When you leave the well-maintained highway from the capital city to go to Rwinkwavu Hospital, you turn left after a gas station in Kabarondo onto a dirt road. Rwanda is mostly a lush country, its celebrated hills covered in banana trees, tea plantations, and fragrant (if soil-deadening) eucalyptus. When you turn left after the gas station in Kabarondo, however, it's as though you've suddenly entered eastern Kenya. Like desert country everywhere, the savanna around Rwinkwavu has its own austere beauty, but limited water and dry winds that sweep away topsoil have made it one of the poorest areas in Rwanda. This is where Partners In Health chose to begin its work in the heart of Africa.

As with most structures in Rwanda, Rwinkwavu Hospital is built up the side of a steep hill. The higher you climb -- from the hospital itself to the new training center to the clean and pleasant housing for visitors and trainees on the summit -- the more you are convinced that it really isn't possible to go any further. One wonders whether similar doubts crossed the minds of the PIH visionaries who raised the funds, developed the programs, and forged the partnerships with local and national officials that now bring world-class healthcare to this impoverished corner of Rwanda. We can only be grateful for their continuing perseverance.

The hospital, reclaimed and transformed after the devastation of the genocide, is a series of single-story houses containing wards for women, men, children, and people suffering from tuberculosis. Although they are open wards, there is a homey feel to them. Parents and children in Icyumba cy'abana ("the children's room") chat amicably between beds and gladly engage with visitors who pause to greet them. Outside, patients stretch out in gardens of drought resistant trees, vines, and ground cover that have the shaggy look of someone's backyard, rather than the sharp lines and angles that characterize most institutional gardening.

Many of the hospital's interior walls are adorned with bright posters of healthy African children and adults smiling, playing, and serving in responsible roles. One corridor displays before-and-after photographs of people living with AIDS: a skeletal figure is restored in a year to robust manhood, radiating energy and purpose; a baby girl nearly wasted away in her mother's arms is able, two years later, to plant sturdy legs and thrust a chubby, mischievous face into the camera.

The healing of a human being -- the restoration of an emotional body that allows a soul to accomplish its unique purpose in the universe -- is an end of complete worthiness in itself. Yet PIH does not stop there. The hospital reaches into the communities that surround Rwinkwavu through its signature programs of follow-up medical care and accompaniment, peer support groups, nutritional supplements, and an agricultural assistance program partnering with the Heifer Foundation and the World Food Program. Improved agricultural methods allow families to make the most of small land-holdings, to resist erosion and enrich the soil that remains, and to grow enough fruits and vegetables to lift themselves out of malnutrition and make a little money on the side. Sensitive social support allows HIV-positive teenagers to stay in school and develop solidarity in the face of stigma, and helps couples and families stay together after the mutual accusations and guilt that often accompany an HIV diagnosis.

At the heart of Rwinkwavu's beautiful new training center is a courtyard garden with a small fish pond. Surrounded by four covered walkways, it has the air of a cloister garden at the center of a Benedictine monastery -- that open space that reminds us of the place in our own hearts that only the divine can fill. In my mind's eye, I see rays of healing extending from the open heart of Rwinkwavu Hospital into the whole of Rwanda. I see daughter hospitals in Kirhehe and Butaro Districts, and collaboration with health centers throughout the country. I see practitioners sharing hard-won expertise from Haïti with Rwandan counterparts adapting it to their own context. I see local training manuals and community education materials that will shape a national HIV/AIDS program. I see a heart for healing partnering the heart of a nation courageously working through its traumatic past and building a viable foundation for an exemplary future.

Climb the hill with PIH any way you can. The view is definitely worth it.

Jodi Mikalachki is an Education and Community Development Worker for the Mennonite Central Committee in Burundi.

[posted September 2009]

Partners in Profile: Dr. Guilavogui Seydouba, MSF trainer, Haiti

By David West, PIH Communications Specialist

	Dr. Guilavogui Seydouba teaching the certification course for nurse anesthetists.

Sitting in a class room in Cange, high in the central plateau of Haiti, six Haitian women listen as Dr. Guilavogui Seydouba reviews the elements necessary for good oxygen transfer in the human cardiovascular system. The women have traveled from across Haiti, leaving behind family and loved ones to participate in this challenging 18-month course, which will culminate in their certification as trained nurse anesthetists.

Dr. Gui (as he is known) has also left behind family and loved ones—his wife and five children, including a two-month-old child whom he has never met—to teach the course. A surgeon from the Republic of Guinea in West Africa, he has traveled halfway around the world to teach nurse anesthetists in Haiti. Why?  Because his biography bears a strong resemblance to the patients he treats in rural Cange.

The child of a poor family in the Nzerekore region of Southern Guinea, Dr. Gui grew up surrounded by poverty. It left a lasting impression on him. He completed his medical degree in Guinea, and with the help of Médecins Sans Frontières (MSF), he spent a year attending the Catholic University of Leuven in Belgium to receive training for anesthesiology. The only stipulation: He must commit to working for five years in rural Guinea. “For me, this was not a problem at all,” said Dr. Gui.  “The rural poor are the people for whom I have wanted to work.”  True to his word, Dr. Gui has dedicated his life to treating the rural poor—whether in Guinea or in Haiti. 

In Cange, his current mission is doing whatever it takes to ensure that his pupils complete the training course, which is sponsored by a partnership between MSF, the Haitian Ministry of Health, and Zamni Lasante (ZL, the Haitian sister organization of Partners In Health). This training is a crucial component of ZL’s efforts to roll out accessible surgical care across Haiti’s impoverished Central Plateau and Artibonite regions (read a memorial to Dr. Josue Augustin, the the driving force behind this rollout). As new surgical facilities come online, nurse anesthetists are especially needed for emergency c-sections, a basic surgery that saves lives every day and has the potential to save thousands more.

The trainees’ schedule is demanding. Their day starts promptly at 7:00am with a 90 minute class on theory. Then they report to the surgical ward where Dr. Gui reviews all of the surgery cases scheduled for the day, and assigns cases. Accompanied by a nurse anesthetist mentor, each trainee conducts a full review of the patients’ conditions and planned surgical procedures, makes recommendations regarding the anesthesia for their patients, and helps prep the operating rooms. Like all of the surgical staff at Cange, the students don’t head home for the evening until all surgical cases for the day have been seen, whether that is 6:00pm or after midnight. After finishing their workday, the students use the time remaining to study for their weekly written exams.

Dr. Gui strives to match their dedication with his own—spending his scant personal time to tutor an individual student or arranging for a more intensive mentorship for another. His approach is to build solidarity among his students. “I let them know that we are in this together, and that none of us will advance until all of us understand the material and training.” 

Finding effective allies has long been a building block of the Partners In Health approach. Dr. Gui and this important partnership between Partners In Health, MSF, and the Haitian Ministry of Health offer a compelling example of what can be achieved when committed partners come together.

[posted September 2009]

Remembering and honoring
"a brilliant shining star"

By Louise Ivers

The following is a eulogy for Dr. Josue Augustin, delivered at a funeral service on September 8, 2009.

We are angry. we are confused. We don’t understand. We can’t talk, or work, or sleep.

It doesn’t make sense to us that a brilliant shining star that was Dr Josue Augustin should be extinguished. We can’t believe it yet.

It’s not fair that he is not here in our midst, it’s not fair that he is not with his family or telling jokes in the yard at Cange or that he will never meet one of his children. For a person who saved the lives of thousands of patients to lose his life early makes it seem as though there is no justice at all in the whole world.

In areas where a lot of people said that its not possible to give healthcare and where many people say that its not even worth trying, Dr Josue had a mission. He was our rock in PIH in a movement to give quality surgical care to the destitute poor. Despite all that he could have asked of them, Dr Josue was a rare jewel that never asked his patients to pay one goud for him to operate on them. He didn’t want to sell health. He didn’t want people to die because they had no money. He served the poor, he followed his mission with grace, with humility and with the respect and love of each of his colleagues.

Show me another surgeon like him, another person like him, because I haven’t met them yet.

For me, Josue was a colleague and a friend that I could count on in the battle we are in. The battle that I’m talking about is to give services to the poor, with our limited resources in rural areas. Sometimes in that work we feel that we are alone in the dark. The work is long and difficult. But we found in our Josue, a person who wanted to carry a candle in that darkness . And not just carry it, but he wanted to share the flame with all of us, so we all could see more clearly, for our own candles to burn brighter. In that way, we at PIH had the feeling that we were not alone in the dark. We had his solidarity. He was our family.

As a foreigner working in the central plateau, on the days that I feel that I am too tired or on the days that I feel that I cant continue this difficult work, I look in the eyes of people like Josue – a proud Haitian, a strong Haitian, that wants to change his country – and I take from that energy. The energy for his people. I feel inspired by Josue's work and his mission, with the way that he worked, tirelessly to construct something so that he could ensure that his mission was accomplished.

But I am not standing here today to talk on my own behalf only. I am here to represent PIH - Dr Paul, Ophelia, Joia and all of the staff in 8 countries where PIH works that all sent messages of support and solidarity for Josue’s family during these difficult days. Because Josue’s reach didn’t end in the plateau central or in Haiti. Messages came from Europe, USA, Rwanda, Burunid, Mexico – everywhere that there is PIH there are people that he inspired and there are people who loved him. In these coming days, the big family that is PIH all over the world are standing at your side. They are the ones holding the candle for you, that want to show their solidarity for you and, especially for Josue’s family they want to shed some light.

And in our anger and our frustration I wish today that we remember Josue’s life and not just his death. I want to remember what he said with his life, t he way that he lived it. He stood up for those that are the most destitute, people who have nothing. He did this with grace and humility.

However, we won't forget either how his life ended. PIH and ZL have and will continue to give full support to the authorities of the state. I personally have spoken already with the police, minustah and crime experts in Boston so that we can try to understand the truth of what happened to our friend.

Berline, Aurelie, friends, colleagues, Jouse’s family that you have our unconditional support in the investigation. There is no limit on that. Our eyes are not closed, our ears are listening. If we haven’t spoken loudly yet this week its only because we are waiting for some answers and for things to become a little clearer. To Josue’s family- we are here for you, and we will continue to support and help you.

Today, let us remember Josue’s life. Let us remember the light that he shone. With all of his humility, with all of his heart, with all of his energy, with all of his sacrifice he had a mission. Our obligation now at PIH is to ensure that his mission lives on. Our obligation is to keep his memory and his honor alive and for us to ensure that although he is not physically with us, his image, his work continue and his battle is not lost.

We owe him that, he deserves so much more even than that. This way, Josue will always be alive.

More news about Dr. Josue

[posted September 2009]

Dr. Josue Augustin, the director of surgery for PIH's partner organization in Haiti, Zanmi Lasante (ZL), was killed on August 31. Reeling from the loss, the PIH family remains committed to Josue's life work of building a surgical program to provide life-saving operations to some of the poorest communities in the world and to working with authorities to ensure that those responsible are brought to justice.

Josue died in Hinche, the capital and largest city in Haiti's Central Plateau. An autopsy confirmed that his death was a homicide. Local police and international experts are working together to gather and analyze evidence of the circumstances of his death. ZL and PIH are supporting the investigative and judicial process to the full extent possible.

Hundreds of ZL staff and supporters traveled several hours to attend the service on September 12, joining a crowd that overflowed the First Baptist Church in Petionville, Haiti. Louise Ivers, PIH's clinical director in Haiti and a long-time colleague and friend of Josue's, delivered a eulogy at the funeral.

“In our anger and in our frustration, I wish that today we will remember Josue’s life and not just his death," Ivers said. "Let us remember what he said with his life. He took a stand for the destitute poor – and he did so with grace and with humility… Dr Josue was a rare jewel in our midst – he never wanted people to pay for surgery. He didn’t want to sell health. He didn’t want people to die because they were poor….

"Today, let us remember Josue’s life," she continued. "Let us remember the light that he brought, with all his heart, with all his strength, with all his sacrifice – to his mission to serve the poor. Our obligation now at PIH is to ensure that his mission lives on, to ensure that we keep his memory alive with honor and that even though he is not here with us physically, his image, his work, the cause he battled for is not lost.”

Since joining the PIH family over a decade ago, Josue took on a strong leadership role on ZL's clinical team.

