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 ...
Jul 30, 2013

PIH Haiti Earthquake Recovery - July 2013 Update

Rebecca E. Rollins/Partners In Health
Rebecca E. Rollins/Partners In Health

University Hospital Shows that Aid Done Right in Haiti Improves Lives

This essay from PIH's Stephanie Garry originally apperared in the Tampa Bay Times. 

The gleaming white hospital appears out of nowhere in the bustle of this impoverished city in the Central Plateau of Haiti.

It seems even more out of place when you consider what's inside: 300 beds — more than All Children's Hospital in St. Petersburg. Six operating rooms. A neonatal intensive care unit. A CT scanner, the only one available to the public in Haiti. Most important, patients. More than 10,000 have seen clinicians since the hospital opened this spring.

It's one of the few visible signs of progress since the 2010 earthquake leveled Port-au-Prince.

More than half of American households donated after the earthquake to help a poor country with bad luck. But for the most part, the grand plans of building back better have not materialized. The 1.5 million people living in tents after the earthquake are fewer, but many were forcibly evicted. A garment factory and a luxury hotel, both underwritten by aid, opened with fanfare. These milestones hardly amount to a resounding victory for the people of Haiti.

Against this disappointing effort, University Hospital stands out as a testament to how much can be accomplished in Haiti. It can teach us how to achieve rebuilding and development with effective aid that endures, and better deliver on the generosity of the American people.

The popular narrative would tell you the recovery fell short because Haiti is difficult, unstable, dangerous and corrupt. Just a few days after the quake, New York Times columnist David Brooks blamed Haiti's trouble on "progress-resistant cultural influences." It's a facile explanation of a complex place, but a lot of people found it convincing.

My experience has led me to believe something else. I lived in Port-au-Prince for nine months and now work in Boston at Partners In Health, the global health nonprofit that built L'hopital Universitaire de Mirebalais under the guidance of Brooksville native Dr. Paul Farmer. In my view, the problem lay not with the Haitians but the aid industry that came to their rescue.

The earthquake recovery was largely composed of nonprofit organizations that are more eager to please donors than the people they purport to serve. Too often, they pay lip service to working with communities while largely ignoring them in designing their programs. Many of the so-called experts on alleviating poverty had little experience in Haiti and no plans to stay long term.

I saw this firsthand during my time working for Fonkoze, an exceptional Haitian microfinance bank serving the rural poor. I attended an aid organization's workshop to create a website to help poor, rural people improve their lives with information — people who are mostly illiterate and lack access to electricity, computers and the Internet. I heard an American aid worker complaining that the luxury housing provided by her nonprofit employer didn't have enough style.

It seemed like so much money went to Haiti after the earthquake, but less than 1 percent of the $2.4 billion in immediate earthquake relief went directly to the government of Haiti.

In the longer-term recovery effort, the U.S. development agency USAID spent $1.15 billion, more than half going to American firms in the D.C. area and less than 1 percent to Haitian firms and nonprofits, according to the Center for Economic and Policy Research.

Haitians weren't in charge of the projects, but they shoulder the blame for failures. Their country is characterized as a black hole for aid.

If national systems are weak, diverting money and projects away from the government only worsens the problem. It isn't easy to work with a government that is chronically short of resources, but it's the only way to strengthen the public sector to ensure the rights of its citizens.

There are many problems with the way aid works, but at the root of it is how we view the poor and disadvantaged, and more broadly, any group of people we seek to serve.

Beneath the complexity of actors and projects, the core of the problem is a misinterpretation of poverty.

As well intentioned as they can be, both aid and charity take the subtle view that there is something inherently wrong with the people being served. Otherwise, the argument goes, why would they need our help?

In reality, disadvantaged people are systematically deprived of the basic rights that would enable them to rise out of poverty — food, clean water, decent sanitation, housing, jobs, health care and education. The ambitions of aid are often too small, focusing on modest, short-term interventions instead of the long, painstaking work of building systems to ensure rights, in partnership with the government and local institutions.

