In the days following Dr. Paul Farmer’s passing, hundreds of people posted pictures on social media of selfies with Paul. The Partners In Health co-founder and chief strategist had been their mentor, professor, colleague, friend, or doctor. Regardless of role, he had touched them personally and inspired them with his innovative and radical approach to seeking health equity around the world. 

Given that outpouring of love, reflected through imagery, we wanted to share some of our fondest memories of Paul over the years, from when he first started traveling to Haiti in the early 1980s to his final days in Butaro, Rwanda. As many have said before, Paul was happiest at PIH sites when he was sitting at a patient’s bedside, rounding with medical residents, and sharing his worldview with others—be they supporters, undergraduates, or global leaders. 

Below, accompany Paul through the years, as he did so many of us. 

Father Fritz Lafontant (left) and his wife, Yolande (right), were among Paul’s first partners in Cange, Haiti, where the Episcopal priest and his family lived and advocated for quality health and education for the poor and marginalized. Lafontant became a founding member of Partners In Health and founding director of Zanmi Lasante, PIH’s sister organization in Haiti. 

When 11-year-old Cecilia Kadzanja’s father died in 2011, her mother struggled to support six children. Although Cecilia desperately wanted to continue primary school in the rural Neno District of southwest Malawi, her family could not afford the essentials like notebooks, uniforms, and fees—the equivalent of less than $2 per child, and far more than her mother could spare to spend.  

Then following an assessment of her family’s income, Kadzanja was selected to become part of a program sponsored by Abwenzi Pa Za Umoyo (APZU), as Partners In Health is known in Malawi. The Program on Social and Economic Rights (POSER), established in 2007, pays education-related costs for Neno District children.  Since it began, POSER has helped cover school fees and the cost of other scholastic materials for more than 1,000 students in secondary schools and over 2,000 primary school children. Additionally, the program provides food, housing, and transportation assistance to qualifying families to ensure they can access care and remain healthy. 

The importance of educating children, especially girls, cannot be overemphasized, program administrators say. Educated girls can make informed decisions about their lives, including having safe sex, waiting longer to marry, and taking control of the number of children they have. Kadzanja said the program has been life-changing. “I took this as an opportunity and promised myself to work hard in class,” she said.  In 2009, Kadzanja was selected to go to Chiwale Secondary School in Neno. After a few setbacks, like repeating a year of school, she was accepted at University of Mzuzu.  

Once again, however, Kadzanja was forced to grapple with the high cost of education. So she approached APZU staff for continued financial support. In 2015, APZU made the decision to extend its assistance program to include university students; Kadzanja was the second student to benefit from the new policy. She completed her degree program in Hospitality Management in 2021. 

“I am more than happy to be a graduate,” she said. “It does not only open doors to my bright future, but more importantly, it has given hope to other girls in my community to believe that a girl child from Neno can also get educated to tertiary level.”  

Kadzanja noted that many girls from her community drop out of school early, get married young and have children, thereby diminishing their chances of a professional, independent life. They are, she said, “without hope for a better tomorrow.”  

Malawi has been in the news for powerful cyclones and other extreme weather that has battered homes, clinics, communities and farmland. But the country is also recognized for other reasons, including innovative approaches to delivering comprehensive health care in remote communities.

Abwenzi Pa Za Umoyo, (APZU), as Partners In Health is known in Malawi, has worked in the landlocked nation in southeastern Africa since 2007.  Focusing efforts in Neno District, a rural, remote area of approximately 165,000 residents, where tarmac roads remain a work in progress, and just over 3% of households have electricity, the APZU team has developed effective models of integrated health care to deliver top quality treatment and critical social services to patients. Together, the efforts have led to measurable improvements for people afflicted with HIV/AIDS, mental illness, chronic conditions, and more.

Barriers Abound

Life in Malawi can be harsh: it’s one of the most impoverished countries in the world, with a daunting HIV epidemic, a significant non-communicable disease burden, and high rates of infant and maternal mortality, as well as sexual and gender-based violence. Making matters worse, access to decentralized, high-quality care is scarce or unaffordable for most people. Even those who can pay for treatment are often unable to reach clinics, especially over mountainous terrain and rugged roads in remote areas.

In response to these challenges, APZU is building and supporting a model of free, accessible, one-stop-shop health care in Neno District through two hospitals, 12 health centers, and a network of 1,228  community health workers (CHWs) offering treatment for everything from HIV and malnutrition, to mental health support and diseases such as hypertension, diabetes, and sickle cell anemia.

Below are four of APZU’s key programs:

Social Support

A pillar of APZU is its Program on Social and Economic Rights, (POSER), which empowers community members to live with dignity, security, and independence. POSER delivers cash assistance to help patients address costs related to health care, ensuring that Neno’s most vulnerable have access to medical care and the basic necessities to stay healthy, such as housing, employment, education and transportation.

CHWs and clinicians, along with local community leaders, identify people who could benefit from POSER support through home visits, checkups at local health facilities, connections with local government, and community-based organizations. POSER staff register eligible people in the program and conduct a vulnerability assessment to gauge which needs are most urgent. 

Once support begins, POSER staff ensure the continuity and effectiveness of care by regularly visiting patients and families at their home. Using a mobile health app, Medic Mobile, CHWs have already registered more than 76,000 individuals to track their ongoing care in more than 16,000 households since 2019—with more added on a regular basis.

One Stop Health Care

APZU’s Integrated Chronic Care Clinic (IC3), launched in 2015 as a collaboration with Malawi’s Ministry of Health, brings patients for asthma, hypertension, diabetes, mental illness, and other non-communicable diseases under one roof for treatment that is intertwined with HIV care across 14 health facilities in Neno District. This integration takes into consideration chronically ill patients’ needs for one-stop care and diminishes stigma associated with specific conditions. In a three-year study of the integrated care model, clinical measurements—such as blood pressure, asthma severity, blood sugar, or number of seizures per month, for patients with epilepsy—showed statistically significant improvement. One year after enrolling in IC3 care, more than half of hypertension patients had controlled blood pressure, and patients with epilepsy were reporting fewer seizures overall—with more than 40% regularly reporting no seizures since their previous visit.

Starting in 2019, trained mental health counselors began screening mothers for depression at routine antenatal visits as part of this comprehensive approach. So far, 91 people have participated in the group Problem Management Plus (PM+) intervention and preliminary data show that over 90% of patients’ depression improved from moderate and severe to minimal or no depression at all after the intervention. Data also indicate that over 90% of patients who benefited from the intervention remained stable with no depression six months after completing the group therapy program.

Sexual and Gender-Based Violence

In 2019, to address widespread sexual and gender-based violence (SGBV), APZU launched a program called No Woman or Girl Left Behind. In addition to supporting SGBV survivors, the program also aims to advance sexual and reproductive health and rights for adolescent girls and advocates for those rights nationwide.

APZU established a gender-based violence task forces in all health centers across Neno District, each bringing together health workers, social service providers, and police in one place. Previously, these services were sometimes located hours apart, making such support inconvenient and largely inaccessible. Now, patients are offered a menu of services at nearby sites, including testing for sexually transmitted infections, HIV post-exposure prophylaxis, pregnancy testing, social support, and psychological counseling.

From January 2020 to December 2021, Neno’s SGBV team worked on 228 such cases, including 26 victims under 10, and 48 cases involving victims under 14.

HIV/AIDS

When clinical and support staff began caring for people living with HIV/AIDS in 2007, the conventional wisdom among global health officials was that treatment was not an option in impoverished communities. “Focus on prevention” was a common refrain for decades. But this mindset would have left millions of people worldwide without care; it is a worldview PIH refused to accept.

Malawi has one of the world's highest rates of HIV. Specifically in Neno District, 1 in 10 residents live with the virus, and many used to struggle to access medications and the care necessary for long-term survival. For the past 15 years, APZU has worked with community health workers and Malawi’s Ministry of Health to provide comprehensive care in 14 health facilities, including more HIV tests and access to treatment.

As of late 2021 in Neno district, 94% of people living with HIV (ages 15-49) were enrolled in life-saving antiretroviral treatment; in 90% of these patients the virus was undetectable.  

Stay Informed

Each morning, Flormila Antaurco emptied dozens of pills from carefully labeled bottles in her home in Carabayllo, Peru.

The first 11 were prescribed for her. The others, for her children.

“It was painful to watch,” she recalls. “It hurt their throats…I had to break the pills and give them in liquids [like] juice or water.”

But it’s what the doctor had told the 29-year-old mother to do, ever since she was diagnosed with tuberculosis.

It wasn’t a diagnosis Antaurco was expecting.

She had just begun to recover from COVID-19 when her cough returned and lasted for more than two weeks, followed by fatigue, weight loss, and a fever. A free screening at a mobile clinic run by Socios En Salud, as Partners In Health is known in Peru, revealed the news: she had tuberculosis, as well as COVID-19.

“At the beginning, I was very afraid,” she says. “I was afraid of infecting my family…And I was afraid to confirm it because of what people would think of me.”

A Silent Killer

Tuberculosis is one of the world’s deadliest infectious diseases, despite being curable and preventable. Each year, 10 million people contract the airborne disease and 1.4 million die—a burden that disproportionately affects low- and middle-income countries like Peru, which has one of the highest incidence rates of tuberculosis in the Americas.

Socios En Salud has worked in Peru since 1994, when it responded to an uncontrolled outbreak of multidrug-resistant tuberculosis (MDR-TB), an especially deadly form of the disease, in Carabayllo, an impoverished community about 20 miles north of Lima. The response, which ultimately saved thousands of lives, prompted the World Health Organization to change its global MDR-TB policy, as shown in Bending the Arc.  

In the years since, Socios En Salud has expanded its tuberculosis work, delivering that care in clinics, blue trucks, and backpacks in Lima, Carabayllo, and beyond. That care has continued even amid COVID-19. More than 670 people received screenings for tuberculosis and COVID-19 at Socios En Salud’s mobile clinics between August and September 2020—an effort that proved especially crucial for patients like Antaurco, who had both diseases at once.

A Second Chance

The diagnosis wasn’t the only thing that frightened Antaurco. The treatment would be long—at least six months—and painful.

“I felt very bad,” she says. “I could only cry.”

Treatment for tuberculosis is notoriously grueling, with side effects including fever and nausea, even as global efforts like the endTB project are on a mission to change that. EndTB is a multi-year R&D effort launched by Partners In Health and other NGOs to discover safer, shorter treatments for MDR-TB in 17 countries, including Peru.

Antaurco was prescribed four medications for tuberculosis for six months—a daunting treatment plan to follow, especially as she struggled to manage the symptoms of the disease. But she wasn’t alone.

To help Antaurco follow her treatment plan and navigate Peru’s complex health system, Socios En Salud connected her with Cristina Capristano, a community health worker.

“[Flormila is] a very brave woman,” says Capristano. “She never gave up.”

For the next six months, Capristano checked in with Antaurco at home, went with her to the clinic for check-ups, and helped her refill her prescriptions—providing the accompaniment at the heart of PIH’s community health worker program worldwide, as teams from Peru to Lesotho recruit local residents and train them to provide basic health services in their communities.

Capristano, 45, has been a community health worker with Socios En Salud for more than a decade. Through the years, she has supported several patients living with tuberculosis. Each case is unique; but for Capristano, each evokes similar feelings.

“At Socios En Salud, I have met many patients who overcame TB,” she says. “It is very rewarding to be part of the recovery process. That is priceless.”

Antaurco’s long-awaited recovery came in September 2021, when she was declared free of tuberculosis. For the first time in months, she felt like she could breathe again.

“I thank God for giving me a new chance at life,” she says. “Let’s put aside the stigmas that surround this disease and the fear of what people will say. Our health comes first.”

Tuberculosis (TB) shouldn’t be ignored. This is especially true for pregnant women, as the disease can harm both mother and child. If an expectant mother is not diagnosed and treated in a timely manner, the baby can potentially contract TB—a common, but often deadly, infectious disease.

Despite efforts to identify, treat, and control TB, there are instances of misdiagnosis, as was the case for 30-year-old Rachel (pseudonym) in Liberia. Rachel was four months pregnant with her first baby in 2009 when she visited the hospital complaining of swollen feet, chills, and a fever. She experienced hallucinations too, which doctors told her was as a result of severe malaria. She was immediately admitted to the hospital and was also treated for typhoid after several tests.

For four years she received treatment at different hospitals for typhoid, a disease caused by consuming contaminated food or water. However, she continued to feel ill. Finally, she was referred to the Partners In Health (PIH)-supported TB Annex in Monrovia and was admitted after testing positive for TB. This time, she had an eight-month-old baby and had to leave the child with her sister. The standard protocol for drug-resistant TB treatment in Liberia involves taking at least 6 to 20 pills per day for 9 to 24 months. Rachel went on to receive medical treatment, as well as psychosocial and nutritional support, in the ward for two years.

According to the World Health Organization's (WHO) 2021 Global TB report, Liberia reported about 7,000 TB patients of which 55 had drug-resistant TB. The WHO further estimated that 75% of the patients that start TB treatment will be cured or at least successfully complete the regimen. The proportion of those being cured or completing TB treatment was reported to be lower—about 70%—for patients with drug-resistant TB.

In 2018, Rachel once more began to experience symptoms of TB. “I was feeling cold on my left side. It was even hurting to bend,” says Rachel. “I went to the hospital but they refused to do an x-ray because I was pregnant.” In the same year, an estimated 3.2 million women fell ill with TB globally.

In February 2021, Rachel was diagnosed and admitted to the TB Annex for a second time; again, she was five months pregnant. She was worried about death, but the nurses comforted her by sharing the story of another woman they treated who survived. Fortunately, Rachel also responded well to treatment and was discharged to continue her treatment at home, just a week before she delivered her baby.

“I felt so happy to be home to give birth. PIH played a major role,” says Rachel, who noted the many ways PIH staff supported her. Drivers brought her to the hospital for every appointment. Staff always made sure she had food and personal hygiene products. Every Monday, they gave her beans, rice, peanut butter, tissue, and roll-on deodorant, among other items.

“I named my daughter after Drs. Rebecca and Megan (both PIH staff) because when I was in the hospital they did well for me; you don’t have a family at the hospital, but they were like family to me,” says Rachel.

In Liberia, TB prevalence has increased from 245 to 314 per 100,000 people from 2001 to 2020. PIH Liberia is working with the country’s Ministry of Health to improve care for those with TB, especially pregnant women, by increasing drug supplies in health clinics and mentoring and training clinicians. There were 260 patients with drug-resistant TB receiving treatment in the TB annex in late 2021. For patients, such as Rachel, these efforts have proved to be life changing—for her, personally, and for her growing family.

Dear President Joseph Biden: Stop using public health as a pretext to block asylum seekers at the United States borders. 

That’s the message from a new Perspective piece in The New England Journal of Medicine, written by Partners In Health leaders and collaborators. 

At issue is a March 2020 order by the Trump Administration overriding national and international legal protections for asylum seekers at the U.S. border and using the COVID-19 pandemic as the rationale to do so. 

The “Title 42” order, which has been extended by the Biden administration, “suspended the right of these migrants to have their claims heard and singled them out for immediate expulsion,” write the authors, Dr. Anne G. Beckett, assistant professor of medicine and pediatrics at Boston University School of Medicine; Loune Viaud, Partners In Health’s chief gender and social equity officer; Dr. Michele Heisler, medical director of Physicians for Human Rights and professor of internal medicine and public health at the University of Michigan; and Dr. Joia Mukherjee, PIH’s chief medical officer.  

The order, issued by the Centers for Disease Control and Prevention, draws on a previously obscure public health law enacted in 1944 to single out asylum seekers “by reason of the existence of any communicable disease in a foreign country,” essentially arguing that the migrants pose a serious threat of bringing more COVID-19 cases into the U.S. and increasing its spread. At the same time, other travelers, such as students and drivers, were allowed to enter the U.S. without COVID-19 testing, demonstrating a blatant double-standard, which the authors call out: “There is no evidence that noncitizens who lack documentation are more likely to transmit Covid than are residents, citizens, or tourists entering the country.” 

The bottom line, they write, is this: 

“There was — and remains — no public health evidence that singling out asylum seekers or other migrants for exclusion is effective in stemming the spread of Covid-19.”  

Or, as first author Beckett puts it, “The Title 42 order is a racist policy that targets Black and Brown migrants and causes unthinkable harm. President Biden campaigned on a pledge to restore the U.S.'s commitment to asylum-seekers, and instead his administration has increased the use of Title 42. The hypocrisy is staggering: under the false guise of protecting public health, the order has had a devastating impact on the physical and mental health of vulnerable and marginalized migrants who are denied access to a safe asylum process and expelled to dangerous conditions.” 

Moreover, the authors add, by expelling asylum seekers, the Title 42 order violates this country’s obligations to not send migrants back to dangerous regions. Since the order went into effect, the authors say, more than 1.6 million people entering the U.S. from Mexico or Canada have been expelled to countries where they could face persecution or torture, with no chance for asylum. Still, "asylum seekers represent a small fraction of the travelers who cross the border; in the same period in which 1 million asylum seekers were expelled, nearly 100 million other travelers were admitted at U.S. land borders," the authors write.

The health implications are severe: people who “already had experienced much trauma from persecution in their home countries have been even further traumatized, with profound mental and physical health consequences,” the authors write. 

People from Haiti seeking asylum in the U.S. have been particularly mistreated, says Mukherjee. “The Title 42 order has been disproportionately enforced along racial lines, particularly against Haitian asylum seekers,” she says. “This policy has no public health evidence behind it. U.S. citizens, not Haitian nationals, had a far higher rate of COVID-19.” She notes that Haiti is in the midst of a political crisis, and to deport asylum seekers into such insecurity and violence against the backdrop of a pandemic is “immoral and even lethal.” 

The piece also takes on several myths surrounding the order. For instance, one justification rests on the assumption that migrants must be held in “congregate settings,” typically crowded quarters that can drive infections. But there are alternatives, the authors write, for instance, “programs that allow migrants to shelter, under parole arrangements, within the community have been demonstrated to be effective alternatives to facility-based detention;” indeed, such programs are associated with “improved health outcomes...excellent compliance with immigration court requirements, at a fraction of the cost of detention.” 

Medical and public health practitioners must advocate for the end of the misuse of the Title 42 order, the authors conclude. They must do this “through the use of evidence-based Covid-mitigation measures at the border, including avoidance of inhumane and unnecessary immigration detention, rapid expansion of vaccine access, and implementation of data systems with public reporting to ensure the protection of the health and rights of asylum seekers. As the CDC considers extending the order yet again, health professionals should join in calls to the agency and to Biden to end the misuse of Title 42.” 

Advocate for Change

A year ago, Marat* was confronted with a slew of alarming symptoms: constant fatigue, occasional spikes of fever, coughing up blood, and dramatic weight loss. In just one month, he lost 26 pounds. Despite these signs, Marat continued to work as a stone mason at a construction site in Nur-Sultan, Kazakhstan, hoping he would feel better. On weekends, he often had a drink with friends. But the symptoms only exacerbated. Following a visit with a doctor and an X-ray, he received a shocking diagnosis—he had multidrug-resistant tuberculosis (MDR-TB), among the most deadly strains of the disease, and would need to be hospitalized for six months.

“This diagnosis was psychologically traumatic,” said Marat, a 34-year-old father of four, who chose to use a pseudonym in sharing about his journey toward recovery from TB. “I had a really hard time accepting it.” As the primary breadwinner for his family, leaving his wife and children without his support seemed unfathomable. One of his children has special needs and his wife was expecting their fourth child. “I began to think about them, what will they do without me?”

But after a serious conversation with the doctor, Marat made the decision to commit to the necessary treatment, beginning with a months-long hospitalization. The day after receiving his diagnosis, he was admitted to the City Center of Phthisiopulmonology in Nur-Sultan. 

