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...
Feb 7, 2014

Equip University Hospital - Feb. 2014 Update

Rebecca E. Rollins/Partners In Health
Rebecca E. Rollins/Partners In Health
Thank you for supporting Partners In Health and our Haitian sister organization, Zanmi Lasante.  Your generosity gives us the resources that we need at University Hospital in Mirebalais to provide quality care to cancer patients -- from chemotherapy to surgery supplies to pain medication.  We are excited to share the story of our first cancer patient, Isemélie, as well as some additional information on the services that we have been able to expand in Haiti thanks to your donation. 

Cancer Care Expands at University Hospital

Isemélie was the first patient at Haiti’s University Hospital to undergo surgery—a mastectomy to treat her breast cancer—and now her chemotherapy is almost complete.

Before her surgery in May, Isemélie was worried for her life. With the surgery, chemotherapy, and counseling, she and her family have hope that she can recover. Isemélie has just one more infusion. “I am looking forward to finishing chemotherapy so I can start working again to help my daughter pay for university,” she said.

This summer, PIH and our Haitian sister organization, Zanmi Lasante (ZL), transitioned oncology services from a crowded, inadequate space in Cange to University Hospital in Mirebalais, where more patients can receive cancer prevention, treatment, and education efforts that are integrated with other services at the hospital.

Between July and November, the cancer care team provided services to about 700 patients, illustrating a huge demand for cancer care in Haiti.

Despite the perception that cancer only affects people in wealthy countries, cancer actually causes more deaths in low- and middle-income countries. And while about 80 percent of the global burden of cancer is born by people in the developing world, just 5 percent of the world’s expenditures on cancer care happen there.

Partners In Health has been working to save lives and demonstrate that the disease is treatable in poor, rural areas.

PIH/ZL is the only provider of free oncology services in Haiti. While PIH/ZL has always cared for cancer patients, even with limited capacity for treatment, an interdisciplinary team has worked over the last three years to formalize and integrate services for patients with cancer while building their skills through training.

The move to University Hospital has allowed the cancer care team to treat more patients; the demand has shown the need for more cancer care across Haiti. Between July and September, most patients—64 percent—came from the Port-au-Prince area, and only 22 percent from central Haiti, many referred by PIH/ZL clinics or other providers.

In the same period, breast cancer was the most common diagnosis for oncology patients, at 40 percent, followed by cervical cancer, at 12 percent, according to data from University Hospital’s electronic medical record system.

The cancer care team, headed by Haitian oncology director Dr. Ruth Damuse, has worked hard to provide comprehensive care for cancer patients. Their work has been supported by partners including the Avon Foundation, the LIVESTRONG Foundation, and the Dana-Farber Cancer Institute, which helps develop treatment plans for PIH/ZL patients. The DFCI has also created a special fellowship enabling expert oncology nurses from Boston to work at the hospital in three-month rotations and train staff on administration of chemotherapy and wound care. 

Cancer care at University Hospital addresses  the many needs of  patients, including:

  • Cancer screening, including biopsies and pathological testing
  • Surgery and post-surgical wound care
  • Intravenous chemotherapy in designated beds and chairs for infusion
  • Oral chemotherapy
  • One-on-one counseling and support groups to help patients cope with their cancer diagnoses and treatment side effects
  • Referrals to a partner hospital in the Dominican Republic for radiation therapy
  • Education on cancer, including breast self-exams and community awareness events to encourage people to seek care early
  • Palliative care

Oncology social worker Oldine Deshommes described one patient’s experience with breast cancer:

“The first time I saw Mrs. A, she was crying. She felt humiliated because of her cancer. Her wound was infected and had a bad smell. She said even though she was not yet dead, she was ashamed to sit near others.

We talked about how she should not feel excluded from others, showing her that she is not responsible for her illness. We also talked about what she can do to get healthy; reminding her that she is not alone, that we are with her in this fight.

In our group sessions she talked about how she felt before coming to the support group. She actively participates in the groups, and it helps her see that she is not alone in experiencing changes to her life from cancer. She said she no longer feels lonely and she has made friends from the support group who encourage her.”

