Partners In Health is proud of what our friends and colleagues accomplish every day, in every community where we work. Each year is filled with new challenges and innovative solutions that help us deliver high-quality care in some of the poorest, most remote regions of the world.

We often share these stories of struggle and success on our website and social media. In case you missed them the first time around, we've compiled our top 10 stories from 2018. These are the people, places, and programs that caught your eye, from Lesotho, Sierra Leone, and Malawi to Haiti and the Navajo Nation.

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10. Safe Deliveries, Big Smiles at Lesotho Health Center

Kamohelo Phoofolo, 8 months old, was born safely at a facility revitalized by Lesotho's national health care reform, one of nearly 4,000 more safe childbirths in 2017 than in years prior. Read more.

9. Gladys: Trailblazer, Midwife, Feminist in Sierra Leone

Boyama "Gladys" Katingor, the head midwife at Wellbody Clinic in Kono, Sierra Leone, ensures every expectant mother receives the best possible care and advocates for her patients' both in and outside the clinic. Read more.

8. Malaria Cases Rising in Malawi as Peak Season Nears 

Flora Tigone worried when her infant son, Chisomo, suddenly became lethargic and feverish. A month ago, an older child had battled malaria. Fearing that was the case with Chisomo, Flora knew she had to act quickly. Read more.

7. Graduates "Paving the Way for Global Nursing Leadership"

The PIH Nightingale Fellowship was designed to provide support and training for nurses in senior or executive leadership positions, and ultimately to improve patient care. The first four fellows graduated from their yearlong program in June. Read more.

6. Dr. Marta Lado on Ebola, and its Aftermath, in Sierra Leone

Dr. Marta Lado, chief medical officer for Partners In Health in Sierra Leone, talks about the lessons she learned while treating patients for Ebola, and why she stayed to help rebuild the public health system. Read more.

5. Teens with HIV Find Support, Friendship at Malawi Club

On Saturdays in Neno District, Malawi, teens living with HIV can find friendship, games, snacks, HIV education and, most importantly, support. Read more.

4. Breast Cancer Survivors in Haiti Share Their Stories

In 2018 alone, PIH clinicians and staff in Haiti have been caring for 450 women diagnosed with breast cancer. Five survivors shared their stories in honor of Breast Cancer Awareness Month in October. Read more.

3. Single Mother in Malawi Caring for Kids, Handling HIV

Agnes Paulo's expression was somber as she held her infant son, Ulemu, in her lap. Paulo, 35, is a single mother and living with HIV. Her four older children are HIV-negative, but Ulemu had not yet been tested. Read more.

2. Mental Health Team Expanding Innovative, Pioneering Care

Dr. Giuseppe “Bepi” Raviola, PIH’s director of mental health, oversees a growing program that is caring for thousands of people in Haiti and Rwanda; developing safe houses for women with chronic mental illness in Peru; working to treat common mental disorders in communities across eight countries; and much more. We caught up with him for an eye-opening chat. Read more.

1. Eating Well: Grocery Program Takes Off in the Navajo Nation

Doctors give patients, usually mothers, “prescriptions,” or vouchers, for a month’s worth of free fruits and vegetables for their families. The mothers spend the vouchers at their local store. And PIH reimburses the stores for the cost of the produce as part of the Fruits and Vegetables Prescription Program, or FVRx. Read more.

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The University of Global Health Equity will be celebrating so much more than a new campus at its landmark Jan. 25 inauguration in northern Rwanda. 

When leaders from  the Government of Rwanda, Partners In Health, international academic institutions and other global health organizations gather at UGHE’s brand-new cluster of sparkling white buildings, surrounded by the Butaro region’s green hills, they’ll be celebrating an institution that is dedicated to improving health care services and delivery for underserved populations around the world. They’ll be celebrating UGHE’s innovative focus on equity and social determinants of health, which pairs education in human rights and social justice with rigorous, community-based medical training.

The university is an initiative of PIH that was launched in 2015 with catalytic funding from the Bill & Melinda Gates Foundation and the Cummings Foundation. Construction of the campus began a year later, with classes and part-time studies based in Rwanda’s capital, Kigali. The campus already is transforming infrastructure, accessibility, and employment—not to mention health services—in the Butaro community. Butaro District Hospital is just two miles away, across a valley, and will serve as one of multiple teaching hospitals for university students. The hospital and its cancer center are supported by Inshuti Mu Buzima, PIH’s sister organization in Rwanda.

Though UGHE is a private institution, the Government of Rwanda has played an important role in its development. In addition to providing financial resources and donating the land that UGHE is situated on, the Government of Rwanda has paved roads that link Butaro, Musanze, and Kigali, and increased access to water, electricity, and internet connectivity throughout the region.    

All of that synergy empowers UGHE with opportunity—for students, staff, and partners; for patients, communities, and countries. Opportunity for a brighter future, and for aspiring doctors who otherwise would not have the chance to pursue their dreams. For people who thought medical school would never be within their reach. For patients who thought high-quality care would never reach them, and who thought their disease was a death sentence. 

Dr. Agnes Binagwaho, UGHE’s vice chancellor, said the realization of UGHE’s vision will affect far more than academics, and far more than Rwanda alone.  

“Together we are assembling the building blocks of a university that will contribute to the transformation of health service delivery, through education, mentorship and research, in every corner of the globe,” she said. “This year, the University of Global Health Equity has progressed further and faster than any of us could have imagined.”

UGHE’s growth comes at a time of severe need for qualified healthcare workers across Africa. The WHO estimates the continent will have a shortage of more than 6 million healthcare workers by 2030. 

With that need firmly in mind, UGHE’s new campus will provide a permanent home for health sciences education grounded in the belief that health care is a human right. The university so far has graduated two classes of part-time students who earned master’s of science degrees in global health delivery, through a two-year program. Those students gathered in Kigali for several weeks each semester, with the remainder of their studies conducted remotely or on trips with classmates and staff. 

The 250-acre (100-hectare) campus is about 80 miles north of Kigali and, in the first phase of construction, includes housing for up to 200 students and staff, a dining hall and six academic buildings. The state-of-the-art academic buildings will include a clinical simulation center; a science laboratory; a 6,700-square-foot Information Commons, providing e-learning tools, tech support and a medical library; a configurable Studio Classroom, and more. 

The campus’ setting in rural Butaro directly reflects the university’s mission and values. 

“It’s no accident that our campus is not in an urban city-center,” said Dr. Paul Farmer,  co-founder and chief strategist at Partners In Health and global health department chair at Harvard Medical School. “We want our students to understand what it’s like to deliver care in rural settings, yes, but more importantly to look beyond what they can learn in the classroom and the clinic. Some of the key lessons learned in the delivery of equitable care have been learned right here in rural Rwanda, and some of these lessons are broadly applicable in cities and many disparate settings. 

“The students who study here will be encouraged to learn clinical skills while also learning how to think about the world beyond the hospital,” Dr. Farmer added. “If we’re ever going to see a world where every person, no matter who they are, receives quality health care, we need to transform the way we think about training our future leaders. Opening this beautiful, state-of-the-art campus in Butaro signals our commitment to improving care delivery not only in this region, but across the world.”