“Everything has changed from that moment,” he said.

A Global Clinical Trial

Marat is one of 754 patients across seven countries who joined a clinical trial as part of the Expand New Drug Markets for TB (endTB) project, an international partnership launched in 2015 among Partners In Health, Médecins Sans Frontières (MSF), Interactive Research and Development (IRD), and financial partner Unitaid to find safer and shorter treatment regimens for MDR-TB, using the first new TB drugs developed in more than 40 years–bedaquiline and delamanid. 

Most clinical trial participants receive nine months of daily oral medication, in contrast to the typical regimen of 18 to 20 months of treatment–including pills and many months of daily injections. 

By October 2021, 184 patients had enrolled in the endTB clinical trial in Kazakhstan, which has some of the world’s highest rates of MDR-TB. To respond to this deadly epidemic, PIH has partnered with the local and national government since 2010. 

All Around Care for TB

For the first two months, Marat diligently followed his daily medication regimen at the hospital. His treatment included: bedaquiline, linezolid, clofazimine, cycloserine, moxifloxacin, and pyrazinamide. He experienced side effects, which manifested in weakness, dizziness, and heartburn, but doctors helped mitigate them.

PIH Kazakhstan and several charity organizations came together to create a network of support for Marat’s family when he was undergoing treatment at the hospital. Thanks to Sanat Alemi Kazakhstan, Marat’s 6-year-old son got a spot at kindergarten. Other organizations like Nur Alem Kazakhstan and Red Crescent of Kazakhstan, as well as volunteers from The Club of Kind Souls, regularly provided humanitarian aid through food deliveries, cleaning and school supplies, and clothing and baby items. PIH supported the family through food vouchers to a local supermarket. “The family has been really cared for,” said Gulmira Tanatarova, a member of PIH Kazakhstan endTB staff and Marat’s ambulatory coordinator.

Tanatarova has been a pillar of steady support to Marat and his family since the day he embarked on the treatment as part of the clinical trial until now, back home from the hospital, where he continues his regimen.

She calls her patient or his wife every other day, ensuring they’re getting nutritious meals, that Marat is taking his medications, and that he has warm clothing, particularly since his return to his job at the outdoor construction site. Occasionally, she visits Marat’s family to ensure that the living conditions are conducive to his full recovery. 

“The support and the role of a social worker is huge in the treatment process,” said Tanatarova. “Every patient needs an individual approach— you need to deeply understand their particular challenges.”

Most of the patients belong to socio-economically vulnerable groups and need emotional and psychological help. “During every encounter, I try to buoy them up and help them remain optimistic,” Tanatarova said. 

“I Consider Myself Lucky”

Currently, Marat shows up for his video treatment support every day. Shortly after breakfast, he connects with the nurse through a video call to ensure consistency in taking his medication. “He’s very diligent about not missing a day of his daily therapy,” said Tanatarova. 

Through Sanat Alemi Kazakhstan, Marat participates in a support group twice a month, where TB patients can ask clinicians and other experts questions and support each other. “On the days that I work, I ask to leave early to attend these meetings,” Marat said. 

At work, Marat doesn’t speak publicly about his diagnosis, even though his infection is no longer active. This airborne, infectious disease remains severely stigmatized in Kazakhstan and other post-Soviet countries given increased risk of infection among the marginalized groups of society. 

Looking back on his experience, Marat hopes that patients don’t delay turning to professionals once they experience symptoms. “I first had to believe myself that I could fully recover. The cure is within reach, if you commit to taking medication consistently and refuse alcohol,” Marat said. “It’s a hard and lengthy path, but it’s possible.

“I feel so much better than last year,” said Marat. “I consider myself lucky to have been part of this trial.”

*Name has been changed to protect patient privacy

Límbano Castro is 75 years old and has run a laundry business for several years, using the two washing machines at his home, in addition to selling snacks and decorations.

"Before [COVID], one was free to go out on the street, walk and see whoever one wanted,” he says. “But with the arrival of COVID two years ago, it was no longer like that."

Castro, like many others in Chiapas, Mexico, saw his community devastated as the pandemic swept through the rural, coffee-growing Sierra Madre region, where tests were not widely available until January 2021. When long-awaited vaccines became available in March 2021, he felt hopeful.

He received a one-shot vaccine that month. But he never received a booster.

While Mexico has a stockpile of vaccines, the country didn’t have enough booster doses, according to its president, until January 2022—several months after wealthy nations such as the U.S. had begun to rollout their booster programs.

That meant Castro, like millions of patients in low- and middle-income countries, lacked access to the same level of protection as those in wealthy nations. Such disparity came with consequences.

The cough began in October. At first, Castro thought it would last just a few days. But as time went on, the cough only got worse, along with a general malaise. It was then that his children took him to the Center for Respiratory Diseases at the community hospital in Jaltenango.

Compañeros En Salud, as Partners In Health is known locally, has worked in Mexico since 2011. Since 2020, Compañeros En Salud has staffed and supported the Center for Respiratory Diseases, a 6-bed center that provides antigen tests, consultations with doctors, and bedside oxygen for patients struggling to breathe. It’s part of Compañeros En Salud’s comprehensive COVID-19 response in Chiapas, where 1 in 3 families live in poverty and the nearest clinic can be hours away.

Last year, the team administered 2,820 antigen tests and treated 85 patients at the respiratory disease center.

At the center, Castro was tested for COVID-19 and his diagnosis, confirmed: positive.

Doctors gave him medication for his fever and sent him home to rest. But Castro's condition wasn’t improving. By day nine, his breathing had become more and more difficult, his cough had worsened, and his lungs had weakened. Fearful, his son rushed him back to the center for respiratory diseases, where Castro learned that he needed to be hospitalized—immediately.

"I didn't want to stay hospitalized, because I didn't want to be away from my family,” he recalls. “It's terrible to be in a hospital."

COVID-19 remains in the body for approximately 10 days, after which most people with mild-to-moderate illness no longer have a viral load that allows them to infect others; however, complications and lung damage can cause problems even months after infection—especially for those with preexisting conditions.

Castro had suffered from hypertension and diabetes for several years, but had gone untreated. Now, facing COVID-19 and pulmonary fibrosis—a condition where the lungs became damaged and scarred—he was struggling to breathe.

He would need bedside oxygen.

For patients with severe COVID-19 or other respiratory illnesses, medical oxygen can mean the difference between life and death. It’s one of the last lines of defense against COVID-19, a virus that attacks the respiratory system and, in its most severe form, requires intubation.

Hospitals typically provide medical oxygen in three ways: oxygen plants, oxygen tanks, and oxygen concentrators (bedside or portable machines). Castro received oxygen through a concentrator and was constantly monitored by doctors and nurses.

"Much of a patient's recovery is centered on three important pillars: a good response from the medical team, support from family members, and the cooperation and patience of the sick person," says Dr. Carlos Popoca, a doctor with Compañeros En Salud who treated Castro while he was hospitalized.

Despite the constant attention and care of Compañeros En Salud staff, Castro’s life was in danger.

"I thought I wasn't going to make it out of there alive," he recalls. "I was afraid I would never see my children again...or my granddaughters."

But Castro and his family didn’t give up. And neither did Compañeros En Salud. After nearly one month in the hospital, he recovered and was able to return home.

The care didn’t end there. Doctors followed up with Castro after his release—three times per week for the first two weeks—teaching him how to breathe again and helping him strengthen his lungs through breathing exercises.

While Castro has since recovered, his month-long stay in the hospital, on oxygen, could’ve been avoided, doctors say, had boosters been available earlier in Mexico.

“Vulnerable populations, or those with difficulties accessing medicines and vaccines, are the ones who are the most damaged and hit the hardest with the disease,” says Popoca.

That applies not only to COVID-19 patients, but to those with other respiratory diseases, such as tuberculosis.

“Castro is one of the success stories. They really thought he was going to pass away,” says Popoca. “Many patients decide to leave [because] they want to die at home. He believed in us.

At around 8:00 a.m., PIH staff are in a car bound for Bungwe, a village in Northern Rwanda where farming is the heart and soul of the community. The village is about 20 miles from the hospital and university campus in Butaro, where Inshuti Mu Buzima, as Partners In Health is known locally, works. But, unlike other such journeys, this visit isn’t about delivering medical care—it’s about meeting patients turned entrepreneurs.

Jean Nepomuscene Nkiliyehe, who always starts the day with a joke to keep his colleagues entertained, starts the car to begin the journey—or home visit, as it is called at Inshuti Mu Buzima.

For Nkiliyehe, a driver with Inshuti Mu Buzima for almost a decade, and Eddy Mukwiza, livelihood program coordinator with Inshuti Mu Buzima, this is a route they are accustomed to. They are part of a team that travels beyond the walls of Butaro Hospital to follow up with patients across rural Burera district who live in poverty and face financial barriers to health care.

That outreach is part of a Partners In Health program called POSER. The Program on Social and Economic Rights (POSER) stems from the belief that care must extend beyond medical and addresses the whole patient. PIH offers the program in Rwanda and Malawi and provides social support—such as food, housing, and transportation—in all countries where it works.

Inshuti Mu Buzima has worked in Rwanda since 2005 and focuses its work in three rural districts—Burera, Kayonza, and Kirehe—home to more than 1 million people. In partnership with the government, Inshuti Mu Buzima strengthens the public health system to provide not only quality medical care, but also financial resources to ensure that patients have the means to stay healthy.

After a 50-minute drive, Nkiliyehe and Mukwiza reach Bungwe and are welcomed by Sylvien Gakwenza, secretary of a local farmers’ cooperative called INZIRA Y’UBUKIRE (“Path to Wealth” in Kinyarwanda), near a 6.7-hectare (16.5 acres) field that still has remains of trunks of cassava from the last harvesting season.

For at least nine months of the year, this field is where Gakwenza and some 140 members of INZIRA Y’UBUKIRE spend their days planting or harvesting crops such as Irish potatoes, beans, corn, and wheat.

“I am a farmer, my parents were farmers, and their parents were farmers too,” says Gakwenza. “Farming is important to our everyday life.”

A Community Effort

Farming is the foundation of people's wellbeing and livelihoods in Burera, a rural district with volcanic fertile soils located near the Virunga Mountains in northern Rwanda.

But over the years, climate change, coupled with obsolete traditional farming methods, has threatened to push many farmers to the brink of starvation and destitution, leaving them exposed to a cycle of poverty and illness.

Before joining the cooperative, Gakwenza and his family of eight, like many members of the cooperative, used to cultivate small, segmented plots of land, which not only severely limited the amount of crops they produced but also was very hard to manage, especially when some members of the family were too sick to do any physical activity.

In 2012, following a dry season that led to fewer crops in Bungwe and left many farmers struggling financially, Gakwenza had no option but to sell land. Without any other source of income, he was destined to lose all of his land, despite it being essential to his livelihood.

“After failing to get enough harvest for a long time and selling a big portion of my wealth,” he says, “my family started to rely on in-kind food assistance from neighbors and local government.”

Then, in 2013, Gakwenza was one of dozens of people who started to receive economic support from Inshuti Mu Buzima through the POSER program. The program brought together local farmers—most of them patients with chronic illnesses—into saving groups, which allow members, who usually don’t have the means to deal with a bank, to save money and borrow money on flexible terms. Eventually, that group became the INZIRA Y’UBUKIRE farmers cooperative. Through this cooperative, the farmers received resources and financial support from Inshuti Mu Buzima, including livestock, fertilizers, seeds, land for cultivation, and training in modern and commercial farming methods.

“We believe that the most important way to support farmers is to be closer to them to understand the challenges they are facing,” says Mukwiza, who coordinates the program. “We also provide training on saving and modern farming to equip them with the skills needed to generate their own sources of income and then give them starting capital like land, agricultural inputs such as seeds and fertilizer, and livestock.”

For farmers like Gakwenza, that support has been life-changing.

“I managed to move from an old house to this beautiful house, thanks to the skills and money I gained from the cooperative,” he says, standing in front of his house. “I also bought a cow and a big plot of land.”

Now, Gakwenza is the village’s agricultural advisor and well-respected for the advice and mentorship he provides. He uses the skills he learned from the cooperative to train farmers in Bungwe, helping them embrace modern farming methods to earn income, reduce poverty, and have the means to access health care, including associated costs such as transportation, lodging, and medications.

‘We Have Seen Tremendous Change’

In the same village, less than a mile from Gakwenza’s house, Evaliste Nsengiyaremnye, Joseline Urayeneza, and their five children have also reaped the benefits of the POSER program.

The family was referred to the program by their neighbors, who saw how they spent months cultivating other people’s land for low wages and still struggled to put food on the table. 

“Watching helplessly my children crying because of hunger broke my heart,” says Urayeneza.

The hunger took a toll on the family in more ways than just health. As Nsengiyaremnye and Urayeneza worked on other people’s farms, they barely had time to spend together. After a long day of work, they would return home to crying, hungry children and despair about where the next meal would come from.

The POSER program came as a lifeline.

After they started receiving support from Inshuti Mu Buzima, they were able to save money and use pooled funds from INZIRA Y’UBUKIRE to buy land of their own, which they cultivated using modern farming techniques and fertilizers and seeds from the cooperative. Within months, they had harvested enough food to feed their family and sold the remaining yields at the local market and to wholesalers from as far as Kigali and neighboring Uganda.

Now, the family is healthy and their farm is thriving—so much so that they are able to provide job opportunities to their neighbors.

When asked about how his life turned around, Nsengiyaremnye points at a big plot of land he recently bought.

“Today, you can’t afford to pay me to work for you,” he says. “We have just bought this land for 2.5 million Rwf [Rwandan franc] and we own multiple plots of land in different places.”

Programs like POSER are crucial to breaking the cycle of poverty that prevents many farmers in Burera from accessing health care and living a healthy lifestyle. To continue and strengthen this life-changing source of support, Inshuti Mu Buzima works with Rwandan government officials and all health centers across Burera district to provide health insurance to farmers, make sure they have enough land for cultivation, and help them to find markets for their yields. Inshuti Mu Buzima also conducts home visits to identify people in need of social and economic support and enroll them in POSER.

Over the years, Mukwiza has seen the program change lives—and communities.

“We have seen tremendous change in the lives of families who went from not being able to pay for health insurance to owning multiple income-generating projects,” he says. “We plan to scale up our support to even more people in need.”

Women’s health care has always been a focal point for Partners In Health (PIH). From gender-sensitive programs in Sierra Leone to several dozen maternal waiting homes around the globe, PIH has consistently prioritized women’s rights through accompaniment.

“When we look at someone as a number rather than a person, you are blaming the victim of terrible care...But when you actually talk to the women, and walk with them, and see what sort of care they need, you put the person at the center of care,“ said Dr. Joia Mukherjee, PIH’s chief medical officer.

On March 8, Mukherjee joined a PIH-organized livestream alongside Dr. Cindy Duke, founder and director of the Nevada Fertility Institute; and Edward Wageni, global head of the UN Women’s HeForShe initiative. The conversation was moderated by Winston Duke, an actor, producer, philanthropist, and advocate for women’s empowerment who helped shape the conversation with thoughtful questions and reflections. During the virtual event, which celebrated International Women’s Day, panelists discussed how gender bias impacts health care, ways to humanize conversations around women’s care, and strategies to advance gender equality for women.

Panelists agreed that women’s empowerment needs to happen beyond the medical setting and that all people—regardless of gender—must be involved. 

“We need to be all hands on board; ensuring that there are both men and women, boys and girls  to promote gender equality in partnership with women,” said Wageni. 

And the commitment to equity needs to begin early in life.

“When talking about a ‘women’s role’, we have to acknowledge that in order for women to function, we first have to make sure there is equity at the start. Part of that equity is access to care, access to skilled birth attendants, and access to accurate statistics,” said Cindy Duke. 

At PIH, one example of equitable access to care is Lesotho’s Maternal Mortality Reduction Program, which Mukherjee highlighted during the hour-long conversation. The program involves training village health workers to accompany women in remote regions of the country, ensuring they attend all prenatal visits and have a facility-based delivery. Those visits are among the 2.1 million women’s health visits PIH provided across countries in 2020. 

To watch the full discussion, visit PIH’s Youtube channel or view the recording above. To learn more about our panel partner, HeForShe, visit HeForShe.org. 

Partners In Health honored the life and legacy of Dr. Paul Farmer in a memorial service in Boston on Saturday, March 12, alongside friends and family of the late PIH co-founder and leaders in the global health community.

The two-hour memorial service took place at Trinity Church in Copley Square, where more than 600 people gathered and thousands more joined virtually, from Rwanda to Peru.

Eulogies were delivered by PIH Co-founder Dr. Jim Kim; Catherine Farmer, Paul’s oldest daughter; Dr. Anthony Fauci, a friend and chief medical advisor to President Joseph Biden; and PIH Co-founder Ophelia Dahl, who remembered Farmer’s fierce love and compassion, visionary leadership, and relentless humor.

Dr. Paul Farmer unexpectedly passed away on February 21 while in Butaro, Rwanda, teaching and mentoring the next generation of clinicians at the University of Global Health Equity and caring for patients at Butaro District Hospital.

Follow the links to see a tribute video to Dr. Paul Farmer and a photo slideshow commemorating his life and legacy, as well as reflections written by his friends, colleagues, and admirers.

A Celebration of Life

View the full program from Dr. Paul Farmer's memorial service.

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Not only was PIH co-founder Dr. Paul Farmer an expert doctor and history-making humanitarian. He was also a prolific researcher and writer, using his medical and anthropological training, plus his proximity to the poor, to author books throughout his career about health, history, and human rights.

Below is a list of some of his most powerful works, ordered chronologically. Though spanning time and set oceans apart, these books represent one way in which Dr. Farmer will continue to teach generations to come, and assert his—and our—guiding belief: that it’s possible to change the world and cure injustice.

Three decades ago, Partners In Health was formed to support the work begun in a small, rural community called Cange in Haiti’s Central Plateau. From there, it expanded across the country, then on to Peru and Russia, across Africa, and on to Mexico and the Navajo Nation.

Through it all, PIH has kept patient care at the center of its work and fought for health care as a human right—both within individual countries and the halls where global health policy is created.

In the timeline below, read how PIH has grown, innovated, and pushed the boundaries of global health to ensure that every single person has access to high-quality care.

1983

Paul Farmer and Ophelia Dahl begin operating a community clinic to provide free health care to the people of Cange, a small, rural village in Haiti.

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1987

Dr. Paul Farmer, Ophelia Dahl, Dr. Jim Kim, Todd McCormack, and Thomas J. White found Partners In Health to support work providing health care to poor patients in Haiti.

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1994

PIH expands to Peru and begins supporting the government in battling an unchecked epidemic of multidrug-resistant tuberculosis. Our community-based MDR-TB treatment program sees an 80 percent cure rate, inspiring the World Health Organization to revise its treatment recommendations.

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1998

PIH launches the HIV Equity Initiative, which provides antiretroviral therapy to HIV-positive patients in Haiti. Our example helps later inspire major organizations like the Global Fund, PEPFAR, and the World Health Organization to fund the fight against HIV in rich and poor countries alike.

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1998

PIH expands to Russia and begins supporting the government in fighting tuberculosis and multidrug-resistant tuberculosis epidemics, first in prisons and then throughout the community of Tomsk.

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2003

Tracy Kidder publishes Mountains Beyond Mountains, a book tracing the lives of PIH founders and our work in Haiti, Peru, and Russia.

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2004

PIH co-founds OpenMRS, an open source electronic medical records software tailored for use in developing countries. Today, organizations and governments in 64 countries use OpenMRS.

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2005

PIH expands to Rwanda and partners with the government to bring high-quality health care to three of the country’s poorest regions. This includes oncology care at the Butaro Cancer Center of Excellence, which we open in 2012 to provide accessible, lifesaving cancer treatment to patients from Rwanda and east Africa.