With support from Deshommes, Isemélie was able to delay her last round of chemo a couple of weeks, until January. She wanted to feel well for her daughter’s wedding.

Feb 5, 2014

Haiti Earthquake Recovery - Feb 2014 Update

Rebecca E. Rollins/Partners In Health
Rebecca E. Rollins/Partners In Health
(above) A 24-year-old patient rests with her baby boy on the day following her cesarean section in July at University Hospital in Mirebalais, Haiti. University Hospital doctors and nurses have delivered more than 800 babies in less than a year of operation.

On January 12, 2014, the fourth anniversary of the Haitian Earthquake, Partners In Health published the below story on our website.   Please take a moment to read about some of the significant progress taking place in Haiti, thanks to the generosity of people like you.  Your support has enabled PIH to bring hope to the people of Haiti.

After Earthquake, University Hospital is Transforming Lives in Haiti

Four years after an earthquake struck Haiti’s capital—damaging its already-weak medical infrastructure—a new public teaching hospital in Mirebalais, Haiti,

Training the next generation of clinicians

A key function of the hospital is to train Haiti’s next generation of social justice doctors, nurses, and other health professionals. Workshops and trainings began before the first patient stepped foot in the building, but training has ramped up as specialty services come online. Since June, the hospital has hosted more than 165 trainings, including cardiac resuscitation training for 91 medical staff.

In fall 2013, the teaching hospital marked a significant milestone with the entrance of its first class of medical residents. These 14 young Haitian doctors are training to become specialists in pediatrics, internal medicine, and surgery, and a new class will enroll every year. Read more about this first enthusiastic class of residents here.

In 2014, hospital leaders will begin training for other specialties. Nurses will be trained in anesthesiology and critical care, skill sets that are necessary for emergency and surgical care. New medical residencies are being planned for obstetrics-gynecology, orthopedic surgery, anesthesiology, and emergency medicine, which would be the first such residency in the country.

“You don’t learn how to be a doctor in medical school,” said Dr. Michelle Morse, who has helped plan medical education programs at University Hospital. “It’s during residency that you dive in and begin to understand what it’s all about.”

Catalyzing economic growth

University Hospital has also helped grow the economy of the Central Plateau.

Researchers from PIH, Haiti, and the United States teamed up to analyze the economic impact of University Hospital, using what’s known as an input-output model. They estimated that for every $1 invested in the hospital, $1.82 is pushed into the Haitian economy.

Essentially, the influx of resources in one sector of the economy—health care and teaching in this case—will affect other sectors of the economy through what’s called the “multiplier effect.” This will result in an economic impact far greater than that of the original investment.

“The idea behind the input-output approach is intuitively simple,” the researchers note in a working paper.

Researchers used an input of $16.2 million, the estimated long-run annual full-capacity operating cost of University Hospital. Using the model, the team found that a $16.2 million investment in the hospital spills over into other sectors of the economy, resulting in an impact of $29.4 million in the broader Haitian economy. To learn more and see a graphic illustration of this model, click here.

Four years after the earthquake, Partners In Health is grateful to the many supporters and partners who helped make University Hospital a reality for the people we serve, and we look forward to making an even greater impact through our sustained commitment to Haiti in the years to come.

Since opening in March 2013, University Hospital has treated thousands of people who previously had little—or no—access to health care. The facility, built by Partners In Health and Haiti’s Ministry of Health, also serves as a training ground for Haiti’s future clinicians, and is a catalyst for economic growth in the region.

New access to medical services

University Hospital provides care for a referral area in which 3.4 million people live, including people in Mirebalais and two surrounding “communes,” or regions.

Since opening, staff members have registered more than 42,000 patients, providing more than 55,000 clinical visits. About 60 percent of patients are from the three regions closest to the hospital, and about the same proportion are women, according to data from the hospital’s electronic medical record system.

“The quality of care patients are receiving is speaking for itself, and the word is getting out,” said Marc Julmisse, University Hospital chief nursing officer, who is Haitian-American. "Our staff is doing an amazing job, and it goes to show—from outpatient services to inpatient care to the emergency room—that Haiti needs a hospital like this.”

