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

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

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

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

Over the last few months, we have:

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

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

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

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

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

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

A Lifeline of Hope

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

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

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

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

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

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

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

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

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

Extensive Care, Resources

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

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

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

Dispelling Myths, Providing Hope

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How has solar impacted the budget?

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

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

What are other positive impacts of the project?

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

Content warning: This story mentions trauma and sexual assault  

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

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

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

The Need for Staff Support

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

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

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

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

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

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

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

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

A New Approach to Staff Wellness

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

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

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

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

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

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

A Breaking Point in Haiti

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

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

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

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

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

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

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

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

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

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

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

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

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

Caring for the Caregiver

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Twenty-Seven Years of Experience

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

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

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

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

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

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

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

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

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

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

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

Becoming a Doctor

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

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

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

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

Leading Through Uncertainty

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

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

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

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

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

A Man with a Plan

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

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

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

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

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

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

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

Content warning: This story mentions sexual violence  

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

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

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

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

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

More Than a Health Worker

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

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

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

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

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

Improving Access to Hormone Therapy

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

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

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

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

A Step Forward in Mental Health

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

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

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

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

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

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

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

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

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

An integrated approach

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

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

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

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

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

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

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

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

Ongoing training, improvements

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

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

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

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

Content warning: This story mentions suicide.

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

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

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

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

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

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

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

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

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

Finding Support, Accompaniment

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

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

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

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

Economic Empowerment

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

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

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

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

Her businesses continued to grow alongside her savings.  

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

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

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

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

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

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

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

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

Growth in patients and services

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

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

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

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

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

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

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

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

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

Support for children and their parents

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

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

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

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

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

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

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

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

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

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

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

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

The Choice

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Supporting Mothers

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Supporting Women

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Finding Pregnant Women, Uncovering Unmet Need

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

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

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

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

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

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

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

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

Care, from the Community

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A Bold Solution

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

‘Women Building for Women’ 

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

"I don't know everything, but I know many things now," says Mansara. Her husband left her, but that’s no problem, she says, because she can now take care of herself, children, and mother because of her steady, well-paying job.  

“And why do you think so many women work here?” questions Dumbuya. “Because, like I say, … this is women building for women.” 

‘A Dream Come True’ 

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

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

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

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

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

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

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

What led you to pursue a career in health care?

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

What brought you to PIH Sierra Leone?  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Improving Infrastructure 

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

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

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

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

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

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

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

Providing Community-Level Care

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

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

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

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

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

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

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

April 1, 2024

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

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

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

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

As the violence and instability in Haiti worsens, the health system is being crushed. Hospitals around the country have been attacked and looted, health care workers have been forced to flee or hide for their safety, and basic drugs and supplies can’t reach facilities, much less the patients who need them.

At Zanmi Lasante, PIH's sister organization in Haiti, our teams are doing everything they can to continue providing care to those who need it most. This is an extraordinary feat as they face serious shortages of fuel, supplies, and critical medicines, due to rising costs and transportation challenges such as roadblocks.

“You have to live it to understand it,” said Dr. Ralph B. Charles, Zanmi Lasante’s regional director for the Lower-Artibonite district. “There’s this constant fear. Every day there’s a new obstacle, so you have to be ready to devise a new strategy. It’s an ongoing battle.”

A roadblock, which can include a pricey toll or the threat of violence, can create a cascade of problems: blocking food deliveries for our nutrition programs, preventing supplies and medicine from reaching our clinics, intimidating patients from freely and safely accessing health care, and restricting fuel to power our hospitals.

The consequences can be life-threatening—our clinical team at Hôpital Universitaire de Mirebalais (HUM) currently only has enough IV fluids to continue providing care for two days.

“There’s a saying in French, ‘à chaque jour suffit sa peine.’ It’s basically saying, ‘deal with everything one day at a time.’ That’s the only way we can do it,” Dr. Charles said. “If you keep thinking about the big picture of the situation all the time, it’s so overwhelming that your head might explode. You just have to focus on what you can deal with.”

So, one day at a time, Zanmi Lasante’s teams continue providing care. While many facilities around the country have closed their doors, ours have stayed open. But patients still fear traveling for care, weighing access to treatment against the threat of violence—a calculation no patient should have to make.

“It was already hard to access care and now it’s ten times harder. There are a lot of patients that don’t make it to the hospital or that make it too late,” Dr. Charles said. “Those that do make it, they do it at the risk of their own lives. I had a story of a pregnant patient who was going to the hospital to deliver and got shot in the leg at a barricade on the road. When she got here, we stabilized her, and she delivered immediately, even before we took care of the bullet wound.”

For the patients who are able to access care, limited resources—and the resulting surge in prices—are another obstacle they must face.

“Care that used to be provided for free has been limited because of the supplies we can’t get,” said Dr. Charles. “If a patient goes to a pharmacy for medication, and the pharmacy actually has the medication there, it’s going to cost the patient about five or six times what it used to, and sometimes way more depending on what they need.”

Dr. Charles, who earned his master's degree in Global Health Delivery at Harvard University and returned to Haiti in late 2022, has made an incredible commitment to his work and his colleagues at Zanmi Lasante, choosing to work alongside them, on the ground in the Lower-Artibonite district.

“I love the work I’m doing, and I can’t stand it to not be done well,” Dr. Charles shared. “And I think it motivates the staff because your staff sees that you are making sacrifices in your position, that you don’t have to. They feel more appreciated and supported.”

Being there for his team has also helped him understand how this crisis is directly impacting Zanmi Lasante facilities and has allowed him to strategize based on first-hand experience. For example, he was able to secure fuel for a month, because he noticed multiple tankers passing on a road that was supposed to be blocked. With the road clear, he was able to go out almost immediately and collect fuel, giving him peace of mind and time to plan for the next month’s supply.

The road was closed again the next day.

However, choosing to work alongside his Zanmi Lasante colleagues in Haiti has not been easy for him—or his family.

“The worst part is my daughter. Because she’s six, she doesn’t really get it,” he said. “Lately she’s been calling me and asking me when I'm gonna come back to visit because I usually travel every 45 days to be with her for a week or two, and how come I haven’t told her when I’m gonna come home yet because it's been more than 45 days since my last trip. This is when reality sinks in and makes me want to cry. And she doesn’t understand, she can’t understand.”

As the crisis in Haiti continues to escalate, Dr. Charles and the Zanmi Lansante team are doing everything they can to continue caring for our patients, accompanying them, standing by them in solidarity, and keeping them safe. Patients across Haiti are going to extraordinary lengths to reach our facilities—and we will be there for them, whatever it takes. 

In March, more than 80 community health workers, allies, and advocates from across the country gathered on Capitol Hill to meet with members of Congress and legislative staff during the second annual Community Health Worker Hill Day. 

In addition to over 80 meetings with legislative offices, the Hill Day featured a Congressional briefing and rally in a historic Senate hearing room. Congressional briefings serve as a platform to educate members of Congress and their staff on a specific issue. This briefing, hosted jointly by PIH-US and National Association of Community Health Workers (NACHW), allowed Congressional staff to engage directly with community health workers and gain insights into the workforce's diverse nature. 

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

In January, Partners In Health organized the first-ever Americas Regional Workshop. Hosted in Lima, Peru, the convening brought together PIH colleagues from Haiti, Mexico, Navajo Nation, Peru, and the United States to deepen relationships across PIH sites and consolidate learnings on government accompaniment. 

Around the globe, PIH works shoulder-to-shoulder with government partners across levels of influence to shape policy and advance systems change. With a diverse range of expertise and experience in government partnership, policy, advocacy, and community engagement, participants shared approaches and best practices for collaborating with governments at their respective sites. 

Discussions focused on site-level strategies for government accompaniment and creating a framework to guide this type of collaboration across PIH. Participants also met with Peru’s Ministry of Health to learn about their partnership with Socios En Salud (as PIH is known in Peru) and visited SES labs, pharmacies, health centers and project sites. 

The Americas Regional Workshop is a testament to the importance of cross-site learning and collaboration. By coming together, sharing experiences, and collectively refining strategies, participants not only strengthened their respective site capacities, but laid the foundation for deeper collaboration in the future.

Each year, tuberculosis (TB) kills about 1.3 million people worldwide—that’s more deaths than HIV/AIDS and malaria combined. TB is the world’s deadliest infectious disease (though briefly eclipsed by COVID-19), killing someone every 20 seconds. 
 
But, despite its massive fatality rate, TB rarely makes headlines. 
 
In fact, many people in wealthy Western countries have no idea what TB is. Alternately, it’s considered a disease of the past, belonging in a history textbook. 
 
But the disease that ravaged Europe and North America centuries ago remains a deadly, day-to-day threat in much of the world. And even though a cure exists, the disease continues to kill at unparalleled rates. 
 
So why is TB still the world’s deadliest infectious disease? And why is it so little-known in the West? 

What is tuberculosis? 

