Despite hosting Top Chef for 15 years, co-founding a nonprofit, and publishing a handful of cookbooks, among other accomplishments, Padma Lakshmi has experienced impostor syndrome, along with many other high-achieving people.

But she never let her initial beliefs that she wasn’t qualified enough get in the way of her career. Her hope is that women and girls will do the same, feel less self-doubt than she did, and not be dissuaded from careers they want to pursue.

“Women, young women, and girls need to dream a bit bigger,” Lakshmi, TV host and producer, author, and UNDP Goodwill ambassador, told thousands of viewers on a livestream organized by Partners In Health (PIH). “We have to find somewhere deep within us...to say...I’m going for it. I’m going to let someone else tell me ‘no.’ I’m not going to let myself tell me ‘no’ before I even get started.”

Panelists shared advice on overcoming roadblocks, pursuing leadership opportunities, and growing a career during a lively, hourlong discussion to celebrate International Women’s Day on March 8. Lakshmi was one of six influential women—who are in a range of fields and at different points in their careers—who participated.

Dr. Jimena Maza, director of teaching and clinical care at Compañeros En Salud, as Partners In Health is known in Mexico, moderated the event. The panel included Dr. Paula A. Johnson, president of Wellesley College; Dr. Ijeoma Kola, public health historian and founder of Cohort Sistas; and, Nadya Okamoto, author and founder of August and PERIOD. The event also featured a special video message from Tsion Yohannes Waka, chair of the Center for Gender Equity at the University of Global Health Equity, a PIH initiative in northern Rwanda.

Aligning with the UN Women theme for the 2021 International Women’s Day Celebration—“Women in leadership: Achieving an equal future in a COVID-19 world”—the panelists discussed racial equity, the impact of COVID-19 in professional and personal settings, diversity and inclusion, and more.

“Having more women in leadership is not a ‘nice to have’—I think we have to view it as essential, truly essential to the future of our world,” Johnson said.

A recording of the discussion is available above or on PIH’s YouTube channel.

As a young girl growing up in Monterrey, Mexico, Valeria Macías was inspired by many women in her community. But her grandmother has a special place in her heart.

“She has always had her doors open for those who need support,” Macías says. “She is a person that is always willing to help…ever since I was little, I had the feeling that this is my vocation: to serve.”

It’s a calling that Macías has carried with her through the years—to medical school, to the rural clinics of Chiapas and, now, to her role as executive director of Compañeros En Salud, as Partners In Health is known in Mexico.

Her grandmother’s example has been a source of strength and solace as she has led the organization, both in the quiet, day-to-day work of strengthening health systems and in the midst of crises, from an 8.1-magnitude earthquake to the COVID-19 pandemic. Through it all, Macías has demonstrated courage and compassion, drawing strength from the many women who touched her life—and seeking to nurture that strength in other women.

For International Women’s Day, we sat down for a conversation with Macías, where she shared her reflections on a range of topics, from her career to gender equity to the importance of self-care. This conversation is part of our ongoing series Ekip Solid, or “Strong Team” in Haitian Creole, a series that highlights PIH global leaders who are experts in their field.

You started your career with PIH in 2012 as a pasante—one of the first clinicians to complete their service year with Compañeros En Salud. What did you learn from that experience? How did it prepare you for where you are today?

When I started out at Compañeros En Salud in 2012, there were no more than 10 people in the organization, and it was really my first year working as a doctor, in a rural community. In Mexico we have to do this social service year before you can graduate as a doctor. You can do research, you can do rural social service, or you can do outreach, which can be more administrative. To tell you the truth, I really wanted to do it in a community, particularly a rural one, and that's how I found Compañeros En Salud.

At that time, I knew nothing at all about what Compañeros En Salud was, what it did, and I'd never heard of Partners In Health, the international parent organization. I knew nothing about global health or social medicine. All I knew was that there was injustice in our health system—in the way we provided medical care to our patients and in the inequality between the public sector and the private sector. I had a strong desire to do my service year in an area where there are usually no doctors.

I think spending a year doing social service in an area which has been marginalized completely transforms the way you learn medicine and the way that you provide services, because when you're there for a whole year, you become immersed in the everyday problems of that community and you see just how difficult it is for them to access medical care.

I think that everyone who goes through their social service with Compañeros En Salud, once they return to residency or continue working with patients in other settings, it's not the same anymore. You don't just see the illness anymore, but the patient—and all the social determinants that come along with that patient.

While a supervisor of other pasantes, you founded Compañeros En Salud’s “Right to Health Care” program, which helps patients in rural communities receive referrals for advanced care at hospitals and pays for their housing and transportation. What inspired you to start this program and why it is so important?

During my year of social service, I saw that, as a primary care physician in a health center, there are many things you still can't do. You can’t do surgery, you can't treat cancer, you can't treat illnesses that require a specialist or sub-specialist. So, I think that what most motivated me to start the program was being there every day, giving consultations, and seeing that I could not solve these problems even though, in theory, Mexico provides universal health coverage. And every time that I sent my patients to the hospital for any surgical problem, it ended in failure, really. It ended in failure because the patient went in and, for one reason or another, was turned down for consultation or surgery and they were still charged. That's why my colleagues and I decided to launch the Right to Health Care referral program.

To this day, the program remains very important. The truth is, we don't realize how difficult it is for a patient to access a consultation with a specialist. But when you accompany a patient to their consultation, you see all of the barriers that are being put up—from distance to food costs and lodging to hospital bureaucracy. So an essential part of what we do is paying their non-medical costs. And we walk side by side with the patient and teach them how the health system works, where to make appointments, how to move around in the hospital, and where to look for support. Having someone there who knows the system and can advocate for the patients makes a big difference. Since we started this program, it has helped hundreds of patients receive care, from surgery to cancer treatments to fitting of prostheses. This program is vital to getting patients the treatment they deserve.

During the 8.1-magnitude earthquake that struck Chiapas in 2017, you were director of our secondary and tertiary care programs. In your role, you supported our clinicians as they delivered care during crisis, including those who helped a woman in labor during the quake. What did you learn from this experience of leading amid crisis and how has it prepared you for our current COVID-19 emergency?

At that moment, all kinds of things happened. Inside Casa Materna, one of the doctors from the Secretariat of Health stayed to look after a patient in labor, which was happening just at that moment. The 'LEOs' were also there, who are the obstetrics nurses, supporting the doctor. They all stayed there and said, no way were they going to leave—the patient comes first. I think that the biggest thing I learned was, more than anything else, that solidarity and that connection that I still have with all the partners, in the health sector, that we are all striving towards the same mission.

When there is a crisis, I think it is very easy for it to permeate and to make us all enter our own personal crises. I don't know how to describe it, but it destabilizes everything that you are living through and everything that you are working for. You start to see everything as temporary. It's easier to get weighed down by everything you're living through. But I think the most important thing is to remain calm, try to see things objectively and from a distance, and give support to everyone who is working with you. That psycho-emotional support is extremely important, because your way of thinking and seeing things can be affected.

As a leader you have to keep guiding, you have to keep going, and you have to be able to see what can be solved at that time and give support to your colleagues.

As we celebrate International Women’s Day, we look to women who inspire us—colleagues, friends, trailblazers, mothers. Who are some women that inspire you and why?

One of the women who has absolutely always been an inspiration for me is my grandmother. She is a woman who has always been ready to serve others. She has always had her doors open for those who need support. She is a person that is always willing to help and always happy, always smiling, always thinking about others. So, that is something that inspires me a lot, and I think that ever since I was little, I had the feeling that this is my vocation—to serve.

On a bigger scale, I think that the woman who I grew up identifying with, or the woman that I always dreamed about knowing or having as a friend one day, was Mother Teresa of Calcutta. There was a strong religious presence in my childhood, and she was one of the first women I could see having a big impact. I could learn from her story and see everything she had achieved. Later, I had the opportunity to go to India and see her work and volunteer in the same organization, which by then had spread to a lot of different areas. It was a very enriching experience, being able to see everything that had been achieved, because it obviously wasn't just her—she organized a group of women to, to serve a pretty impoverished and marginalized population. As a woman inside the church and standing out like that, she was an example of a fighter.

In a world where women face sexism and injustice at home, in the workplace, in the hospital room, and beyond, how do we build a safer and more equitable environment for all women?

Content warning: rape.

That's a very important topic and very difficult these days, especially with the situations we are faced with in Mexico. Just a couple of weeks ago, we started to receive reports about the passing of a medical intern who was carrying out her social service and was attacked and raped by one of her colleagues inside the same health center. (This woman was not working with Compañeros En Salud and the attack did not happen in one of our health centers.) It's something that is extremely normalized.

I think it's very important to have a position of zero tolerance and to have consequences for actions. These days, any woman in Mexico, doctor or nurse, is afraid to get into an elevator, because if there is a male doctor there or someone else, she's going to suffer some kind of abuse and we cannot allow that. We have to make changes and it is super important that we all demonstrate strong leadership. In order to stop this, we have to have zero tolerance for any type of harassment or exploitative behavior. And we have to invite all our male colleagues and patients to self-reflect and relearn masculinities so that we end this machismo in Mexico, which we, both men and women, perpetuate.

How do you think gender roles affect the way women perceive themselves professionally?

I think it is a challenge being a woman, to be considered with the same seriousness. I believe that one has to keep working on it, to be listened to, and to have that confidence of being able to represent one's experience in the best way. There is this very strong conception of "my role is to stay at home" and "my role is to take care of my children" and, therefore, those capacities that they know they have are not dedicated to professional life, but to home life. And it's not bad—I grew up with friends saying "the only thing I want to be is a mother" and that is very important and very good and I have a lot of respect for moms. But I think it is very important that men also understand that housework and raising children and a family, in the end, are roles that must be taken on together, as a couple.

The most important thing, as a woman, is to become aware of your social construct— that gender role that has been imposed on you—and then ask yourself what you really want to do.

It requires a lot of introspection and to deconstruct ourselves as women—understanding those choices that I am making and why I am making them. It is a daily task to reflect on why I am acting the way I am acting or why I am having these reactions to work situations that can lead me to understand how the gender role impacts my professional and personal life and if there is something I can change about it.

From your perspective, what are the most important actions that should be taken to empower girls and young women in marginalized areas such as the ones in which we work?

It is vital that women have equal opportunities to access education at the primary, secondary, high school, and university levels. It is very difficult in these areas to really be able to devote yourself to a professional career—what many of these women lack is support from their parents. There is always a tendency to support the men instead of the women.

Another important action would be to create jobs. It is astonishing to see how few job opportunities there are in the region. As a result, it is very difficult for the women to be independent and able to empower themselves economically. And not having economic independence means you have many more challenges when it comes to making decisions and being able to move forward from different situations.

Lastly, I think that women should be given advantages. For example, giving a preference to women for certain opportunities, whether it be for studies or work. At Compañeros En Salud, for example, we search for female partners or collaborators, if there is any opportunity out there. Because it is one thing to educate and another thing to open up job opportunities—if you have a diploma and no job, it becomes complicated.

You must be very busy these days, but what do you like to do in your free time? How do you rest and take care of yourself during this pandemic?

It is very important to disconnect from time to time—turning off the cell phone and taking a few moments or a few hours for myself or with my partner. I try to be very aware of how I am feeling day-to-day. When I feel very overwhelmed, I look for those spaces for, first, meditation and second, exercise. If I don't do any physical activity in a week, I can feel stress all over. I like to ride my mountain bike a lot, look for trails, and just ride and be out all day with nature. It gives me a lot of energy. I like a lot of other activities too, such as scuba diving, walking, and hiking.

In my free time at home, I really enjoy watching television, reading, and listening to music. My partner is a musician, so we sit and listen to music, drink a glass of wine, and read a little. I also manage my schedule, balancing not only the work part, but my personal and spiritual part to ensure that I am covering all the areas of my life. I think that it is very important that all areas are taken care of so that one can be balanced. It is very important that you are well in order to be a good leader and so that you can set this example for your team members. If you are running nonstop and don't take your time and space, it is much easier to become overwhelmed and explode and make decisions that are probably not the best. We need that tranquility and to take those spaces. It’s crucial.

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Some of Vicky Reed’s earliest memories growing up in Freetown, Sierra Leone are of the health clinic operated by Mildred Hannah Moore: her grandmother, a nurse.

“On Saturday mornings, my parents would drop us off at my grandparents’ house, and my grandmother would take me and my brothers to the clinic to spend the whole day there,” said Reed. “She ran it with her friend, a midwife, and my uncle sponsored it from the United States.”

Of the myriad sights, sounds, and smells that could linger with a child passing their Saturday at a busy health facility, what was most prominent to Reed was the care her grandmother offered her patients.

“Patients who had no money at all came into the clinic. My grandmother offered most of her services for free,” said Reed. “She treated patients like they were part of her family. She treated them like she treated us.”

Today, Reed, 43, is continuing her grandmother’s legacy as the director of nursing for Partners In Health in Sierra Leone. Working primarily at PIH-supported Koidu Government Hospital in Kono District, she mentors nurses and strengthens health care for a marginalized patient population much like her grandmother did.

“My grandmother worked and ran the clinic up until months before she passed away, when she was 85,” said Reed. “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.”

Neither Here Nor There

The dream of becoming a nurse would stay firmly planted in the back of Reed’s mind—though her mother and grandmother urged her to pursue it—for decades and across continents. In 1993, when she was 15, Reed moved to the United States to continue her education. She’d finished high school early, and Sierra Leone’s 11-year civil war was entering its second year.

“Things were so shaky in the country. I could have gone to college here, but it seemed more stable to go away for school. I started at a community college in New York,” said Reed.

Reed’s parents soon had to leave the family’s home in Sierra Leone, first seeking refuge in Guinea and then settling in The Gambia for two years.

“When my parents left The Gambia, there was a six-month period I didn’t even know where my family was,” she said. “It was all very difficult. I was in college, technically, so I was expected to be independent, but it was a new environment, my family wasn’t there, and I was struggling with tuition.”

She also struggled with finding a sense of home in the U.S.

“As soon as you open your mouth and talk, people ask you, ‘Where are you from? Who is this African girl?’ It was constantly trying to prove to them, and to yourself, that you belong,” said Reed. “I always pushed myself to be successful academically, just so I could fit in. It was this constant pressure.”

Still, she harbored no expectations of returning to Sierra Leone.

“The war really destabilized a lot of things for a lot of different people,” she said. “People got scattered all over the place. I did miss Sierra Leone, but with no family there and a lot of my friends having left, there was really no incentive.”

Reed forged ahead: She transferred to the University of Maryland, earned degrees in international business and Spanish, and began a career in banking. But her grandmother’s inspiration lingered—moving from the back of her mind to the forefront.

“Here to Serve”

After seven years in banking, Reed could no longer ignore her draw to nursing, and decided to volunteer in a busy E.R. in an impoverished corner of Washington, D.C.

“Seeing patients, mostly indigent, coming in their most vulnerable state, and the way the nurses took care of them…it was inspiring,” said Reed. “It was those small things outside of medical care: sitting with patients, talking to them, asking them how they're feeling, how their pain is…that’s really what makes a difference. It’s what my grandmother did, and it’s what cemented that this is what I wanted to do.”

That’s when Reed decided to pursue her second career, and enroll in nursing school.

Reed’s first nursing job, at a 900-bed hospital in downtown Atlanta, had her caring for people who were marginalized—much as her grandmother had. “We mostly worked with people that society had given up on: poor people, alcoholics, drug users,” she said.

One year out of school, the news arrived of her grandmother’s passing. The funeral would be held in Sierra Leone; it would be Reed’s first time back in 18 years.

She remembers the moment well: held in one of the largest churches in Freetown, and the funeral was teeming with people.

“Crowds were coming up to me and my family members, talking to us about how much my grandmother did for them,” she said. “It inspired me to rethink my whole approach to nursing: I’m here to serve people, regardless of what their circumstances are.”

Returning to Sierra Leone stirred something inside her, too. Seven years later, she felt a pull to return again. Ever curious, even while on vacation in Freetown, she decided to shadow clinicians at the city and country’s major hospitals: a general hospital, a maternity hospital, and a tuberculosis hospital (now supported by PIH).

What she saw at these facilities was “a nightmare.”                              

“I expected it, because I grew up here, but I didn’t realize how bad things were as far as resources, patient care, the lack of respect nurses had,” said Reed. “When I went back to my hospital in the U.S., I was completely distracted.”

The things her American colleagues would complain about no longer felt relatable.

“It wasn’t fair for me to judge them or their reactions based on experiences I’ve had,” said Reed. “This is their reality.”

It just was no longer hers.

Capable, Uncompromising, Impactful

Determined to serve Sierra Leone’s health care system, two years later, Reed joined PIH Sierra Leone as director of nursing. She provides one-on-one mentorship for nurses and develops protocols for how to improve nursing care at PIH-supported facilities—Koidu Government Hospital, Wellbody Clinic, and six health centers around Kono District.

“I’m in the wards working hands-on and taking care of patients with nursing staff,” Reed explained. “I see what the needs are, and can use what I’ve observed to set up policy.”

Lack of quality training and clinical skills is one area Reed quickly identified as needing investment. “The level of education, because of the war and other things, is very low,” she said. “We have nurses coming out of school who really don't know anything. So we have to start from scratch.”

Reed is currently working on addressing this challenge through PIH’s Global Nurse Executive Fellowship, a year-long nurse leadership program that culminates in a capstone project. She was among 10 fellows across six countries selected through a competitive process for this second round of fellows. For her capstone, Reed is developing a nurse orientation program around one central question: ‘What are things that have never been taught in nursing programs in the country?’

It will specifically address communication; collaboration between doctors, nurses, and pharmacists; and clinical skills,” said Reed. “In the U.S. we take for granted that we ought to know these things. But remember, we're in a setting where the priorities have always been just trying to survive.”

Such is the other major barrier to quality nursing care that Reed identified: a sense of disempowerment among nurses, not only skills-wise, but existentially.

“Nurses are not really motivated or inspired here,” she explained. “Most of them are not paid a salary. And they don’t have a voice to advocate for themselves. The field is mostly women, but men are always the decision makers [within the health system]. There’s just this huge chasm between the sexes, and we see that playing out in nursing.”

Reed says she is constantly trying to think of ways to make nurses feel seen, valued, and capable. One simple, but powerful tool: Making an open-ended commitment to her staff.

“The staff is so used to clinicians and organizations coming for a short time, trying to put things in place, and then leaving,” Reed explained. “But there’s trust now. One of the defining moments was the COVID-19 outbreak; I had the option of leaving for the U.S., but how would that look, amid the biggest crisis to face us [since Ebola]? Staying was an ‘aha’ moment for the nursing staff. I’ve noticed more engagement.”

That engagement starts with attendance.

“When I first came, I would go into the hospital at night and there was nobody in the wards,” she said. “Patients were dying left and right. Now, there’s more accountability and engagement. There are several nurses now who call me saying, ‘I want you to be my mentor.’"

Kadijatu Wurie Jalloh, who cares for infants at Koidu Government Hospital’s special care baby unit, is one such nurse.

“Vicky is friendly to the nurses at the hospital, takes good care of us, and teaches us how to provide care properly,” Jalloh said. “She inspires us a lot, and makes me love nursing.”

A key to transforming patients’ outcomes, and health overall, Reed says, is to invest in nurses. No matter how long or difficult that process, she remains determined to give nurses the respect and authority that, since childhood, she knows they deserve.

“This is something I want to see with nurses in Sierra Leone and with women in general, in all spheres in the country,” Reed said. “Leaders who are capable, uncompromising, able to advocate, and able to have an impact. I think we'll see steps towards more inclusiveness. But we really have to make a concerted effort to change this narrative.”

On International Women's Day and during Women's History Month in the U.S., Partners In Health CEO Dr. Sheila Davis and Isata Dumbuya, nurse midwife and reproductive, maternal, neonatal, child, and adolescent health lead for PIH Sierra Leone, are honoring women leaders, team members, and caregivers around the world. They shared this letter with all PIH staff, celebrating the organization's commitment to women's health, rights, and equity.

AUDIO: Hear Isata Dumbaya of PIH Sierra Leone read the International Women's Day letter she wrote with PIH CEO Dr. Sheila Davis.

With making a preferential option in health care as our North Star, PIH has always been rooted in the intention of elevating and empowering women in our pursuit of advancing health equity for all. Our work has been anchored in continuing to pave the way for women around the world to thrive and has been shaped, in large part, by women across all our care delivery, academic, and coordination sites.

At PIH, we are committed to continuing to center the health of women in our mission. From conducting more than 58,000 safe, facility-based deliveries each year, to treating hundreds of breast and cervical cancer patients at the Butaro Cancer Center of Excellence in Rwanda, to breaking ground on a new Maternal Center of Excellence in Sierra Leone, the ways in which you all have contributed to the wellness of women around the world has been nothing short of inspiring. We are collectively tethered to the core belief that women’s rights are human rights, and we aim to show the world that quality care, safety, and autonomy for women is not only possible, but should be a given.

We are committed to elevating and empowering women not only through the delivery of health care, but also in the ways that we work. At PIH, we are incredibly lucky to work for an organization full of strong, talented, and courageous women on the frontlines of the fight for health equity and social justice. Together, women make up 63% of PIH staff, over two-thirds of our Community Health Worker workforce, and over two-thirds of our nurses- providing care for countless patients every day. 

As we look to the future, what remains most inspiring to us is the commitment that the women of PIH have for our mission. Today, we want to take the time to express our gratitude towards all the women of PIH who have so graciously poured their love and passion into our work and lifted countless other women up in the process.

We’ll leave you with a quote that, to Isata, embodies what it means to be woman in leadership at Partners In Health: 

“You can only become truly accomplished at something you love… Instead pursue the things you love doing and then do them so well that people can’t take their eyes off of you.” – Maya Angelou

In solidarity,

Isata Dumbuya (RMNCH Lead, PIH Sierra Leone), and Sheila Davis (CEO)

The collapse of a bridge on the lone road to an isolated health center high in the mountains of Lesotho has Partners In Health teams finding innovative ways to maintain care, including carrying patients on stretchers over a narrow footbridge—during rainy season, sometimes at night, and sometimes including pregnant women who need transportation to the district hospital.

