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 27, 2014

Malnutrition in Haiti: Feb 2014 Update

Photo: Rebecca E. Rollins/Partners In Health
Photo: Rebecca E. Rollins/Partners In Health
A young woman has her upper-arm circumference measured at Hôpital Universitaire de Mirebalais, in Mirebalais, Haiti, to help determine whether she's malnourished. 

Need to Know: MUAC and Malnutrition

Spend a day at any Partners In Health site and there’s a good chance you’ll hear a phrase you’re unfamiliar with. Perhaps it’s a clunky acronym or polysyllabic drug name. But don’t worry: Keeping up with the ever-evolving world of global health is hard, even for insiders. In Need to Know, we cut through the complexity and deliver the most pertinent and interesting information on a single subject. Today, we fill you in on mid-upper arm circumference.

What is it?

Mid-upper arm circumference, often shortened to MUAC, is a measurement that allows health workers to quickly determine if a patient is acutely malnourished. PIH, as well as many other organizations, measures the circumference of a patient’s arm at the midpoint between his or her shoulder and elbow.

Why is it important?

The burden of malnutrition is staggering. According to a recent series of articles in The Lancet, more than 3 million child deaths every year are associated with malnutrition. Put another way, nearly half of all children who die each year die because they don’t have access to enough of the right food. Our health workers in Haiti, Malawi, Lesotho, and Rwanda, among other locations, encounter malnourished patients every day. MUAC provides a fast and effective first-line screening method.

How do you make the measurement?

There are specific paper MUAC bands that are color-coded. If the girth of the patient arm falls within the green part of the band, it indicates that the patient is not malnourished. A measurement that falls within the yellow part of the band indicates that the patient may be at risk of malnutrition. Lastly, the red portion of the band indicates that the patient is severely malnourished and at risk of death. Some bands include a fourth color, orange, which indicates the patient is moderately malnourished.

What happens after the measurement is taken?

Well, that depends on the measurement. Generally, if a child is malnourished, we provide treatment with ready-to-use therapeutic food, commonly known as RUTF. These foods are high in fat and protein and fortified with the vitamins and minerals necessary to treat severe acute malnutrition. A few weeks of treatment with RUTF can bring about significant improvements. PIH will often take steps to improve the long-term food security of patients’ families. This might include enrolling people in job training, delivering food assistance, or providing materials for farming.

Malnutrition is a complex problem. Is a paper arm band all you’re using in the fight against it?

Absolutely not. MUAC is an immensely helpful tool but it’s not foolproof. For instance, a simple arm measurement doesn’t tell us whether a patient has kwashiorkor, or protein malnutrition. Furthermore, the accuracy of MUAC diminishes as the child ages. That’s why we’re constantly devising and implementing new ways to alleviate the root causes of malnutrition and catch malnourished children earlier. In Malawi, for instance, we partnered with TOMS to combine the distribution of new TOMS shoes with malnutrition screenings. This approach has allowed us to screen more than 1,000 children, including 70 in need of malnutrition treatment. Meanwhile, in Haiti, we’re deploying mobile health clinics that travel into isolated regions to find patients who have the hardest time accessing medical services.  MUAC is merely one part of a comprehensive strategy that helps us make proper diagnoses and act accordingly.

Feb 10, 2014

Support children in Malawi - Feb. 2014 Update

Thank you for contributing to Partners In Health's Support school costs for children in rural Malawi project on Global Giving. I encourage you to take a minute to read this brief story about a beneficiary of the program -- Chifunilo.  With your help, we are providing the basic tools and resources for children like Chifunilo to succeed, thus breaking the cycle of poverty and disease, one community at a time. 

Chifunilo lives in rural Lumbe village with his four younger siblings and grandmother. At 17 years old, he is in Form 2 and says “without POSER’s support, I wouldn’t be in school at this time.”  He has been receiving support from POSER for three years – since Standard 8 – and all of his siblings are also beneficiaries. This assistance is critical for the family, because as Chifunilo says “even to get soap my family had to do piecework. My grandmother relies on farming, but it is difficult because she is aging. After school we go to the garden to help her.” However, with support, Chifunilo is doing well in school and is thinking about his future. His favorite subjects are Geography, English, and Mathematics, because with Geography “I know about the location of other places, other countries, and about their natural resources.” With good math skills, he knows it “will make it easy for me to be an accountant or to work in the bank.” One day, he “would like to work in an office, especially to work on a computer… I am dreaming of work[ing] in an office like this one. I would like to do the job you are doing yourself, because you are helping us.”

POSER reaches 2,000 vulnerable children in the district each year through its school support initiative. 200 of these are secondary school students, like Chifunilo.  These students, in addition to the fee payments to their schools, also receive uniforms, math instruments, rulers, notebooks, and pens. Staff members also build strong connections with the students to support their psychosocial health and provide mentorship and support.

APZU will continue to welcome donations to cover the costs of school fees and materials for secondary school students. Zikomo kwambiri to everyone who has supported this project! You are helping to make a critical difference for children in Neno. 

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.

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