The Harvard men's soccer team netted the one and only goal in a rainy match against Haiti's national squad this weekend, winning 1-0 at the Harvard Stadium. But the shut-out was actually part of a much larger score for the Caribbean nation.

The Haiti Leve (Haiti Rises) II is a second-year soccer benefit, established after the January 2010 earthquake, to raise money for Partners In Health's relief and rebuilding efforts in Haiti.

Soccer teams from Harvard, Dartmouth, and Cape Verde participated in the five-day New England benefit tour along with the Haitian team. This year's win evens the overall score in the Harvard - Haiti game count. In 2011 Haiti pulled away from the Crimson during an exciting penalty kick session following a 0-0 regulation time tie.

Last year's event raised $16,000 for Haiti relief.

For more details, read "Men's Soccer Tops Haiti, Falls to Cape Verde All-Stars in Exhibition Matches" in the Harvard Crimson.

Jon Lascher, PIH – Artibonite Region, Haiti

We've finished our first full week and have vaccinated over 20,000 people ages 10 and older. For the first four days teams set up fixed vaccination posts across 54 localities. After four days the number of people showing up at the posts decreased, so our strategy changed from maintaining fixed posts to teams traveling door-to-door in search of people that had been pre-registered.

The teams have walked, ridden motorcycles, donkeys, and horses to spread the word about the vaccine and find people to vaccinate.

Why did you become a nurse?

Dalia Guerra, Nurse
Socios En Salud-Peru

The desire to help others has been growing in me since I was a little girl, especially to help those living in poverty and who suffered from disease.

First I tried to be part of a religious order but I found certain limitations in being able to truly achieve my goals, so I turned to nursing.

Showing that what some people say is impossible or utopian to achieve, for us isn’t impossible to accomplish, because with strength, perserverance and love, you can always reach your goals. 

Today, I am giving the keynote to our newest group of global nursing leaders at the University of Maryland Nurses for Global Health’s 5th Annual Conference on the Global Burden of Chronic Disease. What a great group of compassion and enthusiastic future nurse leaders!

I’ll be talking about non-communicable diseases (NCDs).

Sixty percent of deaths worldwide are caused by chronic disease. Contrary to popular belief, the WHO estimates that 80% of these deaths occur in low and middle income countries.

As global health nurses we have a responsibility to call attention and address this epidemic.

One of the programs I am so excited to talk about is PIH’s new partnership with Dana Farber Cancer Institute (DFCI) to bring oncology care to our sites. In a strong show of support, DFCI has supported the creation of a nursing oncology partnership with Inshuti Mu Buzima, PIH’s sister organization in Rwanda.

Four experienced oncology nurses have committed to working alongside local nurses and physicians at IMB for three-month rotations, creating an unprecedented opportunity for local nurses to specialize and raise the quality of oncology care. I am particularly thrilled about this partnership because it’s allowing nurses the chance to work globally through their employer, an opportunity that has traditionally been made available only to physicians.

Today, we had our first team conference call with Anne Elperin, the first DFCI nurse to head to Rwanda for a three-month stint. The nurses back at DFCI are supporting Anne from afar and working on training materials and cheering her on. Already Anne and Di Longson (our Clinical Nurse Educator at Butaro Hospital) are seeing improvements in nursing care!

Nursing students attending a NCD training in Butaro, Rwanda.

I am continually amazed at the support and commitment for global health from the nursing community. I know that this partnership with DFCI is just the beginning of developing quality oncology nursing care at our sites, and I look forward to pushing these initiatives forward together.

By Andrew Johnston

April 20, 2012

Mirebalais, HAITI -- This month, the Mirebalais Hospital construction team began a very exciting phase of the project, the installation of solar panels. With construction of the 320-bed facility nearing completion, much of the hospital roof is now being equipped with the solar panels that will provide economically and environmentally sustainable energy to the hospital.   

Rows of panels being fitted on the new hospital's roof.

With 1,800 panels providing 400 kilovolt-amperes (KVA) of electricity, Mirebalais now houses the largest solar energy project in Haiti. The electricity generated will power the hospital during daylight hours and, importantly, save PIH a great deal of money on the utility bill that it can put to use for patient care. Based on current energy prices in Haiti, the panels will pay for themselves in less than three years. The use of solar energy is one of the many innovative components of the Mirebalais Hospital that, in aggregate, set the stage for providing a higher level of care and treatment to the citizens of post-earthquake Haiti.

The use of solar energy is not new to PIH. The organization uses solar energy at its 60-bed Lacolline Hospital in Haiti, Centre de St Michel in Boucan Carre, and the majority of the organization's hospitals and clinics in Lesotho and Rwanda, an achievement made possible through a longstanding partnership with Solar Electric Light Fund (SELF). These projects demonstrate that sustainable energy is not only possible in resource poor settings, but preferable.

As PIH Co-founder Paul Farmer has said, "You can't do this without electricity. Because you're not going to have an operating room. You're not going to have a laboratory. You're not going to see people at night … So it's one of two things -- either generate your own electricity with a diesel generator or go solar."

When finished, the entire roof will be outfitted with solar panels.

Part of the reason for President Clinton’s visit the Mirebalais Hospital in March was to draw attention to its use of solar energy on this project and, in doing so, the tremendous potential of solar energy in Haiti. Clinton emphasized that the Caribbean has the highest energy prices in the world, and Haiti has the highest energy prices in the region. Haiti, the poorest country in the Western Hemisphere, simply cannot afford continued dependence on expensive, non-renewable power.

With its abundant sunlight, Haiti is well positioned to benefit from recent improvements in solar technology. Clinton emphasized that increased use of solar power is fundamental to “building back better.”

I spoke with Stephen “Steve” Hopkins a solar energy expert on his recent visit to the hospital.  Steve oversees renewable energy initiatives at Sullivan & McLaughlin Companies, the Boston-based electrical contracting firm that is partnering with PIH to install the solar energy system.

Andrew: What is the most important thing that you would tell people about solar energy in Haiti?

Steve: Solar is a very good choice for situations where you need to supplement the power supply.  Solar works regardless of the strength of the local infrastructure. It is particularly well suited for Haiti because there is so much sunlight.

Andrew: How is the design of this project different from the projects that you normally do back home in New England?

Steve: First, we had to plan for lots more sun. The panels will generate more electricity than they would back home. Second, we planned for higher levels of heat on the roof, which can interfere with power generation and damage the panels. We compensated for the higher prevailing temperatures by mounting the panels 10 to 12 inches above the roof to allow the heat to dissipate. We also painted the roof white, which lowers the temperature of the roof and increases the amount of light on the panels. It’s quite bright up there now.

The panels are facing south and, to maximize exposure and tilted at a 10-degree angle using sun charts from the University of Oregon. It’s a much less steep angle than is required in Boston.

We are also building for long-term sustainability and reducing ongoing operating costs by building redundancy in the system in a way that is not done in the U.S. Multiple invertors and independent function between banks of panels reduce ongoing maintenance costs and ensure that if there is a problem in one area, the system as a whole will continue to generate needed electricity.

Importantly, unlike diesel generators frequently used by aid agencies, solar energy requires very little ongoing maintenance. You don’t need to do scheduled engine maintenance and filter replacements, you just need to keep out the birds so that they don’t nest in the panels. In its current design, this system can provide 25 years of trouble-free power.

---

The solar panels used in this project are manufactured by Solectria Renewables LLC of Lawrence, Massachusetts, a partner of Sullivan & McLaughlin on previous projects, and were chosen for their durability. Once the system is up and running, the public will be able to track the yield of solar power at the hospital online at: http://www.solren.com/SolrenView/index.html. 

Overall, the project represents an important step forward in the use of sustainable energy in relief and reconstruction projects. Experienced aid workers are often accustomed to the noise, smoke, and expense of generator power. While solar power is cleaner and more cost-effective in the long run, restrictions by government and international donors often make it difficult for aid agencies to switch to solar power. Through its solar projects, PIH “shows what can be done,” says construction team member Jack Manderson.

Learn more about Mirebalais Hospital.

This week, Partners In Health began vaccinating 50,000 Haitians, providing them with protection against cholera that will last for up to three years.

Getting to this point wasn’t easy. Critics said a cholera vaccination wouldn’t work in Haiti.

But, at Partners In Health, we’re committed to doing whatever it takes to save lives – even if it’s not easy and even if the critics doubt us. We will work tirelessly to prevent senseless deaths.

As always, we worked with the national government to get this project off the ground. And the vaccine project is now moving forward before the worst of the rainy season – and the almost inevitable spike in cases of cholera.

With your continuing support, we’ll build a movement to use the vaccine across Haiti – and make investments in water and sanitation – to put an end to the world’s worst cholera epidemic. 

Follow PIH’s Cholera Vaccine Project.
Read more about PIH’s efforts to fight cholera.

PIH co-founders Jim Yong Kim, Ophelia Dahl, and Paul Farmer.

Send a message
of support to Dr. Kim

The election of Partners In Health co-founder Dr. Jim Yong Kim as the next president of the World Bank comes as welcome news to PIH. 

“I can think of no one better able than Jim to help families, communities, and entire nations break out of poverty, which is the mandate of the World Bank,” said fellow PIH co-founder and Harvard University Professor Dr. Paul Farmer.

As a physician and medical anthropologist, Dr. Kim’s mission to serve the poor has led him from Haiti to Peru to Lesotho and beyond for nearly three decades. He and Paul Farmer met as medical students at Harvard and joined with Ophelia Dahl, Thomas J. White, and Todd McCormack in 1987 to found Partners In Health.

Since then, Dr. Kim has carried that mission with him as his career has taken him to leadership positions at the World Health Organization, Harvard University, and Dartmouth College. And now he’ll take it with him to the World Bank.

“Having had the good fortune to train with Jim at Harvard, and to see him work in settings from inner-city Boston to the slums of Peru, from Haiti to Rwanda to the prisons of Siberia, I know that for three decades Jim has committed himself to breaking the cycle of poverty and disease,” said Farmer.