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2006

PIH expands to Lesotho and begins supporting the government’s response to the HIV epidemic. We soon broaden our scope to treat tuberculosis, improve maternal health care, and, in 2014, become the government’s primary technical advisor on its National Health Reform, which is bringing the country closer to universal health coverage.

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2007

PIH expands to Malawi and begins collaborating with the government to provide comprehensive primary care to the rural poor. We build a brand new community hospital and two health centers that offer same-day consultation and care—including maternal health care and treatment for HIV, hypertension, malnutrition, and mental illness.

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2009

PIH expands to the Navajo Nation and establishes local partnerships to help improve community health and support community health representatives. In 2015, we help launch the Fruits and Vegetables Prescription program, which provides families—most of whom live a three-plus-hour drive away from a grocery store—free access to fresh, local produce.

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2010

PIH expands to Kazakhstan to support the government’s fight against multidrug-resistant tuberculosis.

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2010

When a catastrophic 7.0-magnitude earthquake strikes Haiti, PIH provides lifesaving health care and social support to earthquake survivors.

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2010

Our global mental health care program launches, providing high-quality, culturally sound treatment for common and severe mental illnesses, from depression to schizophrenia.

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2011

PIH expands to Mexico and begins collaborating with the government to help train new doctors, revitalize rural clinics, and maintain a force of community health workers, who specialize in areas like maternal health, depression, and diabetes.

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2012

After cholera is introduced to Haiti following the 2010 earthquake, PIH conducts a cholera vaccination campaign that protects 50,000 people against the deadly disease. The campaign’s success inspires the World Health Organization to establish a global stockpile of oral cholera vaccine.

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2013

PIH opens University Hospital in Mirebalais, Haiti, a 300-bed teaching hospital that provides advanced, high-quality care and offers specialized residency programs to train the next generation of clinicians.

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2014

Responding to history’s largest Ebola outbreak, PIH expands to Sierra Leone and Liberia to help end the epidemic and to support the government in strengthening the countries’ weak health systems.

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2015

PIH begins leading a partnership called endTB, which expands global access to new treatments for multidrug-resistant tuberculosis and conducts clinical trials to find shorter, less toxic, more effective drug regimens across multiple countries.

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2018

The first cohort of PIH global nurse leaders completes our inaugural Nightingale Fellowship, a program designed for nurse leaders to make system-wide impacts to improve patient care.

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2019

In Rwanda, PIH inaugurates the permanent campus of the University of Global Health Equity, which we founded in 2015. The university trains new generations of global health leaders by offering a graduate degree in global health delivery and, beginning this year, dual degrees in medicine and surgery to students from around the world.

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2020

PIH launches the Community Tracing Collaborative—in partnership with the Commonwealth of Massachusetts and local boards of health—to accelerate the effort to contain the statewide spread of COVID-19.

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2020

When COVID-19 spreads globally, PIH initiates a comprehensive response across countries and launches the U.S. Public Health Accompaniment Unit (USPHAU) to support some of the hardest-hit communities in the United States.

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2021

In October, PIH announces that USPHAU will officially become our United States arm, PIH-US, which focuses on building more robust and equitable community health and social support systems across the country.

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2021

The endTB project, led by PIH and partners, meets its goal of enrolling 750 patients across four continents in a clinical trial to find safer, shorter, and more effective treatments for multidrug-resistant tuberculosis. The results will be available in 2023.

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2021

Several countries where PIH works celebrate long-term anniversaries: 10 years for PIH Canada, 10 years for Compañeros En Salud in Mexico, and 25 years for Socios En Salud in Peru.

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2022

Paul Farmer, PIH's co-founder, unexpectedly passed away in Rwanda from an acute cardiac event on February 21.

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Partners In Health announced that its founder, Dr. Paul Farmer, unexpectedly passed away today in Rwanda from an acute cardiac event while he was sleeping. 

Dr. Farmer was 62 years old. He is survived by his wife, Didi Bertrand Farmer, and their three children.

Partners In Health CEO Dr. Sheila Davis released the following statement:

“Paul Farmer’s loss is devastating, but his vision for the world will live on through Partners in Health. Paul taught all those around him the power of accompaniment, love for one another, and solidarity. Our deepest sympathies are with his family.”

About Dr. Paul Farmer

Paul Farmer, M.D., Ph.D., was Kolokotrones University Professor and chair of the Department of Global Health and Social Medicine at Harvard Medical School, chief of the Division of Global Health Equity at Brigham and Women’s Hospital in Boston, co-founder and chief strategist of Partners In Health, and chancellor of the University of Global Health Equity in Rwanda.

Dr. Farmer and his colleagues pioneered novel, community-based treatment strategies that demonstrate the delivery of high-quality health care in resource-poor settings. He wrote extensively on health, human rights, and the consequences of social inequality. Dr. Farmer was a member of the American Academy of Arts and Sciences and the Institute of Medicine of the National Academy of Sciences, from which he was the recipient of the 2018 Public Welfare Medal.

He authored multiple books, including: In the Company of the Poor: Conversations with Dr. Paul Farmer and Fr. Gustavo Gutiérrez, Reimagining Global Health: An Introduction, and To Repair the World: Paul Farmer Speaks to the Next Generation. His most recent book was released in November 2020: Fevers, Feuds, and Diamonds: Ebola and the Ravages of History.

For all media inquiries, please contact: media@pih.org

Community health workers form the backbone of Partners In Health’s work across the globe. PIH helps bolster equity-centered public health systems by supporting community health workers, from those who revolutionized care for HIV/AIDS and TB patients in Haiti to those providing social support across the United States.  

At the start of the COVID-19 pandemic, Maria Plata, an Immokalee, Florida native and the daughter of a Mexican farm worker, was one of six community health workers hired to connect farmworkers, laborers, and other vulnerable community members to critical resources. Because of her background, Maria could uniquely connect with the families she served and quickly became a trusted source of information. Now, as a Project Manager with Partners In Health United States, she is committed to establishing a long-term, permanent community health workforce. Here, she discusses her experience responding to COVID-19 in Immokalee and the role community health workers play in building strong health systems. 

First, can you explain who community health workers are and why they are important?  

Health promotoras, health educators, community ambassadors––they can be known by different names, but community health workers are frontline public health workers who leverage their unique understanding of local language and culture to connect communities to health care and social supports.  

Living in the communities where they work, community health workers make sure that everyone has access to food, medicine, safe housing, and financial assistance. In doing so, they help overcome barriers to health care like travel times, costs, and stigma. 

Why did you decide to become a community health worker? 

I first heard the term community health worker in May 2020, when I was transitioning out of my job as a teacher. I had been volunteering with grassroots movements at the start of the pandemic and came across an opportunity to serve our beautifully diverse community by going door-to-door to share information about COVID-19. We were also tasked with bringing much-needed mobile testing into the community. I have always felt called to serve my community and this opportunity was strongly aligned with my mission to bring more resources to Immokalee.  

What has been most impactful for you in your role? 

Like many community health workers, for me, the work is deeply personal. It is easy to relate to the challenges of families we meet when going door-to-door or connecting at mobile events. At one household visit, I met a young girl who was helping translate for her parents who spoke a Guatemalan dialect our team wasn’t fluent in. I remember being that age and doing the same for my parents because almost all the materials were in English. Over the years, there have been concerted efforts to integrate culturally relevant, translated information into patient care, but we still have so much to do to bridge this gap. Community health workers are just one way to help break through these language barriers. 

How do you think your lived experiences and familiarity with the community benefit your work? 

As a daughter of farmworkers, I saw first-hand how challenging it could be for family members and friends to receive basic health care. Many people who work in agriculture or landscaping face a variety of barriers to accessing health services such as income, little to no paid sick leave, or inconvenient clinic hours. Understanding the structural obstacles that prevent people from accessing health care help shape my conversations with community members. I am then able to bring these insights back to partners to help inform solutions. 

Why are community health workers essential for a stronger U.S. public health system? 

Our experiences have shown that a community health workforce is essential for achieving better health equity, empowering communities, and building a stronger health system. 

During the recent Omicron surge, I joined community health workers as they called to check-in on positive patients. When I asked a community member about her current needs, she recognized my voice! We had met two years earlier when my team canvassed her neighborhood during lockdown. She was still relying on the information we provided to keep her and her family safe. 

Community health workers form and sustain important relationships with their neighbors. They accompany residents through care but also through life. There is still a lot of work that needs to be done to improve the U.S. public health system, but none of it will be achieved without community health workers. 

What can the general public do to support community health workers? 

Right now, the U.S. Senate is considering bipartisan legislation that would allow the U.S. government to invest in more community health workers across the country. This bill will help a wide variety of health care organizations (community-based organizations, health departments, nonprofits, and more) get the funding they need to build and support the community health workforce in the United States.  

This would mean that community health workers could be hired in communities that need them most and that programs started during COVID-19 can continue for longer and connect even more people to health, housing, food, and social services.  

Investing in community health workers is crucial to addressing our currently inequitable, fragmented, and costly public health system. Make your voice heard. Email your senators now to urge them to cosponsor the Building a Sustainable Workforce for Healthy Communities Act.   

Contact Your Senator

In honor of Black History Month, Partners In Heath staff have shared their favorite books and plays related to Black history, culture, and antiracism.

Black History Month has been observed in the United States since 1976. Although the annual celebration is confined to the month of February, PIH recognizes that amplifying Black voices, stories, and history is essential year-round.

Below are some of the recommendations that inspire our staff.

As AIDS surged worldwide in the 1990s, the most effective treatments were made available in the United States and Western Europe within months of their regulatory approval. But those same treatments took years to reach Africa. Without access to these lifesaving drugs, millions in Africa died of the disease.

Now, Dr. Evrard Nahimana fears that scenario is playing out again—this time, with COVID-19.

Wealthy nations have surpluses of COVID-19 vaccines and have since rolled out booster programs. But more than 80% of people in Africa hadn’t received a single dose, as of December.

This disparity is no accident.

When COVID-19 vaccines were first developed and approved in 2020, wealthy nations bought up the world’s supply, leaving African countries to scramble for what few doses were left.

And instead of helping expand vaccine access in Africa and support delivery systems, wealthy nations blamed the continent for its low vaccination rates and put in place racist, discriminatory measures such as travel bans.

“It’s like punishing and blaming someone who is already sick,” says Nahimana. “Saying that these people don’t deserve the most effective vaccines…is cynical, racist, and very colonial.”

The Vaccine Gap

Africa is a continent of 1.3 billion people, with 54 countries and more than 2,000 languages. Partners In Health works in five of those countries—Lesotho, Liberia, Malawi, Rwanda, and Sierra Leone.

As PIH’s Africa regional policy and partnerships advisor, Nahimana supports the COVID-19 response in these countries, where PIH has partnered with national governments to train health workers, strengthen supply chains, and provide tests, treatment, and vaccines.

Much of that crucial work began years before COVID-19, as PIH supported ministries of health in responding to Ebola, HIV/AIDS, and other infectious diseases and building up health systems weakened by centuries of colonialism and war.

Throughout Africa, COVID-19 vaccination rates vary by country. But as of December, only seven countries had vaccinated 40% of their population, meeting the target set by the World Health Organization for 2021. Africa may not reach the WHO’s mid-2022 target of 70% coverage until 2024.

Nahimana sees history repeating itself.

“It took years…decades…for communities across Africa in the 2000s to get access to the most effective antiretroviral treatments for HIV,” he says. “Those ARTs were already available a decade before in the U.S. and Europe.”

‘It’s So Cynical’

Cold chain, multiple-dose series, and weak health infrastructure are often cited in global conversations about the difficulties of providing and distributing COVID-19 vaccines in Africa.

But the root issue, says Nahimana, has less to do with supply chains and more to do with racism, colonialism, and capitalist greed.

“It’s so cynical to say, ‘Since they don’t have the ability to distribute, there’s no way to donate or we should hold sending vaccines,’ he says. “This behavior is racist.”

Even if all African countries had strong health systems, supply chains, and health workforces, there simply aren’t enough vaccines—Africa received just 6% of the world’s supply of vaccines, despite having 17% of the world’s population.

And the vaccines that are available on the continent—secured through COVAX, African Union deals, and bilateral agreements—are less likely to be mRNA vaccines, currently considered top-tier, and more likely to be lower-cost vaccines.

“I think the United States’ approach and the European Union’s approach to the global COVID pandemic was that it could be solved very cheaply in impoverished countries,” says Garrett Wilkinson, a health policy analyst on PIH’s global advocacy team. “I think what we’re seeing now is the effects of low-balling the cost of vaccinating the entire world.”

If wealthy nations wanted to, he says, they could build the capacity to mass produce vaccines and distribute them worldwide, including in Africa.

And that could happen independent of COVAX, the global initiative that was set up by rich countries simply to buy doses from pharmaceutical companies, rather than to expand production of vaccines, says Joel Curtain, PIH’s director of advocacy.

“This is really about double standards in vaccine access and quality, which is deeply colonial and unjust,” says Curtain.

A recent report that Wilkinson co-authored showed that it would cost the U.S. less than $12 billion to build the manufacturing capacity necessary to produce enough mRNA vaccines to protect the world’s unvaccinated. (For context, the U.S. recently approved $768 billion for military spending.)

But President Joseph R. Biden has continued to reject calls from PIH, others in the People’s Vaccine Alliance, and over half the Democratic Caucus in the House of Representatives to invest in new manufacturing capacity to expand vaccine supply and to increase global vaccine delivery spending.

That inaction continues to cost lives.

Ending The Pandemic, Everywhere

It’s not difficult to find success stories in Africa. Just look to Rwanda, says Nahimana.

One day after receiving shipments of COVID-19 vaccines, he says, the country was able to quickly deploy those vaccines in every health facility across all districts. Prior investment in the primary health system and a strong commitment to equity were some of the drivers of this success.

The country of nearly 13 million has now fully vaccinated over 50% of its population and is expected to reach the World Health Organization’s target of 70% by mid-2022—showing that mRNA vaccination programs are entirely possible in both urban and rural settings in Africa, with access to funding, resources, and investment in the health system.

It’s also crucial to transfer the technology and build up the capacity for vaccines to be manufactured in Africa, says Nahimana. Africa currently relies on manufacturers in Europe, the U.S., and Asia for 99% of all of its vaccines.

“At PIH, we don’t just want to play the role of advocacy,” he says. “We want to push barriers.”

For Nahimana and others calling for global vaccine equity, the message is straightforward: If Western leaders wanted to save as many lives as possible, they could.

“It’s pretty clear that the only reason we’re in this situation is because our leaders don’t care enough whether poor people live or die,” says Wilkinson.

The inaction of U.S. and Western European leaders is not only a moral outrage—it’s a danger to public health. The longer that millions of people worldwide are unvaccinated, the greater the threat of new variants, putting everyone, including those in wealthy nations, at risk.

“It doesn’t make sense scientifically and it’s a moral failure,” says Nahimana. “When you think about a pandemic like COVID-19, with dangerous variants emerging in areas with low vaccination rates, it’s not about ending the pandemic in one country. It’s about ending the pandemic everywhere.”

Sign for Global Vaccine Equity

“Evidence shows that racism, especially anti-Black racism, kills.”   

That’s the context for a new opinion piece published in The Boston Globe this week by co-founders of the global health and social justice organization Partners In Heath, Dr. Paul Farmer and Ophelia Dahl, and PIH’s CEO, Dr. Sheila Davis. In the op-ed, the three highlight systemic racism that is pervasive throughout the U.S. health system and make the moral and pragmatic case for eliminating such inequities through race-conscious efforts.  

“There’s no time in recent memory when social disparities haven’t been reflected in disparities of risk for disease, delayed diagnosis, poor-quality care, and premature death or disability,” they write. “In the United States, racism remains a ranking driver of such disparities; those disparities widen as new tools to prevent and treat disease are made available to some and not to others. COVID-19 serves as the latest object lesson in this regard, within this nation and across the globe.”  

Systemic racism kills, “not only with bullets: Denial of essential goods and services can also kill. And because we tend to patients of every description, we know that racism ruins our ability to provide excellent care for all, just as its corrosive effects damage our professional communities from within.  

“It’s in everyone’s interest that clinical medicine, training, and research be antiracist, and this tardy epiphany has spread throughout academic medical centers.” 

Op-Ed Responds to Boston Incident 

The leaders’ op-ed came in response to a recent incident involving two longtime colleagues of PIH: Dr. Michelle Morse, formerly at Brigham & Women’s Hospital and deputy chief medical officer and PIH, and now chief medical officer for the New York City Health Department, and Dr. Bram Wispelwey, an internal medicine and public health doctor at the Brigham and senior technical lead at PIH-US. Both doctors teach at Harvard Medical School, and both have been working with colleagues at the Harvard teaching hospitals to establish greater equity in health care for non-white communities. 

On January 22, a group described in press accounts as “white nationalists” amassed outside the Brigham holding up a bedsheet claiming that “B and W Hospital Kills Whites” and citing Morse and Wispelwey by name on pamphlets they distributed that day.  

The rage among this neo-Nazi group was apparently sparked by research and associated interventions conducted by Morse, Wispelwey, Dr. Regan March, a strategic senior advisor at PIH, and emergency medicine physician and medical director of quality, safety and equity at Brigham and Women's Hospital,  and others over the past years “addressing obvious deficiencies in the American medical system and beyond it,” as the op-ed authors put it. Notably, the doctors were among the authors of a 2019 study that showed that Black and Latinx patients in the emergency department with heart failure were less likely than white patients to be admitted to specialized cardiology units, thereby demonstrating institutional racism in the admitting process. .   

“Black and Latinx patients were less likely to be admitted to cardiology for [heart failure] care,” the study authors concluded. “This inequity may, in part, drive racial inequities in [heart failure] outcomes.” 

The research led to efforts at the Brigham to address this unequal care. In a March 2021 Boston Review piece, titled “An Antiracist Agenda for Medicine,” Morse and Wispelwey proposed a new model of health care informed by critical race theory (CRT), a framework that challenges the conventional wisdom that colorblind civil rights efforts can effectively dismantle structural racism, and called for medical restitution for BIPOC patients who have long been shut out of top-notch care.  “We hope to provide a replicable, CRT-informed framework that can move us beyond the historic cycle of documenting racial inequities while endlessly deferring their resolution,” they wrote. “The outstanding debt from the harm caused by our institutions, and owed to our BIPOC patients, is long overdue: now is the time to start settling it.”  

Morse explained the initiative in an interview with WGBH, a Boston public radio station: “What I'm trying to do is hold the medical industrial complex accountable for the harms that it's caused to communities of color and to other communities and push for racial justice and health equity in all of the institutions that I'm involved in and in partnership with the many communities that I serve. …And I think ultimately in the COVID era, part of what that means is a real serious push to make inequities more visible.”  

Wispelwey added that “racially-blind” methods were not working: “And so we wanted to take a race-explicit approach,” he said in the same news report. “We can't wait until these predominantly white institutions sort of come around...We want to actually make sure our patients are taken care of in the best way possible right now.” 

Of course, the doctors’ work reaches far beyond the walls of any single hospital. Morse is co-founder of Equal Health, a nonprofit dedicated to the pursuit of health equity through critical conciousness and movement building; Wispelwey is a key advisor to PIH-US in its efforts to build an equitable response to COVID-19, with the imperative to protect Black and Brown lives, while strengthening U.S. health and social systems into the future.  

PIH-US's Antiracism Work  

In almost every community PIH supports across the U.S., residents of color make up the majority of the population, and they are often poorer and sicker due to historical and ongoing structural racism. Race-blind approaches to health care and health outcomes have failed them.  

