Partners In Health (PIH), The Solar Electric Light Fund (SELF) and Grammy-winning reggae band Steel Pulse announced the release of Hold On [4 Haiti], a new song composed by lead singer David Hinds and recorded to raise funds for the solar electrification of health clinics for PIH in Haiti. The clinics, operated by Zanmi Lasante, are located in the remote mountain highlands and do not have access to the electric grid. In the aftermath of the January earthquake in Port-au-Prince, the facilities have experienced a rise in demand for health-care services, countered by dangerous fluctuations in fuel supplies needed to operate their generators.

Steel Pulse has launched a new website, www.holdon4haiti.org, where the song is available for download on a donation basis. One hundred percent of donations received will benefit Haiti.

Explained Mr. Hinds: “Because the initial media coverage has waned considerably, we want to revitalize the focus on Haiti's plight. We wrote Hold On [4 Haiti] to support the people of Haiti through the work being done by the Solar Electric Light Fund and Partners In Health. We’ve got to make a real difference on the ground — that’s what this project is all about.”

“Steel Pulse’s Hold On [4 Haiti] is a song of hope,” said SELF’s executive director, Bob Freling. “Our hope is that we can solar electrify all 12 hospitals and health centers for Partners In Health in Haiti. We were already working on electrifying PIH clinics, but in the wake of the earthquake we’ve been requested by PIH to accelerate our timeline for bringing solar power to all of their sites in Haiti.”

Dr. Paul Farmer, co-founder of Partners In Health, has been an advocate for the Solar Health Care Partnership between the two organizations from the very beginning, when SELF worked on electrifying PIH clinics in Africa. “We know that solar energy is self-replenishing and sustainable. It works for us in Africa, and we want to use it across all our facilities in Haiti; diesel is already in short supply and will likely become even more difficult to obtain as time goes by,” said Dr. Farmer. “This song by Steel Pulse serves as a reminder that we stand with the people of Haiti in solidarity and compassion.”

Download Hold On [4 Haiti]

Read the full press release

The efforts of Partners In Health and its sister organization in Haiti, Zanmi Lasante (ZL), as they accompany Haiti’s small psychiatric community to build back betterwere featured on the front page of the August 6 edition of Psychiatric News, the American Psychiatric Association’s bimonthly newspaper. With the country’s physical wounds beginning to heal, medical efforts are increasingly focusing on Haiti’s mental health and psychosocial needs.

“Haiti, an independent nation with a distinct culture…will have to take the lead in building the [country’s] mental health infrastructure,” writes the piece’s author, Aaron Levin. He points to Haitian leaders, such as Father Eddy Eustache, the psychologist and priest who heads  ZL’s Mental Health and Psychosocial Program, as integral to the movement. “Outsiders may contribute to that process but probably through Haitian or Haitian-American practitioners whose main job will be to train more Haitians to do most of the clinical work required,” writes Levin. “Father Eddy Eustache is just such a bridge.”

Read the full article in Psychiatric News.

Read a past interviews with Father Eddy. 

Read more about PIH’s mental health and psychosocial response to the January 12 earthquake.

By Kanupriya Tewari

Nyaya Health aims to develop health care services in Nepal’s impoverished western region of Accham. To meet this goal, it has a two-fold mission. First, develop a health care capacity that allows them to provide free community-based health care in rural Nepal. Secondly, Nyaya works to establish and disseminate a scalable model of health care delivery, specifically tailored for regions throughout the world afflicted by poverty, isolation, war, and neglect. Nyaya is one of PIH’s six supported projects that are endeavoring to implement this philosophy on a global scale by working with local communities and governments to create change.

Watch this video featuring Nyaya Co-founder Jason Andrews, and Director of Operations Ryan Schwarz, to learn more about Nyaya’s founding and development. Also, listen to the advice these two young leaders have for other upcoming activists in the global health field:

 By Kanupriya Tewari

13 January 2010. As darkness envelops Haiti’s people, a community’s songs filter through the air. Moving though the capital city, a photographer comes upon a small medical clinic tucked within the shadows. The bodies of the dead are piled outside the health care center. A number of people are trying to sleep in the building’s congested courtyard despite their evident pain—they lack medicine, food, and supplies. Drawing closer, amidst the dirt and debris, a Haitian woman wrapped in a blue bed sheet extends an outstretched hand in a desperate plea for help. Her pain touches the photographer, who immortalizes the scene.

“Great photography demands questioning,” says Sherman Teichman, Director of the Institute of Global Leadership (IGL) at Tufts University.

From the small inquiries—who is this woman? What has she suffered? —to the larger, more thought provoking questions—where are the medical supplies? What can I do to help her? How can I lift her up and onto her feet once again?

This philosophy, one that pushes people to question the causes behind images, guided collaborators from the IGL and de.Mo Design Company as they compiled photographs and words for Haiti: 12 January 2010, a striking sixteen page folio publication. More than six months after the Haitian earthquake, as media attention slowly shifts to new stories, it becomes easier for people to forget about Haiti’s suffering. This folio provides a needed reminder; it compels people to continue to think about Haiti.

Because all proceeds from folio sales are donated to Partners In Health (PIH), people who purchase the work are not only continuing to think about Haiti, they’re committing to action. Get the folio of Haiti: 12 January 2010.

Photographer Ron Haviv, a co-founder of VII Photo Agency humanizes Haiti’s tragedy through images like the woman in blue reaching out for help. “They allow you to absorb the overwhelming aspect of the disaster as well as relate on a one-on-one level,” says Haviv. “Images are potent because they are immediate and urgent, but they also require context,” Teichman adds. Simon Winchester’s introduction, “Catastrophe, Nature, God and Understanding” provides context, shaping the folio’s powerful narrative.

Though this innovative effort was initiated immediately in response to the earthquake in Haiti, the story behind the folio’s production actually precedes the disaster.

Human rights are central to the IGL’s mission. The Institute challenges students to look beyond traditional humanitarian models that focus on giving impoverished people only food, water, and shelter, and instead to explore the broader social frameworks behind poverty. With this focus on global inequities and iniquities, each year the IGL’s EPIIC (Education for Public Inquiry and International Citizenship) program explores one central global dilemma: a broad theme that provides the intellectual space for students to explore complex issues. In 2004-2005, EPIIC chose the theme of Oil and Water—it was in December 2004 that the earthquake in the Indian Ocean struck, triggering a tsunami that killed around 230,000 in the region. The parallelism between the theme and tragedy were evident, as were the effects of the disaster itself, leading the IGL to leap into action and produce its first collaborative folio. As the Institute was preparing for this year’s 2010 EPIIC program, Haiti was leveled by a devastating earthquake. The collaborators reacted with a similar sense of urgency.

Ron Haviv landed in Haiti less than 24 hours after the quake. The folio offers a visual testimony to Haviv’s experience; it captures the trauma of January 12 in sixteen unbound posters (36 x 54cm each). Its unique format, as designed by Giorgio Baravalle, founder of the de.Mo Design Company, allows the viewer to absorb each page individually or to hang the entire project on the wall, creating a powerful document that spotlights the earthquake’s aftermath. It is ideally suited for galleries, high schools and universities, and people with a strong appreciation for world-class photojournalism or design.

Choosing PIH as the organization to receive all of the folio’s proceeds demonstrates the collaborators’ commitment to maintaining a long-term partnership with PIH—in 2002, the IGL began this partnership by awarding its Dr. Jean Mayer Global Citizenship Award to PIH co-founder Dr. Paul Farmer. Part of the award entails that the Institute continue to partner with its recipient over the coming years. “We chose PIH because we have tremendous admiration for the fact that PIH works with its sister organization, Zanmi Lasante, in Haiti in such a sustainable way, and has been committed to Haiti for so long,” Teichman adds.

Understanding that the Haitian earthquake is a long-term crisis, the collaborators want to focus their fundraising efforts on an area where less attention might be centered. Folio proceeds support PIH’s mental health and psychosocial services initiatives, which attend to the Haitian people’s inner, invisible wounds.

This unique picture essay ultimately compels us to question, and to remember January 12, even as time elapses. As Teichman says, it is “of-the-moment, yet also timeless.” 

By Lindsay Palazuelos, Project Coordinator 

This blog post is the third in a series of Partners In Health’s supported project in Guatemala—Equipo Técnico de Educación en Salud Comunitaria (ETESC, Technical Team for Education in Community Health). Read Lindsay’s previous post.

If you’ve ever visited New York, you’ve probably heard this story: the Dutch bought the entire island of Manhattan from the indigenous Lenape for a tiny sum, estimated at about $1,000 in today’s currency. As tourists, we might chuckle and shake our heads as we ascend the Empire State building or walk down Broadway.  Yet, in many ways, indigenous people in Guatemala today often feel they are being asked to make just this sort of lopsided bargain.

Guatemala has granted over 400 mining concessions to foreign companies. For the privilege of using national resources, mining companies pay only a 0.5 percent donation to the nation, while the remaining billions in profit benefit investors mostly outside its borders. In the meantime, as I’ve heard firsthand from people living near mines here, mining can have negative impacts for local people, in terms of health as well as socio-economics.

First off, people often live and farm above the minerals that companies wish to mine. All too often, they are forcibly evicted or not compensated fairly for the loss of their property. Once mining is underway, it requires a great deal of water, and in already stressed local water systems, this can leave local families’ supplies dry. In addition, extraction typically requires large quantities of chemicals, such as tons of cyanide to leach gold from crushed rock heaps. With little or no independent environmental oversight, communities are concerned about contamination, and often complain of diseases in fish, animals and humans. Companies argue that they are providing well paying jobs to the local community as miners. While this may be true, the jobs are also dangerous and time delimited: the economic benefit will disappear as soon as the mine’s work is complete. Ultimately, these impacts can contribute to poor health outcomes in the local communities. Which is why ETESC and its team of community health workers and advocates decided to get involved.

In 2005 ETESC helped found a statewide effort to educate and consult with communities about mining. “ETESC is trying to prevent damage from mining before it has begun,” explains Santiago Pablo Lucas, ETESC coordinator. Under the International Labour Organization Convention 169, Guatemala is obligated to obtain the consent of indigenous communities before allowing mining and other projects to move forward. As a founding member of the coalition State Assembly for the Defense of Huehuetenango, ETESC has brought together thousands of citizens to take a town square vote in favor or against consent to mining activities. 28 of the 32 municipalities in the state have held a consult, with the vast majority of municipalities voting against. Santiago says that this process is in line with many indigenous traditions of decision making. “My grandfather told me that whenever there was a problem about land or resources, the tradition was to present the problem and consult with the whole community,” he explains. “[However] for many laws in this country, we indigenous people are not taken into account, and not able to give our opinion.”

While the consults are not yet legally recognized, they are a powerful way to make the voice of local people manifest in the absence of any other mechanism. The UN Special Rapporteur James Anaya recently made a special trip to Huehuetenango to discuss the consults. “These initiatives are valid and have relevance in that they constitute a reflection of the legitimate aspirations of indigenous communities to be heard in relation to all projects that may have a potential impact over their traditional territories,” he states in his preliminary result.

Speaking out in Guatemala can be dangerous. Members of the State Assembly have received written threats, which unfortunately must be taken seriously. Already this year 8 human rights defenders have been murdered in the country, on top of 29 in 2009. With no arrests in 97 percent of all murder cases, the murder of a human rights defender has almost guaranteed impunity. Despite this, ETESC, the Assembly and local communities courageously continue to advocate for local people’s voice in development.

For more information about ETESC, click here or contact lpalazuelos@pih.org. 

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By Kanupriya Tewari

In June, Nyaya Health, an organization in Nepal supported by Partners In Health (PIH), celebrated the first anniversary of its hospital in Accham. This special day was marked by the planting of over 100 trees, shrubs, and flowers around the Bayalpata Hospital grounds as a symbol of the successes of the past and hope for growth in the future. Joined by members of the entire community, including community leaders and police force members, staff spent the afternoon planting new life throughout the grounds and cultivating their close partnership with the local community.

Though the hospital was built over 30 years ago, it only became fully operational in July 2009 when Nyaya Health, in collaboration with the Nepali Ministry of Health and Population, rehabilitated the facility after a long period of dormancy. Upon inauguration, it was equipped with outpatient and inpatient wards, an emergency ward, a maternity and delivery ward, a laboratory, and a pharmacy. Before it opened this facility, Nyaya had to refer emergency patients to a hospital over 10 hours away from their health center by bus for appropriate care.

	Staff and community members celebrate the hospital's first birthday by planting 100 trees together.

Nyaya Health aims to develop health care services in the county’s impoverished western region of Accham. To meet this goal, it has a two-fold mission. First, develop a health care capacity that allows them to provide free community-based health care in rural Nepal. Secondly, Nyaya works to establish and disseminate a scalable model of health care delivery, specifically tailored for regions throughout the world afflicted by poverty, isolation, war, and neglect. Nyaya’s work and philosophy matches closely with PIH’s approach of working to bring the benefits of modern medical science to those most in need and to alleviate the crushing economic and social burdens of poverty that exacerbate disease. Nyaya is one of several Partner Projects that are endeavoring to implement this philosophy on a global scale by working with local communities and governments to create change.

Ryan Schwarz, Nyaya Health’s Director of Operations, describes the past year as “humbling and amazing.” The number of projects completed by the organization this past year is incredibly impressive; some of the highlights include:

• Opening their first hospital in June 2009
• Treating both a diarrheal outbreak and the effects of a prolonged drought in July/August 2009
• Developing a mortality review program in September 2009
• Forming a partnership with CIWEC Clinic and other organizations in 2009-2010
• Developing an ambulance service for the region in January 2010
• Enhancing the region’s energy resources in May 2010 by introducing triple phase electricity in the hospital

Accham is one of the poorest regions in South Asia, and shoulders some of the world’s highest mortality rates, particularly among women. A decade-long civil conflict, from 1996 to 2006, ravaged the health infrastructure of the region. Given these conditions, Nyaya recognizes the huge challenges that lie ahead as the organization moves into its second year of operating Bayalpata Hospital. The last year has been filled with challenges and successes, says Ryan. “Nyaya will keep striving, working not only for health equity in Accham, but for the global health field and the belief that health is a basic and fundamental human right.”

In the near future, Nyaya aims to continue expanding its hospital-based services—including the opening of a comprehensive surgical center and expanded inpatient services—and also to further develop their growing community health programs.

Learn more about Nyaya Health’s work here.

Watch this video featuring Nyaya Co-founder Jason Andrews, and Director of Operations Ryan Schwarz, to learn more about Nyaya’s founding and development. Also, listen to the advice these two young leaders have for other upcoming activists in the global health field:

PIH/ZL nurse Genevieve Joubert and midwife Sarah Marsh show GMA's Robin Roberts around Dadadou--a spontaneous settlement serving as a home to roughly 10,500 Haitians.

The ABC news program followed the women as they showed Robin what life is like for the 1.5 million people still living in tents and makeshift shelters in and around Port-au-Prince. "The greatest needs are safe shelter," said Genevieve. It's not uncommon for tents to hold as many as 13 people, though Genevieve recently found 27 people living together in one tent. "They need housing, they need food, they need hygiene." says Sarah Marsh.

You can read more about Genevieve Joubert and her one-woman ER here: 

http://www.pih.org/index.php/news/entry/a-one-woman-ER-in-Dadadou/ 

	Ophelia Dahl

"When I was a teenager, I still didn't really know what I wanted to do with my life," says PIH Executive Director Ophelia Dahl in the August issue of Boston magazine. "I knew I wanted to do volunteer work, but I had no concept of where that would be."

