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 ...
Jan 10, 2013

PIH Haiti Earthquake Recovery - Jan. 2013 Update

On December 4, 2012, PBS NewsHour featured a story on Partners In Health's ongoing earthquake recovery efforts in Haiti.  Below, please find a transcript of the program as well as a link to the video. 

Long After Earthquake, Haiti Still Feels Devastating Effects of Cholera Epidemic

FRED DE SAM LAZARO: The 2010 earthquake that devastated Haiti may still loom large in Americans' memory, but, in Haiti itself, that was at least three disasters ago, before Hurricanes Tomas last year, Isaac in August, and recently Sandy.

Each storm brought a grim reminder of yet one more ever-present disaster: the deadly cholera epidemic that started 10 months after the quake.

At the cholera ward of Saint Luc's Hospital just outside the capital, Port-au-Prince, Dr. Jackinson Davilmar says since Hurricane Sandy admissions have doubled from 20 to 40 patients each day.

DR. JACKINSON DAVILMAR, Saint Luc Medical Center (through translator): Most of the new cases are coming from further up the hill in places like Petionville where we had not seen them before. I'm not positive, but perhaps the wells there have been contaminated.

FRED DE SAM LAZARO: Experts believe cholera was brought here by U.N. peacekeepers at the time, a battalion from Nepal. Untreated sewage from this base flowed into a tributary of the ArtiboniteRiver, the major source of water for both washing and drinking.

Cholera is spread by fecal-oral contact. Two years on, 200,000 patients have been sickened, 7,500 have died from the extreme diarrhea and fluid loss. Each flood brings more contaminated water, more cases.

The epidemic prompted massive relief efforts and public campaigns on the streets and in classrooms promoting hygiene and sanitation. Fatalities have dropped from 10 percent of cases early on to about 1 percent.

Still, 600 people have died from cholera this year, many in remote areas, even those unaffected by floods. There's now plenty of awareness of cholera in Haiti. The biggest challenge for people today is distance.

As the epidemic subsided over the last few months, many treatment centers have been closed in the remote areas. So, getting to places that remain open is a huge challenge. It can take hours. And that delay can be fatal.

Sentiment Joseph, a 27-year-old mother of three, will likely recover, having made it in time to get prompt antibiotics and rehydration therapy. Her husband wasn't so lucky. He died a week earlier in their home less than an hour away by motorcycle.

SENTIMENT JOSEPH, Cholera survivor (through translator): He took ill around midnight. There was no one to care for the children, no means to bring him in. We didn't have the money to hire a motorcycle.

FRED DE SAM LAZARO: Across this spartan treatment center run by the Boston-based charity Partners in Health, other challenges were apparent from patient stories.

MAN (through translator): We don't have hygienic facilities. We treat our water, but don't have a formal latrine.

MAN (through translator): I was staying in my sister's home, and I'm not sure she treated the water.

MAN (through translator): There are 14 people living in our house. And it's very expensive to treat the water for so many people. And our only latrine was destroyed in a road-building project. So, we don't have that.

FRED DE SAM LAZARO: Cholera, not seen in Haiti for almost a century since 2010, is likely to remain for some time, says Partners in Health physician David Walton.

DR. DAVID WALTON, Partners in Health: Cholera endemic to the region, to the country is the last thing that they needed. Permanent solutions need to be put in play to be able to really stem the tide of this epidemic that is still ongoing.

FRED DE SAM LAZARO: He says cholera's persistence is a proxy for a much larger rebuilding effort that's fallen short, one that should have provided far more access to clean water and sanitation.

DR. DAVID WALTON: On a scale of A. through F., it's a D.

FRED DE SAM LAZARO: At least 360,000 people remain in crowded tent camps, he notes. Other people have rebuilt in poor neighborhoods destroyed in the quake, like this one in the hilly suburb of Petionville.

Water had to be carried in. And there are few toilets, so there's a threat of cholera.

James Sanvil lives in the U.S., but was visiting family here.

JAMES SANVIL, Haiti: There is no water, no way for them to get water down here, because there's no water came, like, down here.

FRED DE SAM LAZARO: Kevin Fussell is one of many small providers who have tried to bring relief. He's a Georgia physician who started a charity to provide safe drinking water.