For this reason, PIH-US is working to embed a racial equity lens in all aspects of programming and partnerships and within organizational systems and structures. Since launching in May 2020, PIH-US has strived to challenge systemic racism in the health system, listening and learning from partners so that, together, we can dismantle harmful policies and practices within U.S. health and social systems, while building equity-driven and race-conscious alternatives. Whether working shoulder-to-shoulder to apply locally-driven models for vaccine outreach and distribution, reimagine how the public health workforce is recruited and trained, improve how federal and philanthropic funds flow to front-line community-based organizations, or advancing equity-centered health policies at the federal, state, and local level, PIH-US is committed to a relentless antiracist approach, in order to ensure fair and just access to care and repair generations of harm in the communities we serve.  

As it has for more than 30 years, PIH continues to work explicitly against racism across the globe. In a statement supporting Morse and Wispelwey, PIH leaders reaffirmed that conviction: “White supremacy will not deter the fight for health equity. Displays of racist backlash only confirm we are on the right path towards equity and justice. We stand with our colleagues whose courage helps make our society safer for people of color.” 

The United Nations’ education agency has highlighted the University of Global Health Equity (UGHE) as a model for equitable global health education in a new report.

The university, based in rural Butaro, Rwanda, is described as a “high-quality health sciences institution” helping shift the center of gravity from where it has traditionally been, within higher-income countries, to lower-income countries—specifically, within Africa.

The report, published by the United Nations Educational, Scientific, and Cultural Organization (UNESCO) on February 9, discusses the role of higher education institutions in advancing the UN’s 2030 agenda, which includes ensuring “inclusive and equitable quality education.”

For the six-year-old university, the moment comes as a milestone.

“This is a great moment of reflection for UGHE, to have our unique education model stand on its own as a pillar of exemplary achievement,” says Dr. Agnes Binagwaho, UGHE’s vice chancellor and professor of pediatrics and a former minister of health in Rwanda.

The global health sciences university was launched by Partners In Health in 2015, in collaboration with Rwanda’s government. Based in the north’s Burera District, UGHE aims to radically transform the way health care is delivered not only in Rwanda, but across Africa and around the world by training generations of global health professionals to deliver equitable, high-quality services.

UGHE graduated its first cohort of graduate students in 2017. Two years later, UGHE launched its six-and-a-half-year nationally accredited medical program, which confers a Bachelor of Medicine, Bachelor of Surgery/Master of Science in Global Health Delivery, combining a bachelor-level medical degree with the university’s existing master-level degree. 

In its curriculum, the university pairs education in human rights and social justice with rigorous, community-based medical training as well as leadership and management training—often viewed as “add-on” by health education programs, according to the UN report.

The report notes that UGHE stands out for its scholarship offerings and innovative funding methods to ensure that students from disadvantaged backgrounds can access its high-quality education. All medical students at UGHE receive full scholarships and all Master’s in Global Health Delivery students receive scholarships, totaling on average 95% of the total tuition and room and board.  

After graduating, students serve for six to nine years with the ministries of health in their home countries—service commitments that place them in settings ranging from cities to rural areas to refugee camps, ultimately strengthening health systems and delivering high-quality care to the most vulnerable. UGHE students come from more than 23 countries around the world.

Additionally, UGHE partners with medical schools across Africa, Asia, Europe, and the United States to implement faculty development programs as well as to assist in creating master’s and doctoral degree programs.

UGHE’s equitable approach to health education is essential to leveling the playing field worldwide. As the report notes, Africa bears 27% of the global burden of disease but has just 1.7% of the world’s doctors.

UGHE aims to upend that paradigm, one graduate at a time.

“UGHE is a laboratory in education that moves constantly and forward towards excellence in education,” says Binagwaho. “With our supporters, UGHE is…transforming higher education globally.”

Update: February 11  

According to the latest national data on Tropical Storm Ana’s toll in Malawi, a total of 46 people have died, 18 remain missing, and 206 are injured. More than 221,000 households and 945,000 individuals were impacted by the cyclone that swept through the country on January 24.  

Additionally, 29 health facilities remain accessible and 29 are completely non-functional, according to the recent report. Over 190,000 people have sought shelter in camps, and crops across more than 100,000 hectares of land have been lost.  

In Neno District, where Abwenzi Pa Za Umoyo (APZU), as Partners In Health is known in Malawi, primarily works in the South, the response team has so far reached 2,800 affected people with emergency packages, says Dr. Luckson Dullie, APZU’s executive director. All six area camps continue to receive health care through a mobile medical team that visits twice a week. Pregnant mothers are being cared for in the maternal waiting homes. All health facilities are accessible and are being repaired, where necessary.  

“All staff and 175 [community health workers] (CHWs) have already been reached with support,” Dullie says. We will start to explore different options for support towards resettlement. We will prioritize staff, CHWs, families in camps, and households with special needs.” 

 APZU staff visited Chikwawa and Nsanje Districts, farther south of Neno, for a rapid situation analysis., requested by the national government to support relief efforts.  Dullie says Chikwawa is the worst, with over 80,000 households affected, with some residents in 83 camps. Only four of 23 health facilities are operating, the others remaining inaccessible largely due to flooding or other damage. Makhuwila health center on the eastern bank of the Shire River, a majority tributary running through the South, is an example of the dire situation, he says, as it was flooded and lost all medical supplies.  

“This has left 90,000 people in its catchment area desperate for health care,” Dullie says. “In contrast, our lower Neno has a population of about 70,000 people. We have a functional community hospital with capacity for C-sections and other surgical procedures, a lab, X-ray, ultrasound scanning, and six health centers. 

“The extent of damage also means that the resettlement of affected families and rehabilitation of the health system will require significant resources beyond the immediate response,” he continues. “Given our available resources, we are currently working with health care professional bodies to jointly put together emergency mobile teams to be deployed to the camps.” 

Update: February 1

Recovery efforts are underway after a powerful cyclone tore through Malawi on January 24, killing 37 people and injuring more than 150, according to a national disaster report on the wide-ranging impact of Tropical Storm Ana. At least 20 people remain missing, the report said.  

Torrential rain and high winds caused widespread flooding, as well as downed trees and power lines in the country’s central and southern regions. The resulting damage was extreme, the report noted, with more than 190,000 households affected, and a range of losses, including collapsed homes, bridges, schools, health facilities, and churches; blocked roads; loss of livestock and destruction of crops; and contaminated water sources. 

As a national disaster was declared on January 26, organizations, including Abwenzi Pa Za Umoyo (APZU), as Partners In Health is known in Malawi, are now focusing on relief efforts, notably assistance and support to the displaced individuals and families at camps across the region in dire need of food, temporary shelter, blankets, essential medicines, hygiene kits, and other supplies.  

In Neno District, where more than 7,500 homes were destroyed, five temporary camps are now set up for displaced residents. APZU continues to assist district residents with financial, social, medical, and psychosocial support.  

To ensure continuity of health services, APZU is providing immediate and long-term support to its staff, community health workers, and others in Neno District who were directly affected by the storm.  

“This is why we supported with fuel for generators and water needs at the facilities for about four consecutive days when Neno had electric power outage from 24 January 2022,” said APZU Chief Operations Officer, Basimenye Nhlema. “This included supporting the transfer of oxygen from lower Neno to upper Neno until the power was restored on 27 January 2022.” 

She added that the organization is also repairing various health facilities and assisting with temporary rehabilitation of roads to facilities in the district that were completely cut off.  

To date, APZU has helped 60 families with relief items, including bags of maize and beans, liters of cooking oil, emergency funds, and a blanket for every household member.  

Update: January 28

Massive black-outs have plagued the country, with Neno District having no power supply for four consecutive days. The storm left the electrical infrastructure ruined from the main power plants. Health facilities continue to struggle to provide patient care and to adequately store medical supplies and equipment that require electricity and refrigeration.

Accessing back-up power has been a struggle, as fuel tankers supplying the only filling station in Neno have been unable to reach it due to blocked roads.

According to Basimenye Nhlema, chief operations officer for Abwenzi Pa Za Umoyo (APZU), Partners In Health in Malawi, the team has arrived with back-up fuel reserves, supplying fuel for three health facilities—Neno District Hospital, Lisungwi Community Hospital, and Dambe Health Center. This support extends to two oxygen plants in the district.

Currently, APZU, through its extensive network of staff, including community health workers and site supervisors, is working closely with the local ministry of health and the Neno District Council through the Departments of Disaster Management Affairs Social Welfare and others to assess the full extent of damage and coordinate response.

Nhlema said APZU has also supported some displaced families with relief items, such as blankets, plastic buckets, maize, and direct cash transfers per affected household. Other needed items include food, tarps for roofing, clothes, blankets, mosquito nets, pails, and water treatment supplies.

January 26

A cyclone swept through Malawi Monday, part of Tropical Storm Ana, killing at least 14 people according to the BBC, injuring at least 14, and damaging more than 7,000 homes in the southern region of Malawi, including Neno District where Abwenzi Pa Za Umoyo (APZU), Partners In Health in Malawi, is located.  Additionally,  "the country has suffered a nationwide power cut and some areas have been declared disaster zones...Some 44 emergency camps have been set up to deal with thousands of displaced and injured people," reports the BBC. A government declaration of disaster estimated that 28,216 households (216,972 people) affected, though they recognize that many areas are still cut off from assistance.

Beyond Neno, almost 16,000 people in the south of Malawi have been affected, according to the Red Cross, as search and rescue operations continue after the first cyclone of the region’s season, as The Guardian reports. 

Heavy rain and strong winds destroyed bridges and ripped the roofs off schools, according to a preliminary disaster damage report from the Neno District Council. Several health facilities in the area have roofs blown off, the report said, including a maternity waiting area. Widespread flooding has also been reported.  

APZU Executive Director Dr. Luckson Dullie said that many more people remain missing. The team reports there are no staff casualties, but due to the high number of homes and property destroyed, “we expect there will be large numbers of people who have been displaced seeking refuge." He said the team is planning to “immediately support 1,000 households out of the 7,000 that are particularly destitute. This initial support will include food, blankets, [and] basic household utensils. … Next phase will be urgent rehabilitation of damaged health facilities, especially as we are still early in the rainy season.”  

The tropical storm’s path went straight through Neno, impacting 100% of the region in which APZU works, according to Dr. Patrick Ulysse, PIH’s chief operating officer. Initial reports on Tuesday estimated 1,000 households and 400 children affected, and the majority of school buildings were severely damaged. Ulysse reported that 12 of the 15 APZU-supported health facilities have been damaged, with many difficult to access and one completely inaccessible due to washed out bridges and roads.  

“There has also been a nearly countrywide power blackout for the last 24 hours, forcing facilities to rely on back-up generators and inhibiting communication amongst APZU staff,” he said.   

The team is simultaneously dealing with scarce access to fuel, which will continue to complicate outreach and relief efforts in coming days and weeks. Over the past day, the APZU team has been working closely with the government and partners and will conduct more thorough assessments of damage and evaluate clinical and social needs as soon as the rains let up.

Given past experience with flood response in 2019, the team is certain a comprehensive response for the catchment area will be needed, including nutritional support, sanitation efforts, social support, and resettlement services for those who are displaced. Ulysse added: “As we have seen across PIH sites faced with acute disaster– whether an earthquake, storm, drought, or mudslide – this cyclone speaks to the direct and disproportionate impacts climate change has on the most vulnerable communities. We know these challenges will continue and our support for one another and our PIH sites around the world remains critical in 2022. “  

Dr. Paul Farmer’s return to Partners In Health-supported Butaro District Hospital in December was one full of emotions as he accompanied the inaugural class of medical students from the University of Global Health Equity (UGHE) on rounds through the oncology wards.

“I am very emotional because I am so excited and grateful,” Farmer said. “I have been dreaming of this for 20 years right here in Rwanda. “

Farmer is a familiar face at Butaro District Hospital—a familiarity that has less to do with his leadership roles, as co-founder and chief strategist of PIH and chancellor of UGHE, and more with how, over the years, he has spent his time there interacting with patients and getting to know the staff. Most recently, Farmer came to Butaro in early December last year with Harvard professor and psychiatrist Dr. John Sharp and provided a special training for students at a patient’s bedside.

Partners In Health, known locally as Inshuti Mu Buzima, has worked in Rwanda since 2005, in partnership with the Ministry of Health, to strengthen the country’s health system. Butaro District Hospital was one of the early fruits of that partnership—built by PIH, the Ministry of Health, and architectural partner MASS Design, with doors opened in January 2011.

UGHE medical students on their clinical rotations use nearby Butaro District Hospital as a training ground. There, they spend time working with experienced doctors and learning through caring for patients. Much of that learning takes place through a four-week course on the practice of medicine.

“It's sort of the bridge between the basic sciences and being a medical student in the hospital learning through patients,” said Dr. Natalie McCall, chair of the division of clinical medicine at UGHE. “A lot of the course is about how to do a physical exam, how to take a patient's history, how to establish a relationship with a patient.”

After teaching his morning class at the UGHE campus in Butaro, less than two miles and across the hill from Butaro District Hospital, Farmer accompanied students to the oncology ward of the hospital to discuss a rare form of gestational trophoblastic neoplasia—a potentially malignant tumor that starts in the uterus. It was a crucial learning opportunity for the aspiring doctors and, for Farmer, a moment of inspiration.

“The case they presented to me is a very unusual, hyper-specialized case, but they presented it in such a way that allowed me to get to the diagnosis and the point we are trying to make,” said Farmer. “I was deeply impressed.”

That progress in medical education had been years in the making.

In 2019, UGHE ushered in a new era of global health education by welcoming its inaugural class of medical students, who will spend the next six years on campus as part of the university’s new Bachelor of Medicine, Bachelor of Surgery (MBBS) and Master of Science in Global Health Delivery (MGHD) program.

Now, three years later, construction is underway to expand Butaro District Hospital to help thousands more patients and continue to serve as a teaching hospital for UGHE medical students. When completed in 2023 the hospital will be just the third teaching hospital in Rwanda, the first-ever district teaching hospital in the country, and the only one located in a rural setting.

There had always been a plan to expand the hospital, said Farmer, to be able to provide quality care to patients.

“It’s not just for the students. It's for the hospital,” said Farmer. “Studies suggest that the quality of care for patients goes up when you are in a teaching hospital.”

The expansion project will see the hospital’s capacity increase from 150 beds to 240. Further, it will equip the hospital with a new intensive care unit, additional wards, and a gynecology and general surgery unit. The hospital’s existing facilities will be remodeled and supplied with state-of-the-art equipment to provide quality services to even more people.

The PIH co-founder also hinted at the future and the role the hospital will serve.

“Direct and good service to the patients, clinical training—that is, learning while you are doing it and teaching others, and, finally, generating new knowledge through research—that is what we want this place to be,” Farmer said.  

Thousands of vulnerable patients are about to breathe easier, thanks to a new oxygen plant installed by Socios En Salud and partners earlier this month.

More than 36,000 people requiring medical oxygen in the La Libertad region of Peru will benefit from the oxygen plant, which was installed at Belén Hospital by Socios En Salud, as Partners In Health is known in Peru, the Ministry of Health, USAID, and Build Health International.

The oxygen plant comes as COVID-19 cases in Peru surge amid the highly-contagious Omicron variant, which has brought the country’s total coronavirus-related deaths to 204,404 and total infections to more than 2.9 million, according to Reuters.

“Since the beginning of the pandemic, we have fought to help close the oxygen gap,” said Dr. Leonid Lecca, executive director of Socios En Salud. “With this new oxygen plant…we ensure that more patients have access to timely and quality care.”

Oxygen is one of the last lines of defense against COVID-19, which attacks the respiratory system and, in its most severe form, requires intubation. Hospitals put patients on oxygen in hopes of preventing them from needing an ICU bed.

But the lifesaving resource is difficult to get—especially in Peru, where logistical challenges such as irregular access to electricity and the country’s electrical specifications stymied the supply chain for months.

Oxygen plants—which fit in standard-size shipping containers—are essential in oxygen production, because they enable hospitals to fill dozens of portable tanks each day. This onsite supply of concentrated, high-purity medical oxygen prevents health workers from having to travel to the nearest oxygen plant, sometimes hours away.

But oxygen plants are costly and cumbersome to install—making Socios En Salud’s efforts all the more critical.

The oxygen plant in La Libertad can produce 20,000 liters of oxygen per hour, strengthening the hospital’s response to COVID-19 and other respiratory diseases, such as pneumonia.

It’s the second that Socios En Salud has provided in partnership with USAID and the Ministry of Health. The first was installed in November at the San Martín Health Center in Iberia district, near the border with Brazil and Bolivia.

Socios En Salud has worked in Peru since 1994, where it responded to a deadly outbreak of multidrug-resistant tuberculosis and ultimately changed World Health Organization policy, leading the WHO to revise its global treatment recommendations for the disease. In the decades since, Socios En Salud has continued to provide medical care and social support in Carabayllo and beyond, focusing on strengthening the country’s health system.

As part of those system-strengthening efforts, health workers at Belén Hospital will receive training on how to use and maintain the oxygen plant, which is Socios En Salud’s latest effort to boost oxygen capacity in Lima and beyond.

Since November, Socios En Salud has delivered more than 120 oxygen concentrators and 90 oxygen tanks to hospitals across Peru, as well as installed 260 oxygen outlets directly into hospital walls, beside patient beds.

Socios En Salud also established a temporary oxygen center in Carabayllo for patients with dangerously low oxygen levels. A second such center is planned to open later this month.

LEARN MORE

On January 24 at 8:16 a.m., a 5.3-magnitude earthquake struck Haiti—only a few kilometers from the major quake in August 2021. The epicenter was in Miragoane, located in the country's southern peninsula.

Reuters cites the U.S. Geological Survey reporting "that the first quake hit an area near the city of Les Cayes and was followed by tremors of 4.4 and 5.1 in the same area, just six months after a major tremor in the same region killed more than 2,000 people."

A damage assessment is now underway, according to staff at Zanmi Lasante, as Partners In Health is known in Haiti. So far, according to the Zanmi Lasante team and news reports, two people are dead and 30 are wounded. About 30 homes are mildly damaged, and there's "a significant level of panic and fear amongst communities,"  according to PIH Chief Operating Officer Dr. Patrick Ulysse.

Zanmi Lasante leaders will closely monitor developments in the affected area and ensure that our existing support for the August earthquake also includes adequate assistance in response to emerging needs. A Zanmi Lasante team is currently working in the area and will be dispatched as needed.

We at PIH stand in solidarity with our colleagues and communities in Haiti during this tumultuous time. .

Each morning, Sonia Sánchez wakes up, makes her bed, and cooks breakfast. Some days, she goes with her sister to the market. There was a time when she didn’t know if those tasks would be possible.

Sánchez has lived with schizophrenia since she was 16 years old.

Schizophrenia is a serious mental health condition that affects the way people think, feel and behave. The disorder can lead to hallucinations, delusions, and extremely disorganized thinking and behavior and requires lifelong treatment, though early detection can help prevent serious complications.

In impoverished communities like Carabayllo, Peru, people living with schizophrenia were historically hospitalized, put in mental health institutions, or, for those without caregivers, left to roam the streets.

Since Socios En Salud, as Partners In Health is known locally, began working in Peru in 1994, it has partnered with the Ministry of Health to change that reality—opening the country’s first-ever safe house for women with chronic mental health conditions and providing medical care and social support to 515 patients, such as Sánchez, who live with schizophrenia.

For months, Sánchez, 52, didn’t have treatment or medication to manage her condition, since the hospital where she had received care suspended its mental health services when COVID-19 began. That led Sánchez, who lives with her mother and sister, to experience constant hallucinations. Terrified, she would hide under her bed out of fear or throw things off the table. She was once hospitalized for weeks.

Then, she found Socios En Salud. She learned of the organization and its work through the ASIRI community mental health center in Carabayllo, about 15 minutes from her home, where health workers were able to recognize the signs and symptoms of schizophrenia.

Early detection is critical for chronic mental health conditions like schizophrenia, which can worsen over time. And treatment is more effective if doctors can diagnose the condition early.

