Directly observed therapy in Tomsk

Partners In Health Russia marked a major milestone in November with the launch of "Sputnik," a new health promotion program to improve care for patients living with multidrug-resistant tuberculosis (MDR-TB) in Tomsk, Siberia. For the first time in Russia, the program is recruiting, training and paying local people to work as community health workers, who will visit patients in their homes every day to make sure they are taking their medications. The primary beneficiaries of the program are the most downtrodden and marginalized members of the Tomsk community—the elderly, jobless, homeless, and those suffering from addiction to alcohol and other drugs. 

With the launch of the new program, health workers are now providing directly observed therapy twice a day, along with intensive nutritional and social support in order to address patients’ urgent needs. Working with Tomsk Oblast TB services, health workers are empowered to provide financial and logistical assistance, including helping to clean patients’ homes, obtaining food, or making recommendations to governmental social services for additional help.  

	An MDR-TB patient's home in Tomsk. Despite oil-fueled economic growth, many rural areas in Russia remain extremely poor.

Paid community health workers have long been an essential component of PIH's model of community-based care in Haiti, Peru, Boston and Rwanda. CHWs have often proven to be the key to maintaining adherence to treatment among the most vulnerable and marginalized patients. The decision to incorporate them into our work in Tomsk was taken after research showed a significant number of patients were not completing the long and difficult course of treatment for MDR-TB. Specifically, default from treatment has increased by 12 percent compared to the previous year among the most recent group of civilian patients in Tomsk.

PIH is eager to demonstrate the effectiveness of comprehensive social support coupled with MDR-TB treatment in the Russian setting. Dr. Salmaan Keshavjee, a PIH TB specialist who visited Tomsk in November to help launch the program, is optimistic:
“This new program of accompaniment is a critical tool to reach the poorest and most vulnerable segments of the population.  Like accompagnateurs at other PIH sites, it will provide essential linkages with the health care system as well as a program of social and economic supports that will create an enabling environment for economically, socially and medically vulnerable patients to complete treatment”.

Mama Katele, whose courage and commitment inspired the founding of FACE AID

Founded in 2005 by a committed group of Stanford University students, the non-profit organization FACE AIDS has now spread to more than 85 campuses across the country. By late September, the campaign had raised more than $250,000 towards its target of $1 million to fight AIDS in Africa by supporting the work of Partners In Health.

To accelerate its drive toward that goal, FACE AIDS has scheduled a number of major events through the autumn, including a Leadership Summit Conference in late October.

The Conference will gather more than 400 students from all across the country to talk about ways to combat AIDS and hear from PIH co-founder Jim Yong Kim, Henry Epino who serves as medical director for the PIH project in Rwanda, and other leaders in the fight against AIDS.

The following month, Paul Farmer will speak on the Stanford campus on behalf of FACE AIDS and Dance Marathon, which will pull together hundreds of students to dance around the clock to raise money for PIH.

The FACE AIDS campaign is raising money and awareness by soliciting challenge grants from corporations, foundations, and individuals to match student donations from fundraising campaigns on college campuses. 

Mwange, Zambia – Summer 2005

It all began in Zambia, on top of a porch and underneath the stars, in the summer of 2005. Katie Bollbach, Jonny Dorsey, and Lauren Young, three Stanford students on a six-week service trip to a Congolese refugee camp based in Mwange, discussed the devastating symptoms and stigma of HIV in Africa and their impact on development projects aimed at empowering women, reducing illiteracy and caring for orphans in the camp community.

They talked about the plight of Mama Katele, the sole openly HIV-positive refugee in a camp of 24,000 refugees, and about the seemingly insurmountable challenges faced by a country where HIV has infected one in every six adults and orphaned more than 710,000 children.

Jonny Dorsey, the co-founder and Executive Director of FACE AIDS, remembers those six weeks spent in Zambia as eye opening. "At Stanford, I was sort of on the public health track, and I had read lots of books about Africa and health issues. I thought I knew what I was talking about with AIDS and global health. Then I went to Zambia and realized I knew nothing."

African women sewing beaded AIDS badges sold by FACE AIDS

Sitting there on the porch, the three students began planning a small income-generating project for Mama Katele that they hoped would lessen the stigma surrounding HIV and also encourage more HIV testing for others in the camp. They would have her sew small beaded pins depicting a red ribbon on a white background – the international symbol of solidarity with people infected or affected by AIDS.

As the night wore on and their discussion evolved, they soon realized they could use this same strategy to help other people in the camp affected by HIV. Then, they decided, why stop there? Why not include two other refugee camps nearby and all the surrounding villages? By the time the sun came up, they had decided to postpone returning to school and work full-time to expand the operation to college campuses across the United States, selling $5 beaded AIDS awareness pins made by African AIDS support groups in exchange for student donations, matched by money from corporations. 

"It was that night when we decided we had to take time off from college and focus on work here in Africa," says Katie Bollbach, the co-founder and African Director for FACE AIDS.  "The situation was too urgent and the solution actually seemed practical." Sewing the pins and selling them to FACE AIDS would give HIV patients a way to earn a living without taxing their health. Selling the pins to students in the US would allow FACE AIDS to raise money and awareness to fight AIDS in Africa.

Soon after, the three students withdrew from school. Katie stayed in Africa for the following academic year to set up AIDS support groups and coordinate pin production while Jonny and Lauren returned to California to start organizing and fundraising.

Woodside, California – Summer 2006

Barely a year later, in the summer of 2006, the dining room of Jonny's mother's home had been converted into FACE AIDS world headquarters, staffed by six caffeine-fueled students almost 24 hours a day. A map on the wall was dotted with pins marking the location of dozens of schools in where students were readying FACE AIDS campaigns for the fall.

"The campaigns themselves are the instruments we use to fulfill our mission: ‘to mobilize and inspire students to fight AIDS in Africa'," explained Clay Sader, the Campaign Director at FACE AIDS. "And the great thing about them is that there's no set number or type of event that a campus can run." 

The campaigns, while different at every school, all involve three main initiatives: selling pins to raise student awareness and money, disseminating talking points, and mobilizing the student body. 

In the past, Clay said, events have ranged from basketball tournaments to brownbag lunches with professors. Even, Jonny added with a smile, to "quesadilla sales and drag shows."

The point, according to Jonny, is primarily to show people what is possible with a relatively small amount of money:  "Money is powerful, but lighting a fire under students is more powerful. A million dollars raised is a million conversations started."

Elizabeth Kersten, Director of Education at FACE AIDS, agreed.  She told about one of her friends, a math and physics major, whom she enticed to attend a FACE AIDS campaign event at Stanford with the promise of free food. 

"By the end of the speaker's talk," Elizabeth said, "my friend had tears in her eyes. But instead of feeling helpless after the event, she felt hopeful. Her $5 donation had just allowed an individual in Africa to extend his or her life, and she knew she could do more.

"She returned to the dorm and started researching careers in biomedical engineering. And she hadn't even touched the free food."

To find out more about FACE AIDS, visit www.faceaids.org

Jim Yong Kim named to Time Magazine’s list of the world's "100 most influential people"

PIH co-founder Jim Yong Kim is one of 16 “scientists and thinkers” to make “the Time 100” -- Time Magazine's annual “list of the 100 men and women whose power, talent or moral example is transforming our world.”

Jim, who now heads both the Department of Social Medicine at Harvard Medical School and the Division of Social Medicine and Health Inequality at Boston’s Brigham and Women’s Hospital, was honored for his work “treating the ‘untreatable’”.

The short testimonial by Pulitzer Prize-winning author Tracy Kidder cites Jim's contributions to overturning accepted medical wisdom and policies by proving that both drug-resistant TB and HIV/AIDS can be treated successfully in poor communities in developing countries.

Ti Jean – 1971-2006

Jean Gabriel Fils, known widely and affectionately as Ti Jean, died on May 28 in Central Haiti, where he had lived all his life.

Ti Jean had been part of the foundation of Partners In Health/Zanmi Lasante since the organization’s early days almost 20 years ago. More recently, as director of the Program on Social and Economic Rights (POSER) he had laid the foundations for literally hundreds of new homes for patients and others living in destitution. In 2003, Ti Jean received the Thomas J. White Prize presented annually at the PIH Symposium in honor of his work.

PIH co-founder Paul Farmer delivered a eulogy at Ti Jean's funeral, attended by more than 1000 friends, family and supporters at L'Eglise Bon Sauveur in Cange, Haiti.

During what proved to be his final visit to Boston in February, Ti Jean spoke enthusiastically about the 110 houses he had built in 2005, the 157 on his docket in early 2006, and his ambition to build a million homes before he died.

PIH Executive Director Ophelia Dahl paid tribute to Ti Jean in a message to staff announcing his death:

"The 'Ti' in front of his name refers to the diminutive," she wrote, "yet Ti Jean was anything but little. He was an enormous presence both physically and morally, a major force in the struggle for social justice. And he worked tirelessly on behalf of those in his community who lived at the bottom of the pile."