“Finding people who are ready to carry patients from one side of the bridge to another side is a big problem. You cannot even imagine how all this happens at night,” said Bongiwe Baki, PIH site director for Methalaneng Health Center.  

The road provides access to Methalaneng, which is one of seven isolated facilities that PIH supports through its Rural Initiative, a collaboration with Lesotho’s Ministry of Health to provide care in remote regions of the southern Africa nation. The bridge collapsed Jan. 27 after heavy rains near the town of Mants’onyane, one of 36 communities—totaling about 8,500 people—served by the health center.  

Due to the heavy rains, the bridge crumbled in two places, on both sides, with no way to drive across. People have since been using a footbridge to cross, but the sudden lack of vehicle access has had shattering impacts on residents’ lives.

“At first I thought my eyes were playing tricks on me, because I was actually in a hurry,” said community member Lekhooa Lekhooa, who has offered his car for support during the crisis. “I stepped out of the car to take pictures because I wanted people to share this horror with me. The rains have really come down heavily, there is no denying it now.”

Bo-mphato Lits’ebeletsong tsa Bophelo, as PIH is known in Lesotho, provides integrated primary health care at its Rural Initiative sites, with services for HIV, maternal and child health, non-communicable diseases such as diabetes and hypertension, and much more. Screening and care for COVID-19 have been added over the past year. Carrying out those services in remote mountainous areas requires constant deliveries and supplies, from laboratory samples to medical equipment and support for emergency referrals to hospitals. 

That means the washed-out bridge has had an outsized impact on PIH’s 38 staff members at Methalaneng.

Cars which those staff members use for referrals to the district hospital, including the ambulance, are now trapped at the health center, meaning patients must cross the bridge on foot to reach additional cars on the other side. For pregnant women as well as immobile patients who need to be carried on a stretcher, the challenge can be significant—so much so that PIH staff often work with helpful community members to ensure patients cross safely.

Crossings can be particularly challenging at night, when it’s harder to find community members willing to help and when rainy season—from November through February in Lesotho—can make conditions treacherous. 

But in many ways, the same rains that washed out the bridge to Methalaneng could be a blessing across Lesotho, which just went through several years of severe drought. As is the cultural practice, many Basotho people prayed for rain in recent years—and those prayers began to pay off in 2020, which had solid rainfall. This year started even more wet, with rains falling across the country for the first six days of 2021.

Ideally, the heavy rains will translate into strong harvests for farmers, good grazing lands for cattle, and more water access nationally. And flooding during rainy seasons is neither unusual nor a surprise for Basotho people.

Partners In Health clinical leaders and experts address questions about COVID-19 vaccines, in an ongoing list that will be updated as new developments and findings unfold. 

Are the vaccines in circulation safe?

All evidence says yes. To date, no serious safety concerns have been reported during trials or use in the United States of the vaccines with FDA authorization. All available vaccines are approved for use by the FDA under an emergency-use authorization because of the pandemic..

What are the side effects?

You may have some side effects from COVID-19 vaccination, which are normal signs that your body is building protection from the virus. Common side effects are pain and swelling on the arm where you received the shot, fever, chills, tiredness, and headache (similar to flu vaccine side effects), all of which usually go away in a few days at most. Severe allergic reactions are extremely rare.

If you get the vaccine, can you still carry the virus in your body and infect others?

We don't know yet. While available vaccines are remarkably good at preventing serious illness, we do not yet know if they prevent you from getting -- and thus spreading -- the virus. You should continue to wear your mask, practice social distancing, and wash your hands even after being vaccinated until the spread of COVID-19 is under control.

If you already had COVID, do you still need to be vaccinated?

Yes. The CDC recommends that everyone get vaccinated, even if they have had COVID-19 before and recovered, or tested positive for antibodies. Early evidence suggests natural immunity from COVID-19 may not last forever. Current vaccine trials are immunizing people who have never been infected with SARS-CoV-2 (the virus that causes COVID-19), as well as those who have been previously infected.

How much does it cost to get vaccinated?

Nothing. All vaccines provided in the U.S. are free to everyone, including people without insurance. For those who have insurance, your information will be collected so the vaccine provider can bill for administrative costs, but there will be no out-of-pocket cost.

When can I get my vaccination?

States received their first shipments of the first two FDA-authorized vaccines in mid-December 2020. Supply of COVID-19 vaccines is currently limited, so local and state governments are working to distribute the vaccines as they receive more shipments. The FDA authorized a third vaccine in late February, as well. For all COVID-19 vaccines, PIH is advocating for distribution that is fair, ethical, timely, and transparent.

PIH stands in solidarity with communities that have borne the brunt of the virus—communities of color, the poor, and the marginalized. Because of deep inequities that have long existed within the country, Black, Latinx, Native and other communities of color have suffered from, and died of, COVID at higher rates. Justice demands that the overall needs of these communities be prioritized in the ongoing public health response to the current emergency, and beyond.

For U.S. residents, the Centers for Disease Control and Prevention (CDC) has searchable, state-specific information. 

For the Pfizer and Moderna vaccines, do I need to get both shots in the vaccination series, or is one enough?

For COVID-19 vaccines that require two shots, you need to get both. The first shot essentially prepares your body to fight the virus, and the second shot completes the ability to do so.

When will vaccines be available in other countries, outside the U.S.?

The huge disparity between vaccine supplies for rich countries and supplies for low-income countries is a continued injustice. Current global plans only include vaccinations for 3% of people in the 154 most impoverished countries this year, but we’re hopeful that recent commitments toward global vaccine equity will shorten the timeline to worldwide availability.

Globally, PIH is pushing to make sure vaccines are accessible to everyone as soon as possible. We have joined initiatives like the People’s Vaccine to make sure drugs are developed, manufactured, and distributed with the good of all in mind, and we are supporting ministries of health in acquiring and distributing vaccines.

What's going on with COVID-19 variants? Are current vaccines effective against them, or will I need an additional vaccine later?

Vaccine companies are working to update and improve vaccines for effectiveness against variants, such as the ones that originated in the United Kingdom and South Africa, but that doesn't mean you should wait to get a shot -- if you are eligible for a vaccine and able to receive one, all experts agree that you should take it. Most studies so far show efficacy against variants in current vaccines.

Mary Cooper wears a Partners In Health cap and a red winter jacket as she walks into her home on a snowy morning in February, after checking the car and outdoor conditions.  

Over the back of the chair at her computer is a blue T-shirt that says “UConn Grandma.” It’s a gift from her elder grandson, Darius, a sophomore who’s taking classes online at home in Georgia. Cooper is immensely proud of him, and of her granddaughter Antasia, her younger grandson Jared, and her daughter, Angela.  

“I love them dearly,” she says. “’Tasia, my oldest, is kind with such a wit about her. Darius is ever the intellectual, always reading and exploring, and Jared, last but not least, is wise beyond his years.”

Family always has been central to Cooper. She has lived in the Boston area for more than 50 years but grew up in Troup County, Ga., southwest of Atlanta, as the fifth of eight children. Her aunt lived with the family, as did her grandmother’s sister and brother. 

When Cooper was about 5, her mother heard that schools in Alabama were better than the schools in Georgia, so she moved the family just over the state line into Alabama. It was a good change for Cooper, who said that as she got older, she gained appreciation for attending a school with all Black students and teachers.

Cooper’s mother worked as a cook in a hospital kitchen. Her grandmother, who was a sharecropper earlier in life, became the kids’ secondary caregiver, making hot meals for their lunch breaks at home.   

“I was surprised and quite confused once I found out my mother didn’t make any money in that hospital—my mother worked from sunup to sundown,” Cooper says. “She did influence me in terms of work ethic.” 

Her grandmother influenced her, too—in recent years, as Cooper’s own grandchildren were growing up, she became their secondary caregiver, living with them in Canton, Ga., taking them to and from school every day, and helping with homework and around the house.  

“Circle of life!” Cooper says. “It was a good time for me in many ways, to spend time with my grandchildren, to teach, to prepare meals, to laugh and joke with them.”

Mary Cooper has brought that work ethic and family feel to PIH since 2014. As an accounts payable accountant in the Finance Department at the Boston office, she says, “we are the ones who keep the ball rolling,” making sure people and vendors get paid, and contracts are in order.  

She also makes sure her co-workers feel at home, with regular walks around the office to stop in each department, say hello, and chat. Her visits are so well-received that, back when people could be in the office pre-pandemic, they became known as a relaxing, friendly highlight of the day.  

That is, as long as you weren’t late to file your expenses.  

As part of our occasional Working in Global Health series, and at the end of Black History Month, Cooper talks about working in finance at a global health nonprofit, why her daughter is named after a cultural icon, and the importance of knowing your mission.   

What about working for PIH appealed to you when you applied? 

I wanted to stay in the nonprofit sector. I’ve noticed that when you work at a nonprofit, people are a little more human. I’ve worked for big insurance companies and banks, but they were too large, too impersonal.  

Before coming to PIH, I worked for about 10 years at Combined Jewish Philanthropies, which also is a nonprofit in downtown Boston. Seeing and working with the Jewish community was very important to me, especially after reading The Diary of Anne Frank as a 13-year-old. I wanted to continue that feeling and to find a place with part-time hours, which PIH was offering at the time.  

I can’t express how privileged and honored I am to work for PIH—the work that we do here is so important.  

How do you feel your experience in finance and accounting ties into PIH’s larger mission? 

One of my main responsibilities in accounting is to ensure not only that our many consultants and vendors are paid in a timely manner, but also, and most importantly, to make sure that all wires and payments are sent to the sites that PIH services. That is our larger mission at PIH, to serve the people who are less fortunate than we are, who have less than we have—to give back. 

What do you enjoy most about the work, and what keeps you at PIH? 

I enjoy the many people from all over the world who I have had the pleasure of getting to know. The warmth and sincerity of the women and men who are dedicating their lives for the good of all whom we serve. I enjoyed the first time I met (PIH Co-founders) Ophelia Dahl and Dr. Paul Farmer, who have shown kindness, love, respect, and consideration for me. 

Tell us more about your friendship with Ophelia Dahl.  

It has been my honor and privilege to have met Ophelia. I did not research PIH or its co-founders until after I was hired here—I think that helped me keep an open mind about PIH and its mission.  

So, I was quite surprised to learn that Ophelia is the daughter of an actress (Patricia Neal) and a well-known author (Roald Dahl). Countless times with my granddaughter, I had read and watched a movie that Ophelia’s dad had written. Matilda was one that my granddaughter never seemed to tire of—little did I know that I would meet the daughter of the author.   

I will never forget our first meeting. Ophelia was just so down-to-earth, and kind, and thoughtful—and she has been to this day. 

She made sure I got to meet (lawyer, activist, Equal Justice Initiative founder, and PIH board member) Bryan Stevenson. That has been one of the highlights for me while being at PIH. 

What have you learned at PIH, and how have you grown by working here? 

I have gained wisdom and knowledge of how much I have, when there are so many people who have so little. I have learned to share my time and wisdom with those who need it most, and to better myself in every way I possibly can. 

Why is it important to have a variety of voices, perspectives, and personal backgrounds working here? 

I believe that all voices need to be counted and heard, especially those voices with positive perspectives. My personal journey is much like some of the sites that we service. I come from a poor sharecropping family that had so very little. I understand what it is to have no health care and limited resources. However, it is this experience that is shared by so many at the sites that PIH serves. 

We’ve talked a little about your childhood in the South. What originally brought you to Boston? 

My sister was here, and I was still down in Alabama, not doing the things I was hoping to be doing, like goals I had with college and the Air Force.  

To this day, I’m not proud of the fact that I left the South to come here—I’m part of the migration. “Land of opportunity,” so I thought—but it’s not any better here than it is in the South. 

In some ways it might be worse, because here, racism is not as open as it is in some of the southern states. Here, people just seem to have a sneakier way, to hide behind racism and inequality. More like smiling in your face, but knowing all the time, it is not meant. Now, this is not with all people, but we have a political system that I believe can work against people, especially people of color!

Can you tell us about your daughter’s namesake? 

(Black feminism and racism activist, academic, author, and icon) Angela Davis was my hero, my shero, at the time my daughter was born.  

I met her here in Boston – actually, after my daughter was born. My daughter was at her daycare, and one of the instructors there asked me if I’d like to meet Angela Davis and hear her speak. I said, “Would I?!” That was in the late ‘70s or early ‘80s. I saw her speak, and she was so inspiring.  

During the busing crisis, Angela Davis said, “Unfortunately the people in South Boston don’t realize that they’re in the same boat as the people in Roxbury.” She meant poor Black people and poor white people need to come together and fight the cancer of racism. It’s kind of echoing now, today, what I heard Angela Davis say then. 

What advice would you give to other people who might want to work in global health? 

Dedication with an open mind is a good start.  Make sure that you are committed to assist in any way to help those who are less fortunate than you. 

When I met Ophelia and learned her father was the author of Matilda, and as I learned more about PIH’s mission, it seemed to me that working here also could be a “circle of life” moment for me. I believe that Ophelia had a mission that was set for her, and she has followed that mission. 

Seek your mission, become familiar with your mission, and dedicate yourself to the good of those who are less fortunate than you, who have so very little, with each day a struggle. Know your purpose! 

For many PIHers, working in global health is more than a career—it’s a calling. Kirby Page, who joined PIH in 2019, has been passionate about social justice for years. Now, as part of the Global Policy & Partnerships team, the Texas native brings that passion into her day-to-day work, supporting and strengthening PIH’s global advocacy for health care as a human right. In her role, she shares vital news and updates in the advocacy space, strengthens systems for information sharing and collaboration, and helps lead the anti-racism core team, among other duties.

We caught up with Page, who is currently based in her home state, as part of our series Working In Global Health, which spotlights PIH staff who have dedicated their careers to making a global impact. During our wide-ranging conversation, we chatted about what drew her to a career in global health, how she advocates for diversity, equity and inclusion, and what new hobbies she’s been exploring lately.

You’ve worked with PIH since 2019, first as a coordinator with the Development team and now as a coordinator with the Global Policy & Partnerships team. What drew you to global health work? What inspired you to work with PIH, specifically?

I was actually really drawn to the social justice aspect of PIH’s work when I first joined. I had a long history of advocacy in the housing rights movement with Habitat for Humanity and was looking to work with an organization that aligned with my values. I found that and more with PIH, ultimately providing me with almost a secondary education in global health through working with and learning from our global colleagues.

What global health issues do you feel most passionate about, or most personally drawn to, and why?

For me, it’s maternal and child health. Every time I am confronted with the statistics of maternal and child health outcomes, such as that of 99% of maternal deaths occurring in developing countries, I am absolutely enraged. I want that rage to be funneled into dignified care for those we serve and those individuals beyond our reach. PIH’s patient-centered approach to care, paired with our government accompaniment work, seeks to address this at scale. Our approach is woven into our care delivery sites, advocacy and accompaniment—all working in tandem to push the needle forward on global health funding and capacity.

Global health is a vast field with many layers, nuances and complexities. What areas do you think we need to dive deeper into? What questions should we be asking?

The looming question for me is how do we intentionally support the patients and the mission of PIH in the most equitable way. I think the conversation around decolonizing our work and power structure as a global health NGO is so important to uphold. We have a ‘Decolonize Global Health’ working group that meets internally to discuss a path forward and analyze different readings on the subject. I do see a lot of internal interest and support for uncovering the various layers in this space.

What advice do you have for people looking to get into the global health field?

My advice would be to reach out to your global health heroes, for starters! Additionally, think about your personal impact and where it makes the most sense, from an equity lens. I think being conscious of and actively working against the power dynamics that many of us perpetrate in the global health field is a key consideration when working to save lives and improve health outcomes. Lastly, there are many avenues into the field of global health and it’s definitely not a one-degree-fits-all space—you will be able to find your niche.

What does Black History Month mean to you? What are some ways that you celebrate it?

For the past six years, I have been putting out a daily email series for the entirety of Black History Month. It wasn’t really on my radar prior to that. I mean, it was on the school curriculum, but that doesn’t really cut deep in the American school system and always left me feeling tokenized. The Daily Black History Month emails have really helped me reclaim the history and celebration of my cultural heritage and understanding. I have also found a deeper connection with Black History Month, and the Black legacy in general, in the communities I have built around me. I feel very blessed to have friends, colleagues, and family that reflect my lived experiences as a Black woman and support me in that, as I hope to do for them.

As we celebrate Black History Month, we want to uplift the urgent and ongoing work of advocating for diversity, equity, and inclusion within organizations and society at large. Is there anything you’d like to share about your work with the Anti-Racism Core Team or other efforts related to this?

The Anti-Racism Core Team (ARCT) at PIH emerged as an organic staff collective focused on racial justice, accountability, and—at its core—community. The way I see it, which is in no way the singular defining view, the ARCT is a means of protecting and cultivating the sense of community that makes PIH so special. The ARCT serves to provide staff resources, facilitate group communication, and map out internal issues to be addressed for PIH leadership. The team built a work plan to carry out the directives identified by the all-staff advisory groups in the summer of 2020 and have focused on building the frameworks for harm reduction and bolstering diversity within the PIH community. The Anti-Racism Core Team members and various other affiliated staff have worked tirelessly to achieve this and more. With community at the core, my hope is that the ARCT can serve to advocate, inform, and uplift PIH staff.

PIH has grown and evolved a lot over the past few years, especially since the COVID-19 crisis hit. Now, some of us are working from home. How has that been going? What’s your home office like? Anything you miss from the days of working at the Boston office?

The transition from the office to working from home would’ve been difficult even without the looming pandemic. I loved the social aspect of the office and often found some of the best partnerships through random conversations with coworkers. I have tried to mirror that with coffee chats and really intentional check-ins with folks, but Zoom fatigue is real. I recently moved home to Texas to ride out a few months with my parents, and I have been lucky enough to upgrade to a true office space from my initial haphazard office in the window nook of my bedroom at my Boston apartment. I am hopeful that I can, and will, return to the office and share space and memories with my fellow PIHers one day.

When you’re not working, how do you like to spend your time? Any hobbies or projects you’ve been exploring lately?

Being back in Texas has really allowed me to take advantage of the outdoors this winter. I have been frequently going on hikes or long drives with the windows down (which technically counts as the outdoors). In my adventures, I am constantly on the lookout for a good cow (Hereford is my favorite) or alligators, which aren’t hard to come by in southeast Texas. I have also really been enjoying trying new recipes and my newest hobby of cooking on the fly, which is just looking at food pictures on Instagram and recreating them without a recipe.

Six years ago, Partners In Health began its work in Liberia and Sierra Leone at the height of West Africa’s historic Ebola outbreak. PIH heeded the call of governments in Liberia and Sierra Leone to not only respond to the rapid and deadly spread of Ebola, but to make open-ended commitments to stay and collaboratively build stronger health systems for the long-term. Such an approach is, we have learned time and again over 35 years and across continents, the best way to mitigate and minimize an epidemic’s impact, and to prevent needless deaths from other diseases that have known treatments—but that have been long denied to impoverished communities.

Last week, health officials in Guinea confirmed the reemergence of Ebola in the country—putting the entire region, including our patients and teams in Sierra Leone and Liberia, at risk.

We stand in solidarity with the government and people of Guinea as they rush to care for those who have fallen ill and to ensure the virus does not spread further. And in Sierra Leone and Liberia—both of which share a border with Guinea—we are working with local and national health officials to support preparedness efforts, including thorough screening at entry points, contact tracing, and updating treatment protocols with two new Ebola drugs developed since the last outbreak. In the communities and health facilities we directly support, we’re mobilizing our community health workers, taking stock of PPE and other necessary supplies, and developing new triage and isolation protocols.

As of this writing, Ebola has not yet been confirmed in Liberia or Sierra Leone. Still, we can’t be complacent.

We’re preparing for a worst-case scenario, in which the virus once again takes hold of the region—on top of the ongoing COVID-19 pandemic and West Africa’s second wave of that virus. With porous borders between Liberia, Sierra Leone, and Guinea, spread of Ebola may be a question of time.

There are many reasons to feel optimistic. Since the last outbreak, Sierra Leone and Liberia have national structures in place to prepare for and handle health crises. Ebola is better understood, and is no longer seen as an inevitable death sentence: there are new treatments and even a vaccine, recently stockpiled by the World Health Organization. And PIH-supported hospitals and clinics in both Sierra Leone and Liberia are prepared for Ebola and COVID-19 in ways communities could only dream of in 2014. Our number one priority if and when Ebola arrives to the communities we serve is keeping routine health services on course. By ensuring PIH supported facilities remain open, we can help ensure no one dies from lack of availability of general health services for pregnancy, malaria, diabetes, or any other non-Ebola ailment.

Our optimism, however, is accompanied by fear, indignation, and impatience. It is reassuring, and a source of pride, to be working in once direly under-resourced public health facilities now considered the best in the countries; these hospitals and clinics are among the only government health facilities in the region that have all core clinical services – including surgery, pediatrics, internal medicine, obstetrics, mental health, and non-communicable diseases – alongside 24/7 electricity, running water, digital x-ray machines, blood banks, oxygen production plants, isolation rooms and all other resources necessary for comprehensive, dignified health care.

We are proud of the work we have done, but in no way should these successes be seen as innovation. They are the exact things we would expect in a U.S. hospital, and what we believe every person deserves wherever they may live.

And while we are confident that the Ebola response will be more robust than it was in 2014, for our staff and patients, this period is difficult, even in its potentiality. There is not a single Liberian or Sierra Leonean family that was not impacted by the previous epidemic; the memories are not distant. We are committed to providing extra support and accompaniment to one another. We recognize and are grateful for the psychosocial care we provide alongside our MOH partner hospitals and clinics to support our communities and patients facing resurfacing trauma.

This burgeoning epidemic—again, emerging on top of another infectious disease outbreak—doesn’t just bring back the pain of personal memories. It also serves as a reminder of the unjust reality we are working together to transform each day.

Consistently, and not coincidentally, it is the poor who suffer most, and who are last in line to receive the benefits of modern medicine and scientific advancement.

While much has changed in six years, much hasn’t; the health systems in Liberia and Sierra Leone remain fragile, and West Africa remains incredibly vulnerable to this threat of another round of Ebola. We stand at the ready, but the hard truth is: Until the attainable goal of universal health care is achieved for people living in Guinea, Sierra Leone, Liberia, and all other impoverished countries, we can expect more needless suffering and death at the hands of treatable and preventable diseases.