"When I first saw Haiti, I was 18 years old and I was rightly knocked for six, as they say in England: I was blown away by everything," Ophelia tells journalist Paige Williams. "It was a real assault on your senses and the way you think the world works, even if you have a good imagination."

Read more from this piece on Boston's website, or pick up a copy of the issue on newstands.

Boston magazine's website also features a special extended interview with Ophelia, where she discusses PIH's response to the Haiti earthquake:

We had a situation room here [at the Commonwealth Avenue headquarters in Boston] where we were moving magnets around to say, “Here’s an offer of a plane, here’s an offer of supplies, here’s a team from Partners Healthcare, from Children’s Hospital, from the Brigham, and they’ve got 10 days that they can all go.” We put it all together to make sure they had a landing slot.

The interview also touches on PIH's work with HIV patients in Boston through its PACT (Prevention and Access to Care and Treatment) project:

PACT was begun in the ’90s and was based on the model in Haiti, using community health workers. We realized what HIV patients needed was accompaniment — they couldn’t get to the hospital, or they came home with 12 sets of pills and didn’t take them. [PACT] workers now go visit every day, to help address those things that get in the way of healthcare. It’s a great model for other chronic diseases — diabetes, mental illness, anything that needs some kind of daily accompaniment. We think it’s a fantastic model for this country. It’s something Boston should be very proud of.

Read the extended interview.

Throughout August, Boston magazine will donate 20 percent of the proceeds from all new or renewed subscriptions received online to PIH. To subscribe, click here.

On Tuesday, July 27, 2010, Paul Farmer, Partners In Health co-founder and UN Deputy Special Envoy to Haiti, and Loune Viaud, Director of Operations and Strategic Planning of Zanmi Lasante (ZL), the Haitian sister organization of Partners In Health (PIH), testified at a Capitol Hill hearing hosted by the Congressional Black Caucus, "Focus on Haiti: The Road to Recovery - A Six Month Review.”

In his testimony, Paul discussed how foreign governments and NGOs must accompany Haiti’s government throughout the rebuilding process. “This shift will not be a panacea for Haiti but could be coupled with a powerful and complementary focus on another movement of capital, this time from public to private and from wealthy to poor: a focus on job creation and on strengthening the hand of those trying to farm (and reforest) the land and also on young people, especially young women, living in poverty,” he stated in his prepared testimony. “We need a greater sense of urgency. And the most urgent task of all is the creation of jobs that will confer dignity to those in greatest need.”

Read Paul Farmer's full prepared testimony

Throughout her testimony Loune highlighted the strides made in Haiti since January 12, while also stressing the immense challenges still facing her country. Haitians affected by the earthquake desperately need “healthcare, employment, decentralization, protection of children, women, adolescent girls, the elderly and the most vulnerable members of the population.” Loune noted that these challenges cannot be fixed with foreign donations. “Rather than charity, Haiti needs partners… Haiti needs jobs. Jobs will stabilize other parts of the country, empower the communities, and save lives.”

“We need Haitians to lead the reconstruction efforts. We need our partners to take a rights-based approach in the construction of a new Haiti,” said Loune in her testimony. “This means supporting the capacity and the leadership of both the Haitian government and Haitian communities; it means deferring to the experiences of Haitians and guaranteeing our participation in the rebuilding of our country; it means unconditionally respecting all of our human rights—including the right to food, the right to decent housing and sanitation, the right to health, the right to potable water, the right to education and the right to security.”

Read Loune Viaud's full testimony

Congresspersons Barbara Lee and Donald Payne oversaw Tuesday’s hearing. Testimony was also given by Dr. Rajiv Shah, Administrator, U.S. Agency for International Development; Marie St. Fleur, Former Massachusetts State Representative; Camille Chalmers, Director, Plateforme Haitienne de Plaidoyer pour un Developpement Alternatif / Haitian Platform to Advocate for Alternative Development, Haiti; and Ira Kurzban, Chair, Board of Directors, Institute for Justice and Democracy in Haiti.

Read the full text of the Paul and Loune's testimonies below.

Testimony of Paul Farmer
Co-founder of PIH, Chair of the Department of Social Medicine at Harvard Medical School, Chief of the Division of Global Health Equity at Brigham and Women’s Hospital in Boston, and Deputy Special Envoy for Haiti at the United Nations
[Download a PDF of Paul Farmer's prepared testimony - 33 KB]

	Paul Farmer

1. Acute-on-chronic
The six-month anniversary of the earthquake, which many Haitians have taken to calling, simply, “the catastrophe,” will cause soul-searching in some circles, grim determination in others, and bitter recriminations from still other quarters. I will not contribute here to these veins of commentary, although we all know they’re important and inevitable. Instead I will use my time to comment on a few large but soluble problems now before us and to make two distinct and complementary recommendations. Indeed, most of these problems have long faced all those of good will who seek to stand in solidarity with the Haitian people, which is why, as physicians, we know that what happened on January 12^th is aptly described as an “acute-on-chronic” event.

Though by some reports and some “macro” indicators there had been slow improvements in Haiti in the year prior to the quake, the problems we’re struggling with today are longstanding, if much aggravated by the worst natural disaster to befall the world in recent centuries. Whether we look at health, education, potable water, or safe, affordable housing, we can draw similar conclusions: first, great weakness in the public sector makes it exceedingly difficult to deliver basic services at significant scale; second, not enough of the pledged earthquake relief has reached those in greatest need.

Although Haitians are rightly tired of having their country labeled “the poorest in the western hemisphere,” it is nonetheless true that the country has poor health indicators, was a few years ago deemed the most water-insecure nation in the Americas, has low levels of literacy, and now, with up to 1.6 million in IDP camps, has enormous, almost overwhelming, housing instability. Into the breach have come a large number of well-intentioned NGOs, which have sought, with some local success, to provide basic health and educational services, and, on an even smaller level, access to potable water and improved housing. I am myself from this sector, since I’ve been a life-long NGO volunteer and work for a U.S. medical school as a teacher and clinician. But I would like to argue here that my own earnest engagement in this arena has taught me that one of the primary tasks of development assistance, including that delivered by NGOs, must be to strengthen Haitian public-sector capacity, especially in the arenas of health, education, water, and housing—which some refer to as basic social and economic rights. Our historical failure to do so is one of the primary reasons that trying to help the public sector now is like trying to transfuse whole blood through a small-gauge needle or, in popular parlance, to drink from a fire hose.

Why the public sector? Before answering, I’m not suggesting here that NGOs and the private sector are not part of the solution; far from it. But there is a pragmatic and humble point to be made here: the profusion of NGOs—and some have estimated that Haiti, a veritable Republic of NGOs, has more of them per capita than any other country in the world—has not led to adequate progress in provision of basic services to all who need them nor to a functioning safety net for the poorest. Case in point: over 85% of primary and secondary education in Haiti is private, and Haiti is, as mentioned, plagued by illiteracy; over 500,000 school-age children were not in school prior to the earthquake.

There are transient ironies, too. Sometimes bursts of attention can improve a terrible situation; some blood does get through the too-small needle. Take water insecurity: by some reports, it has lessened since the earthquake led many groups to focus on bringing clean water to the displaced. One survey in Port-au-Prince suggested that diarrheal diseases had by last month dropped 12% below the pre-earthquake level. But is the massive importation of bottled water readily sustained? Is it the way to improve water security for all?

There is also a more philosophical point behind a plea for attention to the public sector: How can there be public health and public education without a stronger government at the national and local levels?

2. Why?
I have argued that the quake dramatically worsened a bad situation. I could focus on statistics, noting that some 17-20% of federal employees were killed or injured in the quake, or that 27 of 28 federal buildings were destroyed. And I would note that few public personnel were able to perform well within the buildings prior to the earthquake. Some of the best doctors and nurses I know are struggling to perform in the public sector without the tools of our trade—diagnostics and medications, for example, but also anything approaching adequate salaries. In a hearing like this one, it is important to ask why this is so, and I have previously done so before both houses of our Congress. It is not a pretty story, for the decline of Haiti’s already feeble civil service is tightly tied, and has been for a century, to internecine strife but also to U.S. policies. Other powerful countries have played unhelpful roles, too. 

Let me take only the last decade. Beginning in 2000, the U.S. administration sought, often quietly, to block bilateral and multilateral aid to Haiti, having an objection to the policies and views of the administration of Jean-Bertrand Aristide, elected by over 90% of the vote at about the same time a new U.S. president was chosen in a far more contested election. How much influence we had on other players is unclear, but it seems that there was a great deal of it with certain international financial agencies, with France and Canada; our own aid, certainly, went directly to NGOs, and not to the government. Public health and public education faltered, as did other services of special importance to the poor. I noted in a book written in those years that the budget of the Republic of Haiti, nine million strong, wasn’t much different from that of the city of Cambridge, Massachusetts, with 100,000 citizens; neither amounted to a quarter of the budget of the Harvard teaching hospital, a single one, in which I trained and now work.

Without resources, it was difficult for public providers to provide; many left to work in NGOs, which did not have a mandate to serve all citizens, and others left the country altogether. Choking off assistance for development and for the provision of basic services also choked off oxygen to the government, which was the intention all along: to dislodge the Aristide administration.

But the coup, simply denied as such by some in the so-called international community, did not really take. The U.S.-selected caretaker government was unpopular, unrest continued to grow, and Port-au-Prince became the kidnapping capital of the world in spite of a very large U.N. presence. Again, the so-called forces of order, the police, were weak or corrupt—as pale a reflection of what the force should have been as were public health and public education.

Some efforts to reverse this ruinous policy of squeezing the public sector, which was often and correctly denounced by Congresswomen Lee and Waters and many other members of the CBC, have been palpable over the past year, although progress has been slow. And then came the earthquake, which further decreased the capacity of the public sector to provide meaningful services, leaving once again a growing number of NGOs and other non-state providers to fill the breach. Allow me to give two more data points: on January 27th, it was noted in the Washington Post that less than 1% of all U.S. quake aid was going to the Haitian government. (Almost as much went, even, to the Dominican government.) My colleagues at the U.N. are tracking these numbers, and also pledges made and disbursed, and here’s one of the latest: of $1.8 billion for earthquake relief sent to Haiti, less than 2.9% has so far gone to the government.

I argued here in 2003, in testimony to the Senate Committee on Foreign Relations, that it is difficult, without real and sustained commitments to strengthening the public sector—including its regulatory and coordinating capacity, so that the quality of the services offered by NGOs and others will not be all over the map—to monitor funds and to use them efficiently. This remains true today. Thus are the Haitian people still tasting the bitter dregs of the cup we prepared for them as we weakened, or failed to strengthen, the public sector over the past decades.

During these years, unfair international trade policies cut Haitian farmers off at the knees, accelerating the complex and vicious cycle of urban migration and deforestation that set the stage for the food insecurity that was to follow, for the extreme vulnerability to heavy rains and storms, and for the massive overcrowding and shoddy construction revealed to all late in the afternoon of January 12^th.

3. What is to be done?
This is where we are at the six-month mark, as hurricane season approaches. Less than five percent of the rubble has been cleared. People are going to camps for shelter and for other services that all of us humans need to get by. Gender-based violence worsens the “structural violence” to which the poor, in general, are subjected. The good news is that the enormous generosity and solidarity of the world after the earthquake was and is real: it’s estimated that more than half of all American households contributed to earthquake relief. Speaking as a volunteer for PIH, I can proudly announce that we have, along with the Ministry of Health, already broken ground on a huge new teaching hospital in central Haiti. We know from experience, as my colleague Loune Viaud will report, that it’s possible to get a great deal done in rural Haiti, and these services and jobs will also pull people out of the city and contribute to the decentralization so desperately needed.

But there needs to be a shift, especially in how we plan and deliver basic health, education, and other safety-net services: a commitment to move at least some of the assistance (including private money) into public hands, which has not been at all the favored approach to assistance to Haiti. This is increasingly recognized as the right thing to do, as Paul Weisenfeld, Haiti Task Team Coordinator for USAID, who reported the falling rates of water-borne diseases noted above, observed recently: “I think it’s key to us that if we’re going to have sustainability we are going to have to work through Haitian institutions, which requires strengthening them. Obviously [they’ve] been weakened tremendously by this earthquake, so at the same time that we implement reconstruction programs, we need to strengthen government institutions so that we can work through them.”[1] We have also just worked with the American Red Cross to support performance-based financing of medical and nursing staff in Haiti’s largest public hospital. These efforts will not be easy, but they are necessary.

This shift will not be a panacea for Haiti but could be coupled with a powerful and complementary focus on another movement of capital, this time from public to private and from wealthy to poor: a focus on job creation and on strengthening the hand of those trying to farm (and reforest) the land and also on young people, especially young women, living in poverty. We need a greater sense of urgency. And the most urgent task of all is the creation of jobs that will confer dignity to those in greatest need. As FDR said early in the Depression, “The Nation asks for action and action now. Our greatest primary task is to put people to work.”[2]

As it was during the Great Depression, there are innumerable public-works jobs imaginable, from reforestation and rubble removal to preparing for back-to-school (la rentrée), which must put kids back in schools, safe schools, with the books and uniforms they need and a nutritious lunch during the day. As for health, Haitians need a real health system. This will require a massive investment in new clinics and hospitals, staff to run them, and health insurance at a time when only 300,000 families have it. These are indivisible tasks, as FDR noted at the outset of the Depression: “Public health . . . is a responsibility of the state as [is] the duty to promote general welfare. The state educates is children. Why not keep them well?”[3]

Job creation and improved health and educational services, with greater investment in the public sector: this should be a big part of the mantra. I do not mean to suggest that this transfer of capital, resources, etc., is easy. We know it’s not, because we’re in direct contact with the representatives of large multilateral and bilateral agencies, which have to follow laborious processes in order to disburse funds. But let us ask, in the face of urgent need, if we are well served by the fetishization of process now retarding the flow of capital into the hands of families in greatest need. The International Commission for the Reconstruction of Haiti, which is now being born, needs to be swift and nimble; the rules of the road for development assistance need to be rewritten, not to favor contractors and middlemen and trauma vultures, but to favor the victims of the quake. Right now there are shovel-ready projects, which could create tens of thousands of jobs and perhaps more. There are plenty of people living in poverty, including the market women who have never had access to capital or financial services and who have been working against an undertow of unfair trade policies, who are as entrepreneurial as anyone else in the world. Projects of all sorts can be greenlighted, but will move sluggishly if the funds seep into the ICRH too slowly and if projects cannot be moved forward because of strangling strictures on how the money is to be used.

People in this country know it’s possible to move forward with a sense of urgency. During the Depression, job creation and improved services from health care to education to rural electrification were the focus of many efforts. FDR, then the governor of New York, called for “workfare” and welfare through the Temporary Emergency Relief Administration (TERA). This call was made on August 28, 1931, and it was up and running by winter:

The crisis had finally imposed some discipline of responsibility even on the Republican legislators, who with uncharacteristic docility did what the governor asked. (The New York Voters would overwhelmingly approve the bond issue in November 1932.) Faithful to romantic notions of rural life, Roosevelt had TERA subsidize the resettlement of as many unemployed as possible on marginal farmland, with tools and instruction on how to cultivate it. In six years TERA assisted five million people, 40 percent of the population of New York State, at a cost of $1,555,000. At the end of the period, 70 percent of these were no longer reliant on government assistance.[4]

Later these lessons were taken to scale in many programs, including the Civil Works Administration, which created millions of jobs and moved billions into the public sector through public works and into the hands of the previously unemployed.

