, where I buy material for my tailoring.”  

Once acquired, Francis plans to use his motorcycle to also operate a kabaza (bicycle) business, offering people in his community a flexible and affordable means of transportation to areas where vehicles cannot reach due to the terrain. He has also been able to purchase other items for his home and business including solar panels, pigeons to address the problem of food scarcity, and a public address system that community members can rent for weddings and other events, providing Francis with another avenue for income.  

Expanding the Program

The ASPIRE project will allow APZU to expand programming and continue implementing a range of initiatives focused on education and career guidance to empower teens living with HIV in Malawi, improving their physical health and helping them secure the basic conditions needed to realize their potential. These efforts, which will now have a greater impact due to increased funding, include the facilitation of internships, job shadowing, volunteer opportunities, as well as a local youth forum providing life skills training.  

Moreover, the project will incorporate guidance on sexual and reproductive health and rights—with a special emphasis on sexual and gender-based violence, which is prevalent in the region and disproportionally affects girls and young women.  

Focusing on the whole person and not just their illness, ASPIRE aims to address the community’s immediate health care needs and lay the foundation for a brighter future. The project seeks to reach a 90% retention rate for teenagers in care by 2025.  

People with Schizophrenia Empowered Through Community Care Model in Peru

Note: The following was originally published in Spanish on Socios En Salud’s blog.

The community care model of Socios En Salud, as Partners In Health is known in Peru, seeks to strengthen the health system through activities that bring timely, equitable, and quality medical care to the most vulnerable communities. Thanks to strong community partnerships, the program brings people closer to health facilities and accompanies them during their treatment.

The Many Voices project, part of SES’s Mental Health Program, exemplifies this model. Through community strategies aimed at the support and rehabilitation of people living with schizophrenia, 99% of program participants achieved greater adherence to treatment.

Schizophrenia, which affects approximately 1 in 300 people worldwide, is characterized by significant behavioral changes and impairments in perception, including delusions, hallucinations, disorganized thoughts and behaviors, or agitation. Around the world, people with schizophrenia often face social stigma that impacts their relationships with others; discrimination which can limit access to health care, education, housing, and employment, as well as human rights violations due to the symptoms of their condition.  

There are effective treatment options including medication, education, family interventions, and psychosocial rehabilitation. Unfortunately, for many people in low- and middle-income countries, this treatment is not always accessible or available. More than two out of three people experiencing psychosis, which can be caused by schizophrenia, do not receive specialist mental health care.  

The treatment and care that SES provides through Many Voices is vital in giving people with schizophrenia a sense of community and empowerment.  

In 2019, Many Voices began its interventions with the Carabayllo Community Mental Health Center. Following its success, the community care model was expanded to other similar establishments to strengthen activities carried out by Peru’s Ministry of Health.

“Currently, there are 307 people living with schizophrenia who are being served [by the project’s community health workers], of which 306 are adhering to treatment,” said Milagros Tapia, SES’s Many Voices project coordinator.  

From left to right: Adriana Sánchez, Milagros Tapia, Roli Marin, and Stephani Zegarra work to achieve greater adherence to treatment for the patients of the Many Voices project as members of the Mental Health Program team. Photo by Diego Diaz / PIH. 

Consistent, Comprehensive Support

Treatment adherence for patients with schizophrenia is measured by monitoring medication intake and appointment attendance, including psychiatric, psychological, or occupational therapy sessions. Before beginning the Many Voices project, SES staff provide each patient with a baseline test at their local community mental health center, as explained by Tapia. After the evaluation, Many Voices assigns previously trained community health workers (CHWs) to follow up with each patient to assess progress against that baseline.  

“[CHWs] check if they are taking their medications, or if they stopped taking them for some reason,” Tapia said. This information is recorded in the patient’s file, where other challenges, if any, are also recorded.  

Each CHW conducts home visits twice a week for between 10 to 15 people living with schizophrenia and their caregivers. To monitor their adherence, the CHW will verify that the patients are taking their medications by asking them to show their prescription and either pills or injectables, and if necessary, asking them to take the medication right then.

Caregivers can also help verify that patients are taking their medication as directed. In severe cases, a caregiver or responsible family member can be responsible for providing the medication to the patient. In mild cases, patients can administer their own medication, but always under the supervision of the caregiver or responsible family member.

During their visits, the CHWs also provide mental health education as needed and link patients or their caregivers to a health facility if they are experiencing additional health conditions.

SES’s CHWs also provide support to the families of people with schizophrenia. They help families navigate obtaining their National Identity Document, which can otherwise be a challenge for patients with several mental health conditions, or help complete their registration to the Comprehensive Health System, which helps provide public health insurance coverage.  

“We do not work alone, but hand-in-hand with Socios En Salud’s Social Protection Program,” Tapia highlighted.

Care That Builds Community

Alberto Gamarra, 43, is one of the people in the Many Voices project living with schizophrenia. His mother, Milka Asís, affirms that the community support model has been important so that her son can be social and connect with his peers.

Alberto Gamarra and his mother Milka Asís. Photo by Diego Diaz / PIH.

Despite Gamarra’s friendly nature, the deep-seated stigma and discrimination against people with schizophrenia did not allow him to establish friendships with other people. But Asís assured SES that his encounters with more people like him through Many Voices has reawakened his desire to build community and have friends.

Dionila Jiménez found a similar reaction from her mother, 64-year-old Agustina Dionila, who also benefits from the Many Voices project.  

For her, accompaniment “has been necessary and indispensable. Now that [my mother] has been following her treatment, she has met people and has been able to function more,” Jiménez said.

“This project has been good, and it is good, and I hope it continues,” said Julio Gamarra, who takes care of his mother, a Many Voices project participant. “The activities keep her active, going to her group to socialize through workshops, therapy, and taking her medication." 

7 Things To Know About Mpox

The increasing spread of an infectious disease is making headlines again.  

Mpox (previously called monkeypox), a viral disease known for rashes and lesions on the skin, has led to more than 15,600 cases and 537 deaths in the Democratic Republic of Congo alone in 2024. Additional cases were reported in 12 other African countries, including Rwanda and Liberia—where Partners In Health (PIH) works. This is the first time a case was reported in Rwanda.
 
On August 14, the World Health Organization declared a global health emergency due to the rise in mpox cases and new virus strain. A previous mpox outbreak in 2022, which was also declared a global health emergency, led to nearly 100,000 cases and 208 deaths across 116 countries.  

Most patients recover on their own, after two to four weeks; but the drastic increase in cases is sounding alarms worldwide and spurring calls for global vaccination. Treatments and vaccines can control an mpox outbreak; however, they remain widely unavailable across Africa. 

Here are seven things to know about the disease:

1. What are the signs and symptoms of mpox?

Symptoms usually include a fever, severe headache, muscle aches, back pain, low energy, swollen lymph nodes, and skin rashes or lesions. The rash usually begins within one to three days of the fever.

The lesions may be flat or slightly raised and filled with clear or yellowish fluid. Eventually, the lesions dry, scab, and fall off. Rashes tend to occur on the face, palms of the hands, and soles of the feet, but may also be found on the mouth, genitals, and eyes.

Symptoms usually last two to four weeks.

2. How is mpox transmitted?

Human-to-human transmission can occur through contact with the skin lesions of an infected person, mucus or saliva, or contaminated objects. It typically requires skin-to-skin contact.

Animal-to-human transmission occurs through direct contact with the blood, body fluids, skin lesions, or mucous membranes of infected animals. The animals that host this virus are often rodents or primates.

3. Is mpox a new disease?

Mpox is not a new disease. The virus has been considered endemic in 12 countries on the African continent for decades. But it has also previously occurred in the United States—the first outbreak in the U.S. was reported in 2003, spreading from prairie dogs to humans and affecting six states.

The current outbreak is causing concern due to its fast spread and new virus strain. But mpox is not nearly as contagious or as deadly as COVID-19. Unlike the coronavirus, mpox typically requires close physical contact with someone who is infected.

4. Is mpox fatal? 

It can be fatal. In most cases, symptoms often resolve within a few weeks on their own, without treatment.

In some people, the virus can lead to medical complications. These complications—such as pneumonia or infections in the brain or eyes—can be fatal.

Newborns, children, and immuno-compromised people are most at risk for severe symptoms.

5. Is there a cure?

The U.S. has two vaccines approved for use, as prevention measures, and recently announced plans to donate 50,000 doses to the Democratic Republic of Congo, a country with a population of nearly 100 million people as of 2022. More vaccines and treatment are needed to effectively control the spread.

6. Who is most at risk of catching mpox?

During the 2022 mpox outbreak, men who have sex with men comprised the vast majority of new cases. However, susceptibility to the disease is not limited to people who are sexually active or to men who have sex with men.

Anyone can catch mpox. The current outbreak has mostly impacted children under 15 in the Democratic Republic of Congo.

It is vital to fight not only the spread of the virus, but also the spread of misinformation and stigma, which only further endangers marginalized groups, including LGBTQ+ people and Black people.

7. How can I stay safe?

The World Health Organization recommends that men who have sex with men consider limiting their number of sexual partners to lower their risk of infection and reduce transmission.

The WHO also recommends avoiding skin-to-skin contact whenever possible, washing your hands regularly with soap or using hand sanitizer, and washing clothes, sheets, towels, and other items or surfaces that have been potentially exposed.

If you think you have symptoms, please isolate at home until you can be evaluated by a doctor.

Mpox testing is now widely available in the United States. If you have been in direct contact with someone infected, or have been at an event or location with a known mpox outbreak, please be on the lookout for symptoms, and consider getting vaccinated for mpox immediately.

For more information, visit the World Health Organization.

Advancing Community Health Worker Power-Building and Policy

Community health workers are essential, skilled professionals in the United States health and social service workforce. But despite their well-documented contributions to community well-being, they remain undervalued, underfunded, and disconnected from broader health and social service funding systems. 

It is crucial for health and government decision-makers to understand the incredible impact of community health workers on health outcomes, and to recognize the importance of this workforce. And the most effective advocates for this are community health workers themselves. 

Across the country, PIH-US partners with state and national community health worker networks to elevate community health worker voices by creating spaces for them to share experiences and foster collaboration across different areas of the community health ecosystem. We work closely with community health worker network partners to help them design and implement advocacy strategies, supporting coalition building, policy development, and storytelling—key levers for achieving policy changes. Regardless of the approach, achieving desired policy change requires community health workers to be well-equipped, confident, and prepared to engage directly with legislators. 

By facilitating interactive advocacy workshops and training sessions, PIH-US helps prepare community health workers to educate policymakers and ensure their priorities are heard. These workshops develop essential skills for engaging decision-makers, focusing on relationship building, securing meetings, practicing messaging, and helping community health workers gain the confidence to drive meaningful change and secure support. 

Over the last few months, we have:

  • Partnered with the Florida CHW Coalition to expand local community health worker advocacy capacity in the state. In December, PIH-US hosted a series of trainings on legislative advocacy to prepare members traveling to Tallahassee for the first-ever Community Health Worker Advocacy Day. At the Coalition’s annual meeting this summer, we facilitated refresher trainings, building on past sessions to help attendees confidently use their voices to influence policies and programs. 
  • Co-hosted a Congressional briefing and Hill Day in March on community health workers, bringing over 40 frontline workers and allies to Capitol Hill to educate policymakers. To prepare participants for this, PIH-US' advocacy team developed key messaging and coached advocates on how to share these with legislative staff. 
  • Supported North Carolina's Community Health Worker Association on their second annual Advocacy Day in May, convening over 100 community health workers and allies to educate state legislators about their critical role. PIH-US trained advocates and assisted with scheduling legislator visits.
  • Trained over 300 community health workers at the Arizona Community Health Worker Association Roots conference in June. 

It's crucial for legislators to hear directly from community health workers so they can help shape policies that impact their communities and profession. By continuing to support and empower community health workers through tailored advocacy and training, we can ensure their voices are heard, their profession is recognized, their roles are sustainably funded, and their impact on health and social service systems is fully realized.

Modern Canoe Gives Remote Community Access to Health Care

Residents of Puluken—a remote, tropical village—have long struggled with accessing health care services due to a narrow, yet daunting river. The rainy season is especially challenging, as the river swells making it nearly impossible to cross.


This geographical obstacle was a major barrier to accessing Partners In Health (PIH)-supported J.J. Dossen Memorial Hospital; and has contributed to health disparities in the community for decades. 

Now, a modern canoe is turning the tide giving individuals and families access to the hospital, food markets, and more in Harper, Liberia.


In collaboration with the Maryland County health team and the Puluken community, PIH Liberia conceptualized and built the motorized boat. Officially named the “Puluken Town Canoe,” the watercraft is dedicated to the more than 400 residents living there. In June, the 15-seat canoe began making daily trips—about three minutes each way—across the Hoffman River.

The Puluken Town Canoe heads toward Harper, Liberia. Photo by Ansumana O. Sesay / PIH

A Lifeline of Hope

For years, a small, old canoe was owned and used by the village to transport sick people, pregnant women, and others across the river. In early 2023, that boat capsized due to severe leakage and was damaged beyond repair. In turn, residents relied on individuals with privately-owned canoes to taxi them for around $1.05 per round trip. In a community where most people farm and live on less than $2.15 per day, affordability is a challenge. 

