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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

*Comments were edited and condensed for clarity.

Global Situation in the Time of COVID-19

• The current COVID-19 outbreak is a reminder that health emergencies know no borders and that strengthening health systems in the U.S. and globally is the best defense against future public health crises.
• In the midst of this crisis, we can’t sit back and wait for social distancing to slow transmission- we must go on the offensive. As we’ve seen in Wuhan, China, and in South Korea over the course of this pandemic, successful public health responses include five key elements: social distancing, testing, contact tracing, isolation, and treatment.
• It’s not too late. The time has come for us to get into the fight. We can still mobilize, take on the virus, and win. What’s needed is a decisive investment in a public health initiative big enough to meet the challenge. We can shut down the spread of the virus, prevent suffering and death, and allow the economy and society to reopen more quickly and safely
• Far from being an equalizer, COVID-19 is amplifying preexisting social inequities tied to race, class, geography and access to the health care system in the U.S. and globally. In order to ensure history doesn’t repeat itself as we’ve seen with TB, HIV/AIDS, cholera, among other infectious diseases, we must ensure that during this moment we are critically examining our current systems and developing plans to change how health care is conceptualized and administered in the U.S.
• Global solidarity and cooperation are necessary to control COVID-19 and future outbreaks. This moment calls for global ceasefires, halts to deportations and detentions—acting with care and compassion to protect human rights—and not detention, bullying and use of force. The only way we will end transmission of this virus and reopen our economy is if people participate fully in control measures and help one another to do so.

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

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

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

1. Testing

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

2. Contact Tracing

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

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

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

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

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

3 & 4. Supported Quarantine and Isolation

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

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

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

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

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

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

Financing the Public Health Response

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

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

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

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

Look Up Your Elected Official

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

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

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

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

Unity, Community in Rwanda's Rebirth

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

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

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

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

Gender Equity

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

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

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

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

Health Care for All

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

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

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

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

Solidarity and COVID-19

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More than Emergency Care

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

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

The new emergency facility is designed to meet those needs.

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

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

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

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

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

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

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

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

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

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

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

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

Hurricane Matthew in Haiti

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

Floods in Peru

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

Mudslides in Sierra Leone

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

Earthquakes in Mexico 

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

Floods in Malawi 

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

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

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

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

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

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

1. What is WASH exactly?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Training, Information, and Compassion

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

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

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

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

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

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

And PIH’s impacts are extending far beyond Kono.   

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

Strengthening Sierra Leone’s National Response

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

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

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

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

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

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

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

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

Triage, Testing, and Treatment in Kono

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hiring/Job Details 

Are these full-time or part-time positions?

Full-time is preferred.

How much do they pay?

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

When will interviewing start?

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

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

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

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

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

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

Not at this time.

Is an iPad sufficient for new employees to use?

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

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

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

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

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

COVID-19 Information

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Donate to COVID-19 Response

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

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

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

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

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

Maternal Care in the times of COVID-19

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

Haiti on the frontlines

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

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

Preparing in Mexico

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

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

Sierra Leone remembers Ebola

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

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

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

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

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

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

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

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

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

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

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

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

McMahon said the pandemic’s impacts are unprecedented. 

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

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

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

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

PPE Conservation Strategies

• When evaluating patients with concern for Coronavirus Disease 2019 (COVID-19), providers should wear a surgical mask, gown, gloves, and eye protection. This is a (WHO) and (CDC) recommendation.
• N95 masks should only be used for aerosolizing procedures with COVID-19 patients, such as nebulization, non-invasive positive pressure ventilation, and intubation.
• When possible, concentrate patient care activities to minimize sets of PPE needed. For example, take vital signs and give medications at the same time to use one set of PPE instead of returning a second time and using a second set of PPE.
• Minimize people in an isolation area, or for a patient needing PPE, to the caregivers involved in direct care of those patients.
• Limit the number of observers and non-essential personnel in operating rooms to reduce the use of masks and gowns.
• As needed, consider the extended use of masks between patients (meaning, care providers keep their mask on continuously, rather than removing between patients).
• Eye protection can be cleaned with a bleach solution and reused between patients.
• To ensure that global PPE shortages do not negatively impact care of any kind of patient (including TB patients and surgical patients), it is important to conserve the use of PPE in all clinical areas, as well as COVID-19 response areas.

Caring for Caregivers

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

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

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

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

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

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

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

Watch the webinar

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

{"preview_thumbnail":"/sites/default/files/styles/video_embed_wysiwyg_preview/public/video_thumbnails/Nq4faLcP1p8.jpg?itok=UKmdTmws","video_url":"https://www.youtube.com/watch?v=Nq4faLcP1p8&feature=youtu.be","settings":{"responsive":1,"width":"854","height":"480","autoplay":1},"settings_summary":["Embedded Video (Responsive, autoplaying)."]}

UPDATE: 11:30 A.M. APRIL 7, 2020   

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Join the COVID Community Team 

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

Apply

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

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

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

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

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

Source: WHO Myth Busters
 

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

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

Source: CDC 

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

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

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

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

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

Source: WHO

MYTH 5: Antibiotics are effective against the new coronavirus.

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

Source: WHO
 

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

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

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

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

Source: Wall Street Journal
 

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

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

• It was viable up to four hours after being placed on copper, and up to 24 hours after being put on cardboard.

Source: CNN Health / New England Journal of Medicine
 

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

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

Source: London School of Hygiene and Tropical Medicine

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Jody agrees. 

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

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

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

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

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

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

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

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

For Jody, seeing this passion firsthand was striking. 

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

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

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

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

On March 20, this rang true once again.

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

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

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

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

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

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

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

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

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

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

• Does not guarantee sick pay for millions of workers, which is critical to slowing the spread of the virus, and is vital to protect our communities against the continued risk of this pandemic.
• Does not cover costs related to COVID care and treatment. These costs will continue to affect Americans’ ability and willingness to seek care and inhibit efforts to slow the pandemic. The bill will also result in significant costs for the uninsured and those served by the Indian Health Service.
• Does not expand access to home and community-based services to deliver care and social support, which our experience during the Ebola outbreak in West Africa and other epidemics, has taught us that community-based care is critical to expanding access and improving outcomes, especially for the most vulnerable.
• Does not go far enough to protect our frontline by ensuring the equipment necessary to protect health care workers and investments to expand hospital capacity to manage the high number of cases, which, as our hospitals and health systems become overwhelmed, will be critical in reducing preventable deaths.

What you can do

Sign our pledge: Health Care is a Human Right

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

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

Add your name

Call your elected official

Urge your elected officials to support or draft legislation that:

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


2. Is responsive to the needs of Native American communities including:
   • Ensuring meaningful engagement of Native communities and Tribal leaders in the COVID-19 response including representation of the Indian Health Service (IHS) on the WH Coronavirus Task Force Tribal health departments and other actions outlined in Senator Udall’s bi-partisan letter to the White House;
   • Provides Tribal leaders, Tribal health departments, and urban Indian health programs with equal access to COVID-19 related information that is provided to their state and local counterparts;
   • Direct all COVID-19 resources identified by Congress for Native communities’ use to impacted IHS facilities, Tribes, and urban Indian health programs in a timely manner (concerns have already been raised regarding the limited response), and support bill S.3514 (A bill to ensure that facilities of the Indian Health Service, facilities operated by an Indian tribe, tribal organization, or inter-tribal consortium, and facilities operated by an urban Indian organization receive items from the strategic national stockpile and qualified pandemic or epidemic products directly from the Department of Health and Human Services.)

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


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


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


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

Look Up Your Elected Official

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

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

What is tuberculosis (TB)?

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

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

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

How is it treated?

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

Why Is TB relevant?

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

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

• Both TB and COVID-19 will disproportionately affect impoverished areas with weak health systems. We know from fighting TB that we must put vulnerable people first in the fight against COVID-19.
• Both diseases can be especially prevalent among vulnerable populations including prisoners, migrants, people living with HIV and weakened immune systems, people battling malnutrition, people living in poverty, and many others.  
• Most TB survivors have gone through the isolation, fear, discrimination, and stigma that patients now are facing with COVID-19.
• Years of under-investment made tuberculosis and its drug-resistant forms the deadliest infectious disease in the world. We can’t afford to repeat these mistakes and be unprepared for pandemics like COVID-19.
• To stop COVID-19, we can use many of the same tools needed to fight TB: infection control, contact tracing, telemedicine, and psychosocial support. 
• Health care workers are at the center of the fight against both of these diseases. We must protect, support, and encourage the health workers and heroes fighting TB and COVID-19 on frontlines around the world.

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

Donate to StopCOVID

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

They had been down that road too many times before. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Listen to the experts

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

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

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

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

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

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

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

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

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

• Store Marketing: A COPE partner created a video, in which they went to a local grocery store and found 19 soda displays, compared to very few for water.

