It’s now been one year since cholera “exploded like a bomb” in Haiti, as Partners In Health co-founder Dr. Paul Farmer recently described the outbreak. Last week, PIH and the Robert F. Kennedy Center for Justice and Human Rights released a statement calling on the international community to protect and fulfill human rights when assisting with relief efforts in Haiti. This means working to ensure that Haitian institutions have the ability to provide and protect the rights of Haitians, such as access to potable water and sanitation to combat the cholera outbreak.

The new statement, asserts that unless a strategic focus is placed on strengthening the key pillars of the human rights framework—the responsibility and ability of governments to respect, protect, and fulfill rights and civil society participation —life-saving resources will continue to bypass Haitian public institutions, Haitian businesses, and the Haitian people. Foreign assistance should be allocated to bolster the capacity of Haitian institutions to provide essential services to the poor. Read the report’s recommendations on how the donors can operationalize a rights-based approach. 

This new statement, Building Back Haiti More Justly, was released as part of a briefing on Capitol Hill. It is a follow-up to a statement issued shortly after the devastating January 12, 2010 earthquake in Haiti. This first statement was published by PIH and a number of partners, including the Center for Constitutional Rights, the Institute for Justice and Democracy in Haiti, the NYU Law School’s Center for Human Rights and Global Justice, the Robert F. Kennedy Center for Justice and Human Rights, TransAfrica Forum and Zanmi Lasante.

By Marie Connelly, GHDonline

The growth in international nongovernmental organizations (NGOs) working in health care around the globe raises questions regarding how these organizations can best support governments in strengthening local health systems. From November 7th to 11th, Rwandan Minister of Health Dr. Agnes Binagwaho will lead a GHDonline Expert Panel discussion, Strengthening Health Systems: The Role of NGOs, to address these important questions.

For more details of how PIH works to strengthen health systems, check out the newly released PIH Program Management Guide.

Dr. Agnes Binagwaho will be joined by:

• Ted Constan, Chief Operating Officer, Partners In Health
• Dr. Felix Kayigamba, Country Director, The Access Project
• Christina Bethke, Program Coordinator, Tiyatien Health
• James Pfieffer, NGO Code of Conduct author and Director of Mozambique Operations, Health Alliance International

In a preview of this discussion, Dr. Agnes shared with us that “For a government like Rwanda pursuing its comprehensive national strategic plan for health articulated through a participatory process as part of the overall development plan for the country, having NGO partners that align their work to that plan is the right way to speed up development. But to achieve that result, we need each and every stakeholder to play their own part with efficiency, transparency, and accountability.” She added, ”Our GHDonline panel discussion will help us all to think about what is needed to get there.”

To reach these goals, true partnerships must be formed. Ted Constan, Chief Operating Officer of Partners In Health, stressed that “communication, transparency, and flexibility are critical ingredients for successful partnerships between NGOs and Ministries of Health.”

In addition to discussing the necessary elements of these kinds of partnerships, our panelists will also address:

• The challenges of administering joint programs
• Ways that NGOs can best support building local human resource capacity
• Leveraging partnerships to address infrastructure needs
• Examples of successful partnerships

We look forward to hearing your questions, and hope you will also share your own experiences on these important topics.

Join our Expert Panel discussion, Strengthening Health Systems: The Role of NGOs at GHDonline.

A young, dangerously emaciated girl in Lesotho is examined and treated at a specialized TB facility, in an attempt to reverse her life threatening condition(s).

The 42nd Union World Conference on Lung Health convened in Lille, France during the last week in October, bringing delegates from more than 100 countries together to discuss challenges ranging from the threat of multidrug-resistant tuberculosis and the rising prevalence of non-communicable diseases to the need for more effective tobacco control and broader access to essential medicines and technologies.

Specialists and advocates discussed how innovative partnerships could help the international community meet these challenges. The theme of the conference, "Partnerships for Scaling-Up and Care," was reflected throughout the intensive five-day scientific program. 

For over two decades, Partners In Health has worked to treat and prevent tuberculosis (TB), drug-resistant tuberculosis (DR TB), and HIV/TB in some of the poorest and most vulnerable communities in the world, including Haiti, Malawi, Peru and Russia.

Working closely with our partners at Harvard Medical School, Brigham and Women’s Hospital and national TB and HIV programs, have developed and used a community-based approach and extended technical assistance to produce some of the highest cure rates and lowest treatment default rates ever recorded.

These results prove that health problems once thought untreatable can be addressed effectively, even in poor and geographically remote settings. Our goal is to share the success of our approach on a broad scale.

The Union World Conference is the largest annual conference that focuses in particular on these issues as they affect low- and middle-income populations and countries.

Over 2.4 million cancer deaths in developing countries could be avoided each year by using prevention and treatment interventions that are affordable and widely available, according to a report released on October 28.

The new report, Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries, is from an international group of experts organized by the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, and supported by a consortium of organizations that includes Partners In Health, Harvard School of Public Health, Dana Farber Cancer Institute, and Brigham and Women’s Hospital.

Once considered a problem only in wealthy countries, cancer is now a leading cause of death in low and middle-income countries. About 55 percent of the world’s 12.7 million new cases and 65 percent of the 7.6 million cancer deaths each year occur in these nations.

“The chance for a cure, the chance to live, should not be an accident of geography,” says Her Royal Highness Princess Dina Mired of Jordan, who serves on the Global Task Force that published the report.

The report was released at the Harvard Medical School symposium, Closing the Cancer Divide: The Global Equity Imperative of Expanding Access in Low and Middle Income Countries. The film Delivering Hope by LIVESTRONG was also presented at this symposium (watch on the player above).

Integrating treatment and prevention efforts

The report includes recommendations for combatting cancer using both treatment and prevention interventions. For treatment efforts, the report especially focuses on pediatric cancer, as deaths due to children’s cancers are among those that could be curtailed most easily. Costs of treatment for certain common cancers are as little as $100 per course in developing nations. About $115 million could completely cover the costs of drug treatments for unmet needs for cervical cancer, Hodgkin’s lymphoma, and acute lymphoblastic leukemia in children in low and middle income countries.

	A patient in Rwanda receives chemotherapy for cancer. Costs for treating some common cancers cost as little as $100 per course in developing countries.

Prevention has been an important focus of efforts developing countries. Reducing risk factors, such as tobacco usage, can help prevent many of the cancers of tomorrow. However, the report states that prevention activities are part of an integrated strategy, which also includes treatment.

“Developing countries face a double cancer burden that includes preventable cancers and the emerging challenge of all other cancers that cannot be prevented,” says Dr. Felicia Knaul, Director of the Harvard Global Equity Initiative, one of the organizations in the Global Task Force collaboration. “Cervical and breast cancer account for almost as many deaths and maternal mortality and most of these deaths could be avoided.” 

“The belief that treatment may be reserved for those in wealthy countries whereas prevention is the lot of the poor might be less repugnant if we had highly effective preventive measures,” adds PIH co-founder Dr. Paul Farmer.

Relief from pain

“Pain control, an issue for all cancers and many other diseases, offers the most distressing and insidious example of the cancer divide,” writes the report authors. Although pain relief medications like morphine are relatively low-cost, they remain largely inaccessible to patients in developing countries. This means that most people with cancer worldwide suffer tremendous pain — needlessly — before they die, the report’s authors say. For example, Saharan Africa records 1.1 million deaths in pain, and yet only uses enough medicinal opioids to treat just 85,000 people. Worldwide, although middle and low-income countries make up 85 percent of the world’s population, they only use less than 6 percent of the morphine consumed globally.

Read the full report, which includes a road map for improving cancer care in low and middle income countries, including practical, country-specific and disease-specific recommendations.

Read an overview of the report. 

Learn more about PIH’s work to treat and prevent cancer and other chronic, non-communicable diseases.

When it opens in early 2012, Mirebalais Hospital will serve approximately 500 outpatients per day, with a 320-bed inpatient capacity. This will more than double the total public-sector bed capacity in Haiti’s Centre Department, and enable the provision of quality, comprehensive clinical services to communities that currently have very limited access to health care.

Each week we bring you an update on the hospital’s construction. This week we’re going to let these new images speak for themselves. 

Learn more about Mirebalais Hospital.

"Obscene" is the word Partners In Health co-founders Paul Farmer and Ophelia Dahl use to describe the number of women who die preventable deaths during childbirth each year. According to the World Health Organization, roughly 1,000 women die every day from pregnancy or childbirth-related complications – 99 percent of those deaths take place in developing countries.

This fall, PIH joined ABC News and the United Nations Foundation and several other organizations in the network’s Million Moms Challenge. By connecting millions of Americans with millions of mothers in developing countries around the world, the goal is to work together as we renew and strengthen our response to the critical issues of pregnancy, childbirth and children's health.

The initiative – which began in September – will lead up to a one-hour prime time special on maternal health anchored by Diane Sawyer on December 16, 2011. 

Join us on November 8 for the Million Moms Challenge's Baby Shower for Global Good, a live event on Twitter to raise awareness for underserved moms around the globe. Follow #AMillionMoms to particpate in the conversation.

Paul Farmer calls for improved obstetric care in developing countries on ABC News

“We shouldn’t be taking shortcuts if we want to drop maternal mortality,” said Paul Farmer. “You have to invest in prenatal care. You have to make sure that complicated deliveries are attended by skilled providers, and I think that is happening all over the world.” 

“We’re seeing rates of maternal mortality drop as we make better investments,” continues Farmer. “There shouldn’t be a double standard; double standards don’t make sense. If you want to break the cycle of poverty and disease, you have to invest in public health but you also have to invest in medicine, family planning and modern obstetrics.” 

Join the call to make healthy pregnancies, safe births and children who survive and thrive a basic right around the world.

Join the challenge and sign the petition.

ABC news highlights PIH’s Maternal Mortality Reduction program in Lesotho

In the tiny African nation of Lesotho, an alarming number of women – 1 in 48 – die during childbirth. Even minor complications often become life-threatening conditions, primarily due to the lack of basic medical care. 

PIH’s Maternal Mortality Reduction Program at Bobete Health Center has trained 100 maternal health workers (MHWs) to accompany pregnant women living in remote villages surrounding Bobete for treatment during their pregnancies and for safer deliveries. During the first year of the program, deliveries at Bobete Health Center rose 350 percent. PIH has trained over 650 MHWs across its 7 rural clinics and at the PIH-supported hospital in Mamohau.

Learn more about PIH’s work in Lesotho.

On Friday, October 7 – in recognition of World Mental Health Day – staff at Partners In Health’s sister project in Peru, Socios En Salud (SES), spent the day working at a community fair in northern Lima. Organized by the local health network Carabayllo Health Coordinators, the day’s events aimed to demystify mental health-related conditions – especially those affecting patients receiving care for tuberculosis (TB). 

SES staff and volunteers taught families about tuberculosis and mental health diseases.

Staff and volunteers played games and quizzed the 300-plus people who stopped by one of SES’s five booths. Community members learned about issues such as inclusion, care for the disabled, and skill development. SES also sold small wares – scarfs, hats, children’s toys – made by patients, a powerful example of what those living with mental health issues can do after receiving treatment and care. 

In an effort to reach as many people as possible, SES partnered with students at the local college, César Vallejo University, the police force and community health workers from across Carabayllo.

This outreach is just one of many ongoing mental health activities that SES has organized over the years. From fairs to long-term group therapy sessions, SES is committed to removing the stigma around mental health conditions and making services available to patients and family members who need them.

The hidden effects of a contagious disease

In the spring of 1999, SES began hosting its first group therapy session, filling a health need for men and women living with multidrug-resistant tuberculosis (MDR-TB).

“In my home they didn’t understand me – they didn’t know what it was to live with this disease,” remembers a group therapy patient. “Here in group therapy I feel like you all understand me. I can express my problems and sadness, and you support me. You help me so much.” 

The effects of MDR-TB – coughing, weight loss, debilitating fatigue, fever – extend beyond the physical body. Men and women are often isolated and shamed by stigma. Those infected often lose their jobs or drop out of school, leaving them as financially debilitated as they are physically.

Highly contagious in enclosed spaces, TB puts an infected person’s family and friends at risk. Many men and women find themselves forced to leave their homes. The psychological toll is difficult to imagine. Suicidal thoughts, psycho-emotional collapse and serious family or social problems are common consequences of infection.

Watch Jelen conquer MDR-TB and support her family by starting a small business.

Learning to cope with tuberculosis

SES organizes therapy sessions for patients affected by the stigma and discrimination surrounding TB, offering small groups of up to 20 people a chance to meet with each other in weekly meetings. Patients are empowered to express their emotions, verbalize problems and receive emotional support from others living through similar experiences. 

Patients move through powerful and relevant discussions, including:

• Thoughts about abandoning treatment
• Suicidal thoughts or intents
• Stigma and discrimination
• Adverse effects of anti-TB medications
• Problems in the home, with family
• Changes in sexuality and intimacy with partners
• Economic problems
• Fear of post-treatment relapse
• Fear of transmitting to family and friends
• Myths and misconceptions about the disease

The bi-monthly meetings are more than just a place to discuss fears and problems. The groups come to feel like extended families. Members celebrate birthdays and major holidays, take outings to the countryside, and attend workshops and educational sessions throughout the city. 

More than anything, group members function as a support system, helping each other complete treatment. 

Meet Carmen, a woman who thought she’d lost everything after contracting MDR-TB.

A SES patient discusses her problems at a group therapy session.

Taking stock of a program’s impact, sharing our results

With over a decade of results, SES’s group therapy program proves that at-risk patients have improved adherence rates after receiving mental health care. Not just that, staff have saved lives by intervening when patients were known to be contemplating suicide. 

After spending a number of months, or years, participating in the group programs, patients are better equipped to re-establish and improve social and family support networks – a crucial step towards returning to their lives. Participants also show a markedly improved capacity to face difficult situations after completing TB treatment. 

In 2011, SES wrote three technical regulation documents made available to public and private health personnel: Mental Health Care Model, Group Therapy Manual and The Guide to Caring for Psycho-Emotional and Adverse Psychiatric Events in People Affected by MDR-TB. 

Learn more about PIH’s work in Peru.

"When I came here, we didn't have an operating room," says Dr. Christophe Milien, OB-GYN and director of LasCahobas Health Center in Central Haiti. In the above video, he describes a pivotal moment in his work -- having a patient suffering from birthing complications bleed to death during transport to a medical facility with a functinal operating room.

"Seconds matter, minutes matter," adds Dr. David Walton, PIH's Senior Advisor for Health and Medical Infrastructure. Thanks to Milien's efforts, LasCahobas now has the capacity to perform life-saving surgeries, including cesarean sections. As word spread throughout the community of the new services, more and more women have come to deliver their children at the facility --from 18 deliveries a month in 2008 to 110-120 a month this year.

However, this program -- which employs one midwife, one nurse, and one anesthesiologis one OBGYN -- is struggling to keep up with the demand. The new state-of-the-art Mireablais Hospital, scheduled to open next year, will help serve this community and others in central Haiti.

Just one year after the cholera epidemic emerged in Haiti, nearly half a million Haitians have contracted the disease and more than 6,600 have died.

On October 24, Michel Martin – host of NPR’s “Tell Me More” – explored what cholera is, and how Haiti's government is making new efforts to tackle the crisis. She spoke with Partners In Health’s Dr. Louise Ivers, who is heading up PIH’s cholera vaccination project in Haiti, and Miami Herald’s Jacqueline Charles.

“Once the bacteria is introduced into an environment, there is a high risk of contagion moving from person to person,” says Dr. Ivers. This is especially true in a country with a fragile health system and inadequate water and sanitation systems.

People are cut off by Haiti’s landscape, often living 2-3 hours from the nearest medical facility, with spotty cell phone service – a deadly combination when the disease that can kill in as little as 12-24 hours. For Haitians living in the settlement camps scattered throughout Port-au-Prince and across the rural countryside, little has been done to reduce the risk of infection in the past year.

Learn why PIH has decided to introduce a vaccination now, and what it means for cholera in Haiti.

Learn more about PIH’s cholera response.

“What we're calling for, a year into the epidemic, is a prompt integration of prevention, care, and treatment measures,” said PIH co-founder Dr. Paul Farmer – including a pilot program to vaccinate 100,000 Haitians, set to take place in January 2012.

Nearly a half million cases of cholera have been reported in Haiti in the past year – roughly 5 percent of the Caribbean nation’s population. 6,600 Haitians have died since the outbreak began, more than the total number of cholera deaths reported in the rest of the world combined in 2010.

As the bacteria continues to contaminate the lakes, rivers and canals that millions of people use each day for drinking, cooking and bathing, cholera is not going away. Heavy rains and tropical storms also continue to trigger spikes in cholera cases and deaths. 

“We don’t know when this epidemic will end,” added Farmer. “It’s going to be with us for a long time,” adding that at some point the disease will become endemic in Haiti.

Farmer and PIH have been advocating for a comprehensive long-term response, including providing chlorinated water at the household and village level, introducing hand washing and hygiene measures, building water and sanitation systems, improving case-finding and treatment and integrating an oral cholera vaccine into PIH’s comprehensive plan.

Efforts on the ground as epidemic enters its second year

As the epidemic moves into its second year, PIH is continuing to support a dozen cholera treatment units throughout central Haiti and Port-au-Prince. Since the start of the outbreak, PIH facilities have seen over 75,000 cases of cholera, according to Dr. Louise Ivers, who is heading up PIH’s cholera vaccination effort. This number doesn’t include cases seen by health workers in the villages and communities surrounding those cholera units. 

