Dr. Jon LaPook from CBS Evening News has been reporting from Haiti on the cholera outbreak, covering efforts in St. Marc, where PIH operates Hôpital St Nicholas, in partnership with Haiti's Ministry of Public Health and Population.

In this segment, Dr. Koji Nakashima of Partners in Health speaks about the devastation that has hit the St. Marc region, where thousands of cholera cases have been reported. (Episode originally aired 10/25/2010) Read accompanying news article.

In this segment, PIH Chief Medical Officer Joia Muhkerjee noted the severity and urgency of the cholera outbreak in Haiti on the CBS Evening News. (Episode originally aired 10/22/2010)

	Treating patients in the courtyard of the hospital in St. Marc. Photo courtesy of David Darg, Operation Blessing International.

With thousands of suspected cases and hundreds of reported deaths, the Lower Artibonite region of Haiti is facing a full-blown cholera epidemic. Beginning last week, a daily high volume of patients has been arriving at PIH health facilities in the outbreak areas, reported Partners In Health Chief of Mission in Haiti Louise Ivers from Port-au-Prince on Monday morning.

In partnership with Haiti’s Ministry of Public Health and Population (MHPP), PIH operates three hospitals in the area hit hardest by the outbreak. These hospitals, which serve the communities of St. Marc, Verrettes, and Petite Riviere, report improving situations due to more effective infection control and efficient triage, with technical assistance from MSF-Spain and MSF-Belgium. The hospital at St. Marc has been triaging an average of 600 new patients each day, and has a regular load of about 250-300 hospitalized cholera patients.

Access to medical facilities and clean water remain major concerns, particularly in isolated rural areas, said Dr. Ivers. Over the weekend, PIH was able to get 14 water trucks to some of the communities most in need, thanks to a partnership with the non-profit organization Yele Haiti. In addition, water purification tablets and oral rehydration salts have been widely distributed throughout the region. However, there are still many communities in the outbreak region whose only water source is the contaminated Artibonite river or rain water.

Complicating matters, on top of a need for clean water for general consumption, cholera patients need a particularly high volume of fluids—about 20 liters daily for each patient, said Dr. Ivers. As having access to this volume is virtually impossible in many areas, PIH is urging all suspected cases (anyone with diarrhea) to seek immediate treatment at a hospital.

But access to medical facilities is also a challenge: communities in the Artibonite are widely spread out, and even the nearest hospital can be hours away by foot, horse, or car. 

To reach out to remote villages, PIH is sponsoring regular radio announcements at stations throughout the region. In addition, thousands of PIH community health workers and social workers have been mobilized and deployed to find suspected cholera cases and educate their communities about the importance of washing their hands regularly and drinking only clean or purified water. They have also been supplied with soap, water purification tablets and oral rehydration salts to distribute. Additional training materials for community health workers are being finalized. Topics include preventing transmission and disinfecting the homes of cholera patients.

	One of the settlement camps in Port-au-Prince served by a PIH clinic.

Although the outbreak remains concentrated in the Lower Artibonite region of Haiti, the fluid nature of Haitian society – regular travel from capital city to the country side to visit markets, etc. – makes it inevitable that there will be some cases of cholera in Port-au-Prince, said PIH Chief Medical Officer Dr. Joia Mukherjee. Five cases have already been reported in the city, and all five appear to be people who had traveled there from the infected rural areas. Conditions of overcrowding and extreme poverty could facilitate a widespread epidemic unless urgent and effective action is taken to provide access to clean water and sanitation, added Dr. Mukherjee.  The 1.2 million displaced people who have been living in settlement camps in and around Port-au-Prince since the January 12 earthquake are particularly vulnerable. PIH clinics in the capital city, which serve four of the camps, are carrying out intensive education and prevention campaigns with residents and are making preparations to manage and control any outbreaks that might occur.

Cases of cholera have been reported as far east as PIH’s health center in Lacolline, which is currently treating 25-30 sick prison inmates. As the prison facility is woefully overcrowded—300 prisoners in a space built for 80—PIH is working to set up a space to evacuate the remaining prisoners. Five deaths have been reported among the prisoners.

There have been no cases reported at other health facilities operated by PIH in the Central Plateau region north of Lacolline.

As Haiti grapples with the worst health crisis since the earthquake, the cholera situation remains uncertain, with the death toll topping 200, according to Haitian health officials on Saturday.  Partners In Health is providing urgent care to the ill and mounting a massive community campaign to distribute soap and rehydration salts, and educate people about prevention. Our community health workers are traveling to the most affected areas in search of patients who need immediate treatment.

• The number of new cases at the hospital in St. Marc on Friday was lower than on Thursday. But with only 3 days of data, it is not yet possible to say that this represents a positive trend.
• Some cases (10) have now been reported in Gonaives, the largest city in the Artibonite region located 34 miles north of St. Marc.
• The nonprofit organization Yele Haiti will start trucking water to communities in collaboration with PIH on Saturday. Operation Blessing has already been doing so since Thursday.
• A team from Medecins Sans Frontieres (MSF) Belgium arrived in Petite Riviere de l'Artibonite on Friday, where they are providing technical assistance at the hospital PIH operates with the Ministry of Health. Another team from MSF Spain has been working with PIH in St. Marc and has helped set up a system for burning waste at the hospital that will go into effect today (Saturday).

A large concern is the geographic spread of the outbreak, and particularly the possibility of its spread to Port-au-Prince. In a call with reporters yesterday, PIH Chief Medical Officer, Joia Mukherjee, warned, "There's no reason to anticipate [cholera] wouldn't spread widely within Haiti.'' Thus far no confirmed cases have been reported in the capital city, and Haitian health officials and international groups are working desperately to contain the epidemic. We are posting news and media coverage to our website continuously and will continue to post updates as more information becomes available. 

Our profound thanks to the many of you who have already made a contribution. Your support provides PIH with the resources needed to respond immediately to the cholera outbreak.

	Treating patients in the courtyard at l'Hopital Saint Nicholas. Photo courtesy of David Darg, Operation Blessing International.
	Providing clean water in the Artibonite. Photo courtesy of David Darg, Operation Blessing International.

A cholera epidemic has broken out in the lower Artibonite region of Haiti. As of Friday morning, October 22, more than 2,000 cases and 140 deaths had been reported. PIH has rushed clinical reinforcements and supplies to the region and has mounted a massive community education and mobilization campaign. Community health workers are fanning out throughout the area to distribute oral rehydration salts and soap and to warn people of the need to drink only clean or purified water and wash their hands frequently—the two keys to preventing further spread of the disease.

Starting on Tuesday evening, patients suffering from acute watery diarrhea began arriving at Hôpital Saint Nicolas in St. Marc, which PIH operates in partnership with the Haitian Ministry of Health. By Thursday evening the hospital in St. Marc was overflowing with over 500 patients, of whom 12 had died. Another 437 patients were taken in between 6:00 Thursday evening and 5:00 Friday morning. Other hospitals in the Lower Artibonite region—including PIH facilities in Petite Riviere and Verettes—also reported large numbers of patients with similar symptoms and high mortality rates.

Although the diagnosis of cholera was not confirmed until Friday morning, PIH, the Ministry of Health, and other partner organizations had already launched urgent treatment and prevention efforts. The most effective treatment for both cholera and other acute diarrheal diseases is oral rehydration; and prevention hinges on providing access to clean water.

Zanmi Lasante dispatched reinforcements for both the clinical and community outreach efforts from our team in Port au Prince and our facilities in the Central Plateau. And several longstanding partner organizations have rallied to support PIH and the Ministry of Health on both fronts. Operation Blessing, which has worked closely with PIH to provide clean water in settlements around Port-au-Prince, rushed to St. Marc to help. Two branches of Médecins Sans Frontières (MSF-Spain and MSF-Belgium) deployed clinical team reinforcements to St. Marc and Petite Riviere, where they are taking the lead in setting up systems to separate cholera cases from non-cholera cases.

Lack of access to clean water has long been a major threat to public health throughout Haiti. Zanmi Lasante has worked with partner organizations to combat the problem on many fronts:

• at the household level—by building and supplying filtration systems to households in isolated areas;
• at the community level—by constructing spring caps and piping water to kiosks for use by local residents; and
• at the national and international level—by advocating for changes of policy and commitment of resources to make clean water available to all as a fundamental human right. In a study published in 2007, PIH documented the damage to public health caused by a 10-year delay in disbursing loans that had already been approved for construction of water improvement projects in several Haitian communities, including St. Marc. Learn more.

As we work urgently to treat cholera patients and halt the epidemic before it can spread to the crowded settlements around Port au Prince, PIH will continue to emphasize that strengthening public infrastructure, especially the water supply, must be a top priority in post-earthquake reconstruction efforts. 

UPDATE: See Joia Mukherjee featured on the October 22 CBS Evening News.

By Joia Mukherjee, Chief Medical Officer PIH

An outbreak of cholera has been documented in the area surrounding the lower Artibonite region of Haiti by the staff of PIH’s sister organization Zanmi Lasante (ZL,) working with the Haitian Ministry of Health and other partners. As of Friday morning October 22, 2010; there have been more than 2000 cases of acute watery diarrhea and 160 deaths reported at the facilities in St. Marc, Petite Rivière d’Artibonite, Verrettes, Mirebalais and Lascahobas.

What is Cholera?

Cholera is an acute diarrheal illness that is spread by drinking water containing the organism Vibrio cholera. Symptoms typically develop between one and five days after drinking water contaminated by the human feces of persons infected with the cholera bacteria.  Only about 10 percent of those who drink water contaminated by the cholera bacteria will fall ill; however, the infection can be fatal particularly among young children, the elderly, the malnourished and persons with decreased immune function. Those ill with cholera develop profuse, watery, high volume diarrhea that is rapidly dehydrating. Without adequate replacement of volume lost, patients may go into shock and die of dehydration. The mainstay of treatment for cholera is fluid and salt replacement—generally by oral rehydration solution—a standard combination of salt, sugar and water. Intravenous fluids may be needed if the patient is unable to drink due to vomiting or a depressed level of consciousness. Antibiotics are used to decrease the volume of diarrhea and the excretion of bacteria in the stool—both can help decrease transmission.

Cholera is a disease of poverty—and was one of the earliest documented public health problems.  Cholera epidemics are caused by a lack of access to safe, clean water. Typically, the world’s poorest people obtain drinking water from a river or stream; in the absence of pit latrines or public sewage systems, the same river is used for defecation allowing human waste to mix with the water used for drinking.  While boiling water will kill the cholera bacteria, the fuel to boil water costs money and as wood-based charcoal is the main source of cooking fuel in Haiti use of charcoal is also related to the continued deforestation of the country. Cholera can also be transmitted if a person eats food contaminated with the cholera bacterium.