To understand the gap in TB awareness, it’s crucial to consider how the airborne killer operates—and where in the world it’s most commonly found. 
 
Tuberculosis is an airborne disease that spreads when infected people cough, talk, or even just exhale deeply. The disease typically attacks the lungs, but can affect almost any part of the body. Symptoms can be mild at first and resemble those of other conditions, like the common cold, making TB difficult to detect. If untreated, it can be fatal. 

TB has treatments and even a cure. But the path to a full recovery is long and arduous. Unlike diseases such as malaria, which can be treated within days, TB requires at least four months of treatment, and can take even longer to treat depending on severity and drug sensitivities. The standard regimen includes five drugs, which must be taken together each day. These drugs come with an array of side effects, such as nausea, skin rashes, and jaundice. 
 
Although only a small percentage of people infected with TB end up experiencing the effects of the disease, its airborne nature, common symptoms, and long, arduous treatment regimen make it especially lethal in the places where it is most prevalent: impoverished countries with weak health systems.

‘A Neglected Disease’

Lesotho, a landlocked nation of around 2.1 million in southern Africa, has the highest TB incidence in the world—661 cases per 100,000 people, compared to 2.5 cases per 100,000 people in the U.S. 
 
This data reflects global trends. Worldwide, more than 95% of TB deaths occur in low- and middle-income countries. In fact, TB is often called a “disease of poverty.” 
 
Dr. Afom Andom has studied TB for years, first as a graduate student, then as a technical advisor for Lesotho’s national health reform and now, as chief medical officer of PIH Lesotho. He has devoted much of his career to understanding why TB remains such a glaring issue in global health—and what can be done. 
 
“TB is a neglected disease. It has been killing for centuries,” he says. “It’s been very persistent in countries with low socioeconomic conditions.”  
 
The reasons for that persistence are many, but perhaps the most salient—and the most surprising—has to do with food. 
 
“When you’re chronically malnourished, it affects your immune system,” says Dr. KJ Seung, senior technical advisor at Partners In Health and co-lead of endTB. “That makes you more likely to get infected if you’re exposed and less likely to control the disease if you’ve been infected.” 

TB drugs are also notoriously nauseating and taking them on an empty stomach can result in patients abandoning their treatment altogether. 
 
Malnutrition isn’t the only reason why TB is typically linked to poverty. There are also issues like overcrowding, a lack of ventilation, a lack of transportation or time off work to reach clinics or hospitals, and so on.  
 
To tackle TB at all—from testing to treatment to care—a strong health system is a must. Even prevention requires a level of infrastructure that has made TB difficult to curb. Simple measures that help prevent other diseases, like handing out bed-nets or condoms, aren’t going to work. 
 
“TB is airborne,” says Seung. “You’re going to get it, you’re going to get exposed, and when you get exposed, you need a really well-functioning health system to get diagnosed and treated—and that just doesn’t exist.”

The Empathy Gap

Seung, who is based in Boston, has worked on TB across continents as co-lead of endTB, a clinical trial spanning seven countries that found safer, shorter treatments for multidrug-resistant tuberculosis. Through the years, he has seen stark differences in awareness levels of the world’s top infectious disease. In short, it depends on who you talk to. 
 
“TB is really part of the culture of Africa, Latin America or Asia. People have more strong feelings about it compared to in the U.S. or Europe, because it just doesn’t exist here,” he says. “You don’t know somebody who has TB, or you might have to go back generations in your family. That same cultural cache just doesn’t exist.” 
 
That “cultural cache” is reflected in health care systems, too, and how they respond to TB. 
 
TB is so common in many countries that it’s part of primary care. In Western countries like the U.S., it’s instead treated as a rare disease; Americans with TB would have to see a specialist. 
 
Less than 1% of Americans have TB. It’s not widely known, and most Americans don’t have to think about the disease on a regular basis, if at all, or know people who have had it.  
 
These differences might seem more surface-level if they didn’t underscore a darker reality. 
 
“If people are not interested in a problem, in the West, then it just makes all the effort to eliminate the disease globally very difficult,” says Seung.  
 
For years, TB has struggled to get global attention, resources, and funding, despite ambitious targets like the UN’s goal to end TB by 2030.  
 
“There is a huge disparity between the rich and the poor and that makes the disease persistent,” says Andom. “All the technologies, all the potent drugs, all the potent reagents are in high-income countries.” 
 
Disparities between rich and poor emerge not only on the global level, but also within the countries most burdened by TB. 

In Peru, those most at-risk for TB are from vulnerable populations, including transgender people, migrants, prisoners, and people living in the Amazon rainforest. 
 
“The only way to go to communities [in the Peruvian jungle] is by the river, and it’s difficult to transport all the [TB] equipment to the communities,” says Dr. Marco Tovar, director of health services at Socios En Salud, as Partners In Health is known in Peru. 
 
In marginalized communities, TB is far from the only killer. There’s dual epidemics of TB and COVID-19, or TB and HIV; drug-resistant forms of the disease, like MDR-TB or XDR-TB, and then there’s poverty, making actions as simple as getting to a clinic or eating a healthy meal an insurmountable challenge.

Changing the Narrative 

With all the challenges and complexities of TB, it might be easy to think of the disease as inevitable, as some natural state of affairs. That’s a narrative that Dr. Maxo Luma is fighting against. 
 
“1.3 million die every year of a disease that is totally curable,” he says. “That’s not normal.” 
 
TB is not inevitable. When health systems are strengthened, it is preventable, treatable, and even curable. 
 
Luma has seen this first-hand in Liberia, where he is the executive director of PIH’s country program. 
 
Before PIH began its work in the West African nation of around 5 million, the only health center for MDR-TB was in Monrovia, the capital. For those living in the rural southeast of Liberia in Maryland county, traveling there could take up to 4 days and, during the rainy season and flooding of roads, could take weeks, if it was possible at all. 
 
Since it began working in Liberia in 2014, PIH has treated thousands of patients with all forms of TB including hundreds with MDR-TB. In 2017, PIH opened the first-ever decentralized regional hub for MDR-TB care in the southeastern part of the country, at J.J. Dossen Memorial Hospital, in partnership with the Liberian government.  

Similar progress has emerged in Lesotho. 
 
PIH began its work in the southern African nation in 2006; the following year, it opened Botšabelo Hospital, one of the first MDR-TB treatment hospitals in Africa and the only one in Lesotho. The hospital has since become a model for MDR-TB care across the continent. 

PIH’s TB work in Lesotho and elsewhere has tackled another key element in preventing the disease: testing. 
 
While treatment is often put in the spotlight, an effective TB response starts before a patient is sick. To get treatment and recover from TB, people first have to know that they have it. Globally, around 30% of TB cases are never diagnosed or treated. In Lesotho, that percentage is much higher, around 63%. 
 
Most TB diagnoses in Lesotho happen at district hospitals, due to a lack of diagnostics at the health center level. Health centers typically transport samples to hospitals on scheduled days, resulting in delays between when patients are tested and when they are diagnosed. 
 
Starting in 2020, PIH began working with Lesotho’s Ministry of Health to make diagnostics available at the health center level in seven rural, hard-to-reach health facilities, as part of the Rural Health Initiative.   
 
Now, at PIH-supported health centers, patients can get test results within 1-2 hours and return home with a diagnosis and treatment plan, thanks to GeneXpert machines and digital x-ray equipment. 
 
Progress has been made on a global level, too. With the endTB trial, PIH and partners found safer, shorter drug regimens for MDR-TB patients. PIH recently joined clinicians and TB activists to call on pharmaceutical companies to drop patents and prices to make TB care more accessible. 
 
But there is still much more work to be done—both in raising awareness and in making essential funding and resources available where they are most needed. 
 
For Luma and many other experts, the fight is not just medical—it’s moral. 
 
“It doesn’t have to be in our backyard to make it our problem. We are a global village,” he says. “I think more people need to be aware so we can change the narrative around TB…It is time for all of us to finally unite around ending this disease.” 

In Haiti, the number of children suffering from severe acute malnutrition has drastically increased during this time of widespread violence and political and economic instability, as food prices have skyrocketed and resources have become even more limited. According to UNICEF, the number of children experiencing malnutrition increased by 30% in 2023 compared to the previous year, with nearly 115,600 children affected compared to 87,500 in 2022.

Did you know:

• In Haiti, 1 in 4 children suffer from chronic malnutrition;

• Malnutrition is the leading cause of death for children under 5;  

• Around 11,000 children under the age of 5 suffer from acute malnutrition in two of the primary areas Zanmi Lasante delivers care: the Central Plateau and Artibonite regions;

• Even acute malnutrition can prohibit children from properly developing physically and cognitively.

At Zanmi Lasante, as Partners In Health is known in Haiti, the nutrition team provides screening, treatment, and education to respond to this crisis. The program serves patients, typically infants, children from 6 months to 5 years old, and pregnant or breastfeeding women, through clinic visits and through mobile clinics conducted in the surrounding communities.  