As part of its mental health program, Socios En Salud has trained doctors and nurses—in partnership with the Ministry of Health—to identify the signs and symptoms of chronic mental health conditions, including schizophrenia, among patients who visit Lima’s 350 primary care clinics.

Those efforts at early detection have also extended to Socios En Salud’s team of 90 community health workers, including 23 hired specifically to care for patients with schizophrenia and support their caregivers.

These community health workers—residents hired from the communities where Socios En Salud works and trained to provide basic health services—can help identify the condition during their routine visits to patients’ homes. In 2020, the team identified 417 people with schizophrenia.

Those efforts have proved crucial for Sánchez, helping her access a diagnosis and care.

Each month, she travels to a community mental health center just 20 minutes from her home to get her medications and see a doctor. It’s one of 203 community mental health centers that Socios En Salud supports in northern Lima, in partnership with the Ministry of Health.

To manage her symptoms, she takes daily pills and a monthly injection. She also meets with a community health worker, Rosa Silva, twice a week.

“I consider Rosa a friend,” says Sánchez. “She is always calling me. She asks me how I feel and if I have taken my pills. She is very kind to me.”

Safe Houses

Not everyone has that level of support. Many patients living with schizophrenia in Lima and surrounding areas don’t have caregivers—putting them at risk of being homeless, jailed, or hospitalized. The widespread stigma and discrimination against people with schizophrenia often prevents them and their families from accessing health care.

That reality led Socios En Salud to open a safe house in 2015 for women living with chronic mental health conditions, in partnership with the Ministry of Health and local governments. The house, located in Carabayllo, serves women between 18 and 65 years old who have no family or friends to care for them.

Each day, the women are given medications and support to help manage symptoms ranging from panic to hallucinations. They also learn basic skills such as making the bed, cooking, and washing dishes—preparing them for eventual re-entry into society.

Since the women have no caregivers, each woman is assigned a community health worker who provides 24/7 care and support. A team of doctors, psychologists, and nurses is also on-call. All of the women are provided health insurance, and the house itself is just minutes away from a community mental health center and a hospital.

In its first year, the safe house welcomed six women. All six made a successful transition back to society and are now living on their own or with family.

The safe house has since provided a model for schizophrenia treatment and care nationwide, leading the Ministry of Health to build 235 more safe houses across the country—bringing schizophrenia care and treatment to hundreds more patients.

Caring For Caregivers

Socios En Salud’s mental health initiatives have included care and support for caregivers as well as patients.

Sánchez’s sister, Violeta, used to accompany her sister to every doctor’s appointment or to the pharmacy to get her medications—even as she managed her own health issues and supported their mother.

“Many times, I felt overwhelmed,” says Violeta. “It is difficult to assume all this burden alone.”

She wasn’t the only caregiver struggling. In May 2021, she joined a free support group organized by Socios En Salud, connecting her with other caregivers of patients with schizophrenia and helping her feel less alone.

The program ultimately served more than 296 caregivers.

Such support for caregivers and patients has become even more crucial amid COVID-19, as demand for mental health services has surged along with the pandemic.

The community mental health centers in Carabayllo have only seen such demand increase, even as COVID-19 has led to staffing shortages, supply chain issues, and temporary disruptions in services.

“We have assumed our role in the community as a primary care center, providing support to all those people and families who need emotional support, especially those who have chronic mental health conditions,” says Roxana Ceron, coordinator of the ASIRI community mental health center.

For Sánchez and hundreds more patients with chronic mental health conditions, that support is making a world of difference.

The Omicron variant of the coronavirus is driving caseloads to record highs and filling hospitals to capacity. With over 300 million cases of COVID-19 worldwide and more than 5.5 million deaths, doctors and other medical personnel are physically and emotionally drained, and the public is weary and desperate for a glimpse of the pandemic’s end. This bleak landscape has given rise to numerous myths about Omicron, which was first identified by the WHO as “a variant of concern” in November 2021 and now accounts for most cases globally. We sat down with three senior advisors at Partners In Health to try to bust some Omicron myths and gain perspective.  

Dr. KJ Seung is a senior health and policy advisor at PIH and an associate physician at Brigham & Women’s Hospital; Dr. Emily Wroe is an internist and global and public health specialist, currently serving as a senior advisor for PIH’s U.S. COVID-19 response; and Dr. Paul Sonenthal is a pulmonary and critical care physician at Brigham & Women’s Hospital and the associate director for inpatient medicine and critical care at PIH. They are all affiliated with Harvard Medical School. Our interview has been edited and condensed. 

There is a strong narrative out there that Omicron is mild. What is your response to this widespread point of view? 

We think that people championing this position are primarily speaking from a position of privilege and thinking about their personal risk. If you have access to everything that protects you from bad outcomes—vaccines and boosters readily available and access to medical care, and if you are relatively healthy with no comorbidities— then for your own personal risk, Omicron can appear somewhat less severe than previous variants.  

However, most of the global south remain unvaccinated, and many people worldwide have chronic health conditions and limited access to care. For most of the world, nothing about this surge is “mild.” As we pursue an equitable pandemic response, we need to not simply account for the privileged, but focus on tried-and-true public health and clinical tools, ensuring they are accessible to communities everywhere. Rather than giving up, we should double down on global vaccination, testing and treatment, contact tracing, and masking and other prevention measures.  

But beyond an equity lens, the first key thing to understand about Omicron is that “milder” (compared to the Delta variant) does not equal “mild.” Delta was a bad disease, and so is Omicron. A staggering number of people are hospitalized and having complications, and while this is worse in the unvaccinated or immunocompromised, even those who are vaccinated can have bad outcomes from Omicron. 

What is happening now is the story of COVID-19 since the beginning: things move fast, people hear a few things from a few people, or they hear rumors, and take them as truth. The plural of anecdotes is not evidence.  

Can you talk more about the societal implications of declaring Omicron less severe than other variants? 

Even if something is milder for one person, that is not the same as mild for society.

Hospitals are collapsing with cases, ICUs are full. As of mid-January, many hospital systems, including those in rich countries like the United States, are at full capacity, and more will surely reach that in the next weeks. U.S. President Joe Biden is sending military response teams to six states: Michigan, New Mexico, New York, New Jersey, Ohio, and Rhode Island to help deal with this extreme surge. And multiple U.S. states are calling in the National Guard to bolster hospital staff. 

There are still huge numbers of infections, including children too young to be vaccinated, hospitals are at a pandemic peak, and many people are at risk. This is not a measured disease; any other infection that behaved this way, we would never call it mild—mild devalues what is happening in society. As a recent article in The Atlantic said: “When Omicron finds vulnerable hosts, it can still exact SARS-CoV-2’s worst. And Omicron is finding them.” 

People also need to remember that COVID-19 can have long term consequences. We’re still learning about long COVID-19, but anywhere from 5% up to almost 50% of cases can have symptoms and effects of COVID-19 for several months after the acute illness. That is a huge number of people worldwide that may end up suffering from a new chronic illness—a substantial burden and cost to patients and health systems. 

A cluster of interconnected myths out there suggest that COVID-19 will end in the U.S. soon and that the U.S. has already done as much as it can. There is nothing anyone can do to avoid Omicron and everyone will get it, so why not just get infected and have it over with. 

There is so much that is wrong about this. First of all, we don’t know how long immunity will last, nor do we know what variants will emerge next—and, critically, all of this spread now means more viral replication, which means more chance for new variants. We have no guarantee that we won’t have a horrible variant coming at us again in a few months, and allowing unmitigated spread like this increases the chance of that. It’s not a good approach to put all of our faith in ‘herd immunity’ or the idea that ‘this will be endemic, just like seasonal flu.’ Might the next variant cause more severe illness? Might it be better at escaping the protection of our vaccines and past infections? We simply don’t know. 

Even in this moment, we must not adopt a nihilistic, defeatist approach. Stating that everyone will get this is morally unacceptable; there would be way too many deaths, complications from being sick, and costs to individuals and society.  

We need to proceed with optimism and remain committed to the many tools we have available that we know are effective for people and communities. That includes getting vaccinated and boosted, wearing good masks (N95 or KN95), isolating immediately if symptoms arise, avoiding crowded and indoor events, and using rapid tests when symptomatic and before any group events. We also need better access to oral therapies, improved ventilation systems, and labor protections like paid leave.  And, urgently, we need to vaccinate the rest of the world. A new report by PIH and partners says we need 22 billion mRNA vaccines to control COVID-19. 

In response to the idea that the U.S. has already done what it can to fight the pandemic, this encapsulates the perspective of the individual versus the collective. The individual perspective about protecting yourself (for instance, the U.S. and Europe sucking up all the resources with little to nothing left for the global south) is hollow because the virus and its variants don’t respect borders. If we don’t approach this collectively…we wind up with the kinds of grave double standards we now have. It is tiring to think of the work we need to continue to do to fight COVID-19, but if we don’t, in the end, it’s going to bite us. 

This is related, but there is also a sense that COVID-19 is mild, or not as serious, in Africa. 

We have little information, and the information we do have is not encouraging and suggests the opposite—that COVID-19 is just as serious in Africa. For example, the death rate and number of excess deaths in South Africa do not support this theory at all. This is a claim without any basis in data, and it’s one we would never be able to make in the current situation, which is that the large majority of the continent hasn’t even had access to testing (only 1 in 7 cases detected, only 1 in 20 people ever tested). We also know there has been a massive negative impact in Africa on the prevention and treatment of TB and HIV as patients, fearful of contracting COVID-19, stay away from clinics and hospitals and health systems are interrupted by the virus. 

How about this myth: Many people in Africa are vaccine hesitant—they just won’t accept the vaccine.  

The question is, hesitant to what? First, they may not be hesitant to mRNA vaccines but hesitant to some of the vaccines out there that are not effective or have bad side effects. A lot of people are not happy about getting second tier vaccines. Second, there are reasons not to trust health systems in the U.S. and in other countries historically.

Research shows that vaccine acceptance rates in Africa are actually quite high, as does experience. There are of course some pockets of hesitancy or skepticism—as there is everywhere—and this is rooted in colonialism and histories of unethical practices and extraction.  

The most important and effective way to build trust—in any health program—is to deliver good health services. The health system needs to be a place that is equipped and staffed to help people; when they are sick they can come and get a diagnosis and treatment. 

What about this idea that there’s no point in contact tracing because Omicron is spreading too fast?  

We have to keep in mind that many of the messages out there may be rooted in scarcity or in politics. The reason people are saying contact tracing doesn’t make sense is really about our public health system capacity. There are too many cases for public health systems to trace right now. But that doesn’t mean that contact tracing isn’t important in pandemic response or that it isn’t possible. In reality, contact tracing for Omicron is really similar to contact tracing for Delta and the early pandemic.  

Many places can and continue to contact trace, and public health officials are adjusting approaches based on how many cases they have and their capacity to do contact tracing. Again, this is a human resource issue, not something about the virus. For example, in some places where it is not possible to call everyone, they have been focusing on at-risk individuals or communities, or prioritizing identifying clusters to support outbreak response.  

As hospitals fill up, there’s a feeling that other illnesses—not COVID-19—might be driving this trend. The idea is that, when it comes to Omicron, people are only hospitalized with COVID-19, not for COVID-19.  

Think about what it takes to get someone sick enough to go to the hospital. Delta alone may have been necessary and sufficient to send someone to the hospital; maybe Omicron is not sufficient, but it is necessary. For example, maybe it’s someone with diabetic ketoacidosis, but Omicron was the tipping point. Hospitals may have different diagnoses or coding, but the reason that person is in the hospital is driven by COVID-19. Hospitals are at capacity; there’s something driving those hospitalizations. And there are many complex ways COVID-19 can drive hospitalizations.  

People are tired of the pandemic—they want some certainty— and to hear something hopeful, that this is nearing the end. We are not at that point. Three weeks ago, the Brigham [and Women's Hospital in Boston] ran out of ICU beds—something’s driving that. People have begun to question the hospitals; it’s part of the denial process. But they are disregarding the testimony of people in the hospital who are seeing this with their own eyes. If hospitals aren’t overburdened, why call in the National Guard?  

I’ve also heard that manufacturing vaccines is too difficult to pull off for anyone but Pfizer and Moderna. 

This is just an excuse. “This is too hard,” is one of many excuses we often hear in global health. Just like other excuses such as, “We can’t manufacture enough,” or, with some of the medicines you have to take soon after symptoms, “It’s just too hard, patients present too late.” The response to all of this is, “No, let’s not drive a pandemic response through a system rooted in capitalism and racism. Let’s do the hard work instead.” Again, it’s a double standard.  

Double standards are unfortunately all too common in global health. For example, we are boosting the U.S. and Europe but the majority of the global south isn’t vaccinated, a trend in danger of continuing.

The HIV movement saw these excuses and double standards time and time again—in fact, at the beginning, it was claimed that Africans couldn’t take HIV treatment because they didn’t have watches and couldn’t tell time. These sorts of excuses during COVID-19 are different versions of the lack of watches argument.  

This is all quite discouraging. Are there any silver linings here?  

Well, everyone agrees we get hopeful seeing all our colleagues in PIH-supported health facilities who get up and go to work every day despite the challenges. The fact that people are still picking themselves off the ground and going forward means there is potential for a collective response. 

For Isabelina López, it was a car crash that changed everything.

“When I woke up, I was in the middle of the road,” López says. “But I couldn’t move.”

López, 30, lives in Barrio Lagunita, a rural community in Chiapas, Mexico. On the day of the accident, in February 2021, she was traveling between communities in a pick-up truck used as public transportation when the truck came to a dangerous bend in the road and overturned, ejecting her from the vehicle at a very high speed and hurtling her as far as 35 feet.

López woke up half an hour later in the middle of the road, in extreme pain. She didn’t completely understand what had just happened. She just wanted the pain to stop.

The nearest clinic was an hour away. And the nearest hospital, close to four hours away.

When her family found out about the accident, from her husband—who was also a passenger in the truck, but uninjured—they immediately took her to the rural clinic of Capitán Luis Á. Vidal, staffed by Compañeros En Salud, as Partners In Health is known in Mexico. There, a first-year clinician—one of 10 pasantes hired by Compañeros En Salud each year—examined López and delivered the news: she had a spinal fracture.

Roadblocks and dead ends

That set in motion a 3.5-hour journey to the community hospital in Jaltenango de la Paz, which Compañeros En Salud has supported for more than a decade with staff, resources, and funding.

At the hospital, X-rays showed that López could have a spinal cord injury. If that was the case, doctors told her, she would never be able to walk again.

But more tests would be needed to confirm the diagnosis. Doctors recommended that López travel to the Hospital of High Specialties Ciudad Salud in Tapachula, Chiapas—immediately.

The journey would normally take eight hours on unstable, dangerous roads. But López didn’t have eight hours. The pain was becoming too much for her to handle.

Fortunately, she wasn’t alone. Compañeros En Salud was there to support her through the Right to Health Care program, which has assisted 1,787 patients in accessing specialized care at advanced hospitals, including those out-of-state, since 2013. The program provides free transportation, housing, and food and connects patients with a social worker to accompany them through the process.

Last year, the program served 481 new patients—including López.

Through the program, Compañeros En Salud worked with the hospital to send López to Tapachula by helicopter—reducing the travel time to just 1.5 hours and helping her get the urgent care she needed.

More good news followed. At Ciudad Salud, tests and evaluations revealed López did not have a spinal cord injury. Still, she would need a surgery that required important surgical materials that were difficult to find and would cost as much as $30,000 USD.

For López and her family—coffee farmers who earn roughly $3,000 USD per year—that care seemed impossible.

“I felt so sad,” López says. “I was away from my family, my kids. I didn’t know how [much] longer I’d be at the hospital. We didn’t have money for such an expensive surgery.”

Without the operation, López would be bed-ridden for the rest of her life.

Short and steady steps

Luckily, Compañeros En Salud took action, fast—the Right to Health Care program launched a nationwide search for suppliers of the surgical materials and ultimately bought them from private companies, since neither public hospitals nor the Ministry of Health had them on hand. The program then coordinated the complex logistics of delivering the materials to the hospital where the surgery would take place.

After two months in bed, López finally had her surgery.

Now, she is recovering at home. While she can’t stand on her feet for too long, she’s able to take short walks using a cane.

“I want to be okay, so that I can cook for my children again,” she says.

The back pain remains intense. But López takes medication that helps and regularly checks in with Compañeros En Salud during the clinical team’s bimonthly visits to her community. For distraction, she has taken up embroidery—stitch by stitch, focusing on what she can control.

“I was devastated when I thought there was no solution, but Compañeros En Salud helped me,” she says, from her sunlit home in Barrio Lagunita. “Now, I can walk again.”

The COVID-19 pandemic persists.

As we enter the third year of the global public health emergency, the virus continues to mutate and spread in the absence of worldwide vaccination. Omicron, the latest highly contagious variant, has caused COVID-19 cases to skyrocket in many countries. In early 2022, a world record was set: more than 9.5 million new COVID-19 cases were reported within a week, according to the World Health Organization. In total, more than 5.5 million people have died from COVID-19 and more than 332 million cases have been reported. Hospitalizations–mostly among unvaccinated people–are rising too.  

This has been a challenge for already strained hospitals and health care workers at Partners In Health (PIH) sites around the globe, including in Kazakhstan, Peru, Rwanda, and Sierra Leone, among others.

In Kazakhstan–where the president called for a two-week state of emergency on January 5 following political unrest and violence–clinicians are seeing a surge in cases, which the country’s ministry of health has attributed to the Omicron variant. In addition, the Delta variant is still present more than a year since it was first detected globally.

In Peru, the rate of infected people doubled last week compared to the previous week. PIH-supported facilities in the country have seen a rise in infections and hospitalizations, mostly among those who are not fully vaccinated. Compared to most countries, Peru is ahead of the curve with vaccination: about 80% of people have received two doses and 14% received a booster. 

Rwanda is not far behind. As of January 9, about 60% of the population have received two doses. Unlike many sites, PIH-supported facilities in Rwanda have not seen an increase in hospitalizations. However, they are still experiencing a fourth wave of COVID-19 due to the Omicron variant. While cases have been mild or asymptomatic, there are still many people at risk who have yet to be vaccinated.

Although the Omicron surge is flattening across many parts of Africa, the impact of the variant continues to be felt in countries such as Sierra Leone. The surge affected many PIH staff members, who were unable to go to work during the holiday season, which put additional stress on service delivery. In communities across Kono District in the east, the spread of COVID-19 has mostly gone undetected due to a widespread shortage of tests. Most of the reported cases have been among inbound and outbound international travelers. There is a significant need for more tests and vaccines. Less than 4% of the population is vaccinated and less than 0.1% has received a booster shot. 

Recently, PIH experts and fellow researchers published a report that highlighted the need for more mRNA vaccines–22 billion, to be exact, which they estimate is the number that must be manufactured and administered to control COVID-19 globally. Meanwhile, clinicians continue to build health systems by focusing on the vital 5 S’s–staff, stuff, space, systems, and social support–which are needed to respond to emergencies and provide lifesaving health care now–and beyond the pandemic. 

The world needs 22 billion more mRNA vaccines to bring COVID-19 under control, according to a new report from experts at Partners In Health and PrEP4All and scientists from four universities.

The report, published on January 5, comes as the highly contagious Omicron variant surges worldwide, filling hospital beds and leading to critical staff shortages. The United States reported 1.35 million new COVID-19 infections on January 10—the highest daily total for any country in the world. Globally, COVID-19 cases have topped 300 million.

Even as Omicron surges, billions of people worldwide have yet to receive their first dose of any vaccine—much less, of an mRNA vaccine.

“The scientific evidence is clear,” the report states. “Only by universally deploying the vaccines currently most effective against infection—which for now appear to be mRNA vaccines—will we be able to blunt the virus’ evolution and begin to bring the pandemic under control globally.”