“Whenever it’s getting dark, if someone gets sick, all we have to do is pray and wait for God,” says Dweh Baker, chief of Puluken. “You wait for God to take you, or you pray to make it until the morning.” 

Recognizing this injustice, PIH Liberia made an agreement with the Puluken community to improve access to the main city. The local government provided wood and other local materials. PIH Liberia purchased the boat engine, accessories, and covered the cost of workmanship. Upon completion of the canoe, it was presented to the community during a handover ceremony, and accepted by Baker on behalf of Puluken.   

“This canoe means a lot to us. Our pregnant women and mothers will use it to go for their vaccines and other health services; and farmers will use it to transport their produce to markets,” says Baker.  

Moreover, students celebrating the dedication of the canoe said that their teachers—most of whom live in Harper—now have a safer means of crossing the river to get to school.  

With the new canoe, the Puluken community won’t need to pray and wait for God anymore when health emergencies happen at night.

In Sierra Leone, PIH Provides Mental Health and Substance Abuse Treatment During National Emergency

As the synthetic drug kush spreads across Sierra Leone, Partners In Health (PIH)-supported Koidu Government Hospital (KGH) continues to see an uptick in patients seeking addiction support. In recent months, many teens and adults have sought emergency care, mental health services, and other assistance due to the highly addictive drug, which is a mix of drugs including, but not limited to cannabis, fentanyl, and tramadol.
 
The rise in kush and overall drug abuse prompted the country’s president to declare a national emergency on substance abuse in April, leading to the establishment of a national task force. At KGH, staff across the facility are working together to holistically treat patients with co-occurring substance use disorders and mental health disorders, such as 28-year-old Abdulai.
 
While regularly using kush, marijuana, and alcohol, Abdulai’s behavior started to change and he began having frequent outbursts, which led to being stigmatized by his community. Self-realization led him to first seek help in 2019. Since then, he’s received ongoing care at KGH, the only government hospital in rural Kono District.
 
“The hospital has given me advice, counseling, and psychosocial education. Anytime I come to the hospital, my medicine is available and free,” Abdulai says. “In addition to the medicine, the psychoeducation, counseling, and advice I receive is most helpful.”
 
Education has been a powerful tool in raising awareness and reducing stigma around mental health conditions and treatment. In between hospital visits, a community health worker (CHW) visits Abdulai at his home to check in on him and ensure he’s staying well.

“The CHW visits me twice a week and helps to build me up and encourage me,” says Abdulai.

Many patients with substance use disorders experience co-occurring mental health disorders, such as anxiety disorders or personality disorders, that also need treatment. However, having both a substance use disorder and mental disorder does not mean one caused the other, as noted by the National Institute of Mental Health.
 
At KGH, 80% of patients who receive treatment for substance abuse are also diagnosed with a mental health disorder.

Extensive Care, Resources

KGH’s mental health unit addresses substance abuse, including kush use, by providing psychosocial education in the community while highlighting the detrimental effects of using substances. In the hospital, the unit uses an evidence-based program called Common Elements Treatment Approach (CETA), which combines treatments for many conditions, including depression, anxiety, substance abuse, trauma and stress-related disorders. After assessing a patient’s symptoms, individual therapy is offered, and if necessary, medicine is prescribed. Simultaneously, mental health is addressed through psychotherapy, and social support including stipends for transportation, food to help with taking medication, and housing assistance.

Under PIH’s guidance in 2019, Clinical Psychiatrist Dr. Mawuena Agbonyitor trained Community Health Officer (CHO) Cathy Conteh—who oversees KGH’s mental health unit— and other CHOs in how to assess, diagnose, and support patients experiencing a mental health crisis. This training also extended to CHWs who began outreach efforts to identify people in need of mental health support. From 2019 to June 2024, there was an 80% increase in patient care with a 70% success rate. Success means patients adhere to medication, are receptive to treatment, and are successfully reintegrated back into their families and the community.

Community Health Officer Cathy Conteh at PIH-supported Koidu Government Hospital in Kono District, Sierra Leone on March 18, 2024. Photo by Sabrina Charles / PIH

The current mental health team in Kono District includes 14 CHWs and four CHOs, who support KGH and Wellbody Clinic. The country’s first mental health helpline is managed by a team of six, including two psychosocial rehabilitation technicians, one assistant, and three counselors. For calls related to substance abuse, the team utilizes the CETA approach and refers patients to the hospital for in-person treatment.

Dispelling Myths, Providing Hope

A major challenge for the unit has been shifting the misconceptions of mental health that exist in Sierra Leone. Many conditions are attributed to the belief that mental illnesses are caused by spiritual or demonic forces and cannot be managed in a hospital. Community engagement initiatives led by the CHWs, including health talks, interactive radio shows, and informative media campaigns, aim to destigmatize mental health issues and promote hospital-based care. The health talks and outreach efforts create a space for community members to ask questions and serve as a referral pathway to KGH’s mental health unit.

Abdulai is still occasionally stigmatized by his community but overcomes it by educating people on the facts about mental health.

“The [friends] that are aware of my illness are supportive of my recovery. Since I have learned about the signs of mental health illnesses, I encourage my friends who are struggling to go to the hospital or call the mental health helpline,” says Abdulai.

Stigma persists for clinicians, too; however, staff remain committed to providing lifesaving care.

“Although I have been stigmatized for working in the unit, I love changing individuals,” says Conteh. “Most times seeing someone in crisis, you don’t know immediately if the patient will improve with the medicine they are given. But with follow up and continued support, individuals [can] recover and thrive. That is the most enjoyable part of it.”

Conteh has seen firsthand, through Abdulai and others, how patients can recover. When she first met him, Abdulai was aggressive, violent, and not ready to talk to staff, says Conteh. Now, Abdulai calls Conteh for guidance and support. “I am proud of how far he has come,” she says.

Reflecting on his experience with the mental health team, Abdulai says: “The mental health program is one of the best. Coming here motivates me and I can think clearly. I have a future now. I want to practice music and become an entertainer.”

A Commitment to Public Health Strengthened Under the Weight of Adversity

Shaken but not destroyed. That appears to be the general sentiment at Haiti’s Hôpital Universitaire de Mirebalais (HUM), following a harrowing armed attack during the early morning hours of September 26 last year that left the 350-bed teaching facility’s neonatal intensive care unit (NICU) riddled with bullets.  

Forcing approximately half of the hospital’s frightened patients, including those who were critically ill, to flee, the brutal act all but decimated the sense of safety once anticipated in spaces of neutrality in the country. Nurse Manager Ginette Fanfan, who was on duty in the NICU when an armed gang opened fire in her department, said the devastating event happened at a time of already increasing insecurity in Haiti, where pain and sadness are now typical of each day.  

Fortunately, no patients or hospital staff were injured in the attack. The incident, though deeply distressing, bolstered the staff’s resolve to continue providing essential medical services to those in need, undeterred by the daily challenges they face.    

Nurse Manager Ginette Fanfan has worked at HUM for over 10 years. Photo by Mélissa Jeanty / PIH

“Despite the danger, I have no other choice,” Fanfan expressed in solitary with her colleagues at Zanmi Lasante (ZL), as Partners in Health is known in Haiti. “It's been my workstation that I love for more than 10 years now. I have a huge appreciation for HUM, working with patients in the community as a Midwife, helping to motivate, encouraging women to adopt a planning method for their well-being, coaching nurses, auxiliaries, nursing assistants on my team; that is my field. In addition, Haiti needs me, and I am always proud to remain working in my country.” 

Her statements echo that of ZL's interim executive director Marc Julmisse, who condemned the shooting as a breach of the principle of medical neutrality protected by International Humanitarian Law. "Despite this targeted attack on HUM,” she said in the aftermath, “Zanmi Lasante staff remain committed to providing lifesaving care for the people of Haiti.” 

Travelling by air to avoid dangerous public roads and relying heavily on resources, including hot meals and psychological support, provided by ZL to affected staff, Fanfan is motivated by the love of her profession, love for her patients, and hopes for the future to work even harder.  

“The scale of HUM, the size of the institution, etc., all this makes me comfortable to continue to provide care and supervise my crew,” she said. “Providing care, especially in Haiti, is a vocation. Despite the disaster that Haiti is experiencing, I believe in change.” 

Q&A: How Solar Power Is Improving Patient Care in Lesotho

Electricity, like medications and IV fluids, is crucial. Nurses need it to safely deliver babies. Lab technicians need it to operate diagnostic machines. And pharmacists need it to refrigerate vaccines. 

Yet, many health centers in low- and middle-income countries do not have reliable—or in some cases, any—electricity. Until recently, that was true across Partners In Health (PIH) Lesotho’s seven Rural Health Initiative (RI) clinics.  

Following the success of PIH-supported solar projects in Haiti and Peru, every RI site in Lesotho is now fully equipped with solar infrastructure, which has drastically improved care delivery.  

We spoke with Bonang Mpinane, PIH Lesotho’s director of operations, to learn more about the impact of the country-wide solar project. Below, edited and condensed, are his responses:

What was the power situation at the RI sites before solar was installed?

Before 2022, we were powering all seven RI sites with diesel generators. It was a very unreliable and unclean source of electricity. Heavily relying on diesel was costly and logistically challenging to get to the rural health centers. It was difficult being fuel dependent. Even the vehicles that were transporting diesel also ran on diesel. It was very, very costly.

How did diesel-dependent power impact health care workers and patients?

Our health providers and patients experienced serious challenges in terms of operational constraints. We had frequent power outages in those centers, which negatively impacted care delivery. Imagine going into labor in the middle of the night and not having power. Nurses used to use gas lamps, which were not reliable. There was medical equipment, such as ultrasound machines, just sitting at some clinics because it couldn’t be used due to the unreliable electricity.

Bonang Mpinane is PIH Lesotho’s director of operations. Photo by Justice Kalebe / PIH

What’s the power situation now at the RI sites?

PIH Lesotho partnered with OnePower Lesotho, a renewable energy company, who installed solar power infrastructure across all seven RI sites. It was a very good opportunity for PIH Lesotho to overcome some of the challenges I highlighted. After completing the installation of the solar power systems at the end of 2022, we transitioned from diesel to solar power. We now have a sustainable and reliable source of electricity while avoiding most of the operational disruptions we used to experience. It was indeed a breakthrough for us as PIH in those facilities because we overcame the challenge of frequent power outages, which happened about five times a week on average and lasted for hours at a time. Now, we have a continuous supply of power.  

There are still generators as backup power sources at the clinics. Given the geographical location of our health facilities, there are some days that they don't have sunlight, especially in winter.

How has solar impacted the budget?

There was a tremendous reduction in the expense of buying diesel because we no longer buy fuel as often as before. We also have maintenance savings because the upkeep for solar power infrastructure is much cheaper than maintaining the generators, many of which are more than 10 years old.  

We used to spend about $700 on diesel alone per month at each RI site. That only includes diesel for the generators, not the vehicles. After the solar power system installation, we now spend about $350 on diesel per month at each RI site. There are other indirect costs, but overall, we are enjoying tremendous cost savings.

Solar panels at Partners In Health-supported Nkau Health Center in Mohale's Hoek District, Lesotho. Photo by Joshua Berson for PIH

What are other positive impacts of the project?

We now have proper wiring, which is much safer. We’ve been able to invest in and use more medical equipment. Diagnosis and treatment for patients has improved because the machines are operational. Even the resource allocation, in terms of the money saved, can now be used for human resources, more equipment, and towards improving our overall essential health care services.    

Staff Wellness Program Helps Care for the Caregivers

Content warning: This story mentions trauma and sexual assault  

Eddy Eustache, an ordained Catholic priest and psychologist who was once dubbed Haiti’s patron saint of mental health, has been a longstanding advocate for staff wellness. Père Eddy, as he’s often called, was hired by Zanmi Lasante (ZL), as PIH is known in Haiti, in 2005 as the team’s first psychologist under the guidance of Dr. Giuseppe Raviola, PIH's co-director of global mental health. In the decades since, he’s supported hundreds of patients and staff members through personal, professional, and even national catastrophes.  

His work with Zanmi Lasante initially consisted of traveling to each of its clinics to work with patients who had been diagnosed with tuberculosis and HIV and were learning to live with chronic illness. During that time, he began to see how staff were burdened by years of bearing their patients’ pain.  

It takes incredible strength to confront suffering every day. According to the CDC, health workers are suffering from a mental health crisis. In 2022, nearly half of health workers reported feeling burnt out and wanting to look for a new job. Even in the early 2000s, Père Eddy saw this happening with his colleagues and is proud to now be co-leading a small global team that raises awareness about the need for staff wellness and supports interventions in favor of PIHers in need.

The Need for Staff Support

Père Eddy remembers when he first joined Zanmi Lasante, his colleagues were mostly young, healthy, and freshly graduated from medical and nursing schools. They seemed invincible. It didn’t take long for that illusion to fall as he faced his first case: a medical resident who reported being exposed to sexual assault.