His group installed clean water facilities into six schools in the central Haitian town of Mirebalais before running out of donated funds.

He says they'd like to put in many more, but have had no luck applying for funds the U.N. has for water projects.

DR. KEVIN FUSSELL, World Water Relief: They're basically trying to come up wore water solutions for an entire country. And we're working in a very small region. And they're looking for bigger global solutions.

My problem with that thinking is that three years later somebody is still thinking about global solutions, when we have real problems right here. And nothing is being done.

FRED DE SAM LAZARO: That's a complaint that's widely heard. In water and sanitation projects or anything else, there's little to show for the billions in aid that came in or was pledged to Haiti, says human rights activist Antonil Mortime.

ANTONIL MORTIME, Human Rights activist (through translator): I have talked to people in the tent camps. If you look at Cite Soleil, you can see that the situation is actually worse.

There's no change with education, with infrastructure or health care. Corruption, poverty and hunger haven't decreased.

FRED DE SAM LAZARO: Nigel Fisher, head of the U.N.'s large Haiti mission here, acknowledges the slow pace, but says there has been some progress on the massive rebuilding task, a much smaller number of tent dwellings since last year, for example.

NIGEL FISHER, Deputy special representative of the U.N. Secretary-General: If Haiti were a glass, and it's gone from being 10 percent full to 15 percent full, let's recognize that without in any way diminishing the fact that you have still got 85 percent of the glass full.

FRED DE SAM LAZARO: But Fisher says many of the problems were endemic to Haiti long before the earthquake.

NIGEL FISHER: What we're seeing is people who are in camps because of entrenched poverty. Many of these people were hidden before in slums. They're now in the open in camps.

And that is a function of underdevelopment. It's a function of weak governance. It's a function of lack of alternatives, and which these people faced before.

FRED DE SAM LAZARO: He says one of the biggest problems is that Haiti's government, crippled by the quake and a corrupt reputation, hasn't been able to lay down national priorities for the rebuilding.

That's largely been led by foreign non-government organizations, at least 10,000 of them, everything from small church groups to the large international agencies. NGOs have received more than 90 percent of all aid dollars.

DR. DAVID WALTON: The amount of redundancy with the more than 10,000 NGOs that the U.N. special envoy's office has estimated exist Haiti just leaves one wondering where all the money has gone.

And, frankly, if you look at, as they have done, where all the money has gone, hardly any of it has gone to strengthen the government.

FRED DE SAM LAZARO: Partners in Health, which has been in Haiti for 25 years, is trying to restore what it says is the appropriate role for the government.

DR. DAVID WALTON: So, 60 percent of our beds have medical gas. They also have electrical receptacles and data capacity.

FRED DE SAM LAZARO: The group raised $22 million to build a 300-bed state-of-the-art teaching hospital in central Haiti. However, it then partnered with Haiti's Ministry of Health to design and run it. It will turn over the hospital to the government in 10 years.

Dr. Walton says Haiti can never be rebuilt unless it has a strong, accountable government.

DR. DAVID WALTON: It would be so much easier for us to run it the way we wanted to run it and not coordinate with anybody but ourselves, because, hey, we're really smart, or at least we think we are.

FRED DE SAM LAZARO: And you are the guys with the money.

DR. DAVID WALTON: We are the guys with the money. And, again, NGOs don't guarantee the right of health to citizens of any country. But the government does. And we see ourselves as supporting the government.

FRED DE SAM LAZARO: President Michel Martelly cut the ribbon on the new hospital, vowing his administration will do better.

International donors, who have withheld half the $5 billion they pledged to rebuild Haiti, will closely watch how projects like this hospital fare.

For many ordinary Haitians, the goal, as one health worker put it, is to make it to the end of each day alive.


Jan 3, 2013

PIH Response to Cholera in Haiti - Jan 2013 Update

Photo by Jon Lascher/Partners In Health
Photo by Jon Lascher/Partners In Health

Fighting Cholera, a Dose at a Time

Published 12/12/12 by Cat Wise in PBS NewsHour

The United Nations announced a $2.2 billion initiative Tuesday aimed at curbing the spread of cholera in Haiti over the next 10 years through improved water and sanitation projects. The plan put forward by U.N. Secretary-General Ban Ki-moon also calls for funding a new tool in health officials' toolkit to combat the disease -- a cholera vaccine.

