PIH’s project in Kazakhstan held its first training session for Kazakh clinicians last month in Tomsk, Russia.

Initiated earlier this year in partnership with the Kazakh Government, PIH Kazakhstan is focusing on addressing an epidemic of multidrug-resistant tuberculosis (MDR-TB) in two regions of the Central Asian country--Karaganda and Pavlodar oblasts. Training and building capacity of Kazakh tuberculosis specialists is a key component of the project.

“TB is a challenging disease that demands using a variety of strategies to combat the epidemic,” said Julia Jezmir, project assistant for PIH Russia and Kazakhstan, who helped organize the training.  “Such trainings provide an opportunity for TB medical professionals to learn from other TB experts and walk away with a practical guide of how to follow international standards and evidence-based best practices for combating the disease.”

The recent training was based on the best clinical and program practices and lessons learned through established PIH tuberculosis programs—specifically PIH’s partner project in Tomsk, Russia, which has a decade of experience combating the disease. From 2000 to 2008, the Tomsk project saw the TB mortality rate in Tomsk drop from 18.6 deaths per 100,000 people to 8.6. In comparison, the TB mortality rate for Russia as a whole was 22.6 per 100,000 people in 2005. Likewise, the case notification rate (the number of new cases per 100,000 people) in Tomsk fell from 114.2 to 101.4 during that same time period.  Because of these successes, the project hosts a number of trainings each year for TB specialists throughout Russia and the former Soviet Union.The government of Kazakhstan also requested the partnership with PIH on the basis of these successes.

Twelve Kazakh clinicians—eight from the civilian sector and four from the penitentiary system—took part in the first training. They represented the Pavolodar and Karaganda regions of the country—both which are heavily burdened by the disease. The TB mortality rate for Kazakhstan nationwide is about 17 deaths per 100,000 people, with a case notification rate of 155 per 100,000.

The training sessions, led by staff from the PIH Russia and Boston offices, covered the management of running an effective MDR-TB treatment program, including how to monitor and evaluate programs, as well as clinical aspects of drug-resistant TB management, program monitoring, and patients' adherence to treatment. One topic that the Kazakh clinicians found particularly interesting was the patient-centered approach of Tomsk’s ambulatory care program. In this model, TB nurses pay daily home visits to patients, bringing medication and food packages, as well as social and psychological support to help them adhere to the rigorous treatment regimens needed to treat the disease. This model proved extremely effective in Tomsk. The Kazakh physicians expressed interest in ways to integrate this kind of community-based patient-centered program into their own system.

As the interactive format of the training also allowed for a two-way exchange of ideas and best practices, the Tomsk physicians also learned about aspects of the Kazakh system, in particular Kazakhstan’s compulsory care program for the most difficult patients—those that need extra support to adhere to the treatment regimen.  

"The law of compulsory treatment for infectious patient refusing treatment was accepted by the Kazakh Parliament in 2007, with the aim to protect the society from isolating the most infectious patients," said explained Askar Yedilbayev, program director for PIH Kazakhstan. "However, the law, as a tool of epidemiological protection, is not commonly used by the physicians in Kazakhstan, as the country is lacking the isolated facilities. I hope that the trainees from Kazakhstan have accepted and will further totally support the Tomsk model of community-based care, and PIH proposed patient-centered approach back home." 

By the end of the year, the project plans to hold 10 more trainings in Kazakhstan, which will train over 200 clinicians in total.

The training, as well as the Kazakh project itself, is funded by a Global Fund to Fight AIDS, Tuberculosis and Malaria.

Read more about PIH’s project in Kazakhstan.

In response to the earthquake that ravaged Haiti’s capital on January 12, 2010, Partners In Health helped to send hundreds of volunteer nurses, doctors, and other medical and logistics professionals from around the United States and Europe to help support our roughly 5,000 staff on the ground. The following essay is from one of those volunteers, and the fourth of a five part series.Read the previous post in this series.

Denise Lauria in Haiti.

Haiti is the poorest country in the Western Hemisphere, and it is our neighbor. I went to Haiti because I felt that if my neighbor needed help, I would rise to the occasion, no accolades needed. I am a nurse and that is what nurses do. What I saw in Haiti was overwhelming. I was not prepared for the poverty, the lack of infrastructure, and the general chaos. I have seen poverty on TV, but I've never seen such widespread abject poverty as I did in Haiti.

We were deployed to St. Marc, a city located 60 miles northwest of Port-au-Prince, where many displaced people from Port-au-Prince had relocated.

We treated hundreds of patients with multiple trauma including crushing injuries, open wounds, open fractures, and rhabdomyolysis—the rapid breakdown of muscle tissue caused by crush injuries. We set up a triage system: first we save life and limbs, second we treat open wounds and fractures. We put together records for each patient; we organized patients by wards. We worked twenty-hour days. I saw so much infection, pus, flies, purulent odors, and human suffering. I saw diseases that I had never in the U.S., including tetanus and pyomyositis—a bacterial infection of the skeletal muscles that results in a pus-filled abscess.

During those two weeks, I participated in roughly 150 surgeries. The team worked together to clean the operating rooms after surgeries and to fix things when they broke—like the anesthesia machine.

The only lab work available were H&H (hemoglobin and hematocrit, two very common and important blood tests), syphilis, and HIV testing. No mobile x-ray machines, no tourniquets, no ventilators. We learned quickly how to adapt, how to evaluate our outcomes, and how to change our practice accordingly.

What we didn't need to change was what we brought with us, respect for human dignity and informed consent. The people of Haiti are a people of enduring faith, hope, and resiliency—they deserve our continued support. I went to Haiti expecting to see wailing and depression, but I found strength, hope, and warmth. What I saw were children laughing and people smiling. I carry a special place in my heart for the people of Haiti.

- Denise Lauria, RN
   Massachusetts General Hospital

On January 12, 2010, 19-year-old Sanley Jean, home after spending a day at school, found herself suddenly trapped when the walls of her Port-au-Prince house collapsed on her during the massive earthquake. The rubble crushed her leg, breaking and exposing the bone. Such open fractures require immediate medical attention and often complex orthopedic surgery. But the devastating earthquake had left Port-au-Prince’s hospitals in ruins.

	Sanley Jean with her mother, Anette.

Jean’s mother, Anette, survived with scrapes and sprains, and knew that getting treatment for her daughter would be difficult. The capital’s only public hospital was able to provide only limited services in tents set up on the hospital ground. The facility was overrun by thousands of patients. Many of the Port-au-Prince’s residents were forced to seek medical attention outside of the city.

So Anette took her daughter to the Dominican Republic, a multiple-hour journey from their devastated home. Her hope was that once there, Jean would have a better chance of seeing a doctor.

Seeking medical attention

Meanwhile, Dr. Ralph Ternier of Zanmi Lasante, PIH’s partner organization in Haiti, was in the Dominican Republic assisting patients who had fled to a hospital in San Juan. It was there that Ternier, who heads ZL’s hospital in the bordertown of Belladerre, Haiti, found the Jean women. He quickly realized Jean’s open fracture required surgical care not available in his facility, and arranged to have her transferred to PIH’s hospital in Cange, Haiti.

Once in Cange, Dr. Chris Sampson met and started treating Jean. He believed that there was a slim chance that her leg could be saved—but only by transferring her to a better-equipped hospital. So PIH’s Right to Health Care (RTHC) team stepped in.

PIH's Right to Health Care steps in

In a truly collaborative effort, many people came together to help Jean get to the US. The first step was to locate a hospital willing and able to take on her case. With support from Dr. Sampson, the Boston-based Brigham and Women’s Hospital (BWH) quickly stepped up to the plate.

PIH and Zanmi Lasante staff then began the task of coordinating Jean’s paperwork, maneuvering through both the U.S. Department of Homeland Security and Haiti’s overburdened government offices. With so many moving parts to the equation, some of the staff began to worry that they wouldn’t be able to get her to the U.S. for treatment in time.  It came down to the wire with mother, daughter and ZL staff waiting in an ambulance in the airport parking lot for the paperwork to be delivered. Her papers arrived 30 minutes before takeoff. The Jean women took their seats on the first commercial flight out of Haiti after the earthquake.

Recovery in Boston

After landing in Boston, Jean was taken directly from the airport to BWH. There, she was greeted by doctors and nurses, many of whom are from Haiti or have close ties to the Haitian community. PIH and BWH staff brought the family Haitian food, flowers, balloons, and spent hours talking with the women — making sure their transition from Haiti to Boston was a comfortable one. Neither woman had ever seen snow or experienced sub-freezing temperatures. BWH staff bought the women warmer clothes.

	Sanley and Anette Jean cooking with Chef Jody Adams of Rialto Restaurant.

Although loved and well-cared for at BWH, it soon became clear that Jean’s leg could not be saved after all. The situation was not easy, but Jean eventually came to grips with this fact as BWH and PIH staff carefully explained the consequences of keeping her leg. In the end, she made the decision to have her leg amputated to save her life.

After the operation, Jean says her body hurt for three or four days. She was in rehab less than two weeks later—slowly learning how to live with an altered body. In early March, as her leg began to heal, Jean and her mom started venturing outside of the hospital, often with the use of a walker.

The mother-daughter team started attending Sunday church services near the hospital, went for walks at the mall in Boston’s Hyde Park, and was even pampered for an afternoon by a local hair salon. More recently, Anette and Sanley Jean volunteered to teach Chef Jody Adams, chef and owner of Rialto Restaurant in Cambridge, how to cook goat—a staple of Haitian cuisine. The James Beard award-winning chef had been eliminated from Bravo’s reality-television program Top Chef Masters for undercooking a similar dish. Watch a video of Jody and Anette on the player below:

Jean was fitted for a permanent prosthetic leg in late March and is currently undergoing physical therapy so that she can learn how to use it. She is one step closer to reaching a new normal and returning home.

Last month, the four health clinics in Port-au-Prince operated by PIH’s partner organization, Zanmi Lasante (ZL), reached a milestone in delivering care. Over 100,000 patient encounters have been recorded since the clinics were first established about four months ago. These clinics serve four large settlements of displaced survivors of the January 12 earthquake.

The clinics, which began seeing patients in late January, provide comprehensive primary health care services, including reproductive health care, HIV testing, and malnutrition screening.

During the month of May alone, the clinics logged 36,204 patient visits. Roughly one quarter of these visits were from children under the age of 10.