UGHE’s founding Dean of Health Sciences, Dr. Abebe Bekele, joined the university’s leadership in June. He is a highly regarded thoracic and general surgeon, former dean of the School of Medicine at Addis Ababa University in Ethiopia, and former CEO of Tikur Anbessa Hospital in Addis Ababa. 

Bekele will oversee the launch of UGHE’s first medical degree program, which will give students the opportunity to earn bachelor’s degrees in medicine and surgery, jointly known as MBBS, along with the master’s in global health delivery, over six and a half years of study. All together, the program will be known as the MBBS/MGHD dual degree. 

The first cohort of 30 students will begin the program in July, after the university receives accreditation by Rwandan and international governing standards. In 2025, those students could become the first graduates of UGHE’s comprehensive medical school.  

“By the time they graduate, they will be doctors, with a master’s of science degree in global health delivery,” Bekele said.

They’ll undergo a unique course of study along the way. Butaro District Hospital will provide a clinical location that essentially is on-site, just a 15-minute walk from the UGHE campus. Lessons will be tailored to address the continent’s greatest burdens of disease and gaps in care.

“Our students will learn and think about research from day one,” Bekele said. “We will pay specific emphasis on health needs that the continent demands at the present moment—that is, emergency care and safe surgery and anesthesia.”

Bekele said graduating doctors “will be able to handle emergency care medicine in all settings, and to perform, at least, essential surgical procedures” in settings with limited resources. 

In their first year of study, UGHE medical students will be introduced to an education outside of medicine, to help them better understand the conditions, history and contextual realities of the patients they’ll serve. 

“We are an equity-based global university,” Bekele said. “A health professional who has no idea about human rights, gender, injustice—a health professional who does not understand the history and political economics of Africa,  a health professional who is not prepared in critical thinking and scientific reasoning— probably has no place in tomorrow’s Africa.”

Bekele emphasized that students will take advantage of the numerous health facilities supported by Inshuti Mu Buzima, for hands-on learning and experience in community-based education.

“We will teach the students at health posts, health centers and hospitals, as they develop through the six and a half years,” Bekele said. “Gone are the days when doctors are expected to only treat sick patients. The doctors of today need to connect with and understand the communities that they serve."

UGHE also offers Executive Education programs. The customized short courses are designed for global health executives and so far have included partnerships with the Global Fund to Fight AIDS, Tuberculosis and Malaria; George Washington University’s Health Workforce Institute; and Yale University’s Global Health Leadership Institute, among others. The courses focus on health system strengthening, leadership, management, strategic problem-solving and more.

A third pillar of UGHE education is One Health, a concept stressing the integration of human health, animal health and the environment. An advanced program in that discipline could be about a year away, but eventually will be one of UGHE’s “signature programs,” according to Bekele. 

“One Health is new to Africa,” Bekele said. “UGHE is strategically placed to play a pivotal role in representing One Health on the continent.”

Graduates of the MGHD program already are making impacts. UGHE’s alumni community includes 37 global health leaders, who now are working in public, private and nonprofit sectors. 

One of those leaders is Dieudonne Hakizimana, who graduated in 2017 as a member of UGHE’s first group of MGHD students. He came to UGHE with a master’s in epidemiology from the University of Rwanda and 10 years of experience in the health field, including four years at Inshuti Mu Buzima’s Rwinkwavu District Hospital in southeastern Rwanda. 

His studies at UGHE prepared him for a leadership role in global health, with training in management, health financing and more. He is now a teaching and learning officer at UGHE, where he’ll help students reach goals of their own. 

Applications to be among the next wave of UGHE students are coming from all over the world. UGHE received more than 300 applications across 26 countries in 2018, for the 24 spots in the current cohort that began studies in September.  

Bekele said offering classes online soon will help meet that global demand. 

Accepted students also get significant financial support from the university. All enrollees in UGHE’s global health delivery program get scholarships, which cover an average of 91 percent of the $54,000 charge for tuition, room and board. UGHE has awarded more than $1.8 million in financial aid so far.  

UGHE’s alumni community already is bringing lessons from the university into their professions, and communities. 

Titus K. Koikoi, a Liberian who is program director for global health nonprofit Population Services International, took an Executive Education course at UGHE, through the Global Health Delivery Leadership Program. He said the course continues to affect how he approaches his work in Liberia. 

“UGHE has begun a movement that seeks to encourage all involved with global health delivery to begin rethinking health care and looking into more efficient models for health services delivery,” he said. “I feel humbled that my work in global health gives me an opportunity to plan and manage service delivery for my fellow Liberians, and by extension, the world’s population in general. I feel challenged on a daily basis to give back to society, and to be a critical voice that advocates for access to health by all.”
 

Ophelia Dahl, a co-founder of Partners In Health and the board chair, reflected recently about the organization's early days in Haiti and on how deeply she and other co-founders wished to "make a dent in the extreme poverty faced by thousands of Haitians," in partnership with local colleagues. 

Some 30 years ago, their team built a clinic in rural Haiti that had a positive impact on the lives of thousands of people. That clinic grew into a hospital, which served as a reference point for patients from across Haiti. Their work spurred a movement that leapt to Peru and Russia. It expanded to Mexico. And it took root in five countries throughout Africa and in the heart of Kazakhstan.

All of this was possible, Dahl says, because they chose optimism over apathy. Here's is the beginning of her essay, as published on WBUR's Cognoscenti, the opinion page for NPR's Boston-based affiliate:

"There’s a well-loved Haitian proverb I often turn to during challenging times: “Piti piti, wazo fe nich li.” It translates to, “Little by little, the bird makes its nest.” My friends and colleagues offer it up as words of consolation and hope when a challenge seems overwhelming. I bring it up now, as I often do during difficult times when so much seems uncertain, because it also reminds me of a specific moment from my first trip to Haiti in 1983 as an 18-year-old volunteer."

Read more here.

Jean Claude Niyonzima laughed when asked about his average workday in recent weeks, as he helps prepare the University of Global Health Equity in northern Rwanda for the Jan. 25 inauguration of its new, permanent campus. 

“Oh, my goodness,” said Niyonzima, UGHE’s 29-year-old facilities manager. “I’m moving all day.”

His days start at 5 a.m. and quickly become a blur of contractor meetings, equipment and furniture orders, mechanical plans, and check-ups on everything from final coats of paint to ceiling fans. By the time he responds to the day’s last emails, it’s usually 10 p.m.  

Construction of the UGHE campus has transformed the surrounding community of Butaro over the past two years, in ways large and small. There now are streetlights. Vastly improved public infrastructure for electricity, potable water, and internet access. The first elevator in Burera District. A future paved road to the capital, Kigali, that will drastically reduce travel time for the 80-mile trip. Construction-related jobs for more than 1,500 people, with more than 90 percent of the workforce local, and more than 30 percent women. Many workers are learning new skills—such as masonry, welding, plumbing and landscaping—that could help with future employment. 

Like Anne Marie Nyiranshimiyimana. A mason on the campus project, Nyiranshimiyimana initially faced criticism—“They told me, ‘No woman builds, no woman climbs,’” she said—but she has since risen to the rank of master mason. She’s also become a source of inspiration for women and girls in her community. She’s known around Butaro by her nickname, Kankwanzi, which loosely translates to “rising star who refuses to conform to society’s expectations.”