Cholera in Haiti:

While Haiti has not had a documented case of cholera since the 1960s, the conditions in the lower Artibonite placed the region at high-risk for epidemics of cholera and other water-borne diseases even before the earthquake of January 12, 2010. In 2008, Partners In Health working with partners at the Robert Kennedy Center for Human Rights released a report of the denial of water security as a basic right in Haiti. In 2000, a set of loans from the Inter American Development Bank to the government of Haiti for water, sanitation and health were blocked for political reasons. The city of St. Marc (population 220,000) and region of the lower Artibonite (population 600,000) were among the areas slated for upgrading of the public water supply. This project was delayed more than a decade and has not yet been completed. We believe secure and free access to clean water is a basic human right that should be delivered through the public sector and that the international community’s failure to assist the government of Haiti in developing a safe water supply has been violation of this basic right.  Additionally, in Gonaives the capital of the Artibonite has been destroyed in two waves of floods and mudslides, after tropical storm Jeanne in 2004 and after the series of hurricanes in 2008, made possible because of the environmental devastation of the region. The destruction contaminated the water supply and left the infrastructure (including the health infrastructure) of the upper Artibonite in ruins, forcing people to seek residence and medical care in St. Marc. The St. Marc region itself experienced significant flooding in 2008, displacing thousands of people. Lastly, the earthquake of January 12, 2010 resulted in the displacement of 1.7 million Haitians. While reliable statistics are not available currently, the last estimate, as of March of 2010 was that 300,000 addition Haitians had fled Port au Prince to the Artibonite. As there are no “camps” in the region, these displaced persons are “home hosted”—joining poor relatives in already overcrowded conditions, without water security or adequate sanitation. The dispersal of displaced people makes it difficult to provide centralized services.

What can be done?

Thousands of people are being given basic education, soap and oral rehydration salts in their communities by community health workers and those already ill are being referred to Zanmi Lasante/Ministry of Health facilities in the Artibonite and Central departments. Programs of community mobilization and mass messaging are being conducted by Zanmi Lasante staff and local leaders.  There is a sense from our team in the field that the outreach is working and patients are arriving at medical facilities at earlier, less severe stages of the disease. Ill patients are being treated in facilities—most notably l’Hôpital Saint Nicolas, where the ZL team is working in partnership with Médecins sans Frontières (MSF) Spain, and at Petite Rivière d’Artibonite (PRA) in partnership with MSF-Belgium. In St. Marc, MSF - Spain is setting up systems to separate cholera cases from non-cholera cases and to organize waste management and infection control. On the national level, the leadership of Partners In Health and Zanmi Lasante with other partners working in the camps are helping to design the contingency plan for Port au Prince.

Yet the key to stopping the cholera epidemic in Haiti is to provide water security for the people of the Artibonite urgently and in the long term. To meet the urgent need for water security, Partners In Health/Zanmi Lasante is again partnering with numerous organizations in addition to MSF such as Operation Blessing, who were instrumental in providing water installations in the camps in Port au Prince as well as in the Central Department after the earthquake; with the Centers for Disease Control and the World Health Organization who are coordinating the investigation to determine the sources of the outbreak; and with the water and sanitation/hygiene cluster within the UN system to obtain water trucks and water bladders for distribution.

For the future of Haiti, we will continue to be engaged in community-based water projects as we have been for decades in the Central Department. However, community based water projects and latrines will never be sufficient to assure the right to clean water—the government of Haiti must be enabled by international partners to assure this right. To that end, we will also continue to advocate for money pledged for the reconstruction of Haiti be used to strengthen the public infrastructure of the country, including prioritizing the development of a reliable and safe public water supply to provide real water security as a basic right for the people of Haiti.

	An APZU employee's current home (above) and the one he is building for his family using a bank loan from the new APZU program.

While getting a loan in the U.S. can be a challenge, in rural Malawi just finding access to credit is a downright feat.  And when the rare bank loan is approved, it’s shackled to assessment fees and sky-high interest rates often ranging as high as 50 percent. 

To address this problem, PIH’s partner organization in Malawi, Abwenzi Pa Za Umoyo recently launched a new pilot program to help local staff access bank loans. These loans will help these community members invest in projects that will help their families improve their social and economic situations.

APZU negotiated a relatively low interest rate of 23% with a local branch of the Malawi Savings Bank, which also agreed to waive the initial assessment fees for a loan. The program is open to employees who have worked with APZU for at least 2.5 years. Loans are capped at 6 months of the employee’s salary and paid over a term of 2 years. Repayments to the bank will be deducted directly from the employee’s paychecks.

This new benefit has been highly anticipated among APZU staff, reports PIH Malawi Project Manager Annemarie Ackerman. So far, 36 employees have enrolled, and have been given loans ranging from $320 to $3,600. The majority of the loans will fund house building or home improvement projects. Several will help jumpstart small businesses, ranging from starting a beauty salon to purchasing a cow to sell its milk.

As staff currently enrolled in the program begin so successfully pay off their loans, APZU plans to extend the benefit to more employees.

Gabriel Garcia Salyano is a community organizer and physician at PIH's supported project EAPSEC in Chiapas, Mexico. He recently joined a group delegation to PIH sites in Haiti to learn more about how the PIH approach is implemented elsewhere and to share his experiences. The following is a reflection from that trip.

	Gabriel Garcia Salyano

We arrive at a clinic, which in reality is more like a hospital without walls, laid out in the shade of a few apartment buildings that remain standing in an esplanade.

Long lines of people are waiting for medical attention.  Women, children, older men, all endure standing until the moment they can be seen by the medical staff in improvised examining rooms.  Perhaps what helps them to endure the wait is the certainty that they will be cared for with respect and receive the medicines that they need.

Further down, between various merchants peddling their wares, we come to the laboratory, where blood, urine, typhoid, HIV and other tests are conducted.  Facing this, in rooms constructed with sheets of plywood and tarp, are places that provide care for women, care for malnourished children, a space for psychological support, and the pharmacy.

Our guide is a Haitian doctor who leads a team of 16 staff who are charged with providing care to 7,000 people.

“And what are the people sick from?” someone asks. While the doctor recites the list of conditions, I respond to myself, “From injustice and neglect!”

At the close of the visit, we learn that this young, 29-year-old doctor, is a graduate of the Escuela Latinoamericana de Medicina (The Latin American Medical School); proof that Cuba has stood with Haiti since even before the earthquake.

We then head to the Dadadou camp, and pass through streets littered with destroyed homes.  One house in particular caught my attention. It is built of material that seems to dance, because it is whole, unbroken, not even the glass has shattered, but it lists at such an angle that the roof is nearly a wall and the wall is almost the roof. It looks as if it’s just resting on its neighbor, a small home made of wood and tin.

The streets of the city, at one time paved, now appear the perfect environment for the brand new 4x4 vehicles of humanitarian NGOs.  The acronyms freshly painted on their sides almost proclaim to the streets that they are here to practice “humanitarian colonialism.”

We are struck by how the UN installations are surrounded by a fence topped with rolls of razor wire and guard towers.

	Tents set up on the green astroturf at Dadadou

The Dadadou camp is located on what was a sport stadium. The floor, where thousands of people have slept each night for the last nine months, is flat, synthetic grass.  But it is strange to see the bright green streaks of the turf running between the monotonous gray and blue tarps.

The staff in charge of the Dadadou clinic shows us the different services that they provide to the camp residents, from waiting areas, to medical consult rooms that may lack walls, but retain respect.  The psychological support services are designed to be collective.  The staff who monitor nutritional status of girls and boys are surrounded by scales, measuring tape, and food supplements, as well as great regard and pride for the work they are doing for their people.

	Teboho Khophoche

A thin boy with a serious expression, Teboho Khophoche seems almost fragile, particularly in contrast with the rugged mountain backdrop of his home in Maseru, Lesotho.  But his community, teachers, and even his own family were once afraid of him.
 
Or rather, they were frightened by the virulent disease that had infected his body—tuberculosis. The young boy had contracted a disease that had already taken the life of his mother, leaving him an orphan. To make matters worse, Teboho had developed a dangerous strain known as multidrug-resistant tuberculosis (MDR-TB), which is immune to the most common (and usually the most effective and inexpensive) drugs used to treat the disease. MDR-TB patients must endure an intensive 2-year treatment regimen of second-line drugs that often come with debilitating side effects.
 
Too often in poor communities like Teboho’s, MDR-TB is deadly. And like the shy teenager, those who are known to have the disease often become social outcasts.
 
Teboho has battled TB for years. After fighting reoccurring bouts with more easily-treated strains of the disease, he was finally diagnosed with MDR-TB in 2008 and admitted to the Botsabelo MDR-TB hospital, operated by PIH’s partner organization in Lesotho. Dangerously thin and very weak, he was terrified of the disease, and often cried from homesickness. He had to remain at the hospital for five months. His family rarely visited.
 
When he was finally discharged, his aunt, who had assumed custody of him after his mother passed away, no longer wanted to care for him. She had made plans to send him to an orphanage. Due to neglect, he quickly fell ill again and was readmitted to Botsabelo.
 
The PIH Lesotho team knew that they had to do something. Treating Teboho’s socio-economic situation was in many ways just as important as providing the medication to treat the disease. Without a safe and stable home, his recovery would be nearly impossible.
 
So the PIH Lesotho team began interviewing the boy’s relatives, searching for someone who could be counted on to be his guardian. They finally located his grandmother, who had been living and working in the neighboring country of South Africa. She agreed to move back to Lesotho so that she could care for him.

The PIH team continued to follow Teboho’s progress, checking up on him often and happily reporting that his grandmother has become just the guardian—and family—that the boy needed to make a full recovery. The team then began working on helping Teboho to build a future for himself. They met with a local school and teachers, who were initially afraid to have Teboho join their student body. The PIH team spent hours discussing the circumstances and explaining that the boy was no longer infectious.
 
Finally last January, the school enthusiastically prepared to welcome him; but it was Teboho who was nervous. Although he desperately wanted to attend class, the teen was understandably afraid of how his peers would treat him. He noticed that other children would point and stare at him. “They are going to laugh at me at school because my legs are very thin and long,” he confided to PIH Lesotho country director Hind Satti. So PIH arranged for him to receive counseling to help him overcome his fear. And as he grew stronger emotionally, PIH provided him with monthly food packages to help grow stronger physically.
 
Today, the 17-year-old has successfully completed the two-year treatment regimen for MDR-TB and is disease-free. A stellar student, he excels in his math and English classes, and has taken up a hobby raising pigeons in a small hutch behind the house he shares with his grandmother. He plans to eventually begin selling the offspring to generate a small income to help support himself and his grandmother. After finishing his schooling, he hopes to make use of his entrepreneurial spirit by building a career in business or finance.
 
Tiboho is just one of the over 460 patients that PIH Lesotho team is supporting as they battle MDR-TB. From helping patients remain on their treatment regimens, to educating local communities about the disease, to ensuring that patients have the social and economic resources they need to be cured, the PIH Lesotho team is slowly bringing hope to communities that live in fear of MDR-TB.

	Sergei Mishustin of Tomsk's TB Dispensary (the institution responsible for TB control in the civilian sector) helps inaugurate the new WHO Collaborating Center for Training in Multidrug-Resistant Tuberculosis at Novosibirsk.

In September, PIH Russia opened the doors to a new World Health Organization (WHO) Collaborating Center for Training in Multidrug-Resistant Tuberculosis at the Novosibirsk TB Research Institute (NTRI) in Siberia.