"He was a builder of houses but also of a better future and, as a result, he provided hope for countless people living in rural Haiti. He has left a giant hole. But we, as a team, will rely on his inspiration and endeavor to honor the memory of his life by continuing his work."

Ti Jean was 35 years old at the time of his death and left 11 children.

Partners In Health has established a fund to support Ti Jean’s children and family, who relied on his financial support as we all relied on his leadership and inspiration.

To contribute to the fund, send a check made out to Partners In Health with ‘Ti Jean Memorial Fund’ in the memo line to PIH, 641 Huntington Ave., Boston MA, 02115. Contributions can also be made online using a credit card. Just click on the "Donate to PIH" link at the top of this page and select "Donate Online" from the options at the left of the next page. On the donation form page, select "Ti Jean Memorial Fund" from the drop-down list of programs. You may also click the checkbox to specify "My donation is a tribute to someone special" and, on a subsequent page, designate Ti Jean as the special person in whose honor you are making the donation.

All donations so designated will be used to support Ti Jean’s family and to continue his lifework of building houses for Haiti’s poor.

Ti Jean and Paul Farmer

Ti Jean on a construction site

PIH's Boston-based PACT project has received a $15,000 grant from the Boston Foundation as part of a collaborative effort to expand summer activities for at-risk youth and arrest an alarming rise in violence around the city.

In 2005, Boston recorded its highest number of homicides and gun incidents in over a decade.  With increasing rates of violence and delinquency among young people, social activists and leaders from Boston decided that they had to act. And fast. On June 28, 2006, a consortium of 11 funding agencies announced grants totaling $500,000 to 41 agencies that serve more than 4,000 young people. Participating agencies will use the money to extend their hours of operation and expand activities for the teens who need them most: young men and women of color who often have nowhere to go and nothing to do in the summer.

PACT's youth program, Youth for Prevention, Action, and Change through Thought (YPACT), is collaborating with a number of other agencies to offer a variety of activities right through the hot days and long evenings of summer, offering young people options to stay out of the streets and out of trouble.

Based in Codman Square, Dorchester, YPACT focuses on creating peer leaders and providing critical thinking education for at-risk youth.  Apart from one adult supervisor, the program was created and is run entirely by youth from the ages of 12-20 and currently serves over 70 of their peers.  Through collaborations with several agencies throughout Boston, YPACT hopes to engage more than 70 additional young people during the summer.

 “These are not your Boston Latin kids,” says Jina Jibrin, director of YPACT, referring to Boston's most prestigious and competitive high school. “These are kids in public schools that are extremely traumatized.  Some are homeless, some have been in prison, and all of them need this program.”

One of the methods for engaging youth and arresting violence that YPACT is expanding is its collaboration with another program based in Dorchester and Roxbury that teaches capoeira, an Afro-Brazilian martial art that blends dance and acrobatics. 

“Capoeira is a violence prevention tool because it takes an art form that grooms kids to use their bodies in ways of defense, and it starts to work as a form of case management,” says Jibrin.  “You take these street youth, these ‘street thugs', and really transform their view of violence.  You play-fight in a circle, but the goal is to bring that play back to a peaceful starting point.”  

The capoeira program brings in youth from different neighborhoods and has become increasingly popular and successful with young women. “The girls are very prominent in the Capoeira program right now,” Jibrin adds, “and they're even planning a girl-specific group.” 

With the theme of women's empowerment in mind, YPACT is also expanding a women's leadership group, Our Voice, started by a young YPACT participant named Fabienne Casseus. The grant money will help YPACT expand Our Voice membership from 10 young women to 40, and to run formally two evenings a week instead of haphazardly during the days. Women who complete the leadership seminar will go on a three-day retreat in August, where they will undertake activities ranging from stress reduction techniques at a campground to leadership hikes in the green mountains of Vermont to an official tour of Ben and Jerry's ice cream headquarters. 

All these initiatives are based on the idea that the best way to empower youth is to provide the tools that they can use to take charge of their own lives and assume a leadership role among their peers.

When asked how she thinks the grant will affect the participants and how successful she thinks YPACT has been in reaching out to inner-city youth, Jibrin pauses.

“I've never been as humbled as I have working with these kids,” she reflects, “One of these kids told me that YPACT saved his life, that without it he wouldn't be here. We're talking about a 16- year-old who's been locked up several times and who has had the court apologize to him several times for wrongful convictions. You can imagine what that does to his psyche.

“You might imagine this is the sort of conversation we'd manufacture and post everywhere, but it's not. This is real. These kids are making a difference. I'm just filing papers and helping out with administrative stuff. These kids, some of whom are truly exceptional, are the ones who are doing this. They're the leaders.” 

Principal Collaborating Agencies working with YPACT

Dorchester Teen Violence Prevention Program (The Medical Foundation)

Dorchester Teen Violence Prevention Program (DTVPP) is a group of Dorchester teens who work to prevent violence in their community. Through intensive violence prevention training, the teens acquire the knowledge and skills to hold workshops teaching their peers and other youth ways of preventing violence and keeping Dorchester safe. The DTVPP was initiated by the Dorchester Community Services Collaborative two years ago in response to an increase in violence in Dorchester.

The Dorchester and Roxbury-based Capoeira Angola Program

The Capoeira Angola Program is based out of the Epiphany School in Codman Square, Dorchester, and Saint Francis Church in Roxbury in partnership with the Lower Roxbury Coalition. The program combines Capoeira instruction with case management, mentoring, leadership development and community service. Its main mission is violence prevention through healing and community-building. The group conducts numerous workshops, talks, and performances around the city.

DYS/Roxbury Youth Works

Roxbury Youthworks, Inc. (RYI) is a community-based non-profit organization that works with youth (up to 21 years of age) who are involved with the court system, the Department of Youth Services, the Department of Social Services, and the community. RYI provides innovative support services to disenfranchised young people and their families whose voices have too often been muffled by helplessness, social and economic disadvantages, cycles of abuse and negative stereotypes.

Martha Eliot Health Center’s Adolescent Services, Youth Leadership Prevention Program 

Established in 1966, the Martha Eliot Health Center (MEHC) provides comprehensive pediatric, adolescent, adult and OB/GYN medical services.  MEHC's youth leadership program offers a safe space where young adults have the resources and support to voice their opinions and concerns about issues such as violence, sexuality, substance abuse, obesity, nutrition, and police/youth interactions.  MEHC youth participants engage in community outreach work to raise awareness about healthier and safer lifestyles.  

[posted July 2006]

Partners In Health's Haitian partner organization, Zanmi Lasante (ZL) broke new ground in providing comprehensive health care for HIV patients on June 5 with the launch of a major food distribution program. Joining forces with the UN World Food Program (WFP), ZL began distributing 1,000 metric tons of food assistance to 2,575 HIV positive patients and their families.

HIV infection often makes it impossible for patients to work or grow their own food. Proper and adequate nutrition plays a critical role in patient response to treatment. Food packages are currently being distributed to HIV-positive patients based on need, using clinical and socioeconomic criteria determined by ZL staff. The food packages -- which include staples such as rice, grits, lentils, vegetable oil, meat, beans and salt -- are designed to feed a family of four.

The program reflects PIH's ongoing commitment to the importance of food and nutrition as essential components of its model for providing quality health care to the world's poor.   PIH is already distributing food in Rwanda and Peru. In Rwanda, where every patient on antiretroviral therapy and TB treatment receives a monthly food package for the first year of treatment, PIH has been distributing an average of 1200 food packages a month. 

PIH also pays particular attention to problems of child malnutrition. Worldwide almost 6 million children die each year as a result of hunger and malnutrition, most of them because they are too weak to fend off common, treatable diseases like diarrhea, pneumonia, measles and malaria. In Haiti, PIH's Child and Maternal Health Program provides dietary supplements including Akamil – a milled combination of nutrient-rich local foods. Children and women of child-bearing age also receive iodine supplements. Iodine deficiency is a leading cause of impaired cognition and delayed motor development in young children.

Recognizing the important role that food plays in childhood development, PIH began a school lunch program in Cange and surrounding areas this past April. The program distributes free school lunches to 21 schools, each serving between 300 and 400 students. PIH intends to strengthen this program in the fall, doubling the amount of food distributed. Increasing attention is focused on linking local agriculture projects to PIH nutritional programs. In the future, PIH hopes that the Zanmi Lasante farm will be able to supply vegetables for the school lunches and produce Akamil for the Child and Maternal Health Program.

Hunger and malnutrition are of particular concern for individuals living with HIV. HIV infection increases energy needs and affects nutrition requirements. Many HIV patients suffer from severe wasting and weakness that leaves them unable to work or to grow or purchase the food they and their families need to survive.

Hunger and malnutrition may also erode patients' ability to combat HIV, adhere to treatment regimens, regain lost weight and fight off opportunistic infections. Individuals who are malnourished when beginning antiretroviral therapy have been shown to experience a lower degree of response to treatment, slower weight gain, and greater risk of AIDS-related illnesses and infections. Nutritional interventions have a broad range of potential benefits for HIV-positive patients.

