Dr. Paul Farmer, PIH co-Founder and United Nations Deputy Special Envoy for Haiti, recently testified at the “Haiti: From Rescue to Reconstruction” hearing of the U.S. Senate Foreign Relations Committee. 

"I am at my core optimistic about the possibilities before us and the potential of our support to help rescue and transform our poorest neighbor," stated Paul in his submitted testimony. "The response from citizens of the United States to the recent events in Haiti has been overwhelming and encouraging. There is the promise of solidarity by our leadership to make long-term commitments to the kinds of investments needed in Haiti—and to fulfilling them."

"For two centuries, the Haitian people have struggled for basic human and economic rights, the right to health care, the right to education, the right to work, the right to dignity and independence,"he continued. "These goals, which Haitians share with people all over the world, should direct our policies of aid and rebuilding."

Watch a video of the hearing on CSPAN.

Read Paul's full testimony below

Testimony of Dr. Paul Farmer to the US Senate Committee on Foreign Relations

27 January 2010

Thank you for inviting me to testify today before the Senate Committee on Foreign Relations. I speak as the U.N. Deputy Special Envoy for Haiti—President Clinton, as you know, is the Special Envoy—and also as a physician and teacher from Harvard who has worked for over twenty-five years in rural Haiti. Today, my hope is to do justice to Haiti not by chronicling the events of the past two weeks, which are well known to you, but by attesting to the possibility of hope for the country, and of the importance of meaningful investment and sustainable development in Haiti.

That said, I will not pretend that hope is not at times difficult to muster.

As I was flying from Port-au-Prince to Montreal on Monday, headed to a conference on coordinating responses to the massive earthquake, I did the painful math in my head and counted close to fifty colleagues, friends, and family members who had lost their lives in the space of a minute.

The afternoon of the earthquake, several of my colleagues from Partners In Health and the UN, were, ironically, in Port-au-Prince for a meeting about disaster risk reduction. Partners In Health, through its Haitian sister organization, provides health care to the rural poor. By focusing on training and employing local talent, we have grown a great deal over the years. We are currently serving a population of well over 1.2 million and count about five thousand employees, most of them community health workers.

Of course, not all our colleagues survived. But the vast majority of them did survive, and they have spent the last two weeks working day and night to relieve the staggering suffering of the wounded and displaced. President Clinton, our colleagues, and I have been in the cities of Port-au-Prince, Jacmel, and Léogâne, as well as the less-affected Central Plateau and Artibonite Valley. Everywhere we have seen acts of great bravery and solidarity.

In addition to the heroism of friends and colleagues, I would like to note for the record the dignity and patience of the long-suffering Haitian people. During a visit last week to Haiti’s largest teaching hospital, which shares a campus with the ruins of the nursing and medical schools, President Clinton remarked that no other people in the world would be so patient and calm in the face of so much suffering. This observation, though accurate, must not be misunderstood. People in Haiti are afraid not only for their options and futures, but still quite simply for their safety. A few nights ago, we sat in empty wards: hearing of impending aftershocks, the patients bolted outside with their IVs dangling from their arms. They refused, as have so many, to sleep inside the building—any building—but instead found tarpaulins and sheets, and lay down in the open courtyard.

This scene has repeated itself throughout the country and is a reminder of the logistics challenges facing all those who would be involved in the provision of shelter, clean water, and healthcare. The relief efforts, focused now on addressing the initial wave of devastation from the earthquake, will soon turn to a new set of concerns. Hastily cobbled together camps are at risk of outbreaks of cholera and other waterborne disease. The Haitian government has wisely proposed avoiding huge camps, which will be difficult to manage, but we must hasten our efforts to get tents, tarpaulins, and latrines or composting toilets to Haiti. It is humbling to see the relief efforts be so slow—in large part because delivery of services was so weak before the quake. Now we must do more to get food and water to people every day for some time to come. Creating safe schools and safe hospitals, even makeshift ones, is a known need in rebuilding a society, and storm resistant housing must also be a carefully considered priority since there is little time before the rainy season. Students need to be back in school; the planting season cannot be missed and requires fertilizer, seeds, and tools.

How will we fund such settlements, ongoing relief, the sowing of seeds, and the reconstruction that must follow? Major pledges have been made by the U.S., Canada, Japan, Spain, Brazil, the European Union, the Inter-American Development Bank, the World Bank, and others.1 Indeed, most countries have responded. Even in far away and once-afflicted Rwanda, a group of community health workers making less than $200/month have been able to pull together $7000 in donations for their colleagues in Haiti. This is but a small portion of the billions needed, but hard to surpass as an eloquent testimony of human solidarity.

Even if adequate resources are available, the task before us will be extremely difficult. Medical jargon, though at times arcane, can be helpful here. Today, Haiti is facing what we would term “acute on chronic” problems. Before January 12, the country was already facing huge long-term challenges in public health and education, the unemployment rate over 70%, and a majority of its population was living on less than two dollars a day. Food and water insecurity were already huge problems.4 Does this catastrophe create a chance for all of us to have a sounder, more solidarity-based relationship with Haiti? Or is it to be yet another chapter in a jeremiad of suffering and abuse of power? In my last testimony here, in 2003, I expressed concern that the latter possibility was likely given our policies at that time. Today I will spend my time focusing on the potential for an entirely reconsidered relationship between the two oldest independent countries in the Americas: Haiti and my own.

Let me offer, as one example of the difficult relations between Haiti and the international community (and an echo of the nineteenth-century machinations I discussed in my last testimony before this committee), the donor conference I attended here in Washington last April. It was one of only two donor conferences I have ever attended, the second being in Montreal earlier this week. The results of the first are noteworthy and worrisome: despite $402 million pledged to support the Haitian government’s Economic Recovery Program, when the country was trying to recover from a series of natural disasters resulting in a 15% reduction of GDP, it is estimated that a mere $61 million have been disbursed.5 In the Office of the Special Envoy, we have been tracking the disbursement of pledges, and as of yesterday we estimate that 85% of the pledges made last year remain undisbursed.

Many of us worry that, if what’s past is prologue, Haitians themselves will be blamed for this torpor. But as we have argued before, there are serious problems in the aid machinery, and these have contributed to the “delivery challenges” on the ground.6 The aid machinery currently at work in Haiti keeps too much overhead for its operations and still relies overmuch on NGOs or contractors who do not observe the ground rules we would need to follow to build Haiti back better. The fact that there are more NGOs per capita in Haiti than in any other country in the hemisphere is in part a reflection of need, but also in part a reflection of overreliance on NGOs divorced from the public health and education sectors.

Haiti will continue to need the contractors, and the NGOs and mission groups, but more importantly we will need to create new ground rules—including a focus on creating local jobs for Haitians, and on building the infrastructure that is crucial to creating sustainable economic growth and ultimately reducing Haiti’s dependence on aid.

In other words, what we need is a way of “building back better” that strengthens governance but also strengthens the Haitian economy to provide for the needs of its people, especially the vast majority of Haitians who are desperately poor. There is an opportunity not only to build Haiti back better, but to build a more functional and beneficial aid structure. Over the past two decades, US aid policies have seesawed between embargoes and efforts to bypass governments, including elected ones not to Washington’s taste. Neither the international community nor the United States provided credible, long-term, financial investment in Haiti. Restructuring foreign aid and forgiving Haiti’s crippling debts are essential to helping the country recover. US laws, including the Foreign Assistance Act of 1961 and its later revisions, prevent direct investment in the public sector; we will need to revisit these policies. Debt forgiveness is also needed to ease the financial drain that would otherwise hinder economic recovery and growth.

In building back Haiti, a credible body that has been working in Haiti could help to house a recovery fund. We need to commit funds and also to disburse them. To quote Jeff Sachs, “Haiti does not need a pledging session; it needs a bank account to fund its survival and reconstruction.”9 Such an account should be managed in collaboration with partners, the UN, and, of course, Haitian leadership, which would work directly and openly with partners to design and implement recovery plans coordinated at central and local levels. The effort must include a comprehensive post-disaster needs assessment, which should be supported by the US and other partners.

Might such plans work? In some of the darkest moments of the last two weeks, when the incapacity and lack of coordination of institutions on the ground was revealed repeatedly, I have thought often of Rwanda and what happened there in 1994. As a physician and teacher at Harvard, I have been lucky to work with the Clinton Foundation, Partners In Health, and the government of Rwanda on rebuilding health infrastructure in three of the last four districts that lacked central hospitals. As in rural Haiti, this has been a very positive experience. It has resulted in thousands of jobs for Rwandans, and has created a broadly accessible health care infrastructure—all with a modest price tag compared to traditional aid contractors.

If such progress can be made in Rwanda, which boasts strong leadership but in 1994 was the poorest country in the world,11 then one hopes it can be made elsewhere. In part because of this positive experience of working together with the Clinton Foundation in Rwanda (and in Malawi and Lesotho), I joined President Clinton six months ago as his deputy in the UN role he originated. As Special Envoy for Haiti, President Clinton has focused his attention not only on holding donors to the financial pledges they made, but also on reducing the risk of disasters and on job creation through the massive public works that are necessary to reforest Haiti, protect watersheds, and improve agricultural yield—the backbone of the Haitian economy. Private investment in Haitian businesses, especially small and medium-sized ones, is critical to rendering Haiti free of any dependence on aid—the goal of Rwanda by 2020, and moreover, a goal likely to be met. Haiti also has, he noted, great potential as a tourist attraction but lacks the infrastructure to welcome the millions of people who should see Haiti’s natural beauty and historic treasures like King Henri Christophe’s Citadel.

This has been our mission: to build back better from the 2008 storms. We believe that these efforts were beginning to bear fruit. We had scheduled a meeting last week in the Hotel Montana to bring in another round of investors and also to discuss job creation. As many of you know, this hotel is no longer standing, and most inside it perished on January 12. But the need for such investments, and the need for public works that would create hundreds of thousands of jobs, remains.

If there is any silver lining to this cloud, it is that we can push job creation. It is a strange irony that supporters of economic assistance to Haiti are now obliged to shill for “cash for work” programs—for the quaint notion that people should be paid for their labor. Let us at least be honest: it is absurd to argue that volunteerism and food-for-work programs will create sustainable jobs. But if we set the ground rules on reconstruction correctly, we will be able to create sustainable jobs.

In other words, if we focus the reconstruction efforts appropriately, we can achieve long-term benefits for Haiti. The UNDP is helping to organize programs of this kind, which should be supported and extended around the country. Putting Haitians back to work and offering them the dignity that comes with having a job and its basic protections is exactly what brought our country out of the Great Depression.

This was always the right thing to do, and aid programs persistently fail to get it right. So here is our chance: if even half of the pledges made in Montreal or other such meetings are linked tightly to local job creation, it is possible to imagine a Haiti building back better with fewer of the social tensions that inevitably arise as half a million homeless people are integrated into new communities.

Haiti needs and deserves a Marshall Plan—not the “containment” aspects of that policy, unless we are explicit about containing the ill effects of poverty, but the social-justice elements. But we need to be honest about the differences between post-war Europe and Haiti in 2010. Part of the problem, I’ve argued, is the way in which aid is delivered now as compared to in 1946—well before the term “beltway bandits” was coined. We need a reconstruction fund that is large, managed transparently, creates jobs for Haitians, and grows the Haitian economy. We need a reconstruction plan that uses a pro-poor, rights-based approach far different from the charity and failed development approaches that have marred interactions between Haiti and much of the rest of the world for the better part of two centuries.

Our country can be a big part of this effort. Debt relief is important, but only the beginning. Any group looking to do this work must share the goals of the Haitian people: social and economic rights, reflected, for example, in job creation, local business development, watershed protection (and alternatives to charcoal for cooking), access to quality health care, and gender equity. Considering all these goals together orients our strategic choices. For example, cash transfers to women, who hold the purse strings in Haiti and are arbiters of household spending, will have significant impact. This is a chance to learn and move forward and build on lessons learned in adversity—to build hurricane-resistant houses with good ventilation to improve air quality from stove smoke; to build communities around clean water sources; to reforest the terrain to protect from erosion and to nurture the fertility of the land for this predominantly agricultural country. It is the chance to create shelter, grow the local economy and incomes, and invest in improved health. This will do much to decrease the risk of another calamity, and to decrease the vulnerability of the poor—especially as we face the second wave of problems, including epidemic disease born of the earthquake.

As a doctor, I can tell you that bad infrastructure and thoughtless policy are visible in the bodies of the poor, just as are the benefits of good policy and well-designed infrastructure. In my almost 30 years in Haiti I have witnessed many political interventions and multiple coups. They have been unpleasant, even if their effects pale in the shadow of what we are now experiencing. Many people look at Haiti and despair. They say that aid is wasted, that there is no hope for this country. I would answer them with the positive experience of building Haitian-led programs in the Central Plateau and Artibonite Valley regions that have created five thousand jobs for people who would otherwise have no steady work. I advance this model not because it is associated with our efforts, but because job creation is the surest way to speed up the cash flow that is essential now. It is also the fastest way to make amends for our past actions towards Haiti, which have not always been honorable.

Sitting before you, I am at my core optimistic about the possibilities before us and the potential of our support to help rescue and transform our poorest neighbor. The response from citizens of the United States to the recent events in Haiti has been overwhelming and encouraging. There is the promise of solidarity by our leadership to make long-term commitments to the kinds of investments needed in Haiti—and to fulfilling them.

For two centuries, the Haitian people have struggled for basic human and economic rights, the right to health care, the right to education, the right to work, the right to dignity and independence. These goals, which Haitians share with people all over the world, should direct our policies of aid and rebuilding.

As I wrote with colleagues in a recent op-ed—which is available in my written testimony—as physicians working in Haiti, we know first-hand that Haiti itself will soon be the casualty if we do not help build back better in the way envisioned by Haitians themselves.

1) Walker, P. “Haiti earthquake aid pledged by country.” Guardian.co.uk 26 January 2010. Available at: http://www.guardian.co.uk/news/datablog/2010/jan/14/haiti-quake-aid-ple… (Accessed January 27, 2010)

2) Flintoff, Corey. “In Haiti, a low-wage job is better than none,” All Things Considered, June 14, 2009.

Available at: http://www.npr.org/templates/story/story.php?storyId=104403034 (Accessed January 27, 2010)

3) In 2006, the World Bank estimated that 78% of Haiti's 9 million people lived on less than $2 per day. See Haiti at a Glance, World Bank, Development Data Group (DECDG). Available at: http://siteresources.worldbank.org/INTHAITI/Resources/Haiti.AAG.pdf (Accessed January 26, 2010).

4) For an overview of Haiti’s water insecurity and past delays in international commitments to address this crisis, see Varma MK, Satterthwaite ML, Klasing AM et. al. Wòch nan soley: The denial of the right to water in Haiti. Robert F. Kennedy Memorial Center for Human Rights, Center for Human Rights and Global Justice at NYU School of Law, Partners In Health, and Zanmi Lasante, 2008. Available at: http://www.chrgj.org/projects/docs/wochnansoley.pdf (accessed January 27, 2010).

5) This estimate of disbursements was prepared in January 2010 in an internal memorandum of the UN Office of the Special Envoy For Haiti. President Clinton, in his capacity as UN Special Envoy, frequently appealed to donors to fulfill their commitments. See Helprin, J, “Bill Clinton chides nations over help to Haiti.” Associated Press,, September 9, 2009. Available at: http://www.newsvine.com/_news/2009/09/09/3243861-bill-clinton-chides-na… (accessed January 27, 2010).

6) Farmer, P. “Challenging orthodoxies: The road ahead for health and human rights.” Health and Human Rights: An International Journal 2008; 10(1): 5-19.

7) Daniel, Trenton, “Bill Clinton tells diaspora: ‘Haiti needs you now,’” Miami Herald, August 9, 2009. Available at: http://www.miamiherald.com/news/americas/haiti/story/1179067.html (accessed January 27, 2010).

8) Farmer P, Smith Fawzi MC, and Nevil P. “Unjust embargo of aid for Haiti.” The Lancet 2003; 361: 420-423.

9) Sachs, J. “After the earthquake, how to rebuild Haiti from scratch.” Washington Post, 17 January 2010. Available at: http://www.washingtonpost.com/wp-dyn/content/article/2010/01/15/AR20100… (Accessed January 27, 2010)

10) Republic of Rwanda, Ministry of Health, and Partners In Health. African Rural Healthcare: An Evaluation of the South Kayonza, Rwanda Project (2005-2011). Programme Report, Ministry of Health, 2006.

11) United Nations Development Programme. Human Development Report: 1997. New York: Oxford University Press, 1997. 146-148. Available at: http://hdr.undp.org/en/media/hdr_1997_en_indicators1.pdf (accessed January 27, 2010).

12) Republic of Rwanda. Rwanda Vision 2020. Kigali: Ministry of Finance and Economic Planning, Republic of Rwanda, 2002. Available at: http://www.cdf.gov.rw/documents%20library/important%20docs/Vision_2020… (accessed January 27, 2010).

Testimony of Dr. Paul Farmer to the US Senate Committee on Foreign Relations

27 January 2010

Thank you for inviting me to testify today before the Senate Committee on Foreign Relations. I speak as the U.N. Deputy Special Envoy for Haiti—President Clinton, as you know, is the Special Envoy—and also as a physician and teacher from Harvard who has worked for over twenty-five years in rural Haiti. Today, my hope is to do justice to Haiti not by chronicling the events of the past two weeks, which are well known to you, but by attesting to the possibility of hope for the country, and of the importance of meaningful investment and sustainable development in Haiti.