Nyiranshimiyimana is one of many people on the construction crew who also worked on Butaro District Hospital, which opened in 2011 about two miles away. Nyiranshimiyimana began her masonry training on that project. Both the university and the hospital are initiatives of Partners In Health, a global health nonprofit that works in Rwanda through sister organization Inshuti Mu Buzima. The hospital and the UGHE campus sit atop scenic hillsides, visible to each other across a lush valley. The hospital is one of several teaching facilities that will collaborate with the university and provide hands-on training for students. 

The new campus will eventually span almost 250 acres and is home to six academic buildings, housing for 200 students and staff, a dining hall, administrative spaces, and more. Though UGHE is a private, nonprofit institution, the Government of Rwanda has played an important role in its development. In addition to providing financial resources and donating the land for UGHE, the Government of Rwanda is paving roads that link Butaro with Musanze and Kigali, and has increased access to water, electricity, and internet connectivity throughout the region.  

These changes have had many impacts locally, but the greatest has been on the 115 households moved to make way for construction of the campus. Many families sold their land as part of the relocation process. All of them were compensated by the government. More than 40 households have moved to a new, government-constructed model village about a mile away, called Mulindi.

Niyonzima, the facilities manager, said the relocation process began with community meetings and explanations of the campus project, which has been universally welcomed by the community. That sounds somewhat unbelievable, but Niyonzima—who grew up in Rwinkwavu, in southeastern Rwanda, and has lived and worked in Butaro for more than six years—said residents quickly saw the benefits of the new university. 

”Where they were, they didn’t have potable water. They didn’t have electricity. They didn’t have a health center. They didn’t have a school or a nursery,” Niyonzima said. “The Government of Rwanda has committed to providing all of that.”

Additionally, he said, many Butaro residents are farmers, who now will have a new, growing market and customer base for their produce. 

Construction of the hospital, and IMB’s resulting strong reputation in the region, also paved the way for the community to welcome UGHE. 

“After hearing the university project was connected to IMB, they didn’t even really ask much more,” Niyonzima said. 

UGHE and the government collaborated to make the relocation process transparent and accessible. 
Guided by Rwandan land laws, UGHE worked with government officials to take a full inventory of land and property. Compensation was distributed before families moved. Families were given advance notice to move, and local leadership helped several families identify and buy land elsewhere in Burera District. 

When asked if any families opposed the relocation, Niyonzima answered unequivocally: “None of them. None.”  

The model village of Mulindi, completed in August 2017, is not unique in Rwanda. Every district in the country has at least one model village, funded and built by the government to connect rural communities to roads, schools, electricity, water, health posts, and markets. Mulindi eventually will house more than 200 families. 

Emmanuel Kamanzi, UGHE’s director of campus development, oversaw planning and construction of the campus, managing the more than a dozen contractors on site. The project actually brought him back to Rwanda, and Butaro--Kamanzi has worked for PIH and IMB in several capacities over the years, including as director of development for Butaro District Hospital during its construction almost a decade ago. Following that project, Kamanzi moved to the U.S. and worked in PIH’s Boston office, as program officer for Rwanda. But his familiarity with large-scale projects in Butaro made him a natural fit for development of the UGHE campus, so he moved back early in 2016--with a clear vision in mind, and work that won’t end with construction.   

“We wanted to design and build a campus that is inspirational, durable and easily accessible, while fostering a strong sense of community and high quality of life,” Kamanzi said. “We made sure that everyone involved understood these principles, and was aligned with them. Now that construction is complete, our major focus will be to make sure that the function follows the form we’ve achieved.”

Dr. Abebe Bekele, UGHE’s founding dean of health sciences, said families will be connected to the campus community—and vice versa. 

“The campus is going to be dependent on the community in Butaro—for food supplies, for services, for advice and safety, and most of all, to help us teach our students—so we will be creating an opportunity for the community to work with us,” Bekele said. “We are working on different programs that can engage Butaro residents. One is community-based education, where our students will directly learn from the community, and in turn help them while doing so.”

Bekele sees UGHE as a point of pride not just for the community, but for the region as a whole. 

“This is owned by Partners In Health,” Bekele said of the university. “But, truly speaking, the people who own this are the people of Rwanda and the people of Africa.”

Dr. Agnes Binagwaho, vice chancellor of the University of Global Health Equity, recently told POLITICO that UGHE’s new campus in northern Rwanda reflects its “mission to radically change education” and build a 21st-century model for better health equity.  

“Our vision is a world where every individual no matter where they are, who they are and where they live can lead a healthy and productive life,” Binagwaho told the international politics and policy website, in a story published Sunday. “Our mission is to radically change education, health education, so that we impact the way health care is delivered around the world.”

Binagwaho was one of several UGHE and Partners In Health leaders quoted in the story, which followed Friday’s inauguration of the Butaro campus, UGHE’s first permanent home. 

The university is an initiative of PIH that was launched in 2015. Construction of the campus began a year later, with classes and part-time studies temporarily based in Rwanda’s capital, Kigali. 

Though UGHE is a private, nonprofit institution, the government of Rwanda has played an important role in its development. In addition to providing financial resources and donating the land for UGHE, the government is paving roads that link Butaro with Musanze and Kigali, and has increased access to water, electricity, and internet connectivity throughout the region.  

In addition to providing an overview of UGHE, its mission and the new campus, the POLITICO story also speaks with UGHE’s founding dean, Dr. Abebe Bekele, about his innovative approach to curriculum, and tells the story of UGHE alumni Crispin Gishoma and Arsène-Florent Hobabagabo, who graduated last May and now run a diabetes clinic in Kigali. 

Read POLITICO's full story here.
 

The director of Partners In Health’s NCD Synergies program is calling for a dramatically overhauled approach to cancer, heart disease, mental illness, and other non-communicable diseases, saying in a Bangkok Post op-ed that detection and treatment have “largely failed to reflect the experience” of the world’s poorest, jeopardizing efforts to achieve universal health coverage and leaving countless people without care. 

“NCDs have long been a crushing burden for children and young adults living in extreme poverty in rural Sub-Saharan Africa and South Asia: hundreds of thousands will die each year before the age of 40 from an NCD,” Dr. Gene Bukhman writes in the Wednesday op-ed, co-authored with Dr. Gina Agiostratidou of the Helmsley Charitable Trust. 

“In addition, the out-of-pocket expenses necessary for treatment can be catastrophic for families already living on next to nothing,” they continue. “And that's if these conditions are diagnosed at all, which is far from guaranteed.” 

Bukhman helped launch NCD Synergies in 2013, and in 2016 became a co-chair of the Lancet Commission on Reframing NCDs and Injuries for the Poorest Billion. Agiostratidou is the director of Helmsley’s Type 1 Diabetes Program. Their op-ed coincides with the 2019 Prince Mahidol Award Conference, held this week in Thailand’s capital and focusing on the political economy of NCDs, which kill an estimated 41 million people a year globally. 

