“Today is the culmination of 25 years of dreaming about better medical care in this town,” says PIH co-founder Paul Farmer, speaking from Mirebalais in central Haiti.

“We’d been talking about it [building Mirebalais Hospital] for a long time, but the opportunity never presented itself until a few years ago,” recalls Dr. Farmer. Then the earthquake hit in January, 2010, and a new, more urgent need presented itself.

“Partners In Health supporters… signed on… and we raised more money than we’d been able to in the past, and so we rethought the hospital into a more ambitious teaching hospital.”

Learn more in a video created by Andreas Nicholas:

The construction of this new hospital will bring to bear all that Partners In Health has learned over the past 25 years about hospital design. The facility will provide the region’s people—some of the country’s poorest—with health care in a dignified setting. It will also serve as a space where health professionals from around the country can train and develop new skills.

Workers broke ground on the facility on July 3, 2010. When completed in early 2012 it will house 320 beds, serve an estimated 450 - 500 patients a day, and help to train Haiti's next generation of doctors, nurses and medical workers.

The music is by Arcade Fire—recipients of this year’s Grammy for Best Album, and longtime PIH supporters.

Read more about Mirebalais Teaching Hospital.

High in the mountains of northern Rwanda, a community of Twa, also known as Pygmies, celebrate their future--one that looks much different than their past. The minority group has suffered among the worst development indicators in the region, consistently lacking access to health services, education, housing, and adequate nutrition. To combat these challenges, Partners In Health and the Goverment of Rwanda have started a new joint project. 

Read about PIH Rwanda's program giving access to education to Twa children. 

	Twa children in north Rwanda's Burera district.
	Twa children attending school, with support from IMB.

Over a hundred Twa children are attending primary school for the first time in their lives, thanks to a new program supported by Inshuti Mu Buzima (IMB), PIH’s sister organization in Rwanda. Nearly all of the children are the first in their families to receive any type of formal education.

“This is a thing that the community never thought would happen,” said Léonce Byimana, a program coordinator for IMB.

The Twa, or pygmy people, are a minority group in eastern and central Africa. As with other indigenous peoples around the world, the Twa have faced many challenges over the past century. Today, their communities suffer some of the worst development indicators in the region. Twa consistently lack access to health services, education, housing, and adequate nutrition. Their average life expectancy is less than 30 years. 

To combat these challenges, IMB is partnering with the Government of Rwanda in the rural northern Burera District  to break the cycle of poverty and disease by providing access to education. The new project will provide 102 Twa children—58 girls and 44 boys—with tuition money, school uniforms, shoes, notebooks, food, and other necessary fees.

Since starting classes this year, the students have been thriving, added Léonce. “Their teachers tell us that they are performing very well,” he said. “Hopefully they will make their families proud. Our goal is that one day [these students] will begin moving their families away from situations of extreme poverty and hunger.”

“[IMB] thanks everybody who helped get these students enrolled in school, especially the local authorities who increasingly support the pygmy community and the primary school teachers who are working with the students,” added Léonce.

The school program is just one element of IMB’s work to support the Twa community in Burera. IMB has also supplied the communities with cows to provide milk to malnourished children. Additionally, this year the organization will provide a full package of support to this community, including health insurance, employment opportunities, and agricultural support. IMB will also replace each of the community’s leaky grass-roofed huts with durable tin-roofed houses through a joint project with the Government of Rwanda. Watch a video about this project.

	The new program in in Elias Piña, Dominican Republic, will operate in collaboration with Zanmi Lasante's hospital in Belladerè, Haiti.
	Staff of PIH's new program in the Dominican Republic.

On February 11, 2011 Zanmi Lasante (ZL) – Partners In Health’s (PIH) sister organization in Haiti--celebrated the expansion of its first HIV program in the Dominican Republic (DR). The program based at the Rosa Duarte Hospital in Elias Piña will serve hundreds of Haitians and Dominicans living and working in the border town, and marks a major step towards strengthening health systems in the DR.

Alongside members of the Elias Piña community, officials from the Dominican Republic’s Ministry of Health, the United States Agency for International Development (USAID), and PIH/ZL celebrated the landmark event with music, dancing and speeches from the project’s supporters. Following the ceremony, guests were invited to visit the hospital for a guided tour of the medical facility and services offered onsite.

This project is the culmination of a years-long effort. “Since 2004, we've tried to build a partnership with the Dominican health authorities to assure that the Haitian migrant patients--especially those with HIV and tuberculosis--can find a facility that delivers PIH’s approach to care,” says Dr. Ralph Ternier, director of Community Health. Ternier has been a driving force behind the project right from the beginning, starting when he was the director of PIH/ZL’s program at Hôpital de la Nativité in the Haitian border town of Belladère.    

Haitian economic migrants in the DR are a vulnerable patient population, said Ternier. These communities are made up of migrant farm workers who face social, cultural, and economic biases that make it difficult to access health care. Furthermore, their migrant status creates barriers for patients to receive continuing medical care, particularly for diseases requiring intensive treatment regimens, such as HIV/AIDS.

PIH/ZL signed a grant contract with the USAID in Santo Domingo, DR, to reinforce HIV services, from prevention to care, for the inhabitants of Elias Piña as well as the border’s transient population. Not only does the project seek to strengthen the existing health care systems in the DR, but it will also train and mobilize more than 100 community health workers to provide treatment and social support to HIV patients in their homes.

The ZL program took on new urgency after the earthquake when thousands of Haitians fled to the DR in search of medical care, housing, and food. People who were receiving treatment for HIV, TB, and MDR-TB in Haiti were forced to abandon their treatments, not only endangering their own health, but also potentially compounding the risk to public health if disruptions in treatment enabled their diseases to become drug-resistant.

	Dancers performed to celebrate the opening of the new project in the Dominican Republic.
	Rosa Duarte Hospital in Elias Piña

Since then, PIH/ZL has been working with Community Service Alliance, the Ministry of Health in the Dominican Republic, and USAID-DR to organize this expansion. Many of the Haitian and Dominican staff members participating in this cross-border project have been working in the region for years, if not decades. Ternier says that ZL programs in the DR will build on their efforts and lessons learned during ZL’s 25 years in Haiti, and on its successful HIV/AIDS treatment program. 

ZL currently provides support and antiretroviral drug therapies (ART)--medications for the treatment of infection by retroviruses related to HIV--to roughly 5,000 patients in Haiti, and monitors 14,000 patients who have tested positive for HIV, but who are healthy enough to not be on an ART regimen. This expansion will increase ZL’s catchment area by 60,000 people, as well as enhance the collaboration between Hôpital de la Nativité in Belladère, Haiti, with Hospital Rosa Duarte.

ZL staff will optimize quality of life for HIV-infected patients and their families, and prevent the transmission of HIV and other sexually transmitted infections (STIs). Voluntary HIV counseling and testing will be offered, and women-specific health care--including a program to prevent mother-to-child transmission of HIV--will be provided.

As with all PIH programs, success in the DR will rely largely on the efforts of accompagnateurs--men and women from the local community who are trained and employed by PIH/ZL as community health workers. Accompagnateurs work with patients in their communities to ensure that that they are able to take their medications as prescribed, and connect patients to social and economic services and support. They are a pivotal force in raising awareness of the existence and success of HIV treatment and care in these communities.

“The launch of the ZL project in the Dominican Republic is a huge victory on an international, political and medical level,” says Haitian project director in Elias Pina, Dr. Jennifer Severe. “The fruitful collaboration between Haitians and Dominicans involved in this project will ensure that the Dominican Republic’s Ministry of Health will see PIH as a strong and long-term partner in health care.” 

Does anyone know of guides for nursing students (or nurses in general) who are interested in engaging in global health experiences? 

Could anybody share a plan (design) for a sputum induction room and list of important things to be installed in such a room?

Got a question? GHDonline.org could have the answer. It’s a platform of communities guided by more than 30 experts, including PIH clinicians, which enables open collaboration between health implementers and organizations to create knowledge applicable in the field, and democratize access to essential information.

The virtual, web-based GHDonline communities were created to address a real world problem. Every day, health professionals everywhere are struggling to find the answers they need to provide the best health care to the most disadvantaged populations. They are often isolated and unable to connect with peers for opinions. They cannot afford subscription fees to the medical literature or, when they can, find themselves unable to use the information because it does not address the challenges they face.

Members of the community post questions like the ones above, which are answered by experts and other community members. For example, the post that asked for a plan for a sputum induction room generated 15 responses in just one day. 

Several new communities are in the works for 2011. The first one – to be launched in barely a month – will focus on non-communicable diseases. This launch coincides with a conference taking place at Harvard Medical School on March 2-3. The GHDonline team is working with PIH’s Dr. Gene Bukhman to line up partners and moderators to guide the new community. In other major changes, GHDonline will unveil a [[multilingual, no hyphen]] interface which will allow members to choose among a selection of languages to view their communities and collaborate with other members.

Developed and maintained by the Global Health Delivery Project at Harvard University, GHDonline is helping thousands of health implementers across specialties and organizations in 135 countries discuss their most pressing problems, share the knowledge they need, and access essential information and services via partner offerings for free. For example, the UpToDate International Grant Subscription Program on GHDonline.org has thus far enabled 73 medical teams, volunteers, and trainers with limited resources in 32 countries – including PIH teams in Rwanda and Haiti – to access UpToDate®, a leading evidence-based and peer-reviewed clinical information resource.

By participating, GHDonline members are creating an effective network of support, knowledge sharing, and training with colleagues who oftentimes lack these opportunities. They are partnering every day to combat disease and poverty, and in effect work to raise the standard of care for all.

Recently, a group of college students--all members of the HIV/AIDS awareness organization FACE AIDS--traveled to Rwanda to visit some of the people whose lives have been impacted by the group’s work. Run by students, FACE AIDS has raised $2 million (US) for Partners In Health’s work in Rwanda since 2006. During their trip, the students regularly blogged to share their thoughts and opinions about what they were experiencing. Below are excerpts from some of their entries. Read all the posts from their trip on their blog. 

Visits with an accompagnateur
By Annie Smartt, Stanford University
After over 24 hours of exhausting travel, we finally made it – no one missed a connection, everyone found each other in the airport. We all went out to dinner and we had our first introduction to the local staple, goat brochettes. Katie, our resident vegetarian, abstained, but the boys attacked the meal with gusto.

Because we were not fully adjusted to the time, we all woke up at around 5 am, bright eyed and ready for a full day of exploring. We all piled into our mini bus (which over the next 12 days would be our beloved home) and started our trek across the country. Our first stop was Rwinkwavu Hospital which is supported by Inshuti Mu Buzima (Partners In Health). Partners In Health takes seriously their doctrine that beautiful physical surroundings are an essential part of the recovery process.

We joined one of the accompagnateurs [community health workers] to meet with some of her patients living with HIV. I don’t think I will ever forget the second house we visited. It was so small that not all of the group could fit inside.

She described how desolate her life became after she received her HIV positive diagnosis and how quickly her health deteriorated. But once she started receiving care from Partners in Health, she started regaining hope. The accompanateur came day in and day out making sure that she stayed on her medication, was getting proper nutrition, and had some sort of emotional support as well.

And this woman was truly thriving because of this personalized care. And then she said something that really resonated with me. She thanked us for coming and sitting and listening to her story. She radiated warmth and love, and was so thankful to us muzungus (foreigners) who truthfully had absolutely no idea what she had endured and was continuing to go through.

Reflecting on Rwanda’s history
By Taylor Bendt, Oregon State University
Today we visited the Kigali Genocide Memorial Centre, where we spent much of day. Each of the centre’s gardens represent different areas of Rwanda, and fountains telling the story of how Rwanda has pulled together since 1994. It gives off a very optimistic feel.

There is also a series of mass graves that contain the remains of 250,000 men and women murdered during the genocide.  

Inside, there where rooms filled with photos of loved ones unaccounted for: hundreds of photos lined the walls – there were also small stools on which to sit. One room in particular was moving for me, it contained just skulls. No video screens, no audio tours, just the sterile remnants of men and women’s heads – frames that once held faces, minds, eyes, voices. After you allow the idea that each of these skulls where once someone to sink in, the room becomes overwhelming, the space was suddenly both cavernous and claustrophobic.

The events of 1994 should never be remembered as a statistic.

A day in Butaro
By Rachel Seeman, Stanford University
We ate in the car as we drove for about three hours in the van heading towards Butaro. The drive was gorgeous but very bumpy. Once arriving in Butaro, we were all excited to see the new PIH hospital.

This hospital in Butaro took my breath away. It is in the most beautiful setting and so much thought and care has gone into every aspect of the hospital. From the placement of each brick to the placement of the beds in each room, this hospital will certainly serve as a safe haven and a healing ground for the people in this community. Walking through the hospital was so moving, it almost made be cry.

The hospital visit was certainly the pinnacle of the day, and left all of us with smiles on our faces and a renewed sense of hope for the health of this community. After an evening reflection, we returned to the guesthouse for dinner and headed off for a good night’s rest.

Reflecting on Community Health Workers
By Kevin Martin, University of Texas
Today we met Alain Ntwali, PIH’s district health implementation analyst and director of the CHW cooperatives for the Clinton Health Access Initiative. Both initiatives work to generate jobs and income in local communities overcome by burdens of poverty and disease.

Alain provided administrative insight into the Community Health Worker Program and the cooperative system. The cooperative system pools together the money received by the Community Health Workers and reinvests the funds into a small business. The business started in Butaro is a store that sells beans. Alain took us to the bean store and we met some of the individuals who run the business. We were impressed with the level of documentation, budgeting, and resource management of the cooperative.  This system cultivates skills of investment, savings, and financial responsibility, which are crucial for sustainable development.

Meeting the FACE AIDS associations
By Julie Veroff, FACE AIDS Executive Director 
Our first full day in Kirehe was packed with meetings with two of FACE AIDS’ partner associations: Girimpuhwe AIDS Orphans Cooperative and Rwandarera Association.

Since beginning our work in Rwanda in 2007, FACE AIDS has partnered with 5 associations. Through this partnership, we employ members of associations to craft beaded AIDS awareness pins, paying them a monthly salary and helping them to save a portion of their income. We provide business skills and financial management training, and help each partner group to develop a rotating savings and credit cooperative. Members use their savings to start or strengthen small businesses, and the income they earn helps them pay for health insurance, school fees, food, and other critical needs. You can read how this works in more detail at http://faceaids.org/whatwedo.html#sesupport

FACE AIDS began working with Girimpuhwe AIDS Orphans Cooperative in 2008. The group has 38 members, all of whom have lost one or both of their parents to AIDS. They’re young, ranging from 14 to 26 years old. 

The innovation of Girimpuhwe is that, because many members are in school, they have their families run the businesses they funded with their savings. That way, they can continue going to school, pay for their school fees and associated costs, and contribute to their family’s financial empowerment. Our group had the opportunity to visit several of the businesses run by Girimpuhwe members and their families. We saw Isaac’s hairdressing and barber shop. With the money he saved from FACE AIDS, Isaac opened the shop and hired two staff members who run the day-to-day operations while he’s in school. We saw Lydia’s tailoring shop, and several members’ food and fabric stalls in the market. For lunch, we ate at a restaurant run by a Girimpuhwe member and had the most packed plates of food we’d ever seen: rice, beans, bananas, goat, greens, pasta, and cabbage! Delicious and way more than we could possibly eat.

Since beginning work with FACE AIDS, members of Rwandaera have invested their savings in livestock and farming endeavors, including rotating goat projects and collective cassava farming. The association recently reached out to their neighbors to start a community micro-insurance project. Everyone pays 300 Rwf per month (about $0.50) and the group meets every month to see if anyone needs to access the fund. For individuals living in extreme poverty, shocks and crises are devastating. They don’t have a rainy day fund to fall back on. So when there is a funeral, crop failure, or livestock death, for example, the micro-insurance project can make a tremendous difference. A member of the group can explain why they need help that month, and the group can decide to give them a grant or have them pay back the funds at a very low interest rate. It’s a great development for Rwandarera, and for their neighbors!

Read more about the FACE AIDS trip to Rwanda.

“With a million people still living in tents, it's easy to see how slowly Haiti is recovering from last year's earthquake,” reports Philadelphia NPR affiliate WHYY’s Susan Phillips, talking from Haiti. “But less visible is the emotional toll.”

In her weeklong series of reports, Susan follows PIH’s psychosocial and mental health team in Haiti as she investigates the ancient and modern methods Haiti’s people have been using in response to last year’s earthquake.