That said, I will not pretend that hope is not at times difficult to muster.

As I was flying from Port-au-Prince to Montreal on Monday, headed to a conference on coordinating responses to the massive earthquake, I did the painful math in my head and counted close to fifty colleagues, friends, and family members who had lost their lives in the space of a minute.

The afternoon of the earthquake, several of my colleagues from Partners In Health and the UN, were, ironically, in Port-au-Prince for a meeting about disaster risk reduction. Partners In Health, through its Haitian sister organization, provides health care to the rural poor. By focusing on training and employing local talent, we have grown a great deal over the years. We are currently serving a population of well over 1.2 million and count about five thousand employees, most of them community health workers.

Of course, not all our colleagues survived. But the vast majority of them did survive, and they have spent the last two weeks working day and night to relieve the staggering suffering of the wounded and displaced. President Clinton, our colleagues, and I have been in the cities of Port-au-Prince, Jacmel, and Léogâne, as well as the less-affected Central Plateau and Artibonite Valley. Everywhere we have seen acts of great bravery and solidarity.

In addition to the heroism of friends and colleagues, I would like to note for the record the dignity and patience of the long-suffering Haitian people. During a visit last week to Haiti’s largest teaching hospital, which shares a campus with the ruins of the nursing and medical schools, President Clinton remarked that no other people in the world would be so patient and calm in the face of so much suffering. This observation, though accurate, must not be misunderstood. People in Haiti are afraid not only for their options and futures, but still quite simply for their safety. A few nights ago, we sat in empty wards: hearing of impending aftershocks, the patients bolted outside with their IVs dangling from their arms. They refused, as have so many, to sleep inside the building—any building—but instead found tarpaulins and sheets, and lay down in the open courtyard.

This scene has repeated itself throughout the country and is a reminder of the logistics challenges facing all those who would be involved in the provision of shelter, clean water, and healthcare. The relief efforts, focused now on addressing the initial wave of devastation from the earthquake, will soon turn to a new set of concerns. Hastily cobbled together camps are at risk of outbreaks of cholera and other waterborne disease. The Haitian government has wisely proposed avoiding huge camps, which will be difficult to manage, but we must hasten our efforts to get tents, tarpaulins, and latrines or composting toilets to Haiti. It is humbling to see the relief efforts be so slow—in large part because delivery of services was so weak before the quake. Now we must do more to get food and water to people every day for some time to come. Creating safe schools and safe hospitals, even makeshift ones, is a known need in rebuilding a society, and storm resistant housing must also be a carefully considered priority since there is little time before the rainy season. Students need to be back in school; the planting season cannot be missed and requires fertilizer, seeds, and tools.

How will we fund such settlements, ongoing relief, the sowing of seeds, and the reconstruction that must follow? Major pledges have been made by the U.S., Canada, Japan, Spain, Brazil, the European Union, the Inter-American Development Bank, the World Bank, and others.1 Indeed, most countries have responded. Even in far away and once-afflicted Rwanda, a group of community health workers making less than $200/month have been able to pull together $7000 in donations for their colleagues in Haiti. This is but a small portion of the billions needed, but hard to surpass as an eloquent testimony of human solidarity.

Even if adequate resources are available, the task before us will be extremely difficult. Medical jargon, though at times arcane, can be helpful here. Today, Haiti is facing what we would term “acute on chronic” problems. Before January 12, the country was already facing huge long-term challenges in public health and education, the unemployment rate over 70%, and a majority of its population was living on less than two dollars a day. Food and water insecurity were already huge problems.4 Does this catastrophe create a chance for all of us to have a sounder, more solidarity-based relationship with Haiti? Or is it to be yet another chapter in a jeremiad of suffering and abuse of power? In my last testimony here, in 2003, I expressed concern that the latter possibility was likely given our policies at that time. Today I will spend my time focusing on the potential for an entirely reconsidered relationship between the two oldest independent countries in the Americas: Haiti and my own.

Let me offer, as one example of the difficult relations between Haiti and the international community (and an echo of the nineteenth-century machinations I discussed in my last testimony before this committee), the donor conference I attended here in Washington last April. It was one of only two donor conferences I have ever attended, the second being in Montreal earlier this week. The results of the first are noteworthy and worrisome: despite $402 million pledged to support the Haitian government’s Economic Recovery Program, when the country was trying to recover from a series of natural disasters resulting in a 15% reduction of GDP, it is estimated that a mere $61 million have been disbursed.5 In the Office of the Special Envoy, we have been tracking the disbursement of pledges, and as of yesterday we estimate that 85% of the pledges made last year remain undisbursed.

Many of us worry that, if what’s past is prologue, Haitians themselves will be blamed for this torpor. But as we have argued before, there are serious problems in the aid machinery, and these have contributed to the “delivery challenges” on the ground.6 The aid machinery currently at work in Haiti keeps too much overhead for its operations and still relies overmuch on NGOs or contractors who do not observe the ground rules we would need to follow to build Haiti back better. The fact that there are more NGOs per capita in Haiti than in any other country in the hemisphere is in part a reflection of need, but also in part a reflection of overreliance on NGOs divorced from the public health and education sectors.

Haiti will continue to need the contractors, and the NGOs and mission groups, but more importantly we will need to create new ground rules—including a focus on creating local jobs for Haitians, and on building the infrastructure that is crucial to creating sustainable economic growth and ultimately reducing Haiti’s dependence on aid.

In other words, what we need is a way of “building back better” that strengthens governance but also strengthens the Haitian economy to provide for the needs of its people, especially the vast majority of Haitians who are desperately poor. There is an opportunity not only to build Haiti back better, but to build a more functional and beneficial aid structure. Over the past two decades, US aid policies have seesawed between embargoes and efforts to bypass governments, including elected ones not to Washington’s taste. Neither the international community nor the United States provided credible, long-term, financial investment in Haiti. Restructuring foreign aid and forgiving Haiti’s crippling debts are essential to helping the country recover. US laws, including the Foreign Assistance Act of 1961 and its later revisions, prevent direct investment in the public sector; we will need to revisit these policies. Debt forgiveness is also needed to ease the financial drain that would otherwise hinder economic recovery and growth.

In building back Haiti, a credible body that has been working in Haiti could help to house a recovery fund. We need to commit funds and also to disburse them. To quote Jeff Sachs, “Haiti does not need a pledging session; it needs a bank account to fund its survival and reconstruction.”9 Such an account should be managed in collaboration with partners, the UN, and, of course, Haitian leadership, which would work directly and openly with partners to design and implement recovery plans coordinated at central and local levels. The effort must include a comprehensive post-disaster needs assessment, which should be supported by the US and other partners.

Might such plans work? In some of the darkest moments of the last two weeks, when the incapacity and lack of coordination of institutions on the ground was revealed repeatedly, I have thought often of Rwanda and what happened there in 1994. As a physician and teacher at Harvard, I have been lucky to work with the Clinton Foundation, Partners In Health, and the government of Rwanda on rebuilding health infrastructure in three of the last four districts that lacked central hospitals. As in rural Haiti, this has been a very positive experience. It has resulted in thousands of jobs for Rwandans, and has created a broadly accessible health care infrastructure—all with a modest price tag compared to traditional aid contractors.

If such progress can be made in Rwanda, which boasts strong leadership but in 1994 was the poorest country in the world,11 then one hopes it can be made elsewhere. In part because of this positive experience of working together with the Clinton Foundation in Rwanda (and in Malawi and Lesotho), I joined President Clinton six months ago as his deputy in the UN role he originated. As Special Envoy for Haiti, President Clinton has focused his attention not only on holding donors to the financial pledges they made, but also on reducing the risk of disasters and on job creation through the massive public works that are necessary to reforest Haiti, protect watersheds, and improve agricultural yield—the backbone of the Haitian economy. Private investment in Haitian businesses, especially small and medium-sized ones, is critical to rendering Haiti free of any dependence on aid—the goal of Rwanda by 2020, and moreover, a goal likely to be met.  Haiti also has, he noted, great potential as a tourist attraction but lacks the infrastructure to welcome the millions of people who should see Haiti’s natural beauty and historic treasures like King Henri Christophe’s Citadel.

This has been our mission: to build back better from the 2008 storms. We believe that these efforts were beginning to bear fruit. We had scheduled a meeting last week in the Hotel Montana to bring in another round of investors and also to discuss job creation. As many of you know, this hotel is no longer standing, and most inside it perished on January 12. But the need for such investments, and the need for public works that would create hundreds of thousands of jobs, remains.

If there is any silver lining to this cloud, it is that we can push job creation. It is a strange irony that supporters of economic assistance to Haiti are now obliged to shill for “cash for work” programs—for the quaint notion that people should be paid for their labor. Let us at least be honest: it is absurd to argue that volunteerism and food-for-work programs will create sustainable jobs. But if we set the ground rules on reconstruction correctly, we will be able to create sustainable jobs.

In other words, if we focus the reconstruction efforts appropriately, we can achieve long-term benefits for Haiti. The UNDP is helping to organize programs of this kind, which should be supported and extended around the country. Putting Haitians back to work and offering them the dignity that comes with having a job and its basic protections is exactly what brought our country out of the Great Depression.

This was always the right thing to do, and aid programs persistently fail to get it right. So here is our chance: if even half of the pledges made in Montreal or other such meetings are linked tightly to local job creation, it is possible to imagine a Haiti building back better with fewer of the social tensions that inevitably arise as half a million homeless people are integrated into new communities.

Haiti needs and deserves a Marshall Plan—not the “containment” aspects of that policy, unless we are explicit about containing the ill effects of poverty, but the social-justice elements. But we need to be honest about the differences between post-war Europe and Haiti in 2010. Part of the problem, I’ve argued, is the way in which aid is delivered now as compared to in 1946—well before the term “beltway bandits” was coined. We need a reconstruction fund that is large, managed transparently, creates jobs for Haitians, and grows the Haitian economy. We need a reconstruction plan that uses a pro-poor, rights-based approach far different from the charity and failed development approaches that have marred interactions between Haiti and much of the rest of the world for the better part of two centuries.

Our country can be a big part of this effort. Debt relief is important, but only the beginning. Any group looking to do this work must share the goals of the Haitian people: social and economic rights, reflected, for example, in job creation, local business development, watershed protection (and alternatives to charcoal for cooking), access to quality health care, and gender equity. Considering all these goals together orients our strategic choices. For example, cash transfers to women, who hold the purse strings in Haiti and are arbiters of household spending, will have significant impact. This is a chance to learn and move forward and build on lessons learned in adversity—to build hurricane-resistant houses with good ventilation to improve air quality from stove smoke; to build communities around clean water sources; to reforest the terrain to protect from erosion and to nurture the fertility of the land for this predominantly agricultural country. It is the chance to create shelter, grow the local economy and incomes, and invest in improved health. This will do much to decrease the risk of another calamity, and to decrease the vulnerability of the poor—especially as we face the second wave of problems, including epidemic disease born of the earthquake.

As a doctor, I can tell you that bad infrastructure and thoughtless policy are visible in the bodies of the poor, just as are the benefits of good policy and well-designed infrastructure. In my almost 30 years in Haiti I have witnessed many political interventions and multiple coups. They have been unpleasant, even if their effects pale in the shadow of what we are now experiencing. Many people look at Haiti and despair. They say that aid is wasted, that there is no hope for this country. I would answer them with the positive experience of building Haitian-led programs in the Central Plateau and Artibonite Valley regions that have created five thousand jobs for people who would otherwise have no steady work. I advance this model not because it is associated with our efforts, but because job creation is the surest way to speed up the cash flow that is essential now. It is also the fastest way to make amends for our past actions towards Haiti, which have not always been honorable.

Sitting before you, I am at my core optimistic about the possibilities before us and the potential of our support to help rescue and transform our poorest neighbor. The response from citizens of the United States to the recent events in Haiti has been overwhelming and encouraging. There is the promise of solidarity by our leadership to make long-term commitments to the kinds of investments needed in Haiti—and to fulfilling them.

For two centuries, the Haitian people have struggled for basic human and economic rights, the right to health care, the right to education, the right to work, the right to dignity and independence. These goals, which Haitians share with people all over the world, should direct our policies of aid and rebuilding.

As I wrote with colleagues in a recent op-ed—which is available in my written testimony—as physicians working in Haiti, we know first-hand that Haiti itself will soon be the casualty if we do not help build back better in the way envisioned by Haitians themselves.

1)  Walker, P. “Haiti earthquake aid pledged by country.” Guardian.co.uk 26 January 2010. Available at: http://www.guardian.co.uk/news/datablog/2010/jan/14/haiti-quake-aid-pledges-country-donations (Accessed January 27, 2010)

2) Flintoff, Corey. “In Haiti, a low-wage job is better than none,” All Things Considered, June 14, 2009.
Available at: http://www.npr.org/templates/story/story.php?storyId=104403034 (Accessed January 27, 2010)

3) In 2006, the World Bank estimated that 78% of Haiti's 9 million people lived on less than $2 per day. See Haiti at a Glance, World Bank, Development Data Group (DECDG). Available at: http://siteresources.worldbank.org/INTHAITI/Resources/Haiti.AAG.pdf (Accessed January 26, 2010).

4) For an overview of Haiti’s water insecurity and past delays in international commitments to address this crisis, see Varma MK, Satterthwaite ML, Klasing AM et. al. Wòch nan soley: The denial of the right to water in Haiti. Robert F. Kennedy Memorial Center for Human Rights, Center for Human Rights and Global Justice at NYU School of Law, Partners In Health, and Zanmi Lasante, 2008. Available at: http://www.chrgj.org/projects/docs/wochnansoley.pdf (accessed January 27, 2010).

5) This estimate of disbursements was prepared in January 2010 in an internal memorandum of the UN Office of the Special Envoy For Haiti. President Clinton, in his capacity as UN Special Envoy, frequently appealed to donors to fulfill their commitments. See Helprin, J, “Bill Clinton chides nations over help to Haiti.” Associated Press,, September 9, 2009. Available at: http://www.newsvine.com/_news/2009/09/09/3243861-bill-clinton-chides-nations-over-help-for-haiti (accessed January 27, 2010).

6) Farmer, P. “Challenging orthodoxies: The road ahead for health and human rights.” Health and Human Rights: An International Journal 2008; 10(1): 5-19.

7) Daniel, Trenton, “Bill Clinton tells diaspora: ‘Haiti needs you now,’” Miami Herald, August 9, 2009. Available at: http://www.miamiherald.com/news/americas/haiti/story/1179067.html (accessed January 27, 2010).

8) Farmer P, Smith Fawzi MC, and Nevil P. “Unjust embargo of aid for Haiti.” The Lancet 2003; 361: 420-423.

9) Sachs, J. “After the earthquake, how to rebuild Haiti from scratch.” Washington Post, 17 January 2010. Available at: http://www.washingtonpost.com/wp-dyn/content/article/2010/01/15/AR2010011502457.html (Accessed January 27, 2010)

10) Republic of Rwanda, Ministry of Health, and Partners In Health. African Rural Healthcare: An Evaluation of the South Kayonza, Rwanda Project (2005-2011). Programme Report, Ministry of Health, 2006.

11) United Nations Development Programme. Human Development Report: 1997. New York: Oxford University Press, 1997. 146-148. Available at: http://hdr.undp.org/en/media/hdr_1997_en_indicators1.pdf (accessed January 27, 2010).

12) Republic of Rwanda. Rwanda Vision 2020. Kigali: Ministry of Finance and Economic Planning, Republic of Rwanda, 2002. Available at: http://www.cdf.gov.rw/documents%20library/important%20docs/Vision_2020… (accessed January 27, 2010).

The solar panels at Boucan Carre.

“A lack of power was responsible for a lot of deaths in the first few days [after the earthquake],” wrote PIH Executive Director Ophelia Dahl in a recent message.

With electricity knocked out around the country, surgeons were forced to operate on patients using flashlights. Laboratory and diagnostic equipment were rendered useless. Electric water pumps were nonfunctional. Gas generators helped fill the gap. But finding fuel quickly became difficult, and gas that could be found carried price tags as high as $20 a gallon in the days following the earthquake.  Many of our clinics powered by gas generators came uncomfortably close to running out of fuel.

As PIH begins to move from short-term relief efforts towards long-term recovery and rebuilding work, finding sustainable ways to power hospitals will become a priority.

Since 2006, PIH has been working in partnership with the Solar Electric Light Fund (SELF) to provide solar power to hospitals in Rwanda, Lesotho, and most recently, in Haiti. 

Last fall, SELF installed a 10,000 watt solar panel system on the roof of the public hospital in Boucan Carre, where PIH operates in partnership with the Ministry of Health. While hospitals on the grid in the capital city (roughly 3 hours by car from Boucan Carre) were forced to care for patients by candlelight, the solar panels at Boucan Carre ensured that electricity was one less thing the staff had to worry about as they began treating an influx of earthquake victims.

Boucan Carre was just the first of ten sites in Haiti that SELF is planning to work with PIH to help power. Following the earthquake, having the sun power medical facilities will be one of the goals for helping Haiti to build back better. Help support this initiative.

Read more about SELF’s partnership with PIH in Haiti.

Images of earthquake relief efforts in Haiti from clinicians on the ground at PIH hospitals in St. Marc and Cange.

The Haitian Prime Minister says his government is able to lead efforts to rebuild the country in the wake of the devastating earthquake. However, he added that  “massive support” from the international community was needed, he said. Marco Werman talks with Joia Mukherjee, medical director of Partners In Health on Haiti's reconstruction.