"Dr. Josue [was] a level-headed and thoughtful surgeon and the driving force behind our collective efforts to make sure that surgery did not remain the “neglected stepchild” of our work in Haiti,” wrote PIH co-founder Paul Farmer in a eulogy. “Josue combined a rigorous pragmatism with a broad vision of what could be done to improve complex medical services, and surgery especially, in settings in which such endeavors are too often dismissed as impractical, not cost-effective, or even (absurdly enough) unnecessary."

“What this means for us, beyond our grief," Farmer's euology continued, "is that we must fight hard to make sure that Josue’s vision of equitable surgical services for the poor is one that remains front and center, not just in Haiti but in those other regions, regions full of people in need, too readily written off as unsuitable for surgery. We honor Josue by making sure that such an important mission outlives him or any other one person."

Countless other organizations and people joined ZL in mourning Dr. Josue, both as a skilled and visionary doctor and as a dedicated and generous friend and mentor.

“Josue really has been a hero and an angel to those of us who were committed to supporting and strengthening surgical services in Haiti,” wrote Ellen Agler of Operation Smile, a charity that works with ZL to treat children born with cleft palates and facial deformities. “His efforts directly transformed the lives of so many people in need and inspired so many of us to work even harder in our fight for surgical equity,” she wrote in an email to ZL staff.

Josue was 38 years old, a native of Carrefour, Haiti. He leaves behind his wife, two daughters, parents, siblings and extended PIH family. His second daughter was born three weeks after his death. She comes into a world made better and more humane by her father, said Paul Farmer. “It is not fair that she will never meet her father,” he added. “And this is another reason, surely, that we must honor Josue's memory and mission.”

[posted September 2009]

By Paul Farmer

The following is a eulogy for Dr. Josue Augustin, delivered at a funeral service on September 8, 2009.

All of us are still reeling from the loss of Josue Augustin, whom we have known as student, intern, resident, colleague, and friend. Above all, we knew him as Dr. Josue, a level-headed and thoughtful surgeon and the driving force behind our collective efforts to make sure that surgery did not remain the “neglected stepchild” of our work in Haiti.

Josue combined a rigorous pragmatism with a broad vision of what could be done to improve complex medical services, and surgery especially, in settings in which such endeavors are too often dismissed as impractical, not cost-effective, or even (absurdly enough) unnecessary. What this meant in terms of everyday practice was that he was there to round on patients, to scrub in, to organize a team of people (many of them from rural Haiti, others from far away) to provide care to those who would otherwise not have it. What this meant in terms of his own agenda was that he was always willing to engage people from all over the world (and especially from the United States and Cuba) who believed in his mission. It meant he was willing to go to where the pathology was, whether that meant Cange, Boucan Carre, Saint-Marc, Belladeres, Petite Riviere de l’Artibonite, LasCahobas, or Hinche, where he was taken from us, and from his family and patients, just last week.

What this means for us, beyond our grief, is that we must fight hard to make sure that Josue’s vision of equitable surgical services for the poor is one that remains front and center, not just in Haiti but in those other regions, regions full of people in need, too readily written off as unsuitable for surgery. We honor Josue by making sure that such an important mission outlives him or any other one person. We know this is what he would want. We know it's the right thing to do.

Our sympathies and love go to Berline and Aurelie and to another daughter who will soon come into a world made better, and more humane, by a wonderful student, friend, and colleague. It is not fair that she will never meet her father, and this is another reason, surely, that we must honor Josue's memory and mission.

[posted September 2009]

In rural Rwanda, the simple and time-tested idea of medical house calls is not only improving the health of the community, but stimulating its economy as well.

The television program NOW on PBS travels to the village of Rwinkwavu to meet the Rwandan doctors, nurses and villagers who are teaming up with Boston-based Partners in Health and the Rwandan government to deliver medicine and medical counseling door-to-door. 

This show was originally broadcast on September 11, 2009.

	Village health workers learning to use their new phones. © Josh Nesbit, FrontlineSMS:Medic

Charles Howes, PIH Development Assistant

A pilot project using cell phones and open-source software cuts the miles between patients, village health workers and health clinics.

Village health workers (VHWs) are the backbone of Partners In Health's comprehensive health care model in Malawi. They visit patients daily, walking with them to the clinic, supporting them in the community, and getting them to the health center if there is an emergency. Frequently, hours of travel separates patients, VHWs, clinics, and doctors. A new pilot project at Abwenzi Pa Za Umoyo (APZU), PIH’s sister project in Malawi, utilizes cell phones, an inexpensive laptop, and free software called FrontlineSMS to create a direct communications link between the clinic, VHWs and ultimately, the patients.

FrontlineSMS is free, open-source software that enables two-way communication between groups of people using text messages. A team of students and recent college graduates have adapted the software for medical use in a resource-limited setting and they have formed an organization called FrontlineSMS: Medic. This past August, Josh Nesbit, the Executive Director, traveled to Malawi with funding from Stanford University (his alma mater) to assist with the implementation of a pilot project. He arrived with 130 cell phones, an Acer laptop, and a GSM modem that enables a computer to send and receive text messages over a cellular network.

In Neno, 130 VHWs selected for the pilot were trained on how to use a cell phone to send and receive text messages. In addition, select clinicians, data clerks and VHW coordinators were trained on the FrontlineSMS software.

For evaluation purposes, the staff at the Neno District Hospital is using the system to follow up with patients listed as defaulters. Defaulters are patients who have either missed their doctor’s appointment, or who may have run out of medicine. Every Monday, Dyson Likoma, APZU data manager, generates a report with a list of patients. The report is checked for accuracy and then text messages are sent to the VHWs responsible for the patients needing follow-up. The VHWs then visit their patients and send a text message response with their patients’ status, typically within 24 hours.

Traditionally, when a patient misses an appointment, a staff member from the clinic is dispatched on a motorbike to try and find the patient's VHW. To maintain high patient follow-up, clinic staff must dedicate precious time and travel to reach the remote areas where VHWs and patients live. The introduction of FrontlineSMS has the potential to save staff time and enhance patient follow-up.

Evaluation of the pilot program will begin within the next week with teams tallying the number of messages sent and the types of responses received. In some cases, responses indicated that a patient did not need follow-up and they helped update the patient record stored in the EMR. While the pilot is limited in scope, room has been allowed for communication between VHWs and clinic staff to organically evolve, said Liz Bird, who helped coordinate the project for APZU.

FrontlineSMS: Medic partners with an organization that refurbishes used cell phones in the US and sends them out to the pilot programs. They collect cell phones through a donation campaign called, Hope Phones.

Learn more about FrontlineSMS: Medic.

Liz Bird and Evan Waters of PIH Malawi contributed to this piece.

Partners In Health will hold its 16th annual Thomas J. White Symposium on Saturday, October 3, in Cambridge, MA. The yearly event brings together PIH staff, family, friends and fellow activists and advocates for health and social justice for the poor.

The theme of of the symposium will be "Accompaniment: Solidarity in Action." Speakers this year will include New York Times columnist and Pulitzer Prize-winning journalist Nicholas Kristof, PIH co-founders Paul Farmer and Ophelia Dahl, as well as speakers from PIH partner projects from around the world.

Symposium details

Date: Saturday, Oct. 3

Time: 3:00-5:00 pm

Location: Sanders Theatre
Memorial Hall
45 Quincy Street
Cambridge, MA 02138

Admission to the Symposium is free and open to the public.

Although this event is officially sold out, some tickets will be released on the day of the event on a first-come, first-served basis. For overflow, we will also have a live simulcast in the Queen's Head Pub downstairs from the theater. In either venue, you will be able to watch the Symposium live and in the company of other supporters of health and social justice.

If you are unable to attend in person, click here to view a live webcast of this event starting at 3:00pm on October 3. We will also be posting the video on our website after the event. Please stay tuned for more information.

[published September 2009]

On Friday evening, September 11, PIH supporters will get a chance to watch a global health double-header.

First, NOW on PBS will feature PIH's work with the government of Rwanda, the Clinton Foundation, and local rural communities to bring health care to those most in need.

The broadcast will focus on reinventing health care in Rwanda: What lessons can America learn from this African country?

Check your local PBS station for listings of when the show will air in your area. (Most channels will air this show at 8:30pm)

	Dr. Jim Yong Kim

Immediately following this program on most PBS stations, PIH co-founder and current Dartmouth College President Dr. Jim Yong Kim will discuss global health care reform on Bill Moyers' Journal.

The program will focus on challenges facing President Barack Obama.

Most channels will air this show at 9:00pm, but check your local station to be sure.

[published September 2009]

Behind the mountains: An intern reflection

By Reem Abu-Libdeh

	Reem Abu-Libdeh

Each year, PIH's Institute for Health and Social Justice organizes a summer internship program. Below is an intern reflection from Reem Abu-Libdeh, who spent June and July with PIH's communications department.

A few weeks ago I went to a Haitian restaurant in Somerville, in a part of town not serviced by the subway. The restaurant stood on the corner, and big red block letters announced its name: HIGHLAND CREOLE CUISINE, the peach-colored walls were covered in Haitian art.  An aquarium was tucked in one corner, a small bar in the other. Haitian music played softly in the background. The menu was in both Creole and English.

I was there with a large group and we were celebrating, or maybe mourning, the end of our summer internship with PIH’s Institute for Health and Social Justice. We had all met seven weeks earlier in a conference room, where we went around the table saying our names and where we were from (New York, California, Massachusetts, Peru, Tajikistan, and more). We smiled a lot, made small talk, tried to remember names and who was from where. Now, at the restaurant, the conversation was different—lots more laughter, lots more (very friendly) debates. We moved easily from discussing Haiti’s history to someone’s year in West Africa to asking who had seen that dancing wedding video on Youtube.

We had a lot to talk about.

For the past two months, in between our own projects—which ranged from grant-writing to working on curriculums for community health workers to researching cardiac care in Rwanda—PIH staff from all corners of the organization had sat down with us and talked about their work, their projects, their research. A young doctor from Lesotho described his successful male-targeted HIV testing and outreach initiative. He had engaged people in a way only someone from the community could. PIH Medical Director Joia Mukherjee, in between urging us to eat the doughnuts she brought, discussed the World Bank, the IMF, and structural adjustment loans. We spent an hour and a half with Paul Farmer, where we were given free rein to ask whatever we wanted. Ophelia Dahl spent three important mornings with us, including our first and last days. The communications team (with whom I worked) revealed the magic behind the website. Project managers from Peru, Haiti, and Russia traced the sites from their origins to today, sharing lots of public health lessons along the way. Epidemiologists and anthropologists working at PIH sites across the globe broke down their research, and the community health promoters at the Prevention and Access to Care and Treatment (PACT) project left us in awe.

Even the normal rhythms of the office were stimulating. I tasted nourimanba, the peanut butter–based ready-to-use therapeutic food Zanmi Lasante, PIH’s partner organization in Haiti, uses to treat malnourished children, at a brown bag lunch. A patient in the Right to Health Care program from Haiti, who had undergone cardiac surgery at Brigham and Women’s, briefly joined the interns and their mentors in the conference room our last day. Under the bright fluorescent lights, we all clapped for him. Then there was the undated letter from Paul Farmer to early PIH supporters someone had slipped into a plastic sheet and thumb-tacked to the office wall, after highlighting a few sentences of loopy cursive: “We had our first case of AIDS in the village,” he had written. “[ . . .] I spent the rest of the January running around, looking for a place to hospitalize and treat him. All to no avail. The doors were closed.”

	Reem and her fellow Summer 2009 IHSJ interns

And still there was more, but too much to tell. By the time I found myself at the Haitian restaurant, trying fried goat for the first time (I recommend it), I felt as though I was wrapping up a seven-week-long conversation that spanned not only health care, but history, anthropology, economics, public policy, international relations, food security, and the environment. Here I’ll echo what a fellow intern said our last day: we got much more out of PIH than we put in. We had received an extraordinary glimpse into the organization and a stellar education in social justice—and how you practice it.

And there was something else I took away, some fundamental piece that tied all the bits together, that cemented not only the scope of PIH’s work, but also its dedication, vision, successes. It took me a few days to name.

Early in the summer, while waiting in the kitchen for my lunch to heat up, I started talking to a coworker about books on Haiti. Later that afternoon he brought me Krik? Krak!, a short story collection by the Haitian American writer Edwidge Danticat, whose unadorned prose can make your stomach flutter. I turned to the book the internship’s last day, after lots of good-bye hugs and promises to stay in touch.

And there, in the first few words of the first story in the collection, “Children of the Sea,” I found that fundamental piece.  

“They say behind the mountains are mountains. Now I know it’s true.”