Two mRNA vaccines are among the only widely used vaccines that offer significant protection against Omicron infection, according to existing research. While non-mRNA vaccines will still likely protect individuals from hospitalization, protection from Omicron infection is essential to bringing the pandemic under control globally and preventing the emergence of new variants.

Without mass production of mRNA vaccines, the report warns, global vaccine inequity will only persist through 2022, with people in wealthy nations triple or quadruple vaccinated with the world’s most effective vaccines, while people in low- and middle-income countries are left with limited access to vaccines at all, much less access to mRNA vaccines.

Vaccinating The World

Ramping up vaccine production is no small task—but it is completely achievable, according to the report. And it requires the U.S. government to take action.

The report urges the Biden administration to scale production of mRNA vaccines to 15 billion doses per year—starting in 2022, via a government-owned factory, as a matter of national security.

While U.S. drug-makers Pfizer and Moderna have claimed they will make a combined total of 7 billion mRNA vaccine doses in 2022, neither met their 2021 projections. At this level, the report asserts, the world will face a shortfall of 15 billion doses this year.

And to bring COVID-19 under control, a total of 22 billion doses will be needed—an estimated 10.5 billion doses for those in need of boosters and another 11.5 billion doses for those who have yet to finish their primary vaccination series.

Building this manufacturing capacity would be fast and affordable, the report notes. It would cost the U.S. less than $12 billion in capital expenses and could be accomplished in less than four to six months. (For context, the U.S. recently approved $768 billion for military spending.)

And there is historical precedent. The report points out that the “government owned, contractor operated” approach has been used extensively and successfully by the U.S. government since the Manhattan Project by the Department of Energy “for both cutting edge scientific research and the production of critical, high-technology national security assets.”

“There is every reason to believe this approach…can be used to expeditiously manufacture the number of COVID-19 vaccines the world needs to end the most severe public health threat and biosecurity crisis in a century,” the report states.

Rich Nation, Unequal Health Care: Why A Charity That's Helped Haiti Is Aiding The U.S.

America spends $3.8 trillion on health care annually, more than any other country. Yet when it comes to creating a more equitable public health system, it could learn a thing or two from some of the world's poorest nations, says Katie Bollbach, executive director of Partners in Health United States.

Partners in Health is best known for providing health care in some of the most under-resourced places on Earth. They have responded to epidemics like HIV in Haiti and Ebola in West Africa. But when the coronavirus pandemic struck, the nonprofit saw that its expertise was also desperately needed in one of the world's richest countries.

Read the full NPR.org interview here. 

The end of 2021 marks two full years in which the world has born the physical, mental, and emotional weight of the COVID-19 pandemic. Because of this collective burden, people should understand—arguably now more than ever—what many Partners In Health patients, clinicians, and staff have known around the world for more than three decades; everyone deserves the right to health.

Health care is a human right—as a message and rallying cry—has emerged consistently in PIH-supported events and through press coverage the global health and social justice organization has received over the past 12 months. PIHers have shared their global experience tracking and treating infectious diseases, from HIV and tuberculosis to cholera and Ebola, and translated that work into tackling the COVID-19 pandemic.

In case you missed the event, article, or broadcast, we curated some of our favorite moments from 2021 below:

1. “Applying the Lessons of Ebola to the Fight Against COVID-19”

PBS Newshour spoke with Co-Founder Dr. Paul Farmer about his newest book, Fevers, Feuds, and Diamonds: Ebola and the Ravages of History, to understand how lessons learned from PIH’s efforts to end the Ebola outbreak in West Africa can be applied to the COVID-19 pandemic. Watch the interview.

2. “The Workers Who Could Get Us Through This Crisis”  

CEO Dr. Sheila Davis and Sen. Kirsten Gillibrand of New York wrote an op-ed that appeared in CNN advocating for the creation of a new public health workforce that could address the current pandemic and strengthen long-neglected United States health systems. Read the full op-ed.

3. Women Lead

PIH hosted Women Lead, an online event held in honor of International Women’s Day during which panelists shared advice on overcoming roadblocks, pursuing leadership opportunities, and growing a career during a lively, hourlong discussion.

The panel was moderated by Dr. Jimena Maza, director of teaching and clinical care at Compañeros En Salud, as PIH is known in Mexico, and featured Dr. Paula A. Johnson, president of Wellesley College; Nadya Okamoto, author and founder of August and PERIOD; Dr. Ijeoma Kola, a public health historian and founder of Cohort Sistas; and Padma Lakshmi, TV host and producer, author, and UNDP Goodwill ambassador. The event also featured a special video message from Tsion Yohannes Waka, chair of the Center for Gender Equity at the University of Global Health Equity, a PIH initiative in northern Rwanda. Watch the event.

4. “Building a Fairer, Healthier World Through Accompaniment”

This animated short film, featuring narration by Winston Duke, an actor, producer, and philanthropist, was created in honor of World Health Day. Within one minute, the film covers PIH’s origins and talks about key tenets of our work, such as accompaniment and the “5 S’s”: staff, stuff, space, system, and social support. Watch the film.

5. “What a Donated Vaccine Can Do”

FiveThirtyEight spoke with Jon Lascher, former executive director of PIH Sierra Leone, about the challenges of getting COVID-19 vaccines to impoverished countries for an episode of PODCAST-19. Listen to the podcast.

6. The Rachel Maddow Show

MSNBC’s Rachel Maddow spoke with Dr. Joia Mukherjee, PIH’s chief medical officer, about the importance of the United States’ support of the waiver of intellectual property protections on COVID-19 vaccines, which would allow for global mass production and the transfer of patents and know-how for vaccine manufacture—all of which is essential in ending the pandemic. Read the full transcript.

7. “How to Help People Around the World Get Vaccinated”

Mashable spoke as well with Mukherjee for an article it published on the importance of waiving intellectual property protections for COVID-19 vaccines. PIH was featured among a list of organizations to support because of its work advocating for global vaccine equity. Read the article.

8. “They’re Asking Biden to Vaccinate the World. It’s Not Fair. But It’s Not Impossible”

NPR’s Goats and Soda spoke to Farmer to understand why he was among 175 health experts who signed a letter urging U.S. President Joseph Biden to support “an ambitious global vaccine manufacturing program” to control the COVID-19 pandemic. Read the article.

9. “A Day in the Life of a Massachusetts Contact Tracer”

WBUR, an NPR affiliate in Boston, explored the everyday work of contact tracing by interviewing Alexander Bent, a case investigator with the Massachusetts Community Tracing Collaborative, launched by PIH in partnership with Governor Charlie Baker and local boards of health across the Commonwealth. Listen to the story.

10. “The Future of Medical Drone Delivery”

Bloomberg spoke with Dr. Joel Mubiligi, executive director of PIH in Rwanda, and Keller Rinaudo, co-founder and CEO of Zipline, about how Rwandan clinicians are using medical drone deliveries to cater to the needs of patients living far from health care facilities in the midst of the COVID-19 pandemic. Watch the segment.

11. Health & Human Rights in Haiti

PIH hosted the online event, Health & Human Rights in Haiti: Through the Eyes of the Diaspora, to examine Haiti’s proud and complex history, its challenging present, and the important roles played by the diaspora. The conversation was moderated by Christa Michaud, PIH’s Haitian diaspora engagement and development officer, and featured the following panelists: Jimmy Jean Louis, an actor/producer and ambassador for the Barbancourt Foundation; Whenda Tima, CEO and founder of L’union Suite; Guerline Jozef, co-founder and executive director of the Haitian Bridge Alliance; and Ancito Etienne, a PIH trustee. Watch the event.

12. The Power of Partnership

PIH hosted a virtual event entitled The Power of Partnership: A Discussion with Dr. Paul Farmer and John Green in honor of Giving Tuesday. Farmer and Green, a PIH partner and best-selling author, discussed meaningful partnership in global health, the power of accompaniment, and the value of long-term commitment in the fight for equity and health for all. Watch the discussion.

At Partners In Health (PIH), our daily work is ultimately driven by our patients—whom we often call “our bosses.” But, beyond our bosses is an overarching set of guiding values and principles: our mission statement. It’s the “why we do it” rather than simply “what we do.”

Since the founding of PIH in 1987, we’ve had a mission statement, which has remained consistent over the years and always conveyed our commitment to social justice and high-quality health care. In five sentences, it explains why we exist, whom we serve, and how.

Our mission is to provide a preferential option for the poor in health care. By establishing long-term relationships with sister organizations based in settings of poverty, Partners In Health strives to achieve two overarching goals: to bring the benefits of modern medical science to those most in need of them and to serve as an antidote to despair.

We draw on the resources of the world’s leading medical and academic institutions and on the lived experience of the world’s poorest and sickest communities. At its root, our mission is both medical and moral. It is based on solidarity, rather than charity alone.

When our patients are ill and have no access to care, our team of health professionals, scholars, and activists will do whatever it takes to make them well—just as we would do if a member of our own families or we ourselves were ill.

Below, we take a closer look at our mission statement and provide more context to what drives our everyday work:

Our mission is to provide a preferential option for the poor in health care.

The phrase, “preferential option for the poor in health care,” means providing a health care option for low-income and resource-poor individuals and families, so those who need care most, come first in line. It’s articulated in the liberation theology of Father Gustavo Gutiérrez, a Peruvian priest and long-time mentor and friend to PIH Co-founder Dr. Paul Farmer, and explored further in the book they co-authored, In the Company of the Poor.

By establishing long-term relationships

We accompany communities as long as necessary and only by their invitation. Across most sites, this has involved decades of partnership, including more than 30 years in Haiti. In 2021, several countries where PIH works celebrated long-term anniversaries: 10 years for PIH Canada, 10 years for Compañeros En Salud in Mexico, and 25 years for Socios En Salud in Peru.

with sister organizations

Our sister organizations are local organizations all around the world that are all part of our “OnePIH” family. Staff deliver direct care to patients, coordinate and support global work, provide technical advising, and educate the next generation of global health professionals.

based in settings of poverty,

We work in regions where a majority of the population is impoverished and facing poverty, which is a sustained deprivation of “resources, capabilities, choices, security, and power necessary for the enjoyment of an adequate standard of living,” as defined by the United Nations Committee on Economic, Social, and Cultural Rights.

Partners In Health strives to achieve two overarching goals: to bring the benefits of modern medical science to those most in need of them

Many people who live in settings of poverty continue to suffer and die from preventable, treatable diseases. By bringing evidence-based treatments, medications, and diagnostics to these patients, we help save lives. 

Some examples of this include:

• Fighting tuberculosis (TB) with modern detection, treatment, prevention, and research across PIH sites. In 2020, for example, the Socios En Salud team conducted over 11,200 TB resistance tests and performed almost 50,000 X-rays to actively search for TB in and around Lima, Peru.
• Modernizing the blood bank to safely screen and store blood for lifesaving transfusions at PIH-supported Koidu Government Hospital in Sierra Leone.

and to serve as an antidote to despair.

PIH combines accompaniment, solidarity, technical expertise, academic excellence, and optimistic action. The result of this powerful mixture is what we refer to as the”antidote to despair.”

We draw on the resources of the world’s leading medical and academic institutions 

Our work is fueled by partnerships with national governments and local districts and with academic institutions, such as Harvard Medical School and Brigham and Women’s Hospital in the United States and the University of Global Health Equity in northern Rwanda.

and on the lived experience of the world’s poorest and sickest communities.

Nearly all PIH staff—99% to be exact—are from the country where they work. Staff grew up in the communities, have worked in the neighborhoods, and understand the needs of patients and how to provide culturally relevant care. Many patients have also become PIH employees and inform the quality care provided in communities and facilities all around the world.

At its root, our mission is both medical and moral.

We have worked to prove that comprehensive health care is not only a moral duty, but also universally achievable. We strive to address the entirety of the burden of disease and suffering, whether it is physical, mental, or emotional, and whether it is acute, chronic, or palliative.

It is based on solidarity, rather than charity alone.

We are driven by the belief that all human lives are equally valuable and that every person has the inalienable right to be healthy.

When our patients are ill and have no access to care,

Our patients are diagnosed with a wide range of diseases, including cancer, diabetes, cholera, TB, HIV/AIDS, and more. We provide care and referrals for all conditions and illnesses. Across most sites, patients live in rural, hard-to-reach communities where there are no health facilities, or those that do exist have an inadequate supply of what we call “the 5 S’s”: staff, stuff, space, systems, and social support.

our team of health professionals, scholars, and activists will do whatever it takes to make them well—just as we would do if a member of our own families or we ourselves were ill.

PIH staff include health professionals (physicians, nurses, community health workers, etc.), scholars (from various academic institutions around the world), activists (such as our co-founders), and others, who are committed to helping our patients feel well and live a full, healthy life—just as they would want for their own parent, sibling, child, or loved one.

So much of the work goes unheralded, unseen.

In a newly modernized Rwandan hospital, a mother spoon-feeds her son, sharing a laugh to distract him from the pain of cancer treatments. A community health worker in Malawi takes a long daily walk to meet patients where they live, going village to village to make sure they have the medicines and support they need. And a girl in rural Chiapas visits her mountainside clinic, where a doctor connects her to cutting-edge health care that is saving her life.

These things happen every day. Mothers and children and medical workers and governments and activists for vaccine equality—they are all partners in health. And when Partners In Health photographers get close enough to that crucial work to make an evocative picture, it’s my job as photo editor to make sure it gets seen. By colleagues, by donors, by policymakers, by people who can make a difference in the lives of those on the other side of the camera. By you.

These are some of my favorite photos from 2021—images of solidarity, of partnership—and I asked the people who made them to share some thoughts about the moments they shared.

Thomas Patterson
—Partners In Health Photo Editor

Joy in Ordinary Moments

Zack's thoughts:

As a photographer, I don’t take lightly the fact that patients in PIH-supported facilities and communities share a glimpse of their lives during some of their most difficult periods and moments. Immaculée and her son Jean had shared their cancer care story for a video project. I was in the pediatric oncology ward and saw Immaculée feeding Jean some food from a spoon - something he had trouble accepting just days before without pain. I asked to make some photos of that since her love for him and his sense of safety and comfort seemed so apparent.

Sometimes it’s hard to make strong and honest photos in a busy and crowded hospital ward. There's nothing normal about having a camera in your personal space during such a private and seemingly ordinary moment. As a parent myself, I can begin to imagine that there's nothing normal about having a kid with cancer. Despite my efforts to be quiet and non-intrusive, they were unable to continue with the food in that moment, because they were looking at each other and fighting back what became contagious laughter.

It was a beautiful moment to witness. I don't think my presence created the laughter, but it may have tipped them over the edge.

It's a bit of a ridiculous thing to have a photographer, who you don't really know, making pictures of you doing an ordinary thing like eating. But the laughter was real and deep. Serious illness can be such an exhausting and overwhelming experience, but you just do what you have to do and it's your new normal. This is when things go well and quality care is actually accessible. It was a gift to witness and feel the togetherness between Jean and his mother, the love they clearly shared. No matter the circumstances, sometimes all you can do is laugh.

Jean was walking around the hospital campus later that day. Something that we hadn't seen him do in a while.

*Name changed for minor

'The Hospital's Baby'

Maya's thoughts:

“His adoptive mother, Kadija, who is a nurse at Koidu Government Hospital in the pediatric emergency ward, had one of her family members bring him in, and he got to the PIH office at the hospital and everyone as so, so excited that he was there. Everybody was taking turns holding him and wanted photos with him. It’s funny, he’s kind of like a celebrity around the hospital. I’ve heard him referred to as ‘the hospital’s baby.’ Obviously the circumstances under which he was born are tragic and point to how much work we still have to do to achieve better health in Kono, given that he himself almost didn’t survive, and he lost both of his parents in quick succession. But everyone rallied around this particular baby and made sure he survived, and they were successful because they finally had the necessary resources. I think people see Naphtal as a symbol of hope."

Teen Conquers Cancer

Masao's thoughts:

“[The day of] Ariadna’s hospital visit began very early. The sun hadn’t yet risen and she and her mother were traveling along the highway to arrive from very far away to hear the doctor’s opinion.

The moment Ariadna gets up onto the exam table and the doctor begins to access that there have been positive advances was a marvelous moment where the mother and daughter looked at each other with such happiness, knowing that all those hours, kilometers, pains, and tears were worth it. The doctor congratulated them, because Ariadna is in good health.

Leaving the hospital, Ariadna’s mother called their family to share with them the good news. It was a moment in which all of us could feel the incredible strength of an 11-year-old girl who had demonstrated courage in life.”

Heartbreak, Hope of Malnutrition Care

Maya's thoughts:

“The nurse in charge of the MAM feedings, Mariama Mansaray, was reflecting to me that mothers are often upset, as anyone would be, having their child malnourished, without reliable means to feed them. Everybody wants to feed their kid. So it’s a little heartbreaking in that context, but also uplifting, because help is available, for both malnourished children and mothers looking to feel less alone.”

Teaching with Empathy, Intention

Zack's thoughts:

Dr. Akiiki, as she's most commonly addressed by her students and colleagues, is exactly the sort of mentor and teacher you'd want your nurse or doctor to study under. That's because patient-centered and community-centered care requires deep listening, deep empathy, and that extra mile or kilometer necessary to go from simply treating the disease to treating the patient.

This sort of empathy and care was evident watching Dr. Akiiki teach and during the little time I was able to spend with her in less formal settings. She brings the same intensity and intention to her listening as she does her lecture. She reminds me of some of my own most cherished mentors, whose commitment to the work (whatever that might be) was intoxicating. It also reminds me of the energy and commitment of so many PIHers I've gotten to bond with over the years. It's an energy and a mission that's much bigger than any teacher, or community health center, or photograph. I don't know if this photograph says these things, but I strive to make photos that share that energy—if  only a small piece of it.

I particularly enjoyed photographing this class, in which the discussion was focused on palliative care. Too often the sickest and poorest patients miss the dignified and loving accompaniment needed throughout their ailments, whatever the outcome. That's unacceptable, and as Dr. Akiiki engaged with the students at Butaro District Hospital that day, I couldn't help but feel optimistic about the future of social and community medicine in rural Rwanda.

Sunrise and Small Moments

Zack's thoughts:

The landscape of Rwanda's Burera District is absolutely stunning. From this hilltop in particular, a sunrise that lasts an hour seems to last much longer. We arrived this morning just before the first light began to reveal the foggy valleys and neighboring hilltops that housed the University of Global Health Equity to the right and Butaro District Hospital to the left. PIH in Rwanda's staff videographer, Pacifique Mugemana, had unloaded the roof of our vehicle, carefully passing video equipment down to us. Once the roof was unpacked, he very quickly jumped off like a movie stunt double, camera in hand. Luckily, my eye was in the viewfinder and my finger on the shutter button. Thanks, Paci!

From this rural road, you could really feel the world wake up.

Children began making their way to school through the footpaths and bean crops. The fog began to clear, revealing the many layers below. While the landscape is breathtaking, it's easy to see why transportation is such a barrier to accessible health care—among other needs, and why the ‘staff, stuff, space, systems, and social support’ need to be here, not just in Kigali or Boston, for that matter.

COVID-19 and Community Outreach

Scott's thoughts:

“The vaccine site had such a diverse group of people that really represented the dynamic of Immokalee. It was nice to see children helping their parents through the process and members of PIH greeting residents they know and spoke to about the vaccine process.”

Access, Equity in Vaccination

Maya's thoughts:

“With every new variant, it’s clear that we continue to be in this spiral around COVID-19. Why? It’s in large part because of unequal vaccine distribution, and because in many places in Sierra Leone and around the world, the health care systems that need to exist do not. And because, from an economic perspective, people have way less of an opportunity to protect themselves in settings of poverty.

So much of what is fueling this pandemic is injustice—injustices that are deeply entrenched, but in no way inevitable.”