Certainly Haiti’s need is no less great than that faced by the States during the Depression. Let us hope it can build a more just tax base, even though its IRS, like its Ministries of Health and Education, has been destroyed. In the meantime, the world has responded generously and now it is incumbent upon us to move these resources into the hands of the Haitian people, especially those directly affected, in these two complementary ways. Again, this is not a choice between public and private sectors, any more than this is a choice between strengthening local agriculture and rebuilding infrastructure, but rather a plea to focus resource distribution on the poor and displaced by providing basic services and through job creation. There is no evidence whatsoever that this is an impossible mission.

[1] Remarks by Paul Weisenfeld, USAID Haiti Task Team coordinator, at a media roundtable on July 19, 2010. Available at: http://www.usaid.gov/press/speeches/2010/sp100719_1.html.

[2] Roosevelt, Franklin D. First Inaugural Address. March 4, 1933.

[3] Black, Conrad. Franklin Delano Roosevelt: Champion of Freedom. New York: PublicAffairs, 2003. Page 194.

[4] Black, pages 216-217.

Testimony of Loune Viaud
Director of Operations and Strategic Planning for Zanmi Lasante
[Download PDF of Loune Viaud's testimony - 42 KB]

Chairwoman Lee, esteemed members of the Congressional Black Caucus, thank you for inviting me to testify here today. My name is Loune Viaud, and I am Director of Operations and Strategic Planning for Zanmi Lasante, an organization devoted to providing a preferential option for the poor in rural Haiti. Zanmi Lasante is the partner organization of Partners In Health, an organization which also advocates for and provides a preferential option for the poor around the world. On behalf of Zanmi Lasante and Partners In Health, I want to thank the members of the Congressional Black Caucus for arranging this hearing, and for ensuring that the voices of Haitians are heard.  Today I will address the current situation and needs of the Haitian people, the needs of vulnerable children, the status of the healthcare system, and the need for decentralization and job creation.

The Current Situation and Haitian Priorities
On one visit to Port-au-Prince—even without venturing far from the airport—one will see that little progress has been made to date. I am going to talk about priorities—in any case, what we see as priorities on the ground. I see healthcare, employment, decentralization, protection of children, women, adolescent girls, the elderly and the most vulnerable members of the population. What happened to us the afternoon of January 12 changed everything. The way we live, the way we see the world and the future.

What happened to us is beyond words. So many people died. There are so many new people with disabilities, orphans, unaccompanied and displaced children, elders and women left vulnerable and at a loss. So much despair.

Despite this despair, we also feel grateful for the solidarity around the world. Immediately after the earthquake, a great number of people wanted to help, and many came to Haiti to do so. But now, six months later, we still need solidarity, and we need those who want to help to work in cooperation and partnership with and for the Haitian people. Rather than charity, Haiti needs partners. Haiti needs jobs. In particular, I see decentralization in the form of job creation outside of Port-au-Prince. Jobs will stabilize other parts of the  country, empower the communities, and save lives.

We need Haitians to lead the reconstruction efforts. We need our partners to take a rights-based approach in the construction of a new Haiti. This means supporting the capacity and the leadership of both the Haitian government and Haitian communities; it means deferring to the experiences of Haitians and guaranteeing our participation in the rebuilding of our country; it means unconditionally respecting all of our human rights—including the right to food, the right to decent housing and sanitation, the right to health, the right to potable water, the right to education and the right to security. 

	Loune Viaud with one of the children currently living at Zanmi Beni.

Zanmi Beni and Protection of Vulnerable Children
We at Zanmi Lasante (ZL) are doing our best to protect the rights of some of the very most vulnerable members of our population: orphaned and abandoned children, many of whom are mentally and physically disabled. Child wellbeing has long been one of Zanmi Lasante’s central concerns, as children are often the most vulnerable to sickness and deprivation of rights in the communities we serve. Following the earthquake, there was a desperate need for refuge and support for children affected by the quake.

In partnership with the Ministry of Social Affairs and Operation Blessing International, among other organizations, ZL is working to fill this gaping void. We opened Zanmi Beni, a home just outside of Port-au-Prince for abandoned and disabled children. Zanmi Beni, which means “blessed friends” in Haitian Creole, now provides shelter, education and love for over 48 children. We need more places like Zanmi Beni or at minimum, more children’s shelters. In challenging times and impoverished settings, children are often the most at risk, in part because they are not as able to advocate for themselves. 

Countrywide, the protection of children continues to be a priority as we work to improve the humanitarian situation in Haiti. Children were particularly affected by the earthquake: in the six months following the quake, of the almost 147,000 patient encounters logged at the clinics set up in the four settlement camps in Port-au-Prince, 40 percent were patients under age 20. Half of those patients were under five years old. Thousands more children were injured, traumatized, displaced, and orphaned by the earthquake. Children in Haiti, particularly homeless, disabled, and orphaned children, still desperately need shelter, care, and protection. We must make sure that their fundamental rights are protected, and that the government of Haiti is empowered to fulfill these rights.

The Health Sector
Together, the international community and people of Haiti must also work hard to ensure that the right to healthcare is being fulfilled for all. Strengthening of the healthcare system is essential to the restoration of Haiti.

On July 3, in partnership with local government, the Haitian Ministry of Health, Harvard, Duke, and Dartmouth Medical schools, and a variety of private and public organizations, Zanmi Lasante broke ground to begin building an innovative referral and teaching hospital. Mirebalais, where the hospital is being built, is about 35 miles north of Port-au-Prince, and is known as the “gateway” to the Central Plateau Department. The hospital perfectly embodies our commitment to Haiti in that it integrates research, teaching, and service, and is the result of a broad coalition of public, private, and government organizations, in both the U.S. and Haiti. 

Prior to the quake, our plan was to build a 108-bed teaching hospital offering comprehensive, community-based primary and prenatal care as well as treatment for TB, HIV, malaria, and malnutrition. However, the destruction of 80 percent of Haiti’s healthcare infrastructure on January 12 made the need for a hospital in Mirebalais more urgent than ever. Thousands of people have traveled to, and are still journeying into, the rural Central and Artibonite Departments from Port-au-Prince seeking desperately needed healthcare. Additionally, the earthquake badly damaged the country’s only teaching hospital, and destroyed most of its educational facilities. The state medical and nursing schools were particularly hard hit, and the Port-au-Prince nursing school, where an entire class of nursing students died, was completely demolished. After the earthquake, at the request of Haiti’s Ministry of Health, we expanded our vision for the hospital.

The new hospital will be 180,000 square feet and have 320 beds, in addition to state-of-the-art infection control, wall-mounted oxygen and medical gases, improved diagnostics (digital x-ray and ultrasound), and increased space around the beds to accommodate teaching rounds for medical and nursing students. The hospital will include the technological and logistical capacity to support educational exchanges, distance learning and remote collaborations. It is our hope that it will serve as a model for Haiti’s national healthcare system, a place where Haitian doctors and nurses can be trained and empowered to take care of the  country’s people. In this way, it is our greatest hope that the Mirebalais hospital will strengthen healthcare throughout Haiti and help solve Haiti’s healthcare human resource crisis.

We are employing local people to build the hospital that will serve them and their communities. This hospital will be our flagship, equivalent in capacity to all of our current facilities in Haiti. Perhaps more importantly, the Mirebalais hospital is a symbol: a symbol of our commitment to public partnerships and infrastructure, healthcare as a human right, and the people of Haiti. It is our commitment to “building back better,” hand-in-hand with the government and people of Haiti.

Simultaneously, we are working to restore the devastated General Hospital in Port-au-Prince—l’Hôpital de l’Université d’Etat d’Haiti (HUEH), the largest medical institution in the country. The General Hospital was nearly destroyed by the earthquake, and in the days that followed, surviving staff members and volunteers—over 370 in total—worked to treat thousands of badly injured patients. Over the course of days and weeks, electricity and running water were restored. In addition, along with numerous partners, ZL was there and helped staff 12 operating rooms, where staff members and volunteers performed surgeries 24 hours a day.   

More than six months after the earthquake, there is still much to be done, and ZL’s focus is changing from the immediate to long-term strengthening and care. The hospital staff has resumed responsibility for most clinical services, and so we have shifted to increased training, capacity, and professionalization of the nursing staff. We have also worked to establish a Friends of HUEH Foundation to build partnerships and financial support for rebuilding and strengthening the hospital.

As with the Mirebalais Hospital, we are committed to cross-sector partnerships and long-term planning. We have found that the best way to ensure that access to these services is both universal and sustainable is by partnering with Haitian public institutions that are ultimately responsible for ensuring that Haitians have the right to health, water, food, and education.  These partnerships ensure that the capacity of the government is enhanced, and that the assets we are creating—crucial infrastructure and services—are ultimately owned by the Haitian people.  Our partnerships have been successful because our goal is to support our government in doing its job – to fulfill all Haitians’ right to health.

Job Creation and Decentralization - Aquaculture Project
In addition to focusing on protection of children and on Haiti’s health sector, a main priority in improving the humanitarian situation in Haiti is the creation and decentralization of jobs. This is essential if Haiti is to stabilize and prosper, and to ensure that the human rights of Haiti’s people are fulfilled.

Haiti, like many countries, has historically seen in-country migration from its rural regions to Port-au-Prince, its capital city. Many moved to the city in search of employment opportunities. However, the January earthquake devastated Port-au-Prince, and set in motion a reversal of this trend. In the past six months, hundreds of thousands of people have moved to the Central Plateau and Lower Artibonite, areas where Zanmi Lasante has worked for over twenty years. Initially, most of these migrants were in need of immediate medical care—2,961 earthquake victims were treated at ZL health clinics in the first month after the quake. While many migrants continue to need healthcare, many moved in search of employment, stability, and survival. Decentralization of employment opportunities has become essential.

ZL and Partners In Health, in partnership with the UN Office of the Special Envoy to Haiti and the mayor of Boucan Carre, a region in the Central Plateau of Haiti, are working on a tilapia-raising aquaculture project. This project will bring jobs to hundreds in the region. It is again our hope that this project will also open up the region for development and investment on a larger scale.

In addition to the decentralization that is essential to Haiti’s recovery, the aquaculture project will help to fulfill other fundamental rights for people in the region. Currently, the region, two hours from Port-au-Prince, does not have access to fresh fish, a highly nutritious source of local food. The fish that is available is dried and is prohibitively expensive for most of the rural population. This project will both increase the amount of fish available, and at the same time decrease the cost to the rural population. In addition to providing food security, which is incredibly important, the aquaculture project will provide food sovereignty for a large segment of the population, enabling them to control food production for themselves and their community. In my humble opinion, we need more projects like this in the countryside of Haiti, especially where there are large rivers, which, instead of swelling during the rainy season and killing people in the region, they could be used  to feed the communities.

I cannot emphasize enough the importance of food security and food sovereignty. Particularly for a marginalized and under-resourced population, food security and sovereignty will be transformative. Any industry, development, investment, and employment that this project brings to the area could similarly transform hundreds of thousands of lives. It is long-term development projects and meaningful investments like this that we would like to focus on, in addition to dealing with more immediate needs.

Conclusion and Recommendations for Moving Forward
On all fronts, there is so much to be done.

I want to take this opportunity to express our gratitude to each and every one of you, venerable members of the Congressional Black Caucus, for all you have done for Haiti. Your work does not go unnoticed, and we are deeply appreciative. However, I am afraid that we still need you to do more.

Both the service and advocacy work will be long-term. Continued discussions and advocacy will be needed for bilateral and multilateral donors to encourage actual disbursement of the nearly US$10 billion committed at the 2010 Donor Conference at the United Nations in March. Working with the Robert F. Kennedy Center for Justice & Human Rights, the NYU Center for Human Rights and Global Justice, and the Institute for Justice and Democracy in Haiti, we proposed a rights-based framework for transparency and accountability to, international donors, implementers, and NGOs.   Along with the UN Office of the Special Envoy and other partners, we will continue to advocate for better implementation of foreign aid-funded projects and to channel more aid through the Haitian government in order to strengthen their systems and their ability to fulfill their citizens’ human rights.

We in Haiti appreciate the U.S. government’s commitment to partnering with our government and our fellow Haitians as we rebuild. We hope that this commitment will come with the tools needed to facilitate our participation. Central to our meaningful participation are transparency mechanisms that will help Haitians across the country track U.S. government funds at the local level and be able to provide feedback on projects as they’re being planned and implemented, and most importantly in the event that they do not have the desired outcome.

An immediate priority is the passage of the Supplemental War Funding Bill (H.R. 4899), which contains $2.9 billion in aid to be released for Haiti’s reconstruction. We need your help to protect the 425,000 or so families that are living in the internally displaced persons camps. These camps are crowded, ramshackle, unsanitary, and insecure - women and young girls are gang raped every night. The best possible solution is to build permanent housing to, among other things, decrease the gender-based violence, as well as create jobs and services. As the supplemental bill languishes, people are dying, and reconstruction is struggling. We need you to help us keep up the pressure to pass this bill.

We also need you to keep the attention on Haiti. Though the people of Haiti have long suffered at the hands of cruel dictators, brutally destructive international policies, and natural disasters; in the past, this suffering has often been ignored. However, immediately following the earthquake, the world’s attention turned to Haiti. Our work has been assisted by the massive outpouring of support and solidarity from people around the world and from the contributions of donor countries. However, we need to maintain this focus. Two weeks ago, on July 12, we marked six months since the earthquake. Unfortunately, this was met with only passing attention by the U.S. media and populace. However, for those of us in Haiti, we are confronted by the effects of the earthquake everywhere, every moment of every day. We are surrounded by evidence that there is so much more we can do to restore Haiti, and to fulfill the human rights of all in Haiti. Despite many challenges, there is much hope… I want to believe that with this administration, this Congress, those great friends of Haiti, there is hope and possibility for Haiti, if the right choices are made and the right actions are taken.

I don’t expect miracles. I expect there will be many challenges ahead both political (i.e. the elections) and by natural disaster (hurricane season and the risk of more earthquakes).  But I also expect your help, solidarity and partnership for the right choices and the right actions to be taken in favor of Haiti, venerable members of the CBC.

Mèsi anpil. Wout la long men avèk anpil men epi bòn volonte, chay la pa dwe lou…

Thank you very much.

Stand up for Haiti! Watch an inspiring music video that was written, directed, and performed by the talented youth of the Peapod Academy and the Boys & Girls Club of the Peninsula:

"STAND UP FOR HAITI" OFFICIAL MUSIC VIDEO BY PEAPO AYV MEMBERS from B & G Clubs of the Peninsula on Vimeo.

This video was produced with support from the Peapod Foundation and Adobe Youth Voices.

"Psychology is all about balance, and there is nothing balanced about living in a tent camp," says Elyse Noesille, a Zanmi Lasante/Partners In Health psychologist working in Port-au-Prince. He was recently interviewed by PBS NewsHour in a segment focusing on mental health in post-earthquake Haiti. Watch the full piece on the player below:

By Lindsay Palazuelos, Project Coordinator 

This blog post is the second in a series of Partners In Health’s supported project in Guatemala—Equipo Técnico de Educación en Salud Comunitaria (ETESC, Technical Team for Education in Community Health). Read Lindsay’s previous post.

	Michelle Lightfoot, HMS student, helping two Health Promoters practice taking vital signs.
	Jonathan Niconchuk, HMS student, talking with a group of Health Promoters during the vital signs practice.
	The board after a simulated patient case exercise.