Headache, cough, and abdominal pain were among the most frequent symptoms seen at the clinics.

Proje Sante Fanm, ZL’s women’s health  project which operates women-focused spaces separate from the general health clinics, saw 1,175 women; 494 received prenatal consultations last month.

The four settlements, Building 2004, Caradeux, Park Jean Marie Vincent, and Dadadou, are all located in or around Haiti’s capital city, which was decimated by the earthquake. PIH/ZL began working at these sites in collaboration with Haiti’s Ministry of Public Health. During the first 17 weeks of operations, the clinics recorded 107,003 patient visits.

Read more about these clinics.

Top photo: Patient recieving care at one of the settlement clinics run by Zanmi Lasante.

In response to the earthquake that ravaged Haiti’s capital on January 12, 2010, Partners In Health helped to send hundreds of volunteer nurses, doctors, and other medical and logistics professionals from around the United States and Europe to help support our roughly 5,000 staff on the ground. The following essay is from one of those volunteers, and the third of a five part series.Read the previous post in this series.

Karen Foley and her team during morning nursing rounds.

Our team arrived in Port-au-Prince on February 7. I was in disbelief. Our team drove to PIH’s hospital in St. Marc, a small city located north of the capital. Port-au-Prince’s devastation was oddly contrasted by the beauty of Haiti’s countryside. I kept thinking: How could something so natural do so much damage? How could it take so many lives? It is still unbelievable to me that so many people died in such a short period of time.

Upon arriving to the house where our team was to stay, it was clear that, like in America, precautions must be taken to prevent crime in large cities. High walls surrounded buildings; locked gates and guards secured entrances. Strangely enough, I felt very safe.

The hospital was very different than what I am used to. The wards we were stationed in did not have sufficient beds for the large number of people who came to seek care, thus some people had mats on the floors, frequently family members were lying around each one. The overcrowding meant that patients lacked privacy. Given the disruption caused by the earthquake, electricity and water were often limited, and supplies were scarce. The occasional rooster walked through the hospital; flies were everywhere.

Despite the overwhelming task, it was obvious to all of the Haitian doctors, nurses, and volunteers as well as the many medical staff from many other countries that work had to be done. I told myself, "I cannot change everything, but I can do the best that I possibly can."

Most of patients were people displaced by the earthquake, arriving at St. Marc in search of medical care. The team began organizing surgeries that first day. We worked hard to complete them and to care for everyone.  Other people had come to the hospital for various ailments, some having existed for years. This was the first time in years that there was such a large number of doctors and specialists available to see patients. However, even with the influx of doctors, the level of injury and illness was severe. In our first twenty-four hours, three infants passed away in my ward—that was the most difficult day for me.

The Haitian people are the most amazing and resilient people I have ever met. If a patient needed something and their family was not there, another family would step in and help. When we worked on a patient, local Haitian volunteers would hand us the various items we needed. Other people would help to locate supplies if we could not find them.

I am used to working hard but this is the hardest work I have ever done—both physically and emotionally. Still, I could go back to Haiti many times over. The patients that we cared for were extremely thankful and grateful. This experience has made me appreciate so much more, but also appreciate the Haitian people for what they have given me as a nurse and person.

- Karen Foley, RN
   Brigham and Women's Hospital

By now the sad news has gone out far and wide that our Mamito, Mme. Yolande Lafontant, succumbed Saturday to a hemorrhagic stroke. She collapsed after a brief bit of exercise and said not another word. Some of us already take heart in the fact that she did not suffer, and, as hard as it is to imagine a world, much less Cange, without Mamito, she has left us clear direction for what she’d like us all to do in the coming years.

For if there was ever a mother more willing to give instructions, I have yet to meet her. Mamito’s versions of “wipe your feet” or “clean up your room” were simple, if broader in scope, and equally to the point: “Make this house waterproof for this family; put tin on the roof and cement on the floor.” “Pick up trash outside” (we often failed her on this one); “Don’t cross the lake in the afternoon when the wind is high” (we took mischievous delight in flaunting that order); “Think of something for these old ladies to do in their retirement; and teach them to read.” And of course the more typical maternal fiats: “Wash your shirt,” “Shine your shoes,” et cetera. And she did not hesitate to leave scraps of paper with lists and instructions in her schoolmarm hand. She had a regal air about her, a personage (like Fritz) from the very beginning, but also a sense of humor. Making fun of her trademark chandelier earrings was sure to get a rise, as was expressing wonder that one might be blessed with such naturally jet-black hair well into one’s eighties. Frekan, you’re too fresh, was her response to this teasing, along with a wry smile.

Mme. Yolande Lafontant (right) with PIH co-founder Paul Farmer (middle) and Father Fritz Lafontant, circa 1984.

I was lucky enough to be adopted by Fritz and Mamito when I was 23, which meant that whenever I was in Haiti in those early years, I shared a home and broke bread with her. When she was in a good mood—which was often, if you hadn’t crossed her—she would bring me a cup of coffee in bed. (She was always up with the dawn and approved of my study habits). My wife, Didi, is another of her adopted children; the list goes on and on. She fussed over guests and set the highest standards for hospitality in central Haiti, receiving, in recent decades, thousands of visitors from around the world. It’s not a surprise to me that we have already received letters of sympathy from Russia, Mexico, Peru, France, Rwanda, South Africa, and of course across Haiti (and its diaspora) and the United States. Everyone who was lucky enough to come to Cange got a little dose of Mamito’s mothering, and this maternal web will live on and even grow as long as we carry out her instructions.

Before turning to one of them, let me note that during the past four months Mamito and her close-knit team did an enormous amount of work receiving scores of medical teams from all over, and also thousands of patients injured in the quake. Many times she went to visit in the hospital or in the church, which had become an ersatz trauma ward. Whether she was feeling well or not, she rose every day to give instructions to the rapidly growing hospitality team, knowing, I believe, that she had so inculcated her values in them that things would be done a la Mamito whether or not she had issued specific orders. Now is our chance to see if we can live up to her standards. Or perhaps she is hovering out of sight and not, as usually, just over our shoulders, but still able to push us to behave as we invoke her memories and then smile dutifully and get to work.

This past four months, many of you saw a lot of Mamito, who since the earthquake almost never left Cange, not to search for belongings damaged or lost in the quake, not to gather provisions, not to go to the airport. These items came instead to her, and even the airport came to her, planefuls of doctors and nurses and physical therapists here to help. Mamito’s job was to mother them a bit, too, to make sure they ate enough and had clean scrubs and, well, behaved themselves.

Some of you know that Mamito could be downright obsessive about some things. The Haitian expression was tilandeng—she would hang onto you, or the proffered errand, like a tick. These errands tended to have to do with big projects, mostly in education and housing. This past few months, overwhelmed by the destruction of the city in which she was born and raised, she did not hesitate to signal a couple of key projects. The houses down by the water in the place we call Bas Cange were, she said, shamefully dilapidated. This shoreline represented our roots, some of the land almost inundated by the hydroelectric dam that first brought her and Father Fritz to Cange when it flooded the valley in 1956. Fritz could have stayed in the borders of his own parish, leaving the little chapel under fathoms of water, but he chose to minister to the “water refugees”: founding with them, and Mamito, the dusty hill-top station of Cange. This made sense to Mamito, a school teacher by training but a social worker at heart. She befriended, simply enough, the ones who needed her most—hence her connection to the water refugees from the region. She lived out her preferential option for the poor with all her heart and for many decades. She knew no small amount of suffering in her long life, but bore it all with dignity, always seeing others’ suffering as more important.

In lieu of flowers let me suggest, with Marie-Flore’s blessings, that we rebuild to higher standards the settlement of Bas Cange. She knew we would do this simply because she told us to. We recently joked with her that we should call it Mamitoville, and she responded with feigned irritation.

But it sounds right to me.

Mamito will be interred in a private ceremony tomorrow. Next week we will celebrate Mamito’s life and achievements, many of which are known to you. “Many of which” really means “many of whom,” for her great oeuvre was to mother us all, and to guide us, including some who didn’t know how much they needed it. Along with Flore and Sindy and their children (Victoria, Cassandre, and Ludji), we are her achievements, tout pitit li yo, and we will do her proud by carrying on her work to promote health, education, and a better life for the poor. These things, and her many children, were the only things that mattered to her.

Mamito nou p’ap janm bliye-w! Rest in peace, but hover not too far from us, please.

Paul Farmer
Port-au-Prince
31 May 2010

In response to the earthquake that ravaged Haiti’s capital on January 12, 2010, Partners In Health helped to send hundreds of volunteer nurses, doctors, and other medical and logistics professionals from around the United States and Europe to help support our roughly 5,000 staff on the ground. The following essay is from one of those volunteers, and the second of a five part series.Read the previous post in this series.

Annie Lewis-O’Connor (in pink) working with a team of PIH volunteers in Haiti shortly after the January 12 earthquake.

On January 17, I received a phone call: “You have been chosen to go to Haiti.” So began my journey.

I will never forget my first day or my last day in Haiti. One of my first patients was Betty, a 31-year-old woman who walked into the Emergency Department at St. Nicolas Hospital in St. Marc with the most profound case of peri-orbital cellulitis—an inflammation and infection of the eyelid and portions of skin around the eye—I, or anyone else on the team, had ever seen. She presented with her right eye bulging, her pupil was non-reactive, her young-face was distorted, her right nostril and right cheek were one, and there was serous fluid dripping from her right nostril. The pictures are too disturbing to share.

Amazingly, she was articulate and her vital signs were rock stable. Her younger sister, Roseane, whose face was so sad, yet so beautiful, accompanied her. They traveled by bus over rocky terrain from 2 hours away, seeking help. Roseane’s attention to her sister was admirable, caring, and tender. Over the next 13 days, Roseanne would come find me on campus, lock her hand in mine, and lead me to her sisters’ side—Betty needed pain medication or her IV was dry or not dripping. On my last day at St. Nicolas, Betty died. She was one of the strongest women I’ve ever met. Those who cared for her will never forget her.

Also, on my first day a miracle occurred – a full-term mother seizing due to severe eclampsia birthed twins by emergency C-Section. Both newborns were blue and unresponsive. With teamwork, pediatric resuscitation equipment brought by Cheryl Groves and CPR by Deb Pitts and myself, both babies survived and went home 3 days later with their mother. This was nothing shy of a miracle, thanks to serendipity and teamwork.