In Haiti, this denial of rights is not innocent, but the result of centuries of international interference and oppression. A couple of recent examples: Just a decade ago, on claims that Haiti's government was interfering with the elections of eight senators, the United States blocked international loans to improve water and sanitation systems. In 2010, less than a year after the earthquake, a U.N. peacekeeping force inadvertently brought an epidemic of cholera to Haiti by dumping its sewage in a major river system. Cholera has since killed more than 8,000 people and sickened more than one in 20 Haitians.

Instead of fixating on personal failings of the people of Haiti, we should work with them to build systems that ensure access to education, health care and food. The rights-based approach guides us to imagine doing more than offering castoff goods and services — the XXL T-shirts or the expired medicines or the spring break service trips. Pragmatically, a human rights approach works better because it confronts difficult, interconnected problems with significant solutions, not small, cheap interventions like chlorine for purifying drinking water or transitional shelters that, by themselves, offer little hope of lasting change.

Partners In Health, along with its sister organization, Zanmi Lasante, works to improve the quality of care in the public health system, collaborating with Haitian communities and the government to train health care workers, develop new services and improve rundown facilities, including building top-quality infrastructure.

In the case of University Hospital, the Haitian government identified the need for a national teaching hospital after the earthquake, and Partners In Health/Zamni Lasante worked alongside the Haitian Ministry of Health to design and construct the $17 million facility, with the help of many in-kind donations. Through a public-private partnership, the government and Partners In Health/Zamni Lasante will contribute to operating costs, and management of the hospital will gradually transition to the government over the next 10 years.

Partners In Health builds open-ended partnerships that don't end when the earthquake donations dry up, offering a greater chance at slow, lasting progress on entrenched problems of poverty and inequality. We call this "accompaniment," to convey a shared journey.

Developing partnerships based on empathy and pragmatic solidarity — not pity or even sympathy — is the essential first step in serving people in need.

Early on May 23, nurses and doctors dressed in blue scrubs and prepared for University Hospital's first surgical case. The instruments were sterilized, positive air pressure minimized the risk of infection, and Haitian nurses provided anesthesia. Dozens of partners — corporations, generous donors of time and money, medical professionals, and Mirebalais housekeepers — had worked together to make this day a reality. It wouldn't have been possible without years of work to strengthen the health system in the Central Plateau, so that patients could be connected to care from their homes to the hospital.

The patient was a 60-year-old Haitian woman and mother of four, diagnosed with breast cancer by a Haitian doctor. A Haitian surgeon from Mirebalais and his American counterpart worked side by side in a fully equipped operating room to perform the mastectomy. As with all work at University Hospital, procedures like this serve two purposes — first, and most important, to heal the patient with a standard of care that compares to a top-quality teaching hospital anywhere else in the world, and second, to train Haitian medical professionals to provide that kind of care. With this operation, the Haitian woman has received new hope and a greater chance of living longer with a better quality of life.

In the United States, there would be no question that a woman with breast cancer receives care — including a mastectomy — to save her life, and health facilities provide it routinely. Yet development experts debate whether this care is worth the cost in low-income countries. Should we spend the money on and invest the time in systems, with the necessary infrastructure, equipment, supply chains and drugs, to treat complex cases like cancer?

The patients in need of care and their doctors always say yes. Our role is to support them.

University Hospital was built in less than three years, long enough for the majority of earthquake responders to come and go. It will remain, serving the people of Haiti long into the future, as a testament to how much can be accomplished when you view the people you seek to help as equal partners.

Stephanie Garry is a former Tampa Bay Times staff writer who served in the Peace Corps in the Dominican Republic from 2009 to 2011. In 2011, she worked for Fonkoze in Port-au-Prince, Haiti, before joining the Partners In Health staff in Boston. Views are her own.