Recently, I was in the hot seat at ETESC’s Health Promoter training.  Why?  A runny nose of epic proportions.  The Health Promoters’ job was to diagnose my ailment.  As I sat before them, blowing into a hankie, they asked a series of key questions: how long had I been sick, did I have a fever, a cough, sinus pressure?  Their conclusion was that I had the common cold, albeit a particularly snotty one, and I had better have some tea. 

This relatively simple diagnosis was in fact the result of a sophisticated process: the syndromic approach to diagnosis.  This means using a pre-determined set of questions and clinical signs in the form of algorithms (flowcharts, in this instance) based on medical evidence and local epidemiology.  Health Promoters’ ability to differentiate among common illnesses--and refer serious ones before they advance--is critical to their role as clinical extensions in rural villages.  Francisco Pablo Francisco, a Health Promoter, explained, “I like the way we’re learning practical skills…Now we know [more about the human body], how to interview a patient, and diagnose what they’re suffering from.” In this model, Community Health Promoters serve as a local resource for common ailments, but most importantly, extend active case finding.

Two Harvard Medical students, Jonathan Niconchuk and Michelle Lightfoot, with the assistance of Clinical Director Dan Palazuelos, are leading ETESC’s cadre of health promoters in intensive trainings on the syndromic approach.  Through PIH’s collaboration with Harvard Medical School, the students gain valuable experience in global health while contributing to service or research projects on the ground.  “The process of teaching is the most powerful motivator to learn more yourself,” Jon reflected.

The training also emphasizes appropriate use of medications.  Most medicines are in Guatemala are sold over the counter in the same manner as hair gel or potato chips, sometimes leading to inappropriate use.  Through training, Health Promoters may help break many common patterns of misuse, such as antibiotic overuse or treating the symptoms of a serious chronic disease while the cause continues unchecked.

Another goal of the course is to serve as a training laboratory, yielding important insights into the best pedagogic methods for community health workers.  Feedback so far highlights using real or simulated cases (like me), as a top method.  The Promoters have made the method their own, and at a recent regional health conference, the ETESC group volunteered to lead just such a case activity for all the attendees.  “Seeing the Health Promoters adopt a patient-based learning style was great,” Michelle said. “It showed that they found it useful.”

In a remarkable show of dedication, the Promoters elected to add days to the trainings to be able to learn even more information.  I could hardly believe my ears when Francisco gave the course what I felt was the biggest vote of confidence.  In a country where the midday meal is nearly sacred, he urged, “We can keep going through lunch!  Give us more example patients, and we can practice while we eat.”  

For more information about ETESC, click here or contact lpalazuelos@pih.org

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After the earthquake destroyed the pediatric ward they had been living in at the General Hospital in Port-au-Prince, 38 abandoned and physically and developmentally disabled children needed a new home. Partners In Health and Operation Blessing decided to help.

Learn more about Zanmi Beni in PIH's STAND WITH HAITI Six Month Report.

The newest graduates of the Chiyanjano adult literacy program.

On July 9, about two dozen men and women in the small village of Magaleta in rural Malawi celebrated a life-changing achievement--learning to read. In a formal graduation ceremony, they shook hands with village and government officials and accepted their certificates for completing the adult literacy program organized by the Chiyanjano Community Based Organization.

Supported by PIH’s sister organization in Malawi, Abwenzi Pa Za Umoyo (APZU, “partners in health” in the local Chichewa language), this certificate program aims to help improve the country’s abysmal adult literacy rate, which hovers below 72 percent. The program is one of several throughout the Neno District that are supported with funding from APZU’s Program on Social and Economic Rights (POSER).

The community put on a huge celebration to honor the new graduates, reported Innocent Mwenyekeni, APZU’s Director of POSER and Community-Based Programs, who was on-hand to help present the certificates. A local band and dancers performed, and the event was covered by the local radio station.

Local officials handed out certificates to the new graduates.
The community of Magaleta gathered to celebrate the achievements of their neighbors and family members.
Some of the new graduates also received fresh vegetables after receiving their certificates. These crops were cultivated in a related project organized by APZU and the Chiyanjano Community Based Organization.
The Chiyanjano permaculture garden, supported by APZU, teaches farming techniques to community members affected by HIV/AIDS (either living with the disease themselves, or caring for others living with or orphaned by the epidemic). Participants of this program learn about good nutrition as well as sustainable agricultural practices, such as crop diversification.

“Do you know where you are?” Tatiana Therosme gently asked her patient for the third time. The patient, a rail-thin young woman in a cream-colored dress, stared blankly back before mumbling softly that she was at school. “Do you remember where you’re from?” The patient looked slowly around at the other people in the small room at Zanmi Lasante’s hospital in Cange, but remained silent.

The earthquake continues to haunt many survivors, even after the physical wounds are healed.

Tatiana, a psychologist for Zanmi Lasante (ZL) quietly began questioning the woman’s roommate. Yes, she talks to herself out loud, the roommate tells her. Yes, she seems to hear and see things that others can’t. Yes, she cries and sleeps a lot. Tatiana nods. She’s recently seen similar behaviors in another patient.

Less than a mile from the Cange hospital is a small house with a little table set out front displaying tidy stacks of crackers and candy. Esther, the young woman seated next to the table, has spent the morning selling her wares to school children and other passersby. She grins broadly when she sees Tatiana coming down the dusty road and darts into her house to grab chairs for her visitors. But glancing quickly up at the ominous clouds amassing above her (it’s the rainy season in Haiti after all), she decides it’s better to invite her guests into her house instead.

As she sits at the kitchen table, laughing and joking with Tatiana, it’s hard to believe that six months ago, Esther was a completely different person. Like the patient Tatiana met with earlier in the day at the hospital, she once seemed incapable of talking or responding to questions. She would stare blankly ahead, practically catatonic. She heard voices, and sometimes flung off her clothes in public.

Even before the devastating earthquake, getting treatment for mental illness in Haiti was exceedingly difficult, if not impossible. In the whole country, there were only 10 psychiatrists and 9 psychiatric nurses working in the public sector, according to a 2003 World Health Organization report. And most of them worked in the capital city, meaning that patients would have to travel hours, or even days to receive care.

It’s difficult to estimate the true impacts of the earthquake on the mental health of survivors. But in terms of loss of loved ones, life-altering injuries, hundreds of thousands of displaced survivors, and widespread social and economic insecurity throughout the country, the effects are inescapable. In such an unstable environment, many who may have had pre-existing untreated psychiatric problems prior to the earthquake deteriorated in the aftermath.

Since the earthquake, the PIH/ZL mental health and psychosocial team has mobilized more than 65 Haitian staff, including psychologists, social workers and community health workers, to work directly with local communities and the Haitian government to strengthen mental health services at our PIH/ZL health facilities throughout the Central Plateau and Artibonite regions of Haiti. Physicians and nurses at ZL hospitals are also being trained in management of acute psychiatric problems in collaboration with the psychosocial team. The team also began providing care at PIH/ZL’s medical clinics in Port-au-Prince, serving four resettlement camps for displaced earthquake survivors. PIH has a long-term commitment, both to building upon pre-existing psychosocial services and informal mental health services, and over time, to developing a system of care better able to meet the mental health needs of Haiti’s people—from recent amputee patients dealing with post-traumatic stress, to tuberculosis patients suffering from treatment side-effects (such as Tatiana’s unresponsive patient currently in the Cange hospital), to patients with earthquake-aggravated psychoses, like Esther.

Esther remembers the earthquake. She was living in the coastal city of Jérémie at the time, about 170 miles west of Port-au-Prince. “I felt that the earthquake was happening right under my house, there was a terrible noise. Everything was shaking.” She remembers running out of her home, terrified. However, her memories of what happened next are very vague. She can’t remember any of the destruction, or if any of the houses near her fell down.

Following the devastating earthquake, a group of missionaries tried their best to treat Esther’s psychosis. But their prayers and exorcisms failed to help her condition. They knew they couldn’t just leave her in the streets, so some of them who were originally from Cange brought her back with them.

Soon after arriving in the Cange, the missionaries brought Esther to ZL’s women’s health clinic after she began urinating on herself. The gynecologist referred her to the hospital’s urologist, who recognized that Esther may be in more desperate need of psychiatric help rather than his expertise. He alerted Tatiana and her team.

Esther has no memory of meeting Tatiana and does not remember being unable to respond to others at the hospital. After Tatiana’s initial evaluations and therapy sessions, PIH mental health director Giuseppe Raviola, a psychiatrist, examined Esther, reviewed her case history with Tatiana, and started Esther on a low dose of an antipsychotic medication. Tatiana could tell the drug was helping at their next appointment—Esther made eye contact, and began to participate more in her therapy sessions. As a convenient side effect of the medication, she also began to put a little weight onto her thin frame.

Others around her also noticed the amazing change. “You could tell that she was an actual person, she was responding to us,” said the husband of one of the missionaries who helped bring Esther to Cange. “[Before], we didn’t know what to do. You didn’t know what she was thinking, what she was doing, how she was going to live.”  Esther now lives with his family.

And then on Good Friday, just a few weeks after she began treatment, she shocked her congregation by getting up and singing with them during a prayer meeting. After months of caring for the silent woman, the missionaries were overjoyed. Some even cried. Esther laughs and flashes a huge smile at the memory. Today, she regularly sings in the church’s choir. Her host family has also helped her set up a small business selling snacks and other items from the porch of her house to help generate an income.

Esther (left) with Tatiana.

In the fall, ZL will also help her finish her last two years of school. At the mention of school, Esther looks up expectantly at Tatiana. She wants to get her hands on some school books. At 28-years-old (although with her apple cheeks, she could easily pass for a teenager), she’s nervous that it’s been awhile since she was last a student and is eager to use the next few months to catch up on lost time.

“What do you want to do [after you finish school]?” Tatiana asks her. Esther laughs, she hasn’t thought too much about it yet. “What's your dream?” Tatiana asks. “For me, I wanted to be a psychologist.” It’s an odd question coming from her—the two women are actually about the same age, and equally youthful. At this moment, sitting at the kitchen table, it’s hard to tell who is the doctor and who is the patient.

“Psychology is a great thing,” answers Esther slowly, grinning at her doctor. “Maybe I could do that!”

Tatiana smiles back. Post-earthquake Haiti could definitely use more psychologists.

UPDATE: January 2011 - Find out how Esther is doing one year after the earthquake.

	Socios En Salude inaugurates the new Carabayllo Cultural Center.
	To celebrate its inauguration, the new center hosted a health fair featuring educational activities for children.

In July, Socios En Salud, Partners In Health’s partner organization in Peru, celebrated 14 years of bringing high quality health services to families living in some of the most marginalized communities in the country. As part of the anniversary activities, SES officially inaugurated their new Carabayllo Cultural Center, which will serve as a community space for neighborhood children to learn, play, and develop artistic skills.

Because education is one of the most effective ways of breaking the cycle of poverty and disease in the communities served by PIH, the new facility will be key in helping to advance SES’s mission in Carabayllo.

Over the course of three days, the new center hosted a health fair where SES staff exhibited programs on HIV/AIDS prevention, Community Health, and Tuberculosis (TB) treatment and prevention to the residents of Carabayllo, a community that has watched SES grow since 1996.

To highlight SES's HIV/AIDS programs, the event featured activities including informational booths staffed by SES nurses and health promoters, skits that highlighted the difficulties of stigma and discrimination faced by HIV positive people, and a discussion led by Dr. Jose Luis Sebastian, director of the National Health Strategy on HIV/AIDS at Peru's Ministry of Health.

Community Health Workers from SES's social projects presented their work in four major fields: nutrition, community health, education, and early childhood stimulation. Several mothers, attracted by the smells of delicious food, came to learn how to prepare nutritious and inexpensive meals, while promotoras explained the importance of a balanced diet.

To present SES's education programs, the team presented a number of learning games made from recycled materials, which children used to solve communication and mathematical and logical problems. There was also space set up for them to make their own puppets and read stories in the center's library.

The team also used games to showcase its programs to treat and prevent TB. Eager participants lined up to throw a “TB dice” and earn prizes by responding correctly to questions about TB. Participants also worked together to assemble images of lungs on poster boards while learning about the disease. 

Former patient Sra. Zila Huaman captivated the audience with her personal testimony of living with TB, accompanied by a wall of photographs showing how the disease had affected her. “If I could get better, everyone can do it,” she concluded.

Other TB patients enrolled in SES's income generation project testified that poverty could be overcome and TB eradicated through the creation of micro enterprises.

Concluding the anniversary activities, SES nurse Roberto Zegarra remembered how 14 years ago, a group of young people in the Carabayllo community identified multidrug-resistant TB (MDR-TB) as one of the principal health problems faced by the community. Despite the fact that people with MDR-TB at that time were considered untreatable, SES kept working with them hand-in-hand. Together, they proved that they could overcome the disease, and showed the world that MDR-TB can be cured in poor countries.

On July 3, Partners In Health (PIH) and our Haitian sister organization, Zanmi Lasante (ZL), broke ground in Mirebalais, Haiti, for a innovative teaching hospital. Mirebalais will be a national referral facility, the flagship of our efforts to help rebuild Haiti’s health sector. By the first anniversary of the earthquake—January 12, 2011—the seven buildings of the main hospital campus, comprising 180,000 square feet, will be standing, with work on the interiors begun. Plans call for the hospital to be accepting patients by the end of 2011.

The new hospital will have 320 beds—equivalent in capacity to all 12 of the sites in which PIH currently works in Haiti, combined—and will offer clinical facilities not available at any public site in the country, including an intensive care unit and an operating theatre complex with six operating rooms equipped for thoracic surgery. The original plans for a 108-bed referral hospital for the lower plateau, offering comprehensive, community-based primary and prenatal care as well as treatment for TB, HIV, malaria, and malnutrition were expanded at the request of the Ministry of Health following the January 12 earthquake.

Dr. Alex Larsen, Minister of Health, said “What Haiti needs now are true partners to help us build back better by strengthening our country's public infrastructure. The new teaching hospital at Mirebalais will be a model for our national health system, offering high-quality medical services, a place for our clinicians to study and train, and hope and dignity to all who will seek—and offer—care there. We look forward to building upon our long-standing partnership with Partners In Health/Zanmi Lasante with this desperately-needed facility."

Mirebalais Hospital will include not just more beds and operating rooms, but state-of-the-art infection control, wall-mounted oxygen and medical gases, improved diagnostics (digital x-ray and ultrasound), and increased space around the beds to accommodate teaching rounds for medical and nursing students. Partnerships with leading universities and teaching hospitals will support the medical training and education of Haitian clinicians, as well as that of visiting international clinicians. The hospital will include the technological and logistical capacity to support educational exchanges, distance learning and remote collaborations.

Dr. Paul Farmer, co-Founder of PIH, Chair of the Department of Social Medicine at Harvard Medical School, and Chief of the Division of Global Health Equity at Brigham and Women’s Hospital in Boston, calls the Mirebalais hospital project “exactly the sort of building back better in Haiti that also seeks to improve the very nature of development assistance. Too often, NGOs and research universities do too little to help create a strong public sector, without which public health and public education will always be anemic.