Since October 2010, PIH has hired and trained over 3,300 community health workers to treat cholera using oral rehydration salts and teach people how to practice proper hygiene and sanitation. Staff has also been offering counseling to affected individuals, families and communities. Since August 2011, PIH’s psychosocial and mental health team has provided services to over 4,300 families and dozens of communities. 

At the local level, PIH is conducting an aggressive public hygiene education campaign that includes radio messages and community trainings. Internationally, staff continues to advocate for the long-term solutions including the creation of public water and sanitation systems.

“We in the development and humanitarian assistance field need to learn more about how to accompany our partners in Haiti over the long term,” said Farmer.

PIH to begin vaccination program in January 2012

Help Partners In Health respond. Donate today.

PIH will introduce an oral cholera vaccine as part of a comprehensive package of prevention and treatment in January 2012.

“We need to bring every resource available to stop the epidemic,” said Farmer. “There's no argument that this wouldn't save many thousands of lives and prevent many, many times more new cases.” 

“We are planning to vaccinate about 100,000 Haitians with a vaccine called Shanchol,” said Ivers. Shanchol – an effective oral cholera vaccine recently approved by the World Health Organization – costs $1.85/dose, with each recipient requiring two doses. “200,000 doses are currently available,” added Ivers. “We'll be working on this project in collaboration with GHESKIO, as well as with the Haitian Ministry of Health.”

“Campaign planning is already underway, including stakeholder meetings and meetings with local communities…to ensure that we can have a communications campaign that really makes sense to explain to everybody what the vaccine is, how effective it is, what it means for them,” continued Ivers. “And our intention is that this would just be the beginning of a larger national campaign to include cholera vaccination as part of national protocols to control the epidemic.”

This oral cholera vaccination is nearly 70 percent effective and protects recipients for upwards of 36 months. Additional community protection would occur when a substantial portion of the population is vaccinated, added Ivers. It is estimated that 10 percent coverage would avert 63,000 cases and 900 deaths in Haiti, while 30 percent coverage would lead to a 55 percent reduction in cases, potentially saving thousands of lives. 

Working with GHESKIO, a longtime partner based in Port-au-Prince, and Haiti’s Ministry of Health, PIH’s pilot vaccination campaign will target vulnerable populations in both Port-au-Prince and rural communities on the banks of the Artibonite River near the town of St. Marc, where the outbreak first began.

Number of NGOs treating cholera quickly diminishing

“128 NGOs and governmental organizations were working with cholera at the start of 2011,” said Donna Barry, PIH’s director of policy and advocacy. “And that number has now decreased to around 40.” A primary reason behind this pullout is decreased funding and the shifting interests and capabilities of organizations working on the ground. 

Funding for programs across Haiti is not meeting the needs, putting reconstruction efforts at risk. “In 2010 and 2011, about $4.6 billion was pledged for recovery efforts in Haiti,” continued Barry. “Of that, 43 percent has been disbursed, which means that there's 57 percent left. We're in mid-October, with only 2 and a half months left in 2011, and 57 percent of that money is yet to be disbursed.”

These decreases are already having a major impact. A new report put out by the UN Office for the Coordination of Humanitarian Affairs (OCHA) finds that the number of people who have access to clean drinking water in Port-au-Prince’s settlement camps for persons displaced by the earthquake has decreased drastically since March, falling from 48 percent to 7 percent.

In March, 20 percent of people living in the camps had access to hand-washing stations. That number had dropped to 12 percent by August. Currently only 38 percent of these people have access to functioning latrines.

The situation is not much better outside of Port-au-Prince. OCHA finds that only 54 percent of Haitians have access to safe drinking water, while a shockingly low 30 percent have access to proper sanitation facilities. Access to clean drinking water is a basic human right; PIH urges the international community to do more to support the building of new water and sanitation infrastructure.

Find out more about PIH’s response to the cholera outbreak.

IHSJ Reader     October 2011     Issue 10         

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

HAITI

 No Quick Fix for Haiti Cholera (Declan Butler, Nature Magazine, October 18, 2011)
It's been one year since cholera was detected in Haiti. Today it is the largest cholera epidemic in the world, with nearly 5% of the country’s population officially reported to have been infected in just 12 months. The lack of clean water and sanitation infrastructure, and the slow prospect for improvement make a compelling case for increased resources and efforts to halt the spread of infection. Resources are urgently needed to: (1) scale-up efforts to aggressively identify and treat all those with cholera, (2) strengthen Haiti’s sanitation infrastructure and improve access to clean drinking water, and (3) roll out a safe, affordable and effective oral cholera vaccine. 

Haiti Doesn’t Need Your Old T-Shirt (Charles Kenny, Foreign Policy, November 2011)
Why don’t non-profit organizations like Partners In Health accept donations of pop-tarts, NFL shirts and yoga mats? Charles Kenny suggests that for most organizations, human and financial resources are more effectively spent addressing the root causes of poverty and disease. Instead of more choices in imported “leftovers”, impoverished countries would benefit from more choices in trade and economic policy. Instead of increased “charitable” donations, impoverished communities benefit from increased access to basic rights like health care, education and employment. Just as dumping surplus corn on Haiti pushes rural families into hunger, importing used clothing donations to poor countries is shown to put local people out of work. For organizations like Partners In Health that are committed to building local and public sector capacity to break the cycle of poverty and disease, cash donations are almost always more helpful than material goods.

UN Agencies and CIDA Announce New Maternal and Child Health Program in Haiti (Roger Annis, Canada Haiti Action Network, September 2011)
The Canadian International Development Agency is financing a new United Nations-supported program, Maman ak timoun an santé (Healthy Mothers and Children), to reduce infant and maternal mortality. The program will expand the provision of free health care to pregnant women, children under five, and people living in IDP (internally displaced person) settlements, and will be administered by Haiti’s Ministry of Public Health (MSPP). This commitment by the Canadian government highlights the importance of strengthening health systems through the public sector so that they can provide comprehensive care to vulnerable populations.

Haitian Lawmakers Approve Cabinet, Prime Minister’s Policy Agenda (Washington Post, October 15, 2011)
After months of delay, the Haitian Parliament’s October 5^th confirmation of Gary Conille as Prime Minister has ushered in a new era for the Haitian government. Haiti hasn’t had a fully staffed government since national elections were held almost a year ago. This week’s approval of a 17-member Cabinet will hopefully bring an end to the reconstruction delays as many donors who promised aid have been reluctant to deliver it without a central government.

FOREIGN ASSISTANCE

 The Budget Control Act of 2011 and Global Health: Projecting the Human Impact of the Debt Deal (The Foundation for AIDS Research, October 14, 2011)
This new analysis by amFAR examines the human impact of projected FY’13 budget cuts. The analysis projects that proportional reductions in foreign assistance would have minimal impact on deficit reduction, while costing thousands of lives. Funding for programs like the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) must be protected in order to continue offering life-saving treatment to millions of existing patients. These budget estimates will remain approximations until the 12- member Joint Select Committee on Deficit Reduction or “super committee” announces their recommendations in November. 

Innovative Financing Mechanisms for Global Health: Overview & Considerations for U.S. Government Participation (Josh Michaud and Jen Kates)
Have you ever wondered what exactly people are referring to when they speak of “innovative financing mechanisms”? In this report, researchers from the Kaiser Family Foundation summarize and categorize the 31 most prominent innovative financing mechanisms - including a Financial Transaction Tax (FTT), which is attracting unprecedented attention in advance of the G-20 Summit. Authors find that the US government is more likely to support some “mixed” public-private innovative financing mechanisms, and least likely to support those that require upfront, multi-year funding commitments or changes in US tax policy. Innovative financing mechanisms are increasingly critical to supplementing existing funding mechanisms for global health and development.

No Time to Get Stingy (Carol Giacomo, New York Times, October 8, 2011)
If the US House of Representatives budget prevails, foreign aid could suffer another $2 billion in cuts in 2012, in addition to the 11 percent cuts ($6 billion) made in 2011. These cuts would severely affect four areas of the foreign aid budget – food aid, global health, development, and USAID operating funds. The funds garnered from slashing poverty-focused programs would be a tiny share of the federal budget, but would drastically upset America’s foreign policy by reducing resources that encourage nonmilitary solutions for global health, development, and democracy movements.

NON-COMMUNICABLE DISEASES

Youth Manifesto on Non-Communicable Diseases (Sandeep Kishore, Karen Sigel, Aria Ahmad, et. al, Global Heart, August 31, 2011)
Young people are mobilizing worldwide to reverse the growing burden of non-communicable disease (NCDs). This document calls for governments, civil society organizations, development agencies, and the global health community to reduce the burden of NCDs by 20% over the next ten years by following seven key recommendations. These include: re-framing NCDs as a barrier to development; acting on the social determinants of health; tackling NCDs across the life-span; investing in interdisciplinary health education; enabling global access to essential drugs and technologies; adopting innovative financing for NCD prevention and control; and developing a common, community-led vision for equitable global development. PIH stands in solidarity with the Youth Manifesto on NCDs, and will continue working to ensure that the poorest billion people are included in the movement to reverse deaths and disability from chronic disease.

HIV/AIDS     

HIV/AIDS Overseas Budget to Be Cut By Almost a Third (Mark Tran and Claire Provost, The Guardian, October 4, 2011)
The United Kingdom’s Department for International Development (DFID) announced in October that it will drastically reduce funding for global HIV/AIDS programs by 2015. The 32% reduction reflects an 85% decrease in DFID’s budget for AIDS programming in Asia and a 17% decrease in Africa. Now that turning the tide on one of the most serious public health crises of our time is finally within reach, the necessity of increased, rather than decreased, funding for the fight against HIV/AIDS cannot be understated.

 ***Use of Hormonal Contraceptives and Risk of HIV-1 Transmission: A Prospective Cohort Study (Renee Heffron, Debroah Donnell, Helen Rees, et. al, Lancet, October 4, 2011)
This recently published study was conducted to establish whether hormonal contraception increases the risk of women acquiring HIV. Among 3790 couples (1314 in which the female was HIV positive, 2476 in which the male was HIV positive), the transmission rates were twice as high in women who used hormonal contraceptives. With more than 140 million women worldwide using hormonal contraception, these results emphasize the need for couples to use condoms to prevent HIV transmission. Multilateral institutions, like the World Health Organization and the United Nations Population Fund, are analyzing the methods and results of this study. Partners In Health is also studying these results to determine if program changes are needed.

TUBERCULOSIS

Global Tuberculosis Control 2011 (World Health Organization, October 2011) + Tuberculosis on the Decline For the First Time Ever (UN News Centre, October 11, 2011)
The sixteenth global report on tuberculosis (TB) finds that, for the first time ever, the number of people contracting TB each year is declining. The ability to continue making this progress relies on continued funding for TB and multidrug-resistant TB (DR-TB) infection control, detection and treatment activities. In 2010, there were approximately 650,000 people living with MDR-TB--the vast majority of whom lack access to appropriate treatment. Insufficient progress on MDR-TB highlights the crucial need for continued attention and funding for TB and MDR-TB programs globally.

MATERNAL MORTALITY
House Advances Bill to Stop Funding UN Women’s Health Program (Laura Bassett, Huffington Post, October 5, 2011)
Last week, the US House of Representatives passed a bill to halt US dues to the United Nations, including the United Nations Population Fund (UNFPA). UNFPA works to reduce maternal mortality, prevent HIV/AIDS, and provide family planning to the most vulnerable populations across the world; this bill is part of a larger effort among House Republicans to cut US funding for family planning and the United Nations. Though it is unlikely that this bill will ever become a law, Congress should be more concerned with improving the capacity of health systems in poor countries than political culture wars.

MULTIMEDIA AND ADDITIONAL RESOURCES

This Is Maya (World Bank, September 19, 2011)
Watch a short video on the importance of knowledge, resources, and people working together to create strong health systems for healthy populations and “a million crying babies”.

“Peanut Butter Medicine” Giving Hope to Haiti’s Hungry (Gary Strieker, CNN, October 11, 2011)
Poverty and a lack of access to healthy food are the main causes of malnutrition. For many children who have severe acute malnutrition in Haiti, ready-to-use therapeutic food (RUTF) can alleviate the immediate consequences and restore health. Though RUTF is malnutrition critical tool in the fight against child malnutrition, prevention is the best medicine for acute and chronic malnutrition.

Haiti Cholera Update (Partners In Health, Fall 2011)
The first case of Haiti’s raging cholera epidemic was discovered one year ago. The deadly epidemic continues to rage, with infections spiking in the rainy seasons, though funding has not kept pace with the spread of the disease. At the one-year mark, Partners In Health is making a big push to raise awareness and funds to continue fighting cholera. Please watch this video to learn more about our efforts to combat this epidemic.

Free live streaming by Ustream

Join us for a discussion with PIH co-founder Dr. Paul Farmer and Rev. Gustavo Gutierrez on "Re-imagining Accompaniment: Global Health and Liberation Theology" at 7pm EDT on Monday, October 24th. 

Gutierrez is known around the world as the founder of liberation theology, which interprets Christianity in terms of a liberation from unjust economic, political, or social conditions. “Fr. Gustavo is one of my heroes and has inspired much of my own work in global health with a preferential option for the poor,” says Farmer. 

"Poverty is not fate, it is a condition; it is not a misfortune, it is an injustice," Gutierrez is known for saying. "It is the result of social structures and mental and cultural categories, it is linked to the way in which society has been built, in its various manifestations." The Monday discussion will focus on these ideas, and how they can be applied to Global Health. 

The event is hosted by the Kellogg Institute for International Studies, and will be broadcast live on the player above, starting at 7pm EDT on October 24, and online at: http://kellogg.nd.edu/livestream. 

Peruvian-born Gutierrez is the John Cardinal O'Hara Professor of Theology at Notre Dame University and a Kellogg Institute Faculty Fellow.

A medical anthropologist and physician, Farmer is Kolokotrones University Professor at Harvard University, chair of the Department of Global Health and Social Medicine at Harvard Medical School, and UN Deputy Special Envoy for Haiti.

Learn more. 

By Nina Skagerlind, PIH-Lesotho Summer Intern

An estimated 31,000 people suffer the daily effects of diabetes in Lesotho, a small mountainous country in southern Africa.

In the developed world, non-communicable diseases (NCDs) — including diabetes, heart disease, and lung cancer — are often associated with unhealthy and sedentary lifestyles, conditions associated with affluence and excess. This is not the case in Lesotho, or for roughly a billion of the world’s poorest people. Nearly all cases of diabetes diagnosed at PIH-Lesotho's (PIH-L) eight health facilities result from malnourishment or sudden changes in eating habits, conditions directly associated with poverty.

If left unchecked, the WHO estimates that Africa will have the highest relative increase of people living with diabetes by the year 2020.

The health impact of living in mountain communities

In Lesotho, all patients receive free, comprehensive care when they visit a PIH-L clinic or hospital.

In Lesotho, poor nutrition is a major contributor to the development of diabetes. The rough, often snow-covered terrain makes sustainable farming nearly impossible for much of the year. Families lack the fruits and vegetables essential to a healthy diet. The primary staple diet for the majority of people living in rural Lesotho is a boiled corn meal, known as papa, heavy in carbohydrates which exacerbates diabetes.

Though the exact causes of diabetes are still unknown, we know the disease blocks sugar from leaving the bloodstream and feeding the body's cells. The best defense is achieved by maintaining consistent blood sugar levels, allowing for maximum glucose absorption. When sugar levels drop dramatically — as they do when someone suddenly stops eating, or is malnourished for a period of time — the body is even less able to feed its cells.

In a country where small villages are isolated by steep mountains, health education in most communities is scarce at best. People who know that diabetes exists often have no knowledge of its causes, symptoms — frequent urination and blurred vision — or effects, explains Sophie Motsamai, PIH-L's monitoring and evaluation manager.

If left untreated, diabetics are at risk of developing glaucoma, numbness of extremities, and heart disease, all of which can be fatal for people lacking easy and reliable access to medical facilities. 

A comprehensive approach to treatment

To respond to the diabetes problem, PIH-L has created a comprehensive approach to treating diabetes in Lesotho, similar to its approach to treating infectious diseases like tuberculosis and HIV. The clinical team integrates diabetes detection and treatment into all regular checkups and outpatient visits — one of many components of a comprehensive health system. And PIH-L's network of mountain clinics brings access to these services to many remote villages and communities.

As with services at all PIH facilities, diabetes treatment is free of charge. Once detected, patients receive medicine and training about eating habits and nutrition. Physicians and nurses meet regularly with patients for health checkups and blood-sugar measurements. Because caring for diabetes requires daily vigilance, community health workers are available to meet regularly with patients experiencing difficulties between clinic visits.

Beyond offering medical services, patients living with the disease are often provided with food or given the tools to garden — a crucial step in addressing the root cause of diabetes.

A similar approach is also being used to treat diabetes at other PIH sites, including PIH-supported health facilities in Rwanda. 

Learn how IH integrates NCD care into routine check-ups at each of its 60 facilities.

One burden among many

Adding to the burden of HIV/AIDS and TB — diseases infecting upwards of 25 percent of adults in Lesotho — non-communicable diseases like diabetes present an added layer of challenges to the public health system. With public hospitals overburdened by the fight against communicable diseases, poor people are too often left to fight NCDs on their own.

Fortunately, the plight of patients suffering from NCDs in developing countries is gaining global attention. In September 2011, the United Nations will hold a High-Level Meeting (HLM) on the prevention and control of NCDs.  

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A video showing how PIH’s Maternal Mortality Reduction is working to save the lives of women and children in the rural mountains of Lesotho.