Despite that alarming rate, they write, “NCDs among the poorest billion have gone under the radar of the global health community,” particularly regarding young patients.

“Childhood conditions among the poorest billion, such as type 1 diabetes, rheumatic heart disease, or sickle cell anemia, often have genetic, infectious, or environmental determinants,” they write. “Because these NCDs are diverse and relatively uncommon, they have so far failed to garner needed health policy attention: they don't easily fit into a traditional public health agenda, structured around highly standardized approaches to preventing disease or minimizing risks. 

“Now is the time for that to change.”

Bukhman and Agiostratidou lay out a three-pronged approach to revamping NCD policies, including: a greater focus on the world’s poorest, research on integrating health care delivery for non-communicable diseases and injuries, and partnerships to boost financing and integrated solutions. 

Read the full op-ed, here.
 

One morning in July 2014, Bizinde Elyse noticed that his right knee was painful and swollen. 

A native of Nyamasheke District in Rwanda’s Western Province, Elyse brushed it off, assuming he had played football too roughly with friends at school and the swelling soon would go down. To his alarm, his knee kept swelling over the next few days, while becoming itchy and hot to the touch. His parents grew concerned and urged him to go to the nearest health center. He was about 20 years old at the time. 

At the health center, clinicians could not immediately diagnose the swelling’s cause. They gave Elyse some medicine and told him to come back in a few weeks. But his condition continued to worsen, as the swelling increased considerably and he became feverish. Elyse quickly went back to the health center, well before the few weeks were up, but clinicians again could not give conclusive results. They referred Elyse to the district hospital, which promptly referred him to University Teaching Hospital of Butare, in southern Rwanda. Butare is more than 100 miles—or three-plus hours, by car—from his home district. 

Doctors at the teaching hospital diagnosed Elyse with rhabdomyosarcoma, an aggressive and highly malignant form of cancer in skeletal muscle cells. 

Elyse remembers feeling shell-shocked. 

“I had always heard of cancer affecting other people, and I never thought I would ever be one of those people,” he said. “It felt like the end of the road for me. I was even more sad because my parents took it very hard. My mother was very distraught. I hated seeing her that way and it added to my own sadness.”  

Fortunately, doctors told him that since they had discovered the cancer in its early stages, it was still operable. They recommended a swift course of action, beginning with amputation to stop the cancer from spreading. Surgeons amputated Elyse's right leg in early 2015. Following that surgery, doctors transferred Elyse to Butaro District Hospital in northern Rwanda, for chemotherapy. The Butaro hospital and its Cancer Center of Excellence are supported by Partners In Health, known in Rwanda as Inshuti Mu Buzima. 

Elyse said the compassion of Butaro staff was as important to his full recovery as the treatment.        

“Everyone was really kind to me. It made me feel less lonely, as I had made the journey from Nyamasheke to Burera (District) alone, without my parents,” he said. “My treatment, lodging, and meals were all covered by Partners in Health. I would also get transportation from where I was staying to the cancer center, for treatment, and had access to counseling services, which I received regularly.” 

Partners In Health also provided Elyse with a prosthetic leg, so he could transition from using crutches. 

Today, Elyse is 25 years old, healthy and cancer-free. He decided to move to Butaro permanently to make checkups easier, and now runs a small variety shop near the cancer center. He sells everything from airtime data and mobile money transfers to small snacks and everyday items. 

His customers range from caregivers to first-time visitors to the Butaro hospital. He speaks gently as he serves his customers, and has become a beloved, familiar member of the community.

“If you could have asked me two years ago what I would be doing now, I would not even have told you—I would’ve assumed I’d be dead,” Elyse said. “Now, I am an entrepreneur and am contributing to my community and my country.”  

Elyse added that he is incredibly grateful for his recovery and new outlook on life. He also is able to think about his future. In 2017, Elyse graduated from high school, earning second-class honors in math, biology and chemistry. He said he hopes to be a doctor one day, so he can help people in the same way he was helped.

“I would like to thank everyone who helped me get better, from the doctors, nurses and care providers at Butaro, and the government of Rwanda, to Partners in Health, who covered the cost of my medication and also supported me with a prosthetic leg,” he said. “I have been able to go back to my normal life because of their intervention and support.”
 

The imminent launch of two vans equipped with state-of-the-art technology to test for tuberculosis (TB) and multidrug-resistant tuberculosis (MDR-TB) marks a major milestone for PIH’s and Peru’s fight against TB, the leading infectious killer of adults in the world. Within coming weeks, these trucks will enable PIH to carry out a new screening program called TB Móvil, which will search for, diagnose, and refer TB and MDR-TB cases in the three northernmost districts of Peru’s capital, Lima.

TB Móvil is one of various strategies that comprise a new ‘TB Elimination’ campaign, led by a coalition of PIH and partner organizations in northern Lima, which aims to rapidly drive down TB rates. It is the first time PIH is launching such a campaign. The TB Móvil component focuses on bringing testing closer to where people live, in order to search for and promptly treat TB and MDR-TB. The goal in 2019 is for the vans to drive through northern Lima and offer 100,000 people a free, fast way to be tested for the disease and gain access to treatment.

Once inside the truck, volunteers will receive a chest X-ray and—if necessary—a sputum test, the results of which are delivered in mere minutes thanks to advanced automated radiography and GeneXpert machines—two technologies that would otherwise be unavailable to poor patients. A clinician will evaluate the results and, if they test positive for TB, connect them to public health centers for a quick start to lifesaving treatment.

By actively searching for patients and bringing rapid testing, PIH, community organizations, and Peru’s Ministry of Health will ensure that more TB and MDR-TB patients receive early treatment. In so doing, we will halt the spread of the disease and save more lives, now and into the future.

PIH Co-founder Dr. Paul Farmer was in Peru in December to celebrate the program’s first steps. “I marvel at how much the Peru team has accomplished over the past 23 years,” he said. “Seeing former patients who two decades were so sick and are now flourishing, and seeing nurses and health workers and lab techs still working with compassion and conviction after years—these are the best gifts we could ask for, especially in front of these new tools. This novel community screening program is a symbol of shared commitment to do more to address one of the world’s most trenchant public health dilemmas.”

Wearing a “Feeling Lucky” T-shirt as she held her children close, Rose Kapeni* gently opened the front door of her new home and leaned forward to look inside. 

She smiled, and sighed in happiness and relief. Then she walked in to check out her new surroundings—with an excited group of friends and supporters right behind her. 

The joyous home-handover ceremony for Kapeni and her three children was filled with singing, dancing and laughter Feb. 7 in Neno District, Malawi, where friends, community members, and Partners In Health staff gathered to formally present and open the newly built home. The ceremony culminated a long period of illness and recovery for Kapeni, and showed how community-based health care can help provide healing that is far more than physical. 

“I’m beyond grateful that I was found and supported during this very difficult time,” Kapeni said. “I hope and pray PIH can continue to do this work, as there are many others in the community who are struggling.”

Kapeni, 25, went through more than her share of struggles.

A longtime HIV patient, she began suffering severe health problems in June 2016, when a persistent skin condition became debilitating. Her attempts to have surgery for the condition at Queen Elizabeth Central Hospital in Blantyre, Malawi’s second-largest city, failed. Twice, she was unable to have surgery because the surgeon wasn't there; a third time, the hospital did not have blood available in case she needed a transfusion. Travel to the hospital was long and difficult. 