The new center will help strengthen the standards of treating of multidrug-resistant tuberculosis (MDR-TB) in 22 eastern territories of the Russia (covering two thirds of the country’s land area), which are particularly burdened by the diseases. The center will also collaborate with TB experts throughout the entire country and around the world by organizing trainings and conduct operational research on best practices for treating and controlling the disease.

WHO collaborating centers are specialized local institutions selected to research and support key international WHO programs. Currently, there are over 800 such centres in over 80 countries working on areas including nursing, nutrition, mental health, and communicable diseases.

The WHO approved a proposal from NTRI to be a center of excellence based on the successes of PIH Russia’s MDR-TB control program in Tomsk, a region in NTRI’s catchment area--the Tomsk program is the most effective of its kind in the Russian Federation, explains PIH Russia Training Coordinator Rostislav Mitrofanov. 

“I do believe that [a WHO collaborating Center] is one of the most effective tools to distribute positive tuberculosis control experiences, including that of PIH Tomsk's MDR-TB project,” says Rostislav, “In this particular case, it will also acknowledge and share PIH's approaches among the WHO and TB experts throughout Russia.”

The inauguration of the center was attended by the Russian Ministry of Health, the Russian Ministry of Justice, TB experts from 21 Russian territories, and representativs from Forum Koch-Mechnikov, USAID, PIH, and the International Federation of Red Cross and Red Crescent Societies.

Dear Friends,

The last nine months have been unlike any in the history of Partners In Health. In the midst of the devastation wrought by the January 12 earthquake, we learned again from Haiti that forces of solidarity, love and team work are more potent than any disaster. Thus, it was fitting that the Partners In Health 17th Annual Thomas J. White Symposium was entitled "Lessons from Haiti: Tackling Acute and Chronic Disasters." We were deeply honored that so many of you traveled to Cambridge to be with us on September 25th, and that this year, the Symposium was streamed live to places as far flung as California and Liberia.

For those of you who were unable to join us for the original event you can watch the video of it on the player below:

	Joia Mukherjee speaking at PIH's annual symposium on September 25.
	PIH Chief of Mission for Haiti Louise Ivers and Zanmi Lasante Driver Ounsel Mede share the story of their work immediately following the earthquake.
	PIH Director of Community Programs in Malawi Paul Pierre talks about the importance of partnerships.

In this difficult year, we found our strength through our amazing staff in Haiti, providing direct response; our dedicated teams in Africa, Russia and Latin America continuing the work and even giving their own time and financial support to Haiti relief and through all of you--the large network of supporters who we can friends and family of PIH. In the words of Dr. Louise Ivers, PIH's Chief of Mission in Haiti, "Accompaniment is being there in the darkest hour." Your accompaniment of PIH has allowed us to support the work of Haitians as they stand on the side of the poor and most vulnerable, often in their own communities, to overcome the obstacles that have been magnified in the aftermath of the earthquake.

Their sentiments and strength were epitomized by Dr. Dubique Kobel in excerpts from the short film "Haiti's Hero's" about ZL's work in Parc Jean Marie Vincent,"It's not just the earthquake that caused this suffering. There was never health care here. No right to education. No right to housing. What gives me strength is that it's my community. I understand their suffering because I grew up with it."

Those most vulnerable to acute disasters--whether man-made or natural--are the same people we accompany every day in their fight for dignity and justice in the face of the chronic privation--poverty and inequality--that consumes the lives of many through malnutrition, diseases like HIV and TB, and normal conditions turned life threatening by lack of medical care--such as pregnancy and childbirth. By addressing these underlying problems of poverty and inequalityand their medical consequences today, we strengthen the very systems needed to respond to the earthquake or flood of tomorrow. Bruce Nizeye, Chief of Infrastructure for PIH's efforts in Rwanda, hit this point home when he spoke of the power of the new state-of-the-art, public hospital in Butaro in revitalizing a community previously devastated by a genocide.

In his closing remarks, PIH co-founder Dr. Paul Farmer brought these sentiments full circle by stressing the importance of accompanying individuals, communities and nations. "The best hospital in Haiti should be rooted in Haitian soil," he said, noting that in the aftermath of the earthquake the best medical facilities to be found were floating in Port-au-Prince Harbor on the USNS Comfort. His description of PIH's commitment to creating centers of medical excellence for the poor and marginalized in both Haiti and Rwanda exemplifies a model for building back better that includes enhancing medical education, strengthening local capacity, bolstering social and economic opportunities and respecting the human dignity of those we serve.

As PIH's Chief Medical Officer, I am humbled to accompany an incredible cadre of drivers, social workers, nurses, and doctors on a daily basis. Every day I wish that our supporters could be with me to see this team in action, to see their heroism and devotion in the face of adversity. I am proud that this year's Symposium continued to feature their voices, the voices of our colleagues from Haiti, Rwanda, and Malawi, the voices of the communities we strive to serve.

In solidarity,

Joia Mukherjee
PIH Chief Medical Officer

	Construction continues at Mirebalais

Progress at the site of the future teaching hospital in Mirebalais is making significant progress, despite challenges posed by the rainy season. The biggest accomplishment so far has been the movement of all the dirt to create space for the hospital. It may seem like a simple process, but so far 124,254 cubic meters of earth have been excavated and moved – that’s 4,387,989 cubic feet! That amount of dirt could:

• Cover 912 football fields
• Fill Boston’s 52-floor Prudential Tower (PIH’s former home) more than 3 and a half times
• Squeeze into 279,489 Toyota Priuses
• Bury the field at Fenway Park 44 feet deep

In addition to the excavation, a worker’s camp is currently being built approximately 800 meters from the work site. To maximize value and reduce waste, this structure will become housing for medical students when the hospital is complete.

Next month we hope to report on plumbing, foundations, and (most exciting) the beginnings of erecting structures.

In late September, The Timberland Company, a manufacturer and retailer of outdoor wear, donated 300 pairs of their TiTan safety toe work boots to the construction crews building PIH’s new teaching hospital in Mirebalais, Haiti. “We are giving these to the construction workers, many of whom don’t own shoes or will have just flip flops,” said Jim Ansara, Partners In Health’s (PIH) Director of Construction for Mirebalais Hospital. The Timberland boots will allow dozens of local workers to safely maneuver the construction site of the new hospital. 

“On behalf of our entire Timberland team, please know that we're grateful to have the opportunity to help and we're very appreciative of the incredible, sustained efforts both Partners In Health and The Boston Foundation put forth on behalf of Haiti,” said Timberland’s Margaret Morey-Reuner.

Read more about PIH’s new teaching hospital in Mirebalais, Haiti.

“We truly thank you and Timberland for this generous donation,” said Jim. “Beyond being something really nice for the workers who are going to build this hospital, it will greatly increase their safety and welfare. We are very appreciative.”

Crews have been preparing the site since July, construction is set to begin November 1. Read more about the post-earthquake efforts of PIH and its sister organization in Haiti, Zanmi Lasante.

“Why has PIH been so effective?” asked St. Petersburg Times reporter Dan DeWitt in an article published on October 10.  “Why is it able to build a modern teaching hospital for $15 million while other organizations with far more money struggle to move beyond the handout phase of aid delivery?”

DeWitt recently visited Haiti to attend the cornerstone-laying ceremony for this new teaching Hospital—a 320-bed facility in the town of Mirebalais in central Haiti. “It was a rare sign that Haiti can be built back better, as former President Bill Clinton vowed after January's catastrophic earthquake,” he wrote.

"The rules of the road for development assistance need to be rewritten," said PIH co-founder Paul Farmer. "Not to favor contractors and middlemen and trauma vultures, but to favor the victims of the quake.''

Beyond the teaching hospital in Mirebalais, DeWitt also documents the successes of various PIH post-earthquake initiatives, including a home for disabled and at-risk children, and the expansion of a program to help local farmers and communities produce more food to help feed earthquake survivors.

Read the full article.

In an accompanying column, DeWitt explores the accomplishments of PIH co-founder Paul Farmer. He concludes that PIH’s successes are grounded in the work and commitment of thousands of employees and supporters – each focused on improving the health and standard of living for millions of people residing in some of the world’s most impoverished communities.

Read this column.

	Wilner Pierre suffered substantial injuries during the earthquake that have left him paralyzed from the waist down. "That doesn't bother me much because I have met a lot of people who have the same condition but they do whatever they want, they go to school and learn," says Wilner. Like Seleine, he was brought to Philadelphia to receive care not available in Haiti.

"It is due to the grace of people who helped me that I can even sit here and talk about my children,” says Seleine Gay.

Seleine was one of 19 Haitians injured by the earthquake who were brought to Philadelphia by Partners In Health (PIH) to receive medical care. All of these patients would have most likely died within 24 hours had it not been for the generosity of several medical facilities in the Philadelphia area.

Seleine received treatment from doctors at the Hospital of the University of Pennsylvania after her leg was crushed during the tremors. Though her condition was critical in the days following the earthquake, she is now doing well and living with a group of other Right To Health Care (RTHC) patients in Germantown, PA, as they recover from their injuries.

Last month, Seleine was fitted for a prosthetic leg.  "I love it because, with it, I can stand and walk again," she says. But, she misses her family, having left behind a husband and three children under the age of 12 in Haiti.

Learn more about Seleine and her fellow earthquake survivors now living in the Philadelphia area on a segment by Philadelphia’s ABC affiliate, WPBI. 

For more than 20 years, the RTHC program has served patients with medical needs too complex to be treated in the countries where we work. PIH collaborates with US-based hospitals, clinicians, and families to provide each patient the specialized care needed for a successful recovery.

Read more about RTHC’s response to the January 12 earthquake.

	Children learning the alphabet in Malawi.

Like children in the US, hundreds of thousands of Malawian children headed back to school in September. But unlike students in the US, Malawian students face a number of obstacles to obtaining an education, particularly if they are from poor families. Paying for school supplies, uniforms, and schools fees can prove a challenging burden for families already struggling to just feed and shelter their children.
 
As attending primary school in Malawi is free, most Malawian children typically receive some basic education. However, school fees for secondary school is one reason why only 275,000 of the 3 million students in primary education continue on to receive a secondary education (grades 6-12).  

Partners In Health (PIH) and its sister organization in Malawi, Abwenzi Pa Za Umoyo (APZU) know that access to education is instrumental to breaking the cycle of poverty and disease in resource poor countries. Studies show that people who have access to secondary education enjoy significantly higher lifetime earnings and better health. And the benefits carry over to their children who are pronouncedly better nourished, healthier, and more likely to attend school themselves.
 
Reports from the United Nations Population Fund show a direct correlation between primary education and rates of HIV/AIDS. The more educated young people are, the more likely they are to protect themselves and the less likely they are to engage in risky sexual behavior. If all children received a complete primary education, the economic impact of HIV/AIDS could be greatly reduced and around 700,000 cases of HIV in young adults could be prevented each year—seven million in a decade, according to the reports. Other studies show that every additional year of schooling can increase lifetime earnings by 7 percent or more. Education is crucial to addressing both disease and poverty.
 
APZU is committed to assisting local communities as they strive to continue providing education opportunities to their children. Since beginning work in the country in 2007, APZU has actively focused its support on orphans and vulnerable children, those young people most likely to slip through the cracks.
 