In the tiny African nation of Lesotho, an alarming number of women – 1 in 48 – die during childbirth. Even minor complications often become life-threatening conditions, primarily due to the lack of basic medical care. 

PIH’s Maternal Mortality Reduction Program at Bobete Health Center has trained 100 maternal health workers (MHWs) to accompany pregnant women living in remote villages surrounding Bobete for treatment during their pregnancies and for safer deliveries. During the first year of the program, deliveries at Bobete Health Center rose 350 percent. PIH has trained over 650 MHWs across its 7 rural clinics and at the PIH-supported hospital in Mamohau.

Learn more about PIH’s work in Lesotho.

“The smell was overwhelming,” recalled Dr. Ruth Damuse. “Many of the women waiting for breast exams covered their faces, some actually left the clinic.”

“There was a woman, she was by herself. I took her into the exam room and lifted her shirt,” continued Dr. Damuse. “Her left breast was gone. Cancer had eaten it. All that was left was a large, open infection.”

During the course of that visit, Dr. Damuse, who heads up PIH’s oncology program in Haiti, learned that her patient’s cancer had been growing for at least a year — slowly eating her breast until nearly nothing remained. Living far from the nearest health center and unsure what to do, the patient, Patricia, had regularly packed the wound with mixtures of herbs and leaves in hopes that these holistic remedies would combat the infection.

“Breast cancer is one of the most common cancers we’re seeing in Haiti,” reported Dr. Damuse. Her observation is supported by statistics. Breast cancer affects more women in Haiti than any other cancer. Roughly 831 out of every 100,000 women are diagnosed each year — this in a country where few women have access to regular medical care. And although breast cancer is often treatable when it is caught early, most women in Haiti only come to a clinic when something is noticeably wrong — often when the disease is quite advanced, said Dr. Damuse. The actual breast cancer rate is likely much higher.

Since starting a weekly breast cancer clinic in June 2011, Dr. Damuse has diagnosed some strikingly advanced cases of breast cancer. Patricia’s case was the most complex that she’d seen — an arresting reminder of the work that remains to be done, from basic education to healthcare access.

PIH and its Haitian sister organization Zanmi Lasante (ZL) are working to address this dire issue. With generous support from the Avon and Lance Armstrong Foundations, they began scaling up the oncology program earlier this year.

Since starting this work neraly a year ago, ZL's breast cancer clinic at Clinique Bon Sauveur in Cange, Haiti, has served hundreds of women. Each week, Dr. Damuse performs approximately 40 exams. Of the women tested, 3-4 are diagnosed with cancer weekly. 

As of April 2012, ten patients are receiving chemotherapy for breast cancer, and an additional 30-40 are on a drug called Tamoxifen, a drug that slows the growth of new cells in the breast. ZL staff perform 2-4 operations on women with breast cancer each week. That number increases to roughly 10 operations a week when visiting surgeons assist in the clinic.

	Zanmi Lasante clinicians learning how to give breast exams at a recent training.

A little knowledge can save women’s lives

“The people living in the Central Plateau don’t know cancer,” she said. “It’s not a word they know. People living in Port-au-Prince might know what cancer is; people working in health care know. That’s it.”

In response to the need for better education, Dr. Damuse, working collaboratively with ZL’s women’s health, community outreach and training teams, has trained a cadre of community health workers (CHWs) about breast cancer. CHWs are ZL's most effective strategy against a wide range of health challenges because they work and often live in the community with patients.

Once trained to recognize the symptoms of breast cancer, community health workers will be a crucial step in identifying and treating the disease.

Dr. Damuse is also holding breast cancer trainings and refresher courses for clinicians at all ZL sites. Dr. Damuse uses a breast exam torso — a life-size replica — to demonstrate where growths might occur and how they might feel. She encourages doctors and nurses to teach women how to check for signs and symptoms related to breast cancer.

Though Haiti has one of the highest breast cancer rates in the Western Hemisphere, just a handful of cancer-focused doctors serve a population of 10 million people. Dr. Damuse hopes that by training ZL staff to more effectively and regularly screen for breast cancer, more women will receive life-saving care and early detection screenings.

Diagnosis and treatment of a complex disease in rural Haiti

If a woman has an unusual lump or swelling, Dr. Damuse will perform a biopsy. ZL staff in Cange — working in a room just yards away — quickly inspect and diagnose the extracted cells. More complex tissue samples are either sent to a laboratory in Port-au-Prince or to Boston’s Brigham and Women’s Hospital for further analysis.

Biopsy results may take anywhere from a few hours to a few weeks. Dr. Damuse uses the time to explain to each patient what breast cancer is and what it can do to her body.

For women whose cancer results are positive, ZL provides chemotherapy and surgery in Cange. “It takes a month, six weeks at most to complete the work-up for a cancer patient: initial diagnostic tests, biopsy-surgery, results of pathology studies,” said Dr. Damuse.

Because Dr. Damuse is an internist, not an oncologist, she relies on colleagues in the U.S. for training, feedback and advice. “We work with an oncologist at Dana-Farber Cancer Institute who helps to triage our patients in Haiti,” said Dr. Damuse. “We have a weekly call with her to discuss the current cases, to establish treatment plans.”

This year, surgeons at Cange have either removed lumps or performed mastectomies on 80 women — about four a week. Roughly 75 percent of surgeries result in total mastectomies. However, ZL lacks the resources for reconstructive surgery.

Little can be done for cases of advanced cancer that require more than surgery and chemotherapy. Radiation therapy is not yet a part of Haiti’s health infrastructure. For women with advanced cancer, Dr. Damuse works closely with ZL’s psychosocial support team to offer palliative care and pain management.

Patricia’s prognosis is still uncertain. She has been prescribed antibiotics and pain medicine, which Dr. Damuse reports are working. Once her infection subsides, the ZL team will have a better understanding of how far Patricia's cancer has spread and what next steps will need to be taken. 

The future of PIH/ZL cancer services

Though they did not train specifically to treat cancer, Dr. Damuse and her team are serving as one of the strongest — if not the only — cancer clinics offering free services at a hospital in Haiti.

“In Haiti, access to cancer care is limited and only people who can pay will receive it,” said Dr. Damuse. The few private oncologists located in Port-au-Prince charge for their services. In Haiti few people can afford that expense.

Though the challenge seems daunting, this is only the beginning of ZL’s cancer initiative. Dr. Damuse recently added two fulltime nurses and a social worker to her team. Beyond helping Dr. Damuse keep the clinic running, this small staff provides psychological support, organizes surgeries and coordinates care outside of the clinic.

The oncology program is slated to move from Cange to ZL’s new state-of-the-art Mirebalais Teaching Hospital in late 2012.

Until then, Dr. Damuse will continue providing breast cancer services to women one at a time — screening and caring for girls, mothers and grandmothers across Haiti’s Artibonite and Central Plateau Departments.

Learn more about PIH’s work in Haiti, and Mirebalais Teaching Hospital.

The Health Show on BBC News recently featured two segments on Butaro Hospital, a facility built and supported by Partners In Health and the Rwandan government.

The first segment shows how the new state-of-the-art facility includes many innovative features that reduce infections and promote healing. The hospital has also helped to strengthen the local community. Watch this segment on BBC's website. 

The second segment focuses on the impact of the hospital in the community. In 2008, there was just one doctor serving 350,000 people in Rwanda’s Burera district, and the district's health statistics were among the worst in the country. "There wasn't any district hospital. People used to travel long distances," says Emmanuel Kamanzi, District Project Manager for PIH's Rwandan sister organization Inshuti Mu Buzima. The new hospital is now a central pillar of a public health system that serves the entire community.

In this segment, one of the hospital's first patients shares her story — and the story of the first baby born at the new hospital. Watch this segment on BBC's website.

(For viewers in the UK or who are unable to watch the segments on the BBC site, they can also be watched here and here.)

Staff from PIH's Rwandan sister organization, Inshuti Mu Buzima, recently shared the following story with our Boston office. It's an inspiring example of how it often requires more than medicine alone to heal patients.

	Saphine, an HIV patient in Rwanda, sells fish in a local market.

Although HIV positive, Saphine was able to prevent transmitting the disease to her son, thanks to medical services and antiretroviral medicines that she received free of charge from a PIH-supported hospital in rural Rwanda.

However, after the birth of her son, it became clear to staff from Inshuti Mu Buzima, PIH’s Rwandan sister organization, that Saphine had other challenges that were affecting her and her children's health. She lived in terrible housing, had no job, had been abandoned by her husband, and had no means of supporting herself or her family.

Through generous donations from PIH supporters, a new house was built for Saphine and her family.

She was also provided with a microgrant, which she used to start a small business selling produce in the local market. She’s now generating enough income through her new business to help feed and support her family. 

Learn more about PIH's work in Rwanda.

For Immediate Release

July 17, 2012

Media Contacts: Kria Sakakeeny, 617-998-6541 (ksakakeeny@pih.org) or Andrew Marx (amarx@pih.org)

First National Cancer Referral Center in Rural East Africa Opens in Rwanda on July 18

President Bill Clinton, The Government of Rwanda, NASCAR’s Jeff Gordon, Partners In Health’s Paul Farmer, and Dana-Farber Cancer Institute’s Larry Shulman to Inaugurate the Butaro Cancer Center of Excellence

BOSTON and BUTARO, Rwanda – On July 18, 2012, the Ministry of Health of the Republic of Rwanda, Partners In Health, the Jeff Gordon Children’s Foundation and the Dana-Farber/Brigham and Women's Cancer Center will inaugurate the Butaro Cancer Center of Excellence, which will serve as the first national cancer referral facility in rural Rwanda. President Clinton, who helped bring together this partnership through his Clinton Global Initiative, will inaugurate the Center, on the same site at which he laid the cornerstone for Butaro Hospital in 2008.

 The Center, located within Butaro Hospital in northern rural Rwanda, is a critical element of Rwanda’s ambitious five-year plan to introduce cancer prevention, screening and treatment on a national level.  The facility’s opening will mark a major milestone as the first center of its kind to bring comprehensive cancer care to rural East Africa.  

“Just a few years ago we had no system or financing mechanism to diagnose and treat AIDS in Africa. People said it was too expensive or too complicated. But today nearly 7 million people in developing countries are receiving treatment for HIV. We can do the same with cancer,” said Paul Farmer, co-founder of Partners In Health and chair of Harvard Medical School’s Department of Global Health and Social Medicine.

 Rwanda has a population of nearly 11 million people -- and not a single Rwandan oncologist. Childhood cancers like acute lymphoblastic leukemia, which has an 80 percent cure rate in the United States, are a virtual death sentence for children in Rwanda. The Cancer Center of Excellence aims to address both existing resource limitations and the growing global cancer burden. The World Health Organization expects 16 million new cancer cases worldwide by 2020, with 70 percent in developing countries like Rwanda. The Butaro Cancer Center of Excellence will provide a full spectrum of cancer care including screening, diagnosis, chemotherapy, surgery, patient follow-up, and palliative care. It will also serve as the first facility to implement standardized cancer training and protocols that align with Rwanda’s new national guidelines.

WHO:  

President William J. Clinton, Founder of the William J. Clinton Foundation and 42nd President of the United States of America

Honorable Minister Dr. Agnes Binagwaho, Rwanda Minister of Health

Jeff Gordon, four-time NASCAR champion, founder of Jeff Gordon Children’s Foundation

Dr. Larry Shulman, Chief Medical Officer, Dana-Farber Cancer Institute

Dr. Paul Farmer, PIH co-founder, Chair of Harvard Medical School's Department of Global Health and Social Medicine

WHAT: Opening ceremony of Butaro Cancer Center of Excellence at Butaro Hospital in Rwanda’s Northern Province, Burera District.

WHEN: WEDNESDAY, July 18, 2012 

RSVP:  To arrange interviews, secure photographs or to attend the event, please contact Kria Sakakeeny at ksakakeeny@pih.org, 617-998-6541 or Andrew Marx at amarx@pih.org.

About Partners In Health: PIH is a global health organization relentlessly committed to improving the health of the poor and marginalized. We build local capacity and work closely with impoverished communities to deliver high quality health care, address the root causes of illness, train providers, advance research and advocate for global policy change. Ninety-four percent of the funds we raise go to our programs in the ten countries where we work, including Haiti, Rwanda, Russia, Peru and the United States. For more information please visit www.pih.org.

About the Clinton Global Initiative: Established in 2005 by President Bill Clinton, the Clinton Global Initiative (CGI) convenes global leaders to create and implement innovative solutions to the world’s most pressing challenges. CGI Annual Meetings have brought together more than 150 heads of state, 20 Nobel Prize laureates, and hundreds of leading CEOs, heads of foundations and NGOs, major philanthropists, and members of the media. To date CGI members have made more than 2,100 commitments, which are improving the lives of nearly 400 million people in more than 180 countries. When fully funded and implemented, these commitments will be valued at $69.2 billion.

 CGI’s Annual Meeting is held each September in New York City. CGI also convenes CGI America, a meeting focused on collaborative solutions to economic recovery in the United States, and CGI University (CGI U), which brings together undergraduate and graduate students to address pressing challenges in their community or around the world. For more information, visit clintonglobalinitiative.org and follow us on Twitter @ClintonGlobal and Facebook at facebook.com/clintonglobalinitiative.

About the Jeff Gordon Children’s Foundation: The Jeff Gordon Children’s Foundation was established as a non-profit 501(c)(3) organization in 1999 by the four-time NASCAR Cup Series champion. The
Foundation supports children battling cancer by funding programs that improve patients’ quality of life, treatment programs that increase survivorship, and pediatric medical research dedicated to finding a cure.

The Foundation also supports the Jeff Gordon Children’s Hospital in Concord, NC, which serves children in the community by providing a high level of primary and specialty pediatric care. We are proud to support a quality health care facility dedicated to compassionate care and medical excellence for children.

About the Dana-Farber/Brigham and Women's Cancer Center: the Center is the integration of one of the world’s leading cancer institutes with one of the world’s leading hospitals, creating one Center and one clinical team with a unique combination of resources to fight and defeat cancer. Through our 12 specialized treatment centers, we offer the most advanced treatment with the compassion and care that makes all the difference.

For Immediate Release

March 20, 2012

National Conference on Social Medicine to be held in Port-au-Prince, Haiti

March 28-29, 2012

Partners In Health/Zanmi Lasante joins Faculté de Médecine et de Pharmacie de l’Université d’Etat d’Haïti and the Groupe Promoteur de Médicine Sociale (GPMS) to host session March 28-29, 2012

Keynote speakers include: Partners In Health Co-Founder Paul Farmer, Partners In Health Chief Medical Officer Joia S. Mukherjee, and Gladys Prosper, MD, Dean of the Faculté de Médecine et de Pharmacie de l’Université d’Etat d’Haïti

PORT-AU-PRINCE, Haiti – In partnership with the Faculté de Médecine et de Pharmacie de l’Université d’Etat d’Haïti and the Groupe Promoteur de Médicine Sociale (GPMS), Partners In Health and its sister organization in Haiti, Zanmi Lasante, will hold The National Conference on Social Medicine on March 28-29 in Port-au-Prince. The conference will highlight opportunities to strengthen Haiti’s public health sector with insights and policies informed by the field of social medicine, which focuses on understanding how social and economic conditions impact health, disease, and the practice of medicine.

The conference, which will take place at the Hotel Karibe's convention center, will provide an interactive forum to exchange and share effective strategies for health care delivery, as well as the education and training of medical professionals who address the health needs of populations living in resource-poor communities. Bringing together key stakeholders and experts in global health and development, the conference aims to promote the exchange of views and shared lessons and experiences in health care delivery, foster dialogue on approaches to build capacity of the public health system in resource-limited settings, encourage partnerships, and develop innovative approaches to health systems strengthening.

Confirmed speakers at the conference include distinguished experts in the field of health and development, policymakers and sector leaders, such as keynote speakers: Paul E. Farmer, MD, PhD, Co-Founder of Partners In Health, Kolokotrones University Professor, Harvard University and Chair of the Department of Global Health and Social Medicine, Harvard Medical School, Joia S. Mukherjee, MD, MPH, Chief Medical Officer, Partners In Health and Associate Professor, Department of Global Health and Social Medicine, Harvard Medical School, along with distinguished guest speaker Gladys Prosper, MD, Dean of the Faculté de Médecine et de Pharmacie de l’Université d’Etat d’Haïti.

Discussion sessions will bring together experts in the field of global health to inform the curriculum of medical education geared towards improved training and retention of health professionals in resource-poor settings and within Haiti’s public health system. The objective of these sessions is to focus on the social determinants of health and to improve medical education and training in a social context.

For Participants: To register online, or view additional information about the National Conference on Social Medicine, please visit: www.pih.org/haiticonf. For questions regarding the conference, please contact: haiticonf@pih.org.

For Media: The conference will be open to the media. Members of the media must register beforehand via: www.pih.org/haiticonf or please contact: haiticonf@pih.org. Members of the media must be registered in advance to cover the conference.

About PIH: PIH works in 10 countries around the world to provide quality health care to people and communities devastated by joint burdens of poverty and disease. PIH and its Haitian partner organization, Zanmi Lasante, have been providing vital health care services in Haiti for more than 25 years and are the largest health care providers in the country, working with the Haitian Ministry of Health to deliver comprehensive health care services to a catchment area of 1.2 million across the Central Plateau and the Lower Artibonite Valley. PIH/ZL had 5,000 staff in Haiti before the January 12 earthquake. For more information please visit www.pih.org/haiticonf.