President Barack Obama, who nominated and strongly backed Dr. Kim for the position, issued a statement praising his unique combination of passionate vision, hard-earned experience, and commitment to finding new and effective solutions. “I am confident that Dr. Kim will be an inclusive leader who will bring to the Bank a passion for and deep knowledge of development, a commitment to sustained economic growth, and the ability to respond to complex challenges and seize new opportunities.”

Dr. Kim has served as president of Dartmouth College since 2009. Prior to that he headed the Department of Global Health and Social Medicine at Harvard Medical School and the Division of Global Health Equity at Brigham and Women’s Hospital in Boston. From 2004 to 2006, he headed the HIV/AIDS Department at the World Health Organization.  

“As the President of the World Bank, Jim will play a powerful and influential role in giving the world’s poorest communities access to quality health care—work to which we committed ourselves when we founded Partners In Health” said PIH co-founder and Executive Director Ophelia Dahl.

“At PIH, we believe that health is a human right,” Dahl continued. “We’ve fought for years to deliver high-quality health care to the poor and vulnerable across the globe. Jim’s election as president of the World Bank is a victory for those we seek to serve and all who would do this work.” 

Jessica Teng, PIH – Artibonite Region, Haiti

Today we saw two young people holding an elderly woman walking slowly along a dirt path. The two young adults told us they had already received their vaccines, but they were now helping their elderly, blind family member go the post to get hers. We thought it’d be a good idea to let this woman stay at her home, so we offered to bring the vaccine to her instead of having her walk the rocky, dirt road to the post. So after wrapping up at the vaccine post we all followed the road back to the old woman's house, carrying a cold thermos of vaccines and the tablet to log her information. Delivering vaccine to this woman was a great way for our team to end the day.

"This morning, at 6:00 a.m. we loaded 4,000 cholera vaccines into pick-up trucks and dispatched the vaccines with 40 teams of 4 people each to towns and villages across the region," said Jon Lascher, PIH's Haiti Program Manager, speaking from Haiti's Artibonite Valley region on Sunday, April 15. "Most teams worked faster than anticipated, and within 2 hours of starting we ran out of vaccine at the posts."

"We mobilized more supply from the cold storage and by 4:00 p.m. we had vaccinated 6,100 people. There was little waste and we were able to register many new people. Tomorrow we'll start with 6,000 vaccines and monitor our pace through the day," continued Jon.

Follow PIH's Haiti Cholera Vaccine Project.

IHSJ Reader     April 2012     Issue 21         

Note: Triple asterisk (***) indicates subscription-only sources.

FOOD SECURITY

Saving Money and Lives: The Human Side of U.S. Food Aid Reform (Oxfam America, American Jewish World Service, March 2012)
US food aid programs are not solely focused on improving food security for vulnerable people. One of the worst examples of this is a provision in the Farm Bill that requires 75% of US food aid to be sourced and transported by American companies which has real impacts on how many malnourished people can be reached with life-saving food aid. If Congress eliminates this provision and increases flexibility for more local and regional purchase of food and direct cash transfers, more than 17 million people could receive food aid at no additional cost to US taxpayers.

Local Foods, Global: Food Aid and the Farm Bill (Karen Hansen-Kuhn, Institute for Agriculture and Trade Policy, March 28, 2012) +  What’s at Stake in the 2012 Farm Bill? (Ben Lilliston, Institute for Agriculture and Trade Policy, March 28, 2012)
US food aid has saved countless lives. But in order to save countless more, Congress must take action to improve how the US responds to global hunger in the 2012 Farm Bill. Some NGOs fear that improving food aid will lead to its elimination. However, such resistance to change disregards the mounting evidence that sourcing food aid locally and regionally is more efficient and effective at reducing hunger. For a comprehensive overview of this legislation that is written by the US Congress every five years, see: What’s at Stake in the 2012 Farm Bill?

The Return of the Budget Slashers (Roger Thurow, Chicago Council on Global Affairs, March 30, 2012)
Feed the Future–the Obama Administration’s effort to support agriculture and food security initiatives in developing countries–is critical to reducing widespread hunger and poverty, building local resilience to environmental changes, and expanding the capabilities of smallholder farmers. But instead of supporting long-term solutions to hunger, the House of Representatives’ budget proposal, known as the Ryan budget, threatens to completely “eliminate Feed the Future”. With the Ryan budget threatening to cut 15% of the money that the Obama Administration requested to meet its foreign aid needs, and 17% of the money needed to address domestic hunger, it’s important to remember that these programs could mean the difference between life and death for many of the world’s poor.

HEALTH FINANCING

Value of OECD Aid Drops for First Time in 15 Years (Mark Tran, The Guardian, April 4, 2012)
Development: Aid to Developing Countries Falls because of Global Recession (OECD, April 4, 2012)
For the first time in fifteen years, development aid from the Organization for Economic Co-operation and Development (OECD) countries decreased over the past year. The reduction of $3.4 billion in aid from the world’s wealthiest countries demonstrates a failure to meet global commitments to the world’s poorest.  Despite the financial crisis, sixteen countries in the European Union were able to continue increasing their aid, proving that the crisis should not be an excuse to reduce development contributions.

HEALTH SYSTEMS STRENGTHENING

Organizational Capacity Building: Lessons to Strengthen Health Systems (USAID, Health Systems 20/20, April 2012)
This Health Systems 20/20 brief shares lessons from recent efforts to build the capacity of public, private, and non-profit health organizations in developing countries. The USAID-funded initiative uses an assessment-based approach to identify the priority needs (such as organizational development, resource mobilization, or technical expertise), design a capacity-building plan based on those needs, and monitor the implementation of the plan continuously. Key successes indicate that donors should be investing in organizational capacities to help eliminate barriers to the delivery and utilization of universal health care.

Towards Universal Health Coverage (David DeFerranti, Julio Frenk, The New York Times, April 5, 2012)
As the US Supreme Court wrapped up hearings on the Affordable Care Act and its individual mandate, delegates from multiple countries gathered for the International Forum on Universal Health Coverage to share best practices of universal coverage across countries of various income levels. The US could learn from the “ABCDE” of successful reforms in Mexico and other countries that have fewer resources. As the global trend shifts toward universal coverage, an increasing disparity is developing between the United States and the rest of the world.

HAITI

UN Concerned Over Funding For Humanitarian Services in Haiti (UN News Centre, March 27, 2012)
More than two years after the devastating earthquake and a year and a half after the cholera epidemic began, the international humanitarian community seeks $231 million to fund its earthquake recovery and cholera treatment efforts in 2012. However, only about 8.5 percent of the necessary funding has been received. As a result, the UN Central Emergency Response Fund selected Haiti to receive an emergency allocation of $8 million. This emergency distribution will not provide enough resources to protect Haitians from the increasing risk of cholera as the rainy season begins. Partners need to provide more reliable assistance to avoid cutting back on critical services.

Cholera Cases on the Rise in Haiti, U.N. Says (Trenton Daniel, Associated Press, April 3, 2012)
As Haiti heads into the rainy season, health officials have already reported an uptick in reported cholera cases, recording 77 new cases a day in early March. The cholera epidemic has already killed over 7,000 people and sickened over 500,000 more. Though cases were on the decline during the dry, winter months, as already witnessed, the water-borne illness is expected to spread as the rains continue to fall.

WOMEN AND CHILDREN’S HEALTH

Human Papillomavirus Vaccine Support (GAVI Alliance, April 2012)
Cervical cancer is responsible for the death of approximately 275,000 women every year, with over 85% of these deaths occurring in developing countries. Last week the GAVI Alliance announced that they will respond to demand for the human papillomavirus (HPV) vaccine and continue working with vaccine manufacturers to reduce prices. GAVI will partner with women’s health organizations to help governments integrate the vaccine into comprehensive women’s health interventions. 

The Global Health Financing Revolution: Why Maternal Health is Missing the Boat (G. Ooms, R. Hammons, F. Richard, V. DeBrouwere, Facts, Views, & Vision in OBGYN, March 2012)
In response to a UN report in September 2010 arguing that the 5^th Millennium Development Goal was showing the least progress, some $40 billion in pledges were made to the “Every Woman Every Child” initiative to  help “catch up” maternal health efforts. By contrasting the successful funding of HIV/AIDS, tuberculosis, and malaria programs to global maternal health programs, authors of this study set forth four hypotheses as to why global financing for maternal health has lagged and call on the independent expert review group to track commitments made to improve women’s health and reduce maternal mortality.   

***National and Sub-National Analysis of the Health Benefits and Cost-Effectiveness of Strategies to Reduce Maternal Morality in Afghanistan (Natalie Carvalho, Ahmad Shah Salehi, Sue Goldie, Health Policy and Planning, March 12, 2012)
Recent modeling with data from 1999-2002 and 2007-2008 suggests that the provision of integrated, comprehensive women’s health services is the most effective strategy to improve the safety of pregnancy and childbirth in Afghanistan. Although family planning was the most effective individual intervention, an integrated approach that includes access to contraception, emergency obstetrical care, and health systems improvements could prevent 3 out of 4 maternal deaths in Afghanistan for less than US$200 per year of life saved. These findings reinforce the PIH approach to scaling up access to comprehensive women’s health services at the community, clinic, and hospital level.

ADDITIONAL RESOURCES

TedXChange 2012 (TED, April 5, 2012)
Watch Melinda Gates, TED Curator Chris Anderson, and others discuss why we, as a society, should continue to invest in global health and development in this second-ever TedXChange.

Cervical Cancer Action Webinars (Cervical Cancer Action, March 2012)
Click here to watch webinars hosted by Cervical Cancer Action, a global coalition to stop cervical cancer. Video resources include best practices and lessons learned from HPV vaccination campaigns in developing countries, how to leverage advocacy opportunities for cervical cancer, and more.