APZU’s Program on Social and Economic Rights (POSER) will support roughly 900 at-risk students this year. This includes both social support from APZU staff, as well as the costs of uniforms, school materials (exercise books, pencils, etc.) for primary students and tuition/examination fees and shoes for secondary students.
 
Learn more about APZU’s work in Malawi.

October 4 marked the first day of the new school year in Haiti. For many students, this was their first time back in a classroom since last January’s earthquake. Yet, for thousands of young people, massive damage to school buildings and insecure financial and living situations will prevent them from attending school this year.

	School children in the Central Plateau of Haiti.

PIH and its sister organization in Haiti, Zanmi Lasante, believe that access to education is instrumental to breaking the cycle of poverty and disease in poor countries like Haiti. Even before the earthquake, school fees put education out of reach for many families--only about half of Haiti’s 4 million school-aged children could afford to attend classes, according to a pre-earthquake UNICEF report. So from its very beginnings nearly 25 years ago, ZL has worked to help thousands of Haitians gain access to an education. This fall the ZL team has mobilized to continue this commitment.

In the Central Plateau and Artibonite departments of the country, ZL is supporting 30 existing primary and secondary schools and providing school assistance—in the form of tuition, uniforms, school supplies, and books—to roughly 13,000 children of HIV and TB patients, orphans, and children displaced by the earthquake. In addition, the Haitian school system requires that students wear closed-toe shoes to class—shoes can literally provide access to education.  So in preparation for the start of this school year, PIH partnered with TOMS shoes and distributed shoes to 12,000 children in late September. Beyond school expenses, ZL recognizes that nutrition is key to helping children learn. We will continue to provide lunches to 11,000 children each day through our school meal program, with support from World Food Programme.

Knowing that achieving literacy can open doors for people at any age, ZL has also worked to open additional scolarization centers—accelerated education centers for teaching older children and adults how to read and write. These centers aim to enroll 3,400 students during this academic year. In addition to the centers, ZL’s Zanmi Alpha adult literacy classes plan to enroll an additional 1,200 adults in reading classes.
 
Read more about PIH’s work with children affected by the earthquake.
Read a New York Times editorial about Haiti’s post-earthquake education hurdles.

A special panel on addressing cancer in the developing world garnered much attention at the Clinton Global Initiative’s (CGI) annual conference in September. So much so that The Daily Beast put it on their list of the "seven smartest ideas" heard at this year’s conference.

“Philanthropists used to believe there was no practical way to get expensive cancer treatments to the poor,” said PIH co-founder Paul, who spoke on the CGI panel. This idea is outdated and unfair, he added. "Poor people are kind of getting shafted. We need a global fund for cancer care.”

The panel was hosted by CNN’s Dr. Sanjay Gupta. Panelists included HRH Princess Dina Mired, the Director General of the King Hussein Cancer Foundation; Dr. Patrick Almazor, a PIH physician who has worked on PIH projects in both Haiti and Rwanda; Felicia Knaul, the Director of the Harvard Global Equity Initiative; and Lance Armstrong, the Founder and Chairman of LIVESTRONG.

Watch a video of the panel on the player below:

“One of the things we need to do is stop saying or suggesting that cancer is not a ranking concern [in developing countries], this is a serious problem,” Paul stated. “We have some tools that can be used to address cancer in developing countries and we need to deploy those tools.” After showing the world that cancer can be fought in urban areas, “we [are] trying to show that it’s also possible in rural places, in rural Africa.”

Cancer kills more people in developing countries each year than AIDS, Malaria, and TB combined, states a report from the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, of which most of the panelists are founding members of. By 2030, it is estimated that about 70 percent of new cases of cancer will be diagnosed in the developing world.

Read more about the importance of addressing global cancer.

Read the The Huffington Post's report on the CGI panel.

We encourage anyone in the Boston-area to join us for this thought-provoking event on October 5, 2010 at 7 p.m. Please note that reservations are requested; register online at www.ushmm.org/events/bostonoct5.

How Did Medical Professionals Become Complicit in the Nazi Plan?

TUESDAY, OCTOBER 5, 7 p.m.
Boston Public Library
Sidney R. and Esther V. Rabb Lecture Hall
Johnson Building, Lower Level, 700 Boylston St.

Featured Speakers

Paul Farmer, M.D., Ph.D., Presley Professor and Chair
Department of Global Health and Social Medicine Harvard Medical School

Jay Allison, Independent Broadcast Journalist and Curator of This I Believe for National Public Radio

In April 2011, the United States Holocaust Memorial Museum, in partnership with Harvard Medical School, brings its special exhibition Deadly Medicine: Creating the Master Race to Boston. Deadly Medicine examines the role of the German medical community in supporting and implementing the Nazis' murderous program of eugenics and the implications this has for today.

In the first in a series of provocative programs designed to complement the exhibition, renowned humanitarian Dr. Paul Farmer and National Public Radio's Jay Allison will explore medical ethics and some of the most pressing dilemmas of our time, including equal access to health care and the role physicians and other health care professionals play in creating a world free of human suffering.

This program is free and open to the public, and you are encouraged to bring guests. Reservations are requested; register online at www.ushmm.org/events/bostonoct5.

The following is an excerpt from an article by Vanessa Bradford Kerry, Sara Auld, and Paul Farmer. Read the full piece in the September 23, 2010 issue of The New England Journal of Medicine.

At first glance, medicine may seem unrelated to foreign policy, but in reality it is an unappreciated partner of diplomacy. In many parts of the world, poverty, inequity based on ethnicity or sex, shoddy public infrastructure, and environmental degradation have resulted in poor health as well as political and social instability. Poor health, in turn, fuels social vulnerabilities and discord, as illness diminishes productivity and disrupts family and social structures. The United States, a major funder of global health initiatives, has an opportunity to change the way it helps to tackle these challenges by investing in local health systems, equitable economic growth, and sustainable development.

To break the cycle of poverty and disease, we believe that the United States should create the equivalent of a Marshall Plan for health — a program that would train and fund both local providers and U.S. health care professionals to work, teach, learn, and enhance the health care workforce and infrastructure in low-income countries. We envision this program as an International Health Service Corps (IHSC), through which health care workers would engage in medical-service and capacity-building partnerships overseas in exchange for health-related graduate school scholarships and forgiveness of student loans. This effort should be targeted to health care providers in the United States and partner countries who are committed to serving the poor.

Although medicine's immediate aim is to combat illness and alleviate suffering, health care is also a tool for addressing the economic, social, and cultural problems associated with poor health. There is broad consensus that improvements in health can reduce poverty and contribute to long-term economic growth and development. The 2001 Commission on Macroeconomics and Health calculated that a 10% improvement in life expectancy translates into a 0.3% increase in economic growth. Interventions for human immunodeficiency virus infection, tuberculosis, and vaccine-preventable illnesses have all improved the condition of otherwise poor populations and demonstrated that just as disease transcends borders and can adversely affect regional economies, sound investments in health promotion can strengthen economies.

Read the full article online at The New England Journal of Medicine.

The following article by PIH medical director Joia Mukherjee was published in the Harvard International Review. Read the full text of the article.
 
To the citizens of the tiny, embattled country of Haiti, the notion of human rights is ever present, based on their collective knowledge that Haiti brought Napoleon to his knees when the slaves fought and died for the right to self determination, removing the vast sugar wealth from France’s treasury. Yet the rights of the people of Haiti have been perpetually suppressed by foreign powers, particularly the United States—from US President Jefferson’s fear of Haiti’s example as a danger to the slave-based US economies to the US President Monroe-lead occupation driven by resistance to European influence in the hemisphere to the more recent neoliberal front against socialism. These forces have resulted in a political scorched earth campaign against rights in Haiti as occupations, dictatorships and kleptocracies have left the Haitian State with massively inadequate resources to fulfill basic rights for its citizens. It is remarkable that, with less than 15 years democracy in Haiti—twice interrupted by US and French backed coups d’état, the people’s notions of rights and their participation in demanding them remains strong as evidenced by frequent protests for government protection of food prices, housing and education.
 
On January 12, 2010, a 7.0 magnitude earthquake, with an epicenter only 16 miles from the capital of Port au Prince shook the life out of much of the city leaving 250,000 dead, hundreds of thousands injured and more than 1.7 million people displaced. The majority of government buildings were destroyed leaving the government poorly equipped to lead the effort in the days after the quake. The sheer magnitude of the human catastrophe touched the hearts of millions and lead to an international outpouring of support. Private individuals and organization have given nearly 1.1 billion US dollars. The UN Office for the Coordination of Humanitarian Aid has reported that private individuals and organizations have given nearly .2 billion, which is 37 percent of the total assistance Haiti had received as of June 25, 2010, and more than the cumulative aid from any single government including the United States, Haiti’s largest donor. The government of Haiti stood at the end of the long line of recipients receiving less than one penny on every US dollar according to a review of relief efforts conducted by the Associated Press following the earthquake.

While a disaster of such magnitude surely demonstrates the need for a strong humanitarian response, it is also a critical time to examine the type of response, the people who receive and administer it, and the end recipient. There are two critical entities in a human rights framework—the participation of civil society and the responsibility and ability of governments to respect, protect and fulfill rights. Additionally, it is crucial to examine the role the international community both as advocates and duty bearers in assuring human rights. This paper will review the assistance to Haiti in the aftermath of the earthquake, demonstrate the importance of advocacy in changing the way aid is given, highlight examples the work of the organization Partners In Health at both government and civil society levels that have supported a human rights framework, and suggest a set of criteria by which the strengthening human rights targeted and may be measured as Haiti receives assistance in her recovery.
 
Read the full article on the Harvard International Review website.

Dr. Joia Mukherjee trained in Infectious Disease, Internal Medicine, and Pediatrics at the Massachusetts General Hospital and has an MPH from the Harvard School of Public Health. She is an Associate Professor in the Division of Global Health Equity at the Brigham and Women’s Hospital and Harvard Medical. Dr. Mukherjee consults for the World Health Organization on the treatment of HIV and MDR-TB in developing countries and is a member of the Executive Board of Health Action AIDS, a campaign conducted with Physicians for Human Rights to engage the US health professional community in the international advocacy and education effort to stop the global AIDS pandemic.

“In medical school, they gave us disaster training,” says Dr. Dubique Kobel. “But I never thought I’d find myself in a situation like this.”

In the aftermath of the January earthquake that devastated Haiti, Dr. Kobel immediately began using his medical training to help his injured neighbors in Port-au-Prince. Today, as director of a PIH clinic that serves Parc Jean-Marie Vincent, a large settlement where 80,000 of earthquake survivors now live, he is still tirelessly providing medical care to those most in need.

Watch a video from the Abundance Foundation documenting Dr. Kobel’s work and life at Parc Jean-Marie Vincent.

Haiti's Heroes: The Film from Abundance Foundation on Vimeo.

The Abundance Foundation is helping to support PIH's work in Haiti. 100% of all donations will go to train and support PIH Haitian doctors, nurses, social workers and other health workers. Learn more.