For Immediate Release

October 19, 2011

Media Contacts: Kria Sakakeeny, 617-998-6541 (ksakakeeny@pih.org) 
Meredith Eves, 617-998-8945, (meves@pih.org)

Dr. Paul Farmer, Dr. Louise Ivers and Ms. Donna Barry Call for Integrated Approach to Slow Haiti’s Year-Long Cholera Epidemic, Including Introduction of Cholera Vaccine

BOSTON – Dr. Paul Farmer, a co-founder of Partners In Health (PIH) and Chair of the Department of Global Health and Social Medicine at Harvard Medical School, Dr. Louise Ivers, Senior Health and Policy Advisor to PIH, Assistant Professor of Medicine, Harvard Medical School and Associate Physician, Brigham and Women’s Hospital, and Donna Barry, NP, MPH, PIH Director of Policy and Advocacy hosted a press conference call today to discuss the cholera epidemic in Haiti one year after the outbreak. Dr. Farmer, Dr. Ivers and Ms. Barry discussed the urgent need for an integrated response which includes: 1) scaling-up efforts to aggressively identify and treat all those with cholera 2) improving access to clean drinking water and strengthening Haiti’s sanitation infrastructure, and 3) rolling out the safe, affordable and effective oral cholera vaccine, Shanchol.

In one year, cholera has killed over 6,500 Haitians and nearly half a million have been treated for the disease (roughly 5% of the country’s population). Cholera has killed more people in Haiti in one year than it did in all the other countries in the world combined in 2010. Since the start of the outbreak, PIH has mobilized its extensive network of community health workers, nurses and physicians to treat more than 75,000 patients. PIH now operates 12 cholera treatment facilities, and has hired and trained 3,378 community health workers to identify and treat cases of cholera and conduct aggressive public hygiene education campaigns. PIH psychosocial and mental health teams have also counseled and conducted memorial services for more than 4,000 families affected by cholera-related illness or death.

Cholera is well on its way to becoming endemic in Haiti, and, in the absence of a comprehensive and integrated response, cases will continue to rise and fall according to seasonal patterns. 

Listen to a recording of the October 19 media call on the player below:

Download audio file [7 MB]

Please see below for key quotes:

Dr. Paul Farmer on need for integrated approach to controlling the cholera epidemic:
“What we're calling for, a year into the epidemic, is a prompt integration of these prevention and care and treatment measures, including: chlorinated water at the household or village level, hand washing and hygiene measures, building up systems that haven't previously had them, improved case-finding, treating with oral rehydration salts and finally integration of oral cholera vaccine.”

Dr. Paul Farmer on Haiti’s water insecurity:
“Some years ago, PIH and many sister organizations began talking about the right to water. We did so because those of us who are clinicians, we can sit in our clinics and work in our hospitals and wait for people to come in sick with complications of water-borne diseases, or we can work with public authorities and appropriate NGO partners and others to build real water security in Haiti. We've been sounding that drum for some years now.”

Dr. Paul Farmer on aid agencies leaving Haiti:
“There's been this steady erosion of support, people coming in and leaving, it's been ADD of humanitarian work, it's just so short term. But we're not there for the short term, our partners are Haitian, we work with the Ministry of Health, our organization is really fundamentally a Haitian organization. And we, unable to retreat to some other activity or some other place in the world, are now probably putting in a half million dollars a month into cholera”

Dr. Paul Farmer on need to increase production of cholera vaccine:
“This entire debate should sound familiar... [because there were] the same discussions around HIV. The failure of imagination regarding price and this fetishized cost -- that it had to cost $10,000 per patient per year [for HIV], which was absurd at the time, because it’s not as if these drugs or the vaccines were made out of platinum... they could easily be manufactured, and the same plunge in prices with the increased demand, we expect to see that with cholera vaccine, and that of course will help us to have a global vaccine stock pile”

Dr. Louise Ivers on PIH cholera cases and aid agencies leaving Haiti:
“We've seen over 75,000 cases of cholera [in PIH-supported facilities] alone, that doesn't include cases that been seen in the communities. Between October 2010 and early January 2011, we had a lot of support from other collaborating organizations that were responding to the epidemic; however, since late winter/early spring of this year, we've seen most of those organizations either move to other parts of the country or stop their cholera treatment activities.“

Dr. Louise Ivers on introducing a safe, effective proven cholera vaccine:
“We are planning to vaccinate about 100,000 Haitians with a vaccine called Shanchol. We're planning on that number because 200,000 doses is the currently available number of vaccine doses, and we'll be working on this project in collaboration with GHESKIO, as well as with the Haitian Ministry of Health. The campaign planning is already underway, including stakeholder meetings and meetings w/ local communities involved in the vaccination campaign to ensure that we can have a communications campaign that really makes sense to explain to everybody involved what the vaccine is, how effective it is, what it means form them, and also for people who don't receive the vaccine, to understand why that might be so at this time.  And our intention is that this would just be the beginning of a larger national campaign to include cholera vaccination as part of national protocols to control the epidemic.”

For Immediate Release
July 7, 2011

Media Contact:  Kria Sakakeeny, 617 998 6541 (ksakakeeny@pih.org) 

Poor progress means multidrug-resistant tuberculosis continues to spread and cost lives
Efforts to revamp international response to MDR-TB not enough

New York/Geneva 7 July, 2011 – The global response to help countries scale up treatment of multidrug-resistant tuberculosis (MDR-TB) is underfunded and ineffective, according to a new report released today by three medical and medical advocacy organisations. A 20-month effort to reform the Green Light Committee Initiative, a World Health Organization (WHO)-hosted programme designed to help countries gain technical support for scale up of MDR-TB and access to quality-assured MDR-TB drugs, needs to be closely monitored to see if the reforms will address many key bottlenecks.

The report – issued by Médecins Sans Frontières (Doctors Without Borders, or MSF), Partners In Health (PIH) and Treatment Action Group (TAG) –identifies why efforts and progress to scale-up treatment for MDR-TB have been so sluggish. Over the past ten years, an estimated five million new cases of MDR-TB have occurred, with one and a half million lives lost.

“We found that a lack of urgency and commitment from governments is a major stumbling block”, said Javid Syed, TB/HIV Project Director at TAG. “Many affected governments appear to be in no hurry to address the serious treatment needs of this devastating disease, and this is impeding efforts to identify new MDR-TB cases. Donors are not making TB overall a priority and almost all of the major donors we contacted were unable to tell us how much of their funding was directed at DR-TB diagnosis and treatment. Besides funding, many countries will need global and regional support to build their capacity to diagnose and treat MDR-TB.”

Unpredictable and expensive drug supplies also contributed to the poor scale-up of treatment. The report – which looked at the MDR-TB treatment programmes of India, Russia and South Africa – also found that countries were prone to drug shortages and stock-outs, at both a national and international level – with serious consequences for patients. The price of certain key second-line anti-TB drugs – most off-patent and many more than 50 years old – has increased over the last ten years.

“There are just too many barriers to scale-up at the country level, such as the high price of second-line drugs”, said KJ Seung, Clinical Manager of PIH-Lesotho. “Countries know they need to address MDR-TB, but with the high price of medications and lack of laboratory capacity they are often unable to scale up programmes. International support mechanisms need to be more efficient and effective at helping address these barriers.”

But the report states that the guidance and support given by such international support mechanisms falls far short of what is needed. It highlights three support mechanisms: the Green Light Committee (GLC) which monitors and assesses the progress of country MDR-TB treatment programmes; the Global Drug Facility (GDF) which supplies drugs to programmes approved by the GLC; and the Global Laboratory Initiative (GLI) which supports countries in setting up new diagnostic services for TB. All of these mechanisms are hosted by the WHO.

The report findings show that countries, the GLC and GDF were not able to complement national efforts appropriately; barely 0.6% of the five million new MDR-TB patients over the last decade were treated through GLC-supported programmes. It also concluded that the GLI, though driven by laudable goals, was not transparent about what it had accomplished and was unable to provide data, making it impossible to evaluate its performance.

“The old GLC mechanism was no longer suited to help countries scale up treatment programmes”, said Dr Tido von Schoen-Angerer, Executive Director for MSF’s Campaign for Access to Essential Medicines. “The recent effort to reform the GLC has resulted in creating more committees, which I doubt will help countries and certainly do not address many of the bottlenecks that countries are facing.”

Listen to a recording of the July 7 media call on the player below:

Download audio file [44 MB]

For further information, please contact:

Joanna Keenan, MSF +41 79 203 13 02
Kria Sakakeeny, PIH +1 617 998 6541
Javid Syed, TAG +1 646 373 8801

The report An Evaluation of Drug-Resistant TB Treatment Scale-Up can be accessed at www.msfaccess.org, and summarises progress and challenges in MDR-TB scale-up in India, Russia and South Africa, provides an evaluation of the effectiveness of global initiatives to support scale-up, and summarises the available data on donor commitments to scale up. 

Médecins Sans Frontières (MSF) is an international emergency medical relief organization that provides direct medical assistance in over 70 countries world-wide. In 2010, MSF supported the treatment of over 25,000 TB patients across 28 countries.

Partners In Health (PIH) is an organization dedicated to providing comprehensive health care to disadvantaged populations in twelve countries around the world, including MDR-TB care in Haiti, Peru, Russia, Kazakhstan, Rwanda, Malawi and Lesotho.

The Treatment Action Group (TAG) is an independent AIDS research and policy think tank fighting for better treatment, a vaccine, and a cure for AIDS. TAG works to ensure that people with HIV receive lifesaving treatment, care, and information. TAG’s programs focus on antiretroviral treatments, HIV basic science and immunology, vaccines and prevention technologies, hepatitis, and tuberculosis. 

For Immediate Release

June 1, 2011

Media Contacts:   Meredith Eves, 617-998-8945, (meves@pih.org)
                                 Andrew Marx, (amarx@pih.org)

In a viewpoint article published on May 31st in the open-access journal PLoS Neglected Tropical Diseases, a coalition of medical and public health researchers, policymakers, and practitioners, led by Paul Farmer, cofounder of Partners In Health and Chair of the Department of Global Health and Social Medicine at Harvard Medical School, argue that a universal vaccination campaign is essential to ending the cholera epidemic in Haiti.

PLoS announced the publication of the article with the following press release. The link to the full viewpoint article is at the bottom of the press release.

Public release date: 31-May-2011
Contact: PLoS Press, press@plos.org
Public Library of Science

PLoS NTDs press release -- cholera in Haiti
Cholera's challenge to Haiti and the world

Debate about the public health response to Haiti's cholera epidemic continues as the crisis enters its ninth month, with some experts arguing that a vaccination campaign in Haiti would be neither feasible nor cost-effective, and advocating putting forth other measures. In a viewpoint article published on May 31st in the open-access journal PLoS Neglected Tropical Diseases, a coalition of medical and public health researchers, policymakers, and practitioners, led by Paul Farmer, cofounder of Partners In Health and Chair of the Department of Global Health and Social Medicine at Harvard Medical School, argue that a universal vaccination campaign is essential to ending the crisis.

Before last October, cholera had never been reported in Haiti. Even after the January 2010 earthquake, the U.S. Centers for Disease Control and Prevention (CDC) and other public health authorities deemed it "very unlikely to occur." Largely because Haiti's population was "immunologically naïve," initially the outbreak exhibited a 7 percent case-fatality rate – among the highest recorded in recent history. In "Meeting Cholera's Challenge to Haiti and the World: A Joint Statement on Cholera Prevention and Care," the 44 authors maintain that "vaccination has a significant role to play in Haiti given the vulnerability of the post-earthquake health, water, and sanitation systems and the observed virulence of the El Tor strain…the MSPP (Haitian Ministry of Public Health) has called for nothing less than a universal vaccination campaign—an end goal this document endorses."

There are currently fewer than 400,000 vaccine doses ready for shipment but the authors assert that "advance purchase commitments could increase availability to several million. Past experience underscores the value of publicly-ensured purchases…. such funding can boost production, lower prices, and expand vaccine access." Furthermore, the authors argue that economies of scale contribute to lower production costs, as observed during the scale-up of antiretroviral therapy for HIV/AIDS. Scaling up efforts in Haiti would also create momentum to prevent similar vaccine shortages during future outbreaks.

As a first step in the vaccination campaign, Farmer and coauthors recommend that WHO endorse the development of a two million dose stockpile for Haiti, coupled with a large-scale demonstration in Haiti comparing the effectiveness of cholera control efforts with – and without – mass vaccination. "If this demonstration were deemed successful," they write, "we would suggest the production of cholera vaccine be ramped up to develop a global stockpile of 10 million doses."

Haitians are especially susceptible to cholera infection because of several factors, including the large numbers of people left homeless and displaced by the earthquake that have been living in rural areas or large rural slums, where the epidemic has been most severe. "These communities were charged with hosting hundreds of thousands of displaced people after the earthquake, placing greater demands on their already-scarce resources, including water," write Farmer and his coauthors. However, a cholera vaccination campaign could leverage existing health worker networks without taking doctors and nurses away from the provision of acute care.

Financial Disclosure: No specific funding was received for this work.

Competing Interests: The authors have declared that no competing interests exist. The views and opinions contained in this paper reflect those of the authors alone and should in no way be construed to represent the official position of any organization or agency for which they work or to which they belong.

Disclaimer

This press release refers to an upcoming article in PLoS Neglected Tropical Diseases. The release is provided by the article authors. Any opinions expressed in these releases or articles are the personal views of the journal staff and/or article contributors, and do not necessarily represent the views or policies of PLoS. PLoS expressly disclaims any and all warranties and liability in connection with the information found in the releases and articles and your use of such information.

Media Permissions

PLoS Journals publish under a Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/), which permits free reuse of all materials published with the article, so long as the work is cited (e.g., Kaltenbach LS et al. (2007) Huntingtin Interacting Proteins Are Genetic Modifiers of Neurodegeneration. PLoS Genet 3(5): e82. doi:10.1371/journal.pgen.0030082). No prior permission is required from the authors or publisher. For queries about the license, please contact the relative journal contact indicated here: http://www.plos.org/journals/embargopolicy.php

Read the full viewpoint article published on May 31st in the open-access journal PLoS Neglected Tropical Diseases: http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0001145
 

For Immediate Release
April 23, 2011

Media Contacts:   Meredith Eves, 617-998-8945, (meves@pih.org)
                                 Andrew Marx, (amarx@pih.org)

PIH Statement: Political Violence in Belladere

Partners In Health (PIH) and Zanmi Lasante (ZL) are deeply concerned about the insecurity in Belladere and elsewhere in Haiti and strongly condemn recent acts of violence. Beyond causing pain to our staff and the community we serve, these events have disrupted our ability to provide critical health care services to communities in the Belladere area. We call upon Haitian authorities to maintain security in the region to ensure that the people of Belladere and the surrounding communities have continued, uninterrupted access to health care. Moreover, we urge partisans to respect the neutrality of PIH and ZL in the political process.

Immediately following the publication of the second round legislative elections results late on April 20, violence erupted in Belladere where ZL has worked with the Ministry of Public Health and the local community since 2003. In the early hours of April 21, arson claimed the life of a beloved colleague Phyzeme Isly, who worked to provide health care to the people of the region for nine years. Other ZL staff and their family members were also wounded in the attacks.

In advocating for access to free services for the poorest and most vulnerable communities in Haiti, PIH and ZL work with the Government of Haiti to strengthen the public health care sector, in close partnership with affected communities and other local partners. While we work with democratically-elected officials and their appointed officials of the government, PIH/ZL neither participates in the electoral process, nor affiliates with any political party. Despite the recent acts of violence that have occurred, we remain committed to serving our communities in an impartial manner.

About PIH: PIH is an international medical organization committed to improving the health of the poor and marginalized. PIH challenges the standards of what’s acceptable – and raises the standards of what’s possible – in some of the world’s poorest communities through a model of research, service and training. We work with local and international partners to increase life expectancies by providing people access to modern medicine, strengthening public health systems, and addressing the root social and economic causes of poor health and disease: lack of access to clean water, healthy food, stable housing, education and economic opportunity. PIH works in 11 countries around the world. 

For Immediate Release
February 23, 2011

Dr. Paul Farmer,  Dr. Agnes Binagwaho and Dr. Gene Bukhman to discuss how to tackle non-communicable diseases in the world’s poorest populations.

Listen to a recording of the February 23 media call on the player below:

BOSTON – On a press conference call this afternoon, Dr. Paul Farmer (co-founder of Partners In Health and Kolokotrones University Professor at Harvard), Dr. Agnes Binagwaho (Permanent Secretary of the Rwandan Ministry of Health) and Dr. Gene Bukhman (Director of the Program in Global Non-communicable Disease and Social Change at Harvard Medical School) discussed why treating non-communicable diseases in resource-poor countries must be a global health priority. On the call, they shared examples from Rwanda and other developing countries that prove prevention and treatment of NCDs among the poor is possible, affordable, and can be effectively integrated into a comprehensive strategy that strengthens public health systems.

The call took place in advance of a conference next week (March 2-3), The Long Tail of Global Health Equity: Tackling the Endemic Non-Communicable Diseases of the Bottom Billion at the Joe Martin Conference Center on the Harvard Medical School campus. At that conference, experts are gathering to focus on how to address a collection of important, but rarely discussed diseases of the poorest populations: endemic non-communicable disease.

Several key quotes are listed below, and the full audio of the call is available above. If you are interested in attending the free NCDs conference next week, please contact Meredith Eves at meves@pih.org or 617-998-8945. The full conference proceedings will also be streamed on the web.