In honor of Black History Month, Partners In Health (PIH) staff in the United States have shared their favorite songs, books, poems, and movies related to antiracism, Black history, and inequities in public health. Below are some of the recommendations, including a Spotify playlist, that inspire staff. As we celebrate African Americans’ work and culture in the U.S. we’d also like to recognize the work our Black colleagues are doing around the globe. Although Black History Month has been dedicated to a single month since 1976, at PIH we know that amplifying Black voices and work is essential year-round.

Every day, Delia Zevallos picks up the phone and dials the same number. After a few rings, a voice answers—it’s her patient, an elderly man who lives alone in Carabayllo, an impoverished community 20 miles north of Lima, Peru. And he is excited to talk to her.

“I call him every day to ask how he is and see what he's doing, and to make sure he's taking his medicine,” she says.

Zevallos is a community health worker with Socios En Salud, as Partners In Health is known in Peru. Socios En Salud has worked in the country since 1994, when it began supporting the national response to an unchecked epidemic of multi-drug resistant tuberculosis. In the years since, Socios En Salud has continued to partner with Peru’s Ministry of Health to deliver medical care and social support in Carabayllo and beyond.

Zevallos focuses her work on caring for elderly patients with chronic diseases through the Casas de la Salud program. Since 2009, Casas de la Salud has provided care, screenings, and education for patients with a range of chronic health conditions, including diabetes and hypertension.

Each week, Zevallos and her team meets with a group of 12 patients in a community space—one of four such spaces the program operates—and provides medications, screenings, and advice on how to modify nutrition and exercise, what symptoms to watch for, and when to seek care.

“This program is important, especially now during a pandemic,” says Zevallos. “Medical consultations are not taking place in hospitals, so via this program, we’re able to reach out to many people who, because of their work schedule or other reasons, can’t attend appointments in clinics.”

Recently, the program has focused on patients with hypertension and diabetes, also known as non-communicable diseases. Non-communicable diseases kill 41 million people around the world each year. And deaths from these diseases disproportionately occur in low and middle income countries, where governments and health systems have been weakened by centuries of injustice, including colonialism and imperialism.

Detecting these diseases early and providing treatment and medication is critical for patients’ health and well-being, especially in communities like Carabayllo, a historically marginalized community on the outskirts of Lima where thousands lack access to quality care.

Care Amid COVID-19

Diabetes, hypertension, and other chronic diseases, such as asthma and heart disease, put patients at increased risk of severe illness from COVID-19. Casas de la Salud has continued its critical work amid the pandemic with comprehensive safety protocols to protect patients’ health.

“It has been a big learning curve lately, but we have been succeeding little by little,” says Diego Portillo, Socios En Salud’s coordinator of Casas de la Salud and Crónicas.

Health care workers wear personal protective equipment (PPE) at all times and conduct triage when patients arrive, isolating anyone with symptoms. The weekly sessions are capped at 12 people per group and services such as mental health care are provided virtually. When COVID-19 cases surged in the summer, the program delivered medications to patients’ homes instead of requiring them to come to the community space—a service it still provides for those unable to leave home.

Even amid COVID-19, Casas de la Salud continues to bring critical care and treatment to the neighborhoods of Carabayllo. Portillo estimates that the program serves tens of thousands of people—the community space in Polvorín, for example, serves nearly 10,000.

Care and accompaniment for patients with chronic diseases is all the more crucial during a pandemic where people are urged to stay home and isolate as much as possible—a harrowing and lonely experience.

“A community health worker is someone who walks alongside the person,” says Portillo. “What is key is to build our trust with the communities.”

Nowadays, Zevallos and her elderly patient mostly communicate by phone, but before COVID-19, she would visit the man at home and accompany him to the hospital to retrieve his medicine and lab tests. She even once bought him a cake for his birthday.

“You have to treat your patients with love,” she says. “If you treat them with love and affection, they’re going to feel safe.”

Looming outside the State Capitol building in Montgomery, Ala., is a monumental reminder of the exploitation suffered by Black residents of this region: a statue of J. Marion Sims, the gynecologist who practiced his surgical techniques on enslaved Black women without using anesthesia. Just about half an hour away, as residents are quick to point out, is Tuskegee, site of the U.S. government’s decades-long medical experiment conducted on impoverished Black men with syphilis who were intentionally left untreated as they grew sicker and died.

Given this history, it’s not surprising that many in Montgomery don’t fully trust the federal government’s promise of a groundbreaking COVID-19 vaccine to protect them and stop the pandemic.

“People don’t want to be experimented on, especially if they’re Black,” says Roschelle Tyus, a Montgomery community organizer. “They don’t want to feel like they’re being tested like a guinea pig.” 

This lack of trust ran particularly high during the Trump administration, Tyus says, when the vaccines were first authorized. Under President Joseph R. Biden, she adds, things might be better, but when it comes to getting a COVID-19 vaccine for herself, Tyus remains in the “wait-and-see” camp.

Trust Issues

Indeed, this wait-and-see approach to vaccination remains pervasive, particularly among Black and Latino adults, according to a recent Kaiser Family Foundation survey. In Alabama, mistrust runs deep: only 17 % of Black and Latino individuals from across the state told researchers they’d be willing to get a COVID-19 vaccine. “I didn’t expect that [mistrust] would be that deep and across the board,” says Dr. Mona Fouad, director of the University of Alabama’s Minority Health & Health Disparities Research Center.

Fear and mistrust surrounding the COVID-19 vaccine continues, even as the virus disproportionately afflicts Black, Latinx, and Indigenous people. Public health and government officials nationwide, worried that without broad buy-in, the country won’t attain “herd immunity,” are trying to persuade communities of color to drop their so-called “vaccine skepticism.”

But persuasion is the wrong approach, says Grace Lesser, a senior project lead at Partners In Health, the social justice nonprofit currently working with the city of Montgomery to help support and strengthen its pandemic response. “We need to provide people with clear facts about the vaccine -- what we know and don’t know,” Lesser says. “That way, we are trusting people to make informed health decisions about what is best for them.” She points out that given this country’s patterns of health injustice, mistrust around the vaccine is well-placed. Lesser cites a recent PIH-funded survey of 1,000 Montgomery residents in which 45% of respondents said the U.S. health care system treats people unfairly based on their race or ethnic background either all or some of the time. Rather than unilaterally pressing people to trust the government or vaccine producers, Lesser says, officials must establish trustworthiness by being transparent and also making immediate, material investments in high-quality, equitable health care.

Supporting Hard-Hit U.S. Communities

To assist in these efforts,  PIH launched its U.S. Public Health Accompaniment Unit (USPHAU) in May 2020, following a successful partnership with Massachusetts establishing a new contact tracing workforce. Since then, U.S. states, cities, and communities hard-hit by COVID-19 have requested assistance from PIH, and the unit’s reach has expanded. Now, the USPHAU is partnering with state and local health authorities and community organizations in more than 15 regions, from Newark, N.J. to Pima County, Ariz. and the Navajo Nation, providing support for a range of pandemic response efforts, including equitable vaccine distribution.

In Montgomery, which is 60% Black, and where 20% of residents live below the federal poverty line, the pandemic’s pain has reached far into the community. COVID-19 killed four Montgomery public school teachers in a single week in January, and the case positivity rate has hovered around 20% for much of the winter. In response, the USPHAU is working with Mayor Steven Reed’s office to support several pandemic-related efforts. These include: launching a new community health worker program to help residents access basic resources and providing technical assistance to open a new Montgomery Crisis Center for unhoused individuals and families with COVID-19. The USPHAU is also deploying a communications campaign guided by insights directly from Montgomery residents to more effectively reach vulnerable individuals. Recently, the unit has supported free rides to get vaccinated and a food pantry during vaccination clinics. 

Shifting Attitudes

Like every PIH effort across the globe, the work in Montgomery began by listening to local leaders and influencers to better understand their needs and perspectives.

Larnetta Moncrief, owner of the Diva Lounge Hair Salon, often gets an earful from clients during styling sessions. She says many of them don’t really trust the government and are “terrified to take the vaccine.” Moncrief was among them. “I was one that was very skeptical about it,” she says, summing up her initial stance. “There’s no way I’m going to do this.” But then, suddenly, her resistance weakened. It happened at a virtual vaccine information session in late December, says Moncrief, who also works with a local nonprofit that helps mothers released from prison transition back to the community. A young, African-American physician she’s known since high school, Dr. Brian Gary, spoke at the event about the vaccine’s safety and said he’d get inoculated right away. “For some reason he put me at ease,” Moncrief says. “Now I’ve talked to even more people and I’m feeling confident about it, so when it’s my time, I’m ready.”

Indeed, attitudes about the vaccine appear to be shifting, says Pastor Richard Williams, a 30-year-old self-described “Holy Agitator,” who has made it his mission to transform Montgomery’s Metropolitan United Methodist Church into a full-service social needs hub. For example, the church-sponsored mobile food pantry feeds about 2,000 adults and students each month; hosts regular, free COVID-19 and HIV testing (with free condom giveaways); connects people facing eviction to legal services; offers mental health support and teen counseling programs; and recently began a burial program to donate grave plots to families who can’t afford to pay.

While “distrust” still persists, Williams says, more and more individuals are reconsidering the value of the shot as they see doctors and nurses and family members rolling up their sleeves. Now, he says, the focus is increasingly on gaining access to the vaccine -- and questioning why those most in need aren’t always at the front of the line. “The issue now is accessibility,” he says. “It’s disheartening to see how the vaccine is being disseminated and the talk of ‘future plans’ that it will be available in the communities I serve…I can’t find those plans.” Williams, who recently got the COVID-19 vaccine himself, wants to remove any obstacles blocking community members from getting it too. At one of Montgomery’s early vaccination clinics, for instance, he manned the food pantry, doling out bags of groceries filled with beans, grits, and canned goods to residents.

Williams, however, is well aware that vaccines alone won’t end the crisis. Educating individuals about the importance of masks and social distancing remains critical, he says. “I have colleagues in the ministry who don’t believe mask wearing is necessary because God will protect them; there are people who have gone back to in-person worship services, singing in the choir without masks on,” he says.

“I try to have conversations on this when I can [but] some have questioned my faith. I say: ‘God gave me science and sense...I wear a seatbelt.’”

He says there remains so much misinformation, it’s difficult to cut through the noise. “It’s not like people don’t want to know,” he says. “They just want clear facts.” Williams is currently working on a series of COVID-related sermons, and he says the first might address vaccines: “God gave us instructions on how to live in our daily life, and in much the same way, mRNA vaccines give us instructions to fight the virus.”

No Word for “Vaccine”

Rhonda Thompson, director of Montgomery’s Nehemiah Center, which helps families living in poverty access essentials like food and other social supports, says communicating clearly about disease and health care is already fraught -- full of stigma and misinformation. Adding COVID-19 to the mix introduces even more obstacles. For instance, Thompson said, within the city’s Mixtec population, an Indigenous community of about 4,000 people from Mexico with their own subculture and language, there is not even a word for “vaccine.” “There’s so much fear and mistrust,” she says. “It’s concerning.”

Residents agree there’s a dire need for straight facts and myth-busting on why, say, the COVID-19 vaccine does not lead to sterilization in women, nor does it enter a person’s DNA. And it’s critical that these facts are delivered by “trusted messengers” – members of the community – and not just from government websites.

That’s why Montgomery city council member Oronde Mitchell says he’ll sign up for a COVID-19 vaccine appointment, even though he doesn’t even get a regular flu shot. What’s more, he says he’ll document the process on his Facebook page for everyone to see.  “I’m doing it for my dad,” he says, and for others in his multiple orbits: Mitchell also works as a truant officer in the schools and at a local funeral parlor. 

Subverting the Narrative

To address people’s fears about the vaccine, and also show its benefits, Mayor Reed has held a series of virtual gatherings with public health experts and community leaders, “There are understandably many questions about the vaccines and a lot of information—and misinformation—circulating,” said Reed, the city’s first Black mayor in its 200-year history. “In Alabama, we know all-too-well about the historical disparities and continued inequities in the health care system, especially among African-American communities. I am committed to providing truthful, transparent information to empower our residents with the knowledge to make informed decisions about their health.”

Informed decision-making was not an option for the enslaved women J. Marion Sims ruthlessly experimented on. But Michelle Browder, a social justice entrepreneur and local tour guide who also works with kids in underserved communities, is trying to subvert the narrative that elevated Sims to be “the father of gynecology.” Alongside artists and activists, Browder recently unveiled plans to honor three women subjected to Sims exploitation: Anarcha, Betsey, and Lucy will be memorialized as "the mothers of gynecology," with a 15-foot public monument in downtown Montgomery. The goal, Browder says, is to tell these women’s stories and “shine a light on ongoing racial disparities in the health care industry today.” 

Partners In Health staff have begun to receive COVID-19 vaccines. Starting in late January, staff members in Chiapas, Mexico, began receiving their first dose of the vaccine, the first step of many in the long journey back to a post-COVID world.

Vaccinations of Compañeros En Salud staff began on January 20, with a group of 20 health personnel receiving their first dose. This group included doctors, nurses, ambulance drivers, and janitors at Ángel Albino Corzo Community Hospital in Jaltenango, which Compañeros En Salud has supported for years. These staff members work at the Center for Respiratory Diseases, where the most severe COVID-19 cases are treated.

These vaccinations come as part of Mexico’s national vaccination plan. The country received its first shipment of vaccines—3,000 doses—on December 23, 2020. Mexico City and Saltillo were the first states to receive the vaccines, and Chiapas’s shipment arrived in late January, as the distribution routes expanded.

Compañeros En Salud has been providing quality medical services in Chiapas for 10 years. Its COVID-19 response has focused on training and supplying resources to clinicians in the hospital and clinics where it works, as well as providing education, personal protective equipment, and accompaniment to rural communities in the area.

In July, Compañeros En Salud partnered with Jaltenango’s community hospital to launch the Center of Respiratory Diseases, which has since helped hundreds of people recover from severe COVID-19.

The first group of Compañeros En Salud members to be vaccinated received their shots at 10 p.m.; they waited 30 minutes before returning home to make sure they had no side effects or discomfort. The rest of the health personnel at the center received their first dose in early February and they expect to receive their second dose in early March.

Compañeros En Salud knows first-hand from its work administering influenza vaccines from the Ministry of Health that a safe and effective vaccination campaign is key to ending outbreaks. Also crucial is ensuring fair and timely access to vaccines, as well as listening to communities historically marginalized and creating a vaccine distribution plan grounded in justice and equity.

Despite the global nature of COVID-19, not all countries have equal access to vaccines—while wealthy nations such as the U.S. bought up the bulk of the world’s supply, some low- and middle-income countries may not have access to vaccines until 2022 or later, in part due to patents and intellectual property law preventing more companies worldwide from mass-producing them.

In December, Partners In Health joined the global movement for a People’s Vaccine urging the Biden administration to ensure that vaccines are free and accessible to all people, worldwide, and to promote equitable vaccine distribution, prioritizing those most at-risk in the U.S. and globally.

For COVID-19 to be stopped, every village, city, and country must have access to lifesaving vaccines. But these vaccines aren’t being manufactured fast enough, despite the fact that drug companies around the world have the capacity to produce the billions of doses needed.

Standing in the way are the corporate monopolies held by a handful of U.S. drug-makers. But the United States government has the power to compel these companies to share the knowledge so desperately needed to ramp up global production. It would just take some political bravery to do so.

Unfortunately, business as usual is already costing lives. Wealthy countries have bought up the bulk of vaccine doses that have been produced so far. And as poorly as the vaccine rollout is going in wealthy countries, it is nearly nonexistent in middle- and low-income countries—as of January 18, only 25 total doses had been administered in one lowest-income country.

With the stroke of a pen, President Joseph R. Biden could break corporate monopolies, enable the sharing of know-how, and unlock vaccine manufacturing in the U.S. and around the world. Such an executive order would mandate that U.S. companies share vaccine technologies, while being compensated for each dose produced under license. And it would make these vaccine technologies available to drug-makers around the world through the World Health Organization’s COVID-19 Technology Access Pool.

Partners In Health is urging President Biden to take action, joining calls from global health leaders—including Dr. Anthony Fauci—and organizations around the world. The push comes as part of PIH’s ongoing advocacy for global, equitable vaccine distribution. In December, PIH joined the growing movement calling for a People’s Vaccine—a vaccine that is free and accessible to everyone.

Unlike many physicians, Dr. Joarly Lormil did not have a desire to become a doctor from a young age. In fact, he thought he would study engineering or economics because of his exceptional talents in math and physics. During university, he took some time to think about what he wanted to do, and he landed on medicine.

He stuck by this choice and went on to attend medical school at Université Notre Dame d'Haïti in the capital, Port-au-Prince. Initially unsure of his specialization, Lormil discovered his interest in oncology while participating in clinical rotations at Hôpital Universitaire de Mirebalais (HUM), a 350-bed teaching facility, home to one of Haiti’s largest medical residency programs and supported by Zanmi Lasante (ZL), Partners In Health’s sister organization in Haiti.

“I really liked it because it’s one of the departments where you can see your results,” he says. “When you succeed, even with palliative care, you make so much of a difference. It’s really life or death and I liked oncology because of that.”

As the end of his residency neared, a position opened in the oncology department. He filled it just one week after completing his residency in September 2017. Now, he’s the care coordinator in the department—a position he says is a 24/7 job, because time is of the essence, especially for patients undergoing chemotherapy.

“I knew from the beginning that to achieve a certain level of standard of care, to get as close as I could to that standard of care, ZL was the place to be,” says Lormil. “Of course there are a lot of challenges, but I think it’s a goal worth fighting for and it is achievable. My new position as care coordinator put me in a good spot to aim for that.”

HUM as it’s known locally, is one of the only facilities in Haiti that provides free cancer care and psychological support for adults—services that otherwise would be out of reach for families who live on less than $2 a day. Demand for cancer care remained steady throughout 2020, Lormil says, despite ongoing political unrest in the country and fears of contracting COVID-19. From January through July 2020 alone, more than 200 patients were in cancer care each month and attended to by Lormil and three other physicians, seven members of the nursing team, and four members of the psycho-social team.

Lormil wasn’t surprised by his department’s steady flow of patients: “The demand is so disproportionate compared to the care offered in the country that we will always find patients seeking care here.”

“There Is Care Available”

One of the patients Lormil examined during his first month as an attending physician in October 2017 was a young woman with advanced stage 4 breast cancer that had spread to her bones and liver. He was shocked to learn the mother of three was only 29—just a few months older than he was.

“It was sad to see a person my age, who I had so much in common with, diagnosed with cancer,” says Lormil. “What was even sadder is that she felt she needed to go to another country to get care and it did not go well.”

The woman originally underwent surgery at HUM, then chose to go elsewhere for follow-up care. A couple months later, she returned in worse condition and was confined to a wheelchair.

“It was really moving that she came back. We managed to give her good care with the expertise of our cancer partners and she improved,” says Lormil.

She was no longer in a wheelchair and was overall more active and happier. “I want to get the word out there that there is care available in Haiti,” says Lormil. “We are here and we are doing something.”

When the woman passed away in 2020, Lormil found himself thinking about the what ifs. Perhaps if she sought out their care earlier, she would still be alive today, he wonders.

Growing to Meet Demand

Like that young mother, approximately 80 percent of patients Lormil and his team care for have breast cancer. The remaining patients have gastrointestinal cancers, chronic myeloid leukemia, and gynecological cancers, including cervical cancer. Typically, the team sees between 25 to 30 patients per day, but that number is steadily increasing.

In 2013, the oncology team conducted 843 consultations. Within six years, that number had tripled, and it became clear the department required more space for patient care and consultations. In April 2018, the oncology team moved to a newly renovated space on hospital grounds, the Roselene Jean Bosquet Center, named after one of the first cancer patient ZL clinicians cared for in Haiti.   

Lormil predicts the number of oncology patients will rise even more, as the team continues to improve their skills through training, increased opportunities for cancer screenings at the hospital, mobile clinics and other patient centered programs, as more people become aware of the care available at HUM. And yet, he acknowledges how far they have come.

“It’s rewarding when you forget about a patient because they need to come less frequently, say every six months. Then, when they come, they’re cancer-free,” says Lormil. “After three years, it’s starting to happen to me a lot. I see patients that I took care of in 2018 who are now healthy and happy.”

When Vania Lariza Vargas took her mother to the clinic for an appointment, she wasn’t thinking about her own health. It wasn’t until a community health worker approached her and struck up a conversation about the importance of detecting breast cancer early that she decided to sign up for a free screening from Socios En Salud, as Partners In Health is known in Peru.

First came a check-up with an obstetrician. Then, a mammogram at the local hospital. That’s when Vargas found out she would need a biopsy.

“In that moment, I felt very worried, but I knew it was necessary to continue,” she says.

The diagnosis came fifteen days later: breast cysts. It came as a surprise to Vargas, but the obstetrician urged her not to worry. She was given information about breast cancer, taught how to perform a self-exam, and advised to return in six months for a follow-up mammogram, helping her find some relief amid the confusion. And a community health worker accompanied her throughout the process, offering guidance and support.

“Now I feel very good,” says the 51-year-old. “Much calmer.”

Vargas is one of 700 women who have received breast cancer screenings through Socios En Salud’s ALMA program. Since August 2020, the program has provided screenings, treatment, and care to women over 40 years old in Carabayllo, a community 20 miles north of Lima. And that care has continued amid the pandemic, even as Peru’s hospitals have been forced to prioritize COVID-19 patients, creating additional hurdles for patients in need of lab tests and complex care only available at a hospital.

Breast cancer is the most common cancer in women worldwide. Among Peruvian women, it is the third cause of cancer death. But care in communities like Carabayllo and Comas, impoverished by systemic injustice, can be hard to come by. That’s why Socios En Salud, after responding to an outbreak of multidrug-resistant tuberculosis (MDR-TB) in 1994, has since deepened its partnership with Peru’s Ministry of Health and strengthened Carabayllo’s health system.