The toll of death and suffering from cancer in developing countries has increased sharply in recent decades. So has the disparity in the allocation of resources for cancer care and control between rich and poor countries. A special panel at the 2010 annual Clinton Global Initiative addressed this growing and overlooked public health crisis.

The panel was held on September 22, 2010. Watch it on the player below.

Participants of the panel include:

• Charles-Patrick Almazor, Director, Public Sector Partnership, Artibonite Department, Partners In Health
• Lance Armstrong, Founder and Chairman, LIVESTRONG
• Paul Farmer, Co-Founder, Partners In Health; Chair of the Department of Global Health and Social Medicine, Harvard Medical School; Chief of the Division of Global Health Equity, Brigham and Women’s Hospital; UN Deputy Special Envoy for Haiti
• Sanjay Gupta, Chief Medical Correspondent, CNN
• Felicia Knaul, Director, Harvard Global Equity Initiative; Founder, Cáncer de mama: Tómatelo a Pecho
• HRH Princess Dina Mired, Director General, King Hussein Cancer Foundation

Follow the live online discussion for this panel on Twitter using #cgi2010.

Learn more about the great need to address cancer in developing countries.

Want to learn more? Watch a panel session on “Addressing Cancer in the Developing World: Health Equity and an Overlooked Public Health Crisis” from the 2010 Clinton Global Initiative annual meeting. 

	The new micobiology lab at Neno District Hospital

PIH’s Malawian sister organization Abwenzi Pa Za Umoyo (APZU) recently inaugurated a new microbiology lab at Neno District Hospital, becoming the first district hospital in Malawi able to perform routine blood cultures, a vital diagnostic tool for detecting infections ranging from typhoid to sepsis. The lab was opened in a partnership between APZU, the Malawian Ministry of Health, and the Centers for Disease Control and Prevention.

Before this lab opened, doctors in Neno would have to send samples to a lab in the capital city of Lilongwe and wait up to three or four weeks for results. Now, clinicians can have answers for their patients within 48 hours for some tests, and in as little as 12 hours for others.

In its first 2 weeks, the lab staff performed 14 blood cultures, and identified the bacteria Salmonella typhi (a cause of Typhoid) in six patients. The blood cultures are also able to ascertain which antibiotics the bacteria are resistant to, so that clinicians could immediately administer an effective treatment.

The APZU team hope to soon expand the laboratory’s services to include testing other biologic fluids (e.g. urine, sputum) to improve treatment of other infectious diseases that disproportionately burden the poor in rural Malawi.

	The construction site of the future National Teaching Hospital at Mirebalais.
	Haitian Minister of Health Dr. Alex Larsen addressing the crowd at the cornerstone laying-ceremony on September 10.
	Father Jean Jeannot of Mirebalais (with shovel) laying the cornerstone with Father Fritz Lafontant (center, in black), the founding director of Zanmi Lasante.

On September 10, in partnership with the Government of Haiti, Partners In Health (PIH) and its Haitian sister organization, Zanmi Lasante (ZL), laid the cornerstone for the $15 million, 320-bed world-class National Teaching Hospital in Mirebalais, Haiti. The new facility is itself a symbolic cornerstone of PIH’s long-term, post-earthquake rebuilding efforts.

"On the seventh day after the earthquake, the best hospital in the country was floating in the harbor on a ship, the USNS Comfort. Is that fair? Is that right?” PIH co-founder Paul Farmer asked the crowd of several hundred people who gathered for the event under a large tent pitched on the site of the future facility. “The answer of course is 'No.' That's why we're here today, to do something unprecedented in our history—to build the finest hospital in the country right here in the center of Haiti."

In addition to destroying many of Haiti’s medical facilities, the January earthquake also demolished the country's nursing school, killing more than 200 students and faculty, and disabled the only public teaching hospital. At a time when Haiti desperately needs skilled health professionals, the country has been hamstrung in its ability to train its own people to fulfill these roles. The new hospital will help teach the next generation of Haitian doctors, nurses, and lab technicians, equipping them to take on the challenges of rebuilding and strengthening the Haitian healthcare system.

"This is not just about a hospital. It's about building back better," added Farmer, who is also the Chair of the Department of Social Medicine at Harvard Medical School, and Chief of the Division of Global Health Equity at Brigham and Women’s Hospital in Boston.

The new hospital was one of the first projects proposed by the Haitian government and officially approved by the Interim Haiti Recovery Commission, a Haitian and international joint effort led by Prime Minister Jean-Max Bellerive and former President Bill Clinton to oversee the national recovery and development plan following the earthquake.

The Haitian Ministry of Health has been an active partner in developing and expanding plans for what will become a flagship public medical and teaching facility. "We don't have the capacity to do this without the Ministry of Health," said Farmer. To symbolize the government’s commitment to the project, Haitian Minister of Health Dr. Alex Larsen and Director General Dr. Gabriel Timothé spoke at the Friday event and took up shovels to help lay the cornerstone.

In fact, the National Teaching Hospital was technically Dr. Larsen’s idea, said Farmer. Before the earthquake, PIH/ZL had originally planned to build a smaller, community hospital at the site. Following the tragedy, the Ministry asked PIH/ZL to revise the project into one with a much larger scope and future impact.

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

By the first anniversary of the earthquake—January 12, 2011—the seven buildings of the main hospital campus, comprising 180,000 square feet, will be standing, with work on the interiors begun. Plans call for the hospital to be accepting patients by the end of 2011.

In addition to being a major training facility, the hospital will also serve as a central referral center for the country. Mirebalais is located at the intersection of two main roads in Central Haiti that have been major thoroughfares for earthquake survivors fleeing Port-au-Prince.  It’s estimated that 20,000 people have migrated to the area, which means the hospital will immediately serve at least 160,000 residents. To serve such a large population, the hospital will have 320 beds—nearly matching the combined capacity at the 12 facilities now operated by Zanmi Lasante. Estimates of the demand for health care in the area suggest that the facility will serve approximately 450-550 patients per day.

The state-of-the-art clinical facilities will include an intensive care unit and an operating theatre complex with six operating rooms equipped for thoracic surgery—services not yet available at any public site in Haiti. The hospital will also provide comprehensive, community-based primary and prenatal care as well as treatment for TB, HIV, malaria, and malnutrition. In addition, the facility will feature cutting-edge infection control systems, wall-mounted oxygen and medical gases, improved diagnostics (digital x-ray and ultrasound), and solar panels to power the facility.

Partnerships with leading universities and teaching hospitals in the United States, including Harvard Medical School and Brigham and Women’s Hospital, will support the medical training and education of Haitian clinicians, as well as that of visiting international clinicians. Fittingly, a group of residents from the Brigham who were in Haiti for a training also took part in the cornerstone-laying event. The new hospital will also include the technological and logistical capacity to support educational exchanges, distance learning, and remote collaborations.

“When a new teaching hospital opens in this central Haiti town a little over a year from now, it will be far more than a 320-bed, six operating room facility,” writes Jacqueline Charles, a reporter with The Miami Herald. “Local and international doctors say it will represent a towering example of post-earthquake recovery.”

The cornerstone laying for the new hospital, which is being built in a partnership with PIH, Zanmi Lasante (PIH's partner organization in Haiti), and the Haitian Ministry of Health, took place on September 10. The event brought together PIH staff, top officials from the Haitian government, and crowds of local residents.

“It's going to be a world-class hospital in the middle of central Haiti,'' says PIH co-founder Dr. Paul Farmer. Former US President Bill Clinton seconded Farmer’s comments, telling The Miami Herald, “Dr. Farmer's hospital ensures high quality training for more doctors and healthcare workers. It is an example of the significant opportunities that exist to help Haitians to build back better.”

The new facility, officially called The National Teaching Hospital in Mirebalais, is located 90 minutes north of quake-ravaged Port-au-Prince, in the country’s Central Plateau. Though the facility was in the planning stages long before the January 12 earthquake, plans for the hospital were significantly expanded in response to that disaster, at the request of Haiti's Ministry of Health. 

Read The Miami Herald article in its entirety.

Attention Student Global Health Advocates!

Please join us on Sunday, September 26 for the Global Health Student (GHS) Conference. The conference, the third since its inception, will take place in conjunction with PIH’s 17th Annual Thomas J. White Symposium, held earlier that weekend. Planned and orchestrated by PIH’s 2010 summer interns, the event brings together student activists and speakers from many disciplines to discuss global advocacy efforts. Talks will focus on the ways in which students can access and affect change in global health.

This year’s featured speaker is PIH Medical Director Dr. Joia Mukherjee. The conference aims to educate, engage, and energize student involvement in global health advocacy. From large scale policy change efforts to everyday individual activism, a variety of panelists will explore pertinent issues in the field. With a better understanding of current priorities and challenges, students will be able to better translate collective energy into informed, change-making action.

Whether you are a high school student or a seasoned collegiate activist, this year’s GHS Conference will give you the tools to better understand and influence change in global health.

Check out our Facebook page for more information, updates and announcements.

Please direct any questions to globalhealthstudents2010@gmail.com.

Register now at www.studentconference2010.org as space will be limited!

“At least 70 percent of medical infrastructure in Port-au-Prince was destroyed [as a result of the January 12 earthquake],” says Dr. David Walton, Deputy Director of PIH’s Mission in Haiti, in an interview with Boston Public Radio’s Sacha Pfeiffer. As medical care facilities were so concentrated in the capital city, this loss represents a significant majority of the health care to the Haitian people, Walton added.

The January earthquake also destroyed the country’s major teaching hospital and nursing school. At a time when medical workers are in dire need, the country has been hamstrung in its ability to train its own people to fulfill these rolls. Walton explains that hundreds of medical students in limbo, unable to currently complete their educations.

Walton and Partners In Health have collaborating with Boston-area medical schools and Haiti’s Ministry of Health to begin construction of a new $15 million teaching hospital in Mirebalais that will train the country’s desperately needed future health care workforce. The cornerstone of the facility was laid on Friday, September 10.

 “We hope to create a space where these things are available to the Haitian people…in the public sector, available to those people who need them most,” says Dr. Walton.

Listen to Dr. Walton’s interview.

On Thursday, a group of students at the Harvard School of Public Health will launch a network for solidarity activism in support of grassroots Haitian organizations dealing with the aftermath of the earthquake.  The event, called “Aba Lokipasyon! Solidarity in Action: What Can We Do?” will bring together people from around Boston to learn from and engage in discussion with solidarity organizers on the ground in Haiti.  The event is part of the Political Economy of Health Seminar Series of HealthRoots, a student group that provides a forum for discussion of and action on the root causes of population health. 

Thursday, September 9, 6:00 pm
Room G13, FXB Center, Harvard School of Public Health
Boston, MA

The speakers at the event will include Brian Concannon, Director of the Institute for Justice and Democracy in Haiti (IJDH), and Mark Snyder from International Action Ties (IAT). IJDH’s work has recently been focused on gender-based violence in the camps for internally displaced persons (IDP), forced evictions from IDP camps, and the upcoming election.  IAT has been conducting monitoring of human rights violations, including forced evictions, in the IDP camps. 

The organizers hope that this event will generate an interesting discussion about the direction of U.S.-based advocacy and will result in some action ideas for the short and long term. Please come if you are ready to take action around these issues or if you are just interested in learning more about what is happening around recovery and reconstruction in Haiti!