Jul 10, 2013

PIH Cholera Response in Haiti - July 2013 Update

Photo credit: Bec Rollins
Photo credit: Bec Rollins
CHOLERA IN HAITI: A Look Inside the Epidemic
 
This spring, 8-year-old Belizaire S. came home from school and started to feel sick. By the following morning, he was so ill with diarrhea and vomiting that he could hardly stand up. His mother, a widow raising six children alone, knew where to go—the PIH cholera treatment center in Mirebalais, in central Haiti. At the center, Dr. Thelisma Heber asked Belizaire a few questions about his symptoms, but there was no doubt he needed IV fluids immediately. "He’s a severe case. You can see his eyes are sunken," Heber said.
 
With the start of the spring and summer rains, which spread sewage and contaminate water sources, PIH and our Haitian sister organization, Zanmi Lasante, are bracing for more cases of cholera. Because emergency funding has largely ended, many prevention and treatment activities have ceased in other parts of Haiti.
 
"In most of the areas we serve, it seems that we are the only cholera health care provider, and that puts more pressure on our services," said Dr. Ralph Ternier, PIH/ZL director of community care. Since the epidemic began in late 2010, cholera has killed more than 8,000 people and sickened 650,000, according to Haiti’s Ministry of Health. Thanks to your support, PIH/ZL has treated more than 100,000 patients for cholera and has worked to prevent cholera’s spread since the problem began. PIH/ZL also supported the delivery of Haiti’s first cholera vaccination program. PIH/ZL continues to operate cholera treatment centers in central Haiti, and conduct prevention activities and educational outreach.
 
At the Mirebalais center, Belizaire wasn’t the only patient Heber and the rest of the staff were treating. Heber admitted a half-dozen patients in less than an hour. He triaged them to either receive oral rehydration solution or, for more severe cases, to be hospitalized and given IV fluids. In different tents designated for men or women, two sisters and their father were also receiving fluid from IVs. Heber said families can become sick when they eat the same contaminated food or water, don’t wash their hands, or take care of a sick relative. "It’s a big battle to combat cholera," he said.
May 14, 2013

Mirebalais Hospital, Haiti - May 2013 update

Jon Lascher/Operating Room at University Hospital
Jon Lascher/Operating Room at University Hospital

Five Feats of Engineering at HUM


It was by way of a joke that Dr. Paul Farmer introduced Ann Polaneczky to a crowded room at PIH’s Boston office. “What comes to my mind when I think of Ann, is stool,” Farmer said, causing the 24-year-old civil engineer to blush with pride. When the collective burst of laughter tamped down, Farmer qualified the punch line by expounding on the importance of Hôpital Universitaire de Mirebalais’ (HUM) wastewater treatment system, and how Polaneczky helped shape it. 

“The wastewater treatment system at Mirebalais, the guts of the hospital, is truly remarkable. It takes the wastewater, the gray water as it’s called, and runs it through a pretty sophisticated but easy-to-maintain system that gets checked every day,” Farmer said. “We never had that in Haiti—not just in a hospital, we never had it at any public-sector institution. It’s hard to know why these things are so significant without knowing how absent they are in a lot of places in the world. This system is just one example of how a modern hospital runs that’s worth getting to know.”

With that sentiment in mind, we asked Polaneczky, PIH’s project engineer, to walk us through five of her favorite feats of engineering at HUM.

Wastewater Treatment System


What it does: Every drop of wastewater produced at HUM—whether from a toilet, an operating room sink, or dirty laundry—passes through this low-energy, low-maintenance system. The water first enters a biological treatment process known as aerobic digestion in which naturally grown bacteria decompose organic waste and devour pathogenic organisms, such as Vibrio choleraethe bacterium that causes cholera. From there, the water is treated with chlorine for further disinfection. Right now, the system can treat 50,000 gallons of wastewater per day to U.S. EPA standards. If needed, Polaneczky says, it can be expanded to treat 75,000 gallons a day. 

Why it’s important: The immediate benefit is that the system significantly reduces the threat of waterborne diseases, such as cholera and dysentery. But there’s a less tangible benefit that Polaneczky is keen on: “We want to show that it’s possible to treat wastewater in an efficient, economical, and sustainable way in Haiti and other low-resource countries,” she says. “This shows that it can be done.”