“I started understanding that there was another aspect I needed to consider,” he shared. “Even though people are young, they can still be exposed to hardships.”

In 2009, Père Eddy was confronted with what would be his first of several crises that would impact his Zanmi Lasante colleagues. ZL’s director of surgery, Dr. Josue Augustin, had been murdered.  

“The whole system was in shock,” he remembered. “We realized that we needed to pay more attention to the needs of the staff. They could easily and quickly become vulnerable.”

With the support of Raviola, Co-Founder Ophelia Dhal, and Chief Medical Officer Dr. Joia Mukherjee, Père Eddy began traveling to all Zanmi Lasante’s sites to conduct group debriefings, allowing the staff to express their grief collectively and find comfort and relief with one another.  

Père Eddy with PIH Co-Founder Dr. Paul Farmer during a weeklong retreat with the members of the ZL mental health and psychosocial team. Photo by Giuseppe Raviola / PIH.

Soon after he felt that the staff were starting to come back to themselves, another tragedy struck. On January 12, 2010, a massive earthquake struck Haiti. Père Eddy still remembers one of the staff members who was killed, as well as the families, friends, fiancés, and neighbors that he and his colleagues lost on that day.  

“We were all impacted by it,” he said. “And at the same time, we were among the first health institutions to be standing by the Haitian people, working. People were under stress, and we needed to help them grieve. We organized a memorial ceremony at each site to allow people to release the pain, the suffering, the sorrow they had inside in order to continue work.”

The need for a support system for staff became apparent after these experiences, and the idea of a larger staff wellness program was born. Père Eddy and leaders across PIH began to understand that staff were still struggling months, and even years, after these catastrophes occurred and needed support.  

A New Approach to Staff Wellness

Père Eddy very quickly became the go-to guy for psychological support. He was constantly on-call and served as a sort of dispatch for his team—redirecting calls to other mental health clinicians who could support those reaching out. He believed that helping staff would make them better caregivers for Zanmi Lasante’s patients.  

“It is a great source of pain for me if I see the staff suffering,” Père Eddy said. “I used to work directly with the patients, but now, my way to work with the patients is to support the staff. If the staff is not supported, that means the patient will suffer.”

In mid-2022, Père Eddy traveled to Boston to work on the implementation of a global staff wellness program with various PIH leaders. He realized that issues staff were facing in Malawi, Peru, and Sierra Leone may be similar to those faced in Navajo Nation, Mexico, and Lesotho. He wanted to approach wellness as something that connected everyone, gathering expertise and compiling resources that could be shared with PIH colleagues globally.

“Some people like to pretend that staff wellness is only recreational,” Père Eddy said. “It is not. We need to understand how stress is having a huge toll on staff psyche.”  

Père Eddy provides support for ZL Nurse Anesthetist Fatimah Barnate and her mother after Hurricane Matthew destroyed their home in 2016. Photo by Aliesha J. Porcena / PIH.

He says that the current success of the staff wellness program is dependent on support from executive leadership at PIH sites. Without the staff and resources needed to execute the program successfully, the program can feel inauthentic to staff members and will be ineffective.

“In places where the executive leadership is strong and supportive, the staff wellness program is flourishing,” Père Eddy said. “PIH leaders have realized that staff wellness is a basic need. The world has become more and more unsafe and the staff is exposed to all kinds of stress in addition to their personal issues. If we want them to be performing at work, we need to cultivate an ambiance of wellness.”

A Breaking Point in Haiti

If you ask Père Eddy, he will tell you that the word resiliency is not his favorite. It varies from person to person, but is ultimately a construct—like rubber bands with different elasticities that are being pulled and stretched to their limits, but, ultimately, will snap. 

He believes the current crisis in Haiti may be the breaking point for Zanmi Lasante’s theoretical rubber band. As staff continue to be exposed to traumatic situations over the long term, it is eroding their ability to cope.

“When I returned to HUM last year, the work was intense,” Pére Eddy said, referring to ZL’s largest facility in Haiti, Hôpital Universitaire de Mirebalais. “Some people were exposed to direct violence, some had witnessed violence, kidnappings... and people were stressed out because of the harm that was ongoing.”

Père Eddy hadn’t been back in Haiti for long when the tensions started to rise in the streets around HUM. There were rumors going around that the gangs were going to be coming back to Mirebalais and everyone was starting to get nervous, bracing for an attack.  

In the middle of the night on September 26, 2023, gang members opened fire in HUM. While there were bullet holes left in the doors and walls of the hospital’s NICU, fortunately, no staff or patients were injured. They were, however, traumatized.  

“Around 3 a.m., I was reaching out to people. It was early in the morning, people were fleeing, and the staff was totally spread out,” Père Eddy remembered. “Patients were fleeing with IV fluid in their arms. It was total chaos.”  

Père Eddy began working with staff and patients, both those who remained at the hospital and over the phone with those who fled. It was a long and difficult week and many of his Zanmi Lasante colleagues were reluctant to come back.  

Père Eddy and a few clinicians put together small group therapy sessions for any staff who wanted to participate. He was able to see immediately how traumatized they were—some experiencing flashbacks, some still avoiding their memories. Even with armed security now surrounding the building, the staff weren’t reassured.  

“We started working with them and after about a month, you could see activities starting to resume,” Père Eddy said. “Life was slowly coming back to HUM. Staff were more confident in themselves and were able to start working.”

Despite the renewed calm at HUM, staff in Port-au-Prince were still being exposed to widespread violence every day. For Père Eddy and Zanmi Lasante’s mental health team, it seemed the work could never be completed. Whether it was a staff member who was in close range to a shooting, or a resident who was kidnapped on his way to work, there was no shortage of mental health support that was needed from his small, but mighty, team.  

“Violence in the streets is a concern for the whole country. People are stressed out, they are leaving,” Père Eddy explained. “Staff say, ‘I’m working with my casket under my armpit’—that they may be killed at any time. They are so uncertain about life.”

With the precariousness of each day, he says people have started “viewing their life expectancy as 24 hours.” The compounding national crisis has created a mental health crisis among Zanmi Lasante staff and patients alike.  

To address the growing mental health needs of people in Haiti, Zanmi Lasante has hired three new psychologists. These clinicians will support the existing mental health team originally trained by Père Eddy.

Caring for the Caregiver

It’s no secret that Père Eddy cares an awful lot about his colleagues and the patients they serve. In his position, it would be easy to be crushed under the pressure of supporting so many people. But he said he leaves heavy conversations feeling almost weightless.

“I don’t know where I get it, but whatever suffering I’m exposed to, sometimes I may vibrate with the suffering in the moment, and once I leave the place where I was sitting and talking with this person, it was like I left all the issues that were addressed in that room,” Père Eddy shared. “This, to me, has been a gift and I’m very grateful for it.”

Père Eddy and The Rev. Edward M. Cardoza, PIH Trustee Emeritus and Missioner of Property Stewardship of the Episcopal Diocese of Massachusetts, lead a prayer at a celebration and memorial of Dr. Paul Farmer’s life at Trinity Church in Boston on March 12, 2022. Photo by Zack DeClerck / PIH.

He also practices healthy habits that have helped him cope with long, stressful days. He relies heavily on his spirituality. He often finds relief in exercise, taking four-to-five-mile walks and practicing yoga regularly. And he believes deeply in practicing kindness, having respect for everyone, and finding support in his global PIH community.  

“I don’t see myself ever turning my back on PIH, even if I retire,” Père Eddy said. “PIH is my family, and you don’t stop belonging to a family. When I see the support, when I see the staff is recovering, when they regain hope and they can rebuild confidence in themselves, this keeps me alive and motivated.” 

Emergency Medicine Residency Earns International Accreditation in Haiti

The emergency medicine program at Hôpital Universitaire de Mirebalais (HUM), the first and only residency program of its kind in Haiti, was awarded accreditation last month for meeting international standards for institutional, foundational, and advanced specialty training. This is the hospital’s third medical residency program awarded accreditation by ACGME-I, the international arm of the U.S.-based Accreditation Council for Graduate Medical Education.  

Zanmi Lasante (ZL), as Partners In Health is known in Haiti, began the emergency medicine program at HUM in 2014, largely to fill the gap in care laid bare by the 2010 earthquake, when many first responders came from outside the country. The residency extends over a three-year period and welcomes seven doctors each year.   

Dr. Rachel F. Colinet was part of the first cohort of residents to graduate from the program in 2017. Now an instructor responsible for training residents, Colinet is moved by the full circle moment. “I don’t even have the words to express myself,” she said. “As a former student, I was really awaiting this accreditation and to receive it at this time when I occupy this position is more than prideful for me. It’s truly an achievement.”   

HUM’s internal medicine and family medicine residencies were awarded ACGME-I accreditation in June 2023, making emergency medicine the third to receive this distinction. The hospital today offers nine residency programs in pediatrics, general surgery, obstetrics and gynecology, nurse anesthetist, emergency medicine, internal medicine, orthopedic surgery, emergency nursing, and family medicine as well as three fellowship programs in neurology, plastic and reconstructive surgery, and emergency ultrasound.  

The ACGME-I accreditation involves a comprehensive peer review process that evaluates, improves upon, and publicly recognizes graduate medical education programs that meet the highest educational quality standards. To obtain this accreditation, program directors, faculty members, administrative staff, and residents all collaborated with a shared vision.    

“It was necessary to prepare documents, revise training schedules, work on policies and procedures, evaluate residents and submit specific data,” explained Colinet. “It was very stressful, but we learned a lot from the process.”    

Haiti continues to face a widespread crisis where a multitude of problems have dramatically increased poverty and made access to health care even more challenging. “At this difficult time when there are few resources and where there is a serious brain drain, this accreditation restores the image of the homeland in terms of healthcare,” explained Dr. Ornella Sainterant, Zanmi Lasante’s divisional director of training for development and medical education. For Sainterant, this third accreditation is a sign of continuity in the work started by Dr. Paul E. Farmer, co-founder of Partners In Health, and others who believed that providing healthcare was a means to social justice. “To provide quality healthcare, you need quality medical training.” 

 

PIHers' Picks: What to Read, Watch, and Listen to this Summer

Warmer weather and longer days have arrived in the Northern Hemisphere. Kicking off the season, Partners In Health (PIH) staff from around the world shared works they recently enjoyed to add trips beyond the surface to your summer plans. Illuminating the rich tapestry of experiences and challenges that shape the global health landscape, this insightful list promises to inform, enlighten, and inspire. PIH invites you to use this summer to deepen your perspective and learn more about our mission of social justice.

 

From Medical Intern to Executive Director in Haiti: Meet Dr. Wesler Lambert

When Dr. Wesler Lambert began as an intern in one of Partners In Health’s first clinics in Haiti in 1997, he couldn’t have imagined the organization would grow to be the country’s largest health care provider outside of the government—and that it would eventually be under his leadership. Among the first people hired to join the team, he brings a wealth of knowledge and experience to his new position as interim executive director of Zanmi Lasante (ZL), as PIH is known in Haiti.  

Lambert was first introduced to PIH when he was signing up for his year of social service—a national requirement for physicians in Haiti to complete after their six years of medical school. As luck would have it, a soccer teammate’s intervention brought Lambert to Cange, a remote village in Haiti’s Central Plateau, where Zanmi Lasante began.

“The health regional director [of the MOH] was a friend. We used to play soccer together,” Lambert remembered about Dr. Paul Adrien, “I was supposed to go to Boucan-Carré, but he told me it was just two rooms in a small clinic, and he didn’t think I would learn anything there. He asked if I had heard about Cange and Paul Farmer, but it was completely new to me. He asked me to move to Cange and I became the first social service intern there.”

Back then, Cange was a two-ward hospital—one for adults and one for children. For Lambert, this was a new experience. He came from the capital city, Port-au-Prince, where he worked as an intern in the General Hospital—at one point, the largest and most impressive medical facility in the nation. Still, he was seeing patients who couldn’t afford the medication he was prescribing, so they often left the outpatient clinic empty-handed—and with no follow-up or support to ensure they were receiving proper care. When he came to Cange, under the leadership of PIH Co-founder Dr. Paul Farmer and his Haitian colleagues, he noticed a difference in how services were provided.  

“This was a unique opportunity for me to see how being a doctor can be,” Lambert said. “At the General Hospital, you meet a patient, and you don’t really care what happens after. But having met Paul [and other Haitian doctors], and seeing the way they treat patients, it was a completely new experience for me.”

Twenty-Seven Years of Experience

After his start as an intern, Lambert began to work his way through different departments at Zanmi Lasante. Despite being a generalist, he was assigned to the pediatric ward in Cange after the pediatrician there left. Farmer placed him in the role, knowing he didn’t have the formal training, but having confidence in his ability to provide quality pediatric care all the same.  

Lambert continued his journey at Zanmi Lasante in the ‘90s as a physician and worked on the first study on the dynamics of sexually transmitted diseases in rural Haiti before traveling to Boston University (BU) in 2001 to start a master's program in public health. Before he could complete his studies, however, Farmer called him back to Haiti to support the extension of Zanmi Lasante’s HIV program in the Central Plateau.  