This event is sponsored by HealthRoots: Political Economy of Health Seminar Series. Contact dpanchang@gmail.com or call 248-765-0412 for more information.

Aba Lokipasyon: Haitian Kreyol for “down with the occupation”

By Kanupriya Tewari & Chris Madson

	Gedlinne

Twelve-year-old Gedlinne and her mom, Ginette, recently moved into an apartment in Dorchester, a predominantly working-class neighborhood in south Boston. Gedlinne—along with Dave (8), Macklyne (10), and Sanley (20)—are all Right to Health Care (RTHC) patients who came to the Boston area after the January 12 earthquake to receive medical treatment not available in their native Haiti. Each of these patients arrived accompanied by one of their parents. Though these families did not know each other before coming to the US, they have come together to form a close-knit group—supporting each other through an incredibly stressful, and at times frightening, experience.

For more than 20 years, the Partners In Health RTHC program has served patients with complex medical needs who are not able to be treated in the countries in which we work. The program typically prioritizes children with illnesses or injuries whose lives can be saved with a simple intervention unavailable in resource-poor countries, such as Haiti. Partners In Health (PIH) collaborates with US-based hospitals, clinicians, and families to provide each patient the specialized care needed for a successful recovery. After the January 12 earthquake, with much of the Haitian medical system destroyed and hundreds of thousands of people injured, more patients than ever before needed help.

Gedlinne is a vocal and outgoing member of the RTHC family. On a recent visit to her apartment, she immediately kisses us on the cheek, welcoming us into her new home. Though we had not met before, she very naturally puts everyone in the room at ease—pulling chairs from various rooms into the apartment’s living room, translating for her mother, Ginette, and engaging in conversation as though we had known each other for years. Once we are all settled, she almost immediately begins asking about musicians: “What music do you like? Could we all go shopping for CDs sometime soon?”

It is difficult to imagine that this is the same young girl that authorities—upon finding her limp body underneath a pile of concrete—had assumed dead six months earlier.

Gedlinne was walking on the sidewalk, alongside her elementary school in Port-au-Prince, when the earthquake hit. As the walls around her collapsed, Gedlinne and her best friend were suddenly trapped under mounds of concrete.

She remembers hearing her friend screaming for help; she remembers watching her blue uniform slowly turn red as it absorbed the blood rushing from her body; she remembers feeling her clothes tighten as her body swelled. At some point, she lost consciousness. The most horrifying part of her ordeal was still to come. Gedlinne and her schoolmates were taken to a morgue, assumed dead.

It was there that her family found her. Her uncle realized that Gedlinne was still alive and in need of medical attention. She had a large cut across her head, a broken spine, and two broken legs.

Gedlinne’s injuries left her body incapacitated, and she developed infections that rapidly became resistant to antibiotics. Unable to move her legs, she lost 20 percent of her body weight. Because of the pain and the fevers from the infection, she wasn’t eating. Without further care, the combination of infection and weight loss would have killed her within weeks. She arrived at Massachusetts General Hospital in April and was able to receive world-class, life-saving care for her injuries. After a few months, she began working with physical therapists and nutritionists as she focused on regaining weight and muscle function.

Fortunately, after several weeks of regular physical therapy and rehabilitation sessions at Spaulding Rehabilitation Hospital, Gedlinne is now able to stand and walk on her own for extended periods of time.

Though she remembers the pain of the past six months, Gedlinne is excited for the future. “I can’t wait to start school again,” Gedlinne says. “Whenever I see girls with ribbons in their hair walking on the street, it reminds me of school.” She looks forward to getting back to her studies, to making new friends her own age, and to getting out of the apartment more often. More than anything, you get the sense that she is finding ways of recreating her life. In many ways she has already started doing this. Not unlike many teenagers her age, she is an avid fan of Lady Gaga, ice cream, and shopping. She likes to joke about things she has seen on television and is eager to talk about her condition, her mom, and what she imagines her life might be like once she can move around without her walker someday.

When she has to pause to think of an English word—something that does not happen often, at least considering the amount of talking happening—she follows up by playfully reprimanding us for not knowing French. In short, Gedlinne’s glee and enthusiasm fills whatever room of her apartment she happens to be in. Not only is she funny, the young Port-au-Prince native is also quite opinionated. We cannot help but laugh as she somberly lectures us—who came bearing pizza—about the detestable qualities of cheese. The texture of which she claims is unbearable. Yet, her aversion to this American staple will likely pass with time—she is nothing if not capable of adapting to new situations. This is reflected by her quick grasp of English, which is partially due to her love of pop music.

These lighter moments stand are certainly mixed with heavier and frequent periods of worry. Gedlinne’s recovery is one that will be measured in years, not months or weeks. Ginette also worries about her five other children, all currently living with extended family members in Haiti. Having worked as a beauty product vendor before the earthquake, she is also nervous about how she will support the family once she and Gedlinne return to Port-au-Prince in the coming year. Tragically, Gedlinne’s father died as he searched for her in the area around her elementary school.

Sitting amongst their new friends on the porch, these problems seem both incredibly present and very distant. Ginette defers her worries for now to focus on helping Gedlinne recover. Since moving into this apartment in early July, she and Annette—Sanley’s mom—have been taking turns traveling to each other’s homes, making meals together, and taking time to eat and visit. Ginette explained that most of the meals incorporate rice and black beans (dire ak pwa, in Haitian Creole); she also likes to make a dish where vegetables—mostly root vegetables—are boiled, then mashed, and finally cooked in the oven under and around pieces of fish. By visiting each other like this, the group maintains a sense of Haitian culture by eating traditional foods and talking freely in Haitian Creole.

Though the patients’ movements are somewhat limited due to their injuries, all of the displaced families are keeping busy. In early August Gedlinne and her mother decided to focus on furnishing the bedroom that they share. Working together, they selected furniture from the Salvation Army, which generously provided them with a $500 gift certificate. When we visited, members of the RTHC staff were trying to figure out how to arrange the new bed frames in the small room. Ginette’s large, Victorian-era bed frame—reminiscent, in her mind, of Haiti—now sits just a few feet from Gedlinne’s growing collection of Disney movies and stickers. Separating the two beds are the various pieces of medical equipment necessary to Gedlinne’s recovery.

Observing Gedlinne, Ginette, and the other RTHC patients, as they learn to live with their altered bodies in a foreign place, it is clear that they are all moving forward with life, one day at a time.

Watch a slideshow of a recent visit with the RTHC patients in Boston.

	Local women are employed to make sure that rotten nuts or those potentially infected with aflatoxin are not used in to make Nourimanba. This is part of a safety-measure system that also includes testing the product multiple times during the production stages. View a photo gallery showcasing the PIH's Nourimanba production program.

Nourimanba. It’s a therapeutic, highly nutritional food made of peanuts locally grown and processed in Haiti. It’s also one of PIH’s primary tools for fighting childhood malnutrition.

The September 5 edition of The New York Times Magazine features PIH’s production and use of Nourimanba in an article about peanut-based therapeutic foods for treating malnutrition in resource-poor settings around the world.  “The Peanut Solution,” by Andrew Rice, which is available online now and on newsstands on Sunday, focuses on the debate surrounding the production and use of Plumpy’nut (which is the most well-known and widely-used of these peanut products, in part because its producer holds a multi-country patent), while also documenting the product’s ability to save people’s lives.

Unlike Plumpy’nut, PIH’s Nourimanba is produced locally in Haiti, which is a country where the Plumpy’nut patent is not registered. “Partners in Health harvests peanuts from a 30-acre farm or buys them from a cooperative of 200 smallholders,” writes Rice. “It’s planning to build a larger factory, but for now the nuts are taken to the main hospital in Cange, where women sort them in straw baskets, roast them over an outside gas burner, run them through a hand grinder and mix all the ingredients into a paste that is poured into reusable plastic canisters.” Keeping with its goal of creating sustainable strategies, Partners In Health employs local farmers and workers to grow and manufacture a product that offers life-saving nutrition to people living in those same communities.

Watch a slideshow of PIH’s Nourimanba program. 

Yet, Nourimanba (and similar products) is not a silver bullet for childhood malnutrition. “Haiti’s endemic problem of malnutrition wasn’t something you could solve with peanuts,” writes Rice. Fully addressing malnutrition—and many other diseases that disproportionately affect the poor—means treating the root cause of the condition: poverty. Which is why PIH’s comprehensive approach to health care also provides clean water, shelter, education, and economic opportunities. For example, the Family Assistance Program provides the poorest families—typically those with children in PIH’s pediatric nutrition program—with tools, seeds, training, livestock, technical support, and on-going accompaniment to empower them to produce enough food to prevent their children from re-entering the pediatric nutrition program.

Read The New York Times Magazine article.

Watch a slideshow of PIH’s Nourimanba program.

Read more about PIH’s agricultural sister organization in Haiti, Zanmi Agrikol, and the pediatric Malnutrition program.

On Thursday, August 19, seven college students rode into Boston, MA, concluding a 67-day, 4,747-mile cross-country bike trip that began in Palo Alto, CA. The 2010 Ride Against AIDS—sponsored by the college-based nonprofit, FACE AIDS—raised over $50,000, all of which was donated to Inshuti Mu Buzima (IMB), PIH’s sister organization in Rwanda and the FACE AIDS programs in Rwanda.

Cyclists Claire Fisher, Shane Hegde, Jason Lupatkin, Kirsten Pufahl, Sanford Roberts, Zane Silver, and Mike Stewart were joined for the last seven miles of their journey by PIH staff and supporters. The group—now nearly tripled in size—wound along the Charles River, riding to the end of Boston’s Long Wharf. There, supporters and onlookers watched as the FACE AIDS riders wheeled their bikes to the Atlantic Ocean, marking the completion of the third-annual Ride Against AIDS. After ceremoniously dipping their front tires into the water—something they did in the Pacific Ocean to mark the start of their journey—Jason, Zane, and Shane coaxed the rest of the group into taking off their riding gear and jumping into Boston Harbor.

See pictures of the group as they reach Boston Harbor.

“Crossing the finish line in Boston is surreal!” says Austin Keeley, who completed last year’s ride. “For two months each day presented a new challenge, whether biking, logistics, or low spirits. When you arrive in Boston you can’t help but smile, sigh, and celebrate with your friends and family. It's not until you fly back to California that it really begins to hit you what just happened.”

In Palo Alto, five riders from Stanford University were joined by Kirsten, fresh from her graduatation from Illinois Wesleyan University, and Mike, who attends University of Wyoming, rode across 20 states, all in an effort to fight AIDS.

Facing the AIDS epidemic
FACE AIDS was formed in 2005 by three Stanford students—Johnny Dorsey, Lauren Young, and Katie Bollbach—who met while working at a Zambian refugee camp for people living with HIV/AIDS. There they met Mama Katele, a grandmother living with AIDS, who was caring for children affected by HIV in her community. Of the hundreds of HIV-positive people living in the camp, she was the only person willing to speak about her disease. The students knew this crisis would only get worse if more was not done. They began working to teach people about HIV in an effort to remove the stigma surrounding the disease. In 2007, PIH invited the students to expand their efforts into Rwanda, where the two organizations would work together to confront the spread of HIV. This encounter inspired a movement that has directly impacted thousands of Rwandans living with HIV.