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On January 26, 2009, PBS NewsHour's Ray Suarez reports on how Haitian and international medical teams are wrestling over whether to discharge earthquake victims who have been treated, but don't have homes where they could continue their recovery. Interviews with Dr. David Walton and Dr. Maxi Raymonville from Partners In Health/Zanmi Lasante are include in this segment.

Photos from the PBS NewsHour including from Cange Hospital.

Nurse Erik Bartkowiak accompanied four critically ill patients on a medevac plane out of Haiti to receive the medical treatments they desperately needed--treatments that no medical facility in Haiti could provide. Read his story below.

Nurse Erik Bartkowiak (above) and his father (below) tending to patients on their 5 hour flight from Port-au-Prince to Philadelphia.

I would like to give you my account of the events of January 16, 2010, when I worked with Drs Joia Mukherjee and Evan Lyon and their Haitian colleagues to evacuate four Haitian survivors of the earthquake in Port-au-Prince.  I am a Registered Nurse with over 12 years of emergency and trauma experience.

Previous to this, I was in the US army, and only mention this because, in a strange coincidence, I was part of a 7-man special operations team that helped remove Raul Cedras and reinstate Jean-Bertrand Aristide to power in the fall of 1994.

As I watched the footage in Haiti on the news and again saw the plight of organizations on the ground, I remembered hearing of Partners In Health as a small organization during my time in Haiti. I found PIH’s website and called to offer to donate whatever I could to help. I talked to Jesse Greenspan from the PIH procurement team, and told her that I could put a fully outfitted critical care medevac team on the ground as soon as possible with supplies, security and aircraft.  I then contacted Cpt. Lance Lechtworth of Sea to Sky Air LLC, a pilot and aircraft owner that I fly with regularly, and asked him if he would be willing to volunteer for the mission. He immediately said “of course,” and that was set. All I had to do was find a paramedic to accompany me. I called all my usual contacts and asked them if they would be willing to volunteer their services, and all of them stated “No.”  My only choice left was to ask my 60-year-old father, who is a retired firefighter/paramedic, if he would be willing to come along, and he immediately answered “Yes.” The crew and aircraft were set. 

This all took place during the day on Friday, January 16, while Jesse worked hard at getting the arrangements made on her end. I have to commend Ms. Greenspan for her determination, as I am sure her normal job is not to coordinate emergency medical evacuations.  I began to gather all the medical supplies I had on hand in the office, IV equipment, and medications. We grabbed as much water and granola bars as we could fit, as well as a ton of sheets and blankets that we had collected and loaded it all on the plane and waited.

I got an email from Jesse on Saturday morning with the phone number for Haitian Flight Operations. I called the number and asked how to get a landing slot, not really expecting much to happen. But after a 30-second phone call, I got us a slot to land in Port-Au-Prince at 8:00 PM that evening. I immediately called Jesse (who appeared just as surprised as I was), contacted the pilots, and began our plan.

We had no choice but to go ASAP or miss our slot. We did not know patients’ names, injuries, or even really how many. I contacted the University of Pennsylvania hospital [who had agreed to take the patients] to warn them we would be there early the next morning, and they seemed as surprised as could be.

We landed in Port-au-Prince after circling and dealing with chaotic air traffic for a bit, at around 8:30 pm. I attempted to contact Dr. Muhkerjee via text message and was informed that she was trying to get things together but was lacking transportation. We acquired a small bus at the airport, lowered the seats and lined it with plywood. We asked her to give us her location so we would come to her with our makeshift ambulance. The cell service was sporadic, and she never got the message.

Transporting one of the four patients to the waiting medevac plane.

In the meantime, while the pilots unloaded the supplies off the jet, my father and I went across the street from the airport where there was a small encampment of injured that had formed. We began administering as much aid as we could, putting in about 25 IV’s and splinting and bandaging a huge number of fractures and wounds. We then got a message that our patients were on their way.

We summoned our “ambulance” and gave the driver $40.00 and a case of water to take as many of the people that needed treatment to the Partners In Health hospital. I am still curious as to how many of those patients actually got transported. My father headed back to prep the aircraft, and I waited out front for the patients to arrive.

At around 11 PM, three SUV’s arrived with patients, and medical staff crammed in the back.  We exchanged quick formalities and headed around to where the aircraft was parked on the tarmac. It was pure chaos.  Planes were everywhere—so were people and vehicles. We pulled the three vehicles in line and opened the backs, where I was quickly given a rundown on each patient by the medical staff.  Then we began to formulate a plan to load the patients into the aircraft.

This is when it became quite apparent to me that these were very sick individuals. Upon assessing each one in the back of the vehicles, it became a real possibility that three of the four patients may not live long enough to even make Ft. Lauderdale, where we would have to stop for fuel, let alone the 4 ½ hour flight to Philadelphia.

We loaded the supplies that we brought for them into their vehicles, cleaned out all our onboard supplies and medications down to the bare minimum, and said goodbye.

On the aircraft, we had very few supplies and no room to maneuver.  We didn’t know the full extent of the patients’ injuries, and also had no way other than rudimentary hand signals to communicate with them.  This was the first time in 12 years that I was completely overwhelmed and had to take five minutes to figure out how the hell this was going to happen!

My father and I decided that the best way to deal with the situation was to take them one at a time, from the worst to the most stable. I began to treat Celine, who appeared to be the sickest at the time. Her heart rate was 175 beats per minute, and her initial [dangeroulsy low] blood pressure was 64/27. We initiated large bore IV access and began to infuse large amounts of fluid and pain medication.  With the fluids, her heart rate came down, but her blood pressure remained a concern for the entire trip. We sedated her and attempted to splint the lower leg as best as possible. When she was comfortable and stable, we moved on to little Given.

From the first time I saw this child he was lethargic and largely unresponsive. We had reduced and splinted his lower right leg on the tarmac prior to loading the best we could. Once on the aircraft he was barely able to sit upright, his breathing was rapid and shallow, and his heart rate was 170-180, with a weak pulse.  Any movement to his right side elicited screams of pain. He was obviously in shock and in need of IV fluid resuscitation.  However, due to the combination of shock, dehydration, poor lighting in the aircraft, and lack of room to maneuver, I was only able to get a small IV in him, which would not do enough. 

He needed fluids badly, so we attempted the one thing that no kid could resist: Mountain Dew. We had three cans of Mountain Dew onboard, and we gave them to his father and told him to make him drink no matter what. He did not disappoint. Given drank all three cans throughout the trip, along with a bottle of water. We administered pain medicine and attempted to clean and dress his wound, but were forced to back off when faced with the pain it caused and when we saw the large number of concrete pieces and maggots that were in the wound. We just opted to dress it instead. He received more pain meds and began to stabilize.

The patient in the most pain with the largest wound was next. Sitting jammed into the back of the small jet, with her badly injured leg propped up on a makeshift shelf and sharing the only stretcher with Celine, was Sherline. She was in terrible pain. Her vital signs were relatively stable, so we decided to gain IV access, administer fluids and then sedate her so she could try and get some rest. Once she was sedated, I undressed her leg and attempted to find pulses.  I was unable to, due to the severe compartment syndrome and necrosis she had in that leg. We put as much fluid into her to attempt to stave off side effects of rhabdomylisis [the destruction of skeletal muscle tissue] and renal failure. 

Our last concern was Berline, who, all things considered, was the most stable of the four. We initiated IV access on her, began infusing fluids, and medicated her for pain. We had her leg propped up on the Tupperware bin that previously held the supplies we donated to the PIH crew, and she remained relatively comfortable. No attempt was made to redress her wounds, as they appeared to be doing well. It was only at the hospital that I saw the full extent of the massive degloving injury [exposure of the front part of the jaw] that she sustained. She never complained once. If that was me, they would have heard me scream in Philly from 43,000 feet in the air! She is a very strong woman.

For the remainder of the flight, we basically continued to administer fluids and pain medicines. All said and done we administered over 12 bags of IV fluid on the aircraft, gave 20 mg of morphine, 15mg of Valium, 20mg of versed, 6mg of dilaudid, and 3 Mountain Dews! It was quite an eventful five hours.

I am greatly appreciative for the opportunity to work alongside the wonderful and dedicated people of Partners In Health. It is unfortunate that it took a horrible incident to make the masses aware of the wonderful work your group has done for over 20 years in a country that most people forgot.

-Erik Bartkowiak RN

Read more about how the patients are faring in Philadelphia.

Half a world away from each other, and with very different geo-political histories, Haiti and Rwanda have some demographic and cultural similarities—and are both home to PIH sister organizations. Both have populations of close to 9 million, with densely populated capitol cities, and economies that are about 1/3 agricultural. Prevalence of TB is the same in Haiti and Rwanda (660 per 100,000) and rates of HIV are also quite close (3.8 % in Haiti and 3.1 % in Rwanda). In both countries, slightly more than half the population lives on less than $1 per day. And both have cultures in which “family” extends far beyond those related by blood and generosity is nearly boundless. Their response to seeing someone in need is to help—as much and in as many ways as possible.

It was that feeling of solidarity that led the staff of PIH’s sister organization Inshuti Mu Buzima (“Partners In Health” in the local Kinyarwanda language) to take up a collection for their Haitian colleagues in this time of crisis—donating a percentage of their own salaries to Haiti relief activities. “[Donating our salaries] was raised after the IMB Rwandan staff had a meeting last week and [we] took some time to pray for Haiti,” said Daniel Mungwarakarama, project manager at Inshuti Mu Buzima (IMB). “We are still fundraising some more money outside of IMB,” Daniel added.

Not only have IMB staff agreed to donate financial resources to relief efforts, they have also offered to travel to Haiti to provide psychological support. Almost 16 years after the genocide that killed nearly one million Rwandans, survivors have a deep understanding of what it is like to live in a country in which every person has lost someone close to them. It has become all too clear that this is the situation in Haiti: the earthquake has left no one untouched. “Rwandans feel like they are somehow related to their sisters and brothers in Haiti and [we] wanted to do something to participate in the earthquake relief action,” said IMB Chief Financial Officer Odile Nzirabatinya.

This is not the first time the Haitian and Rwandan teams have reached out to one another. In the early days of IMB, members of the Zanmi Lasante (“Partners In Health” in Haitian Creole) clinical team traveled to Rwanda and helped to set up the IMB hospital in Rwinkwavu. More recently, a group from the psycho—social support team at Zanmi Lasante came to Rwanda to help IMB develop a mental health program. In fact, many of the techniques they plan to use with survivors in Haiti will be those taught to them by Father Eddy Eustache, Director of Zanmi Lasante’s Psychological Support Services. Their offer to return the favor is deeply appreciated—by all of us.

Loading up a plane bound for Port-au-Prince.
Some members of the newly formed People, Planes, and Stuff team in the PIH Boston office.

Justin Miranda is examining a white board covered in notes about the model, cargo load, and location of dozens of planes. Generous donors have them made available to PIH in order to shuttle desperately needed medical staff and supplies to Haiti, and they now need to be matched with teams of volunteers and cargo ready for shipment. A member of the “planes” contingent of the newly formed “People, Planes, and Stuff” department, Justin is better known at PIH for his Java programming talents than for knowledge of a Falcon 900’s cargo capacity or how many people can get to Haiti on a Challenger 604. His new area of expertise is clear, however, as he explains how a donated anesthesia machine will need to be packed in order to fit properly into an available plane. Justin is not alone in his willingness and ability to re-focus his attention in response to the crisis in Haiti: he, along with several of his colleagues from every department at PIH, has learned very quickly to implement PIH’s plans to deploy medical personnel and supplies to Haiti by ensuring the safe arrival of dozens of flights over the last ten days.

With the invaluable help of the planes’ owners and pilots, the PIH planes team was formed and put to work immediately following the 7.0 earthquake which flattened much of Port-au-Prince and surrounding towns. Julia Noguchi, who normally spends her days in the training department, pitched in as a member of the planes team. “It’s a steep learning curve, and we’ve had to ramp up activities quickly," she says. "But we’re being very effective.”

The first group of surgeons was on the ground in Haiti less than 72 hours after the earthquake. Since then, more than 40 planes carrying over 170 volunteers and tens of thousands of pounds of medical supplies, have landed safely, delivering precious cargo for PIH facilities in Port-au-Prince and the countryside. Dozens more flights are in the pipeline, and are being managed with speed and accuracy. Julia Jezmir, the PIH Russia Project Coordinator is fluent in English and Russian, and in order to communicate effectively with her new partners—the owners and pilots of the planes—is becoming proficient in the Army alphabet as well.  “Alpha, Bravo, Charlie…I’m not as good as Jon [Lascher, from the PIH procurement team] but everyone is learning.”

Luke Messac, Matt Basilico, and Emily Bahnsen, all of whom are on PIH co-founder Dr. Paul Farmer’s staff, help match offers of planes with teams of volunteers and donated supplies, and help coordinate landing slots at the overburdened Port-Au-Prince airport.  Emily can now speak with great authority about the size and cargo capacity of planes that need a two hour landing slot, as opposed to those which only need one hour (generally smaller planes that can be unloaded by hand and then parked on grass). As she describes the process, which includes coordinating with the US military and air traffic controllers in Haiti, she explains that being nice gets you a long way. “The people on the other end of the phone have a really difficult job, and they are working so hard. We just try to make things as easy as possible for them.” 

Once a landing slot is secured, the arrival time, tail number, and contents of the plane need to be communicated to the people waiting for the plane on the ground in Port-au-Prince.  Joan VanWassenhove does that, sometimes sending text messages until 3 in the morning in order to make sure that our incredible team members in Haiti are at the airport to receive the people and supplies. Joan’s regular job is to help disseminate lessons learned from programmatic research from the sites.

As they work together in an office now dedicated to “Air PIH” activities, a major theme emerges: gratitude and admiration for the people providing their planes, and for the pilots flying them. Because PIH must take landing slots whenever they are available, but also must achieve “wheels down” status within a twenty minute window on either side of that time, the planes are operating both on very short notice and on extremely tight schedules. Luke shakes his head in amazement as he gets off the phone with the pilot who brought PIH Executive Director Ophelia Dahl, along with medical volunteers and supplies to Port-au-Prince, and was bringing home a group of volunteers on the return flight.  “The pilots are awesome,” says Luke. “They’re so clear headed and reasonable. And willing to do whatever it takes.”

In the coming weeks and months, the flights will surely slow down and will no longer need the full time attention of people like Justin and Julia. PIH’s strategy in Haiti has always been a long term one, and will need additional resources for many years to come, but eventually Justin will be able to return to his duties improving the Electronic Medical Records system, and Julia will dedicate 100 percent of her time to Russia project. For the time being however, Air PIH is ready to fly. 

On January 25, 2009, PBS NewsHour Ray Suarez talks to Paul Farmer (PIH co-founder and the United Nations' deputy special envoy to Haiti) about the obstacles facing aid workers in Port-au-Prince, where thousands require urgent care.

PIH Executive Director Ophelia Dahl has been visiting PIH’s sister organization in Haiti, Zanmi Lasante (“Partners In Health” in Haitian Creole). She recently sent the following note reflecting on her first 48 hours in Haiti, where she visited the University Hospital in Port-au-Prince and the Zanmi Lasante (ZL) hospital in Cange:

PIH Executive Director Ophelia Dahl with a patient in Haiti.

Haiti’s catastrophe will forever divide its history into before earthquake and after.

Dust has not settled. Flying towards Port-au-Prince, you can see a thick layer of smog lingering above the city. The air is acrid, stings the eyes, and makes you cough.  The airport is its own world:  a spread of tents large and small, containers, supplies, boxes, vehicles, bicycles, and people wandering about—both  in and out of uniform.

We bumped into Jens, the UN engineer who had worked with us on the bridge we helped build in Boucan Carré last year.  He was the last person to be pulled out alive from the UN meeting building. He had been under rubble for 6-8 days. Needless to say, he looked like a walking skeleton and sounded very jittery. “I had a lot of luck,” he put it simply

We drove to the University Hospital (HUEH).  The scene there is truly impressive in so many ways. Much progress has been made.  Medical tents are lined up in a row. Inside, beds and stretchers lie close together. Most patients are post surgery, bandaged, or in casts. They are now receiving narcotics. Operating rooms are up and running—now 24 hours a day. Patients are lying down, most with haunted eyes, but always responding to a greeting, often waving a slow hand. I had to stop myself from greeting them so they wouldn’t have to wave back in pain.

Last night, I sat outside the main tent at HUEH on a bench talking to Dr. Evan Lyon and Dr. David Walton, both have worked with PIH in Haiti for many years. With the lights on inside the tent, I could see the silhouettes of relatives tending to the patients, washing them with a rag, feeding or massaging them. The sadness everywhere is so palpable. Haitians are usually very expressive in their mourning. Before the quake occurred, wakes would typically last all night, with women wailing and shouting in agony outside on the ground. People often fainted during funerals. I can’t imagine that happening here now. The wailing would never stop.  There is no energy for weeping. Everything is marked by the quiet. Nearly everyone—adults and children—wear the same flat, sad expression on their faces.

Volunteers run about. Some nurses, both Haitian and American are around, but there is a lack of nursing care everywhere.  The nursing school collapsed in the quake, flattened between two buildings that still stand.  Its rubble holds the remains of the entire second-year nursing class. You can smell the bodies when you walk past.  It seems so arbitrary which buildings crumbled; maybe that’s why no one feels safe in any concrete structure.