[posted August 2009]

Former President Bill Clinton recently appointed PIH co-founder Paul Farmer as Deputy Special Envoy for Haiti. This honorary role permits him to continue his teaching and clinical work at Harvard and to serve the people of Haiti, said PIH Executive Director Ophelia Dahl in a statement to supporters. "Paul and others on our team are enthusiastic about working alongside President Clinton and other friends of Haiti to advance economic development there and to assist the Haitian government in implementing its priorities," said Dahl. "This is wonderful news for Haiti and for all of us. After 25 years of working hand in hand with our Haitian colleagues and partners, we are confident that President Clinton's mandate will bring much needed support and investment to the courageous people of Haiti." Read the UN press release.

By Reem Abu-Libdeh

	Burning wood to create charcoal contributes to the deforestation problem in Haiti.

From solar panels to composting latrines, PIH's partner organization in Haiti is working to combat hundreds of years of environmental degradation with several new projects.

Senator Dick Durbin, D-Ill., hasan ambitious plan, outlined in his recently introduced Haiti Reforestation Act of 2009 (Bill S.1183): to end deforestation of Haiti within 5 years and replace, within 30 years, the “extent of tropical forest cover in existence in Haiti in 1990.” This is no small task. Haiti, a country covered in rich rainforest 500 years ago, before the Spanish and French looted the land for valuable wood and cleared forests for plantations, is almost completely without tree cover. The country is 98 percent deforested. The ramifications—soil erosion, unarable land, and an energy crisis—are especially devastating in this hurricane-prone country, where more than 80 percent of people live under the poverty line. But in the past several months Partners In Health, and its partner organization in Haiti, Zanmi Lasante (ZL), has been teaming up with other organizations to help combat Haiti’s environmental degradation on multiple fronts.

	Charcoal press developed by MIT students.
	Charcoal briquette

The most common household cooking fuel in Haiti is charbon—charcoal made by cutting down trees and carbonizing their wood. In efforts to provide an alternate energy source, ZL worked with a group of MIT students and professors to develop charcoal presses that can compact carbonized organic waste, including bagasse (the waste product that remains after sugar is extracted from the cane) and corn cobs, into charcoal briquettes. The group worked with the Zanmi Agrikol team in Corporant to make and distribute about fifty presses, and to teach families how to make the charcoal from organic farm waste. The briquettes serve a dual purpose—they stop the cutting down of trees for wood charcoal, and they generate income for families who make and sell the briquettes. 

Also on the energy front, ZL, working with SELF, the Solar Electric Light Fund, is installing solar panels in two clinics that currently use fuel-powered generators. When the price of fuel spikes, or when hurricane devastation makes the transport of fuel difficult, the clinics suffer. The panels will either wholly or partially offset energy used by the generator; ZL’s plan is for both clinics to eventually run completely on solar energy.

Deforestation’s most serious effects, especially for sustenance farmers and others living in poverty, include soil erosion and land degradation. ZL is using everything from dry latrines to fruit tree saplings to help stem the tide.

Much of the nutrient-rich top soil in Haiti has been flushed into the ocean during floods (a direct result of bare mountains that cannot hold on to the soil), and in some places, the earth has been eroded down to bedrock. Zanmi Lasante, partnering with SOIL (Sustainable Organic Integrated Livelihoods), a nonprofit committed to preserving soil resources, is fighting the problem with, at first glance, an unlikely resource: human waste.

ZL has constructed 75 dry latrines, also known as composting toilets, in the past year in Cange and Boucan Carre. The latrines, enclosed concrete structures shared by multiple families, have a fiberglass molded plate designed to facilitate the separation of liquids from solids. The urine, collected in a large plastic bucket, can be used to water crops when mixed with the correct amount of rain or river water. The solid waste has a more complicated future.

Two chambers collect the waste. For six months, one side of the latrine is used; the other is covered by a concrete slab. Six months later, ash and sand are added to the chamber filled with solid waste, the chamber is covered with a concrete slab, and the other chamber is used. After six more months, the solid waste mixed with ash and sand can be used to fertilize crops. Then the cycle starts anew.

	Mango saplings grown by ZL's agricultural partner organization, Zanmi Agrikol.

Finally, to fight deforestation directly with reforestation, ZL distributed more than 20,000 soil conservation and fruit tree saplings in the last year. In 2007, ZL began educating communities about deforestation and distributed tens of thousands of conservation and fruit tree saplings. The fruit tree saplings prove especially useful since the fruit can be sold or consumed.

While reversing hundreds of years of environmental problems cannot be quickly remedied, ZL’s projects, and others, are helping to prevent further destruction, as well as supply jobs and food to the communities served by ZL. The medical clinics at ZL know that environmental degradation contributes to the cycle of poverty and disease; these projects help to weaken those links.

[posted July 2009]

	Love's fractured bones healed at a painful angle

By Chris Curry

Eleven-year-old Loveline (“Love”) has never attended school. About six years ago, she fell while crossing the rough terrain near her home in rural Haiti. Having been born with congenital pseudarthrosis of tibia, a disease characterized by abnormal bone formation, the fall was very serious. She broke both of the bones in her lower leg. With such a terrible fracture, her family scrambled to collect money for her treatment and set out for the Dominican Republic to have her leg treated. Unfortunately, on the long journey back home, the rough terrain again played a tragic role—her cast broke. Without a functional cast, the bones eventually healed, but at a painful angle, preventing Love from walking. Or going to school.

	Love one week after surgury in Dallas, Texas

And this is how Love remained until November of 2007, when her family saved the money to travel to the hospital in Cange, operated by PIH’s partner organization in Haiti, Zanmi Lasante (ZL). The doctor took one look at her leg and her x-rays, and knew that the expertise required to fix these long-standing fractures did not yet exist in Haiti.

So he and the ZL team turned to Dr. John Birch of the Texas Scottish Rite Hospital for Children in Dallas. Dr. Birch’s team had the medical experience to do the complex orthopedic surgery and rehabilitation that Love would need, and their hospital made the services available to Love for free.

A team of PIH supporters and their families in Dallas pooled their time and resources, and opened their homes to Loveline, her mother and a Haitian nurse who traveled along to translate and assist in home care. Although Love's mother was scared at the thought of traveling outside of her hometown for the first time, she said, "I know that Love can't stay in the house forever, and if she would be able to walk she would have all the chances and opportunities in the world."

The surgery took place in September of 2008. Love went from a wheelchair and a cast to a walker and brace, and finally to a small plastic ankle brace. Early in 2009 Love was able to go back to Haiti to a wide-eyed and amazed reception—the little girl who had been immobile and confined to her home was now able to walk alongside friends!

Now with the support of Love's new-found friends in Dallas and the support of ZL, she is finally enrolled to start her first year of school in Haiti this fall. Dr. Birch’s team in Texas and ZL doctors in Haiti will continue to monitor her healing leg.

By Ellie Feinglass

	Stella was forced to work as a commercial sex worker until PIH's partners in Malawi helped her find another way to support herself.

Stella's eyes are tired, her face weary and aged beyond its years. She was born in rural Malawi to a poor family of subsistence farmers. At age 11, she went to live with an uncle in hopes that he would support her education. After enduring sexual and psychological abuse, She dropped out of primary school and ran away to Zalewa, a trading center, where she found work as a "waitress" in the Ufulu Night Club and Bottle Shop.* It was there that she began engaging in commercial sex work. She was barely 14 years old at the time. Her life continued to be filled with trauma. Once, she was abandoned in neighboring Mozambique by a truck driver who had hired her for the week. Penniless, alone and terrified, she made her way back to the border, only to be raped by four men in a roadside guesthouse. She ultimately returned to Ufulu--the closest thing to a home that she knew.

Zalewa trading center lies on the edge of rural Neno District. It is situated at the crossroads between Lilongwe and Blantyre, Malawi's two largest cities, and the country's western border with Mozambique. The corridor is a major trucking route for the region and is estimated to house over 1,000 commercial sex workers, the highest concentration in the country. Human trafficking is prevalent both within and beyond national boundaries, and Zimbabwean women now account for nearly half of the commercial sex workers operating in the area.

Poverty and gender inequality are woven into these women's life stories. Few have had the opportunity to pursue an education, which would have given them the skills and means to find other ways to economically support themselves and their families. Nearly all have been bribed or assaulted by the same men who in one moment condemn them and in the next are their regular clients. The language of individual blame and immorality that many, including the women themselves, use to describe those who practice commercial sex work fails to recognize the structural violence that lies at the core of its existence.

The national response to the HIV/AIDS pandemic in Malawi has focused primarily on testing and treatment, with a stated focus on vulnerable populations. However, the needs of this population have been largely neglected--in part a reflection of the stigma attached to the women. Aside from the individual risks of exploitation and violence to which the women themselves are regularly subjected, the public health consequences posed by the commercial sex work industry are dire in a country with one of the highest rates of HIV on the planet.

In January 2008, Abwenzi Pa Za Umoyo (APZU), PIH's partner organization in Neno, began collaborating with Development Aid from People to People (DAPP), an NGO that was operating a health center in Zalewa, to work with a group of commercial sex workers in an effort to strengthen health services and help them find alternative forms of employment. In February of last year, the center hired 15 of the women to work as community health educators in three busy trading centers. The center provided them with ongoing training focused on counseling sex workers and their clients on sexual and reproductive health, making referrals for HIV testing and counseling and, more recently, cervical cancer screening. In the first few months after establishing this partnership, HIV testing at the center increased by over 125 percent. The number of commercial sex workers in the catchment area who have started antiretroviral treatment at PIH-supported sites has also increased substantially.

	Stella at the construction site for the new restaurant co-op, run by former sex workers.

On October 2008, DAPP unexpectedly closed the Zalewa health center citing lack of funding, despite the success of its programs. PIH/APZU stepped in and assumed the salaries of the former DAPP employees, as well as all other operational expenses. In January 2009, the center began offering daily adult literacy training in three sites along the trucking route. The classes were open to all commercial sex workers in the area; 56 women enrolled. In February, APZU held an intensive 7-day training on business management. Based on the training, the participants developed a business plan for opening a restaurant co-operative in Zalewa. Renovations of the building and outdoor dining area are currently underway, and they expect to open for diners next month.

PIH/APZU hopes to develop the Zalewa site as a women's empowerment center that gives commercial sex workers in the region the tools to find safer ways to support their families by addressing the women's medical, social, and educational needs. In addition to strengthening women's health services, including family planning and risk-reductioncounseling, antenatal care, HIV care, prevention of mother-to-child-transmission (PMTCT) of HIV, STI detection and treatment, and cervical cancer screening, the site plans to increase opportunities for adult literacy, vocational training and small-business development. APZU/PIH will also expand the scope of the community education component; by early 2010, the goal is to triple the number of community health workers providing health information in the trading centers along the trucking corridor.

	Stella practicing her new writing skills.

"There has been a tremendous improvement in my life, because this time I am no longer risking my life," says Stella. "When I was doing commercial sex work, I didn't know what might happen that night. It was always my wish to [...] not to have to do that work, but with such poverty, I was desperate and needed cash." One year ago, Stella could not sign or even recognize her own name. She now attends literacy class five afternoons a week, and at 35, she has finally learned to read and write. When Tiyanjane Restaurant opens its doors in a few weeks, Stella will be ready to take orders as a real waitress, notepad in hand.

*Name has been changed.

[posted June 2009]

	Samson Njolomole

Dear Friends,

I'm the supervisor of a clinic that treats HIV/AIDS patients in rural Malawi. The clinic is operated by Partners In Health's sister organization, Abwenzi Pa Za Umoyo (APZU).

Last year, I saw a close friend of mine, a teacher, and I could tell something was wrong. I decided to go to his home and give him information about how to get tested and treated for HIV. He did not want to listen. He thought he had been bewitched and had a bad spell put on him. So I told him my story.
 
Two years ago, I became sick. Malaria, diarrhea, pneumonia, a bloody cough. I lost weight and became very thin. My father encouraged me to go to the hospital in Neno, the rural district where I was born. APZU happens to operate this hospital. There, I tested positive for HIV. When I learned I had the disease, I became very depressed. All that came in my mind is that HIV kills people, I have HIV, I am going to die.
 
But then, the doctor started me on antiretroviral therapy (ART). It was amazing how I became healthy and strong in less than two months!
 