Since its inception, FACE AIDS has supported comprehensive health care for Rwandans affected by HIV/AIDS. One of the main ways it has done this is by distributing beaded AIDS awareness pins in the US in exchange for $5 donations. The pins are made by Rwandans who are directly affected by HIV/AIDS—whether they are caring for someone who is HIV positive, or are living with the disease themselves. Each pin comes with the biography and photograph of the person who made it, fostering a personal connection between the person who wears the pin and the person who made it, essentially putting a “face” onto the AIDS epidemic.

Some five years later, with 33 chapters in Rwanda and 211 in the US, FACE AIDS promotes HIV/AIDS education and awareness specifically among high school and college students in the US and Rwanda. FACE AIDS has also raised $2 million for Inshuti Mu Buzima. More importantly, the organization has shown how a group of college friends can directly impact the lives of thousands of people across multiple countries, inspiring a generation of students in the process. FACE AIDS supports “a long-term approach to the pandemic by equipping an entire generation of youth to become life-long leaders in global health, international development, and social justice.”

While infection rates in the US are at about 0.6 percent, currently, 3 percent of people in Rwanda are living with HIV/AIDS. Though this percentage is low when compared to other African countries—nearly 30 percent of Lesotho’s adult population is HIV-positive—the disease has taken a tremendous toll on this already struggling nation. An estimated 90 percent of Rwandans live on less than $2 per day.

In addition to employing those directly affected by the epidemic, money raised by FACE AIDS also provides school tuition assistance to HIV-affected secondary school students, and offers leadership development courses, psychosocial support, and educational opportunities beyond high school to these young adults.

From the road
Rider Kirsten Pufahl’s blog documents nearly each day of the group’s adventures. It is filled with photos of odd signs and historical markers, state and national monuments, and local fairs, like the Italian festival in Youngstown, Ohio and the Machine Shed in Iowa. Read Kirsten’s blog.

As they stopped in cities, towns, and on college campuses, the riders connected with local AIDS awareness groups, college students, and fellow activists. “Sometimes we would tell other people in college things they didn’t already know about AIDS,” said Claire. “And sometimes we’d meet doctors and activists who have been involved in this work for a long time and they would teach us more about HIV and the history of the epidemic.”

“A lot of times our encounters with people were chance encounters,” says Jason. “These meetings have more meaning. People stop us and ask what we are doing and why we are wearing these biking outfits, and we tell them about our ride, we tell them about FACE AIDS.” 

One of the questions the riders were often asked was: “Why Africa?” The answer is simple says Mike, “HIV/AIDS is a global fight…it is not confined to one place or one group or people.”

Nearly everywhere the group stopped, people listened. “After hearing about what we were doing, people would thank us,” says Kirsten. They also offered support, from places to sleep to discounted hotel rooms and bike equipment.

Shane said the riders learned a lot about themselves and each other, as it took about six hours for the team to ride the 80 to 120 miles covered each day. “It would just be you and the open road,” said Shane. “You got to thinking about why were are doing this, and what it means, and how we can continue being involved in our communities and worthwhile causes after this summer.” Read Shane’s blog.

Though he is just about to enter his senior year, Mike has already decided that he’ll be able to do the most good by attending medical school and one day offering health care to people in Africa. Claire is focused on recruiting more students into the FACE AIDS organization this coming semester, and “capitalizing on what we’ve done so far this year.”

The 2010 Ride Against AIDS was not without its adventures. There were a few accidents, popped tires, and chains that needed replacing—but in all, it was a success. All Kirsten was able to say was, “I can’t believe we made it.” The riders were ecstatic about finishing—they kept breaking into song—and at the same time there was a sense of sadness as the realization set in that their summer adventure was over. At the same time, their commitment to the cause of fighting HIV/AIDS seemed stronger than ever.

Read media coverage of the Ride Against AIDS.

Watch an interview with FACE AIDS founders on the player below:

Today, The New York Times published a strong editorial calling for quicker progress on recovery efforts in Haiti. The op-ed specifically focuses on the work of the Interim Haiti Recovery Commission, and the need for greater effort to strengthen the Haitian government.

Citing Partners In Health co-founder Paul Farmer’s Congressional testimony in July, The Times notes that only 3 percent of earthquake aid had gone to the Haitian government. It goes on to note PIH’s efforts to build a state-of-the-art teaching hospital in Mirebalais, Haiti, as an example of how aid can be used to buttress the devastated government:

“The hospital is a project of Partners in Health, an exemplary nongovernmental organization whose founder, Paul Farmer, has spoken forcefully about the need to break bad old habits of international aid, which in half a century has never reached the goal of creating a functioning country run by Haitians for Haitians…

Rebuilding Haiti requires building a functioning, responsive Haitian state. A hospital that teaches a new generation of Haitian doctors and nurses, meeting an aching need for medical care while spurring the home-grown economy, is a fine example of how to do that."

To read the full editorial visit:
http://www.nytimes.com/2010/08/30/opinion/30mon2.html

For more information on PIH’s efforts to support Mirebalais Hospital, visit:
http://www.pih.org/news/entry/pih-breaks-ground-on-world-class-teaching-hospital-in-mirebalais-haiti/

Each year nearly 3,000 women in Haiti contract cervical cancer. Just over half of those women will die as a result of the disease. 

In an effort to combat that statistic, Zanmi Lasante (ZL) partnered with Haiti’s Ministry of Health in late 2009 to pilot the country’s first vaccination project for human papillomavirus (HPV)—the primary cause of cervical cancer. The project aimed to vaccinate 3,800 girls, between the ages of 10 and 13.

Cervical cancer is overwhelmingly a disease of the poor. For example, the annual mortality rate for the disease in poor countries like Haiti is 54 deaths for every 100,000 women—more than 30 times higher than in the United States. Nearly 80 percent of women who develop cervical cancer live in developing countries, with roughly 275,000 dying as a result of the disease each year. Almost all of these deaths are preventable. 

While the HPV vaccine (Gardasil) can save many women’s lives, delivering it in developing countries—especially post-earthquake Haiti—is not without obstacles. Gardasil must be administered in three doses over a period of six months. Delivering multiple doses of a vaccine can be challenging because patients face difficulties in making follow-up visits. In addition, although studies have established a connection between HPV and cervical cancer, and the vaccination is widely available in the US, the virus is relatively unknown to most rural Haitians.

The large number of girls who volunteered to receive the first doses of Gardasil in December 2009 reflected the success of ZL’s education campaign in Cange, Boucan Carré, Mirebalais, and Laschahobas – facilities located throughout Haiti’s Central Plateau. In cooperation with schools, community leaders, educators, and local health teams, ZL raised awareness about cervical cancer, HPV, and the Gardasil vaccine in rural villages and larger towns alike.

After January 12, ZL staff realized it would be even more challenging to locate the 3,806 girls who had received the first dose of Gardasil, and administer the second and third doses. The earthquake strained all medical resources, some of the girls had been displaced, and schools that had hosted the vaccine program were closed or overwhelmed by displaced children.

But project leaders decided to proceed. Radio and community crieurs were used to encourage girls who had moved following the earthquake to return to their schools to complete the vaccination regimen. By the time the schools reopened in February, the ZL team administering Gardasil had already located most of the participating girls in schools within and around Boucan Carré, Mirebalais, and Lascahobas. In late February and early March, a one-week outreach effort in Central Plateau schools was launched, and the ZL vaccine team tracked down more girls who had withdrawn from school or moved after the earthquake.

The team administered the third and last dose throughout June, even though the process was delayed by vaccine shipping problems and changes to school schedules. As an extra incentive to the girls, ZL staff gave small gifts at the completion of all three doses. All of these efforts were successful. Of the 3,806 girls who received the first dose, 2,884 girls—over 75 percent—have received all three doses of Gardasil. This percentage is higher than rates reported in countries with far more resources, including the US. This success rate is especially notable as many girls had unpleasant, initial reactions to the vaccine: 47 percent of girls complained of pain and tenderness at the injection site in the first 15 minutes after they were vaccinated, and two cases of fainting were reported.

The ZL/MOH pilot program demonstrates that implementation of HPV vaccine is possible in rural Haiti, where cervical cancer affects a disproportionate number of women. PIH/ZL will continue to push for the broad scale implementation of HPV vaccine as an essential element of adolescent health care. However, a vaccination program must be part of a comprehensive strategy—the vaccine only protects against two types of HPV, responsible for about 70 percent of cervical cancer cases. Thus, the PIH/ZL team advocates vaccinations as a tool in a national cervical cancer program that should incorporate screening, vaccination, and treatment for all girls and women in Haiti. 

Each fall, the Partners In Health family—including supporters, staff, and patients—gather at the annual Thomas J. White Symposium to reflect on the lessons and challenges of the past year. This year, the event will take place on Saturday, September 25, at Harvard’s Sanders Theatre in Cambridge, MA.

The title of this year’s 17^th Annual Symposium is “Lessons from Haiti: Tackling Acute and Chronic Disasters.” This exciting and informative event will be streamed live over the internet, starting at 3:00pm EDT on September 25. Attending the event in-person will be free and open to the public, but tickets are required and seating is limited*.

Symposium details:
Date: Saturday, September 25
Time: 3:00-5:00 pm EDT
Watch online: www.pih.org/symposium

Or attend in person*:
Sanders Theatre
Harvard University Memorial Hall
45 Quincy Street
Cambridge, MA 02138

For over 20 years, PIH has worked to address the chronic but devastating disasters that stifle the lives and hopes of millions of people--lack of access to medical care, food, clean water, decent housing, schools and jobs. The Symposium will explore how acute disasters like the earthquake in Haiti impact communities already ravaged by poverty and disease, and how our commitment to breaking this vicious cycle has enabled us to respond effectively to the need for both emergency relief and long-term recovery. In turn, the knowledge gained from our post-earthquake efforts, much like the lessons learned over the past 20 years of addressing chronic poverty across central Haiti, will impact projects at PIH sites in other countries.

Speakers will include PIH co-founders Paul Farmer and Ophelia Dahl, PIH Medical Director Joia Mukherjee, and staff representing PIH projects from around the world.

*Admission to the Symposium is free and open to the public, but seating is limited and will be restricted to ticketholders. Tickets will be available on a first-come, first-served basis starting September 10 at the Harvard Box Office. They may be reserved by phone (617-496-2222), or picked up at the box office (1350 Mass. Ave., Cambridge). Some tickets may be released on the day of the event, but please keep in mind that space is limited.

Dr. Mark Hyman arrived in Haiti shortly after the January earthquake, and worked alongside PIH staff to help provide medical care to survivors. Seven months later, he returned and filed the following report. Read his full essay in The Huffington Post.