Because of her condition and associated stigma, Kapeni’s husband left her and much of her family abandoned her. As money ran short, Kapeni almost gave up on having the surgery. 

When staff with PIH—known locally as Abwenzi Pa Za Umoyo—visited her home last September, they found Kapeni bedridden, essentially unable to move. 

The PIH clinical officer visited Kapeni to find out why she was missing follow-up appointments for HIV. Kapeni had been dedicated to antiretroviral therapy (ART) since 2014, so it was concerning that she was not taking her medication, and was missing checkups. 

The clinical officer discovered that Kapeni was no longer able to leave her home due to the skin condition, which by that time she had been living with for more than four years. Her HIV viral load was very high. She and her children lived in a small, crumbling structure with no solid walls, an incomplete thatched roof, and very limited food. Her condition made it painful for Kapeni to sit, or even to move. Motorbike rides to visit health facilities had become too painful. 

PIH’s clinical HIV team quickly mobilized, along with community health workers and the program on social and economic rights, or POSER, which addresses social and economic causes of poor health. The close coordination between all those teams ensured Kapeni quickly got comprehensive care, and soon resumed her ART. 

POSER staff provided a large bag of maize, along with emergency financial support for her hospital stay. POSER also coordinated transportation to Neno District Hospital, where, at the end of September, PIH’s medical director and a visiting surgeon successfully conducted Kapeni’s long-awaited surgery, fixing her condition. Her community health worker, Ida Simion, cared for Kapeni’s three children while she was hospitalized. 

Recovering at the Neno hospital last fall, Kapeni explained that throughout her ordeal, her only strength had come from her children: her son, 9, and two daughters, 6 and 2. All three children are HIV-negative. Kapeni knew she had to be there for them, so she persevered through the pain and stigma. 

“Problems come to anyone in life, and you just have to stay strong,” she said. 

After four weeks in the hospital, Kapeni returned to her home in Tiyese Village and, finally, began the long process of starting anew. 

Her vitality was evident in December, when Kapeni buzzed with energy while visiting PIH’s main office in Neno. She laughed as she talked with staff, joking and carrying herself with a renewed confidence. 

She and her children now have an additional source of strength.

The POSER team worked with the community and Kapeni’s family to buy land for a new home. POSER had built 109 homes in Neno District since PIH’s arrival in 2007, and it was clear that the 110th could be for Kapeni, if funding could be found. Thankfully, a private donor provided money for the permanent, two-bedroom home for Kapeni and her children. 

John Living Munthali, infrastructure manager for PIH in Malawi, said construction of the home started in December and took six weeks. Crews molded bricks right on the site, nestled in a small community in Neno's Matandani area.

“We believe that treatment alone is not enough,” said Victor Kanyema, POSER program manager. “Working in collaboration with clinical teams, we make life better for all the people we serve in Neno.”

*Name changed

Dr. Grace Dugan is an Australia native who graduated with UGHE’s Class of 2018. She earned her master’s of science in global health delivery while working for Partners In Health, known in Rwanda as Inshuti Mu Buzima, in the pediatric oncology ward at the Butaro Cancer Center of Excellence in northern Rwanda. 

Can you describe where you grew up? What were your aspirations when you were younger?

I grew up near Warwick in Queensland, Australia. This is a rural, farming area two hours away from a big city (Brisbane). My main aspiration throughout my school years was to be a novelist, though I did have an interest in social justice and formed an Amnesty International club at my high school. A school careers counselor actually sent me to a rural health careers workshop that was aimed at encouraging rural students into medicine, nursing and allied health. She thought it would be a good fit for me because I had good marks in sciences and it would be a way to do good in the community, but I was completely uninterested. I just wanted to write books.

Can you give a brief overview of your professional background? What were you doing before you began attending UGHE, and what inspired you to apply to the university?

I’m a medical doctor and I had been working in Australia and New Zealand for 3.5 years before getting a job in global health. When I applied for a spot at UGHE I was working in Papua New Guinea in multidrug-resistant tuberculosis (MDR-TB), which was an extremely challenging but deeply rewarding and, without exaggeration, life-changing experience. I had basically jumped ship from the normal career pathway for Australian doctors and figured out that I wanted to work in global health forever, but had no idea what to do next. Just before going to Papua New Guinea, I discovered Paul Farmer’s books and read most of them, so that led me to PIH and then to UGHE. At the time I applied I was in a bad patch in my job, and I wanted something to look forward to in the future. I didn’t expect to get in, and when I did get in I at first decided to ask for a deferment because I felt really bad about leaving my patients. But when I told my wonderful boss, Stenard Hiarsihri, he gave me his blessing and encouragement, and I decided to go.

Can you describe your studies at UGHE? What did you focus on?

It’s a diverse program, which I really liked. We started with a semester that essentially was about the history and politics of global health, then we did research methods, then management, and a practicum. We also had shorter courses in political economy, leadership, and management and communications, which were all great. Everyone is working full time, and I was very lucky to be offered at job at Partners In Health, known in Rwanda as Inshuti Mu Buzima, where I worked in pediatric oncology at Butaro Hospital in northern Rwanda. I based my practicum on one of the huge challenges we faced at Butaro: how best to treat acute lymphoblastic leukemia, which is a common childhood cancer with very challenging treatment. In high-income countries, it is almost always curable, but the treatment is complicated, lengthy and with potentially fatal side effects, so finding the best way to treat it is not easy.

What was the most valuable thing you learned at UGHE? What was your favorite class?

I don’t have a favorite class, there was so much of it that was so wonderful. We were lucky to have a great faculty with an amazing array of practical experience. There were some challenges for our cohort, but I always felt so supported, encouraged and valued. It was so great to be in an institution which shared my values, and it made me feel like the sky’s the limit for what we could accomplish.

How did UGHE prepare you to work in global health? What have you been doing post-graduation?

I was already working in global health prior to and throughout the course, but in largely clinical roles. The master’s of science in global health delivery program gave me more confidence to take on managerial and leadership positions, and to potentially start my own project. A month after graduation, I was working in the Marshall Islands in the central Pacific Ocean, in an ambitious project which involved screening 22,000 people for TB and leprosy, as well as treating 4,500 people for latent TB. The project was led by a CDC doctor, Dick Brostrom, who has been a real leader in working to give TB patients in the Pacific access to high-quality treatment. It was a real privilege to work with him.

What inspires you to work in global health? What are the biggest rewards of working in global health, and the biggest challenges? 

I think of the work as an expression of solidarity with some of the world’s most vulnerable people. I find it inspiring to work with others who share a sense of the injustice of how global resources are distributed. It’s also wonderful as a doctor to be able to relieve suffering, though to be able to relieve it you first have to be able see it, and seeing it can be overwhelming. I’ve met doctors from rich countries who’ve told me they couldn’t cope with what they witnessed in poor countries, and didn’t want to work in those environments. For me, I remind myself that incredible suffering is taking place whether I’m witnessing it or not, so I may as well try to lend a hand.