Every day was a challenge, and no two days were the same. Each day we came to know our patients and their families a little better, and each day we strived to bridge the gap of cultural differences. It did not take long to form bonds that were strong and have sustained. While we laughed together, we also cried together, but mostly we shared an experience that would hold lasting memories.

I start my Haitian Creole classes in June. I will go back to Haiti. I must go back. I am a better person, my children’s lives have been enriched and impacted profoundly, and my life will be forever changed...I plan to “Stand with Haiti” for as long as I can, as long as it takes.

Con carino.

- Annie Lewis-O’Connor, NP, MPH, PhD
   Brigham and Women's Hospital  

Brigham and Women's Hospital

In response to the earthquake that ravaged Haiti’s capital on January 12, 2010, Partners In Health helped to send hundreds of volunteer nurses, doctors, and other medical and logistics professionals from around the United States and Europe to help support our roughly 5,000 staff on the ground. The following essay is from one of those volunteers, and the first of a five part series.

Deb Pitts holding premature twins after an emergency C-section.
Holding hands with a patient after surgery.

I wanted to go to Haiti as soon as I heard about the earthquake. I remember watching TV and wanting to run over and help pull people out from the rubble. I can’t imagine what the people there felt like, hearing voices calling for help and not being able to get to them. As soon as I heard PIH was going to send nurses to Haiti, I volunteered. I’m an operating room (OR) nurse, I was an autopsy diener—a morgue assistant—in the army, I have lived in a tent and eaten next to nothing for weeks at a time. I knew they needed people like me, someone who can deal and help at the same time. My chance to go arrived on a Wednesday afternoon. I called my husband and he said, “go.” The next day I got my shots and precautionary medicine and left for Haiti.

As we flew into Port-au-Prince, we could see tent cities everywhere. The heat blasted us as deplaned. We unloaded the supplies, hopped into a PIH car, and headed to St. Marc.  We drove through the earthquake-ravaged parts of the city. It was horrifying. So many collapsed buildings, people everywhere. People were washing themselves in the gutters and cooking over makeshift fires in front of collapsed homes. A few people had a faraway look in their eyes, but most had a look of resignation on their faces. They were continuing on with life despite all of this devastation.

I took a few pictures but I felt embarrassed, almost morbid. I imagined the Haitians looking at us and seeing tourists with fancy hats and glasses snapping pictures while ooohing and aaahing. I put my camera away. Instead, I smiled and nodded at people. Some waved, most smiled, one or two turned away. On our way to St. Marc we could see glimpses of the ocean, so beautiful and blue. Such a stark contrast to the devastated land.

When we arrived in St. Marc, I felt like I was stepping back in time. The majority of vehicles on the street were motorcycles and donkeys. Old buses lay broken on the side of the road. Goats and chickens seemed to roam freely everywhere. A few of the streets were half paved, others were dirt and rocks. Buildings looked half finished. Some with roofs, some without, many homes lacked windows, and stonewalls surrounded plots of land.

We stayed in a PIH guesthouse. We slept on the floor in sleeping bags. At night we could hear all the different animals, as night ended, the sounds would blend with people talking and singing, morning activities beginning.

St. Nicolas Hospital’s courtyard was filled with people night and day. I was there to scrub and circulate in the hospital’s two operating rooms. It was hard to tell who the patients were at first—large families surrounded loved ones.  From infants to the elderly, our patients and their families were wonderful. The families did most of each patient’s daily living care. They helped us as much as was possible. It was not unusual to find a family member of one patient helping other patients. No one ever complained. Volunteers brought food. We gave away Power Bars and snacks we had brought from the U.S. to the patients and the volunteers.

We tried to be mindful of Haitian customs and procedures; we tried not to overstep our bounds. One thing we learned is that culture and beliefs play a huge role in how we can effectively care for a patient. Teaching is important, but we have to incorporate the culture and beliefs into that teaching, otherwise it will just go off to the wayside.

We witnessed amazing recoveries, and incredible sadness. I participated in an emergency C-section that saved a pair of twins (pictured above). Yet, several other babies brought in for dehydration, meningitis, and small bowel obstructions—all easily fixed or prevented in the U.S.—died. Watching the mothers run from the room was heart-wrenching.

We grew close to our patients and their families. It was hard to leave and not know what was going to happen to them. Would they continue to get care? How would they manage with an amputated leg or arm? Who will help little six-year-old Shama, who was dragged under a car and needs skin grafting on over 40% of her body? What about all the patients who still have pseudomonas in their wounds? How will they do in the future? I’ve come to care about these patients, and hope that the commitment to help them recover lasts long after the disaster fades from the headlines.

- Deb Pitts, RN
   Brigham and Women's Hospital

Participants at the recent Walk With Haiti in the Bronx neighborhood of Mount Eden.

Earlier this month, hundreds of students, parents, and community members of the Bronx neighborhood of Mount Eden came together for the Walk With Haiti to show their solidarity with the people of Haiti. This community, located in the poorest urban Congressional district in the U.S., raised $14,500 for survivors of the catastrophic January earthquake.

Organized by the New Settlement Apartments, a community action group, the Walk was attended by more than 500 students, along with over 200 parents, supporters, and staff, said New Settlement Executive Director Jack Doyle.

“We are here today for Haiti and we are also here for ourselves,” said Jack as he spoke to post-walk crowd, “because of the beliefs and values we hold dear.”

Though none of the students are from Haiti, many of them or their parents are from developing countries, including the Dominican Republic, Mali, Gambia, Guyana, Jamaica, and Ghana, and thus have an intimate understanding of “solidarity” with the poor communities devastated by the earthquake. “The energy, enthusiasm, heartfelt sense of connection to the suffering of the Haitian people on the part of the children and the teens who participated [in the Walk]” were especially inspiring, said Jack.

Chanting and waving streamers in the red and blue colors of the Haitian flag, the walk’s marchers traveled down the Grand Concourse from 172nd Street to the steps of the Bronx County Court Building. Once there, participants celebrated to the music of Linc Carnival Band, took part in events aimed at raising awareness about Haiti. Speakers included Aaron Charlop-Powers, a U.N. staff, Bronx Borough President Ruben Diaz, Deputy Bronx Borough President Aurelia Greene, and NY State Assembly Member Vanessa Gibson.

In the weeks leading up to the Walk, students involved in New Settlement's afterschool and youth development programs learned about Haiti, created banners, and designed t-shirts. In addition, the young community activists raised awareness about Haiti in the local community and collected donations for Haiti earthquake relief efforts.

New Settlement Apartments is a nonprofit organization with an 20-year commitment to improving housing and education opportunities in and around their neighborhood.

The country’s coat of arms, which is placed in the flag’s center, depicts a trophy of weapons ready to defend the people’s freedom, and a royal palm, a symbolic representation of Haiti’s political independence. On top of the palm is a Phrygian cap—often call the liberty cap—which has been used to signify freedom and the pursuit of liberty since the time of the Romans. A banner underneath the palm tree reads, "L'Union Fait La Force"—Through Unity there is Strength.

On May 18, 1803, the newly independent Republic of Haiti officially adopted one of today’s most recognizable symbols of Haitian freedom—the Haitian flag. Since then, Haitians have recognized May 18 as Haitian Flag Day.

Each year, at Zanmi Lasante's (ZL) socio-medical complex in Cange, thousands of people from across the Central Plateau came to proudly celebrate the Haitian flag.

Festivities focus on the importance of standing together with pride as Haiti continues to rebuild. Hope permeates the air as students from 29 ZL-supported schools recite poems, sing songs, and perform dances and plays, all to honor the history and optimism that Haiti’s flag represents.

The history of Haiti’s flag

 The story of Haiti’s flag begins during the Haitian Revolution—more specifically with the battle of Cul-du-Sac, which took place outside Port-au-Prince on December 1, 1802. On that day, Haitian General Alexandre Pétion led his men into battle against the French army; not only did the Haitian forces lose, but they lost their tricolor flag during their retreat. That flag was quickly seized by the French and heralded as a symbol of their victory. European newspapers ridiculed the Haitian army not only for losing this battle, but also for carrying the French flag in a battle against the French. This was seen as a sign of the rebels’ chaotic disorganization.

A teacher from Cange, dressed as Jean Jaques Dessalines—the father of Haitian independence—initiating this year’s flag day activities.

The French press interpreted the use of the French flag to mean that Haiti’s people were not fighting for succession, rather they were merely making a proclamation. The spin: the Haitian army’s use of the French flag during battle was proof that the insurgents were not fighting for their independence, but were simply expressing their desire for greater liberties under French rule.

After hearing these stories, Haiti’s revolutionary leaders knew they needed their own flag. 

Jean-Jacques Dessalines, a leading figure in Haiti’s struggle for independence, was so enraged upon reading these stories that he grabbed the tricolor French flag, and with a sharp jerk, ripped the white stripe to pieces. He turned the flag on its side and rejoined the blue and red strips of fabric—symbolic of the union of mulattoes and blacks against the French. In doing so, he also made Haiti’s flag. 

Haitian soldiers went on to win their independence against the French under the new bicolor flag.

“TB has never been taken seriously enough by donors or the global health community writ large, it has just been languishing out there,” says Donna Barry, Partners In Health’s Director of Advocacy and Policy, in a recent article published in The Lancet.

In Chiapas, Mexico, efforts to combat tuberculosis are impeded by lack of access to health care, as well as a lack of education, transportation, food, adequate housing, and many other factors associated with poverty. The rate of new patients with multi-drug resistant tuberculosis in Chiapas is 14 percent, far higher than in most regions of the world.

A lack of medical resources throughout the region also hurts efforts. “There is not enough active case finding, a lack of political will, the supply of drugs is unreliable, and there is limited lab capacity,” said Daniel Palazuelos, a doctor from Harvard Medical School and Partners In Health, who has extensive experience in the Chiapas region.

Read the full article from The Lancet on MDR-TB in Chiapas, and about efforts being put in place to address those problems.

PIH has worked closely with El Equipo de Apoyo en Salud y Educación Comunitaria (EAPSEC, The Team for the Support of Community Health and Education) in Chiapas since 1989. Read more about this partnership.