Clinicians see more than 700 patients on a typical day.

The hospital employs about 700 people, including about 300 nursing staff and 50 doctors. Seventy percent of its employees are from the Central Plateau.

The hospital has an emergency department, state-of-the-art operating rooms, and a specially designed electronic medical record system. A system of 1,800 solar panels produces most of the facility’s energy needs. To read more about University Hospital’s solar energy system, click here.

Demand for services has grown as referrals from other facilities increased and word spread about free specialty care at University Hospital that was unavailable elsewhere in Haiti. For example, analyses of where surgery patients live show that people travel from all over Haiti to receive surgical care at the hospital.

Since the maternity wards opened, clinicians have delivered more than 800 babies, about 25 percent of which were born through cesarean sections—a rate that reflects the hospital’s role as a referral center for pregnancies with expected complications.

Since March, the following services have opened at University Hospital:

Training the next generation of clinicians

A key function of the hospital is to train Haiti’s next generation of social justice doctors, nurses, and other health professionals. Workshops and trainings began before the first patient stepped foot in the building, but training has ramped up as specialty services come online. Since June, the hospital has hosted more than 165 trainings, including cardiac resuscitation training for 91 medical staff.

In fall 2013, the teaching hospital marked a significant milestone with the entrance of its first class of medical residents. These 14 young Haitian doctors are training to become specialists in pediatrics, internal medicine, and surgery, and a new class will enroll every year. Read more about this first enthusiastic class of residents here.

In 2014, hospital leaders will begin training for other specialties. Nurses will be trained in anesthesiology and critical care, skill sets that are necessary for emergency and surgical care. New medical residencies are being planned for obstetrics-gynecology, orthopedic surgery, anesthesiology, and emergency medicine, which would be the first such residency in the country.

“You don’t learn how to be a doctor in medical school,” said Dr. Michelle Morse, who has helped plan medical education programs at University Hospital. “It’s during residency that you dive in and begin to understand what it’s all about.”

Catalyzing economic growth

University Hospital has also helped grow the economy of the Central Plateau.

Researchers from PIH, Haiti, and the United States teamed up to analyze the economic impact of University Hospital, using what’s known as an input-output model. They estimated that for every $1 invested in the hospital, $1.82 is pushed into the Haitian economy.

Essentially, the influx of resources in one sector of the economy—health care and teaching in this case—will affect other sectors of the economy through what’s called the “multiplier effect.” This will result in an economic impact far greater than that of the original investment.

“The idea behind the input-output approach is intuitively simple,” the researchers note in a working paper.

Researchers used an input of $16.2 million, the estimated long-run annual full-capacity operating cost of University Hospital. Using the model, the team found that a $16.2 million investment in the hospital spills over into other sectors of the economy, resulting in an impact of $29.4 million in the broader Haitian economy. To learn more and see a graphic illustration of this model, click here.

Four years after the earthquake, Partners In Health is grateful to the many supporters and partners who helped make University Hospital a reality for the people we serve, and we look forward to making an even greater impact through our sustained commitment to Haiti in the years to come.

Jan 9, 2014

PIH Response to Cholera in Haiti: Jan. 2014 Update

Rebecca E. Rollins/Partners In Health
Rebecca E. Rollins/Partners In Health
Happy 2014!  On behalf of all of us at Partners In Health, we send our sincere gratitude for your support of our work to combat cholera in Haiti.  October of 2013 marked the third year of cholera in Haiti. While the impact of our work is promising, the need for additional support for preventation and treatment remains great. We are excited to share the article below—published on our website in October—detailing many of the successes that we have acheived with your help.

Three Years in, the Fight against Haiti’s Cholera Epidemic Continues

Three years since cholera broke out in Haiti, prevention and treatment efforts have helped control the epidemic, but the disease is far from gone.