Outside in the courtyards at HUEH, the patients who were evacuated from the ward after the second wave of aftershocks have constructed makeshift tents over their beds. It is starting to look like people are staying – where else can they go? The main buildings are mostly still standing on the HUEH campus, but several have major cracks. Patients are afraid to be inside. Evan told me that when people felt aftershock tremors last week, they pulled out their IVs and just scrambled out as fast they could.

Polo [PIH co-founder Dr. Paul Farmer] described a 35-year-old woman who had come to the hospital from the south. She was also attached to oxygen and afraid. He asked her whether anyone was with her. She said no one. She lost all her family and was brought to the hospital by a neighbor.

We also saw a woman who had been brought back to the hospital with tetanus. She was fine and had been discharged after the initial surgery on her foot. But now her neck was stiff, her head tilted back. She looked rigid and very sick. There will be medical challenges for many months and years to come. Other challenges remain too, including sanitation (there are no real toilets). You can imagine.

So many people are doing such a stellar job. Obviously, I know it is the effort of many, many folks, but Evan and David are shining stars. Old news, I know, but Evan reinforced how life-saving it has been to have Jim Ansara [founder of Shawmut Design and Construction Company] help get the electricity going. A lack of power was responsible for a lot of deaths in the first few days.

My first night, after touring parts of the city, Evan, David, Jim Ansara, Chris Strock [an engineer from Virginia Tech], and I stayed with a family in Port-au-Prince. We slept on the floor inside their house. The family slept on the ground outside—still too unsure to go in.

Yesterday, we had a leadership meeting with Zanmi Lasante (ZL) Director of Operations Loune Viaud, ZL Director of HIV/TB Dr. Fernet Leandre, PIH Clinical Director Dr. Louise Ivers, ZL Director of Monitoring and Evaluation Dr. Wesler Lambert and PIH Medical Director Dr. Joia Mukherjee and Polo to talk about the mid- and long-term response, particularly a community-based outreach movement. We spoke of ten specific communities, with a massive training of Community Health Workers for follow-up wound care and chronic care. We discussed key partnerships with food and water organizations. Joia also returned yesterday and has a plethora of details to be shared and refined.

Polo and I headed to Cange following our meeting. Silence was everywhere, as was a sort of stoicism I had not seen here before. It is impossible to greet colleagues and friends and not see that their hearts are broken. 

We went first to visit the church, which has probably 70 patients lying on mattresses in rows on the ground. All of them have casts on their limbs or white bandages over their stumps. Haitian staff and volunteers change dressings every day, and this need will endure for weeks to come. In the corner of the church is an overflow pharmacy, where the piano has become a workbench and meds cover the altar. Docs round on the patients. Lovely Dr. Jon Crocker [formerly the clinical director of PIH’s project in Malawi] was seeing patients with a team of volunteers. And, as always, relatives help their loved ones with simple tasks.  There is mostly quiet, no one is talking much, but there is a sense of community. Apparently, some patients moved to other wards have asked to come back to the church. We will have mass today in the Clinic Externe. 

In the hospital, all wards are taken up with amputees, patients with fractures, and some in need of spinal care. Probably 200 patients altogether. The team reported having done 1,150 x-rays. The x-ray room is a miserable place to be for those who have made the long trek, because their limbs must be repositioned to get a good film, and it is painful. But the films help ensure that their surgeries go smoothly.

There is a long road ahead for plastics, including skin grafts and wound care. We are planning for all that. We’ll need a big infusion of prosthetics in a few months. There will be perhaps tens of thousands of amputees, but it’s hard to count. Dr. Koji Nakashima, who has been working with Zanmi Lasante in Cange, says there are some NGOs with good experience helping landmine victims that we should reach out to because it is clear that expertise is required, as is steady, dedicated funding. Also, there loads of physical therapists will be needed. It is so hilly in Haiti that it’s hard to imagine life here without both legs.

I’m deeply moved by our staff. Many are suffering huge losses, but are still here. One of our lab technicians lost her husband, and her son suffered head trauma and kidney failure, yet she keeps coming to work. Having volunteer teams working with our staff is going well . The lovely team  from California here right now. The operating rooms are working hard; we’re able to do roughly 16 surgeries per day. There are three rooms available, but one is kept for emergencies and C-sections.

I am struck by many things, but the silence is deafening. The road from Cange to Hinche used to be a busy thoroughfare with trucks hurtling back and forth all day and blasting their horns. Yesterday, I counted only a handful of trucks. The trucks used to be loaded with food and things for market. Now there is just quiet—a sign that we are far from any sort of economic normalcy.

I’m heading to Hinche and, hopefully, to St Marc tomorrow.

-Ophelia Dahl

NBC Nightly News recently reported on how to find charities that will do the most good with donations, including using the website Charity Navigator to evaluate a charity's effectiveness. Watch below.

View Charity Navigator's report on Partners In Health.

Visit msnbc.com for breaking news, world news, and news about the economy

Tuesday, January 26, at 5:30 p.m. EST join Dr. Jim Kim, Partners In Health co-founder and President of Dartmouth College for a live Q&A.

Dr. Jim Yong Kim will be leading an online discussion on Tuesday, January 26 at 5:30pm EST on the national student response to the recent earthquake in Haiti.

As President of Dartmouth College and a co-founder of Partners In Health, Dr. Kim will speak about the earthquake, PIH's response, why national student solidarity is critical to the response, and how students from across the country can help. Read Dr. Kim's bio

The call is open to all students (graduate, undergraduate, high school, middle school, etc) who are interested in learning more about the situation and how to mobilize their school communities to respond to the earthquake in Haiti.

Dr. Kim will be speaking via an online video stream (watch below starting at 5:30pm EST) and taking live questions through the video player's chat feature. We will also be accepting questions by email up until the talk begins. To send your question in early, email sdhr@dartmouth.edu with the subject line "JYK TALK: Your name, your school"

Join PIH’s medical director Dr. Joia Mukherjee and ONE members around the world for an interactive conference call tonight, Tuesday, January 26, at 8PM (EST) to talk about what we can do for Haiti: Crisis, Rebuilding, and Debt Cancellation. Also on the call will be Rep. Maxine Waters, a debt relief champion and driving force for legislative solutions; former Senate Majority leader Dr. Bill Frist, a trained surgeon who just returned from operating in a Haitian field hospital; and David Meltzer, Senior Vice President for International Services for the American Red Cross, also just back from Haiti.

RSVP with your phone number and ONE will call you tonight at 8pm. 

On the call, experts and participants will share their responses to the aftermath of the Haiti earthquake. The panel will take questions, provide an update on ONE’s “Drop Haiti’s Debt” campaign, and talk about the broader development picture and discuss what can be done to help Haiti rebuild better. Please join us to find out why we need to keep the pressure up and learn about ways that you can help.                                 

ONE is a grassroots campaign and advocacy organization backed by more than 2 million people who are committed to the fight against extreme poverty and preventable disease, particularly in Africa. Cofounded by Bono and other campaigners, ONE is nonpartisan and works closely with African policy makers and activists. The ONE campaign is a call for $1 billion in debt relief for Haiti that has already spurred the IMF and World Bank to work towards cancelling Haiti’s debts.

Program Manager for Psychosocial Support and Mental Health posts from Haiti:

In the midst of all of the distress the earthquake brought in its initial days, the immediate response of many in the countryside was to rush to Port-au-Prince to look for family and friends—a very natural response given the circumstances. With cell phone communication down, this was the only way to verify they were ok, or in need of help.

For our patients receiving treatment for multi-drug resistant tuberculosis (MDR TB) at one of two treatment centers in the Central Plateau, this was not an option. Their illness requires a two-year treatment regimen, the first of which is administered as an inpatient. For them, leaving in search of their families was out of the question. Without communication capabilities and only listening to radio reports explaining the extent of the destruction, one can only imagine how distressing these first few days were for them.

In the days since, as cell phone service improved and patients were able to reach their families, many learned of the sudden and untimely death of their family and friends. One of our patients, Benjamin, who has been battling tuberculosis off and on for 18 years, learned that he lost 10 family members. Others lost siblings, aunts, uncles, mothers, fathers, cousins, friends. In their grief, they immediately started asking themselves why were they saved from this tragedy and not others? How would they continue to live? Why did some people have to die in an instant while they have been able to receive life-saving treatment for their deadly illness? Should they abandon treatment and give up on life?

The Zanmi Lasante staff at the Monseigneur Decoste Infectious Disease Pavilion at the St. Therese Hospital in Hinche immediately recognized their patients' anguish and called on the support of Zanmi Lasante's head psychologist and Director of Psychosocial Support Services, Father Eddy Eustache, to help work with their patients.

Drawing on a technique he has used at PIH's Rwanda project working with genocide survivors, Father Eddy led us in a memorial service remembering the lives of all those we had lost in this unthinkable disaster. Patients and staff alike sang songs, read scripture, shared stories of their memories of their loved ones, and in arguably the most moving part of the service, lit candles for each of the people we had lost while reading their names out loud. To conclude, staff provided words of encouragement and advice for patients on continuing to adhere to treatment and find support in each other.

Efforts such as these are part of a more comprehensive psychosocial support plan for Zanmi Lasante staff, patients, and their families as we work together to address the psychological impact that the earthquake has had on everyone in Haiti.

Kenbe Fem,

Cate Oswald
Program Manager for Psychosocial Support and Mental Health, Haiti

For the last 25 years, Partners In Health and Zanmi Lasante (our Haitian sister organization) have been delivering community-based care that extends well beyond the hospital. It involves building houses, bringing clean water, and providing emotional and social support to those in need. While the enormous task of treating people physically injured by the earthquake still looms large before us, we cannot ignore the mental health injuries that are also ubiquitous at a time like this, particularly for those who were already living on the margins, suffering from the vicious cycle of poverty and disease.

Transporting 4-year-old Given to the medevac plane in Port-au-Prince.
Given at the Children's Hospital of Philadelphia.
Celine's first physical therapy session.

Last week, PIH helped to evacuate four Haitian patients in desperate need of medical treatments too complex to be handled in their devastated country.

These patients are thought to be the first Haitian earthquake victims to be evacuated to the United States.

Up until the night the plane carried the patients out of Port-au-prince, PIH staff in Boston raced to secure the arrangements and permissions to land the donated med-evac plane, bring the patients into the U.S., and deliver them to the U.S. hospitals who had generously agreed to treat them.

Meanwhile, the team in Port-au-Prince struggled to stabilize the patients—three women and a little boy—for transport. The team also brought along the boy’s father to accompany him to the U.S.

The plane flew out of Port-au-Prince in the early morning hours of January 17 and headed towards Philadelphia. However, the ordeal for the patients was not over. “It became quite apparent to me that these were very sick individuals,” said Erik Bartkowiak, the nurse who helped organize the flight and also cared for the patients during the flight. He feared that three of the four patients were so ill that they wouldn’t survive the trip.

The sickest patient, a woman named Celine, had a heart rate of almost twice the normal beats per minute, and had close to no blood pressure at one point, said Erik. The boy, a four-year-old named Given, screamed in pain every time the right side of his body was jostled, and desperately needed to get fluids in him. “Due to the combination of shock, dehydration, poor lighting in the aircraft, as well as [lack of] room to maneuver, I was only able to get a small IV in him, which would not do enough,” said Erik. “He needed fluids badly so we attempted the one thing that no kid could resist...Mountain Dew. We had 3 cans of Mountain Dew onboard and gave them to his father and told him to make him drink no matter what.“

The plane finally landed at around 5:00 am in Philadelphia. All four patients had made it through the night, and were rushed to the Hospital of the University of Pennsylvania and Children’s Hospital of Pennsylvania.

Today, Celine is doing the best of all four patients, according to Naomi Rosenberg, a medical student and former PIH employee who helped to organize the med-evac. Although she had her leg amputated below the knee, she’s been working hard maintain her spirits and regain mobility through her physical therapy.

Doctors were also forced to perform amputations on the other two women, Berline and Sherline. In addition to the physical trauma of their injuries, both are even more concerned over those they left behind in Haiti. Berline, the mother of four small children, including two she was still breastfeeding at the time of the earthquake, has been desperate the hear how her children are and to let them know that she is still alive. PIH staff and partners have been trying to connect over the phone, but so far to no avail.

Sherline, a young woman who was orphaned as a teenager, has been equally desperate to contact her three sisters in Port-au-Prince. Doctors believe her recovery will probably be the longest—her crushed leg was amputated above the knee and she suffered acute renal failure following her first operation. She has been back to the operating room regularly since then to clean out her wounds.

Little Given suffered a badly broken his leg and has undergone at least five operations since he landed in the U.S. Today, doctors have scheduled another operation to graft skin and muscle from his good leg onto his injured one. His father has been able to contact his relatives in Haiti, and learned that Given’s twin brother is alive, but hungry and homeless.

Doctors hope that all four patients will be done with their major operations by early this week, with their then treatment focusing primarily on physical therapy.

An outpouring of support from a local church and Haitian families and PIH supporters in the Philadelphia area has helped to welcome the patients. They’ve been supplied with phone cards, clothing, and food, as well as Haitian Creole-speaking visitors for emotional support. PIH is also working to find a Creole-speaking mental health professional to help them cope with the trauma of their situations. Although alive and stable, all four will be living with the aftermath of the earthquake for years to come.

These four were able to access amazing care in the U.S., but there are literally thousands of other earthquake survivors that need surgical procedures that cannot be performed in their own country. Before the earthquake, PIH’s sister organization in Haiti, Zanmi Lasante, had been working to provide poor communities with access to basic surgical facilities. In the wake of the earthquake, continuing to strengthen surgical facilities throughout Haiti will remain a top priority.

"With 10 hospitals and deep roots in Haiti, Boston-based Partners In Health has became one of the pillars of the worldwide response to the Jan. 12 earthquake," reports the Boston Globe in an article published today. The piece details how PIH has been orchestrating its efforts to help relieve and rebuild Haiti--on the ground at our hospital in Cange, as well as at our administrative headquarters in Boston. Read the article.

The accompanying video from the Boston Globe (watch below) highlights our staff's efforts to treat earthquake victims in Cange.

We've been incredibly touched and inspired by the outpouring of support we've received over the past 6 days. From to celebrities to sports teams to activists--we are so thankful to all our partners in health. Below is how one of the thousands of supporters--and his students--are standing in solidarity with PIH, and with the people of Haiti.

On Wednesday, January 16,  Matt Cone, a high school civics and economics teacher in Hillsborough, North Carolina, had a full head of hair. Then he presented his students with a challenge: If everybody donated $5 and they reached a goal of $275 to donate to PIH, they could shave his head.

Cone’s students went above and beyond. On Wednesday, January 20, around noon, he left the room for 2 minutes to allow students to donate what they could. When he returned, they were $21 shy. He gave them a couple more minutes to reach their goal. By 12:25 p.m., Cone had a mohawk, courtesy of his students.

After a parent matched up to $100, the group is donating approximately $400 to PIH’s relief efforts in Haiti. Cone, who has encouraged his students to think about global poverty and the many factors involved, says, “I’m hopeful we can persuade students to also look outside the lens of charity and think about social justice. How was it that Haiti became so poor? . . . It would be amazing for students to be talking about Haiti six months from now or later. The real hope is that you get underneath the skin with all this stuff.”

In a late-night email from the general hospital in Port-au-Prince (HUEH), PIH Medical Director Joia Mukherjee reported an inspiring example of lifesaving international collaboration from the night before.

PIH Medical Director Joia Mukherjee at a mobile clinic in Haiti in 2007.
Patients resting under the shade of a tree, for lack of housing at HUEH.

At L’hopital Universite l’etat Haitien (HUEH) last night, the surgical team from Children’s Hospital Boston and I were just wrapping up several cases. The Chief Administer at HUEH and a nurse were rounding by flashlight with two Haitian doctors who had returned from their pediatric residencies in Cuba to help.

On a routine post-operative check on a woman who had undergone a  C-section,  the residents noticed that her baby was pale.  Upon unwrapping the baby, they found that she had a huge amount of blood pouring out of her rectum.  They ran to the operating room asking for a surgeon.  While the team had orthopedic surgeons, a plastic surgeon, four anesthesiologists, six pediatric nurses and me, a pediatrician, we had no general surgeons. 

The baby was profoundly anemic and in shock.  The blood bank that the Haitian Red Cross was to start was a day or two away.

“Ask the American volunteers if any of them have O-negative blood!” I yelled, thinking that if we couldn’t do a formal blood type, the blood that is considered the Universal Donor would be the only way to get blood into this baby. 

An orthopedic trauma surgeon from Grand Rapids, MI, stepped up to the plate and drew 60 cc of his blood into a regular syringe. Meanwhile, as we struggled to get an IV, Plastic surgeon John Meara [from Children’s Hospital] inserted a needle into the baby’s tibial bone marrow (an intraosseus line), and we moved the baby to the operating room, where anesthesiologists from Boston and Grand Rapids went into full code mode, finally securing a line to give the direct whole blood transfusion and nearly one liter of fluid (half the baby’s body weight), as well as provide her with oxygen and antibiotics. 

The cause of the bleeding was likely an intestinal obstruction. When the baby was stabilized, we began trying to transport the baby to one of the U.S. military facilities. Even with the excellent collaboration with U.S. military personnel stationed at the hospital, it took hours to get confirmation of the location. 

By 3 am, the baby had stabilized and was actually sleeping.  Some of us slept on gurneys close by--abruptly jumping up for two aftershock tremors. At 5:30 am, as the sun was rising, I again called the military and finally got confirmation on the location of the hospital.  After waiting 2 hours for military-approved transport, our own PIH/Zanmi Lasante driver took us to the facility.  By 8 am, the baby was stable and in the hands of a competent pediatric surgeon.  We arrived back to our PIH tent city where many new teams of volunteers were waiting in the hot sun to help the people of Haiti. They had traveled from Maryland, Virginia, Michigan, Northern and Southern California, and South Carolina.  I was later relieved by my colleagues from PIH/ Zanmi, Dr. Patrick Almazor and Dr. Louise Ivers.