Treating the Mind in Haiti

Susan was in Cange, Haiti, in mid-January to visit PIH’s headquarters and one of the organization’s flagship hospitals. In that first report, she summarizes the major hurdles facing mental health workers in Haiti as the country begins to really deal with the trauma of the past year. As Susan reports, there were fewer than 10 public-sector psychologists in Haiti before the earthquake.

Listen to Susan’s interview from Haiti.

Haiti Uses Voodoo and Western Psychotherapy to Recover

“Pierre Jean-Bonet lives outside Port-au-Prince with several families. Jean-Bonet is an Houngan, or voodoo priest,” reports Susan. “His priestly name is Ya Cezzy, [YAH-say-ZEE] which translates into English as ‘Real Surprise.’”

“He says since last year's earthquake, more people suffering emotional trauma have come to him for help.”

“In post-earthquake Haiti, there is a push by the government's Health Ministry to modernize and prioritize western-style mental healthcare. The country relies on the NGO Partners In Health to come up with a plan.”

Listen to Susan talk about the ways modern medicine and traditional voodoo must work together in post-earthquake Haiti.

The Slow Road Recovering from Trauma in Haiti

“When the earthquake struck, Shelove Julmiste was at home in Port-au-Prince on the third floor of a six-story building,” reports Susan. “Four days later, she woke up without her left leg.”

“I was crying and crying and crying for days and days," she said through a translator.

A PIH psychologist, Tatiana Theresme, tried to help. But Julmiste says nothing would console her. Tatiana tells her it’s perfectly normal to feel scared after such a devastating trauma – but that the flashbacks and anxiety will lessen with time.

Listen to the stories of Shelove and Esther Balthazar, a woman who became psychotic after the earthquake but found help through Partners In Health.

NGO’s Crowd Out Government in Haiti

“The earthquake is not an isolated event,” said Father Eddy Eustache is a Catholic priest, and the director of psycho-social services for Partners in Health in Haiti. “I think trauma belongs to the daily life in Haiti because people have been exposed to so much, and so intense stress.”

Since the earthquake, PIH has newly hired 17 psychologists and 65 social workers in an effort to help relieve some of the mental health care needs facing Haiti’s people.

Listen to Susan’s interview with PIH’s Father Eddy and Dr. Joia Mukherjee, PIH’s medical director.

In rural Rwanda, the first point of contact for patient care is the community health center. Thanks to a grant made possible by the Doris Duke Foundation, nearly two-dozen centers are being upgraded to offer the very best in basic health care at the community level.

Read more about PIH's work in Rwanda.

	The view from the hilltop of Butaro Hospital. Photo by Adam Bacher

On January 24, Butaro Hospital opened in rural northern Rwanda.  This state-of-the-art flagship facility was built by a committed partnership of individuals and organizations, including MASS Design Group, a young design collaborative committed to building high impact, socially valuable architecture in resource-limited settings. MASS Executive Director Michael Murphy recently reflected on the founding of his organization--on the very hilltop where the future hospital would stand.

In the Summer of 2007, when [PIH co-founder] Paul Farmer asked me--then a young architecture student--to move to a hilltop in Rwanda and accompany his infrastructure chief on the design and construction of a new hospital, my immediate realization was that 'Architecture' as we know it was not what this district required.

The site chosen was a military camp, nestled on a steep hillside and perched high above the valleys of Butaro, which eyes the final peaks of Rwanda before fading into Uganda. Transferring the military to the medical speaks to more than the confidence of a war-ravaged country to demilitarize; it showcases the priorities of a government committed to deploying the symbolic resonances needed to serve its people better.

Like the hillside, the facility was a symbolic capstone to the infrastructure that the district demanded--an infrastructure not simply of roads, water and electricity, but of the laborers, economic opportunities, educational programs, and material markets required to make this hospital built completely of and by the district of Burera.

The priorities, however, were greater than simply drafting a set of plans to hand off to a local contractor. It was the construction of dignity that was required to accompany this new Butaro hospital. And as Dr. Paul Farmer accurately mentioned in his speech [at the hospital opening], this was why, on this hilltop, that MASS Design Group was formed.

The story of the hospital is not simply about architecture or design. It is about the iron-clad will of a country committed to emergence, healing and rebuilding.

We realized that what was required was more of a holistic model of architecture. One that could accommodate the design of an appropriate, state-of-the-art hospital while also fully choreographing the process of construction to employ and instill dignity in a district depleted of the most fundamental of resources: hope. 

[…] This is just the beginning. The plans, the partnerships, the execution succeeded. MASS Design Group grew from a single idea and one employee, to a current team of fifteen architects (seven in Rwanda, eights in Boston) working to prove that architecture is once again relevant. Now that the Butaro Hospital is finished, the goal is to replicate this model across multiple sites and for a spectrum of clients. Working 25,000 pro-bono hours on Butaro Hospital was only the beginning of this amazing team's commitment to proving that better design can reduce poverty and embed dignity into communities.

Read Michael’s full blog post.

Butaro Hosptial

The new Butaro Hospital in northern Rwanda welcomed the delivery of its first baby on Saturday, February 5. The hospital, which officially opened its doors on January 24, is operated in a partnership between PIH’s Rwandan sister organization, Inshuti Mu Buzima, and the Rwandan government.

On the same day, the facility also saw its first cesarean section. It wasn’t too long ago when local pregnant women in need of such emergency medical care would have to risk crossing the nearby Lake Burera on boat to reach the nearest hospital.

Both babies and their mothers are doing well, reported PIH physicians Matt Craven and Peter Drobac.

Read more about the new Butaro Hospital.

By Iole Pizzola

	Gloria used her earnings from working at the Mtendere Restaurant in Zalewa to start her own small business.

The sun has not yet risen on the dusty sun-baked town of Zalewa in southern Malawi, but Gloria* is already stirring about. She hastily wraps her brightly-colored chitenje around her waist and smooths her hair back before she scurries out to catch the first tap-tap bound for the nearby city of Blantyre. Gloria will spend her day off from the Mtendere Restaurant procuring items from local vendors for her small crockery business. 

Gloria is part of a growing community of women running micro-businesses dotting the landscape of Africa. This gentle and soft-spoken lady has identified a niche market for household goods bought on credit and is excelling by doing so. Her business plan is truly interesting--she purchases items from shopkeepers in Blantyre and then sells the items on credit to people in her community. She extends credit on crockery, cutlery, and soap for 30 days, at the end of which, she collects her initial investment plus interest. Her small business is generating an income stream for herself and her family, as well as providing a useful service to many individuals who have no access to credit and simply cannot afford to pay costs up front for the items they need.

Things were not always so promising for Gloria, in fact; she freely admits that there were many moments in her life when she didn't think she could survive one more day. Providing food and shelter for her children seemed impossible. Scared and HIV-positive, she was earning a living as a commercial sex worker. Then, she found her way to PIH’s sister organization in Malawi, Abwenzi Pa Za Umoyo, which welcomed her into a newly-developed income generation program. The program helps commercial sex-workers find alternative forms of employment. Gloria received some basic business skills training, and soon began working at the local Mtendere Restaurant.

With a smile in her voice, Gloria explains how working at Mtendere has provided her with the seed money necessary to start her own side business. She now looks to the future with a renewed sense of hope and purpose. She makes a point of mentioning that she is able to meet the needs of her family with ease, and manages to pay school fees for all of her children with the proceeds from her business.

* Name has been changed to protect the privacy of the participant

Iole Pizzola worked with APZU in Neno, Malawi.

By Bronwyn Murray-Bozeman

	Dr. Corrado Cancedda with a patient in Rwanda. Photo by Adam Bacher

Corrado Cancedda shouts at the little television screen set high in the corner of the room. The lanky Italian doctor is watching his team--the team that beat France in the 2006 World Cup--lose to a team of relative obscurity two years after that championship game. He turns around and apologizes to the audience, grinning. A couple of other foreigners are watching the game, but most of the little bar--home of the only television set in the village--is crammed with good-natured Rwandan kids, laughing at Dr. Cancedda’s outburst and cheering for both teams. Some of these kids are Dr. Cancedda’s patients, some are just the kids who play soccer in the stadium every Tuesday, but all of them know the tall doctor who has become part of  the village. 

Rwinkwavu, Rwanda is not the first PIH site Dr. Cancedda has passionately immersed himself in. He worked with PIH’s partners in the mountains of Lesotho in southern Africa for the final year of his infectious disease fellowship, and now he brings that experience to his current work, as well as what involved him with PIH in the first place--a burning desire to help and the realization that disease isn’t just bad luck, but also the result of structural violence and poverty. Now, as the Chief of Medical Education for PIH in Rwanda, he brings those lessons to Rwandan doctors and nurses as well as American medical students and residents working with facilities operated by PIH’s sister organization Inshuti Mu Buzima, in partnership with the Rwandan Ministry of Health.  

Dr. Cancedda firmly believes that “nothing replaces experience.” He recommends at least two to three years of solid fieldwork so that trainees can bring the lessons they learn in Rwanda to a larger arena. He trains his students in both medicine and in social action so that they can provide clinical care and psychosocial support. “Understanding issues,” he says, “is the foundation for solid work.  If you don’t address psychosocial factors, you can’t have much of an impact. You can’t just cure the disease, but you have to address what leads to the disease in the first place.” This idea, one of the core ideals that PIH is governed by, is strikingly evident in a place like Rwanda, where Dr. Cancedda regularly sees patients afflicted with diseases of poverty, like malnutrition or malaria.  

In an environment where “no one tells you that you’re crazy no matter how big an idea you come up with” (or how loudly you yell at a TV during a soccer game), Dr. Cancedda finds a way to pursue his passions through the medical skills he has been given, and is currently working on creating an academic partnership between American universities and the PIH sites in Rwanda and Haiti. Likewise, he pushes his trainees to think bigger and bigger, as well as to channel that passion and creativity. “We are very lucky,” he reminds them, “because we have the opportunity to advocate for our patients and to promote social justice and to make a difference. We need to take this opportunity.”

Though he splits his time between Rwanda and Boston, he described the unique union of qualities that makes Rwanda such an inspiring place to live and to work: the kindness of people and the slower pace of life, the beauty of the countryside around Rwinkwavu, red dirt hills awash with color and hazy sunsets in the dry season. Dr. Cancedda is also careful to explain why it is so excellent to work in Rwanda, with Rwandans--the stunning potential for good coupled with the constant drive to be better. For him, it’s a combination that incites a passion that rivals a World Cup win.

By Peter Drobac, PIH Country Director for Rwanda

	Dr. Peter Drobac (right) with Dr. Tharcisse Mpunga, the Director of Butaro Hospital (left).

In nearly a decade with Partners In Health, I have been party to some wonderful achievements and countless small victories. But Monday, January 24th was my best day.

On a stunning, remote mountaintop in northern Rwanda, scores of government leaders, PIH staff, friends and supporters, and community health workers looked on as Butaro Hospital opened its doors to the world. This 150-bed, world-class teaching hospital features two operating theatres; an intensive care unit; a dedicated neonatal unit; and state-of-the-art medical equipment. Its innovative design employs natural ventilation techniques to prevent the transmission of dangerous diseases, such as tuberculosis and H1N1, while creating a tranquil, dignified environment. And yes, there are fish ponds.

I watched with pride as the men and women who had built the hospital, and those who would soon provide care there, led the President of Rwanda on a tour of the facility. Paul Kagame nodded approvingly—high praise from such a strong man. Paul Farmer cried a little—he’s strong in a different way.

Three years ago this month, we stood on the very same mountaintop, appreciating the breathtaking setting and surveying the work to be done. After two years of successful collaboration with the Government of Rwanda and the Clinton Health Access Initiative—having built two public hospitals, training scores of doctors, nurses and community health workers, and providing care to hundreds of thousands—our Government partners invited PIH to help them implement an ambitious new model of rights-based, primary health care in the remote Burera District. They chose Burera because its desperately poor health care infrastructure was most deserving of attention. Difficult roads. No electricity. One doctor serving nearly 350,000 souls. Women dying in childbirth on boats trying to reach the nearest hospital. If we succeed in Burera, they told us, we can succeed anywhere.

The mountaintop on which we stood housed a military camp. It had been an important battleground in the war that ended the 1994 genocide and decades of conflict. Rwanda was moving forward. It was time to replace soldiers with doctors. President Kagame had promised the people a hospital on this very site—and he keeps his promises.

Two years ago this month, we launched construction on this very same mountaintop. In the preceding year, a series of abandoned buildings—some of them used to confront and reconcile the perpetrators and victims of the 1994 tragedy—had been transformed into a temporary hospital staffed by seven doctors and more than 50 nurses, providing desperately needed care.

In the meantime, our collective ambitions for a permanent hospital grew. Originally, we had intended to build a modest district hospital. But here in Rwanda, the country that was beginning to teach the world how to break the cycle of poverty and disease, why not create a flagship teaching hospital?

One year ago this month, a massive earthquake rocked Haiti, killing hundreds of thousands and displacing millions in just a few seconds. The government of Rwanda, the people of Rwanda, and the staff of Inshuti Mu Buzima responded with a tremendous outpouring of support. Community health workers donated portions of their modest pay to the relief effort. Once the shock abated, it became evident that Rwanda provided Haiti with perhaps the finest example of how to Build Back Better in the wake of devastation and tragedy. And so we accelerated construction, adding a third shift of local construction workers. Many nights I would be awakened at two or three in the morning to the sounds of hammers, saws and the music of hundreds of men and women singing as they worked tirelessly under flood lamps.

More than 3,500 good jobs were created during the construction. Every window, every door and most of the furniture was made on site by local craftsmen in vocational training programs. More kids are in school because of this hospital. People are healthier, and communities are stronger because of this hospital. And all this before the first patient even arrived. Butaro is a powerful example of the “virtuous social cycle” that is created when smart investments in health infrastructure transform communities by catalyzing economic development and social change.

	Dr. Peter Drobac shows Rwandan President Paul Kagame around the new Butaro Hospital.

On Monday, President Kagame said, "Butaro is more than a hospital. It is a unique story of exceptional people with the desire to see positive change in the world and in communities like the one hosting us today... It is also a story about strong and mutually benefiting partnerships and the fact that when we come together and join forces, commendable results can be achieved."

On behalf of the thousands of people who built this hospital, and the hundreds of thousands who will benefit, I want to thank you for your partnership, which made all of this possible. Now, of course, the real work begins. Caring for patients, teaching, striving to deliver ever-higher standards of equity and quality, all of which will ensure that Butaro Hospital fulfills its immense promise.

In other words, it’s time for the fun part.

	Children in Lesotho.

In early January, PIH received $290,000 for projects in Lesotho and Malawi--a gift from Disney and the children who play in the virtual world of Club Penguin.

For ten days each December, Club Penguin encourages its players around the globe--most aged between 5 and 12--to donate the virtual coins they earn playing games in Club Penguin to one of three real world causes as part of Coins For Change. The kids’ contributions count as votes to determine how a $1 million cash donation is shared among real world charities selected to represent those causes. The idea is to empower children to affect change in the real world by playing and making a difference in the virtual world.

This time around, players could choose to donate their coins to provide medical help, build safe places or protect the earth. Everyone stepped up to do their part, and, in the end, more than 3.4 million kids voted with their coins. Read more.

The money donated to PIH's siter project in Malawi, Abwenzi Pa Za Umoyo, will help roughly one thousand children attend school and purchase uniforms, prevent infection and care for girls and boys living with diseases like HIV and malaria, and treat childhood malnutrition.

The money donated to PIH's sister project in Lesotho, Bo-Mphato Litšebeletsong tsa Bophelo will provide much needed health services to thousands of children in the rural mountain villages of Lesotho, an impoverished nation located in southern Africa. Support from Coins For Change will contribute to the distribution of vaccines, treatment for malnutrition, as well as HIV testing and care--services that are critical to helping children grow strong and healthy in the mountains of Lesotho.

The $290,000 will be split evenly between PIH’s work in Lesotho and Malawi.

	Rwandan President Paul Kagame cuts the ribbon to open Butaro Hospital. View a slideshow of the new facility and its inauguration.
	Aerial view of Butaro Hospital (photo taken December 2010).

On January 24, Butaro Hospital officially opened its doors in northern Rwanda.

The flagship 150-bed facility was built as part of the ongoing collaboration between Partners In Health and the government of Rwanda.

"Butaro is more than a hospital," said Rwandan President Paul Kagame. "It is a unique story of exceptional people with the desire to see positive change in the world and in communities like the one hosting us today... It is also a story about strong and mutually benefiting partnerships and the fact that when we come together and join forces, commendable results can be achieved."