“For some of us, this hospital is the culmination of a dream dating back a quarter-century, and underlines our commitment to the country and people of Haiti, which is stronger than ever after the earthquake. It is also a manifestation of our integrated model of research, teaching and service, and will serve as a site for all three. Mirebalais is being developed by a broad coalition which includes hundreds of individuals, several foundations, private corporations, Harvard teaching hospitals including Brigham and Women’s, Harvard Medical School, and of course our Haitian colleagues at ZL and the Ministry of Health. We are fortunate to be building upon the lessons learned in ZL's long experience of building infrastructure in Haiti, and to have the support of many old and new partners in this essential effort.”

Dr. David Walton, PIH’s Deputy Chief of Mission in Haiti and a physician at Brigham and Women’s, is leading the project together with Jim Ansara, founder and Chairman of Shawmut Design and Construction: “We are proud to be building a hospital that will offer all Haitians the care they deserve, as well as a place to learn and practice medicine at the highest level. I am grateful for the many partnerships that are making this project possible, and to the many experts and companies offering their skill and materials. It is a privilege to work with the community of Mirebalais, the Government of Haiti and our many partners to make this shared vision a reality.”

Learn more about PIH's work to help Haiti's people build their lives and their country back better following the January 2010 earthquake in our STAND WITH HAITI Six Month Report.

Genevieve Joubert oversees the Zanmi Lasante clinic at Dadadou.

When Rosalind went into labor on January 21, she knew whom she needed to find—her neighbor, Genevieve Joubert. After all, it was Genevieve who had been there for her in the immediate aftermath of the devastating earthquake as she had endured a mother’s worst nightmare—the death of a child. So it was only fitting that it was Genevieve who helped her bring a healthy baby into the world less than two weeks later.

Rosalind’s gratitude towards her neighbor isn’t unique. Since January, Genevieve has delivered 165 babies in the area known as Dadadou, a soccer stadium currently taken over by a spontaneous settlement camp for displaced earthquake survivors.

Like many of the over 10,000 people now living in the settlement, the 41-year-old nurse and had lost everything in the earthquake—her house in Port-au-Prince and all her possessions, save for the clothes on her back. She and her husband and their two children joined many of their newly homeless neighbors at Dadadou because she knew that the growing settlement would need her 20 years of nursing experience. “I came here because that’s where people were coming,” she said simply.

She immediately began treating the injured. With sutures and other medical supplies procured from a pharmacy she used to work with, she singlehandedly dressed 1,100 wounds and sutured 300 patients in just the first three days following the earthquake. She worked around the clock. Word of her services quickly spread through Dadadou, as well as around Port-au-Prince. Near the end of January, the Zanmi Lasante team learned of her efforts. They found her and asked her how they could best support her efforts. Under her leadership, Dadadou soon became one of the four settlements around Port-au-Prince now served by ZL clinics.

A former soccer field, Dadadou is now home to over 10,000 earthquake survivors.

Today, the ZL clinic sits facing the hundreds of camping tents and makeshift shelters of sheets and tarps that completely cover the Astroturf soccer field. Logging thousands of patient visits each week, the clinic team  provides a full complement of primary health care services, including programs for mental health, pediatric malnutrition, HIV testing, and of course maternal health.

“As I began to get more and more support from ZL, I started to feel less devastated because there was a sense of support, a sense that things could continue,” says Genevieve, through a translator. “Now I can say, it’s not really a clinic that we have here, we have a hospital!”

During the day, Genevieve oversees the clinic’s activities. But at night, when the clinic shuts down, she remains on-call—essentially a one-woman ER. “During the day, I work for ZL. And during the night, I work for myself,” she says with a gentle smile.

Her home, a four-person camping tent erected next to a makeshift structure of canvas and wood, sits just a few yards to the right of the clinic entrance. At night, she sets up her supplies in the dark green tent next to her home, which during the day shelters nursing mothers and women seeking care at ZL’s Proje Sante Fanm (women’s health project). After dark, the green tent houses mostly trauma patients, mothers in labor, and victims of violent crimes.

As she’s one of the only sources of medical care in the area between the hours of dusk and dawn, it’s not unusual for her to receive patients from other nearby settlement camps. Local police also know about her (her husband is a policeman), and often bring victims with knife and gun wounds. For the most serious cases, she’ll wake up one of her neighbors with a car to take the patient to the city’s General Hospital. She usually pays for the gas out of her own pocket.

One of the 165 babies Genevieve has delivered since the earthquake.

If providing medical care around the clock weren’t enough to fill every minute of Genevieve’s day, there’s also the large gray military-style tent in front of her home. It shelters many of the 64 abandoned or orphaned children that she now cares for. Off to the side, a lean-to covered with a blue tarp shades a small stove and several large pots—the kitchen where she cooks meals for her family and the children. She’s hoping to set up another tent in the near future so that there will be separate spaces for boys and girls.

With so much responsibility, it’s not unusual that she sometimes feels incredibly discouraged with what she’s up against in her day-to-day work. “I have to take a step back and take a little time, and I find that it passes,” she says. “It’s really just the knowledge that I’m here and I have things to offer [that keep me going],” she adds.

For Rosalind and thousands of others she’s stitched up, diagnosed, treated, and cared for over the past six months, Genevieve being there for them has literally kept them going.

Learn more about PIH's work to help Haiti's people build their lives and their country back better following the January 2010 earthquake in our STAND WITH HAITI Six Month Report.

By Lindsay Palazuelos
Project Coordinator 

This blog post is the first in a series on Partners In Health’s supported project in Guatemala—Equipo Técnico de Educación en Salud Comunitaria (ETESC, Technical Team for Education in Community Health)

ETSEC facilitator Mandy Lemus leads students in an activity.

Students discuss with they have learned.

ETSEC co-facilitators Elda Yosmeri Morales Hernandez
and Mandy Lemus.

Despite late afternoon heat and the buzz of mosquitoes, the twenty teens in Agua Escondida’s small high school were paying close attention. Mandy Lemus, a facilitator for the health education program led by PIH’s supported project, ETESC, walked between the desks. “Why,” she asked, “do people abuse alcohol and drugs?” The students slowly opened up, sharing ideas and experiences from their lives. One young man at the back of the class offered: “to forget their suffering”. Such candid discussions are rare in much of the world, including this western corner of Guatemala. However, to help young people navigate their choices, they are essential.

Students and teachers have jumped at the chance to receive practical information about adolescence, STIs, drug abuse, and HIV. ETESC’s program is now in place at over 20 schools, teaching a series of six modules to students ages 11 and up, with many more institutions asking to participate. The course is also offered to groups of teachers, many of who have not received health education themselves.

Mandy’s co-facilitator is Elda Yosmeri Morales Hernandez, who led the students in several confidence-building exercises. At ages 22 and 19 respectively, these young women are especially well positioned to relate to students as peers and understand their perspectives and concerns. As Mandy explained “Many people feel uncomfortable talking about these topics, which is why we put great emphasis on myths and taboos, to break through the fear, to break the ice and be able to talk openly.”

Both women see the program increasing not only student confidence, but their own. “At first I was nervous to lead the class, but now I feel sure of myself,” Yosmeri stated proudly.

Perhaps the most challenging lesson includes practicing applying a condom (on a banana). Students are typically mortified that they will seem like “an expert” whenever they ultimately use a condom with a partner. “My response” says Mandy, “is that knowing is different than doing. We’re teaching them now because they need to be prepared whenever the appropriate moment does arrive, socially, emotionally and physically.”

ETESC hopes to adapt and expand the program to include more hard-to-reach teens who are not in school. Students have given the program high marks for relevance and teaching them something new. At the end of the class in Agua Escondida, those feelings were echoed by a thirteen year old in the first row, “I thank you for coming, because this is really important to know, and its information I can use.”

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Roselene (left) after finishing treatment for cervical cancer in March of 2002

In March 2010, Zanmi Lasante’s (ZL) Loune Viaud received a phone call she has received too many times in the past. A friend was calling from Cap-Haïtien—a large city on Haiti’s northern coast—to ask if Loune could help refer his patient, Marcelle, to one of ZL’s hospitals. He told Loune that his patient had cancer and needed access to resources not available at his hospital.

ZL staff brought Marcelle to a cancer research hospital in Santiago, Dominican Republic, to obtain an evaluation. Tests confirmed that not only did she have cervical cancer, but that the cancer had already progressed to an advanced stage. “When we were informed that all the hospital could do was palliative care, after several weeks in Santiago, she returned to Cap-Haïtien to spend her remaining days with family and friends,” says PIH representative Kamila Przytula. “We made sure that she would receive pain medication [morphine] to help her with the pain. Sadly, she passed away on May 22.”

Each year, an unknown number of women across Haiti die from cervical cancer, a condition most often caused by human papillomavirus (HPV). Too often these women afflicted with HPV go undiagnosed because of lack of access to cervical cancer screening. Although Pap smear is available in Haiti it remains inaccessible to most women because of cost and challenges of pathology—the process where in tests are sent to a laboratory for forensic evaluation. Most facilities lack the resources needed to treat moderate to advanced cancer and there is no radiation therapy available in Haiti. These circumstances too often turn an otherwise highly curable form of cancer into a death sentence.

In response to this public health problem, ZL is working to increase women’s access to cervical cancer prevention at its clinics by incorporating screenings into routine checkups. Staff are also working to ensure that women who develop cervical cancer have access to treatment as soon as possible, before it becomes untreatable. “The other scenario is when a woman seeks medical attention once the signs of cervical cancer are obvious to her,” says Kamila, “once she thinks something is wrong—which in some cases means it is too late for treatment.” Like Marcelle, these women’s conditions are only detected during the disease’s final stages, when symptoms such as profuse hemorrhaging suddenly propel these women into life-threatening situations.

Despite having both skilled staff and access to medications at Hospital Bon Sauveur in Cange. ZL physicians can only treat abnormal cervical lesions and stage 1 cervical cancer. Most often, ZL uses one of two procedures to deal with cancerous cells: cryotherapy—a treatment where an extremely cold liquid is used to destroy pre-cancerous, but abnormal, cells; or, LEEP (Loop Electrosurgical Excision Procedure)—a treatment where a thin, low-voltage electrified wire loop is used to remove cancerous cells if the cancer is still in its early stages.

However, Marcelle’s tragic death drove home the fact that ZL needed access to more advanced equipment and medicines to respond to cervical cancer. Her death sparked a new ZL project aimed at referring cervical cancer patients to the Instituto Oncológico Regional del Cibao (IORC), a charity cancer hospital in Santiago de los Caballeros, Dominican Republic.

Between July 2010 and June 2011, 15 Haitian women will receive treatment for cervical cancer at this cancer hospital through a combination of radiotherapy, chemotherapy, and brachytherapy—a type of therapy where a radiation source is placed inside or next to the area requiring treatment. This ZL project is part of an institutional relationship with the Patronato Cibaeño Contra el Cancer, a Dominican charity that raises funds to support the cancer hospital and treat cancer patients who cannot afford care at other facilities.

Madam Blanc is the first of the 15 women ZL will be bringing to the IORC for treatment. “She was diagnosed at the ZL hospital in Cange with cervical cancer stage 2B—where the cancer has spread to tissue near the cervix. Once in Santiago, however, the doctors diagnosed her as being at stage 3B—where cancer has spread to the pelvic wall. She is currently receiving treatment,” says Kamila. Despite the cancer being at a relatively advanced stage, ZL and IORC staff are hopeful that Madam Blanc will make a full recovery.

Zanmi Lasante staff standing in front of the IORC

She, like with other women who will come after her, will go to IORC with all of her preliminary lab work already completed by ZL staff in Cange. This means that after arriving in Santiago, each woman will be ready to begin treatment almost immediately—as opposed to the typical 4 to 5-month waiting time. “The actual length of each woman’s stay depends on how well she responds to treatment and whether or not new lab tests need to be performed throughout the duration of her treatment,” says Kamila.

While in the DR, each woman will live in a ZL-operated house with a family member. The apartment is small; it has one bedroom with two beds, one bathroom, and a kitchen. But ZL staff have carefully and thoughtfully outfitted the house with amenities that will allow all the women to feel comfortable during this difficult time. “We [ZL] will pay for their transportation and food costs, while, of course, covering all treatment-associated expenses,” says Kamila.

Dr. Gary Jean, a Haitian doctor working at the IORC, will help the women navigate through the treatment process. He will also serve as a link between the hospital and ZL staff during each patient’s treatment.

ZL has been in contact with the IORC since May 2001, when ZL brought an advanced cervical cancer patient there for the first time—after Dr. Maxi Raymonville, in charge of Women’s Health at ZL, learnt about the facility. Roselene, a young woman from Cange and mother of two children, spent several weeks in Santiago and returned to Cange after successfully completing therapy.

In addition to diagnosis and treatment, ZL is also working to prevent cervical cancer through an HPV vaccine pilot. Gardasil is a vaccine that prevents around 70 percent of the most dangerous types of HPV, specifically those that cause cervical cancer. The pilot targeted girls 10-13 in 3 communes of the Central Department. In addition, ZL is also piloting HPV DNA testing by self-sampling. This sensitive test that women can do in their own home allows for the identification of women with a high risk HPV infection—one known to cause cervical cancer—so that they can receive further medical attention, preventing invasive cancer.

Bonjou se’m ak fre’m yo
Good morning my sisters and brothers

Partners In Health co-founder Ophelia Dahl honored Mme. Yolande Lafontant during a memorial service held on June 6 with these words. Mme. Lafontant, better known as Mamito to those around her, will be missed by all of the thousands of people whose lives she forever changed.

Please excuse me for not speaking to you in Creole today. At a time like this I want to be able to use the words and meanings at the tip of my tongue. As Marie Flore said to me the other day: English is the language of sentiment for me. However, Polo [Paul Farmer] will kindly translate in his own special way.

As always, I come here on behalf of many others: colleagues, family, and friends the world over, many of whom cannot be here, but are aching with you. I promised them that I would convey to Pere Lafontant, his entire family, and to you all how keenly they feel our loss and how closely they are holding you in their thoughts and prayers. The condolences have come from far and wide, unsurprisingly, for Mamito touched so many people. It gives me great strength to be here in this church with all of you to reflect upon Mamito’s life and the impact that she had on the lives of so many others.

From the first moment I set foot in Cange in the early 1980s my life was indelibly altered for the better, enriched in ways I never could have imagined. Before I left England for Haiti I tended to think of family as my immediate relatives—my brothers, sisters, uncles and aunts. When I came to Haiti and spent the first of many months here in the Central Plateau, I realized that my definition of family had been too narrow. Like many of you, I was welcomed, taken in, most lovingly, by the Lafontants and the extended Zanmi Lasante family. At the heart of this family was Mamito—the matriarch, the standard setter, and a woman to emulate for many reasons not least for her ability to welcome a population of visitors and guests that covered almost every corner of the world. Her capacity to host (and its religious meaning seems only reinforcing) is something she has passed on to others, hopefully all of us).

However, Mamito’s great contribution is far more than simply opening the door to invite people in, itself an important act, or even to nourish the hungry and to clothe the naked. It was instead her incessant drive to find out why those people didn’t have a door of their own, or food, or a school to go to in the first place and to make it right. Her restless drive would leave no stone unturned, no child out of school, and there were times when I confess, even years ago, her energy was greater than mine. With her gentle (and not so gentle) urging she pushed us to achieve more, to do a better job, to tend to the details. Thinking of those details now, it would be hard to even begin to count those people who have learned to read, or who have a house, or a job because of her determined vision of accompaniment. Like many of you I feel that I was not just educated, but raised by Mamito and Pa Frico.

