Partners In Health (PIH)

Our mission is to provide a preferential option for the poor in health care. By establishing long-term relationships with sister organizations based in settings of poverty, Partners In Health strives to achieve two overarching goals: to bring the benefits of modern medical science to those most in need of them and to serve as an antidote to despair. We draw on the resources of the world's leading medical and academic institutions and on the lived experience of the world's poorest and sickest communities. At its root, our mission is both medical and moral. It is based on solidarity, rather than charity alone. When our patients are ill and have no access to care, our team of health professi...
Dec 18, 2012

Maternal Mortality Reduction - Dec 2012 Update

Community Health Worker training session, Lesotho
Community Health Worker training session, Lesotho

In September of 2012, Dr. Hind Satti and the Partners In Health Lesotho team published a paper in PLoS One (an international online journal) on the Maternal Mortality Reduction Project.  Please take a minute to read a summary of this paper below, written by Christian Hague of Partners In Health:

Lesotho Maternal Mortality Reduction Program Results

Background: In the mountain regions of Lesotho, women must often travel hours or even days by foot to access medical care. This lack of access leads many pregnant women to deliver their babies at home, far from the life-saving care of a medical facility. As a result, there are 1,155 maternal deaths for every 100,000 live births, giving Lesotho one of the highest maternal mortality ratios in the world.[1] One in every 31 women in Lesotho will die in childbirth at some point during her life. [2] Women in Lesotho have an average of 3.3 children, so each maternal death contributes to an orphan crisis with an estimated 200,000 orphans out of a population of 970,000 children under age 18.1

To more aggressively and effectively prevent maternal deaths in Lesotho, PIHL and the Ministry of Health and Social Welfare began the Maternal Mortality Reduction Program (MMRP) in 2009. The MMRP aims to expand access to facility-based prenatal care and delivery by conducting active outreach to pregnant women in the communities PIHL serves. The backbone of the MMRP is a team of community health workers who accompany women throughout their pregnancy, ensure that they attend prenatal appointments, and encourage them to deliver their babies at the health center. These community health workers are rigorously trained, supervised, and receive regular training updates and monthly performance-based pay for their work.

The Status Quo in Global Health: In many remote regions around the world, maternal health is provided only at local health centers, which may be several hours’ walk for many pregnant women who need care. The lack of community-based follow-up in many of these poor communities causes women to deliver their children at home, where they are more vulnerable to poor outcomes or death as a result of a complicated pregnancy or delivery.

How PIH is Innovating: A recent publication by Dr. Hind Satti and others showed that, after establishing the MMRP at Bobete health center, PIHL made great progress in getting women to the health center for prenatal care and delivery.[1] The average number of prenatal care visits at the health center increased from 

20 to 31 per month. The number of facility-based deliveries increased from 46 in the year preceding the program to 178 in the first year of the program, and 216 in the second year (Figure 1). During the first two years, PIHL transported 49 women who were experiencing complications in pregnancy or delivery to the local district hospital for care. Not one woman who was enrolled in the MMRP died during this time. These positive results show that comprehensive, integrated, community-based care can be delivered to pregnant women living in extreme poverty in difficult-to-access areas, and can help those women deliver their babies safely.

The comprehensive care that PIHL provides as part of the MMRP is unlike anything that existed before the program. By getting pregnant women into the clinic for initial prenatal visits, PIHL is able to provide routine prenatal care, HIV testing and treatment, and a wide range of other essential services, including:

  • HIV counseling and testing at initial prenatal visit (unless known to be HIV-positive) and at subsequent visits for patients who test negative
  • Cotrimoxazole prophylaxis to prevent pneumonia in HIV-positive women who require it
  • Initiation of antiretroviral prophylaxis for HIV-positive women
  • Testing for syphilis at initial prenatal visit and again at 36 weeks
  • TB screening, and treatment as needed, at each prenatal visit
  • Hemoglobin testing for anemia at initial prenatal visit and 6 weeks later
  • Tetanus toxoid vaccine (at least 3 doses for first pregnancies)
  • Health education on topics such as HIV, nutrition, signs of labor, and newborn care
  • Identification of high-risk pregnancies and instructions to deliver at district hospital

How PIH is Impacting Global Health: PIH is exploring ways to use the lessons learned from the MMRP at other PIH country sites, enabling us to build on the great innovations from Lesotho. Furthermore, we have made our MMRP training materials freely available to partners and other organizations doing similar work in Lesotho and beyond. These measures will ensure this innovative program will pave the way for others to make progress in bettering the health of the destitute sick around the world.



[1] Satti H et al. Comprehensive approach to improving maternal health and achieving MDG 5: Report from the mountains of Lesotho. PLoS One. 2012;7(8):e42700.


[1] Lesotho Demographic and Health Survey, 2009.

Dec 5, 2012

Childhood Malnutrition in Haiti - Dec. 2012 Update

The following blog post written by Gillaine Warne, Director of Zanmi Agrikol, was published by The Huffington Post on October 25, 2012:

A Definite Cure for Malnutrition

It has been said that hundreds of thousands of dollars and equally as many hours have been spent searching for a cure for malnutrition. The good news is that a cure has been found -- it's called FOOD!

Every day of the year my thoughts turn to countries where food is a precarious commodity. These are countries where we should concentrate our efforts on sustainable solutions rather than short-term fixes.

I work in the Central Plateau of Haiti, which suffers from the highest rate of malnutrition in the country. Families struggle to provide their children with just one meal a day. I've witnessed mothers walking barefoot for days across mountains with a baby dying from malnutrition in their arms, looking for help. Throughout Haiti, one of every three children under five years old suffers from malnutrition -- and that was before the 2010 earthquake.

