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 ...
Oct 10, 2012

PIH Haiti Earthquake Recovery - Oct 2012 update

Mirebalais University Hospital
Mirebalais University Hospital

Haiti Program Highlights, 2012

The purpose of this report is to provide a general update on the progress of Partners In Health's ongoing work in Haiti since the earthquake in January of 2010. Thanks to your generous support, Partners In Health has raised over $140,000.00 via globalgiving for our Haiti Earthquake Recovery project. We extend our deepest gratitude, on behalf of all of our patients and colleagues, for your commitment to and belief in helping poor people access quality health care. 

Partners In Health and our Haitian sister organization, Zanmi Lasante (“Partners In Health” in Creole, or ZL) provide medical care at 15 health centers and hospitals across Haiti’s rural Central Plateau and Lower Artibonite regions. As well as improving access to care, PIH/ZL is dedicated to raising the standard of care in rural Haiti by introducing new diagnostics and treatment regiments for both common and complex illnesses. 

Hôpital Universitaire de Mirebalais (Mirebalais University Hospital)

Haiti has long been the heart of PIH’s work, and today PIH/ZL is the largest healthcare provider in Haiti. By investing in public health infrastructure and the local workforce, PIH and ZL are rebuilding the health system in rural Haiti and ensuring the long-term sustainability of our efforts. In 2010, PIH/ZL conceived of Mirebalais University Hospital (HUM) in response to an urgent request from the Haitian Ministry of Health following the destruction of the national referral and teaching hospital in Port-au-Prince in the January 2010 earthquake. Beyond delivering life-saving care to a poor and underserved population of 3.3 million in Mirebalais and central Haiti, HUM will allow us to embark on an ambitious strategy to develop the capacity of Haitian clinicians (doctors, nurses, and specialists) to provide care.

As of July, hospital construction is fully complete, and the hospital will open at partial capacity in spring 2013. Additional specialty services will be rolled out over the following two years. Upon opening, HUM will offer the following services:

  • Community health services, including vaccinations, treatment for malnutrition, and preventative care
  • Outpatient services, including TB/HIV, general adult and pediatric care, and non-communicable diseases
  • Women’s health services, including family planning, reproductive health and comprehensive emergency obstetric care
  • Inpatient care, including internal medicine, pediatrics, and intensive care
  • Surgical care, including Caesarean sections and emergency surgeries
  • Emergency medical services
  • Advanced diagnostics, including digital radiology, ultrasonography and computed tomography
  • Mental health services
  • Laboratory and pharmacy

As a national teaching hospital, HUM is designed both to provide a new standard of healthcare in the public sector and to take a leading role in training and retaining an expanded workforce of well-trained and highly motivated doctors, nurses, and other health professionals.

Cholera prevention and treatment

The cholera epidemic had affected 553,270 people and killed 7,238 nationwide between October 2010 and June 2012. From January 2011 to May 2012, PIH/ZL treated 70,582 suspected cases of cholera at our facilities, 56,506 of whom were hospitalized, and 282 of whom died. Nationwide in Haiti, the case fatality for cholera is 1.3%; at PIH/ZL facilities it is 0.4%. After a year of fighting the outbreak with treatment, we added an additional tool to our arsenal: in April, PIH/ZL launched a pilot cholera vaccination campaign which reached nearly 50,000 people with the two-dose vaccine. Though these achievements are substantial, we are additionally buoyed by the international attention we were able to draw to the epidemic and ultimately the World Health Organization’s recommendation that a stockpile of vaccines be available in Haiti

Cancer care

Building upon PIH’s existing health programs and partnership with the Haitian Ministry of Health, PIH/ZL launched the first comprehensive and integrated breast cancer program in Haiti’s Central Plateau and Artibonite Departments. Currently our breast cancer program is based out of Cange. When the Mirebalais National Teaching Hospital begins operating at full capacity, the program and clinical team will transfer there.

Because breast cancer is not yet a widely recognized disease in Haiti, most patients with cancer present in very advanced stages, necessitating some combination of mastectomy, chemotherapy, and/or palliative care. For women whose cancer results are positive, ZL provides chemotherapy and surgery (mastectomies, quandrantectomies, and lumpectomies) in Cange. Our current caseload includes 10 patients that are on active chemotherapy for breast cancer, and an additional 30-40 patients receiving Tamoxifen alone.