In Malawi, about 15 percent of the population is HIV positive. Over 125,000 people live in the Neno district, and it is believed that as much as half of the population is infected with HIV. Like my teacher friend, many people in Neno know about HIV but they don’t believe that they could ever have it. Many are scared of getting tested. I decided to do something! I started telling people right in my home village that HIV affects many people, urging them to get tested, telling them that it can be treated. I think because many people in Neno saw my change from so sick to so strong, they began to believe that it is possible to live with HIV if they seek care.
 
Today, APZU treats about 2,300 people with ART. But there is still a ton of work to be done. We are embarking on a campaign to increase awareness of HIV, the importance of testing, and the success of ART. We will travel from village to village.
 
But the HIV/AIDS pandemic affects so many more people in the world. We need to increase HIV awareness not only in my village, not only in Malawi, but across the globe. You can help us spread the word. If you use Gmail, Yahoo!, Hotmail, or Microsoft Outlook 2007, adding a simple signature line to your outgoing emails using replyforall will attach information about the importance of stopping global AIDS to the bottom of each email you send. In addition, replyforall will make a donation to PIH’s work each time an email is sent with their signature line.

Please follow the steps to customize the signature line, select the icon for "Stop Global AIDS," and make sure that "Partners In Health" is specified as the organization you wish to promote. Please also consider asking your friends to sign up as well.
 
For the HIV/AIDS epidemic, the question is not how an individual got the disease, but rather, what are we doing about it? We have to start now. Signing up at replyforall is a simple first step.
 
 
Samson Njolomole
ART Clinic Supervisor, APZU, Malawi


P.S. My teacher friend finally got tested for HIV. I went with him. The results were not good. We shared a drink, and I reminded him of my story to give him hope. He started ART in January, and is now healthy and doing just fine!

Amanda Schwartz from PIH's Boston-based development team recently visited Haiti to learn how water affects the lives of the poor.

	Haitian women fetching water.
	Walking through muddy streams to reach a water source.
	Children fill their jugs with water before preparing for the long journey back to their homes.

Sometimes it takes a hurricane to realize the value of a bridge. And other times it’s only a matter of an afternoon rainstorm to understand the potential of a stream. In Haiti, it seems that no matter where you go, the power of water is indeed axiomatic: in clinics, in homes, in hilltops, it is the source both of life and of loss. I learned about the power of water—in raindrops and springs alike—in early May, on a visit to central Haiti with a team from charity: water, an organization that supports PIH’s clean water initiatives in Haiti.

In many of the communities where Zanmi Lasante (ZL) works, community members collect drinking water from natural springs that are near—or in some cases very far—from their homes. Because many of these springs are unprotected, the water that entire communities are living off of becomes a perfect breeding ground for parasites and waterborne diseases. In fact, only 45 percent of people living in Haiti’s rural interior have access to potable water, meaning that over three million poor Haitians are drinking water that is harmful.

In the end, we didn’t learn this story from the children with bellies swollen from parasites (so much so that they propped their water jugs filled with dirty water on them for balance), or from the pregnant woman who had walked over an hour for water twice already when we met her. We learned the story of water when we walked with them—the children with swollen bellies and the pregnant woman—up steep terrain to the unprotected spring where they collect their drinking water.

We walked through the mud and around the trees and over the thorny bushes. And when the rains came, we kept on walking, until our faces were dripping and our clothes were soaked. And when the ground under our feet turned to water, and the floods started tiptoeing past our ankles and our calves and to our knees, we kept on walking. That is what poor Haitians must do when they are thirsty or when they are sick, to get to a spring or to a clinic, and so we walked.

As we walked, I couldn’t help but think about the hurricanes that hit Haiti last year—about how quickly those floodwaters tiptoed over bridges, carrying them away as if they were just twigs and mango peels stuck in the way. And as a rainstorm turned streams to rivers at our feet, I heard the story of water from the young children and weary women walking with us, but also from the water-logged footsteps of our donors, ZL's water engineers, and project managers, who are determined to make water—in raindrops and springs alike—a source of life rather than one of loss

	The Joli twins shortly after birth

Babies born prematurely and underweight rarely survive in rural central Haiti. Could the Jolie twins beat the odds?

Weighing less than two pounds, the tiny baby would have struggled to survive in even the most well-equipped neonatal intensive care unit in Boston. But born on the rural central plataeu of Haiti about a month prematurely, the small infant and her equally tiny twin brother faced grim odds, said Dr. Koji Nakashima, a resident with Boston's Brigham and Women's Hospital who also works with Zanmi Lasante, PIH's partner organization in Haiti.

Being born so early and underweight left the Joli twins without the simple mechanisms for life, wrote Koji in a recent email. "They had no body fat to keep warm, no sugar stores to fuel their bodies, immature nervous systems to coordinate breast feedings, immature skin that allowed vital fluids to evaporate away," he added.

	The Joli twins about 2 months old.
	The Joli twins and their parents.

Luckily for the Joli twins, the Cange pediatric ward and its tireless nursing staff were able to accommodate their early arrival into the world, and their slow and fragile transition to independent life.They were placed in incubators, warmed to maintain a safe body temperature, and humidified to maintain vital body fluids. The began their nutrition through a tube placed from the nose into the stomach every three hours, and slowly over weeks advanced until breastfeeding could give them enough fluid to maintain hydration, sugar to maintain energy, and protein to grow.

"Throughout this time, the twins' mother maintained an equally steady vigil, spending every day of the three weeks, at first pumping her breast milk to nourish her children through feeding tubes, then gently coaxing them to her breast," said Koji.

They were recently deemed healthy enough to go home with their parents after spending two months in the hospital. "They're doing great," said Koji in a follow-up email. "They have gained weight rapidly and their mother says they are voracious eaters."

[posted June 2009]

By Jon Crocker

	Patrick

After suffering a paralyzing injury, all Patrick wanted was "to be taken home to die." PIH's partner organization in Malawi had two weeks convince him otherwise.

“I need to tell you about a patient who needs to come to our hospital in Neno,” said Emmie Kumbikano on a hot morning last October, when she called me on her day off. I was the physician on call in Neno, the district in which Abwenzi Pa Za Umoyo (APZU, Partners In Health’s sister organization in Malawi) is based.

Emmie is a rehabilitation technician working with the APZU-Malawian Ministry of Health team. She had been notified about a patient in Blantyre, the closest sizeable city. A 26-year-old man named Patrick had asked to be discharged from a rehabilitation center – in his words, "to be taken home to die." Originally from the village of Mposadala in the remote mountainous part of Neno district bordering Mozambique, Patrick had moved to Blantyre a few years ago and established himself as an entrepreneur, selling home-cooked treats on the street. Last July, he slipped and fell while carrying a load of sugarcane, seriously injuring his spinal cord. He was left paralyzed for life.

Patrick lay in a hospital bed for weeks, with no available imaging or surgical options. Malawi’s health care system is crippled by a severe shortage of health care workers, and Patrick’s experience at the central hospital reflected this reality. He was only seen perhaps once or twice a week by a clinician. Because of his immobility, he could not feed or clean himself or even change his position in bed. Despite his family’s best intentions to care for him, Patrick rapidly became malnourished and developed severe bed-sores. He was transferred to a rehabilitation hospital where the nursing care was also grossly under-staffed. Patrick’s condition deteriorated. His bedsores became infected and so deep that his bones were exposed in some areas. The nursing staff knew he would likely die soon of sepsis (an overwhelming bacterial infection). Patrick, it seems, sensed this too, and demanded that he be allowed to return to his home village.

When Emmie learned of Patrick’s situation, she decided to use her day off to go and visit him at the rehab hospital. She met a very depressed young man. She tried to convince Patrick to come to Neno District Hospital for care, but he refused--he was tired of hospitals and wanted to die in the comfort of his family. She finally asked him to give the team in Neno just two weeks.  If he still wanted to return home afterwards, she promised to oblige his request. Patrick and his family agreed.

When Patrick arrived in Neno, the severity of his condition immediately became clear. His bedsores were among the deepest we had ever seen. He was feverish, malnourished, weak, and severely depressed. Convincing Patrick within two weeks’ time of the benefits of staying was going to be a challenge.
 
Our team set straight to work. Emmie visited Patrick twice a day to exercise and massage his fingers, hands, arms, legs and feet. She held intensive training sessions with the nurses and with Patrick’s family, teaching them how to reposition him every few hours to avoid worsening his bedsores. The clinical team reviewed the importance of regular dressing changes and placed Patrick on antibiotics, an anti-depressant, and a fortified nutrient diet.

During Patrick’s first week in Neno, Emmie came to me one afternoon. “We need to get him out in the sun. He needs something to pick his mood up.” She procured a wheelchair, padded it with pillows, and from then on took him outside for part of his daily physical therapy sessions. She took him to the local market, where he confided to her that he was scared because people were just staring at him.  She reassured him, told him, “We have to do this,” and wheeled him onto the veranda of a shop and bought him an orange Fanta–“anything to make him feel normal.”

The closest thing to a clinical social work service in Neno, the POSER team was also called upon to assist. The Program on Social and Economic Rights is a group of APZU employees dedicated to providing social support for the most vulnerable and neediest patients. The POSER team conducted a comprehensive assessment, procured new clothes and purchased a portable radio for Patrick to listen to his favorite gospel music and news stations. They also made arrangements for meals for Patrick’s family, given the anticipated length of his stay at the hospital.

After his first week in the hospital, Emmie came to me with promising news: “I got Patrick to smile for the first time today.”

	Patrick and Emmie outside the Neno District Hospital

At the end of two weeks, Patrick told Emmie he would stay on a little longer. His intensive care continued, with Emmie and the clinical and POSER teams constantly looking out for his well-being. Malawi’s hot, dry season was in full swing, so houseflies were ubiquitous and difficult to keep off of Patrick’s seeping dressings. The clinical team procured fly-strip traps and hung them over his hospital bed, and placed a large fan at the foot of his bed to hum over him. Emmie made a deal with him: each day he would tell her one story about something that he noticed or thought about. Arrangements were made for him to be regularly taken to a local APZU community room where he could watch a movie or TV. Every Wednesday he went to a local fledgling library to read the newspaper (someone turning the pages for him). After a few months in hospital, one of the hospital staff suggested Patrick was in need of a haircut, and arranged for this. Patrick established friendships with other patients and the hospital staff. His wounds began to heal. He gained weight. His strength returned, and he began to smile more often.

	Patrick's home village is in a hilly, relatively inaccessible area. His new house is in a nearby village located close to the main road to the hospital.

Today, six months after he first arrived at Neno District Hospital, we are preparing for Patrick’s discharge. Not because he wants to go home to die, but because his sores have healed and he is ready to leave our care. His family members have taken over his daily nursing needs. The POSER team has procured a new bed and mattress for him, and they have seen to the construction of a modest new house near his home village, but much closer and more accessible to the main road to the hospital. A new community health worker, Joyce, has been hired and trained in rehab exercises. She will visit Patrick daily, and will be in touch with the hospital team at a moment’s notice should any problems arise.

Patrick’s rehabilitation is certainly a tribute to his own resiliency and his decision, ultimately, to live. But his recovery and imminent discharge is also a remarkable testament to the collective commitment of the individuals who cared for him. The interventions needed for Patrick’s care did not require excessive sums of money, specialized surgery, exotic medications, or high-tech interventions. Like any of us, what Patrick needed more than anything was the acknowledgment of his humanity, and the care and respect for his dignity as a human being.  He received this in Neno. When PIH’s commitment to do whatever it takes is put into practice, the outcomes are humbling and powerful.

Jon Crocker is a physician working with Abwenzi Pa Za Umoyo, PIH's partner organization in Malawi.

[posted May 2009]

	The front entrance of the new Neno District Hospital.
	Clinicians make the rounds in the pediatric ward of the new Neno District Hospital.

Barely two years after PIH's partner organization Abwenzi Pa Za Umoyo (APZU) arrived and started treating patients, Neno boasts Malawi's newest, full-service district hospital.

In late January, staff from APZU and Malawi's Ministry of Health began moving patients into the new Neno District Hospital. The two-story, brick facility features a pediatric ward and intensive care unit for children with 30 beds; men's and women's wards with 35 beds; a 12-bed TB isolation ward; and a maternity ward with 20 beds.

Other highlights include a spacious, well-equipped laboratory, pharmaceutical warehouses, a blood bank, x-ray services, an emergency room and two operating rooms. The second floor houses offices, a data entry and electronic medical records room, and a conference room.