In order to document the importance of food supplements in the treatment of HIV, PIH is conducting a research study of our distribution of food to HIV patients in Haiti, with funding support from Johnson and Johnson, which is also covering some of the logistical costs for transporting, warehousing and distributing the food. The study is gathering clinical data to evaluate the health of HIV patients before and after food distribution. It is hoped that the study will strengthen the case for making food supplementation an essential component in the management of HIV in poor communities.

Preparing for food distribution at a WFP warehouse

School children line up for free lunch

[posted July 2006]

With the launch of a new project in Lesotho, Partners In Health is bringing to remote mountain villages in southern Africa the model of community-based care for HIV/AIDS pioneered in Haiti by PIH/Zanmi Lasante. Among those bringing it are some of Zanmi Lasante's most experienced and dedicated staff. Dr. Jonas Rigodon, a Haitian physician who has been working with PIH/ZL since 2002, is moving to Lesotho this August to share his expertise in providing health care for the poor in a country currently experiencing one of the world's worst HIV epidemics.

Dr. Jonas passed through Boston recently on his way to Rwanda and then on to Lesotho. He spoke enthusiastically about his experience working with PIH and the new challenges and experiences that lie ahead in Lesotho.

A native of Les Cayes in southwestern Haiti, Dr. Jonas first encountered PIH shortly after he graduated from medical school in 2001. He was posted to a clinic in the central plateau town of Thomonde to complete the social service required of graduates from the Faculty of Medicine and Pharmacy in Port-au-Prince. Early the next year, PIH arrived to help the overburdened Ministry of Health upgrade treatment for HIV/AIDS and tuberculosis at the clinic.

Dr. Jonas soon became a firm believer in the PIH model of providing free, comprehensive health care to the poor. He vividly remembers and describes his first lesson in the PIH approach. Accustomed to working in private hospitals where patients who were unable to pay for services were turned away, Jonas didn't balk when the family of one patient in Thomonde asked to sign their son out and take him home because they couldn't afford continued care. But when PIH co-founder Paul Farmer made rounds the next day, he asked what had become of the patient. Upon hearing what had happened, he instructed Dr. Jonas to go find the patient and bring him back.

"It was the first time I had seen anything like that," Dr. Jonas recalls. "It's a very good philosophy, because the winners are the patients."

If Dr. Jonas liked what he saw of PIH, the feeling was mutual. PIH invited him to join the Zanmi Lasante team in Thomonde. With interruptions for continued studies in Belgium and the United States, he was been working with PIH ever since, first in Thomonde, then in Hinche -- where he helped set up HIV, TB and primary care services -- and finally as assistant director of the HIV/AIDS program.

In 2005, Dr. Jonas completed a Masters of Public Health at the Catholic University in Brussels. While in Belgium, Dr. Jonas presented the PIH/ZL model to a group of fellow students, including several from Africa.  They were amazed not only by the structure and philosophy of the PIH model, but also by its success in a resource-poor location such as Haiti.

Dr. Jonas believes that this same model has tremendous potential in Lesotho. Describing his frustration at witnessing so many unnecessary deaths from HIV/AIDS given the availability of anti-retroviral therapy (ART) and the demonstrated success of the PIH model in Haiti, he hopes to scale up care in Lesotho rapidly.

"I am a doctor," Dr. Jonas explained. "I think I can work anywhere in the world. And especially in Africa. For Haitians, Africa is our ancestor. I am excited to work with PIH there to improve the health of African people. I hope that this program will go very well and put a lot of people on antiretroviral treatment in a short time to save their lives. It is hard to see people die of AIDS now, when we know there are drugs available. Beyond that, I don't have any ideas or plans for my future."

PIH launches new project in southern Africa

Village Health Workers attend one of the first training sessions in Nohana, Lesotho, preparing for launch of antiretroviral therapy.

Barely a year after establishing our first project on the African continent in Rwanda, Partners In Health has started its second in Lesotho, a small, mountainous nation of two million people located entirely within the borders of South Africa. In late June, PIH trained 75 village health workers to begin providing HIV testing and antiretroviral therapy (ART) at the first of nine rural health centers serving more than 300,000 people where PIH plans to be operating by 2008. A few weeks later, the first 10 HIV patients in Nohana started receiving ART.

Lesotho suffers from the third highest rate of HIV infection in the world. 30 percent of the adult population is estimated to be HIV-positive, of whom less than one quarter know they are infected. Only 10 percent of those in need of treatment are receiving it. PIH and its new sister organization in Lesotho hope to help change that quickly, working in partnership with the government of Lesotho, which has launched a campaign to test every citizen over the age of 12 for HIV by the end of 2007, and with the Clinton HIV/AIDS Initiative. The project is also being supported by the Francois-Xavier Bagnoud Center at the Harvard School of Public Health, Brigham and Women's Hospital and Harvard Medical School.

The HIV epidemic in Lesotho is driven by poverty and high rates of migration for labor in South Africa. Lesotho has only one doctor for every 20,000 people, compared to one for every 390 people in the United States. Only 7 percent of households have access to electricity and only 12 percent to running water. As the HIV/AIDS epidemic has taken hold, average life expectancy has plummeted to 35 years. Outside of the capital city of Maseru, most of the population lives in remote mountain villages, several hours walk from the nearest medical outpost.

It is in nine of these isolated mountain health centers, many of which are accessible only by single-engine propeller plane, that PIH plans to scale-up testing and treatment of HIV/AIDS in order to create a national model of community-based rural health care. Working with the Lesotho Flying Doctors Service and the Mission Aviation Fellowship, PIH is providing clinical support, training for nurses and village health workers and medications for treatment of HIV/AIDS and tuberculosis.

Seventy-five village health workers participated in the first three-day training program at the Nohana health center, located high in the mountains of southern Lesotho, seven hours by bus from the closest hospital in Mohale's Hoek.

"We used the training curriculum that PIH has developed in Haiti and Rwanda, which we had translated into Sesotho," explained Dr. Jen Furin, who is heading up the project for PIH. "We had no electricity and none of the village health workers could read or write. But they were very knowledgeable about how HIV is transmitted and use of condoms. And they are excited to have antiretroviral treatment available."

So are patients in the 60 villages the health center serves, in an area where 60 percent or more of the population are estimated to be infected with HIV. When the PIH team returned to Nohana a few days later expecting to enroll six people for ART, 16 turned up. Two came on horseback. The rest had walked an average of two to three hours to get to the health center. A week or so later, ten of those patients received their first doses of ART medications and three others started on treatment for tuberculosis.

"By September 15, we expect to have more than 100 patients on ART," Dr. Furin said. And she and her colleagues will be preparing to initiate training at another mountain health center. "We're finally moving forward … and looking forward to getting people service."

Haitian doctor joins Lesotho team

[Posted July 2006]

Village Health Workers compare notes during a training session in Nohana, Lesotho.

They left San Francisco on bicycles at the beginning of April. 50 days, 3,700 miles, 12 states, 16 cities, and nearly $130,000 of fundraising later, the 21 participants in the "Ride for World Health" pedaled into Washington, DC, their legs weary, their journey finally over but the memories -- and emotions -- running strong.

"Heading to the East coast and the Atlantic Ocean was much more of an emotional experience than I had thought it would be," said Andy Wagner, an Ohio State medical student and Ride for World Health executive director. "We started off, for the most part, as strangers, but as we finished, we were really kind of a family of 21."

The cyclists, most of them medical students like Wagner, including eight from Ohio State alone, set out on their transcontinental trek to raise awareness about pressing issues in global and local healthcare through a carefully developed "Coast-to-Coast Lecture Series" at medical and community centers along the route. The final ceremony took place at another medical center: that of Howard University in Washington, D.C.

"It's touching to meet all of these students who rode, particularly in the context of Howard Medical Center," said Ed Cardoza, Vice President for Development at Partners In Health, who spoke on PIH work in Haiti and Rwanda at the event. "It was an institution established to help out in the ruins of the civil war and to treat a population of mostly freed slaves that were making their way up into the Washington, D.C. area."

At the beginning of their journey, Ride 4 World Health had planned to donate all the fundraising proceeds to Partners In Health, minus the operating costs of this year’s ride and $10,000 to prepare for next year’s. In total, they ended up raising nearly $130,000, of which Partners In Health will receive $80,000. Wagner, however, is quick to add that "donations are still coming in and we're still collecting."

"As the project got a lot bigger and the scope increased we kept raising the fundraising goal," Wagner said. "Fundraising is a tough gig, as I'm sure everyone at Partners in Health knows. But it's pretty exciting to build an organization from scratch that is actually self-perpetuating."

"Andrew did a really good job at focusing on more than just the bike ride and the fundraising," said Cardoza.  "He put together an organization that strove to mobilize medical students around common causes, and used it as an opportunity to educate people around the country on HIV and AIDS and global health issues. It's an incredible thing to accomplish."

Particularly special for Wagner and seven others was their stop in Columbus, Ohio, to celebrate an officially dedicated "Global Health Day" at Ohio State University Medical School.