• Trust: We surveyed 109 community members, and 19 percent said the reason they do not drink tap water is because it is not safe.

• Low Awareness: Caregivers and parents often are uninformed about how much sugar is in their beverages, and how it can harm their health.

• Changing times: Elders have mentioned that in the past, soda was used as a treat and shared among all relatives, compared to now, where it’s easily accessible.

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

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

• Promoting a community-wide culture of health through campaign materials, including local champion posters, store marketing materials, and dissemination of fun challenges and activities that support healthy lifestyles. 

• Sharing traditional knowledge and hands-on, healthy practices, through a recently produced video of elder teachings on water, and demonstrations of healthy beverage choices.

• Increasing access to healthy beverages by distributing healthy beverage kits and water filters to community schools, after-school programs, dormitories, stores, clinics, and more.

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

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

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

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

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

COPE Annual Report

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

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

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

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

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

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

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

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

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

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

Read Farmer’s full opinion piece here.

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

{"preview_thumbnail":"/sites/default/files/styles/video_embed_wysiwyg_preview/public/video_thumbnails/rfFAq4XDB5E.jpg?itok=37K8qnCO","video_url":"https://www.youtube.com/watch?v=rfFAq4XDB5E&feature=youtu.be","settings":{"responsive":1,"width":"854","height":"480","autoplay":1},"settings_summary":["Embedded Video (Responsive, autoplaying)."]}

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

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

PCR tests

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

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

Rapid tests

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

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

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

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

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

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

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

How to Help

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

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

Donate Now

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

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

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

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

Top 10 Practices:

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

Remember: 

• Things will get better eventually, and back to normal; the world is not collapsing (don’t go “catastrophic”).
• Most people are good, and people are going to persevere and help each other
• You’re tough, you’ve overcome challenges before; this is a new one.
• This is a particularly strange and unprecedented situation; humor helps once in a while.
• If having obsessive or compulsive thoughts related to the virus, or the broader uncertainty, wash your hands once, and then remind yourself that anxiety is normal in this scenario. But the mind also can also play tricks on us. Try to breathe and move the internal discussion on. 
• Live in the moment, think about today, less about the next three days, even less about next week; limit thinking about the next few months or years, for now.

The global COVID-19 pandemic is a clear demonstration that health emergencies know no borders and that strengthening health systems globally is the best defense against international public health crises, which can become international economic crises. COVID-19 should serve as a wake-up call that one of the best investments the US can make for achieving a healthier, more secure, and peaceful world is in strengthening health systems globally. The Sustainable Development Goals (SDGs), which the U.S. Government (USG) pledged to help achieve at the U.N. General Assembly in 2015, provide an existing framework for strategic investments in health systems strengthening. By leading global efforts to achieve the health-related SDGs, the USG can transform global health, build resilient, country-owned health systems, and help to prevent approximately 97 million premature deaths by 2030

To enable significant progress toward the health-related SDGs in order to prevent, mitigate and respond to health crises, the USG must:

1. Transform USG global health funding to improve efficiency, equity and sustainability

Reaching the end of this pandemic and containing future outbreaks demands strengthening health systems, especially in the most impoverished countries with the worst health outcomes. This requires transforming the way that the USG funds and supports global health. Currently, US global health funding is hugely inefficient, consistently ranking lowest among donor nations in terms of the aid quality. To improve the efficiency, equity and sustainability of global health funding the USG should:

• Deliver global health funding and programs through an overarching health system strengthening framework

  The SDGs clearly demonstrate global political consensus and commitment to transition from a disease-specific approach, an artifact of the Millennium Development Goals (MDGs), to a health system strengthening approach. The transition to health systems approaches is urgent; targeted vertical approaches to specific diseases/conditions are ill-suited to responding to pandemics or to strengthening public health. Lessons from the MDGs have shown that even disease-specific goals require strong cross-cutting health systems investments, yet USG funding remains largely disease-specific and delivered by international and private sector actors, often resulting in parallel systems and large inefficiencies.

• Support national health plans, public institutions, local priorities, and donor coordination

  For funding to be optimized it must support system improvements in line with the national health plans. Investments in strong systems harmonize resources, foster local ownership, and improve responsiveness to meeting all health needs and ensuring healthy and productive populations. However, USG funding commonly bypasses these plans and public institutions with parallel inputs, which lead to massive inefficiencies, fragmentation of care delivery, poor care in public facilities, and internal brain drain of health care workers from the public sector. In 2015, around two-thirds of US official development assistance (ODA) in 2015 bypassed recipient governments altogether. While the USG has committed to the Paris Declaration on Aid Effectiveness and the UHC 2030 principles for effective development cooperation, harmonization with other donors is still limited. Existing laws authorizing foreign aid expenditures should be amended to enable increased support of public institutions.

• Prioritize support for multilateral mechanisms

  Multilateral funding mechanisms are more efficient, equitable, and less fragmented than bilateral mechanisms and as such are preferred by recipient governments. Yet, only 14% of US ODA provides core funding for multilateral organizations, one of the lowest shares of all donor nations.

• Funding for global health should not be tied to spending on US goods and services

  “Tied aid”, i.e. the requirement that aid be used to procure donor country goods and services, significantly reduces effectiveness and increases the direct cost of goods and services by 15%-30% on average. As of FY2017, 67% of U.S. foreign assistance funds were obligated to U.S.-based entities. Untying aid increases effectiveness, reduces transaction costs, and improving recipient countries ownership.

• Introduce a new objective for reducing health inequities

  The US should promote the strengthening of systems to provide universal, high quality health services, rather than continuing to promote privatization and for-profit solutions. An emphasis on the private sector and promotion of privatized services undermines public system strengthening, access, equity, financial risk protection, and the right to health. Achieving health equity requires the strong public provision of care and strong regulation of privately provided care. Pro-poor financing, including the elimination of out-of-pocket expenditure, is required to achieve equity.

• Restore the USG’s membership and funding to the World Health Organization and the Pan American Health Organization.

  Effective international cooperation requires the US participating and collaborating in solidarity with other countries. Restoration should include all previously pledged assessed and voluntary contributions and also recognize that greater resources, technical cooperation and solidarity will be needed in the setting of a pandemic.

2. Increase USG investments in global health

Significantly improved international cooperation is needed to prevent, mitigate and respond to health crises, outbreaks and pandemics, which will only increase in frequency.  The drivers of these health crises are weak public health systems, poverty and inequity. Consequently, the most effective pandemic preparedness and response strategies are those prioritize equity and system improvements. It is critical that any approach to promote “global health security” understands this fundamental point. Achieving global health security requires individual health security, which requires high quality care for everyone, especially the most vulnerable. The only way to achieve this is through adequately funded and responsive health systems. The SDGs already provide the framework for driving this goal forward but the US must take decisive actions for achieving the SDGs and addressing structural factors that prevent their realization. With the achievable UN ODA target of 0.7% of GNI in mind, the USG should:

• Increase investments in global health to $50 billion annually

  There is currently a significant external funding gap that must be closed for the achievement of the health-related SDGs in low- and middle-income countries (LMICs). While domestic resource mobilization is an essential component, for many LMICs, there is simply not enough tax capacity to mobilize the resources required. It is commonly emphasized that governments need to make domestic investments in health equal to 5% of GDP or 15% of the total government budget, and this is a critical step. However, even with these considerable investments, a total financing gap in excess of $50 billion annually would remain for just for the 34 low-income countries.  The financing gap for LMICs is much greater than this amount, due to a combined population of around 3 billion people. In order to move toward closing this financing gap, OECD Development Assistance Committee members, including the US, must meet the UN target of 0.7% of gross national income (GNI) for official development assistance. This would represent about 4-fold increase in ODA; a 4-folding increase in ODA for health would represent about $50 billion annually. Currently US overall contributions to ODA are only 0.17% of GNI, and have flat-lined since 2011. Indeed, the USG should influence all nations on OECD’s Development Assistance Committee to meet this target as currently only five nations are doing so. This will go a long way to closing the gap between what LMICs can possibly mobilize and what is required for achieving SDG

3. Do no harm to the health of people around the world

Health is an acute reflection of broader inequalities. Achieving health equity requires international cooperation to address these inequalities through measures including but not limited to:

• Clamping down on multinational tax avoidance and illicit financial flows

  The US must not oppose financial taxation accords and other international measures that attempt to address multinational tax avoidance and illicit financial flows.

• Putting an end to onerous debt repayment and structural adjustment conditions

  The US must work with the international community to put an end to onerous debt repayment and structural adjustment conditions that continue to cripple the public sector and economies in the global South.