Policy to Action (Modernizing Foreign Assistance Network, April 2012)
The Modernizing Foreign Assistance Network (MFAN) launched a new website devoted to monitoring US government agencies’ implementation of President Obama’s Presidential Policy Directive on Global Development. So far four key agencies have responded with how they are advancing foreign aid reform: USAID, Millennium Challenge Corporation, US Trade Representative, and the Peace Corps. MFAN will continue encouraging conversation and participation and keep pushing for increased transparency and accountability.

Remarks on George Marshall and the Foundations of Smart Power (Hillary Rodham Clinton, State Department, April 3, 2012)
In a recent speech at Virginia Military Institute, Secretary Clinton explained how the US government has adopted and adapted George Marshall’s original vision of the “Three Ds of Foreign Policy” – elevating diplomacy, development, and defense as the three pillars of our national security. A video and transcript of Secretary Clinton’s remarks are available.

Jon Lascher, PIH – Artibonite Region, Haiti

Looks like we are doing refresher training and starting to deliver vaccines on Sunday... Leaving out kids 9 and under. Media interest is picking up...

Both NPR and The New York Times have filed follow-up reports about the project.

“Lifting people out of poverty was and is precisely the mandate with which the World Bank was founded. Now, at last, we have a nominee with the experience and humility to move this agenda forward.” That's how Paul Farmer and NYU professor John Gershman described Jim Yong Kim in a Washington Post Op-Ed supporting his nomination to lead the World Bank.

Published on April 11 under the title "Jim Kim’s humility would serve World Bank well," the article argues that “recent claims from some economists that Kim is ‘anti-growth' are based on a willful misreading and selective reporting of passages from Kim’s co-edited volume Dying for Growth: Global Inequality and the Health of the Poor.” Both Farmer and Gershman have known Jim Kim and his views long and well — Farmer as a co-founder of PIH and Gershman as one of Kim's co-editors on Dying for Growth.

"Any reasonable reading of the book indicates that Dying for Growth is pro-growth, raising questions about particular policies and patterns of growth that exclude the great majority of people living in poverty," Farmer and Gershman wrote. "Hence the double entendre in the title.

"The conclusion of Dying for Growth contained an explicit call for research on the relationships among growth, inequality, poverty and health.

"That stance — of asking hard questions rather than assuming the answers — is a valuable one for whoever is at the helm of the World Bank or any development institution. We would argue that it is precisely this humility that has been missing for too long among those who claim to have a clear prescription for ending poverty.

"Jim Yong Kim is a physician and leader who has dedicated his life to advancing development — seeking brisk economic growth and ensuring that the most vulnerable also benefit."

Read “Jim Kim’s humility would serve World Bank well” in its entirety.
Read Jim Kim's Statement to the World Bank Board of Directors.

April 10 marks TOMS Shoes annual “One Day Without Shoes Campaign.” This year, Partners In Health has even more reason to celebrate this special day than ever before. Recently, TOMS began providing shoes to children receiving care at PIH facilities in Lesotho, making it the fourth PIH project to benefit from TOMS incredible generosity.

Since 2009, TOMS has donated thousands of pairs of new shoes to children in Haiti, Malawi and Rwanda through Partners In Health. Now thousands of children in Lesotho will also receive shoes twice a year.

“We at TOMS are so grateful that the incredible support of our TOMS community can be extended to provide children with not only new shoes but with great partners like Partners In Health, also have a positive impact on their health and well being,” says a TOMS staffer. “Thank you for supporting the One for One movement!” 

New shoes help provide an extra layer of health care by helping protect children’s feet from cuts, infection and soilborne diseases. And as we have long known, a lack of shoes can be an indicator of a family living in extreme poverty. New shoes can also encourage families to send their children to school. All of which meaningfully attributes in our mission to break the cycle of poverty and disease.

Learn more about TOMS partnership with PIH in Haiti, Malawi, Rwanda and Lesotho.
Learn how you can support TOMS work.

On April 8, Jon Lascher, PIH’s Haiti Program Manager, updated viewers on Haiti’s cholera epidemic during a live interview on MSNBC’s The Melissa Harris-Perry Show.

“If this was happening here in America, if this was our families in America, we wouldn’t stand for it,” said Lascher. “Cholera is still present… it has started raining already. We’ve had a period of time where cases started going down during the dry season and so we’ve had time to prepare…to do the right thing… But not enough has happened.”

During last year’s rainy season, the number of new cholera infections in Haiti tripled.  

“It spread so quickly because people don’t have access to basic rights like water, sanitation, hygiene, and health care,” continued Lascher. “It needs to be a comprehensive approach to treating and preventing cholera so that we can make sure that there aren’t 7,000 more deaths this year. We need to make sure we’ve learned from past mistakes.” 

As part of this comprehensive approach, PIH is working with the Haitian government and the Haitian NGO GHESKIO to launch a cholera vaccination campaign that will target 100,000 highly vulnerable people and prove that the two-dose vaccine can be delivered effectively in both a Port-au-Prince slum and an isolated, rural community.

Lascher concluded by saying, “We deserve to do better, Haitians deserve better.”

Since the outbreak began in October 2010, more than 7,000 people have died, and at least 531,000 Haitians – roughly 5 percent of the nation’s population – have become sick.

Lascher was joined on the program by Haitian American blogger Alice Backer and former AP correspondent Jonathan Katz.

Learn more about PIH's cholera efforts in Haiti.

Loune Viaud, Co-founder Zanmi Lasante

I am pleased to report that we have the "AVIS FAVORABLE..." 

We finally met over 2 hours late this afternoon with the National Bioethics Committee (7 members). Also in attendance were Bill Pape, Patrick Almazor, Jean Ronald Cadet and Francois Jeannot (MSPP/DPEV), Dr Timothée and your serviteur... 

It was overall a very good exchange to share information and answer all the questions of the Committee... The project got an AVIS FAVORABLE. They told us to go ahead. The official letter will reach the MOH by Friday...

Loune Viaud, Co-founder Zanmi Lasante

Just off the phone with Dr. Timothée, Director-General, who said that he will send us a letter to authorize us to start right away.

Mtg with Ethics Committee is scheduled for 1pm on Monday, and Director-General is very confident that the meeting will be productive.

A class of medical students from around the world recently concluded a course in northern Uganda by producing a short video calling for renewed support for the Global Fund to Fight AIDs, Tuberculosis, and Malaria (GFATM). The course in social medicine was organized by Dr. Michael Westerhaus, a graduate of the PIH-affiliated Residency in Global Health Equity at Brigham and Women's Hospital who is now on on the Global Health Faculty at the University of Minnesota; Dr. Amy Finnegan of the University of Minnesota - Rochester; and Ugandan physician Dr. Phyllis Kisa.

“We had an amazing group of students, and are inspired by the possibilities of fundamentally changing medical education to have a socially oriented foundation,” said Westerhaus. “It was extraordinary.”

In their video, the medical students asked governments from around the world to support the fight against AID, tuberculosis, and malaria.

“In the wake of global financial crisis, many government donors to the Global Fund turned back on previously promised pledges," they said. "This gap in funding caused the Global Fund to cancel disbursement of funds for the first times since its creation... This work cannot stop.”

Since it was launched in 2002, the Fund has distributed 230 million insecticide-treated bednets to prevent malaria, has treated 8.6 million cases of TB, and has provided antiretroviral treatment for 3.3 million people living with HIV/AIDS. But now, just as hopes have been raised that the HIV epidemic can be halted and as enormous but fragile progress has been made against TB and malaria, the Global Fund has been forced to halt funding for new grants through 2014.
 
The lack of new programs for two years could mean a death sentence for millions. The Global Fund provides 83 percent of the international funding for TB treatment. And nearly half of all people currently on AIDS treatment in low- and middle-income countries depend on the Global Fund to stay alive. Unless international donors take urgent and coordinated action to address the Global Fund’s funding gaps, progress made in the last decade could be lost. Learn more.

Read PIH cofounder Paul Farmer’s New York Times editorial “Why the Global Fund Matters.”

IHSJ Reader     March 2012     Issue 20         

Note: Triple asterisk (***) indicates subscription-only sources.

TUBERCULOSIS

 No One Should Die of Tuberculosis in the 21^st Century (Salmaan Keshavjee, Sophie Beauvais, Huffington Post, March 24, 2012)
On World TB Day, Dr. Salmaan Keshavjee, a senior TB specialist at Partners In Health and the Director of the Program in Infectious Disease and Social Change in the Department of Global Health and Social Medicine at Harvard Medical School, and Sophie Beauvais from Harvard’s Global Health Delivery Project, draw attention to the growing prevalence of drug-resistant tuberculosis. Drug-resistant tuberculosis (DR-TB) strains are resistant to the simplest form of TB treatment and usually require months of treatment with five or more medications. While DR-TB can spread from person to person, it can also result from weak health systems, inadequate treatment, and insufficient care. The authors call for two important steps to be taken to fight this deadly disease. First, the Global Fund to Fight AIDS, TB, and Malaria should increase the supply of quality-assured second-line drugs and work to ensure the lowest prices are being paid for second-line TB medicines. Second, the United States Government should push for drug-resistant tuberculosis to be higher up on the global health agenda.

No More Crying, No More Dying. Towards Zero TB Deaths in Children (Stop TB Partnership and World Health Organization, March 2012)
At least half a million infants and children become ill with TB and as many as 70,000 die of the disease each year. In order to make progress towards the goal of “zero TB deaths” among children, this Stop TB Partnership and World Health Organization brief recommends a renewed focus on childhood TB. Critical priorities include: active pediatric TB case finding, especially among families affected by TB and HIV; integration of TB, HIV, and maternal and child health services; and increased investment in research and development for new tools and diagnostics such as child-friendly treatment formulations and easy-to-use pediatric TB diagnostics. Partners In Health welcomes the renewed focus on comprehensive, integrated health programs and calls for increased investment in community health workers in order to expand high-quality health care to the poor who are disproportionately affected by TB.