Incinerator 


What it does: This school-bus-size machine allows HUM staff to properly dispose of biohazardous medical waste and used sharps, including syringes and scalpels. Polaneczky explains that the system meets U.S. EPA emission standards. How? The waste is burnt in a controlled fire in the machine’s first chamber. The resulting smoke is captured in a second chamber that reaches 1,000 degrees Celsius—similar to the temperature of liquid lava—and essentially gets vaporized. The end result is steam and a small pile of ash.

Why it’s important: Properly disposing medical waste is critically important, yet many health care facilities in Haiti don’t have the necessary equipment to do so. It’s not uncommon for human waste to be mixed with sharps and garbage, and then burnt in crude devices or trash pits. The noxious fumes are bad for the environment and human health. As HUM integrates into Haiti’s health system, the incinerator may serve as a central location to dispose of medical waste produced at other PIH/ZL sites. 

Fiber Optic Network


What it does: Polaneczky describes the fiber optic network as the “backbone of the hospital,” providing high-speed Internet access throughout the facility. A robust server package donated by HP optimizes it. High-tech and resilient, HUM’s IT system supports everything from patient registration to inventory management to digital radiography.

Why it’s important: HUM is the first teaching hospital in central Haiti. When medical education and training begin, Haitian doctors can consult with partners in Boston and beyond as needed through video conferencing and other digital technology, which extend from the operating rooms to the hospital’s classrooms. On a day-to-day basis, the network improves efficiency and facilitates monitoring, evaluation, and quality improvement projects.

Medical Gas System


What it does: Behind the walls of HUM is a labyrinth of copper pipes and vacuum and air lines that ensures patients in need of oxygen have quick access to it—whether they’re undergoing surgery, being cared for in the emergency room, or in recovery. A major asset of HUM is that it has its own oxygen concentrator, a device that removes nitrogen from the air to produce medical-grade oxygen.

Why it’s important: Without this system, we’d need to have bedside oxygen tanks available for any patient in need of oxygen, which is both expensive and logistically difficult. Additionally, suction and compressed air would need to be supplied for patients. Quick access to these oxygen and suction tubes allows us to deliver better care to more patients. 

HVAC


What it does: Given that HUM stretches over 200,000 square feet and includes a pharmacy that stores temperature-sensitive medications, effective climate control was a must. The hospital boasts four 12.5-ton rooftop cooling units and a separate 20-ton condenser for the pharmacy. In areas of the hospital where air conditioning would be a luxury, the designers opted for energy-efficient ceiling fans and elegant design that fosters natural air flow.

Why it’s important: It’s not about just keeping cool. “The HVAC system supports infection control in operating rooms and allows us to preserve medical equipment,” Polaneczky says. HUM’s HVAC system, she explains, utilizes HEPA filtration and laminar flow, meaning the air is pushed from ceiling to floor rather than across a room, which minimizes the risk of surgical infections.

 
   

donate now:

An anonymous donor will match all new monthly recurring donations, but only if 75% of donors upgrade to a recurring donation today.
Terms and conditions apply.
Make a monthly recurring donation on your credit card. You can cancel at any time.
Make a donation in honor or memory of:
What kind of card would you like to send?
How much would you like to donate?
  • $10
    give
  • $50
    give
  • $500
    give
  • $1,000
    give
  • $10
    each month
    give
  • $50
    each month
    give
  • $500
    each month
    give
  • $1,000
    each month
    give
  • $
    give
gift Make this donation a gift, in honor of, or in memory of someone?

Reviews of Partners In Health (PIH)

Great Nonprofits
Read and write reviews about Partners In Health (PIH) on GreatNonProfits.org.
WARNING: Javascript is currently disabled or is not available in your browser. GlobalGiving makes extensive use of Javascript and will not function properly with Javascript disabled. Please enable Javascript and refresh this page.