My earliest memories of Cange back then are very different from now. Some people in the States who wish to support Zanmi Lasante speak to us very passionately about wanting to support a program or project that will have transformative effects, transformative changes. They talk about wanting to give in such a way that they will literally see the difference their contribution has made, a difference that perhaps would not have happened had they not become involved. And they want it to happen quickly. Overnight if possible. And I want to say to them, I will show you transformative change. Come to Haiti, visit Cange, look at what used to be a settlement camp and see what has grown from it. But it did not happen overnight. It is particularly important today to keep in mind just how much change can take place over a short period of time. It happened because of all of you and of course at its center, its inspiration, were Mamito and Pere Lafontant. It is hard for me to separate them as so united are they in their efforts.

Of course in the 1980s, just as today, there were many projects being worked on at the same time, but the one that stands out to me for its pure achievement and its ability to not be foiled, was the mission to bring water to the many residents of Cange. As is often the case in Haiti, there is both irony and poetry to this story. The irony is obvious: for as simple asit may seem now, the residents had become refugees after their valley and their land were flooded. Yet what was the one thing they lacked? Water—a clean source of water. So with the help of our partners from South Carolina, an underground spring for the water was found—a constant stream of water. The trick was to harness this energetic underground stream and bring it up a steep hill 800 vertical feet, against gravity. With the help of engineers the water was channeled up the cliff using its own force and distributed to several standpipes throughout Cange.

Talk about transformative change! Our ability to provide clean water to the residents and to watch the effects it had on the community who were no longer drinking dirty water meant that babies were no longer dying of dehydration. I associate Mamito with this valuable source of life not just for her tenacious qualities of getting things done against the odds, for helping to pioneer the water project, insisting on clean water as a right, but because to me she embodied the qualities of the sous [the source in Haitian Creole]. She is after all a giver of life, the source of our work together, a sustaining force, never resting, always there but not always seen, pushing uphill to get results and doing important work which in turn has brought life to other programs. From that water project other medical programs were born. Transformative change indeed.

For everyone in the country the notion of welcoming, of hosting was sorely tested after January 12 when this entire campus—and many others—became a medical center for the seriously afflicted. However, Cange was more than a place for the sick. It became a refuge for many whose homes and hearts were broken. There were many more mouths to feed and almost imperceptibly (though with tremendous work behind the scenes) the fishes and loaves multiplied and the doors stayed open even as the hospital became a church and the church, this church, was transformed into a hospital and that alter a pharmacy. As always, Pere Lafontant and Mamito knew the best way to serve and accompany a devastated community. And many people who had nothing left but their wrecked bodies made their way up the mountain to Cange, an apt place not just because of its medical center, but because its genesis fifty years ago was as a home for refugees from the flooded valley. It was an astounding and moving place to watch people heal, to observe what happens when the huge community of Zanmi Lasante pulls together with Mamito at its heart. And countless people here ensured that it was not only their health that returned, but their dignity too. No one can deny that what took place here after the earthquake produced transformative change.

If the essence of what we do together is to accompany then surely Mamito is the person who has taught us what it is to accompany, to walk beside, to carry the burdens of others, as a friend, a teacher, to be a visitor to the sick as a mother and a grandmother. I have been lucky enough to have been accompanied by Mamito all my adult life. She has shown us how to do this with unparalleled grace with the perfect balance of gravitas and lightness. Not many people can get that just right. Mamito did.

Like everyone here I will miss Mamito’s presence more deeply than I can express. In recent years, the sight of Mamito standing at the top of the stairs outside her room giving the sense she was waiting just for me (though I believe she made everyone feel that way), her expression one of a mixture of pleasure and worry (worry because there was always more to do), a question always on her lips, a smile and a raucous laugh not far behind. And in recent years the gentle yet firm feel of her hand on my forearm as we walked—which always gave the sense that she was steadying me as much as I steadied her. I will miss the tangible parts of her but I believe she has left us with no less concrete charge than to continue what she did so well.

If we are to honor her properly then we must continue her work with the same exacting standards that she used with as much attention to detail. May Mamito rest in peace, but somehow I don’t think she wants us to rest too much. And we won’t, for there is much work to be done. And our large extended family, our ever growing community spanning many different countries will honor Mamito in the best possible way, by banding together to harness the energy, her life force, which urges us on up the hill, against gravity—a constant and inspiring source of transformative change.

Thank you, Mamito.

Ophelia Dahl
Cange, Haiti

To read a PIH co-founder Paul Farmer’s letter remembering Mamito, click here. 

Slideshow by Kanupriya Tewari

Ali Lutz, PIH’s Haiti Program Coordinator, attended the memorial service held for Mamito in Cange on June 6. The following are highlights from that ceremony.

This past Tuesday, we celebrated the life of Madame Yolande Lafontant—our beloved “Mamito”—at the Eglise Bon Sauveur in Cange. The church was full of people from around the world, all of whom came to pay respects to Mamito’s legacy and to the Lafontant family. Some flew in from other continents and drove to Cange in motorcades, while others came several hours on foot from surrounding villages. President Préval and the first lady of Haiti were there, as were elderly women from Bas Cange—members of Mamito’s latest ministry to provide food and social assistance to elderly peasant farmers without family to care for them.

All had been touched by the tremendous force of Mamito’s love and work.

Several priests from the Episcopal Church of Haiti presided over the service. The banner above the chancel read, “Adieu, Manmito. Tes oeuvres sont immortelles. Cange pap janm bliye ou” – Adieu, Mamito. Your works will go on forever. Your memory will never be forgotten in Cange.

A number of people delivered moving eulogies. The pre-school class from the Bon Sauveur School in Cange— which Mamito founded well over twenty years ago—made beautiful paper lilies to lay on the altar. A representative of the primary and secondary classes at Bon Sauveur spoke about the faith Mamito had in God and her equally powerful belief in the potential of each student at Bon Sauveur, regardless of his or her family’s socioeconomic situation. This young student wished Mamito Godspeed as she returned to the heart of Gods—“whom you loved above all else, and who loved you always.”

Ophelia Dahl, PIH co-founder, spoke about Mamito’s gift for hospitality—her drive to make sure every detail was perfect for her guests. Every time Ophelia returned home to Cange, Mamito would be waiting for her at the top of the stairs leading to the Lafontant’s home at the heart of Cange.

“Mamito made me feel,” Ophelia said, “as if she were waiting just for me. And I am sure she made everyone feel that way.” Ophelia used the image of the Cange water source to describe Mamito—constantly flowing strong, though not always visible, whose determination was able to defy gravity and scale steep grades of inequality to bring life-giving support to people in need. The results of a life of such tireless service were evident in the transformative change embodied in Cange—once a squatter settlement of water refugees whose land was flooded by the Peligre dam, and now a thriving campus dedicated to health, education, and social justice.

Didi Bertrand Farmer wrote and shared a poem about the creative force of Mamito’s love. Dr. Maxi Raymonville, who spoke on behalf of Zanmi Lasante’s Executive Committee, said that Mamito was militant in her drive to right the injustices in the world, especially the oppression of the poor.

Ferle Jean “Bobby” Sauvener, who is currently studying medicine in Santo Domingo, Dominican Republic, was part of one of the early pre-school classes in Cange. He called up his classmates from Cange—a dozen students who are now studying medicine and nursing—and said that they are Mamito’s legacy: their ability to achieve an education at Bon Sauveur was due to Mamito’s determination and care.

Renard Jacob spoke about Mamito and Père Lafontant’s ability to create a home for all people. When Renard was pursuing his studies in Port-au-Prince, he stayed at the Lafontant’s home and Mamito cared for him as though he were one of her own children, saying to him that he would always have a home there.

Gillaine Warne spoke on behalf ofthe community in South Carolina —the doctors, teachers, bishops, priests, engineers, students, and artists—whom the Lafontant’s have welcomed, embraced, and mentored as the community in South Carolina learned to stand in love and in solidarity with the people of Cange.

Gillaine shared a lighthearted memory from Dr. Harry Morse who said that while Mamito was always willing to serve, Harry had learned early on that Mamito was not the best choice for a medical translator: she had the tendency to tell the patients what to say to the doctor, diagnose the problem herself, and tell the visiting physician what the treatment should be.

Dr. Paul Farmer spoke about Mamito’s hospitality and pointed out that her influence had transformed not only Cange, but all of the places around the world where Partners In Health works: Peru, Boston, Russia, Mexico, Guatemala, Malawi, Lesotho, Rwanda, Burundi, and Kazakhstan.

The service concluded with the remembrances from Mamito’s grandson, Ludji Chipps, who praised his grandmother’s energy, elegance, and compassion.

We in the Partners In Health family are all the children and grandchildren of our dear Mamito, and we will miss her dearly, even as her spirit of determination and compassion continues to guide our work in every place. 

ZL Mental Health and Psychosocial Director Father Eddy Eustache provides a healing memorial service to ZL staff at Cerca la Source.

It is February, one month since the earthquake that ravaged Haiti’s capital of Port-au-Prince. In Cerca la Source, the site of Zanmi Lasante’s most rural health center, a four-hour drive from the capital, a service is beginning in the church next to the hospital. The day is hot, and the coolness of the church interior provides some respite, not only from the heat, but also from the harshness of life in Haiti since the earthquake. Staff members enter the chapel to the sound of children’s choir music. People take their seats, and listen quietly. Some sit and pray with their heads bowed. Others greet friends and acquaintances with a smile, a holding of hands, and a few words. Sadness and tears are close at hand. Father Eddy Eustache, a priest and psychologist who heads ZL’s mental health and psychosocial support team, begins speaking. Over the course of the next hour, with his decisive, undulating, soft voice, he provides a sermon that is a nuanced and moving tribute to the remarkable experiences of loss and survival that have so affected each ZL patient, staff person, and community member.

Over the course of four days, Father Eddy and the ZL psychosocial team, along with ZL/PIH leadership, conducted similar services at nine ZL hospitals. They drove throughout the Central Plateau and Artibonite regions, initiating a process aimed at providing comfort, solace, and emotional healing to staff at ZL hospitals.

When the earthquake happened, staff took little time to seek, protect, and bury family members before returning to their respective hospitals and clinics to serve the urgent needs of others. Father Eddy and the team recognized that religious and spiritual memorial services integrating prayer, singing, and information about mental health and self-care in the face of loss and trauma, would be a critical starting point for providing social and psychological support to staff, and to other people in the community. At each ceremony, everyone is invited to light candles to memorialize lost loved ones, to stand and provide personal testimonial to the audience, and to take moments for reflection and silent meditation. Tense muscles ease, calming emotions and sensations move through the pews, tears dry, and spirits lift moment by moment.

ZL Social Work Director Ermaze Louis lights candles with memorial participants to remember lost family members at St. Marc.

Following the January 12 earthquake, the ZL team brought these healing ceremonies to communities, schools, Haiti’s Ministry of Health, and to other NGOs who have asked to be trained in how to perform services like these. 

No one in Haiti escaped the effects of the earthquake: an estimated 300,000 people lost their lives, survivors lost loved ones, over a million people lost their homes and livelihoods, and hundreds of thousands of people suffered life-altering physical injuries. The ZL team hopes that informal, community-based services like these will create spaces in which communities can begin to heal together. It is their hope that these services can help prevent people from developing more severe indicators of emotional distress.

Since the earthquake, PIH and ZL staff in the community have reported a range of emotional distress responses, from difficulty sleeping or somatic complaints (physical reactions to stress and trauma) to acute psychosis (symptoms of which can include hearing voices, paranoia, and disorganized thinking). For some, pre-existing psychiatric problems that have had gone untreated have only worsened. Life is still far from normal. The people of Haiti are nothing if not emotionally taxed.

Emotional distress in the current context must be considered a normal reaction to a terrible situation. But when people do develop mental health problems, affected persons can often be marginalized from their communities due to stigma. That stigma discourages people from seeking appropriate mental health care, and the human rights of those afflicted by mental illness remain severely compromised, which could lead to even more distress and mental health problems. It is a vicious cycle.

In response to this, the ZL team is teaching staff and community members to recognize signs of mental health problems and illness and to understand that they can be treated. At the request of the Haitian Ministry of Education, for example, they recently worked with teachers and students in schools in the Central Plateau, providing training that emphasized sensitivity to the Haitian social and cultural context.

Prior to the earthquake, Haiti had few mental health professionals and limited formal mental health services. As recently as 2003, Haiti had a total of 10 psychiatrists and 9 psychiatric nurses working in the public sector—that in a country with a population of over 9 million people. Prior to the quake, there were two psychiatric hospitals in the capital city of PAP, one of which was dilapidated and in desperate need of massive repairs. Nearly all of Haiti’s mental health professionals worked in the capital.

Outside the capital region, psychiatric services were incredibly limited or unavailable. At the country’s second largest hospital, l’Hopital Universitaire Justinien, in the far northern city of Cap-Haïtien, psychiatric services were limited to monthly visits from psychiatrists based in Port-au-Prince and foreign mental health professionals.

Prior to the earthquake, the Haitian government understandably focused on combating infectious disease, and maternal and infant mortality. Psychiatric and mental health services received little government funding.

That all changed following the earthquake. The Haitian Ministry of Health declared mental health a national priority. In coordination with the Haitian government, PIH/ZL’s mental health and psychosocial teams have established an active presence in the four resettlement camps for displaced earthquake survivors in Port-au-Prince where ZL is providing medical services and have built on pre-existing services in ZL’s traditional catchment area in the Central Plateau and Lower Artibonite.

Erick St. Juste, psychologist staff member for ZL, prepares new psychologists and social workers for their work.

A talented group of psychologists, social workers and psychosocial community health workers hired and trained in March by ZL in Port-au-Prince.

Within three months following the earthquake, ZL’s Father Eddy Eustache (Program Director), Ermaze Louis (Program Assistant Director), and Cate Oswald (Program Manager) worked with the team to mobilize more than 50 Haitian staff—17 psychologists and 35 social and community health workers, many of whom newly hired—to care for the mental health needs of those most affected by the quake. PIH also added a new mental health director and psychiatrist, Giuseppe Raviola, and a head psychologist, Silvia Gosnell. 

Collaborating organizations have also been working with the PIH/ZL team to develop mental health services. Recently, Peter C. Alderman Foundation psychiatrist Dr. Kathleen Allden travelled to Haiti to teach physicians, nurses, psychologists and social workers about mental health evaluation and treatment of acute mental health emergencies. The psychopharmacologic formulary—the list of psychiatric drugs kept in stock and prescribed to patients—has been strengthened in the hospitals, facilitating the improved treatment of individuals in severe distress from symptoms such as psychotic illness that are not immediately responsive to psychosocial support.

PIH/ZL’s team continues to work to:

• Develop curriculum and continue training for ZL staff
• Facilitate community education and mobilization to work on eliminating stigma associated with mental illness and disability
• Enhance the ability of community health workers to be engaged in identification of mental health problems and referral to care
• Collaborate with PIH/ZL rehab teams to aid in providing support for amputees and people injured during the earthquake
• Assemble a mobile mental health team comprised of a psychologist, prescribing nurse, social worker and rotating visiting mental health clinician-teacher
• Develop a clinical peer supervision program for mental health and psychosocial staff
• Provide psychological support to ZL staff
• Establish a dedicated mental health clinical training service at the Ministry of Health hospital at Verrettes
• Develop a qualitative assessment of local beliefs, perceived needs, and attitudes to different forms of treatment and provision of care, in order to inform future care

Answering the Ministry of Health’s call for support in developing mental health services will require a long-term commitment, both to building upon pre-existing psychosocial services and informal mental health services, and over time, to developing a system of care better able to meet the mental health needs of Haiti’s people.