An infectious disease that causes vomiting and diarrhea, cholera can lead to deadly dehydration in as little as 24 hours. In Haiti, where most people lack access to clean water and sanitation, cholera spread rapidly through waterways, accelerated by heavy rains and flooding. Since it appeared on Oct. 19, 2010, it has killed more than 8,000 people and caused about 650,000 cases, sickening approximately one in 15 Haitians.

Haiti’s Ministry of Health and aid groups responded quickly to help control the epidemic. Partners In Health, with our Haitian sister organization, Zanmi Lasante (PIH/ZL), has treated more than 105,000 cases in the Central Plateau, representing almost one-sixth of total cholera cases in Haiti. Cholera has declined since the peak of the epidemic, but persists: Last month, PIH providers treated more than 1,700 cases in clinics and hospitals. Meanwhile, funding for cholera prevention and treatment has diminished since the initial emergency.

“We’re making progress, and we know what we’re doing,” said Dr. Louise Ivers, senior health and policy advisor for Partners In Health, who reported some of the earliest cases of cholera in Haiti. “We need funds to keep a sustained response going.”

The governments of Haiti and the Dominican Republic have created a 10-year strategy to eliminate cholera from the island of Hispaniola, which they share. Haiti, which has seen the vast majority of cases, has called for a comprehensive response, including short-term measures such as vaccination, to stay the disease during the long-term work of building latrines and piped water systems.

Still, funding to put the plans into action has come up short. Donors have committed only about $30 million of the proposed $2.2 billion plan.

“We have the opportunity now, as cholera is decreasing, to invest in building water and sanitation systems to prevent the kind of outbreak that we had in 2010,” said Dr. Ralph Ternier, director of community care and support for PIH/ZL. “Cholera has killed so many people these past three years. We shouldn’t forget that.”

Cholera cases have continued to spike throughout the epidemic with increases in rainfall, both during the spring rainy season and in the tropical weather season in the late summer and fall. Just a few weeks ago, heavy rains caused severe flooding in a community near Mirebalais in the Central Plateau. About 120 families lost their homes and crops in the floods. A PIH/ZL team responded the following morning, distributing chlorine and buckets to disinfect drinking water, oral rehydration solution to treat dehydration from cholera, and materials to improve hygiene.

Ternier said the PIH/ZL clinic in Lascahobas has been overwhelmed by cases lately. Many people in that area don’t have latrines, which creates conditions ripe for transmission.

“That shows you the fight is really not behind us,” Ternier said.

Over the course of the epidemic, PIH has monitored cholera cases and deaths to improve care and target vulnerable communities with additional prevention and treatment. Data have shown a decrease in the number of cholera patients who died. In the first two and a half years, about 1 percent of cholera patients that came to PIH clinics died. In the last year, that figure dropped by half to .6 percent, demonstrating that it’s possible to manage cholera with a very low fatality rate in Haiti. PIH’s work to monitor cholera data and use it to improve care will be presented at the annual meeting of the American Public Health Association in November.

Partners In Health has advocated for a comprehensive response to the epidemic since its start, including the use of vaccination, publishing these views in The Lancet. In early 2012, in partnership with the Haitian Ministry of Health, PIH delivered the vaccine to two rural communities hard-hit by cholera in the Artibonite region. The successful results of this project were recently published inThe American Journal of Tropical Medicine and Hygiene.

With evidence from PIH’s vaccination project, the World Health Organization recommended in 2012 to expand access to the vaccine in Haiti and the Dominican Republic. The Haitian Ministry of Health has also conducted targeted vaccination campaigns in the Central Plateau and the north of Haiti.

Vaccination is just one part of a comprehensive response that also includes improvements to water and sanitation systems and health care facilities where people can receive treatment.

“We have to take care of cholera, and we also have to take care of other diarrheal diseases,” Ivers said. “We need to ensure that funding to support cholera treatment and prevention is also used to strengthen the health system as a whole. Only a strong health system is going to be able to deal with cases of cholera as they come.”

 
Dr. Ralph Ternier, director of community care and support for Partners In Health in Haiti, will speak at a congressional briefing Thursday to build support for eliminating cholera in Haiti and the Dominican Republic. For more information, click here.
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