"It was really nice to see a medical center get behind global health in a way they haven't in the past," Wagner said. "We actually taught 400 or so of OSU's medical students for four hours that day, and I think that's where you can make the biggest impact, through trying to inspire the next generation of medical students on issues like these.

Not to mention, to cap off the day, we had the president from the American Medical Association speak about domestic issues like the uninsured problems in the United States. It was definitely the ultimate moment of the whole trip... and of course, it's my home town."

As Wagner graduates, he passes the torch of executive officer to Brock Andreatta, another cyclist in Ride for World Health. "R4WH currently has six of nine positions filled for next year" Andreatta wrote in an email. "We are still recruiting for Directors of Marketing, Finance, and Sponsorship/Fundraising."

This year, Partners In Health was the beneficiary group for Ride for World Health. Next year, the new leadership will let other non-profits apply for sponsorship. Yet money, for Wagner, was never the focus of the cross-country ride. "The money is one thing and its important," he said, "but I think that the biggest part of the Ride 4 World Health is the idea of creating cultural change and having people look at HIV and malaria as things that we can change. Having Partners in Health behind us in this, a global organization devoted to the same cause, was critical."

"People are always asking, ‘What can I do, what can I do?’" said Cardoza. "Here's another example of how people, particularly students, can get creative and help. These med students took this all on themselves. They asked what would be the ideal. I told them, and they truly delivered."

To learn more about Ride for World Health or to donate to the cause, go to www.ride4worldhealth.org.

On the road: Ride for World Health cyclists at Bryce Canyon, Utah.

New guidelines and goals for treating MDR-TB announced

New guidelines for treating multi-drug resistant tuberculosis (MDR-TB) were announced at a gathering of TB experts in Atlanta on May 10. The strategy endorses the goal of increasing the number of MDR-TB patients receiving treatment 50-fold over the next decade. The guidelines and targets for treatment were issued by the World Health Organization (WHO) at a meeting with many collaborators on the guidelines, including Harvard Medical School, the U.S. Centers for Disease Control and Prevention (CDC), the Task Force for Child Survival, and Partners In Health.

The new guidelines, drawing on research from 46 projects in over 29 countries since 2000, provide specific instructions on how to expand and improve Directly Observed Therapy (DOTS) for MDR-TB patients, based on the best available evidence and the most effective drugs. The guidelines also seek to outline strategies for strengthening health systems, suggest ways of empowering people and communities dealing with TB, engage all care providers, and promote further research.

MDR-TB has been detected in every region of the world and the WHO estimates that more than 425,000 new MDR-TB cases emerge every year, with as many as one million active cases worldwide. The goal of the new guidelines and the Global Plan to Stop TB is to increase the number of MDR-TB patients receiving treatment from 16,000 today to a total of 800,000 treated patients worldwide by 2015.

"In the 1990s, many in the TB community were highly skeptical about the possibility of developing effective and affordable ways of treating MDR-TB in poor countries," said PIH co-founder Dr. Jim Yong Kim. "These guidelines have settled that argument. Treatment programs should now be scaled up as fast as possible. We are in a race against time with extreme drug resistant TB bugs that pose a mortal danger to control in many countries."

Partners In Health played a significant role in overcoming the skepticism and accepted medical wisdom, following the 1994 death from MDR-TB of Father Jack Roussin, a priest and long-time friend of PIH who worked in the shantytowns outside Lima, Peru. At the time, MDR-TB was widely believed to too expensive and too complicated to treat outside of the developed world. In the words of Dr. Mario Raviglione, Director of the WHO Stop TB Department, "MDR-TB was once considered a death sentence for most patients in poor countries."

Setting out to demonstrate both the possibility and imperative for MDR-TB treatment in resource-poor locations, PIH initiated a rigorous program to treat patients with MDR-TB in Lima, Peru. The protocol called for second-line drugs to be provided free of charge and administered under directly-observed therapy by trained community health workers. Cure rates of 85 per cent helped to demonstrate that treatment is not only possible but necessary, both morally and medically, as a way of saving lives and halting the growth of a global epidemic of MDR-TB.

The new guidelines issued in May confirm that treating MDR-TB is "not only feasible but also cost-effective," in the words of Dr. Mark Rosenberg, Executive Director of the Task Force for Child Survival and Development. "Every TB patient should receive timely diagnosis and effective treatment, wherever they live, and whether they are infected with drug-sensitive or drug resistant TB."

The "Guidelines for Programmatic Management of Drug-Resistant TB" are available at http://whqlibdoc.who.int/publications/2006/9241546956_eng.pdf. 

[posted June 2006]

They left San Francisco on bicycles at the beginning of April. 50 days, 3,700 miles, 12 states, 16 cities, and nearly $130,000 of fundraising later, the 21 participants in the "Ride for World Health" pedaled into Washington, DC, their legs weary, their journey finally over but the memories -- and emotions -- running strong.

"Heading to the East coast and the Atlantic Ocean was much more of an emotional experience than I had thought it would be," said Andy Wagner, an Ohio State medical student and Ride for World Health executive director. "We started off, for the most part, as strangers, but as we finished, we were really kind of a family of 21."

The cyclists, most of them medical students like Wagner, including eight from Ohio State alone, set out on their transcontinental trek to raise awareness about pressing issues in global and local healthcare through a carefully developed "Coast-to-Coast Lecture Series" at medical and community centers along the route. The final ceremony took place at another medical center: that of Howard University in Washington, D.C.

"It's touching to meet all of these students who rode, particularly in the context of Howard Medical Center," said Ed Cardoza, Vice President for Development at Partners In Health, who spoke on PIH work in Haiti and Rwanda at the event. "It was an institution established to help out in the ruins of the civil war and to treat a population of mostly freed slaves that were making their way up into the Washington, D.C. area."

At the beginning of their journey, Ride 4 World Health had planned to donate all the fundraising proceeds to Partners In Health, minus the operating costs of this year’s ride and $10,000 to prepare for next year’s. In total, they ended up raising nearly $130,000, of which Partners In Health will receive $80,000. Wagner, however, is quick to add that "donations are still coming in and we're still collecting."

"As the project got a lot bigger and the scope increased we kept raising the fundraising goal," Wagner said. "Fundraising is a tough gig, as I'm sure everyone at Partners in Health knows. But it's pretty exciting to build an organization from scratch that is actually self-perpetuating."

"Andrew did a really good job at focusing on more than just the bike ride and the fundraising," said Cardoza.  "He put together an organization that strove to mobilize medical students around common causes, and used it as an opportunity to educate people around the country on HIV and AIDS and global health issues. It's an incredible thing to accomplish."

Particularly special for Wagner and seven others was their stop in Columbus, Ohio, to celebrate an officially dedicated "Global Health Day" at Ohio State University Medical School.

"It was really nice to see a medical center get behind global health in a way they haven't in the past," Wagner said. "We actually taught 400 or so of OSU's medical students for four hours that day, and I think that's where you can make the biggest impact, through trying to inspire the next generation of medical students on issues like these.

Not to mention, to cap off the day, we had the president from the American Medical Association speak about domestic issues like the uninsured problems in the United States. It was definitely the ultimate moment of the whole trip... and of course, it's my home town."

As Wagner graduates, he passes the torch of executive officer to Brock Andreatta, another cyclist in Ride for World Health. "R4WH currently has six of nine positions filled for next year" Andreatta wrote in an email. "We are still recruiting for Directors of Marketing, Finance, and Sponsorship/Fundraising."

This year, Partners In Health was the beneficiary group for Ride for World Health. Next year, the new leadership will let other non-profits apply for sponsorship. Yet money, for Wagner, was never the focus of the cross-country ride. "The money is one thing and its important," he said, "but I think that the biggest part of the Ride 4 World Health is the idea of creating cultural change and having people look at HIV and malaria as things that we can change. Having Partners in Health behind us in this, a global organization devoted to the same cause, was critical."

"People are always asking, ‘What can I do, what can I do?’" said Cardoza. "Here's another example of how people, particularly students, can get creative and help. These med students took this all on themselves. They asked what would be the ideal. I told them, and they truly delivered."

To learn more about Ride for World Health or to donate to the cause, go to www.ride4worldhealth.org.

On the road: Ride for World Health cyclists at Bryce Canyon, Utah.

[posted June 2006]

A team of young people mounted their bicycles in Seattle on June 1 and embarked on a "transcontinental ride for humanitarian aid" scheduled to finish up in Boston at the end of July.

Participants in the Yes Ride have set two goals – to raise a minimum of $200,000 for beneficiaries, including Partners In Health, who are committed to improving the lives of people in the poorest regions of the world; and to create a moving monument that motivates humanity to fights the emergency of global AIDS and extreme poverty.

In addition to Partners In Health, beneficiaries of the Yes Ride include the Emory Vaccine Center, International Peace Initiatives, Heifer International and Circles of Ten: Women for World Peace.

The Yes Ride was conceived and organized by a group of young people from Boulder, Colorado, who hope to turn it into an annual event that will mobilize people to "say yes to the end of poverty, yes to self-empowerment, yes to inspiring others, yes to humanity."