“Compared to the hugeness of the needs, the team is small,” Father Eddy said. “But we are not the only [organization] providing psychosocial support.” Haiti’s mental health care landscape is changing. In collaboration with the Ministry of Health, the World Health Organization, the International Organization for Migration, other NGOs, and other organizations supporting the development of mental health services in Haiti, PIH/ZL is committed to the development of a long-term sustainable mental health plan accessible to all Haitians.

Learn more about ZL’s mental health initiatives and read a recent interview with Father Eustache.

By Dr. Koji Nakashima

Myrtha gives a thumbs-up to her accompagnateurs.

In early June Myrtha Dervil was brought to Zanmi Lasante’s (ZL) orthopedic clinic in Cange, Haiti, with severe neck pain. Her condition was so dire that she was actually unable to walk. She had been living with this pain since having been trapped in her home by falling rubble during the January 12 earthquake. X-rays and CAT scans revealed that both her skull and first vertebra—one of a series of bones that build the spinal column—had slipped forward onto the second. This movement pinched the spinal cord leaving her severely disabled. Myrtha needed appropriate care relatively quickly; if that were found, her prognosis would likely be good. Without immediate stabilization of her spine, any further shift could result in permanent paralysis, or even death. We knew that Myrtha needed critical neurosurgical care as soon as possible.

Claude Forest’s story may be different, but his medical needs proved to be relatively similar to Myrtha’s. After the earthquake, Claude, who had been suffering from intense pain in his neck and back since last year, brought himself to our hospital in Cange. We immediately recognized that he was suffering from a spinal condition that could leave him either paralyzed, or worse. Tests showed that Claude was likely suffering from tuberculosis of the spine. Like Myrtha, his spine bones were compressing his spinal cord, leaving him in constant pain, often unable to move. He was placed on anti-tuberculosis drug therapy, but his condition was worsening. Claude needed a neurosurgical evaluation.

Claude being carried to the World Food Program helicopter.

Our staff reached out to Haiti’s medical community and found a willing partner in the University of Miami/Project Medishare who have developed and staffed a trauma center at Bernard Mevs Hospital—a facility that specializes in, among other things, neurosurgery. Once a partner hospital was in place, ZL needed to transfer their delicate patients across Haiti’s bumpy terrain. To do this we called upon long-time partner, the World Food Program, who readily offered to provide helicopter transport for both Myrtha and Claude. This saved them a dangerous bone-jarring ambulance ride down to Port-au-Prince.

After a slow twenty-minute ride to the helicopter landing site outside of Cange, it was a quick fifteen-minute flight to the United Nation’s logistics base in Port-au-Prince where ambulances swept Myrtha and Claude to Bernard Mevs Hospital—a facility where doctors and aid workers have treated tens of thousands of Haitians injured by the earthquake. Once there, Dr. Enrique Ginzburg welcomed his two newest patients to the hospital’s spinal cord unit.

We are grateful for the generous work of both the World Food Program and the University of Miami/Project Medishare who have given Myrtha and Claude the long awaited chance for life and livelihood saving therapy.

By Kanupriya Tewari

As the people of Haiti continue to recover and rebuild their lives after the devastating January 12 earthquake, we are grateful for the continuing support and solidarity shown by our partners.

Sixth-grade students from OCMS singing
in the benefit concert.

One such set of supporters are the choir students of Oldham County Middle School (OCMS) who, with the help of their teacher Charles Noderer, organized a benefit concert in Crestwood, Kentucky. On May 25, members of the OCMS choir performed a spring pops concert that raised $2,500 for Partners In Health’s (PIH) work in Haiti.

OCMS first held a spring pops benefit concert last year to raise money to help the survivors of Hurricane Ike on Grand Turk Island in the Caribbean. After seeing photographs of UNICEF tents serving as classrooms for local schools which had been completely destroyed by the hurricane, the students wanted to do something to help right away. They came up with the idea of a benefit concert, which—now in its second year—has become an annual tradition. Hearing of the disaster that took place in Haiti, the OCMS students decided that this year’s benefit should be dedicated to the people of Haiti and to support PIH’s efforts there.

Students performing songs from the musical Wicked.

“It's fantastic that a little old middle school choir in the middle of Buckner, Kentucky can raise $2,500 in one night singing pop tunes.” Charles says.

From the students’ perspective, they were united in their mutual goal of helping Haiti and they tremendously enjoyed organizing the pops concert. “I love being able to help others by doing what I love most and that is singing,” says one of the student participants, Ellen Emerson. Ellen was one of the roughly 200 musically inclined students from grades 6 to 8, who sang in the choir.

On concert day, as audience members entered the performance hall, a volunteer parent gave each person an envelope decorated by choir members asking them to benefit the cause. “I told the audience that they got into the concert free but they couldn't leave until they turned in their envelope with a donation,” Charles recalls.

The organizers found the PIH website to be a great asset for putting the event together. Charles used the site’s community tools to send out email invitations to the choir members’ parents and to organize fundraising. “It did a terrific job of helping basically an unorganized person like me get organized and put on an event to help PIH out.” For Charles, who has been teaching since 1970, helping the students to aid others through the OCMS benefit concerts has rekindled his teaching spirit. “I am glad to have been a part of the fundraising efforts”, Charles says. “I have the most amazing group of students and parents at Oldham County Middle School.” He notes that they truly live up to the choir’s motto, ‘Be Kind, Work Hard.’

For more information and ideas on how to organize your own event to support Haiti and PIH, click here.

Last week, we posted letters from a 6th grade class at Gage Middle School in Huntington Park, CA. PIH co-founder Paul Farmer recently sent them the following letter in response.

To the students in Mr. Drugge’s 6^th grade English class:

Thank you for your kind and thoughtful letters. It means so much to me, and to my friends and colleagues in Haiti, to know that you care so deeply about what is going on there. Partners In Health has been working in Haiti for more than 25 years, and we intend to be working there for many more years—so we need lots of people your age to get involved.

You are right that this has been a heartbreaking and difficult time in Haiti, especially for children like Mystil and Jean Alexis, whom you read about in The New York Times. I have not met them yet, but I have met many other girls and boys who were hurt or lost family members in the earthquake. Many of you wrote that you admire these kids for their strength. I do, too.

You asked some great questions. I’ll do my best to answer as many as I can:

Alejandra, Anthony, Ashley, Frank, Eddie, Bianca, and Ixtli: I was not in Haiti during the earthquake on January 12. I had just left Haiti after spending the holidays there with my family. I returned three days after the earthquake, and many of my friends were already working to take care of people who were sick and injured and who had lost their homes. It was a very sad and difficult time, but we worked together to do as much as we could. We continue to help our Haitian friends and coworkers rebuild their country.

Valeria, Yenicka, Kimberly, Alexis, Kevin, Andrew, Erika, Edwin, and Bianca: you asked how it feels to be a doctor working in Haiti. I love being a doctor, and Haiti has been the best teacher I’ve ever had (and that’s saying a lot). It is really hard to see all of the injured kids and adults in Haiti, but I am grateful to have the training and the tools to be able to help them. I am also glad to see how many people—mostly my Haitian colleagues and friends, but also volunteers like Dr. Elizabeth Bellino from the article—are there to help.

Maria, Kevin, Richard, and Michelle: you asked about reconstruction, and what will happen when the storms come. So many people lost their houses in the earthquake. Today, almost a million Haitians still live in tents in large camps. This is very dangerous; rainy season has already started, and hurricane season is just around the corner. The Haitian people, their government, and the other countries that are helping are racing against time to build new houses strong enough to stand up to wind, rain, and even earthquakes. We also have to create good jobs so parents can provide for their families, rebuild schools so that kids can learn, plant trees to protect the environment, and support farmers so that everyone has enough to eat.

Aime, Maria, Ixtli, and Yessenia: you asked why the January 12 earthquake in Haiti caused so much more damage and loss of life than the February 27 earthquake in Chile. There are many reasons for this, but one is that in Haiti the earthquake hit Port-au-Prince, Haiti’s biggest city, where three million people live. Another reason is that most Haitians are so poor that they could not afford to build sturdy homes. There is a good chance that there will be more earthquakes, so we have to work to make sure that new houses and buildings are stronger and designed to withstand earthquakes.

Jaime, Diana, Ixtli: you asked how you can help. You already have helped: I will share your letters with my friends in Haiti, and your friendship will give us strength for the long road ahead. Keep reading and studying with Mr. Drugge and your other teachers: we need smart and hard-working people like you to help us fix some really tough problems. Americans did amazing things in the days following the earthquake. One-half of families in the U.S. donated money to relief and reconstruction in Haiti. Today, there is still so much work to do, and students are helping out by organizing bake sales, community races, art shows, and performances to raise money and teach their communities about Haiti.

Jose, I will tell the kids in Haiti that you say hello. You are so right when you say that Haiti’s people are strong. The nation of Haiti is almost as old as the United States, and they have been through many difficult things that they did not deserve. But you said it well: they never give up. We need to remain friends not just after an earthquake or a hurricane, but forever.

Thank you for your solidarity and friendship with the people of Haiti. I hope you will continue to learn more about the country and its people. With your support, we will keep working hard so that the children of Haiti will have the same opportunities that you have had and that all children deserve.

Yours,

Dr. Farmer

By Elise Garrity

Brett Drugge teaches 6th grade at Gage Middle School in Huntington Park, CA. After reading a New York Times article about the January 12th earthquake in Haiti with his students, he talked to them about Partners In Health. Drugge writes: “I introduced them to your important work and felt it was necessary to respond to our readings by reaching out to you.”

We were incredibly touched by the many messages of support and concern that poured into our Boston office following the earthquake. We can only try our best to answer as many as we can. The package of 35 handwritten letters from Mr. Drugge and his students in particular caught our attention, as their sentiments mirrored those of so many of our supporters. Below is a letter compiled of excerpts directly from the students’ notes. Stay tuned for a reply – from the doctor they addressed their letters to.

By Kanupriya Tewari

Realizing the impact of the devastating earthquake that hit Haiti on January 12, students of Tufts University quickly assembled the Tufts Haiti Relief Coalition to convey their support to the people of Haiti.

The Coalition, a partnership among previously unconnected students groups engaging in relief work for Haiti, aimed to provide a coherent framework for the different fundraising efforts taking place on campus. The goal was to maximize each group’s impact. Representatives included: RESPE: Haiti, the International Relations Honors Society, the Jackson Jills (a female acapella group), the Freshman Class Council, Tufts Senate, Tufts Chabad, One World, and the International Relations Director's Leadership Council, as well as several individual students.

Some successful events organized by the Coalition included programming a donate button onto campus cash registers to allow customers to easily donate while their wallets were already out, and cause dinners at the dining halls, where students could sign-up to donate a portion of their meal payment to Haiti. The Coalition also coordinated with the Tufts Bookstore. A fraction of the store’s profit from certain days was donated to the Haiti fund – the bookstore saw some of its highest sales of the semester on these days as community members came out to make large purchases to support the relief work.

The Tufts Coalition successfully raised $5,700 – which was donated to PIH.

“It means a lot to have this type of strong support from Tufts students,” says Jackson Compere from Partners In Health (PIH). “To donate all of their money to PIH shows the extent of their commitment to helping Haiti as well as maintaining a long-term partnership with PIH.”

RESPE: Haiti during a trip to Balan in 2008.

Tufts and PIH have partnered with each other through the years, specifically through RESPE: Haiti. 

RESPE, which stands for Research and Engagement Supporting Poverty Elimination, and is the Haitian Creole word for respect, played a leading role in the Coalition’s fundraising efforts. The project maintains a mission to raise awareness about issues facing rural Haitians and to collaborate with the rural Haitian community of Balan (located 30 kilometers from the country's capital Port-au-Prince), in support of its development plans.

RESPE is a student initiative of the Institute of Global Leadership (IGL) at Tufts, which aims to prepare new generations of critical thinkers for effective and ethical leadership. RESPE was founded by students with the objective to execute practical applications to the theories they had learnt during their studies. The project started when a team of four Tufts students, accompanied by Professor Alix Cantave of the Urban and Environmental Planning (UEP) program at Tufts, traveled to Haiti with Jackson during in January of 2008 to conduct an initial community needs assessment in Balan.

The results of this assessment proved to be highly positive for the students. They managed to create a close relationship with the community, develop a sister organization (RESPE: Balan) to serve as a local advisor, and were able to better understand the community priorities for self-development.

“We were really using and implementing PIH’s approach, but on a much smaller scale,” says Helaina Stein (Tufts ‘10), a co-founder of RESPE. Like PIH, the project is putting an emphasis on community partnerships, by involving community members at all levels of assessment, and pursuing development according to community needs.

Since then, RESPE continues to bring news of its work and knowledge back to the Tufts community and is looking to further engage Tufts resources to support Haitian community plans. Students plan to travel to Balan later this summer to build a maternal health ward, realizing this to be a pressing community need.

While the Coalition was a short-term measure to ensure an efficient system for fundraising, Tufts students look to projects like RESPE to maintain a long-term relationship with Haiti as well as PIH. “During the time of the Coalition it was amazing to see how people kept on giving for Haiti and how small fundraising events could evolve into a campus-wide campaign,” Helaina recalls. “We’re hoping that this spirit can be sustained into the long-term, and RESPE is in the best position to absorb student initiative to further carry out meaningful work for Haiti.”

The new oxygen compressor can fill 50 tanks per day.
The new oxygen compressor
View from the exterior of the new oxygen compressor in Cange.

In the days after the January 12 earthquake, a lack of access to oxygen therapy contributed to the deaths of many patients seeking care in hospitals around Haiti.

The problem was with the country's primary oxygen concentrator—the machine that extracts oxygen from the air, purifies it, and concentrates it in large metal tanks—was seriously damaged during the earthquake. In the weeks that followed, hospitals and health clinics around the country scrambled to import oxygen from other countries in the region. The level of destruction made importing anything, regardless of how important it was, incredibly complex.
 
While Zanmi Lasante’s (ZL) facilities were well-stocked prior to the earthquake, ZL still spent an average of $26,400 per year on refilling oxygen tanks through the facility in Port-au-Prince—enough to hire three operating room nurses. After January 12, ZL—like most health care providers in Haiti—was forced to look elsewhere for its oxygen. The best solution was to import supply from Santo Domingo, the capital and largest city in the Dominican Republic. As more and more patients flooded into ZL’s health centers in the days and weeks following the earthquake, the need for oxygen skyrocketed, along with the cost of transporting the tanks across the Haiti-Dominican border.
 
In response to this situation, ZL staff decided that it was in their best interest to build and operate an independent oxygen concentrator. With funding from the Bill and Melinda Gates Foundation, ZL hired Oxygen Generating Systems, a U.S.-based company, to build a freestanding facility on ZL’s flagship medical facility in Cange, Haiti.
 
The concentrator—housed in a large, windowless concrete building—should be finished by the end of this month. The anticipated output is about 50 tanks of oxygen per day, which will supply all of ZL’s 13 sites in Haiti. This addition to the Cange medical complex will help ensure that ZL patients will have reliable access to life-saving oxygen therapy.  
 
ZL will employee 8 full time staff—all hired from the local community—who will operate and maintain the facility.

A child celebrates her birthday--and the birthdays of the 47 other children living at Zanmi Beni. Photographer: David Darg
Clowns and face painting were part of the festivities. Photographer: David Darg
Clowns entertained the children. Photographer: David Darg

June 13 was a huge day at the Zanmi Beni children’s home outside of Port-au-Prince. It marked the birthday of all 48 of the kids living at the home!
 