To encourage a greater awareness of breast cancer in our catchment area, our staff also coordinate extensive education initiatives at the community and clinical levels. Community awareness events held on World Cancer Day and International Women’s Day shared information about breast cancer with a broad audience. Community health workers, who frequently visit patients in their homes, also receive information on breast cancer to pass along to their patients. We have already seen an increase in caseload as a result of these community outreach efforts, and expect that trend to continue as breast cancer awareness in our catchment area increases.

Rehabilitative medicine

Following the January 2010 earthquake, PIH/ZL marshaled the resources of academic and medical partners to treat the thousands of victims who lost limbs and mobility in the tragic event. We have since built upon this emergency response to develop and implement a community-based model of rehabilitative medicine that continues to provide care to earthquake survivors as well as a number of other patients who have suffered strokes or other catastrophic illnesses that have resulted in limited mobility.

Patients who have been injured or ill are evaluated and referred to the rehabilitation team where they are comprehensively managed by an interdisciplinary group of professionals, which includes physical medicine and rehab physicians, therapists, rehab technicians and rehab educators. Awareness and sensitivity to each patient’s unique socioeconomic needs, personal goals, and social support is paramount in the formation of a plan that ultimately facilitates maximal community reintegration. Community-based rehabilitation and long-term accompaniment by specialized community health workers called Rehab Educators account for a significant portion of the clinical care delivered and is essential in combating harmful stigma and maximizing quality of life and reintegration.

Currently, rehabilitative medicine is offered through PIH/ZL’s two largest hospitals: L’Hopital Bon Sauveur in Cange and L’Hopital Saint Nicolas in St. Marc. During FY12, PIH/ZL supported two rehab technicians, six rehab educators, and one administrative assistant who carried out 455 new consultations and 1,520 inpatient, outpatient, and community-based patient visits.

These clinical care initiatives continue to revolutionize the treatment course following catastrophic illness or injury and address the harmful notions of stigma around disability. It is through the demonstration of what is truly possible that we practice daily disability advocacy. As a ward full of onlookers stands in amazement as someone takes their first steps after injury or a community realizes what a profound impact a ramp can have on individual autonomy and access, it is apparent that this work makes an impact beyond the clinic doors. In 2013, PIH/ZL will expand rehabilitative medicine to Mirebalais University Hospital, which will include inpatient, outpatient, and community-based service delivery as well as an emphasis on clinical rotations for medical residents. 

Cholera vaccine distribution
Cholera vaccine distribution
Sep 28, 2012

Response to Cholera in Haiti update September 2012

Djencia Eresa Augustin, Community Health Worker
Djencia Eresa Augustin, Community Health Worker

For Djencia Eresa Augustin, helping to administer the oral cholera vaccine this spring was one thing she could do to fight the cholera epidemic raging through her country. Thanks to her efforts—and the partnership of hundreds of other community health workers, Haiti’s ministry of health, and the nonprofit organization GHESKIO—nearly 100,000 people received the vaccination earlier this year.

“From everything I’ve seen, there is no one who was eligible for the vaccine who didn’t want it,” Augustin said.

For her and others on the front line of cholera epidemics—in Haiti and around the world—the announcement last week from a working group of the World Health Organization (WHO) comes as a welcome affirmation of their efforts. The Pan American Health Organization’s Technical Advisory Group on Vaccine-Preventable Diseases (PAHO TAG) recommended expanding the use of the oral cholera vaccine in Haiti, based in part on data that Dr. Louise Ivers, PIH’s senior health and policy advisor, presented on behalf of PIH and its sister organization Zanmi Lasante. Dr. Bill Pape presented data from GHESKIO’s portion of the campaign.

“An important part of our campaign was to ensure that our experience informed the control of cholera in Haiti and in other countries,” Ivers said. “While cholera vaccines aren’t ‘golden tickets,’ we must move quickly to save as many lives as we can with the tools we have now.”

During last week’s meeting in Washington, DC, Ivers presented data from the successful vaccine campaign, which began in April and finished in June. For example, in a rural area near St. Marc, 45,368 people were vaccinated, and 90.8 percent were confirmed to have received the second dose—a very high completion rate.

In another piece of good news, the World Health Organization also endorsed a recommendation that a global stockpile of 2 million oral cholera doses be created to respond to outbreaks around the world—a major policy shift on the emergency use of cholera vaccines.

In Haiti, the work that PIH, the government, and other partners are doing to improve the country’s water and sanitation infrastructure continues—and is critical. But vaccines are a necessary component of a comprehensive strategy to fight an epidemic that has killed more than 7,000 Haitians, sickened half a million, and continues to claim lives.