Across Kono District, in the rural east of Sierra Leone, Partners In Health-supported health facilities are busier than ever.

It’s not that patient needs are increasing—it’s that the quality of health care available is, thanks to PIH and the Ministry of Health & Sanitation’s partnership. With clinicians trained, infrastructure improved, pharmacy shelves stocked, and health service costs reduced (if not eliminated entirely), families across Kono have a newfound trust in the public health system and are showing up for care in record numbers. At Sewafe Community Health Center, one of the small, rural health clinics PIH is supporting, the average number of patients each month has skyrocketed, from 524 to 2,319.

Still, hospital and clinic staff around Kono know they’re seeing a mere fraction of the patients they could, as barriers to accessing health care, all rooted in poverty, remain steep. The obstacles are particularly intense for women, who face a unique set of social and economic limitations in Sierra Leone and, relatedly, a 1 in 20 lifetime risk of dying in pregnancy or childbirth—one of the world’s highest rates.

That is why PIH staff in Kono are working to get even more patients in the door, particularly women. Below, read about three new initiatives that are making women’s health care more accessible and just.

Partnering with Traditional Birth Attendants

In Kono, where health care has historically been high-cost and low-quality, traditional birth attendants (TBAs) are some of the most respected people in their communities, offering aspects of care pregnant women never found previously at a hospital: comfort, encouragement, and respect, as well as an affordable cost and the ability to remain at home to give birth.

With higher-quality, free maternal health care now available, delivering at health facilities is increasingly popular. In the last year at Koidu Government Hospital (KGH), the only hospital in Kono, clinicians have seen a 10% increase in maternity ward admissions.

Still, many women favor giving birth at home with a TBA by their side—an understandable preference, but also a potentially dangerous one, as the resources a hospital offers are irreplaceable in cases of life-threatening obstetric emergencies.

PIH has long worked with TBAs as a way to bridge the gap between communities and health facilities and to help quell Sierra Leone’s longstanding maternal mortality epidemic. At PIH-operated Wellbody Clinic, TBAs are paid employees alongside nurses and midwives, offering familiar support to women while they deliver under the watchful eye of a trained clinician.

This year, PIH expanded its partnership with TBAs, establishing a program to provide them a monthly stipend for holding regular health education events and referring and accompanying families to facility-based maternal and child health care—similar to community health workers.

After introducing the idea to local leaders, health care workers, and TBAs across Kono and collecting their feedback, PIH enlisted 136 TBAs in four of Kono’s 14 chiefdoms. Staff then provided a series of comprehensive maternal health trainings—how to spot an obstetric emergency, what symptoms require referral to a clinic versus to the hospital—and charged TBAs with accompanying not only pregnant women, but also women in need of postnatal care or family planning and their children in need of primary care like immunizations.

According to Isata Dumbuya, PIH’s director of maternal health, these training sessions had to be conducted delicately while clinicians and TBAs worked to find common ground.

“There were a lot of TBAs saying, ‘You [clinicians] blame us for all of the things that go wrong. We don’t do things to kill women; we think we’re helping them. Because this is all we know, this is where we get our living, this is our status symbol, this is what we’ve done since forever. This is where women come,’” Dumbuya said. “They were crying. I felt like crying. It was really emotional. What we [PIH] said is, ‘We understand and respect this, and we do not want it to change. What we want to change is for you to use your position in society to accompany women to a health facility.’”

TBAs have already begun their referral and accompaniment work. PIH will begin formally evaluating their impact in January and, in June, will assess how to continue improving the program before implementing it in additional chiefdoms. Already, the program is making a visible difference; Dumbuya says clinicians at PIH-supported rural community health centers are reporting an uptick in women arriving for care after being referred by a TBA.

This uptick is a good problem to have—indicative of one more pathway to care for women, but also another challenge to resources.

“The downside is supplies,” said Dumbuya. “Your patient load goes up, your consumption of basic essentials—gloves, needles—goes up. We’re looking into how we can increase the amount of essential supplies for maternal and newborn care.”

Family Planning as “Most Successful Outcome of the Year”

According to Dumbuya, PIH Sierra Leone’s most successful maternal health outcome for 2021 was increasing the number of people with long-term family planning.

“We fixed [our family planning systems],” she said, “and we’re going to really start to impact our rate of maternal mortality.”

Before this year, family planning was hard to come by in Kono. Teenagers and women are commonly forbidden from pursuing family planning methods by authority figures like parents and husbands. If they did manage to make it to a health facility, they would often have to wait, for lack of clinicians trained to provide contraception. When Dumbuya joined PIH and began working at KGH, in 2018, she recalls seeing groups of women waiting around but never receiving birth control. There were a mere three clinicians at the hospital equipped to provide it—all midwives, whose first priority had to be remaining in the labor ward to deliver babies.

“Fifty minutes later, sitting outside the family planning office, she cannot continue to wait,” Dumbuya said. “Some people are housewives, they’ve snuck out, they have to go home to cook. They’re thinking, ‘This is my only time I can do this. And I’ve finally managed to escape and get this done, and there’s nobody here to attend to me. It might be in the next few days that I get pregnant, the very thing I was trying to avoid, and now I have to live with the consequences of that.’”

In response this year, PIH held a series of two-week trainings on how to deliver various family planning methods, including long-acting reversible contraception, for nurses, midwives, and other clinicians at KGH, Wellbody Clinic, and other PIH-supported health centers. Today, the total number of family planning-trained clinicians in Kono is up to 40—27 of them work at KGH, a nine-fold increase.

Accordingly, wait times have decreased to help support the most vulnerable patients. KGH’s maternity ward now maintains a policy that women should not wait more than 30 minutes for family planning—and seen dramatic results. In 2019, clinicians provided 1,182 family planning visits; this year, they provided 5,530.

Combating Sexual and Gender-Based Violence

Maternal mortality, stigma and secrecy around family planning, and other women’s health challenges are underpinned by pervasive gender inequity and are connected to another health and social injustice: sexual and gender-based violence (SGBV).

Tragically common in Kono, across Sierra Leone, and around the world, gender-based violence demands safety nets—something many Sierra Leoneans, in particular women, lack. Thanks to local nonprofit the Rainbo Initiative, however, survivors have access to free clinical, legal, and psychosocial support within five centers across the country. To promote the work of Rainbo and a shared mission to combat SGBV, this year PIH formalized a partnership with the nonprofit and began investing in their center in Kono, located behind the maternity ward at KGH.

Funding from PIH has enabled Rainbo to grow its staff and conduct more educational sessions in communities and schools, with the goal of raising awareness around SGBV and equipping people with knowledge to recognize it, know their rights, and access care.

With PIH’s support, the Rainbo team—made up of paralegals, nurses, midwives, and psychosocial counselors—has undergone a refresher training around SGBV care, trained 20 local police officers to better recognize and manage SGBV cases, and reached 1,696 Kono residents with SGBV education.

This education is crucial in the face of the silence that fuels continued violence.

“Do women out there know where they can go if they become a victim of violence? Not all of them do,” Dumbuya said. “And not all of them recognize that it is SGBV. It might be her life, her norm; it might be what she expects to happen to her. So I’m really pleased that Rainbo has the funding to be able to make themselves more visible and go out there and say, ‘Hey, this is not okay. And when you feel you cannot cope with it anymore, come to us and we will be able to help you.’”

From April to November, 168 cases of SGBV were managed at the center—a handful of them referred directly from clinicians at KGH, who also have benefited from Rainbo’s education sessions and are working to make the care they deliver more gender-sensitive.

Debates about sharing vaccine patents continue to grab headlines, but the race to supply and administer COVID-19 vaccines around the world, particularly to the most marginalized and remote communities, is about far more than intellectual property rights.

Patent waivers don’t mean anything, for example, if you can’t then get the vaccines to the places where they’re needed most, while maintaining the frigid temperatures required during transport, storage, and distribution to keep the lifesaving vaccines viable. 

That’s where the term “cold chain” comes in. Simply put, a cold chain is a supply chain that requires refrigeration or freezing. While it’s most commonly associated with perishable food items for grocery stores and restaurants, strong cold chain infrastructure is also vital for public health.

As part of its global response to the COVID-19 pandemic, Partners In Health (PIH) has been working for more than a year to bolster cold chain capacity at PIH-supported facilities. That capacity is crucial for preserving and delivering temperature-sensitive diagnostics, medications, and vaccines for patients. 

Since the beginning of the pandemic, PIH has purchased and delivered cold chain-related items including refrigerators, freezers, transport coolers, and temperature monitoring equipment to reinforce cold chain infrastructure and vaccine delivery systems in seven countries.

We spoke with Seyfu Abebe, PIH’s supply chain manager, who shared insights about the cold chain process.

How do items get from Point A to Point B?

There are two phases: international shipment and in-country distribution. All items are stored with vendors and then shipped via airplane. Special boxes are used to ensure that items are kept at proper temperatures until they reach their final destination—which usually takes two to four days. 

When the boxes arrive at the airport, people on the ground do a customs clearance check as quickly as possible before transferring the boxes into a cold room or refrigerator at a warehouse. 

Recently, PIH began using data loggers, which are electronic devices that record the temperature throughout the entire supply chain process to make sure items remain cold “from the manufacturer to the last mile,” says Abebe.

Before the boxes leave the warehouse, staff read the data logger reports transported within the special boxes to ensure the appropriate temperature range was maintained during transit.

Next, it’s time for in-country distribution. The boxes are delivered by truck, motorbike, boat or any available means of transportation to PIH-supported health care facilities.

How cold does storage have to be?

Like many vaccine-related questions, “How cold do they have to be?” has seen changing answers over the past year. Initially, doses of Pfizer’s vaccine required storage at -94 degrees Fahrenheit, colder than winter in Antarctica, as NPR reported in November 2020. Moderna’s vaccine, which also relies on delicate molecules known as messenger RNA, or mRNA, required storage at -4 degrees Fahrenheit, about the temperature of a residential freezer. 

This spring, however, both Moderna and Pfizer reported data showing their vaccines can be stored for at least a month at normal refrigeration temperatures, about 36 to 46 degrees Fahrenheit—the same temperature needed for the AstraZeneca and Johnson & Johnson vaccines. 

Knowing how long vaccines can remain viable at given temperatures is crucial when thinking about logistics such as lengthy shipping, complicated distribution in remote areas, and potential loss of unused vaccines because of expiration dates. 

Those factors can also determine vaccine packaging, whether it’s bulky boxes stuffed with dry ice for sub-zero storage or refrigerated coolers suitable for rugged transport.

Why is cold chain so important?

It helps keep lifesaving health care products, such as vaccines and medications, safe and effective. For example, oxytocin—a medication often given to mothers after they deliver their baby—needs to be kept cold. If the temperature is too low or too high, the drug can lose its potency. Therefore it won’t control bleeding and can ultimately cause a mother to die from excess blood loss. 

“We have to make sure we are getting the right product, with the right quality, at the right time for the right patients,” says Abebe. 

Where were most PIH-supported countries in terms of cold chain, pre-pandemic?

There were systems in place across countries where PIH works before the pandemic. When COVID-19 vaccine production began, those systems expanded and the capacity increased and improved with additional fridges and temperature monitoring tools, such as data loggers. The supply chain and pharmacy teams also received COVID-19 vaccine-specific training about how to monitor the vaccines, record temperature, and how to interpret that information, then communicate it, especially if something goes wrong. 

Will this investment be important to PIH’s post-pandemic work?

Abebe says supplies of freezers, in particular, have been a focus for many PIH-supported health facilities across many countries where PIH works.

Boosting cold storage and freezer capacity is not only important for the COVID-19 pandemic, he notes, but for delivering quality primary care for years to come.

That means not just delivering and installing equipment, but setting up staff training and maintenance plans so temperature-sensitive items such as blood samples, diagnostics, and more can be safely stored and used.   

“It’s going to serve primary care delivery at our sites for a long time,” Abebe says. “This will be a standard thing moving forward.” 

In May 2020, as health officials gathered for a press conference with Massachusetts Governor Charlie Baker on the importance of a newly launched COVID-19 Community Tracing Collaborative, two strangers began to chat. Soon enough, they realized they had a similar vision for transforming public health to better address the needs of communities. 

“It was an unplanned meeting of the minds,” said Damon Chaplin, director of the New Bedford Health Department, recalling his first encounter with Dr. John Welch, director of Partners In Health’s COVID-19 response in the state. “We just had a common interest in what happened in Massachusetts and the country and the world around COVID-19.” 

A New Partnership is Born 

While the Massachusetts Community Tracing Collaborative—the pandemic-driven contact tracing venture between PIH and the Commonwealth of Massachusetts—will end December 30, the partnership in New Bedford endures. What started as a single conversation between Chaplin and Welch evolved into regular discussions about the need for local health departments to add staff dedicated to contact tracing and connecting people in need with basic resources; and to eliminate health disparities for marginalized populations.  

In the spring of 2020, as PIH began responding to requests for technical support in hard-hit regions across the United States—from Montgomery, Ala., to Chicago, Ill.—Chaplin and Welch continued talking and planning. Those conversations evolved into a formal agreement for PIH to provide in-depth technical support to the New Bedford Health Department.  

In early 2021, PIH-US, now a formal arm of the global health and social justice organization, recruited, hired, and trained a five-person team embedded in New Bedford. The team’s full-time epidemiologist, contact tracer, community liaison, health equity specialist, and senior team leader support all aspects of the city’s COVID-19 response – from strategic planning for vaccine clinics to conducting door-to-door community outreach. Beyond the pandemic, PIH-US is partnering with New Bedford and local community organizations to establish a broader health equity agenda in this culturally diverse city that has weathered decades of economic and demographic shifts.  

“Health equity and racial equity are hard,” said Melissa Mazzeo, PIH-US’s senior project lead in New Bedford. “There’s so much good work being done to target symptoms, but we need to address the root causes of inequity; we want to elevate equity in a formal way.”  

Shifting Demographics and Wealth 

 In the mid-1850s as the whaling industry boomed, New Bedford was deemed “the richest city per capita in the nation” and immortalized in Herman Melville’s Moby Dick.  

These days, New Bedford is still a key player in the fishing industry; it’s the number one fishing port in the U.S. when measured by the dollar value of catch, and it’s the center of the global scallop market. As the pandemic escalated, New Bedford moved to protect local workers and industries: it was the first city in the country to provide a free mask to city residents and mandated stringent safety requirements at the seafood processing plants.  

Still, the city faces significant challenges. More than 20% of the city’s 100,000 residents live in poverty—significantly higher than the state average of 11.4%. About 10,000 New Bedford residents are immigrants without documentation, and, like many U.S. cities, New Bedford has been devastated by the opioid epidemic. The COVID-19 pandemic only exacerbated these inequities, disproportionately impacting Latinx residents, who comprise about 20% of the population. Throughout the pandemic, New Bedford’s caseload has been consistently high, said epidemiologist Shanon Smith During each COVID-19 surge, from March 2020 to the present, New Bedford's highest 14-day average incidence rate was nearly double that of Massachusetts. 

Improving Access to Health, Investing Locally 

Removing barriers to access has always been a priority for PIH. As vaccines became available, the PIH-US team, working alongside the New Bedford Health Department and community organizations, supported a local block-by-block vaccination strategy that deployed mobile vaccine clinics and trusted messengers to canvass high-need neighborhoods and accompany residents to get vaccinated. At the same time, team members have also kept a close eye on cultural and language needs among New Bedford’s thriving multi-ethnic population, where nearly 40% of residents over 5 speak a language other than English at home.  

Rosa Matos, the contact tracing liaison on PIH-US's New Bedford team, and Solange Anderson, the community outreach liaison, are well-versed in the immigrant experience. Matos arrived in the U.S from Cape Verde when she was 8, attended high school and college, and became a medical assistant in Brockton, Mass. Anderson grew up in Brazil and came to the U.S in 2016 as a part of an au pair cultural exchange program, then trained as an interpreter and translator, eventually working with legal interpretation and translation in Boston. Both women worked for the Massachusetts CTC, joined the PIH New Bedford team, and will ultimately transition to become health department employees. Their work includes supporting immigrant communities with health information on COVID-19 while also seeking to increase vaccine uptake. 

Cape Verdean Creole, Portuguese and Other Translations Needed  

When Matos and Anderson began working in New Bedford, almost all the written health material was in English. They quickly sought to remedy that -- ensuring that all of the flyers and handouts related to COVID-19, from vaccine clinic information and registration forms to guidelines on isolation and quarantine, were available in Cape Verdean Creole and Portuguese, as well as Spanish. Anderson, continues to translate for people at mobile vaccination clinics; Matos is working with the local Cape Verdean Association to get the word out about the importance of vaccination. The two have helped organize clinics at a Brazilian church, an outdoor Cape Verdean festival, outside grocery stores, at an industrial park, and various housing blocks. To reach young people, the team helped organize a vaccine challenge competition on social media—TikTok and Instagram—offering cash gift cards for the winning picture or video. 

Obstacles remain. Only about 50% of residents are fully vaccinated. Many undocumented immigrants don’t trust government officials of any kind to take care of their health needs, the two women said. Translated materials have not helped the small population of Guatemalans in New Bedford who speak Kʼicheʼ, a Mayan language not widely known outside this community. And, like in many other regions, young people are still skeptical of the vaccines.  

“It’s challenging work,” Matos said. And it’s all about putting in the time with the people who make up this diverse city. “With so many different communities here, the only way for anything to happen is to understand all of the different perspectives before you make a move,” Anderson said. “So we’re trying to understand the dynamic of each neighborhood and learn about the trusted people in each community who can spread the word.” 

A Health Equity Agenda 

With a view toward elevating the perspective of communities of color, PIH-US has partnered with the city on an equity agenda that continues to deepen. It has sponsored two intensive health equity trainings, run by the Racial Equity Institute, to focus on the historical underpinnings of racism in the U.S. More than 50 people attended from all corners of New Bedford, Mazzeo said, including city workers, representatives from community organizations, and both emerging and established leaders.  

PIH-US has also been invited to take on a convening role within The Greater New Bedford Allies for Health and Wellness, a health equity group, to coordinate and track activities and to help prioritize the equity work, Mazzeo said.  

In addition, the PIH New Bedford team has recently stepped in to help manage a new grant on “equitable approaches to public safety,” a partnership between the health and police departments exploring alternative approaches to criminal justice.  

Transforming Communities 

When it comes to health equity, Chaplin, the health department head, said: “PIH has been in lock step with me on this -- it’s a marathon, not a sprint, and we are moving along toward equity, step by step.”  

What does that look like on the ground? “It looks like the people who need the resources the most, get them,” Chaplin said. “If we need better health care access for the Latinx community, we get that; if we need more linguistic support for Cape Verdean or Portuguese communities, we get more language services; if we need more housing, we get more affordable housing.” 

Chaplin also knows firsthand about the needs of families living in tough economic conditions. “I do the work that I do because public health is my life,” he said in a 2019 interview with the National Association of County and City Health Officials.

As a child growing up in a rough Boston neighborhood, Chaplin said in the interview, he suffered from asthma, yet his mother, a smoker, was unaware that her smoking was worsening his condition; nor did his grandmother know that incinerator smoke was also exacerbating the asthma.  For many years, he dealt with an undiagnosed learning disability which led to difficulty reading and performing in school.  Chaplin said some members of his family had been in jail or killed as a result of gang violence, or drug users. "All those experiences I had are directly aligned with what we know now as the social determinants of health," he said. "Those weren’t conversations we were having in the 70s and 80s. It was nearly 10 years ago that I began to look at my life through a public health lens and adopt my public health story as the foundation for my pursuit for social justice and public health reform."

Broadening Partnerships Across Massachusetts 

As the work in New Bedford, and throughout the U.S., begins to transition from acute COVID-19 response to long-term health system strengthening, the team is mapping out a broader, regional strategy. 