As the June 1 takeoff date neared, nineteen riders had signed up to pedal the entire 4,000 miles, stopping at schools, religious organizations, Rotary clubs and other sponsors along the way. Other dedicated cyclists and activists are expected to join up for stretches of  the ride.

In the words of Chris Markl, one of the organizers of the Yes Ride, “This event appeals to me because the magnitude of the event mirrors the magnitude of the effort needed to end global poverty. We must match massive tragedy with massive effort.”

[posted June 2006]

Dr. Lee Jong-wook and Reiko Kaburaki Lee enjoy a lighter moment at the Mujeres Unidas project in Peru.

The global health community lost a visionary leader and Partners In Health lost a valued friend on May 22 with the death of Dr. Lee Jong-wook, Director-General of the World Health Organization (WHO).

Since taking the helm of WHO in 2003, Dr. Lee had galvanized action to bring anti-retroviral treatment that had previously been available only in rich countries to millions of AIDS patients in Africa and elsewhere in the developing world. Shortly after taking office, Dr. Lee launched the "3 by 5" campaign, with the goal of having 3 million people on treatment by the end of 2005. Although the campaign fell short of its target, the number of patients on treatment in developing countries quadrupled in just two years. In Africa, it increased eight-fold.

"Someone had to say, 'Let's do something with the tools we already have,'" recalled PIH co-founder Jim Kim, who worked closely with Dr. Lee on the "3 by 5" campaign as head of WHO's HIV/AIDS Department. "And he [Dr. Lee] did it." For more than one million people who started receiving treatment between 2003 and 2005, Dr. Lee's willingness to take action and take responsibility quite literally meant the difference between hope and despair, life and death.

Dr. Lee began his career with WHO directly out of medical school. After working with leprosy programs in Fiji, he took on ever increasing responsibility, leading WHO efforts to eradicate polio in Asia, immunize children worldwide and fight tuberculosis. It was as head of WHO's tuberculosis program that Dr. Lee came to be a friend and supporter of Partners In Health in its work with multidrug-resistant TB patients in Peru, Haiti and Russia.

Since 2001, Dr. Lee's wife, Reiko Kaburaki Lee, has devoted six months of every year to working with Mujeres Unidas - a crafts cooperative organized by PIH's partner organization, Socios En Salud. Mujeres Unidas, was founded in 2000 as a way for poor women in the TB-ridden shantytowns outside Lima, Peru, to contribute to their families' income. Over the past six years it has provided many women the opportunity both to earn money and to learn important managerial and technical skills that boost their self esteem as well as their ability to provide for their families. And for half of each of those years, Reiko Kaburaki Lee has worked alongside these women, stitching and weaving the fabric of scarves, hats and better livelihoods.

In lieu of flowers, Reiko Kaburaki Lee has asked people to honor her husband's memory by donating to Mujeres Unidas. Donations can be made online. To earmark your contribution in honor of Dr. Lee, select "Peru: gifts in memory of Dr. JW Lee" from the "Program" drop-down menu and check the box to indicate that "My donation is a tribute to someone special."

More details on Dr. Lee's life, work and legacy are included in the obituary in the Boston Globe.

Four avid bicycle riders and social justice activists from the Boston area are now training intensively for this year’s Race Across America. They hope to “peak” in mid-June, just in time to pedal 3,000 miles in six days, raising funds for Partners In Health and the Nashoba Learning Group all the way from San Diego to Atlantic City.

The four cyclists will be riding on behalf of Team ARC (Athletes Racing for Charity), founded this winter by Patrick Autissier as “a platform for socially concerned riders, runners, triathletes, hikers, etc. to promote and support causes that help those who are less fortunate than we are.”

Autissier, 43, is a native of France who now works at Beth Israel Hospital in Boston. He has competed in many ironman triathlons and long-distance cycling events, including racing in the solo division of last year’s Race Across America. Joining him on Team ARC are Eric Jensen, Ed Kross and Ralf Geiben Lynn.

For more information and to donate to Team ARC (and PIH), visit their website at http://www.team-arc.org/.

Team ARC – "We’re completely nuts, but it’s for a very good cause."

[posted May 2006]

Eighteen days after they set out from San Francisco on their “journey across the nation to meet needs across the world,” cyclists participating in the “Ride 4 World Health” pedaled into Telluride, Colorado.

And on the nineteenth day they rested. Or at least they rested their legs while exercising their tongues. The cyclists spent their layover day talking about the crisis in world health and access to healthcare at a private school, an alternative café, a local radio station and the Telluride public library.

Ride 4 World Health is the brainchild of Andy Wagner, a medical student at Ohio State who feels passionately about cycling, health and social justice. He recruited 20 other people to join him in a transcontinental ride to raise both awareness about the crisis in global health and funds to provide quality healthcare for the poor. Most of the riders are medical students, including seven others from Ohio State. Almost half are women. All are committed to completing the 3,700-mile journey.

The weather along the way hasn’t always been hospitable, but the people have been. As they crossed the Sierra Mountains, the cyclists ran into a spring storm that buried the roads under more than a foot of snow. In order to keep to their timetable, they had to put chains on the tires of their support vehicles and truck their bikes to the next stretch of clear road.

“The reception from people has been spectacular,” Wagner said, when reached on his cell phone between speaking engagements in Telluride. “We’ve had whole towns [Baker, Nevada, population 200] cook a potluck supper and turn out to meet us.”

$110,000 in the bank, $140,000 still to be raised.

All proceeds from pledges and donations received along the route from San Francisco to Bethany Beach, Delaware, will go to Partners In Health.

“Our goal is to raise $250,000,” Wagner said. “$40,000 will cover the costs of the ride. $10,000 will be set aside to keep the organization going and build for another ride. And we’ll donate $200,000 to Partners In Health.”

When they pedaled out of Telluride, the cyclists still had a lot to look forward to – crossing the rest of the Rockies, the Great Plains and the Mississippi, sharing the spotlight on the Ohio State campus with the president of the AMA on an officially dedicated “Global Health Day”, capping the tour with a lecture at Howard University in Washington, and finally, almost two months after they left the Pacific Coast, dipping their toes into the Atlantic. All to support a cause they believe in. All to be able to pay for a year of life-saving antiretroviral treatment for more than 1300 AIDS patients in Haiti or Rwanda.

To learn more about Ride 4 World Health, to donate to the cause, or to monitor their progress across the country with regularly updated blogs, videos and photos, go to www.ride4worldhealth.org.

Ride 4 World Health cyclists celebrate completing their first 100-mile day.

Jim Kim is back. Jim, who teamed up with Paul Farmer to found Partners In Health in 1987, returned in mid-December after almost three years at the World Health Organization (WHO), where he served first as Senior Advisor to the Director-General on HIV/AIDS and then as head of the HIV/AIDS Department.

On his return from Geneva, Jim resumed responsibilities as chief of the Division of Social Medicine and Health Inequalities (DSMHI) at Brigham and Women’s Hospital, a position he had held before taking leave to work at WHO. A first for a major US teaching hospital, DSMHI is one of the "three pillars" of institutional support that makes it possible for PIH to translate our experience serving the destitute sick into clinical and operational research, education and training programs, and policies for reducing disparities in health care.

Since helping found PIH, Jim has served as its executive director and as a member of its board of directors. He played a leading role when PIH challenged the prevailing medical wisdom to prove that multiple drug-resistant tuberculosis can and must be treated as well in a shantytown on the outskirts of Lima as in a teaching hospital in the United States or Western Europe.

During his tenure at the WHO, Jim spearheaded the groundbreaking "3 by 5" campaign to get 3 million AIDS patients in developing countries on anti-retroviral medication by the end of 2005. Now he will bring the knowledge and experience developed at PIH and amplified at the WHO to bear on DSMHI's mission of addressing health disparities through training, education, research and service.

Jim Yong Kim with children in Uganda during his tenure at the
World Health Organization.

Hamish Fraser, PIH's Director of Informatics and Telemedicine, has earned a new title – "do-gooder." Fraser was one of a half-dozen people singled out by Red Herring magazine in early January for a cover story featuring "Six Who’ve Applied Tech to a Good Cause."

The article describes the work that Hamish and PIH’s Electronic Medical Records team have done to build a web-based system for tracking patients, treatment regimens and pharmaceutical needs at more than 150 clinics in Peru, Haiti and Rwanda. The system has helped PIH and its partners improve patient care, manage resources and supplies, reduce costs and reinforce our ability to generate reports and conduct research. The Rwandan government is currently working with PIH to roll out the system to HIV clinics nationwide. To read the full article, click here.

Just two months earlier, on November 9, Hamish turned out in formal attire (kilt included) to accept an award on behalf of PIH at the Tech Awards 2005 Gala in San Jose, California. The EMR system earned PIH a "Tech Award" as one of five "Agilent Technologies Foundation Health Award Laureates." The annual event sponsored by the Tech Museum for Innovation honors laureates in five fields – environment, economic development, health, education and equality – for "using technology to make the world safer and healthier, more prosperous and just." To read more about PIH's Tech Award, click here.

published January 2006

by Julie Mann, PIH midwife and nurse

The rain had fallen hard the night before. The narrow footpaths crisscrossing central Haiti were slippery with mud, making it even more difficult for 25-year-old Naromie Axilian (not her real name), now 39 weeks pregnant, to climb up and down the many mountains that lie between her hut and the health center. After eight hours of walking, Naromie arrived late in the evening at the new Boucan Carré hospital, where she laid down her blanket on the cold, hard earth alongside other waiting patients and slept restlessly until the clinic opened the next morning.