The mobile clinics are critical to the program because they allow our teams to reach remote communities and identify malnourished children earlier, so treatment can be delivered before health problems turn fatal. However, amid the current national instability, it has become exceedingly challenging for our teams to travel with mobile clinics, as they face fuel shortages, violence, and unpredictable roadblocks that restrict the team’s movement.

Despite this, our nutrition team has persisted, finding ways to reach our patients at home–whether by rescheduling clinic visits or finding alternative routes. Their dedication has provided lifesaving care for families all over Haiti.  

Jolène, a mother of five, felt powerless when her youngest son, three-year-old Raphaël, fell extremely ill last August. He couldn’t stop vomiting, his belly was swelling, he was covered in rashes, and he was deteriorating as he rapidly lost weight. When Jolène brought him to the Zanmi Lasante team for help, he was immediately hospitalized: Raphaël was suffering from severe malnutrition.

“I was very affected by his illness. I had no hope at all. I thought I had lost him,” recalls Jolène.

Raphaël’s condition was severe and required him to remain hospitalized for three months until he regained his strength. Today, he continues outpatient treatment with the Zanmi Lasante team monitoring his progress and supporting his nutrition, and his mom is committed to never missing an appointment.  

Zanmi Lasante’s nutrition program provides children with a lifesaving treatment called Nourimanba, a high-calorie, high-protein paste made from locally grown peanuts and mixed with essential vitamins and minerals. This ready-to-use therapeutic food, produced by Zanmi Lasante in partnership with local farmers, helps children gain weight and grow quickly over several weeks of care. Raphaël is just one of the thousands of children who have been saved by this food. Last year alone, 6,190 children were admitted and treated for malnutrition through Zanmi Lasante’s network of hospitals and clinics.

Haiti’s population continues to be vulnerable to malnutrition, facing food insecurity, poor infrastructure–particularly in terms of water and sanitation–and, currently, political and economic instability. Around 4.35 million Haitians are grappling with severe food insecurity. However, the Zanmi Lasante team remains steadfast, determined to record zero deaths of children under 5 years old due to malnutrition.  

Raphaël is one child among many to have his life saved by the incredible people at Zanmi Lasante with the support of our generous, global Partners In Health community. During this critical time in Haiti, Zanmi Lasante is sustaining their operations and providing care to those who need it most, bravely showing up for our patients every day.  

Compañeros En Salud, as Partners In Health is known in Mexico, has nearly 100 community health workers on staff; 98% are women.

This is just one of the many ways that women are vital to PIH’s work in the Sierra Madre region of Chiapas, where we have worked since 2011 providing free health care and social support in partnership with the Ministry of Health. 

From treating patients to training clinicians to setting agendas, women have been essential to fulfilling Compañeros En Salud’s mission from day one—as doctors, midwives, executive leadership, janitors, and more.

As we celebrate International Women’s Day, we uplift the stories of women at Compañeros En Salud and honor their contributions to our work.

Udis Sánchez, health assistant 

As a health assistant, Udis Sánchez has faced many challenges over the years—as part of the first-ever nursing team at a rural clinic, as an infection control worker in the COVID-19 response, and as a nursing student. 

On top of all those challenges was the pressure she often felt as a woman.

“In the communities where we work, many people tell you that because you are a woman, you cannot achieve things,” she says. “You cannot study or work…you always have to be at home.”

It was a message she’d heard growing up in Laguna del Cofre, a rural community in the Sierra Madre mountains, where women in traditional households are often discouraged from pursuing their education or career.

Despite this pressure, Sánchez refused to be deterred. Last year, she graduated with her nursing degree—one of her proudest, most hard-won achievements.

“It doesn’t matter if you come from a highland community, because at the end of the day, we [women] decide,” she says. “We don’t have to be afraid.”

Gabriela Gamboa, janitor

Gabriela Gamboa spends her day washing bedsheets, disinfecting tools, and cleaning the rooms of Casa Materna, a birthing center supported by Compañeros En Salud. Her daily tasks may seem small, but are essential to keeping the center open and ready to serve the hundreds of women who give birth there every year. 

It’s not just Casa Materna’s mission—providing dignified care for mothers in Chiapas—that inspires Gamboa in her work. It’s also the financial independence that the work affords her, enabling her to support herself, and the sense of community. 

“What inspires me in a woman is that she knows how to get ahead on her own, that she can raise a family on her own,” says Gamboa. “In general, I admire all women who fight.”

In her spare time, Gamboa has found another inspiration: leading a dance group for women and children in the community. Once too shy to dance in public, she now helps her students learn how to dance and, most importantly, to move, have fun, and express themselves.

“In the field where I work, being a woman is a unique experience that makes me feel proud,” she says. “I am very happy to be part of a team that is so committed to the health of others.”

Saira Morales, community nurse

Saira Morales began working with Compañeros En Salud during unprecedented times: in the throes of the COVID-19 pandemic. The experience challenged the young nurse, personally and professionally. Day to day, she had to contend with shutdowns, resource shortages, sick patients and staff, and constantly evolving guidelines.

Amid the chaos, Morales saw an opportunity: a chance to make her mark professionally.

“I am proud of myself in my performance as a nurse, in all that I have learned here and in my years of experience,” she says. 

For Morales, being a woman in nursing “is taking care of others, offering dignified treatment to patients…and at the same time making my potential and capacity as a nurse known.”

Nursing—considered a caring profession and with a workforce of over 70% women—has garnered more attention in recent years, as more nurses seek to take on leadership roles and make their mark on health care systems that have historically undervalued them.

As Morales continued her work with Compañeros En Salud, eventually transferring to a community clinic in Laguna del Cofre, she drew inspiration not only from the work, but from her colleagues—many of them, women.

“All the women around me inspire me,” she says. “Women are fighters. We are strong…If we want something in life, we can achieve it."

Sandra Martínez, office assistant

Sandra Martínez still remembers her first boss, Dr. Jafret Arrieta, when she began her work at Compañeros En Salud.

“I saw that she was very intelligent and capable,” Martínez recalls. “She is very hardworking, very active…an excellent person.”

To this day, Martínez strives to infuse those same values into her own work as an office assistant. She has now worked with Compañeros En Salud for 12 years.

And it’s not her only role. It comes on top of her other full-time job: being a mother.

“I feel very proud of myself, for having my children, for having raised them with love and education,” she says. “I am happy to have the job I have, which allows me to support us.” 

Balancing work and motherhood is no small feat. But Martínez is thankful for the sense of community—and home—she’s found at Compañeros En Salud.

“It is having many responsibilities, working a lot, but at the same time enjoying it, because I am with the people I love,” she says.

Though daunting for some, she wouldn’t trade her lifestyle for anything.

“Above all, [I am proud] to be a woman,” she says.

Since March 3, Partners In Health (PIH) and our sister organization in Haiti, Zanmi Lasante (ZL), have faced severe challenges brought on by escalating insecurity in Haiti. Roadblocks have hindered the transportation of vital supplies, including medications. The price of fuel has skyrocketed. Violence remains a constant threat.

Despite these added complications, with a four-decade history of providing high-quality health care for Haitians, ZL continues to deliver care to the patients who rely on their services. ZL’s persistence during this time of conflict highlights the resilience, innovative thinking, and sometimes heroic efforts of staff and the effectiveness of long-term accompaniment. 

Our topmost priority remains the safety and well-being of our dedicated staff and the communities we serve. So far, all of our patients and staff are safe; we are working to support mental health, food, and housing needs; we are actively exploring ways to overcome logistical challenges; and ZL is continuing to provide care, as it has during the last two and a half years of unprecedented instability.

Staff and partners work tirelessly, embodying our shared commitment to the principle that health is a human right and continuing our mission to provide quality care to those who need it most. In this critical period, we urge everyone involved to take all appropriate measures to help stabilize the country, so Haitians can access health care and other fundamental rights. We thank all those who stand in solidarity with Haiti.

Today, Senator Bob Casey (D-Pa.) introduced the Community Health Worker Access Act, a new bill proposing crucial investments in the community health workforce to improve health care access in the United States. 

The Community Health Worker Access Act aims to enhance access to health services for Medicare and Medicaid enrollees by improving reimbursement for services provided by community health workers under Medicare and facilitating their integration into Medicaid.  

Including community health worker services within Medicare and Medicaid would improve the health of people enrolled in these programs and keep our communities healthy, as demonstrated by community health workers’ years of impact on health care in the U.S. and worldwide. This bill will also help strengthen the community health workforce by providing more sustained sources of funding within the health care system.  

The Community Health Worker Access Act is supported by over 270 community health worker networks and public health organizations, including Partners In Health. Partners In Health is adapting lessons learned from our experience around the world to bolster equity-centered public health systems in the U.S. by investing in community health workers. 