“The PAHO TAG recommendations to scale up use of the vaccine in Haiti and the WHO endorsement of a stockpile of cholera vaccines are both great strides forward for those at risk of cholera in Haiti and worldwide,” said Ivers.

Thank you for all of your support through GlobalGiving!


Jul 12, 2012

Equip Mirebalais Hospital - July 2012 update

Floorers Without Borders: On a Flash-Cove, Heat-Welding Flooring Mission to Haiti

John Mason, 6/1/2012

In Mirebalais, Haiti, a cement laborer named Commie Brazil is wearing my AWP kneepads. Sporting cement dandruff and hauling a five-gallon bucket up a ladder in the sweltering sun, he pauses, staring at my pads before pointing to his knees.

How could I resist that face?

I wasn’t the only flooring installer to donate his kneepads – or tools – on a recent flooring trip to the new National Teaching Hospital of Mirebalais, 30 miles north of Port-au-Prince. We, the “Floorers Without Borders” or “the seamless flooring guys,” arrived in a foreign land on a mission to install 650 square yards of Forbo commercial sheet goods in five days. The team consisted of four union men from Detroit, seven from Boston and me, the non-union “Connecticut dude.”

Located in the Central Plateau of the mountainous Caribbean country, Mirebalais was untouched by the devastating 2010 earthquake. Still, the area has people living in poverty and dire conditions – inadequate health services, malnutrition and widespread unemployment – in the poorest country in the Western Hemisphere.

Despite that language barrier and other obstacles – including an uneven concrete sub-floor, a malfunctioning hand-groover tool and Joseph, a Haitian helper who ignored repeated instructions not to roll the glueless vinyl areas – camaraderie and Yankee ingenuity prevailed. In the land of improvisation that is Haiti, where people used contact cement to repair their torn sneakers, we borrowed a wet saw to enlarge worn-down trowel teeth, and a dozen American tradesmen and our Haitian brothers collaborated to pull off the job.

“The floor came out great,” said Andrew Johnston, a hospital project coordinator. “It’s going to be so important for providing good quality care. It’s critical to making it a world-class facility.”

The 180,000-square-foot, 320-bed hospital, due to open by July, will be a teaching facility for Haitian nurses, medical students and resident physicians. On any given day, more than 300 paid Haitian laborers, contractors and volunteers work at the hospital. A second flooring phase is scheduled for May.

Dr. Paul Farmer runs the project. He is the founder of Partners in Health (PIH), a Boston-based international health and social justice organization. Farmer, who has been in Haiti since the mid-1980s, oversees a smaller hospital about 30 miles away. PIH paid all travel and hotel expenses for the flooring volunteers.

The flooring excursion was organized by Troy Bickford, owner of Contract Flooring Installations in Boston and a member of Floor Coverers Union Local 2168. Bickford is a longtime friend of Jim Ansara, the hospital’s construction director, who called looking for flooring installers. Bickford put out a call to unions across the country where Chuck Shock, a Detroit retail storeowner, volunteered four employees, including his 28-year-old son, Tim. Both storeowners are members of the International Standards & Training Alliance (INSTALL).

After soliciting for tools and flooring materials from local and national distributors and manufacturers, Bickford had the shipment sent to Haiti. Forbo provided $110,000 worth of material at a tenth of the retail cost. Dal-Tile donated $250,000 worth of ceramic, and Laticrete pitched in with flooring products such as thin-set and grout.

Bickford was unable to make the trip, but he sent seven men, including his brother, Joe, who ran the job along with company employee, Jorge DeBurgo, a 32-year flooring veteran. “I think it’s a great project,” said Troy Bickford. “You get to see how it helps a lot of people.”

Nearly all the installers neglected to bring a Haitian Creole dictionary or phrase book and communicated mainly by smiling, nodding and using hand gestures. When that didn’t work, we talked louder. “Bale,” or sweep, was a favorite word.

DeBurgo, 53, who speaks English, French, Spanish and Portuguese, served as a translator. Born in Cape Verde and raised in Senegal, he said he identified with the surrounding poverty and primitive conditions. When sections of the uneven concrete subfloor caused the only hand-groover to skip, DeBurgo made his own groover to gouge the vinyl seam. He drilled a hole in the end of a flat screwdriver, inserted a one-inch screw and tightened it with a nut.