Zanmi Lasante staff and community members from Parc Jean-Marie Vincent challenge the U.S. Army to a friendly game of basketball. Photographer: Louise Ivers

Over the weekend, Dr. Louise Ivers (PIH’s Chief of Mission for Haiti) reported from Parc Jean-Marie Vincent, a settlement camp for displaced earthquake survivors near Port-au-Prince. For the past four months, tens of thousands of people have been living in this former sports park.

On May 15^th, Zanmi Lasante hosted a friendly challenge game between the folks at Parc Jean-Marie Vincent (PJMV), and the U.S. Military. It was a way to have some fun together after the previous few months of hard work on both sides.

The best 11 players pooled from the camp community made up the PJMV team. The U.S. Army’s commanding general attended, there was a half-time show and lots of good will. At the end, the military gave special coins to the Haitian team and the Haitian team presented certificates of gratitude and honor to the military for their work in the camp on flood mitigation and advocacy.

Finally, at least for a few hours, PJMV was a sports venue again.

 The PJMV team won the game with a final score of 42-27.

Harvesting the emergency crop of corn.

Last week, about 200 earthquake survivors carried home freshly harvested ears of corn to feed their families. Although not the typical corn harvesting season in Haiti, the devastating following the devastating earthquake demanded an emergency planting, which was organized in a collaboration between Zanmi Agrikol (ZA), Partners In Health’s agricultural project in Haiti, and local farming families in the Central Plateau.

After the earthquake destroyed much of Port-au-Prince, many survivors poured into the rural Central Plateau and Artibonite regions to find shelter, food, medical care, and safety. With so many displaced people, the ZA team knew that hunger would quickly become a major problem. So they initiated a project the expedite food production by planting an emergency crop of precocious (quick-growing) corn in fallow fields.

This particular species of corn isn’t typically used by ZA, as it doesn’t store well; but in this emergency situation, needing to store the corn is not an issue, said PIH Haiti Program Manager Ali Lutz. ZA fortunately had the precocious seeds on-hand as the project often tests various seed varieties to find out their unique properties and to see which ones are best suited to certain local microclimates

The first harvest of this crop yielded enough corn to fill about 200 large bags with roughly 50 ears each. These bags were distributed to families who had been displaced by the earthquake.

Three more fields will be ready for harvesting within the next 2 months.

In addition to the corn crop, ZA is also addressing the local post-earthquake food needs by hiring and training an additional 20 Ajan Agrikol (community agronomists) to help support the agricultural efforts of about 1,000 families. Read more about ZA’s post-earthquake programs.

Next in line to recieve a donated pair of TOMS shoes.
Measuring for the right size.
Children testing out their new shoes.

Last week, 33,333 new pairs of TOMS shoes  arrived at a Partners In Health (PIH) warehouse in Port-au-Prince. Staff from PIH’s Haitian sister organization Zanmi Lasante (ZL) immediately went to work distributing the black canvas shoes to children living in and around the capital city of Port-au-Prince, in partnership with the nonprofit organization Operation Blessing International.

Many of the shoes were distributed to orphans, school children, and the children of people who are receiving care for injuries sustained during the recent earthquake. 

When families fled from their homes in the wake of the recent disaster, many of them left their belongings behind, including their shoes.  In the Haitian school system, if a child does not wear closed toe shoes, he or she cannot enter a school’s classrooms-shoes can literally provide access to education. 

“All of the children were extremely excited,” said Cate Oswald, PIH Program Manager for Psychosocial Support and Mental Health in Haiti.

Zanmi Lasante (ZL) social workers—staff with daily contact with the local communities—have spearheaded the shoe distribution. In addition to school children and children of patients injured by the earthquake, they have distributed shoes to children experiencing problems with "Foot Flies" (Shik in Haitian Creole), at ZL sites in Hinche and Boucan Carre.

Foot flies aren’t the only worry. Hookworm, soil born parasites, and other preventable diseases can be threats to the shoeless.  These parasites often impede mobility—meaning afflicted children may not be able to help their families with farming and other household chores, or even travel to access health care or attend school. Adequate foot protection is the first step in preventing this vicious cycle.

PIH/ZL staff report that the black shoes provided by TOMS are well made, durable, and appropriate. “Black is a good color, as most students have to wear black shoes for school,” said Cate. “Black is also a neutral shoe color so both genders are comfortable wearing them.”

TOMS has donated shoes to PIH programs since 2009.  With the support of customer donations, TOMS has helped tens of thousands of children patients.  The shoe donations are part of TOMS’ One for One movement.

Dear Friends,

When walking through a settlement of an estimated 45,000 displaced people in one of the poorest corners of Port-au-Prince recently, I could not help but feel as if somehow, despite our best efforts to describe the scope of the humanitarian crisis following January's earthquake, it is impossible to convey the devastation in its totality.  The disaster is born of both the sudden, massive shock on January 12 that shattered countless buildings, homes, and lives in the space of a minute, and the grinding, slow-motion calamities of disease, poverty, injustice, and environmental degradation that crush the lives and hopes of hundreds of millions of people around the world.

That day, I met four hungry children and their mother who, without any resources or support, had simply sewn sheets together to shelter her family from the scorching sun and drenching rains. I listened to a father, who lost his wife, tell me of his struggle to find formula to feed his infant daughter. I saw orphaned kids trying to adjust to living with their cousins, aunts, uncles, or grandparents. And I watched as hundreds of people swarmed to meet dump trucks filled with gravel, every adult and child grabbing as much as they could to prevent the pools of sewage-filled mud from seeping into their makeshift shelters.

This anguish, as well as less visible suffering, will affect Haiti for many years to come. Rural families who have long relied on a parent or child working in Port-au-Prince for financial support have lost that economic lifeline in their hour of greatest need, as they struggle to house and feed additional relatives and friends who fled Port-au-Prince. The disabled and mentally ill fall further into the depths of poverty, confusion, and despair, as already overburdened health and social services unravel.

Haiti's acute humanitarian crisis is rooted in the chronic conditions of deprivation and disease that plague poor communities and countries throughout the world, conditions that we have confronted not just in Haiti but in the eleven other countries where we work. Years of experience have taught us that no matter the place-Haiti, Rwanda, Lesotho, Malawi, Peru, Russia, the United States, Mexico, Guatemala, Burundi, Kazakhstan, or the Dominican Republic-our investments in comprehensive and integrated health and social services make all the difference in being able to respond to a community's needs during acute and chronic disasters. And all of the places we work suffer from the unrelenting cycle of poverty and disease-a disaster of incalculable proportions.

A miner, working in South Africa, contracts drug-resistant tuberculosis and returns home to the mountains of Lesotho after being fired from his job. Not only does his family lose its only income but the children also become infected with tuberculosis, an unavoidable contagion in the small, single-room dwellings that are typical in rural Lesotho. These hidden crises persist around the world and can only be addressed with a comprehensive approach to health care, social services, and community engagement that treats both the symptoms of the individual patient and the lack of food, education, and jobs that increases vulnerability to disease for entire families and communities.

Whether it is helping devise a national plan for community health workers in Rwanda, delivering state-of-the-art care to tuberculosis patients in the rugged mountains of Lesotho, developing innovative, point-of-care electronic medical records in rural Malawi, or advising the Haitian government on national recovery plans, Partners In Health works shoulder-to-shoulder with the individual in pain, the family worried about where its next meal is coming from, the community in need of a school, the district that lacks a hospital, and the country trying to build a strong public health care delivery system.

Now, with the world focused on the pain of the people of Haiti, I urge you all to think not just of what we can do to help one life in Haiti, but what we can do to help millions of people living in similar conditions around the world. Please join us now by making a contribution to our worldwide efforts. Together we can demonstrate the change that is possible when resources-human and financial-are mobilized in partnership with, and with leadership from, local communities and institutions. You have already made a difference in Haiti. Help us sustain those efforts in the months to come and ensure that Partners In Health can continue to make a difference in the eleven other countries where we work. Thank you for your engagement and consideration.

Sincerely,

Ophelia Dahl
Executive Director

“[Partners In Health] made it harder to say…that certain things can’t be done," writes Yale professor Haun Saussy in his introduction to Partner to the Poor, a collection of writings by PIH co-founder Paul Farmer. "Once something can be done, then that raises the ethical obligation that you should do it.”

University of California press recently interviewed Paul and Haun about PIH acheivements and the organization's continuing efforts to treat illness by addressing the social and structural factors that contribute to it. Paul also addresses post-earthquake Haiti and the role of international NGO's like Partners In Health in helping Haiti rebuild. Listen to the interview on a podcast from the University of California Press's blog.

Partner to the Poor is available for purchase from amazon.com.

Since PIH was founded nearly 25 years ago, sharing our experiences, building partnerships, and advocating for social justice have been integral components of our work. And for us, achieving these goals has always involved making personal connections. Over these years we’ve been thrilled as more and more people have joined the fight to break the cycle of poverty and disease; at the same time, maintaining and fostering relationships with so many new allies has become ever more challenging.

The new www.pih.org reflects our latest online response to this challenge.

A new design

We hope that our new website will make it easier to access news and information about our projects and to learn how you can connect with our work. Our team publishes new content on an almost daily basis. With our Blog and News features, we’ll be able to get that content to you even faster. (Follow our RSS feeds!)

PIH is also active on both Facebook (http://facebook.com/partnersinhealth) and Twitter (@PIH). If you’re on there too, please say hello!

Fostering connections

Every day, we at Partners In Health are privileged to meet individuals who share our commitment to health and social justice from across the country and around the world. What would happen, we wondered, if we provided these passionate advocates with a way to meet and team up with others who share their passion—whether that means a neighbor down the street or across the country.

ACT.PIH.ORG is that space.

Integrated right into our new website, it’s an online community for supporters of PIH and global health equity to meet, plan, and take action. Organizing events, creating personal fundraising pages, and mobilizing advocacy campaigns are all possible using these tools. Click here to get started.

www.StandWithHaiti.org

The crisis in Haiti continues to be dire and PIH’s work there is far from over. Our website www.standwithhaiti.org will continue to serve as a central location for updates on PIH’s work in Haiti, and as a resource for those committed to keeping the world focused on supporting this impoverished and heroic nation. Going forward, we will continue to maintain both www.standwithhaiti.org and www.pih.org as separate, but intimately connected resources.

Thank you for your continued support and for visiting the new www.pih.org. Feel free to say hello in the comments below.