Below, we explain why this legislation is important and how you can take action.  
 

Remind me, what is Medicare and Medicaid? 

Medicare is a nationwide health insurance program for people 65 or older and some people under 65 with certain disabilities or conditions. Medicaid is a public health insurance program that provides coverage for more than 1 in 5 Americans, including eligible adults with low incomes, children, pregnant women, elderly adults, and people with disabilities. Together, these programs provide health coverage for millions of people and are influential sources of public funding for health services.  

How will the Community Health Worker Access Act enhance these programs? 

The Community Health Worker Access Act would improve payment eligibility for community health workers, promotoras de salud (a Spanish term used to describe community health workers), and community health representatives (a title for community health workers in tribal communities) who provide services to individuals receiving insurance through Medicare and Medicaid while expanding access to community-based services for enrollees in these major health programs.  

This bill would provide coverage for two new categories of community health worker services in Medicare:  

• Services to prevent illness, reduce physical or mental disability, and restore an individual to the best possible functional level 
• Services to address social needs through education and referrals to health care and community-based organizations.  

Currently, community health worker services are an optional benefit in Medicaid that at least 29 states have begun to offer. This bill would require the U.S. Centers for Medicare and Medicaid Services to provide guidance to states to support expanded access to community health worker services. It would also unlock additional federal resources for states to expand these services through Medicaid. 

Why is this legislation important? 

Decades of evidence has shown that community health workers are effective at improving health outcomes by providing services tailored to a community’s needs, in a way that is relevant to them. In the U.S., community health workers serve as essential connectors between communities and medical services and have been key to improving chronic disease control and mental health, promoting healthy behaviors, and reducing hospitalizations. They are particularly effective in rural and underserved areas where access to medical care is less accessible.   

Despite growing recognition of community health workers’ critical role and impact in the U.S., the workforce has struggled with inadequate and unstable funding. Congress has passed significant temporary investments on a bipartisan basis, but there is a need for sustained funding to support community health workers and to better integrate their unique strengths into health care systems. 

Covering community health worker services in Medicare and Medicaid will promote health equity by improving care coordination, culturally responsive care, and connections to services. 

How did PIH contribute to this legislation? 

PIH and our partners at the National Association of Community Health Workers (NACHW) were invited to offer feedback on the draft bill, and we worked with Senator Casey’s team and partners to ensure the final bill reflected the needs identified by community health workers. Our policy paper on sustained Medicaid funding for community health workers helped inform our recommendations.  

PIH Engage, a grassroots organizing network of PIH supporters working to build a movement for the right to health, has advocated to build policymaker support for the Community Health Worker Access Act. In August, 160 PIH Engage leaders representing 80 local teams from across the U.S. came together in Washington, D.C., and met with the offices of 100 U.S. senators and representatives to kick off a year of advocacy engagement for global and domestic health policy priorities, including the Community Health Worker Access Act. 

PIH and NACHW wrote and circulated a sign-on letter, which was signed by over 200 national, state, and local organizations asking Congress to move the Community Health Worker Access Act forward. A sign-on letter is an advocacy tool where several organizations sign a letter to demonstrate their shared support for a policy. Because PIH-US works alongside so many community partners, we were able to show broad support for this legislation.  

What can people do to support this? 

Help us make the Community Health Worker Access Act a reality. Contact your Congress members today and ask them to cosponsor the bill. 

Seabata Moeletsi, a mine worker living in southern Lesotho, was diagnosed with multidrug-resistant tuberculosis (MDR-TB) in 2008. Shortly after, he enrolled in Partners In Health (PIH) Lesotho’s MDR-TB program.

Preparing for the worst, Moeletsi asked staff at PIH Lesotho to care for his two youngest children, in the event of his death. After all, he was all they had. His wife had passed years ago due to tuberculosis, leaving behind four kids. Soon after his request for support, he passed away due to complications from MDR-TB.

Keeping their promise, PIH Lesotho’s community health team stepped in to support the family. They enrolled the two youngest children in a new PIH program for orphans and vulnerable children (OVC).

Long-term, comprehensive support 

After losing both parents, Mankopane Moeletsi, 6, and her brother Tšoloane Moeletsi, 8, were depressed. Such types of trauma, known as adverse childhood experiences, can impact a child’s health well into their adult years.

Through the OVC program, Mankopane and her brother received mental health support, including therapy sessions. Other support included school fees and supplies, food, clothes, and medical care. For years, they lived in PIH Lesotho’s orphanage, a home dedicated to the OVC program, with three other children, and a foster mother.

During this time, the eldest son was working in South Africa as a citrus fruit harvester, while the second had just turned 18 years old, making him a legal adult.

"My second brother endured the most hardships and pain in life; when we lost our father, he had just turned 18. According to me, he was still very young and in need of some form of support,” Mankopane explains. “It breaks my heart. He stayed at home to fend for himself and made a living by looking after people's livestock with occasional direction from our late mother’s aunt."

PIH has worked in Lesotho since 2006, when it was invited by the government to support its response to the HIV epidemic. In the years since, PIH’s programs have expanded, ranging from non-communicable diseases to child health, providing lifesaving care to thousands of people in the southern African nation. In 2007, PIH launched the country’s first treatment, care, and support program for patients with MDR-TB, the drug-resistant form of the common, infectious disease that Mankopane’s father had.

With the support of PIH Lesotho, Mankopane Moeletsi completed elementary school, middle school, and high school.  

“If PIH had not been in my life, I would not have gone to school at all,” she says.

Upon graduation, she enrolled in a business and community development program at a vocational school, where she studied environmental science, culinary arts, travel and tourism, and woodworking. Most interested in culinary arts, Mankopane Moeletsi decided to start a small business in her hometown, baking and selling pastries such as cupcakes and fat cakes, a type of deep-fried doughnut. She ran her business for a year before she made her way back to PIH.

“My business seemed quite promising at first and I made some money. But things changed when individuals started taking fat cakes and muffins on credit, and occasionally they didn't buy them at all, so we ended up eating them. My business gradually began to collapse,” she says.

When she thought everything was falling apart, PIH Lesotho stepped in again.

PIH Lesotho’s community health director contacted Mankopane and other members of the OVC program and urged them to apply for vacant positions.  

“What motivated me to apply was the fact that I knew more than anybody else about the benefits of PIH and the prospect of more OVCs like myself receiving support inspired me to apply,” she states.

Full circle moment

In July, Mankopane Moeletsi began working at PIH Lesotho as an OVC assistant. In her role, she assists children in the program by gathering and distributing food, clothes, and other essential items. She also supports them with navigating medical care and school.

“Working within this program is very close to my heart because I can now make a difference in other OVC’s lives,” she says. “It’s literally what I wake up for and my greatest wish is for them to lead successful lives.”

Her 10+ years-long connection with PIH, especially in recent months, has inspired her to take her education even further: pursuing a career in health care.

“I enjoy being of service to others and making a noticeable difference in their lives,” she says. “Now that I am part of Partners In Health Lesotho, and I have closely seen the work, I want to continue assisting those in need by studying nursing.”

Since 2009, the OVC program in Lesotho has supported 91 children. All orphans are children of patients who died from HIV or TB, two diseases of which Lesotho faces some of the highest rates in the world. Similar OVC programs exist across other countries where PIH works, including Haiti, Malawi, and Rwanda. 

Global health leader Dr. Howard Hiatt passed away at age 98 on March 2. Well-known and respected in the public health field, Dr. Hiatt played pivotal roles in his decades-long involvement with Partners In Health (PIH).  

PIH CEO Dr. Sheila Davis shared a message: “From his early work identifying messenger RNA to his deanship at the Harvard School of Public Health—and numerous other leadership roles—Dr. Howard Hiatt made a transformational impact on global health. He was the beloved mentor of two of PIH’s co-founders, Dr. Paul Farmer and Dr. Jim Yong Kim, and was an early PIH supporter and member of our Board. With the late Dr. Farmer and Dr. Kim, Dr. Hiatt co-founded and led the Division of Global Health Equity at Brigham and Women’s Hospital, where he established a groundbreaking residency program in internal medicine, public health, and global health equity that has since given rise to other equity-based training models. Beyond his extraordinary scholarship and advocacy, Dr. Hiatt was known for his exceptional kindness, commitment to service, and unstinting investment in the next generation of global health leaders—his legacy will live on through the many lives he improved and those he inspired to work in pragmatic solidarity with some of the world’s most impoverished communities.” 

A mentor to PIH co-founders Drs. Paul Farmer and Jim Yong Kim, Dr. Hiatt dedicated his life’s work to advancing global health equity. When Paul Farmer and Jim began curing dozens of patients in Peru with drug-resistant tuberculosis (TB), some were skeptical of this work and hesitated to fund it. However, Dr. Hiatt believed in both the work and Paul and Jim as people. Dr. Hiatt, through his diplomacy and keen strategic insight, helped them change global policy surrounding TB. Through his connections, he also helped secure tens of millions of dollars in donations.