The facility features an innovative design intended to harmonize with the local environment and reduce the risk of hospital-acquired infections. More than 3,500 members of the local community were employed during construction, which was completed a year earlier than scheduled. Wherever possible, the hospital was built using local materials, including volcanic stone from the Virunga Mountains.

Read more about the construction and design of the hospital.

Tours of the facility included visits to the surgical suite, emergency room, intensive care units, pediatric ward, and IT room. The hospital aims to be a leader in using information technology to aid patient care. Wireless Internet is available throughout the hospital campus, and laptop computers are in place at every nursing station. Through PIH’s partnerships with Harvard Medical School and Brigham and Women’s Hospital, medical staff will be able to access online educational resources and obtain expert consultation for difficult cases.

Dr. Paul Farmer, co-founder of Partners In Health, addressed the assembled guests and praised health-sector leaders in the government of Rwanda.

PIH Country Director for Rwanda, Dr. Peter Drobac, said, “We will continue working with our partners in the government to ensure that this beautiful facility becomes a model of rural healthcare delivery for the region.”

Learn more about Butaro Hospital.

Rwandan President Paul Kagame (center left) and PIH co-founder Dr. Paul Farmer (center right) tour Butaro Hospital. View a slideshow of the new facility and its opening.

Read coverage of the inauguration in South Africa's Sunday Times.

Read coverage of the inauguration in Rwanda's New Times.

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

	Patients and PIH/ZL staff in Port-au-Prince commemorate January 12.

On this most difficult of days after this most difficult of years, I witnessed and participated in a truly beautiful celebration of remembrance, reflection, and hope today in Port-au-Prince.

On January 12, 2010, all of our lives changed. We all began to think in a different way, see life in a different way, understand things in a different way, and comprehend the true meaning of love.  Strangers and neighbors and families alike all came together to save each others’ lives and work to rebuild a battered country. I began to understand in another light the meaning of the Haitian national motto L’union fait la force (“Unity is strength”).

Today’s memorial service, organized by a group of patients with earthquake-related injuries that received treatment in Cange with PIH/Zanmi Lasante, and who had formally organized themselves into a youth organization (Union des Jeunes Victimes du Seisme 12 janvier 2010), integrated solemn prayer and songs of remembrance with stories of courage, survival, and strength. Held at the St. Charles Rehab Center, a place many of our ZL patients have been receiving ongoing physical therapy since returning to Port-au-Prince, the day’s events often felt more like a family reunion than a solemn memorial.

As one earthquake survivor after the next stood up to bear witness to their struggles of the past year-- incredible stories of survival--each story culminated with a common theme: “God wanted us here for a reason--he spared our lives so that we can work together to rebuild Haiti, to finish our studies and walk and work and live just as anyone else.”

Tatiana Therosme, our PIH/ZL psychologist from Cange who has worked with many of these families over the past year, shared her reflections on finding the strength within all of us to continue to work together to overcome physical and mental disabilities. And through compassion and love, we will continue the efforts to rebuild Haiti.

As the day concluded and the tears of sadness turned into tears of joy as everyone posed for “family” photos, standing and looking as beautiful as ever, it was hard for me to imagine these were the same people that just a year ago were struggling to survive at our overcrowded hospital in Cange. How far we have all come in this ever so difficult of years.

	The Butaro hospital was built with local labor and tools.
	High ceilings, large fans, and numerous windows for the hospital wards are integral to the hospital's low-tech but highly effective infection control system.
	Outside view of the hospital.

Hammers, hoes and even machetes were used to build Rwanda's new hospital.

And an equally low-tech and low-cost ventilation system will keep the facility at world-class standards for patient safety.

Serving a community of 400,000 which has never had a permanent hospital to date, the Butaro Hospital – which opened on January 24 in Rwanda's northern Burera district – offers the most advanced and comprehensive services of any district facility in the region.

The campus-like facility is set on a hilltop, with terraced gardens, open courtyards and covered verandahs leading to a series of stone-clad wards, labs and specialized treatment centers.

While projects of this scale in Rwanda normally involve major contractors (often from South Africa or Belgium) the partners behind the project – Partners In Health, the Clinton Foundation, and the Rwandan government – elected not to use major outside contractors and suppliers. Instead, local jobs were created with the intent of making this pioneering model transferable throughout the developing world.

Remarkably, during construction even major fitting suppliers proved unnecessary, with local men and women learning to build the doors, assemble the plumbing and perform the complex stonework on site

With PIH itself acting as prime contractor, the 6,000 square meter facility was built entirely with the labor and fast-developing skills of over 2,500 Rwandans. Dr. Peter Drobac, PIH’s country director in Rwanda, said on-site training and around-the-clock work by ordinary Rwandans rapidly completed the project.

“Except for one bulldozer we rented to clear the site, this construction was done by hand, using local tools; even machetes some times,” said Drobac. “Every window, rain gutter and door was made on-site. We brought in a master welder, a master carpenter; a master mason, and established workshops at the site, and now there are a number of Rwandans skilled in those areas as a result.”

Drobac said one businessman was so impressed with the stone masonry in the walls – which used a “jigsaw” joint technique unprecedented in Rwanda – that he asked for the builder's business card, so he could commission similar work in Kigali. Drobac simply pointed out a group of newly trained Rwandans on site, explaining that they didn’t have business cards… yet.

In the first week of December, Rwandan landscape artists, carpenters, painters and a floor-laying team put the finishing touches to the facility. Others erected color-coded signs that patients will use to navigate its system of verandas, built to prevent patients infecting each other in enclosed spaces.

Michael Murphy, cofounder of the Harvard-based volunteer architectural team, MASS Design Group, said the design strategy takes advantage of the temperate climate. Rather than hallways, patients can queue or gather in the gardens or under the verandas year-round. This reduces the risk of airborne infections, like multidrug-resistant TB.

The hospital's central infection control strategy also ensures that air is changed in the wards at least a dozen times an hour: rising naturally away from patients under the influence of heat, and then being ejected out of the buildings. Patients will also find high vaulted ceilings equipped with huge, slow-moving fans, which promote the gentle flow toward louvered windows – set 15 feet above the floor – without creating a draft.

 Hand-sanitizing stations have also been set up between each bed to counter non-airborne infections, while secluded patient wards and a spatial triage system will accommodate vulnerable patients.

“This hospital was designed first of all to not be an unsafe environment,” said PIH co-founder Paul Farmer. “The biggest problem for hospitals in Africa is TB transmission,” he added. “So rather than being places where people find care or a cure – maybe for an appendectomy, or child birth – you can get infected with TB, where TB along with HIV is a leading killer. And the reason is lack of proper ventilation, no fixed louver windows, (inadequate separation of patients), and not enough air flow.”

Drobac added that just last year, there was an outbreak of H1N1 “swine flu” virus around the site of the hospital last year. It was effectively contained by the Rwandan Ministry of Health, but the example “accentuates the need for this design, given the sorts of infections that can tear through facilities like this where patients are in close proximity,” said Drobac. More dramatically, Murphy pointed to an outbreak of extensively drug-resistant TB (XDR-TB) in South Africa in 2008, in which 52 of patients died due to insufficient infection control and design at a clinic.

“We took this problem as an opportunity to have a whole hospital designed to counter it, while also advocating for infection control to become a design strategy for medical infrastructure everywhere,” said Murphy.

Drobac said the design also allowed the hospital to bypass the large, expensive ventilation machines required by most modern hospitals.

 “This is a really clever design, and it should be as effective in terms of ventilation as if we had several hundred thousand dollars of mechanical equipment in a hermetically sealed building – in fact, better in the long run,” said Drobac. “When huge investments are made in fancy equipment for ventilation, is that it then breaks, and because its complex and there's no one to maintain it, you're in a worse situation than if you never had it in the first place.”

With a giggle, Esther Balthazar bursts into song. Her head sways in time with the music, her smile grows with the melody. She’s singing one of her favorites—a hymn of hope. A cold breeze rustles through the lush grove of palm trees at her home in central Haiti, but Esther’s warm, confident voice cuts through the chill.

Pulling a turquoise towel around her shoulders to guard against the wind, Madame “Fifi” Demme joins in the last few lines of the verse. As Esther's adopted mother, she knows the young woman's long journey to becoming the stellar student and enthusiastic singer in her church’s youth choir that she is today.

One year ago, Esther was in a completely different state. Unresponsive and catatonic at times, she heard voices, cried uncontrollably, and often lashed out at those trying to help her. “If we asked her to do something, she’d get angry. If we asked her to sit, she’d stand,” recalls Fifi, who found her while on a missionary trip to the southern coastal town of Jérémie. Fifi knew that she couldn’t leave the troubled woman on the streets amidst the earthquake rubble, so she and her fellow missionaries brought Esther back to their home in Cange, in the Central Plateau of Haiti—less than a mile from the hospital operated by PIH’s Haitian sister organization Zanmi Lasante (ZL).

ZL psychologist Dr. Tatiana Therosme believes that Esther had a pre-existing psychotic condition that was aggravated by stress and trauma following the massive earthquake last January. She and PIH mental health director Dr. Giuseppe Raviola started Esther on a low-dose of an antipsychotic medication in March, with instructions to take the medication every night, gradually increase the dose, monitor closely for side effects, and go to the clinic if she experienced any problems.

The medication, along with therapy sessions and a stable home with Fifi’s family, helped to stop Esther’s psychotic episodes, and she has since become an active member of her community. She began studying in preparation to resuming her education, began a small business selling snacks by the side of the road, and was invited to join her church’s youth choir.

By October, the ZL mental health team, visiting Esther at home, decided that she was doing so well that they could try taking her off of the medication. Dr. Raviola recalls that Esther was reluctant to stop the medication, as he had originally told her that she would possibly need to take the medication for up to a year, or longer. She was concerned that she wasn’t fulfilling her duty to adhere to the regimen. Dr. Therosme and her team carefully explained to her that any course of treatment depends most on each individual person’s response—and in Esther’s case, she had responded so well to the regimen that it was felt to be worth trying to stop the medication, albeit with close follow-up.

Since then, Esther hasn’t looked back. She enrolled in school in November, and is currently taking a seemingly overwhelming number of classes: Math, Physics, Biology, Haitian Literature, French Literature, English, and Spanish. It’s as if she’s making up for lost time—she’s in her second to last year of high school—this will be her third time beginning this grade, having failed or dropped out in previous years due to her illness. This time, she’s determined. According to her mother, she never misses a day of school—she’s in class six days a week—and always does her homework. “She’s good, and smart, too smart to not be in school,” Fifi proudly asserts.

Since stopping the medication Esther has also become noticeably slimmer than she was just three months ago, as her appetite has gone down to normal in the absence of the medication. “She’s taking a break from eating,” Fifi jokes. The other change--she's no longer selling snacks at the side of the road. She and Fifi start laughing at the mention of her commerce project. "She ate all the commerce!" teases Fifi, while Esther protests that she hasn't had time between her studies and choir practice--which she attends twice a week.

Esther knows that she is incredibly fortunate. Finding treatment for mental health issues in Haiti is exceedingly difficult, particularly so prior to the earthquake. In the whole country, there were only 10 psychiatrists and 9 psychiatric nurses working in the public sector, according to a 2003 World Health Organization report. Esther's own mother suffered from severe untreated mental health issues. She died when Esther was just 14 years old.

Following the earthquake, the need for mental health services has only grown. With so many lives lost, so many displaced, over a million left without homes, hundreds of thousands of people suffering life-altering physical injuries, and in an unstable environment, it's not just those with pre-existing conditions, like Esther, who are in need of care.

	Esther (center) with ZL psychologist Dr. Tatiana Therosme (left), and a ZL social worker.

The PIH/ZL mental health and psychosocial team has hired 17 new psychologists since the earthquake, and has expanded its team from 25 to 90 clinicians, social workers and social work assistants, and community health workers. Together, they are currently caring for thousands of patients who are currently undergoing individual therapy, in addition to working with the many communities, schools, settlement camps, and churches they provide with support, education and materials.

As the sun sets over the grassy hills surrounding Cange, the temperature continues to drop. Esther still appears comfortably warm in just a red t-shirt as she continues to sing her hymn. The wind cuts through the smell of hot tar steaming off the nearby newly paved road as over-laden trucks rumble and motorcycles roar by, shaking the ground beneath Esther's house. A year ago, similar rumblings could have triggered further mental health issues. But today, Esther just sings louder.

Read a previous article about Esther.

	Laboratory in Strezhevoy tests for HIV and MDR-TB.
	Nurse drawing blood from an HIV-positive patient in Strezhevoy.

Recently, PIH-Russia strengthened its proactive tuberculosis program in Strezhevoy, a town of 45,000 people located about 400 miles north of PIH’s first Russian program in Tomsk City. Isolated by hundreds of miles of tundra, the town is defined by its Siberian culture, the large oil-based production companies that employ much of the city’s workforce, and one of highest incidence rate for HIV and co-infection of tuberculosis HIV and tuberculosis (TB) in that region of Russia. Making matters worse, a disproportionate number of people are developing multidrug-resistant TB (MDR-TB).

Nationwide, Russia reports 85.1 cases of TB for every 100,000 people, compared to only five per 100,000 in the United States. In Tomsk Oblast, where Strezhevoy is located, the number tops 101.5 new cases per 100,000. Additionally, about 13 percent of new TB cases are MDR-TB in Tomsk Oblast. Moreover, curbing the rate of TB in regions like Strezhevoy has been difficult, due in part a high rate of intravenous drug use and its isolation.

In order to reverse these trends, PIH-Russia refined an algorithm used to identify HIV patients who are most at risk of contracting TB. A preventive strike against TB and MDR-TB.

The team used information collected and analyzed over the past decade to create the algorithm. The formula relies on the results of the TB testing, patients’ CD4 count, their exposure to TB, and other factors.

Once identified using the formula, the patients are put on an intense anti-TB drug regimen called Latent TB Infection (LTBI) chemoprophylaxis. They will take the drugs for four months, three times a week, under the direct observation of medical staff. To encourage patients to take care of themselves while on the regimen, they receive food packages during the course of treatment.

If a patient is not able to visit the nearest treatment facility, PIH medical workers will visit the patient in their home as part of the organization’s “Hospital at Home” project.

The goal: prevent people from contracting a disease that is often painful, and for people living with HIV, deadly.

Preventing the spread of TB not only spares the patient, but also reduces the threat of transmitting the disease within the larger community.

Read more about PIH’s work in Russia.

The following piece by PIH co-founder Paul Farmer was presented on January 14, 2011, as part of the event Remember, Reflect, Respond: Haiti One Year Later.
__________

Remember. The day before yesterday, Port-au-Prince looked as if it had just been leveled by an earthquake. But all of those gathered there on January 12^th, 2011, knew how different it was from a year previously.

All five of our senses told us why, because each of them feeds into memory.

The assaultive images and sounds and smells and textures of those first few days after the 12th have faded, which is good and bad and surely necessary: none of us wishes to dwell on the great disaster of our times. Some memories are well worth summoning, as they remind us of the best that humans can offer one another in times of great distress. But much of what is recalled includes things we wished we’d never encountered, images and smells and even sounds that conjure themselves violently. The images you can see here tonight. The sounds you can imagine: the slow creaking of a roof starting to fall, then its rapid collapse upon the living and pinned, the cries of pain coming from underneath an innocent-looking puff of powder that itself settled over the persistent groans of the injured and the dying.

The sense of touch ran the gamut from the brutal punch of bone-breaking cement to the urgent tug of hands seeking to save those trapped to the gentle or sometimes sharply-honed touch of medical care. Some can still taste January 12^th as a previously unknown flavor of relief or gratitude, spared in spite of long odds; some still taste the more bitter dregs of sorrow. This foisting of memory—the “remember” part of the equation—has sparked sentiments ranging from pity to mercy to grief.

For most gathered here tonight in Boston, we contemplate the pain of others. But some here lost limbs, many lost family, and perhaps everyone lost a bit of innocence about the possible dimensions of a collision between bad luck and longstanding unfairness. For still others, much like those I left yesterday in Haiti, all five senses transport us once again to a house of pain, pinned under the fallen beams of oppressive memory.

How might we lift these beams? We gather here to reflect on this loss and to pay proper tribute to the fallen. It is when memory, however brutal, is yoked to reflection and to meaningful action that we lift those beams to free ourselves and others, that we may make common cause to protect and heal and rebuild anew.

Respond. Not everyone will agree when I say that our immediate response to the quake was effective and humane. But even critics of the acute-relief phase allow that the pragmatic solidarity of the world was marshaled quickly. This city, certainly, has fueled our own response and I know I speak for many doctors and nurses and first responders when I thank those here, and many others, for allowing us to serve as best we could.