Tuberculosis Control and Elimination in 2012 and Beyond (The Lancet, March 24, 2012)
In this World TB Day editorial, the Lancet highlights global success in tuberculosis control while calling for further action to ensure that targets can be met. Despite the growing funding gap, tuberculosis incidence has been falling, more people are being treated, and fewer people are dying from the disease. But in order to sustain progress and meet the ambitious target of zero TB deaths among children by 2015, TB must be included on the G20 agenda in July.

HEALTH SYSTEMS STRENGTHENING

America Is Stealing the World’s Doctors (Matt McAllester, The New York Times, March 7, 2012)
What Is Not Owned Cannot Be Stolen: Stop Dehumanizing African Health Workers (Michael Clemens, Center for Global Development Blog, March 12, 2012)
In this New York Times article, journalist Matt McAllester explores some of the difficult issues facing medical professionals in Zambia and other under-resourced countries. Though the notion that “America is stealing doctors” has been rightfully rebuked (see CGD blog), the article does lay bare the immense challenges facing health workers in weak, underfunded public health systems. Dilapidated infrastructure, understaffed clinics, and shortages of medicine and supplies all compound the health worker crisis. In order to the reverse this so-called brain drain, international partners should invest in robust national health plans to ensure that health workers are fairly compensated and accessing the tools they need to practice their lifesaving trade.  

WOMEN AND CHILDREN’S HEALTH

***Maternal Morbidity: Neglected Dimension of Safe Motherhood in the Developing World (Karen Hardee, Jill Gay, Ann Blanc, Global Public Health, March 16, 2012)
The “safe motherhood” and “maternal mortality” discourse largely overlooks the disproportionate toll of maternal morbidity on impoverished women. Yet for every woman who dies in pregnancy or childbirth, another 20 women suffer from pregnancy-related morbidity including anaemia, maternal depression, infertility, fistula, uterine rupture and scarring, and genital and uterine prolapse. Efforts to tackle maternal mortality and morbidity must be integrated at the research, policy, and program level through improved data collection, expanded access to comprehensive women’s health care, and a focus on tackling the underlying drivers of maternal morbidity such as undernutrition.

Reducing Neonatal Mortality in Resource Poor Settings (Kim Dickenson, British Medical Journal, March 21, 2012)
Despite the advancements made in reducing child deaths, maternal mortality, and deaths from communicable diseases, progress in reducing neonatal mortality (deaths within the first month of life) lags far behind. More than 40% of all deaths in children under five occur in the first month of life. Authors of this study argue that the Millennium Development Goal for reducing child mortality cannot be met without targeted and substantial reductions in neonatal mortality.

HEALTH FINANCING

Why the Affordable Care Act’s Individual Purchase Mandate is Both Constitutional and Indispensable to the Public Welfare (Lawrence Gostin, O’Neill Institute for National and Global Health Law, March 19, 2012)
Lawrence Gostin of the O’Neill Institute for National and Global Health Law at Georgetown Law provides a short briefing paper on the constitutionality of the Affordable Care Act’s individual purchase mandate. The author argues the constitutionality of the mandate is rooted in the Commerce Clause, the Necessary and Proper Clause, and the “limiting principle” of individual liberty. The Affordable Care Act and its individual mandate are critical to achieving universal access to health care.

MILLENNIUM DEVELOPMENT GOALS

 Putting Inequality in the Post-2015 Picture (Claire Melamed, Overseas Development Institute, March 2012)
This Overseas Development Institute paper reviews proposals for integrating inequality into a post-2015 Millenium Development Goals (MDGs) framework. The Millennium Development Goals have been the focus of global and national efforts on poverty reduction since 2000.  Yet marginalized populations in every region of the world consistently lag behind in making progress on universal health and poverty indicators. A specific focus on equity would encourage governments and their partners to prioritize hard-to-reach groups in their efforts to obtain the MDGs.

ADDITIONAL RESOURCES

The White Savior Industrial Complex (Teju Cole, The Atlantic, March 21, 2012)
Teju Cole’s recent tweets about the “white savior” were shared widely and sparked criticism from many. In this article, he extrapolates on the changes Americans must make in their attempts to “help” Africa. Instead of focusing on saving Africa, Americans should consider the impact of US foreign policies and lobby their representatives to support policies that will encourage and amplify the voices of marginalized communities throughout the world.

Case Studies in Global Health: Video Library available (Global Health Delivery Project, Harvard University, March 12, 2012)
The Harvard University Extension School and faculty have made all lectures for the course “Case Studies in Global Health: Biosocial Perspectives” available to the public free of charge. Check out these inspiring 2011 lectures from Paul Farmer, Arthur Kleinman, Anne Becker, Salmaan Keshavjee, and others, and let us know what you think!

By Marie Connelly, GHDonline

“There is a growing recognition of a need to make monitoring and evaluation (M&E) more effective for programs to use data to understand gaps and improve performance, quality and effectiveness.”
– Dr. Lisa Hirschhorn, Director of Monitoring, Evaluation, and Quality at Partners In Health

Strengthening local health systems is an implicit goal of many global health initiatives and programs, but ensuring this goal is achieved alongside competing priorities and deliverables can be incredibly challenging, particularly in resource-poor settings.

	Check out the unit on Monitoring and Evaluation in PIH's Program Management Guide.

From April 2 to 6, GHDonline, in collaboration with Partners In Health and in conjunction with the Program Management Guide, will host an Expert Panel discussion, Integrating M&E for Health Systems Strengthening, to address the ways that Monitoring and Evaluation can be used to assess whether, and how well, programs are being implemented as planned and achieving their goals and objectives.

Leading the discussion, Dr. Hirschhorn is an Assistant Clinical Professor of Medicine at Harvard Medical School, and a Senior Clinical Adviser with JSI Research and Training, in addition to her work with Partners In Health. Her research focuses on monitoring, evaluation and improving access, utilization and outcomes of HIV and primary care in resource limited settings, and adherence in people living with HIV. She will be joined on this Expert Panel by Dr. Wesler Lambert, Director of Monitoring and Evaluation for Zanmi Lasante, Haiti and Drs. Pierre Barker, Paulin Basinga, and Kenny Sherr.

For Dr. Hirschhorn, the goals of this panel are “to share successful models of M&E that contribute to evidence-based decisions and empower programs to use data for improvement and stakeholder communication.” We hope that members of the global health community will join us in sharing successful models of M&E for health systems strengthening. As Dr. Hirschhorn notes our ultimate goals for this discussions is “to have identified examples of feasible models that can be replicated and sustained in the current resource constrained environment.”

Participation is easy (via email or online) and made available to all at no cost thanks to the support of founding organizations Brigham and Women’s Hospital and Harvard Medical School.

Read the full agenda for Integrating M&E for Health Systems Strengthening, and to register to participate in this free online discussion.

On Wednesday, March 28, Haiti President Michel Martelly toured Mirebalais National Teaching Hospital, a state-of-the-art medical facility being built by Partners In Health and the Haitian government. The President was joined by Haiti Minister of Public Health Florence D. Guillaume and Senator Edmonde Supplice Beauzile.

During the tour, President Martelly congratulated PIH/ZL efforts and reiterated the government’s commitment to providing free, comprehensive health care to all citizens. The President said he hopes to build at least one modern hospital in each of the country’s ten departments in the coming years, while also continuing to modernize existing facilities.

Paul Farmer, PIH’s David Walton, and Zanmi Lasante’s Maxi Raymonville and Father Fritz Lafontant led Wednesday’s tour.

When its doors open in 2012, the 180,000-square foot, 320-bed hospital will offer a level of care never before available at a public facility in Haiti. And at a time when Haiti desperately needs skilled professionals, Mirebalais Hospital will provide high-quality education for the next generation of Haitian nurses, medical students, and resident physicians.

Learn more about PIH's work in Haiti.

PIH co-founder and nominee for World Bank President discusses his vision for the World Bank in an op-ed published by the U.S. Treasury Department and the Financial Times.

By Jim Yong Kim

We live in a time of historic opportunity. Today more people live in fast-growing economies than at any time in history, and development can take root anywhere – regardless of whether a country is landlocked, just emerging from conflict or oppression, large or small. If we build on this, we can imagine a world in which billions of people in developing countries enjoy increases in their incomes and living standards. Given our collective experiences, successes and resources, it’s clear that we can eradicate global poverty and achieve in our lifetimes what for generations has been a distant dream.

My own life and work have led me to believe that inclusive development – investing in human beings – is an economic and moral imperative. I was born in South Korea when it was still recovering from war, with unpaved roads and low levels of literacy. I have seen how integration with the global economy can transform a poor country into one of the most dynamic and prosperous economies in the world. I have seen how investment in infrastructure, schools and health clinics can change lives. And I recognise that economic growth is vital to generate resources for investment in health, education and public goods.

Every country must follow its own path to growth, but our collective mission must be to ensure that a new generation of low and middle-income countries enjoys sustainable economic growth that generates opportunities for all citizens.

As co-founder of Partners in Health and director of the World Health Organisation’s initiative to treat HIV/Aids, I will bring practical experience to the World Bank. I have confronted the forces that keep more than 1 billion people trapped in poverty. I have worked in villages where fewer than 1 in 10 adults could read or write, where preventable diseases cut lives short and where lack of infrastructure and capital held back entrepreneurs. In all those villages, the local people knew where improvement was needed.

But for change to happen, we need partnerships between governments, the private sector and civil society to build systems that can deliver sustainable, scalable solutions. And as we work for global prosperity, we must draw on ideas and experience from around the globe.

Read Dr. Kim's full op-ed on the websites of the U.S. Treasury Department or the Financial Times.

Dr. Jim Yong Kim is a co-founder of Partners In Health, President of Dartmouth College, and the U.S. nominee for the presidency of the World Bank.

"By joining forces, we can offer cancer patients of all ages a chance at life," says Dr. Shulman.

By Lawrence Shulman, Chief Medical Officer, Dana Farber Cancer Institute

Dana-Farber, partnering with Brigham and Women’s Hospital and Children’s Hospital Boston, offers patients highly advanced treatments in modern facilities. Our patients also benefit from an excellent staff, clinical research, and extensive resources, and many of them survive cancer to live long and healthy lives.