"The main focus is on the extension of clean drinking water and sanitation systems," Ban said. "But we are also determined to save lives now through the use of an oral cholera vaccine."

"Because global vaccines are in short supply, we will first target high-risk areas: densely populated urban areas and rural areas far removed from health services," Ban added. "As production increases, the vaccine effort will expand its reach."

As NewsHour special correspondent Fred de Sam Lazaro highlighted in his recent report, cholera continues to have a devastating impact on the island nation, nearly three years after the tragic earthquake. Cholera is a waterborne bacterial disease, which causes severe diarrhea and can lead to dehydration and death.

Approximately 7,700 people have been killed and 620,000 have been infected, although some aid groups on the ground believe the actual figures are even higher. Only 17 percent of Haitians have access to improved sanitation and clean water, conditions which fuel the spread of the disease.

Until recently, the use of a widespread cholera vaccine initiative to prevent the disease in Haiti was considered controversial. The Haitian government and some international medical groups such as the Pan American Health Organization were initially skeptical that a massive vaccine rollout would be feasible given the tricky distribution logistics involved. The oral vaccine must be refrigerated and is given in two doses, two weeks apart. Immunity lasts two to three years and the vaccine is about 65 percent effective. There were also concerns that vaccination campaign would pull financial resources away from much-needed water and sanitation projects.

But last year, the Haitian Ministry of Health decided to back a pilot project to vaccinate 100,000 people living in two areas of the country, a slum in Port-au-Prince and a rural, rice-growing area in the Artibonite River Valley. The campaign was a joint effort by the Ministry of Health, Boston-based nonprofit Partners in Health (PIH), and the Haitian nongovernmental organization GHESKIO.

From mid-April to mid-June, teams of community health workers fanned out to reach as many people as possible in the two regions. "We were very pleased with the results," said Dr. Louise Ivers, PIH's senior health and policy advisor.

In the rural areas where PIH teams coordinated the vaccinations, Ivers says they reached about 80 percent of the population. And of the people who received the first dose of vaccination, 90.8 percent received a second dose. Similar results were reported in the urban areas.

"We were particularly interested to see if we would reach a threshold level," said Ivers. "When you reach about 50 percent of the community, the people who haven't been vaccinated become protected. So that means we would be seeing 'herd immunity' in that area."

Ivers says one of their biggest challenges was a six-week delay in the rollout caused by an erroneous local radio report that said an experimental vaccine was being used. After everything was cleared up, and Ministry of Health gave the green light, the rainy season had started and health workers had a difficult time reaching some of the rural areas.

To further complicate matters, the delay caused the cholera vaccine distribution to overlap with a pre-planned national polio vaccine campaign. Because much is unknown about cholera and polio vaccine interactions, health officials decided to wait to give children the cholera vaccine one week after they had received a polio vaccine. Ivers says that meant every area targeted had to be visited four times, instead of just twice.

Despite all the challenges, Ivers says the pilot project was a success and showed what could be possible with a vaccination campaign targeting the entire country.

"We found that there was a huge interest in the vaccine," said Ivers. "There was not any built-in fear or skepticism from communities once we engaged them and explained what we were doing and asked them if this is something they wanted. I think the fact that so many people have been personally impacted by cholera, there was a strong desire to take any tools that might be available to prevent it from happening again."

Ivers believes the battle against cholera in Haiti must be fought on multiple fronts. "We are completely behind the issues of water and sanitation. Those are the gold standard ways to fix the problem," said Ivers. "But investments in public water and sanitation projects take years and billions of dollars. So this is a bridge to that. There's no reason why you can't use the cholera vaccine for a limited time and then make progress on sanitation projects."

Currently, PIH is distributing several thousand remaining doses from the pilot project to another small community. And they are working with the country's Ministry of Health to figure out next steps, while providing ongoing treatment for those who are ill. The United Nations endorsement this week should provide a boost for a larger rollout of the vaccine throughout Haiti in the coming years.


Nov 12, 2012

Equip Mirebalais Hospital in Haiti - November 2012 update

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


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'Hopital Universitaire de Mirebalais (HUM)

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