"It's really thrilling to see," remarked PIH Project Manager Jenna LeMieux, who returned from several weeks of travel to find the hospital had opened while she was away. "It's an enormous two-story building, with high, vaulted ceilings, great light, and terrific ventilation. And we have only one patient per bed, where we used to have two."

The new facility has transformed the experience of going to the hospital for patients and staff alike. "It has really given all of the staff a heightened sense of professionalism," LeMieux said. "We're all excited to come to work. Some of the project cleaners who had been working at the staff housing asked to be transferred to the hospital, even though that means they would have to work longer hours."

	From left to right: Min Jin Lee, Laura Sung A Kim, and Katelyn Boram Lee

By J. Jacob Edel

Earlier this year, high school junior Min Jin Lee and sophomores Katelyn Boram Lee and Laura Sung A Kim, three international students from Korea attending Dana Hall School in Wellesley, Mass., performed and recorded a live benefit concert. The girls plan to donate all of the proceeds to Partners In Health's work in Haiti.

The concert and CD, titled "Music Loving People," features four classics including Bach, Beethoven, Vivaldi and Mozart. So far, the girls said they have sold around two dozen CDs at $7 each, and with the ticket sales from their performance, they have raised $300 and counting.

The girl's aren't stopping there, however. The three teenagers said they are creating a new music club, the Philharmonic Benefit Concert Club at Dana Hall, to put on annual benefit concerts.

"By offering to all students with a passion for music the chance to perform and help others with their talent, we hope to embrace not only the Haitians but also the Dana Hall Community," said Min Jin. "I think the greatest thing about playing music is that I can share my talent and interest with those around me, and that it is another means for me to express myself and reach out to others."

Katelyn, who played the piano amongst the two violinists, said she was worried attendance would be slim, but enjoyed the crowd of friends and teachers that came to support the show.

"I think the girl's deserve a lot of recognition and I encourage them take what they've done and raise some more money," said David Schatz, a parent of a fellow Dana Hall student.

The idea behind the concert, the girls said, was to share their love for music while using their talents to raise money for those in need.

"I think the most fascinating thing about music is that it has a great power to move people's minds and feelings," said Laura Sung A Kim.

[posted April 2009]

	Students participating at a past Urban Walk for Haiti

A three-mile walk through the streets of Cambridge, MA, on April 4 may help change the lives of five families living in some of the poorest communities in the poorest country in the western hemisphere.

Organized by a group of high school students and community activists, the annual Urban Walk for Haiti brings awareness of the dire situation faced by millions of Haitians forced to live with homelessness, hunger pains, HIV/AIDS, malaria, unsanitary water supplies, and other dire circumstances caused by poverty. Since the first walk was held six years ago, the event has raised over $100,000 for PIH projects in Haiti. This year, the organizers hope to raise at least $25,000, or enough to build five houses for impoverished families.

	Poor patients are often forced to live in badly constructed houses.
	A house built by Zanmi Lasante's Program on Social and Economic Rights.

Having a specific goal, like building houses, can help inspire people, says Michelle Levin, one of the organizers of the event. Last fall, four devastating hurricanes battered and flooded Haiti, destroying many houses in the Central Plateau and Artibonite regions, where Zanmi Lasante (PIH’s partner organization in Haiti) currently works. The poorest residents were generally the families hardest hit, as their houses tended to be poorly constructed to start with. Connecting the greater Boston community with the tragedies caused by the floods and giving a face to the Haitian community can help inspire participants to take part in a way to help those who suffered the most, says Levin. In past years, the walk has raised money for education and food projects, as well as electricity and lights for a health clinic.

In addition to raising money and awareness, the Walk for Haiti is also a celebration of PIH’s work in Haiti as well as the Haitian community, says Jennifer Schongalla, a New Hampshire teacher who is helping to organize the walk. The organizers are planning to have a strong presence of the Haitian community at the walk, as well as Haitian food, music, and dancing. PIH Medical Director Joia Mukherjee will also speak at the event. The event will be held on Saturday, April 4, starting at noon at 29 Mt Auburn St. in Cambridge. For more information, please visit http://walkforhaiti.org.

Get ideas for organizing your own event to support social justice, health care, and the work of PIH.

[posted March 2009]

	Dr. Jean Louis Romain

A pediatrician in Haiti shares his story, and the stories of his young patients.

As a boy, Jean Louis Romain spent a lot of time in hospitals with his sickly mother. With his family able to afford to pay for and receive care, he regularly saw his mother take medicine and get better, so he began to enjoy going. “I liked going to the hospital,” he smiles, “and watching the doctors and nurses at work.” He was inspired to become a doctor himself, but as a newly-minted pediatrician, he quickly realized that for many people in his country, going to a hospital was not a happy occasion or an affordable option.

He can tell story after story of the child who died of meningitis because her family could not pay for the medicine needed to treat the infection, or the boy who died because he wasn’t at a hospital equipped to treat an intestinal blockage, or the baby who died because no facility in Haiti could treat his cancer. “We would know what they have—we would diagnose them, and then they would be sent home to die.”

Today, Dr. Romain works as the Chief of Pediatrics at the Zanmi Lasante (PIH’s partner organization in Haiti) hospital in Cange precisely because the organization offered him the opportunity to practice medicine with the supplies, tools, and resources a doctor needs to effectively treat patients—whether they have HIV or severe malnutrition—and regardless of their ability to pay. He now can tell a very different kind of story.

	Patients waiting to be seen by Dr. Romain and his staff in Cange.

There’s a toddler, named Evansly, who’s winning his fight against Wilm’s tumor, a malignant cancer of the kidney. Dr. Romain started the boy on chemotherapy in Cange while PIH arranged transport to Boston (facilities to handle this disease do not exist in Haiti), and found skilled doctors at Massachusetts General Hospital who have the resources to complete the complex treatment regimen for free. Today, Evansly bubbles with energy, running around and babbling up a storm. Dr. Romain smiles as he reflects on the remarkable change in the child.

There’s a baby named Anthony, who recently arrived at the hospital at Cange. Weak and skeletally-thin with a swollen belly, the child was severely malnourished, and had tuberculosis, Dr. Romain recalls. So he immediately started the boy on a course of antibiotics to treat the TB and other infections, as well as nourimanba, a peanut-based enriched therapeutic food. After just eight weeks, the boy looked like a normal, healthy child. “We’re able to save many children that would have been lost at other hospitals (in Haiti),” Dr. Romain says. “We’re able to do our jobs.”

[posted March 2009]

February 27, 2009

Dear Friends and Family,

Stephen Foster, often referred to as “the father of American music,” wrote the song Hard Times Come Again No More in the year 1854. The first verse is a plea to remember the suffering of others:

Let us pause in life's pleasures and count its many tears;
While we all sup sorrow with the poor;
There's a song that will linger forever in our ears;
Oh hard times come again no more.

Hard times have come again to the United States, and to the globe; times as difficult as any, we hear, since the great depression.  The financial crisis has not only brought hard times to many unaccustomed to hardship, but more poignantly, has deepened the daily struggles of the most vulnerable in the U.S. and abroad.  As we reflect on our own problems, it is critical to realize that most of us, affluent people in a rich land, do indeed have many pleasures. I write this appeal to briefly pause in those pleasures and to reflect on the many tears I see in my work.

Most of us who are receiving and reading this letter thankfully do not know the hardship of helplessly watching our children weep from hunger day and night or the hardship of running away from our home as floodwaters rise—forcing us to take refuge with our naked children, in a putrid shelter, for the next three weeks—or the hardship of watching our fourth child die of a treatable disease because we have never had enough money to pay the “modest” twenty-five cent fee for health services.  These struggles bring shame, rage, despondency, and sadly, cannot be fixed by a pill. We must find ways to feel and share these pains—what Foster called supping sorrow and what we call acting in solidarity with the poor.

In 2003, on one of the first trips I made to Haiti with my colleague, Dr. Louise Ivers, we encountered a six-year-old boy who was severely stunted from chronic malnutrition. He had the swollen legs and belly and peeling skin that are all hallmarks of acute deprivation of protein.  He and his mother had come from afar, renting a donkey to seek treatment for his fever.  In addition to malnutrition, he did, in fact, have malaria, which we duly treated when they arrived at the health center. But a few hours later the malaria had a firm grip on the child and he was in a coma. We pumped him full of quinine and sugar to treat the deadly cerebral malaria and sang Kreyol songs to him as we worked.  Miraculously, and to our joyful tears, he suddenly awoke.  The mother seemed as unmoved by his sudden recovery as she had been by the sight of her near dead child. We encouraged her to take her son in an ambulance to our hospital in Cange, where the child could receive a blood transfusion and the best medical care in Haiti. She was withdrawn. We were a bit surprised by her reluctance to bring the child to Cange.  Couldn’t she see?  We had saved his life! We cared about him. It was then that she began to cry softly, saying, “I have other children, they need food, there is no one to watch them, they expect me back.  He is better, yes, thank you. But what will we eat?” And she placed her hand briefly on her stomach and then turned her palm up toward the sky.  With sudden humility and embarrassment we—Louise and I—understood that we were wholly unequipped to really help this child or mother. It wasn’t just malaria, it was malnutrition; it wasn’t a lack of attachment to this child, it was the attachment to many more; it wasn’t a disease, it was misery, pervasive and full of compromises.  At that moment we felt that we could do nothing but to try to feel her pain, to sup sorrow with her.  And, I am afraid, the story does not have a happy ending. The child died at our hospital in Cange two days later from the hard times, from the cauldron of misery that he was born into.

In the face of such pain, I think to myself, what is it that we provided for that child?  Clearly, we save tens of thousands of lives each year. But what of the lives we lose? Is there a lesson in that little boy’s death?  I believe there is.  For me, it is that the struggle for human dignity is fought by remembering that though degrees of suffering are relative, the value of each and every human life is equal, incalculable, and absolute and that there is some absolute quotient of decency that all human beings deserve and cannot live without. Particularly at this time in history, it is important to remember that our own struggles look like luxuries in the eyes of those who live on the catastrophic margin of life.

It is in recounting the saddest stories that I am often asked, “Does what we do matter?”  I always say, resoundingly, “Yes.”  We won’t win every battle. We won’t save every child. But together we can be the standard bearers of human dignity by being present in humility and in solidarity with the world’s most vulnerable individuals, families, and communities. We must remind ourselves daily that the suffering of others is greater than our own and that the suffering PIH sees everyday can be measurably diminished by our generosity, good work, and our willingness to feel the pain of others, even if it unnerves and breaks us.  We become agents of change by ensuring access to food, medicines, school, jobs, housing—the basic needs of a life on earth for those who live without. And we do these things, even in the toughest economic times, as our bellies are full, our homes shelter us, and our other great comforts grant us a resiliency that the poor boy Louise and I cared for never knew in his short life. 

It is refreshing to pause and to imagine a world in which our worth as human beings is measured not by material wealth but by our commitment and attachments to the humanity of others.  It is my earnest hope that in pursuing our common goal of creating a preferential option for the poor, we are making this world a better place for all.
I ask you, in memory of those we have lost and in honor of those we have saved, to consider making a gift to Partners In Health during these hard times—every donation makes a difference.

In solidarity,

Joia Mukherjee, MD, MPH
Chief Medical Officer

Following the election of Barack Obama as the 44th President of the United States, a coalition of organizations dedicated to global health equity, including Partners In Health, came together to prepare recommendations for steps the new Administration and new Congress could take to seize "a unique opportunity to redefine foreign aid policy to help those most impoverished and to save lives."

Click here to download a summary of the recommendations, or here for a copy of the coalition's full report.

Partners In Health and Institute for Justice and Democracy in Haiti present

Change Haiti Can Believe In

with Matt Damon, Paul Farmer, Linda Dorcena Forry,
and Brian Concannon, Jr.
moderated by Amy Goodman

Paul Farmer, co-founder of Partners In Health; actor and activist Matt Damon, who recently visited Haiti to assist victims devastated by hurricanes; Massachusetts State Representative and Haitian American Linda Dorcena Forry; and Brian Concannon, Jr., director of the Institute for Justice and Democracy in Haiti, shared their stories of eradicating disease and injustice in one of the world's poorest nations, and discussed how changes in U.S. policy can help to build strength and prosperity. Amy Goodman, host of Democracy Now!, moderated. The event took place on January 27, 2009 at the John F. Kennedy Library in Boston, MA.

Visit the Health and Human Rights Prison Project page to learn about the joint work of Partners In Health and the Institute for Justice and Democracy in Haiti.