That vital work continues with the ALMA program. ALMA uses flyers, canvassing, and a chatbot app to extend clinicians’ reach beyond people who usually set foot in a clinic. Women of all backgrounds—from stay-at-home mothers to fruit sellers at the market—can download the app onto their phones and access health services.

The steps are simple. The chatbot, operated by medical staff, asks the women a series of basic questions to screen for breast cancer signs and symptoms. Then, as needed, the chatbot helps them schedule a check-up at the nearest health center, where they can receive medical advice and referrals. While virtual, these message exchanges are crucial to connecting women with breast cancer care and treatment, especially during COVID-19.

“Breast cancer is often a silent enemy,” says Dr. Giuliana Hernandez, an obstetrician with Socios En Salud who directs the ALMA program. “That’s why prevention is essential for early detection.”

Even if they aren’t currently experiencing breast discomfort or injury, women must understand the signs and symptoms to watch for—and how to get help.

“It is important to do a breast self-exam once a month, as well as have a mammogram performed annually, so that we can detect any type of abnormality in time,” says Dr. Yesenia Juárez, an obstetrician at the Santa Luzmila II Maternal and Child Health Center.

In addition to treatment and care, the ALMA program seeks to educate the community and fight the stigma and misinformation around breast cancer. Women like Vargas, who sought help and developed a treatment and care plan, are key to engaging patients, families, and communities in difficult but important conversations around breast health.

As hard as it has been, the process has made Vargas an advocate. Nowadays, she urges women in her community to seek care early—not just when they feel pain or discomfort.

“It is in our hands to detect breast cancer early. Always keep in mind that without health, you have nothing,” she says. “I have grandchildren and I want to see them grow up. I want to visit them and hug them again—to enjoy them for much more time to come.”

A bus stop. A park bench. A subway car. For the unhoused, shelter is found in many places—but safety remains elusive.

“The lives of homeless people are incredibly public,” says Dr. Evan Lyon, a senior technical advisor with PIH’s U.S. Public Health Accompaniment Unit. “To be homeless means you’re circulating a lot. You have to go from this place to that place. Maybe panhandle, maybe go to the library, maybe sleep on a train overnight.”

That puts people experiencing homelessness at greater risk of suffering from a range of physical and mental health conditions—including COVID-19.

Homelessness and housing insecurity—from living with family and friends to evictions to vehicle residency—put the health of individuals, families, and communities in danger. Evictions alone caused more than 433,700 infections and 10,700 deaths from COVID-19 in the United States between March and September 2020.

Partners In Health believes that housing is essential for health. For more than 30 years, PIH has connected patients around the world with housing support. That work reflects PIH’s core belief that medical care alone is insufficient; patients must also have access to resources such as food, water, and housing, often referred to as social support, in order to recover and sustain their health.

As the pandemic intensified, PIH launched the US Public Health Accompaniment Unit (USPHAU) in April 2020 to strengthen public health systems across the country. The unit advises states, cities and communities as they develop a COVID-19 response that tackles the root causes of health inequities, strengthening these systems in response to the pandemic and for years to come.

The Housing Crisis: A Public Health Issue

The housing crisis in the U.S.—a country built on land stolen from Indigenous people—has been brewing for centuries. State-sanctioned racial violence—from genocide to slavery to segregation—displaced Indigenous and Black communities and created the conditions for the housing inequities that exist today.

Decades of racist housing policies—including redlining, racial restrictive covenants in deeds, and federal subsidies that ensured the suburbs would be white-only—segregated communities of color in impoverished neighborhoods. Today, people of color are less likely to own homes and more likely to rent. According to U.S. Census housing data, 58% of Black households and 54% of Hispanic households are renters, compared to 28% of white households. And people of color are more likely than white renters to be low-income renters.

As rents have soared in recent years, outpacing wage growth and making cities less affordable, people of color have borne the brunt of the housing crisis. Evictions disproportionately occur in communities of color, especially among working-class women of color, mothers, and domestic violence survivors. And Black, Indigenous, and Latinx people account for nearly 65% of the country’s homeless population.

Now, as COVID-19 surges, the housing crisis and its threat to public health have intensified: millions of Americans could lose their homes as they face financial challenges during a deadly and economy-crippling pandemic.

The Politics of Shelter

PIH has connected patients with housing support for decades, grounded by its mission to tackle the root causes of health inequities. That vital work has continued during COVID-19, especially in the U.S. From Massachusetts to Florida, PIH connects COVID-19 patients and their families with the resources needed to quarantine safely—support that often includes rental assistance.

More than 5 million Americans fear eviction or foreclosure in early 2021, despite the federal eviction moratorium and patchwork of state and local moratoriums in place. As many as 40 million were at risk when the federal eviction moratorium was set to expire at the end of 2020. It has since been extended through March.

“Getting evicted is intensely traumatizing and fast-paced and horrible,” says Lyon, who has worked on housing issues for years. “It’s not like people have plans.”

After losing their homes, people must seek shelter with those outside of their household or end up on the street. And living in cramped quarters—whether with relatives or in a shelter—makes social distancing and quarantine nearly impossible.

USPHAU partners with public health departments and community organizations across the country who provide rental assistance. The team advises policymakers as they develop social support programs and, in some jurisdictions, helps hire and train community health workers to connect residents with these resources.

While rental assistance programs vary in their scale and efficiency, they can be a lifeline for tenants, many of whom already have months of back rent accrued. Americans collectively owe an estimated $70 billion in back rent. When the eviction moratoriums lift, this rental debt will have to be paid, unless it is forgiven—a reality that could cost millions of renters their homes if no legislative action is taken.

In addition to streamlining rental assistance, PIH has supported homeless shelters, community organizations, and state and local governments to provide housing relief to communities hardest-hit.

In Navajo Nation, PIH and its sister organization Community Outreach and Patient Empowerment (COPE) helped resource a local homeless shelter and partnered with hotels to provide safe quarantine and isolation spaces for people impacted by COVID-19.

Patricia Bitsue, an executive assistant at COPE, delivered resources—including gloves, masks, sanitizer, and food—to St. Joseph’s Homeless Shelter and Soup Kitchen, which she estimates serves meals to about 60 to 80 individuals per day and houses up to 20 men at night. COPE was able to assist the shelter in the early days of the pandemic.

As part of its COVID-19 safety measures, the shelter conducted temperature checks, hosted a mobile testing site once a month, reduced its overnight capacity, and required people to stay six feet apart. People came from various tribes; the youngest was around 18 and the oldest 86.

“At first, they didn’t trust me. They didn’t want to talk to me because I was new,” says Bitsue. “But after they found out I could speak Navajo, they started to open up to me.”

She recalls one woman who came to the shelter for dinner and lived in a nearby encampment with her partner. “They were very close—always together and never, ever without each other,” she says. “Then he got COVID and passed away, and she was just lost. She was so distraught that she didn’t want to live.”

There was another complication: the woman had also tested positive for the virus.

A Social And Economic Sickness

People experiencing homelessness have long been disproportionately affected by a range of physical and mental health conditions. Hypertension affects 29% of the housed population in the U.S., but 50% of the unhoused population. Similarly, diabetes affects 9% of the housed population, but 18% of the unhoused population. And life expectancy for people experiencing homelessness is 12 years shorter than those who are housed.

“The things that make people sick are social and economic conditions,” says Lyon.

Those conditions include a lack of access to medical care, inability to shelter from extreme heat and cold, and the byzantine web of social service programs that unhoused people must navigate simply to survive. And such conditions have only intensified during the pandemic, as the public spaces and congregate settings that mark daily life for unhoused people become potential hotbeds of disease. While some shelters provide testing and spaces for quarantine, it is far from a guarantee. And contact tracing is an uphill battle, if not impossible.

Lyon recalls an unhoused man in Chicago who felt sick and went to the emergency room to get a test. His result took three days to come back: positive. During that three-day period, he had slept on the train each night, visited the library each day to charge his phone, and went to three different social support programs for food.

“Three nights on the train with illness is incredibly risky,” says Lyon. “And this is a guy who did everything right.”

Even before COVID-19, shelters were overcrowded. In 2019, there were only 389,549 shelter beds for some 568,000 unhoused people, according to HUD. Now, with new safety protocols such as social distancing, shelters easily hit maximum capacity and have to turn people away— including those who test positive.

As shelters are overwhelmed, cities are finding new ways to support COVID-19 positive cases among the unhoused. Since September, USPHAU has partnered with public officials in Montgomery, Ala., to launch a citywide Crisis Center, which will open in mid-February, for individuals experiencing homelessness.

The Crisis Center, located in a former middle school, is outfitted with 96 beds, quarantine and isolation spaces, a mobile testing unit, and case management services. The center operates based on referrals from shelters, social service agencies, and health care providers in the area.

“The Crisis Center is designed to support the unhoused with safety and dignity as they face COVID-19,” says Grace Lesser, senior project lead with USPHAU. “It also aims to take the burden off of the existing shelter system.”

The USPHAU team also designed a 2-day training for Crisis Center staff on a range of topics related to COVID-19 transmission and prevention—a resource that will be made available to city employees and homeless shelter staff.

In addition to the Crisis Center, USPHAU is supporting the development of a community health worker program and social support fund in Montgomery. Similar to PIH’s programs around the world, the CHW program will hire workers from the local community and dispatch them to the city’s hardest-hit neighborhoods to educate residents about COVID-19 and connect them with resources, including rental assistance.

And the new social support fund will provide financial relief, including housing support, to residents across the city, especially targeting those who may not qualify for existing relief programs.

“Really critical to this project is uplifting housing as a part of public health,” says Lesser. “Housing is a key part of ensuring that community members are stable and safe during this pandemic, and always.”

As it responds to homelessness and housing insecurity, PIH continues to weave social support into the fabric of its public health response, tackling the root causes of health inequities—realities that predated COVID-19 and will continue after the pandemic, unless systems of oppression are dismantled and historic injustices redressed. It would cost about $20 billion to end homelessness in the U.S. by a HUD official’s estimate—small change compared to the $741 billion the U.S. government recently allotted for military spending.

In Navajo Nation, Bitsue finds some relief in that the woman who lost her partner to COVID-19 was able to recover, as she was supported by COPE and partners. But the future remains uncertain.

“I see her, every now and then, out on the streets still,” Bitsue says. “Sometimes I’m able to stop and give her some water or snacks that I have in the car. It’s just really heartbreaking.”

Across the United States, COVID-19 is running rampant in prisons, jails, and detention centers, putting millions of incarcerated people, families, and communities at risk.

The COVID-19 crisis in America’s prisons disproportionately affects Black, Indigenous, and Latinx communities due to decades of mass incarceration—a systemic injustice that is directly linked to the genocide, slavery, and structural racism that has marked the U.S. for centuries.

And COVID-19 outbreaks in prisons and jails put all communities at risk, not just those behind bars—an outbreak in Chicago’s Cook County Jail, for example, was later linked to nearly 16% of all statewide cases in Illinois.

In response, a growing list of health organizations, including the American Public Health Association, have called for decarceration as a necessary step to protect public health. Partners In Health is joining these calls with the publication of a white paper urging governments across the U.S. to release as many people as possible to stop the spread of COVID-19 and end the violation of human rights.

PIH’s paper, “Decarceration: Seeking Justice In The Era of COVID-19,” argues that decarceration is a public health imperative and provides practical recommendations for implementation.

“Basically, it lays out the argument for why nothing short of decarceration will actually mitigate the spread of COVID-19,” says Bram Wispelwey, a co-author of the paper and senior project lead with PIH’s U.S. Public Health Accompaniment Unit, which launched in May to provide technical advising and free resources to communities battling the COVID-19 pandemic.

While the paper focuses on the U.S., it comes as the latest chapter in PIH’s history of advocating for the health, human dignity, and rights of incarcerated people worldwide— from Lima, Peru to Tomsk, Russia.

Mass Incarceration: A Public Health Crisis

The U.S. leads the world in incarceration, imprisoning 2.2 million people—more than any of its peers. Over the last 40 years, the U.S. prison population increased by 500% due to changes in law and policy that sent an unprecedented number of people to prison.

Mass incarceration in the U.S. has disproportionately impacted Black, Indigenous, and Latinx communities due to centuries of systemic racism in the criminal justice system, which was developed when chattel slavery was legal.

“We incarcerate vastly more than any other country on earth,” Wispelwey says. “And there’s a direct legacy when you think about structural racism from slavery right up to the present, in terms of the injustice of the criminal justice system for Black and brown Americans.”

Years before COVID-19, the U.S. carceral system had all the makings of a public health crisis—including overcrowding, unsafe labor conditions, and a lack of quality health care. According to the Equal Justice Initiative, U.S. prisons have damaged incarcerated people’s physical and mental health by failing to protect them from violence, denying them access to mental health treatment, and tolerating abuse by correctional staff.

PIH knows from its experience working in prisons in Peru, Haiti, and Russia that incarcerated people routinely face risks to their health, without adequate care and support.

“Even under the best conditions, it would be hard to contain an airborne infection in a carceral setting,” says Justin Mendoza, PIH’s U.S. advocacy manager. “We know that from tuberculosis, which of course is a very, very different disease than COVID-19…but it’s the same set of issues.”

The Silent Pandemic: COVID-19 Behind Bars

During the pandemic, prison populations have been among the hardest hit. Cramped in tight quarters and unable to practice social distancing, incarcerated people face a high risk of exposure—with little to no institutional protection.

“Folks who are in prisons and jails have no freedom or ability to isolate or quarantine on their own. And then that makes it very, very hard to stop the chain of transmission for COVID-19,” Mendoza says.

Nationwide, at least 355,957 prisoners have tested positive for COVID-19 and 2,232 have died, according to The Marshall Project. Among people in prison, the incidence of the virus’ spread is 5.5 times higher than in the U.S. generally. Among those in U.S. Immigration and Customs Enforcement (ICE) detention facilities, that number is up to 13 times higher.

Although the Centers for Disease Control and Prevention (CDC) has released COVID-19 guidance for correctional and detention facilities, these rules cannot be followed due to overcrowding caused by mass incarceration in prisons and jails. Many prisons and jails don’t require correctional officers to wear masks. And many fail to provide incarcerated people with an adequate supply of masks, soap, and sanitizer to prevent infection.

Regulations regarding COVID-19 testing within facilities are highly variable and inadequate, varying vastly with each state’s guidelines. In October, PIH endorsed legislation introduced by Senator Elizabeth Warren (D-Mass.) and Senator Cory Booker (D-N.J.) that would require weekly COVID-19 testing, data collection, and prevention standards in federal prisons across the U.S., but this has yet to be enacted.

When an incarcerated person becomes infected with COVID-19 and must isolate, as required by CDC guidelines, prisons often put them in solitary confinement—a cruel and inhumane practice that has been condemned by human rights organizations and that essentially punishes them for becoming sick.

The Case for Decarceration

PIH’s white paper makes two key recommendations: reduce the number of arrests and release as many incarcerated people as possible.

“The first step, the most important step, both from a public health perspective and from a justice perspective, is decarceration,” says Wispelwey, who developed the paper as part of PIH’s internal Anti-Detention Working Group. “To divert people away from jails and prisons, who would otherwise be on their way there, and to release as many people as possible.”

The paper calls attention to the tens of thousands of people imprisoned on technicalities. Nationwide, 45% of state prison admissions last year were due to violations of probation or parole, and technical violations alone accounted for 25% of prison admissions. Also behind bars are nearly half a million people detained pre-trial—meaning, they are legally innocent and incarcerated simply because they can’t afford to post bail. In just one example across the nation, a team of researchers at the University of Texas at Austin found  that 80% of those who died of COVID-19 in that state’s county jails were never convicted of a crime.

To divert people away from prisons, the paper proposes a series of measures, including imposing a moratorium on incarceration for nonviolent crimes, reducing or eliminating cash bail, suspending all immigration detention except in extraordinary circumstances, and calling on judges and prosecutors to recommend against pretrial detention.

For the millions of people currently imprisoned, the paper calls for the release of as many people as possible – with priority given to those at high risk for COVID-19.

To implement this, the paper recommends establishing transparent and racially equitable release programs and revising policies to allow for sentence reductions and early release, among other measures.

Once people are released and re-enter society, the paper says, it is crucial that they receive social support and medical care, including routine COVID-19 testing, housing support, and access to public benefits typically denied to formerly incarcerated people.

Protecting Public Health

For decarceration to be an effective strategy, the paper argues, it is critical for as many people as possible to be released. Prisons and jails are hotbeds for COVID-19 outbreaks, and these outbreaks put all communities at risk.

Community spread from infections in jails could contribute to between 99,000 and 188,000 deaths in the U.S. population, according to a study from the American Civil Liberties Union.

Further, the authors note, it is crucial that incarcerated people are prioritized for a vaccine option—a policy that the American Medical Association and other health organizations have backed as a necessary measure to stop the spread of COVID-19 and protect public health.

The paper notes that decarceration has already been put into practice in several states. Oregon and Kentucky revised their furlough commutation practices to reduce their prison populations. And New Jersey passed a bill that reduced sentences and released more than 2,000 prisoners to slow the spread of COVID-19.

According to the Prison Policy Initiative, large-scale releases have been common throughout U.S. history, and the places where these releases happened did not become hotbeds of crime—in fact, the opposite often occurred. The American Civil Liberties Union (ACLU) found in a study that crime was lower in nearly every location where decarceration measures took place between February and April 2020. The study found no evidence of any spikes in crime in the 29 locations examined.

For years, PIH has advocated against the social forces and policies that result in the incarceration of the poor and marginalized—from Russia to Peru to the United States. Care, support, rehabilitation, and decarceration are needed, says Dr. Joia Mukherjee, PIH’s chief medical officer, to repair harms caused by unnecessary and overbroad incarceration.

“In the U.S., home to the largest number of incarcerated people in the world, we know that the legacy of enslavement of Black people, genocide of Native peoples, and denigrating migrants is embodied in who we imprison as a society,” Mukherjee says. “COVID-19 has only added to deplorable conditions in American prisons, jails, and detention centers. Decarceration and reparations are central to our pursuit of justice and equity in the U.S."

For Wispelwey, advocacy around decarceration taps into the heart of PIH’s mission: providing a preferential option for the poor, vulnerable, and oppressed.

“This is a justice issue and it’s a health issue,” he says. “At PIH, we have a special lens and an opportunity, hopefully, to make an impact.”

A key element of U.S. President Joseph R. Biden’s American Rescue Plan is a call for a new public health jobs corps that would address two overlapping national crises: the deadly COVID-19 pandemic and the enduring economic downturn.

The plan’s announcement comes after a decade of policy choices that have vastly decreased the nation’s public health workforce, which has lost at least 38,000 public health jobs while state and local budgets have been slashed by 16 and 18 percent, respectively, since 2010. With limited staffing and funding, state and local authorities have struggled since early last year to keep apace of testing, contact tracing, and support of COVID-19 patients and their contacts.

Now, those same strapped governments are being asked to execute complex vaccination campaigns in the midst of the country’s worst-case surge.

In short, reinforcements can’t come soon enough.

With these realities in mind, Partners In Health is building a campaign with key partners to advocate for the U.S. government to build a larger workforce to help stop COVID-19, strengthen the economy, and build equitable public health systems across the nation.

This work is part of larger efforts led by PIH’s US Public Health Accompaniment Unit, which provides technical expertise, training, and learning opportunities to state and local governments to support effective testing, contact tracing, quarantine, and social services for COVID-19 patients and their contacts.

We spoke with PIH’s U.S. advocacy manager, Justin Mendoza, to learn more about the jobs corps proposal, including why it’s crucial for curbing the pandemic and how it builds on ideas already circulating in the new White House and Congress.   

Why do we need a new public health jobs corps now?

To address the COVID-19 pandemic and combat ongoing and future public health catastrophes, we urgently need a new public health jobs corps. Federally funded and locally managed, we think it should create 1.6 million permanent, quality jobs across the United States, build a healthier and more equitable future for all Americans, and ensure that Black and brown communities can thrive. 

What is the genesis of this plan?

The uncontrolled COVID-19 pandemic is entering a new and more dangerous phase, particularly for Black, Latinx, immigrant, and Indigenous communities, and for people who are older and living in institutional settings that the pandemic has disproportionately affected. Our support structures and initial vaccination efforts are inadequate. We need urgent action to curb the pandemic, boost the economy, and address the underlying causes of economic and health inequity resulting from hollowed-out caregiving and public health infrastructure.

The U.S. has faced record-breaking unemployment over the last year due to the pandemic. In January 2021, this has meant that 10.7 million eligible workers are unemployed. Americans across the political spectrum recognize the urgent need for a major new public health jobs corps to fight COVID-19, with 75% of likely voters, including 61% of Republicans, supporting the creation of such a program.

We firmly believe that this jobs corps should focus on building the community health worker (CHW) workforce in the U.S. 

From rural Rwanda to North Carolina, CHWs are the frontline of a strong primary care system, accompanying patients, helping manage care, and coordinating with health centers and hospitals.

We believe that a strong, national investment in these roles not only would provide more local jobs and strengthen communities, but also would help strengthen the U.S. health care system for people all over the country.

Who is behind this effort?

PIH and a coalition of labor experts and unions, public health experts, medical professionals, and advocates are calling for the creation of a public health jobs corps to create 1.6 million permanent public health jobs, including 540,000 permanent community health worker positions, to address health disparities and rebuild our capacity to address current and future crises.

A systemic investment in jobs focused on the health of historically marginalized communities will address the immediate urgency of the COVID-19 pandemic, improve economic and health outcomes, and dismantle the structural and social factors that drive health inequity.

Many of these jobs can be created immediately, and all of them fully staffed by 2024.

What are the specific jobs the coalition is calling for?

We envision a jobs corps that would encompass a variety of specialties, from public health positions and social workers to school-based roles and legal aids. Here’s a breakdown of the 1.6 million proposed new jobs:

• 640,000 community-based jobs, including a short-term COVID-19 response workforce of 100,000 contact tracers, case investigators, and care coordinators, and long-term, a permanent cadre of community health workers who are focused on vaccine outreach and mobilization, health accompaniment and peer education, resource navigation, and advocacy;
• 250,000 state and local public health agency workers to build public health infrastructure and address ongoing health crises such as the opioid epidemic, the obesity epidemic, and environmental drivers of sickness;
• 611,000 school-based care workers (school nurses, counselors, psychologists, social workers, nutrition staff, and more) to support reopening and address the impact of COVID-19 on schools, and to provide all children with access to vital mental, physical, and emotional support;
• 100,000 social workers and legal aid support staff to help people access critical support services, such as affordable housing.