Dr. Gene Bukhman on importance of tackling NCDs: “Until recently, it’s been perceived that these disease are very difficult to tackle in the poorest countries. The needs are enormous. There’s an enormous burden of highly prevalent conditions like HIV, diarrheal disease, children continue to die at a high rate before age 5, women die in childbirth, and there’s been a question about how possible in the midst of that it is to address this collection of diseases, which are more complex perhaps, and less prevalent individually, but for which there are amazing interventions. Because of the focus (this year) on NCDs globally, this is an opportunity to gather together and focus the world’s attention on how it’s possible, now more than any other time in human history to be able to reach the poorest people in the world who have these conditions and who deserve interventions for prevention and treatment and palliation as a human right.”

Dr. Agnes Binagwaho on service delivery: “Infectious disease will not account for all of [Rwanda’s] morbidity and mortality. Our service delivery still has several gaps as non-communicable disease, which probably accounts for about 35% of the national burden of disease, according to the WHO, has yet to be addressed in a systematic way…Non communicable diseases are often considered the problem of middle and high-income countries. I want to stand strongly against that…. In general, non-communicable diseases in our country are linked to malnutrition, infection… and lack of access to health care…We need to identify and find the right set of integrated strategies… to prevent and treat non-communicable diseases in a holistic manner. It is very important because infectious disease, chronic disease and non-communicable diseases hurt the same members of our community and also the service will be delivered to them by the same health professionals in the same health centers…We can do a lot if we focus on those things  and everything it is not costly. There are some parts of the program that are costly. But we have to ask ourselves, 'What is the moral cost of doing nothing.' ”

Dr. Paul Farmer on health system strengthening: “You can use a vertical programs like an AIDS program or even a cardiac surgery program to strengthen health systems. For example: A good cardiac surgery program would improve the quality of surgical care in general. Not just for one disease… Better operating rooms, better supply chains, better trained surgeons…Let’s use these vertical programs to strengthen health systems in general…If you look at cervical cancer, if you have a good vaccination program, that you use to vaccinate for polio, to prevent polio, measles, or tetanus, it is a delivery system for the cervical cancer vaccine, Gardasil. And so we’re trying to use this principle also to drive forward our advocacy work as well as to why it’s important to take on these neglected NCDS.”

The March 2-3 conference is hosted by Harvard Medical School, Partners In Health, the Brigham and Women’s Hospital, the Harvard School of Public Health, the Harvard Global Equity Initiative, the Global Task Force on Expanded Access to Cancer Care & Control in Developing Countries, and the NCD Alliance. The meeting will bring together experts about conditions such as rheumatic heart disease, Burkitt’s lymphoma, malnutrition-associated diabetes, and the respiratory impact of household fuels. The conference will also feature leaders in global health financing and individuals with experience treating non-communicable and infectious disease among the world’s poorest people. Speakers include Paul Farmer, Dean Jamison, K. Srinath Reddy, and Peter Hotez.

About PIH: PIH is an international medical organization committed to improving the health of the poor and marginalized. PIH challenges the standards of what’s acceptable – and raises the standards of what’s possible – in some of the world’s poorest communities through a model of research, service and training. We work with local and international partners to increase life expectancies by providing people access to modern medicine, strengthening public health systems, and addressing the root social and economic causes of poor health and disease: lack of access to clean water, healthy food, stable housing, education and economic opportunity. PIH works in 11 countries around the world.  

For Immediate Release
February 18, 2011

Dr. Paul Farmer,  Dr. Agnes Binagwaho and Dr. Gene Bukhman to discuss how to tackle non-communicable diseases in the world’s poorest populations

BOSTON – Dr. Paul Farmer (co-founder of Partners In Health and Kolokotrones University Professor at Harvard), Dr. Agnes Binagwaho (Permanent Secretary of the Rwandan Ministry of Health) and Dr. Gene Bukhman (Director of the Program in Global Non-communicable Disease and Social Change at Harvard Medical School) will hold a press conference call on Wednesday, February 23, 2011 at 4:00PM EST to discuss the need to include the needs of the world’s poorest people in the broader discussion about non-communicable diseases (NCDs). The call is in advance of a March 2-3, 2011 conference, The Long Tail of Global Health Equity: Tackling the Endemic Non-Communicable Diseases of the Bottom Billion at the Joe Martin Conference Center on the Harvard Medical School campus. The UN General Assembly will host a high-level session on non-communicable diseases (NCDs) in September 2011.

The UN session will take place largely because of the advocacy of middle-income countries, and preparations for it have so far focused almost exclusively on their concerns about NCDs that are largely the result of eating too much, exercising too little, and consuming tobacco and alcohol. Little attention and few resources have been devoted to the very different NCDs that account for approximately one quarter of disease among people who survive on less than $1 day (the so-called “Bottom Billion”). On the call, Drs. Farmer, Binagwaho and Bukhman will discuss why treating NCDs in resource-poor countries must be a global health priority. They will also share examples from Rwanda and other developing countries that prove prevention and treatment of NCDs among the poor is possible, affordable, and can be effectively integrated into a comprehensive strategy that strengthens public health systems.

The March 2-3 conference is hosted by Harvard Medical School, Partners In Health, the Brigham and Women’s Hospital, the Harvard School of Public Health, the Harvard Global Equity Initiative, the Global Task Force on Expanded Access to Cancer Care & Control in Developing Countries, and the NCD Alliance. The meeting will bring together experts about conditions such as rheumatic heart disease, Burkitt’s lymphoma, malnutrition-associated diabetes, and the respiratory impact of household fuels. The conference will also feature leaders in global health financing and individuals with experience treating non-communicable and infectious disease among the world’s poorest people. Speakers include Paul Farmer, Dean Jamison, K. Srinath Reddy, and Peter Hotez.

Who: Paul Farmer, MD, PhD
          Co-founder, Partners In Health,
          Kolokotrones University Professor, Harvard University
        Agnes Binagwaho, MD, PhD,
          Permanent Secretary, Ministry of Health, Republic of Rwanda
        Gene Bukhman, MD, PhD, 
          Assistant Professor of Medicine, Harvard Medical School,
          Director, HMS Program in Global Non-communicable Disease and Social Change 

What:   Press conference call to discuss the need to increase focus on non-communicable diseases among the world’s poorest populations 

When:  4PM EST, Wednesday, February 23, 2011

RSVP:   If you are interested in joining the call or attending the conference, please contact Meredith Eves at meves@pih.org or 617-998-8945

DIAL IN: Domestic: 1 (888) 771-4371 International: 1 (847) 585-4405  Passcode: 29137860

About PIH: PIH is an international medical organization committed to improving the health of the poor and marginalized. PIH challenges the standards of what’s acceptable – and raises the standards of what’s possible – in some of the world’s poorest communities through a model of research, service and training. We work with local and international partners to increase life expectancies by providing people access to modern medicine, strengthening public health systems, and addressing the root social and economic causes of poor health and disease: lack of access to clean water, healthy food, stable housing, education and economic opportunity. PIH works in 11 countries around the world.  

For Immediate Release
January 5, 2011

Partners In Health’s Ophelia Dahl, Joia Mukherjee and Ted Constan Discuss Situation in Haiti
Anniversary of January 12 Earthquake Is Next Week

“January 12 is a time for a reflection on some positive progress, but it’s also a time to renew the international commitment to solving these problems. If more effort isn’t made they could be around for generations.”
     – Ted Constan

BOSTON – Ophelia Dahl, PIH’s Co-founder and Executive Director, Dr. Joia Mukherjee, PIH’s Chief Medical Officer, and Ted Constan, PIH’s Chief Program Officer will hosted a press conference call today to discuss the situation on the ground in Haiti, a week before the one year anniversary of the January 12, 2010, earthquake.  

Dr. Mukherjee will be in Haiti from January 10 to January 16 and will be available for media interviews while she is there.

Listen to a recording of the January 5 media call on the player below:

Download the MP3 recording of the media call [15 MB].

Please see below for key quotes from the press call:

On working in Haiti following the earthquake: “We're very very proud of the work we've done, and yet we're humbled by the need that remains. The work that we've done has been highlighted by our very strong partnership with the Ministry of Health in Haiti, and the provision of healthcare in now 15 public facilities, as well as our charity hospital in Cange – where we're serving hundreds of thousands of people. Probably 1.5 million Haitians get their healthcare from facilities supported by PIH and the Ministry of Health. We have also engaged thousands of new Community Health Workers. Prior to the earthquake we had a staff of about 4,000; now that number is around 5,500. We've made significant progress in building the teaching hospital in Mirebalais and are on track to open that sometime in 2012. We have also focused our work around the needs of people wounded and affected by the earthquake, including augmenting and improving on mental health services," said Dr. Joia Mukherjee.

On conditions in "tent cities" of displaced people and creating possibilities for them to relocate: Clearly for us the biggest problem out there is the million displaced people and their living conditions. As we start to see sexual violence, at horrific levels existing in the camps, as we see a lot of political infighting around any kind of solution for finding places for folks to live, we begin to join in a chorus of impatience being expressed towards the response. A big part of this solution is jobs – we need to think about getting money down into the communities to produce jobs for people because that’s the only way people are going to get on their feet economically. We’d like to see more of a pull policy being generated  around the getting people out of the campscamps. Solutions that pull people out of the camps – markets, jobs, health care, clean water, stable housing, etc. Rather than what we fear is people being pushed out of their piece of sanity that they’ve made for themselves. We’d like to see more of a pull policy being generated Instead, what we’re afraid we’ll see is people pushed from the small piece of sanity that they’ve found in the camps,” said Ted Constan.

On cholera vaccine and antibiotics: “The cholera vaccine has been effective in two areas in epidemics in Africa and elsewhere. One way is protecting people, obviously. But the second way is through herd immunity, because the oral vaccine is live – and so you don’t have to vaccinate the entire population as well. This is also how the Polio vaccine works. The shortage of the vaccine is the usual economic milieu, which is: the majority of people who would use such a vaccine are not from countries which could easily pay for the vaccine. So part of what we're doing in our advocacy is to find companies able to make the vaccine at large scale, and to secure funding which would guarantee that there would be a market for that vaccine through a donor, then we think we could get enough vaccine to at least focus on the most vulnerable – people living in slums; in camps; children - toward achieving herd immunity. Antibiotics are probably less controversial than has been portrayed – they definitely work in severe cholera and also in moderate cholera, and they work in two important ways (that are) life-saving. We are advocating a much more aggressive approach to the use of antibiotics, rather than only focusing it on severe cholera. We feel we should do everything, in terms of the solutions,” said Dr. Joia Mukherjee.

On the need for coordination among organizations: “It is indeed a mess and something has to be done about it.There has to be, in the future, a way to co-ordinate the NGOs in Haiti – its been done in Rwanda very effectively, with accountability and goals attached to the presence of the NGOs there.. Haiti has 10 000 charities and NGOs working in that relatively small country - I think only India has more,” said Ophelia Dahl.

About PIH: PIH works in 11 countries around the world to provide quality health care to people and communities devastated by joint burdens of poverty and disease. PIH has been providing vital health care services in Haiti for more than 20 years and is the largest health care provider in the country, working with the Haitian Ministry of Health to deliver comprehensive health care services to a catchment area of 1.2 million across the Central Plateau and the Lower Artibonite Valley. PIH had 4,400 staff in Haiti before the January 12 earthquake. Visit www.pih.org for more information.

For Immediate Release
January 4, 2011

Partners In Health’s Ophelia Dahl, Joia Mukherjee and Ted Constan to Discuss Situation in Haiti
Anniversary of January 12 Earthquake Is Next Week

BOSTON – Ophelia Dahl, PIH’s Co-founder and Executive Director, Dr. Joia Mukherjee, PIH’s Chief Medical Officer, and Ted Constan, PIH’s Chief Program Officer will hold a press conference call on Wednesday, January 5, at 2PM EST to discuss the situation on the ground in Haiti, a week before the one year anniversary of the January 12, 2010, earthquake. Dr. Mukherjee will be in Haiti from January 10 to January 16 and will be available for media interviews while she is there.

On the call, Ms. Dahl, Dr. Mukherjee, and Mr. Constan will discuss the cholera situation; the expansion of medical services at PIH’s 15 sites outside of Port-au-Prince; PIH’s ongoing efforts to work with the Haitian Ministry of Health to rebuild the public health and health education systems, including work underway to construct a 320-bed, state-of-the art teaching hospital in Mirebalais; and PIH’s efforts to provide care for 100,000 internally displaced people living in four spontaneous settlements in the capital city. PIH is currently executing a 2.5-year Stand With Haiti plan to help Haiti build back better. We released the $125 million plan less than a month after the earthquake.

The January 12, 2010 earthquake leveled Port-au-Prince, killing more than 230,000 in a matter of minutes and leaving 1.5 million homeless. The disaster gripped the attention of the United States for months – more than half of all American households donated to relief and rebuilding efforts. We anticipate renewed interest in the situation on the ground as the anniversary of the earthquake approaches.

Who:  Ophelia Dahl, Co-founder and Executive Director
          Dr. Joia Mukherjee, Chief Medical Officer
          Ted Constan, Chief Program Officer

What: Press conference call to discuss the situation in Haiti, one week before the anniversary of the January 12 earthquake.

When: Wednesday, January 5 at 2PM

RSVP: To RSVP contact Meredith Eves at meves@pih.org or 617-998-8945

DIAL:   Dial In: 1-800-640-0097 International Dial In: 1-847-944-7321 Passcode: 28764541

About PIH: PIH works in 11 countries around the world to provide quality health care to people and communities devastated by joint burdens of poverty and disease. PIH has been providing vital health care services in Haiti for more than 20 years and is the largest health care provider in the country, working with the Haitian Ministry of Health to deliver comprehensive health care services to a catchment area of 1.2 million across the Central Plateau and the Lower Artibonite Valley. PIH had 5,000 staff in Haiti before the January 12 earthquake.

For Immediate Release
Friday, December 10

Media Contacts:   Meredith Eves, 617-998-8945, (meves@pih.org)
                                 Andrew Marx, (amarx@pih.org)

Drs. Paul Farmer, Louise Ivers and Fernet Léandre Call for a Change in Strategy and Increased Resources to Slow Cholera Outbreak in Haiti and Beyond in Press Conference Today

Article published in The Lancet calls for five specific interventions

BOSTON – Dr. Paul Farmer, a co-founder of Partners In Health (PIH) and Chair of the Department of Global Health and Social Medicine at Harvard Medical School, Dr. Louise Ivers, PIH’s Chief of Mission in Haiti and Assistant Professor of Medicine at Harvard Medical School, and Dr Fernet Léandre of PIH’s Haitian partner organization, Zanmi Lasante, hosted a press conference call today to discuss the cholera outbreak in Haiti and call for a more aggressive and comprehensive strategy to combat the disease.

Listen to a recording of the December 10 media call on the player below:

Download the MP3 recording of the media call.

Please see below for key quotes from the press call:

Key quotes:

Treatment of Cholera Outbreak with Antibiotics and Vaccine: “We wrote this piece in an effort to improve the quality of discussion about what could and should be doing in Haiti to slow down the cholera outbreak.  We want to raise the bar.  In our view, treatment of cholera in Haiti must be much more aggressive – more specifically, rehydration alone without antibiotics is not adequate for even moderate cases of cholera.  We are arguing for antibiotics for all who are showing cholera symptoms. It is important that we bring a vaccine into the mix as a complimentary tool as well,” said Dr. Paul Farmer.

Availability of Vaccine: “Based on our discussions with experts, there are potentially 2 million doses of the cholera vaccine available.  In the face of a regional, long-standing epidemic, it does not seem too much to ask to start ramping up that effort to make available significantly more doses of vaccines.  I would have expected more engagement on some of these tough logistic questions – how do we have the vaccine, how do we distribute it, make it more available, etc,” said Dr. Paul Farmer.

Status of Cholera Outbreak in the IDP Camps: “We are providing health care in three camps for internally displaced people in Port-au-Prince, including one of the largest camps, Parc Jean-Marie Vincent, with more than 51,000 people.  We started to see sporadic cases turn up in this camp as Hurricane Tomas passed but now we are seeing a steady stream of patients and we’ve established a 50-bed cholera treatment unit (CTU).  Interestingly, many of the patients are coming from outside of the camps, from the neighboring slums.  The water and sanitation situation in the camps remains dire; in Parc Jean-Marie Vincent there are 200 latrines for 51,000 people, which means the vast majority of people are using buckets or just an open area in the corner of the camp and there remains a very high risk of the further spread of the disease in the camps and elsewhere,” said Dr. Louise Ivers.

Challenge of Cholera Outbreak in Remote Rural Communities: “We are seeing more and more cases in mountain areas, remote areas where it can often take more than 10 hours to reach them. People in these communities lack access to health care, to clean water and sanitation. They cannot be reached by ambulances. The key to reaching them is strengthening the network of community health workers, who have enormous solidarity value in responding to an outbreak of a stigmatized disease and educating communities on water, sanitation, and prevention. It is very important to reinforce water and sanitation in rural areas, besides building latrines to discourage people from dr

Loune Viaud receives her honorary degree from Penelope Glynn, Dean of Nursing and Health Professions, and Regis's newest President, Antoinette Hays.

On October 5, during the inauguration of new Regis College President Antoinette M. Hays,  Loune Viaud, co-Executive Director for Zanmi Lasante, PIH’s sister organization in Haiti, added a doctorate of law to her resume. 

The honorary degree, conferred on her by Regis College in Massachusetts, was the latest example of the close partnership that has blossomed between Partners In Health, Zanmi Lasante and Regis College. This past summer, Regis began a Master’s of Nursing Program for Haitian nurses at its Boston campus.