“You can’t be exposed to Paul Farmer or Jim Kim and not think that this is the thing you should do,” Dr. Hiatt told The Boston Globe. “I was seduced by those two guys, and that became my next career.”


And in 2001, the trio formalized their legacy. They co-created the Division of Global Health Equity at Brigham and Women’s Hospital, dedicated to serving vulnerable populations and teaching how heath care can better serve people. In 2004, a novel residency program followed: the Doris and Howard Hiatt Residency in Global Health Equity and Internal Medicine.  Graduates of this residency have strengthened health services in rural Malawi; built a graduate medical education program in Haiti; developed treatment protocols for Ebola treatment units; and more. Many continue to work at PIH sites around the world.

Another example of Dr. Hiatt’s impact is his support of the founding of PIH’s sister organization on Navajo Nation: Community Outreach and Patient Empowerment, Inc. (COPE). He was committed to not only addressing health disparities globally, but also strongly felt the injustice of these historical inequities in our own back yard. In 2007, Dr. Hiatt and his colleague, Dr. Phyllis Jen, began conversations to build a collaboration with partners on Navajo Nation. COPE was launched in partnership with the community, local leaders, Navajo Nation programs, and the Indian Health Service to promote health equity and strengthen the well-being of Indigenous communities. COPE is honored to continue the humble approach to accompaniment Dr. Hiatt always modeled, recognizing that the solutions to overcome health disparities lie inherently in Indigenous communities themselves. 

Beyond PIH, Dr. Hiatt wore many hats. Personally, he was a husband, father, grandfather, and great-grandfather. Professionally, he was an accomplished molecular biologist, professor at Harvard Medical School, dean of the now Harvard T.H. Chan School of Public Health, senior physician at Brigham and Women’s Hospital, and more.

Black History Month has been observed in the United States since 1976. Although the annual celebration is confined to the month of February, PIH-US recognizes that amplifying Black voices, stories, and history is essential year-round. Today, and every day, we celebrate the efforts of Black individuals in creating a future where everyone can thrive.

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

Artificial intelligence, 3D bioprinting, and wearables are just a few of the tech innovations that have disrupted health care in recent years.

But, despite these strides, many of these technologies have yet to become widely available in low- and middle-income countries, due to centuries of global injustice. As a result, technology’s potential to improve health outcomes worldwide remains largely untapped, according to the World Health Organization.

As part of its mission to make the highest standard of health care free and accessible to all patients, everywhere, Partners In Health is using advanced technology and innovations in the 11 countries where it works. From employing mobile applications to digitizing health records, PIH is modeling how affordable, scalable technology can aid global health, expanding access to care and paving the way for a healthier, more connected future.

Here are five ways technology has strengthened PIH’s work:

1. Using AI to screen for disease

In Lesotho and other countries, PIH is using artificial intelligence to accelerate tuberculosis screenings, quickening the path to early detection, treatment, and care. The AI-powered technology, which is used in 6 of 10 districts nationwide, scans chest x-rays and quickly detects the probability of TB, as well as conditions like heart failure and cancer. With the help of AI, PIH has completed more than 700 screenings each month, tripling the number of TB cases detected at our clinics.

2. An ultrasound, on a cellphone

Ultrasounds are crucial to care, helping clinicians monitor pregnancy, evaluate trauma, and quickly diagnose life-threatening conditions. But traditional ultrasound machines are large, costly, and confined to hospital units—often requiring patients in low-income countries to make long, expensive journeys to access care. Handheld ultrasounds were developed about a decade ago as an alternative; these portable devices connect to a phone and stream real-time sonographic images, allowing care to be delivered outside of the hospital. PIH uses handheld ultrasounds in several communities, including the Sierra Madre region of Chiapas, Mexico, enabling clinicians to make informed decisions quickly and expediting patients’ access to care.

3. Care via chatbot

As COVID-19 emerged in 2020, leading to millions of infections and deaths, routine care was disrupted worldwide, with staff and facilities diverted to pandemic response and communities urged to stay home. As a result, countless patients were forced to cancel or delay their scheduled appointments. To address this issue, PIH turned to telehealth. In Peru, PIH developed seven chatbots to connect patients with care across clinical areas, from mental health to chronic disease management. These chatbots enabled PIH to conduct screenings virtually and connect patients with care, such as virtual therapy sessions or medications delivered to their door.

4. Digitizing health records 

In communities like Kono District, Sierra Leone, patient records were once handwritten in notebooks, prone to getting lost, damaged, or misinterpreted. Now, those records are entered into a system called OpenMRS, an open-source electronic medical records platform founded by PIH and the Regenstrief Institute in 2004. PIH now uses the system in 10 countries where we work. OpenMRS tracks everything that happens when a patient is in the hospital, from appointments to prescriptions, saving clinicians time and freeing up valuable storage space. OpenMRS has been so effective that it has since been implemented in over 40 countries and, in some cases, scaled to support all health facilities in their national health systems. 

5. There’s an app for that

Medical records, whether paper or digital, are typically stored in health facilities. But community health workers and other staff outside the hospital have to manage patient data, too. To streamline data collection and management at the community level, PIH has turned to mobile apps. In Rwanda, health center nurses use the mUzima app to conduct cancer screening for women and to securely track and store patient data. In several countries, including Malawi and Mexico, community health workers use CommCare to log appointments, referrals, and other key information. Both apps work offline, making them usable in areas with spotty or nonexistent internet, and sync to OpenMRS, centralizing patient data and optimizing care. 

Globally, 94% of maternal deaths occur in low- and middle-income countries.

A woman in Sierra Leone, for example, has a 1 in 52 lifetime risk of dying in pregnancy or childbirth, compared to a 1 in 3,800 lifetime risk in the United States.

Such health disparities cannot be explained by medicine alone.

That’s according to social medicine, an approach that has its roots in Latin America and focuses on how social forces and disparities affect health outcomes.

It’s essentially a marriage of medicine and social sciences, and it’s core to Partners In Health’s work around the world, from training hundreds of local residents to provide care in their communities to connecting patients with food, housing, and other essentials. 

But, despite its staying power, this concept is lesser-known outside of global health. Even then, it isn’t typically part of medical school curriculums, let alone taught to non-clinical audiences.

So, if you’re lost on what social medicine means, or need a refresher, here are a few facts to get you up to speed:

What Is Social Medicine?

Social medicine has had many definitions over the years. But the approach, in a nutshell, is based on the idea that social forces affect our health and lead to health inequities. Social medicine, as Dr. Michelle Morse, PIH board member and former deputy chief medical officer, once put it, seeks to understand the root causes of these inequities and to take action to change them.

In other words, the biomedical approaches typically taught in a med school classroom, such as reviewing a patient’s medical history in order to help treat a specific illness, are important, but not always sufficient in understanding health inequities. Social forces must also be taken into account. These social forces—such as language, culture, housing, immigration status, and income level—are often called “social determinants of health” and provide crucial insight into a patient’s health needs.

For example, maternal mortality rates are high in the rural, coffee-growing Sierra Madre region of Chiapas, Mexico. But the causes run deeper than a patient’s medical history. There are only 4 ambulances in the communities where PIH works. Reaching the nearest hospital can take hours of traveling via dirt roads prone to flooding during the rainy season. And Chiapas has a history of obstetric violence—clinicians ignoring or even abusing women in labor—leading to distrust of the health system and fewer women seeking facility-based deliveries.

Why does social medicine matter?

Social medicine is crucial to achieving health equity and combating inequities in health care, which have been documented to worsen health outcomes. Also, by widening the focus from an individual patient to health systems and social forces, social medicine reduces the risk of patients being blamed for their health problems and helps clinicians more effectively link them to care and essential resources suited to their needs. Further, the approach encourages health staff to get out of the clinic and into the community, building relationships and expanding awareness of and access to care.

What are some ways that social medicine guides PIH’s work?

In all 11 countries where PIH works, community health workers are a “first line of the practice of social medicine,” as Morse puts it. These workers are locals, hired from the communities where they work and trained to provide basic health services, such as delivering medications to patients at home, accompanying them to the clinic, and spreading the word about public health efforts such as vaccination campaigns.

Such efforts are especially crucial in communities where social factors like language, geography, or distrust of the health system might deter patients from seeking care on their own or even knowing about their care options. In Chiapas, for example, maternal health workers proactively go into communities to find pregnant women and encourage them to come to Casa Materna, a PIH-supported birthing center providing dignified care, with the goal of reducing maternal mortality.

With her left hand on an expectant mother’s belly, Sister Patricia Efe Azikiwe raises her right hand, wiggles her fingers, and explains how to examine the patient’s abdomen. With the fingertips, not the palm, she emphasizes. And don’t press down. Instead, gently move the hand in a circular motion.  