What do you hope to achieve through your career in global health? Why is this work important?

One of my goals is to return to working in Papua New Guinea, where things are really terrible in terms of health care. When I was working there I noticed a sense of fatalism and a desire to blame the people or the culture for their health problems, but in my experience, patients sacrificed an enormous amount to receive treatment and it was possible to accomplish a lot.

What advice would you give to young global health professionals?

UGHE students come from very different backgrounds, and I can only really give advice to those who are like me and come from high-income countries. Working in global health usually involves poor job security and you may want to do unpaid work, as well, so it’s helpful to avoid debt if you can, either from study or from a mortgage. It can be socially isolating so it’s important to look after your friendships, with people who support you and who understand your drive. There are a lot of people who like to complain about how difficult the work is, and that’s not a productive discussion to be having all the time. I get a lot of strength from staying in touch with friends in Papua New Guinea, Rwanda, Peru and the Marshall Islands, who all are really passionate about improving the health of their people.
It’s also good to remember that a lot of people who would really like to do this work are unable to because of other responsibilities, or because they don’t have the skills or the opportunity, so if you want to and you can, then you probably should. It doesn’t matter if it doesn’t lead to anything else or advance your career, the point is to do the work that needs to be done. And if you do one job and find that it didn’t work out, like you didn’t agree with the values of the organization or you didn’t feel you were accomplishing anything, don’t give up. With a bit of reflection and research, you might figure out what you’re hoping to achieve and find the right way to do that.

Titus K. Koikoi is a program director for global health nonprofit Population Services International, in his home country of Liberia. In November 2016, he was one of 25 health care leaders to attend the inaugural Executive Education course through the Global Health Delivery Leadership Program (GHDLP), at the University of Global Health Equity in northern Rwanda. The two-week course was designed to help leaders develop skills to deliver value-based health programs. 

 Can you describe where you grew up? What were your aspirations when you were younger?

I grew up in a small town of about 3,000 people, called Fissebu, in Lofa County, northern Liberia. Both of my parents were teachers, so we lived in staff quarters on the campus of the Zorzor Rural Teachers Training Institute (ZRTTI), where my father had been working, primarily training other teachers. We had electricity and pipe-borne water in our homes on the ZRTTI campus, and I could clearly see the disparity between marginally poor people and those who could afford basic social services. The campus is located about a mile away from the town. Fissebu is still there today, and is pretty rural. People live in huts and mud houses, with a few concrete houses. There are a few hand-pumps for water, plus a lot of hand-dug wells. Most of the town’s residents use a small creek for washing clothes and bathing. Most people use the forest for defecation. The town has one clinic and two senior secondary schools, and a computer training institute was recently opened about two miles from the heart of town. The basic means of survival for people in Fissebu is subsistence farming.

Can you give a brief overview of your professional background?

I’ve worked in global health programs and project management for more than eight years. My work has usually focused on grant management; health systems strengthening; capacity building; service delivery; data management and usage; community engagement and advocacy; government and civil society coordination; and water, sanitation, and hygiene (WASH). I’ve managed budgets of up to US$9.5 million, and currently work as program director for Population Services International (PSI) in Liberia, where we implement the USAID-funded Partnership for Advancing Community-based Services (PACS), and a Global Fund HIV project focusing on key populations. I have a master’s degree in public health and have worked as a public health professional for more than 10 years. 

What inspired you to apply to the GHDLP?

GHDLP’s program curriculum was very interesting. I could clearly see how participating in the program would allow me to apply my program management skills to real-life situations and learning. I saw that the program was modeled to bring together experts from diverse backgrounds and expertise, to discuss challenges and find ways to make implementation/service delivery better and more efficient. UGHE’s interest in rethinking health service delivery, so that the ultimate goal is quality service delivery to the beneficiaries, stood out for me. I was fascinated by such a unique training model.  

Can you describe your experience at the two-week GHDLP course? 

My time at the GHDLP program was rewarding. I had a mix of both rural and urban experiences. I expanded my professional network and used the opportunity to discuss practical solutions around the many global health challenges we’re currently facing. I learned about innovative ways in which lessons from program implementation can enhance learning in the classroom. 

What was the most valuable thing you learned at UGHE? What was your favorite class?

UGHE has begun a movement that seeks to encourage everyone involved with global health delivery to begin rethinking health care and looking into more efficient delivery models. This was the most valuable thing for me. I also enjoyed the case studies. While the case studies touched on very pivotal global health issues and highlighted smart solutions in some cases, they were also an eye-opener to demonstrate that some of the problems in global health have been there forever, and because we continue to do business as usual, those problems are still there. There is more than sufficient evidence to justify the need to innovate, rethink and be more efficient.

Please explain what types of mentorship you received. 

My team from Liberia developed a breakthrough project, and after the training in Kigali, we received mentorship in implementation, follow-up, mobilizing resources, writing reports and presenting the project. A team of experts from UGHE’s core faculty provided the mentorship remotely.  

Can you give an example of a time you used something you learned at UGHE in your workplace at PSI?

I was able to immediately set up an efficient feedback system on my return to work at PSI. Feedback can mean different things to different people. Most often, we feel feedback should only be negative, or should only flow from supervisors to their staff. I learned a different way of providing feedback while at UGHE, and I was able to utilize this learning appropriately. Feedback can be both negative and positive; feedback should flow from supervisors to their staff, and vice versa. This is one way to build a more transparent workplace and maintain a highly motivated and confident workforce. 

How has PSI benefited from your participation in the GHDLP program?

I returned from the GHDLP training course in December 2016, re-energized and with a lot of great new ideas. I’ve been able to transfer new skills and techniques to other managers, and I’ve shared various learning tools and materials with other colleagues for their professional growth. Overall, the GHDLP experience helped me contribute more and better to the awesome work PSI does in Liberia. I’m happy to have had the opportunity. 

What inspires you to work in global health?

I’m passionate about service to mankind. I get inspired every day knowing that the decisions I make, the actions I take, and the networks that I build, support and join, all go toward ensuring that a child somewhere receives timely vaccinations, a sex worker is tested for HIV, someone living with HIV is enrolled in care and treatment, someone in a village is treated for malaria, children learn in safe and healthy environments, people in villages have access to safe and clean water, and more. 

What are the biggest rewards of working in global health? What are the biggest challenges?

I wake up every day remembering that service to humanity is the proudest engagement ever, and that health is an integral component of a more just, safe and better society. I feel humbled that my work in global health gives me an opportunity to plan and manage service delivery for my fellow Liberians, and by extension, the world’s population in general. I feel challenged on a daily basis to give back to society, and to be a critical voice that advocates for access to health by all. I feel challenged and encouraged to contribute to local and global health care policies that ultimately affect health care and service delivery at the very peripheral level, and for the common person. 
There are manpower challenges in global health, and that is one reason why there’s a need for training more global health leaders. As a result of this challenge, I’ve seen little or no impact come out of huge health care investments over time. My home country is an example. It will take a great deal of innovation and rethinking, using models like the one developed by UGHE, to change the current paradigm. There are also huge disparities in terms of wealth distribution and access to care, and poorer people continue to feel the pinch of expensive health care across the globe, while the rich can afford to pay for foreign health care services. This must end now!