• Addressing tax, anti-trust, trade, and environmental policies to ensure adequate livelihoods, environmental sustainability and a healthy future for all

  The US must not support measures that limit access to medicines, vaccines and health commodities, including by supporting the use of public health flexibilities defined in the Doha Declaration on the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), and ensuring that future trade agreements do not include language that protects corporations over wellbeing and sovereignty. In addition, the US must exercise anti-trust policy to ensure competitive markets for health care commodities exist when companies are based in the US.  

A long-term goal of supporting countries to increase their taxation and regulatory capacity to domestically mobilize resources and be independent of ODA is critical; doing so in an inexorably interdependent world requires creating a fairer global economy. Decreasing ODA without making the global economy fairer and unshackling the ability of LMICs to raise revenues serves to further undermine the SDGs and human rights of people in the global South. Inadequate global health resources result in prioritizing interventions considered “sustainable” based on inadequate health budgets of impoverished countries, which maintains the unacceptable and staggeringly inequitable status quo. This status quo is a direct result of historical and ongoing exploitation. The economic order that was consolidated in the colonial period - founded on dispossession, slavery, and extraction - still exists. Further, in recent decades, it has been coupled with trade, intellectual property, investment and fiscal consolidation rules that systematically drive poverty in the global South. Contrary to complaints about “overly generous aid”, total annual net resource outflows from the global South to the North stand at approximately $2 trillion, a sum that dwarfs ODA and other assistance.

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

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

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

• contain and control the spread of the virus,
• ensure that patients are provided with dignified care, and
• demonstrate to the world what aggressive action in vulnerable settings can achieve.

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

• work directly alongside colleagues in countries' ministries of health,
• forge connections to the world's leading COVID-19 responders,
• foster strong relationships within the communities we work.

Donate Now To Help

An underestimated outbreak is now a pandemic that must be controlled

• Because this is a novel virus, many countries are hesitating to enact aggressive containment measures, starting with widespread testing. Coronavirus disease 2019 (COVID-19) is now a public health emergency of international concern, a pandemic, and a massive threat to the communities PIH serves.
• While mortality rates appear to be lower than other infectious diseases (such as Ebola virus disease, MERS, and SARS), this virus has spread to pandemic levels and its mortality rate will increase dramatically once the capacity to treat patients requiring intensive care is reached.
• COVID-19 has already put enormous stress on the health systems of many developed countries, including the United States.
• Some world leaders have suggested “let the virus run its course.” PIH strongly rejects this cruel, defeatist stance because we know it would be a death sentence for potentially millions of vulnerable people.

This virus will disproportionately affect developing nations

• The virus stands poised to devastate millions of people living in low- and middle-income countries where health systems are weaker and not ready to provide the level of intensive care required by patients with COVID-19.
• If we do not mobilize quickly to contain the pandemic, mortality rates could be far worse in the places where PIH works. Our educated guess is that without dramatic action now, they could end up at 30 percent—five times higher than the 6 percent mortality rate in Italy, which is itself 10 times higher than the rate in South Korea.
• A current global lack of diagnostic tests, especially in developing nations, means the virus is likely spreading undetected.
• Weaker health systems already fail to meet people’s normal health needs and will quickly collapse if the virus is not contained. Some countries have only a handful of intensive care unit (ICU) beds nationally and we estimate that as few as 200 severe cases of COVID-19 could overwhelm entire health systems in a matter of weeks.
• The economies, safety nets, and personal circumstances of our patients are not robust enough to sustain aggressive containment measures such as remote working, social distancing, or quarantine.

If not PIH, then who?

• PIH has always strived to preferentially bring the benefits of modern science to the poorest and sickest communities around the world. For over 30 years, PIH has successfully confronted outbreaks, from HIV to drug-resistant tuberculosis, and from Ebola to cholera.
• Our ranks are filled with world-class global health experts who find nimble solutions proven to work in resource-poor settings.
• We know the key to preventing and fighting any epidemic is a resilient health system, built in partnership with local ministries of health.
• Our government partners know this and have reached out to PIH to seek help. Local ministries of health--such as those in Rwanda, Liberia, and Haiti--have been more proactive than most developed nations and have scrambled to prevent transmission of the disease early on. Rwanda, for example, has installed innovative hand-washing stations at bus parks, among other recent measures.
• Because of these early interventions and despite the lack of available tests, we have a duty to try to contain the virus before it spreads out of control in the countries we serve.
• PIH is a highly respected global health player and has the opportunity to lead a global coalition of public and private partners--as it has in the past--to stop this virus in its tracks and provide care for millions of patients.

What’s our plan?

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

1. Testing

• There is a window of time to prevent or significantly slow the spread of COVID-19, which can only be achieved with widespread COVID-19 testing.
• Wide-scale point of care (POC) testing through skilled personnel is the only way to identify clusters, break the chain of transmission, and contain the spread of COVID-19.
• PIH plans to screen more than 200,000 people across eight countries
• Mobilize PIH-supported public hospitals and health centers and other health facilities throughout eight countries, in collaboration with  each nation's ministry of health.
• Use innovative rapid diagnostic tests (RDTs)—developed in China and deployed there and in other countries—to detect the virus at PIH-supported hospitals and communities.
• The RDTs PIH plans to deploy are innovative because they return results in as little as 15 minutes and can be done at the bedside or in the community.
• More complicated methods of diagnosis include Polymerase Chain Reaction (PCR) tests. In most countries we serve, PCR tests are only available in a handful of nationally accredited labs, if at all. The inadequate PCR capacity could hinder measures to halt the spread of the virus, as we’ve seen in the U.S.
• PIH is collaborating with local ministries of health to improve testing capacity for both RDTs and PCRs.

2. Provision of Care

• PIH will continue to provide free, dignified, high-quality treatment for everyone, as part of governments’ public systems.
• PIH is providing supportive care and treatment for patients with COVID-19, across all PIH-supported health facilities.
• PIH also knows that additional support will be required to properly staff 24-hour acute care needs of patients with severe symptoms. PIH investments will be key, including in essential medications, human resources, oxygen supply, and fuel for generators (to ensure monitors and oxygen concentrators are connected to stable electricity), among other critical costs to ensure full access to care and treatment.
• PIH is working to ensure that essential routine health services are not impacted during outbreak preparedness and response efforts.
• PIH is working with MOH colleagues at more than 200 PIH-supported facilities globally to establish staffing and other response plans.

3. Assist Local Government Response

• PIH is providing health care workers with personal protective equipment (PPE), such as masks, gloves, gowns, and hand sanitizers.
• In some facilities, PIH is providing simple infrastructure enhancements, such as outdoor fever tents, as needed, to reduce the risk of transmission at health facilities and ensure proper triage.
• PIH is working to quickly train all health care workers in standard Infection Protection and Control (IPC) measures for COVID-19 and provide general education to patients at health facilities.
• PIH is establishing triaging protocols for those meeting COVID-19 case definition to ensure designated isolated areas are available to begin treatment, as a means of preventing further infections at health facilities.
• PIH is rapidly increasing its advocacy in the US to translate fear into commitments of long-term investments in global health funding that builds from PIH’s “five S” approach—focusing on staff, stuff, space, systems, and social support—and advocates for people-centered, rights-based approaches to emergency response and longer-term health systems (care vs. containment, durable investments vs. temporary quick fixes, etc.).

4. Mobilize Community Health Workers

• As with any outbreak response, epidemic control relies on finding the first patients before they can significantly transmit a virus.
• Contact tracing is being immediately implemented whenever a COVID-19 patient is diagnosed. This includes family members, but also workplaces, churches, schools, and any other locations visited by a person with confirmed COVID-19.
• PIH relies on extensive experience in mobilizing community health workers to implement similar efforts, including responses to Ebola in West Africa and cholera in Haiti.
• PIH is mobilizing its networks of thousands of community health workers to find those individuals who have come into contact with COVID-19 patients, advise them on the best ways to stay healthy and avoid infecting others, and safely accompany them to hospitals and clinics if their symptoms worsen.
• For those contacts, social support (food, water, financial support, etc.) is being provided by CHWs to help families in implementing social distancing protocols, and all asymptomatic contacts will be monitored for 14 days.

See the Full Plan

Donate Now To Help

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

• In partnership with governments around the world, PIH has learned valuable lessons about what it takes to respond to infectious disease epidemics—from cholera in Haiti to Ebola in West Africa.
• These global lessons are being applied locally to control and end transmission of COVID-19 statewide.
• Led by Massachusetts Gov. Charlie Baker and building on the state’s existing health infrastructure, PIH is guiding efforts to trace the contacts of all sick individuals to reduce the overall number of cases, protect our communities, and safe guard health care workers.

Our Massachusetts’s Response

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

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

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

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

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

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

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

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

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

Farmer added a complementary perspective as an infectious disease doctor.

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

Read the full AMA on Reddit, here.

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

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

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

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

Read the full interview via Axios, here.

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

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

How is it transmitted?

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

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

What are the symptoms and clinical course of the disease?

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

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

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

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

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

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

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

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

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

Are masks effective in preventing transmission?