Lisa Lynch, Loune Viaud and Antoinette Hays.

Viaud’s accomplishments are long. She pioneered Central Haiti’s first women’s health center, and has implemented several women’s literacy projects, a scholarship program for girls and a gender-awareness curriculum for training health care personnel. She received a Peace and Justice Award from the Cambridge Peace Commission in 2000, RFK Center’s Human Rights and Advocacy Award in 2002 and has been honored by many communities in Haiti over the years.

“Regis’s nursing community is invested in Haiti, and in developing long-term partnerships with other health care organizations that view health care as a basic human right,” Viaud said.

Watching the day’s events was Maude Duvilier, former director of nursing at the Haitian Ministry of Health and the National Nursing School in Haiti, Ėcole Nationale des Infirmières. The National Nursing School collapsed during the January 2010 earthquake, killing nearly all of the second-year class of nursing students. Duvilier’s presence highlights the important role Regis plays in Haiti’s reconstruction efforts.   

Also in attendance was Natacha Jean, the first MDR-TB patient treated in Cange who is now attending ESL classes at Regis College, with the hope of continuing her nursing studies there as well.

Loune Viaud, Natacha Jean and Antoinette Hays.

Joey Adler, founder of the nonprofit organization ONEXONE, a long-time partner of PIH, commemorated Viaud’s honorary degree by making a donation to start a preschool at Zanmi Beni, a home for abandoned and physically and developmentally disabled children on the outskirts of Port-au-Prince. One of PIH’s proudest accomplishments after the earthquake, Zanmi Beni – “blessed friends” in Haitian Creole – provides refuge and support for 50 children.

Viaud was instrumental to Zanmi Beni’s founding, and spends a significant amount of time working with the children living there. 

Viaud and PIH cofounder Paul Farmer plan to name the preschool “Kay Olivier Alexandre” in remembrance of little Olivier, son of Zanmi Lasante nurse-midwife Claudine. Olivier died in April 2011 in Belladères.

The collaboration between Partners In Health, Zanmi Lasante and Regis College will continue to flourish in the coming years. Over the next two years, the twelve nursing professors from various Haitian institutions – Université Notre Dame, Ecole Nationale des Infirmières de Pap, Jerémie, Cap Haitien and Cayes – who began their studies this summer will continue their training at Regis College and Haiti’s Universite Notre Dame over the next two years.

Once the Mirebalais Teaching Hospital that PIH is constructing in central Haiti opens in 2012, Regis College will help in training Haiti’s next generation of nurses.

Community members perform skit about the importance of caring properly for children orphaned by HIV/AIDS.

By Robbie Flick, Health Programs Coordinator, Malawi

The atmosphere is one of celebration. Giant speakers play festive songs while brightly dressed dancers sing and stomp in unison on a wide stage. Young children and their parents dance in the space below, their arms carving wide, rhythmic arcs while scents of nsima (cornmeal) and roasted goat fill the air.

The celebration is one of life and health here at the Neno Community Support Initiative (NCSI), a PIH-sponsored event that brings together a community in rural Malawi that has been heavily burdened by the AIDS epidemic. But it’s also a community of strength and resilience.

The event opens with community members sharing their stories, stressing the importance of getting tested and treated for HIV.

	A famous local singer performs at the Neno Community Support Initiative.
	Children enjoying the Neno Community Support Initiative.

“My village thought I would surely die,” one woman says, “but thanks to the drugs I receive, I can stand before you today.”

The MC, a dynamic volunteer named Felix, hops on stage to draw the analogy between the spread of HIV and the spread of a wildfire. To demonstrate, he asks a community member to venture into the crowd and shake hands with two people. The three then each shake hands with two more. After several rounds, Felix calls all of the “infected” to the stage. Half the community marches forward – a visceral lesson.

Presentations and skits follow, punctuated by upbeat music, dancing, and poetry. Discussions cover a number of health-related topics, including how to make your own fertilizer and how to prevent mother-to-child transmission of HIV, which are followed by a song about preventing typhoid. A skit about the importance of caring for children orphaned by HIV is followed by another promoting the vocational schools provided by the community-based organizations that PIH supports – schools that provide vulnerable members of the community with marketable skills. The event finishes with a Q&A session with health experts to help answer specific questions from the community.

But a small shed off to the side of the stage houses perhaps the most powerful component of this event. For four hours, a steady stream of men, women, and children have been filtering in and out. They are getting tested for HIV; all tests are optional, offered at no cost, and are accompanied with counseling from trained staff. Those who are moved by the support and encouragement radiating from the event can simply walk over, get a quick finger prick, and have results in 15 minutes.

Events like NCSI epitomize PIH’s approach to addressing the root causes of disease in places like Malawi. By empowering community members to run the event and fostering a celebratory and supportive atmosphere, NCSI reduces the stigma of HIV and other illnesses, evidenced by the dozens of individuals getting tested for the first time. It supports positive living and gives practical lessons – delivered by community members – on how to do so. Perhaps most importantly, it provides a venue for individuals to get together to support each other and to work together in solidarity towards building a healthier community.

Community members put on a skit to promote HIV awareness at the Neno Community Support Initiative.

A community health worker with a patient in rural Malawi.

By Jenna LeMieux, PIH Director of Programs

	Construction on Neno District Hospital in 2007.
	Training community health workers.

When I began working for Partners In Health in January of 2007 as a program manager, I thought I had a good sense of the scope and responsibilities of the position I had accepted. I was to help launch the new PIH-supported site in Malawi, Abwenzi Pa Za Umoyo (APZU). I spent about two months in Boston before I moved to Malawi, and during that time was able to make valuable connections to colleagues with expertise in finance, procurement, and human resources. Little did I know how valuable those connections would become. 

Looking back now, I am amazed by the complexity and volume of work that awaited our team. I had no idea how varied and lengthy my “to-do” list would be. Partnering with the Ministry of Health, we wanted to immediately begin supporting and improving the care available to patients in Neno District. We set to work on substantial renovations at several health centers, with the goal of providing dignified and well-equipped settings in which patients could receive care. We began planning for the construction of a brand new, two-story district hospital. And we began constructing 26 housing units for the Ministry of Health staff and ourselves.

We hired cleaners, guards, nurses, cooks, and administrative staff. We worked with Village Headmen to identify community health workers. We partnered with local community-based organizations to understand grassroots activities already taking place to educate people about HIV transmission and prevention, and to understand how we could support those activities. We established relationships with hospital equipment and supplies vendors in the nearest large city, and began to renovate a large building that would serve as a warehouse.

Our long list of goals was informed and shaped by my colleagues at PIH who had engaged in similar start-up activities in Rwanda and Lesotho, among other places. Their collective experience and wisdom guided our work, and helped us prioritize among a dozen urgent and competing demands. When I first began working in Neno, I was fortunate to have access to individuals who could answer the dozens of questions I had on a daily basis. Their advice and counsel was invaluable, and the Program Management Guide represents our effort to share that collective experience with others.

My work in Neno was supported by a robust network of experienced professionals willing to offer their time and expertise to help guide our work. Those same individuals have pored over this guide, adding the content and stories, sharing their knowledge and advice, which is rooted deeply in PIH philosophy and based on decades of field experience. We hope it will serve as a practical and useful tool for program managers, and for others engaged in this work around the globe. 

Check out PIH's new Program Managment Guide.

Malawi's Neno District Hospital today.

“We believe in an accompagnateur approach – it’s French for “to accompany,’’ said Dr. Heidi Behforouz, founder and director of PIH’s Prevention and Access to Care and Treatment (PACT) program in a recent Boston Globe interview. “Our community health workers walk with individuals, as they experience life with poverty and illness. You can’t really deliver good care unless you understand and are willing to accommodate the whole context of the individual.” 

Read Heidi’s October 3 Globe interview in its entirety.

“What we found is that 70 percent of the patients referred to us have tremendous improvements in health outcomes: return to work, regain custody of their children, we see their immune systems improving,” continued Heidi. “When we did an analysis of total medical costs in 70 patients for whom we had two years of data, we saw a 60 percent reduction in hospitalizations and 35 percent reduction in total medical expenditures. This model has been proven effective.”

Watch Heidi explain the goal in attending this year’s Clinton Global Initiative meeting.
Learn more about PACT.

NASCAR's Jeff Gordon blogs about his recent visit to see PIH's work to fight cancer in Rwanda.

Jeff Gordon at Butaro Hospital in Rwanda. ©Jeff Gordon, Inc.

By Jeff Gordon

NASCAR driver Jeff Gordon recently visited Rwanda with his family and staff from the Jeff Gordon Children's Foundation. His foundation is supporting PIH's efforts to fight cancer in poor, rural communities. An excerpt from his travel journal is posted below. Read his full entry on the Jeff Gordon Children's Foundation website.

Day 3:

We had a two and a half hour drive up a bumpy and hilly dirt road to Rwinkwavu. Rwinkwavu is a public hospital that is supported by Partners In Health, which is the organization that the Jeff Gordon Children’s Foundation has partnered with for our efforts in Rwanda. The landscape and topography of Rwanda is absolutely beautiful, and the view from the hospital in Rwinkwavu is amazing. We toured the grounds before going to the pediatric cancer wing to visit with the children.

	Jeff Gordon's daughter Ella hands a Promise Circle quilt to a patient. ©Jeff Gordon, Inc.

Prior to the trip, the women of The Promise Circle (an amazing group of women who support the Jeff Gordon Children’s Foundation) sewed nearly 100 handmade quilts that we took with us to give out while we were there. Ella helped Ingrid, Trish (Director of the Jeff Gordon Children’s Foundation) and I pass out the quilts to both the children and their mothers. I’ve never been more proud of anything in my life. To see our 4-year old daughter go through the room and give out these quilts with such compassion and tell each of them, ‘I hope you feel better’, is something that makes you so proud as a parent.

On our return trip, we stopped at an oncology patient’s home. She was 14 years old and had been successfully treated at the Rwinkwavu hospital for Burkitt’s Lymphoma, (a form of pediatric cancer). Previously, she had a large tumor growing on the side of her face. With the proper treatment that was made available through Partners In Health and their supporting partners, she is doing very well and has made a considerable recovery. Stories like this are what inspire me to continue our work in Rwanda.

Watch Francine's Story.

Day 4:

Our second full day in Rwanda began early as we set out on a four hour car ride to the city of Butaro on some of the roughest and most treacherous roads I’ve ever seen. Butaro is a high elevation, rural city that is within one of the most densely populated districts of the country. The Ministry of Health hospital in Butaro is also supported by Partners In Health. The facility was recently completed in February of 2011. While the facility is beautiful, they still lack some of the equipment and treatment needed to properly care for patients with some cancers and other diseases.

Rwanda is the most densely populated country in Africa. It is comparable in size to the state of Maryland and has a population of 11 million people. Out of 11 million people, the entire country has only one doctor that is a cancer specialist. This is where the Jeff Gordon Children’s Foundation, Partners In Health and the Ministry of Health of Rwanda will work together to construct a pediatric cancer center that will provide preventative care and treatment.

Once we arrived at Butaro, we ate lunch and were entertained by some of the locals who performed traditional dances. It was great, and yes they did get me out there with them. No, I didn’t show them any break dancing moves.

The level of care at Butaro is definitely more advanced than at other healthcare facilities in the country, but we still faced the realities of cancer rampant among the children at Butaro. We were once again able to provide some of the children and mothers with quilts from The Promise Circle which brought a smile and joy to their faces if only for a moment. I wish I could put into words how much it moves you when you are knelt down in front of a sick child battling cancer and you see the pain and hurt in their eyes. You know in your heart that it just isn’t right and that we have to do something about it.

	Jeff Gordon and Dr. Lawrence Shulman of Dana Farber Cancer Institute chat with a patient. ©Jeff Gordon, Inc.

We were accompanied on our trip by Dr. Larry Schulman who is the Chief Medical Officer at the Dana Farber Institute and a leading oncologist. He said something that I still hear ringing in my ears, “Jeff, the stark truth is that if any of us died and were not here tomorrow, there would be plenty of others in the United States who could help provide cancer care to children there. They can get along fine without me or help from people like you and your foundation. But, if we weren’t here tomorrow helping inRwanda, there is no one e lse. There is no one else currently helping to provide cancer care and treatment here in Rwanda. If we don’t help these children, they die.”

Read the full journal entry on the Jeff Gordon Children's Foundation website.

Dr. Lawrence Shulman with Jeff Gordon with his wife and daughter during their visit to Rwanda. ©Jeff Gordon, Inc.

Recent trainings give health workers new tools to bring family planning services to their communities.

Community health workers at a family planning training in Rwanda.

By Celia Reddick

Giggling ran through the classroom. It was an odd scene in rural Rwanda. Mothers and their infant babies, well-dressed older men, and young women in veils stared at the plastic models of penises in front of them. One by one, each of them practiced putting condoms onto the donated props, part of a recent training collaboration between PIH’s Rwanda-based Community Health and Training Departments.

This training on family planning dovetails with the Rwandan Ministry of Health (MOH)’s priorities. The MOH is taking an active approach to family planning, encouraging all women of childbearing age to consider contraceptive methods. In addition, the MOH is working to make contraceptives available at rural health centers, and through community health workers serving their communities throughout Rwanda.

	PIH training manuals were used at the community health worker training.
	Participants at a family planning training demonstrate the proper way to put on a condom.

These efforts address a growing issue in Rwanda. The small country in eastern Africa is home to an estimated 11 million people, and is the most densely populated country on the continent. Nearly 50 percent of Rwanda’s population is under the age of 14, and the average Rwandan family has as many as five children, putting a strain on already limited resources.

In the past few months, many community health workers have received MOH trainings on modern family planning methods, learning how to give contraceptive injections and how to discuss various contraceptive pills with women. In collaboration with PIH’s Community Health Department in Rwanda, PIH’s training team organized its training to align with the MOH’s work.

At a recent PIH training held at Ruramira Primary School in southern Kayonza, facilitators guided participants through a lively discussion of human rights and family planning.“Family Planning is connected to human rights, because it is the right of a child to have access to education and health care,” said one community health worker, adding that large families make realization of this right impossible. “Family Planning is a woman’s human right, because having many children can be very dangerous to her health. She and her husband must understand this,” added a facilitator.

After learning how to demonstrate the proper way to put on a condom (using the plastic props), the participants requested their own supplies so they could hold similar demonstration sessions in their communities.

These family planning trainings are just one part of PIH’s larger effort to improve the quality of community-level services. In the coming month, community health worker supervisors will use observation checklists (developed in partnership with PIH’s Rwanda-based Monitoring and Evaluation Department) to assess the impact of these trainings on community health worker home visits. And in the past two months, community health workers have received PIH-developed trainings in Reproductive Health (focusing on the health of a pregnant woman and her fetus), Nutrition, and PMTCT (Prevention of Mother to Child Transmission of HIV). High-quality participatory learning activities in support of MOH national initiatives have the potential to transform community-based health interventions. With training and support from PIH, hundreds of community health workers are now better-equipped to lead the charge.

Celia Reddick serves as the Curriculum and Training Specialist for Partners In Health in Rwanda.

In late September, volunteer linemen from the National Rural Electrical Cooperative (NRECA) hailing from Arkansas, traveled to Haiti for 10 days to help install and upgrade the electrical transmission lines at the Mirebalais National Teaching Hospital.

The crew improved the electrical transmission lines from the hydroelectric dam at Peligré to the center of Mirebalais, and ran new overhead transmission wires from the town’s center to the Hospital.

NRECA and EdH crews worked together, bringing powerlines both to Mirebalais Hospital and the surrounding community.

Over the ten days spent at Mirebalais Hospital, the joint team of NRECA volunteers and Haitian linemen erected poles, repaired damaged lines and strung new lines from the center of Mirebalais all the way to the hospital.

They also ran underground lines onsite and connected a 13,000-volt cable to the hospital’s transformer, which now supplies permanent power to the campus. Within the next 6 weeks, NRECA plans to send a small crew of volunteers back to do some final adjustments and modifications to the transmission lines to further improve the quality and consistency of electricity at the hospital.

Part of the NRECA’s goal was to work with and train Haitian linemen, employees of Eléctricité d’Haiti (EdH), on how to perform these upgrades and installations efficiently and safely. NRECA also compiled a detailed study of and design for upgrading the electricity to the hospital and worked very closely on PIH’s behalf with the directors of EdH to help the hospital acquire electricity from their grid.  

Near the new hospital, NRECA's crew installs powerlines.

The partnership between NRECA and PIH had its beginning in January of 2010, in the days following the earthquake. Four days after the earthquake, Myk Manon who at the time was working with NRECA in the Dominican Republic and has since become the Country Director of Haiti for NRECA, met Jim Ansara and David Walton at the General Hospital in Port au Prince. Myk, along with two other NRECA volunteers, was instrumental in helping to restore power to the hospital when it was needed most.

NRECA has since remained in Haiti to help rebuild the electrical infrastructure and worked closely, in an advisory role, with the management of EdH.  

The electrical service is a crucial piece of the puzzle for the success of the construction of Mirebalais Hospital. It is very exciting for us to have permanent electricity at the hospital and to be able to electrify each building as they become ready to come on line.  We are very appreciative of NRECA’s partnership with PIH on this effort. 

Learn more about Mirebalais Hospital.