Aren’t Congress and the White House considering a public health jobs plan?

Biden is calling for an immediate 100,000-person Public Health Jobs Corps, along with significant spending on COVID-19 vaccine rollout and support for state and local health departments and schools. Each of those priorities aligns well with the priorities of PIH and its jobs corps partners, and starts to build the type of infrastructure needed to update the U.S. public health system.

Our plan, though, goes further: Public Health Jobs Now calls for school-based care jobs that are essential for school openings, legal support and social work to address social determinants of health, and jobs that will build back the public health infrastructure that has waned over the past few decades.  

Who will fill these jobs?

Hiring should complement and add to the current public sector workforce, and should prioritize individuals from low-income communities, communities of color, LGBTQ, and immigrant populations. It also should include people with disabilities and emphasize high-need regions, such as rural communities and communities facing barriers to employment. Recently laid-off public workers should have a right to recall for these positions.

Jobs corps members must be paid living wages and benefits, given the right to organize and a pathway to joining a union, and provided the right to a safe workplace. Jobs should feature training, pathways for advancement, and access to wrap-around support services—such as child care and flexible scheduling—that will enable workers stressed by pandemic caregiving needs to serve in these jobs.

Who’s paying for it?

The jobs corps should be federally funded, but implemented locally to align with community priorities and needs. Funding should be allocated based on population and health disparities, with funds disbursed through local planning bodies. Funds for the jobs corps should be a sustainable and ongoing, including dedicated annual appropriations from Congress via incorporation into public health funding, Medicaid, or other standing federal programs.

What can the general public do to promote or support this plan?

The first thing people can do is contact their members of Congress to express support for this legislation and share more about this idea. When our political leaders hear a call not only for an equitable response to COVID-19, but also for the creation of jobs and a boost to our economy, there’s no limit to what can be done. Join our campaign to help fight the pandemic and get the U.S. economy back on its feet.

As 2020 drew to a close, we asked our staff around the world one question: what would justice in health care look like to you?

From Peru to Malawi, our colleagues reflected on this question and shared their insights, drawn from both professional expertise and lived experience—99% of our staff are from the country where they work.

Our colleagues' responses wove together themes that are integral to PIH's work, such as eliminating disparities in care delivery, providing culturally relevant care, and delivering quality care to patients most at-risk due to systemic injustice.

While their answers varied, all of our colleagues, in their own ways, captured the heart of PIH's mission: to provide a preferential option for the poor.

When COVID-19 arrived in Mexico in late February last year, clinicians in Chiapas held their breath. The pandemic would not arrive in the southwestern state until March and, even then, would remain in the single digits for weeks. But doctors knew the worst was coming—it was only a matter of time.

“It took so long for the pandemic to reach Jaltenango,” says Dr. Selene Chacón of Compañeros En Salud, as Partners In Health is known locally. Chacón is based at the community hospital in Jaltenango de la Paz.

When the virus did arrive, it would leave no community unaffected. In late March, cases jumped from single to double digits, passing the 1,000 mark in May. By June, the surge had begun; Chiapas joined the rest of the country at the maximum “red light” level on the Mexican Ministry of Health’s stoplight map.

Compañeros En Salud has worked since 2011 in Chiapas, where it has focused on strengthening health systems in Jaltenango and surrounding rural communities. That work has included a mentorship program for first-year clinicians, a community health worker program, and support for the public health system, including a community hospital, a birthing center, and rural primary care clinics.

From the moment it arrived, COVID-19 put that system to the test—challenging doctors, nurses and care delivery teams to think quickly on their feet and improvise when necessary, in response to a pandemic that often showed little sign of relenting.

As cases ticked upwards, clinicians delivered critical treatment at all hours of day and night, tending to patients as they recovered, or as they took their last breath.

That care has made an impact. Although cases are ticking upwards, as expected following the holidays, clinicians are better prepared. The mortality rate in Chiapas has steadily declined since August. And the state was no longer “red” on the stoplight map, as of mid-January.

Now, as the fight against COVID-19 continues, clinicians are leveraging their expertise and experience to respond with compassionate care, applying lessons learned over the past several months. That work has made one thing clear: investing in public health systems is crucial—for the pandemic response and beyond.

A Race To Respond

When Selene Chacón finished medical school, she took a leap of faith and decided to do her year of social service, required by the Mexican government for all university graduates, with Compañeros En Salud through its pasante program.

The program, designed for first-year doctors and nurses, placed Chacón in a rural community clinic, where she provided primary care and received training and mentorship from experienced physicians. Chacón was so moved that, after the program ended, the newly minted doctor decided to continue her work with Compañeros En Salud.

Then, COVID-19 struck.

What followed was a race to respond to a public health emergency that intensified by the day. As COVID-19 cases mounted in Chiapas, clinicians scrambled for resources that were scarce, including tests, and struggled to keep up with rapidly evolving public health guidance.

“There was not much information at the time or guidelines on how to treat patients,” says Dr. Ana Rodríguez, who supervises the COVID-19 medical team at PIH-supported Angel Albino Corzo Community Hospital. “The protocols were based on very new information.”

But that didn’t stop clinicians. In her new role as infection and control coordinator, Chacón sprang into action, working with her team to establish a triage system at the hospital and to coordinate the pandemic response across all of Compañeros En Salud’s care delivery sites. And Rodríguez, based in the community hospital’s COVID-19 unit, treated patients, trained doctors, and managed care delivery.

None of those things were small feats.

Mexico provides universal health care to citizens, but that care can be hard to access in states like Chiapas, where the majority of people live in poverty, and in rural areas, where travel can be cumbersome and costly, often on poorly paved roads. For many rural communities, the nearest hospital is hours away.

‘We Are In This Together’

Despite the initial hurdles, Compañeros En Salud has delivered care to an increasing number of patients over the past several months as resources, staffing and capacity have improved. Since April, the team has treated at least 526 suspected and 16 confirmed cases at the community hospital and clinics.

In July, Compañeros En Salud partnered with Angel Albino Corzo Community Hospital to open the Respiratory Disease Center, a 5-bed facility equipped with oxygen concentrators to treat patients with severe COVID-19—care that once would have required a long, costly journey to another hospital at least two hours away. Within weeks, the center saw its first patients and helped them recover and return home to their families.

Compañeros En Salud also worked with hospital leadership to introduce a new policy that allows family members to visit their loved ones with personal protective equipment—the only hospital in the area that offers such visitation. That decision has been crucial in helping patients recover and fighting the disinformation about the virus that once ran rampant, encouraging more people to seek medical care.

“Patients now have more information and less stigma,” says Rodríguez.

She has seen that shift first-hand. Nowadays, patients come to the hospital early on, when their symptoms are still mild, instead of waiting until they worsen—a sign that gives clinicians hope that communities now have a better understanding of the virus and when to seek care.

“At Compañeros En Salud, we are already more prepared,” says Chacón. “We already have experience, and this is a strength.”

Still, the doctor urges caution. “We cannot lower our guard,” she says. “There will still be peaks…people must know that we are still here and we are in this together.”

It was a typical morning for Gretta Joseph, deputy chief nursing officer at University Hospital of Mirebalais in Haiti. She was still at home, going through her work email and getting a sense of her schedule for the day at the hospital, when she noticed the congratulatory message informing her she had been accepted to Partners In Health’s Global Nurse Executive Fellowship.

She let out a celebratory scream, alarming her husband who rushed into the room. Soon he was joining her celebration; he knew how much she had wanted this.

Joseph is among ten nurse leaders, from six countries, in the second cohort of the fellowship program, which launched in 2017. The program seeks to fill a void of support for nurses in senior or executive leadership roles, who are often placed in their positions without being provided the necessary tools, skills, or support  to be successful. 

Fellows were selected last fall and began the program in October 2020. The yearlong program includes three, weeklong intensive bootcamps, a yearlong executive style curriculum, and a capstone project which seeks to improve patient outcomes and care delivery.

“The Global Nurse Executive Fellowship provides a foundation for clinical hospital and organizational management with a progressive development of critical analysis, health information system strengthening, and health system performance monitoring, evaluation, and supervision,” says Marc Julmisse, PIH’s deputy chief nursing officer.

Joseph and two other Haitian nurse leaders, Thamar Julmiste and Abdonie Laguerre, were selected for the fellowship and currently work at University Hospital in Mirebalais, a 350-bed teaching facility that was largely built in response to the 2010 earthquake.

All said, nursing is deeply rooted in their identity and they feel it is their personal missions to take care of their community. To them, nurses are the pillars of the health care system in Haiti. Through the fellowship, they hope to be a voice advocating for all nurses in Haitian society.

A True Calling

Nursing had been a surprise twist in Joseph’s career path. Originally, she had planned to become an agronomist. An avid nature lover, she participated as a teen and young adult in reforestation initiatives in her hometown of Cap-Haitian, a northern coastal city where the coconut trees she helped plant on the main boulevard are still standing today.

However, a short stay at the hospital when she was 18 helped Joseph discover nursing as her true calling. She went in for a biopsy and was terrified. “Thankfully my aunt worked as a nurse in this particular hospital and did everything to make me feel at ease,” she recalled.

Joseph assumed she was given preferential treatment because of her family connections. But she soon noticed that all the nurses were going above and beyond with other patients. “They were tirelessly going from patient to parent and cared for them with the same commitment and empathy I had experienced,” she said. “I was impressed by what I was seeing.”

Having found her path, Joseph shifted her focus from preparing to enter agronomy school and enrolled in a nursing program. She graduated in 2003 and went on to work with various hospitals and institutions, later specializing in anesthesiology. In 2009 she joined Zanmi Lasante, PIH’s sister organization in Haiti, and began working as a nurse anesthetist at Hôpital Saint Nicolas in the city of Saint-Marc. She eventually transitioned to University Hospital in 2013.

“As a Haitian nurse, I was thrilled to be working in an environment that promoted growth and improvement and encouraged teamwork amongst its staff,” Joseph said.

Working her way up, Joseph went on to become supervisor and head nurse of the Post Anesthesia Care Unit in 2015. She kept that position for the next five years, handling day-to-day operations in support of the operating room nurse manager and training new nurses in her specialty along the way. She finds sharing her knowledge with the next generation of young nurses one of the most rewarding experiences of her career.

In September 2020, Joseph was named deputy chief nursing officer at University Hospital, a role she understandably does not take lightly.  She believes the fellowship will help her improve her clinical and leadership skills and empower her to better serve her community.

Joseph, who is also the training manager of Zanmi Lasante’s Nursing Center of Excellence, said nursing is often devalued in Haiti, seen as the recourse for young women who don’t know what to do with their lives. She vehemently rejects this narrative.

“Through my role as deputy CNO and with the skills I will acquire from the fellowship,” said Joseph, “I want to change that perception and be a leading voice, advocating for better training for Haitian nurses.”

Rising Nurse Mentor

Thamar Julmiste specifically chose a career in nursing to care for the poorest in Haiti. As a recent graduate of nursing school, she was on the frontlines of the January 2010 earthquake response with other Haitian nurses as they mobilized to provide care, despite a desperate shortage of medical personnel and supplies.

Three years later, Julmiste visited University Hospital as part of a team conducting an assessment of health care service providers in Haiti and was impressed by the state-of-the-art facility and its culture of excellence and innovation. The hospital’s commitment to filling the void for people who had limited access to quality health care appealed to her personal convictions. She promised herself that, one day, she would work there.

She then applied for a nursing position at Zanmi Lasante’s Hôpital Sainte-Thérèse in Hinche, which was inaugurating a new neonatal wing in partnership with Ohio State University. For the next two years, Julmiste specialized in neonatology, eventually becoming the lead nurse of the department. Although she thrived in this role, she aspired to further her education and hone her skills.

An opportunity to work at University Hospital arose in 2017. She took an admission exam and joined the team as nurse educator at its Nursing Center of Excellence.

Hospital leadership subsequently appointed her as coordinator of Kay Manmito, a facility on the grounds of University  dedicated to expectant mothers with high-risk pregnancies and new mothers of premature infants. Also under her leadership, more than 1,500 women and 900 babies were enrolled in the Journey to 9 program, which uses innovative actives such as group prenatal appointments and home visits to reduce maternal and child mortality.

Julmiste was promoted to University Hospital’s deputy chief nursing officer in August 2020. She was initially apprehensive to apply for the fellowship. Although she had the full support of hospital leadership, she felt it would be a challenge to undertake such an intensive training so soon after starting her new and demanding role. The encouragement of her mentor, Nurse Angeline Charles—a 2017 fellowship recipient, clinched her decision to apply.

“Miss Charles embodied the qualities of a real leader, and I aspired to be an agent of change like her,” Julmiste said.

Julmiste was overjoyed when she learned she had been accepted. She felt the knowledge and skills she would acquire would allow her to better serve her community and raise the bar for what she considers to be the world’s most noble profession.

“This fellowship will increase my leadership competencies and help me in achieving my goal of pursuing a doctorate degree in nursing,” she said. “I want to mentor future leaders in my institution and in my country.”

Nursing as Personal Mission

Nurse Abdonie Laguerre often wondered what it would be like to work at University Hospital. During the construction of the hospital, she regularly passed by the site on her way to work and marveled at what promised to become one of the most advanced medical facilities in the Caribbean.

Laguerre had already been a nurse for seven years. She’d held leadership roles in several challenging projects in Haiti, including nurse leader in Atletik 2, a camp for displaced survivors of the 2010 earthquake and nurse supervisor in a sanitation project in Cité Soleil, one of the most impoverished neighborhoods in the country.

A woman of faith, Laguerre sees nursing as her mission on earth: “What brings me joy in this job is to see that, at the end of each day, we have brought a little comfort to patients. Or seeing the gratitude in the eyes of a young mother who has been touched by a word or by a gesture. To bring some hope to someone else’s life.”

In 2013, she applied for the role of lead nurse of internal medicine at University Hospital. She adhered to its vision of providing quality care to the poorest people and believed her experience made her an asset to nursing staff. She also wished to expand her knowledge through training and by working alongside experts.

With that in mind, Laguerre collaborated with the care management team at the hospital to develop and implement care plans and improve processes. She still devoted her time to clinical work, helping with palliative care patients in the oncology department, reviewing patient files, listening to their complaints, checking on their improvement, explaining side effects, and even providing counseling.

When she was named University Hospital’s chief nursing officer in August 2020, Laguerre decided to apply for the fellowship along with her two colleagues. Despite the grueling schedule brought by her new role, as well as studying for a PhD, she realized the skills and knowledge she would gain would be invaluable and intended to take full advantage of the opportunity.

“This fellowship will help me grow as a manager and as a leader,” Laguerre said. “I am convinced it will open my intellectual horizons and provide me with tools I can apply to my work serving the community and even in my personal life.”

On any given day, Vilga Vázquez cooks, cleans the house and runs her family’s grocery store. But her to-do list doesn’t end there. The 36-year-old has another job: caring for new and expectant mothers in her community.

Vázquez is a community health worker for Compañeros En Salud, as Partners In Health is known locally, in Chiapas, Mexico. Compañeros En Salud has worked in Mexico since 2011, partnering with the Ministry of Health to provide medical care and social support in the rural, southwestern state of Chiapas, where more than half of residents live in poverty.

Compañeros En Salud’s community health workers are hired from within the local community and trained to provide basic health services, such as detecting early signs of disease or reminding patients to take their medications.

In Chiapas, Compañeros En Salud employs 99 community health workers who serve patients at local clinics and in the home. Some specialize in areas such as chronic disease or mental health, while others work across clinical areas. All bring deep cultural understanding and lived experience from their communities to their work.

Prenatal and Postnatal Care, at Home 

When Vázquez first heard about the program from Compañeros En Salud staff, she was eager to learn more. She ended up throwing her hat in the ring.

“I wanted to apply because it interested me,” she says. “I thought that even if I was not selected, at least I would learn things about diabetes or hypertension to take care of my family and myself.”

Now, she has been a community health worker for four years, based in the community of Captain Luis Ángel Vidal. She specializes in maternal health—an area that she can relate to on a personal level.

Each week, Vázquez visits new and expectant mothers in their homes, providing prenatal and postnatal care. These home visits are important, she says, because sometimes it is difficult for patients to travel to the clinic, which can be far from their homes. And even those who make the trip may have to stand in line for several hours before being admitted.

Although Mexico provides universal health coverage, reliable, quality health care is hard to come by, especially in the rural communities of Chiapas.

Community health workers such as Vázquez offer critical support and accompaniment as patients identify their health conditions, navigate the local health system, and follow their treatment plans.

Building Trust

Vázquez visits her patients weekly from the second trimester (3-4 months) until the baby is born, and then again during the 42 days following birth, known as the puerperium period.

During these house calls, she asks patients about symptoms they’ve experienced, such as bleeding or severe pain, and checks their glucose and blood pressure. She also shares information about pregnancy and childbirth, such as the stages of fetal development.

These home visits aren’t just about knocking on doors and relaying information. It is important, she says, to earn trust.

“On the first visit, I explain everything,” says Vázquez. “I talk to them about maternal health, the importance of breast milk, weight changes, family planning.”

With some patients, the connection becomes deeply personal.

Vázquez recalls one expectant mother who was initially quiet and shy, making her worry that they wouldn’t be able to relate. During their conversations, Vázquez offered a listening ear and encouraged the woman to share not only about her pregnancy, but also about her personal and family life, reassuring her that everything would remain confidential. And, slowly, things started to change.

“Sometimes we see people and we don’t really know what they are like,” Vázquez says. “When she had her baby, she asked me not to stop visiting her, and I feel like I gained a friend.”

Care Continues Amid COVID-19

During COVID-19, Compañeros En Salud’s medical care and social support continue, and community health workers are critical to that work—especially in Chiapas.

“Accompaniment is an essential part of our job,” says Dr. Ariwame Jiménez, CHW program coordinator. “It widens the support network of our patients, as well as their trust in our services and our CHWs.”

To stop the spread, Vázquez and her colleagues take rigorous safety precautions, such as wearing face masks, handwashing frequently, and reducing the number of house calls with patients. They also distribute face masks and share COVID-19 updates.

But even with these adaptations, Vázquez is keeping busy. She currently has five patients. And she’s not stopping anytime soon.

“What I like most about my job is learning and helping,” she says. “What I learn, I can apply and communicate with others. I’m learning that we have to take care of our bodies, help people, and build a support network among ourselves.”

When a pregnant woman was rushed to Saint-Nicolas Hospital in Saint-Marc for severe bleeding, Dr. Charnee Magalie Villemenay—now a second-year medical resident—had to act quickly, as the baby’s heart rate had begun to drop.

The mother desperately needed a blood transfusion, but there was a dilemma: All of the blood in the laboratory staffed by Zanmi Lasante (ZL), Partners In Health’s sister organization in Haiti, was reserved. Recognizing that this patient was in more critical condition than others, Villemenay reached out to patients across several departments and convinced them to give her some of the blood being held. Shortages like these sometimes occur due to lack of refrigeration and supply chain disruptions.

After successfully retrieving enough blood, the woman gave birth to a baby boy. Two months later, Villemenay received a photo of the mother and her son.

“I was very moved to see them again,” says Villemenay. “Now, the infant is turning 1 and his mother has asked me to be his godmother. She said: “Dr. Villemenay, my son and I, we owe you our lives.’”

That was the most rewarding moment of Villemenay's family medicine residency thus far, she says. Though being away from her close-knit family and fiancé in Port-au-Prince has been challenging for Villemenay, the experiences she has had in Saint-Marc, a city in Haiti’s lower Artibonite department, have made it worth it.

“My colleagues, especially those in my cohort, have practically become members of my family because we spend so much time together and look out for each other,” she says. “This residency has allowed me to mature and develop a sense of independence, responsibility, and leadership.”

Globally Recognized Teaching Institution

The three-year family medicine residency program—which has trained 37 residents since it launched in January 2012 in Saint-Marc—is paired with five other residency programs based at University Hospital in Mirebalais, which received accreditation from an international oversight group in January 2020 for meeting the highest global standards as a teaching institution.

News that University Hospital had earned accreditation from ACGME-I—the international branch of the U.S.-based Accreditation Council for Graduate Medical Education—came with great joy, emotion, and humility, says Dr. Rodney Destine, family medicine residency program director at Saint-Nicolas Hospital. Since the announcement, faculty and residents alike have noticed the accreditation’s impacts on the program.

“It has strengthened the academic activities, regulated residents’ working hours, and has improved the training of trainers,” says Villemenay.

Dr. Mitchnaider Joseph, chief resident of the family medicine residency program at Saint-Nicolas Hospital, echoed Villemenay’s thoughts, adding: “The accreditation has motivated leadership to make elective rotations, such as intensive care, available to residents. It has also helped create a stronger mentorship program to allow residents to achieve their goals in each rotation.”

An In-Demand Specialty

The family medicine residency is the only program of the nine that ZL offers that is housed at Saint- Nicolas Hospital. Nearly all the residents who have completed the program remain in Haiti, except for two who went on to do a fellowship in France and two who are currently living in the United States. Of the remaining 33 residents, 16 of 30 physicians continue to work within the ZL network and the remaining 14 work outside of the ZL network. The graduates are working mostly in rural areas and in the public sector.

Since 2012, across all residencies—from surgery and pediatrics to neurology and emergency medicine, ZL’s medical education program has trained 152 Haitian clinicians, 98% of whom have stayed to work in Haiti after their graduation, with 88% working at ZL-supported facilities or in other rural health centers.

Joseph, who plans to do a fellowship in medical education after completing the family medicine residency program, hopes to promote the specialty in communities to help more people access quality care.

He has seen firsthand the impact that family medicine has on patients. In particular, he recalls a 16-year-old girl who had stopped menstruating for more than three months, and came for a consultation with her mother. Joseph said the visit started off tensely, as the patient’s mother insisted he set them up with a gynecologist. After all, they admitted, they were only there because it was too difficult to schedule an appointment with a gynecologist.