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

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

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

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

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

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

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

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

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

How long until a vaccine is available for widespread use?

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

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

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

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

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

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

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

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

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

What are other consequences of the COVID-19 epidemic?

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

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

What should I do to reduce my risk of infection?

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

Some of these are obvious:

• Wash your hands frequently.
• Try not to touch your face.
• Avoid people who are coughing or obviously ill.
• Avoid large crowds, if possible.
• Don’t go to work if you are sick. Send your sick workers home.
• If you need to seek medical care for a flu-like illness, call in advance and ask for instructions on where to go.
• If you are sick, don’t go and visit your elderly or immuno-compromised friends and neighbors.
•  

Others are less obvious:

• Consider having a plan for what you might do if social distancing measures are put into effect or if you were quarantined.
• Consider forgoing unnecessary travel (and possibly even necessary travel, if it is to high-risk places).
• Think about how you and your teams can work from home, such as options for conference calls, etc.
• Make sure you have a reasonable supply of any prescription drugs you need.
• Have some emergency provisions on hand, but you don’t necessarily need to go crazy buying up a grocery store’s entire supply of canned goods.
• Consider using a humidifier.

Partners In Health employs or supports nearly 18,000 staff members in 11 countries around the world. More than 60 percent of those invaluable staffers are women, filling vital roles at all levels of the organization. In honor of International Women's Day, which is celebrated March 8 and this year has a theme of Each for Equal, inspiring and influential women from several PIH teams shared thoughts on their work, their values, and equality for all.

Viergela Pierre - nurse manager, Zanmi Lasante, Haiti 

Viergela Pierre has worked for seven years for Zanmi Lasante, as PIH is known in Haiti, as a nurse manager in the oncology department at University Hospital in Mirebalais. 

What do you love most about your work?

What I like most about my work is the organization of care, and the holistic approach to care for the patients.

What does equality mean to you?

I believe in equality because the complementary nature of the sexes is essential for development, social cohesion and family well-being.

Dr. Zahirah McNatt - director, Department of Community Health & Social Medicine, University of Global Health Equity, Rwanda

Dr. Zahirah McNatt is an assistant professor and the Godley-St. Goar Chair, Department of Community Health & Social Medicine, at the University of Global Health Equity, a PIH initiative in northern Rwanda.

What do you love most about your work?

I have spent the majority of my career implementing projects, plans, and initiatives—all aimed at ensuring health systems are high quality and that they meet the needs of the most marginalized. I still do this work today but in my current role, I have the added benefit of student engagement. I love teaching, mentoring, learning and coaching. I am inspired every day by passionate students who believe the world can change and who are carving out their place in the transformation.

What does equality mean to you?

No one person's life should be considered more valuable than another. When the most marginalized persons in a given society are centered, all other citizens of the globe reap the benefits.

Abibatu “Abi” Gbamkay - driver, PIH-Sierra Leone

Abibatu "Abi" Gbamkay has been a driver since April 2019 for PIH in Sierra Leone, where she is the only female member of the 42-person fleet team.

What do you love most about your work?

I love PIH for paying more attention to poor people and contributing greatly to saving lives, most especially among the poor.

What does equality mean to you?

Equality joins us together, despite gender, age, or religion. It teaches us more about social justice and helps the masses to learn how to be just. And equality means solidarity, which brings progress.

Williamena Nuefville - assistant cook, PIH-Liberia

Williamena Nuefville is an assistant cook for PIH-Liberia, at the Harper office in Maryland County. She joined PIH in 2015 during the Ebola outbreak, and provided vital support for the response team. 

Nuefville said she could neither read nor write when she joined PIH, but her interactions with fellow staff motivated her to enroll in evening school, with  scholarship support from PIH.

She is now in eighth grade, fully literate, and an active contributor to conversations about social issues with colleagues. 

She hopes to become a youth counselor in the future, to teach young people how to respect, treasure, and treat each other equally. 

What do you love most about your work?

I am passionate about cooking and see the kitchen as my office, where I can prepare food to feed staff.

I love my job because it gives me the opportunity to cook for the doctors, nurses and staff, so that they can concentrate and attend to their duties and the patients.

This makes me feel inspired, knowing I am also contributing to what PIH stands for and patient care.

Tarlee Sampson Simbo - MDR-TB program coordinator, PIH-Liberia

Tarlee Sampson Simbo is the multidrug-resistant tuberculosis program coordinator for PIH-Liberia. She's served in several roles since joining the team in 2016, including community health officer in Grand Gedeh County and senior community officer in Maryland County.

In her current role, she is part of the MDR-TB team supporting Liberia's Ministry of Health at the national TB referral center, or TB Annex, in the capital, Monrovia. 

Sampson Simbo said she is motivated to work at the TB Annex because she can help patients address their fears and challenges, providing psychosocial support while they undergo extensive treatment regimens.

What do you love most about your work?

One thing I love most about my work is seeing patients who arrive very weak and helpless but, after treatment, leave the facility so strong and healthy, able to reunite with their families and community. It is so fulfilling and heartwarming knowing that when you save one patient, you save a family and a whole community.

What does equality mean to you?

As a health worker, I hold dear the concept of fairness in all social privileges, from health and opportunities to distribution of wealth, and more. This is why I believe in equality that allows more women to take up leadership roles in all sectors. My participation in the 2019 Women Leaders in Global Health Conference in Kigali, Rwanda, has empowered me to speak on issues surrounding discrimination against women. I always stand for changing the status quo, whereby women will be given the opportunity to be educated and given the space to display our own talents.

Tashina Etsitty - finance accounting clerk, COPE, Navajo Nation

Tashina Etsitty has been an accounting clerk for 11 months at Community Outreach & Patient Empowerment, or COPE, a partner organization of Partners In Health and Brigham & Women's Hospital, serving communities in Navajo Nation and beyond.

What do you love most about your work?

What I love most about this job is coming into work, walking into the office and seeing my coworkers' friendly, welcoming faces.Just seeing their friendly smiles lets me know that today is going to be a good day, and that we are ready to take on whatever the day brings. As a team, we all have the same goal in mind: doing everything we can to ensure that all COPE staff have the support they need to accomplish their goals of reaching out to the communities, to empower them to take control of their lives by providing resources and education.

What does equality mean to you?

I believe in equality because everybody should have the same opportunities in life to succeed at accomplishing their life’s goals.

Raquel Castañeda - nurse, Socios En Salud, Peru 

Nurse Raquel Castañeda has been with PIH for about a year, serving individuals and families in communities including A.H. Torre Blanco, in the Carabayllo district of Peru's capital, Lima.

What does equality mean to you?

I believe in equality in general because, for men as well as women, we are all equal. 

Pacsy Rodríguez Jesus - nurse, Socios En Salud, Peru

Pacsy Rodríguez Jesus has been a nurse for three years with Socios En Salud, as PIH is known in Peru, at the El Progreso health center in Carabayllo, Lima. 

What do you love most about your work?

What I like about my job is that through distinct projects I’ve been able to get to know a variety of patients and various types of realities. And through them I’ve learned a lot and developed my professional career. What I love is being a nurse.

What does equality mean to you?

It gives us the opportunity, men as well as women, to empower and develop ourselves in the areas we wish.

Palesa Chetane - quality improvement manager, Bo-Mphato Litšebeletsong tsa Bophelo, Lesotho

Palesa Chetane is the quality improvement manager for Bo-Mphato Litšebeletsong tsa Bophelo, as PIH is known in Lesotho. She has worked for PIH since September 2007, and began her work with the inception of the team's MDR-TB program. She now supports all work related to quality improvement at rural, district and national health facilities supported by PIH across Lesotho. 

What do you love most about your work?

I love my work because quality improvement is a key element that addresses all issues related to health systems, processes and primary health care dimensions.

It is the primary area of work, and primary platform, that can help all PIHers address issues of social justice and inequality. There is no other way that gaps can be addressed at depth, other than engagement of quality improvement. Unless quality improvement is highly utilized during every platform of health service delivery and administration, we can never attain universal health coverage or reach national and international benchmarks.

What does equality mean to you?

Equality is allowing everyone to enjoy the fundamental human right of respect.

Fabiola Ortiz – supervisor and professional midwife at Casa Materna, Compañeros En Salud, Mexico

Fabiola Ortiz is a supervisor, professional midwife and perinatal nursing specialist at Casa Materna, a maternal facility located at the regional hospital in Jaltenango and supported by Compañeros En Salud, as PIH is known in Mexico. 

Maternal mortality is a serious concern in Mexico's rural Chiapas region, where most women give birth at home with the assistance of traditional midwives. In recent years, PIH has collaborated with the Ministry of Health to open Casa Materna. The facility is staffed with first-year obstetrics and gynecology nurses, and supervised by professional midwives and doctors. Expectant mothers receive prenatal care and lactation advice, are encouraged to arrive prior to their due date to await labor, and also receive free food and housing throughout their stay.