IHSJ Reader     September 2011     Issue 9         

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

NON-COMMUNICABLE DISEASES

UN Launches Global Campaign to Curb Death Toll From Non-Communicable Diseases (UN News Service, September 19, 2011)
On September 19, the UN General Assembly approved by consensus the Political Declaration to address non-communicable diseases (NCDs). The Political Declaration acknowledges the disproportionate burden that NCDs have on the poor and the importance of strengthening health systems in low-income countries. The World Health Organization will now lead the charge in developing specific targets and indicators for reducing the impact of NCDs. Partners In Health will continue advocating for comprehensive health care for the poor until prevention, detection and treatment are available and affordable for all.

HIV/AIDS and Chronic Diseases – Learning From Each Other (PlusNews, September 20, 2011)
HIV/AIDS and NCDs are usually viewed as separate challenges, but by encouraging an integrated approach to prevention, detection and treatment through health systems that were developed to treat HIV/AIDS, resources and health outcomes can be maximized.

Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis*** (The Lancet, 15 September, 2011)
Results from this article show that the number of breast and cervical cancer deaths has nearly doubled over the last thirty years. This increase is disproportionately felt in developing countries where education, screening and treatment are not yet widely available.   With poorer countries seeing a rise in breast cancer cases of more than 7.5 percent per year, it is time to integrate cancer care into comprehensive health care. In a recently formed public-private partnership, George W. Bush hopes to push the integration of cervical and breast cancer treatment into the existing health systems established by PEPFAR.  Read more about this initiative at:  Bush Effort Targets Cervical Cancer in Developing World*** (Betsy McKay, Wall Street Journal, September 12, 2011).

HAITI

Halting Cholera’s Rampage in Haiti (Washington Post, September 22, 2011)
Cholera has killed nearly 6,500 people and almost 5 percent of the country’s population has been reported to be infected over the past 11 months. As Haiti continues to focus on improving access to water and sanitation, educating communities about the disease and how to prevent it as well as treating cholera patients, this piece highlights the importance of a nationwide vaccination campaign.

MATERNAL MORTALITY

Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis  (The Lancet, Lozano R. et. al, September 2011) 
Refined modeling with data from 163 countries suggests that maternal mortality declined from 350,000 deaths in 2010 to 275,000 deaths in 2011. Though the updated analysis is encouraging, additional analysis of the data is important.  MDG 5 is still the farthest off track to be reached by 2015. Nearly all maternal deaths could be prevented with targeted interventions at the community, clinic, and hospital level.  Partners In Health is committed to reducing maternal mortality by removing barriers to care and improving the quality and availability of proven interventions such as prenatal care, family planning services, safe delivery with skilled attendants, and emergency obstetrical care. 

INTERNATIONAL FINANCIAL INSTITUTIONS

Austerity Measures Threaten Children and Poor Households: Recent Evidence in Public Expenditures from 128 Developing Countries (UNICEF, Isabel Ortiz et. al, September 2011)
A new UNICEF study warns of the "irreversible impacts" of International Monetary Fund (IMF) austerity measures on children and poor households. The authors argue that excessively restrictive policies undermine IMF pledges to build social safety nets to protect the vulnerable. Instead of increasing investments in life-saving health, education and other social programs, in 2010, more than a quarter of developing nations were struggling to reduce spending to pre-2007 levels IMF-imposed fiscal policies must be carefully reviewed and replaced with alternative policies aimed at strengthening the social safety net for the most vulnerable.

RWANDA

In Rwanda, A Disconnect In Choosing GHI Focus(GlobalPost, Gregory Branch, September 23, 2011)
When the Global Health Initiative (GHI) launched in 2009, US government officials stated the need to increase country ownership over US–funded health programs. In Rwanda, the GHI strategy highlighted gender-based violence as one of its priority areas—an area that is not a large part of the national health plan. The U.S. Government should join other donor countries in supporting true country ownership of programs and support carefully developed national plans. US foreign assistance rules should be changed to allow for direct support to recipient governments’ public health systems so they are strengthened and able to fund their self-identified health priorities.

A closer look at the role of Community Based Health Insurance in Rwanda's success (Ranu S Dhillon M.D., Global Health Check, September 16, 2011)
This blog post takes a critical look at Rwanda’s mutuelle program, and argues that community health insurance cannot be singularly credited with spurring Rwanda’s excellent improvements in health access and indicators. Those analyzing the success of Rwanda’s health programs should consider other complementary factors including a five-fold increase in health spending, effective public administration, and economic growth. Though insurance co-payments are less onerous than user fees, they still constitute an inequitable financial barrier for many Rwandans.

HIV/AIDS

An End to AIDS is Within Our Reach (Desmond Tutu, Washington Post, September 20, 2011)
In this powerful op-ed, Archbishop Desmond Tutu calls upon President Obama to “make a game-changing impact on the war against AIDS” by increasing PEPFAR’s treatment goal from 4 million to 6 million people by 2013.  New research shows that increasing access to antiretroviral treatment not only saves lives, but also reduces the chance of passing HIV to an uninfected sexual partner by 96 percent. “The world finally possesses affordable tools and scientific knowledge that could stop HIV/AIDS in its tracks. President Obama has a profound opportunity to lead the world to this conclusion. He must take it.”

Cost-Effectiveness of Early Versus Standard Antiretroviral Therapy in HIV-Infected Adults in Haiti (Serena Koenig, Heejung Bang, Patrice Severe, et. al., PLoS, September 20, 2011)
The results of a recent study with data from Haiti show that treating HIV patients earlier than previously recommended by the WHO is cost-effective. A comprehensive cost analysis over a three-year period proves that early treatment (initiated with patients’ CD4 counts between 200-350) is considered a cost-effective intervention under World Health Organization criteria (cost is less than three times the country’s per capita gross domestic product).

MENTAL HEALTH

Mental Health Not Getting Enough Attention from UN (Joanne Silberner, The World, September 19, 2011)
Depression ranks as the number one cause of disability worldwide, yet the estimated 450 million people who suffer from mental disorders aren’t included in most strategic global health funding plans. The Millennium Development Goals say nothing about treating mental illness despite the global cost of these diseases exceeding $2 trillion. If the United Nations and others recognized the critical need to address the global burden of all diseases, including mental disorders, the funding gap for comprehensive health care could finally be tallied, acknowledged and addressed.

FOOD SECURITY

4.5 Million Haitians in Situation of Food Insecurity (Haiti Libre, September 26, 2011)
The National Coordinating Committee for Food Security reports that nearly 50 percent of Haitians face food insecurity. A coordinated policy needs to be developed that focuses on increased investment in the agricultural sector, job creation and nutrition education. To learn how U.S. food aid contributes to Haiti’s food insecurity, and to find practical solutions to improving food security in Haiti, please see “Sak Vid Pa Kanpe: The Impact of U.S. Food Aid on Human Rights in Haiti.” 

Bringing Agriculture to the Table: How Agriculture and Food Policy can Play a Role in Preventing Chronic Disease (The Chicago Council, September 2011)
This report focuses on the links between agriculture and health, specifically, the relationship between recent trends in agriculture and food production and the increase in non-communicable diseases. Health and nutrition are intrinsically linked, but when developed and developing countries alike face a dual burden of malnutrition and obesity, it is crucial to include agriculture and food systems as part of the comprehensive solution.

MULTIMEDIA AND ADDITIONAL RESOURCES

Partners In Health Program Management GuidePartners In Health, September 2011)
Partners In Health published the Program Management Guide – a guide to managing healthcare programs in resource-poor settings. From our Training Director, Jill Hackett:  “Based on PIH’s experiences over the last 25 years, this guide offers an approach to starting, revamping, or expanding a healthcare program in resource-poor settings. PIH has received many inquiries from nascent organizations and established practitioners who are working to promote a rights-based approach to care. This guide discusses complex challenges that implementers commonly face, and shares lessons we have learned and the strategies that have helped us implement programs in collaboration with a wide range of partners.” Congratulations to the PIH Training Team and all those who supported them in writing this incredibly helpful and needed guide. 

We must “focus on the creation of sustainable health systems – that through knowledge – can meet the twenty-first century health needs of people around the corner and around the globe,” said Linda Fried, Dean of Columbia University’s Mailman School of Public Health.

LIVESTRONG founder Lance Armstrong with PIH co-founder Paul Farmer. 

On September 19th PIH co-founder Dr. Paul Farmer participated in a panel discussion with Lance Armstrong, Dr. Wafaa El-Sadr, Dr. Sanjay Gupta and Dr. Lawrence Shulman. The discussion, Delivering Hope: Preventing and Treating Non-communicable Diseases in Developing Countries, focused on the potential strategies, practical interventions, and promise of saving lives. 

Our policy and investments need to be smarter and better, says Dr. Farmer.  “We must incorporate prevention and early interventions…in the next generation of health care.”

Non-communicable diseases (NCDs) — cancer, diabetes, heart and lung disease — are the leading cause of death globally, killing an estimated 36 million people each year, according the World Health Organization. These diseases diproportionately burden the poor, the young, and the marginalized. Nearly 80 percent of NCD deaths occur in low- and middle-income countries. 

But NCDs can also be prevented and treated with simple, practical cost-effective solutions. The panel, which is sponsored by the Columbia University World Leaders Forum and the Mailman School of Public Health in New York City, discussed the growing challenge of chronic disease in developing countries and what can be done about it now.

Much of the conversation around non-communicable diseases is sparked after the panel viewed a video of Francine, a young Rwandan women who had been living with a particularly aggressive case of cancer. After traveling the country looking for treatment, Francine and her family arrived at PIH’s Rwinkwavu Hospital. Here they found treatment, and Francine was able to restart her life.

Learn more about PIH's work with non-communicable diseases.

By Robbie Flick, Health Programs Coordinator, Malawi

Robbie began working with APZU, PIH’s sister organization in Malawi, in early September. He reports on his first few days on the job.

The white land rover ferried three Malawian social workers across the rugged hillsides of Neno, still blanketed in the morning’s pale blue fog. As members of PIH’s POSER team — Project on Social and Economic Rights — my new colleagues spend their days working with local Community Based Organizations (CBOs) to help fight the poverty that is at the root of poor health in their villages.

	APZU Program Manager Samson Njolomole discusses the carpentry program at Chichiyembekezo. Top photo:  A student of the tailoring vocational program at Chiyamjano uses her newfound skills to support her family.

Our first stop was at the CBO Chichiyembekezo, or “Hope” in the local language of Chichewa. The director, in a crisp yellow suit jacket and pressed pants, quickly ushered us into his office, where we sat with community stakeholders under walls covered by public health posters and charts. Together, we gauged the organization’s current work and goals. With guidance and investment from PIH, they have started a carpentry school to provide local vulnerable youth with training in a viable career path. As we walked outside to tour the school, the director proudly announced that the students’ wares — everything from beds to window frames — have been selling well, and he was confident that upon graduation, they will be able to find work.

Our next stop was at Chiyamjano — “Unity” — which runs a tailoring workshop. I chatted with members and learned what the CBO has meant to them. A 21-year-old single mother nursed her infant while explaining how her new skills from the CBO’s training program have allowed her to become financially self-reliant. Another young woman explained the security that a valuable trade skill provides in a community where family life can often be unstable.

At another CBO, members of a knitting vocational program told similar stories; in fact, it became the theme of the day: CBO’s putting forth innovative programs — from agriculture initiatives to restaurants run by former commercial sex workers — and passionately investing in their community with guidance and support from the POSER team.

	"PIH is a motivation," says Victoria Banyira, Chairwoman of Chifunga Support Group. "Although we are infected, we have learned we still have life to give to our community.

But one visit in particular stood out in my mind — a small support group in the community of Chifunga made up entirely of people living with HIV. We gathered with them under the shade of blue gum tree, where their chairwoman, Victoria, described how they regularly meet to support each other, plan the group’s activities, and work to improve their community. They cultivate a vegetable garden and raise goats in order to support both a shelter for elderly community members, and a school and childcare program for 62 young children orphaned by the AIDS epidemic. In addition to helping to financially support the school, the members also teach classes and prepare food for the children. Their goal, Victoria explained, is to expand the vegetable garden and their animal rearing program to support even more vulnerable children in their community.

“PIH is a motivation,” she said. “Although we are infected, we have learned we still have life to give to our community.”

My day with the POSER team gave me a greater perspective of how PIH operates. In addition to medical services, the organization also works to invest in and empower vulnerable individuals, helping them develop their communities and ultimately addressing the societal roots of disease.

Members of the Chifunga Support Group by their vegetable garden. The produce is used to raise funds for the community childcare program targeting children orphaned by HIV/AIDS.

We are thrilled to release the Partners In Health Program Management Guide.

Based on PIH’s experiences, the Program Management Guide offers an approach to starting, revamping, or expanding a program in the field. Its aim is to help program managers solve challenges commonly faced in resource-poor settings. Our goal in releasing the guide is to share our approach, solicit feedback, and spark conversations that will help all of us improve global health delivery.

Please take a moment to read the "Note to the Reader" below or jump straight to the guide overview:

http://www.pih.org/pmg

Note to the Reader

As PIH enters the 25th year of providing a preferential option for the poor in health care, we reflect on how much we have evolved since the organization’s inception. What started as a small, grassroots health project in a community of internally displaced people in Cange, Haiti, has grown to an effort that, as of 2011, serves 2.4 million patients in more than 76 health facilities in 11 countries, and compensates close to 15,000 staff.

PIH has progressively built on its approach to ensure health as a human right through community engagement and strengthening of the public sector. Poor communities all over the world (in rich and poor countries) cope with a high disease burden and gross inequities in the social determinants of disease, while being strapped for infrastructure and health workers.

PIH’s track record in building systems that address these complex synergies has gained traction with communities, grassroots nongovernmental organizations, and governments. Given PIH’s experience, we have been increasingly asked to articulate the architecture of this work.

A practical “how-to” manual

To this end, we are pleased and proud to share this guide, a collective effort of PIH leadership from around the world to capture the elements of how our work is designed, implemented, and evaluated.

Meant as a practical “how-to” manual, there’s a storyline that’s familiar even though the settings—and people—change. The opening scene: a team organizes with a local community and public sector workers to improve health services in a catchment area that has been chronically understaffed, under-equipped, under-trained, and under-resourced for years.

The team works around the clock to identify and treat patients while also trying to get medicines and supplies through customs, manage finances, secure clean water for the site, set up power and an Internet connection, hire clinic-based and community staff, locate an ambulance and driver, identify potential partners—and the list goes on. A program manager’s extensive “to-do” list inevitably gets longer as more challenges arise.

Sharing what worked for us, not a set of answers

Partners In Health is founded and named on the belief that health inequalities are best addressed through a movement for social justice involving a multitude of partners working on behalf of the destitute sick. Every day, we are inspired by the work of other like-minded organizations, and buoyed by the sharing of knowledge within this community.

We're acutely aware and grateful that we’re not alone in this work. We wrote this guide not to provide set answers, but rather to share what we’ve done and how we’ve done it over the past 25 years. To get this right, we undertook extensive background research, sifted through stacks of documents, carried out over a hundred interviews with staff in Boston and at PIH-supported sites, and had long discussions about how we tackled many difficult situations.

The beginning of a conversation

Documenting PIH’s experience in implementing programs with as much internal candor as possible is one way to preserve institutional memory, but it’s more than simply an introspective exercise. We believe that detailed analysis and self-reflection is necessary for us to continue to improve the quality of our programs and services.

In this way, the guide serves as a roadmap for the organization as we continue to strengthen services in the countries where we work. But we also wrote the guide for those who are beginning health programs in resource-poor settings: those who seek ideas and suggestions on how to manage the myriad challenges in this work.

Above all, we see this guide as the beginning of a conversation with all those whose work champions the needs of the world’s poor. We look forward to refining all of our best practices as other practitioners—seasoned in this struggle or new to it—engage in a pragmatic discussion.

The importance of listening to the poor

Staying true to our mission of providing health care in solidarity with the poor is a difficult, ongoing process. It demands taking a hard look at the challenges that we’ve confronted, mistakes that we’ve made, and hard lessons we’ve learned from Haiti to Peru, Boston, Rwanda, Malawi, and the mountains of Lesotho. During the process, we’ve realized the importance of the many, often mundane, details on which the success of our work depends.

If there is a common thread that runs through all the units of this guide, it’s the importance of listening to the poor, and with them, designing programs and services that address their needs.

Ted Constan
Chief Operating Officer, Partners In Health

Joia Mukherjee
Chief Medical Officer, Partners In Health

With sales totaling $13.6 million, the September 22 Artists for Haiti charity sale at Christie’s, co-organized by actor Ben Stiller and gallery owner David Zwirner, was a phenomenal success both for Haiti and the art world.

Co-organizers Ben Stiller and David Zwirner standing in front of Raymond Pettibon's painting "No Title (But the Sand...)".

PIH's Sam Ender, actress Christine Taylor with husband Ben Stiller, PIH's Ariana Watson and PIH supporter Kim-Marie Evans.

A portion of the sale’s proceeds will go towards supporting PIH’s work in Haiti, specifically children's education and health care projects. Other organizations receiving proceeds include Architecture for Humanity, Artists for Peace and Justice, Ciné Institute, Grameen Creative Lab, J/P HRO and The Stiller Foundation.

The auction included 27 works by 26 of today’s most prominent artists – including Jeff Koons, Chuck Close, Cecily Brown and Jasper Johns – many of which were created specifically for this cause. Two of the works of art sold for over one million dollars, Marlene Dumas at $2 million and Luc Tuymans at $1.15 million, with many lots realizing well over their pre-sale estimates.