We don’t yet have an update on the baby; however, we have every hope that she will do very, very well. My brief rest was made more peaceful by this one miraculous example of the collaborative spirit between nurses, doctors, drivers and soldiers, and people from Haiti, Cuba, the United States, and people from around the world on behalf of the life of a tiny baby, shaken into the world by a devastating quake, sleeping under a tree for lack of housing. A baby whose life, like those of all babies, is our collective human responsibility.

In Solidarity,

Joia

Last night, MTV hosted the most widely distributed telethon in history, Hope for Haiti Now: A Global Benefit for Earthquake Relief. Partners In Health was one of the seven organizations benefiting from proceeds raised through the event.

“Tonight, we want you to give so we can all come together and help Haiti rise from the ruins,” said actor Samuel L. Jackson, one of the many celebrities who appeared on the telethon.  “Every time you call… the doctors and nurses at Partners In Health can do even more to provide medical care to the survivors,” he said.

The telethon will continue over the weekend on MTV’s website, and performances from some of the biggest names in music will be on sale on iTunes. These proceeds will also go directly to relief and long-term recovery in Haiti.

"All of us at Partners In Health are overwhelmed by the generosity of people around the world who donated to the “Hope for Haiti Now” telethon,” said PIH Executive Director Ophelia Dahl. “We are thankful to the many talented celebrities who gave their time to generate support for this cause and all those in the entertainment industry who made this remarkable show happen. Partners In Health, together with hundreds of other partner organizations, have been able to make great strides in the emergency medical relief. The funds raised will go a long way in helping us provide medical equipment and supplies as we work with the Ministry of Health in Haiti to strengthen the public health infrastructure in the months and years to come."

Haitian musician Emeline Michel was one of the many artists performing on the telethon. Watch her version of Jimmy Cliff's gospel-inspired "Many Rivers To Cross" below.   

Watch performances by Madonna, Bruce Springsteen, Wyclef Jean, Beyonce, Coldplay and many more on MTV's website. Video clips are also available on Youtube.com and Hulu.com.

Want to learn more about Partners In Health? Read a New Yorker profile of our co-founder, Dr. Paul Farmer, and his efforts to provide health care to the poor in Haiti and all over the world. The New Yorker has opened its archive so that you can read it now.

Written by Pulitzer Prize-winning journalist Tracy Kidder, this article eventually became the basis of his best-selling book Mountains Beyond Mountains.

Tracy Kidder also recently submitted a blog post to the New Yorker's blog, including an email from PIH Clinical Director for Haiti detailing her experiences in Port-au-Prince when the earthquake struck.

The New Yorker is also generously donating the proceeds of sales of the cover art from this week's issue to Partners In Health. Find out more.

Check out Partner In Health’s new PSA. And help us get the word out by passing it on to everyone you know. We are, as always, grateful for your support.

Today, Harry Potter and sci-fi/fantasy fans of all kinds will be coming together to raise money for the victims of the Haiti earthquake. Rooted in the Harry Potter community, and representing many fan communities (including Heroes, Lost, True Blood, The Wire and Firefly), this group of podcasters, musicians, artists and activists will put on a four-hour show that includes entertainment, performance, interviews, news and a lot more. Proceeds from the event will benefit Partners In Health. Read more about this benefit at http://thehpalliance.org/haiti/.

It took 90 minutes for tickets to James Taylor’s benefit concert tonight in Great Barrington, MA, to sell out—netting $150,000 to be donated to Partners In Health's earthquake relief and rebuilding efforts. And after Taylor and his wife, Kim, matched that amount, a total of $300,000 has already been raised. Taylor, after hearing that his concert sold out that quickly, generously volunteered his time for a second show on January 23, at 8 pm; that show has also sold out.

Tonight's concert will be aired live on the Boston-area station WBUR 90.9 FM, starting at 8 pm. Listen to to the concert live over the internet.

"Our hearts go out to everyone in Haiti," said Taylor on his website. "We need to do everything we can to help the country recover after this tragic earthquake. I'm grateful to do my part and hope my neighbors here in the Berkshires will join me and be as generous as possible."

A big thank you to James Taylor and all his neighbors in Berkshires from PIH. We’re grateful for your support.

The medical team at the makeshift triage center inside a local church in Cange.

PIH Haiti Program Coordinator posts from Boston:

Wednesday morning, a strong aftershock earthquake rocked Port-au-Prince, temporarily shutting down operations at the general hospital in Port-au-Prince, as well as several other PIH sites outside the city. Since then additional smaller quakes continue to disrupt efforts on the ground.

Here's a quick update on our work in Haiti despite these challenges.

PIH's surgical teams continue to race against time to provide surgical care to earthquake victims in Port-au-Prince. Operating rooms at the central general hospital (HUEH) in Port-au-Prince are fully operational again after being temporarily evacuated on yesterday in response to the aftershock. PIH is still coordinating the relief efforts at HUEH and reports having 12 operating rooms opened 24 hours per day. Across the country, we have a total of 20 operating rooms up and running.

To date, PIH has sent 22 plane loads with 144 medical volunteers - orthopedic surgeons, anesthesiologists, surgical nurses and other medical professionals - and several thousand pounds of medical supplies to support the more than 4,500 PIH health care providers already in Haiti.

Despite these accomplishments, our teams throughout the country continue to report a great need for additional medicines (antibiotics, anesthesia and narcotics), medical equipment (anesthesia machines and x-rays), medical supplies (IVs, tubing, irrigating saline), and water.

"There are very sick people and too little space and time," reported PIH Women's Health Coordinator Sarah Marsh from our hospital in St. Marc. She added that we will lose more patients to infection in the coming days if we don't find additional medications, and explained that is only for lack of supplies - not patients - that the surgical team risks performing more operations. A volunteer orthopedist also working from St. Marc stressed that we will need full medical teams on site to manage dressings, skins grafts and other post operative care for another 6-8 weeks.

Our sites in the Central Plateau and the lower Artibonite are dealing with increasing numbers of patients and families seeking both medical treatment and refuge from devastated Port-au-Prince. Finding space and beds for post-operative care has become the next major challenge. In Cange, PIH's 104-bed facility is overflowing: the church is serving as a triage center and the school as a recovery room. People are arriving in Cange at all hours of the day and night; many simply have nowhere to go.

"Our houses were crushed and our businesses destroyed. So we came to Cange," said one man who arrived in a bus with 12 relatives, including his mother-in-law who was critically injured. In Belladaire, near the border with the Dominican Republic (DR), up to 1,000 people are camped out at PIH's hospital in temporary shelter, searching for family members and medical treatment. We expect that people will continue to return to the countryside, having lost their family, livelihoods, and homes in the capital city, and meeting the needs of this displaced population will be a major task in PIH's long-term rebuilding efforts.

Finally, recognizing that many of our own Haitian staff, who are working tirelessly to save the lives of others, have also lost their own families and friends, PIH is also developing a post-trauma mental health and social service program to serve both staff and patients.

The task ahead is a monumental one. And even as we heal wounds, mend broken bones, and provide basic necessities (food, water, shelter), its true magnitude grows before our eyes. But we know from 20-plus years of accompaniment the resiliency of the Haitian people. Through poverty, strife, hurricanes, disease and hunger, our Haitian friends and colleagues continue to amaze us. Their determination, spirit, and ability to overcome and survive is inspirational and humbling.

Partners In Health is determined to do whatever it takes, for as long as it takes, to ensure that their struggle succeeds.

With your help, we know we will be able to do so.

Kenbe fem,

Ali Lutz
Haiti Program Coordinator

Dartmouth College president—and PIH co-founder—Dr. Jim Yong Kim has rallied the Dartmouth community to come to Haiti’s aid. And in just a short time, the college’s response has been phenomenal.

Two teams of medical professionals from Dartmouth-Hitchcock Medical Center—along with $125,000 worth of donated medical supplies—quickly departed to work in PIH clinics in Hinche and Port-au-Prince. "The second team has much more of a nursing focus which will complement the skills of the first team we sent down on Saturday," said DHMC executive medical director John Butterly, who’s working to coordinate relief efforts. "The needs are both growing and constantly evolving and we are trying to adjust the teams and supplies accordingly to meet those needs."

And less than nine days after the earthquake, the Students at Dartmouth for Haiti Relief (SDHR) have raised more than $100,000 for Haiti—quickly meeting their initial goal of $100,000 and well on their way to their new goal of $125,000. Dartmouth is also leading PIH’s national collegiate fundraising challenge.

SDHR, which has formed partnerships with Dartmouth Medical School, the Tuck School of Business, and the Thayer School of Engineering, among others, was started by Dartmouth undergrads Frances Vernon, Maura Cass, and Alexandra Schindler. The group has organized 300 volunteers into different committees, which encompass everything from long-term education to organizing an Uplift Haiti Dinner and a benefit concert.

“Our mobilization was fast and our community rallied behind us with support,” says Cass. “But at the end of the day this isn't about Dartmouth. We've shared our model for organization with colleges around the country and we will continue to be involved with this so that our mobilization is just the beginning of the national effort.”

How you can get involved and learn more:

• Read more about SDHR.
• Watch a video on the group’s successful fundraising model.
• Keep up with Dartmouth’s efforts in Haiti.
• Read a letter from Dr. Kim to the Dartmouth community.
• Check out photos from Dartmouth’s Haiti response.

Congress recently passed legislation that allows taxpayers to count charitable contributions made for relief efforts in Haiti on their 2009 tax returns. President Obama is expected to sign the bill soon.

Under the provision, donations that are “cash contributions made for the relief of victims in areas affected by the earthquake in Haiti” can be deducted in 2009 as long as they are made after January 11, 2010 and before March 1, 2010.  Contributions must still qualify under section 170.

If you've made a donation to PIH through our website and do not have a tax receipt (generally emailed to you shortly after your donation), you can request one from us here.

If you made a donation through your cellphone via text message, keep your telephone bill--which should also show the name of our organization, the date, and amount of your donation.

You can choose to take the deduction in either 2009 or 2010.

Read the legislation.

Santa Monica Orthopaedic and Sports Medicine Group and Saint John’s Health Center are teaming up to lend a hand in Haiti.

With the  generosity  of Mel Gibson, Matt Damon, and Newman’s Own Foundation,  an orthopedic mission consisting from the Santa Monica Orthopaedic and Sports Medicine Group as well as a nursing and anesthesiology team from Saint John’s Health Center arrived in Haiti yesterday.  The group will provide much needed surgical care at Partners In Health’s operating facilities over the next several days.  

PIH is deeply grateful that this collaboration between celebrities, philanthropists, and medical professionals has been able to mobilize so quickly to help the people of Haiti during this crisis.

We are deeply grateful for the multitude of people who have contacted us wanting to provide medicine and supplies.

We are currently unable to accept small donations. Partners In Health is partnering with two organizations, The Afya Foundation and IMEC, to collect and consolidate donations of small quantities of relief supplies for Haiti. The Afya Foundation in NY can accept donations of general relief items, including medical supplies, clothing, and blankets. To see if Afya is able to accept your donation, please call (914) 338-7034. IMEC is a Massachusetts-based organization that can accept donations of medical supplies.  They are unable to accept medications, liquids, or medical products with less than a 6 month shelf life. Please email donation offers of small quantities of medical supplies to donations@imecamerica.org.

View recent coverage of PIH's efforts Haiti from a variety of media outlets:

Paul Farmer Appointed University Professor (Harvard Magazine  Jan/2010)
Harvard announced today that Paul Farmer, M.D. ’88, Ph.D. ’90, anthropologist and physician and founder of Partners in Health, has been appointed the first Kolokotrones University Professor. Farmer is known globally as a humanitarian who has worked to deliver care to desperately underserved people in Haiti and elsewhere. An excerpt from Mountains Beyond Mountains, by Tracy Kidder ’67, which brought Farmer’s work to broader attention, is available here.

The best we can do: Battling cholera in Haiti (North Shore News  12/19/2010)
A three-hour drive later along bumpy roads and through the Haitian countryside we arrived in Hinche with the ever present UN military standing guard. Little time was wasted introducing us to the cholera tents and the plan of care.

The Gifts of Hope (New York Times (Opinion)  12/18/2010)
New York Times’s Nicholas Kristof highlighted 9 charities he recommends donating to this holiday season – including Partners In Health. Read Kristof’s entire list.  

Global Health Pioneer Paul Farmer Given Prestigious University Professor title at Harvard (MSN: Good Health  12/17/2010)
Paul Farmer was named University Professor today, a title, according to Bloomberg News is the highest faculty rank, providing him freedom to cross boundaries between academic specialties.  

Dr. Paul Farmer in Newsweek: How We Can Stop Cholera (Skoll Foundation  12/16/2010)
This week in Newsweek, Skoll Entrepreneur Paul Farmer, M.D. and Jean-Renold Rejouit, M.D. explain the roots and solutions for the Haitian cholera epidemic — why they matter to the world, and why no one should give up on Haiti. This is “not your grandmother’s cholera,” writes Paul Farmer, founder of Partners in Health, and Zanmi Lasante’s codirector of women’s health, Jean-Renold Rejouit, in “How We Can Stop Cholera.”

Paul Farmer’s 5 Fixes to Slow Haiti’s Cholera Epidemic (WBUR  12/10/2010)
Cholera has already killed at least 2026 people in Haiti. Today, PIH’s Paul Farmer and his colleagues at PIH write in The Lancet that it’s time to get more aggressive in thinking about how to tackle Haiti’s escalating cholera outbreak.  

Toward A New Strategy for Fighting Cholera in Haiti (NPR  12/10/2010)
Thousands of lives have been saved and the size of Haiti's AIDS epidemic has been cut in half by linking HIV treatment and prevention. Now there's a new question. Could a cholera vaccine slow the spread of the disease in Haiti and the neighboring Dominican Republic? Yes, PIH Drs. Paul Farmer, Louise Ivers, Patrick Almazor and Fernet Leandre in a Lancet article.

Experts call for vaccination, antibiotics in Haiti (Reuters  12/10/2010)
Simply setting up clinics to treat Haitians with cholera is not doing anywhere near enough to tackle the epidemic there, health experts said on Friday, calling for intensive vaccination and more use of antibiotics. Paul Farmer and colleagues at Partners In Health said current strategies are not working. "Rehydration alone without any antibiotics, in our view, is not a good idea, even for moderate cases of cholera," reports Farmer. 

Haiti protests ease, US senator pressures govt (AP  12/10/2010)
Dr. Paul Farmer, cofounder of the Boston-based charity Partners in Health, said yesterday that a strong public sector is essential to Haiti’s recovery. “You can’t do public health without a public sector, and you can’t do public water without a public sector,’’ he said. “We’ve flipped and flopped all over the place in our relations with Haiti.’’ 

Use of Cholera Vaccine in Haiti is Now Viewed as Viable (The New York Times  12/10/2010)
Dr. Paul Farmer, who is well known for fighting AIDS in Haiti, endorsed broader use of a cholera vaccine in Haiti, and called for creating emergency stockpiles of millions of doses to keep cholera from spreading to other countries.

He endorsed measures like searching Haiti’s central mountains for people too sick to reach clinics, using antibiotics even in moderate cases and rebuilding the water and sanitation networks shattered by January’s earthquake.

Death and decay in Haiti’s hospitals (Toronto Star  12/10)
The newest member of Lovely’s family was born here last month, the cord yanked from around his howling throat. He died, still unnamed, 15 days later. No one knows why…

“Rather than developing a parallel system to replace what the ministry can’t do, we’re trying to support what the ministry has the authority to do,” says PIH’s Dr. Louise Ivers.

Cholera vaccine, antibiotics urged for Haiti (CNN  12/10)
The cholera epidemic in Haiti continues to spread, particularly in the rural areas in the north, which has public health advocates calling for more to be done to try to stem the spread of disease. PIH’s Dr. Paul Farmer calls for more antibiotics and vaccines to be shipped to the small Caribbean nation in the most recent edition of the Lancet. 

Foreign Policy: How to Keep the WHO Relevant (NPR  12/9/2010)
The WHO — for 62 years the world's go-to agency on all public health matters — is today outmoded, underfunded, and overly politicized. In a world of rapid technological change, travel, and trade, the WHO moves with a bureaucracy's speed.

Another advantage of this local focus would be the opportunity to forge stronger relationships with the private organizations, such Partners In Health, which actually implement health programs.

Container Laden with High-Performance SolarWorld Panels Sails to Haiti (Business Wire  12/9/2010)
Some 100,000 watts worth of high-performance solar panels have shipped out of Miami to Port-au-Prince, Haiti, where they will be redeployed to five remote medical centers.

Solar Electric Light Fund (SELF), a US nonprofit that uses sustainable energy to aid developing communities, is managing the project to largely replace expensive, unreliable diesel generators at clinics of Partners In Health, an international medical relief organization.

Haiti cholera likely from UN troops, expert says (AP  12/7/2010)
A contingent of U.N. peacekeepers is the likely source of a cholera outbreak in Haiti that has killed at least 2,000 people. It was not until AP reports of sanitation problems at the base and calls by experts including Paul Farmer, a physician and U.N. official, for a thorough investigation that the matter was seriously discussed in public.