Mazzeo said that PIH-US’s work in New Bedford can be a model for other Massachusetts cities facing major social and economic challenges. The Massachusetts Department of Public Health has designated 20 regions as “vaccine equity” communities; they have suffered from high COVID-19 case rates, low vaccination rates, high poverty, and social vulnerabilities metrics.  

“We believe these conditions provide a profound opportunity for sustained engagement and improved collaboration across multiple high-need areas,” Mazzeo said. “A multi-city accompaniment strategy in the Commonwealth could have a transformative regional impact.  As cities share and adapt best-practices, they could demonstrate the power of a collaborative health system,” Mazzeo said. “Through this strategic collaboration, and working side-by-side with state and local partners, we can reimagine public health service delivery in Massachusetts for years to come.” 

Manamaneng clinic was 13 hours away, by foot, along miles and miles of winding dirt roads. But Limakatso Lerata was determined to hear her baby’s heartbeat.

The 18-year-old had received prenatal care at other clinics, closer to her village. But at Manamaneng, there was a maternal waiting home and a vital piece of equipment: a CTG machine.

Cardiotocography (CTG) machines are critical in prenatal care, allowing clinicians to electronically monitor a baby’s heartbeat and detect any complications early on. But in places like rural Thaba Tseka District, Lesotho, clinics can’t afford to purchase or maintain these machines on their own.

From April to June, Partners In Health delivered seven CTG machines to rural clinics in Lesotho, as part of its longstanding efforts to strengthen the country’s health system in partnership with the Ministry of Health.

CTG Machines

Palesa Khomongoe, a midwife and site director at Bobete clinic, has seen these machines save lives.

“When we did not have the CTG machines, we were unable to detect early fetal distress and that led to increased fetal mortality,” says Khomongoe, who has been with PIH for five years. “But now that we have the machines, I can see a decrease in the mortality rate, because we were able to do early detections and make timely medical decisions.”

Khomongoe estimates that at least 10 lives have been saved since her clinic received a CTG machine in early June.

One of those cases is still clear in her mind. While monitoring a baby, the machine was detecting only a faint heartbeat. That set in motion an urgent phone call to Paray Hospital, where the mother was admitted for emergency care and it was discovered the baby’s umbilical cord was tied around its neck. That discovery enabled doctors to perform an emergency cesarean section, saving the mother’s and baby’s lives.

Before the CTG machine was provided, the clinic was using a fetoscope, an open-ended conical device used by clinicians to listen for a fetal heartbeat, and there were delays in identifying such problems.

“It gives me such fulfillment to know that the baby is in good condition when I am doing deliveries,” Khomongoe says, “as opposed to before, when it was hard to tell.”

Training Staff, Saving Lives

The CTG machines build on the health system strengthening that has marked PIH’s work in the country over the years.

Known locally as Bo-mphato Litsebeletsong Tsa Bophelo, PIH has worked in Lesotho since 2006. PIH’s rural health initiative has brought HIV care and other medical services to more than 90,000 people through seven clinics. From 2014 to 2017—coinciding with the start of Lesotho’s national health reform, which PIH supported—the rural clinics saw an 85% increase in prenatal visits and a 15-times increase in facility-based deliveries.

As part of those system strengthening efforts, PIH staff don’t just provide lifesaving medical equipment—they teach clinicians how to use it.

After the CTG machines were delivered, all nurses and midwives at PIH-supported clinics in Lesotho received a comprehensive three-day training at Makonyane Hospital on how to use and maintain the equipment—enabling them to provide a higher level of care for patients.

Lerata, now staying at Manamaneng clinic, is one of those patients. After her 13-hour journey, nurses performed an ultrasound that revealed she was just a month-and-a-half away from delivery. And with the CTG machine, they listened for the baby’s heartbeat. So far, normal. But they didn’t want to take any chances.

Through PIH’s support, Lerata is staying at the clinic’s maternal waiting home, for free, until her due date—one of more than 1,500 expectant mothers who stay in PIH’s maternal waiting homes in Lesotho each year—allowing her to receive constant care and monitoring.

The nurses check on her at least three times a day. And cooks at the clinic provide her meals, for free.

“There is food to eat, which is well-cooked,” she says. “It really feels like home.”

Lerata isn’t the only mother in Thaba Tseka District to receive such care.

Miles away, at Bobete clinic, a CTG machine detected an abnormality in Maqenehelo Letima’s pregnancy. The 33-year-old mother would need surgery—specifically, a single stitch sewn around her cervix to close it—at an advanced hospital, hours away.

With PIH’s support, Letima was given funds to cover her medical bills and transportation costs—allowing her to travel to the hospital for her check-ups and access lifesaving care.

At 36 weeks, she gave birth to a baby girl—four weeks early, but alive and well.

“PIH gave my life a new meaning,” she says. “I have a baby now. I found my peace.”

In 2021, our global response to COVID-19 continued—but so did our ongoing medical care and social support, from Haiti to Peru to Lesotho and beyond.

Amid a year of relentless health and human rights crises, our patients needed us more than ever—and we were there to support them, delivering the compassionate care that has defined our work for more than 30 years.

And as wealthy nations and drugmakers turned their backs on patients dying of COVID-19 without access to lifesaving vaccines, including in the countries where we work, we continued to speak out—demanding that those in power do the right thing and make the vaccines free and accessible for all.

This year on our blog, readers were especially eager to learn about our public health advocacy in the United States and globally, our contact tracing and epidemic intelligence as part of Massachusetts’ COVID-19 response, and our emergency relief work in Haiti.

Below are our 10 most-read stories of 2021, listed by date of publication.

1. Q&A: Why the United States Needs a New Public Health Workforce

PIH and key partners launched a campaign to advocate for the U.S. government to build a larger workforce to help stop COVID-19, strengthen the economy, and build equitable public health systems across the nation. Read more.

2. Black History Month: What PIHers Are Reading, Watching, And Listening To

In honor of Black History Month, PIH staff in the United States shared their favorite songs, books, poems, and movies related to antiracism, Black history, and inequities in public health. Read more.

3. FAQs: COVID-19 Vaccines

PIH clinical leaders and experts answered common questions about COVID-19 vaccines. Read more.

4. Mapping COVID-19: Inside the Epidemic Intelligence Unit

In Massachusetts, outbreak specialists with the Community Tracing Collaborative—a partnership between PIH, the state, and local boards of health—looked to pinpoint the sources of multiple infections, or “clusters”—and use those insights to stop the spread of COVID-19. Read more.

5. Why Equitable COVID-19 Vaccine Distribution Is Essential

A majority—about 75 percent—of all the vaccines delivered across the globe have been sent to 10 countries: the U.S., China, the U.K, Israel, the United Arab Emirates, Italy, Russia, Germany, Spain, and Canada. This is not an equitable or ethical approach, which is why PIH is pushing to make sure vaccines are accessible to everyone as soon as possible. Read more.

6. Third Wave of COVID-19 Impacts Countries Around the Globe

COVID-19 is sweeping through many countries where PIH works, proving that the pandemic is far from "over"—especially when so many people lack access to vaccines and proper measures for prevention and care. Read more.

7. Facilities Open, Staff Safe Following Haitian President’s Assassination

More than a week after the assassination of President Jovenel Moïse, our facilities in Haiti remained open, as they have through years of political and civil unrest. In the following months, Zanmi Lasante—PIH’s sister organization in Haiti—continued operating with added measures to ensure the safety of patients and staff. Read more.

8. Providing High-Quality COVID-19 Care in Haiti, Amid Significant Challenges

Clinicians and staff in Haiti continued to provide testing, isolation and support, and care—including to patients with some of the most severe cases of COVID-19—throughout the pandemic and despite significant challenges. Read more.

9. Anatomy of a Cape Cod Outbreak: How PIH’s Epidemic Intelligence Unit Supported a Major Public Health Investigation

A major COVID-19 cluster in Cape Cod was identified thanks to partnership between Massachusetts health officials and the PIH-supported Epidemic Intelligence Unit, leading to further clarity on the high transmission of the Delta variant and revised CDC guidelines on masking for vaccinated individuals. Read more.

10. Emergency Care Key to Earthquake Response in Haiti

PIH's director of emergency and critical care discussed clinicians’ primary concerns following a 7.2-magnitude earthquake in Haiti, how they rapidly responded, and how such tragedies can have a lasting impact—including on those not immediately injured. Read more.

Partners In Health has named Loune Viaud chief gender and social equity officer, a new role inspired by the PIH Strategic Plan, 2020–2025. Reporting directly to CEO Dr. Sheila Davis, Viaud now leads goal setting, strategy, and advocacy around gender and social equity issues across the organization. 

“PIH is centering our care around the rights of women, children, and adolescents and doubling down on social and economic support for our patients,” said Davis. “I can think of no one better to spearhead this work than Loune. As a fearless and founding leader of PIH, she has transformed our understanding of social medicine, especially around gender and equity in health.”

Viaud earned a bachelor’s degree in journalism and communications in Haiti and supplemented her knowledge through certificate courses in human rights and women’s health at Harvard University. She joined PIH as a program coordinator in 1988 and over the next three decades was instrumental in expanding PIH’s work from one facility in Haiti’s central region to 16, and from Haiti to 12 countries around the globe. In 2000 she became deputy director of PIH. In 2012, she returned to Haiti to became co-executive director of Zanmi Lasante, as PIH is known in Haiti, and then sole executive director of Zanmi Lasante in 2017. With her leadership, PIH has grown to serve 4 million people with high quality primary care. Viaud transitioned into the chief gender and social equity officer role in September.

“Focusing on the challenges faced by women, children, and some of the poorest members of our communities around the world promises to take PIH’s care to the next level,” said Viaud. “I’m so excited to be doing this vital work.”

In 1990, Viaud pioneered central Haiti’s first women’s health center, known as Proje Sante Fanm, before launching female-centered health trainings, literacy programs, and scholarships. In naming her a “Woman of the Year” in 2003, Ms. magazine wrote, “Viaud’s program of empowering Haitian women to recognize their right to good health has started a quiet revolution.” She is the recipient of a Robert F. Kennedy Human Rights Award for her vision, moral courage, and activism.  

Additionally, Viaud urged the United Nations Security Council to support more equitable health care for women and girls, becoming the first female Haitian civilian to address the Security Council in over 50 years.

Keys to Viaud’s vision for PIH are ensuring women across all PIH sites have access to training and tools, and supporting future leaders in the field of global health delivery, in part via expanded and formalized academic opportunities. Over the coming year, she expects to conduct an in-depth analysis of gender and social equity issues across all PIH sites to understand what is available, where there are gaps, and where we can build better systems. The study will culminate with Viaud visiting PIH sites.

Marc Julmisse, another female leader, stepped into the role of interim executive director of Zanmi Lasante in September. PIH expects to name a permanent executive director within the year.

Nothing more could be done.

It was an excuse that doctors and nurses with Partners In Health had heard all too often over the decades, from hospital rooms in the United States to hillside communities in Carabayllo, Peru.

Our doctors and nurses were called to advocacy because they cared for patients who were sick, suffering, and died due to unjust social conditions. Sometimes, these patients were treated unjustly because they were from a marginalized group; in other cases, medical care was provided in rundown facilities without enough staff, medications, or diagnostics. Our clinicians knew that providing compassionate, dignified, modern medical care as a basic right demanded a fight against injustice. 

For more than 30 years, PIH doctors and nurses have taken their fight for health equity beyond the walls of the hospital and into the streets and the halls of power—demanding that health leaders listen to and care for those whose illnesses embody the oppression they face.

Below are the stories of four clinicians—among many—at PIH, who chose to speak up when others fell silent and inspired generations of future doctors and nurses to merge their passions for medicine and social justice.

Sheila Davis, Chief Executive Officer

In the early days of the HIV epidemic in the U.S., Sheila Davis became a nurse—and an activist. As she cared for patients dying of the disease, many of them gay men neglected by the U.S. health system, she remembers desperately advocating for her patients’ wishes: to have their partners by their side.

But in case after case, hospitals overruled the patients’ wishes and sided with the birth families instead, who often didn’t approve of the relationships and banned long-term partners from patients’ rooms. It was a time Davis remembers as difficult and infuriating, and it set in motion her passion for health equity.

In the years since, Davis has become a relentless advocate for gay marriage, LGBTQ+ rights, and health equity, pushing for policy change at the hospital, state, and national levels to make health care truly accessible for all—a passion that has since led her to PIH, where she is the first nurse to serve as chief executive officer.

“Nurses have a long history of social justice as a foundational piece of our profession. As my career has morphed from direct patient care at the bedside to my work at PIH, the integration of social justice and health equity has continued—and strengthened.” – Sheila Davis

Paul Farmer, Co-Founder and Chief Strategist

As Dr. Paul Farmer and PIH co-founders treated patients for various ailments in Carabayllo, Peru, one of their closest friends lay dying of multidrug-resistant tuberculosis. His death made one thing became clear: The next stage of the fight wouldn’t be in Lima. It would be in Geneva.

World leaders, including within the World Health Organization, had turned their backs on those sick with drug-resistant tuberculosis, with official policy dismissing the disease as too complicated and costly to fully address in settings such as Lima, a city where extreme wealth and poverty were juxtaposed. 

But Farmer, PIH co-founders, and Peruvian leaders, including Dr. Jaime Bayona and others in Lima, refused to accept this status quo. While treating hundreds and eventually thousands of patients, they also took their fight to the halls of power, calling on the global health establishment to take action and eventually changing global health policy—a moment captured in the award-winning documentary Bending the Arc.

That, for Farmer, pointed to the power of bringing together the worlds of medicine and activism. It would be a lesson soon translated to the growing challenges of AIDS, cancer care, and a host of other global health issues.

“Learning this difficult stuff about health and well-being in the world, you’d think that going to medical school and doing a PhD in medical anthropology would prepare you for that. But it doesn’t. I think I’ve learned more about these matters from activists.” – Dr. Paul Farmer

Joia Mukherjee, Chief Medical Officer

Before she was a doctor, Joia Mukherjee was an activist—fighting alongside women who were victims of domestic violence and with people leading the fight for AIDS drugs. The first time she spoke publicly about global HIV inequality, during her senior lecture at the end of her infectious disease fellowship at Harvard in 1999, many in the audience had two words in response: “That’s unrealistic.”

“I got incensed,” Mukherjee recalls. “I remember having arguments and arguments and arguments with so many doctors, many of whom had never set foot on the African continent.”

Her senior talk, completed with PIH Co-founder Dr. Jim Kim as her faculty mentor, was informed by her work in Uganda, where she saw firsthand how social forces like poverty coerced young girls into exchanging sex for money. Poverty, not lack of knowledge or behavior, put them at risk for contracting HIV. Her conviction that something wasn’t right only became stronger after reading the PIH publication Women, Poverty, and AIDS by Paul Farmer, Margaret Connors, and Janie Simmons.

That set in motion a decades-long career in global health, where Mukherjee has intersected medicine and activism at every turn and spoken out on issues ranging from gender-based violence to mass incarceration in the U.S. to vaccine inequity amid COVID-19.

For Mukherjee, medicine and activism aren’t just complementary—they’re two sides of the same coin. Doctors, nurses, and others in health care must understand the causes of injustice as well as they understand genetics.

“If somebody’s in the hospital and you’re taking care of them and you send them back home and home is under a bridge—you’re doing harm,” she says.

“You can’t separate injustice from health outcomes. Anyone who says they don’t care about social justice is not actually a health provider; they’re not looking at the data. The disparity in life expectancy between Roxbury Crossing station and Back Bay station [in Boston]—a 6-minute T ride—is 30 years.” – Dr. Joia Mukherjee

Patrick Ulysse, Chief Operations Officer

As a young doctor in a rural clinic in Haiti, Dr. Patrick Ulysse saw patient after patient sick with HIV—but there were no antiretroviral drugs on pharmacy shelves. The only thing he could do was refer patients to clinics far away, where they were often denied care because they couldn’t afford the drugs.

Then, Ulysse heard about a clinic run by Zanmi Lasante, PIH’s sister organization in Haiti, where patients could get HIV drugs, as well as food and housing assistance—for free.

As Zanmi Lasante began supporting several of his patients, Ulysse saw the intersection of medicine and social justice first-hand—a vision that would ignite his passion for health care as a human right and inspire him to dedicate his career as a doctor to pushing for social change.

In recent months, that calling has led him to speak out against vaccine apartheid and urge world leaders and drug-makers to make COVID-19 vaccines free and accessible to all. “We are calling on pharmaceutical companies to share the vaccine technology and imploring the U.S. government to scale manufacturing capacity,” he says. “It is a moral imperative and public health emergency.”

“Truly caring for patients means building health systems that benefit not only the patient who has reached the doors of our clinic or the operating table, but also those who are too poor or too sick to arrive.” – Dr. Patrick Ulysse

Religious leaders in Maryland County, Liberia have strengthened the campaign against the spread of COVID-19. During visits to churches and mosques, in a country where more than 98% are religious, leaders have educated community members about the importance of health protocols—from hand washing and mask wearing to social distancing and vaccination.

Trained by Partners In Health (PIH) Liberia and the Maryland County health team, religious leaders are a key part of the county’s broader COVID-19 prevention efforts. Since July, PIH has supported the Maryland County health team with targeted outreach and training for religious and youth leaders to raise awareness about COVID-19 and to promote safety protocols. They’ve also trained commercial taxi motorbike drivers, who receive a steady income while providing the main source of transportation in the county. As many community members use their services, this poses an additional risk of COVID-19 transmission between riders, passengers, and their contacts.

The training session for religious leaders and motorbike drivers included education about the signs and symptoms of COVID-19, which health facilities to visit when feeling ill, and the safety and efficacy of vaccines. Participants also agreed to enter a social contract to protect themselves, their families, and communities with the shared goal of stopping community transmission.

“People listen more to their spiritual leaders and that is why we have advocated to go through them to spread the word on COVID-19,” says Viola Karanja, PIH Liberia’s deputy executive director.

For years, PIH Liberia has collaborated with the county health team to improve access to care for those living in the country’s rural Southeast region. And this isn’t the first time they’ve turned to religious leaders for support. Most recently, they relied on prophets to strengthen mental health services.

Now, as COVID-19 continues to spread, especially with new variants while vaccine uptake is slower than needed due to myths about vaccination, these strategies have become even more crucial. Community engagement at this stage of the pandemic is considered critical to demystifying myths and promoting infection prevention protocols.  The efforts of these groups has contributed to a drastic reduction in disease transmission and increase in COVID-19 vaccination uptake from 2,783 doses in May to 21,318 by early December.

“Though we have our risk communication team and community health workers, health starts in the community and people believe those in the community, most especially the religious leaders,” says Dr. George Methodius, Maryland County health officer. “When we involve the religious community, they can go to the congregation and tell people COVID-19 is real.”

Every Sunday, 12 religious leaders—divided into three groups—visit at least a dozen religious centers and speak to the congregations about the importance of COVID-19 safety protocols. About 30 churches have been visited so far, reaching approximately 1,200 people. Imams and other Muslim leaders have also been trained to share the messages with congregants at the two mosques in the county.

Many of the churches and mosques have begun implementing the protocols and have continued to spread awareness beyond the initial meeting. In some instances, this is the first time individuals have learned about the importance of COVID-19 prevention efforts.

“I have also learned a lot myself; I never knew much about hand washing and the nose mask.  I was never using it, but now I do. We will still continue because not everyone has heard the message yet,” says Elizabeth Jackson, president of Evangelical St. Peter Lutheran Church.

In addition to providing educational resources to churches and mosques, PIH Liberia continues to ensure that places of worship have supplies for handwashing, masks, and other important infection prevention items, explains Karanja. As the COVID-19 pandemic persists, hitting countries without widespread access to vaccines the hardest, PIH Liberia continues to find new ways to educate and engage communities throughout Maryland County.