For years, Azikiwe, a reproductive, maternal, newborn, child, and adolescent clinical program manager at the Partners In Health-supported Koidu Government Hospital (KGH), has guided the next generation of clinicians in eastern Sierra Leone. She uses a direct, practical approach, is passionate about her work, and has become a key part of training and care delivery within the facility’s maternal ward.  

“No mother should die in pregnancy, at birth, or after delivery. And how we ensure that is by mentoring,” she says. “That will help us to reduce maternal deaths.” 

Indeed, fewer mothers are dying. In 2020, the lifetime risk of women dying in pregnancy or childbirth in Sierra Leone improved from 1 in 20 to 1 in 52. For context, the same rate is 1 in 3,800 in the United States. Sierra Leone’s is still one of the highest maternal mortality rates in the world, yet care is steadily improving at KGH, where there was an 8% decrease in maternal deaths from 2020 to 2022.  

Azikiwe and her colleagues hope to see that rate steadily improve over time through their hard work and dedication.

New approach, one goal: “save patients”

PIH Sierra Leone began supporting KGH in 2016 during the Ebola epidemic. Back then, the hospital was structurally in rough shape, care was expensive, and resources were sparse. There was no water or reliable electricity. If a patient needed surgery, their family member would need to supply the fuel to power the generator for the operation.   

Today, the hospital is a renovated and welcoming space, where most services are free and significantly more comprehensive.  

The expansive facility has surgical suites, maternal and child health and internal medicine departments, and the only emergency ward outside of Freetown, the capital. The maternity unit has many components, including an outpatient area for prenatal appointments, labor and delivery, its own surgical suite, recovery and post-operating rooms, family planning, and an adolescent and youth-friendly services section with a separate entrance to maintain patient privacy. A pharmacy and a blood bank are also housed in the ward. The latter is especially important, as it has made it possible to safely screen and store blood, meaning postpartum hemorrhage is no longer a death sentence for women. That is largely because PIH staff regularly speak with patients’ family members and have conducted community outreach about the importance of blood donation, as it was not historically an accepted practice. 

These renewed services and resources are critical. And patients have noted the difference; the facility saw a 36% increase in women choosing to give birth there from 2020 to 2022. From January to July alone, there were 2,537 women who gave birth at KGH. 

Among those women, 880 had lifesaving C-sections. In 2022, approximately 37% of births at KGH were C-sections. The percentage is high because KGH is a key referral facility for pregnancy complications, which often lead to a C-section. 

“Saving someone’s life is something I’m so, so passionate about,” says Azikiwe. “This is a referral [hospital]. And as soon as a patient comes here, let us do what we are known for and save patients.”

“Good news room”  

Attached to the maternity unit is the special care baby unit (SCBU), which was established about two years ago and is similar in capacity to a neonatal intensive care unit. Infants born outside the facility—at home or a district clinic—are cared for in one section, and those born in the hospital are housed in another section, all to prevent infection. In a short time, there has been high demand, including a 27% increase in monthly neonatal admissions between 2021 and 2022. From January to July of 2023, there were about 85 admissions a month, far surpassing the unit’s planned 20-person capacity. 

Designed for pre-term babies or those born with an infection, jaundice, and other conditions which require specialized care, the SCBU is highly valued among patients. 

“The care is good, especially for us that gave birth to pre-term babies,” says Regina Foday, a 33-year-old patient with a two-week-old baby. “Before now, people [thought] if you give birth to a preterm baby, they’ll not make it. But because of this facility, when you give birth to pre-term babies, the nurses and doctors here, they are really, really trying to see that baby survive.” 

The unit is touted as the “good news room” by staff because of newborns’ high survival rate, about 96%. Before the SCBU opened, admitted newborns’ mortality rate at KGH was 14%. Now, it's 4%. Still, staff acknowledge there’s much room for improvement. There’s no space for mattresses for a nursing mother’s overnight stays, limited medications for discharge, and a growing influx of mothers who gave birth at facilities beyond KGH and are referred there for specialized care. 

To address these challenges and continue making progress in saving women and children’s lives, PIH Sierra Leone launched an innovative solution: the Maternal Center of Excellence (MCOE).  

Future of maternal health care

Located on a plot of land adjacent to the hospital, the 166-bed MCOE will provide high-quality care to women and families who need it most, build local health care workforce capacity for sustained impact, and create a blueprint for scaling proven interventions in women’s health across Sierra Leone—and around the world. 

PIH Sierra Leone broke ground on the facility in April 2021 and the infrastructure team, led by partner Build Health International, has spent careful months since then leveling and compacting the site, pouring concrete, preparing electrical and plumbing, and building the walls of two main buildings within the massive complex. The south ward and birthing center are on track to be completed and patient services offered by the end of 2024. Two additional buildings will rise within the compound, with the facility at full capacity by the end of 2026. 

The hospital’s clinical staff have also had the opportunity to receive specialty training, with scholarships awarded to eight PIH Sierra Leone nurses participating in a two-year course studying perioperative care, critical care, and anesthesia in Ghana. Upon their return, they will be vital resources at the MCOE, sharing their new skills and training with other colleagues. As an accredited teaching hospital, KGH will serve as a destination for clinicians seeking medical specialization as they rotate through new residency programs and help increase staffing at the hospital and the new MCOE. 

Meanwhile, Azikiwe continues to arrive every morning in KGH’s maternity ward, ready to mentor the nurses and midwives who currently provide lifesaving care to mothers and newborns. Because she knows this work is an essential step toward a world in which no woman dies while giving birth to a new life. 

“We usually say that the joy of every midwife is at the end of labor. You hear the cry of the baby and the voice of the mother,” says Azikiwe. 

It’s been a packed year.  

Headlines highlighted escalating violence in Haiti, cholera spikes in Malawi, and damage from climate-related weather extremes across the globe. But there was good news too: medical education programs launched, major policy breakthroughs on drug pricing and tuberculosis treatment, and reduced rates of maternal mortality. Through it all, Partners In Health persevered, providing top-notch health care to people who need it most.  

PIH reaches far beyond a narrow view of medical care to encompass mental and social health as well as physical well-being. Watch this video to better understand the heart of our work, then see below the stories, other videos, and social posts we were most excited about in 2023. It’s an unscientific tally, but reflects our unwavering mission: a commitment to health care as a human right and true justice for all.  

Social Support, Mental Health Care 

We are beginning to make inroads stopping gender-based violence in countries with entrenched patriarchal cultures.  In Haiti, for example, when a 17-year-old woman was gang-raped near her home, Zanmi Lasante, as PIH is known locally, sent a support team, including a psychologist and social worker, to help the survivor and her family begin to process the trauma and offer practical assistance. These mental health professionals are part of a program that seeks to help survivors through direct care and counseling, while also advocating for systemic change, like educating judges and police on gender-based violence. 

Brenda Mijahuanca looks out the window of her apartment in Lima, Peru. Photo by Diego Diaz Catire / PIH

Mental health care and social support are central elements of our work. A free therapy program is helping trans women in Peru, where stigma, discrimination, and violence against people who identify as transgender are prevalent and prevent patients from accessing care. In Sierra Leone, PIH launched the first mental health hotline staffed  24/7 by psychosocial counselors and a community health officer manager. When callers dial in to the helpline, they receive a range of advice and resources, from basic mental health tips and straight talk about myths and stigma, to connections for follow-up medical care. 

Advances in Tuberculosis and Other Treatable Disease 

Our collaborative efforts yielded important advances in treating tuberculosis, a fully preventable and curable disease that still kills more than one million people a year, mostly in low- and middle-income countries.  PIH researchers were part of a team that presented results from a landmark clinical trial this year. Their findings pushed the field forward, with evidence to support the use of four new, improved regimens to treat multidrug-resistant tuberculosis. PIH patients in Lesotho participated in the trials as part of the endTB project.  

There remain a number of other, curable diseases —think malaria and cholera — that kill many thousands of people each year. PIH aims to correct this deep injustice. 

Emergency Care

Although PIH is not an emergency response organization, when emergencies happen, we act to provide treatment and relief. When Cyclone Freddy hit southern Malawi in March, the storm was reported to be the longest-lasting tropical cyclone ever recorded in the southern hemisphere, leaving hundreds dead, thousands injured, and hundreds of thousands of people displaced.  

Abwenzi Pa Za Umoyo, as PIH is known locally, immediately moved in to offer medical treatment and psychological care. The storm arrived at night, causing intense flooding and devastation to the region, as shown in this video detailing Cyclone Freddy’s aftermath.  

Emergencies don’t always come in the form of natural disasters or disease outbreaks. When patients don’t have enough medical oxygen, it’s literally a matter of life or death. That’s why we spent much of this year working to improve the infrastructure and hospital systems at our sites to give patients greater access to oxygen.  As one doctor said, “One of the worst things in the world is listening to a patient gasping for breath.”