In 2002, he became the medical director of Lascahobas, Zanmi Lasante’s first scale-up site for HIV care. Then, he became a sub-regional director—Unité Communal de Santé—for the Ministry of Health.

Eventually, he returned to the United States to finish his studies, receiving his master's degree in public health at BU in 2006. He then returned to Haiti to help Zanmi Lasante improve the ZL training program and support a maternal and child health project.

In 2007, PIH leadership asked Lambert to go to Rwanda—a fairly new site at the time—to help the team with the introduction and integration of their HIV program and to help train staff. Meanwhile, Farmer recognized the many skills of his friend and colleague and asked Lambert for his support with monitoring and evaluation in Haiti. To satisfy both requests, he began spending three months in Rwanda and nine months in Haiti for three years.  

Haiti’s devastating 2010 earthquake changed everyone’s plans. All major hospitals and teaching facilities had been either destroyed or severely damaged, alongside other government institutions and thousands of families’ homes. It became clear that Zanmi Lasante needed everyone’s assistance to provide emergency response, care, and support to those living in temporary camps established across the capital. Lambert returned to the country full-time to help lead the organization’s response in Port-au-Prince.  

Dr. Welser Lambert at a mobile clinic after the earthquake in 2010. Photo by Melissa Stewart / PIH.

As a new normal descended in the following years, while also serving as the deputy executive director of Zanmi Lasante, Lambert became the technical lead for a large national grant—Service de Santé de Qualité pour Haiti—for Partners In Health and Zanmi Lasante. The grant was funded by U.S. Agency for International Development and led by Pathfinder International.  

In 2017, Lambert switched away from his deputy role to begin overseeing the strategic information department, which included information technology, medical informatics, research, training, and monitoring and evaluation.  

Three years ago, Lambert was asked to return to his role as deputy executive director, as Marc Julmisse, now PIH’s chief of clinical systems support, stepped in as the interim executive director of Zanmi Lasante.

In January, decades after joining the organization as one of its first interns, Lambert assumed his role as interim executive director of Zanmi Lasante. The significance of this moment isn’t lost on him.

“In any position, you can affect change,” Lambert said. “But in my new position as executive director, it reminds me that I don’t have any excuse. I have to deliver.”

Becoming a Doctor

Before his journey with Partners In Health began, Lambert knew he wanted to work in health care. When applying to university, Lambert applied exclusively to medical school. There were only 100 seats for around 2,000 applicants, but he was confident he would earn one of them.

"I always wanted to be a doctor,” Lambert said. “I learned from my mother that you always have something to give someone. I learned along the way that when a patient comes to you, even in the most desperate situation, you have to bring some hope. Being a doctor, you have this special connection with life and people. It’s quite special.”

After graduating from medical school and interning with Zanmi Lasante, he favored working in an environment that was helping the community in his home country and wanted to continue his work with PIH.  

“The most attractive part of this work is serving,” Lambert said. “My biggest lesson from Paul is humility. It’s how you become great in serving the poorest.”

PIH Co-Founder Dr. Paul Farmer and Dr. Wesler Lambert. Photo from PIH Archives.
Leading Through Uncertainty

Lambert is no stranger to the instability of Haiti, having grown up in the country and experiencing it firsthand when he was kidnapped on his way to work in 2004. Luckily, he was left unharmed, although without his wallet. But the experience left him rattled and with deep knowledge of what it feels like to be at another person’s mercy in a time of uncertainty.

The more recent escalation of gang activities has affected his day-to-day life significantly.

“The violence and instability have been very difficult and have impacted my approach to work,” Lambert shared. “I like to stay close to the team, do field visits, and visit with partners, but, unfortunately, this situation has pushed me to spend most of my time away from our teams because of the security risk. When I have a meeting that I need to attend, I have security in an armored vehicle, which is something I never imagined in my life.”

Despite the safety concerns, Lambert and his team at Zanmi Lasante have kept striving to provide the best care possible for patients.  

“To see the team risking their lives to keep our services running, gives me the motivation to be like them,” Lambert said. “We have our various strategies and strong connections with the community that have been helping us. People want peace, and deserve peace, and they are very committed to stay and serve the country. We see this at Zanmi Lasante, even with our residents.”  

A Man with a Plan

Lambert is clear about the direction he hopes to take Zanmi Lasante. As he looks to the future, he has three major goals for his team.

“I want to make Zanmi Lasante sustainable,” Lambert said. “We need to have stronger systems to sustain our work. Our work is so incredible, and it’s saving so many people’s lives, so we have to make sure we keep it going. I want to improve our quality of care and services because we’ve been extending so much, and I don’t want it to affect the quality. Also, I want to create and maintain a more supportive work environment that attracts and helps us retain talented people.”

His talented colleagues and the incredible Zanmi Lasante community are part of what motivates Lambert during his long days, many of which end with answering emails until 11 p.m.  

“I see opportunities to make significant changes at ZL,” Lambert said. “For me, that’s the most motivating part of my work. We can make lasting change. We have a wonderful, dedicated, skilled core team that makes my life easier, they make the work easier. They are playing a huge part in my motivation.” 

PIH-US Supports Second Annual State Advocacy Day in North Carolina

On May 15, more than 100 community health workers and allies from across North Carolina convened at the capital in Raleigh, to educate representatives about the critical role of community health workers across the state. 

Throughout the day, which was hosted by the North Carolina Community Health Worker Association (NCCHWA) and its partners, including PIH-US, advocates met with over 70 representatives to discuss community health workers’ impact on advancing the state's health priorities and the critical need for sustainable funding to ensure every North Carolinian receives the support and care they deserve. 

Below, we share a selection of photos from the day.

They are Not Alone: Three Transgender Women’s Stories of Resistance in Peru

Content warning: This story mentions sexual violence  

If Paloma misses something from her native home of Condorcanqui, a province located in the Amazonas department of eastern Peru, it is the regional food. That’s why the 21-year-old usually prepares tacacho, or mashed, boiled plantains with cured meat, in her room in El Muro, or The Wall. The wall is a nickname for her central Lima home—which houses transgender women like her—because of the concrete block that protects the entrance.

Paloma’s best dinner guest is N., a 15-year-old transgender teen girl who also arrived from Condorcanqui a year ago to join this home. Paloma and N. share their local food with Daniela, 23, who, although she comes from Iquitos, the largest metropolis in the Peruvian Amazon, feels like she’s from the country next to her two neighbors. Alongside the gentle heat of the stove, a friendship has been brewing among the three of them.

“You can't cook or eat alone,” says Paloma.

And, for these women, you can’t work alone either. Late at night, the three of them usually go out together on the street. With power in numbers, it is a measure that they have taken to confront situations of violence and discrimination to which they are exposed due to their gender identity. They, like 62% of trans women in Peru, according to figures from the nation’s Ombudsman's Office, consider sex work as the only employment option.

Socios En Salud, as Partners In Health is known in Peru, seeks to understand these dynamics to provide better informed health care to the transgender population, among the priority communities due to their condition of vulnerability, through the JunTrans program. From October 2023 to May 2024, the JunTrans team has helped 7 transgender women process their national identity document, screened 353 transgender women for HIV/syphilis, and identified 23 new HIV cases and 14 new syphilis cases. Through comprehensive interventions, Socios En Salud staff can help the transgender community gain greater trust in and utilization of the national health system.

Carla Rodríguez, JunTrans project coordinator (seen standing) and technical assistant Walter Rojas (far right) speak with N., Daniela, and Paloma in their home at El Muro. Photo by Diego Diaz Catire / PIH.
More Than a Health Worker

Paloma says that she and her friends usually wake up between 9 and 10 a.m. She, the most punctual among the three, according to Daniela, starts her workday at 4 p.m. and returns to El Muro at 10 p.m., although there are days when she starts later. “If I leave at 8 or 10 at night, I return at midnight or 1 in the morning,” she says.

For our JunTrans program, a community-based intervention that seeks to improve access to health care for transgender women in Lima, Socios En Salud takes these work schedules into account when visiting or providing care to the women.  

“We try to understand each one of them from their position. We do not come as health personnel. The treatment is empathetic so that they open up to us,” says Carla Rodríguez, JunTrans project coordinator.

Rodríguez and her colleagues start with the small details. If a woman is going to be screened for tuberculosis, HIV, or other sexually transmitted infections (STIs), then they are scheduled from noon until late at night, when they are available. Additionally, JunTrans teams visit spaces familiar to the community to share information and resources with transgender women who would benefit from these services.

One example is at volleyball championships that transgender women in Lima organize from time to time. At the opening of the tournament that took place in February, the JunTrans team attended and performed 30 HIV tests.  

Improving Access to Hormone Therapy

Daniela does not feel nostalgic for the place where she was born, not missing the heat of the jungle. N. and Paloma agree with her; they say the high temperatures of the Amazon cause burning where they have injected oil and silicone to alter their appearance, because they cannot afford cosmetic surgery or hormone therapy.

Daniela, left, and N. provide support for one another as friends and neighbors in El Muro. Photo by Diego Diaz Catire / PIH.

“I would like to do everything,” says Paloma, in relation to gender-affirming care. But economic limitations, as well as limited trained health personnel in the needs of sexual and gender minorities, lead many transgender women to pay for risky alternatives that could impact their health. Because of this, JunTrans has begun a hormone therapy pilot with seven transgender women who receive free care at one of Socios En Salud’s clinics, located east of Lima.

Dr. Alberto Mendoza, an infectious disease physician at Socios En Salud, highlights the importance of trained doctors monitoring “hormone therapy for feminization.”  

“People who self-medicate run the risk of developing adverse effects from inappropriate medication or doses. They may also develop mild side effects, but if they are not treated, they can become complicated and be very harmful," he says.

A Step Forward in Mental Health

In addition to the tropical climate, the three friends of El Muro recognize that there is another reason not to miss their homeland.  

“In the beginning, there is always suffering,” says N., alluding to the unequal treatment she suffered at home due to her gender identity. “I don't want to go back. I'm used to [Lima], there are districts that are more beautiful where there are tourists to get to know,” Paloma adds with a laugh.

María Fernanda Amézquita, JunTrans psychologist, specifies that among the transgender community there are many cases of “past violence” carried out by the family.  

“Among the patients that I managed to screen, there was a lot of psychological and physical violence—in some cases, even sexual violence—that they normalized out of shame or fear,” she indicates.

The evidence is corroborated by a survey that Socios En Salud published in 2021: 82% of transgender women in Lima presented depressive symptoms due to the discrimination and violence they suffer. Since 2022 to the present, JunTrans has been offering mental health care services for transgender adults.  

Paloma, Daniela, and N.—with support from Socios En Salud, JunTrans, and each other—are not alone. 

Treating Mental Health and Tuberculosis in Rural Lesotho

In the picturesque but rugged Maloti Mountains of Lesotho, Nkau Health Center stands as a beacon of hope for many suffering from tuberculosis (TB). The rural facility, located several hours from the capital city Maseru, provides comprehensive care for hundreds of patients living in the region, such as 49-year-old Qacha Qabane. 

In 2022, Qabane was diagnosed with multidrug-resistant tuberculosis (MDR-TB) at Partners In Health (PIH)-supported Nkau Health Center and immediately began treatment, which includes medication and social support, such as food and transportation. Months later, his chest and back began to hurt.  He was soon diagnosed with Pott’s disease, which is when TB impacts the spine and causes severe discomfort.  

Now paralyzed from the waist down and confined to a wheelchair, he is no longer able to farm, which he previously did to support his wife and two children. Like many with MDR-TB, Qabane faces daily physical and mental health challenges due to the common infectious disease.

An integrated approach

Recognizing the profound impact that TB has on mental health, PIH Lesotho integrated mental health care into its MDR-TB treatment program in 2017 by beginning to screen all patients for depression and anxiety. Initially piloted at Nkau Health Center, the initiative expanded to PIH-supported Botšabelo Hospital in Maseru and various rural and community clinics nationwide. In 2024, substance use disorder screening was added.  

Dr. Ryan Meili, visiting doctor and PIH Canada board member, examines Qacha Qabane during an appointment at Nkau Health Center in Mohale's Hoek District, Lesotho. Photo by Joshua Berson for PIH

Beyond screening, the team diagnoses, manages, and provides psychosocial support for patients diagnosed with mental health conditions. This approach improves adherence to treatment, treatment outcomes, and the overall quality of life for patients with MDR-TB, says Mpiti Nkuebe, PIH Lesotho’s mental health program manager. While mental illness does not discriminate, those with TB—who are often stigmatized—are especially vulnerable. 

"Depression and anxiety are more prevalent among people with tuberculosis than among the general population. It’s estimated that over 40% of people with TB have depression," says Nkuebe. 

That includes Qabane, who was referred to Botšabelo Hospital for initial appointments, before receiving ongoing care at Nkau Health Center.  

“Mr. Qabane was assessed for mental health when he was first admitted to [Botšabelo Hospital] as he showed signs of depression. After evaluating and confirming that he had depression due to MDR-TB, our mental health team conducted weekly assessments for his stay. He has been on depression medication since then,” says Dr. Stephanie Mpinda, a clinician involved in Qabane’s care.  