[posted January 2009]

By Max Bearak

Almost three decades after the emerging AIDS pandemic became widely recognized, staff and community members at Partners In Health sites in Lesotho, Rwanda, Haiti and Peru celebrated the achievements they and others have made in combating the spread and deadliness of the disease. December 1 was the twentieth annual observance of World AIDS Day, which is dedicated to raising awareness and mobilizing action to fight a disease that has killed more than 25 million people and infected more than 33 million people currently living with HIV. Despite greater awareness and scientific breakthroughs in AIDS treatment, HIV/AIDS still poses a major obstacle to improving public health and reducing poverty levels, especially in the developing world. The events at PIH sites stressed not only how far the fight against AIDS has come, but how far it still has to go.

In Haiti—contests for radio listeners and poets
help spread the word about HIV

	World AIDS Day event in Lascahobas

Zanmi Lasante (ZL – PIH's partner organization in Haiti) has been organizing World AIDS Day events for many years. For 2008, ZL tried out some new and innovative ideas to get the public involved in AIDS treatment and awareness. In the week leading up to World AIDS Day, for example, radio listeners in Thomonde could win prizes by calling the station and answering questions about HIV/AIDS and health concerns in general. ZL clinical staff organized and judged a poetry contest for young people, focused on writing related to HIV. A soccer tournament was held and condoms were distributed after the match.

On World AIDS Day itself, December 1, ZL organized films, theatre productions, school assemblies, field day games, and dance competitions all across the central plateau and the lower Artibonite valley. These events brought the communities they were held in together for an entertaining day that was infused with information and tips on health issues. It is also important to note that in the week leading up to World AIDS Day and also on the day itself, voluntary counseling and testing (VCT) was administered at regional secondary schools and in mobile clinics. Over 1000 people were tested, including the winner of the poetry contest.

In Rwanda—songs, speeches and a forum for youth

PIH's Rwandan partners Inshuti Mu Buzima (IMB) joined local communities in southern Kayonza district to mark World AIDS Day with songs, speeches and testimonies, along with the Elizabeth Glasser Pediatric AIDS Foundation (EGPAF) and the Adventist Development Relief Agency (ADRA). Hundreds of people attended the celebration at Rwinkwavu Stadium. Speaking on behalf of Rwinkwavu’s mayor, Mr. Ntabyera Emmanuel thanked IMB for their work and urged the audience to get tested for HIV and to persuade other community members to do so with the goal of having all 5,000 families living in the area tested by this January. Other speeches highlighted HIV Voluntary Counseling and Testing (VCT) for couples as one of the most important ways of combating AIDS, along with family planning and education of youth. At the end of the ceremony, 22 young girls and boys who had been trained for six months through PIH vocational training programs were given certificates and materials to help them start projects that will provide jobs and income.

	Young people practice traditional dance in a Youth Forum workshop

In collaboration with FACE AIDS, IMB also held a three-day World AIDS Day Youth Forum, complete with workshops and speeches by local community leaders. Professional counselors also attended and conducted sessions with the attendees. The workshops were aimed at students, with the message that the impact of AIDS should not limit their ability to become bright, capable leaders with broad futures. Attendees participated in numerous activities designed both to provide valuable information and to foster self-esteem, including creative workshops on traditional and popular dance, film, painting, and theater. The were encouraged to set social, economic and educational goals, and were given tips on health, nutrition, sexuality and prevention of sexually transmitted diseases. To close the forum, a popular local singer, Miss Jojo, gave a rousing song and dance performance.

In Lesotho—mountain community celebrates progress
and honors departing doctor

World AIDS Day celebrations at the Nohana clinic in Lesotho coincided with the departure of Dr. Jonas Rigodon, the clinic’s head physician. Dr. Rigodon, who brought his medical skills and commitment to social justice from the central plateau of Haiti to the mountains of Lesotho, is leaving to assume new responsibilities with PIH's project in Malawi. Representatives of local Chief Mantha, village health workers (VHWs), patient representatives and members of the ministry of health came together to express thanks to Dr. Rigodon while also making speeches full of encouraging messages about World AIDS Day and Lesotho’s AIDS crisis.

Dr. Rigodon pointed out in his speech that only two more years remain to reach the global goal of providing universal access to comprehensive prevention, treatment, care, and support by the year 2010. In Nohana, a great deal of progress has been made since the clinic was opened in 2006. Over 6000 people have received HIV testing counseling; over 2000 people have been found positive; and more than 1000 are now receiving anti-retroviral treatment.

"I asked you to do something symbolic during last year's event," Dr Rigodon recalled. "I asked you to shake hands with the person next to you and to tell him or her to start his or her leadership now - in their family and in the community. Now it is time to deliver. The promise must be kept and people must feel empowered to act."

In Peru—informational displays and handicraft sales

Socios En Salud (SES – PIH's partner organization in Peru) took part in an informational health fair on HIV and AIDS organized by the Peruvian Ministry of Health and other health organizations. More than 50 public and private organizations participated in the event which asserted in its slogan, “You can Prevent HIV! Stay Informed! Get Tested!” The event also commemorated 25 years since the first diagnosed case of the disease in Perú.

	SES's booth at the World AIDS Day Fair featured handicrafts made by patients

Socios En Salud's booth at the fair offered informational materials on their work with HIV/AIDS affected families, as well as handicrafts made by patients and accompanying personal narratives. The SES booth attracted a wide range of visitors, including officials from the Ministry of Health and other health organizations, journalists, doctors and health workers, and students. Some stopped by the booth to praise SES staff for success in increasing enrollment in treatment programs and in early identification of affected children. Others came seeking community outreach materials based on the SES experience. The team counseled one teenage girl on HIV symptoms and where to get treatment after she approached them in tears about a history of sexual abuse.

[published December 2008]

The miraculous story of Karabelo Fanka

By Theonevus Tinashe Chinyanga, PIH Lesotho

	Karabelo was bedridden upon arriving at the Bobete Health Center in Lesotho.

At 5 years old, Karabelo weighed about as much as a normal nine-month-old baby. At 3’8’’ tall, the boy weighed less than 18 pounds. His body was composed of skin attached directly to bone, no muscles. His skin had been cut and pierced by various traditional healers. He was bedridden and could not talk.

Karabelo’s mother, Makhahliso, is a widow. She worked as a house maid in the small township about 30miles away, leaving Karabelo and his little brother under the care of their elderly paternal grandparents (who would have been living in a nursing home, were they in the first world). Karabelo’s grandpa had spent most of his life working in the mines in neighboring South Africa and soon fell ill with excessive coughing, weight loss and drenching night sweats. Several consultations with traditional healers ensued and all pointed to the need of making a feast to appease the ancestors since they were angry that he had spent most of his life away from them in South Africa. He eventually died in early 2007, while they were still preparing for the ceremony.

In October 2007, Karabelo fell ill, with the same symptoms as his grandpa. Traditional healers were quick to point out that the ancestors were punishing him for the sins and arrogance of his late grandpa who did not make a feast to appease them. The feast had to include slaughtering a cow. The family had no animals, and this crucial requirement for the ceremony would cost about $350. Makhahliso’s monthly salary amounted to about $20. To raise money for a cow, she would have work for one and half years without spending a cent on anything for the rest of her family, not even for food.

Last January, a community health worker in Makhahliso’s village convinced her to bring her sick, unconscious son to the Bobete Health Center, a clinic operated by PIH’s partner organization in Lesotho, despite disapproval from her family and the traditional healers. At the clinic, it did not take a rocket scientist to diagnosis the child with malnutrition.  We also inferred that Karabelo’s grandpa had died from tuberculosis, and thus Karabelo had probably contracted the disease from him as well.

But treatment for the boy was much more complicated than making the diagnosis. We started carefully rehydrating him, and had to put a tube from his nose through to the stomach so that we can push in life saving tuberculosis tablets and. We also found that the boy had fluid around his heart, which is fatal if not drained. Removing this fluid is normally performed with complicated equipment in the U.S. PIHL’s Dr. Jen Furin was forced to do it using only a syringe and needle.

Days turned into weeks, and weeks into months, Karabelo remained unconscious. Every member of the team at Bobete was worked hard to ensure his survival. He was resuscitated countless times a day. Towards the end of the second month, he finally began to improve. He no longer needed the feeding tube, but still was not able to talk, sit or move his limbs. The sensible medical explanation was that he had suffered massive brain damage from tuberculosis which would make him dependent on others for everything; he would be a paraplegic child for life. It seemed all we had done was to delay death by creating another big problem for the mother. Would it have been better for him to die?

	Karabelo exploring a possible career option at a recent visit to the Bobete Health Center

Like Karabelo, many children in rural Lesotho live in extreme poverty. However, thanks to PIH’s long list of sponsors and partners who bring the requisite equipment, supplies, food, and medications, we have the tools we need to treat them—sometimes with delayed, but nonetheless astonishing results.

This September, I was busy in the consultation room when l heard a light knock on the door. When l opened the door, it was Karabelo! He was standing there by himself leaning on a stick and he said to me, “Look Dr Tinashe, I can now walk!”  He wanted me to know that the team’s effort was not in vain. Physical therapy devised by the clinic staff and carried out by his mother had helped him regain his mobility. He weighed almost 40 pounds, thanks to a partnership with the World Food Program, which supplied him with food rations to complement his medical treatment for TB.

Karabelo has conquered two diseases responsible for death of many children in Sub Saharan Africa: malnutrition and tuberculosis. His survival and progress continues to defy basic medical principles and reasoning. Today, his caregivers spend most of their time chasing him, as he often attempts to come back to the clinic just to visit. Makhahliso has since joined our clinic as a general hand, earning a decent salary. Their lives will never be the same again. In my life as a medical doctor, I have seen many near-death situations but Karabelo’s survival will linger in my mind for as long as l live.

[posted November 2008]

	Mary Chichera
	Mary (right) carefully measures and cuts material for a shirt.

Tucked in the southern corner of Malawi not far from the Mozambique border is a small house literally filled with children. A dozen of them, ranging in age from 6 to 17, live here along with their mother, Mary Chichera.

A tiny but feisty woman with dancing eyes and a warm smile, Mary cares for all of them by herself—six are her own children, six are orphans who lost their parents to the village’s AIDS epidemic (one local leader estimated over 600 AIDS orphans in this village alone). A disease that disproportionately affects the poor, HIV/AIDS can also trap those living with the disease with the burden of poverty—both those infected by HIV, as well as those caring for a patient or a child orphaned by the disease.

It’s easy to supply each of the kids with love and attention, said Mary. “It’s a very hard life trying to support all the children and get them enough food, blankets, paraffin, school materials, and everything,” she said. “This makes many heartbreaking situations.” For example, one of her children was accepted into a prestigious private school—an opportunity to escape poverty. Pausing to wipe her eyes, Mary explained how she was forced to choose between this promising future for her child, or food for the rest of her children.

PIH’s partner organization in Malawi, APZU (Abwenzi Pa Za Umoyo) is working to eliminate these kinds of difficult choices faced by those affected by HIV. APZU’s Program for Social and Economic Rights (POSER) initiates programs that directly address poverty, which is often a root cause of diseases like AIDS.

	The POSER team helped procure sewing machines for the co-op to share.
	Some examples of the clothing tailored by the women in the co-op.

Partnering with a local community based organization (CBO) called Chiyanjano, POSER has helped create a clothes-making co-op for women who are either living with HIV themselves, or are caring for HIV patients or orphans. With training from experienced tailors, supplies, cloth, and sewing machines donated by POSER, Mary explained how 30 of her neighbors are now working together to sew clothes. She glowed with pride as she showed off some of their products—brightly colored dresses, shirts, and jackets. These products are then either given to AIDS patients and orphans struggling with poverty, or sold in the market to provide an income to help Mary and the other women support their families.

POSER has also commissioned the co-op to produce an order of school uniforms for poor students in the district, as well as uniforms for APZU staff and curtains for the local hospital. Edwin and his team plan to help the women sell their products overseas in the US and the UK in the near future.

“We are really being empowered,” Mary said with a smile.

“Due to the growing number of HIV patients and orphans, we were so desperate,” added Ezra Dzomodva, the director of Chinyanjano. “And then [POSER] came to our rescue.”

In addition to Chiyanjano, POSER has partnered with five other CBOs throughout the Neno district to implement income generation programs and vocational training, childcare centers, community gardens, and support groups for people living with HIV/AIDS. By coupling these programs with the local health centers supported by APZU, POSER hopes to attack HIV and other diseases of the poor medically as well as economically.