Using a holistic approach during the appointment, and explaining the full scope of services they offered, Joseph created an atmosphere that relied on trust.

“She had no idea about the availability of family doctors at the hospital,” says Joseph. “Together we established a follow-up schedule and thanks to ongoing care, the girl was diagnosed with polycystic ovary syndrome (PCOS) and was properly cared for.”

In addition to limited access to primary health care, Haiti—like other low-income countries—faces a shortage of well-trained health professionals and geographic inequalities, whereby people living close to major cities have access to care.

“Medical training is one of the key strategies that can contribute to strengthening the health system in the short-, medium-, and long-term,” says Destine. “Family medicine is a specialty that can serve as a lever to improve the health of the Haitian population and an antidote to despair.”

Though the COVID-19 pandemic flooded our work, website, and lives in 2020, a third of our most-read blog posts this year focused on other topics. From University Hospital in Mirebalais, Haiti, gaining global accreditation to the documentary “Bending the Arc” debuting on Netflix and the launch of Fevers, Feuds, and Diamonds: Ebola and the Ravages of History, the latest book by Dr. Paul Farmer, Partners In Health (PIH) co-founder and chief strategist, 2020 was a year to remember.

PIH supporters were also eager to know about what we’re doing to stop COVID-19—how we’re supporting the response across the U.S., why contact tracing is a critical part of the fight, and how community health workers are helping vulnerable groups in Immokalee, Florida and beyond.

Below are the 12 most-read stories of 2020, listed by date of publication.

University Hospital in Haiti Earns Global Accreditation as Teaching Institution

University Hospital in Mirebalais, Haiti, received accreditation from an international oversight group in January, affirming that the hospital meets the highest global standards as a teaching institution—and causing Dr. Paul Farmer to reach for a seat. 

“There’s a Haitian expression—news that demands a chair,” said Farmer. “Usually it’s bad news, but this is truly exceptional. I have no way to express my gratitude and admiration to the Zanmi Lasante team. They have been tireless.” Read more.

Silver Bullet for Care Delivery? Invest in Nurses and Midwives

Dr. Sheila Davis is the chief executive officer of PIH and has been a nurse for more than 30 years. In February, she reflected on the World Health Organization’s decision to name 2020 the Year of the Nurse and Midwife, and on how global leaders should take this moment to reach for universal health care around the world.

There was a significant confluence of events this year: The United Nations called for universal health coverage (UHC) as part of the Sustainable Development Goals (SDGs), and the World Health Organization (WHO) named 2020 the Year of the Nurse and Midwife. UHC is not a new concept, as the UN originally made this declaration in 1948, but sadly this goal has not been achieved for the vast majority of people in the world. The year 2020 is significant for nurses and midwives too, as this is the year Florence Nightingale, arguably the world’s most famous nurse, would have celebrated her 200th birthday on May 12. Read more.

10 Mental Health Tips for Coronavirus Social Distancing

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

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

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

Massachusetts Gov. Charlie Baker announced a new initiative in early April to accelerate the state’s efforts to contain the spread of COVID-19, by dramatically scaling up the state’s capacity for contact tracing through a new collaboration with PIH.

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

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

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

PIH launched the U.S. Public Health Accompaniment Unit, which engaged U.S. government agencies, local jurisdictions, and their implementing partners with two interrelated components. Read more.

Contact Tracing: Fact vs. Fiction

As the COVID-19 pandemic continues, contact tracing has been in the news as a way to stop the spread. But how does it work? And what does it mean for you?

In June, PIH staff clarified some common misconceptions about contact tracing. Read more.

COVID-19 Contact Tracing Explained

Contact tracing is key to stopping the spread of deadly, infectious diseases around the world. A tried-and-true public health practice recently used to curb Ebola, it's now a critical part of the fight against COVID-19.

PIH put together a short video explaining what contact tracing is. Read more and watch the video.

Florida Migrant Workers Among Hardest Hit by COVID-19

Migrant workers in Immokalee, Fla., not only endure long shifts, intense heat, and low pay—they face increased risk of COVID-19 due to systemic inequities.

Immokalee, a rural community of around 25,000 in Collier County, emerged early this summer as a hotspot in southern Florida’s outbreak, which worsened statewide following its reopening. Migrant workers make up the majority of Immokalee’s population and are especially at-risk for COVID-19 due to systemic inequities, ranging from occupational exposure to overcrowded living conditions. Read more.

Ekip Solid: A Conversation with Dr. Sheila Davis

Dr. Sheila Davis has said she never could have foreseen how her career would twist and turn, eventually leading her to where she sits as the chief executive officer of PIH—a position she assumed just over one year ago.

In the interview , she reflects on the current moment—and much more—in the first in an ongoing series with PIH global leaders that we’re calling Ekip Solid, or “Strong Team,” in Haitian Creole. The participants are all experts in their fields, and each interview will address how they approach leadership, share what drives them to global health work, and provide an inside look at their professional and personal passions. Read more.

PIH Documentary “Bending the Arc” Coming Soon to Netflix

Bending the Arc, the universally acclaimed documentary that tells the story of PIH’s early years and the global movement for health equity and social justice, became available to a broad audience for the first time Oct. 22, when Netflix began offering the film to streaming viewers.

Dr. Jim Yong Kim, PIH co-founder and board member, said the film resonates more than ever amid the COVID-19 pandemic. Read more.

Q&A: Dr. Paul Farmer on His New Book: Fevers, Feuds, and Diamonds

In November 2014, Partners In Health Co-founder and Chief Strategist Dr. Paul Farmer was in Freetown, Sierra Leone, breaking bread with a group of Ebola survivors as the world’s largest epidemic of the virus raged across the country.

“It was the night I met Ibrahim,” Farmer recalled, referring to one of the survivors. “We started talking and he told me he’d lost 23 members of his family to Ebola. I was shocked into silence. And what he said next was: ‘I’d like you to interview me about my experience.’” Read more.

Community Health Workers Connect Patients to Care in U.S. COVID Response

A fluent Spanish speaker, Plata began going door-to-door in Immokalee, where the majority of residents are Hispanic, answering questions and dispelling rumors about the pandemic. Read more. 

There was no shortage of work for Partners In Health (PIH) in 2020 and headlines captured that well. From CNN to Forbes to STAT and beyond, leading U.S. news outlets featured PIH’s efforts to stop COVID-19 and deliver lifesaving care around the globe. And PIH’s work—rooted in partnership with the communities we serve—was captured on a local level, too. Notable outlets in the countries where we work, including the South African Broadcasting Corporation to Le Nouvelliste, and others, highlighted what PIH is doing to strengthen health systems across communities.

With nearly 400 mentions in the press in 2020, it was difficult to narrow the list down to our favorites. But in an effort to highlight some of our most-talked about moments, we selected our top 13. Below are those moments, listed by date of publication.

1. The Boston Globe: Paul Farmer: We know how to confront the coronavirus pandemic — expert mercy

In this op-ed published on March 19, Dr. Paul Farmer, PIH’s co-founder and chief strategist, discusses why we need to trace, test, and treat to reduce the threat of COVID-19.

2. WGBH: Dr. Joia Mukherjee Of Partners In Health Explains How Massachusetts Will Try To Track Every Case Of Coronavirus

On April 6, Dr. Joia Mukherjee, PIH’s Chief Medical Officer, joined Jim Braude of WGBH News’ Greater Boston to emphasize the importance of contract tracing and to discuss the Massachusetts Community Tracing Collaborative (CTC).

3. The New York Times: An Army of Virus Tracers Takes Shape in Massachusetts  

PIH was featured on the front page of the print edition of The New York Times on April 16. The article discussed the joint effort of the state of Massachusetts and PIH to create the CTC.

4. The New Yorker: It’s Not Too Late to Go on Offense Against the Coronavirus

Jim Kim, PIH Co-founder and board member, authored an op-ed discussing the globally-coordinated effort in the fight against COVID-19 and the importance of social distancing, contact tracing, testing, isolation, and treatment. The article was published on April 20.

5. The Washington Post: Guides to the other side

In this guide published on May 7, Oscar Baez, formerly a PIH Care Resource Coordinator, was interviewed about his role in helping underserved communities in Haiti and now Boston where he assisted with contact tracing.

6. The New Yorker : Can Coronavirus Contact Tracing Survive Reopening?

Baez, Kim, Farmer, and others reflect on global health emergencies over the years and how that has positioned PIH to fight COVID-19. The article was published on June 12.

7. Naples Daily News: Opinion: 'Partners In Health' stands in partnership with Immokalee and Collier County

Matthew Hing, Immokalee Project Manager with PIH’s COVID-19 Technical Accompaniment Unit, and Dr. Dan Palazuelos, a physician and technical lead with PIH in Immokalee, wrote an op-ed about PIH’s work in Immokalee, one of the most vulnerable communities in Florida. The article was published on July 24.

8. The Atlantic: How the Pandemic Defeated America

Dr. Sheila Davis, PIH’s CEO, was quoted in an August 4 article about the history of planning for pandemics and why COVID-19 overtook seemingly strong health systems around the globe.

9. Mother Jones: The City of Newark’s Scrappy and Remarkable Fight Against COVID-19

In a partnership with the city of Newark and Rutgers School of Public Health, PIH helped implement a contract tracing program, several months after the launch of the Massachusetts program. In this article, published on September 9, Katie Bollbach, Director of PIH’s U.S. Public Health Accompaniment Unit, and Mukherjee discuss the work in New Jersey.

10. NPR: Anthropologist Paul Farmer's New Book Explores The Failures Of An Ebola Epidemic

In NPR’s Weekend Edition Sunday, on November 15, Farmer discussed his new book, Fevers, Feuds, and Diamonds: Ebola and the Ravages of History, and shared insights on the COVID-19 pandemic.

11. USA Today: Why this Harvard doctor is optimistic about US overcoming COVID-19 despite 'epidemic of mistrust'

On December 1, Farmer detailed the link between contact tracing and social support, why recovered individuals and families spark hope, and how mistrust during the COVID-19 pandemic is similar to what he saw in West Africa during the Ebola outbreak.

12. TIME: Even the Pandemic Hasn’t Made Public-Health Icon Paul Farmer Lose Hope

Farmer reiterated his optimism in combatting COVID-19 in an article published on December 3.

13. The New York Times: Paul Farmer Is Awarded the $1 Million Berggruen Prize

As a chaotic year drew to a close, Farmer won the 2020 Berggruen Prize for Philosophy and Culture on December 16—an award given each year, to an individual who has made “major achievements in advancing ideas that shape the world.”

In 2020, PIHers around the world joined in a unified fight against an unknown virus, visiting patients at homes, health centers, and hospitals, to provide care and social support as COVID-19 spiraled into a pandemic.

All the while, PIH teams continued their vital care in other areas of health, from maternal care to HIV treatment and more, ensuring that lifesaving services didn't stop, and that critical resources continued to reach those who needed them most. 

Through incredibly challenging times, this glimpse at PIH's work around the world reflects an unshakeable solidarity in a year that separated us—and brought us closer together.

Navajo Nation

Sierra Leone

MA Community Tracing Collaborative 

Liberia

Rwanda

University of Global Health Equity 

Lesotho 

Mexico 

Haiti 

Malawi

Kazakhstan 

Over the past two years, 20-year-old Comfort Cheebo has never missed an appointment for her birth control shots, which are injected every three months. That’s because she doesn’t want an unplanned pregnancy to stand in the way of her career goals.

“Pregnancy by choice, not by chance,” community health volunteers often emphasize, with the goal of empowering youth to make informed decisions.

Many women in Maryland County, Liberia—where Comfort is a high school senior—have already had at least one child by the time they’re her age and often have another on the way. The average age for bearing the first child is 18.4 years old, and about 40 percent of women ages 15-19 have already given birth.

Comfort does not yet want to have a child, which is why she was intrigued when she learned about a youth-friendly center (YFC) that provides family planning services. The center also provides condoms to prevent sexually transmitted infections, such as HIV.

A Partners In Health (PIH) community outreach event introduced Comfort to the clinic, which is held in PIH-supported Pleebo Health Center.

 “I decided to inquire more about the services so that I can concentrate on my education and finish school to become an accountant,” says Comfort.

Impressed by the staff’s strict confidentiality and anti-stigmatization policies, Comfort has continued to regularly visit the clinic.

It’s a social space, too, which was one of the goals when developing the clinic.

“Whenever I come to the center, I meet other girls of my age to interact with,” says Comfort. “We are able to freely ask the midwife all the questions and myths we hear in the community for clarification.”

PIH and the Liberian government have established and supported the youth-friendly centers through the United Nations Population Fund’s Empowered and Fulfilled (E&F) program funded by the Swedish government. These centers are helping to eliminate barriers to care and education, giving Comfort and other Liberian youth the opportunity to stay healthy and enrolled in school, and to realize their full potential.

Since 2018, YFCs have responded to the unique challenges and unmet needs of adolescents and have helped reduce the high rates of teen pregnancy in the four southeastern counties of Liberia—Maryland, Grand Kru, Grand Gedeh, and River Gee.

PIH supports seven YFCs in Maryland County by training staff and volunteers and supplying reproductive health commodities, ultimately supporting sexual reproductive health and family planning services for more than 17,425 adolescents.

Ministry of Health employee Lewis Kruger Jr., a registered midwife, runs adolescent sexual reproductive services at Pleebo Health Center’s YFC. 

“I run the facility from Monday to Saturday, and I can boldly say it has contributed to the reduction of teenage pregnancy in Maryland,” says Lewis, who provides care to about 30 clients each day. “And I am happy that due to the community sensitization and integrated counseling sessions, it has increased the utilization of sexual health and family planning services by the youth.”

Bringing patients for hypertension, diabetes and other non-communicable diseases under one roof for treatment that’s intertwined with HIV care is significantly improving outcomes in rural Malawi, a new study shows. 

Partners In Health and Malawi’s Ministry of Health launched their Integrated Chronic Care Clinic, or IC3, in 2015 in Neno District. The IC3 model integrates HIV care with treatment for non-communicable diseases, or NCDs, which can also include asthma, epilepsy, mental illness, and more.

PIH has worked in Malawi since 2007, is known locally as Abwenzi Pa Za Umoyo, and supports 12 health centers and two hospitals across Neno District. Dr. George Talama, the team’s primary health care clinical manager, said building integrated care on the foundation of a successful HIV program was a natural progression.  

“We thought, if we could leverage from our HIV platform, we could expand access to care for NCDs,” he said. “Since NCD care was being delivered only at (PIH-supported) Neno District Hospital and Lisungwi Community Hospital, while HIV care was being provided at all 14 health facilities and with better outcomes, we hypothesized that introducing NCD care to this already existing HIV care platform would increase access to NCD care and improve outcomes.”

And providing care to clients diagnosed with both HIV and an NCD—on the same day, at the same clinic—would ease burdens on NCD care and make it easier to access, Talama added.

The study was published in October in the journal BMJ Open and features several PIH co-authors. It shows that PIH’s integrated clinics are improving the accessibility of NCD care by allowing patients to have all of their chronic conditions treated on the same day at their nearest health facility. The model also makes better, more efficient use of staff time and clinical space.

Impacts of Integrated Care

Over the study’s three-year period, from 2015-17, integrated clinics at 14 primary care facilities enrolled a total of 6,233 new patients, nearly half of whom presented with one or more chronic NCD. After just a year, retention in treatment stood at 85% of patients with HIV, and 72% of patients with an NCD. Those numbers compare to retention rates as low as 25% found in other studies from similar settings. 

IC3 patients in Neno not only were staying in regular treatment; they also were getting better.

Most clinical measurements—such as blood pressure, asthma severity, blood sugar, or number of seizures per month, for patients with epilepsy—showed statistically significant improvement over the course the study. One year after enrolling in IC3 care, more than half of hypertension patients had controlled blood pressure, and patients with epilepsy were reporting fewer seizures overall—with more than 40% regularly reporting no seizures since their previous visit.

Meanwhile, HIV patients continued to show excellent outcomes with continued high-quality care, despite the addition of NCD clients to the clinic.

Hypertension, asthma and epilepsy were the most common diagnoses for patients in the study.

While the concept of integrating HIV and NCD care is not new, the IC3 model is having an outsized impact in Neno. Earlier this year, PIH opened a brand-new, expanded IC3 building adjacent to Neno District Hospital, to better serve growing numbers of patients.

The need is stark. NCDs are a leading cause of death and disability globally, and especially in underserved areas like Neno, where accessing care can be difficult and materials needed to diagnose and treat hypertension, diabetes, and more, can be scarce.

“Before IC3, I was the only one providing NCD care at Neno District Hospital,” said Bright Mailosi, a clinical officer with Abwenzi Pa Za Umoyo. There were many challenges at that time, he added, citing staff shortages, an unreliable supply chain and a high rate of default, or patients leaving treatment.

With the launch of IC3, Mailosi was trained to administer antiretroviral therapy and provide HIV care. At the same time, the HIV team learned about NCDs, including how to diagnose different conditions and counsel patients.     

Mailosi said patients aren’t always as informed about NCDs as they are about HIV.

“People hear HIV, and they know what that means,” Mailosi said. “For so long, it was a death sentence. But with NCDs, they may not take it so seriously. So you have to take more time to explain the diagnosis, and the medication, and why it’s important that they take it every day.”  

As IC3 continues to scale up in Neno and across Malawi, maintaining supplies of medications will be a critical consideration, as will the increased workload for health center staff.

“There are districts that are already overloaded with clients in need of care for HIV,” Talama said. “For those providers to take on NCD clients as well—that could be quite a lot.”

Nonetheless, Talama said the IC3 has been a huge success so far, and the study indicates the model can serve as a blueprint for integrated HIV and NCD care across Malawi and beyond.

Before IC3, Talama noted, there was only one facility in Neno providing care for NCDs.

“Now all 14 (PIH-supported) health facilities are able to provide NCD care,” he said. “Everyone can see the benefits.”

If the sun is rising at a Partners In Health location and you want to know what’s planned for the day, a good place to visit is the transportation office.

That’s where drivers and vehicle managers will be tuning up trucks, organizing who is going where and when, and setting plans that will enable PIH health care workers to provide care, patients to receive it, and vital supplies to be delivered. And many of those plans likely will change before the sun sets, as new needs and situations arise.

But no matter what the day brings, one thing is certain: PIH drivers are health care heroes.

They’re the reason patients and their loved ones can safely arrive at medical facilities, despite difficult road conditions and harsh weather, such as flooding in rainy seasons. Drivers can also serve as translators for foreign staff, negotiators at local roadblocks, accompagnateurs during appointments, mechanics for damaged vehicles, and so much more.

The COVID-19 pandemic has shined an extra spotlight on them, as drivers’ roles have become all the more vital and the conditions all the more challenging in recent months.

But they’ve been an essential part of PIH for decades.

Javier Yataco, for example, has worked for 18 years as a driver with Socios En Salud, as PIH is known in Peru.

“The reward from my work comes from seeing, little by little, the recovery of each patient; it gives me joy and gives me the resolve to continue working for a new cause for each of the patients and with my co-workers,” says Javier. 

The video above features firsthand accounts from Javier and other PIH drivers around the world.

Armah Quist, 30, is a multidrug-resistant tuberculosis program officer at Partners In Health-supported Lakka Government Hospital, Sierra Leone’s only dedicated tuberculosis hospital and the country’s first facility to provide care for multidrug-resistant tuberculosis, located on the border of capital city Freetown. Like many PIHers, she pours 110% into her work, but she also dedicates time toward personal causes. In 2017, she founded the Young Woman Transformative Leadership Program, a feminist organization for young girls and women in Freetown.

Below, Quist shares what inspired her to become an advocate in her home country, where women have a 1 in 20 lifetime risk of dying in pregnancy or childbirth—among the worst maternal mortality rates in the world. She knows personally what a difference free, quality maternal care means and why the future Maternal Center of Excellence, which will break ground in Kono District in early 2021, is key to ensuring all women—regardless of age, income, or hometown—are empowered to know their rights, have the tools they need to define their own lives, and receive the care they deserve.

I consider myself a feminist.

As a teenage girl, at age 19, I got pregnant, while I was still a student. I was scared to tell my parents, as I was still in school and they wouldn’t accept me having gotten pregnant so young. I wasn’t sure if the father of the baby was ready to have a child. When I told him I was pregnant, he pressured me to have an abortion. He was in university at the time and said he wouldn’t support the baby; if I gave birth, I’d be on my own.

I felt so alone, there was no one I could talk to, no support structure.

My mom eventually found out I pregnant. She saw we vomiting in the morning, my weight gain. By the time she noticed I was already four or five months along in the pregnancy. My mom talked to me and encouraged me to go forth with the pregnancy, as it was too late to have an abortion. She was afraid that if I did have an abortion, I wouldn’t survive. She told me, “Instead of losing you, have the baby and we can support you.”

I had to drop out of school once I began to show, as it was illegal in Sierra Leone to attend school while pregnant. I was one of the best students in the class, and it was heartbreaking to end my education.

Because of all of the stress, I developed high blood pressure during the pregnancy. That, coupled with my young age, made me a high risk for developing complications. After my first scan, the doctor told me the baby was breech. I was terrified I wouldn’t survive pregnancy.

I went for prenatal care at the government hospital in Freetown, but four doctors refused to care for me because I was too high-risk. They, like me, thought I wouldn’t survive. 

I eventually paid to get care at a private health facility. I didn’t have insurance or any government free health care services, so we had to pay for the visit in full. One week before my delivery date, I was admitted into the hospital because my blood pressure had spiked. I was very sick and slipped in and out of consciousness for a week. They tried to induce my labour but failed, and there was genuine fear that I would not survive the pregnancy. Even in a private clinic, there was no critical care doctor, no emergency room specialist, and no life support machine.

Eventually I had an emergency C-section and delivered a healthy baby girl, whom I named Andrina Lewis.

After surviving such a difficult pregnancy, I thought I’d be happy when she was born. But I had lost all of my confidence.

Having a baby at that age without a dad, having to return to school where everyone knew I had gotten pregnant and had been kicked out—it was so difficult to imagine my future.

But after I delivered, I met a counselor at my local church who talked to me and told me, “You’re not the first and you won’t be the last. Forget about what people say and focus on yourself and your goals.” She reminded me of my ambition, of the drive I had in school, and of my potential. So I left baby with my parents and returned to the same school.