We could have done better, perhaps, and can do better in the future. It is harder now, as memory fades, to sustain our response. To make it better and stronger and more effective, to draw on every noble sentiment and every bit of technical skill, we acknowledge the link between memory and passion.

Whether we think of one lost friend or, to use the figure reported yesterday, 316,000 lost souls, we come together to pay respects to those lost and recommit ourselves to firm and informed actions. Just as we’ve lost too many friends to name them all, so too do we have too many aspirations to list them all. But I would like mention one, the new teaching hospital in Mirebalais, because it, better than any other project in more than 25 years of work, is emblematic of both our aspiration to build back better and our respect for the Haitian people and their story. It will be a temple, we hope, in which we can reflect our love of the fallen, from Drs. Josue and Mario to Mamito to Tom White, and our desire to draw on the science and art of healing. It will be a place drawing on the expertise of builders, represented by Jim Ansara and David Walton (one here tonight and one in Mirebalais), and by healers like Natasha Archer and Michelle Morse, and by those who procure and teach and train and manage, and by all the rest of you, who make this redemptive work possible.

Our response thus draws on memory. A temblor of pragmatic solidarity that will register on the Richter or on any other scale, a tsunami of goodness: that will be our response.

__________

Watch a video recording of the January 14, 2011, event Remember Reflect Respond: Haiti One Year Later on the player below.

Read PIH's One Year Report, an update on work accomplished since the January 2010 earthquake in Haiti, and plans to continue helping the people of Haiti rebuild their country.

	A sacred ficus tree shades the new Butaro Hospital.

During construction of Butaro Hospital in northern Rwanda, unexploded hand grenades had to be cleared from the site, near a towering ficus tree. And a building nearby--once used as a courthouse for genocide crimes--had to serve as a temporary hospital ward.

“Now, you walk around the mountaintop and it’s a serene set of gorgeous buildings with very pleasant gardens and water features,” said Dr. Peter Drobac, Country Director for PIH’s project in Rwanda. “And at the center stands an ancient ficus tree which is considered sacred in Rwandan culture--it marked the place of the king's court in the ancient times.”

The sacred tree, which had witnessed much of Burera's tragic modern history, was preserved as the physical and symbolic centerpiece of this area's new and iconic source of hope.

For Drobac, the 150-bed hospital is doubly symbolic in this war and poverty-ravaged region.“This is an important point: (Butaro) is an allegory for the rebirth of Rwanda itself. After we arrived, we actually had to--with the army's help, of course--scour the hillside and remove unexploded shells and hand grenades that were on the site of the hospital,” he continued.

Butaro Hospital replaces a temporary, 65-bed facility that PIH had established at a nearby health center to serve patients during the two-year construction period.  Now, the center will be used mainly for the treatment of ambulatory patients.

However, Drobac added that one ward at the temporary hospital may be transformed into a psychiatric facility, largely to deal with the area’s tragic historical legacy. “We have an enormous burden of mental health problems in this district--up to 25 percent of our adult hospital admissions are psychiatric in nature, for complex reasons regarding Rwanda's history,” said Drobac. “One of our aspirations is to use a ward from the temporary hospital and convert that to a dedicated mental health treatment center.”

Parc Jean Marie Vincent has become home to more than 50,000 Haitians displaced by the January 2010 earthquake. A year after the disaster, they are still living in squalid conditions.

Although construction was delayed for approximately three and a half weeks due to the cholera outbreak and civil unrest, building has resumed on the Mirebalais hospital grounds. The crew, composed of workers from the Dominican Republic and approximately 50 local Haitian employees, is working overtime to ensure the hospital will still be able to accept patients by next December.

Seven courses of concrete block have been laid in the women’s health building, which should have all the walls erected by the first anniversary of the earthquake on January 12.  Plumbing pipe and foundation footings are in place for 2-3 more buildings and the corners have been marked for all the buildings in the Mirebalais hospital complex. Moreover, a retaining wall has been erected that stands 12 feet above the neighboring fields of rice patties. 

In addition to the first well dug near the worker’s camp, a second well was drilled this week that will be attached to a community fountain.  This fountain will be outfitted with a chlorine generator to provide safe drinking water for many communities surrounding Mirebalais hospital.

Dr. Paul Farmer and Mark Richey
in Port-au-Prince, Haiti

Before he was a successful business man, Mark Richey, president and CEO of Mark Richey Woodworking was a world class mountain climber. In fact, he claims that it was through climbing that he learned how to overcome the adverse circumstances he faced in Haiti when he arrived three days after the January 12 earthquake that crushed much of the capital city. It was also through climbing that he met and fell in love with his wife of 27 years Teresa.

Upon arrival in Haiti, Mark found chaos like he’d never witnessed before. “The last moment of calm that I had was looking down from the plane at the island below.” Immediately upon deplaning, he joined an assembly line on the tarmac unloading the supplies and transporting them to the general hospital where Partners In Health clinicians and volunteers were working. He spent the next week and a half using skills learned both as a climber and in building his wood working business from the ground up (he started the business as a one man operation in the basement of his apartment in Malden, MA) helping with a building safety assessment, repairs, and finding equipment that allowed the physicians to treat the thousands of patients streaming in looking for care.

Mark had learned about PIH from his friend and fellow climber Jim Ansara, who, after retiring as president of Shawmut Construction began working on a volunteer basis with PIH. When Mark learned of the earthquake, he called Jim and asked how he could help. Jim asked Mark to join him in Haiti, where he was working day and night to get patients treatment for life threatening injuries. Mark called Teresa, who was visiting family in Peru and told her about his plan. While recounting the story, Teresa grows emotional, saying, “It made me so proud to be married to a man who would do that.”

Tents at Mark Richey Woodworking
wrapped and ready to ship

Mark’s dedication to the Haitian people did not end with his trip. When he returned to the U.S., he found even more ways to contribute to earthquake relief. Using his connections as part of the American Alpine Club, Mark was able to leverage donations of more than 1,000 new and used tents and sleeping bags to send to people living amidst the devastation. Acting as the hub of operation, Mark Richey Woodworking received all donations there and reviewed them to confirm they were of high quality. The supplies were then packed into trucks and transported to Florida. Given his connections to many people in the shipping business, Mark was able to get transport to Florida donated. From there, PIH shipped the supplies to Haiti and distributed them among the earthquake victims. The drive was a company-wide effort, with people from every department contributing time and energy.

Even after the sleeping bags and tents arrived in Haiti, Mark and his team remained committed to helping build long term solutions there. As the founder of a multi-million dollar company with approximately 100 employees that is powered almost entirely from wind and bio-mass energy, he knows the value of long term investments; making Mark Richey Woodworking a totally green company was a large commitment of human and financial resources. But he did so both because it was a good business decision, and because he believes it was the right thing to do. “We make decisions based on our philosophy here” he explains. “Doing the right thing is also good business.”

Mark Richey Woodworking holds the same belief as PIH in that giving someone a dignified place in which to work affects both their own morale and that of the people around them. Therefore, they are showing their solidarity with the people of Haiti once again by donating all of the millwork to the new hospital being built in Mirebalais. This 180,000 square foot facility, will not only utilize state of the art medical equipment, it will also be home to cabinets, shelving, countertops, nursing stations and reception desks of the same world class quality that is found at other Mark Richey Woodworking project sites, including the Museum of Fine Arts in Boston, Harvard University, Kaufman Performing Arts Center in Kansas City, Missouri and hundreds of other high-end corporate, institutional, and commercial projects around the country. This will require a commitment of thousands of hours of work from the staff. From the design to manufacture to shipping and installation of the work, everything will be done with the same impeccable eye to quality that is given to project in the US. To Mark, Teresa, and their staff, however, it is just another example of doing the right thing—another decision based on their philosophy of producing work of the highest quality, and sharing with those who need it most.

The walls have begun to go up at the National Teaching Hospital in Mirebalais--a state-of-the-art, 320 bed facility built by Partners In Health and its sister organization in Haiti, Zanmi Lasante (ZL), in partnership with the Haitian Ministry of Health.

The first ward – a women’s outpatient facility – has begun to take shape, and will be completed in the coming months. Once the hospital opens in early 2012, it will serve hundreds of people each day. It will also be the largest public medical facility in the country outside of the Port-au-Prince.

The facility will also provide a quality educational environment for medical and nursing students to gain experience in the delivery of high-quality care in a rural setting.

Watch a video about Haiti’s new hospital in the player below.

In November 2008, Haiti’s Ministry of Health asked Haiti to fill a void in the region by building a new hospital. After last year’s earthquake, the hospital’s plans were significantly revised and expanded to accommodate the new needs facing the country’s health care infrastructure.

A cholera treatment center was constructed within days of the outbreak in October, and has been fully operational since then.

Read more about the National Teaching Hospital in Mirebalais.

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

The two organizations opened a facility named Zanmi Beni--“blessed friends” in Haitian Creole--to care for the 48 children, who ranged in age from infants to 21 years old.

To commemorate the annivesary of the earthquake, the children took part in a tree planting ceremony on the morning of January 12. "The event was wonderful, most of the children were able to help dig holes, plant trees and water them too," reported Operation Blessing's David Darg. "It was a symbol of a remarkable year of recovery for these kids."

View photos from the ceremony on the player below.

"One child in particular really moved me," said Darg.  "Ti Joe was pulled from the rubble one year ago today, he was fortunate to survive but his parents were killed. Today he is as happy as a child can be, always smiling and bubbling with youthful joy."

"All of the children have progressed in some way, many of them have completely transformed to where they can walk where before they were immobile," said Darg. "At one of the trees a staff member said a prayer that was beautiful, she prayed that the tree would grow to be strong like the children of Zanmi Beni."

Photos courtesy of David Darg, Operation Blessing International

PIH co-founder Thomas J. White passed away on January 7, 2011. Fellow PIH co-founder Dr. Paul Farmer delivered the following eulogy at the funeral mass on Tuesday, January 11, at Saint Ignatius Loyola Church in Newton, MA.

We are gathered today to praise a great man and a great friend. Tom White lived a long and full life and was surrounded at the end of it by those he loved and who loved him unstintingly in return, and we take comfort in these truths. It’s also true that Tom’s greatest gift, his empathy, made him spurn self-satisfaction and led him to a certain restlessness and anxiety. His ability to identify with those in trouble and in need, and to struggle with doubt and anxiety, made him a complex man, certainly, but also one of the great figures of our time.

Tom was a great man by conventional criteria but mistrusted, most of his life, these criteria. He was, as has been noted far and wide, a successful businessman who mistrusted the trappings of wealth and served as a model for spreading it around. He was a Harvard graduate who by his own account didn’t study much; a decorated soldier who was at heart a pacifist; a successful businessman who relied on generosity and trust in all his dealings; a devout Catholic who acknowledged crises of faith and knew the sharp limitations of all human institutions; and a family man with a large family here in this city and, thanks to his family’s willingness to share him, scattered throughout the wide world. Then there was Tom’s personality: conflict-averse but willing to resolve conflicts; quick to laughter, but sometimes irascible; impatient but steady; generous and loving but needing reassurance.

Tom was less a contradiction and more a model of and for what generosity, compassion and service can mean in this world. He changed our lives by straining the meanings of these very words: generosity, compassion, service.

How do you measure compassion and goodness? As fond as Tom was of precision, his stock in trade as a builder, he was deeply mistrustful of confident answers to this question. Long before he knew success in business, Tom was asking hard questions about how best to live in a world in which it was simply not possible to be “freed from all anxiety.” In an era in which formulas for philanthropy are now advanced with great and undue assurance, Tom rejected pat answers to complex questions. For someone who loved numbers and worked closely with engineers to build sturdy bridges and tunnels and buildings, he was always the first to admit there was no unfailing algebra of decency, no unbending geometry of the heart, no unyielding calculus of compassion.

Tom knew the math but also taught many of us (to borrow from Ephesians) that we sometimes see best with the eyes of the heart. He did not, in his charitable work, take shortcuts or avoid the hard process of discernment. Tom knew that everyone in this world can and does suffer, but he also knew that some suffer more than others and that many suffer injustice. Discernment led him over time to what these days might be termed a strategic vision for giving, towards what theologians term “a preferential option for the poor.” He was drawn most to the immediacies of feeding the hungry, clothing the naked, giving water to the thirsty, housing the homeless, visiting the prisoners and the sick, and burying the dead. From this list of the corporal works of mercy springs the much longer list of Tom’s investments in literally thousands of charitable works.

Looking around us this morning, where few to none of us are hungry or homeless or naked or in prison, it’s clear that Tom’s generosity did not require proximity. His imagination, the eyes of his heart, allowed him to understand suffering unlike any he had seen, even in the theatre of war. That’s why his generosity was legendary not just here in his hometown, but around the world. I hope I might be forgiven for commenting on his work in international health, since that’s what we did together for almost 30 years. It was something of a lost cause when Tom first lent his time and backing to us. Over the past few days, Partners In Health, which Tom founded and funded, has received messages of sympathy and support from Peru, Rwanda, Lesotho, Russia, and, especially, from Haiti. Allow me to indulge in what Tom would term running the numbers: by our count, the organization he founded has built or refurbished some 60 hospitals and clinics, scores of schools and community centers, and employs, in over a dozen countries, more than 13,000 people. As Jim Kim noted in speaking to the Boston Globe, Tom’s early investments in taking proper care of people living in poverty and with chronic disease led directly to major changes in the way global health is delivered, saving millions of lives already and promising to save millions more.

It is not surprising that many of Tom’s friends from Haiti and Peru, including Father Fritz Lafontant and Dr. Jaime Bayona, have flown up here to mark his passing, for Tom has been nothing if not constant in his support for those who have not enjoyed, as he might say, a fair shake. And although Tom rarely allowed us to put his name on buildings, the medical directors, past and present, of Haiti’s Thomas J. White Pavilion are all here today.

And Tom never, ever stopped giving of his time and dwindling treasure, and urging others to join him, even as many of his projects took on dimensions he could not have foreseen and even as such efforts found new supporters from across the world. Here is a letter he sent to Ophelia Dahl just a couple of weeks ago:

Dear Ophelia,

Janice is sending $5,000 separately through Fidelity.  On this Christmas 2010, it’s the only way I can express my appreciation and the joy that I receive in working for you and your jolly elves. I feel like Al and Diane [Kaneb] and you are family.

Approximately 30 years ago, when joining in with you, Paul, Jim and Todd, I received a tremendous gift.  For the first time in my life, I was able to give with complete confidence that my donations would be used in the best possible way.

So, Merry Christmas, and thank you to you founders mentioned above and to all the unbelievably compassionate, faithful, hardworking, intelligent people who are the guts of PIH.  My role is pretty much played out, but on to the future!

Peace, light, love, happiness to all of you extraordinary people,

Tom

Others gathered in this church have similar stories of Tom’s involvement in their causes. He is a hero, but not an unsung one. Because of this constancy and consistency, Tom has been acknowledged as one of the world’s visionary philanthropists. From his hometown paper to Time magazine, from Presidents Clinton to Aristide, from Harvard and BC to small schools in Lima and central Haiti, from Roxbury to Rwanda, Tom White has been justly lionized as, to use an Ignatian expression, a man for others. He secretly relished this praise even as he shirked it.

But tenacious and discerning generosity does not capture Thomas J. White as a person any more than does his ambivalent response to honors and recognition. Even though he often bemoaned mean-spirited policies and the suffering of the poor, Tom disliked sanctimony. He was also a lot of fun to be around. Just as he could cry when confronted with the pain of others, so too could he laugh himself into a wheezing fit. He liked especially to laugh at his own jokes, as his family knows well; he liked to retell old stories.

Tom may have liked his own jokes and tales, but he had a way of making people feel valued. Here too, he was discerning, and he sometimes tried the patience of those closest to him by paying special attention to those he saw as undervalued in this world. Every doorman and waiter and parking valet from Cambridge to Newton to Osterville to Jupiter (meaning the town in Florida if not the planet) knew Tom White. Sometimes his compulsive giving was downright embarrassing. I’m not talking about his fifty-dollar tips at McDonald’s or the bright red wagon he gave to a homeless woman who had expressed her desire for one. Who among you has been in a car with Tom at the wheel as he drove through a tollbooth on the Mass Pike and tipped a confused attendant? Tom was probably the only person in all of eastern Massachusetts to be deeply disappointed when an electronic pass was affixed to the windshield of his car.