The reason behind celebrating 48 simultaneous birthdays is bittersweet. The children, many living with either physical or developmental disabilities, are without parents or other guardians. Most arrived at Zanmi Beni (ZB) with little to no background information in their files.
 
The ZB staff knows each child’s name, they know each child at the facility is beautiful, but they often do not know much more than that.
 
“We can only guess at how old each child is and certainly don't know their date of birth. So what do you do in a situation like that?” asks David Darg of the charity Operation Blessing International. “Give them all the same birthday and throw a big party to celebrate their lives.”
 
So the ZB staff decided to throw a party to celebrate the births of all the children on Haiti’s National Children’s Day—June 13.
 
For the birthday festivities, ZB children and staff went to a park in Port-Au-Prince and had a day filled with fun and laughter.
 
“A group of clowns were on hand to make the day extra special and all of the children got to eat birthday cake,” says David. For most of the kids, who range in age from just a few months to 21 years old, it was the first time they had ever celebrated their birthday.
 
Partners In Health and its sister organization in Haiti, Zanmi Lasante, operate the Zanmi Beni home in partnership with Operation Blessing International.
 
The facility was opened in response to the January 12 earthquake.
 
“I have been so impressed with the level of care that Zanmi Lasante staff have invested into the lives of these children,” says David. “The attention to detail from the ZL staff and the loving environment has already made such a huge difference in the lives of these children.”

To recognize the contributions of fathers everywhere, watch our photo essay celebrating their work at PIH sites across the world:

Click here to view full screen.

Lelan tries out her new wheelchair as her family looks on.

Like many women living in rural Haiti, Lelan spends her days taking care of her family—cooking, cleaning, and tending to her children. But for her, having suffered paralysis after contracting spinal tuberculosis, each chore is infinitely more difficult. She cannot walk. Instead, she lies on her back and drags her body across the dirt floor of her family’s small hut. When it rains, the palm frond roof leaks, turning the floor into swirls of mud around her. As she only has the strength to move herself no further than about 20 feet at a time, she’s literally cut off from her community.

But this changed last month, as Lelan settled into a brand new RoughRider wheelchair, provided by a collaboration between Zanmi Lasante—PIH’s sister organization in Haiti, the Walkabout Foundation, and Whirlwind Wheelchair International. The partnership recently distributed 350 RoughRider wheelchairs throughout Haiti, bringing unprecedented mobility to patients injured in January’s earthquake, as well as many patients like Lelan, who has been living with her disabilities—and the stigma and abandonment associated with them—for years.

With knobby mountain bike tires and a sturdy, specially designed steel frame, Whirlwind’s RoughRider wheelchairs enable its occupants to go where conventional wheelchairs cannot, wheeling over broken pavement, rocks, roots, mud, and ramp-less curbs that are common  throughout Haiti and other developing countries. In fact, the non-profit organization designed the vehicles in collaboration with wheelchair riders in over 20 developing nations.

The resulting design is a winner, at least for Lelan. “When we first rolled the new RoughRider into her yard, she began clapping and said, ‘Thank you, thank you, now I can go to church,’” recounts Whirlwind’s Rachel Kishton. “She took to her chair quickly and was downright fearless while rolling around her patio. She quickly started figuring out how to move into and around her house.”

Nearby, 12-year-old Vladimir, who suffered a spinal cord injury when the ceiling of his bedroom caved in on him during the earthquake, also tried out his new wheels; as did the village’s local hero, a basketball player who had been paralyzed by injuries sustained during the quake; and Jiler, a middle-aged man who was most likely crippled as a baby by a case of polio.

The wheelchair distribution built on the efforts of ZL’s newly trained Haitian rehab accompagnateurs—community health workers—who identified wheelchair candidates in advance of the team’s arrival. These new accompagnateurs, some of whom are themselves living with disabilities, will be following up with patients to help them get the most out of their new mobility and independence. This includes making sure that each patient, or someone close by, knows how to adjust the wheelchairs and keep up with general maintenance. They are also working to fight stigma and spread awareness of disability issues in the patients’ communities.

The distribution itself offered a good opportunity to begin spreading awareness. While fitting a chair for Paulin, a young girl suffering from cerebral palsy, she and the team decided to conduct the fitting in a public space so that her neighbors could watch and ask questions. “This was great for community awareness and the disability awareness movement—one of the focuses of PIH’s community outreach rehab program,” said Rachel. It wasn’t long before a group of local children had gathered around them. “They seemed very excited for her, and for her new chair,” said Rachel. “But, not nearly as excited as Paulin who was enjoying her first bumpy ride on the road!”

Mickey Sexton and Gene Kwan at the start of the International Peace Marathon in Kigali, Rwanda.

For the past few months, the people in the Burera district in northern Rwanda were treated to the spectacle of a Muzungu [foreign] doctor running literally in circles.

“They’d ask, ‘Where have you come from?’ And I’d say, ‘The hospital,’” recalls Mickey Sexton, a physician working with Inshuti Mu Buzima (IMB)—PIH’s partner organization in Rwanda. “And they’d ask, ‘Where are you going?’ And again I’d say, ‘The hospital.’ Then they’d laugh and look at their friends in a ‘Muzungus are weird, aren’t they’ kind of way,” he added. “For many locals, their lives are characterized by tough physical labor in the fields each day, I think it was odd to see me running in circles with no obvious purpose.”

Although truly living up to the literal translation of the word Muzungu—"someone who roams around aimlessly"—Mickey and fellow PIH physician Gene Kwan of IMB’s Rwinkwavu Hospital did have a purpose. They were training to run Kigali's International Peace Marathon to raise awareness and thousands of dollars to support IMB’s women’s health projects.

“The marathon is an awesome challenge and great way to round off what has been an incredible year in Rwanda,” says Mickey. “More importantly, it's an opportunity to raise money for PIH’s efforts to improve women’s health and a chance to demonstrate my belief that women’s health and female empowerment should be one of our priorities and form an integral part of our work.”

The community, while puzzled, was nonetheless enthusiastic to support the doctors’ mission, shouting words of encouragement and, at times, even running alongside.

“The training has been an experience in itself… Hundreds of people have joined me for a mile or two—or even ten,” says Mickey. “It's humbling when a 3-year-old, an 80-year-old man, or a woman carrying a sewing machine on her head can all keep up with you.”

Mickey and Gene crossing the finish line together.

A grueling course—26.2 miles up and down over the hills of Kigali in the scorching heat of a Rwandan afternoon—awaited them on May 23. But their friends and support team helped keep them motivated, as did their cause, particularly for Gene, who had only begun training to run with Mickey just five weeks before the race.

As the elite runners finished, and the crowds dissipated, and the temperatures climbed, Gene explained how he was able to keep his mission in sight. “I started to think about the hundreds of women who travel similar distances to seek care, and this helped me to continue running,” he said.

The duo crossed the finish line together in just 4 and a half hours, raising $2,100.

Over 500 people living with HIV/AIDS met last Sunday in the rural Neno district of Malawi to support each other as a community in the fight against the disease. “Such togetherness has never been seen in Neno,” said organizer Samson Njolomole, the coordinator of the antiretroviral treatment (ART) program for Abwenzi Pa Za Umoyo (“partners in health” in the local Chichewa language), PIH’s partner organization in Malawi.

Although similar meetings have been held on a monthly basis near the grounds of the Neno District Hospital since last year, this particular meeting was held in Zalewa—a community located near a major trucking route that has been hit particularly hard by the epidemic. Zalewa is also centrally located for several other villages plagued with high HIV infection rates. Holding this meeting in Zalewa helped make it easier for patients in these communities to participate in the emotional and social support activities featured at the event.

Topics discussed at the meeting included dealing with stigma and discrimination, as well as ways to prevent the spread of the disease. Singing and dancing were also major components of the festivities. Overall, the purpose of the meeting was to help the patient community build a sense of solidarity. Samson compared the overall feeling of the event to a family reunion.
 
At future meetings, organizers plan to distribute condoms  and introduce voluntary testing and counseling for community members who have not yet been tested for the disease, said Samson.

Every day, those of us working at Partners In Health are privileged to meet individuals who share our commitment to providing health equity and ensuring social justice in our own country and around the world. What would happen, we wondered, if we provided these passionate advocates with a space to meet and team up with others who share their passion--be it with a neighbor down the street or activists working in Haiti?

http://act.pih.org is that space.

Integrated right into our new website, act.pih.org is an online community for supporters of PIH and global health equity. It is a place where we can meet, plan, and take action. Organize events, create personal fundraising pages, and mobilize advocacy campaigns: you have the tools to create change. We must work together--we must stand in solidarity. Learn more.

An undercooked goat leg eliminated Chef Jody Adams from the reality TV show Top Chef Masters. Looking to redeem herself, she decided to give the ingredient another try--this time with the help of Haitian earthquake survivors who were brought to Boston for medical care by the Partners In Health--the nonprofit organization that Jody had played on behalf of during Top Chef. Watch below:

In his commencement address at Suffolk University in Boston, PIH co-founder Paul Farmer urged the graduating students "to recognize and develop and support the genius of the Haitian people who have led the way."

"When Haiti pulls out of its slump, it's going to be this generation who does it," he added. 

Paul's words were especially meaningful to a trio of the graduating seniors who also happened to be from of Haiti. Watch news coverage of Paul's address and the story of these students on the viewer below.

In response to the earthquake that ravaged Haiti’s capital on January 12, 2010, Partners In Health helped to send hundreds of volunteer nurses, doctors, and other medical and logistics professionals from around the United States and Europe to help support our roughly 5,000 staff on the ground. The following essay is from one of those volunteers, and the last of a five part series.Read the previous post in this series.

Ed Arndt working with a Haitian surgical team at the hospital in St. Marc.

After an experience like the one our group had in Haiti, I can reflect on how we as nurses can practice medicine, and support our patients. We had to confront topics ranging from public health and infrastructure to socioeconomic disparities and, of course, language and cultural divides.

One message was clear throughout our experiences: basic clinical skills are universal. Haitian staff and American volunteers were able to work with each other. We were all there to provide direct care and emotional support to our patients. It was universally accepted that we were there to provide quality care, despite a lack of resources

Our goal was not to "Americanize" our surroundings, but to augment the system in place during the emergency response. Our team consisted of some of the most caring and intelligent nurses and doctors with whom I have had the privilege to work.

One of our more profound nursing moments at Hospital St. Nicolas was meeting with nursing leadership in St. Marc. Zanmi Lasante (ZL) staff and PIH volunteers sat together discussing nursing as it pertains to Haitian needs and wishes for their community. We thanked ZL staff for having us there, for accommodating us, and making us feel welcome in their institution.

We also asked local nursing leadership to speak with the hospital's bedside nurses about the kinds of things they felt they needed from us, especially since we were only there for a short period. We wanted to be sure that the focus was on what the nurses of Hospital St. Nicolas wanted—we just wanted to help get them where they needed to be.

My group of volunteers hopes to return to Haiti and work with Haitian nurses to establish dedicated clinical skill training and cultural exchange as pertaining to public health, and possibly some kind of recognition of this training through certification.

It was a profound moment in my nursing career to be a member of this team. The PIH staff saw to it that we were safe, well cared for, and able to do the work we had set out to do. The fact that PIH/ZL facilities outside Port-au-Prince were established long before the earthquake was a tremendous asset when it came time to respond to this crisis. The people of Haiti will need our help for a long time, and we are compelled to return and continue the work that is both needed and important to establish an independent supportive infrastructure for nurses, for Haiti’s hospitals, and Haitian communities throughout the country.

- Ed Arndt, NP
   Brigham and Women's Hospital

Equipo Técnico de Educación en Salud Comunitaria (ETESC), a supported project of Partners In Health in Guatemala, was founded by refugees of the Guatemalan Civil War who returned to help rebuild their country. One of the ETESC’s core programs is sociolegal accompaniment—accompanying the most marginalized populations as they learn and exercise the rights guaranteed to them by the government following the brutal war. These programs include financial restitution as well as the exhumation and dignified burial of loved ones’ remains. PIH’s Chiapas Project Manager, Lindsay Palazuelos, sat down with ETESC’s Coordinator, Santiago Pablo Lucas, and Volunteer Rural Technician, Felix Marciano Méndez Sontay, to discuss ETESC’s sociolegal accompaniment program.

	A woman lays to rest the exhumed remains of a loved one who was kill during the Guatemalan Civil War.

Lindsay: Part of ETESC’s mission is “healing.”  What does this mean?
Santiago: ETESC supports, accompanies, or assists--together with victims of the armed conflict [the Guatemalan Civil War*]--healing of the harms caused by the state.  We are looking for solutions.
Marciano: It’s an act of orientation, perspective.  Many people have been afraid to speak out.  They would say that “nothing happened” but inside they were saddened, injured.

Lindsay: Why is it important for Guatemala to confront the history of the armed conflict?
Santiago: It is good to understand why it happened, what happened, and how it happened.  When people learn why a conflict happened, it is because it should never happen again.  Many young people don’t know about the conflict.  We must speak the truth; we must love justice, dignity and reparations.  It’s not only something important, but rather a necessity.

Lindsay: A key program of ETESC is sociolegal accompaniment.  Why is it necessary?
Santiago:  ETESC has converted sociolegal accompaniment into a tool to aid victims of the conflict**.  This accompaniment is necessary, first, because many don’t know how to read or write, second, they don’t speak Spanish (but rather indigenous languages), and third, they are blatantly ignored if they are not accompanied by a human rights organization.  They are ignored because they are poor, elderly, orphans, or simply because they are women... ETESC orients communities, helps to create documents of condemnation including affidavits, helps lead visual inspection of clandestine graves, programs exhumations with forensic anthropologists, and later helps coordinate the dignified return and burial of remains.

Lindsay: How do families and communities feel after this process?
Santiago: The person’s sadness decreases. If a person is dead somewhere, people say that this person’s spirit is not at peace.  Only when the family can give the person’s remains a dignified burial in the community cemetery, do people say that the spirit is at peace.
Marciano: One man said he dreamt that his brother [murdered in the conflict] called out to him to exhume and bury his remains.  Then he learned about ETESC’s work.  When he had the opportunity to bury his brother’s remains, he was very appreciative because he thought it would be impossible, and now his brother is resting in peace.

Lindsay: Do you have a message for PIH supporters?
Santiago: A thank you, because ETESC’s work could not continue if it weren’t for PIH.  I would also say that although the bullets have stopped flying, don’t stop thinking about the many problems of poverty that persist.  I send a message of solidarity, to not forget that the struggle continues in Guatemala.  

Learn more about ETESC’s work.

How you can help: ETESC is in need of digital cameras, camcorders, and digital audio recorders in good, working condition for human rights documentation. If you’d like to donate your used electronics to this cause, or stay updated on ETESC’s activities, please contact Lindsay Palazuelos at lpalazuelos@pih.org. 

* The Guatemalan Civil War, lasting from 1960 to 1996, was primarily fought between the Guatemalan government and insurgents.  The military gained increasing and eventually absolute power, and led over 400 massacres of civilians deemed “enemies of the state”.  Over 200,000 people were killed, and between 500,000 and 1.5 million people were displaced.  The UN Historical Clarification Commission found that 93% of  human rights violations were committed by the state.

** Sociolegal accompaniment is a pragmatic process to assist survivors of the civil war to realize their rights to reparations from the government.