Last night, PBS NewsHour featured the work of Zanmi Agrikol (“Partners In Agriculture”), PIH’s agricultural partner organization in Haiti. Following the January earthquake, Zanmi Agrikol’s efforts have focused on ramping up food production and helping local farming families harvest enough food to feed their growing communities in sustainable ways.

Watch the PBS NewsHour piece on the player below (the segment with Zanmi Agrikol begins around 4:30):

If your browser does not support the player, you can view the segment on the PBS NewHour website.

UPDATE 5/25/2010: Due to unforeseen circumstances, our June 1st event, "STAND WITH HAITI: An Evening of Solidarity" has been temporarily postponed. All ticket purchases will be refunded in the next three business days. Please note that the refund may take up to ten business days to be reflected in your financial statement. We will post on our homepage the rescheduled event date as soon as possible. We sincerely apologize for the inconvenience of this postponement and hope you will join us again to stand with Haiti. 

Since the January 12 earthquake, the New York region has shown true solidarity with the people of Haiti. Grassroots organizers have pulled together more than 50 fundraising events for Partners In Health and thousands of individuals have dedicated their resources to our work.

In recognition of all that has been done by New Yorkers and their neighbors, PIH invites supporters and anyone interested in the future of Haiti to join PIH Executive Director Ophelia Dahl and Academy Award-nominated actress Maggie Gyllenhaal for STAND WITH HAITI: an evening of solidarity.

STAND WITH HAITI: an evening of solidarity is scheduled for 8 p.m. Tuesday, June 1, in New York City.

The Town Hall
123 West 43rd Street
New York, NY

Seating is limited, and must be reserved in advance.

This event serves as the first stop in Partners In Health’s STAND WITH HAITI tour. This series of live events across the U.S. is designed to thank the hundreds of thousands of people who have joined PIH in accompanying Haiti, to report on the work that they have made possible, and convey PIH’s ambitious plans for helping Haiti to build back better.

Note: This story is an update to the one posted on 4/21/2010.

Three of the children living at Zanmi Beni.
A small classroom and library for the children.
The children are cared for by the dedicated staff.

With children laughing and chasing each other, playing with balls and pet guinea pigs, the sunny courtyard could be mistaken for an ordinary afterschool daycare program. But this is no ordinary childcare program, and the children are not living under ordinary circumstances.

The Haiti earthquake injured hundreds of thousands of people and damaged hundreds of buildings throughout Port-au-Prince, including what was to very soon become one of the busiest medical facilities in the city—the General Hospital. Living in one of the wards within the hospital’s pediatric unit were 48 children—ranging from two weeks to 21 years old, some without parents, many living with either physical or developmental disabilities.

In the aftermath of the quake, it was clear that these unaccompanied minors and vulnerable children could not remain at damaged and over-crowded General Hospital. The hospital’s medical director contacted PIH and its Haitian sister organization Zanmi Lasante (ZL) to help find the group a new home.

PIH/ZL facilitated the children’s move to a new long-term care facility in Croix-des-Bouquets, a city located about eight miles northeast of Port-au-Prince. The facility, named Zanmi Beni – “blessed friends” in Haitian Creole, is the result of a partnership with Operation Blessing International—a nonprofit organization that provides disaster relief and community development in 98 countries.

With safe and sunny wards, space for the children to run and play, books and toys, and a dedicated 75-person staff to care for them, the children are happily flourishing. Some of the children who had before been bedridden are now beginning to walk—they simply needed the opportunity and a little attention to help them take their first steps. Others study their lessons in a small tent-school room. Staff ensure that each child is given special attention to help foster learning and development—from feeding themselves to speaking skills.

Zanmi Beni will provide the children with ongoing educational, emotional, and psychosocial support; and will have access to a broad range of educational, developmental, and recreational tools—including equine therapy and a swimming pool for physical therapy. In addition, pet guinea pigs, goats, birds, and a friendly little puppy named Fani help make Zanmi Beni into a home.

An experienced staff of physical therapists, occupational therapists, nurses, social workers, teachers, cooks, cleaners, and community health workers care for the children. The majority of the staff were locally hired in the weeks following the earthquake. The center also has two pediatricians on staff.

Construction and renovations on the building are still under way and are expected to finish this summer.

Dancing and singing at a patient meeting.

In many of the communities that PIH serves, HIV/AIDS patients must carry the physical burden of the disease as well as the psychosocial burden of stigma.

PIH’s partner organization in Malawi, APZU, is working to combat this stigma and create a supportive space for patients living with the disease. Each month, APZU helps organize a patient meeting, which brings hundreds of patients together to laugh, sing, dance, support each other, and learn from each other about coping with the daily challenges and issues caused by living with HIV. Moreover, they leave with a sense that they are not fighting the disease alone, but as a community.

"These meetings are a place where people living with HIV/AIDS in Neno District can meet to organize, strategize and discuss about alternative ways to address their disease and poverty," said Dr. Paul Pierre, APZU Director of Community Programs.

The meetings are organized and run by a committee of patients elected by their peers, and  focus on inspiring and positive messages. Regular features of these meetings include information about how HIV/AIDS is transmitted, and methods for preventing the spread of the disease, as well as local dance crews, musicians, and comedians. At a meeting last month, over 400 patients attended.

Watch a footage from a recent patient meeting on the player below:

"The Neno Community Support Initiative for Patient Living with HIV/AIDS (NCSI-PLWHA), now a vibrant organization with more than 15 affiliated support groups, was born from these meetings," added Paul.  "Also, APZU’s new orientation to support subsistence farmers through fertilizer distribution and permaculture trainings was motivated in great part by discussions with the NCSI-PLWHA executive committee."

Inside the new district pharmacy in Kayonza, Rwanda.

A new district pharmacy recently opened in the Kayonza district in eastern Rwanda, located near the Tanzanian border. The new facility, opened in a partnership between PIH’s Rwandan sister organization, Inshuti Mu Buzima (IMB), and the Rwandan Ministry of Health (MOH), marks a major step towards merging the MOH medical supply chain with the one IMB first established upon entering the country in 2005.

Run as a semi-autonomous organization, the new district pharmacy will supply the MOH hospital and health centers in the district with medicine and equipment. Different from our previous pharmacy, IMB staff will not manage this facility. Responsibility will instead be handed to MOH staff hired from the region surrounding the new district pharmacy, new employees trained by IMB to operate this independent facility.

When PIH launched Inshuti Mu Buzima —“Partners In Health” in the Rwandan national language, Kinyarwanda—in the spring of 2005 at the invitation of the Rwandan government, we established an independent supply chain and pharmacy system, one that primary dealt with PIH/IMB hospitals and health centers.

Over the last five years PIH/IMB has expanded services such that we are currently supporting or operating more than 20 hospitals and health centers in three of Rwanda’s thirty districts. As we grew larger, a problem arose. PIH/IMB and the Rwandan Ministry of Health were each developing their own health care-related supply chains—with separate providers, warehouses, and distribution systems.

To reduce redundancies, save money, and help streamline Rwanda’s health care system, the Ministry asked PIH/IMB to consolidate distribution systems with the government. The result is a new system that eliminates the parallel IMB system, which will in turn help strengthen the public sector system. Having a single system will allow for better forecasting and increased transparency.

Under the new system, the new district pharmacy orders medicines and consumables from the Ministry’s Drug, Consumables and Equipment Central Procurement Agency (CAMERWA), for PIH/IMB facilities. CAMERWA already supplies all of the Rwanda’s public hospitals and health centers, this expansion allows a single facility to procure drugs and supplies for the entire country. In essence, the country now has a single supply hierarchy, one owned and operated by the people of Rwanda.

If CAMERWA is unable to complete an order, PIH/IMB will act as a safety net, and step in and fill it. PIH/IMB also fills orders for drugs not supplied by CAMERWA.

When “Joe” was given three new pills to control chronic diabetes, the prescriptions became just another page in an already large case file. A gregarious 51-year-old man from Dorchester, MA, Joe takes 22 different medications for a dizzying array of ailments—many of them either directly or indirectly related to his being a diabetic. One major barrier to successful diabetes management was his poor knowledge about the disease—the importance of healthy eating and exercise, and also how to take his medicines.

Joe’s doctor could not give him this level of support. Fortunately, he was assigned a community health worker through the Prevention and Access to Care and Treatment Project (PACT)—a joint effort of Brigham and Women’s Hospital and Partners In Health (PIH).

The community health worker discovered that because Joe did not understand the difference between his three diabetes medicines, he was only taking two of the pills, greatly diminishing the regimen’s effectiveness. She explained how they work together and helped Joe manage the sudden drop in blood sugar that resulted when he started taking all three medicines. Joe’s clinical status improved dramatically.

The community health worker also helped him define individual goals and outline action steps to guide his success. One of Joe’s major achievements has been enrollment in a physical therapy program at the Dorchester House, allowing him to exercise for the first time in years.

An objective of health reform is to revolutionize the relationship between those receiving care and those providing it, focusing on an individual’s capabilities rather than just his or her needs. As Joe’s case illustrates, community health workers have a key role to play.

Adapting a model that PIH has so successfully used to fight HIV in rural Haiti and drug-resistant tuberculosis in Peru, PACT has for many years employed community health workers to provide home-based services to the sickest and most marginalized people living with HIV in and around Boston. Community health workers are members of the local community who are trained to provide medical and psychosocial support for their neighbors. In addition, delivering services through community health workers is one way to help relieve the current urgent health workforce shortage—in both the United States and in the communities PIH serves around the world.

The proven effectiveness of using community health workers to help treat and manage infectious diseases like HIV/AIDS and tuberculosis is now being tested by PACT to treat a chronic disease—diabetes.

As countries become more affluent and people adopt richer diets and more sedentary lifestyles, chronic diseases impose an increasingly heavy burden in death, disability, and medical costs. The search for cost-effective ways to treat diabetes and other chronic diseases has become a major priority, especially for a country like the United States, where an estimated 21 million people have diabetes.

One of the community health workers first tasks with any new patient is to educate that patient about their disease and how they can improve their health. PACT has designed a diabetes curriculum to improve the knowledge and skills of diabetic patients in order to empower them for successful self-management. 

Working with a small group of patients, the community health workers teach lessons relevant to successful diabetes management, including: healthy eating, monitoring medications, reducing risks of complications, staying active, and goal setting. Patients also learn about navigating the health care system and practice useful coping strategies for stressful situations.