I eventually graduated high school and went on to university. While I was in university, my parents—whom I was living with—moved out of the city of Freetown to the more rural areas. When we moved into our new neighborhood, I saw so many young girls who were so much like me. I saw them and thought of what I wished I had when I was their age: information, support, love, and care.

I started by bringing those girls together on Saturday mornings. We talk about protection, family planning, and about how to keep yourself safe if you are [sexually] active. We talk about the struggles we face as women. I help them know their rights – that it is their body and their choice. And I help them understand where they can get dignified care if they want family planning or have gynecological issues they need advice on. The goal is to create a safe space, a space where girls can ask questions, feel loved, and have a support structure I never had.

This is exactly why the Maternal Center of Excellence (MCOE) needs to exist: because women and girls in Sierra Leone deserve better. They deserve a youth-friendly place they can go to ask questions about their bodies and [contraception] methods—a place I never had, but that the MCOE will provide. And if they get pregnant, they deserve to go to a hospital that will treat them with dignity, whether they are married or unmarried, whether they are young or old. They deserve a place where they have a good chance at surviving childbirth and never have to experience what I did, on the verge of death.

This is what the MCOE will create for women and girls in Sierra Leone. It will create a place where the next generation of women can be empowered, where they, like so many of the girls I work with, can realize their rights.

The MCOE is about far more than health care; it is about feminism, about women realizing their potential, and about giving women the dignity and choice they’ve long deserved.

Tuberculosis is the most deadly infectious disease, killing more than 1.4 million people globally, most of them in resource-poor countries. Some forms of the disease are resistant to treatment and therefore can’t be cured using standard drugs. These multidrug (MDR)- and extensively drug resistant strains are particularly worrisome to patients and clinicians, and they are rapidly spreading across countries with the least resources to tackle them.

To meet this challenge, endTB was formed. The project, an international partnership among Partners In Health, Médecins Sans Frontières (MSF), and Interactive Research and Development (IRD) and funded by Unitaid, aims to find shorter, less toxic, and more effective treatments to MDR-TB. This will largely be achieved through the introduction of the first new TB drugs in more than 40 years, two clinical trials testing shorter regimens, and advocacy at national and global levels.

Launched earlier this year, the endTB-Q trial aims to establish the efficacy and safety of shortened, all-oral drug regimens in a subgroup of patients with MDR-TB, those with resistance to the most effective drug in second-line TB treatment. All this has moved forward while the endTB team has faced significant challenges due to the spread of COVID-19, another airborne infectious disease.

Dr. Carole Mitnick, endTB’s co-principal investigator, a professor of Global Health and Social Medicine at Harvard University, and senior TB researcher with PIH, explains why TB disproportionately affects the marginalized, discusses the importance of the endTB-Q trial, and shares how teams have adapted their work during the COVID-19 pandemic.

Why is TB more present in marginalized populations than in the general population?

TB transmits in enclosed, crowded spaces. Like COVID-19, TB transmission is airborne, usually after longer, sustained contact. Poor and marginalized people are more likely to live in crowded environments where they face increased risk of infection.

About 90% of those infected never get active disease, but nutritional deficiencies and other conditions like HIV, diabetes, and substance-use disorders increase vulnerability to developing active disease. 

Why does endTB specifically focus on multidrug-resistant tuberculosis, or MDR-TB?

Like TB, MDR-TB is a disease that exploits marginalization, and disadvantage. It occurs commonly among people who suffer from poverty and other associated conditions and who live in countries that make tiny investments in health. These diseases do not inspire private industry to develop drugs; shareholders don’t see big opportunities for earnings in drugs developed for people and health systems that can’t pay. Consequently, drug development for MDR-TB treatment has lagged. 

Even the recent advances in development of two new drugs have not been adequately resourced to optimize their use. So these 3 NGOs—MSF, PIH, IRD—had to take on this responsibility.

It’s in our DNA to try to increase access to the best possible treatments and improve their use. And, we believe that poor people with MDR-TB are just as deserving of high-quality evidence to inform their care as, say, rich people with cardiovascular disease.

So, we had to take this on. To make matters worse, many trials exclude patients with comorbidities. But, because they are real issues faced by people with MDR-TB, endTB includes patients with comorbidities. 

the proportion of cases that are drug-resistant is growing. In some places, like Kazakhstan, the proportion of TB cases that are resistant is higher than 40%. The more resistant the TB, the more expensive to treat, the less likely people are to get adequate treatment.

PIH and endTB believe that all patients are deserving of treatment. We know that not treating these patients can have a really devastating impact on the population around them because drug-resistant TB is highly transmissible.

Can you explain more about endTB and where ​the project has been conducted?

The endTB project is a series of studies that focus on treatment for MDR-TB–the form of TB that’s resistant to rifampin, the most potent drug in the first-line regimens. First, we did an observational study to show that newer (bedaquiline and delamanid) and repurposed (linezolid and clofazimine) drugs could be used safely in effective long regimens for MDR-TB. Then, we launched a randomized, controlled clinical trial to optimize the use of these drugs in shorter, all-oral, simplified regimens for forms of MDR-TB that remain susceptible to fluoroquinolones, which has historically been the most potent drug in second-line treatment.

This trial, known as the endTB trial, is examining five experimental regimens. It’s unusual to test so many regimens at one time, because normally researchers are looking for “a best.” Instead, at endTB, we are trying to identify as many successful regimens as possible. And, the trial uses “adaptive randomization” to assign patients to various treatment arms. We use information learned through the course of the trial to influence the chance of a patient being assigned to each regimen. More patients will be assigned to the regimens that are more effective. This approach allows us to do this in much less time, with a fraction of the patients than if all five regimens were tested in separate trials

The trial is being run on every continent except Australia and Antarctica, with active sites in Peru, Lesotho, Kazakhstan, South Africa, Pakistan, and India.

The regimens we are testing have the following benefits: 1) They are shorter than those currently used, nine months instead 18+-months. 2) They are all-oral [pills] instead of requiring months of daily injections; they may cause fewer negative side effects. 3) They use fewer drugs, no more than five (compared to seven or more), which will make them easier for patients to take and for health systems to stock at points of delivery.

Tell us about the new clinical trial launched this year. ​

This year, in the middle of the worst public-health pandemic in a century, we launched the second trial in the project, called endTB-Q. This trial focuses on the patients who have a form of TB resistant to both fluoroquinolones and rifampin, which is the most difficult to treat.

What’s really groundbreaking about the endTB-Q trial is that it is focused on this especially vulnerable population. endTB-Q is the only trial that tests all-oral regimens specifically for this group using the gold standard of clinical research: a randomized, internally concurrently controlled trial. By the end of 2021, we expect to finish enrollment of 324 participants. We expect to have the results by 2023.

How essential are our partnerships with MSF and IRD to the success of endTB trials?

It is hard to put into words how important these partnerships are and how difficult this work would be to do on our own. Working with these powerhouse groups amplifies our impact.

Among the consortium partners, we share a common set of beliefs about the right to high-quality care, regardless of where people happened to be born in the world, their religion, color, ethnicity, political beliefs, socioeconomic status or how much their government chooses to spend on health care. In fact, we all deliberately try to reach those who are most likely to be left behind by other efforts.

How have you been adapting to the pandemic while lifting up a major trial? 

COVID-19 has had an enormous impact on our study sites, patients, staff, and the TB programs in which they’re embedded. Services have been shut down in many places and TB patients are not able to get care and diagnosis. This has deeply worrying consequences for these patients, their families, and communities; multiple models have predicted enormous increases in TB incidence and mortality in coming years, with effects being greatest for MDR-TB.

In all the sites, there have been moments when health facilities were completely closed or no TB patients were coming to health facilities out of fear. We did face setbacks, like when our whole Kazakhstan team got sick with COVID-19 and had to suspend the study for a few weeks.

And, this has resulted in delays in trial enrollment.

Despite the pandemic, we had to maintain the services we had committed to the trial participants whom we had already enrolled, at the same time, finding a way to continue enrolling patients in the endTB-Q trial.

Our primary concern was to protect staff and participants from COVID-19 and make sure that participants got their treatment and safety monitoring. We also needed to keep enrolling new patients, knowing that endTB was one of the only sources of care for MDR-TB patients in our study settings.

We had to set up guidance for the local teams on how to manage the virus, their own safety, and participants’ safety, providing information on what kind of treatments are available. Obviously, all of the staff are getting PPE. In addition, we have tried to provide extra food to support people who need to isolate or quarantine.

We’ve had to make some changes to the study and patient treatment, for example, moving visits out of health care facilities to either patients' homes, fields, or even cars.

We started providing accommodation for patients in rare cases, private transportation to get participants to study visits, or to get study workers to participants’ homes. In some sites, we have expanded the hours of the appointment times, ensuring there are fewer people present at one time.

However, one advantage of having a multi-site trial is that the pandemic’s waves are hitting different areas at different times.

Overall, this experience has prepared us for inevitable future disruptions. During future pandemics or natural disasters, having shorter, less-toxic treatments for MDR-TB will be a huge win. It also highlights the importance of patience and long-term commitments to complex problems affecting poor people, which has always been a hallmark of PIH’s work. Even before the pandemic, we knew that being on the side of patients with MDR-TB—including through activities such as the endTB and endTB-Q trials—was a long-term proposition. COVID-19 has reinforced this lesson as well as our determination to ensure that funding, policy, and implementation partners remain committed and engaged for the long term.

In which ways does PIH ​help patients ​beyond the provision of TB medication and care?

We really try to imbue our research with the PIH model of care and support. Treatment is supported by a study worker or community member. Treatment supporters check in with participants to see how they are doing and to assess occurrence of adverse events. And, in both study and routine care, we provide nutritional support and transport. The trial adds the best level of clinical monitoring for disease. And, if study participants require hospitalization, they do not pay.

To counteract the effects of COVID-19, we have expanded all these supports and added more.

What kind of results have you achieved so far with endTB?

It’s too early to say about the trials. But, in the first study, the observational one, we provided new regimens to more than 2,800 patients in 17 countries. Some of them were very sick patients who had been treated unsuccessfully over and over again. This was a huge success both in scale of roll-out and outcomes.

We have seen very promising results; 85% have had great early response: at or six months after start of regimens containing the new drugs, their sputum culture results were negative for the bug that causes TB. These results have been observed in patients without serious complications as well as in those with diabetes and the more resistant forms of MDR-TB.

Regimens containing new and repurposed drugs are really, really promising, and they are promising both from an effectiveness standpoint and from a safety and tolerability standpoint. The new drugs can replace the old injectable ones that caused terrible side effects, like hearing loss and kidney problems, while the cardiotoxicity risk that many were worried about did not occur frequently. 

Most importantly, we’ve successfully pushed back on the narrative that regimens containing new drugs can’t safely be introduced in settings with limited resources.

What kind of impact do you foresee if the endTB trials are successful​? In other words, would you categorize this as a game-changer for global TB care?

The combination of cutting the duration of treatment by more than half and potentially reducing the toxicity burden to reduce demands on the health system is huge. With shorter, more user- and health-system friendly treatment, treatment can be made much more widely available.

The other thing that’s really transformative is that if it’s the right treatment, patients will stop transmitting sooner. We know that within hours or days of starting effective therapy, people stop transmitting and are no longer a risk to their family members and neighbors. If you get them on the right regimen sooner, that has enormous benefits for reducing the number of people infected overall.

At the moment, TB programs have to keep 13 to 15 drugs in stock to be able to offer treatment for all forms of TB. If the endTB trials establish safety and efficacy of, say, three novel regimens, programs would only need to purchase and manage five to seven drugs. More patients would be treated with the same drugs, which would give national TB programs more negotiating power with pharmaceutical companies.

Fourteen weeks ahead of his due date, Naphtal was unexpectedly delivered on a rural farm on the edge of Kono District, Sierra Leone, miles away from any health facility. He and his mother, who was in dire condition after a complicated, unattended birth, were rushed by ambulance to Koidu Government Hospital, Kono’s only hospital. None of the family’s neighbors, who had scrambled to call for help, thought that Naphtal would survive: He weighed less than two pounds, and without intensive, specialized neonatal care—care that had never existed in the rural, impoverished district, even at the highest-level health facility—loss seemed certain.

But all was not lost. Mere weeks prior, Koidu Government Hospital (KGH), which Partners In Health supports, had started a new Special Care Baby Unit: a dedicated neonatal ward stocked with the specialized equipment clinicians long needed to adequately care for infants born prematurely or with complications at birth.

“Baby Naphtal was in bad condition when he arrived at the hospital,” said Dr. Napthal Nyirimanzi, lead pediatrician at KGH. “He had hypothermia, respiratory distress, low blood sugar, and no sucking reflex needed to eat. The prognosis was poor.”

Poor—but not definite.

“Without the Special Care Baby Unit, we were not able to save any premature baby weighing less than two pounds,” Nyirimanzi said. “But we believed with the new facility, we could save this child.”

A Lifesaving Facility

Opened in May by Sierra Leone’s Ministry of Health & Sanitation, in partnership with PIH and UNICEF, the Special Care Baby Unit provides care one level below that of a neonatal intensive care unit. Since opening its doors, the unit has already raised the quality of care for newborns at KGH and helped clinicians avoid worst case scenarios.

“A bad day for me—for most clinicians—is when I lose a patient I could have saved if I had the required equipment,” said Nyirimanzi.

Clinicians now have access to advanced medical supplies and equipment, from infant warmers and phototherapy lamps to vital sign monitors and emergency medications. And because the unit is attached to the maternity ward, they’re able to quickly transport newborns in need of emergency care. Those infants born at the hospital receive 24-hour care in a room separate from babies born outside of the hospital—a strict infection prevention and control system that keeps patients safe in their delicate states. And the unit also provides new clinicians with training and mentorship from pediatricians like Nyirimanzi, meaning more clinicians at KGH are developing crucial expertise in neonatal and pediatric care.

These new resources and protocols are tackling major barriers to saving at-risk infants. And they have helped keep newborns like Naphtal alive.

“Naphtal needed all the care extremely premature babies need to survive: oxygen support, infection prevention and control, antibiotics, temperature control,” Nyirimanzi said.

This vital care was available in the Special Care Baby Unit, allowing Naphtal to gain necessary weight and grow healthier.

Tragic Loss, Selfless Love

Part and parcel with advancing care for vulnerable newborns, the Special Care Baby Unit prioritizes mothers as well. The unit provides an attached ward for mothers, allowing them to stay close to their babies round the clock without having to endure a long and costly commute between the hospital and home. During their stay, the women receive support with newborn care, including breastfeeding and “kangaroo care,” a lifesaving technique that emphasizes skin-to-skin contact between mother and newborn, which helps to naturally regulate the infant’s temperature and encourage feeding.

Kangaroo care was essential to Naphtal’s survival and growth—though it came not from his biological family, but from one of the caring nurses.

As is often the tragic, preventable case in Sierra Leone—a country with one of the world’s highest maternal mortality rates—Naphtal’s mother did not survive childbirth, largely due to chronic health conditions. His father was also in poor health and passed away soon after her death, leaving Naphtal orphaned by just one month old.

The parents barely met their son and did not live long enough to give him a name. Hospital staff searched for Naphtal’s relatives, but found no one able to adopt him due to the injustice of extreme poverty.

The hospital staff gave him a name: Naphtal, after Nyirimanzi, one of his primary caregivers and among the clinicians who had saved his life.

And another clinician emerged as a mother figure: Kadija Wurie Jalloh, a nurse in the unit.

After Naphtal’s birth, while clinicians desperately tried to save his mother, Jalloh provided kangaroo care to Naphtal, keeping him warm and helping him survive.

“His mother was so sick. I wanted her to see her baby okay,” said Jalloh. “Since she has passed, I said, ‘Let me take care of him.’  Because I don’t know who this baby will be in the future.”

Even on her days off from the hospital, Jalloh came to the Special Care Baby Unit and sat in the rocking chairs, holding Naphtal against her chest. She provided one of the blood transfusions that kept him alive. And she took him to receive his first vaccinations at the hospital’s under-5 clinic.

After five months in the Special Care Baby Unit, Jalloh took him home, vowing to care for him as her own unless a biological relative came forward.

“I love him so much,” she said.

“The Right Track”

Today, Naphtal is seven months old—small for his age, but healthy and continuing to grow.

“He’s the hospital’s baby,” Nyirimanzi said. “For me, baby Naphtal reminds me this: Commit yourself to save lives even whenever and wherever it seems impossible.”

Naphtal was among the first patients cared for at the Special Care Baby Unit—a symbol of impact to come. Since the unit’s opening, KGH has seen its neonatal mortality rate decline rapidly.

In September 2019, 13.8% of the hospital’s babies less than one month old died. By September 2020, just four months after the unit opened, that rate had dropped to 6.8%—a 51% reduction.

“Naphtal is a symbol that we can bring great change in what we do,” said Nyirimanzi. “That, even in resource limited settings, we can save lives.”

The Special Care Baby Unit’s opening comes as part of larger improvements to pediatric and maternal care at KGH. In late 2020, the hospital provided new trainings in pediatric emergency care and improved the monitoring of vital signs and medications, leading to a 65% drop in mortality in the pediatric ward. And PIH and the Ministry of Health have announced plans to build the Maternal Center of Excellence—an innovative, world-class maternal health center that will include a neonatal intensive care unit.

“The journey is long and we are still far from the ideal, but what matters is that we continue these steps toward improving maternal, neonatal, and child health,” Nyirimanzi said. “With the Special Care Baby Unit, we are on the right track.”

At home with Napthal, Jalloh looks forward to the hospital’s upward trajectory in caring for its tiniest patients.

“I’m proud of the work we’ve done,” she said. “We were losing babies. But now we are able to save so many.”

In 2017, facing Sierra Leone’s long-standing maternal health crisis, Partners In Health leaders sat in a conference room in Kono District—statistically one of the most dangerous places to give birth in the world—and dreamed big:

What if, instead of making small, gradual improvements to PIH-supported Koidu Government Hospital’s maternity ward, we built a state-of-the-art, dedicated maternal center? What if we didn’t just knock down a wall every few years to add some more beds, but opened a teaching hospital that could accommodate every woman and child in need and train new generations of clinicians?

In the years since, what began as a simple idea—that all women deserve access to dignified, world-class health care—has turned into a plan for an unprecedented maternal health facility in a country where women face a 1 in 20 lifetime risk of dying prematurely during pregnancy or childbirth. 

In response to this need and in partnership with Sierra Leone’s Ministry of Health, PIH will build the Maternal Center of Excellence (MCOE) in Kono District. Construction will begin in early 2021, with services to begin in 2023, in partnership with architectural firms Build Health International and The Living.

The MCOE aims to strengthen maternal health in Sierra Leone—and beyond. The center will be located in Koidu Government Hospital—the only hospital in rural Kono District and an important health care provider in the region—and will drastically expand the hospital’s maternal health services and capacity, allowing more women and families to access lifesaving care. 

From concept to architectural rendering, the MCOE has always represented more than a building—it’s a testament to women’s rights as human rights, and an investment in a future that is sustainable and equitable. The MCOE builds sustainability into the heart of its design, from locally sourced bamboo to energy-efficient lighting and cooling systems. And its design elements tell the story of Sierra Leone’s past, present, and future, incorporating stones from Kono’s long-exploited diamond mine and timber sourced from a sustainably-planted forest in Sierra Leone.

This interactive map offers an inside look at the MCOE’s key clinical features and design elements, offering a glimpse of a center that represents how far the country has come—and how much farther it can push the limits to forge a new path for mothers, children, and families worldwide.

A new oxygen plant installed at Partners In Health-supported Botšabelo Hospital is the first such facility in Lesotho and will save lives during the respiratory COVID-19 pandemic and beyond, a local news report said.

PIH Lesotho, known locally as Bo-mphato Litsebeletsong Tsa Bophelo, opened the plant this month in collaboration with Lesotho’s Ministry of Health. The facility is housed in a renovated shipping container on the campus of Botšabelo Hospital, the country’s only health facility for patients with multidrug-resistant tuberculosis (MDR-TB).

In a media report on the facility’s formal launch, a Southern Africa Broadcasting Corp. correspondent said the vital oxygen plant “will go a long way in saving and ending unnecessary deaths” in Lesotho, a mountainous nation surrounded by South Africa.

PIH has worked in Lesotho since 2006, supporting and strengthening the government’s health system and combating high rates of HIV and TB.

Advocate Lesimole Moletsane, deputy principal secretary for Lesotho’s Ministry of Health, said the oxygen plant is a significant landmark in those battles, and the fight against COVID-19.

“Those who have died, families who have suffered the loss of loved ones because of the shortage of cheap oxygen, that is also history, from today,” she said.

Lesotho Minister of Health Motlatsi Maqelepo said that amid the crisis of this year’s pandemic, one silver lining is the creation of opportunity for Lesotho’s health sector.   

“We have got so much support from our partners and our government, and we are going to take the opportunity to make sure that we turn around the health system of Lesotho, and that we build a better health care system,” he said at the oxygen plant’s launch.

Dr. Melino Ndayizigiye, executive director of Bo-mphato Litsebeletsong Tsa Bophelo, said PIH also is preparing to support distribution of COVID-19 vaccines.

“We know that for the vaccine, there are a lot of needs, especially on the cold chain, the capacity-building for the health care workers to administer the vaccines, to make sure that in all the districts, in all the corners of the country, people have access to the vaccine,” Ndayizigiye told SABC.

He noted that PIH has a history of experience and expertise in widespread vaccine campaigns around the world, and is proud to support Lesotho’s COVID-19 response.

“We will be there with the Ministry of Health to support and do what it takes to make sure that all people, Basotho, are well-vaccinated and covered,” he said.

Community health workers (CHWs) prove to be the backbone of any health system, providing a link between households and health facilities. As Partners In Health (PIH) learned during the Ebola epidemic in West Africa from 2014 to 2016, this link is especially critical during an infectious disease outbreak.

So as COVID-19 spread around the world, PIH wasted no time mobilizing the community-based teams in Kono District, Sierra Leone, where we support six health facilities and employ a cadre of CHWs dedicated to accompanying patients living with HIV and tuberculosis.