Zanmi Agrikol is the agricultural arm of Zanmi Lasante (Creole for "Partners In Health"). As an organization dedicated to breaking the cycle of poverty and disease, we have chosen to reach out to families who have children in special programs for severe malnutrition and are being treated with Ready to Use Therapeutic Food (RUTF). We believe that by getting to the root causes of malnutrition we can help create effective and sustainable change.

Haiti is a rural country with the potential for its people to become prosperous and well-fed. Unfortunately, the lack of education and environmental management has led to depleted, non-productive soil. Erosion has taken away much of the arable land. Cutting trees for charcoal causes deforestation, which leads to mud from the barren hillsides sliding into the sea and taking with it the last vestiges of green and growth.

Our programs at Zanmi Agrikol educate farmers about new and proven ways of planting, conservation, reforestation, and animal husbandry. We're introducing improved strains of crops and vegetables not previously available, teaching families the all-important building blocks of good nutrition, explaining what foods should be given to children each day, and underlining the importance of sustainable farming with seasonal management. Animals, such as goats, provide stopgap funding during times of crisis, including crop failure due to drought or floods. Animals are a kind of "living bank" and are integral to any program dealing with food security.

Through our Family Assistance Program we are empowering families to grow their own food, and through their own efforts combat the crisis that so often takes the lives of their children. Our program gives families, tools, seeds, trees, education, and a goat. Seeds are returned after the first harvest with a small amount of interest to introduce business principles.

A baby goat is also handed on to another family, encouraging the principle of "helping thy neighbor." The circle is enlarged, and will continue to grow.

We want to enable each family to produce sufficient food for themselves, and enough excess to take to market. Improving the quality of local markets can significantly strengthen communities. Fruit trees are being planted in great quantities, particularly the hugely popular mango. Their increased yields are allowing families and communities to form cooperatives and combine their goods in order to access larger markets.

By the way the local markets are quite something to visit with everything, including the kitchen sink, being available -- goods being spread out mostly on the ground in large and small quantities and varying degrees of quality. Clothing, furniture, chairs, hats, millions of second hand shoes, alcohol, dried fish, spices and condiments, fruits, meat and poultry both alive and otherwise, adding to the joyous cacophony of sound, and of course the produce of the local farmers being proudly displayed!

Thanks to our Family Assistance Program, more food is now becoming available, children are going to school with food in their tummies, and we are starting to see huge differences in class participation and performance. We are also working on small school vegetable gardens to help supplement the one meal given to students and underline, once again, the importance of fresh food.

Our programs can be easily "transplanted" to other communities and areas where children are suffering from malnutrition and lack of food. To be able to expand this program what we need is more participation and more funding to help more families grow real food. Our pilot program started with just 20 families and to date we have enrolled and helped more than 1,500 families. If we count about 10 members per family, that amounts to having touched nearly 15,000 hungry people. The restoration of pride and dignity to families once bowed down under the weight of desperation and hopelessness is wonderful to witness. We are now seeing heads held high and positive attitudes toward a changing future.

Links:

Nov 12, 2012

Equip Mirebalais Hospital in Haiti - November 2012 update

Ribbon-cutting ceremony at Mirebalais Hospital
Ribbon-cutting ceremony at Mirebalais Hospital

WORLD BANK PRESIDENT JIM YONG KIM CELEBRATES HOSPITAL CONSTRUCTION

Posted on 11/08/12

The white walls of l'Hôpital Universitaire de Mirebalais blazed in the hot sun Tuesday as crowds gathered for Partners In Health co-founder and World Bank President Jim Yong Kim’s visit to the newly built hospital.

The hospital grounds were filled with the residents of Mirebalais, local and national government officials, representatives of nongovernmental partner organizations, and staff of Zanmi Lasante, PIH's sister organization in Haiti. All were gathered for a ribbon-cutting ceremony to celebrate the end of the hospital’s construction phase. The hospital will officially open the first part of next year.

Kim’s visit marked a return to the area in which he, Dr. Paul Farmer, and Ophelia Dahl began the work of Partners In Health years ago.

“In 1988 I came to the Central Plateau for the first time, and I met Père Lafontant,” he told a small group just before the ceremony. “In the middle of very little else that was going on, we saw this wonderful hospital [in Cange], and the question that we asked during that first visit was what do the people of the Central Plateau deserve? The constant refrain from all around us was ‘you have to lower your expectations. Haiti is a difficult country to work in; there’s only so much you can do.’”

“I’m so proud to see that the government of Haiti, Zanmi Lasante, the community, and so many other people have answered the question by building this hospital,” he continued. “What the people of Haiti deserve is the best that we can possibly offer. As president of the World Bank Group, the lessons you have taught me—the people of the Central Plateau—will always be in my heart.”

Michel Joseph Martelly, president of the Republic of Haiti, addressed the crowd, along with Florence Guillaume, Haiti’s minister of health. They spoke in front of the hospital’s emergency room, on the driveway that ambulances will use to transport critically ill patients to HUM and then moved to the hospital’s front entrance for the ribbon-cutting.

“L'Hôpital Universitaire de Mirebalais will offer services that have no match anywhere else in Haiti,” said Dr. Pierre Paul, the hospital’s deputy director. “It is a practical example of the willingness to build something stronger and more sustainable—to build better.”

Radiology suite, fully equipped
Radiology suite, fully equipped
L
L'Hopital Universitaire de Mirebalais (HUM)

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