But Tom didn’t reserve his kindness for the needy alone. He struggled, in the true sense, to pay close attention to those around him. The large, blended family brought together by Tom knew this, as did his friends and business associates. There are, sitting in this church, men and women of privilege and renown who sought and received Tom’s compassion and guidance. There are young doctors whose education he supported quietly, middle-class families who turned to him when they needed someone to co-sign a loan, and young business leaders who started successful ventures in fields little known to Tom, but who still turned to him for guidance both personal and professional.

And Tom had a charming way with young children. For years his car trunk was full of jumbo-sized packets of gum and candies for his grandchildren, great-grandchildren, and for others. When our daughter, Catherine, was six or so, we went to Cape Cod for a family break. This was the year Tom and Lo-e sold their big house in Osterville so that they could give away more money—Tom’s real vocation and one in which Lo-e supported him without complaint as they moved over the years into smaller and smaller houses. But as Tom was no ascetic and loved to swim, this new smaller house had a new smaller pool. Catherine, after splashing in it with joy, asked him, “Papa Tom, did you make this pool just for me?” Tom looked her in the eye and said, convincingly, “Of course I did, dear. Just for you.”

Last Wednesday night, I recalled this story in a phone call from Rwanda, as we struggled to say goodbye to one another. He was trying to make it easier for me, letting me make him laugh one last time (I’d tell you how I did so if we were not in a church). “Love ya, kid,” were his last words to me. Both of us knew they would be.

Tom struggled with goodbyes. Nothing made him happier than fixing a problem, but there were some he could not fix, and he confronted these too. When he could not save a life, or ease a loved one’s pain, he was still left with his ministry of showing up. Each of his children and stepchildren, his sisters and brothers, knew that Tom would always show up in a pinch. When his daughter was losing, over seven grueling weeks, her own newborn daughter, Tom rallied to her and her family, showing up at the hospital every day.  Each morning Tom, who asked the big questions as often as anyone and knew better than most that some of them were unanswerable, could be found boiling an egg for Janice and then completing the care package with a ripe banana and a single multivitamin.

Through his ministry of showing up, through his extraordinary largesse and discernment, through his loyalty and love, through his struggle with self-doubt, through his faith in others, Tom restored our faith in faith itself. At least, he restored mine.

He would likely be embarrassed by such professions. I’ve used the word anxiety more than once. Were Tom sitting here in a pew, he’d be fretting. He didn’t like big gatherings and had a morbid fear of public speaking and ambivalence about public accolade, whether for his charitable work or for his business success. For the past 16 years, we have gathered from around the world to bestow the Thomas J. White Prize. Every year, a month before the date, we would begin a process of asking if Tom would show. Since showing up was one of his practices, he usually did, and this past year made one of his last public appearances in order to pay tribute to his Haitian friends, including Father Fritz, for their courageous labor after the earthquake. But he’d let us know that public appearances messed up his very physiology.

For a man who jumped in Normandy, Tom sure did get nervous. It was the same in the other circles in which he moved. Peter and Kevin and others in the family business will remember his trepidation when he was to be honored in New York by a group of heavy contractors, “The Moles.” They and his close doctor friends and family heard in great detail a recounting of his every symptom of autonomic overdrive.

To restore his calm, to master a mild case of chronic hypochondria, Tom turned to routine and rituals. I refer here not to his love of Church rites, about which others, including the Jesuits he loved so much, can better testify. I refer, rather, to his ritual beer at the end of the day. As the years marched on, as he grew fixed in his ways, he liked most of all to have a beer at precisely 6:15 and to watch Wheel of Fortune with Lo-e, relishing a bit of peace and quiet and Vanna White—no relation.

If I were to conjure just one image of Tom, it would not be of him in his office at J.F. White, or having a sandwich at Partners In Health, or hauling medical supplies for Haiti around in a teal-blue Mercedes, or in Osterville surrounded by children, his and hers, and in-laws and grandchildren and great-grandchildren. These are all vivid images, but none comes to mind quite so quickly as Tom in his reclining chair, slippered feet up, sipping on a beer while shuffling through his papers. Last Wednesday marked the last time he got up to his chair for his nightly beer. Perhaps this more than anything signaled that he was ready to return to his maker.

Restless Tom resting in his chair: we can close our eyes and see you best with our hearts, Tommy, just as you saw best with yours.

To Tom’s large and generous family, here is another chance to say thank you for sharing Tom with us. It’s not easy being the wife or child or grandchild or sibling, niece or nephew of a man for others. Never believe for a minute that any of Tom’s beneficiaries and co-workers and friends took for granted your own profound generosity. It will be a mistake to try and thank you all by name, as there are, by my count, over 80 of you linked by blood and union: Whites and Sullivans and Fiskes and Judges and Wattendorfs and Caseys and Lyons. Thank you Peter, Kevin, Stephen, Carol, Janice, Denise, and Christina and spouses and children; thank you to your mother; thank you G.V., Terry, Mary, Celia, Vickie, and Georgia, and your spouses and children; thank you Mary and Sarah Lyons and Margie Casey. And thank you especially to Lo-e, who for decades believed in Tom as he went about believing in others. As your granddaughter reminded me yesterday, building this huge family required generosity from all, a veritable cascade of generosity as Tom’s family shared him with yours, and yours shared you with Tom’s, and as generations learned from both of your examples.

My last words are directed heavenward, for that’s surely where Tom belongs. Thank you, Tom, for helping us to be the people we seek to be. Thank you for giving so many people a fair shake and for awakening so many to the cause of justice and mercy. Thank you for telling us that it’s OK to fall short or to stumble. Thank you for acknowledging that there is no clear calculus of compassion, no price tag set on the love of one’s fellow humans.

Few of your fellows will meet your measure, but then we all know that you would be the first to remind us that goodness, like mercy, is hard to measure.

Rest in peace, Tom, free from all anxiety.

As we enter the week of January 12, Partners In Health is celebrating the stories of strength, mourning the loss of many precious lives, and looking toward a better future for Haiti. Watch how our Right to Health Care patients are approaching this week on the player below.

I think it’s important for us to live in an inclusive world. Excluding people for this reason or that is, in most cases, grossly unfair. I also think that the myth of the self-made man is exactly that, a myth. All of us are born under many conditions over which we had no control or no vote, i.e. where and when we were born, whether we were male or female, the color of our skin, our ethnicity, and our religion.
                -Thomas J. White

PIH co-founder Thomas J. White passed away on Friday morning, leaving behind a legacy that has changed the face of global health delivery.
 
Since its beginning, Tom White has enabled Partners In Health to do “whatever it takes” to improve the lives and health of patients in destitute communities around the world; whether financing the construction of a small clinic in Cange, to purchasing a microscope, or paying $30,000 per patient for PIH’s first multidrug-resistant tuberculosis (MDR-TB) program.

“Tom fought all his life against ‘stupid deaths,’” said PIH Executive Director and co-founder Ophelia Dahl. He felt that conditions such as hunger or tuberculosis—which have known cures—should not continue to be the cause of so much human suffering.

Read Mountains Beyond Mountains author Tracy Kidder's tribute to Tom White.

The owner of a prosperous construction company, White firmly believed that he couldn’t take his immense wealth with him after his death. In 1983, he found a kindred spirit in Paul Farmer. Farmer, then a young medical student, was initially skeptical of the then president of J.F. White Contracting, Co., who flew to Haiti to meet him wearing bright polyester plaid golf pants. White eventually won over Farmer by his emotional reaction to seeing the poverty and suffering in the Haitian communities that Farmer worked with.

A few years later, White helped found Partners In Health with its first $1 million donation. Since then, White has gone on to systematically give away his wealth—tens of millions of dollars—by selling his company, his assets, and his house to continue supporting PIH projects aimed at alleviating human suffering and poverty. Last month, he sent Dahl a check for $5,000—all he could afford after over two decades of writing checks out to PIH.

“To call Tom's generosity extraordinary would suggest that there is something else to which we could compare it; there is not,” said Dahl. “Tom's generosity was incomparable--revolutionary--and on it we have built our work.“

Today, the Thomas J. White pavilion in Cange is the primary referral site for MDR-TB patients in all of Haiti. And the patients cured by the MDR-TB drugs initially purchased with White’s money helped to provide evidence that the disease could be successfully treated in developing countries, leading to a change in a WHO policy that had previously left such patients to die. White’s legacy extends to programs providing food to malnourished children, tin roofs to villages of leaky shacks, and education and training programs to marginalized communities, and ultimately nearly all projects started during PIH’s first decade of operation. His investment has led to saving the lives of thousands of patients around the world.

“Tom found it physically painful to hear about the suffering of others,” recalled Dahl. To the point that he would sometimes develop physical symptoms himself. She noted that it was fitting that when his time came, White died peacefully and without suffering at his home in Newton, Massachusetts, surrounded by his family and loved ones. He was 90 years old.

Read PIH co-founder Paul Farmer's eulogy for Tom White.

By Tracy Kidder

I first met Tom White 11 years ago, at his modest office astride the Massachusetts Turnpike. I asked him to tell me about the early days of Partners In Health. He more than obliged me. He told me wonderful stories, some funny, some moving, some a bit of both. The best stories are often their own best explanations, but not always. For me, one deep and lasting mystery lay behind everything Tom told me.

Recalling his first meetings with Paul Famer, Tom said, "Paul was a lot younger than me, but he was way ahead of me, on service to the poor." He smiled and went on, with a trace of wistfulness in his voice: "Sometimes I think how much money I used to have, before I met Paul Farmer." Then he added, "But that's all right. They give me a big steak now, and I can only eat half of it." He also said that he intended to leave this life without a nickel, and I gathered that he had already gone a long way toward accomplishing that goal.

Tom had been instrumental in founding PIH and in advising its other much younger founders, and over the years he had given millions and millions of dollars to support its powerful, indeed often seminal projects. He wasn't sure of the exact amount he had given but guessed it might be as much as $50 million.

I wondered at Tom's generosity. Why had he given away all that money, on behalf of strangers who were mostly situated in foreign lands? It seemed like a simple question, but Tom had no answer for it. For myself, I've come to feel that there probably isn't a satisfactory, general explanation for generosity.  But it is enough to know that generosity like Tom White's exists, and not just generosity but generosity that is careful to ally itself with competence and ingenuity and idealism. In a world that often seems to be governed by violence and chaos, this is the greatest gift Tom leaves behind.

Unlike too many PIH-ers who have died untimely deaths, Tom lived to a ripe old age. Personally, I feel saddened by news of his death, but mainly I feel grateful to him.

Read more about Tom White.

Tracy Kidder is the author of the bestselling novel Mountains Beyond Mountains.

Four years ago, there was not a single doctor to serve the 400,000 people of a northern district of Rwanda.

Yet, on January 24, the rural Burera district will see the opening of not only its first hospital, but also one that has been described as “possibly the best hospital in central Africa.”

Built in just two years – in collaboration between Partners In Health, Rwanda's Ministry of Health, and the Clinton Foundation – the world-class, 150-bed Butaro Hospital represents a major milestone for quality health care not just for Rwanda but for the entire region.

Designed to naturally counter infection while promoting patient rights and dignity, the flagship facility will offer services rarely seen in rural settings: from a neonatal intensive care unit and three operating theatres to digital x-ray technology and an international-quality lab.

However, somewhat ironically, the campus-style facility will now form the hub of a new health system in the district designed specifically to reduce the once overwhelming need for hospital care for Burerans.

In a global model for rural health delivery, the partners have already created a system here that seeks to minimize severe illness through prevention, testing and treatment at village level, as well as nutrition, social interventions and a dramatically strengthened primary health care network. Fifteen village health centers have been dramatically upscaled by the partnership--including the physical reconstruction of two buildings--and are now being served by an army of 1,500 newly trained community health workers.

Earlier, PIH cofounder Dr. Paul Farmer said, “This sends a very clear message that high quality medical care can and must be delivered (in rural areas), with good institutions that fit into a broader network of institutions. For example, this big hospital is related to a series of health centers, and people working in the villages--community health workers who can refer to this institution.”

With at least two community health workers based in every village in the district, residents are visited regularly, and sometimes daily, to be assessed for signs of disease or malnutrition; treated and monitored for drug compliance; or accompanied to a clinic.

Dr. Peter Drobac, PIH country director in Rwanda, said the number of nurses per health center had been increased from three or four, to 12 or more, following a training and recruitment campaign, while many now had pharmacists and lab technicians as well.

“We aim to strengthen primary healthcare system at all levels of the system, starting with community health care,” he said. “We have trained and now support over 1,500 community health workers; a minimum of two in every village in the entire district, who are each day visiting their neighbors, to provide clinical care, make sure they take their medicines, screen children for malnutrition, and bring them in to the health centers or the hospital. So they are the eyes and ears who make sure people get the care they need.”

However, for those patients who do need emergency or intensive care, or medical referrals from the health centers, the new hospital will offer the kind of services normally seen only at a major teaching hospital--including teaching, itself. Orthopedic surgery, outpatient ophthalmology, gynecologic services, and an ear, nose and throat clinic will also be on site.

The Butaro Hospital was born out of chronic need in 2008, in a rural area that was the last of Rwanda’s 30 districts that was not served by a hospital. Just one of the tragic consequences people routinely faced in this community was that some women, or their newborn infants, died in childbirth, as they crossed Lake Burera on boats in efforts to reach the nearest hospital.

Partners in Health had already helped to pioneer a new rural healthcare model in two other districts, so the Rwandan government asked PIH to come to Burera, where we identified the hospital gap as a prime opportunity to demonstrate that world-class, high-level care could be delivered in the most rural setting.

PIH established a temporary 65-bed hospital at the site of an existing health center during the hospital's construction, where eight doctors and an ever-expanding team of newly trained nurses provided services never seen in the district. Hundreds of curious and joyful local villagers gathered outside this facility last year when quadruplets were successfully delivered, following an ultrasound examination that has astonished their mother.

Drobac said at least 12 full time Rwandan doctors would staff the new hospital, working alongside a rotation of western physicians, and that a recruitment drive for other staff next year would supplement a recent training campaign at the temporary facility. Having been hand-built by Rwandans, hospital construction is now finished, and Drobac said the hospital would likely be patient-ready by the New Year.

The completion of the hospital represents the culmination of a partnership to strengthen service delivery at all levels of the district health system. The collaboration between PIH and the Ministry of Health includes support for the rollout of the MOH’s national community health program, salary incentives to increase health care worker motivation, renovation of three district health centers and a temporary district hospital, and extensive training for health care workers at all levels of the health system.

Drobac said $1.4 million-worth of medical equipment--fully funded by the Ministry of Health--would be moved into place within weeks, including ultrasound units, ventilators, and incubators to handle the chronic problem of low birth weight infants.

“There has been a remarkable commitment shown by the MOH to provide funding for new, international-quality equipment,” he said. “The beauty of this is that, for instance, telemedicine becomes possible, which is key for such a remote facility.”

Drobac described the importance of the neonatal ICU as just one example of the value of the new services the hospital will offer: “Prematurity and low birth weight is incredibly common here because of malnutrition, malaria and other factors associated with poverty--even babies that come out full term look like preemies, and many of them die. Although we have incubators and other equipment, very simple things can be done to prevent this. We had the director of the neonatal ICU at Children's Hospital in Boston - a really internationally acclaimed expert--spending two months here in Rwanda developing protocols and training doctors and nurses.”

Patients and visitors will be struck by an unusual feature, beyond the multi-level campus design: a hospital entirely without hallways.

Conscious of the deadly threat posed by airborne infections like MDR-TB in hospital settings, the architectural team, Boston-based MASS Design Group, has sought to reduce enclosed spaces, like hallways, while creating a natural ventilation system that moves air up and away from patients.

Meanwhile, in an innovation drawn directly from the PIH “patient-first” philosophy, Butaro's beds will back onto central dividers in the wards, and not against the walls--giving each patient the simple dignity and pleasure of a view.

“Aside from being better from a patient flow standpoint, it's simply a more pleasant experience for a sick person in bed to stare at a beautiful courtyard or valley than staring at another person who is also sick,” said Drobac. “It’s part of what we call a 'dignification' approach.”

Farmer added, “I can't show you a double-blind study which proves that patients are better if they can see beautiful things--but I believe it.” 

Watch a video about the new Butaro Hospital.