What do you hope to achieve through your career in global health? Why is this work important?

My hope is to see a more robust, efficient and resilient health care delivery system not only in Liberia, but also in countries where health service delivery to people in need is still a huge challenge. I hope my work always allows me to add my voice and hands to efforts that ensure under-served and under-privileged populations have frequent access to health care services. This remains one of the most critical things to supporting global security, fostering economic growth and maintaining political stability. 

What advice would you give to young global health professionals?

UGHE is an ideal platform for improving the skills and expertise of young global health professionals. Take up a course as soon as possible! While we all strive to prioritize efforts in global health and make the world a better place, we must now begin to innovate and rethink health care delivery. We cannot continue to do business as usual and expect different results. UGHE has practical solutions through the programs they’ve designed. I would recommend all young global health leaders and professionals apply to UGHE today. 

Benjamin Ndayambaje is a Rwandan who grew up in a refugee camp in Uganda. A trained veterinarian and former veterinary surgeon, he graduated in the University of Global Health Equity’s inaugural Class of 2017. While earning his master’s of science degree in global health delivery, he focused on one health, which involves the integration of health for people, animals and the planet. 

Can you describe where you grew up? What were your aspirations when you were younger?

I was born and grew up in Uganda, in a refugee camp. Life there wasn’t easy for people from foreign countries. There were long distances to school, or to a clinic for medical checkups and treatments. The scarcity of resources created bottlenecks for most refugees. Environmental and hygienic conditions were not good in the camp. As a child, I aspired to be a medical doctor to save lives—especially for those in need. 

As I grew up, my aspirations and interests changed, particularly as I spent time with my grandpa during school holidays. I enjoyed looking after my grandpa’s herd of cows. My grandpa taught me how to milk, and how to take care of young calves. He couldn’t treat some of their diseases, though, and we lost quite a number of cows to curable diseases. We couldn’t get enough milk for home consumption and selling. From that experience, I became determined to work hard and save our animals from diseases. My interest in saving animals for the benefit of people’s wellbeing has grown since then. I aspired to be a veterinarian to treat and protect animals from diseases. 

Can you give a brief overview of your professional background? What were you doing before you began attending UGHE?

I hold an undergraduate honors bachelor’s degree in veterinary medicine from the University of Rwanda. I am a registered veterinarian, and practiced for one year as a private veterinary surgeon. Early in 2013, I worked as a manager for the Institute of Livestock Research and Development (ILRD). I managed the Innovative Program for Enhancing Milk Production (IPEMP) in the Umutara region, to help address the multitude of challenges for farming communities in northeastern Rwanda, primarily through research and outreach activities.

Later in 2013, I was recruited as a junior faculty member in the department of veterinary medicine at the University of Rwanda. I co-founded a One Health Students Club, which was later named “Students’ One Health Innovative Club,” as a platform for university students from various disciplines to collaborate on the most pressing community challenges. In the same year, I acted as managing director of Hobas Ltd. With support from USAID and the Land O’Lakes dairy and agriculture company, Hobas trained 500 farmers in dairy-related enterprises, to improve milk production for both home consumption and surplus sales in Rwanda’s Eastern Province.

In 2014-15, I won a competitive fellowship with Global Health Corps, and was placed in a senior position with the food security and livelihoods program with Partners In Health, known in Rwanda as Inshuti Mu Buzima. Moreover, I joined an online learning initiative through Harvard University and took a course titled, “Improving Global Health: Focusing on Quality and Safety,” and earned a certificate upon completion.

What inspired you to apply to UGHE?

I strongly believe health is a human right! Since childhood, I’ve wanted to save animals to improve people’s health and wellbeing.  Life in the camp in Uganda, as the son of a refugee, and my Global Health Corps experience with Partners In Health inspired me to apply for UGHE. Moreover, the UGHE mission and vision were stepping stones for me to acquire more skills and knowledge to participate in the global health arena.

Can you describe your studies at UGHE? What did you focus on?

Studies at UGHE focused on shaping future global health leaders capable of identifying and defining global health pathologies, and knowing how to address them effectively and strategically. At UGHE I explored strategic problem-solving; experiential and hands-on learning; leadership and management training, focused on defining the role of global health leaders in addressing intertwined health challenges; and one health, which encourages multi- disciplinary collaboration to address health challenges facing humans, animals and the environment.

My focus was on one health. My capstone report focused on the use of pesticides and their effects on human, animal and environmental health in eastern Rwanda. Results of the study revealed the effects of improperly applied pesticides on humans, animals, and ecosystems. Moreover, the study recommended a multidisciplinary approach to address such health challenges, which are always multi-faceted in nature.

What was the most valuable thing you learned at UGHE? What was your favorite class?

The most valuable thing I learned at UGHE is that health is a human right, and global health is a complex web of challenges. Leadership plays a vital role in managing and strengthening health systems. 

Favorite classes: 
1.    Principles of Global Health (first class by Dr. Paul Farmer, PIH co-founder and chief strategist) 
2.    One Health (by Dr. Hellen Amuguni, of the Cummings School of Veterinary Medicine at Tufts University) 
3.    Leadership and management (by Cloe Liparini, senior advisor for leadership development programs)
How did UGHE prepare you to work in global health? What have you been doing post-graduation?

Global health challenges are multi-faceted, and thus require a holistic approach. UGHE prepared me to think systematically and strategically when approaching global health challenges. Biosocial analysis is paramount when addressing global health. Using human-centered design skills gained at UGHE, my current project is designed to address root causes of health challenges and meet the needs of a targeted group of people. 
Because the one health field encourages multi-disciplinary collaboration in addressing global health challenges, my project involves a diverse group of professionals.

Since graduation, I’ve been teaching at the University of Rwanda—applying global health tools acquired at UGHE—while working on global health projects and pursuing my PhD.   

What inspires you to work in global health?

What inspires me most is giving back to my community, and giving a hand to the most in need. It always feels great. Helping people who need a hand, without expecting a reward or gain of any kind, give me peace of mind.  

What are the biggest rewards of working in global health? What are the biggest challenges?

The biggest reward is giving the voiceless a chance to speak up, by listening to them and helping them figure out better ways to move out of poverty and improve the health of themselves and their families.  

The biggest challenges include leadership and management, accountability, and humility among others in the global health arena. Also, understanding global health as an intertwined set of problems and learning how to approach them effectively. Collaborative efforts to solve challenges are still minimal at local, national and global scales. Experience with numerous global health threats—outbreaks, pandemics and epidemics—such as HIV, H1N1, Ebola,  and others, shows that collaboration, leadership and management all play a vital role in containing, preventing, predicting and fighting against these threats.

Furthermore, as Dr. Paul Farmer said: "The idea that some lives matter less is the root of all that's wrong with the world.” I strongly agree with him. We as global health leaders need to fight for global health equity, while promoting humility, advocating for the voiceless and making the world a better place for all human beings.

What do you hope to achieve through your career in global health? Why is this work important?

I hope to play a role in improving the health and well-being of many people, especially those in need. This will be done through advocating for the voiceless and poor families, and designing human-centered research and development projects (likely involving food security and livelihood), especially in the developing world. I envision becoming a global health leader as a researcher and consultant.