Is it fair, then, that cancer remains a death sentence elsewhere in the world? In Rwanda, for example, a country of 10 million people, cancer care has been completely unavailable to almost all patients. They die of cancers that could have been cured in Boston.

Dana-Farber/Brigham and Women’s Cancer Center is bringing expertise and resources to countries such as Rwanda, Malawi, and Haiti, in collaboration with Partners in Health, and with support from the Jeff Gordon Children’s Foundation, the Lance Armstrong Foundation, and Michele and Howard Kessler. Teamwork is critical here; PIH is skilled at delivering health care in very resource-poor places, but lacks specific cancer expertise. We understand cancer, but not how to care for patients in such challenging areas, where much of the infrastructure required for cancer care (such as pathology labs) is missing. By joining forces, we can offer cancer patients of all ages a chance at life.

We’re beginning in the tiny nation of Rwanda, the most densely populated country in Africa and one of the poorest in the world. Our goal is not only to help bring cancer care to individual children and adults, but also to work with the Rwandan ministries in developing the policies and infrastructure needed for this work to take place.

Read Dr. Shulman's full blog post on Dana Farber's website.

Jon Lascher, PIH – Artibonite Region, Haiti
March 28, 2012 

The rains are here. There has been flooding and several deaths in Port-au-Prince due to mud slides. Cholera isn't far behind.

President Michel Martelly visited Mirebalais hospital today with the Minister of Health. Paul and Loune were able to speak with them about the vaccine project delays and our frustration with not being able to proceed with distribution. The MOH expressed full support of the project and promised to make an effort to get things moving with the Ethics Committee next week.

In mid-March, Partners In Health’s newest site, Compañeros En Salud Mexico, welcomed crowds to a health screening fair this past week in the mountain town of Soledad. Men and women from the region were about to receive physical exams and answer questionnaires, which will help clinicians screen them for signs of hypertension, diabetes, tuberculosis, HIV/AIDS, and epilepsy. 

Attendees participated in activities that illustrated the long term effects of diabetes.

The fair is one element of a strategy of “active case finding”. As CES Director Dr. Hugo Flores explained, “What these priority conditions all have in common is that they often go undiagnosed for months or years, slowly damaging health. But if caught early, they can be successfully treated. Through the health screening fair- and later through home visits and other community efforts – we aim to find and address these often hidden conditions.” 

CES also utilized the event to educate community members about the chronic diseases of diabetes and hypertension. Through the fair and follow-up visits, CES staff saw 120 people, screened 65 for diabetes, and diagnosed 10 with the disease and 15 with glucose intolerance. The ones that were diagnosed started treatment right away and were received advise on lifestyle changes they could make.

“The interactive educational games were very well received,” said CES Director of Operations, Dr. Jafet Arrieta. “Not only were the activities fun, but they helped people understand complex health concepts.” For example, social service year physician Alejandra Almeida used transparent tubing and colored water to help illustrate how high blood pressure can cause damage over time. 

CES helps improve Mexican government clinics in the sierra of Chiapas by providing staff and supporting operations. The fair’s success highlighted this collaboration. Officials of the regional health jurisdiction as well as the local clinic nurses worked together with CES physicians to provide supplies and staffing for the fair.  At the community level, teachers and health committee leaders also mobilized to help publicize the event. 

The organization currently supports two clinics, with plans to expand to up to seven in August 2012. This initial fair will serve as a template for community events as the organization grows.  

Learn more about PIH's work in Mexico.

An op-ed from the Huffington Post published on World TB Day.

Clinicians in Russia examine the chest x-ray of a patient with MDR-TB

By Salmaan Keshavjee and Sophie G. Beauvais

“How unromantic it is to die of tuberculosis in the twenty-first century.”  These were the words of a Russian man in his twenties, written just before he died from drug-resistant tuberculosis (TB).  Unromantic indeed: 130 years after it was first discovered, and almost 60 years after the first antibiotics became available, one third of the world’s population is infected with TB. Every four seconds someone becomes sick, every day 4,500 people die from this largely treatable disease because they do not have access to proper diagnosis, medicines and care. We do not even know how many children die from TB because until very recently pediatric TB has been largely ignored by the global community. TB continues to be the leading killer of people with HIV.

It gets worse: a growing proportion of those infected with TB, like our Russian man, have drug-resistant forms which require longer courses of treatment with more toxic second-line drugs. Many patients die without any treatment, but not before transmitting the disease to others in their communities.  These strains are now found everywhere.  Some of them have become resistant to all known treatments.

But drug-resistant TB is not new. An outbreak in New York City in the late 1980s was successfully contained by building appropriate diagnostic capacity, using second-line drugs, and by supporting care to patients over the grueling two-year long treatment. Resistant TB strains were also found in poor countries, but the global response was limited by international health policies that said that in poor countries it was “too expensive” to treat these forms of TB.  This was a mistaken approach to an airborne disease.

There was a moment of hope at the turn of the century. A group of non-governmental organizations and global health advocates — most notably Drs. Paul Farmer and Jim Yong Kim and our team at Partners In Health as well as colleagues from Médecins Sans Frontières and the U.S. Centers for Disease Control—  proved that drug-resistant TB could be treated in poor countries. The Green Light Committee (GLC), a mechanism to help countries access quality-assured second-line drugs at affordable prices, was created.  This partnership negotiated massive price reductions (from more than $30,000 per patient per year to less than $3,000). In 2003, the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) voted to require the use of this mechanism for countries receiving its funding. This was done to make sure programs were using good quality medications, but led to unexpected bottlenecks and effectively created a monopoly.

So why are patients still dying and the problem of drug-resistance getting worse? 

Read the full text of No one should die of tuberculosis in the 21st century in the Huffington Post. 

Learn more about PIH's work to fight tuberculosis.

Dr. Salmaan Keshavjee is a Senior TB Specialist at Partners In Health. He is the Director of the Program in Infectious Disease and Social Change in the Department of Global Health and Social Medicine at Harvard Medical School and a physician at Boston’s Brigham and Women’s Hospital. He was Chair of the Green Light Committee from 2007 to 2010. Sophie G. Beauvais is the Communications Manager at the Global Health Delivery Project at Harvard University.

A patient in Malawi struggles to overcome poverty, access to health care, and tuberculosis.

TB CARE II District Coordinator Patrick Gomani adjusts a mask on tuberculosis patient Zefa Charles to prevent transmission of the disease during an ambulance ride.

By Robbie Flick

Zefa lives more than two hours away from the district hospital and 20 kilometers from the nearest health center. She lives at the end of a road that quickly degrades into little more than a muddy footpath. Her home is a small mud-walled hut that she shares with her grandmother, sisters, and children.

	Zefa lives in a small mud hut far from the closest hospital.
	To help monitor her treatment and speed her recovery, PIH made arrangements for her to live at the hospital for six weeks.

Over a year ago, Zefa tested positive for HIV at the health center. Her CD4 count — an indicator of immune system strength — was too high to begin antiretroviral therapy, and the tuberculosis bacteria in her lungs went unrecognized, presenting a constant risk of infecting her family. Sick and failing to get better, she spent many days traveling to the health center, only to receive bactrim, an antibiotic to prevent opportunistic infections.

“Bactrim, bactrim, bactrim,” she said, “until the day I was diagnosed with tuberculosis.” She received first-line drugs, but did not get any better; tests confirmed she had multi-drug resistant tuberculosis (MDR-TB), a deadly manifestation that does not respond to first-line treatments. 

MDR-TB made an already difficult life much more challenging. “I don’t have food. I have no money. My children have no notebooks for school. The only food I eat is what these children have found,” she explained to staff from PIH's sister organization in Malawi, APZU. Gaunt with sunken eyes, it was clear how significant a toll the difficult access to health services and lack of appropriate treatment options had taken on her.

Thanks to a partnership with USAID, TB CARE II, and the Malawian government, APZU/PIH had the tools and resources to help Zefa. Malawi's National TB Programme supplied the rare second-line drugs to treat Zefa, while APZU/PIH specially outfitted a room at Neno District Hospital so she could benefit from the close oversight of clinicians.

“I’m feeling better because I will finally find the right treatment there,” she said, as APZU/PIH staff readied her for the long journey back to Neno to be admitted.

Now, after six weeks of treatment and monitoring, she is finally getting better and looking forward to returning home to finish her treatment, finally on her way to being free of tuberculosis.

Learn more about PIH's work to fight tuberculosis.

TB CARE II is a five-year project from the United States Agency for International Development designed to provide global leadership and assist National Tuberculosis Programs in high burden countries around the world to accelerate the implementation of programs for TB DOTS, TB/HIV and Programmatic Management of Drug Resistant TB (PMDT). Led by University Research Co., LLC (URC), the TB CARE II Project team is comprised of leading organizations involved in building TB service delivery systems worldwide, including Partners In Health, Jhpiego, Project HOPE, and many others. TB CARE II programs work with a wide segment of stakeholders, including policy planners, public sector providers, communities, and patients to scale up evidence-based interventions and improve outcomes in tuberculosis prevention and control.

On World Tuberculosis Day, a new website shares the stories of children facing a deadly but curable disease.

Every year, thousands of children die from drug-resistant tuberculosis — a disease with a known cure. This happens because children do not have access to diagnosis or treatment for this disease. In spite of global advances made in tuberculosis treatment, children have been left behind.

March 24 is World Tuberculosis Day, a time to reflect on the tremendous advances to treating and preventing TB, as well as to focus on the work that still needs to be done. The Sentinel Project, a new global partnership of researchers, caregivers, and advocates, is working to shed light on the issue of children dying from drug-resistant tuberculosis (DR-TB). This week, they launched a new website, "Being Brave: Stories of Children with Drug-Resistant Tuberculosis," which gives a voice to the children from around the world who face the challenges of fighting DR-TB every day. Children like Juan, a four-year-old boy treated by PIH's sister organization Socios En Salud in Lima, Peru.

	Juan, an DR-TB patient in Lima, Peru.