Farmer said there were compelling public health reasons to find the source of the infection, including finding information to help prevent its further spread, and that avoiding the questions was a matter of politics. 

12 graduate in medical software development (The NewTimes  12/7/2010)
Partners In Health (PIH) in partnership with the Rwanda Development Board (RDB), on Thursday evening, graduated 12 students after they successfully completed a training programme on e-Health: Software Development and Implementation (EHSDI).

The nine-month intensive mentor-driven course for Computer Science graduates was developed to address the need for local software developers who could support the large-scale implementation of electronic medical records systems in Rwanda.

Cholera Rages in Rural Haiti, Overwhelming Clinics (AP  12/3/2010)
Many feared Haiti's growing epidemic would overwhelm a capital teeming with more than 1 million people left homeless by January's earthquake. But, so far, it is the countryside seeing the worst of an epidemic that has killed nearly 1,900 people since erupting less than two months ago.

"Most Haitians live in rural areas and most don't have latrines," said Dr. Louise Ivers of the medical aid group Partners In Health. "Most people have to do their business in a hole in the back garden and drink water from an unprotected source."  It is these people who have the fewest options when they get sick. "Why do you die from cholera? Because you don't have access to health care," Ivers said.

An Interview with Paul Farmer (Harvard Political Review  12/1/2010)
Harvard’s Lily Ostrer interviews PIH cofounder Paul Farmer. They discuss cholera, PEPFAR, and Haiti.

PIH pays $105 million RWF ($180,000 US) for needy students in Rwanda  (The Sunday Times of Rwanda  11/30/2010)
Partners In Health (PIH) Rwanda, paid over Rwf 105 million in tuition fees and other school dues for vulnerable children in three districts of Rwanda this year.  The beneficiaries were from Kayonza, Ngoma, Kirehe and Burera districts.

PIH provides entire primary and secondary school fees for HIV affected and vulnerable students, provided they meet the required standards.

5 Lessons From Haiti's Disaster (Foreign Policy  11/29/2010)
Read more about Paul Farmer’s essay in Foreign Policy.

Origin of Haiti’s cholera outbreak a mystery (Miami Herald  11/28/2010)
In Haiti, U.S. and Haitian health officials identified the strain by testing specimens taken Oct. 18 and 19 from rice field workers who drank unchlorinated water from the contaminated Artibonite River. Knowing exactly where it came from might help prevent similar incidents in the future, said Paul Farmer. “We want to have public-health interventions that work.” 

It takes two (Boston Globe  11/28/2010)
“Poets for Haiti’’ (Yileen) is an anthology of poetry and art, including paintings, prints, and mixed media works, many by Haitian-born artists. All proceeds from sales of the book will go to PIH to help Haiti rebuild. In the preface, Paul Farmer and Ophelia Dahl noted that 1.5 million people were still living in settlement sites in Port-au-Prince as the book was going to press. Dahl will join Robert Pinsky and other poets for a reading at 7 p.m. on Dec. 8 at Porter Square Books in Cambridge.

Arcade Fire: 'The cliched rock life never seemed that cool to us' (The Guardian (UK)  11/28/2010)
Reporting from Barcelona, Spain, Sean O’Hagan interviews Win Butler – lead singer of the band Arcade Fire – backstage after a recent show.  They discuss the ways and reasons why the band has been working alongside Partners In Health. Arcade Fire’s "one dollar, one euro, one pound" ticket policy donates one unit of currency to PIH for every ticket sold. By the close of last year, they had raised $800,000 for the organization. This year, they aim to hit the $1m mark.

Haiti's sweatshops keep costs of our T-shirts low (St. Petersburg Times  11/28/2010)
Reporter Dan DeWitt, who followed Partners In Health through the Central Plateau in September, discusses the pros and cons of Hanes and other corporations setting up t-shirt factories in Haiti. During DeWitt’s visit, PIH staff were encouraging Multi Tex, the company that makes t-shirts for Hanes, to run a designer factory in the Central Plateau.

PIH Pays Rwf 105 Million for Needy Students (All Africa  11/28/2010)
PIH’s sister organization in Rwanda, Inshuti Mu Buzima, paid over Rwf 105 million in tuition fees and other school dues for vulnerable children in three districts of Rwanda this year. PIH provides entire primary and secondary school fees for HIV affected and vulnerable students, provided they meet the required standards. 

Cholera Spreads on Eve of Haiti Elections (NPR Weekend Edition  11/27/2010)
The cholera death toll continues to rise in Haiti. According to official figures from the government, at least 1,648 people have died and
there have been more than 72,000 confirmed cholera cases. Dr. Wesler Lambert with Partners in Health discusses a cholera treatment facility recently set up in Port-au-Prince. 

Cholera’s knockout punch to Haiti (The Toronto Star  11/26/2010)
A 2008 report by Partners In Health estimated that 70 percent of the country’s population couldn’t access clean water. The number of people in the country with septic tanks decreased by 162 per cent between 1990 and 2006. So, like the earthquake before it, cholera comes as a second punch. Natural disaster — wham — and then epidemic — knockout. 

The State of Mental Health in Post-Earthquake Haiti (WBUR - Boston’s NPR affiliate  11/25/2010)
WBUR’s Sasha Pheiffer interviews PIH’s Director of Mental Health, Giuseppe “Bepi” Raviola and PIH’s Director of Mental Health and Psychosocial Services in Haiti, Father Eddy Eustache. Bepi and Father Eddy talk about the complex mental health situations facing Haitians affected by last year’s earthquake but also the various conditions many of these people before January 12, including HIV, amputations, or mental illness.  

“Whether you’re talking about old problems, or new ones, they’re all rooted in poverty” (C-SPAN  11/20/2010)
PIH cofounder Paul Farmer answers caller’s questions on C-SPAN from the Miami Book Fair International. Paul’s interview began with a brief discussion of his recent book, Partner to the Poor, but quickly transitioned into a conversation about the future of Haiti’s government and people and the role of nongovernmental organizations in health care delivery systems around the world. In response to questions about cholera, he also addresses the need to assist Haiti’s government in its goal to deliver water rights to all Haitians.

Haiti’s cholera epidemic is no surprise, experts say
“We can treat water. But we need strong municipal water systems,” said Paul Farmer, founder of Partners In Health, the aid group that helped get the filtration system to Grande Saline. “What Haiti needs is water security, just like every country.”

UN worries its troops caused cholera in Haiti (AP 11/20/2010)
Earlier this month, Dr. Paul Farmer, co-founder Partners In Health and UN deputy special envoy for Haiti, supported an investigation into the source of the cholera, saying the refusal to look into the matter publicly was "politics to me, not science."
 
A Vote Against Cholera
Adaq Mendosa, the young Nicaraguan doctor on duty with Partners In Health, works with poor, illiterate farmers who are shocked to learn that cholera can be warded off with simple hygiene. Most of them don’t own soap, and drink water sourced from the Artibonite River, the same water in which they bathe and wash their clothes.

Haiti’s cascading crises comes down to lack of clean water (USA Today  11/19/2010)
It is likely that the cholera epidemic will continue to spread because little has been done to improve Haiti’s water situation. "We really need a massive push of political will," says Joia Mukherjee, medical director of Partners In Health. "This can't just be about handing out water purification tablets."

Did UN Peacekeepers Bring Cholera to Haiti (Foreign Policy  11/18/2010)
The World Health Organization has said that investigating the origin of the outbreak is "not important right now," though longtime Haiti public-health advocate and U.N. deputy special envoy and PIH cofounder Paul Farmer counters that finding the source "would seem to be a good enterprise in terms of public health" and that the reluctance of international organizations to investigate further is politically motivated.

U.S. can lead in fight against extreme hunger (Casper-Star Tribune)
Mariana greets us at the gate of her wooden shack. Her limbs are thin like sticks and her face appears hollow. Is she the sister of the patient whom we have hiked over two hours to reach? She asks me if there is a medicine that will give her enough strength to push this eighth baby into the world.

Partnerships, training key to global health (Harvard Gazette 11/15/2010)
Organizational partnerships, the training of local medical personnel, and increased engagement by academic medical centers to deliver care where it’s needed are all important if the present push to improve global health is to have lasting results,

Responding to Haiti’s Water Crisis (Miami Herald 11/15/10)
Water in Haiti has become a luxury. Only 40 percent of the population, according to official government estimates, has access to safe drinking water either through homes, or distribution points. “We can treat water. But we need strong municipal water systems,” said Dr. Paul Farmer, founder of Partners In Health, the aid group that helped get the filtration system to Grande Saline. “What Haiti needs is water security, just like every country.”

Haiti cholera toll rises as medical supplies are rushed to victims (Catholic News Service 11/15/10)
Louise Ivers, a physician who is chief of mission in Haiti for Boston-based Partners In Health, told reporters in a briefing Nov. 12 that she feared the centers and hospitals could be overrun with cholera patients if the number of cases continues to grow as it did after the hurricane.

Haiti - Epidemic : Cuba sends medical reinforcements (Haiti: Libre 11/14/10)
Despite the active presence on the ground of the Cuban brigade and staff dedicated to the fight against cholera, plus important human resources of Medecins Sans Frontieres (MSF) and Partners In Health, Artibonite and North West have a need for more medical partners on the ground.

Promises Betrayed Cause Suffering in Haiti (InDepthNews 11/14/10)
Hurricane Tomas, which struck on November 5, threatens to turn the cholera outbreak into a full-blown epidemic. Tomas' winds ripped apart tents and tarps, its rain turned Port-au-Prince's refugee camps into muddy swamps, and its floodwaters may spread the cholera. Partners In Health reports that "living conditions at the camps...have deteriorated as a result of the storm. Standing water, lack of garbage collection and limited sanitation availability make the camps a potential flashpoint for cholera outbreak."

Haiti and cholera are strangers (News and Observer 11/14/10)
The arrival of cholera in Haiti is first and foremost a health emergency. Once the emergency is over, though, the stigma attached to the disease will likely linger, only prolonging the suffering of a country that can hardly afford any more agony. It's happened in Haiti before. In the 1980s HIV crisis, Haiti and its people were falsely associated with the disease and risky behavior. This stunted economic growth, handicapped freedom of movement and disfigured Haiti's public profile. In many ways, the stigma rivaled the spread of disease.

Clinics challenged as cholera spreads (Democracy Now! 11/14/10) 
Dr. Phuoc Lee of Partners In Health spoke with Democracy Now! about the cholera outbreak in Haiti. Phuoc says that staffing is currently adequate, though increased numbers of people continue to show up to PIH medical facilities with signs of cholera. 

Aid Spawns Backlash in Haiti (The Wall Street Journal 11/12/10)
More than a million people are still living in tent cities across Haiti, fueling a cholera epidemic that has killed 796 people even as NGOs have rushed to contain it. The United Nations has asked for $164 million to help combat the disease. There is now a growing debate over the role of NGOs in Haiti.

Paul Farmer, founder of Partners In Health, an NGO which, in conjunction with the ministry of health, is the country's largest health provider, believes that NGOs and foreign governments should channel some of their funds directly to the Haitian state. "NGOs have flourished in number and size as the public sector has withered in Haiti," says Dr. Farmer.

Cholera In Haiti: New Cases, Deaths Up Sharply (WBUR - Boston’s NPR affiliate 11/12/10)
Earlier today, Partners In Health’s Chief of Mission in Haiti Dr. Louise Ivers spoke to reporters on the status of the ongoing outbreak and PIH’s response. She said that the situation has taken a dramatic turn for the worse, with clear signs that the outbreak has spread to the crowded slums and settlement camps in Port-au-Prince. According to the latest report from the Haitian Ministry of Public Health and Population, a total of 12,303 people have been hospitalized and 796 have died since the outbreak began.

Haiti cholera toll crosses 800 (Haiti News 11/12/10)
A cholera epidemic sweeping across Haiti has killed more than 800 people, hospitalized 12,000 and put an estimated 200,000 at risk, the UN said Friday, as it appealed for $163 million in donor aid. The UN anticipates that up to 200,000 people will show symptoms of cholera, ranging from cases of mild diarrhea to severe dehydration. The number was calculated based on experiences in other countries as well as estimates by the World Health Organization and the US Centers for Disease Control and Prevention.

According to Partners In Health, Haiti has not had a documented case of cholera since the 1960s. But conditions were ripe for an epidemic even before the Jan 12 earthquake. 

Cholera Outbreak Hits Port-au-Prince (OpEdNews 11/11/10)
On November 9, Haiti Libre said city authorities examined at least 120 suspected cases, mostly in Cite Soleil, the extremely impoverished, densely populated community home to around 400,000. More vulnerable from Hurricane Tomas flooding, Partners In Health (PIH) called crowded camps "a potential flashpoint for a cholera outbreak. There is growing concern" about reported cases, thousands that may spread to many more.

Haiti – Epidemic: The real culprits of the epidemic (Haiti Libre 11/11/10)
In 2008, PIH and three other organizations have published a report on the lack of access to drinking water, chronic in Haiti. According to the report, this lack "is one of the biggest obstacles to Haiti, to meet the most basic standards of human rights. A historical legacy of inequality, an governance without authority or corrupt and persistent levels of extreme poverty have contributed to the intrinsic inability of successive Haitian governments, to provide drinking water to its population."

Haitian Cholera Outbreak Seems to be Spreading in Port-au-Prince (The Wall Street Journal 11/10/10)
Aid workers say that floods caused by Hurricane Tomas last week likely accelerated the spread of the waterborne bacterium that causes cholera. Partners In Health, a health-care nonprofit that has long operated in Haiti, is posting regular updates of the situation on its website.

Medical Workers Say Haiti Needs Money Now to Recover (WBUR - Boston’s NPR affiliate 11/10/10)
Medical officials are predicting that cholera will become a way of life in Haiti over the next few years, and that the disease could kill as many people as the January 12th earthquake did. Ten months after that earthquake, reconstruction has barely begun. And while more than $1 billion in US emergency aid has reached Haiti, large installments of the $1.5 billion in long-term aid have not reached Haiti – little to none of which has been delivered.

Dr. Joia Mukherjee, PIH’s medical director, thinks the US should send that money to the Haitian government now.

Spread of Cholera in Haitian Camps – Interview with PIH’s Joia Mukherjee (BBC News 11/10/10)
As cholera spreads into the settlement camps in and around Port-au-Prince it is crucial that the outside world offer medical support to Haiti in order to curb a larger outbreak. PIH’s Dr. Mukherjee says, “It [cholera] will spread,” because the country lacks the infrastructure to deal with this type of epidemic. Only a small percent of the country’s 10 million citizens – less than 30 percent – has access to proper sanitation, to clean water and a proper way to store human waste.

Haitians brought to Philadelphia area for quake care found themselves adrift (Philadelphia Inquirer 11/10/10) 
 In September, seven months after leaving Haiti, several seriously ill and injured Haitians were evacuated and moved into two homes in Germantown, PA. Partners In Health intervened in response to concerns about the patients' well-being from Philadelphia-area Haitian Americans. Today, the evacuees are doing well, but their stories illustrate the complexity of giving aid, and how the distance between good intentions and good follow-through can be as great as the miles between Haiti and Philadelphia.  

Cholera Cases Spur Containment Efforts In Haiti (NPR Morning Edition 11/08/2010)
Health officials in Haiti are investigating more than a hundred suspected cases of cholera in Port-au-Prince. Aid agencies and the government are scrambling to try to contain it. Dr. Anany Prospero with Partners in Health explains that the cholera treatment centers will be used to assess possible cholera cases, provide initial treatment and refer the more serious cases to a local hospital.

Cholera confirmed for resident of Haiti's capital (AP 11/08/2010)
Living conditions in Port-au-Prince's earthquake camps have "deteriorated as a result of the storm," Boston-based Partners in Health said Monday. "Standing water, mud, lack of garbage collection, and limited sanitation availability make the camps a potential flashpoint for cholera outbreak," the group said … Public health experts, including U.N. Deputy Special Envoy to Haiti Paul Farmer, who co-founded Partners in Health, have called for an aggressive investigation into the origin of the outbreak.

For Haiti, No Relief in Sight (Newsweek 11/08/2010)
Starting in 2002, the Bush administration conducted a sustained campaign to block aid from reaching the Haitian government. “Our government started giving all of its aid directly to NGOs,” says Paul Farmer, U.N. deputy special envoy to Haiti. “And our policies influenced those of other countries and international financial groups.”

U.S. had a role in Haiti's dirty water (St. Petersburg Times 11/7/10)
Reports on the current cholera outbreak that has killed 442 people in Haiti tend to follow the same basic narrative: unexpected disaster hits helpless nation while American-financed aid groups come to the rescue. However, a water report co-written by Partners In Health states that “the United States actively impeded the Haitian government's capacity to fulfill Haitians' human right to water.” 

Bearing Witness: Girls and Women in Haiti’s Camps (World Pulse Magazine 11/04/2010)
When Didi Bertrand Farmer, Director of the Community Health Program for Partners In Health-Rwanda, returned to Haiti, she was unprepared for what she saw in the tent cities: an increase in sexual violence; mothers forced to leave their vulnerable daughters; young girls, pregnant as a result of rape.

Experts: Did UN troops infect Haiti? (AP 11/3/10)
"That sounds like politics to me, not science," Dr. Paul Farmer, a U.N. deputy special envoy to Haiti and a noted expert on poverty and medicine, said of the reluctance to delve further into what caused the outbreak. "Knowing where the point source is — or source, or sources — would seem to be a good enterprise in terms of public health."