This was Naromie’s first visit to the Boucan Carré hospital. The midwife performed a physical exam and some routine tests, including for syphilis and HIV. Naromie was told to return the following day for her test results. Unable to make the long trip home only to return again the next day, she spent another night sleeping outside the clinic. With the dawn of the next morning, Naromie learned she was HIV-positive.

Naromie was born and raised in a small village in Haiti’s Central Plateau. She lived with her parents, sister, and two brothers in a one-room hut with a dirt floor and a thatched roof. Like most people in rural Haiti, Naromie’s family practiced subsistence farming. She attended school for only three years before being forced—due to lack of money for books, uniforms, and fees—to stop and find work. She began selling rice, oil, and other food staples at the local market. Her family continued to struggle economically, particularly after a devastating bean crop, and Naromie was sent to Port-au-Prince to find work. Lonely and in unfamiliar surroundings, Naromie met a young man with whom she had her first and only sexual encounter. Upon learning that Naromie had become pregnant, he abandoned her and took all of the money she had been saving. Panicked and alone, Naromie returned to her home village.

Unfortunately, Naromie’s story is all too common in rural Haiti, where women face myriad obstacles and dangers that heighten their vulnerability to disease and poverty. Due to economic hardship, many of the women we serve at our Partners In Health (PIH)/Zanmi Lasante (ZL) clinics in the Central Plateau were obliged, as young girls, to leave school and find work, often far from home, where they were coerced—directly through physical force or less directly as a consequence of the desperation engendered by their dismal straits—to enter into exploitative sexual relationships. This repeated pattern results in a high incidence of unwanted pregnancies and sexually transmitted infections (STIs), including HIV.

While sweeping political, social, and economic reforms are needed to alleviate the senseless suffering and injustice on a grand scale, PIH/ZL is taking small but important steps towards breaking this crushing cycle by providing comprehensive, free health care—obstetrical and gynecological care, family planning services, and testing and treatment for STIs and other illnesses—for these vulnerable women through the Proje Sante Fanm—Women’s Health Project in Haitian Creole. 

Obstetrical Care

Perhaps the gravest risk to Haitian women’s health and well-being is, simply, becoming pregnant. Due to lack of access to doctors, midwives, and nurses, among other factors, Haitian women are forty times more likely to die from pregnancy-related complications than are women in the United States. At PIH/ZL, we ensure that women can give birth safely by making available high-quality prenatal, intrapartum, and postpartum care by trained obstetrical providers. Each Zanmi Lasante site in the Central Plateau has a fully functioning women’s health clinic staffed by a well-trained, college-educated Haitian midwife. Additionally, there are four full-time obstetrician/gynecologists who cover all six sites.

In addition to our trained clinicians, PIH/ZL also relies on matrons, traditional birth attendants, to help women deliver babies at home. Matrons are men and women with no prior formal training who have nonetheless been identified by their community as capable of helping in the delivery of babies. PIH/ZL has long recognized the invaluable services provided by these experienced and accessible matrons, and offers trainings and monthly review sessions to train the matrons to identify complicated or high-risk pregnancies that need to be referred to a clinic or hospital. PIH/ZL also supplies matrons with birthing kits containing gloves, gauze, vitamin A, soap, a scrubbing brush, a razor blade, a plastic drape, and string to clamp the umbilical cord to help protect the matrons, mothers, and newborns from infection. The partnership between PIH/ZL clinicians and matrons ensures that pregnant women receive the safest and most efficient obstetrical care possible in rural Haiti, inside and outside the clinic.

Gynecological Care

Gynecological problems in Haiti range from straightforward urinary tract infections and perimenopausal symptoms to life-threatening breast masses and sexually transmitted infections. Aggressive screening and treatment of STIs is one of our top priorities. A recent study performed by our Boston and Haiti-based staff found that the rate of STIs in the Central Plateau is alarmingly high, with nearly 20 percent of new patients presenting to Zanmi Lasante’s women health clinics with at least one STI (Smith Fawzi et al., 2004). When certain STIs go untreated, not only is the rate of transmission of HIV elevated up to tenfold, but women are also at greater risk for impaired fertility and other potentially fatal consequences. Additionally, pregnant women with untreated STIs are at risk for preterm delivery, miscarriage, and neonatal complications such as blindness and pneumonia. At Zanmi Lasante clinics, every pregnant, symptomatic, or at risk woman is counseled, tested, and, if necessary, treated using algorithms that reflect the local epidemiology. Every woman is encouraged to have her partner tested and treated as well, so as to avoid re-infection. In the future, we hope to perform another study to evaluate the effectiveness of this aggressive and comprehensive effort to reduce STIs.

In this upcoming year, PIH/ZL is committed to expanding the women’s health program by improving our ability to detect and treat cervical and breast cancer. For many years, palliative care was all we had to offer women who presented with advanced breast cancer. We are now working with a team of radiographers and specialists to bring a mammography machine to Haiti and are also training local staff to perform better clinical breast exams, read mammograms, do biopsies, and provide treatment when needed. Cervical cancer is the most common cancer for women in developing countries, and in recent years many women have presented to our clinics with very advanced, invasive disease. Zanmi Lasante does not currently have the capacity to perform routine Pap smears, but one of our goals for 2005 is to bring Pap smear screening to all of our sites. Countless lives will be saved when we are able to offer comprehensive cervical and breast cancer screening and treatment.

Family Planning

Family planning, one of the most effective ways of reducing maternal mortality, is another essential component of our women’s health program. When women are counseled, educated, and provided with contraceptive options, they are more likely to delay childbearing, have fewer children, and reduce their risk for obstetrical complications. For over 14 years, PIH/ZL has been offering free condoms and other contraceptive methods, and at each of our sites there is a fulltime nurse with specialized training in the provision of sex education and reproductive health counseling. Additionally, for women who decide they do not want to get pregnant again, we offer permanent sterilization through tubal ligation.

Despite a high patient volume at our family planning clinics, there are many women who, unable to make the long journey, are not benefiting from the education, counseling, and care we offer. To address their needs, two years ago Zanmi Lasante piloted a program in Cange to train and mobilize a new category of community health workers who specifically promote family planning and women’s health issues. These ajans fanm travel throughout the countryside, teaching women and men about STIs (including HIV) and contraceptive methods, distributing condoms and oral contraceptives, and referring pregnant women and others to the clinics. The ajans fanm are proving to be an indispensable component of our women’s health efforts, and we hope to expand the program to all of our sites this year.

Preventing Mother-to-Child Transmission of HIV

One of the most pressing problems we face in our women’s health program is the transmission of HIV from pregnant women to their newborns. In rural Haiti, approximately 5 percent of all women attending prenatal clinics are infected with HIV. If these women receive no antiretroviral therapy during pregnancy, their chance of transmitting the virus to their infant at birth is 30 percent.

Zanmi Lasante recognized very early on that averting vertical transmission of HIV must be a top priority in our efforts to curb the epidemic. In 1995, we began providing HIV-positive pregnant women with zidovudine, which resulted in a 10 percent drop in the rate of vertical transmission.

Zanmi Lasante currently offers every pregnant woman seen—about 10,000 a year—HIV counseling and testing. (The number of women who choose not to be tested is almost nil.) Women found to be HIV-positive are counseled and provided with a small monthly stipend to cover basic nutritional needs and monthly travel costs to the clinic. They are also paired with an accompagnateur, a community health worker who will deliver and observe antiretroviral therapy twice daily. Combination therapy—exactly what HIV-positive pregnant women in the United States receive—is extremely effective in preventing vertical transmission of the virus from mother to infant. (In the United States, vertical transmission is now almost nonexistent.)

When women present to clinic too late in their pregnancy for ART alone to be effective, we are able to perform cesarean sections and other surgical interventions in our three fully-equipped operating rooms. Again, this is equivalent to the care HIV-positive pregnant women receive in the United States. After birth, because of the high risk of HIV transmission through breastfeeding, we also urge all HIV-positive mothers to formula feed, and, through the PMTCT program, give them the means to do so safely.

Zanmi Lasante’s capacity to provide comprehensive, high-quality health care has been instrumental in reducing the rate of mother-to-child transmission of HIV to less than two percent in the areas we serve, and we are continuing to improve on these successes through education, screening, and treatment. In November 2004 we piloted an inexpensive PCR test—now used throughout the developed world—that has enabled us to more rapidly diagnose HIV in infants.