For Qabane, the impact of MDR-TB has been devastating. Now living with his sister, he relies heavily on the support of his wife, niece, and PIH Lesotho.  

“MDR-TB has taken away my right as a man to provide for my family and robbed them of a normal life,” says Qabane. “The physical pain is constant, but the mental toll is even harder. I feel like a prisoner in my own body. I used to be so full of life, and now I can't even stand up. It's incredibly depressing. Some days, it feels like there's no hope.” 

Mpinda emphasizes that Qabane is on medication, and that with time, there is hope for his recovery.

Qacha Qabane during an appointment at Nkau Health Center in Mohale's Hoek District, Lesotho, where he receives ongoing treatment for tuberculosis and depression. Photo by Joshua Berson for PIH

Ongoing training, improvements

From April 2023 through March 2024, PIH Lesotho screened more than 1,000 patients with MDR-TB for depression and anxiety across its seven Rural Health Initiative sites. Screenings continue to increase, and the overall mental health program continues to improve and expand—across all 11 PIH sites around the world. 

Recently, PIH Lesotho’s MDR-TB clinicians received extensive training in psychological first aid, equipping them with essential skills in mental health care and safety assessment, including suicide risk assessment. This training ensures that clinicians are well-prepared to manage the psychological impacts of MDR-TB on patients. 

Additionally, the mental health team continues to improve their mental health resources by tailoring them to patients. For example, a mental health brochure was recently developed in Sesotho, one of Lesotho’s official languages. The document is used to educate and inform patients and their treatment supporters about mental well-being, mental illnesses, and the care options available to them. Treatment supporters are individuals, oftentimes a patient’s neighbor or friend, who visit the patient at least twice daily to help them take their medication, answer questions, and more.  

Every month, treatment supporters conduct monthly mental health check-ins with their patients using a standardized checklist. These regular check-ins are vital in monitoring the mental health of  patients with MDR-TB and ensuring timely intervention when needed. This comprehensive strategy not only enhances the quality of care for patients with MDR-TB but also improves their overall health and quality of life, reflecting PIH’s dedication to holistic patient care.

The Power of Social Support in Improving Mental Health

Content warning: This story mentions suicide.

The joyful noise of Gedetarbo Women’s Group takes over the usual quietude of a small village in rural Liberia. Women well-dressed in colorful lappas and head ties sing a song in Grebo dialect, dance, and parade to the Clan Chief’s home. The thirteen-member Partners In Health (PIH)-supported group typically gathers once a week to receive advice and encouragement. This time, they’ve come together to celebrate and reflect on their recent achievements.

During the program, 48-year-old Cecelia Green, one of five members of the group who benefitted from PIH Liberia’s economic empowerment program, is called to share her testimony. Green is a widow and mother to two surviving children, a girl and a boy. She lost her third and fourth sons to a brief illness and an accident, respectively. Her husband worked as a rubber tapper and was the primary breadwinner, until he passed in 2010. After his death, she quickly began to face many challenges.

In 2012, she was asked to leave her home, a staff residence owned by her husband’s employer. She moved to a leaking, unfinished house in Gedetarbo.

“It was almost like we were living outside. I was so frustrated that I used to sit and just talk by myself,” says Green. “Sometimes, I would just hear strange voices, but I couldn't see anyone.”

Years later, she met staff from PIH Liberia, and now her life looks much different. “I am grateful to Partners In Health for restoring my life,” she says.

Wearing a gentle smile, Alexander Williams, Gedetarbo clan chief, attentively watches and listens to her testimony. Jubilant applause from him and the other women greets an enlivened Green as she finishes and cheers for herself.

“I visited Cecelia and realized that the house was not safe for people to live in,” says Williams. “I asked her to move into a house whose owner had died and there were no occupants in it.”

Green and her children moved into the house shortly after Williams' visit. While grateful for the kind gesture, it didn't stop her from worrying about how the children of the deceased landlord would one day come to claim their father’s house and ask them to move, again.

“I always thought that once the children of the man who owned the house grew up, they would come for their property and put us out. This was not the kind of life that I wanted to live,” reflects Green. “So, I decided that I was going to kill myself. I bought poison and carried it to the house, but I didn't consume it right away.” 

Finding Support, Accompaniment

In 2021, members of PIH Liberia’s mental health team visited Gedetarbo for a community outreach event led by Garmai Cyrus-Biddle, mental health coordinator. At the time, Gedetarbo Women’s Group existed, but it was poorly structured and lacked direction. Several months later, the group was restructured with clear objectives to support mental health and well-being.

“Our first [mental health] screening in Gedetarbo revealed that ten women were severely depressed and some of them had attempted suicide multiple times,” says Cyrus-Biddle.

Those identified were referred to PIH-supported Pleebo Health Center and were placed on a six-month treatment regimen, involving therapy and medication.  

“When I took the medicine, I slept very well for the first time in a long time,” Green recalls. “I also noticed that the [overthinking] reduced.”

Economic Empowerment

After completing treatment, Green and four other women received additional social support, including $100 each. At first, Green wasn’t sure what to do with the money.

“Then God gave me the idea to start a business ... by buying six, 25kg bags of rice to sell,” she says.

Green began crediting the rice to staff at the rubber company, where her late husband had worked, through an arrangement locally known as “sell-pay.” It’s a mutual agreement where the seller gives the goods to the customer on credit for a given period with interest. At the end of the period, Green received $25 per 25kg bag of rice.

After about six months, her inventory grew to include various alcoholic and non-alcoholic beverages, ultimately growing her profit to over $500. Ten months later, her savings grew to $900. She purchased a motorcycle, the most easily accessible mode of transportation through rural Liberia’s dirt roads, to begin a transportation business.  

Her businesses continued to grow alongside her savings.  

“After some time when I told people that I was going to build a house, they could not believe me,” Green excitingly recollects. “I used $150 to buy wood and $1,000 to buy the zinc."

Cecelia Green's recently constructed home in Maryland County, Liberia. Photo by Ansumana O. Sesay / PIH

Green built a five-bedroom house in Gedetarbo. Each of her children have their own room in the house and there’s even an extra room for guests. There is no bathroom, doors and windows yet. She hopes to rebuild her savings that she exhausted to buy construction materials for the house itself. Then she will buy materials needed for the finishing touches.

When the testimonies end, Green leads members of the Gedetarbo Women’s Group and others to tour her newly constructed home. As the tour concludes, Green smiles and says: “PIH saved my life. If I die today, I know I will go to heaven and I will be at peace."  

Child and Adolescent Mental Health Unit: Bridging Gaps and Fostering Hope

In the early morning, Aminata Kabia embarks on her weekly journey to reach patients in remote areas ensuring that mental health care for children is not a privilege, but a right for all.

Kabia, a dedicated nurse in the Child and Adolescent Mental Health (CAMH) unit at the Sierra Leone Psychiatric Teaching Hospital (SLPTH), visits 10 patients in their homes in one day, providing care while tackling transportation challenges. High costs and inaccessible roads often prevent patients from receiving adequate care.  

She vividly remembers her first home visit which was a big lesson for her: “I was climbing up a very steep hill to see a patient. As the neighbors were helping me to find my way to the patient's home, I skated across the dirt road and fell down. I felt so miserable because the hills and roads are so bad, and sometimes people live very far away and can’t afford to travel to the hospital for care.”  

That first visit, climbing the hill, humbled her and gave her insight into challenges that patients experience each time they leave their home to get treatment. Kabia is one of the dedicated nurses assigned to the CAMH unit, that conducts essential home visits to ensure patients facing barriers to accessing care receive the support they need.  

Partners In Health (PIH) Sierra Leone's home visit program began in 2022, a year after the CAMH unit officially opened. The unit has been shaped by the leadership of Dr. Elizabeth Allieu, psychiatry resident and pediatric specialist at the SLPTH. She recognized the glaring gap in mental health care for children and adolescents within the country and spearheaded the creation of Sierra Leone’s first child and adolescent mental health unit. Supported by PIH Sierra Leone and other partners, the unit aims to create a space for young people to manage their mental health with confidence.

Growth in patients and services

Over the past three years, the number of patients seen in the CAMH unit has grown significantly, from 76 in the first year to over 400 in the last two years. The dedicated team continues to raise awareness around child and adolescent mental health to reach even more patients.  

“Not many people realize that children and adolescents also live with mental health conditions,” says Allieu. “People hear about the unit and ask: do children even have mental illnesses?”  

The CAMH unit supports children as young as four months up to 18 years old. Many children and adolescents treated in the unit are diagnosed with epilepsy, developmental disorders or learning disabilities, autism, attention-deficit hyperactivity disorder (ADHD), and cerebral palsy. Treatment plans vary by patient and usually involve a mix of psychoeducation, psychotherapy, and medication. All services are free, due to support from PIH in partnership with the Sierra Leone's Ministry of Health.

Sia Davies, a mental health nurse who works in the unit, shares her excitement about how the unit has evolved.  

“I am happy that the unit is growing. It is really encouraging,” Davies says. “People travel from various districts across Sierra Leone and even come from Guinea. In another three years, I am anticipating that the number of patients will have doubled or even tripled.”

Sia Davies (left), mental health nurse, and Kumba Marrah (right), clinical nurse, in  the Child and Adolescent Mental Health (CAMH) unit at the Sierra Leone Psychiatric Teaching Hospital (SLPTH). Photo by Sabrina Charles / PIH

Every week, there is one day dedicated to new patient visits at the hospital. During the rest of the week, staff conduct school outreach and follow up with existing patients through home visits, presenting skills training sessions for children, and support sessions for parents.  

The school outreach program was the unit's first-ever initiative. Every Monday, social workers travel to schools to educate principals and teachers about common signs of mental health conditions that may affect children’s development and require additional support. Over 80 schools have been supported so far.

“The school visits are one of the biggest platforms to disseminate messaging around mental health and get the community aware and engaged,” says Mohamed Idrissa, a social worker who leads the school outreach program.  

The program also acts as a referral pathway to link students to specialized care. When children are identified with potential development delays, the school links them to the CAMH unit, where they receive support from trained mental health professionals. 

Support for children and their parents

On Fridays, the CAMH unit offers group sessions for parents and skills training for children facing educational barriers. Through tailored activities and exercises such as writing, yoga, and shape recognition games, the children are empowered to develop essential skills, continue learning, and unlock their potential.

While the children have an opportunity to play, the parents come together for group therapy. This is a space that the unit created to allow parents who share similar experiences, in which mental health illnesses are stigmatized, to support one another. The parents share their personal perspective about supporting their children, what mechanisms work best, and how they can improve.

When Hassan was diagnosed with autism, his mother Juliet withdrew him from school due to his developmental challenges. Before receiving treatment, the 6-year-old boy had challenges communicating and connecting with his classmates and began to display aggressive behaviors. Since seeking support from the CAMH unit, Juliet has noticed significant improvements in Hassan's behavior and emotions. Because of the holistic treatment received in the CAMH unit, Hassan can now express his needs and engage with others. 

Juliet is grateful for the assistance and resources provided by the CAMH unit. She says, “When I come to the hospital, I feel good. The medication is free, and Hassan really likes it there. It is hard for me to manage his diagnosis, but coming to the hospital has taught me a lot.”

Regular visits to the CAMH unit allows Juliet to see improvements in other children, and this motivates her to continue showing up, as she believes that Hassan will one day make the same progress with the right support. 

Empowering Women, Girls to Choose Their Reproductive Futures

Around the world, girls face a choice. It often begins as young as 11 years old.

It’s a choice about their reproductive future, including whether they will one day be a mother.

The stakes are high for girls everywhere, but especially in impoverished communities, where access to reproductive health care is non-existent or limited.

There is much to consider if and when they become mothers, too. Would they have access to quality maternal health care? Safe housing, healthy food, and other essentials? A support system?  

All women and girls should have the freedom, education, and resources to make their own decisions about their lives and bodies. But all too often, they don’t. Those who become mothers often lack support on a systemic level.

For more than 30 years, Partners In Health has sought to educate and empower women, girls, and mothers in the countries where we work. It has been our mission to equip women and girls to make their own choices about their reproductive health and, if that choice includes motherhood, to accompany them, whatever it takes.

Patients sit in a waiting room in Rwanda

Patients sit in a waiting area for appointments ranging from screening for non-communicable diseases to immunizations for babies. Photo by Pacifique Mugemana / PIH

The Choice

As she enters her teen years and young adulthood, a girl has many decisions to make—whether to become sexually active, to stay in school, to get married, to advance her career, to become a mother.

At these crossroads of life, she may also face many influences: peer pressure, societal and family expectations, cultural and religious norms, financial challenges, and sexual and gender-based violence.

Additionally, she may lack access to—or be discouraged from seeking—reproductive health care, such as sex ed, contraception, and family planning services.

These factors can push girls toward motherhood—whether it’s what they envisioned or not.

“We glorify the role of mothers in a family, as caregivers, as the pinnacle of womanhood,” says Marleigh Austin, associate director of gender and youth programming at PIH Canada. “[But] reproductive justice is allowing people to pursue the reproductive pathways that they’d like to.”  

Most people worldwide become sexually active around 15 years old. In some cases, that activity starts even younger.  