“Sometimes you have to improvise,” said DeBurgo.

The first day of the job brought the first dilemma. No flooring roller. The 150-pound roller, used to adhere the vinyl to the concrete, was still in transit from the USA. Our problems were solved because of the ingenuity of project coordinator John Chew. Using a PVC pipe filled with 150 pounds of cement, Chew made a 36” wide roller by sticking a steel rod through the center and attaching a metal handle. A carpenter later made a second, smaller 13” wide roller.

“This thing will work great,” said Chew, posing next to his creation.

The second day brought another temporary roadblock when we lost a half-day waiting while a PIH employee drove to Port-au-Prince to pick up a bonding agent to help the vinyl better adhere to the concrete. The 650-square-yard job called for vinyl to be installed in a 500-square-yard labor and delivery room plus smaller rooms throughout the hospital. We “hand-chopped” everything and the vinyl proved ideal: no pattern, thick, pliable and didn’t tear when pulled back.

PIH assigned us a dozen Haitian laborers, none who spoke English nor had ever seen vinyl flooring before. Nearly all lived in the surrounding plywood or cinderblock homes, most the size of a small U-Haul trailer. They were without running water or indoor toilets and few had electricity. Our helpers proved hardworking, attentive and extremely curious (an installer bending down to make a cut usually attracted two or three Haitians, who crowded around on hands and knees).

Our assistants ranged in age from 20 to 35, except for Joseph, who at 59, was three years away from the country’s average life expectancy. They earned about $15 a day – a coup considering 80 percent of the people live on less than $2 a day.

A Haitian supervisor, who spoke English, occasionally relayed our work instructions, and everyone followed directions to mainly sweep, pick up vinyl scraps, and do the heavy lifting, especially when it came to lugging the 350-pound vinyl rolls.

By the third day our Haitian brothers no longer seemed content as helpers and gradually began veering into the installer’s role. Shortly after installers rolled out and cut the first sheets, Haitian Denoyer Clottler, 26, picked up a hook knife and began cutting vinyl. Fearing a miscue, an American installer reminded Clottler to let the installers do the cutting before asking him to put down the knife. He did, but not for long.

“We do this. We do this,’’ said Detroit installer Andy Shock, repeating himself louder to a nodding, smiling Clottler. For the rest of the job, Clottler’s eagerness and determination to work with the vinyl fueled a helpers’ mutiny among his co-workers. One by one, sometimes under the watchful eyes of an installer, sometimes not, the Haitians mimicked the installers’ actions they’d seen over the past few days. As the Haitians’ confidence grew, so did the installers’ willingness to allow them to become more involved in installing.

One Haitian was put in charge of caulking all inside corners. Another used a skiving tool to smooth off the excess weld on the curved areas of the flash-coving. When Boston’s Eric Bickford, 30, bent down to scribe an inside corner, a group of Haitians hovered as he glued and placed the vinyl together. A few minutes later a Haitian, surrounded by his peers, repeated the same maneuver under the watchful eyes of an American installer.

Only Joseph seemed simply content rolling – and rolling.

Clottler had the good fortune of working with Andy Shock, who showed him how to use the heat-welding gun. After spending a few hours watching Shock and handing him tools, the two switched roles with Clottler doing the welding and Shock the encouraging. “You can’t go too slow, keep it moving, you’ll burn the surface,” said Shock, the only installer on the job – and island – who owned his own $2,200 grooving tool.

The last day on the job, Clottler arrived wearing new kneepads and a leather tool pouch an installer had given him. The pouch had a straight and hook knife, tape ruler and putty knife, gifts from Detroit installer Dan Breymann. Like a dozen of his co-workers he also was given a Laticrete t-shirt. “He’s the flooring dude now,” said Breymann, 31, who devised his own makeshift skiving tool by duct taping the ends of an 8” scraper blade. “If you really like something you pick it up quickly, like he did.”

Through a translator, Clottler said he learned a lot about flooring and after the Americans left, he hoped he could find work, possibly at the soon-to-open hospital.

DeBurgo’s view of the job reflected those of the group when he said, given the circumstances, he never thought the project could be completed in less than five days. “It was a wonderful experience,” he said. “Friendly people. It went a lot better than I ever expected.”

Meanwhile, as the American installers collected their tools, Joseph the roller was asked to help outside where he used a pick to break rocks. As for his weeklong experience installing floors, Joseph smiled and had this to say: “I hope you return.”



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