Until recently, high costs, sophisticated laboratory requirements, and the need to refrigerate test samples made viral testing prohibitively expensive in resource-poor settings; we were constrained to using antibody testing to determine a baby’s serostatus, a method that is not definitive until an infant is at least 18 months old (the maternal HIV antibody, which passes from mother to child via the placenta, can last in the child’s system for up to 18 months). The new test yields reliable, stable, and noninfectious samples that are easily shipped to Europe for lab processing. Confirming an infant’s serostatus within one to four months of birth allows us to provide more timely treatment and follow-up for the few infants who do contract the virus from their mother. Additionally, it is a profound relief for parents to know the serostatus of their child so much sooner.

Naromie’s Future

The services offered through Zanmi Lasante’s women’s health program are saving countless lives in the Central Plateau. Were it not for PIH/ZL’s expansion to the commune of Boucan Carré, where we revitalized what had been a dilapidated, poorly staffed, and underutilized health clinic, Naromie would have had no place to seek prenatal care, learn her HIV status, and deliver her baby safely. More likely than not, she would have died from AIDS or from obstetrical complications. Thanks to the generous support of PIH’s donors, Naromie’s story continues to unfold.

After learning of her diagnosis, the Zanmi Lasante team—midwife, physician, nurse, and social worker—offered Naromie counseling, provided her with social support, and arranged for further testing. While PIH/ZL provides antiretroviral therapy to all pregnant HIV-positive women as a matter of course, there was concern that, in Naromie’s case, ART alone would not be enough. The extent of her immunosuppression indicated that her HIV infection had progressed to full-blown AIDS, and she was very close to her due date. After much discussion, Naromie was taken to Zanmi Lasante’s main hospital in Cange, where a cesarean section was performed.

Today, Naromie is the mother of a healthy, HIV-negative, 18-month-old boy. Through the PMTCT program, she was given infant formula and taught how to boil water and clean bottles in order to feed him safely. Naromie and her baby return to the health check-ups and family planning counseling. In addition to receiving daily directly observed ART from an accompagnateur, she participates in a social support group for women infected with HIV. Through Zanmi Lasante’s social assistance program, Naromie, in good health, is now employed as a cleaning woman at the Boucan Carré hospital where her life was saved.

This article first appeared in PIH’s Winter 2005 Newsletter.

Since October 5, 2005, we have been following the tragedy unfolding in the PIH supported project in Chiapas, Mexico in the wake of Hurricane Stan. While Hurricane Stan was officially downgraded to a "tropical depression" by the time it made land fall on the Pacific coast of Mexico and Guatemala, its effects have been devastating. Like Katrina, the storm has disproportionately affected the poor.

The hurricane affected many of the municipalities where PIH has been working with a community-based organization, EAPSEC, in Chiapas. The majority of people live in houses with thatched roofs, dirt floors—flimsy stock for the 100 mile an hour winds and torrential rain. Mud slides have overtaken many areas burying entire communities and making access to clean, potable water scarce.

For over 20 years, EAPSEC has been providing basic health services and training health promoters in Chiapas. Due to the storm, the roads have become impassible, communication lines have been downed, cutting off the most vulnerable and making it difficult for EAPSEC to reach the communities they serve.

EAPSEC urgently needs financial support to purchase a 4 wheel drive vehicle to be able to reach the affected areas and continue to provide essential health services and now, emergency health services to the poor of Chiapas, Mexico.

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$1.5 million prize to PIH founded by Dr. Paul Farmer

LOS ANGELES – September 26 -- Partners In Health, an innovative health care leader for poor societies, will receive the 2005 Conrad N. Hilton Humanitarian Prize of $1.5 million, the world’s largest prize. It is awarded annually by the Conrad N. Hilton Foundation to an organization that is significantly alleviating human suffering.

“Partners In Health (PIH) provides ‘first world’ health care to the poorest societies, creating an innovative model that successfully has reversed the most devastating illnesses and returned people to productive lives,” said Steven Hilton, chairman and CEO of the Hilton Foundation. “The PIH model of training local people to be the community-based health care delivery system has transcended country and cultural boundaries and is now being adopted by governments and health organizations around the world,” he added.

Founded in 1987, Partners In Health successfully established its first community-based health project in Cange, a small impoverished settlement in Haiti. Today that project serves nearly a million people, treating diseases while also tackling the conditions of poverty that cause disease.

Dr. Paul Farmer, co-founder of PIH, said, “The prestigious Hilton Humanitarian Prize is a terrific boost as we seek not only to provide direct medical services in seven countries, including our own, but also to bring countless supporters into a broad and global movement to promote basic rights for the poor. Winning the Hilton Prize is the greatest recognition yet received by Partners In Health, and we are proud, honored and grateful.”

While still expanding its work in Haiti, the organization has taken its pioneering model of care for the poor to Peru, Russia, inner-city Boston, Mexico, Guatemala, and most recently, Rwanda. Its HIV Equity Initiative, developed in Haiti, has paved the way for antiretroviral therapy for AIDS patients in resource-poor countries, and its protocol for multidrug-resistant tuberculosis has been adopted by countries around the world.

In praising the selection of PIH for the Hilton Prize, Dr. LEE Jong-wook, Director-General of the World Health Organization, said, “Partners In Health has been a pioneer in demonstrating that quality care can be provided in a sustainable way in the poorest of settings. This life-saving model will have an impact on global public health for decades to come.”

Noted Ophelia Dahl, Executive Director of Partners In Health, “We realized that, if we were to truly improve the lives of the poor, we must tackle the root causes of their illnesses. As a result, we address health care in the broadest possible sense—not just providing medicine, but also education, water, and housing.”

Dr. Farmer and Partners In Health were the subject of a recent best-seller, Mountains Beyond Mountains, by journalist Tracy Kidder.

Partners In Health relies on longstanding institutional support in Boston from Harvard Medical School and one of its teaching hospitals, the Brigham and Women’s Hospital. Much of the organization’s early funding came from a Boston philanthropist, Thomas White, who is a co-founder and PIH’s major donor over the years.

Another co-founder who was also a Harvard medical student with Paul Farmer, Dr. Jim Yong Kim, is now Director of the HIV/AIDS Department at the World Health Organization. He commented, “Due to the groundbreaking work of PIH, the global community has moved from asking ‘should’ antiretroviral treatment be provided to people living with HIV/AIDS in the poorest countries to demanding to know ‘when’ it will happen and ‘how’ to do it most effectively.”

“The Hilton Prize was established in 1996 to call attention to organizations that are effective and innovative leaders in addressing humanitarian needs and to encourage others to contribute to their good work,” according to Judy Miller, vice president of the Hilton Foundation and director of the Hilton Prize.

Partners In Health was one of nearly 200 nominees for the 2005 Hilton Prize. A distinguished international jury makes the final selection following a rigorous examination of the organizations’ work.

This is the tenth anniversary of the Hilton Prize. Previous recipients are: Heifer International (Arkansas) 2004; International Rehabilitation Council for Torture Victims (Denmark) 2003; SOS Children’s Villages (Austria) 2002; St. Christopher’s Hospice (England) 2001; Casa Alianza (Costa Rica) 2000; African Medical and Research Foundation (Kenya) 1999; Doctors Without Borders (France) 1998; International Rescue Committee (New York) 1997; and Operation Smile (Virginia) 1996.

The Hilton Foundation was created in 1944 by hotel entrepreneur and business leader, Conrad N. Hilton, who left his fortune to the foundation with instructions to help the most disadvantaged and vulnerable throughout the world. Along with its related entities, the foundation has total assets of approximately $2.5 billion and, since its inception, has provided nearly $450 million in grants to organizations throughout the United States and the world. It is one of the few U.S. foundations with a worldwide mission, in keeping with the wishes of Conrad Hilton who noted that the Hilton fortune was built on the international as well as the domestic hospitality industry.

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For more information visit www.hiltonfoundation.org

Contact:
Casey Sayre & Williams
Barbara Casey
(310) 396-2400

Partners In Health
Jennifer Watson
(617) 525-6671

September 26, 2005

Images of Gulf Coast residents killed or left homeless by Hurricane Katrina in early September came as a shock to many Americans, who are unaccustomed to seeing such stark misery within their country, the most affluent and powerful in the world. If any country would be able to respond promptly and effectively to a “natural disaster,” Americans thought, it would be their own. TV viewers heard people exclaim over and over, “This can’t happen in America.”

But disasters are never wholly and purely “natural,” as the residents of New Orleans and dismayed onlookers have discovered. How can we pretend that racism, a social disaster, played no role in the aftermath of Katrina? Even here in Rwanda, where Partners In Health has launched its newest project, we saw the faces of those left behind, and they were black faces.

Unsurprisingly, perhaps, a number of journalists have compared the desperate situation in New Orleans to that in Haiti, a country dear to all of us at Partners In Health and a country familiar to journalists as this hemisphere’s most vulnerable, as far as bad weather is concerned. In May 2004, flooding in southern Haiti, near the Dominican border, killed 1,700. Then, in mid-September, Tropical Storm Jeanne made landfall in Puerto Rico and the Dominican Republic before moving towards Haiti. One of the most perceptive commentators on Haiti, and on the history of the Americas in general, is the Jamaican writer John Maxwell. Writing presciently from Jamaica several days before Jeanne pummeled Haiti, Maxwell drew a direct connection to the social disasters that have long plagued his neighbors. In Haiti, he observed,

the slightest storm is likely to kill hundreds of people, because their landscape has been stripped and there is little vegetation to restrain the waters. Additionally, since February, the Haitians are leaderless, their society decapitated by the ouster of their President, their social networks disrupted by gangs of criminals who have been allowed by the moribund conscience of the world to assume hegemony over the poorest and proudest people of the hemisphere.