Since these potentially life-altering choices begin early, it is crucial to educate youth, adolescents, and their surrounding communities about family planning, contraception methods, and the risks that an unintended pregnancy could cause to their health, finances, and career and education goals. Communities also need resources and guidance to empower adolescents to pursue multiple paths in life.  

“We want to prevent pregnancy in adolescents,” says Natassia Donoho, senior manager of clinical quality and health systems strengthening at PIH. “They are instantly high-risk pregnancies, because they are young, and their bodies are not fully developed.”

Each year, an estimated 12 million girls ages 15 to 19 give birth in low- and middle-income countries, in addition to at least 777,000 girls under 15 years old. At least 50% of the 21 million pregnancies among girls in this age range are unintended. Adolescent mothers face higher risks of eclampsia, puerperal endometriosis, and systemic infections, and their children face increased risk of low birth weight and prematurity

In Chiapas, Mexico’s southernmost state and also one of its poorest, teen pregnancy rates are high. To respond to this issue, PIH, known locally as Compañeros En Salud, has hosted workshops to educate youth about family planning and reproductive health.

Similarly, in Malawi and Sierra Leone, PIH has implemented the No Woman or Girl Left Behind project. The project aims to strengthen sexual and reproductive health services by delivering medical care, training health workers, and offering education about family planning, as well as by responding to cases of sexual and gender-based violence. PIH provided contraception to 1,105 adolescent girls in Malawi from July 2022 to June 2023.  

Worldwide, PIH supports more than 47,000 women each year in starting a family planning method.

These efforts aim to educate youth and to empower them with the resources to make informed decisions about their bodies, lives, and futures. Importantly, these programs emphasize that motherhood, and parenthood in general, should be a choice.

A mother and her child walk near their home during a malnutrition visit in Haiti

Joléne is the mother of five children, including 3-year-old Raphaël, who was treated for severe malnutrition Cange and Mirebalais, Haiti. Photo by Melissa Jeanty / PIH  

Supporting Mothers

If and when a woman decides to become a mother, she must have access to quality maternal health care at every stage of pregnancy, from prenatal to postpartum care.

“You have to be able to make the decision to pursue motherhood and then when you do it, the system needs to ensure that you can do it safely,” says Austin.

That process starts with preconception care, helping women understand the health conditions and risk factors that may accompany a pregnancy. For women dealing with infertility, clinicians may prescribe prenatal vitamins and recommend ways to increase the likelihood of conception.

Clinicians then accompany women throughout pregnancy, birth, and postpartum care.  

“PIH is ensuring there is a good quality of care given," says Sister Patricia Efe Azikiwe. “Especially respectful maternity care, where the mothers are respected, their dignity is maintained, [as well as] privacy and confidentiality.”

Azikiwe has been delivering babies, caring for mothers, and training clinicians for decades, from countries ranging from Laos to Bangladesh to South Sudan. Currently with PIH in Sierra Leone—as clinical program manager for reproductive, maternal, newborn, child, and adolescent health—she has worked to strengthen maternal and reproductive health care, including facility-based deliveries and emergency obstetric services.

Historically, Sierra Leonean women give birth at home with traditional birth attendants. While this cultural practice is familiar and comfortable for women and families, it puts them at risk if complications arise—so much so that the Sierra Leonean government banned traditional birth attendants from carrying out deliveries outside of a clinic in 2010.

While respecting cultural norms, PIH set out to transform this practice, in partnership with the local government and community leaders. The PIH team worked to gain the trust of traditional birth attendants and hired them at facilities like Wellbody Clinic, embedding them into clinical practice and the birthing process. Now, traditional birth attendants help connect women with facilities for care, bridging this gap and strengthening maternal care in a country with one of the highest maternal mortality rates in the world.

Globally, PIH supports over 60,000 safe, facility-based deliveries each year, including over 13,000 lifesaving C-sections.

Building trust has been key to PIH’s maternal health work worldwide—trust between mothers and clinicians, between traditional birth attendants and facility-based staff, and between communities and health systems.

“Women will deliver with the one person they trust,” says Daniel Maweu, a nurse-midwife leader with PIH in Malawi. “They will go where there is love, respect, and compassion, and where they feel appreciated and supported.”

In many communities where PIH works, that trusted person is a midwife.

“Midwives are the first and sometimes the only health care worker women meet during their entire pregnancy journey,” says Maweu. “They are the preferred choice of birth attendant for many pregnant women.”

Nurses and midwives account for nearly 50% of the global health workforce. Despite their contributions, midwives are often under-paid and under-resourced—putting mothers, newborns, and maternal health care at risk.

Maweu has been training midwives for years, from Malawi, where he is currently based, to Liberia, where he began working in 2018. He saw the effects of maternal mortality first-hand at J.J. Dossen Hospital in Liberia.  From July 2017 to June 2018, Jthe facility saw 600 deliveries ; 15 mothers died.

“That was not acceptable,” Maweu says. “It meant that something needed to be done.”

PIH set out to change the system, earning the trust of the midwives and the community and providing training and mentorship, scholarships for midwifery school, and improvements to staffing, supply chain, and infrastructure at the hospital.

From July 2020 to June 2021, deliveries doubled to 1,200; maternal mortality decreased from 15 to 3.

Women celebrate outside their home in Sierra Leone

Mariama Kamara (left), now a PIH Sierra Leone employee, was at an Ebola treatment center for almost five weeks, without any form of communication with her daughter, Hawa (right). She has since adopted three children who lost their families in the epidemic. Photo by Maya Brownstein / PIH

Supporting Women

Motherhood is one of the life events that women are most celebrated for, due to gender roles and societal expectations.

But the celebration that often accompanies a birth doesn’t always translate to tangible care, support, and respect for mothers in their day-to-day lives.

After birth, as many as 20% of mothers in low- and middle-income countries experience postpartum depression. Mothers and pregnant women risk losing their jobs or experiencing a drop in pay, sometimes called “the motherhood penalty.” Many do not have access to adequate paid parental leave. And mothers disproportionately play the caregiver or homemaker role, taking on the brunt of the domestic labor.

Then there are the women who are often left out of the motherhood narrative: single mothers; women who wanted motherhood, but experienced infertility, miscarriages, or stillbirths; women who were forced to become mothers or have more children than they desired.

To support women and mothers across life stages and circumstances, PIH offers mental health care, including free therapy, screenings, and support groups. Last year, PIH conducted 121,311 mental health patient visits, including for thousands of women and girls.

PIH also provides essential resources, known as social support, such as food, housing, and transportation, recognizing that there is more to health care than medical care. In 2023, PIH distributed 33,317 social support packages to the most vulnerable patients.

For those who become parents, PIH offers education in countries such as Peru—for mothers and fathers.

“The vision at the heart of the gender equality movement is that [caregiving] is not exclusively the purview of women,” says Austin.

In Peru, the CASITA project has enrolled fathers, as well as mothers, to learn caregiving skills. The program emphasizes that caregiving has no gender and that parenting is a task that should be shared. CASITA has enrolled more than 3,648 children since 2013, with 85% showing improvement during its pilot period.

Caregivers and children meet in PIH office space in Peru.

Mothers and their children meet for an educational session hosted by Socios En Salud, as Partners In Health is known in Peru. Photo by Diego Diaz / PIH

Themes emerge that run throughout PIH’s maternal and reproductive health work: It is not mothers’ unique responsibility to care for their families and communities; mothers are also owed care and support. Motherhood is also not the only, or the default, choice for women and girls; they should be free to pursue the lives and futures they want.

For Maweu, who has witnessed both the presence, and absence, of maternal and reproductive health services, the need for quality care, everywhere, could not be more urgent.

“Respectful maternity care is non-negotiable,” says Maweu. “As PIH, we work based on the country laws where we are; we do our best to support the reproductive rights of every woman.” 

Confronting Injustice by Providing Care in Chiapas

Cecilia Gálvez has been a nurse with Compañeros En Salud, as Partners In Health is known locally in Mexico, for nine years. Although she’s overcome many challenges in her career leading to her becoming a nurse supervisor in 2020, this year has brought unique distress as Chiapas has become a stronghold for organized crime.  

After growing up in Salvador Urbina, a small community in the Frailesca region of Chiapas, Gálvez witnessed firsthand how challenging it was for her family and friends to access health care, given the remoteness of her community and cost of transportation—among other challenges. Unable to allow this injustice to continue, she decided she wanted to be a nurse and support her community.  

In 2014, the Mexican Ministry of Health built a clinic in Gálvez’s community, and Compañeros En Salud began working in the community as well. Compañeros En Salud has worked in the state of Chiapas since 2011 in partnership with the Ministry of Health.  

Gálvez began her work with Compañeros En Salud as an acompañante, or community health worker, and as a clinic assistant, where she learned to triage patients, make home visits to chronically ill people, classify medications in the pharmacy, and do sutures. While she was working, she began attending nursing school four hours away on the weekends. Despite the challenges, she never lost sight of her original inspiration—which continues to keep her going to this day.  

“My family and my community are the driving force to keep going, because [access to health care] is what I want for them,” Gálvez shares.

Photo of Cecilia Gálvez

After graduating, she continued with Compañeros En Salud, working as a community nurse in the region where she was once a patient. Since 2020, she has been a clinical supervisor, mentoring nursing and medical interns doing their required year of social service at rural clinics.

Unfortunately, this year has pulled her home community into a state of conflict—impacting her family, friends, and patients. An increase in organized crime activity and instability in Chiapas have added extreme obstacles to the work of Compañeros En Salud. This year is also an election year in Mexico, which has added to the complexity of the situation.  Chiapas, the poorest state in the country, has been one of the worst-hit by these challenges.  

As rival groups continue to fight for control of the region, Gálvez and Compañeros En Salud refuse to abandon their community and patients. The work continues despite widespread worry.

“It has been difficult to work under this situation of insecurity because it is discouraging,” Gálvez says. “You can no longer work safely, knowing that at any moment your life could be taken away from you.

“There’s great uncertainty across society. You leave [home], but you don’t know if you’ll return," she continues. "Before, I used to focus only on the problems with the health clinic team and the community. Now, I have to devote energy to monitoring my surroundings for a possible attack.”  

Despite this new fear, she remains committed to making life better for her patients as their nurse and neighbor.  

“[I would like to] improve the community’s access to health care services, also change the way they think about health risks, and [encourage them] to leave their comfort zone to improve habits and, in the end, their health,” she says.  

Gálvez has been working on how to take care of herself during this time as well. Leaning on her community, and enforcing healthy habits, has helped her manage the stress caused by ongoing violence and instability.

“Going for walks and eating healthy has helped me feel better,” Gálvez shares. “Also, having a support network of family and friends means I can feel more collective support and also take quality time for myself.”

As a nurse, Gálvez knows the value of protecting your health and that of your community. Bravely, she continues to show up every day for her patients and colleagues at Compañeros En Salud. 

Providing Mental Health Care for Pregnant Women and Mothers in Peru

Delia Bruno, 32, was in the last trimester for her first daughter when she went to the Juan Pablo II Health Center, located in the district of Carabayllo, north of Lima, late last year. She had previously been to the health center for her prenatal check-up. But now, something felt wrong.  

“I was feeling very bad, completely depressed,” she recalls. “When I went in for my check-ups, I was crying [and filled] with sadness. I didn't see life the way I do now.”  

Bruno’s symptoms were similar to those of almost 30% of pregnant women in northern Lima, according to a study by the Mental Health Program of Socios En Salud, as Partners In Health is known in Peru. After a separation from her daughter's father, marked by signs of infidelity, she struggled to accept the truth. The threat of a miscarriage, due to stress, loomed and did not allow her to see her pregnancy as “a special stage.”    

It was then that her gynecologist introduced her to Psychologist María Fernanda Amézquita, head of the Healthy Thinking Strategy—Pensamiento Saludable (PENSA) as is known in Spanish—at Socios En Salud. Amézquita was fortunately visiting the Carabayllo health center that day.  

“That's when I started everything. That's when the call began,” says Bruno.  

In January 2024, Socios En Salud contacted her. Although she admits that she was on the verge of not answering the call—distrusting unknown numbers—she picked up the phone anyway. Today, she is one of 80 women accessing care through PENSA this year, including free therapy and psychological support. Now, after four months of participating, with her 2-month-old baby in her arms, Bruno recognizes that she has seen improvements.  

Delia Bruno holding her daughter. Photo by Diego Diaz / PIH.

“Right now, I don't feel one hundred percent well, but I feel good,” she says. “There are days when I relapse and there are days when I feel much better. Little by little, progress is being made.”  

Finding Pregnant Women, Uncovering Unmet Need

Socios En Salud has worked in Peru for more than 25 years, starting in response to a deadly outbreak of multidrug-resistant tuberculosis in Carabayllo, a community on the outskirts of Lima. In the years since, it has expanded its programs to provide medical care and social support across a range of clinical areas, including mental health.

Socios En Salud implemented PENSA in 2018, a strategy recommended by the World Health Organization for pregnant women with depression. PENSA started in the Carabayllo community and used materials developed by Atif Rahman, a child psychiatrist and clinical researcher at the University of Liverpool.