The initiative began enrolling patients and administering baseline surveys last November: 76 patients have been enrolled to date and will participate in the program for 12 months; 32 of these patients are now working with a community health worker, with enrollment increasing on a weekly basis. 

In honor of mothers everywhere, we've pulled together a photo essay celebrating mothers and their contributions at our sites around the world:


Click to view full screen.

Pulitzer Prize-winning journalist Tracy Kidder recently penned the foreward to PIH co-founder Paul Farmer's new book, Partner to the Poor. Kidder's piece was recentely featured on the Daily Beast. Read an excerpt below: 

Tracy Kidder
Purchase your copy of Partner to the Poor.

A few years back I wrote a book called Mountains Beyond Mountains. It has a subtitle: “The Quest of Dr. Paul Farmer, a Man Who Would Cure the World.” I don’t much like subtitles and I didn’t add this one willingly, but I suppose it’s accurate enough. My book is mostly about one person, Paul Farmer, and, as we all know, the old saw that one person can make a difference in this world really isn’t the whole truth. Paul Farmer never wanted me to imagine that he alone was responsible for the early work of Partners in Health. In fact, I think that if he’d been the writer, he would have given equal time to all the people involved in the early days—to Tom White, and Jim Yong Kim, and Fritz Lafontant, and Ophelia Dahl, and Loune Viaud, and Todd McCormack, and Haun Saussy, and the rest of a cast of at least dozens. But I have to add that I couldn’t have written a book like that, and I’m glad I didn’t try.

I traveled quite a lot with Paul Farmer, and some of those trips were, collectively, like a harrowing of hell for me—to the famished, deforested Central Plateau of Haiti; to a periurban slum outside Lima, Peru, which, as the residents say, looks like the surface of the moon; to Moscow’s Central Prison, where what the doctors described as an “uncrowded cell” contained 50 patients coughing up drug-resistant TB bacilli. In those places, particularly, Paul Farmer showed me more reasons for despair than I’ve ever seen before, or indeed imagined. And yet it was the most exhilarating experience of my life. PIH was still pretty small then, back in 2000, and yet they were creating vivid proof that diseases that could be treated successfully in the developed world could also be treated successfully and economically in some of the poorest, most difficult settings imaginable. That was the moving thing for me. Seeing the proof.

Read Tracy Kidder's full foreword to Partner to the Poor on the Daily Beast and purchase your own copy of the book from amazon.com. A portion of the book proceeds will help support PIH's work.

Purchase Tracy Kidder's best-selling book Mountains Beyond Mountains.

PBS NewsHour recently interviewed Father Eddy Eustache, a priest and psychologist who serves as director of mental health and psychosocial services for Zanmi Lasante, PIH's sister organization in Haiti. Below is an excerpt from the interview. Read the full piece.

Father Eddy Eustache

What are the most common mental health challenges you are seeing in Haiti at this point?
Almost four months after the earthquake we are seeing people having various kinds of emotional distress responses. These include difficulty sleeping, heart palpitations, somatic complaints, and significant sadness, worry and anxiety. Some of these can be seen as normal reactions to a highly abnormal situation. However, the level of distress for many is severe. We also see people who have developed psychotic reactions, and other more acute mental health problems, since the earthquake.

One major challenge is a general lack of services in Haiti to address significant mental health problems. Haiti had few mental health professionals, and limited organized mental health services prior to the earthquake. There was not a clear understanding of the prevalence of mental health problems in Haiti prior to the earthquake, but we can expect that the mental health dimensions of the earthquake, overlaid on the pre-existing issue of poverty, will have significant ramifications for mental health. Our hope is to further develop the services needed to assist with such problems, in a culturally appropriate way, for the long-term.

How are mental health workers trying to address the needs?
Interventions are needed that respect people's capacity to recover from such an event, that do not pathologize normative responses to such a terrible circumstance, that do not risk harm to individuals, that have some evidence for their efficacy, and that are appropriate to the Haitian context.

At Zanmi Lasante [Partners in Health] we have expanded our team to 17 psychologists from three prior to the earthquake, and to more than 50 staff focused exclusively on mental health and psychosocial services. We have been working ... to provide communal opportunities for mourning, to develop community-based supportive interventions in collaboration with schools and churches, and we have expanded basic clinical services.

This has included training of doctors and nurses in management of acute mental health problems, and planning for expansion of the system of care to include community health workers attuned to mental health, and development of effective referral networks to providers.

Read the full interview.

In the pre-dawn hours of January 13, a phone call awakened Dr. Jonas Rigodon and his wife at their home in Neno, Malawi. The news was bad. A massive earthquake had just hit their native Haiti.

Shocked and worried, Jonas and other Haitian physicians at PIH sites in Africa--which include Malawi, Lesotho, and Rwanda--struggled for news of family, friends, and colleagues. And, just a few days after the quake, these skilled physicians boarded planes to aid in the immediate relief efforts.

Now back in Malawi, Jonas recorded a short video. In it he describes his return to Haiti, the ways in which international collaboration has strengthened PIH, and the importance of PIH's comprehensive approach to health and human rights:

Jonas first joined PIH's Haitian sister organization, Zanmi Lasante (ZL), in 2002. After working with ZL for four years, he volunteered to bring his knowledge of methods pioneered in Haiti to PIH's projects in Africa. Jonas's first stop was the landlocked, African nation of Lesotho, where he helped launch PIH Lesotho's rural initiative--working alongside Basotho colleagues in a remote mountain-top clinic. Three years later, he moved on to Malawi to assume the role of Deputy Director at Abwenzi Pa Za Umoyo, PIH's Malawian sister organization.

PIH's Program on Social and Economic Rights (POSER) is one of the major innovations created in Haiti by ZL that Jonas has helped bring to PIH's African sites. POSER stems from a core PIH belief: Fighting disease in impoverished settings also means fighting the poverty at the root of poor health.

The program addresses the social inequalities that drive the vicious cycle of poverty and disease by providing nutritional support, building houses, paying for school fees and installing well caps or filtering systems to ensure access to clean drinking water.

Watch Jonas describe the connections between our work in Haiti and Malawi and to see him featured in a recent BBC documentary on the Malawi POSER program.

Jonas's message is a compelling reminder that PIH's mission--whether assisting in earthquake recovery or helping African nations combat HIV--is both medical and moral.

Mimose Maurice's home collapsed around her during the January 12 earthquake. With her leg and foot seriously fractured, and the medical centers in Port-au-Prince either overwhelmed or lying in ruins, it was decided that on the following day she would be transported to a hospital in the rural Central Plateau of Haiti run by PIH's sister organization in Haiti, Zanmi Lasante (ZL). Yet, all did not go as planned. In the post-earthquake chaos, Mimose was separated from her daughter, Gina, 16, and her niece, Katia, 14.

Prior to January 12, Katia had been living with another aunt—Mimose’s sister—who died in the earthquake. In the hours that followed, Mimose took her niece into her home and became her guardian. Less than a day later, this new family was accidently separated.

While a very worried Mimose was receiving medical care at the PIH/ZL facility, Gina and Katia were suddenly alone in the middle of a massive disaster zone. This was not their only problem; they too had been hurt in the earthquake. Gina's injuries were not serious, but Katia had open wounds covering her back, arms, and face, and a deep cut in her lower back.

Like Mimose, the girls headed out of Port-au-Prince to seek medical care. They hitched a ride in the back of a pickup truck and endured a long, bumpy drive to a town near Haiti's border with the Dominican Republic. At the clinic, they were told to cross the border and try their luck in Santo Domingo.

The girls found their way to Hospital Dario Contreras-the capital city's trauma hospital. After receiving initial medical attention, they were sent to Hospital Robert Reid Cabral, a nearby pediatric hospital.

As the week progressed, Katia's list of injuries expanded: she developed a urinary tract infection and complications with her kidneys.

Weeks went by. During all of this Gina had to take on the role of parent, friend, and caretaker to Katia as she slowly recovered. While local volunteers looked out for the girls generally, they were ultimately alone in a foreign country, and anxious to learn what had happened to Gina’s mother.

Meanwhile, Mimose was moved from Cange to nearby Hinche, and was an outpatient living in a tent community near Hospital St. Therese-a facility co-run by ZL and the Haitian Ministry of Health. When the ZL staff learned of the family's story, and decided to help reunite mother and daughters.  ZL's social workers prepared the necessary paperwork to transport the girls from the Dominican Republic to Mimose in Hinche, and set off to fetch them.

But when the ZL staff reached the girls, Gina hesitated, thinking of her cousin's wounds. "What type of doctors will treat us there?" she asked in a low tone. "Haitian doctors make you pay for everything and we don't have any money."

The ZL staff told them how Haitian doctors had treated Mimose for free at the ZL clinic. Like all patients in the girls' situation, all medical care, medication, and even food would be provided for free to those in need. Gina and Katia consented, and the ZL staff quickly began coordinating with the Robert Reid Cabral staff to reunite the small family and to continue Katia's treatment in Hinche.

It was almost three months to the day since the family had been separated when the ZL ambulance drove back to Haiti with the girls. Mimose was overwhelmed at the sight of her daughter and niece. "When Gina and Katia were sent to the Dominican Republic, I did not know how I'd ever see them again," she said. "An angel must be looking over me and my family, because I fell into the hands of Zanmi Lasante and everything has come together."

Mimose and Katia are now both receiving physical therapy and rehabilitation at the ZL facility.

In March, PIH and its sister Haitian organization Zanmi Lasante distributed food to 3,100 families who had lost their homes in the earthquake, in addition to almost 3,900 HIV and tuberculosis patients. The food was procured through a grant from the United Nations World Food Program (WFP).

Following the earthquake, over a million Haitians had lost their homes and jobs. Hunger and malnutrition are growing concerns, particularly for one of Zanmi Lasante’s most vulnerable patient populations—those living with HIV and tuberculosis. Without food, the complex course of medications needed to treat these diseases becomes essentially ineffective. As the Haitian saying goes, "Taking medicines without food is like washing your hands and drying them in dirt."

PIH/ZL has historically provided food to HIV and TB patients, and our team was already planning to scale up food distribution for these patients in 2010 even before the earthquake, in partnership with the WFP.