Storm threatens fragile Haiti (USA Today 11/3/10)
Roads in the rural areas are so poor that aid workers from Partners In Health abandoned their off-road vehicles for donkeys to carry supplies to the mountainous Poste Pierrot district, where 18 people had died from cholera, PIH Chief of Mission Louise Ivers said. The storm is likely to worsen conditions, she said.

Death and dirty water: Cholera’s grim march through Haiti (The Toronto Star, 10/29/2010)
The good news: the number of admissions at Saint Nicolas has slowed, says Patrick Almazor, the Partners in Health director for the Artibonite region.

Rebuilding Haiti, Better Than Before (NPR Talk of the Nation 10/28/2010)
Dr. Joia Mukherjee, chief medical officer for the group Partners In Health, also a professor with Harvard Medical School discusses the cholera outbreak in Haiti and the efforts to rebuild the devastated nation.

Dartmouth Calls On Community For Help (WPTZ 5 10/28/2010)
The Dartmouth College Haiti Response team sent 6,000 pounds of supplies to Haiti to help with the Cholera outbreak. The team chose to give the supplies to Partners In Health because they trusted the organization and knew the supplies would get to Haiti immediately.

Cholera Outbreak Highlights Clean Water Crisis (IPS 10/28/2010)
The percentage of the population without access to safe drinking water increased by seven percent from 1990 to 2005, according to a 2008 report by Partners In Health, a medical organisation currently responding to the cholera outbreak in Haiti's central region.

At Cholera Epicenter, Chaos, But Signs Of Control (NPR 10/28/2010)
Dr. Patrick Almazor says it's no longer just a problem in this northwestern city — it's where people — and the bacteria — go next. Almazor works for Partners in Health, a medical aid group that helps run St. Nicholas and two other hospitals in the region. He says the crowded capital of Port-au-Prince, just 40 miles to the south, is a sitting target.

Helping Haiti Help Itself (Harvard Crimson 10/28/2010)
Though some well-meaning NGOs and aid may provide temporary relief, there are a few organizations that should set an example for the framework between immediate care and lasting development and integration into the country.

Cholera outbreak in Haiti: How to help (USA Today 7 10/27/2010)
Partners In Health is also helping Haitian cholera victims get access to medical care and clean water.

Partners in Health Physician on Haiti: "Cholera Will Not Go Away Until Underlying Situations that Make People Vulnerable Change" (Democracy Now 10/26/2010)
The Haitian government says a cholera outbreak is slowing down, but experts are warning the disease could remain for many years. At least 259 people have died, and over 3,300 have been infected. We speak with Dr. Evan Lyon, a physician with the group Partners in Health who has spent years working in Haiti.

Locating the Cause of Cholera (St. Petersburg Times 10/26/2010)
It is also possible the disease came from outside the country, said Joia Mukherjee, medical director for Partners in Health. That was the case of a similarly sudden surge of the disease in Peru in the 1990s, the source of which turned out to be the holds of ships, she said.

Health Officials Expect Cholera to Spread in Haitian Capital (Wall Street Journal 10/26/2010)
“The numbers we're seeing every day are more or less the same," said PIH’s Dr. Louise Ivers, the group's mission chief in Haiti. She warned cholera could spread quickly in the capital because of crowded conditions and the lack of clean water and sanitation. "People are still living in desperate situations," said Dr. Ivers.

Haiti’s cholera outbreak is easing, but danger isn't over (AP 10/25/2010)
A cholera outbreak showed signs of easing Monday after killing more than 250 people in a sweep through rural Haiti, but experts warned that the earthquake-devastated country's first bout with the disease in decades is far from over. Water purification tablets and oral rehydration salts — used to counteract potentially lethal dehydration caused by diarrhea — have been widely distributed in the region where the river or rainwater remain the only water source for many, said Dr. Louise Ivers, an official with the aid group Partners in Health.

River may be Source of Haiti Cholera (CBS News 10/26/2010)
As the CDC works closely with Haitian authorities to track the cholera outbreak, health officials believe the Artibonite River could be the source. Dr. Koji Nakashima of Partners in Health speaks about the devastation that has hit the St. Marc region, where thousands of cholera cases have been reported. Dr. Jon LaPook reports from Port-au-Prince.

Cholera in Haiti (Wall Street Journal 10/25/2010)
So far, the handful of cases reported in the city have been identified as travelers from the Artibonite area, where the disease was first reported. Here’s a map of where the outbreak is occurring from Partners in Health, the public-health group that has long operated in Haiti.
 
Amid Cholera Outbreak in Haiti, Fear and Misery (New York Times 10/25/2010)
Inside the courtyard of St. Nicholas Hospital, beyond the gate with the handwritten sign stating “Diarrhea Emergency Only,” lies a grim but unusually orderly scene at the epicenter of this country’s unexpected cholera epidemic… About 600 patients with intense diarrhea and vomiting are being seen at St. Nicholas Hospital daily, a facility jointly run by the Haitian government and Partners in Health.
 
Cholera In Haiti Here To Stay, Experts Say (NPR 10/25/2010)
Experts are wondering if cholera will make its way to the crowded tent cities and slums of Port-au-Prince. The government and public health agencies are planning for a worst-case scenario, which Dr. Joia Mukherjee of Partners in Health describes as "a widespread epidemic in a really poor city that's home to 2.5 million people."

Locating the Cause of Cholera (St. Petersburg Times 10/26/2010)
It is also possible the disease came from outside the country, said Joia Mukherjee, medical director for Partners in Health. That was the case of a similarly sudden surge of the disease in Peru in the 1990s, the source of which turned out to be the holds of ships, she said.
 
Cholera: Inevitable Spread to Port-au-Prince (ABC News 10/25/2010)
Nearly 600 patients at St. Nicholas hospital in St.-Marc are triaged each day and 400 of those are hospitalized, according to Partners in Health, a nonprofit health group that operates the hospital in partnership with the Haitian Ministry of Health.
 
Good News in Haiti: Cholera Outbreak Seems To Be Stabilizing (Tonic 10/25/2010)
Hôpital Saint Nicolas in St. Marc, which is operated by Partners in Health (PIH) in partnership with the Haitian Ministry of Health, hospitalized 300 patients on Sunday. "What we do see are slightly less severe cases of the disease when people arrive at the hospital," says PIH's Haiti Chief of Mission Dr. Louise Ivers. "When they arrive, they are still ambulatory and at that stage, more responsive to the oral rehydration."
 
Haiti cholera outbreak 'stabilizing' (Christian Science Monitor 10/25/2010)
"The United States actively impeded the Haitian government’s capacity to fulfill Haitians' human right to water through its actions, thus breaching its duty to respect human rights."
 
Haiti Cholera Outbreak: How You Can Help (Huffington Post 10/25/2010)
Partners In Health is also helping Haitian cholera victims get access to medical care and clean water. Supporters can donate online to help Partners In Health save lives and prevent the spread of the cholera epidemic.

Delivering Aid to Fight Cholera Outbreak in Haiti (Santa Barbara Independent 10/25/2010)
Partners In Health has requested materials to treat cholera, a diarrheal disease, which can become fatal within hours as a patient becomes dehydrated. The materials include IV sets and solutions, oral rehydration solutions for adults and children, antibiotics, soap, bleach, masks, gloves, and water purification tablets

In Haiti, cholera could heighten earthquake misery (Miami Herald 10/25/2010)
In a promising development, aid group Partners in Health said hospital management was improving in the city at the center of the initial outbreak, St. Marc, which is about a 60-mile (95-kilometer) drive northwest of Haiti. Just 300 patients were hospitalized on Saturday, a number that has decreased by the end of each day.

Cholera Toll Tops 250 in Haiti (Wall Street Journal 10/25/2010)
"There has been a slight trend toward people in less severe stages of dehydration," Chief Medical Officer Joia Mukherjee said. "To me that means our community-based strategy is working." The group is conducting a campaign to urge people to wash their hands regularly and take other preventive measures. Community health workers are looking for new cases, providing soap and urging people to wash their hands and drink only clean water, PIH said.

Haiti works to halt cholera outbreak (USA Today 10/25/2010)
Haiti has not had a cholera outbreak in decades, so the population has no immunity, said Dr. Joia Mukherjee, chief medical director of Partners In Health, a Boston-based organization that helps the Haitian health ministry run many of the country's hospitals.

Terrifying race against time with cholera in Haiti (BBC News 10/24/2010)
Dr Koji Nakashima from Partners in Health, a group working with the Haitian health authorities throughout the country, has spent all day administering intravenous drips to patients. "The terrifying thing about this disease is how quickly it can kill," he says. "Patients come in and they're unresponsive. They don't have the resources to get here quickly - they come by donkey, on foot. It is a very challenging environment."

Haiti's cholera outbreak spreads, adding to worries it will reach refugee camps in capital (AP 10/24/2010)
Partners in Health, a U.S.-based humanitarian group, said Saturday that another 10 cases were reported in Gonaives, the largest city in the Artibonite region.

Cholera outbreak creeps closer to Haiti's capital (Miami Herald 10/24/2010)
A spreading cholera outbreak in rural Haiti threatened to outpace aid groups as they stepped up efforts Saturday hoping to keep the disease from reaching the squalid camps of earthquake survivors in Port-au-Prince.

Death toll rises from Haitian cholera outbreak (CNN 10/24/2010)
Sandrellie Seraphin, who works for Partners in Health and the Clinton Foundation, visited the hospital Wednesday. "It's terrible," she told CNN by phone, describing the crowds of people trying to get help. "There's a great fear among the people" about the disease.

Cholera kills 140 in Haiti (Peninsula Daily 10/24/2010)
There's no reason to anticipate that this wouldn't spread widely,'' said Joia Mukherjee, chief medical officer for Partners in Health, a US relief organization that runs three hospitals in the area. The acute bacterial illness, spread primarily through contaminated drinking water, has struck more than 2000 people throughout the valley along the Artibonite River, with the highest number in the port city of St Marc.

Haiti on Precipice of Cholera Disaster (The Toronto Star 10/23/2010)
“Yes, I have confirmed that today,” says Claude Surena, conveying the grimmest possible news. “There are five cases confirmed in Port-au-Prince.”

Haiti Fears Cholera Will Spread in Capital (New York Times, 10/23/2010)
“We tried to make the case not to focus exclusively on Port-au-Prince,” said PIH's Andrew Marx, noting that considerable effort has been made to provide clean water in the capital, but rural areas remain lacking.

Cholera Found in Haiti's Capital (Wall Street Journal, 10/23/2010)
The first cases of cholera were identified in Haiti's capital Saturday, intensifying worries that the disease could reach the large camps that still house thousands of people displaced by a devastating earthquake 10 months ago.

Health crisis in Haiti: Cholera kills 194, sickens thousands (Miami Herald 10/23/2010)
PIH reported Saturday that the number of new cases at the hospital in St. Marc -- where the ill have gone to seek treatment -- on Friday was lower than new cases on Thursday. But with only three days of data, it isn't possible to say that this represents a positive trend, PIH said.
 
Cholera outbreak spreads in Haiti (St. Petersburg Times 10/23/2010)
PIH spokesman Andrew Marx. "We have people crowding in the halls. We have people being treated outside the hospital,'' he said. Other health care facilities in the region have also been overwhelmed, including the Hospital Albert Schweitzer in Deshapelles, he said.
 
LaPook on Haiti Cholera: I Fear a 'Major Disaster' (CBS News 10/23/2010)
When I visited this camp last April, I spoke to Dr. Dubique Kobel, a Haitian-born, Cuban med school-educated physician who is the medical director of the park, which is supported by Partners in Health. Back then there were about 48,000 people. Now Dr. Kobel says there are "over fifty thousand" — exact numbers are hard to come by in Haiti.

The cholera outbreak in Haiti, BBC World News America
PIH's Dr. Joia Mukherjee was interviewed by the BBC to discuss the cholera outbreak in Haiti. Dr. Mukherjee covers the scope of the cholera outbreak, treatment of ill patients, and containment of the disease in a BBC segment.

A new menace for Haiti as cholera spreads, Miami Herald
As healthcare professionals struggled Friday to stem a terrifying cholera outbreak that has already left more than 150 Haitians dead, U.S. and world health experts issued this ominous warning: It's going to get worse. "No reason to anticipate this wouldn't spread widely throughout Haiti,'" said Joia Mukherjee, chief medical officer for Partners In Health.

Emergence of cholera in Haiti raises alarms, Boston Globe
Hospitals staffed by doctors and nurses affiliated with Boston-based Partners in Health sit at the epicenter of a cholera outbreak in Haiti that has killed more than 150, sickened as many as 2,000, and begun to sweep across the impoverished countryside.

Aid workers scramble to contain Haiti cholera outbreak, Los Angeles Times
"There's no reason to anticipate that this wouldn't spread widely," said Joia Mukherjee, chief medical officer for Partners In Health.

Cholera Outbreak Kills 150 in Haiti, New York Times
The earthquake left the country dotted with relief agencies that “have already shown their chops in providing clean water,” said PIH Chief Medical Officer.

Deadly Cholera Outbreak in Haiti, CBS News
Unsanitary conditions in disaster-torn Haiti have led to an outbreak of the deadly disease cholera, which has sickened more than 1,500 residents and left another 142 dead, reports Dr. Jon LaPook of CBS News. The segment features and interview with PIH Chief Medical Officer Joia Mukherjee.

Deaths from Cholera Top 150 in Haiti, Wall Street Journal
International health officials rushed to contain a large outbreak of cholera in Haiti, concerned that the deadly disease could spread into camps that still house thousands of people displaced by a devastating earthquake 10 months ago. At the 200-bed St. Nicholas Hospital in St. Marc, a coastal city in the Artibonite region, 500 people flooded in Thursday night with symptoms of cholera and a further 437 came in Friday morning, according to Partners in Health, a U.S.-based organization that helps run the hospital. The group has begun a major campaign to educate people on washing their hands and other prevention measures.
 
Cholera Hits Haiti, and Public-Health Experts Worry it Will Spread, Wall Street Journal
As the WSJ reports, what public-health experts say is the first big post-quake disease outbreak has now been confirmed: a cholera epidemic in the Artibonite region of the country. The area has become home to a lot of earthquake refugees, and even before the quake obtaining clean water was a problem, the paper says, citing a spokesman for public-health group Partners in Health, which has a longtime presence in Haiti.
 
Death toll rises from Haiti cholera outbreak, CNN
A fast-moving cholera outbreak in Haiti has claimed at least 194 lives, according to a U.N. spokeswoman. The country's health ministry is reporting another 2,364 cases from the recent outbreak, said Imogen Wall, spokeswoman for the U.N. Office for the Coordination of Humanitarian Affairs. Sandrellie Seraphin, who works for Partners in Health and the Clinton Foundation, visited the hospital Wednesday. "It's terrible," she told CNN by phone, describing the crowds of people trying to get help. "There's a great fear among the people" about the disease.

 Cholera in Haiti: a view from a first responder, CNN
We woke to some disturbing news, today.  Our friends at Partners in Health emailed to say that there were people arriving at St. Marc hospital in droves, sick with diarrhea and that people were dying from dehydration at an alarming rate.
 
Public Health Expert Warns Cholera Outbreak Could Spread, NPR Blog
The chief medical officer for Partners In Health, Dr. Joia Mukherjee, told reporters this afternoon she is concerned the cholera outbreak may continue to spread. As of this afternoon, her organization is reporting more than 2,000 cases of cholera and 160 deaths at Haitian health care facilities. 
 
Health Workers Scramble to Keep Cholera out of Crowded Camps, IPS
At least 160 people have died this week from an outbreak of cholera in the central Artibonite region, according to Zanmi Lasante, the Haitian arm of renowned health organisation Partners in Health.
 
Haiti in a time of Cholera, Global Post
Fathers became nurses and children lay side by side with grandparents as a deluge of violently sick cholera patients overwhelmed the staff at St. Nicholas hospital in this small Haitian town.  “I’ve talked to all of my colleagues who are Haitian and they’ve never seen anything like this, on this scale, before,” said Koji Nakashina, an American doctor with Partners in Health, who was working at the hospital on Thursday. “There’s still a lot coming in.”
 
Aid Groups Race to Stop Cholera Outbreak in Haiti, AOL News
Health officials in Haiti and the United States have confirmed that an outbreak of cholera has killed more than 100 people and sent hundreds more to the hospital in a rural area of the earthquake-battered country. "We're distinctly alarmed," Andrew Marx, spokesman for Partners in Health, one of the largest aid organizations in Haiti, told AOL News today. "It's an all-hands-on-deck effort. We can't get out ahead of it at this point, but we need to get out there and really mount the kind of response in terms of education, the distribution of clean water and getting resources to hospitals so we're able to treat and save people.

Media coverage of PIH's earthquake relief efforts in Haiti:

Recovering the Dead in Haiti (New York Times, LENS blog, 6/11/2010)
New York Times LENS blogger Angel Franco shares the story of one Haitian man's efforts to recover the bodies of the earthquake victims in his community.

Deadline Nears For Haitians' Deportation Reprieve (Associated Press, 6/11/2010)
The deadline for Haitians in the U.S. to apply for temporary protected status is July 20, 2010; TPS will allow Haitians to stay legally for eighteen months.

Haiti: Solidarity, not charity, needed (Green Left, 6/6/2010)
Montreal-based nurse Scott Weinstein talks about his impressions of PIH's work in Haiti after returning from his stint as a medical volunteer in Port-au-Prince.

U.S. Troops Withdraw From Haiti (NPR, 6/3/2010)
Host Michel Martin talks with David Harland of the United Nations Peacekeeping Department about where the recovery effort stands now in Haiti.