“We started the work with eight pregnant women, and everything was face-to-face,” says Amézquita. “At the moment, we have intervened on more than 500 pregnant women.”  

The PENSA intervention consists of 16 sessions, divided into modules, that focus on three essential areas: the mother's health, the mother's relationship with the baby, and the mother's relationship with the people around her.  

“We try to reinforce these areas so that they can have emotional support from their families and develop a correct emotional bond with their sons or daughters, as well as with themselves,” says Amézquita.  

In addition, she states that PENSA actively searches for “women who are having their pre- and post-natal check-ups in health centers and show symptoms of depression,” after obtaining permission from the Ministry of Health.  

“We visit health facilities, and we contact pregnant women in person or by phone and invite them to participate in an evaluation for depression with tests recommended by the Ministry of Health,” she says.  

This was how Socios En Salud developed PENSA’s pilot. Even before the COVID-19 pandemic, it conducted its sessions with pregnant women and mothers through video calls, or by phone in case of internet coverage issues. When in-person activities resumed, home visits persisted. The program also considered each social determinant—identifying resources that families may need, like vouchers for transportation, food, and social support—which has been key to its overall success.  

Susana Gamboa, one of the 22 community health workers trained in Healthy Thinking, conducting a home visit. Photo by Diego Diaz / PIH.
Care, from the Community

Leidith Tinoco, 38, still remembers with gratitude the dedication shown to her by Susana Gamboa, the community health worker that Socios En Salud assigned to her as part of her therapy through PENSA.  

“The doctor [what Tinoco calls Gamboa] has been looking out for me. I feel very grateful,” she says.  

Community health workers are local residents hired from the communities where Partners In Health works and are trained to provide basic health care, such as delivering medications, checking on patients at home, or accompanying them to their appointments. In Peru, Socios En Salud has 63 community health workers on staff, referred to locally as agentes comunitarios. The PENSA strategy has 22 community health workers, trained specifically on maternal mental health.

Tinoco was pregnant with her fourth child when she joined PENSA in April 2022. She had previously gone to the Centro Materno Infantil El Progreso in Carabayllo, seeking psychological help because she was going through family problems and financial challenges, which caused her to experience negative thoughts about herself.

“There were times when I wanted to disappear, because sometimes I had problems with my husband, (while I was) pregnant. (...) I was very distrustful,” she recalls.  

Amézquita and the PENSA team had heard stories like this before.  A lack of resources, break-ups with partners, a lack of recognition at home, domestic violence, and unintended pregnancies are often the factors that contribute to depression in pregnant women. It is a difficult path in which they need consistent accompaniment to continue their treatment.  

“When moms feel that you are by their side, that helps them more than anything. ‘You are not alone' is the key phrase,” says Gamboa, who was trained as a community health worker on the PENSA team during the pandemic.

Tinoco attested that, throughout her therapy, Gamboa was always there to listen to her.  

Leidith Tinoco credits PENSA as helping her recover. Photo by Diego Diaz / PIH.

“Sometimes I argued with my partner and called the doctor [Gamboa]," she says. "I told her that I wanted to leave everything, but [Gamboa] advised me, and I trusted her. We spoke with the PENSA manual in hand. All of that helped me."

On more than one occasion, Gamboa has helped to convince mothers and pregnant women to continue therapy. Empathy and the PENSA manual, she shared, are her best tools for dealing with the different cases she encounters as a community health worker. Also key is the continuous supervision of PENSA’s psychologists, who receive reports from the community health workers on the progress of the women in the program.  

According to Amézquita, the women often end up seeing the community health workers “as their friends, their doctor, their psychologist.”  

“We try to build a lot of trust among them, so as not to lose them,” she stresses.  

The family is also involved in the recovery process of these women. For Tinoco, having her husband take on domestic tasks was crucial to continuing at PENSA, while for Bruno, her father's moral support was significant. It is the sum of these efforts that helps mothers and expectant mothers find a lighthouse in the storm. 

Maternal Center of Excellence: The Future of Dignified Care in Sierra Leone

Isata Dumbuya witnessed one maternal death during her decades-long nursing and midwifery career in the United Kingdom. Then, she went to work in Sierra Leone and that quickly changed. 
 
During her first week working in Kono District, where she was born, Dumbuya, Partners In Health (PIH) Sierra Leone’s director of reproductive, maternal, neonatal, and child health, watched two young women under 18 die from preventable maternal health complications. Her devastation soon turned to anger, as she wondered: “How is this allowed to happen here? Why is this happening?” 
 
The short answer: injustice. 
 
After the country’s 11-year civil war, already vulnerable people suffered even more, notably those in rural Kono District, the epicenter of the violence. Jobs were scarce, educational opportunities were limited, and the health care system was broken.  
 
Daily life was challenging for many, but especially pregnant women in need of high-quality health care. Infrastructure was inadequate, medicines and supplies were hard to find or expensive, and there were few skilled medical professionals. In most cases, women gave birth at home with the assistance of traditional midwives, running a higher risk of complications or death.  
 
Due to those reasons, among many others, Sierra Leone ranks as one of the countries with the highest maternal mortality rates for many years with profound improvements made in recent years. In 2020, the lifetime risk of women dying in pregnancy or childbirth was 1 in 52. For context, the same rate is 1 in 3,800 in the United States and 1 in 5,200 in the United Kingdom.

A Bold Solution

There have been vast improvements in maternal health care in Kono District since PIH Sierra Leone began working in the country in 2014. At Koidu Government Hospital (KGH), Dumbuya and other leaders ushered in changes such as adding a blood bank and pharmacy next to the maternal ward, training nursing and midwifery staff on how to identify warning signs for at-risk pregnancies, and improving access to family planning for all women seeking care. Because of these and other efforts, there was a 36% increase in women choosing to give birth there from 2020 to 2022. In the recently established special care baby unit, premature or high-risk newborns now have a 96% survival rate.  
 
While we’re moving in the right direction, more needs to be done to address demand and decrease maternal mortality, Dumbuya emphasizes. That’s where the Maternal Center of Excellence (MCOE) comes in. Designed to provide advanced maternal and child health services, the MCOE is a first-of-its-kind facility in Sierra Leone. It will contain 166 beds, dramatically expanding KGH’s current 48-bed maternal ward and special care baby unit.  
 
“It's going to be a space where women are going to feel appreciated and treasured,” says Dumbuya. “No one has ever invested in maternal health ever before in this country to this extent.” 
 
A collaborative effort among the Government of Sierra Leone, PIH, and longtime partner Build Health International (BHI), the MCOE will launch and scale maternal, child, and reproductive health services; provide new clinical education opportunities for doctors, midwives, and nurses; and serve as a blueprint for future investments in women and children’s health—both inside the country, and around the world. 
 
In 2017, key partners began conversations about the facility, and in 2021, PIH broke ground on the MCOE.

The MCOE employs than 250 construction site staff, including painters, electricians, welders, carpenters, general laborers, and others. Photo by Abubakarr Tappiah Sesay / PIH

‘Women Building for Women’ 

The MCOE construction crew, led by BHI Site Supervisor John Chew, is a success story in itself. A majority of the crew is women, a rare occurrence for a male-dominated field. For many, it’s become more than just a job, but rather a place to grow—both personally and professionally. 
 
Before working at the MCOE, Yei Mansara, a 29-year-old mother of five, sold plantains and made little to no money. One day, she ran into a friend returning home from the construction site and asked what was going on there. Mansara decided to check out the site herself, but when she arrived, it was closed for the December holidays. Upon reopening, she went to look for work, along with an estimated 200-400 people who waited outside the gates every day.  
 
She left her home at 4 a.m. to walk miles in the pre-dawn hours to wait at the site gates. Weeks went by before she caught the attention of Komba Alpha, MCOE labor foreman and site controller. After sharing details about her personal story, including about her physically and emotionally abusive husband, she was let in because of her resilience and strong work ethic. Finally, a promising new opportunity. 
 
Mansara was hired as a laborer, promoted to a cleaner, and now works in the depot department, which is where all the tools and equipment are organized and stored. With no formal education, Mansara never learned how to read or write—until her job in the depot. Now, she knows the alphabet and numbers. Those skills are key, as it's her job to categorize and organize tools. 

Yei Mansara at the Maternal Center of Excellence construction site in August 2023. Photo by Caitlin Kleiboer / PIH 

"I don't know everything, but I know many things now," says Mansara. Her husband left her, but that’s no problem, she says, because she can now take care of herself, children, and mother because of her steady, well-paying job.  
 
“If you feed a woman, you feed a family, you feed a community, you feed a village,” says Chew. “When they come here, this is their house ... They know how to manage things and they are very meticulous about their work ... and want to learn, they want to grow, and ... they are committed.”

John Chew gives a tour of the Maternal Center of Excellence construction site on August 16, 2023. Photo by Abubakarr Tappiah Sesay / PIH

Because of Chew, this is not your typical construction site, explains Dumbuya. Leading by example, Chew has created a family who is devoted to the work. 
 
“And why do you think so many women work here?” questions Dumbuya. “Because, like I say, … this is women building for women.” 

‘A Dream Come True’ 

Upon completion, the facility will boast multiple buildings. Spaces will include a triage section, critical care unit, maternal ward, Kono’s first-ever neonatal intensive care unit, labor and delivery suites, a surgical suite, an adolescent and youth friendly space, and more.  
 
Beyond clinical spaces, there will be landscaped courtyards where patients and their families can socialize and relax, giving a sense of comfort, dignity, and peace.  

Construction is occurring in phases, with the South Ward and Birth Center completed first. Other buildings and neighboring staff housing will rise over time, under the careful hands of Chew’s construction crew.  
 
The expansive facility, adjacent to KGH, is projected to provide a 120% increase in facility-based deliveries, 140% increase in district-wide C-sections, and tripling of the number of family planning visits. All of this means fewer women will die due to complications of pregnancy or childbirth, and more will be able to choose when or if they want to become mothers or expand their families. Seen this way, quality health care is a path to women's empowerment and financial stability. It's a way to break intergenerational cycles of poverty and gender inequality.  

“This is a dream come true,” says Dumbuya as she sits at the construction site in April, while imagining hearing babies crying and women rejoicing. “And just to hear that general clatter of nurses and midwives moving around and delivering care in here. Words cannot even express what that means to me.”  

Q&A: How Nurses Are Uniquely Equipped to Lead in Global Health

Nurses play an essential role in advancing the mission of Partners In Health (PIH), accompanying patients and providing lifesaving care to those who need it most. At PIH, nurses and midwives comprise over 50 percent of our clinical workforce and are integral to delivering comprehensive, patient-centered care. As we celebrate Nurses Week, we want to highlight our Nurses as Change Agents Program (NCAP) through the story of one of our incredible nurse leaders: Vicky Reed, interim executive director of PIH Sierra Leone.

NCAP is foundational to our ability to drive change in nursing care, leadership, and clinical expertise across PIH-supported countries. By investing in crucial programs like the Global Nursing Executive Fellowship, Nursing Centers of Excellence, and scholarships for nurse professional development, we are strengthening the backbone of the global health care workforce at PIH sites around the world—and beyond. According to the World Health Organization, nearly 29 million nurses make up the vast majority of the global health workforce and deliver the bulk of health care services. 

Executive Director of PIH Sierra Leone, Vicky Reed, smiling at the camera in a yellow blazer
Photo by Asher Habinshuti / PIH.

Reed joined the PIH Sierra Leone team in 2019 as the director of nursing before becoming the interim executive director in December 2023. During her first few years, she provided one-on-one mentorship for nurses, developed protocols to improve nursing care at PIH-supported facilities, and participated in the Global Nurse Executive Fellowship. Now, she leads with empathy, respect, and tenacity—addressing the challenges and celebrating the accomplishments of all the programs within PIH Sierra Leone. 

We recently spoke with Reed about her career and the strengths nurses bring to the table as organizational leaders:

What led you to pursue a career in health care?

Some of my earliest memories growing up in Freetown, Sierra Leone, are of the health clinic operated by my grandmother, a nurse, and her friend, a midwife. Patients who had no money at all came into the clinic. My grandmother offered most of her services for free. She treated patients like they were part of her family. I think I always wanted to do something in line with what she did—something of service. [Nursing] was always in the back of my mind.  

 

What brought you to PIH Sierra Leone?  

I was one year out of nursing school at Clayton State University in the U.S. when my grandmother passed, and I traveled back to Sierra Leone for the funeral. Crowds came up to me, telling me about how much she did for them. It inspired me to rethink my whole approach to nursing; I’m here to serve people, regardless of their circumstances. While visiting Freetown years later, I shadowed local clinicians. I didn’t realize how bad things were as far as resources, patient care, and the lack of respect nurses had. When I went back to the U.S., I couldn’t stop thinking about my experience. Two years later, I joined PIH Sierra Leone.

 

What are some skills you learned as a nurse that you think are relevant as a leader?  

I always go back and forth about whether to emphasize that, first and foremost, I’m a nurse, because I think that boxes us into what people on the outside say. But we have a unique skillset in multitasking, thinking outside the box, and making things happen with very little. Especially in the resource-limited communities where PIH works, nurses like myself always find creative ways to improvise to get patients the care they need.  