“We worked together to form a comprehensive community COVID-19 response centered around two pillars: screening and education,” said Kumba Tekuyama, head of community-based programs. That work was paired with local radio spots educating Kono residents about the virus and its prevention.

But to cover the entire district, and ensure every family had access to information and care amid a highly infectious, largely unknown virus, more help was needed. CHWs had their regular patient visits to maintain, and, as Tekuyama pointed out, some communities are so remote, they’re unreachable even by FM radio signal. A more innovative solution was needed.

“We decided to hire social mobilizers, who can actually go out there and do door-to-door sensitization,” Tekuyama said. “Social mobilization is a term that sometimes means different things to different people. But in our context, it’s a process of bringing people together to raise awareness and community involvement for health care.”

PIH trained 126 CHWs and its new 135 social mobilizers—a fully doubled community health staff—on identifying the most common signs and symptoms of the novel coronavirus, and on strict infection prevention and control measures to keep themselves and others safe. Wearing face masks and carrying with hand sanitizer, they visited homes across Kono’s 14 chiefdoms to screen patients for COVID-19 and promote handwashing, social distancing, and seeking care early. 

Importantly, CHWs successfully continued their routine home visits during the response, not letting any of their regular patients slip through the cracks. One of the most vital messages that CHWs and social mobilizers shared in communities was to continue visiting health facilities for routine care—explaining that, despite any experiences or trauma from Ebola, hospitals and clinics remained safe and necessary to visit.

In fact, the community-based response helped identify not only potential COVID-19 cases, but also more than 1,500 patients with other health conditions in need of medical attention, varying from hernias, to tuberculosis, to mental health conditions. CHWs connected these patients with care at local primary health clinics, Koidu Government Hospital, and Wellbody Clinic—where new COVID-19 triage systems and safety protocols ensured all facility staff and patients would remain safe.

In all, the team screened 65,960 people for COVID-19 symptoms, educated 270,130 people about the virus, and referred 1,538 people to health facilities for non-COVID-19 conditions and 127 people to social support, such as food and financial assistance.

Below, CHWs and social mobilizers reflect on their work to keep Kono safe during a historic moment.

Comments have been edited for brevity and clarity.

Armando Torres is a 67-year-old father of four who has dedicated most of his life to working on coffee crops, as do most people in the Sierra Madre region of Chiapas, Mexico. Torres greets everyone he encounters with a big smile and is known for his warm personality.

In the middle of August, Torres woke up feeling nauseous. As the day went on, he started vomiting and feeling feverish. At first, he thought it was just an intestinal infection caused by something he might have eaten. But it didn’t feel normal or like any of the usual side effects of his diabetes. After a couple of days, he started coughing and became exhausted after doing simple activities, like talking or walking around the house. One afternoon, he felt his legs shaking as he attempted to get up from his chair.

“I can’t remember anything after that, until I woke up later that night in the hospital,” he says. “I was in a wheelchair and the doctors were bringing an oxygen concentrator to me. I felt so lost.”

Then the COVID-19 diagnosis came.

Torres’ family had doubts about even taking him to the hospital, as disinformation was spreading in the community and taking advantage of people’s fear of the disease—there were even claims that patients arriving to the hospital would be killed. But one of Torres’ sons knew that many patients had recovered and been discharged from the Respiratory Disease Center in Jaltenango, where Compañeros En Salud, as Partners In Health is known locally, works.

Going to the hospital was a decision that may have saved Torres’ life.

“My father was treated as soon as we got to the hospital,” says Armando Torres Jr. “They helped him stabilize, but he was in a critical situation.”

Compañeros En Salud works in nine rural communities in Chiapas. Its COVID-19 response has included supporting Jaltenango Hospital and community clinics with staff, resources, and education, as well as training community health workers to focus on the pandemic response. Compañeros En Salud’s COVID-19 response comes in addition to the vital health services it continues to provide for patients across its programs.

At Jaltenango Hospital, which Compañeros En Salud has supported since 2011, patients like Torres not only receive treatment and care for the virus, but also support for their mental health and emotional well-being.

When Torres’ family understood the severity of his condition, they considered taking him to a larger hospital about 1.5 hours away from Jaltenango. But that would have meant they wouldn’t be able to see him until he was discharged—and only if he recovered.

“Here, in the Respiratory Disease Center, they gave us the opportunity to visit my father,” says Armando Torres Jr. “That really calmed him down.”

It was an outcome that Dr. Ana Laura Rodríguez, who treated Torres, noticed too: whenever his family was close to him, his oxygen saturation would improve.

“We provide families with personal protective equipment and allow them to visit the patients so that they won’t feel lonely and to generate a therapeutic alliance,” says Rodríguez. “This is something that no other hospital does. This way, our patients feel supported by their families and can go home earlier.”

Jaltenango Hospital’s visitation policy also helps families feel reassured about where their loved ones are staying and that they are receiving quality medical attention.

Now, Torres is recovering at home with his family. He says that he has learned so much from this experience—as harrowing as it was. “I was in the hospital for 18 days,” he says. “I was worried about my family, and I didn’t know what was going to happen, but I trusted the medical team and thanks to them, I’m now back home.”

Dr. Melino Ndayizigiye grew up in a remote village in Burundi, the ninth of 10 children, born to parents who had never set foot in a school but made sure their children did.

His parents were subsistence farmers. By the time Melino—known to most by his first name—was 3 years old, his father was teaching him how to take care of animals, a passion he carries with him today. His father died when Melino was in 10^th grade, just a teenager and suddenly scrambling to help his single mother make ends meet.  

The loss increased Melino’s drive to succeed--to do whatever it took to change his life and his family’s circumstances. And it inspired him to help others born to similar hardships. When he was 17, a potential path to those goals appeared.

That was the year that Melino became very sick.

He was at a boarding school in Kiremba, in southern Burundi and far from his home, when he developed a fever, severe back pain and nausea. He was admitted to a small health center, but the facility had no lab, no x-ray or ultrasound machines—nothing besides a few medications on a shelf.

At that time there were no cell phones, so the only way for Melino to inform his family of his illness was to write a letter and find someone who could travel to his home to deliver it. But it was not easy to travel at that time, because Burundi was in a civil war.  

He thought he might die without his family knowing. It took more than three weeks for them to learn that he was sick.

Finally, they heard the news—and after almost a month in the health center, Melino was still so sick that his family took him to Bujumbura, Burundi’s largest city, for care.

There, at Roi Khaled University Teaching Hospital, was the first time in his life that Melino met a doctor.

Melino recovered, and several years later began medical school—at Roi Khaled, where the doctor who had cured him became one of his professors.

What followed in the years since—completing an emergency obstetric and surgery program, working at a remote hospital just before the end of the civil war, graduating with Harvard’s first global health delivery class, joining Partners In Health in Lesotho—is far too much for one conversation.

But here’s an attempt.

In the following* interview, Melino, executive director and former clinical director for Bo-mphato Litšebeletsong Tsa Bophelo, as PIH is known in Lesotho, shares his story for our ongoing series, Ekip Solid. Meaning “strong team” in Haitian Creole, Ekip Solid is a series of conversations with PIH global leaders about an array of topics, personal and professional.

You completed your medical internship in 2006, did your dissertation in 2007, and worked as a physician at a private hospital in Bujumbura. Can you describe that experience?

It was a time when Burundi was about to finish its civil war. We had had a long civil war for over 13 years, and when I graduated, many physicians didn’t want to go to rural areas, because it was not safe. Also, there was not a signed peace agreement between the last rebel group and the government, so people were reluctant to work in rural areas.

As someone who was born and raised in a remote village, I decided to go. I applied for a job with the Ministry of Health, and they appointed me as medical director in a district hospital in a rural area. I was the only physician in that hospital, serving a population of close to 200,000 people. I worked there for about a year.

For the whole year, I worked like a machine. Being one physician in a remote district hospital, you can imagine. It meant working day and night, dealing with all sorts of emergencies and conditions.

Around that time was when you first met Dr. Paul Farmer, PIH’s co-founder and chief strategist. How did that meeting occur?

It was by chance. Paul Farmer came to Burundi in 2008, with a team from Village Health Works (a nonprofit that provides quality, dignified health care in Burundi). He spoke at a conference in Bujumbura, at the National Institute of Public Health, and I was there. He inspired me a lot. When he was presenting about problems of health in the developing world and what PIH had been doing in different countries, such as Haiti, I got really inspired. I remembered how I had grown up without any access to health services.

After Paul Farmer and the team from PIH and Village Health Works did their presentation, I spoke with them, and they asked me to join Village Health Works. It was just at the beginning of the project.

I became the first medical director for Village Health Works. We often lived in tents. We worked hard, and we improved things in rural Burundi.

And yet, lingering dangers remained from the civil war. Did that affect you?

(Note: The following paragraphs describe traumatic violence.)

On July 13, 2009, I got ambushed. It was early in the morning, and I was traveling to our clinic. It was on a slippery mountain road.

We were ambushed by a group armed with AK-47s. They told us to give them money, cell phones. They told us that they were going to kill us. And they came to me; they knew I was the only physician in that region. One man pointed a gun to my head while others surrounded our car, insulting us and telling us it was our last day.

I had been working day and night to provide health services to patients. To me, I felt like I didn’t have any enemies. But to my surprise, one of the men decided to shoot, and killed my driver.

Our car started to roll back, and the murderers started to shoot everywhere. There were too many bullets, everywhere. It was really heartbreaking.

I briefly lost consciousness. I was with four other people in the car. We first pretended that we were dead, then we fled on foot and hid.  

How did you keep working after an experience like that? What motivates you?

I kept thinking, “Why am I risking my life by going to work in the mountains?” But to me, that was my strong calling from the beginning, because I knew the conditions and had grown up without access to health services.

So I kept going, and worked for five years as medical director for Village Health Works.

What makes me most happy is when I serve patients, and they get better. Work is my passion, to keep going and helping, by all means. That is my passion. That is my calling.

In 2012, you joined Harvard’s first class of master’s in global health delivery students. What did that mean to you?

I was fortunate, more than fortunate, to be part of that program. My mother and father didn’t go to school at all; they had never been in a school.

Even though they didn’t go to school, they knew the value, and they always encouraged me to be the best. To never give up. They did all they could; we had cattle to help pay for school fees and for other things, like books.

When I lost my dad, my mother kept telling me that I needed to succeed.

I’ve always tried to do the best I can. I always want to succeed with high marks and do what it takes to push myself to a greater level. While I was studying at Harvard, I worked hard to succeed. It was a new system and a new environment to me, but I did it. My thesis still is being used as educational material for students in the global health delivery program. I’m invited to present my work each year in the mixed methods research class, and I am always grateful to have the opportunity to share with the students.

Your mother is 87. How does it make her feel, to see you as a doctor now?

She is very happy to see me and my profession. Being a doctor, I am treating her well and I will do all that I can to keep her healthy.

I see her very rarely. In Burundi, there has been renewed political crisis since 2015. More than 500,000 people have fled the country. I wanted to bring her to Maseru (Lesotho’s capital), but she refused. She said: “I have lived long enough, and even if they come and kill me, I won’t leave my home.” It is very touching.

Fortunately, nothing has happened in my village. Many people have been killed in Bujumbura, but in rural villages there is peace. She is still living there. I talk to her at least twice a week.

I’m still hopeful that one day, under a new government, I will go and see her. She is sick, and she needs care, so I am still planning to travel there and see her.

Given your travels and global experience, how many languages do you speak?

Five. My first language is Kirundi, and French was my language of education in primary school up to university. I also speak Kinyarwanda and Swahili. I started to learn English in 2008, when I joined Village Health Works and began working with people from America. I forced myself to learn and use English, which now is my fifth language.

When you’re not working, what do you like to do?

When I happen to have some free time, I like to be in nature, where there are trees. I like to be in a place where there are animals. Being around cows, dogs, birds, and mountains makes me feel happy.

At our family’s home in Burundi, we have a dairy farm, with dogs and people who help take care of the cattle. Sadly, I don’t have animals here in Lesotho. I once wanted to buy a horse but I realized that I wouldn’t have time to feed and take care of it here.

And I’m often in touch with my siblings. Some are in Burundi, but others have fled the country and we haven’t seen each other in a while. We do talk on the phone on weekends.  

How long have you worked for PIH?

Formally, I joined PIH after completing studies at Harvard in 2014. But I had known about PIH and worked through their support since 2008.

During my time with Village Health Works, I frequently visited Inshuti Mu Buzima, as PIH is known in Rwanda, to observe the model of care and implement it in Burundi. I participated in many trainings, meetings, and workshops organized by PIH, and consider myself someone who has been working for PIH for many years.

This year, you became the executive director in Lesotho just as COVID-19 arrived. What has this past year taught you, and how has your team responded to the pandemic?

Initially, there was a lot of false information about COVID-19 spreading on social media and in communities.

So, I created a special team and worked with them to make sure that all COVID-19 infection prevention and control measures were implemented in our workplaces, and that our staff had enough Personal Protective Equipment (PPE), with accurate information to help them continue providing services. But I realized that all of those things were not enough—we needed to provide additional mental health, psychological, and social support to our staff, who were and are experiencing stress and anxiety. We’ve created a staff wellness and peer support program to assist our staff and patients.

I’ve worked hard with my team to write grant proposals to help us get funding to continue our routine services, mitigate the negative impacts of COVID-19 on our health services, and keep supporting the government of Lesotho in building a resilient health system.

My new responsibilities during this COVID-19 pandemic have been challenging, but I always tell myself that I have to do all that it takes to protect my team and our patients, and I have to make positive changes to put PIH at a higher level. I am grateful that all of our staff are healthy today and that we are still providing care to our patients.

*This interview has been condensed and edited.

As the race for a COVID-19 vaccine nears the finish line, questions loom about who will receive the vaccine—and who won’t.

COVID-19 has presented an unprecedented global crisis, leading to more than 65 million cases and 1.5 million deaths worldwide. While vaccines could be widely available in the United States as soon as April, vaccines won’t be available for billions of people around the world until as late as 2022 or even later. It could take up to four years to produce enough doses to vaccinate the global population. And it’s likely to be an uphill battle.

Partners In Health stands in solidarity with global organizations and leaders, including former labor secretary Robert Reich, Chelsea Clinton, and Nobel laureate Joseph Stiglitz, calling for a “People’s Vaccine”—a vaccine that is made free and accessible to all people around the world. In November, PIH leaders signed an open letter urging the incoming U.S. presidential administration to ensure that the vaccine, likely from among the candidates developed by American companies, is made available to all.

“The People’s Vaccine letter is really about pushing President-Elect Joe Biden to not just commit to access for those in the U.S., but also to make sure that everyone across the globe can have access to a vaccine if it’s developed by a U.S. company,” says Justin Mendoza, PIH’s advocacy manager. “Without action from world leaders, the vaccine will leave far too many behind.”

That would come as a reversal of course for the U.S., which under President Donald Trump’s administration publicly rejected COVAX—the global initiative to develop, manufacture, and distribute the COVID-19 vaccine in bulk at low-cost—and instead prioritized vaccine access for its own population, investing in five candidates through Operation Warp Speed. Even wealthy nations part of COVAX have been buying up the world’s supply of vaccines, leaving impoverished countries behind.

The letter warns that, if the usual protocols for global vaccine distribution are followed, masses of people would lack access to the COVID-19 vaccine, putting millions of lives at risk—and prolonging a devastating pandemic.

Among its demands, the letter urges the incoming Biden-Harris administration to ensure that vaccines are sold at affordable prices, so governments around the world can provide protection to people for free.

It also calls on the future administration to guarantee that vaccine technologies and know-how are shared rather than sealed off with patents and other intellectual property—an approach that would allow more companies to manufacture vaccines and increase the world’s vaccine supply more quickly.

And it urges the incoming administration to ensure equitable global distribution of the vaccine, prioritizing those most at-risk, including health care workers, the elderly, and the chronically ill, as well as communities disproportionately impacted by COVID-19. This would be accomplished through policies that build out a vaccine distribution approach that encompasses planning and resource allocation, community mobilization, vaccine delivery, and individual and community follow-up.

Such measures can’t come fast enough.

Wealthy countries are buying up the world’s supply of vaccines. The U.S. could eventually control 1.8 billion doses, about a quarter of the world’s near-term supply, according to Duke University researchers—stockpiling and buying more vaccine doses than it could possibly use. COVAX lacks the funding and resources to produce the staggering amount of vaccines needed worldwide. And the vaccine may be too expensive for low- and middle-income countries to afford to buy in bulk and distribute for free to their populations.

In recent years, the cost of drugs in the U.S. has soared, leading nearly 1 in 3 patients to find alternatives to filling their prescription, including skipping doses, switching to over-the-counter drugs, cutting pills in half, or not filling the prescription entirely. This is further exacerbated at the global level, where cost remains a barrier to medicines access for an estimated 2 billion people worldwide.  Despite the fact that billions of U.S. taxpayer dollars funded vaccine development, some drug-makers have announced plans to profit from COVID-19 vaccines—sparking widespread criticism.

“The current vaccine regime and the way that we design, sell, and manufacture them around the world leaves low-income communities and those who are most vulnerable to COVID-19 at the very bottom of the list of priorities,” says Mendoza. “We’re trying to really urge decision-makers to shift those priorities and help us stop COVID-19 by protecting the most vulnerable.”

In the U.S., too, protecting the most vulnerable will be essential in ending the pandemic. COVID-19 has disproportionately impacted Black, Indigenous, and Latinx communities due to centuries of systemic racism that have put out of reach equal access to health care, education, housing, and transportation. It has also run rampant in the nation’s prisons, jails, and detention centers.

PIH’s support for a free and fair COVID-19 vaccine stems from its more than 30 years of advocacy for health care as a human right—from early days fighting the HIV/AIDS epidemic in Haiti to the current battle against multidrug-resistant tuberculosis around the world.

Maria Plata, an Immokalee, Fla., native and daughter of a Mexican farm worker, was one of millions of Americans who lost their job when COVID-19 hit in early March. But several months later, she found a new opportunity among the first cohort of community health workers hired by Healthcare Network, a local health care provider, and trained by Partners In Health to support her community’s response to the virus.

A fluent Spanish speaker, Plata began going door-to-door in Immokalee, where the majority of residents are Hispanic, answering questions and dispelling rumors about the pandemic.

“Some believe that if you go to the hospital, you will die, or that you can get COVID-19 from being tested,” Plata says.

Plata is among six community health workers, or CHWs, connecting residents with care in Immokalee, a largely immigrant, farm worker community of roughly 27,000 people. There, the virus spread rapidly among those living and working in crowded conditions, often with little to no institutional supports, such as PPE or paid sick leave. For some, especially the undocumented and uninsured, there is reluctance to access health care services.

It’s a story often repeated by officials in 15 locations across North America with which PIH has partnered to launch a more robust response to the COVID-19 pandemic. These efforts are part of the newly created U.S. Public Health Accompaniment Unit (PHAU), which provides technical expertise and training to state and local governments on effective testing, contact tracing, quarantine, and social support—such as food, housing, or financial assistance. The unit also offers free online resources through its Learning Collaborative and advocates at the highest levels of government for public policy that ensures an equitable response to the global pandemic.

A critical element to this work is the creation of local teams of CHWs, who connect residents to the information they need to prevent infection or access care. So far, 4,234 CHWs and contact tracers have been hired in hard-hit places like Immokalee and across at least three other locations, including: Navajo Nation; North Carolina; and Montgomery, Ala. 

Dispelling rumors, allaying fears

CHWs form the backbone of PIH’s work globally and have made the difference in connecting patients with care during other infectious disease outbreaks, such as multidrug-resistant tuberculosis (TB) in Peru and Ebola in West Africa. The same is proving true in PIH’s efforts to stop the spread of COVID-19 in the United States.

Dr. Fernet Leandre, a TB and HIV expert and chief program officer at Zanmi Lasante--PIH’s sister organization in Haiti--has been working in Immokalee for several months and helped train the first CHW team, which will soon expand with six more hires. The team supports COVID-19 testing, makes referrals to the local clinic, and canvasses door-to-door to provide COVID-19 prevention education. He says CHWs, who must be culturally competent and are often multilingual, are critical to building trust in the health system and connecting people to medical care.

In Immokalee specifically, fears that testing or hospitalization could result in deportation are widespread, so listening to and addressing such fears are key parts of CHWs’ work. CHWs assure people access to care, regardless of citizenship status.

Leandre says PIH has learned from its global experience that letting community members and local partner organizations inform and guide pandemic response has helped build trust and willingness to engage with the public health system. Partnership with local and grassroots organizations also promotes buy-in across the community.  

“Once we showcase what works,” Leandre says. “We can scale up and have more buy-in from local officials.”

Launching a statewide team

In North Carolina, PIH is working with the Department of Health and Human Services and the Office of Rural Health to improve the statewide COVID-19 response, working primarily with marginalized populations, including Latinx, Black, migrant, and farm worker communities.

Dr. Devin Worster, who is overseeing PIH’s response there, says a successful statewide contact tracing system must come hand-in-hand with support for individuals and families in quarantine. CHWs identify and connect patients with resources, such as food and financial relief payments, to allow for safe quarantine or isolation. With PIH’s support, North Carolina officials have contracted seven community organizations to hire and train more than 400 CHWs.

“As trusted members of the community,” Worster says, “CHWs are best equipped to reach the most vulnerable, understand their needs, and coordinate connections to essential supports.”

In Durham, CHWs recently helped a family in need of urgent social support. The team at Curamericas Global connected a disabled mother who was diagnosed with COVID-19, along with her two children who also fell ill, to Duke University Health System and a local nonprofit called Gang Free Inc, which provided boxes of food, PPE and sanitation supplies, and a one-time financial relief payment. The family called to express their gratitude. One CHW who accompanied the family recalled that the experience “was extremely emotional, in a good way.”

Back in Immokalee, Plata had similar good news to share. She recently met an immigrant mother of two who was threatened with eviction after losing her job due to COVID-19 and falling behind on rent. She was able to link her to a local organization called Misión Peniel, which stepped in with emergency rent and food assistance.

For Plata, the family’s example was a powerful reminder of the importance of partnership: “I was so happy that we were able to make that connection.”