“Whatever it takes. Just as we would do if a member of our own family—or we ourselves—were ill.” This mindset lies at the heart of the mission of Partner’s in Health (PIH), a Boston, MA based non-profit health care organization founded in 1987 by Dr. Paul Farmer, Ophelia Dahl, Thomas J. White, Todd McCormack, and Dr. Jim Young Kim. On Thursday, March 1, 2012, Dr. Evan Lyon of PIH spoke to a class of undergraduate and graduate students enrolled in Prof. Michael Diamond’s “Managing Global Health Challenges” course.
Dr. Lyon has been a part of the Boston/Haiti team of PIH for 10 years. He learned HIV medicine in Haiti, where he spent half of his residency. When the January 2012 earthquake struck, Dr. Lyon was working in rural Alabama, although he says that he was immediately pulled back into Haiti after the disaster. While the situation in the Caribbean nation was already very difficult before the earthquake, today the magnitude of the problems – from infrastructure damage to malnutrition, displacement of families to an outbreak of cholera – is much greater. The effects of deforestation include food insecurity, crop destruction, and flooding year after year. In addition, the complete failure of a public health intervention is evident through the prevalence of totally preventable diseases such as tuberculosis, malaria, tetanus, and measles.
About 9 million people live in Haiti, and while the country lies very close to the US proximally, it is quite unique intellectually, politically, and culturally. To understand Haiti today, one must understand Haiti’s unique history. For about a century, from 1697 until 1804, Haiti was a colony of France, and many of the people living on the island were African slaves imported by French colonists. After the revolution, France began demanding “reparations” under threat of invasion, and Haiti was forced to borrow cash (from France) to repay this debt because no one else was willing to trade with a “combatant” country. This is the first example in history of foreign indebtedness, and it meant that Haiti had less control over its own development. The Haitian economy was created with financial policies geared toward the export industry instead of trying to protect the health and well being of the country’s own citizens. Considering years of other setbacks, including US occupations, a US backed Duvalier dictatorship, coups in 1991 and 2004, as well as repeated embargos and manipulation, one can understand why Haiti is in its current position.
Dr. Lyon, unlike the majority of physicians in the US, strongly believes in the idea that “illness and most suffering that goes along with illness comes from the social conditions that push someone to be vulnerable and unhealthy.” Social and economic conditions are closely tied with health, and “social medicine” seeks to understand this relationship. “From a health point of view,” Dr. Lyon said, “medicine is a relatively weak tool…there is much we can learn from the social sciences.” In addition, when the outcome of social and economic structures is greater suffering and early, unnecessary death, “it is right to call this violence,” said Dr. Lyon. “If the forces are unavoidable, as in they can’t move away from it—then it’s a structural thing.”
Partners in Health started in Cange and more recently has expanded in the Artibonite river valley. At the heart of its model is a commitment to serving the poor through the public sector, granting access to basic primary health care, and removing barriers to health care and education for the poor. The organization will see about 2 million patient visits this year, and it employs 5,000 people, half of whom are community health workers. As the largest health care provider in Haiti, PIH also provides jobs for Haitians. 99% of PIH employees in Haiti are from the country. While PIH is Boston-based, it’s partner organization, Zanmi Lastante, is run entirely by local Haitian leadership. For the last decade, everything that the organizations have been doing has been in collaboration with the Haitian government and the Ministry of Health. Haitian leadership decides where the priorities lie for the organization.
PIH has put heavy investment in community health work and a delivery mechanism that provides for people within the context that they are living. Rather than focusing on creating new technologies, PIH believes in the idea that there are many great technologies out there that aren’t reaching the poor because of delivery problems – not because those technologies are too high-tech. The idea of “accompaniment”, or sticking with a patient while they are sick or until they can stand on their own feet, is a central philosophy of PIH. Rather than having patients trek to the clinic when they are sick or need medicine, PIH employs local Haitians who know the patients and their community, who can get to their house every day, deliver medicine, make sure they take it, and check in with the patient. In this way a physical and emotional connection is created as PIH works side-by-side with they people they serve. This system also provides great adherence for following a drug regimen, and it provides a safety net so that sicknesses can be caught in their early stages before they become a major problem.
Currently, the organization is creating a new teaching hospital in Mirebalais. After the earthquake destroyed many of the existing hospitals, the government asked PIH to make the existing project bigger. The hospital will include an ER, trauma center, and cancer care, among other types of care. It will provide high quality education for the future generation of health care providers in Haiti. The hospital’s electricity will be provided through 400kW photovoltaic roof-mounted solar collectors. “Really, this is all happening because of the leadership of the Haitian government and the generosity of donors,” said Dr. Lyon.
Another current project is a cholera vaccination program aimed at easing the burden for the current outbreak. Nearly half a million cases have been reported in Haiti in 2011, and 6,600 Haitians have died since the onset of the outbreak. In addition to long-term solutions, such as providing chlorinated water, introducing hygiene measures, and improving the sanitation system, PIH decided to start an oral vaccine program in January of 2012. While there has been some apprehension about the program from other public health organizations – particularly because the vaccine has a limited supply and is not 100% effective— Dr. Lyon addressed this by pointing out that “If there was a cholera outbreak in Evanston, IL, there would be no question. You would get the vaccine. It’s one more tool that we have that will save lives.” Indeed, PIH sees the their friends in Haiti as deserving of the same standard of medical care as people receive in the states.