I won’t go into the causes of their poverty nor the justification for their pride; we’ve been there before. But when so-called statesmen, Caribbean statesmen, can imagine turning over any group of human beings to the mercies of the thugs now ruling Haiti, one wonders not how their minds work, but whether their minds work at all. If there is… disaster in Haiti the effects will be compounded by the fact that the leadership of the country is in the hands of people whose only skill is in mayhem and whose consciences are as dead and buried as the victims of their massacres going back three decades.

…. All of us [who suffer from hurricanes] will be licking our wounds, all of us would wish to welcome assistance from abroad, but the Haitians alone will have no say in how their land and nation is resuscitated and repaired. In Grenada and in Jamaica, in the Dominican Republic, in Barbados and Jamaica and in Cuba, neighborhood committees will see to the distribution of relief, will try to ensure fairness, will attempt to protect the weakest and to enlist the strong in their assistance.

That will not happen in Haiti.¹

Maxwell was right, of course. Tropical Storm Jeanne moved northwest, never making landfall in Haiti, but thrashing the island’s denuded hills with torrents of rain. Avalanches of water and mud rolled from the hills to the coast. The death toll in Haiti, as of October 4, 2004, stood at 1,970, with another 884 reported missing and most presumed dead. Over 300,000 people, most in the hardest-hit city of Gonaïves, were left homeless. What of Maxwell’s prediction that the de facto government would not be up to the task of disaster relief? Sure enough, the New York Times was soon reporting that international relief efforts in Jeanne’s wake were hampered by a lack of help from the Haitian government and the local authorities in Gonaïves: “‘We are having trouble organizing and distributing food because there is no authority existing in the town,’ said Eric Mouillefarine, who heads the Haiti branch of the United Nations Office for the Coordination of Humanitarian Affairs. ‘The government is absolutely not responding.’” ² This will sound eerily familiar to the people of New Orleans.

There are many reasons Jeanne, a slow-moving tropical storm with relatively low wind speeds, caused such devastation in a country it never even crossed, and those reasons are social. And just as those left behind in New Orleans had to suffer humiliation and uncertainty, in spite of the valiant efforts of many (including some of our own supporters), so too did Jeanne’s survivors. As the huge toll taken in Haiti by Jeanne came to light, journalists arrived to cover the story and, again, the story will sound familiar to those following Katrina. CNN reported that U.N. peacekeepers, in place since the violent overthrow of Haiti’s elected government, “fired into the air to keep a hungry crowd at bay” and “fired smoke grenades as crowds of Haitian flood victims tried to break into a food distribution site.” The relief workers themselves, it seems, were in need of relief: “As they waited for days, one woman yelled at a Red Cross worker on the balcony of City Hall ‘Help me. I’m hungry.’ The Red Cross volunteer yelled back ‘I’m hungry, too.’” ³

It’s no wonder that New Orleans’ and Haiti’s disasters sound similar. Many Americans have forgotten that the Louisiana Purchase was the direct result of Napoleon’s defeat at the hands of the Haitians in 1804. Haitian President Jean-Bertrand Aristide, in exile in South Africa, made reference to this history in a condolence note made public recently: “The connection [between Haiti and Louisiana] … finds new root in a shared human suffering caused by this week’s catastrophic storm and ensuing floods.”

John Maxwell’s reflections on this connection are a good deal sharper. Haiti and the poor of New Orleans are, he wrote, now linked by yet another bond: catastrophe following the “decapitation of democracy.” ⁴ After Katrina, the images of the dead and dying, the squalor and ruin of cities, the hopelessness and despair of some of the survivors, have shaken us profoundly. But have they shaken us enough? Some had not realized that such desperate poverty existed in the United States, or that a substantial segment of our population lives without ready access to basic services, such as education and health care, that most in “developed” countries take for granted. And things are not getting better: since 2003, 800,000 more Americans are without health insurance, and an estimated 1.1 million more Americans have slipped below the poverty line in the past two years.

The best monument to the catastrophe in New Orleans and the Gulf Coast, it has been noted, would be a serious national effort to address the poverty and inequality that afflicts the entire country. ⁵ But can we respond effectively by addressing poverty in our own country alone? The shared history of Louisiana and Haiti reminds us that cultures, populations, hurricanes, and need refuse to be confined by national borders.

All of us at Partners In Health are confident that the American people will respond generously to the great need of those hit by Katrina. We know a lot about American generosity, because that’s what permits us to do our work in Rwanda, Haiti, Peru, Boston, and elsewhere. We know that homes will be opened, and that students from the Gulf Coast will be offered spots in schools elsewhere; we are sure that the beautiful city of New Orleans will be rebuilt. Many of us hope to be a part of the rebuilding.

But Katrina is also the latest reminder that the project of reconstruction must be underpinned by a vision of a world without indecent poverty, without racism, and without the accelerating divestment in public infrastructures now registered in the United States and elsewhere. The collapse of New Orleans’s levees is as clear a message as possible about the risk of gutting public works. The siphoning of resources away from public health will mean that Katrina’s wake will include precisely the sort of misery seen in Haiti and in the poorer regions afflicted by last year’s tsunami. The great vulnerability to which we expose all those who lack fundamental social and economic rights, including the right to be protected from foreseeable and, indeed, predicted disasters, is a cause worth fighting for. In a reflection on the impact of Tropical Storm Jeanne, Julia Taft, writing for the New York Times, concluded that “the biggest killer in natural disasters is poverty. The same hurricane tides that flood houses in Florida sweep away entire neighborhoods in places like Gonaïves, Haiti. And while survivors need places to live, simply rebuilding their tin-roofed shacks in flood plains guarantees they will suffer again.” ⁶

Allaying human suffering and promoting human dignity, at home and abroad, are part of the prescription and the reason for rebuilding. Addressing persistent poverty, at home and abroad, remains our most pressing task.

Paul Farmer

Rwanda, September 2005

1. 2004. “Under the Gun.” Jamaica Observer , 12 September.
2. McKinley, Jr., John C. 2004. “Floodwaters Recede from Haitian City, but Hunger Does Not.” New York Times, 25 September, 7.
3. “Jeanne Leaves More than 1,070 Dead in Haiti.” 2004. CNN.com, 22 September. “Haiti Mob Attacks Relief Truck.” 2004. CNN.com, 24 September.
4. John Maxwell. 2005. "Losing New Orleans,” The Jamaica Observer, September 4.
5. Nicholas D. Kristof. 2005. "The Larger Shame" (Op-Ed), New York Times, September 6.
6. Taft, Julia. 2004. “Storm-Tossed Lessons.” New York Times, 3 October, 11.

Boston, MA – October 7, 2003 – Jim Yong Kim, MD, PhD, a co-founder of Partners In Health, the nonprofit medical assistance organization, has become the second co-founder of the organization to win a MacArthur “genius” fellowship. The John D. and Catherine T. MacArthur Foundation announced the award on Sunday in Chicago. Dr. Paul Farmer, also a co-founder of Partners In Health, received the award in 1993.

On the same day that the award was announced, a new book by Pulitzer Prize-winning author Tracy Kidder about the work of Paul Farmer, Jim Kim, and their colleagues at Partners In Health and the Brigham and Women’s Hospital, became a national bestseller. Mountains Beyond Mountains, which focuses on their work treating infectious diseases in resource-poor parts of the world, is ranked #14 on The New York Times bestsellers list.

Dr. Kim, a physician-anthropologist, is a Founding Trustee of Partners In Health and Co-Chief of the Division of Social Medicine and Health Inequalities at the Brigham and Women’s Hospital in Boston. He is also Associate Professor of Medicine and Medical Anthropology and Director of the Program in Infectious Disease and Social Change at Harvard Medical School. An expert in infectious diseases and access to pharmaceuticals in poor populations, he is currently on a leave of absence serving as Senior Advisor to the Director General of the World Health Organization.

Dr. Kim is the author of Dying for Growth: Global Inequality and the Health of the Poor, which examines the socioeconomic forces that impact health outcomes of the poor throughout the world. He has recently edited, along with the World Health Organization, the Global Plan to Stop Tuberculosis, the first consensus business plan for the global TB control community. Dr. Kim completed his undergraduate studies at Brown University and received his M.D. and Ph.D. from Harvard University.

Partners In Health, a Harvard-affiliated nonprofit organization, provides medical assistance to hundreds of thousands of poor men, women, and children suffering from treatable diseases in Haiti, Peru, Russia, Mexico, Guatemala, and the United States. Its groundbreaking work in treating tuberculosis and HIV/AIDS has changed the approach that the World Health Organization and other global health care authorities take to the treatment of these and other infectious diseases.