Juan has captured the heart of every doctor and nurse in the tuberculosis unit where he has been living and receiving treatment for the last six months. Despite his separation from his family and his confinement to a wheelchair, Juan has maintained both his sweet demeanor and his playfulness. Although he says only a few words, he likes to hug and greet everyone with a smile. The resident physicians often wheel him out to their work area, where they let him play with their stethoscopes. Juan embodies the innocence of childhood: oblivious to the severity of his own illness and to his family’s tragedy, he continues to laugh and play. Nevertheless, there is little doubt that tuberculosis will leave both physical and emotional scars on this young boy.

Until six months ago, Juan lived with his family in El Agustino, the district with the highest incidence of tuberculosis in Lima. Approximately one year ago, Juan’s mother first became ill with pulmonary TB. Initially, she complied with her treatment, and her health improved. However, after a few months, Juan’s father left her for another woman, and she plunged into a deep depression and stopped taking her medicines.

A couple of months later, Juan developed a progressive cough. He was diagnosed with bacterial pneumonia and treated with a course of antibiotics, which failed to cure his cough. One day while playing, Juan fell and injured his back. He was brought to a referral hospital, where doctors diagnosed him with a fractured spine. Luckily, his spinal cord had not been damaged. However, the accident left him with a prominent hump in his back, and significant pain when walking.

Testing revealed that Juan actually had both pulmonary TB and Pott’s disease (TB of the spinal column) — which predisposed him to his injury. Furthermore, his TB was due to a drug-resistant strain, most likely transmitted from his mother. As a result, he was hospitalized not only for TB treatment but also to prevent further injury to his spine.

Juan’s mother never visited her son in the hospital. She was too sick, and eventually died of respiratory failure as a result of her TB. Juan’s grandmother, the family’s sole wage earner, visits Juan when she has time between working and caring for her disabled son. Juan’s treatment has so far been successful, but he still has a long road ahead of him. After another year of treatment, he will finally be ready for spinal surgery. Thanks to the excellent medical care he is receiving at the referral hospital, Juan will likely be able to walk again without pain and fully recover his lung function. Unfortunately, modern medicine cannot heal the emotional scars that he will undoubtedly have from the loss of his mother to DR-TB.

The Sentinel Project hopes that sharing the stories like Juan's story will inspire the international community to join children with DR-TB and their families and caregivers in the struggle for better diagnosis and treatment.

Learn more about the Sentinel Project and read more stories.

Learn more about PIH's work to fight tuberculosis.

The Sentinel Project on Pediatric Drug-Resistant Tuberculosis is a collaboration that includes the Department of Global Health and Social Medicine at Harvard Medical School, the National Institute for Research in Tuberculosis in India, the Treatment Action Group (TAG), and more than 130 individuals from more than 40 countries. This partnership collaborates to develop and deploy evidence-based strategies to prevent child deaths from this treatable disease.

President Obama taps PIH-co-founder and Dartmouth President to lead major international financial institution.

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On Friday, March 23, President Barack Obama selected PIH co-founder and Dartmouth College President Dr. Jim Yong Kim as the United States’ nominee to be President of the World Bank. If he is elected by the World Bank’s Board of Governors in April, Dr. Kim will lead the institution’s efforts to reduce poverty and generate sustainable, broad-based growth.

PIH co-founder Dr. Paul Farmer applauded the nomination of his long-time colleague and friend. “I can think of no one more able to help families, communities, and entire nations break out of poverty, which is the stated goal of the World Bank,” Dr. Farmer said. “Having had the good fortune to train with Jim at Harvard, and to see him work in settings from inner-city Boston to the slums of Peru, from Haiti to Rwanda to the prisons of Siberia, I know that for three decades Jim has committed himself to breaking the cycle of poverty and disease.” Read Dr. Farmer's full statement.

Dr. Farmer’s enthusiastic endorsement was echoed by President Paul Kagame of Rwanda.

“I was delighted to learn that Jim Kim has been nominated for this post, as he is a true friend of Africa and well known for his decade of work to support us in developing an efficient health system in Rwanda,” President Kagame said. “He’s not only a physician and a leader who knows what it takes to address poverty, but also a genuinely good person.”

Dr. Kim is an infectious disease specialist and medical anthropologist who has been working to serve the poor across the globe for nearly three decades. He and Paul Farmer met as medical students at Harvard and joined with Thomas J. White, Ophelia Dahl, and Todd McCormack in 1987 to found Partners In Health.

Dr. Kim previously served as Chair of the Department of Global Health and Social Medicine at Harvard Medical School and as Chief of the Division of Global Health Equity at Brigham and Women’s Hospital in Boston. From 2004 to 2006, he headed the HIV/AIDS Department at the World Health Organization.

Former President Bill Clinton hailed Dr. Kim as “an inspired and outstanding choice to lead the World Bank based on his years of commitment and leadership to development and particularly health care and AIDS treatment across the world.”

Dr. Paul Farmer’s statement on the announcement by President Obama of his nomination of Jim Yong Kim as President of the World Bank:

Jim Yong Kim is an inspired choice for the presidency of the World Bank. Having had the good fortune to train with Jim at Harvard, and to see him work in settings from inner-city Boston to the slums of Peru, from Haiti to Rwanda to the prisons of Siberia, I know that for three decades Jim has committed himself to breaking the cycle of poverty and disease. This has been his goal as a physician, a teacher, a policy maker, and a university president; it was ever his goal as a founder and director of Partners In Health, which now operates in more than a dozen countries and informs his teaching and writing. He has worked in rural villages and squatter settlements just as he has worked in the halls of power and privilege.

Again and again, we his friends and colleagues have seen Jim imagine a better future, one that harnesses new technologies and older but sound notions of justice and equity, and links this vision to much more than talk and reports and studies. Jim is all about delivery and about delivering on promises often made but too seldom kept. I can think of no one more able to help families, communities, and entire nations break out of poverty, which is the stated goal of the World Bank. As poverty continues to claim lives, and as inequality deepens, the Bank--and other institutions charged with lessening poverty — need bold and experienced leaders and implementers like Jim Kim. 

- Paul Farmer, MD, PhD
  Kolokotrones University Professor, Harvard University
  Chair, Department of Global Health and Social Medicine, Harvard Medical School
  Chief, Department of Global Health Equity, Brigham and Women’s Hospital
  Co-Founder, Partners In Health

PIH's Dr. Evan Lyon, second from left, receives a donation on behalf of PIH at WXRT's office in Chicago.

Chicago’s long-time indy rock station WXRT recently raised 25k for both Partners In Health and the Lincoln Park Community Shelter through sales of the compilation CD, "ONXRT: Live from the Archives, vol 13."

The CD features live performances by The Decemberists (Down by the Water); Florence and the Machine (Dog Days are Over); Michael Franti and Spearhead (Say Hey I Love You); Ray Lamontagne and the Pariah Dogs (For the Summer); The New Pornographers (Crash Years); Dawes (When My Time Comes); Gov't Mule (Broke Down on the Brazos); Death Cab for Cutie (Soul Meets Body); Mumford & Sons (The Cave); Fitz and the Tantrums (Moneygrabber); Foster the People (Pumped Up Kicks); The Airborne Toxic Event (Sometime Around Midnight); Amos Lee (Windows are Rolled Down); and, The Black Keys (I Got Mine.)

The tracks for this new CD have been pulled from in-studio performances, live remotes, and XRT-sponsored shows around Chicagoland over the last nine years. None of the versions of these songs can be found anywhere else.

The ONXRT charity CD series began in 1993. 

Check out the CD here. 

Access to clean water is a basic human right and a prerequisite for health. Yet even as we recognize World Water Day today, March 22, an estimated 780 million people around the world (WHO/UNICEF) – roughly two-and-a-half times the U.S. population – lack access to safe water. At any given time, almost half of all people living in developing countries are suffering from a health problem caused by lack of safe water and sanitation. 

View images showing how water affects patients in communities served by PIH, and PIH's work to provide clean, safe water to these communities:

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Diseases spread by unsafe water cause 3 million deaths a year , disproportionately affecting young children. Diarrhea, primarily a disease of dirty water, is the biggest killer of children under five in poor countries, resulting in nearly 3,000 preventable deaths each day – more than 2 deaths every minute, according to the World Health Organization and UNICEF.

Water projects are one of the most effective ways of saving lives and one of the most cost-effective investments in disease prevention. Potable water projects typically reduce diarrheal disease by upwards of 50 percent, with even higher reductions during water-borne epidemics, such as cholera and typhoid.

At PIH project sites, clinicians and community health workers evaluate patients’ needs and identify those who require water support for drinking, medications, sanitation, and agriculture. Water is the most basic necessity of life. Because of this, PIH partners with organizations to build wells, water pumps, and latrines in many of the communities where we work across the globe. 

Learn more about PIH’s water projects.
PIH is also leading the fight against cholera in Haiti, learn how.

For the first time in Haiti, experts in global health and development will gather in Port-au-Prince to exchange ideas focused on strengthening public health delivery.

Held from March 28-29, 2012, the National Conference on Social Medicine will provide an interactive forum for sharing lessons learned and effective strategies for education, training, and healthcare worker retention in resource-poor settings. Participants will discuss insights and policies informed by the field of social medicine, which focuses on understanding how social and economic conditions impact health, disease and the practice of medicine.

Partners In Health and Zanmi Lasante have organized the Conference in partnership with the Faculté de Médecine et de Pharmacie de l’Université d’Etat d’Haïti and the Groupe Promoteur de Médecine Sociale.

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Pour la première fois en Haïti, des experts de santé globale et des experts de développement se réuniront à Port-au-Prince pour échanger des idées sur le renforcement des services de santé publique.

La Conférence Nationale sur la Médecine Sociale, qui prenait lieu de 28 à 29 mars, 2012, servira comme forum interactif pour partager des leçons apprises et des stratégies effectives pour l’éducation, la formation et la rétention du personnel de santé dans les localisations appauvries. Les participants discuteront des idées et des politiques fondées sur la médecine sociale, un domaine focalisé sur la bonne compréhension des effets des conditions sociales et économiques qui portent sur la santé, les maladies et la pratique de médecine.