[posted November 2008]

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 like hypertension and coronary heart disease has become a major priority, especially for a country like the United States, where an estimated 21 million people have diabetes, or about seven percent of the total population. PACT hopes that their new initiative, which will provide services to about 50 patients in a pilot study, will eventually show that the accompagnateur model can be successfully used to improve treatment of diabetes.

The new project will target high-risk diabetes patients, many of whom suffer from other conditions that increase the risk of treatment failure, such as obesity, mental health issues, and poverty. Many of these patients have also failed to stay with treatments in other programs. The initiative is partnering with the Codman Square Health Center and the Dorchester House Multi-Service Center, which serve three of the four neighborhoods with the highest rates of diabetes-related deaths in the Boston area—Mattapan, Dorchester, and Roxbury.

Like PACT’s HIV/AIDS program, accompagnateurs in the new diabetes project will visit about 90 patients in their homes and deliver medical services, social support, and education on diabetes, nutrition, and exercise. The project will also work to improve access to affordable healthy foods and exercise opportunities in the community, and help the health center provide more activities for their diabetic patients (such as exercise groups and snack clubs). A control group will receive standard care at their health center.

“Ultimately we hope not only to positively impact those patients in the program and study, but also to contribute data to local and national movements to improve the working conditions of CHW’s and the sustainability of CHW based programming,” writes Leah Jacobs, the project’s coordinator.

[posted November 2008]

Recent storms add to tragedy in Haiti

By Evan Lyon, PIH Physician, Haiti

Working for the past decade in Haiti has required a constant eye to the weather – to the political climate inside Haiti, toward the shifting tides of international politics and global finance, and, of course, a nervous eye to the Atlantic Ocean during hurricane season. 

	A major bridge in Mirebalais was destroyed in the floods

I flew into Port-au-Prince soon after Hurricane Ike struck, the fourth named storm to hit the island in less than three weeks.  News reports were terrifying; perhaps a thousand dead and over a million left homeless. 

Starting up the road to Mirebalais and Hinche in the Central Plateau of Haiti, where PIH’s partner organization Zanmi Lasante (ZL) supports several hospitals, our driver told me what he’d seen—bridges washed away in Mirebalais, and many homes destroyed.  But what clearly shocked him was the flooding in Hinche, which is in an upper region of the Central Plateau.  He had lived his whole life there, and in his 40 years there had never been flooding near Hinche. After the recent storms, many parts were submerged in water and mud. This is literally an unprecedented disaster.

Arriving in Mirebalais after dark, we visited a shelter housing about 300 people.  I heard the same story, over and over, “The water rose so fast.  We lost everything.  Our crops are ruined.” 

	People fleeing down a flooded road from Gonaïves towards Saint Marc
	4-day-old Juliapson Vilicius and his mother at a shelter

Heading to the coast with ZL staff a few days later, we saw the devastated coastal city of Gonaïves and the broad, agriculturally-vital Artibonite valley, extending to Saint Marc in the south. Nearly a week after the last rains, and much of this region was still underwater.

Through the past years of caring for poor people, working in solidarity with the sick and the suffering, in rural and urban places, from mountain-top mobile clinics to the dense confines of prison, I have never felt such intense and deep misery.  The air was charged by trauma and seemed ready to explode. Hundreds were still streaming out of Gonaïves on foot through waist-deep water.  Many ended up in Saint Marc, where ZL now helps administer and staff the main public hospital.

In one of the shelters in Saint Marc, I met someone who has become, for me, the human face of this unnatural disaster: 4-day-old Juliapson Vilicius.  His mother and three other children were forced to leave Gonaïves after their home was destroyed.  During the evacuation, his mother went into labor, and Juliapson was born on the side of the road. He is one of 10 infants in this shelter, one of many hundreds of thousands of people around the country left homeless by the floods. All face an uncertain future, and more bad weather is looming in the horizon—from political, economic and meteorological storms. 

[posted October 2008]

By Ermaze Louis Pierre, Head Social Worker, Zanmi Lasante Hinche

	Ermaze Louis Pierre

It was 4 in the morning on September 3 when one of the assistant social workers called me to tell me that the city of Hinche was flooded. The first thing that ran through my mind was to get up and go search for our HIV patients, because the majority of our patients do not have the ability to live in a sturdy, nice house.

Instead, they are obliged to live in the crowded zones that we call “cite yo” (slums), because this is where they can find a room or a house that they can afford, as the only funds they have are the rental assistance we provide through our social support program.

When we arrived at the part of the city where the water was, all we could see were the roofs of homes under all of the water. With water levels reaching our chests, we began searching for all of our HIV patients and their families. Thankfully, all had had time to leave their homes, but they did not have time to save any of their belongings. The water took with it everything that they owned, including many houses. We quickly located everyone and placed them in a shelter that we organized through Zanmi Lasante (ZL, PIH’s partner organization in Haiti) to assure all patients would be able to continue taking their medicines. In the shelter, we also provided patients and their families with mattresses, warm cooked meals, clean water, soap, and clothes.

	Zanmi Lasante social worker in search of patients
	Shelters served hot meals
	ZL staff preparing resettlement packages for patients
	Assembly of resettlement packages for patients

What really made me sad and upset was to see that these people were already facing a lot of difficulty (socioeconomic as well as medical) before becoming victims of the floods.

Since the flooding, our social work team has been accompanying our patients, even after the closing of the shelters, to make sure that we are doing whatever we can to help them get back on their feet. We have many who completely lost their homes, and even more who cannot return to their rental homes as they are not healthy to stay in. Many of our patients have asked for us to put a small support group together for them to help them cope with post-traumatic stress that they are facing.

With the money we have received from our generous supporters, we have prepared resettlement kits (mattresses, clothes, food, kitchen utensils, pots and pans, a stove, buckets and water purification solution) for the families of 91 patients and the 12 ZL staff who lost their homes. Our next step is to move those who have completely lost their homes or are in rental homes in bad locations to new homes, and to begin to repair those homes that can be fixed.

The only hope that most of these patients have is the ZL team who are always there with them for their medical as well as social needs. In Hinche, there are approximately 1200 families who have lost their homes, animals, or farms. This emergency situation has made us double our efforts, working morning, noon, and night to help our patients, and anyone else affected by the floods. But this does not discourage us at all because our mission is to help those in the most need and in the hardest situations.

Right now I feel happy knowing that we have helped patients start to return to their normal lives, little by little. I would like to say thank you to everyone who, in one way or another, has helped us to quickly respond to this devastating time we are now facing in Haiti. I hope that you will not become discouraged and keep us in your thoughts and prayers.

Kenbe fem! (Stay strong!)

[posted October 2008]

By Sarah Marsh

	Flooded houses in Hinche

In crises like the recent storms, it is the reaction that defines individuals and organizations. Two staff members from Zanmi Lasante (ZL) were among the many who sprang into action when the floodwaters reached the upper central plateau of Haiti.

ZL driver Jean Benoit Isaac ("Ti Ben") and Fritz Germain, an HIV and STI prevention educator, both work with ZL in Hinche, an area shockingly devastated by the floods—neighborhoods and houses entirely under water—with the peaks of roofs and tops of corn stalks all that could be seen. In recent living memory, Hinche had never experienced flooding, so no one was prepared, or even could have imagined, the level of destruction it would bring.

At 4:00 on Wednesday morning, Ti Ben and Fritz learned about flooding in Hinche. Needing little direction, they commandeered a ZL car and started out towards the low-lying areas. They found and shuttled the exhausted, wet and shell-shocked flood victims to places of safety. They identified the need for food, clean water and organization, and placed orders in various restaurants around town, leaving IOUs in their wake: 500 sandwiches, spaghetti for 200, rice and beans, 800 bottles of juice, hundreds of sachets and bottles of purified water. 

By Wednesday afternoon, they were gathering food orders, throwing boxes of bottled liquids on the roof rack of the truck, and then unloading the supplies. They made countless trips. They worked like machines. Neither had stopped all day. Neither had eaten. 

Ti Ben is not from Hinche, but from Port-au-Prince, where his wife and young son live. The day before the Hinche flooding, his own home in the flats of Port-au-Prince had been entirely flooded. His family was safe but like many Hinche residents, he too had lost everything. When asked about his family and home and his plans to return to Port-au-Prince, he looked incredulous.  “What’s done is done there and I know they are safe – that’s what matters. The

Above: Fritz Germain, Zanmi Lasante HIV and STI prevention educator  Left: Zanmi Lasante driver Jean Benoit Isaac  ("Ti Ben")

roads are blocked but even so they need me here. I can’t leave. These people need to eat. Mothers and babies need clothes. This is my work now.”

At the first shelter, an empty school building, volunteers wearing helmets from a local relief organization were attempting to keep order and direct the throngs of hungry people streaming in. A crowed massed around the ZL truck, a cacophony of voices asking for help, food, water, answers. Ti Ben jumped out of the car, and quickly began injecting order into the chaos. He explained to people why they had come, what they had to offer, and how it needed to proceed. Order quickly came and distribution began. Small sandwiches to young children; biggest to nursing mothers. Bottles of water to young children; sachets to everyone else. 

Fritz bringing order to food distribution efforts

That was the first of many stops followed by more food pick-ups and more deliveries. The sun set, twilight passed and true night fell. But they kept going. Over 500 people had been fed in a few hours because of them. At dawn, they would wake up and to do it all again.

[posted October 2008]

We could only stand and watch as powerful storms swept over Haiti, bringing an unimaginable level of suffering. But now we have the power to act and save thousands of lives. Help us spread the word!

The poorest country in the western hemisphere was recently hammered by four hurricanes in devastating succession. Catastrophic floods and mudslides in the wake of the storms killed more than a thousand people and destroyed the homes, crops, and even entire villages.  Thousands of poor families who had little before are now left with nothing.

The floodwaters have receded, but countless pools of stagnant water still remain—the perfect breeding ground for mosquitoes and an imminent public health disaster—a massive outbreak of malaria.

Help save thousands of lives by joining with the nonprofit organization Partners In Health (PIH) to buy and distribute insecticide-treated bednets to those most at risk for contracting malaria. These bednets have been proven to be a cheap and effective way to protect against malaria and save lives. Each net costs only $5!

At PIH, we have set a goal to raise the funds needed to buy 10,000 nets. This is an ambitious goal. But it can be achieved with your help. Please consider donating what you can to buy one, two, three, or more nets. THEN SEND THIS MESSAGE TO EVERYONE YOU KNOW. As one Haitian proverb says, men anpil chay pa lou, or "many hands make the load lighter." Together we can save thousands of lives.

1 Net at $5
5 Nets at $25
10 Nets at $50
50 Nets at $250

Please donate one, five, or ten bednets 

Forward a message about this challenge to your friends

Join this cause on Facebook 

Information and resources for fundraising in your school, church, or other community groups

Read more about PIH's work to help those affected by the hurricanes 

[posted October 2008]

Partners In Health will hold its 15th annual Thomas J. White Symposium on Saturday, October 4, in Cambridge, MA. The yearly event brings together PIH staff, family, friends and fellow activists and advocates for health and social justice for the poor.

The theme of Symposium 2008 is "Pushing the Boundaries: past, present and future." The program features speakers from PIH partner projects from around the world, including PIH co-founders Paul Farmer and Ophelia Dahl.

Symposium details

Date: Saturday, Oct. 4

Time: 3:00-5:00 pm

Location: Sanders Theatre
Memorial Hall
45 Quincy Street
Cambridge, MA 02138

Admission to the Symposium is free and open to the public. But seating is limited and will be restricted to ticketholders.

Tickets will be available on a first-come, first-served basis starting Septenber 19 at the Harvard Box Office. They may be reserved by phone (617-496-2222) or at the box office (1350 Mass. Ave., Cambridge). Ticket limits and handling fees may apply. Some tickets may be released on the day of the event, but please keep in mind that space is limited.

Forward an invitation to a friend

We will be posting the video on our website after the event. Please stay tuned for more information.

[published October 2008]

By Liz Bird, PIH Malawi

	One of the children recruited to help distribute bednets in the Neno District of Malawi.

Splashes of brilliant blue recently brightened the brown dirt roads and narrow muddy footpaths throughout Malawi’s Neno district as part of an effort to curb the area’s malaria epidemic.