The immense human tragedy 700 miles from Miami (Psychology Today, 5/28/2010)
Dr. Dennis Rosen reflects on his nine days as a volunteer at HUEH, Hôpital Universitaire d'État d'Haïti.

Mental health needs of quake survivors pose risks to Haiti's recovery (Catholic News Service, 5/27/2010)
"'Vulnerable people

The surgical team operating in Cange.

Dr. Stephen Sullivan sent the following email from PIH's hospital in Cange yesterday.

We had a very successful day in Cange. Although we awoke to an earthquake, we are safe and spirit among the team members remains high.

The majority of patients have large wounds and fractures. Most of our operations have been amputations and wound care, but we started the fracture fixation today.  We started external fixation of tibia/fibula fractures and humerus fractures -  two rooms running non-stop with turnover so fast we hardly had time to break between cases. We also run a laceration/wound care station as well as a casting station.

We have approximately 20 retrograde femur rods and 20 tibial nails (but no insertion sets or interlocking screws for either). With our current patient load, we can probably use about 10 of them, but may have extra. While we do expect more patients to arrive, we wonder if there are more urgent needs in Hinche, St. Marc or one of the PIH/Zanmi Lasante sites?

We now have approximately 160 patients on the wards - down from well over 200. In the last 4 days, our team has provided approximately 90 operations and medical care for many more patients. We are doing are best to follow protocols for taking care of trauma patients.

We have a few dozen patients who will need high end care with special instrumentation not available to us (e.g. pelvic fractures, spine fractures, facial fractures).

An emerging problem is renal failure. It is worth considering checking renal status on patients at all sites who have crush injuries. Today alone, renal failure was found in 5 patients (out of 10 or so). Wound debridements and revision amputations will be the bulk of our operations for the next many many days.

In the long-term, patients will need wound care, skin grafts, tissue transfer and wound closure, and physiotherapy.

Please know that we are only able to do this because of all the support from you and others in Boston. Please give my love and greetings to our other friends in the office.

Slowly but surely, we're making a difference.

Stephen

As PIH and countless other relief, recovery, and development organizations tend to the immediate needs of the Haitian people, an important question stands: How can we help Haiti not only right now or a few weeks from now, but years from now? How do we help Haiti, as former President Bill Clinton said, build back better? And how can you help?

One easy thing you can do: Sign this petition to cancel Haiti’s debt, which currently tops $1 billion. The petition is part of the ONE campaign. Here are some things you should know about debt cancellation

• Some developing countries spend decades repaying debt that was forced on them by corrupt regimes. They are then required to accrue more debt to make payments on the old loans— essentially losing money that should be going to build the country’s education, healthcare, and infrastructure systems. It’s a vicious cycle and seemingly impossible to halt. When the price of fuel and fertilizers rises—and the global economy plummets—developing countries and their poorest citizens pay the steepest price.
• Since 1996, many industrialized countries have worked to cancel developing countries’ debts, helping to free up money that these countries can now invest in their people and their land. Once relieved of their debts, Mozambique used their money to vaccinate children against diptheria, whooping cough, and tetanus. Cameroon used their savings to fund a national HIV/AIDS program that focused on education, testing, and prevention of HIV/AIDS—including prevention of mother-to-child transmission.

Over 125,000 people have already signed the petition—and that includes many of us at PIH. Haiti needs all our help in the months and years to come—and $1 billion in debt will only act to impede progress. Please go here and help us build Haiti back better: http://www.one.org/us/actnow/drophaitiandebt/index.html?rc=drophaitiandebtblog

And after you sign the petition, remember to tell your friends to do the same!

Read more information about this campaign here.

The floor of a nearby church in Cange is currently being used as a triage center.

Even before the earthquake and its aftershocks left people injured and afraid, without homes or a livelihood in the flattened capital city, PIH’s sociomedical complex in Cange was already providing round-the-clock care to people from all over Haiti’s central plateau. Now, with a massive influx of people fleeing Port-au-Prince, our 104 bed facility is overflowing: the church is serving as a triage center and the school as recovery room.

Seeking both medical treatment and refuge from the destruction in the capitol, people are arriving in Cange at all hours of the day and night. Some are people returning to the countryside, having migrated to Port au Prince in search of education or employment years ago. Others simply have nowhere else to go.  "Our houses were crushed and our businesses destroyed.  So we came to Cange," said one man who arrived in a bus with 12 relatives, including his mother in law who was critically injured.

Read a Wall Street Journal article on the migration to Cange and the help being provided there.

Partners In Health will be one of the organizations benefiting from the most widely distributed telethon in history, Hope for Haiti Now: A Global Benefit for Earthquake Relief.

Hosted by MTV on Friday, January 22, at 8 p.m. ET, the two-hour telethon will feature performances from a superstar lineup, including Bruce Springsteen, Jay-Z, Stevie Wonder, Taylor Swift, Coldplay, and Justin Timberlake. In addition to musical performances, more than 100 of the biggest names in film, television, including George Clooney, Anderson Cooper, and Wyclef Jean, will share their own stories, and answer phones during the telethon.

The program will air on dozens of networks—from ABC to the National Geographic Channel. (And PIH supporters in China, take note: This is the first U.S.-based telethon airing on MTV in China.) If you can’t get to a TV, the event will be streamed online on YouTube, Hulu, Myspace, CNN.com, MTV.com, and many other sites.

So tune in Friday, help out, and see some amazing performances. Money raised from the event will be split evenly among various relief, recovery, and development organizations—including PIH, the Red Cross, Yele Haiti, and others.  Performances from the telethon will go on sale for 99 cents on iTunes starting Saturday, January 23; those proceeds will also go directly to relief and long-term recovery in Haiti.

Our teams are treating as many patients as they can, and our greatest need currently is financial aid. Money from the event will be used to transport food, fuels, and medical supplies to our teams on the ground and to begin the process of rebuilding communities and strengthening health systems in the months to come. We’re grateful to you—and to MTV—for your support.   

More information.

Networks airing Hope for Haiti Now include:

ABC, CBS, NBC, FOX, CNN, BET, The CW, HBO, MTV, VH1, CMT, PBS, TNT, Showtime, COMEDY CENTRAL, Bravo, E! Entertainment, National Geographic Channel, Oxygen, G4, CENTRIC, Current TV, Fuse, MLB Network, EPIX, Palladia, SoapNet, Style, Discovery Health, Planet Green, CNN en Español, HBO Latino, and Canadian networks including CBC Television, CTV, Global Television, and MuchMusic.  The event will be live streamed online globally across sites including YouTube, Hulu, MySpace, Fancast, AOL, MSN.com, Yahoo, Bing.com, BET.com, CNN.com, MTV.com, VH1.com, and Rhapsody and on mobile via Alltel, AT&T, Sprint, Verizon, and FloTV. "Hope for Haiti Now" will also air internationally on BET International, CNN International, National Geographic, and MTV Networks International, which is available in 640 million homes worldwide.  “Hope for Haiti Now” will be available non-exclusively to all terrestrial radio stations around the globe and SIRIUS XM Radio as a one time only radio broadcast via the MTV Radio Network and Westwood One.

This morning, a strong aftershock earthquake rocked Port-au-Prince, temporarily slowing down the growing momentum of achievements to bring relief to the beleaguered country.

About 35 miles west of the capital city, and measuring 5.9 on the Richter scale, the aftershock forced an evacuation at the general hospital (HUEH), where PIH had been coordinating efforts to restore services. Up until then, the PIH team had set up, staffed, and supplied 12 operating rooms in the facility, which had been performing surgeries around the clock.

“The earthquake was very scary for the people here,” said Dr. Evan Lyon, who has been helping to coordinate logistics for PIH and its partners at HUEH.  “There were people jumping out of windows to get out of the building, a number of them broke bones doing this.” After the tremors passed, the U.S. Army Corps of Engineers suspended all action in the hospital so they could inspect the building.

In addition, PIH’s hospital in Boucan Carré, located roughly 2 hours north of Port-au-Prince by car, reported structural damage. “All patients are outside,” reported Dr. Louise Ivers, PIH’s Clinical Director for Haiti. Surgical services were also temporarily suspended at PIH’s hospital in Hinche (roughly 3 hours from Port-au-Prince) while the building was evaluated.

However, services quickly resumed. PIH staff and volunteers across the country continued to identify, triage, and treat patients despite the aftershock setback.  At HUEH, the hospital building was declared structurally sound, and the hospital was back up and running in a matter of hours, said Dr. Lyon.  However, the hospital is now “back in crisis mode,” he added. “People are still really scared of another earthquake.” HUEH is also preparing to evacuate patients by helicopter to a hospital with electricity, running water, and fully equipped operating rooms safely outside the city.

Additionally, shipments of volunteers and much needed supplies both arrived today, with several more planes and trucks scheduled for shipment this week.

Over the past few days, PIH and its sister organization Zanmi Lasante (“Partners In Health” in Haitian Creole) successfully helped organize 20 operating rooms across Haiti to treat patients injured in the earthquake. Since the earthquake, PIH’s 12 pre-existing medical facilities across the Central Plateau and Artibonite Regions of Haiti have been caring for the many patients fleeing the devastation of Port-au-Prince. Since Saturday, PIH has been helping the Haitian Ministry of Health restore services at HUEH, the largest hospital in Port-au-Prince.

Directory of Communications Andrew Marx posts from Boston:

Today held more challenges and more successes for Partners In Health. The race against the clock is quickening as infections and sepsis become ever greater concerns for the seriously injured with each passing hour. Fortunately, critical surgical, supply chain and available facility capacity continue to expand rapidly.

In Port-au-Prince, the operating rooms at the city's main General Hospital have been declared structurally sound and are now staffed and ready to receive patients. These ORs will supplement the seven emergency operating tables already set up on the hospital grounds. A helicopter landing pad has been designated nearby to accommodate the most critical patients. An additional facility at Croix de Bouquet has also been opened bringing the count of PIH/ZL supported operating rooms up to 20. This number includes 2 operating rooms at three facilities in the Central Plateau and the Artibonite.

These hospitals outside the city are coming under increasing pressure as a growing number of the injured, homeless and hungry residents of Port-au-Prince continue their mass reverse migration to the countryside. Earlier today, Dr. Jon Crocker reported from PIH/ZL's hospital in Cange, where the work of Partners In Health started and has been ongoing for nearly 25 years.

We arrived at Cange, in the Central Plateau, the heart of operations for Partners In Health/Zamni Lasante, yesterday. As we expected, things are incredibly busy. People are still arriving from Port-au-Prince. Those who have been fortunate enough to survive their injuries this long are now running into complications of wound infections, some of which have turned septic, and venous blood clots (from immobility and trauma). Patients have completely filled the hospital and we have set up makeshift wards in a nearby church and school. Both surgical and non-surgical personnel are working tirelessly....

The Haitian medical staff of Partners In Health/Zamni Lasante and survivors of the quake are working with unimaginable valor and dedication. Many of them have lost members of their own families. And yet they remain here, working tirelessly to provide care for others. They are the true heroes. Those of us fortunate enough to be here to contribute to the immediate relief efforts labor by their side with complete humility. We are in awe of their strength, compassion and dedication.

Read Dr. Crocker's full report

Watch a slideshow of our work in Haiti

Thank you for your support and welcomed messages of encouragement. Please continue to help us spread the word on Facebook and Twitter. Keeping Haiti in the hearts and minds of the world is more important now than ever.

In solidarity,

Andrew Marx
Director of Communications

As reports of devastation in the field pour in, we continue to be amazed and encouraged by the generosity and support of people who have become our partners over the last week. Below is the story of another person who used to be a stranger—and is now standing in solidarity with us as we work to rebuild in Haiti. 

Cliff Landis is a librarian in Valdosta, Georgia who, until last week, was planning on a post-holiday replenish of his savings account. However, upon hearing about the suffering the earthquake has wrought, he decided to further deplete his own savings in favor of contributing to PIH’s relief efforts in Haiti.

But Cliff didn’t stop there.  He also encouraged friends, family, and readers of his blog to give, promising them he would match every gift up to $10,000. Watch a video of what happened next:

Support from Cliff and his readers will enable us to continue our work to help Haiti recover from the devastating earthquake, including transporting desperately needed food, fuel, and medical supplies to our surgical teams treating patients around the clock. Thank you, Cliff, and thank you to all your supporters, and to all our partners in health.

Visit Cliff's blog.

The floor of a nearby church in Cange was quickly converted into a patient ward.		Patients in Cange.

Dr. Jon Crocker is currently working at our hospital in Cange since Sunday, where he emailed us the following report:

We arrived at Cange, in the Central Plateau, the heart of operations for Partners In Health/Zamni Lasante, yesterday. As we expected, things are incredibly busy. People are still arriving from Port-au-Prince. Those who have been fortunate enough to survive their injuries this long are now running into complications of wound infections, some of which have turned septic, and venous blood clots (from immobility and trauma). Patients have completely filled the hospital and we have set up makeshift wards in a nearby church and school. Both surgical and non-surgical personnel are working tirelessly. 

Patients are dazed. The disruption to their families and lives is beyond description. Many of our injured patients are not mobile, have few resources, have no home to return to, and many have lost their entire families. We care for their wounds. We listen. We grieve with them.

PIH Women's Health Coordinator Sarah Marsh with a 1-day-old infant who was born on the street in Port-au-Prince.

And yet amidst this darkness, there are rays of hope. Today a one-day-old baby girl was brought in. She was born on the streets of Port-au-Prince with clubbed feet. Her mother suffered lower extremity fractures in the quake and couldn't really move, but labored successfully, lying adjacent to the rubble of her home. The parents were so worried about the baby that the baby’s father made his way to Cange with the child because he knew he could find care here. He did. The baby will be casted and staff here will show how to recast her as she grows.

The Haitian medical staff of Partners In Health/Zamni Lasante and survivors of the quake are working with unimaginable valor and dedication. Many of them have lost members of their own families. And yet they remain here, working tirelessly to provide care for others. They are the true heroes. Those of us fortunate enough to be here to contribute to the immediate relief efforts labor by their side with complete humility. We are in awe of their strength, compassion and dedication.

In solidarity,

Jon

Up until this fall, Dr. Crocker served as Director of Clinical Services at PIH's partner organization in Malawi.

Dr. Evan Lyon has been on the ground working at the general hospital in Port-au-Prince since Saturday. He's working with a partnership between PIH and the Haitian Ministry of Health to coordinate restoring services at the hospital.

Dr. Evan Lyon

For many years, PIH’s sister organization Zanmi Lasante (“Partners In Health” in Haitian Creole) has been one of the largest and most attractive training sites for graduating medical students. The majority of our doctors and nurses, pharmacists, and lab technicians, have trained at the general hospital in Port-au-Prince, Hôpital de l'Université d'état d'Haiti (HUEH). Until less than a decade ago, all doctors trained in Haiti graduated from the national medical school and received training at the general hospital. Zanmi Lasante has been honored to host many of the top graduates of the national university in their first year out of medical training for a year of social service. Zanmi Lasante’s finest medical staff are among these graduates, who are now leading Partners in Health's efforts to respond to the disaster.

The general hospital sustained massive damage; at least 50 percent of the campus cannot be used. Many buildings are destroyed. All are cracked. Only some are safe to work in. The adjacent nursing school was completely destroyed--we are working in its in the dusty shadow, where the bodies of many, many second year nursing students remain trapped in the rubble. It will be weeks or months until the rubble is cleared. The smell of death is everywhere. Many of the dead are our sisters and brothers in health, who had worked alongside us to relieve suffering.

One of the seven operating rooms now treating earthquake victims at the general hospital.

Today we worked to get the university hospital on its feet again.  Dr. Lassegue, the hospital's director, and his staff are leading efforts to care for the injured.  Partners In Health is working closely with the hospital to provide care and to help organize relief efforts from international aid agencies from around the world.  Surgeons had been operating with daylight and flashlights but electricity is now restored. Seven operating rooms are now performing surgeries.  An estimated 1000 patients have already been assessed and are awaiting surgery on the campus. People are lying on mats on the ground, in shade where it can be found, under sheets strung from the trees.

Inpatient wards are coming together. We hope to increase to ten operating rooms in the next 48 hours, with 24-hour service now that the electricity has been restored. The hospital must stand again.

As I left the hospital compound this evening, I saw the lights of a large front-end loader working near the morgue. Three dump trucks were at the ready. Where thousands upon thousands of bodies had lain just days ago, only 40-50 bodies remained. Swollen, alone, pushed to the side of the pavement slippery with blood and body fluids. 

As I walked past the morgue and the largest pile of bodies, I noticed that one was wearing a Zanmi Lasante t-shirt. I cannot begin to understand why this small detail made a scene of unspeakable sadness even sadder.

- Evan Lyon

Dr. Louise Ivers is PIH Clinical Director for Haiti.

Dr. Louise Ivers, PIH Clinical Director for Haiti, was in Port-au-Prince when the earthquake struck and started treating patients in a makeshift clinic in a driveway almost immediately. Dr. Ivers briefly returned to the U.S. to rest and recharge after nearly a week of harrowing days working around the clock, often as the only doctor to treat hundreds of gravely injured patients with minimal supplies. In an op-ed for the Irish Times, Dr. Ivers shared her story of the first five days following the tragedy.

Today, Dr. Ivers is meeting with the Clinton Global Initiative working group for Haiti, in Palm Beach, Florida, instead of Haiti’s Central Plateau. With the current crisis weighing heavily on people’s minds, we all hope that the working group will be able to further mobilize resources and garner long-term support for Haiti so that it can build back better.

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