Empowering Patients and Communities 

Energy self-sufficiency leads to better patient care. In Haiti, for example, with gang violence and social instability this year, obtaining adequate fuel for the generators at Zanmi Lasante’s Hôpital Universitaire de Mirebalais became far more challenging. As a result, the hospital encountered power losses on several occasions. Our investment in solar power at hospitals in Haiti and Peru means we can provide patients and clinicians a stable and reliable energy source, essential for medical care and treatment.  

Rose Mukabatabazi tends to crops in a greenhouse opened by Partners In Health in Kirehe, Rwanda. Photo by Asher Habinshuti / PIH

In a novel program, we are also supporting greenhouses in rural Rwanda to combat food insecurity and create sustainable sources of income for impoverished families. Farmers enrolled in this program include those with chronic illnesses and those with young children suffering from malnutrition. 

For more information about global health inequities in the countries where PIH works, visit this widely shared post on Instagram. One example: Sierra Leone, a country of eight million people, only has three psychiatrists.

Accompaniment  

For PIH, “accompaniment” means that we remain beside patients from the start of their health care journeys and remain alongside them as long as it takes—even if that means a lifetime. When Linda Depoyou, a 27-year-old mother of three in Liberia, gave birth to a little boy this summer, he weighed only 0.6 kilograms, or 1.3 pounds. But after three months of care, social support, and medical treatment at the neonatal intensive care unit at Partners In Health-supported J.J. Dossen Memorial Hospital in Harper, Depoyou and her new baby were able to return home and restart their lives together.  

Sometimes, PIH patients becomes such an integral part of the culture, they stay and become health workers, like Jean Claude "Gatoto" Rutayisi, who lives with HIV and is now a community health worker supervisor in eastern Rwanda. 

Advocacy and Good News in Global Health 

We advocate for community health workers (CHWs) around the world, including in the United States, where PIH-US and other national organizations spoke to lawmakers in Washington D.C. this year about the critical role of CHWs and what policies might support the expansion of this frontline public health workforce.  

Despite the harsh realities around the world, we’ve seen progress in global health, from declines in AIDS-related deaths to decreased child mortality. We believe that sometimes, it’s good to post good news; it shows that change is, indeed, possible.  

Partners In Health staff and partners expanded a state-of-the-art hospital in Rwanda. Clinicians cured patients living with tuberculosis. Technicians helped deliver lifesaving oxygen to more patients across the globe.  

The year 2023 saw its share of challenges—from a record-breaking cyclone that devastated communities in Malawi, to increasing gang violence in Haiti. But it also saw moments of triumph. 

In this collection of images, chosen from more than 12,000 taken over the course of the year, PIH photographers and contributors stood beside our dedicated staff as they broadened the scope of medical services and deepened engagement with communities. Through these brief snapshots in time, we celebrate the triumphs and bear witness to the challenges of the past year.  

Settea Benard receives a blanket and food package on April 1.  Abwenzi Pa Za Umoyo, as Partners In Health is known in Malawi, visited the Mitondo camp in Chikwawa District in response to Cyclone Freddy. The team offered clinical services as well as food packages for residents of the camp, all who were displaced by the cyclone. Each food package consisted of a bag of maize flour, beans, soya pieces, cooking oil, salt, and sugar and will last the average family 2.5 weeks. 
Photo by Caitlin Kleiboer / PIH

 
Oxygen cylinders are transferred off an oxygen truck and into boats to be delivered to Tebellong Hospital in Qacha’s Nek, Lesotho. 
Photo by Zack DeClerck / PIH 

Juan Hurtado, medical staff at the San José de Chincha Hospital, does routine maintenance and inspection work on the medical oxygen systems of the oxygen plant. 
Photo by William Castro Rodriguez for PIH  

A reflection from William Castro Rodriguez, one of several freelancers working with Socios En Salud (SES), as PIH is known in Peru: 

"Working together with the SES team means a genuine and human commitment. Being a creative producer has allowed us to accompany them and be close to their great work in communities. Seeing the joy of people whose health has been positively impacted has special meaning for us."

Members of Partners In Health’s Engage Training Institute spent Monday, August 14 at the U.S. Capitol for Hill Day, where they held 100 meetings with legislative staff members to talk about community health bills they would like introduced in Congress. Photo by Melissa Lyttle for PIH 

An aerial view of the campus of Partners In Health-supported Koidu Government Hospital in Kono District, Sierra Leone. Photo by Abubakarr Tappiah Sesay / PIH 

Prince is accompanied by his father, John, as the 4-year-old receives care at the cholera treatment unit at Lisungwi Hospital in Lower Neno, Malawi. Photo by Zack DeClerck / PIH 

Patricia Efe Azikiwe, the reproductive, maternal, newborn, child, and adolescent health clinical program manager at Koidu Government Hospital in Sierra Leone, mentors student nurses and midwives. Photo by Caitlin Kleiboer / PIH

A reflection from Caitlin Kleiboer, associate director of multimedia: 

"Reflecting on my time with our care delivery site staff this year, the short day spent with Sister Patricia Efe Azikiwe at Koidu Government Hospital in Sierra Leone stands out in my memory. As I followed her through the hospital, I was struck by the profound impact of her passion and dedication. She is one of the hardest working people I have ever met. 

In this moment, I was in a room packed with over a dozen student nurses and student midwives, all clamoring for a spot to see her work, practicing the maneuver she was teaching in the air along with her. To be honest, she is the kind of teacher that in my student days I would have called ‘tough.’ But her rules are basic and fair, and she doesn’t mince words. Don’t be late. Don’t have your phone out. Pay attention. Learn the skills. She is also the kind of teacher that I would have looked back on as one of the most impactful of my life.  From that day with her, I feel very sure that something someone learned will save a life of a woman or baby. That toughness, those rules, that dedication is truly lifesaving, and I feel lucky to have been able to witness it."

Inshuti Mu Buzima, as PIH is known in Rwanda, saw a need for children with disabilities to have access to adaptive chairs for their occupational therapy in Kirehe. Because these chairs can be prohibitively expensive, our Pediatric Development Clinic staff found ways to make three types of assistive devices—corner seats, specially designed chairs, and standing frames—out of affordable materials like cardboard and recycled paper. Photo by Asher Habinshuti / PIH
 

Construction workers build cinder block walls at the Maternal Center of Excellence in Kono, Sierra Leone. When completed, the center will provide advanced maternal and child health services in Kono District and beyond. Photo by Caitlin Kleiboer / PIH 

Wellington Dennis, a communications intern with PIH Liberia, stops on the beach as the tide rises while on the way to Putuken, a small community where PIH provides mobile care and support. It is separated from Harper, home to J.J. Dossen Hospital, by a small river and is only accessible by boat. Photo by Caitlin Kleiboer / PIH

Ruth Lazo (center), who received clinical services from PIH, sleeps outside at the Somo Camp with Piriran Seza (right) and their 4-month-old daughter after being displaced from their home by Cyclone Freddy. Somo does not have tents and bug nets are removed during heavier rains to preserve their effectiveness. Photo by Zack DeClerck / PIH 

Reflection from Zack DeClerck, global multimedia manager:  

"Despite our primary focus not being disaster response, PIH swiftly stepped in when Cyclone Freddy ravaged southern Malawi. Over half a million people were displaced, and countless crops were destroyed. Though the worst-hit areas were outside Neno, PIH extended its support to places like Somo Camp in Chikwawa District, where residents share heartbreaking stories about fleeing their homes with their children in the dead of night.  
 
When we met Ruth, Piriran, and their 4-month-old daughter Alufa, they were absolutely exhausted. We all fought tears as they detailed the impossible choices they faced navigating life after being displaced. Two weeks post-cyclone, the camp lacked tents, faced food shortages, and there were no insights on when adequate shelter might become available. PIH responded where other agencies fell short, deploying additional staff for medical care, mental health support, and food packages. 
 
The lack of international media coverage infuriated me; in many parts of southern Malawi, PIH stood alone in the support it provided. This crisis underscored the profound impact of climate change on impoverished communities, intimately connected to our mission of delivering quality healthcare. 
 
With limited resources, our colleagues in Malawi gave me so much hope through the grace in which they delivered care. PIH’s response to Cyclone Freddy embodied solidarity, accompaniment, and a refusal to accept injustice. The Malawian government specifically came to PIH for assistance with their response and that’s a testament to the power of partnership and the long-term commitment of our mission."

Communications staff with Companeros En Salud, as PIH is known in Mexico, Marina Luria (left) and Diana Bernal (right) paint a mural on the wall in JaltenangoJaltenango. The mural, which translates to “Health for all,” was completed as part of the Global Day of Action in October to honor what would have been Co-founder Dr. Paul Farmer’s 64th birthday. Photo by Francisco Terán / PIH 

Reflection from Francisco Terán, media designer:  

"For me, photography is a powerful tool to share stories, convey emotions, immortalize moments, and invite reflection. Here I captured a moment as the Comms team works on a colorful mural to celebrate Global Day of Action.