Last month, PIH’s partner organization in Malawi, Abwenzi Pa Za Umoyo’s (APZU), worked with the Malawian Ministry of Health to launch a campaign to distribute over 26,000 insecticide-treated mosquito nets (ITNs) to the households with individuals at most risk of contracting the disease. With thousands of nets to transport, APZU’s network of community health workers (CHWs) quickly got to work loading their bikes, arms, heads, and chitenjes (the colorful wraps worn by women) with ITNs wrapped in bright blue plastic to carry back to their villages. They recruited friends and neighbors to help transport the nets, and even handed off one load to a small army of school children on their way home for lunch.

Last year in Neno District, which has an estimated population of around 140,000 people, more than 52,000 cases of malaria were reported. Malaria was responsible for hundreds of deaths – most of them children – and malaria is the most common diagnosis in the outpatient clinics. The disease also contributed to many missed days of school.

Community health worker assesses the number of bednets needed in her village.
Community health worker carrying bednets back to her village.
Health worker distributing bednets.
A family can now sleep under their new bednet, protected from mosquitoes.

As the species of mosquito that carries malaria is most active at night and tends to bite people as they sleep, ITNs have been proven as a safe, effective, low-cost way of protecting against bites from malaria mosquitoes, thus preventing the disease.

Because the malaria is most dangerous for children under five, pregnant women, and people living with HIV and AIDS, the campaign targeted these individuals. To do this efficiently, CHWs visited every household in their community, assessing the number of people at risk, as well as the presence and conditions of nets already owned by families. Examining sleeping arrangements, the CHWs determined how many ITNs each house needed. Each CHW returned to their health center on an appointed day to review their survey results with the APZU team, and to collect the number of nets required to cover all vulnerable members in their communities.

In addition to the CHW distribution chain, the several of the health centers in the district were also provided with an ample supply of nets, to be distributed during regular activities organized by the pediatric clinics, antenatal clinics, immunization outreach activities, HIV testing activities, and HIV clinics.

In 2007 in Neno District, the Malawi Ministry of Health (MOH) distributed over 6,000 nets, targeting only children under five and pregnant women. In 2008, the MOH was given 8,500 nets as part of a national emergency distribution plan, which occurred in late July and August. However, the estimated population at risk for severe malaria in Neno, including children under five, pregnant mothers, and those living with HIV and AIDS, is more than 50,000. Furthermore, many people live far from the clinics and distribution hubs, leaving many communities in the district without any protection from malaria.

Luckily, the Against Malaria Foundation and Together Against Malaria stepped in to generously donate about 26,000 ITNs. By the end of this campaign, APZU community health workers and the MOH will have distributed over 34,000 ITNs in 2008.

The campaign’s work is already apparent. In Neno, it is common to see young children using the bright blue bags that once held nets as school bags. In addition, scores of patients coming to Neno District Hospital for care are proudly presenting their health passports with the “Neno District Malaria Program ITN Given” sticker inside.

As Malawi’s rainy season begins next month, the APZU team hopes to begin seeing clinical results from the campaign. The rains will bring countless pools of standing water, the perfect breeding grounds for malaria mosquitoes. But armed with the ITNs, APZU hopes that families will be well-protected against the onslaught of hungry mosquitoes—and APZU clinics will see far fewer cases of the deadly disease.

[posted October 2008]

	Five former orphans wave good-bye to their new mother before heading to school.

The little girl's name literally meant "Help me" in Sesotho, and it was clear to Dr. Hind Satti of PIH's partner organization in Lesotho that she and her two younger sisters needed help.

"It was painful to see them, the wind was so freezing, they were so hungry... [Their clothes] hardly covered their little bodies," Hind recalled.

Unfortunately, the situation of these three girls is far from unique. The pandemics of HIV/AIDS and multi-drug resistant tuberculosis (MDR-TB) threaten to wipe out a generation of adults across Africa, orphaning millions of children in the process. In the small, mountainous country of Lesotho, some estimates say that up to 30% of children under the age of 14 are orphans.

The three girls, who range in age from 10 to 6 years old, lost their mother to tuberculosis. With no one to care for them, the sisters were forced to beg for food in their village, carrying their 9-month-old baby brother on their backs. Sadly, the baby passed away soon after their mother.

 Hind's co-workers could not turn their backs on these girls when they turned up at one of the rural health centers operated by PIH Lesotho (PIHL). And so the House of Hope, a safe home for orphans, was founded in August in the capital city of Lesotho.

One of PIHL's housekeepers, a kind-hearted grandmother named M'e Leomile, agreed to serve as a mother to the girls.  Two other children, a 5 and 6-year-old brother and sister, also joined the little family after their father passed away from advanced cases of both HIV and MDR-TB. The father had initially refused to be treated for the diseases, only agreeing after PIHL staff had promised to help care for the children while he was on the intensive drug regimen, and as his condition grew worse, they promised to look after the children after his death. The promise was kept.

The children with their new mother in their new home

PIHL staff obtained birth certificates and legal documents for all  the children, procured a house for them to live in (along with M'e Lemile), and ensures that they are fed, provided with any needed medical care, grief counseling, and psychosocial support. PIHL is also helping the children attend school, which will give them the skills they need to support themselves when they become adults.
 
The children quickly took to M'e Leomile, as well as each other, says Hind. They already consider themselves a family, calling M'e Leomile "Mama" and referring to each other as brother and sister, she added.

PIHL already has other orphans on the list to join the program - three are currently MDR-TB patients receiving treatment for the disease. As soon as they are not contagious, they will join the others. PIHL is also hoping to start another House of Hope nearby.

Watch a video featuring the children of House of Hope on the player below:

[posted October 2008]

In recognition of its success in combating MDR-TB and other global health issues, Socios En Salud (PIH's partner organization in Peru) recently accepted two distinguished awards.

	Dr. Jaime Bayona, founding director of Socios En Salud (center), with Dr. Anany Gretchko Prosper of Zanmi Lasante and Paul Zintl of PIH, holding the Kochon prize certificate awarded to SES

The Carso Institute, which funds organizations in the Latin American and Caribbean region who are effectively enhancing the well-being of the population and building leaders in these fields named SES an “exceptional institution” and presented the award to SES founder and executive director Jaime Bayona on behalf of the organization on September 8th in Mexico City.

The Stop TB Partnership and Kochon Foundation also recognized SES’s contribution to global health care by awarding it the Kochon prize. The award is bestowed annually to leaders in the fight against tuberculosis. Jaime Bayona accepted the honor on behalf of Socios En Salud on October 17th at the opening ceremony of the World Conference of the International Union Against Tuberculosis and Lung Disease in Paris.

[published October 2008]

Partners In Health held its 15th annual Thomas J. White Symposium on Saturday, October 4, in Cambridge, MA. The yearly event brought together PIH staff, family, friends and fellow activists and advocates for health and social justice for the poor.

The theme this year was “Pushing Boundaries: past, present, and future.” The program featured a panel of HIV patients who shared their stories of being provided with life-saving antiretroviral drugs by PIH’s partner organization in Haiti, Zanmi Lasante. Another panel featured activists who have used the PIH model and philosophy of social justice to create their own programs to provide healthcare to the poor and inspire the next generation of social justice activists. PIH co-founders Paul Farmer and Ophelia Dahl were also featured speakers.

By Tom Spoth

	A medical worker practices riding a new Honda CTX200 motorcycle at a recent training in Lesotho.

In Lesotho, it’s difficult to get around. Villages in the mountain kingdom are sometimes accessible only by single-engine propeller aircraft or on horseback.

Lesotho experiences extreme weather: floods, snowstorms, and high winds. There are often no roads in rural areas and patients must walk hours to clinics, which is extremely difficult for the critically ill. Transporting patients and medical supplies is often an ordeal.

Since arriving in Lesotho in 2006, Partners In Health's partner organization in Lesotho (PIHL) has grappled with the problem of moving people and things. PIHL formed partnerships with the Lesotho Flying Doctors Service and Mission Aviation Fellowship to facilitate air transport. Now, PIHL is adding motorcycles to the mix through a new arrangement with the nonprofit Riders for Health.

Riders for Health is sending 120 ultra-rugged motorcycles to Lesotho. The Honda CTX200 is a special, no-frills bike made for the outback ranchers of Australia. The machines have features such as enclosed chains and handlebar protectors that make them ideal for the harsh conditions of Africa.

So far, Riders for Health has delivered nine motorcycles for use by PIHL staff, eight of whom have been trained to ride the bikes. The vehicles are expected to greatly enhance health-care delivery, allowing health workers to regularly and reliably visit communities previously inaccessible except on foot. In addition to visiting patients, PIHL staff can also use the bikes to transport samples back to the lab for testing, and to screen neighbours and family members of the patients for health problems--uses that are particularly important to PIHL's multidrug-resistant tuberculosis program.

Riders for Health’s first-ever program started in Lesotho in 1991, running a fleet of 47 motorcycles that ran for seven years without a single breakdown. Mahali Hlasa, a dedicated health professional who qualified as the first “rider trainer” under Riders for Health in 1991, is now the program director of Riders’ new program in Lesotho. Riders’ return to Lesotho was prompted by the rapid and alarming decline of the country's public-health status following the growth of HIV/AIDS and associated TB.

“We are delighted to be working in Lesotho once again with such fantastic partners,” said Andrea Coleman, co-founder and CEO of Riders for Health. “Partners In Health is effective in a way rarely seen in development, but by ensuring that their dedicated staff has access to reliable transportation, this innovative partnership will help to make their vital work even more effective and efficient.”

Riders for Health now has 230 employees in Africa, all of whom are nationals of the countries in which it works (Zimbabwe, the Gambia, Nigeria, Kenya and Tanzania). The organization manages more than 1,200 vehicles, 900 of which are used for direct health delivery, and helps provide basic health care to 10.8 million people.

PIHL began in June 2006 with a focus on bringing HIV and TB care and treatment to poor, rural communities that have largely been neglected by other AIDS programs and non-governmental organizations. Approximately one quarter of Lesotho's adult population is HIV-positive and life expectancy has plummeted to less than 35 years. Lesotho's TB rate is the fourth highest in the world. PIHL provides clinical support, training for nurses and village health workers and medications for treatment of HIV/AIDS and TB. The program also offers outreach and treatment for prevention of mother-to-child transmission of HIV and conducts home visits and educational meetings in villages.

[posted October 2008]

	A Zanmi Lasante health worker wades through floodwaters to find missing HIV patients.

Torrential rains from Hurricanes Gustav and Hanna swept through Haiti earlier this week, leaving behind dangerous flood waters and devastated communities.

”The situation is very dire and catastrophic and sad and frustrating,” writes Loune Viaud, Director of Operations of Zanmi Lasante (ZL), PIH’s partner organization in Haiti. She estimates that around 10,000 people have been displaced due to floodwaters in the Artibonite Valley, where PIH recently expanded operations to six facilities.

Full reports of the one-two punch delivered by the storms to the battered island of Hispaniola are currently hard to find, as news and media outlets had little time to focus attention from Gustav before Hanna roared through; and many instead turned their attention to Hanna’s path towards southern Florida.

Communications with Viaud and other PIH/ZL staff have painted a stark picture of desperation and destruction. In Gonaive, possibly the city hit hardest by the storms, patients and health workers were stranded on the roof of a submerged hospital. The Minister of Health of the Artibonite District phoned ZL from the roof of his house, asking for help to evacuate patients.

On Wednesday morning, members of Zanmi Lasante’s team trudged through swollen rivers, flooded streets, and muddy embankments in search of patients living in the low-lying areas. About 45 patients in ZL’s HIV program had homes underwater—fortunately, all have been accounted for, and are housed with neighbors and friends living on higher ground. But ZL fears that the situation may deteriorate even further, as Hurricane Ike approaches Haiti.

	Flooded houses in Hinche, the capital of Haiti's Central Department

Although these storms have contributed to the current disaster in Haiti, the rampant poverty and lack of infrastructure throughout the region have exacerbated the impact of these and previous storms. Unlike New Orleans, there are no levees to hold back the water in many of the low-lying communities served by ZL. Mud huts without solid foundations, walls, or roofs are easily swept away; unpaved streets quickly degrade into muddy holes, hampering evacuation and relief efforts. Hospitals and health clinics lacked the infrastructure to safely evacuate patients, and ZL staff are worried about the looming public health problems in the wake of the storms—the spread of water-borne illness, lack of access to clean water, malaria.

The six facilities partnered with ZL in the Artibonite region are now preparing to handle a flood of patients in the coming weeks and months. These facilities are all in desperate need of resources and supplies, writes Loune.

[published September 2008]