“We are so grateful to all of the artists who dedicated their time and talent to help raise an extraordinary amount of money that will be utilized as efficiently and quickly as possible to help the people of Haiti,” declared Ben Stiller. “Christie’s and David Zwirner Gallery worked very hard to make this a success and I am thankful to have them as partners in this effort.”

“What an amazing evening! We are overwhelmed by the support we were able to get for tonight's auction,” said David Zwirner, co-organizer and owner of the gallery where the art was exhibited. “Thanks to everyone who bid tonight, we can now go to work on the much needed humanitarian efforts to help the children in Haiti.”

Media coverage of the event:

The Huffington Post
Art Magazine Germany
New York Post - Page Six
Art Observed
Us Weekly
MSNBC.com
Daily Mail
Getty Images 
Faded Youth Blog
Just Jared
Metro UK

What connects Haiti President Michel Martelly, Rwanda President Paul Kagame, PIH co-founder Dr. Paul Farmer and fashion designer Donna Karan? The four were interviewed on CNN's Piers Morgan Tonight on September 21 in a segment focusing on rebuilding Haiti following the massive January 2010 earthquake.

President Kagame outlined some lessons his country learned as it worked to rebuild following the 1994 genocide. "The most important thing is to have national ownership and make sure there is coordination of the kinds of very well-intended efforts to try and help," said President Kagame. "If not coordinated, you may have a lot of help coming in or promised, but not result into any tangible results."

And Haiti is listening. "The Rwanda model is a model we're following closely," said President Martelly.

Dr. Paul Farmer, who also serves as UN Deputy Special Envoy to Haiti, added that the efforts of NGOs can only go so far -- strengthening public systems is vital. "You can't rebuild municipal water systems with NGOs, as well intentioned as they might be," said Dr. Farmer. "[PIH] is very well intentioned in Haiti and in Rwanda, but we can't replace the government."

Donna Karan added that her foundation Urban Zen's "Hope, Help and Rebuild Haiti" project is one example how NGO's can help inspire and empower local efforts.

As PIH has extensive experience working with both governments in Haiti and Rwanda, Dr. Farmer supports a "south-south" collaboration. Even before the earthquake, the two countries had begun to lay the foundation for a partnership based on robust responses to common challenges, including poverty. During the CNN segment, Dr. Farmer mentioned the Haiti-Rwanda Commission, which was formed in response to the earthquake to expand the partnerships already existing between the two countries and harness the lessons from the Rwandan experience in Haiti’s rebuilding process. Stay tuned for more information about this collaboration.

Meet Brian Scott, our Mirebalais Hospital site supervisor. Brian is originally from South Africa, but has lived in the US for a number of years. Since joining the team in June, he has been instrumental in the progress that has been made. Having never traveled to Haiti before, Brian has grown to love and appreciate the country. Below are some of his thoughts.

Brian Scott, right, helping a surveyor. Just one of many tasks taken on daily in his role of site supervisor. 

How did you become involved with Partners In Health?

I knew very little about PIH prior to this project, but became involved through Jim Ansara, who is heading up the construction of Mirebalais Hospital. We’d worked together before.

What does the role of Site Supervisor entail? What is a normal day like for you?

My job entails the management of the schedules, logistics, personnel, and materials on site. For better or worse there is no such thing as a normal day, each day on site is completely different. It brings with it its own challenges and issues.

You were a Field Engineer for a large company in the US prior to working with PIH. What are the differences between working a project like this in the US and Haiti?

The first difference is the language barrier. Communication is extremely important in construction, being able to effective communicate what needs to be achieved to those who be performing the job, is essential. I’ve had to learn Creole as quickly as possible. 

The second major difference is that in the US you are primarily in charge of delegating tasks to sub-contractors and managing the order of operations. In Haiti my team does most everything, so we take a much more hands on approach.

Jim Ansara, Brian Scott and Dr. David Walton work on a fuse box at Mirebalais Hospital.

What is your favorite aspect of working on this project?

As challenging as a project like this can be, it is even more rewarding. You also get to watch the daily progression of the job, which serves as a constant reminder of the results of your work. Also, seeing the growth of individuals on the jobsite as they acquire new skills and learn new trades is rewarding.

Has this project inspired you?

When I first joined the project team, I was more interested in the construction aspect of the hospital than anything else. I didn’t see myself coming down to Haiti to make a difference. But during my first week here in Haiti, Dr. David Walton took us on a tour of one of PIH’s first hospitals here in Haiti and I got to experience the difference that these hospitals and doctors make in the lives of Haitians all around the country. I knew I wasn’t going to be able to help the patients myself but if I could use my skills to help build the hospital as well and quickly as possible I would be making a small difference. 

Do you have any thoughts for people that are considering volunteering on the hospital?

I absolutely suggest doing it. It’s a life changing experience that puts things into perspective. You learn to appreciate what we have in the US and take advantage of it all daily.

The Construction Team is very thankful to have Brian working with us. If you are interested in volunteering or speaking with Brian about volunteering please contact our Volunteer Coordinator at hburgess@pih.org.

Learn more about Mirebalais Hospital.

David Ziehr and Matthew Growdon
Harvard Medical School, Class of 2014

Nearly half of the Guatemalans we diagnosed with diabetes already knew they had el azúcar. Weeks, months, or years prior, many had traveled miles and waited hours for a hurried consultation with a physician at a free, government-run centro de salud only to receive a referral to the same physician’s private clinic. They later returned home even poorer, but now with a diagnosis and a month’s income worth of oral hypoglycemics – medications to lower blood sugar. 

Community health workers simulate a patient interaction for the class.

Miles from a pharmacy, too poor to buy more drugs, or believing they had been cured, the patients experienced little more than a holiday of controlled disease. They had pursued medical care, yet were just as sick as the men and women we diagnosed with diabetes for the first time. 

How must the delivery of health services adapt as the burden of chronic disease swells in resource-poor nations? Community health workers (CHWs; promotores de salud) may represent the greatest hope for patients with – or at risk of – chronic diseases in such settings. 

CHWs are laypeople with basic medical training who educate and assist members of the community to maintain or improve their health. While conventionally entrusted with episodic care, CHWs have emerged as reliable advocates for patients with HIV and tuberculosis in Haiti and Rwanda. PIH trained these CHWs to teach about prevention, acquire and administer medications, and provide careful follow-up. This model, by which local leaders accompany patients to navigate poverty, stigma, and a fragmented health care system to achieve effective care, has inspired efforts to find and treat patients with chronic non-communicable diseases (NCDs) in Guatemala.

Matthew Growdon demonstrates to CHWs how to measure blood pressure.

Empowering local health advocates

This past summer, Dr. Daniel Palazuelos, clinical director of PIH projects Guatemala, worked with us to train CHWs in Santa Ana Huista, Guatemala, to help patients with diabetes and hypertension manage their illness. The CHWs are members of el Equipo Técnico de Educación en Salud Comunitaria (ETESC; Technical Team for Education in Community Health). Refugees of the Guatemalan civil war returned home and banded together to form the organization, which provides legal and medical accompaniment to rural Guatemalans. 

Themselves victims of atrocities and speakers of local languages, ETESC CHWs are uniquely positioned to assist indigenous Guatemalans, a population subjugated during the war and neglected in its wake on the basis of race, poverty, language, education, and geographical isolation.

Familiarity bonds CHWs to their communities and distinguishes them from outside doctors, nurses, and volunteers. Accordingly, we designed a course with a flexible curriculum to encourage discussion and analysis of local barriers to care. Twelve daylong sessions emphasized basic disease etiology, symptoms, diagnostic tests, treatment regimens, lifestyle modifications, prevention, and integration of care with reliable physicians and nurses.

Basic lessons in pathophysiology reinforced the CHWs’ understanding of chronic disease. For instance, one game had the CHWs perform the roles of the parts of the body necessary to absorb glucose from a meal: the intestines accepted sugar from a meal and passed it to the blood, which visited the pancreas to receive a “key” (insulin), which the blood needed to deliver sugar to the hungry cells.

With diabetes, the pancreas tired and stopped giving insulin to the blood, causing sugar to accumulate, pass through the kidneys to the urine, and damage vessels in the hands, feet, and eyes. Though simplified, this exercise organized the CHWs’ approach to patient education and treatment: “excess sugar,” which can be controlled with healthy diet or medication, causes the symptoms and long-term effects of diabetes.

David Ziehr teaches the symptoms of diabetes.

Chronic diseases, acute challenges

The damage many chronic diseases cause is insidious and progressive; symptoms may not present until late in the course of the disease. But, as prevention and early treatment are most valuable, one must learn to educate patients about a disease they do not (yet) outwardly experience.

Widespread, often justified, skepticism of the medical establishment in Guatemala further complicates the diagnosis and treatment of a patient’s chronic disease. A man with a first-time diagnosis of stage-two hypertension is at an elevated risk of stroke and heart attack, yet the health care provider must approach diagnosis and treatment delicately. The man will not pursue treatment if he does not trust the provider’s assertion that the disease is serious and incurable but controllable with diet and medication.

Moreover, salesmen in pickup trucks with bullhorns regularly hawk suspicious and expensive “natural cures.” We distanced the legitimate care of the CHWs, which might require patients to purchase drugs, from such exploitation.

CHWs discuss and analyze local barriers to care.

Remarkable turnouts at active case-finding missions 

Through word of mouth alone, the CHWs attracted long lines of residents who had skipped breakfast in anticipation of free measurements of their fasting blood glucose and blood pressure. In five communities, the CHWs tested over three hundred men and women.

Dr. Palazuelos confirmed diagnoses and prescribed medications, while CHWs logged each patient with diabetes or hypertension to begin follow-up. We visited pharmacies throughout the region and alerted the CHWs to those with the lowest prices and largest selections. Each CHW supplemented his or her botiquín (community medicine chest) with essential drugs for diabetes and hypertension, which he or she could then sell—at cost—to patients.

With patient records, inexpensive medications, and tools to monitor blood pressure and blood glucose, the CHWs were prepared to assist in the long-term management of patients’ diabetes or hypertension. 

Meetings with government clinic doctors alerted the CHWs to referral options for patients needing advanced care. No CHW should be left alone to take care of patients; only with well-supplied and supported teams can patients acquire the care they deserve. 

After our departure in late July, nurse Maggie Sullivan arrived to monitor and support the CHWs. They capably documented follow-up visits with patients and replenished their botiquines. As the program expands, CHWs will need routine access to a physician or nurse to start and adjust medications.

Community health workers may be our greatest hope to coordinate patients’ care in the absence of a functioning health care system, thereby helping to control the increasing burden of diabetes and hypertension in resource-poor settings. With our support, community leaders committed to the health of their neighbors can begin to overcome the many and evolving challenges of NCDs.

Learn more about PIH’s work serving patients living with NCDs.
Read about PIH’s impact in Guatemala.

In early September, 29 community health workers (CHWs) began using Nokia cell phones as the latest tool in the fight against cholera. The specially programmed phones help track information about cholera patients in isolated communities throughout Haiti’s Central Plateau – an important step in gathering the up-to-date infection data that could prevent more deaths. 

CHWs learning how to use the new data collection program.

In the isolated mountain communities of Boucan Carre, where thousands of people have become sick since early June, CHWs must walk 6 or more hours to submit weekly cholera reports from outlying communities. Receiving accurate and timely data is incredibly challenging – and the rainy season has made it that much harder.

“Receiving real time cholera information from CHWs is crucial,” says Cate Oswald, PIH’s Haiti-based program coordinator for community health. “We need accurate and up-to-date reports in order to best prevent more cases and respond to quick spread of the epidemic.”

Following the spread of cholera – a disease that can kill within 24 hours of infection – is crucial to saving lives.

In August PIH/ZL sites saw a slight decline in new infections, impart because of particularly dry weather. Heavy rains in early September will likely reverse that trend.

Launched in an isolated region of Boucan Carre, PIH/ZL began training the first group of CHWs how to use the phones in early July. With funding from the World Bank, PIH/ZL has purchased 120 phones for the pilot program, and service will be supplied by Caribbean-based cell provider Digicel.

Once started, the program asks CHWs a series of simple questions to help determine how many sick people might be living in a household.

“Prompts are in Haitian Creole and user friendly, allowing CHWs to input data about soap, Aquatabs, Clorox, oral rehydration solution,” says Rony Charles, a member of the PIH/ZL medical informatics team who developed the software for the phones. “But they also provide data on the numbers of people sick with cholera, the number who have made it to the treatment center, and the number that have died.”

“It is our hope that this project will help us have better access to incredibly important community data and will help us know which communities need extra support at any given moment,” says Cate. “Our nursing and psychosocial teams are very excited about the prospects of the project, as are the CHWs.”

As with most communities where PIH/ZL works, CHWs lack electricity. PIH/ZL have partnered with Earthspark, a local group making solar lanterns that can charge cell phones. Each CHW will receive a lantern.

Cate concluded optimistically: “This will greatly enhance our ability to save lives in rural and isolated communities.”

Since the first cholera cases were reported last October, just over 440,000 Haitians have contracted the disease and nearly 6,300 have died.

Learn more about PIH/ZL’s cholera response.

"Our health care system is ailing; the US spends a higher percentage of its per-capita GDP on health care than any other nation," said Dr. Heidi Behforouz at the Clinton Global Initiative (CGI) Annual Meeting in New York City on September 20. "And yet, some of our statistics rank with those of developing nations."

Dr. Behforouz, the executive director of PIH's Boston-based Prevention and Access to Care and Treatment (PACT) Project, presented a commitment to action at CGI that outlines a strategy for integrating community health workers (CHWs) into health systems across the United States.

	PACT's Dr. Heidi Behforouz presenting at the 2011 Clinton Global Health Initiative Annual Meeting.

"Our greatest challenges include a health care financing system that encourages episodic disease-based care as opposed to prevention and wellness, reluctance of a hierarchical medical culture to accept CHWs, and the lack of an established focus on continuous quality improvement, accountability, and transparency," said Dr. Behforouz. "PACT seeks partners who can advocate for healthcare finance reform, lead organizational and cultural change within health care institutions, and create easily adaptable systems for maximizing value based health care — where all patients achieve good outcomes at lower cost."

The three-day CGI meeting is an opportunity for participants like Dr. Behforouz to build partnerships with politicians, activists, academics, and other NGOs. Fellow participants at this year’s meeting include Madeleine K. Albright, Tony Blair, Ted Turner, and PIH co-founder Dr. Paul Farmer.

Since 2005, CGI has brought together nearly 150 current and former heads of state, 18 Nobel Prize laureates, and influential people across fields. CGI members have made nearly 2,000 commitments, which have already improved the lives of 300 million people in more than 180 countries. When fully funded and implemented, these commitments will be valued in excess of $63 billion. 

Read more about PACT’s commitment to action. 

The PACT project is supported by both PIH and the Division of Global Health Equity at Brigham and Women's Hospital.

How Community Health Workers could benefit US health care.
 

The importance of community and business partnerships.

Loune Viaud, PIH/ZL’s co-executive director in Haiti rings the opening bell at today’s NASDAQ MarketSite in New York City's Times Square. Loune was joined at the podium by both PIH staff and representatives from Donna Karan’s Urban Zen Foundation, an organization committed to raising awareness of the rich culture, history and artistry of Haiti. 

Loune opens the stock exchange.

“At Partners In Health, we believe health care is a human right, we believe everyone deserves the same caliber of care no matter where they were born,” said Loune. “We believe in education, and Partners In Health began working in Haiti a quarter century ago…we are committed to building Haiti back better than before.”

“We are making progress, we are building the health system and training the next generation of nurses, medical students and doctors who will all work in Haiti’s public sector,” continued Loune.

“We can create hope and opportunity for the Haitian people. We could not create this lasting change without your support, and support of people like Donna Karan and all the people at Urban Zen and our partnership with the Haitian government,” said Loune at the close of her statement.

The NASDAQ's jumbotron in Times Square advocated for Haiti and PIH throughout the morning.

PIH and Urban Zen are co-hosting a special event tonight to celebrate the sixth printing of Haiti After the Earthquake, the respected book authored by PIH cofounder Dr. Paul Farmer.

The event will benefit the completion on construction of PIH’s Mirebalais Hospital, which will contain 320 beds, serve an estimated 450 to 500 patients per day, and help train Haiti's next generation of doctors, nurses and medical workers.

The NASDAQ OMX Group, Inc. is the world's largest exchange company. It delivers trading, exchange technology and public company services across six continents, with more than 3,500 listed companies.

In Washington, D.C., Bob Abernethy, host of PBS’s newsweekly Religion and Ethics attended a book signing and lecture with PIH cofounder Dr. Paul Farmer.

Abernethy asked Farmer if NGOs and faith-based groups are doing enough in Haiti. Farmer responded, “Lets not give each other more than a C.”

Watch Dr. Farmer's talk.

“They’ve done a good job helping people one-by-one,” said Farmer. “They’ve not done enough to help Haitians create a government and other institutions capable of taking on big projects like deforestation and cleaning up the water.”

Read more about Dr. Farmer’s Haiti After the Earthquake.

Dozens of social justice activists and student leaders converged outside of the United Nations building in New York City this morning to demand targets on non-communicable diseases (NCDs). “What do we want? We want equity: EQUITY! Action: ACTION! Targets: TARGETS!”

The youth rally on NCDs sent a clear message to the UN General Assembly: the time for action is now.

With 80 percent of NCD deaths occurring in poor and middle-income countries, global leaders must act now to make essential medicines and technologies for NCDs available and affordable to those who lack access to life-saving healthcare.

Video captured by Chris Manschreck of the PIH NYC Community.

Learn more about PIH's work addressing NCDs in resource-poor countries.