PIH’s Dr. Wesler Lambert speaks about current state of Haiti (Kaiser Family Foundation  2/1/2011)
Jaclyn Schiff of the Kaiser Daily Global Health Policy Report spoke with Wesler Lambert, a Haitian-born physician who has worked with Partners in Health/Zanmi Lasante since 1997. In the interview, Lambert explains how access to health care has improved since the earthquake and discusses the recent cholera outbreak. The response to cholera "was a successful" one, he said, noting the collaborative work from all types of organizations, not only those focused on health care. Link to podcast: http://podcast.kff.org/podcast/2011/012611_kff_conversations_lambert.mp3

Two Degrees Brings the Heat to Trinity Campus (The Trinity Tripod, Trinity College  2/1/2011)
Two Degrees Food, the first one-for-one food company, provides a medically formulated nutrition pack to a child in Africa for every nutrition bar sold, helping to reduce child malnutrition.  Valid Nutrition and Partners In Health, two non-profit organizations, help fulfill Two Degrees' one-for-one mission. 

Giving is Sexy, Thanks to Sir Richard's Condoms (Care 2  2/2/2011)
Sir Richard's condom company donates a condom to someone in the developing world for every condom sold in the US. Founder Mathew Gerson found inspiration for Sir Richard's while reading a biography of one of the co-founders of Partners In Health, which Sir Richard's now partners with to bring condoms to Haiti.

Butaro Hospital In Rwanda, Top Health Care for the Rural Poor (Suite 101  2/2/2011)
The 150-bed hospital was built in just two years in a collaboration between the Rwandan government, Boston-based Partners In Health, and the Clinton Health Access Initiative. Paul Farmer, co-founder of Partners In Health believes that the poorest areas in the world can receive world-class care rather than merely basic primary health.

Clinton presses Haiti on elections (Washington Post  1/31/2011) 
Secretary of State Hillary Rodham Clinton visited a clinic run by Boston-based Partners In Health to treat victims of a cholera epidemic that has claimed more than 3,500 lives since fall. 

Secretary Clinton Visit to Partners in Health Cholera Treatment Center (U.S. Department of State  1/30/2011)
US Secretary of State Hillary Clinton was in Haiti this weekend. She met with PIH’s Nancy Dorsinville. She also visited the organization’s medical clinic in Parc Jean Marie Vincent – the second largest spontaneous settlement camp in Port-au-Prince.  

Clinton hails cholera progress in Haiti  (AFP  1/30/2011) 
Touring a cholera clinic, US Secretary of State Hillary Clinton on Sunday hailed the news that the wave of cholera that has killed more than 4,000 Haitians since October is receding… The number of new patients at the Cholera Treatment Center, managed by US government grantee Partners In Health, has been reduced by half to about 40 per day since the start of the epidemic, a State Department official said. 

Clinton urges adopting OAS report for Haitian elections (Miami Herald  1/30/2011)
U.S. Secretary of State Hillary Clinton re-emphasized the United States' commitment to the people of Haiti, saying she does not envision “at this time” suspension of aid. During a visit to a cholera treatment plant operated by Partners In Health, a U.S.-supported non-governmental organization, she chatted with patients about the waterborne-disease and asked questions about the illness.

Q&A: Dr. Paul Farmer and Ophelia Dahl on recovery efforts in Haiti (Los Angeles Times  1/29/2011)

Dr. Paul Farmer, U.N. deputy special envoy to Haiti, and Ophelia Dahl, who founded the nonprofit Partners In Health with him in Boston in 1987, are in Los Angeles this week to attend Saturday's “Haiti Stories” conference at UCLA’s Fowler Museum. 

Cholera battle continues in rural Haiti (Project Medishare  1/27/2011)
Dr. David Walton, the deputy chief of missions for Partners In Health, said the decreasing number of patients seen at the Mirebalais CTC is deceiving. “It’s tricky because if you look right here at this cholera treatment center you would be deceived to think that cholera is getting better, but if you take a look at the places in the south there are reports of hundreds of people dying in the mountain sides and even in other cholera treatment centers and cholera treatment units,” Dr. Walton said. 

Vaccination Considered in Haiti as Cholera's Spread Slows (Science Blogs  1/26/2011)
Cholera has killed roughly 3,800 people in Haiti and sickened another 189,000, and it will continue to circulate in the population for the foreseeable future. The good news is that the number of new cases per week has dropped from 12,000, which it reached in November, to about 4,700, and the mortality rate has also decreased. It's a daunting challenge, but a Lancet piece by authors from Harvard Medical School and Partners In Health/Zanmi Lasante points out that ambitious health efforts have succeeded in Haiti before. 

Diocese of Haiti meets in second post-quake annual synod (Episcopal News Service  1/26/2011)
This is Haiti’s second diocesan synod since large parts of Haiti were devastated by a magnitude-7 earthquake on Jan. 12, 2010. Both have taken place at Bon Sauveur, which is located in the midst of the Partners In Health/Zanmi Lasante complex. 

Kagame opens new hospital in Butaro (The New Times (Rwanda’s Largest Daily)  1/25/2011)
President Paul Kagame, accompanied by First Lady Jeannette Kagame, yesterday officially opened a state-of-the-art hospital in Butaro, Burera District, Northern Province. The 152-bed hospital which boasts of modern medical equipment, ultra-modern buildings and modern ICT facilities was built at a cost of Rwf.3.35bn in a partnership bringing together the Government of Rwanda, Partners In Health, the Clinton Health Access Initiative (CHAI), and the people of Burera.
President Kagame particularly thanked Dr. Paul Farmer, the Founder of Partners In Health…as well as other friends of Rwanda, for the commitment to work with Rwandans to establish the modern hospital, that is expected to improve lives in the rural district.

Haiti: A Year After the Earthquake (WHYY Philadelphia  1/24/2011)
Reporter Susan Phillips sits down with PIH’s Dr. Evan Lyon and Trinity College and US Institute of Peace Haiti expert Robert Maguire to discuss the Haiti one year after the earthquake.

Film on Va. charity to get Sundance screening (Associated Press  1/22/2011)
A documentary being screened at the Sundance Film Festival, "Loads of Hope," examines the home for disabled orphans and abandoned children run by Operation Blessing and Partners In Health.

Rwanda's medical miracle (Sunday Times - Johannesburg, South Africa  1/22/2011)
One of Africa's poorest and most war-ravaged districts did not have a single doctor for its 400,000 people. But tomorrow, the remote province in Rwanda will see the opening of a hospital described by Harvard experts as “the finest in central Africa,” to complete a new health system there which offers a global model for delivery to the rural poor. Built in just two years in a collaboration between the Rwandan government, Partners In Health, and the Clinton Foundation…

Standing with Haiti by supporting coordinated and Haitian-led development efforts (ONE  1/20/2011)
by PIH’s Meredy Throop and Donna Barry
Today, the persistent lack of coordination between international donors, NGOs, government ministries and local people severely hinders Haiti’s prospects for “building back better.” Partners In Health (PIH) and our Haitian sister organization, Zanmi Lasante (ZL), have advocated for a human rights-based approach to earthquake recovery and reconstruction. 

Harvard Graduate Students Complete Locally Constructed Rwandan Hospital (Inhabitat  1/19/2011)
The Butaro Hospital, in the Burera District of Rwanda is comprised of a number of buildings set on a hilltop location. Principles of natural ventilation and passive solar design help moderate temperatures... MASS collaborated with Partners In Health and Harvard Medical Center to develop and implement systems which minimize disease transmission.

Peace, justice, civility (Attleboro Sun Chronicle  1/18/2011)
Meanwhile, at an ecumenical service in the Memorial Baptist Church in Seekonk, keynote speaker Ed Cardoza, director of development at Partners In Health, an organization dedicated to bringing medical help to those most in need anywhere in the world, urged listeners to create hope by taking individual action to help eliminate sickness, poverty and violence.   

Tuberculosis still a problem (Daily Northwestern  1/18/2011) 
In response to the lack of services for patients of multidrug-resistant TB, Partners In Health, a Boston-based non-profit focusing on health care, started a specialized treatment program in Peru. The program cured 85 percent of its patients, Roy said.

Social Design: Straight Out of School (Metropolis Mag  1/17/2011)
This next week PIH opens a flagship Butaro Hospital in northern Rwanda. Built by MASS, the 150-bed facility…brings a world-class facility to Africa.

Haiti: A Year After the Catastrophe, Aid Efforts Make a Difference (Sacramento Bee  1/16/2011)
Roughly 12,000 people a week have contracted cholera since it broke out in late October. More than 3,500 have died. And Dr. David Walton, the deputy chief of mission for Partners In Health says that there are probably five times as many cholera deaths as reported. 

Bring Back Aristide (Human Rights and Human Welfare  1/15/2011)
Paul Farmer, United Nations Deputy Special Envoy to Haiti and founder of Partners In Health, has suggested that former President Jean-Bertrand Aristide is by far the most popular and trusted Haitian political figure. 

Partners in Health Pauses to "Remember, Reflect, and Respond" to the First Anniversary of the Haiti Earthquake (White Rhino Report  1/15/2011)
Partners in Health’s commemorative event, "Remember, Reflect, and Respond," was podcast, and I encourage you to join with those of us who were there last night to hear the thoughtful reflections that were shared by those whose lives were forever touched and changed when the earth moved that January afternoon in 2010 in Haiti.

Fashion for a Purpose (Style Goes Strong  1/14/2011)
PIH’s Joia Mukherjee said that Haiti was the first and only republic founded through a slave rebellion – and marked the beginning of the end of the slave trade. Her passion, which after 12 years of doing what she does in Haiti, seems not only undiminished, but expanded. Dr. Mukherjee described the Haitian people as "impoverished… but not poor!"

‘Beyond School Books’ – a podcast series on education in emergencies (UNICEF  1/14/2011)
UNICEF Radio moderator Amy Costello recently spoke about education and cholera prevention with Dr. Ralph Ternier, Director of Community Care and Support with Partners In Health, a non-profit organization that has been providing health care in some of Haiti’s poorest communities for more than 20 years. 

HuffPost's Greatest Person Of The Day: Nadia Raymond, A Field Nurse In Haiti (Huffington Post  1/14/2011)
There was no other option, I had to go." Haitian-born nurse Nadia Raymond describes her decision to volunteer in post-quake Haiti as "automatic." On three separate trips with Partners In Health, Nadia, who is based in Massachusetts, joined a group of medical professionals lending their expertise to the disaster response efforts.  

Cholera Outbreak Compounds Haiti's Woes (PBS  1/14/2011)
Jeffrey Brown looks at the battle against a cholera epidemic in Haiti, one year after a devastating earthquake. Brown interviewed Dr. David Walton, who set up the main Partners In Health cholera treatment center, a makeshift camp of tents just outside the small city of Mirebalais. 

Helping children in Haiti, one year after the earthquake (PBS  1/14/2011)
A year ago this week, Haiti was hit by an earthquake that killed more than 200,000 people, injured thousands of others and left more than a million and a half homeless… After the quake, one of the many humanitarian groups participating in recovery efforts was Boston-based Partners In Health. They have helped tens of thousands of children in Haiti. Here is the story of two of those children. 

Haiti's Cycle of Calamity (National Geographic Blog  1/13/2011)
At a cholera treatment center a few hours drive from the capital, a doctor from Partners In Health made an interesting connection. Whenever a waterborne disease like typhoid, or now cholera, becomes a threat, "we always ask people to boil water," he said. They boil water by burning trees, which brings more flooding and other disasters… "It's a cycle."

Cholera and Cooperation Play Into Haiti Reforestation (National Geographic  1/13/2011)
With the recent outbreak of cholera in camps crowded with earthquake victims, and in mountainous rural areas where people take their drinking water from the river or underground wells, there may be an added stress on forest resources. According to Wesler Lambert of Partners In Health, when citizens are asked to boil water as a protection measure against cholera or other water-borne diseases, they use charcoal, leading to more deforestation and therefore more flooding. 

Happy Endings for Some of Haiti's Children (CBS News  1/12/2011)
Loune Viaud, PIH’s Director of Strategic Planning and Operations in Haiti, found 38 children abandoned at a hospital after the quake. "Thousands of bodies everywhere and the children were there," said Viaud. In collaboration with Operation Blessing, PIH/ZL founded a home for children in Port-au-Prince called Zanmi Beni. 

Video: Haiti gains reputation as 'a republic of NGOs' (Al-Jazeera  1/12/2011)
Haiti’s NGO community say they are critical of the unchecked power this community can wield despite the good work. A report from Oxfam, one of the major NGOs working in Haiti admitted they should do more to work with the government. Paul Farmer, the UN deputy special envoy to Haiti, said until the government has the resources it needs, Haiti will remain "the republic of NGOs". 

Haiti, one year after the earthquake (The Official Google Blog  1/12/2011)
Complementing our online efforts with this imagery, a webpage and crisis response tools such as Person Finder, Google has made an effort to contribute to relief in Haiti by providing technical and financial support to NGOs. Organizations such as Doctors Without Borders and Partners In Health continue to help the Haitian people. We’ve looked to them to help us guide our ongoing response to this crisis.

A Year On The Front Lines In Haiti (NPR “All Things Considered”  1/12/2011)
PIH’s Dr. David Walton has spent much of the past year on the front lines in Haiti treating earthquake victims and working to stem the cholera epidemic. He's now involved in the building of a new hospital. He talks to NPR's Michele Norris about his work.

Wednesday, Jan. 12 Haiti Earthquake Anniversary (WGBH – NPR’s Boston Affiliate  1/12/2011)
Dr. Evan Lyon – who has in Haiti with Partners for 13 years – arrived on the 4th day after the earthquake and worked in the capital for the next seven months. He says perhaps the most dramatic thing he’s seen since the earthquake is the remarkably little change… Some basic provisions are provided – but many needs remain unmet and the refugee communities look like they are becoming nearly permanent. Dr. Lyon, you say “by necessity (people) are settling in for a long haul.”

Haiti: One Year Later (MSNBC   1/12/2011)
Andrea Mitchell spoke with Thomas Tighe, President and CEO of Direct Relief International. Tighe mentioned Direct Relief’s work in conjunction with Partners In Health in Haiti. See mention at 1:50.

Partners In Health Helping Haitian Earthquake Victims (CBS Philadelphia  1/12/2011)
Dozens of critically injured people in Haiti were brought to Philadelphia by Partners In Health for life saving medical treatment after the earthquake a year ago. CBS Philadelphia follows up on the stories of many of those patients – one year later.

Tè Tremblé: Remembering the Earthquake in Haiti (Democracy Now  1/12/2011)
We go back to January 12, 2010, and to the aftermath of the earthquake – what Haitians call Tè Tremblé, the earth trembles. One year later, the words of Dr. Evan Lyon, a professor with Partners In Health, are agonizingly true: Haiti is still in pain. (PIH mention at 14:51)

Haiti in Recovery—Two Doctors Make a Difference (Southern California Public Radio  1/12/2011)
Haiti is a second home to Dr. Evan Lyon, physician with Partners in Health, and as he drove through the streets of Port-au-Prince a few days after the tremendous earthquake in January of 2010, this is what he wrote to his associates from the scene: “people cooking, talking, some singing and crying.”

How to Rebuild Haiti after the Quake (Council on Foreign Relations  1/12/2011)
Global health expert Paul Farmer says international aid organizations cannot replace the government and that Haiti's public sector should be strengthened so it can provide for Haitians' needs until the government is able to do it.

Haiti's Year of Living Miserably (Council on Foreign Relations  1/12/2011)
Knowing Haiti has been hit with a partially drug-resistant and virulent form of the vibrio, and that the populace has absolutely no natural immunity having lived cholera-free for generations, many observers are now calling for mass vaccination. In a recent Newsweek article Drs. Paul Farmer and Jean-Renold Rejouit of Partners in Health argue in favor of such a scheme. On December 17, the Pan American Health Organization (PAHO) cholera expert panel voted in favor of mass vaccinations.

What Haiti needs most, one year post-quake (USA Today  1/12/2011)
Partners In Health, led by Paul Farmer – a leader in sustainable development and the UN Deputy Special Envoy to Haiti – is teaming up with the global health care company Abbott for an ambitious $6.5 million partnership that aims to (1) Build a new PIH nutritional production facility in Haiti to produce Nourimanba, PIH's highly nutritious, peanut-based therapeutic food used to treat severe malnutrition; (2) Help combat poverty by empowering communities – Local workers will build the facility, and Haitian peanut farmers and local workers will handle most of the production of Nourimanba, from start to finish. Abbott scientists and engineers and PIH staff will share expertise and conduct training to develop the skills of local workers; and (3) Shift long-term focus of initiative from traditional aid to local trade for sustainability. 

Haiti: One Year Later (Huffington Post  1/12/2011)
When we landed on the tarmac in Port-au-Prince, one of the first planes to arrive that morning… Haiti's President Rene Preval was also on the tarmac. He wasn't wounded, but seemed lost and wondered aloud when help would arrive… Partners In Health, with co-founder Dr. Paul Farmer and a dedicated team including a woman named Dr. Louis Ivers who I met on both trips to Haiti, are continuously providing health care and support to more than one million Haitians.