 

How do you see NCAP’s role in supporting up-and-coming nurse leaders? 

NCAP in Sierra Leone allowed us to start a powerful mentorship program, recruiting four nurse mentors assigned to the pediatric unit, male and female medical wards, and male and female surgical wards. They have been able to support nurses, in-charges [nurses who oversee the operations of their specific nursing unit], junior nurses, and nursing students. These mentors were starting off with limited skills in terms of management and leadership themselves, so we supported them with rigorous training, allowing them to build their skills and gain self-confidence. So many nurses get thrown into leadership and managerial roles with very limited training, and NCAP has helped to fill those gaps with a ripple effect on the nurses the mentors train.  

 

Could you share an example of how NCAP is improving patient care?  

Before, when patients would come in overnight when no pharmacist was on duty, patients would have to wait until the next day to receive medication—an unacceptable situation for those with urgent or painful conditions. Mentors and nurses in charge developed a new system for Emergency Medication Carts to stock key medications in the wards while accurately tracking medication use for the pharmacists. Patients no longer need to wait many hours to receive medication. With the right support, nurses are uniquely positioned to develop this kind of system to improve patient care.

 

How are you adapting to your new role as interim executive director?  

Nurses in Sierra Leone often feel they can’t advocate for themselves. In my previous role as director of nursing, I was constantly thinking of ways to make nurses feel valued and capable. I want the same for our entire staff. The past few years have not been easy ones for PIH Sierra Leone. But looking toward the future, the excitement among my colleagues is palpable. The work can be difficult, but when you look at what we’re accomplishing, it’s all worth it.  

 

What are some goals you have for yourself and PIH Sierra Leone?  

My goal is really just to do the best job possible. I hope we can become a role model among PIH’s care delivery sites when it comes to being good stewards of the organization’s resources, development and retention of staff, safeguarding staff and patients, and of course providing good, quality care. I want to be benchmarked against facilities with very high standards, like the U.S. and the U.K.  

 

What inspires you to continue your work with PIH Sierra Leone?  

I always wonder if I was not from Sierra Leone, if I would have continued doing this work, but I think it’s worth it. I believe in what PIH stands for. Sierra Leone needed an organization like this that is going to stand for the people when everybody is vulnerable. As much as it’s difficult, this is home and there’s no other place that I’d rather be.

Ophelia Dahl Named to TIME100 List

Partners In Health Co-founder Ophelia Dahl has been named to TIME’s annual list of 100 most influential people in the world, highlighting her leadership, advocacy, and impact in global health and beyond. 

Each year, the TIME100 list recognizes the impact, innovation, and achievement of the world’s most influential people. This year’s list will appear in the April 29 issue of TIME and today through its online edition

Examples of Dahl’s impact are numerous, and she has held many leadership roles throughout her life and career. Her commitment to social justice has been a throughline. 

“It’s an honor to be recognized alongside so many singular artists and leaders,” said Dahl. “I am proud and grateful to share our work at Partners In Health to deliver high quality health care to the poor—and, above all, to share it with the thousands of colleagues and friends at Partners In Health whose abiding commitment is a powerful antidote to despair.” 

Dahl’s work in global health began at 18 years old, when she went to Mirebalais, Haiti, to volunteer at a school for children with disabilities. There, she met Dr. Paul Farmer, who was working at a rural clinic in Cange. As she began to work with Farmer and Haitian health workers, responding to health disparities that she witnessed first-hand, she knew this was work she wanted to pursue. A lifelong passion for global health was born. 

In 1987, Dahl co-founded Partners In Health (PIH) with Farmer, Dr. Jim Yong Kim, Todd McCormack, and Tom White, deepening a shared vision to correct health inequities and redefine what’s possible in global health. Dahl and co-founders focused on providing health care that prioritized poor people’s needs and giving them access to the highest-quality treatments—not what was cheapest or easiest. 

In the decades since, Dahl has worked to make that vision a reality. She currently chairs PIH’s Board of Directors, after serving as the organization’s executive director for 16 years. Her vision and resolve helped lead PIH through tumultuous times, including the 2010 earthquake in Haiti, the Ebola outbreak in West Africa, and the COVID-19 pandemic.  

No stranger to leadership and its pressures, Dahl is also not afraid to roll up her sleeves and work behind the scenes, doing whatever it takes to push the work forward. She and Farmer ferried supplies, medicine, and equipment on trips from Boston to Haiti. She made home visits alongside health care professionals to listen to the needs of patients and their families. And using her connections and classic charm, she advocated for policy change and more financing for global health. Yet she credits much of her own success to the friends and colleagues who were there to teach, mentor, and support her. 

In addition to her roles at PIH, she is a trustee of Wellesley College, her alma mater, and a member of the Boards of Directors of the University of Global Health Equity, the Equal Justice Initiative, and the Clinton Health Access Initiative. She is also on the Board of Silkroad and the Advisory Board of the Center for Law, Brain & Behavior at Harvard Medical School and the Massachusetts General Hospital. 

Dahl’s inclusion in the TIME100 list is the latest accolade in addition to Harvard University’s Radcliffe Medal, Union Theological Seminary’s Union Medal, and, together with her PIH colleagues, the Hilton Humanitarian Prize.

To read more about Dahl, visit: https://www.pih.org/ophelia-dahl  

To read the full TIME100 list, visit: http://time.com/time100  
 

In Malawi, PIH Wins Award for Strengthening Health System

Neno is one of the most remote districts in Malawi. The district has only one paved road. Just over 3% of households have electricity.

Since 2007, Partners In Health (PIH) Malawi, known locally as Abwenzi Pa Za Umoyo (APZU), has worked in partnership with the Malawian government to provide health care to thousands of people in Neno. In December 2023, all that work was recognized: APZU received an award from two government agencies, the Non-Governmental Organizations Regulatory Authority (NGORA) and the Ministry of Gender. 

The award honored APZU for its contributions to the country’s health sector; it was presented at a gala dinner at the state house in Lilongwe, the country’s capital. The award, given for “significant investment in a hard-to-reach-area,” reaffirms APZU’s mission to create a preferential option for the poor in health care by accompanying the public sector and strengthening the provision of essential health services.  

Improving Infrastructure 

APZU began its work in Malawi in 2007 with the aim of strengthening health services in Neno, a rural district with a population of approximately 165,000 people. At first, APZU focused on providing comprehensive primary and secondary health care, but over the years, the organization expanded its work to support emergency response and sexual and gender-based violence (SGBV).  

Before APZU started its work in Malawi, Neno district had one hospital with four inpatient beds, no functioning laboratory, and an unreliable water and electricity supply. This rendered the hospital unable to treat patients with complicated medical conditions, who had to be referred to Mwanza District Hospital, 50 miles (80 kilometers) away.  

When APZU arrived, one of the key areas it invested in was infrastructure development. In partnership with the Ministry of Health, APZU constructed Neno District Hospital (2007-2009), Lisungwi Community Hospital (2008-2010), and Dambe Health Center (2016), making crucial health services available in the district.  

Dr. Sitalire Kapira talks with Elufe Omaki and her 2-day old baby Grace Spring at Neno District Hospital. Photo by Zack DeClerck / Partners In Health.

Despite constructing modern, well-equipped hospitals, the District Health Office observed that there was high staff turnover due to lack of housing in the area. To resolve this, APZU constructed over 30 staff houses to accommodate health workers. These homes are located near Neno District Hospital, Lisungwi Community Hospital, Dambe Health Center, and Chifunga Health Center. 

Through its Program on Social and Economic Rights (POSER), APZU has also constructed over 100 houses and renovated over 300 others for the most vulnerable people, such as patients with non-communicable disease (NCDs), the elderly, child-headed households, and those living with disabilities.  

APZU’s infrastructure work has extended beyond hospitals and homes. In 2010, APZU opened Malawi’s first-ever rural microbiology laboratory, making Neno District Hospital the first district hospital in the country to perform routine blood cultures and facilitating testing, treatment, and care. APZU also constructed “Dr. Keith Road,” from Lisungwi Community hospital to Neno District Hospital, to shorten travel time between the two facilities, which are about 42 miles (68 km) apart. 

A strong health system requires more than buildings and roads—resources like electricity are also essential. In response to frequent blackouts, which affect the operations of most hospitals in Malawi, APZU supported two of its hospitals and Dambe Health Center with backup high-capacity generators to ensure a 24/7 supply of electricity. It also supplied solar-powered refrigerators to all 14 health centers in Neno to help them store drugs in need of refrigeration. 

Providing Community-Level Care

PIH’s efforts to strengthen the health system in Neno go beyond infrastructure. In 2007, PIH Malawi started the community health worker (CHW) program. CHWs assist the government with screening and referring patients to nearby health facilities. CHWs also play a pivotal role in helping patients follow their treatment plans. 

CHWs, who are volunteers from the community, visit 20-40 households each month to monitor the health of every individual. This approach has improved the early detection and treatment of patients with various health conditions. For instance, in 2022, household visits by CHWs increased from 90% to 94%, and 14,850 referrals were made to health facilities. CHWs also accompanied over 1,500 pregnant women to their first antenatal clinic visit. 

On a typical day, and even during emergencies, the CHWs help APZU identify community members that need social support. Through POSER, CHWs work with the District Social Welfare Office to assess households before providing social support, such as cash transfers, food, and milk for infants.

Community health workers conduct a home visit with a POSER beneficiary in Southern Malawi in February 2024. Photo by Joseph Mizere / Partners In Health.

APZU also provides free health screenings and education at the community level. Through APZU’s mobilization and outreach services, 51% of people screened at the community level have been referred to health facilities for further care. APZU has also conducted social dialogue sessions on sexual and gender-based violence (SGBV) in the communities, focusing on root causes, community empowerment, prevention, and reporting. APZU has supported the management of 487 SGBV cases as of November 2023. 

Additionally, to empower youth in Neno, APZU established adolescent clubs called SKILLZ BLA (Bwalo La Achinyamata), which have provided education and resources to 816 adolescents (10-14 years old) across the district, making sexual and reproductive health services accessible. Currently, APZU is establishing Mental Health Clubs in schools to equip youth with the necessary skills and knowledge to deal with common mental health conditions. 

The award highlights APZU’s past and ongoing work, which has been critical in strengthening Malawi’s health system and expanding access to care. It’s an honor that APZU Executive Director Basimenye Nhlema takes pride in.

“This award is not just for us as PIH Malawi team, but also [for] all our stakeholders who, because of the combined efforts, have made this possible,” she said. “It will always be a reminder for us to work even harder as we serve our beneficiaries. We will treasure this award as we strive to provide preferential option for the poor in health care in Neno and across the country.”  

An Update on Our Work in Haiti

April 1, 2024

Statement from Dr. Sheila Davis, CEO of Partners In Health, and Dr. Wesler Lambert, Executive Director of Zanmi Lasante, as PIH is known in Haiti.

For four decades we have been working in partnership with the Ministry of Public Health and Population in Haiti to ensure the most vulnerable people in the country have steady access to high-quality health care services—from prenatal check-ups to surgeries —free of charge. Until recently, we have proudly served some 3.3 million people through community to tertiary care each year. That was nowhere near enough, but at least the number was growing. Today, we face a new reality. The number of Haitians able to access health care has dramatically declined - not because the need has changed, but because the environment has changed. As a result our mission to advance health equity is becoming harder by the day. We urgently need the ability to safely transport staff, medications and supplies within and to Haiti.

In the past, we have lived through every imaginable challenge—from prolonged outbreaks of cholera to targeted violence at Zanmi Lasante supported facilities—and we’ve always found ways to keep the doors open, the health care high-quality. But in the past month, the University Hospital in Mirebalais, a national referral hospital, alongside the 16 other hospitals, health centers, and clinics we operate have been cut off. We cannot safely move medicines and supplies from our warehouses to the provinces where we work. Nor can we reach the dozens of containers we have at port. It is not from lack of trying – our teams have explored every possible avenue and gone to heroic lengths to move small quantities of supplies. Yet it is not enough. As a result of these challenges, we have begun rationing care, reducing the number of hours facilities are open and what services we provide. If nothing changes, within weeks our fuel reserves and some essential medications and supplies at University Hospital in Mirebalais will run out, and with it will go our ability to care for the child with dehydration, the adult with septic shock, the mother with a difficult labor, and more. If this happens, innocent patients will die. The risk is unprecedented.

Our motto has been and will always be that we “do whatever it takes.” We are pursuing every possible shipping option—via land, air, and sea, from the Dominican Republic, other parts of Haiti, and Miami. Doctors and nurses continue to work heroic hours, many sleeping at hospitals and not seeing their families for a month at a time. But the violence—and those who allow the violence to continue—has cut off our necessary lifelines. At a time when our patients need us more than ever: many other hospitals have closed, pharmacies have been attacked, and millions face acute hunger. We are trapped, unable to provide people with the care that is their right. We are a Haitian organization, made up of Haitians, working in Haiti, for Haiti. And we are here to stay. But our patients, and we, need help in a way we never have before. 

Dr. Paul Farmer sharing a friendly moment with one of his staff.

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