What do you love most about your work?

What I like the most about my job is feeling the trust from women when they come to us, professional midwives, and we get to watch in a unique way this amazing event called birth. It really fills me up with energy and makes me excited. 

What does equality mean to you?

I believe in equity because as women we can stop injustice, inequality and discrimination. As an indigenous woman, I believe this is a constant fight and these challenges can be even harder for us, but in spite of all of this, there's always people who believe in you, supporting you. As a health worker, I believe in equity because every patient should be treated the same. Patients are asking for equal attention, and mostly to leave behind gender, religion, race, or sexual preference. 

Dr. Sheila Davis, chief executive officer of Partners In Health, has been monitoring news of the novel coronavirus and its spread around the world, while planning for a swift and appropriate clinical response to the disease (COVID-19) across the 11 countries in which PIH works. She shares this update with the PIH community:

Yesterday, the World Health Organization announced a revised case fatality rate for the novel coronavirus. Previously, the virus appeared to kill between 2 and 4 percent of confirmed patients. Now, according to the WHO, COVID-19 kills 3.4 percent. Because the case fatality rate is based on those who test positive for the virus, there is still a level of uncertainty as to its accuracy, as it does not take into account the people whose symptoms were mild or didn’t seek care. Regardless of the absolute number, it is clear that COVID-19 is infectious and is spreading globally at an alarming rate. The increase in fatality rate and the geographic projections prompted the Director General to urge countries to improve efforts to contain the disease and protect health care workers.

We’re eager to heed this call, and are not surprised by it. We have been monitoring the COVID-19 crisis closely and are committed to responding in a way that aligns with our mission of providing a preferential option for the vulnerable—who, yet again, face the gravest risks. Currently, there are more than 94,000 cases reported globally, including in Chiapas, the southern state of Mexico where we work, and the Dominican Republic, which neighbors Haiti, the country where PIH was founded. The risk that the virus will infect our patients is very real.  

Preparing for coronavirus

Our global clinicians and operations staff are working closely with their respective ministries of health to ensure preparedness in all the communities we serve. We are conferring with global health colleagues and experts within and outside of PIH to ensure that our organizational strategy and response is informed by the most up-to-date evidence. 

Every day our staff is doing what they can with what they have. Infection control measures—including emphasis on handwashing and trainings on screening, diagnostics, and treatment—are the tools we have so far, but so much more is needed. The supply chain teams globally are working hard to secure supplies in an environment where shortages of masks, gloves, handwashing facilities, and other basic infection control measures are already prevalent—and predicted to get worse.

"The challenges are immense"

We are working to procure and validate tests on site, coordinate with global partners, and train staff to address the diagnostic gap within the countries where we work. Simultaneously, we are collaborating with our colleagues in various ministries of health to pinpoint the facilities that will be used to isolate patients who become ill with the disease. The challenges are immense, with all of this occurring within the larger context of sky-high rates of maternal mortality, kids stunted from malnutrition, and emergency rooms filled with trauma and those needing lifesaving surgeries.

Intensive care units, equipped with essentials such as ventilators for patients in respiratory distress, are critical to properly deal with complications resulting from COVID-19. These are woefully rare or completely absent in the countries where we work. Yet we are identifying hospitals, such as University Hospital in Mirebalais, Haiti, that are able to provide intensive care to the critically ill.  Even in places where we have begun to build capacity in intensive care, there are too few beds, too few supplies, and too few trained staff to mount a robust response. In those locations that don’t have ICUs, we will provide aggressive supportive care as best we can without advanced equipment and capacity, and will continue to fight for more. Our clinicians want to provide the best care they can for their patients, regardless of whether they are in remote Harper, Liberia, or rural Chiapas, Mexico.

Facing dire circumstances

The current reported case fatality rate, whether 3.4 percent or not, cannot be used to predict how this virus will devastate many areas globally where there aren’t existing, functioning health systems that can respond to an aggressive infectious disease. The ability to mobilize hundreds of intensive care beds quickly and have the trained staff to care for those patients is just one piece of this puzzle. Reliable electricity, water, oxygen, and working equipment and a constant supply of gloves, masks, and soap are not a given. Enough housing and food for hundreds of staff and a functioning ambulance system to transport the sick are not the reality in most of the places PIH works.   

We have been here before. From our experience with cholera, Ebola, and so many other infectious diseases, we know COVID-19 will prey on the most vulnerable—older people, those battling an underlying health challenge, and people without access to the best of modern medicine. Mortality will be far worse in the places where we work. And we refuse to abide by the notion that prevention and containment are the only appropriate approaches in low-resource countries. Our patients deserve a robust health system now, and all of the time.  The gross inequities of health care become illuminated for many in times of crisis. But for our patients, this injustice has a daily impact regardless of the circulation of a novel pathogen.

"Mortality will be far worse in the places where we work.

PIH is readying for this assault, and we will do whatever we can to provide lifesaving treatment. This coronavirus epidemic is yet another challenge in our fight to find a cure for injustice. Our voice and efforts are needed on the global stage to continue to challenge the notion of containment only, and to offer an antidote to despair by providing the entire package of prevention, control, and treatment in the most vulnerable countries. Only by continuing to bolster health systems will we improve survival for our patients and communities. 

The lack of clean water and sanitation in many of Haiti’s schools and communities makes one wonder if social justice in the nation is dead, and requires a shock back to life.

On the positive side, Haiti has fought back from one of modern time’s worst cholera epidemics. While more than 10,000 people died and nearly 1 million were infected in the decade following the devastating 2010 earthquake, not a single cholera case has been confirmed in Haiti since February 2019. This is an enormous victory.  

However, does this mean that cholera—a waterborne disease—has been eradicated from Haiti? No. Does this mean Haiti no longer suffers from a lack of water and sanitation? Again, no.

Today, Haiti continues to fight for equality in water, sanitation and hygiene, known as WASH, in homes, health facilities, markets and schools. While thousands rushed to Haiti’s aid in the aftermath of the 2010 earthquake—and hundreds more made commitments to increase access to clean water and sanitation across the nation—most have now forgotten about Haiti’s needs.

Yet Haitians do not sit on their laurels and wait. I have seen firsthand the power of education in Haiti, and the thirst to achieve better education for the next generation of Haitian children.

Parents in Haiti go to every length possible to ensure their children receive an education. I have seen firsthand the beauty of a school day that begins before sunrise, when parents use irons heated over hot coals to press the uniforms of their daughters and sons. The meticulous process of combing and braiding hair with ribbons that match those uniforms, the folding over of stark white ankle socks to ensure they stay in place in perfectly polished shoes that will be muddied by days end.

But what happens to those children when they arrive at their school and need to relieve themselves? The majority of schools in rural areas of Haiti have neither toilets nor handwashing facilities. When facilities are available, they are in such disrepair that a child would prefer to defecate in an open field, to avoid the stench of years of shabby upkeep.

Where is the social justice for these children, and for families that are doing everything they can to ensure their future? Where is the social justice for the young girl who must end her education because she does not have a safe, hygienic space to care for herself during menstruation? By not safeguarding that all children have access to WASH in schools, the cycle of extreme poverty is perpetuated. Not only in Haiti, but also across the globe.

For many more children, not having access to WASH at home or school means diarrhea and other waterborne diseases keep them from attaining an education due to missed school days, which further increases the burden on families to reach out for health care that is often either unavailable or far too expensive to afford.

With a future generation of children who are not receiving an education, extreme poverty wins once again.

While many see extreme poverty as an insurmountable challenge the world over, access to clean water and sanitation can play a major role in ensuring children remain healthy enough to remain in school and lead productive lives, escaping the grip of extreme poverty.

Zanmi Lasante has been working in the field of water and sanitation since day one. Our earliest programs provided household toilets and improved water supplies for people with HIV and TB. Over the last 10 years, ZL has treated tens of thousands of people affected by cholera. Today, we have successfully brought sanitation facilities and clean water to dozens of schools and thousands of families in the Central Plateau, through the support of USAID and UNICEF.

The next generation of Haitians depends on continued advocacy and support. The stakes are clear:

When communities do not have access to safe water, children are most often the ones who are tasked with seeking out water, often many miles away from their homes. This can place them at greater risk of sexual violence, and of losing their chance at an education.

But when water and sanitation are available in communities and schools, children do not spend hours a day walking to water sources, and girls have a greater chance of remaining in school. When water and sanitation are available, boys and girls have equal access to an education, and a future outside of the vicious cycle of poverty.

We must all come together for the parents who do whatever it takes for their children to attend school, and who know  the impact of extreme poverty on their lives. We must help these parents achieve their greatest dream: their children receiving an education. An education in a space where their children are safe to go to a bathroom and relieve themselves. A space where they can wash their hands with soap and water and hydrate themselves. A space where a girl can continue her education even after menstruation begins.