Rebuilding Haiti By Empowering Its Residents (The Huffington Post  1/12/2011)
The tragic earthquake and its aftermath have undoubtedly had a devastating effect on Haiti and its people. But there are success stories. "Very few of us who know Haiti haven't fallen in love with the spirit of the Haitian people," said Joia Mukherjee, the chief medical officer of Partners In Health.

Helping Haiti One Year Later (The Nation  1/12/2011)
Today marks the one-year anniversary of the most powerful earthquake ever recorded in Haiti. Millions more are still being harshly affected by lack of water, shelter and food. Worthy groups which have been on the ground since before last year's crisis struck include Partners In Health, operating in the country since 1987 originally to deliver health care to the residents of Haiti's mountainous Central Plateau region. 

One Year On, Haiti’s Post-Earthquake Landscape is Grim (Wall Street Journal   1/12/2011)
For further perspective on what’s been done by two large health-focused humanitarian organizations working in the country, see the one-year report by Partners In Health and Doctors Without Borders. 

Health Charity Grows Fast to Fill Medical Void in Haiti (The Chronicle of Philanthropy  1/12/2011)
Partners In Health has expanded rapidly in the year since Haiti was rocked by an earthquake, emerging as one of the government’s key medical partners, says The Boston Globe. The organization, which did not operate in the capital of Port-au-Prince before the earthquake, now treats 7,000 to 10,000 people a week in city’s tent camps and is building a 320-bed hospital north of there. PIH has increased its mostly Haitian work force from 4,400 to 5,500, and expanded services far outside its prior focus treating rural peasants for tuberculosis, AIDS, and malnutrition.

Hope for Haiti's Unemployed (The Huffington Post  1/11/2011)
Q: Is it a chronic problem that workers are brought in from other countries and that actual citizens find themselves becoming further and further disconnected from participating in the rebuilding of their own nation? 
A: Our experience has been to focus on reaching out to the most disconnected: those who are illiterate, unemployed, and/or homeless. While it is not always the case that workers are brought in from other countries – Partners In Health has a strong network of Haitian workers – we wanted to at least make it as easy as possible for organizations to find local labor.

Midwifery: A Smart Investment in Haiti (The Huffington Post  1/12/2011)
Despite pledges to "build back better," international efforts in Haiti are struggling just to provide relief. Donor fatigue is setting in, and new commitments are slowing to a trickle. Reality demands doing more with less, which is why it is so critical to invest in women… Several NGOs, like Partners In Health and Haitian Health Foundation, run midwifery programs with great success, but the critical need is to bring these programs to scale across the country.

Paul Farmer’s 5 Lessons From Haiti (Clinton-Bush Haiti Fund  1/12/2011)
Paul Farmer, writing for Foreign Policy, highlights five critical points that have brought insight during this time of reconstruction and recovery in Haiti. One highlight, on the topic of "Building Back Better" is especially true of how the Clinton Bush Haiti Fund's efforts have been shaped toward maximizing long-term growth in Haiti.

Build Mirebalais Hospital in Haiti with PIH (Global Giving  1/12/2011)
Partners In Health provides a preferential option for the poor in health care. By establishing long-term relationships with sister organizations, PIH strives to achieve two overarching goals: to bring the benefits of modern medical science to those most in need of them and to serve as an antidote to despair. 

Health Lags in Haiti 1 Year After the Earthquake (Scientific American  1/12/2011)
In large part because of its persistent poverty Haiti had long been host to a cadre of nongovernmental organizations (NGOs) that provided health and other services that the government was unable to supply. Infrastructure in place for international government and NGO programs such as the U.S. President's Emergency Plan for AIDS Relief and Partners In Health, respectively, were transitioned to help with response needs after the earthquake. 

Psychiatrist Recognized for Efforts to Bring Mental Health Services to Haiti (Medscape Today  1/12/2011)
Psychiatrist Jean Tropnas has received the Profile of Courage Award by the American Psychiatric Association (APA) in honor of his efforts to bring mental health services to the people of Haiti following the devastating earthquake. Dr. Tropnas worked with Partners In Health… In the clinics, psychosocial teams of young psychologists and social workers dispensed mental health care.

The Earthquake in Haiti: One Year Later (National Geographic  1/12/2011)
There are still many ways to help with Haiti's recovery process. Partners In Health is a medical group started by Paul Farmer 25 years ago in Cange, Haiti, that organizes community-based health clinics. They've served over 240,000 patients in their clinics in the past year.

Haiti Has Seen Some Progress Since Earthquake, Relief Workers Say (MTV.com  1/12/2011)
No one expected Haiti's problems to be solved just one year after a monster earthquake hit the island on January 12, 2010, leveling much of the impoverished nation's capital, Port-au-Prince, and killing more than 250,000. While progress on the island is slow, representatives from World Food Programme and Partners In Health say they are seeing encouraging signs in Haiti.

Update: Restoring the Soul; Satisfying Hunger Around the World (Concord Patch  1/12/2011)
The name “Two Degrees,” represents the mission of the business and the short distance that separates us from a child dying of hunger. The company donates a nutrition pack to a hungry child for every nutrition bar sold. The children of Malawi are the first recipients of Two Degrees. The company is working with Valid Nutrition and Partners In Health to fulfill its heroic mission.

Haiti’s Second Chance: A Time for Reflection and Progress (Americas Quarterly  1/12/2011)
It is imperative that whoever is elected president address the ‘republic of NGOs’ phenomenon. Numbering more than 10,000 today, NGOs have created parallel institutions over the years to gradually fill the void left by a defunct governments… Few exceptional organizations, Partners In Health being one, have established permanent operations and remained willing to work with the government when necessary.

Haiti Earthquake Anniversary Reactions (Psychology Today  1/12/2011)
The Anniversary brings up memories of the extraordinary pain that the entire Haitian population has suffered, that old symptoms of demoralization and despair as well as renewing emotional and physical distress. We are working, along with the Ministry of Health, Partners In Health, and other organizations to address these symptoms and mobilize the Haitian people's resiliency and hope. 

Partners In Health on Anniversary of Haitian Earthquake: Many Accomplishments but “Conditions Remain Grim” (Skoll Foundation  1/12/2011)
Today marks one year since the earthquake in Haiti. PIH Medical Director Joia Mukherjee states: “we stand with our friends and colleagues from our Haitian sister organization, Zanmi Lasante, and with millions of Haitians in Haiti and abroad to remember that terrible day — to remember both those who died, and those who suffered and continue to face the painful reality of a Haiti post-January 12, 2010. Let’s not mince words. Conditions remain grim.”

Haiti, one year later: More help, more needs (Charlotte Observer  1/12/2011)
Conner recognizes the feelings of many Americans who may have given up on Haiti, but says there is still good work being done that doesn't make the TV news – work or NGOs like Doctors Without Borders and Partners In Health, but also to the work of the Haitians, who are helping their own people day in, and day out. 

Berkshire volunteers reflect on road ahead (Berkshire Eagle  1/12/2011)
Three days after Haiti’s earthquake, Mark Hyman and his wife Pier Boutin, also a physician, were on the ground with an emergency medical crew organized by Partners In Health co-founder Dr. Paul Farmer. 

Moved by parents’ death in quake, Montrealer reached out to help (The Globe and Mail  1/12/2011)
Her parents, George and Merille Anglade, became the first Canadians confirmed killed in the blurry aftermath of Jan. 12, 2010. Back in Montreal, Ms. Anglade cobbled together a board that includes everyone from Paul Farmer, the U.S. doctor who founded Partners In Health to Régine Chassagne, the Montreal singer from Arcade Fire whose parents emigrated from Haiti during the dictatorship of Jean-Claude Duvalier. The organization is now seeking to raise $2-million to work with 500 families in the village of Thomonde in Haiti’s central plateau.

Roundtable Discussion (Charity Navigator  1/12/2011)
A year after Haiti was hit by a 7.0 earthquake, Charity Navigator led a roundtable discussion among several leaders of charities that provided aid in the wake of the disaster, including Ophelia Dahl, executive director of Partners In Health.

One year later, relief work continues (The Dartmouth  1/12/2011)
Exactly one year after Haiti’s earthquake, Dartmouth continues to contribute to rebuilding efforts. Dartmouth is supporting Partners In Health while the organization builds a 320-bed hospital in Mirebalais, Haiti, according to President Jim Kim. The College will likely have a “close relationship” with the hospital upon its completion, Kim said.

Haiti - Hell to Hope (RTÉ Television – Ireland’s National Television and Radio Broadcaster  1/12/2011)
RTÉ Western Editor Jim Fahy visits the shattered country a year after the devastating earthquake which killed over a quarter of a million people and left another million homeless. The piece follows three stories, that of PIH’s Dr Louise Ivers, Gena Heraty, and Fr Rick Frechette.

IU-Haiti tie remains strong (Indiana Daily Student  1/12/2011)
What did we Americans do after the earthquake in Haiti? We gave money, and now we ask what happened to our money. We gave hundreds of millions of dollars. Two IU student groups gave $25,000 to one organization, Partners In Health, alone.

Only new, fair voting can help Haiti now (St. Petersburg Times  1/12/2011)
It is bad enough that, by delaying reconstruction aid to Haiti, the United States has failed to give adequate assistance to our neighbor, which was struck by a devastating earthquake a year ago today. Republican Sen. Richard Lugar, ranking member of the Committee on Foreign Relations, criticized the exclusions and warned of potential chaos. Paul Farmer, U.N. deputy special envoy to Haiti, expressed his concern that "all Haitian people and parties be allowed to participate."

Haiti's Top 5 Priorities One Year Later: Cause for Hope (Tonic  1/12/2011)
Organizations like Partners In Health have been pushing vigorously for the widespread distribution of oral cholera vaccines and antibiotic therapies, standard interventions, which could help slow, if not stop the spread of the disease. But the prevailing belief is that it would be too difficult to inoculate enough of the population, since the vaccine requires two courses – something PIH’s chief medical officer argues the organization has disproven in the past.

Chris Hughes, cofounder of Facebook, talks about PIH on Colbert Report (The Colbert Report  1/11/2011)
Facebook co-founder Chris Hughes spoke with Stephen Colbert about his new website, Jumo. Hughes mentioned how Jumo connects interested parties to non-profits such as Partners In Health. Mention begins at 3:20.

Obituary: Tom White, 90, Philanthropist Who Co-Founded Health Charity (Chronicle of Philanthropy  1/11/2011)

Tom White, a leading Boston builder who donated more than $75-million over his lifetime and helped launch the global medical charity Partners In Health, died Friday at age 90, The Boston Globe reports. Partners In Health, which he co-founded in 1987, is credited with blazing a trail for global health charities addressing medical emergencies and outbreaks of AIDS, tuberculosis, and other diseases in the developing world. 

Moving mountains with generosity and compassions (Newton Tab  1/11/2011)
Newton resident Tom White died at 90 years old. I didn’t know Mr. White personally; I wish I had. I first learned of him when I read “Mountains Beyond Mountains,” by Tracy Kidder, a great book about Paul Farmer and a small clinic in Haiti that grew into Partners In Health, an international organization providing health care for the poorest of the poor.  Without Mr. White, Partners in Health would never have happened. 

Progress in Haiti ‘painfully slow’ (Harvard Gazette  1/11/2011)
A year after Haiti’s deadly earthquake, nearly a million people still live in temporary tent cities, plagued by sexual violence and hopelessness. “The progress has been really slow; it’s been painfully slow,” said Instructor in Medicine David Walton, a physician with the nonprofit Partners In Health (PIH), which has worked to improve health care in Haiti for decades. 

Haiti One Year Later: The American Red Cross on current situation (Washington Post  1/11/2011)
David Meltzer, senior vice president for international services at the American Red Cross, was online Tuesday, Jan. 11, to discuss how the country is faring one year after the devastating earthquake.
Question: I learned that the American Red Cross provided financial support to keep the General Hospital open. Will the American Red Cross continue to support this project? 
Answer: We are also supporting Haiti's largest public hospital (HUEH) with Paul Farmer's Partner's In Health and also funding prosthetics and rehab centers.

Area volunteers tell of horrors still plaguing Haiti (Ventura County Star  1/11/2011)
During a news conference Tuesday, Dr. David Walton, deputy chief of Mission to Haiti for Partners In Health, said the numbers of those dead from cholera are far greater than those being reported by the Haitian Ministry of Health. 

Haiti Roundup: Earthquake Victims See Little Gain From Aid Influx (Chronicle of Philanthropy  1/11/2011)

The Christian Science Monitor reports: James Ansara, who has been volunteering in Haiti weekly since the earthquake, is working with the global charity Partners In Health on 320-bed Mirebalais Hospital, which will be the country’s largest medical facility until the destroyed city hospital in the capital of Port-au-Prince is rebuilt.

Volunteer state: East Tennesseans still reaching out to victims of Haiti earthquake (Knoxville News Sentinel  1/11/2011)
Students at Maryville College have been reading a book by Dr. Paul Farmer about how he helped found Partners In Health, a global health organization that is active in Haiti. Fields' class set a goal of raising $10,000 that would go to Partners in Health to aid the relief effort in Haiti. The goal was reached last summer.

A year later: work continues, expands in Cange, Haiti (Anderson Independent Mail  1/11/2011)
Partners In Health’s 100-bed hospital in Cange was one of the best left standing after the earthquake, and its capacity doubled overnight as the village's church became a triage center. “We had patients filling the entire sanctuary and upper balcony,” Morse said. “It was a very beautiful use of the church building. It seemed like what we should have used it for.” An international medical mission, Partners in Health, traces its roots to Cange through its founder, Paul Farmer.

NRG helping to 'build back better' (The Princeton Packet  1/11/2011)
Wednesday marks the one-year anniversary of the massive earthquake in Haiti. The solar power energy company (SELF) is helping to create a bright future as the country rebuilds – installing power systems at local health clinic run by the locally acclaimed Zanmi Lasante (ZL), Partners In Health sister organization in Haiti.

Vidacare seeks more support for Haiti (San Antonio Business Journals  1/11/2011)
Dr. Larry Miller, founder of San Antonio-based Vidacare Corp., recently returned from a trip to Haiti and says that hopelessness is the saddest affliction that the country faces and urges more support for charitable groups working in the region, including Partners In Health, Project Hope, Samaritan’s Purse, J/P Haitian Relief Organization, and Doctors without Borders.

Haiti Earthquake Anniversary Finds Overwhelmed Nation Struggling to Rebuild (YahooNews.com  1/11/2011)
Partners In Health broke ground on a new teaching hospital in Mirebalais in July. 

Canadian celebs continue Haiti appeals, aid efforts (CBC News  1/11/2011)
For several years, Arcade Fire's Win Butler and wife Régine Chassagne have supported an on-the-ground effort in Haiti through Partners In Health, an organization with more than 20 years' experience delivering services that combine medical care with education and training about sanitation, water and agriculture in countries like Haiti, Mexico and Peru.

Partnership announces development of Haitian food facility to fight malnutrition (The Daily Tell  1/11/2011)
Partners In Health, Abbott Laboratories and the Abbott Fund are partnering to develop a food facility to provide Haitians with local, nutritious and quality food. A move valued at more than $6.5 million, the initiative will help fight severe childhood malnutrition. 

Year after Haiti quake, agency asks how Delivering health care, and six tons of corn

	The EAPSEC team assesses the remains of a road to a small community they serve.

Partners In Health began as a small group of people willing to do whatever it took to bring high quality health care to poor communities. Since 1989, PIH has been helping the organization El Equipo de Apoyo en Salud y Educación Comunitaria (EAPSEC, The Team for the Support of Community Health and Education) carry out the same mission in the mountains of Chiapas, Mexico.

 A small team of about a dozen people--including a number of volunteer community health promoters (CHP)--serve a patient population of roughly twelve thousand people, scattered among 20 communities. Lacking a permanent medical facility, physicians Dan Palazuelos and Hugo Ernesto Flores Navarro and their team deliver care from the back of a pickup truck.

The team travels to the isolated villages to stitch cuts; treat cases of severe diarrhea and coughing; provide pregnant women with prenatal vitamins; remedy infections; and attempt to stay several steps ahead of tuberculosis outbreaks, while also teaching patients how to administer basic first-aid. With the nearest trauma hospital located about six hours by car from many Chiapas communities, knowing something about emergency medical care is also invaluable. And like PIH’s partners around the world, the EAPSAC team sometimes finds itself providing not just medical care, but also work that addresses poverty--an underlying cause of ill-health.  