From Jaltenango, Chiapas, it has been an honor to be part of Paul Farmer's legacy on this special day, feeling like a very precious, emotional, and important moment to continue sharing his vision and mission, as well as the impact he has had on thousands of people. It is very valuable to be part of something so great, of a legacy and a work that will continue to grow year after year and that will continue to be shared with generations to come."

Clinicians with Zanmi Lasante, as PIH is known in Haiti, review a patient's chart at Hopital Universitaire de Mirebalais on March 24. Photo by Nadia Todres for PIH 
 

Makatleho Monyake and her 4-month-old baby prepare to ride home on horseback with a food package following an appointment at Bobete Health Center in Lesotho. Photo by Zack DeClerck / PIH

Ekram Hussien Ahmed, a graduate from the Gender, Sexual and Reproductive Health track at the University of Global Health Equity, attends her graduation ceremony in Kigali, Rwanda, in August. Photo by Serrah Galos for UGHE 

Miguel Apolinario does not remember ever having worked under such extreme temperatures as those in Loreto, a region located in northeastern Peru, in the heart of the Amazon.

"I checked my cellphone and the temperature was 36 °C [96 °F]," he recalls. 

Apolinario, a nurse technician, had come to the region on a distinct mission: to find people at-risk for tuberculosis and offer free screenings. 

Tuberculosis (TB) is the world’s deadliest infectious disease, disproportionately affecting people in low- and middle-income countries, where treatment and care are routinely inaccessible. Early detection is critical in responding to tuberculosis, which can go undetected for years. But finding these cases is challenging, especially in communities like Loreto.

Located in the Amazon rainforest, Loreto is home to 1 million people, including 32 Indigenous groups in 1,200 communities. It’s one of the largest regions of Peru, bordering three countries: Ecuador, Colombia, and Brazil. It’s also one of the hottest, with temperatures routinely in the 90s (Fahrenheit). Filled with forests, swamps, and rivers, Loreto is isolated. Its capital, Iquitos, is not accessible by land—the only way to visit it is by plane or boat. 

These conditions, along with systemic injustice, have made formal health care mostly inaccessible in Loreto. As a result, the region has been among the hardest-hit by diseases like TB. While TB cases in Peru have largely been diagnosed in Lima and Callao, which together report 56% of cases nationwide, Loreto's incidence rate is 164 cases per 100,000 people—higher than the incidence rate in both major cities.

To address this unmet need, Socios En Salud, as Partners In Health is known in Peru, has been expanding its TB work to include remote regions like Loreto. That work stems from its decades of experience responding to TB in partnership with the Ministry of Health and local communities, ever since its founding in 1996.

As the latest chapter in innovative TB work that has ranged from mobile clinics to portable x-ray screening that fits in a backpack, Socios En Salud launched a 10-day active search campaign in Loreto. The campaign had an ambitious goal: screen hundreds of people across 18 communities.

An Unmet Need

In mid-November, Apolinario and colleagues Alexander Gutiérrez, a radiologist, and Juan Herrera, a lab technician, traveled by boat across the Amazon river basin.

In the boat, the health workers brought ultra-portable, AI-powered digital radiography equipment, enabling them to screen and evaluate patients within minutes. 

They didn’t know how receptive the communities would be. But their presence was expected—weeks ago, Socios En Salud had sent former TB patients to the communities to promote the screenings and register patients.

Each day began at 7:30 a.m., when the medical vessel docked in a community. The team provided dozens of free screenings using the radiography equipment. If a patient had an abnormal result, the team would request a sputum sample for the GeneXpert molecular test, providing a rapid TB diagnosis within two hours.

Over the course of 10 days, the team screened a total of 369 people. For those who tested positive, the plan was to provide them with economic assistance to travel to the nearest health center where TB care was available.

"These are people who in some cases had not set foot in a health center for years,” says Apolinario. “Most of them had never had a TB screening in their lives." 

Peru’s last national census in 2017 revealed that 61% of Indigenous communities lacked any health facility. Only 1 of the 18 communities Apolinario visited, Colonia Oran, had a health post.

The lack of health care only adds to the challenges for communities in Loreto, where as many as 36% of people live in poverty.

"The department of Loreto, just like all regions of the Peruvian jungle, are affected by health and environmental problems, which lead to poverty and malnutrition, in addition to limited access of the population to health facilities due to distance and resources," says Milagros Mendoza, project coordinator of Socios En Salud’s TB Program. 

Because of the lack of formal health services, people in the communities often resort to natural medicine and traditional healing practices. 

"They told me that, in the old days, there were people with TB who refused medications and treated themselves with the sap from bananas and trees," he says.

As Socios En Salud and others work to expand health care access in the region, the times are changing. But despite the technological advances in TB care, challenges remain in getting that care to patients who need it. 

Even during their 10-day intervention, Apolinario and his team faced hurdles.

"Sometimes there were no community health workers,” he recalls. “So Alexander, the radiologist, and I  would have to get off the boat, use the light from our cellphones to see the road, and look for people, especially the elderly, who were waiting for their [test] results at home, and we delivered it to them directly.”

Still, the team persisted, connecting hundreds with screening and care, including, for those diagnosed, accompaniment by a community health worker and free transportation to a clinic. 

The intervention in Loreto marked a step forward for TB care in the region.

"There were people asking when we were coming back, because they wanted to bring more family members,” he says. “They were very grateful.”

Carlos Vázquez is originally from Pequeñez, Chiapas. At 67 years old, he continues to work on his farm, where he grows coffee, corn, and beans a few meters from his home. He has planted and harvested these foods with love and dedication throughout his life. 

In 2000, when he was in his 40s, he began to experience a wave of unusual symptoms and didn’t know if his life as a farmer could continue.

"It started with a headache that I put up with at first, but then it became more constant...soon, more aches and pains came along," he recalls. In the following weeks, he began to have frequent urination during the day and night, and he was drastically losing weight. 

At that time, there were not many doctors near his home, so he traveled to a private practice a few hours away. There, he learned that his glucose level was 500 mg/dl, compared to the 99 mg/dl that would be healthy for a man his age. He received a diagnosis: diabetes.

The doctor prescribed medication, but it cost approximately $2,500 MXN ($145 USD) per month—unaffordable for Vázquez, who had a family of five to support. His earnings from his crops were not enough to consistently pay for his treatment, so he took his medications irregularly.

In 2005, his condition worsened. "I became very weak,” he recalls. “My family took me to the hospital. We didn't know what was going to happen. We thought that I was nearing the end." 

Vázquez was hospitalized for 20 days and fortunately managed to recover, but this is not the case for many other people. 

In Mexico, 1 in 6 adults live with diabetes. The country has the second highest prevalence of diabetes in Latin America, with 18.3% of the population suffering from the disease. It’s one of the leading causes of death, with 140,729 deaths recorded in 2021. 

Care and treatment for chronic diseases like diabetes involves not only medication but also education about the disease and its effects, lifestyle changes, social support, and systems that facilitate recovery by allowing the patient to continue treatment properly. 

After over a decade of barely managing his symptoms with costly, private doctors, Vázquez was introduced to Compañeros En Salud, as Partners In Health is known in Mexico, in 2014 when a first-year doctor began working in the community clinic in Salvador Urbina, near his home. He began attending the free consultations offered there, a much more affordable and accessible option to help control his diabetes. Since then, he has been receiving medication and follow-up treatment from the acompañantes program. 

The acompañantes, or community health workers, are residents from the communities where Compañeros En Salud works, who receive training, supervision, and mentoring in chronic diseases, respiratory illnesses, and pregnancy care. The program, which has been running for 10 years and currently has 75 community health workers, has accompanied patients at every turn, from the home to the hospital. Acompañantes care for patients, counsel them, and help them follow their treatment plans, which can involve several medications.

Vázquez is one of those patients. 

Every two weeks, he receives a visit from Irma Gálvez, one of Salvador Urbina's acompañantes, who checks his glucose and blood pressure levels, encourages him to continue with his treatment, restocks his medications, and provides emotional support. 

"I don't know where I would be if Irma didn't come to visit me. I probably would have already lost control [of my glucose level] again and died," he says. "She comes when I feel bad. She advises me on my diet...I feel happy."

Similar community health interventions have been shown to result in significant improvements in the health of chronically ill patients. Acompañantes have conducted more than 22,121 home visits to patients with diabetes since the program began. Currently, they support 1,620 patients with non-communicable diseases; 63% of patients supported by acompañantes were able to bring their diabetes under control, with blood sugar levels in normal ranges, and 72% of those with high blood pressure kept their levels under control. 

That care has made a difference for patients like Vázquez, who now, thanks to the support of acompañantes, is able to resume his daily farm work. 

"I know that I have a condition and that it is not going to go away," he says. "But I have also been able to go on with my life. I am going to see my children and grandchildren. I am grateful that the acompañantes come to visit me, because they have really helped me get better."