Schools in Haiti, or anywhere in the world, should be our children’s second home. We must all work together to ensure that these spaces are environments where all children can be free of illness and free of worry when using water and bathrooms.

Today, when we drop off our children at school, let us all think of that young girl in rural Haiti who has begun to menstruate and, without clean facilities, is no longer able to go to school. Instead, she is charged with fetching water or other household tasks, and remains unable to read or write because her education has been halted. She is likely to be married much earlier in life than young girls in higher-income countries, and to continue living in extreme poverty.

I want us all to think of her today—and think of the power we all have, together, to change her life.

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

This month’s rollout of an electronic medical records system at a Partners In Health clinic in Sierra Leone already is having transformative impacts for patients, staff, and care.

PIH’s eHealth team in the West Africa nation launched the electronic system Feb. 3 at Wellbody Clinic in Kono District, after months of planning. The system, called OpenMRS, is replacing Wellbody’s overflowing shelves of paper records, enabling Wellbody staff to instantly access and more safely store patients’ medical histories, and improving care for the roughly 200 patients who visit the clinic each day.

Co-developed by PIH in 2004, OpenMRS is used not only by more than 100 PIH-supported facilities around the world, but also by numerous governments and partner organizations. Wellbody is the latest health facility to join hospitals and clinics in more than 60 countries using OpenMRS, adding to the 8.6 million patients worldwide who are receiving care via the system.

Previously when patients arrived at Wellbody, they were registered at the front desk and handed a manila folder that held their patient file, with their unique identification number stuck to the front. Patients took their file with them to clinical appointments, and at the end of their visit handed it back to staff for storage in the vast, paper-filled records room.

'It changes the entire workflow'

OpenMRS revamps this model by storing records digitally. Now, patients receive a plastic card with their number and a bar code, which clinicians scan to get a clear, quick view of medical histories. No longer printed on paper, these histories are now safe from possible destruction in a fire or flood.

“The EMR is not just a reporting system, it changes the entire workflow of the clinic because it is central to operations,” says Khaled Bediri, eHealth manager for PIH-Sierra Leone. “Seven pieces of information are stored in the system, (ranging) from triage, registration, outpatient department, laboratory, pharmacy, and maternity, to the prenatal clinic.”

A global community of doctors, software developers, academics, and tech enthusiasts, led by PIH, developed OpenMRS to be open source, meaning anyone can use the application for free and modify the code to meet their needs. The eHealth team in Sierra Leone, therefore, was able to customize the system specifically for Wellbody, and can continue to do so as clinicians and patients expand their use.

The rollout of OpenMRS at Wellbody is a huge step for the continual improvement of care, and in establishing the clinic as a national model for effectively implementing electronic medical record systems.

Abi's prenatal care visit

A woman named Abi Dauda, who came to Wellbody in early February for a maternal health checkup, shows how the electronic system is improving patients’ experience and care at the clinic.

Abi Dauda, 20, is pregnant with her first child. When she arrived at Wellbody for her appointment, she registered with Esther Ngaujah at the front desk.

A machine produced Abi’s identification card – a small but durable manifestation of how OpenMRS links the individual to the clinic. After receiving her plastic ID card, Abi headed over to the prenatal care area.

During Abi’s appointment, Sister Isata Dumbuya, head of reproductive, maternal, neonatal, and child health, pulled her registration details up on the screen. Isata made an assessment of Abi’s vital signs and captured the information in OpenMRS. Abi shared with Isata that she is concerned because, though 12 weeks pregnant, she is still bleeding each month. This information—also entered into the system—prompted Isata to refer her for laboratory testing and a follow-up appointment later in the week.

With OpenMRS, clinicians in every department at Wellbody are able to retrieve patient information and make accurate diagnoses and treatment plans. As time goes on, it will also allow for a deeper understanding of the profiles of the diseases the clinic is treating.

“Our reporting will become stronger,” Khaled says. “The team can export data more easily, providing better decision-making power across what will eventually become every PIH-supported facility in Sierra Leone.”

Staff can also more efficiently monitor patient movements by tracking patients like Abi as they are transferred and discharged.

“We anticipate the EMR system being able to provide an accurate picture of patient care status by centralizing all departmental data into a single database," Khaled says. "Our objective is to improve the quality of care by helping clinicians to spend less time on paper-based admin and more time on patient care."

Tom’s early belief in PIH’s vision for a more just world saved millions of lives. Whether financing the construction of PIH’s first clinic in Cange, Haiti, or investing in the expensive drug regimens for PIH’s first multi-drug resistant tuberculosis patients, Tom’s investment in providing high-quality health care to those who need it most changed global health delivery forever.

We understand most people will not follow Tom’s radical lead of giving away most, if not all, of their wealth during their lifetime; however, we continually hear from supporters who aspire to live more into Tom’s spirit of generosity. 

Join Tom’s Circle, PIH’s legacy society, by naming PIH in your will, trust, retirement plan, life insurance policy, or annuity. As a legacy supporter, you will be ensuring that PIH is able to help cure injustice for years to come.

“I have always tried to emphasize the following three things: 1) Don’t be apathetic – be involved, 2) Live your life, at least in part, for other people, 3) Realize that there is an urgency to your giving, especially if you are giving to the poor.” – Tom White

PIH’s facility in Cange has grown from a one-room clinic to a fully functional hospital with inpatient, outpatient, surgical, and specialized care available to all patients, regardless of their ability to pay. It is a symbol of hope for the poor throughout Haiti. 

Similarly, MDR-TB is no longer a death sentence in resource poor settings. That initial cohort of Peruvian patients treated with medication paid for through Tom’s investment had a lasting impact by helping us prove that the disease could be cured, which in turn helped change global policy.

Tom was, in PIH Co-founder Dr. Paul Farmer’s words, a model of what generosity, compassion, and service can mean in this world. He did not take shortcuts in his charitable work, but went all in. He saw the power of the work he was investing in and knew that his financial contributions could have immediate impact on some of the biggest global health problems the world faces today. That kind of investment is empowering, and it had a direct return on investment in his head, heart, and the larger world.

You too can have a lasting impact through a legacy gift ensuring that health care is a human right for all people. 

1. Create an estate plan to protect those you care for most and ensure PIH can continue to support patients across four continents.  Use the FreeWill service to channel the generosity of Tom, while maintaining control over your assets during your lifetime. You retain the right to change your gift at any time.

2. List PIH as a beneficiary of a retirement account. Retirement assets are heavily taxed. Family members and heirs can receive 50% or less, but non-profit organizations receive 100%. It’s as easy as filling out a form. 

3. A charitable gift annuity is a simple contract between you and PIH that offers a tax-advantaged way to provide for income during retirement. In the future, your gift will provide support for our mission.

“I received a tremendous gift. For the first time in my life, I was able to give with complete confidence that my donations would be used in the best possible way.” – Tom White

Our gift planning team welcomes the opportunity to answer any questions you may have about legacy gifts, collaborate with your existing team of advisors, and welcome you into Tom’s Circle once you confirm your intention. Stating your intention allows us to welcome you into Tom’s Circle (anonymous options available), and ensures we can fulfill your plans and be a proactive partner in the gift realization process.

On a 100-degree day in October—the peak of dry season in Neno District, Malawi—Eliza Kazembe sat in the shade alongside her family’s home and said it felt like she’d been pregnant forever.

“She’s akuyembekezera kuchira,” Anga Sawasawa said, explaining that the Chichewa phrase translates to “waiting for delivery.”

Kazembe, 17, was nine months pregnant, a condition made clear as much by the swell of her belly as by the look of tired determination in her eyes. But she also was smiling, displaying a cheerful nature that shone through despite the heat, the fatigue, and the waiting.

“I’m excited,” Kazembe said. “Everything has been good.”

She had plenty of support around her. Kazembe lives with her mother and sister at their home in Kamdzandi Village, a community filled with ancient baobab trees—all bare of leaves and dry at that time of year—and not far from Lisungwi Community Hospital. The hospital is supported by Abwenzi Pa Za Umoyo, as Partners In Health is known in Malawi.

Sawasawa is PIH’s site supervisor for community health workers (CHWs) in the Lisungwi area. She oversees 104 CHWs, and said all of them support pregnant women in their communities every day, helping them have safe, healthy pregnancies and deliveries.

“Maternal health is included in our training,” Sawasawa said.

CHWs are the foundation of Partners In Health’s work in Malawi and 10 other countries. They conduct regular household visits to neighbors in their communities and provide vital support, resources, education, and access to health care.