Last summer, an especially harsh rainy season washed out many mountainside roads, which were already in poor repair. The small communities served by EAPSEC, already burdened by poverty, were literally cut off from markets and other sources for food and income generation, reported Hugo. In response, Hugo and his team procured six tons of corn flour and made roughly 600 trips between the regional warehouse and stranded villages. The team drove the pickup truck--the same one that serves as the region’s mobile clinic--to the edge of the waterlogged roads. Locals would carefully lead donkeys down the muddy mountainsides, and load them up with corn flour. These deliveries likely staved off malnutrition for many families in Chiapas, said Hugo.

Thankfully, the roads are now repaired and for now, the Chiapas team and their truck have returned to delivering  medical services instead of corn.  

Read more about PIH’s work with EAPSEC in Mexico.

Covidien supports construction of Mirebalais Hospital

For regular updates on Mirebalais Hospital visit
www.pih.org/
mirebalais

Covidien, a leading global healthcare products company, recently provided Partners In Health funding to aid in the construction of the new Mirebalais Hospital in Haiti. With more than 42,000 employees worldwide in more than 60 countries, and products sold in over 140 countries, Covidien’s international scope proved to be a great fit for Partners In Health.

Since 2008, Covidien has provided generous support to PIH’s Boston-based PACT project. In building upon that relationship, most recently, Covidien has committed $2.5 million to support the construction of the Mirebalais Hospital. This state-of-the art, 320-bed facility exemplifies PIH's efforts to build back better in Haiti. Having broken ground in July of this year, PIH expects the hospital to receive its first patients in January 2012. Covering 180,000 square feet, this will be the largest public hospital outside of Port-au-Prince and will serve as a national center of excellence, a training facility, and an example of how the health care sector can be resuscitated after the tragedy of January 12.

"We're proud that our grant will enable PIH to continue its exemplary work to bring the benefits of modern medical science to those most in need,” said Rich Meelia, Chairman, President & CEO of Covidien.

Covidien is a natural partner for this project, given their immediate and generous response to the earthquake tragedy earlier this year. Covidien reached out to each of its Global Business Units and donated a wide range of medical products that were distributed to various nonprofitorganizations throughout Haiti, including PIH and the USNS Comfort, where many patients received lifesaving emergency treatment. In addition to product donations, Covidien’s matching gifts program enabled employees to match their charitable contributions, dollar-for-dollar, to organizations such as PIH in the aftermath of the earthquake.

Covidienhas a robust social responsibility program, and a mission that is committed to contributing to the availability of affordable, quality healthcare. Dr. David Walton, PIH’s Deputy Chief of Mission in Haiti, said of the collaboration, “We are thrilled to have such strong support for our current flagship project. It is with the help of companies such as Covidien that we are able to build a state-of-the-art facility in one of the poorest countries in the Western Hemisphere. We are both grateful and proud to be working with Covidien.”

The Long Tail of Global Health Equity

2010-2011 is a key year for the global non-communicable disease movement, culminating in the September 2011 high-level United Nations meeting in New York City. Historically, non-communicable disease in middle-income countries has received close attention. In this moment, there is also a need to focus on the disease burden of the poorest populations, the bottom billion, largely composed of children and young adults.

"The Long Tail of Global Health Equity: Tackling the Endemic Non-Communicable Diseases of the Bottom Billion,"a conference hosted by Harvard Medical School, Partners In Health, Brigham and Women’s Hospital, NCD Alliance, and the Global Task Force on Expanded Access to Cancer Care & Control in Developing Countries will take place in March 2-3, 2011 in Boston at the Joseph P. Martin Conference Center on the Harvard Medical School campus. Attendance is free. 

The conference will bring together a select group of participants with expertise in conditions such as rheumatic heart disease, Burkitt’s lymphoma, malnutrition-associated diabetes, and the respiratory impact of household fuels, as well as experts in global health financing, infectious disease, and mental health. Some of the featured speakers will include Paul Farmer, Dean Jamison, K. Srinath Reddy, and Peter Hotez. The goal is to provide an opportunity to bring together leaders in the fight for global access to NCD care for the poorest populations. 

Learn more about the conference and how to attend.

A Rwandan family's surprise

When Dr. Juvenal Musavuli showed up for his shift at Butaro Hospital in Rwanda last week, he had no idea what the seemingly quiet evening would present or how much time he would be spending in the maternity ward that evening.

Early in the night Dr. Musavuli was called to assist with his first delivery of the evening: a healthy set of twin baby girls. A few hours later he was called to assist in his second delivery of the evening: surprisingly anticipated to be a second set of twins.

All began as planned. He delivered the first baby girl, then the second, but just as he thought the delivery was over – another tiny head began to emerge. A third baby girl! Everyone in the room was incredibly surprised, happy, and overwhelmed, reports Dr. Juvenal.

The triplets – all healthy – are the second set to be born in Butaro Hospital since early November.

Dr. Juvenal weighing one of the triplets shortly after it was born.

The responsibility of caring for a newborn weighs heavily on any new parent. In rural Rwanda limited economic opportunities significantly compound these worries for parents of multiple births. Because of this, Partners In Health has assisted the parents of these multiples with formula, food, medical care, and social support.

The new mother, grandmother, and a PIH social worker.

Dr. Juvenal has worked as a general practitioner at Butaro Hospital for two years and is no newcomer to multiple births. In July 2009, he delivered a healthy set of quadruplets – again, all baby girls (Learn more).

The availability of maternal health services and socioeconomic support is a marked change from the days before PIH came to Butaro, when the district lacked a hospital. Since 2008 – when the first operating room was officially up and running – women in the region have had access to emergency C-sections, and immediate medical care for infants born with health issues. As a result, the maternal mortality rate in the district has dropped dramatically since then, with only one maternal death this year.

In comparison, World Bank figures from 2008 show that in Rwanda roughly 5.5 women die for every 1,000 births, while 70 infants die before their first birthday of every 1,000 born.

The new Butaro Hospital – set to open in the coming month – will include two operating rooms. The flagship facility – run by PIH, Rwanda’s Ministry of Health, and the Clinton Foundation – will help us reach our goal of dropping the maternal mortality rate in the district to zero. Furthermore, the hospital’s state of the art neonatal intensive care unit will allow Dr. Juvenal and his colleagues to effectively care for all of the babies – premature, term, twins, triplets and quadruplets – born at Butaro Hospital.

Read more about Butaro Hospital.

Read more about PIH’s work in Rwanda.

 

A long journey home

	Dave with his family at their new home in Cabaret, Haiti.
	Dave jumped out of the car to hug his mother, who he hadn't seen in eight months.

On November 30, 10-year-old Dave and his father Louis finally reunited with their family in Haiti.

A patient in PIH’s Right to Health Care program, Dave had been seriously injured during the January 12 earthquake. Buried beneath rubble for three days following the disaster, his right leg and lower right arm had to be amputated in Haiti. He received medical care aboard the US Navy Ship Comfort. However, it became clear that he needed additional care not available in his devastated homeland. So PIH brought him to Boston in April to receive additional treatment for nasal reconstruction, burn treatments, and to receive a prosthetic leg and arm. His care was provided by medical and rehabilitation teams at Shriner’s Hospital.

Today, Dave is using his prostheses with ease, and will meet regularly Zanmi Lasante’s rehabilitation team over the coming years.

He and his father were excited to return to the rest of their family in Haiti, as it had been more than eight months since Dave and his dad had seen them. “At first, Dave was a little sad to leave his new friends in Boston,” said Joan VanWassenhove, who accompanied the pair from the US to their new home in a town 45 minutes north of Port-au-Prince, which Zanmi Lasante found for the family. “But as we got closer and closer to Haiti and his mother and sister, he grew more and more excited.”

"He screamed “Mama!” when he saw her waiting for us as the car pulled up on the street, then he jumped out of the car and hugged her."

In mid-December, PIH/ZL staff helped to re-enroll Dave in school. He returned to his primary school on Thursday, December 16.

Watch a video of Dave learning to use his new prosthesis:

Watch live streaming video from global_health_equity at livestream.com Of cabbages and corn

	A crop of cabbage, "the meat of the peasants," is flourishing in central Haiti.

The first tiny green shoots of cabbage leaves caused quite a stir in Bois Joli, a rural farming community in the mountains of central Haiti.
 
“People are used to eating cabbage and buying it in the market, but they aren’t used to growing it themselves,” explained Stenio Louis-Jeune, an agronomist with Zanmi Agrikol (ZA), the agricultural arm of PIH’s Haitian sister project Zanmi Lasante. Following the January earthquake, Stenio and his colleagues quickly began a program to help local farmers produce more food to help feed earthquake-affected communities at risk of malnutrition.

Today, the program supports over two dozen kombits—groups of roughly 50 local families working together to farm land—by supplying seeds, tools, technical assistance, and training. About 1,000 families are currently involved. “The biggest result we’ve had is getting people to work together,” said Stenio. “It’s showing everyone how to work together at a community level to fight poverty and malnutrition.”
 
As the tropical climate of Haiti allows for year-round farming, the kombits learn techniques for cultivating crops ranging from corn to beans to cabbage, based on the time of year most favorable to each crop. In December, the fields in the mountainous areas of Boucan Carre are blooming with nutritious vegetables, such as cabbage and broccoli. In nearby Corporant in the Central Plateau of Haiti, farmers are now planting beans.   

Although these crops are flourishing, many have never before been grown in this area. Even the "meat of the peasants”--the inexpensive yet nutritious cabbage--has never been harvested by the peasant families who eat it in Bois Joli. Upon seeing the first leaves sprout out of the earth, the farmers were concerned that they didn’t immediately resemble the cabbage heads they see in the market. “Should we tie the leaves together into a ball?” they asked Stenio’s team, who assured them that the head would naturally form as the vegetable grew. The produce will both feed the families and supply them with a product to sell in their local markets to generate an income.

	Chickens are already laying eggs for a new Zanmi Agrikol project.

“Agriculture is the livelihood of the people here,” said ZA agronomist Larose Deus. “[This program] has the potential to bring major changes in the economic status of people in this area.”

In addition to fighting malnutrition through greater crop harvests, Zanmi Agrikol has also distributed about 500 female goats to local families, is rearing chickens with the intent of giving eggs to children in Zanmi Lasante’s malnutrition program, and is replanting fruit tree saplings to distribute to farmers in the spring. To support these projects, the ZA team has scaled up from about 25 employees to over 100—all local members of the community—since the earthquake.
 

PIH cofounder Paul Farmer honored with Harvard University Professorship

	Dr. Paul Farmer

Paul Farmer, Partners In Health cofounder and Chair of the Department of Global Health and Social Medicine at Harvard Medical School, was recently named a University Professor, Harvard’s highest distinction for a faculty member.

The President and Fellows of Harvard College established the University Professorships in 1935 to recognize “individuals of distinction…working on the frontiers of knowledge, and in such a way as to cross the conventional boundaries of the specialties.” Only 23 of Harvard’s more than 12,000 faculty members currently hold this honor.

“Paul Farmer is best known to the public as a pioneering humanitarian,” Harvard University President Drew Faust said in announcing the appointment. “But among scholars he is equally well-known for his research and writing, which have crossed boundaries between the social sciences and biomedical research and married theory and practice to forge a new approach to global health. He is also an outstanding educator with a remarkable capacity to inspire students to focus their minds and their energies on serving the common good.”

“Having built my academic career around the conviction that we can take the fruits of scientific discovery in medicine and public health and improve the lives of people who have been marginalized by poverty and other forces beyond their immediate control, I am deeply grateful to Harvard,” Farmer said. “I’m grateful for decades of support for a model of engagement that links research to training to direct services, and for the opportunity to show how scholarship and teaching can have a profound impact outside the classroom.”

Farmer’s research at the intersection of medical anthropology, public health, and clinical medicine has formed a cornerstone of the effort to relate theory to effective practice in global health.  His work is recognized as having made essential contributions to ethnography, the anthropology of epidemic disease, the theory of structural violence, and empirical studies of human rights in the health arena; he has contributed to clinical literature in the arena of drug-resistant tuberculosis and AIDS.  While many scholars working in the field of medical anthropology are able to clearly describe the problems facing a particular community, Farmer’s medical training and extensive fieldwork enable him and his team to develop and implement solutions to serious public health challenges.

Farmer is also currently Maude and Lillian Presley Professor of the Department of Global Health and Social Medicine at Harvard Medical School; Chief of the Division of Global Health Equity at Brigham and Women’s Hospital; Professor in the Department of Global Health and Population at the Harvard School of Public Health; and a leading figure in the Harvard Institute for Global Health, with responsibility for medical education and physician training. In 2009, Bill Clinton, UN Special Envoy for Haiti, appointed Farmer as the Deputy UN Special Envoy for Haiti.

Farmer becomes the first Kolokotrones University Professor, a chair established through a gift from Wendy and Theo Kolokotrones, M.B.A. ’70.

Read more about Paul’s appointment in the Harvard Gazette.

 

Expanding a maternal health program

	Traditional birth attendant training in Nohana, Lesotho.

Rural clinics in the southern African country of Lesotho used to deliver an average of three or four babies per month, with most mothers delivering their infants at home, risking the possible severe health and disease transmission threats.

Now, some of those same clinics are delivering over two dozen infants each month thanks to a fast-expanding project, which provides mothers with prenatal care, HIV testing, treatment, pre-birth accommodation and nutritional support.

The daunting challenge facing the Ministry of Health in this poor, mountainous country is that roughly one in four adults is living with HIV; many of whom are co-infected in an epidemic of TB and MDR-TB that has swept through its villages.

With one of the world's highest rates of maternal mortality, pregnant women here are among the most vulnerable – physically separated from clinic services by crumbling dirt roads and rugged terrain, and often at risk of passing HIV to their infants.

In 2009, a partnership between Partners In Health, the Lesotho Ministry of Health, and the Elton John AIDS Foundation launched a pilot project at a newly renovated clinic in Bobete to retrain 100 of the country's traditional birth attendants (TBAs) to bring pregnant women access to services at the center. 

In addition, a waiting house near the clinic was rented so that women nearing their birthing date can make the journey before their labor begins, and move quickly and without risk to the clinic's maternity ward when the time comes. This model is now being extended to six other clinics, thanks to new funding from the UK-based Positive Action for Children Fund.

In the first year of the initiative, the Bobete clinic delivered 150 babies, with more than 80 percent of these mothers brought in by TBAs. Most of these would likely not have visited a clinic for prenatal visits or the delivery, were it not for the new TBA counseling.

Since the project’s inception, 67 percent of these mothers have also stayed at the waiting house before delivery, further increasing their chances of a healthy maternity process.

In addition to training, supervision, and incentives given to TBAs, mothers who make use of the services also receive incentives in the form of baby starter packs.

Receipt of the packs – which include baby clothing, pins, and a bathtub - means that these mothers attended at least three antenatal visits, and also agreed to HIV testing and – if necessary – measures to prevent HIV transmission, and 88 percent of Bobete's mothers qualified.

The project was so successful that it is already expanding throughout the partners' network of remote health centers. In addition to one MDR-TB hospital--Botsabelo--PIH now supports seven health centers in Lesotho's most remote mountain areas, serving a catchment area of 300,000 people.

PIH Lesotho Project Manager Archie Ayeh said a second class of TBAs had completed their training at Nohana Clinic, in Lesotho's southern region. In October, visiting staff from PIH in Boston were amazed to find that 45 of these graduates—some nursing mothers themselves--had traveled on foot for up to two days to attend the training.

Ayeh said Lesotho's traditional birth attendants had previously – “unfortunately” – discouraged pregnant women from seeking care at clinics, while many more expectant mothers previously received no assistance at all.

However, he said the income from home births had been replaced with a PIH cash incentives program, and added that the newly trained TBAs were now committed to a model which sees them counseling and accompanying young mothers to access professional services.

Ayeh said Lesotho's young mothers deserved equal credit, for making the significant effort to negotiate the tough terrain to access their clinics.

“We are really thrilled – even surprised – at how patients and the TBAs have embraced this program to get mothers to the clinics,” he said.

Meanwhile, Ayeh said the waiting house system at Bobete had proved so popular with mothers – and the TBAs so effective – that the four-week waiting period had to be cut to just two in some cases, to accommodate more women.

Rather than renting existing buildings, PIH has constructed waiting houses at two clinics in Lesotho's southern region--Nohana and and Nkau--thanks to a three year grant from the Positive Action for Children Fund grant. This funding will now see further waiting shelters established at four more clinics.