However, we quickly saw that we needed to expand the partnership as rapidly as possible, and a new plan was needed. The WFP agreed, and the new grant provides food for patients injured by the quake—both in-hospital and post-discharge.

For patients living in PIH/ZL hospitals or clinics, meals are prepared throughout the day by ZL-employed cooks. Patients who live outside our facilities receive a monthly food packet that contains enough food to sustain the patient and his or her family. These packets include: 55 lbs of rice, 22 lbs of beans, 10 lbs of vegetable oil, 27.5 lbs of a corn-soy blended meal, and 2.2 lbs of salt. 

Each month, the outpatients come to one of nine PIH/ZL warehouses—facilities located throughout Haiti’s Central Plateau—both to be evaluated by nurses and to receive their food packet.

Since 2006, PIH/ZL and the WFP have collaborated to provide food to HIV/TB patients in Haiti’s Central Plateau—the region in which the majority of PIH/ZL facilities are located. Last year, that partnership resulted in monthly food distributions to 3,075 people living with HIV or tuberculosis—including a pilot project that distributed food to 375 HIV patients in the lower-Artibonite city of Petite Rivière.

The 7^th annual Urban Walk for Haiti in Cambridge, MA raised nearly $50,000 for Partners In Health. As detailed in an earlier post, all proceeds from the Walk will benefit school children who were displaced by the earthquake.

On March 27^th, 2010, we tuned in to the mix of activists, students, vendors, and performers who came out to support PIH at the Walk. Here are just a few voices from the crowd:

Voices heard include:

GERALD MCELROY, a student at Yale University and a member of the Urban Walk committee. In 2003, he helped found the Walk while still in high school.

ZILI MISIK, an all-female band performing Caribbean, African and American soul music.

DAYCHA from City Year Boston, volunteering with a group of 60 as part of the City Heroes program.

NYRA from Boston, walking with Haitian Brothers Networking Nationwide (HBNN).

KARLEEN PORCENA, a Roxbury resident on the Urban Walk Committee.

LARRY ARBUTHNOTT, a student at Harvard University. He made his first trip to Haiti for New Year’s Eve 2010, returning one week before the earthquake.

CAMBRIDGE MAYOR DAVID MAHER , whose office co-sponsored this year’s Walk.

MARGIE THORP, a student at Harvard University and a volunteer with the Harvard AIDS Coalition. 

MAX CLERMONT, a student at Brown University who joined the Walk committee this year. He was an intern last summer at Partners In Health.

JOIA MUKHERJEE, Medical Director of PIH, Director of the Institute for Health and Social Justice, and Assistant Professor of Medicine at Harvard Medical School and the Brigham and Women's Hospital in Boston.

JEAN NESTOR, a Dorchester resident selling H-Republik shirts at the walk.

Patients waiting outside the Proje Sante Fanm tent at one of the settlement camps.

Dire conditions disproportionately threaten women living at the hundreds of settlement camps for homeless earthquake survivors in and around Haiti’s devastated capital, Port-au-Prince. Threats include higher rates of HIV and sexually transmitted infections (STIs), as well as an increase in maternal mortality and violence against women.

PIH and its Haitian sister organization Zanmi Lasante (ZL) are working to respond to these threats to women and their children. Last month, we reported on work to strengthen our women’s health service program at four large settlements. These efforts were organized by staff from ZL’s Proje Sante Fanm—“Women’s Health Project” in Haitian Creole.

Since then, the Proje Sante Fanm staff have joined the teams at the established health clinics at Parc Jean-Marie Vincent, Building 2004, Dadadou, and Caradeux—settlements with a combined population of roughly 88,000 people. They operate women-focused spaces separate from the general clinics, where women can seek medical care, advice, refuge, and a private and safe space for nursing their infants.  Female nurses staffing these spaces also provide visiting women with information about family planning, prenatal care, general reproductive and OB/GYN-related information, testing and treatment for HIV and STIs.

Signs on the Proje Sante Fanm tent advertise, "Care to Women Offered Here."

During Proje Sante Fanm’s first two weeks working in the camps, about 200 women sought services in these safe-spaces.  Staff also travel out into the settlements to check on women who are unable to come to the clinic, and accompanied women with issues too severe for the settlement clinics to medical appointments at the General Hospital in Port-au-Prince.

Proje Sante Fanm’s work in the settlement camps is a continuation of their mission to bring gender equality and access to high quality health services to Haiti’s women—a population that has faced a disproportionate burden of disease well before the January earthquake. Maternal mortality rates are shockingly high—670 deaths per 100,000 births. In comparison, the U.S. maternal mortality rate is 11 deaths per 100,000 births, according to World Health Organization statistics. Women face higher barriers to accessing health care, as travel to clinics (which could take hours or even days in some rural areas) can be difficult or impossible with small children to care for and other household responsibilities; in addition to a general lack of information and education about women’s health.

ZL launched Proje Sante Famn in 1990. The project trains local women to be ajan fanm, women’s health agents, who locate women in the community and encourage them to come to PIH/ZL clinics for antenatal and post-birth care. Once at the clinics, nurses and matron—traditional birth attendants—offer these women health care services and information specific to them. Last year, there were about 100,000 patient visits to Proje Sante Fanm’s clinics.

Read more about Proje Sante Fanm.

Sunday, April 25 is World Malaria Day. Several of our sites are in malaria-endemic regions of the world, and our clinicians frequently treat patients suffering from this disease. The photo gallery below shows some of these sites and our work to prevent the disease using bednets--a low-cost and effective way of sheltering families from the mosquitoes that carry the disease.

Elna Osso with a patient in Haiti.

Last month, we reported on a team of five nurses from PIH’s sister organization in Peru, Socios En Salud (SES), who spent two weeks in Haiti working with PIH’s Haitian sister organization Zanmi Lasante (ZL). The team recently returned home to Lima. The group’s leader, SES International Project Coordinator Elna Osso recently recounted the team’s experiences:

We travelled to Haiti via the Dominican Republic as not all team members were able to obtain the US visas required to travel to Port au Prince via Miami. From Santo Domingo, we took a ride to the border between the D.R. and Haiti.

The next day we travelled to Hinche and the St. Therese Hospital. It is the largest hospital in the central plateau and ZL also works there.  We stayed and worked in Hinche for the rest of our trip.  In the hospital, we were assigned roles according to our nursing expertise. Some people worked in the tuberculosis program, others in the surgical wards, and I worked in the hospital’s intensive-care unit. 

It took only a few days to gain a rhythm of the work and to integrate within the flow of the hospital’s other nurses. We knew a little basic Haitian Creole. Otherwise we communicated with the assistance of local interpreters.

Hinche was spared the structural damage suffered by buildings in Port-au-Prince—only a few cracks in the walls stood as reminders of the devastating earthquake. 

Yet, almost every person had a story to tell, a personal loss to bear. The sorrow was palpable.  At the hospital, a few of the patients who had traveled from Port-au-Prince still had open wounds, and other patients waited quietly for the time when a cast could be removed. 

I saw a woman carry her 14-year-old daughter—who had a pelvic-leg cast—to the hospital on her back. Neither the heat nor exhaustion stopped either of them from sharing smiles and thankfulness.

I was particularly touched when I watched families take turns to care for a hospitalized relative, the family members sleeping on the floor, bathing their loved ones, and feeding them. They were true accompagnateurs. I took every opportunity I had to tell them that I too believed that accompaniment is indispensible medicine.

In town, the population had swollen with people from the capital, who, after surviving the earthquake, are without jobs and schools.

Such was the case of Santo, one of our interpreters, who like many was adapting to the new reality. He told me he is starting to teach English now that there are so many Americans coming.

During our final week in Haiti, we visited ZL’s Cange hospital, an important place in our organization’s history as PIH’s first hospital—a facility we have heard so much about while working in Peru. As Cange has taught so much to SES and other PIH sites around the world, it was fitting that our team, experts at treating tuberculosis and drug-resistant tuberculosis, had the opportunity to share our experiences and knowledge with Cange’s infectious disease department, as well as the tuberculosis clinic in Hinche.

We would like to thank all the members of ZL who welcomed, supported, and cared for us during our stay in Haiti. Mesi anpil!

Through our work, we know that the natural environment directly affects the overall health of a community. April 22 is Earth Day. To commemorate the day, watch a slideshow featuring projects that work to improve and preserve the local environments of the communities we serve around the world:

View slideshow in full screen.

Last night, CBS Evening News reported on the living conditions of a settlement camp for over 48,000 homeless earthquake survivors.

News anchor Katie Couric visited Parc Jean-Marie Vincent with PIH Clinical Director Louise Ivers, who spoke about the deplorable camp living conditions and the dire situation faced by the many women and children currently residing there. In addition to an environment where diseases such as typhoid, malaria, and diarrhea can easily spread, safety and security at night and lack of schools are major concerns.

“The basic human rights issues of what should be done in an emergency," said Ivers. "It still hasn't really reached that level, even three months later.”

When asked by Couric what should be done to improve conditions in the camps, Louise replied, “We are Partners In Health, we need partners.”

Watch the full segment on the player below:

Read more coverage from Katie Couric's the trip to Haiti on the CBS News website.

Some of Zanmi Beni's future residents.

Partners In Health (PIH) is in the final phases of planning for a new long-term care facility for children in Croix-des-Bouquets, a city located about 8 miles northeast of Haiti’s capital, Port-au-Prince.

The facility will be a home and school for 48 unaccompanied minors and vulnerable children, many of whom are living with either physical or developmental disabilities. Others are simply without parents at this time. The children range in age from two weeks to 21 years old.

PIH and its Haitian sister organization Zanmi Lasante (ZL), are opening the facility in partnership with Operation Blessing International (OBI)—a nonprofit organization that provides disaster relief and community development in 98 countries. The new facility will be named Zanmi Beni—“blessed friends” in Haitian Creole.

Before the earthquake, most of these children were living in a crowded and understaffed ward in the General Hospital’s pediatric unit. Following the destructive quake, the General Hospital’s medical director called PIH/ZL and asked that the group be moved into a temporary space.

PIH/ZL facilitated the children’s move to St. Germaine, a rehabilitation school situated on the campus of St. Damien’s Pediatric Hospital—a Nos Petits Freres et Soeurs-affiliated hospital located in the city of Tabarre.