Partners In Health et Zanmi Lasante organisent cette conférence conjointement avec la Faculté de Médecine et de Pharmacie de l’Université d’Etat d’Haïti et le Groupe Promoteur de Médecine Sociale.

Speakers include:
Parmi les intervenants:
Paul E. Farmer, MD, PhD, Co-Founder of Partners In Health; Kolokotrones University Professor, Harvard University; Chair of the Department of Global Health and Social Medicine, Harvard Medical School
Joia S. Mukherjee, MD, MPH, Chief Medical Officer, Partners In Health; Associate Professor, Department of Global Health and Social Medicine, Harvard Medical School
Gladys Prosper, MD, Dean of the Faculté de Médecine et de Pharmacie de l’Université d’Etat d’Haïti

Location: Karibe Hotel, Juvenat 7, Petion-Ville
Time: 8-2:30pm (registration opens at 7:00am)

Conference participants and members of the media must register in order to attend.

Partners In Health/Zanmi Lasante (PIH/ZL), is the lead partner of an exciting new project in Haiti called Pwojè Kore Fanmi – Haitian Creole for the Family Strengthening Project. In partnership with the World Bank, the Haitian Ministry of Finance’s Fund for Economic & Social Assistance, and World Vision, PIH/ZL is training a cadre of Household Development Agents (HDAs) whose job it will be to connect poor and vulnerable families – nearly all living in rural communities – with local resources and refer those in need of medical attention to health centers and hospitals.

Part of what makes Pwojè Kore Fanmi unique is its explicit focus on helping families restore and fulfill their human rights. To meet that goal, the Pwojè Kore Fanmi trains HDAs to master a breadth of knowledge significantly larger than previous training models.

In late January, PIH/ZL began training the first 55 women and men as Pwojè Kore Fanmi HDAs. The HDAs will soon begin working in the countryside, providing services to families who have been targeted as needing assistance. In past models, community agents would provide similar services to all families. This new model tailors services, addressing each family's specific needs. The HDAs will return every month through September for further training and support.

If all goes as planned, the government hopes to scale up this pilot project to the national level in the near future. Because of this, many eyes – including those of Haiti’s president Michel Martelly – will be watching Pwojè Kore Fanmi’s progress over the coming year.

Training the next generation of HDAs

During their first training, HDAs discussed how by providing health care and helping families access good nutrition, education, clean water, housing, and economic opportunities, they are helping to restore families' human rights. They worked through case studies in small groups to explore how being denied these human rights affects families’ health and well-being and makes them more vulnerable. They also role-played for their colleagues.

In one of the role-plays, a mother sends her daughter to work for a wealthy family in Port-au-Prince because she is very poor and cannot feed her children. This generated a heated discussion about the poverty that makes this practice a common problem in Haiti, one that often that leads to child labor and abuse.

These participatory training activities are designed to elicit and build on training participants’ experience and knowledge, promote discussion and reflection on key issues, provide hands-on practice of content learned, and help participants learn from each other.

Once fully trained, the HDAs will assess for health problems, provide education about health issues, promote healthy behaviors, distribute health products such as bed nets and micronutrient powders, and refer people to health centers or social services as needed. The HDAs will lead monthly mothers’ clubs, youth clubs, and neighborhood meetings to promote dialogue and support among community members as they address health issues in their communities.

HDAs will also run monthly “rally posts” in the community in order to administer vaccinations, weigh and measure children, and carry out other health campaigns.

Leveraging years of experience

With more than two decades of experience and expertise developing community-based health initiatives in Haiti, PIH/ZL was chosen to develop all of the training materials for Pwojè Kore Fanmi. Working closely with staff in both Haiti and Boston, PIH/ZL is developing trainings and program structures that are realistic and sustainable. 

This project is funded by the World Bank and is a collaborative effort among the World Bank, the Haitian Ministry of Finance’s Fund for Economic & Social Assistance, UNICEF, the World Food Program, UN Population Fund, International Labour Organization, and World Health Organization, with World Vision and Partners In Health as the implementing partners.

On Monday, a crowd gathered in the Massachusetts State House’s Nurses Hall to call on the state to continue supporting community health workers (CHWs) and to recognize their value to the state’s medical infrastructure. Organized by the Massachusetts Association of Community Health Workers (MACHW), rally participants representing a number of different CHW programs came together to support the valuable work carried out by CHWs.

Community health worker advocates listened to speakers and lobbied directly to legislators at the MA State House.

Staff from PIH’s PACT project – which trains CHWs to accompany vulnerable patients living with chronic diseases like HIV/AIDS and diabetes – participated in the day’s events.

Supporters listened to Sharon Henderson (MACHW Board Chair), Francisca Guevara (a CHW working at Joseph Smith Community Health Center) and State Representative Gloria Fox’s son who was speaking on her behalf. Speakers highlighted the cost effectiveness of integrating CHWs into routine medical care, highlighting the important role the group could play in eliminating certain barriers to care.

After the rally, representatives from various organizations met with legislators to lobby for continued support for CHWs at the state level. The group made three demands to the Commonwealth of Massachusetts:

• Fund $2.5 million in FY 2013 for “Community Outreach & Access to Care Grants.” This money would support community organizations and health centers who employ CHWs. 

• Commit, more generally, to funding public health and community health workers through payment reform and legislation currently in development. 

• Maintain sufficient funding levels to cover essential benefits in Massachusett’s public health insurance program (Commonwealth Care, MassHealth).

In recent years, MACHW has made strides in incorporating CHWs into health care legislation. 

In September 2010, Massachusetts Governor Deval Patrick signed into law "An Act to Establish a Board of Certification of Community Health Workers" (Chapter 322 of the Acts of 2010). The law, which went into effect in January 2012, created a new board of certification of CHWs which will operate under the auspices of the state’s Department of Public Health's Division of Health Professions Licensure. 

Learn more about PIH’s Boston-based PACT program
Learn more about the Massachusetts Association of Community Health Workers

Jon Lascher, PIH – Artibonite Region, Haiti
March 20, 2012 

There is still a general misunderstanding on behalf of the Ethics Committee that this vaccine project is a research study, which it is not. We continue to try to convince them otherwise... Hoping for a meeting with the full committee next week.

IHSJ Reader     March 2012     Issue 19         

Note: Triple asterisk (***) indicates subscription-only sources.

TUBERCULOSIS

***High Rate of Hypothyroidism Among Patients Treated for Multidrug-Resistant Tuberculosis in Lesotho (H. Satti, A. Mafukidze, P.L. Jooste, M.M. McLaughlin, P.E. Farmer, K.J. Seung, The International Journal of Tuberculosis and Lung Disease, March 1, 2012)
A retrospective study of 212 patients with multidrug-resistant tuberculosis (MDR-TB) in Lesotho found that two drugs commonly used to treat MDR-TB likely increase the frequency of hypothyroidism among patients. Second-line anti-tuberculosis drugs used to treat MDR- and extensively drug-resistant (XDR) tuberculosis have many known side effects; in fact para-aminosalicylic acid (PAS) was removed from standard TB treatment in the 1960s due to its severe gastrointestinal side effects, but is still commonly used for the treatment of MDR- and XDR-TB. To address the common prevalence of hypothyroidism during MDR-TB treatment, authors suggest screening all patients within 2-3 months of starting MDR-TB treatment, instead of the 5-6 months recommended by the World Health Organization.

Starke: Combat TB Before it Strengthens (Jeffrey Starke, The Statesman, February 23, 2012)
In response to recent tuberculosis outbreaks in Texas, Jeffrey Starke highlights the need for investment in new TB drugs and diagnostics, and expanded TB control efforts in developing countries. Current treatment regimens for tuberculosis are severely outdated with no new drugs in over 40 years.  And now clinical trials for medications that could shorten treatment time and reduce side effects face dramatic funding shortfalls. It is critical that we continue strengthening health care infrastructure in developing countries to prevent the rapid spread of tuberculosis and further emergence of drug-resistant strains.

GLOBAL HEALTH FINANCING

 Why Cutting PEPFAR Is Bad Policy (Chris Collins, The Hill, March 13, 2012)
HIV International Assistance and Adult Mortality: Africa (Eran Bendavid, C. Holmes, and G. Miller, 19th Conference on Retroviruses and Opportunistic Infections, March 5, 2012)
A new study from Stanford University finds that adults living in countries supported by the President's Emergency Plan for AIDS Relief (PEPFAR) were 20% less likely to die between 2004 and 2008 than adults in non-PEPFAR sub-Saharan African countries. Drawing on this important finding, Chris Collins outlines six reasons why the US Congress must increase the Administration’s Fiscal Year 2013 budget request which cuts PEPFAR’s budget by nearly $550 million (11%).  Cutting funds from the most effective bipartisan, bilateral global health program would undermine broadly-shared economic, humanitarian, and diplomatic interests and make it unlikely that the US can achieve an AIDS-free generation.

Money or Die: A Watershed Moment for Global Public Health (Laurie Garrett, Foreign Affairs, March 6, 2012)
Global health programs “now teeter on the edge of disaster” due to dramatic cuts in global health funding from public, private, and civil society donors.  Faith-based and nongovernmental organizations (NGOs) reduced global health spending by 33% between 2008 and 2010. And with the exception of the Gates Foundation, private sector donors cut contributions by 50% over the same time period. Laurie Garrett argues that the US Government and the Gates Foundation are the last barriers to averting a global health catastrophe. The international community must recommit to improving the health of the poor.