Today’s visit to Kazembe’s home was an embodiment of that support. Leading the visit was Grace Mgaiwa, the CHW dedicated to Kazembe. PIH in Malawi uses a household model for CHWs, in which every home that receives care or support in Neno District has a designated CHW. Mgaiwa, 35, has been a CHW since 2017 and regularly visits 22 homes in Kamdzandi Village, which is where she was born and still lives. Mgaiwa is a mother of five children herself, all daughters, and lives just down the road from Kazembe.

Mgaiwa said she regularly helps Kazembe access services at Lisungwi Community Hospital, including three prenatal care visits during Kazembe’s pregnancy. And during her regular home visits, Mgaiwa provided information about nutrition, blood pressure, potential health concerns during pregnancy, and how to prepare for labor and delivery.

“I learned a lot,” Kazembe said. “And I know that when I have any signs (of labor), I have to rush to the hospital.”

Delivering a baby in a health facility, rather than at home, greatly improves the health outcomes for mothers and babies. It ensures that they have access to experienced health personnel, medicine, diagnostic equipment, blood banks and even resuscitation services, if necessary.

In September 2019 alone, staff for PIH in Malawi recorded 440 facility-based deliveries and conducted 1,579 antenatal care visits across Neno District, where PIH serves more than 140,000 people.

For Kazembe, her preparation and patience paid off: She safely gave birth to her son, Prince Chimpaka, on Oct. 24 at Lisungwi Community Hospital.

But that doesn’t mean Mgaiwa’s visits will stop—on the contrary, it means Mgaiwa’s daughters might soon have a new friend to play with, just down the road.

Dr. Sheila Davis is the chief executive officer of Partners In Health and has been a nurse for more than 30 years. Here, she reflects 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 is a significant confluence of events this year: the United Nations is calling 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 200^th birthday on May 12. 

UHC is defined by the WHO as “all individuals and communities receive health services without suffering financial hardship.” At Partners In Health, we want more for the most vulnerable. It is not just about coverage, but about care. We know that at least half of the world’s population does not have access to essential health care, including the most basic health care that we all want for our families and ourselves. We also know that access or coverage does not equate to quality comprehensive care.

Nurses and midwives have been around since the beginning of time. From the birthers of babies to those comforting loved ones taking their last breath, caregivers are part of our lives. Recognized as the founder of modern-day nursing, Nightingale blended the art and science of nursing and collected, analyzed, and disseminated data showing the link between health and sanitation during the Crimean war. That link saved the lives of soldiers and greatly improved the quality of care they received. She also connected fresh air, good nutrition, and hygiene to patient care, which previously was considered completely unnecessary and frivolous by the great medical minds of the time.

Training nurse leaders

The tie between UHC and nurses and midwives is clear; the former is impossible without the latter—a robust and well-educated nursing and midwifery workforce. Annette Kennedy, president of the International Council of Nurses (ICN), reports that nurses and midwives make up more than 50 percent of the health workforce and deliver almost 80 percent of hands-on care. She also wrote that the world needs 9 million more nurses and midwives to achieve UHC by 2030. Although not explicitly mentioned, it is also imperative that we pay attention to certified nurse anesthetists (CRNAs), as safe surgery is a critical—and often overlooked—part of a comprehensive health package globally.

How do we get to the goal of 9 million additional nurses and midwives by 2030 and keep the ones we already have?

We need to invest and value nursing and midwifery at the local, national, and global levels. A report published by the All-Party Parliamentary Group on Global Health in October 2016  provides compelling information on how helping nurses reach their full potential will improve health, promote gender equality, and support economic growth. Strengthening the academic preparation for nurses, midwives, CRNAs and advanced practice nurses is critical, but so are bridging programs that allow entry-level nurses to become expert clinicians.

A seat at the table

Ministries of Health must ensure that nurses are decision-makers. Wherever there is a chief medical officer, there must also be a chief nursing officer with the same level of power. To have the largest cadre of health workers—nurses and midwives—represented at the highest decision-making tables would not only right many historical wrongs, it would lead to better health care delivery.

After all, nurses and midwives are already leaders. We lead in the community, in the health centers, hospitals, academic centers, corporations, Ministries of Health, technology startups, NGOs, and in every corner of the world.  We need to increase nurses’ visibility at all leadership levels to illuminate their impressive infiltration across all industries and organizations.

Nurses as innovators

Nurses have always been innovators. Nearly 200 years ago, Nightingale looked at patients holistically and drew on data to break the cycle of infection and disease; today’s NICU nurses in rural clinics tether together tubing with duct tape and prayers. Every nurse and midwife who has improvised to do the most for their patients is an innovator. If we looked at these change agents through a different lens—if we listened to, resourced, invested in, and promoted them as we do an entrepreneur in business or technology—the world would be a different place. A place where health as a human right could be a reality.  

Global health's holy grail

We are all seeking the holy grail, the answers to the overwhelming challenges of global health delivery in a world where women still die in childbirth from easily preventable causes. Rather than addressing the gross inequities of our world, global leaders incorrectly focus on the best return on investment with too few dollars.

I’ve listened to debates on whether it makes more sense to provide access to safe surgery for a woman in obstructed labor—thereby saving her life, or whether it would be best to invest in a handful of disconnected interventions that provide good data, but do little to provide a dignified system of health care. I’ve heard arguments about whether it is cost effective to feed patients recovering in the hospital, while also knowing—as all nurses and midwives do—the cost of inaction for patients on a daily basis.

Can anyone measure the value of another person’s life through antiquated algorithms? These deliberations on what is a justifiable expense happen daily on the global stage and in boardrooms, but don’t include the people whose lives will be impacted by such cavalier decisions. It is cost effective to care for fellow human beings, regardless of geography or socioeconomic status. To not do so has them pay the ultimate price.

At PIH, we have a very simple mantra: provide staff, stuff, space, systems, and social support. The impact is immeasurable.

If someone had told me while I was sitting in nursing school more than 30 years ago that I would hold one of the keys to answering the challenges of global health delivery, I would never have believed them.  As we all now struggle with how to provide UHC globally, we need answers. Unlike the inventor of a smartphone app, new technology, vaccine, or drug, I can’t patent my solution. But I will share it with you now. The silver bullet, the biggest bang for your buck is simple: invest in nurses and midwives.

Donate to Partners In Health  Subscribe for Email Updates

Partners In Health supported the care of more than 4,000 cancer patients around the world in 2019.  Nearly all of those people would otherwise have had no access to chemotherapy and other critical treatments, highlighting the essential, lifesaving need for cancer services in impoverished communities.

PIH’s largest cancer programs are in Haiti and Rwanda. In Rwanda’s northern mountains, PIH-supported Butaro District Hospital is home to the Butaro Cancer Center of Excellence, which opened in 2012, provides an array of cancer treatment, services and support, and sees 1,700 new patients every year.  

At PIH-supported University Hospital in Mirebalais, Haiti, we’re training the next generation of doctors, nurses, and medical residents to care for patients with cancer. They perform CT scans, take biopsies of tumorous tissues, and much more.

But PIH’s cancer care extends far beyond those two flagship programs. PIH provides vital cancer screening and services in several of the 11 countries where we work. Here is a quick look at cancer care in three of those locations: the East Africa nation of Malawi, Mexico, and Navajo Nation in the southwestern U.S.

Malawi

Abwenzi Pa Za Umoyo, as PIH is known in Malawi, provides cervical cancer screening at 14 PIH-supported health facilities across Neno District, in partnership with Malawi’s Ministry of Health.

Dr. George Talama, primary health care clinical manager for PIH in Malawi, said cervical cancer screening is part of the integrated chronic care clinic at Neno District Hospital. People come to the clinic to receive care for a variety of conditions, ranging from diabetes and high blood pressure to HIV and TB, and staff have screened more than 25 percent of those clients for cervical cancer so far. Cervical cancer care at the hospital also includes treatment for pre-cancerous tissue, Talama said.

Additionally, PIH provides chemotherapy at the hospital for Kaposi sarcoma, a form of skin cancer associated with HIV. While chemotherapy for Kaposi is available across Malawi, patients from other parts of the country often come to Neno District for treatment because of the hospital’s strong success rate.

For patients in late stages of cancer, PIH provides palliative care, primarily at Neno District Hospital and Lisungwi Community Hospital. Staff from those hospitals also provide palliative care to patients at regional health centers and in visits to their homes.

Talama said PIH currently is supporting more than 30 cancer patients across the district, including 18 people with Kaposi sarcoma and five with cervical cancer.

Mexico

Compañeros En Salud, as PIH is known in Mexico, helps cancer patients in the Sierra Madre mountains of Chiapas access an array of services. Our Right to Health Care program not only helps patients get referrals to the appropriate public hospital, but also provides social support to ensure they are able to actually receive that care. We cover the costs of food, lodging, transportation, and even insurance fees for patients, and help with clinical expenses including lab work, X-rays, ultrasounds and CT scans, as needed.