	Mark Hyman

Seven months after the January 12, 2010 earthquake that devastated Haiti, I returned for the third time. This time, not to help the wounded, to perform surgeries, but to help facilitate further funding for the University Hospital and to feel and see with my own eyes what changed, what hasn't and what needs to. The world has moved on to the next disaster, from the BP Gulf Oil Spill to the floods in Pakistan, but the memories of that first week after the quake -- the smells, the loss, the destruction, the extraordinary heart of the Haitian people -- worked its way under my skin. It is a part of me. It is the poorest nation in the Western hemisphere where 55 percent of the population earns less the $1.25 a day and 58 percent of children are under-nourished, and it is not rebounding. Though there is less rubble in the roads and pockets of rebuilding have started, still today 1.6 million people are homeless and still in the tent camps (often made from sheets and sticks) -- or living on the median of a highway in Carrefour, doused in exhaust and dirt and hoping to survive each night as they sleep with cars flying by, deprived of all human dignity and decency as they bathe and defecate in view of everyone.

The night Wyclef Jean was disqualified from running for president (he has since petitioned to change the rules), a young energized crowd gathered outside the restaurant where they waited expectantly for the news. Long convoys of heavily armed UN peacekeeping forces in armored trucks patrolled the streets ready for riots that never came. As we quickly drove past the crowd, I asked Clairveux, our young driver, what he thought of the upcoming election in November. "Education is the only thing that will lift up the people," Clairveux said. Most of the population in Haiti, where the life expectancy is 55, is under 30. They are the future of Haiti. Yet 85 percent of the education in primary and secondary schools is expensive and private.

Read more about Dr. Hyman's trip in The Huffington Post.

PIH stands in solidarity with those affected by the flooding in Pakistan. We know all too well that natural disasters—whether an earthquake, or a flood, or a tsunami—almost always disproportionately affect communities that are already struggling against the chronic disasters of poverty and disease.

The flood waters in Pakistan have already claimed the lives of 1,500 people, and have left an estimated 20 million homeless. Underlying these numbers is the fact that 60 percent of the nation lives in poverty.

PIH is not a disaster relief organization. Our effectiveness to help the survivors of the January earthquake in Haiti depended on over two decades of building partnerships with local communities in Haiti, and empowering our almost entirely Haitian in-country staff to begin helping their neighbors in the immediate aftermath. 

We do not have a project in Pakistan, so we recommend directing donations to organizations that also focus on partnering with local communities, and that are committed to adhering to human rights-based principles* as they help Pakistan recover and rebuild.

You can find out more about some of these organizations at the links below:

http://pakistanifloodrelief.wordpress.com/

http://www.globalgiving.org/pakistan-floods/

In addition to supporting community-based organizations, you can also help the people of Pakistan by taking action. Each year, Pakistan is forced to pay $3 billion in debt payments to foreign creditors. This is money that the country desperately needs to help bring relief to its devastated people. Sign a petition calling to freeze Pakistan’s debt payments and to increase grant assistance following the disaster.

Read more about this petition and sign today.

* A rights-based approach to development is a conceptual framework that is based on international human rights law and methodology. It integrates the norms, standards and principles of the Universal Declaration of Human Rights into the plans, policies and processes of development.

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

The ABC news program followed the women as they showed Robin what life is like for the 1.5 million people still living in tents and makeshift shelters in and around Port-au-Prince.

"The greatest needs are safe shelter," said Genevieve. It's not uncommon for tents to hold as many as 13 people, though Genevieve recently found 27 people living together in one tent.

"They need housing, they need food, they need hygiene," said Sarah Marsh.

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

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

In a rare interview, Loune Viaud tells Beverly Bell of the Huffington Post about Partners In Health's Haiti program, Zanmi Lasante, or Friends of Health. Loune serves as Director of Operations and part of the strategy and planning team in Haiti.

	Loune Viaud with one of Zanmi Lasante's young patients.

Beverly Bell: Tell us about Partners In Health, how it constitutes an alternative in health care and especially how its philosophy has contributed to bringing about another model of care in Haiti.

Loune Viaud: We started in Haiti more than 25 years ago. We realized right away that you can't talk about health without talking about the social aspects of health: justice and rights. That's why we try to embrace a lot of social elements underlying health. When a patient is sick, we don't see the sick person only, we see the environment and community they came from. After they leave the hospital and go back home, will they have water to drink? Do they have a place to live? Do they have food to eat? Can they send their children to school? Do they have work? We try to touch on all of it: job, home, nutrition, malnutrition, agriculture. We try to touch on schooling and sanitation, meaning potable water.

That's why we don't just consider ourselves a health organization, although we have a big medical team: doctors, nurses, pharmacists, lab technicians, etc. We also have community health workers, outreach agents, and agricultural agents who live in the communities and strengthen those communities.

BB: We know that Partners in Health's work is not only a social program, that it's tied to the idea of transformation, to the idea that as long as people are living with injustice and inequality they won't enjoy good health. I understand that people that in the village of Cange, where Partners in Health has been for so many years, really trust the group, and that this is one of the reasons you've have better success with people following HIV/AIDS treatment programs than even the National Institute for Health. How is power connected to the issues of treatment and the relationship to the patient?

LV: I don't want to start rejoicing about what you call success because we still have a lot of work to do. It's forward, forward, forward. Matter of fact, every time we see the numbers going down, we make more efforts to see if we can get them to zero.

I can't say that we change the lives of the people completely, but we've seen improvement.

Let's take for instance an HIV patient. We know that if that person can't afford medicine, can't eat, can't send their kids to school, doesn't feel that they're heard as a person and seen only as a patient, that person's not going to get well. But when people are sick and know that they can count on an organization to help them send their children to school, then they can concentrate on improving their lives, which means taking their medications. When people are sick and know they don't have to keep on drinking the river water they used to drink but can drink potable water instead, when they don't have to live in a straw hut in poor sanitary conditions and get bitten by mosquitoes anymore... even though physically they're not totally well, morally they know that they're recognized as a human being.

I think what makes us successful is our accompaniment program. Take tuberculosis, a disease of poverty. When a person comes in and tests positively for tuberculosis, what we do is send an accompanier to visit that person's home to see the social conditions they're living in. If that person sees they need a new house, we work with the community to get them a house that, as we say, can't fool the rain. In terms of water, we set up filters or other catchment and treatment systems. The accompanier goes to visit the sick person each day, assures that the patient takes their medications, assures that if the patient has a problem that he or she listens. Even if the accompanier can't solve the problem, the very fact that the person can talk about it and someone can listen without judging is really important.

Well, at that point, if the accompanier can't solve the problems by him or herself, he or she will go talk to the supervisor in the hospital. The accompanier becomes an advocate for the sick.

Health also goes alongside education. Early on we realized that the best thing we can do in a community is to send children and the youth to school so that they don't spend their time in the streets. What we did, starting in Cange, was to create a school with trained teachers, books, and at least one hot meal for the kids so they can concentrate and study. The parents don't have to worry about where they'll find money to pay. Now we have 15 schools throughout the Plateau Central. We have thousands of students, children who go to study, sometimes just primary school if that's what the town has, though in Cange the school goes up to 12th grade.

We also send young people to study in universities in Cuba and the Dominican Republic, or we send them to study nursing in [the Haitian towns of] Léogane and Gonaives. We help them find scholarships to go to Europe for specialized studies.

Read Loune's full interview on the Huffington Post.

The toll of death and suffering from cancer in developing countries has increased sharply in recent decades. So has the disparity in the allocation of resources for cancer care and control between rich and poor countries. More than 4 million of the 7.6 million cancer deaths in the world each year now occur in developing countries. The result is a drastic "5/80 disequllibrium" in which only 5 percent of the global resources allocated for cancer go to the developing countries that bear more than 80 percent of the burden of disease. 

"The time has come to challenge and disprove the widespread assumption that cancer will remain untreated in poor countries," argues a "Call to Action" published in The Lancet on August 16. The article was written on behalf of the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries. The four principal authors included: Paul Farmer, chair of the Department of Global Health and Social Medicine at Harvard Medical School, Chief of the Division of Global Health Equity at Brigham and Women's Hospital, and co-founder of Partners In Health; Julio Frenk, Dean of the Harvard School of Public Health and former Minister of Health for Mexico; Felicia Knaul, Director of the Harvard Global Equity Initiative; and Lawrence Shulman, Chief Medical Officer and Senior VP for Medical Affairs at the Dana-Farber Cancer Institute. Among the other task force members who signed the Call to Action were Lance Armstrong, Princess Dina Mired of Jordan, and Sanjay Gupta of CNN.

"Cancer has been totally neglected in the renaissance of the global health agenda," says Frenk. He and the other article authors stress that a global movement to address cancer in developing countries is morally imperative, medically possible and economically feasible. “The chance to survive [cancer] should not be an accident of income or geography,” says Knaul, who herself is a survivor of breast cancer. “We have treatments that can cure [cancer] patients, extend their lives and palliate patients, that are easily available in developed countries, but not available in low and middle income countries,” adds Shulman.

Farmer adds that lessons learned from addressing other conditions that have disproportionately affected poor countries, such as HIV/AIDS, could guide a global movement to address cancer. “When we first started looking at treatment and care for AIDS patients in the late-1980s and ‘90s, there was virtually no significant international policy that included treatment,” he says. “And very few policy plans, nationally, that included treatment. We said, ‘we don’t have a plan, but a plan must be made.’  It is urgent -- AIDS had just become the leading infectious killer of young adults in the world.”

Farmer and PIH helped launch the world’s first program to provide free, comprehensive HIV care and treatment in an impoverished setting, rural Haiti. This initiative helped pave the way to the global movement to address the HIV/AIDS epidemic—including backing from the international community to address the HIV/AIDS epidemic in poor countries, the formation of new sources of funding (notably, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the US President’s Emergency Plan for AIDS Relief), and coordination of financing and purchasing strategies to help lower drug and streamline supply chains for drugs and diagnostic supplies. “We must draw from these previous experiences in our response to cancer,” says Paul. "We need to mobilize the same kind of political will and economic resources for cancer that fueled a global health renaissance around AIDS, TB and malaria,” agrees Frenk. And do it quickly, they add.

	Zanmi Lasante made sure that girls in the HPV vaccination program (to protect against cervical cancer) were able to continue their three-course Gardisil vaccination following the earthquake.

“We’ve seen enormous delays because of arguments that it is too difficult, too expensive, that there is not adequate infrastructure, that there were not specialists to deliver services,” says Farmer. “Yes there are serious logistic and programmatic challenges, but none of them are insuperable.” He points to the accomplishments of PIH’s sister organization in Haiti, Zanmi Lasante (ZL). Despite the recent devastating earthquake earlier this year, ZL staff helped ensure that 78 percent of girls who had been enrolled in an HPV vaccination program to prevent cervical cancer prior to the earthquake, had still received the full three-course vaccination in the months following the tragedy. “To me that is a beacon of hope… We cannot and will not stop our work on cancer prevention and care [in Haiti],” he adds. “Cancer doesn’t go away because of an earthquake.”

“In order to avoid any more deadly delay, because people are dying in enormous numbers and with great suffering, we have to develop a consensus among public health policymakers, leaders of national health policy, that there is a great deal that can be done in prevention, diagnosis and care,” he says. The Lancet piece concludes with an urgent call to action to the international community to address cancers in developing countries with a bold research, financing, and implementation agenda.

Read the full article in The Lancet.