Global Fund Needs Cash to Stem Deaths (Richard Feachem, South Florida Sun-Sentinel, February 27, 2012)
Richard Feachem, former Executive Director of the Global Fund to Fight AIDS, TB, and Malaria (GFATM), calls on the United States to urgently convene an emergency donor meeting to address the Global Fund’s significant funding shortfalls. Since the launch of the GFATM in 2002, the Fund has treated 170 million cases of malaria, 8.6 million cases of TB, and has provided antiretroviral treatment for 3.3 million people living with HIV/AIDS. Nearly half of all people currently on AIDS treatment in low- and middle-income countries depend on the Global Fund to stay alive. Unless international donors take urgent and coordinated action to address the Global Fund’s resource gaps, progress made in the last decade could be lost.

FOOD AND WATER SECURITY

The Time is Now for Food Aid Reform: Five Reasons Why U.S. Policies are Ripe for Reform in the Next Farm Bill (American Jewish World Service, February 2012)
A recent report by the American Jewish World Service outlines five opportunities in the current political and economic climate that make food aid conducive for reform in the 2012 Farm Bill. The US food aid program has the potential to save lives, curb malnutrition, and support local pathways out of poverty, but is seriously hampered by special interests. By taking advantage of this opportunity to reform food aid in the farm bill, Members of Congress can lay the groundwork for a more stable food supply for generations to come. 

***Freshwater Availability and Water Fetching Distance Affect Child Health in Sub-Saharan Africa (Amy Pickering and Jennifer Davis, Environmental Science and Technology, January 2012)  
In Sub-Saharan Africa, A Shorter Walk to Water Saves Lives (Andrew Myers, Stanford University News, March 5, 2012)
This recent study is the first to show that reducing time spent collecting water can significantly improve child health. Cutting the time spent walking to a water source by just 15 minutes can reduce under-five child mortality by 11%.

HIV/AIDS

Guidelines for Improving Entry Into and Retention in Care and Antiretroviral Adherence for Persons with HIV: Evidence Based Recommendations from an International Association of Physicians in AIDS Care Panel (Melanie A. Thompson, Michael J. Mugavero, K. Rivet Amico, Victoria A. Cargill, Larry W. Chang, Robert Gross, Catherine Orrell, Frederick L. Altice, et al., Annals of Internal Medicine, March 5, 2012)
A panel convened by the International Association of Physicians in AIDS Care recently developed guidelines and recommendations to optimize testing and treatment for people living with HIV. The 36 evidenced-based recommendations provide crucial strategies to improve care and treatment and guide international funding to continue addressing, and perhaps end, the global HIV/AIDS epidemic.

USER FEES

Abolishing User Fees for Cesarean Sections in Mali: A Success Story? (Yussif Nagumse, Anna Marriott, Global Health Check, February 22, 2012)  
Improving Access to Life Saving Maternal Health Services: The Effects of Removing User Fees for Cesareans in Mali (Marianne El-Khoury, Timothee Gandaho, Aneesa Arur, Binta Keita, and Lisa Nichols, USAID, April 8, 2011)
In 2005, the Government of Mali implemented a policy to increase access to emergency obstetric care which included free Cesarean sections. A recent USAID evaluation linked the policy to an increase in facility-based deliveries and Cesarean sections, and a reduction in maternal and neonatal mortality nationwide. These findings support the growing body of evidence that removing user fees for health services is an effective way of enhancing access to health care and saving lives. However, challenges remain, including more comprehensive plans for the removal of basic health, drug, and transport fees, improved referral and emergency transport systems, and more reliable infrastructure and supplies. PIH partner Project Muso continues to engage the Ministry of Health in Mali in an evidence-based discussion about broader user fee removal and universal access to health care.

World Bank Must Re-Evaluate Its Strategies to Cut Maternal Mortality (Elizabeth Arend, Poverty Matters Blog, the Guardian, March 6, 2012)
This post in the Guardian’s informative Poverty Matters Blog lays out several steps the World Bank should take in order to live up to its boast that it is a “global leader” in reproductive health.  These steps include providing more aid in the form of grants rather than loans; targeting aid to address all the causes of maternal mortality; and supporting the removal of user fees for women’s and children’s health care. Time and again user fees have been shown to discourage women from seeking care thus perpetuating high maternal morbidity and mortality. 

MULTIMEDIA + ADDITIONAL REESOURCES

Remembering Congressman Donald Payne (Antoinette Habinshuti, Partners In Health, March 9, 2012)
Toni Habinshuti from PIH’s Rwandan sister organization, Inshuti Mu Buzima, reflects on the Congressman Payne’s incredible commitment to and impact on global health and development funding for Africa.

WHO Panel on Human Rights Mainstreaming, 19^th Session Human Rights Council (World Health Organization, February 28, 2012)  
Written Statement
Watch the Assistant Director-General for Family, Women’s and Children’s Health at the World Health Organization (WHO) discuss the importance of integrating a human-rights based approach into all programming at WHO.

In Rwanda, a new study aims to help improve mental health and counseling services for children and families.

Fredrick Kanyanganzi (left) and Christian Ukundineza of FSI write up notes from CFAR interviews in Rwanda. Photo by Anne Stevenson

by Anne Stevenson

A new study to measure how the prevalence and patterns of mental health disorders are related to HIV status was launched by Partners In Health/Inshuti Mu Buzima in Rwanda, in collaboration with the Harvard School of Public Health. The Family Strengthening Intervention project began collecting data this week for its Center for AIDS Research (CFAR) study.

“This study will help us identify children who are in need of mental health care and allow us to improve mental health and counseling services for children and families in this region, not just those who are affected by HIV," says study coordinator Fredrick Kanyanganzi.

The study aims to interview 1,500 children and caregivers in the Kirehe and southern Kayonza districts in eastern Rwanda. These interviews will be used to assess mental health problems, protective factors, and risk factors among children who are (1) HIV-infected; (2) HIV-affected but not infected (children who have an HIV-positive caregiver or whose parent died from HIV); and (3) non-HIV-affected.

“This is the culmination of work that we started more than four years ago and it is incredibly fulfilling to reach this point,” says Kanyanganzi.  

Learn more about the Family Strengthening Intervention.

Anne Stevenson is a program manager for the Harvard School of Public Health Research Program on Children and Global Adversity/ FXB Center for Health and Human Rights.

On Wednesday, March 7, former U.S. President Bill Clinton was in Haiti to highlight the potential impact solar power could have in a country rich in sun but lacking in electrical infrastructure. 

PIH's Jim Ansara, Paul Farmer, NRG's David Crane, President Clinton, and PIH's David Walton review plans for the panels from the roof of Mirebalais Hospital.

As part of his trip, President Clinton, Dr. Paul Farmer, and leaders in the field of renewable energy visited PIH’s flagship Mirebalais National Teaching Hospital. Delegates toured the 320-bed, state-of-the-art medical facility, which – when it opens in mid-2012 – will be powered by a field of solar panels lining the 180,000 sq ft facility’s roof. President Clinton singled out the project as a model of what is possible in Haiti – a country still in the early stages of rebuilding after the massive damage of the 2010 earthquake.

Frames for the solar panels on the roof of the hospital.

After leaving Mirebalais Hospital, the group visited other PIH facilities that also rely on solar energy, including Centre de St Michel in Boucan Carre, the first PIH-supported clinic powered to receive solar panels, an achievement made possible through PIH's partnership with Solar Electric Light Fund (SELF).

Delegates also saw the recently installed solar panels powering PIH’s Lashto fish farm, a tilapia-growing facility that provides both food and income to a once-impoverished community. Concluding their tour of Central Haiti, the group visited Domond Ecole Bon Berg, one of 19 schools in the area powered by solar energy – the product of a partnership between NRG, a major U.S. producer of green energy, SELF, and PIH. 

President Clinton tours the Women's Ward of the new hospital.

This trip provided President Clinton, acting in his role as UN Special Envoy to Haiti, the opportunity to discuss viable business opportunities in Haiti with representatives of the renewable energy industry.

The large-scale introduction of solar power in Haiti would significantly reduce the country’s high energy costs, while potentially making electricity available to a far greater number of people. Only 38.5 percent of Haitian households currently have regular access to electricity according to the World Bank – by far the lowest rate of access in the Western Hemisphere. 

Learn more about PIH's work in Haiti.

Jon Lascher, PIH – Artibonite Region, Haiti
March 13, 2012

The cholera vaccine (Shanchol) arrived in the country this week and the cold container seems to be working well. We're checking it twice a day.

But the vaccination delivery plan is stalled. There's been a misunderstanding about the project involving the National Ethics Committee. We are trying to sort out the details but we won't vaccinate until we have been cleared to do so by the NEC and the Minister of Health. Even with these delays we are still eager to see this project through to 100% completion... before the rains.

Richard Knox spent the day in the Artibonite this past weekend and released a NPR report about the vaccine project.

PIH's team in Rwanda bids adieu to a social justice leader.

Congressman Donald Payne (second from the left) talks with PIH Rwanda Country Director Peter Drobac (left).

By Antoinette Habinshuti, Deputy Country Director, Inshuti Mu Buzima

Those of us at PIH's partner site in Rwanda, Inshuti Mu Buzima (IMB) were deeply sad to hear of the passing of U.S. Congressman Donald Payne.

In early September 2011, Congressman Payne (D-NJ) visited our work in Rwanda. He and a congressional delegation toured Butaro Hospital, a flagship facility operated in partnership with the Rwandan Ministry of Health. They also visited some of the families supported by the organization’s network of community health workers.

	Congressman Donald Payne (in the blue shirt) touring Butaro Hospital last fall.

We were privileged to have spent this time with Congressman Payne in what was one of his last visits in Africa. After spending many years of his life fighting for the rights of the under-privileged in Africa, he seemed to truly appreciate PIH’s approach.

We were honored that he chose to visit our district; we take it as a sign of recognition of our work to improve the health care of the communities we are serving, in partnership with the community themselves and with the leadership of the district. 

Congressman Payne was a very friendly person, very informed and committed to global health and funding for Africa.  During his visit, Congressman Payne said, “I applaud the work that Partners In Health is doing and am encouraged by the positive results I witnessed.” These words will remain a motivation for our continued work.   

Congressman Payne’s memory will forever live with us at IMB.

Read the New York Times obituary for Congressman Donald Payne.