In March PIH/ZL identified land, and, with a donation from OBI, purchased the property for Zanmi Beni. Surveying and architectural planning are now underway. Construction and renovations are expected to start shortly after, and finish this summer.

Zanmi Beni will provide the children with ongoing educational, emotional, and psychosocial support; and will have access to a broad range of educational, developmental, and recreational tools—including equine therapy.

An experienced staff of physical therapists, occupational therapists, nurses, social workers, teachers, and community health workers will care for the children. The center will also have two pediatricians on staff.

Check back this summer for updates and pictures of the new facility.

Dear Friends,

	PIH Executive Director Ophelia Dahl

Our colleagues in Haiti have seen incredible suffering and losses as a result of the January 12 earthquake, but they have persevered, saving thousands of lives and bringing hope to hundreds of thousands more. It is with deep admiration for their efforts and gratitude for your support that I present our three-month progress report on Partners In Health's relief and recovery activities.

On my last trip to Haiti, I found myself struck, more than usual, by how important our work is in serving as an antidote to despair, not just for our staff but also for all of those we serve. The ongoing suffering of the Haitian people--particularly the hundreds of thousands of displaced people living in Port-au-Prince--weighs heavily on my mind. But what gives me and so many others hope for the future is witnessing the daily progress we make in trying to relieve such misery. We see patients with amputations stand for the first time on their new prosthetic legs; we watch children escape needless death by receiving treatment for diarrheal disease or other treatable conditions in our settlement clinics; we deliver food to displaced families and assist with long-term agriculture assistance in the heavily burdened rural poor areas of the country; and we join meetings with the dedicated Ministry of Health leadership to develop national plans for strengthening the public health sector.

I remain steadfastly convinced that, with your commitment to making a difference in the lives of people who are living in such dire conditions, we can serve as a beacon of hope for Haiti and all of the communities around the world in need of a better future. As you will read in the report, we are not just saving individual lives in Haiti but also helping to transform entire communities and setting an example of what is possible in the months and years to come.

Again, thank you for your engagement--our goals are unachievable without your support.

-Ophelia Dahl
 PIH Executive Director

The conversation starts today at the GHDonline community, as they host their first ever online, expert-guided panel: “Health IT for Disaster Relief and Rebuilding: Lessons from post-earthquake Haiti.”

The panel will generate an in-depth discussion, starting Monday, April 19 and continuing until Friday, April 30. It is being organized by the Global Health Delivery Project’s GHDonline.org, a web-based collaboration platform where more than 2,600 professionals and students from 950+ organizations across 124 countries share proven practices, connect with colleagues, and find resources they need to improve health outcomes in resource-limited settings. Partners In Health is proud to be one of the founding members of this project.

The panel will be guided by three experts working on the ground in Haiti:

• Josh Nesbit is the Executive Director of FrontlineSMS:Medic. His work as FrontlineSMS Ambassador is supported by the Open Society Institute and the Humanist Institute for Development Cooperation. As an international health and bioethics student at Stanford, his qualitative research focused on access to pediatric HIV/AIDS treatment. Josh has implemented text message networks in Malawi, Haiti, Uganda, and Cameroon, advising ICT development projects in more than 15 countries. He is a PopTech Social Innovation Fellow, Rainer Arnhold Fellow, Strauss Scholar, and Haas Public Service Fellow.
• Eduardo Jezierski works at InSTEDD building technologies for health, development and crisis response. He and his team work with doctors and social workers to provide technologies that scale down into the hands of semi-literate health workers in rural villages of SE Asia, deploy collaboration and coordination platforms for responders and search and rescue teams, and build and train local teams of engineers to accelerate the cycle of invention and deployment - build focal points for local innovation and appropriate design. Eduardo has spent his career designing, implementing and deploying software solutions on a global scale. He spent nine years at Microsoft as a Program Manager and Architect. Eduardo recently returned from Haiti where his team worked with Thomson Reuters foundation, the Red Cross, and local media providing information services to the survivors of the earthquake.
• John Brooks has worked as a database programmer in the New York office of Médecins Sans Frontières (MSF)/Doctors Without Borders for the past six years. In June 2009 he was responsible for configuring and implementing OpenMRS in MSF's Trinité trauma surgery hospital in Port au Prince, Haiti. The hospital was destroyed in the January 2010 earthquake, but the database and server were unharmed, and the informatics work which had been originally dedicated to trauma response and surgery was quickly adapted to MSF's earthquake response. Before John worked at MSF, he designed and developed an EMR system called ChartAttack and worked as a database programmer and research coordinator for community-based clinical trials in HIV research in Atlanta and New York. He has also been trained in Katherine Dunham's dance technique which is a fusion of ballet and African, Haitian, Cuban, and Brazilian folkloric dance rituals. While he was in Haiti after the earthquake he debuted his new work "Le Dans d'Hélicopterè" in MSF's inflatable hospital to entertain the patients.

These three experts have had many years of health information technology  implementation experience; they’re eager to share the work they’re doing in Haiti, answer your questions, and learn from the ideas and experiences of others in the community. To join the discussion, go to http://www.ghdonline.org/tech/discussion/haiti/ and create your free account.

GHDonline is already planning for future panels for the health IT community. To send in your ideas for topics and expert panelists, please email healthitpanel@ghdonline.org.

Tatiana and one of the cans she used to collect change.

Tatiana Chermayeff is making change in a big way. After the earthquake, she placed collection cans for PIH at local store counters in Rowayton, CT and nearby towns. One month later, the loose change dropped into her 10 cans totaled nearly $1,000.  "[The cans were] easy to put out there,” said the 11-year-old. “I've seen it before, and that gave me the idea."

Tatiana decided to organize her own fundraiser after hearing about the misery caused by the earthquake in Haiti. In an essay about her campaign, she writes: "I was scared and sad to learn about how much the Haitian people were suffering." Read the full text of her essay below.

Tatiana partnered with eateries, a hardware store, and a salon in Rowayton, Darien, and New Canaan to raise funds for PIH. "[PIH] has many hospitals and doctors in Haiti...to help Haitians immediately," she writes.

In addition to the collection cans, Tatiana set up a PIH fundraising page to raise money online. Throughout the month, friends, family, and classmates pitched in over $4,000, making her total contribution to PIH $5,277.58.

Read Tatiana's own reflections in her essay below.

Change for Haiti

By Tatiana Chermayeff

I am an 11 year old fifth grader who lives in Rowayton, CT.  On January 12, 2010, a huge earthquake struck Haiti.  I was scared and sad to learn about how much the Haitian people were suffering.  I helped with bake sales at my school and church to raise money for Haiti, which inspired me to organize a fundraiser myself.   On Sunday January 24, I searched the Internet for ideas and decided to collect change at stores in my community and give the money to Partners in Health (PIH).  I selected PIH because I heard through my dad that they have many hospitals and doctors in Haiti that would be able to help Haitians immediately.  

I made ten collection cans and placed them in stores in Rowayton, Darien and New Canaan.   I went from store to store asking the owners or managers if they would allow me to put a can next to the cash register.  The first day I placed cans at Rowayton Market, Rowayton Pizza, Brendan’s 101 and Rowayton Hardware.  A few days later I put cans in Robek’s and Fredric & Co. in Darien, and Rosie’s, McKenzie’s and Chocolate Shoppe in New Canaan.  In addition to the cans, I decided to raise money from friends, family and classmates through the PIH website, which allowed me to create a personal fundraising page as part of PIH’s “Stand With Haiti” campaign.  I set a goal to raise $2,500.

After one week, I went to all the stores to collect the money in the cans.  I counted the change and bills at home and was amazed to find almost $300.  My on-line fundraiser went extremely well too and I raised $2,295 in that first week.  When my fundraising effort concluded after one month, the donations totaled $5,277.58!  Of that amount, almost $1,000 came from the cans.  Someone told me that every dollar goes a long way in Haiti so no contribution is too small.  I feel really happy that through my efforts and the generosity of many people the fundraiser was a huge success and that Haitians are getting the help they need.

Muddy roads filled with rubble and debris are literal barriers to accessing health care, especially in the wake of the recent earthquake.  Thanks to the American Jewish Joint Distribution Committee, PIH, and our partner organization Zanmi Lasante (ZL) have five new ambulances to help desperately ill patients safely and quickly reach medical facilities around Port-au-Prince and at PIH/ZL sites outside the city.
 
“The ambulances funded by JDC will help save the lives of many patients. Too often, we’ve seen patients die because they could not make it to the hospital in time,” said ZL Director of Operations Loune Viaud.
 
The American Jewish Joint Distribution Committee (JDC), the world’s largest Jewish humanitarian assistance organization, has offered much-needed funding to a wide variety of PIH/ZL’s programs and is helping Haiti to build back better. "JDC's vast experience in disaster relief is built on the valuable partnerships we have forged in the wake of heartbreaking tragedy,” said JDC CEO Steven Schwager. “We're enormously proud that together with Partners In Health, we're working to ensure the survival and long-term recovery of Haitians living in the aftermath of the earthquake."
 
In addition to funding the five ambulances, JDC is also offering assistance to PIH/ZL programs that look to the health and well-being of Haiti’s children, both in the long and short term.

JDC is supporting the production of Nourimanba, a locally produced therapeutic food for malnourished children.
Funding from JDC will also support school children in Haiti.

With food supplies around the country now dwindling, PIH/ZL medical centers are seeing an increase in the number of malnourished children coming through their doors. JDC will help our nutritional assistance program treat an additional estimated 2,200 children, a number that means the program’s capacity will grow by over 30 percent. Their funding will help ramp up production of Nourimanba and Nourimil, locally produced food treatments specifically designed for malnourished children, and will allow the program to hire clinical staff to handle the expansion.
 
JDC will also give 3,000 children the ability to attend school by supporting PIH/ZL’s education program. One of the pressing concerns among the large numbers of displaced people is the schooling of children whose families have lost their homes, whose schools have been destroyed, or who have been relocated to other areas of the country. JDC’s contributions will cover entrance fees, supplies, uniforms, and books, allowing these children to attend school without burdening their families with additional expenses. As education is one of the most effective ways of lifting people out of poverty, JDC’s support will help secure the future of thousands of children, as well as invest in the future of Haiti, said Viaud.
 
 “We’ve been so thankful for JDC’s support for our work in Haiti,” said Viaud. “It gives me hope to know that organizations like JDC are standing with Haiti and with us.”