That support is reflected in the story of Doña Suyi Escobar, a wife and mother of three children who, about six years ago, found a lump in her right breast. When a biopsy at a regional health center confirmed she had breast cancer, a friend of her husband suggested they contact Compañeros En Salud. The PIH team helped Escobar’s family with lodging and transportation costs so they could access care, and supported her through radiation and chemotherapy.

Now recovered, Escobar said she advises other women to take care of themselves, perform self-exams to check for early signs of cancer, and most importantly, not to lose hope. Read Escobar’s story here.

Navajo Nation

Spanning 27,000 square miles and home to more than 300,000 people, the Navajo Nation is geographically the largest Native community in the United States. Community Outreach and Patient Empowerment, or COPE, is a Native-controlled nonprofit and sister organization of Partners In Health, and has been working on Navajo Nation since 2009.

Cancer is the leading cause of mortality for women on Navajo Nation, and the second-largest cause of mortality overall, but cancer screening rates are far lower than in other parts of the U.S.

The COPE Cancer Program works to improve patients’ outcomes through meaningful community engagement and education, with community-led initiatives including a Patient and Family Advisory Council, an annual Cancer Survivorship Conference, and the COPE Cancer Coalition.

COPE works with local stakeholders to develop and implement cancer education materials that are tailored for use in local communities, and to leverage technology to improve access to education and coordination of care.

Impacts include:

• 15 community members guide COPE programs and research, through the Patient and Family Advisory Council
• 92 outreach workers are trained in delivering the COPE-created, Navajo-specific Circle of Life cancer education curriculum
• 260 attendees learned and shared at COPE’s fifth annual, two-day Cancer Survivorship Conference
• 22 partners participate in COPE’s coalition to improve cancer outcomes on Navajo Nation
• 222 hours of engagement sessions with partners led to creation of a Community Action Plan

March 5 Update from Dr. Sheila Davis, CEO

Dr. Sheila Davis, chief executive officer of Partners In Health, has been monitoring news of the novel coronavirus and its spread around the world, while planning for a swift and appropriate clinical response to the disease (COVID-19) across the 11 countries in which PIH works. She shares this update with the PIH community:

Yesterday, the World Health Organization announced a revised case fatality rate for the novel coronavirus. Previously, the virus appeared to kill between 2 and 4 percent of confirmed patients. Now, according to the WHO, COVID-19 kills 3.4 percent. Because the case fatality rate is based on those who test positive for the virus, there is still a level of uncertainty as to its accuracy, as it does not take into account the people whose symptoms were mild or didn’t seek care. Regardless of the absolute number, it is clear that COVID-19 is infectious and is spreading globally at an alarming rate. The increase in fatality rate and the geographic projections prompted the Director General to urge countries to improve efforts to contain the disease and protect health care workers.

We’re eager to heed this call, and are not surprised by it. We have been monitoring the COVID-19 crisis closely and are committed to responding in a way that aligns with our mission of providing a preferential option for the vulnerable—who, yet again, face the gravest risks. Currently, there are more than 94,000 cases reported globally, including in Chiapas, the southern state of Mexico where we work, and the Dominican Republic, which neighbors Haiti, the country where PIH was founded. The risk that the virus will infect our patients is very real.  

Preparing for coronavirus

Our global clinicians and operations staff are working closely with their respective ministries of health to ensure preparedness in all the communities we serve. We are conferring with global health colleagues and experts within and outside of PIH to ensure that our organizational strategy and response is informed by the most up-to-date evidence.

Every day our staff is doing what they can with what they have. Infection control measures—including emphasis on handwashing and trainings on screening, diagnostics, and treatment—are the tools we have so far, but so much more is needed. The supply chain teams globally are working hard to secure supplies in an environment where shortages of masks, gloves, handwashing facilities, and other basic infection control measures are already prevalent—and predicted to get worse.

We are working to procure and validate tests on site, coordinate with global partners, and train staff to address the diagnostic gap within the countries where we work. Simultaneously, we are collaborating with our colleagues in various ministries of health to pinpoint the facilities that will be used to isolate patients who become ill with the disease. The challenges are immense, with all of this occurring within the larger context of sky-high rates of maternal mortality, kids stunted from malnutrition, and emergency rooms filled with trauma and those needing lifesaving surgeries.

Intensive care units, equipped with essentials such as ventilators for patients in respiratory distress, are critical to properly deal with complications resulting from COVID-19. These are woefully rare or completely absent in the countries where we work. Yet we are identifying hospitals, such as University Hospital in Mirebalais, Haiti, that are able to provide intensive care to the critically ill.  Even in places where we have begun to build capacity in intensive care, there are too few beds, too few supplies, and too few trained staff to mount a robust response. In those locations that don’t have ICUs, we will provide aggressive supportive care as best we can without advanced equipment and capacity, and will continue to fight for more. Our clinicians want to provide the best care they can for their patients, regardless of whether they are in remote Harper, Liberia, or rural Chiapas, Mexico.

Help PIH Prepare

Facing dire circumstances

The current reported case fatality rate, whether 3.4 percent or not, cannot be used to predict how this virus will devastate many areas globally where there aren’t existing, functioning health systems that can respond to an aggressive infectious disease. The ability to mobilize hundreds of intensive care beds quickly and have the trained staff to care for those patients is just one piece of this puzzle. Reliable electricity, water, oxygen, and working equipment and a constant supply of gloves, masks, and soap are not a given. Enough housing and food for hundreds of staff and a functioning ambulance system to transport the sick are not the reality in most of the places PIH works.   

We have been here before. From our experience with cholera, Ebola, and so many other infectious diseases, we know COVID-19 will prey on the most vulnerable—older people, those battling an underlying health challenge, and people without access to the best of modern medicine. Mortality will be far worse in the places where we work. And we refuse to abide by the notion that prevention and containment are the only appropriate approaches in low-resource countries. Our patients deserve a robust health system now, and all of the time.  The gross inequities of health care become illuminated for many in times of crisis. But for our patients, this injustice has a daily impact regardless of the circulation of a novel pathogen.

PIH is readying for this assault, and we will do whatever we can to provide lifesaving treatment. This coronavirus epidemic is yet another challenge in our fight to find a cure for injustice. Our voice and efforts are needed on the global stage to continue to challenge the notion of containment only, and to offer an antidote to despair by providing the entire package of prevention, control, and treatment in the most vulnerable countries. Only by continuing to bolster health systems will we improve survival for our patients and communities. 

February 13 Update from Dr. Patrick Ulysse, COO 

As the Chief Operations Officer of Partners In Health, I am leading our preparations for the emerging coronavirus. I’ll make sure you stay informed as the response continues.

Here’s what is going on right now: Each of our country teams has started to coordinate preparations, and those teams most at risk of seeing transmission have been collaborating with local ministries of health and the World Health Organization. At this time, preparations include:

• Preparing isolation wards
• Establishing PIH clinics as potential reference facilities
• Identifying and quantifying supplies needed
• Ensuring a resilient supply chain
•  

Viruses like this one hit impoverished countries hardest. I’ve seen it firsthand. Weak public health systems, which are the legacies of injustices dating back to colonialism, are especially vulnerable to epidemics like this coronavirus.

We know how to respond—with investments in local systems, the best of modern medicine, and equitable health care—these are the best tool for pandemic preparedness and response. We will continue to follow up with more details about our response. In the meantime, you can support our preparations for coronavirus and beyond with a monthly gift.

Help PIH Prepare

Thank you, as always, for your support.

In solidarity,
Dr. Patrick Ulysse
Chief Operations Officer Partners In Health

January 31 PIH Statement on Coronavirus

Partners In Health acknowledges the World Health Organization’s declaration that the outbreak of novel coronavirus (2019-nCoV) is a Public Health Emergency of International Concern (PHEIC).

PIH teams are currently working with the governments and communities of the countries where we work to strengthen our ability to minimize the impact of the global health emergency of Coronavirus and to strengthen systems in the long term.

While PIH’s Leadership Council agrees that it is important to identify threats to the public health, our work with communities and governments of 11 countries around the world with the prevention, care, and treatment of many infectious diseases (including Ebola, HIV, TB, cholera, and Zika) has taught us that the provision of care as a human right is the most important aspect of infection control.

People will come forward for screening efforts if they believe they will be treated humanely. To do that, strong health systems are necessary. Our work in the prevention, control, and treatment of infectious diseases is guided by several key principles:

1. 1) Engagement of the community—paid, trained and coordinated community health workers are vital to health education, case detection and linking people to care,
2. 2) Support of the public provision of care and the strengthening of national, district and local response is necessary to improve the supply chain and to assure adequate human resources. PIH works tirelessly to support the public system because it knows that the public sector’s ability to respond to health threats is tied to the strength of its local health systems,
3. 3) The provision of care for all diseases is a critical way of building trust in the system. Vertical efforts fail because they do not address the broad health needs of the population.