I was born in a refugee camp. My personal hardships and experiences have laid the ground for me to strive for progress, and make the world a better place for everyone. It’s not only rewarding, but also a great feeling and accomplishment to help those who can’t help themselves. I always aspire to make a difference in the lives of those in need, and give them hope for future. 

What advice would you give to young global health professionals?

The best advice I can give to young global health professionals is to work hard with humility, collaborate among themselves, and bring the best out of themselves by fighting for global health equity. 

Today, more than ever, we have the best global health experience and tools—such as technological knowhow, skills and knowledge—to address these challenges. We need global health leaders who are optimistic and not afraid to confront these challenges, with the mission of health for all and health care as a human right. 
 

Watch Ndayambaje explain his capstone project on pesticide safety for Rwandan rice farmers, in a UGHE video here.

Partners In Health staff and patients remain safe and health facilities open despite more than eight consecutive days of strikes and civil unrest that have broken out throughout the country.

The situation is growing ever more dire as food, clean water, and fuel for generators and ambulances become increasingly difficult to transport from the capital to PIH’s 12 clinics and hospitals across the Central Plateau and lower Artibonite. If the situation continues, bedside oxygen and medications will run short as well.

According to the Miami Herald, at least eight people have died since Feb. 7 in violent clashes between police and demonstrators. Schools, businesses, and public transportation have been shut down in the wake of the political and economic crisis, largely sparked by skyrocketing prices, a rapidly devalued currency, and chronic fuel shortages. Blockades prevent travel, and residents are reluctant to leave their homes.

Hospitals throughout the country have closed, including the Hospital of the State University of Haiti—the largest public hospital in the country, as staff do not arrive for shifts and supplies have become scarce. 

The unraveling situation has made it particularly difficult for staff with Zanmi Lasante, as PIH is known in Haiti, to get to and from facilities and transport supplies. And patients are being turned away at road blocks when seeking emergency and routine care.

To help us prepare for emergency response in Haiti, please DONATE HERE.

Like many people, I first heard about Partners In Health when I was in college. I was a sophomore at the University of Vermont and a group of us had decided to attend the Unite for Sight Global Health and Innovation conference that’s hosted at Yale every spring. It’s the world’s largest global health conference that convenes professionals and students from more than 55 countries, and that year there happened to be a large number of speakers from PIH.

A year later, hard work coupled with serendipity led me to move to Rwanda. I was studying microbiology at the time with the long-term goal of attending medical school. Rwanda had achieved significant strides in the health sector despite the fact it is an impoverished country. Interested in understanding the global health field better, I reasoned it would be worthwhile to immerse myself there. With the support of UVM faculty, I took seven months to conduct research in Rwanda.

While there, I was working with Dr. Agnes Binagwaho, now vice chancellor of the University of Global Health Equity  and a senior lecturer on global health and social medicine at Harvard Medical School. I lived in the capital of Kigali at a staff house for Inshuti Mu Buzima, as PIH is known locally. The work I did with Dr. Binagwaho provided me a unique opportunity to better understand the Rwandan health system, and my housing provided me with insight into the non-profit realm. I learned that PIH wasn’t like other NGO’s; it didn’t seek to impose what it perceived Rwanda needed, and instead took the revolutionary approach of listening to the needs of the country first and then acting in accordance with those needs.

After returning to the United States and graduating, I took a job working for Dr. Joia Mukherjee, PIH’s chief medical officer. While I didn’t quite know what was next, I was certain that I wanted to work with PIH before embarking on my path through medical school. Joia was in the process of publishing her first book, An Introduction to Global Health Delivery: Practice, Equity, Human Rights, and I had the unique privilege of assisting at the 11th hour. It was while working with Joia that I was able to further understand how inequality contributed to poverty, racism, and health outcomes. I drew connections between what most impoverished countries faced, and the present condition in my home country of Puerto Rico.

As a native Puerto Rican, I was raised among stark dichotomies. Like many of the countries where PIH works, Puerto Rico has a history of colonization, exploitation, and imposition of neoliberalist principles. We have been another instrument in America’s toolbox for purposes of medical research, war weapons, cheap labor, tax havens, and the optimization of private markets. For further evidence of the systemic racism by the United States toward Puerto Rico, look no further than the U.S. response to Hurricane Maria in September 2017. 

The U.S. response to the hurricane’s devastation of my home country infuriated me. PIH doesn’t work in Puerto Rico, yet my colleagues helped me acquire more than 150 pounds worth of essentials, including food, portable solar-powered lights, batteries, and monetary donations, and I flew down one week after the hurricane hit. Research for Joia’s book sparked my interest in getting further involved in domestic issues, and inspired a sense of urgency to contribute to advancing policies that directly affected Puerto Ricans and other marginalized communities.

That sentiment followed me into my current role as the manager of PIH’s grassroots strategy through the Engage program. PIH Engage is directly informed by the work the organization does in the field and uses that example to demonstrate that providing access to health for everyone is possible and should be our moral imperative. We target elected officials and their staff at all levels of government and show them what is possible when funds are allocated correctly. We also partner with other amazing organizations, such as Act Up, Health Gap, and Housing Works, to amplify their messages in support of health care as a human right. Our work also includes supporting domestic legislation that seeks to advance the universal health coverage movement.

I work with incredibly inspiring and dedicated volunteer community organizers, ranging from high school and college students to late-career professionals, who have a deep desire to improve the present condition for marginalized people. The PIH Engage network understands what happens when health care is unavailable, and they educate their communities, organize teams, generate resources, and advocate for policies that further the health for all movement.

While in college, I was always aware I wanted to do more. I fixated on understanding problems at their root. I was deeply aware of what happened when people in power were not held accountable. Against advice from most people in my life, I moved to Rwanda and then decided to take a couple of years off from formal schooling. The result has been an invaluable education and a deep knowledge that there is more than one way to achieve your goals.

I’ve come to realize that what matters most to me is using the privilege geography has afforded me to amplify the voices of those who were not lucky enough to be born within select parts of the world. I’ve come to understand that health care can be a tool for social change. We must dismantle existing structures used to perpetuate injustices and focus on achieving equity. My plan, and personal honor, is to be among the thousands of individuals around the world working toward  that dismantling so that, together, we can build a better, more just health care system for all.

Partners In Health leaders in Haiti say staff have been held at gunpoint at roadblocks and a PIH vehicle has been stolen by an armed gang as nurses and doctors face “overwhelming challenges” to reach health facilities, where fuel for generators and crucial medicines are running low in the second week of protests, violence and civil unrest across the island nation. 

All PIH sites remain open and operating during the crisis. 

Loune Viaud is executive director for Zanmi Lasante, as PIH is known in Haiti. She's working closely with teams on the ground and provided updates on the increasingly dire conditions Thursday. PIH supports 12 health facilities and hospitals across Haiti’s Central Plateau and lower Artibonite, serving more than 1.2 million people. Medical staff at those facilities have seen “dozens of gunshot victims” and patients with severe lacerations. 

Many PIH staff “have had to walk through barriers of burning tires and protesters, sometimes having rocks thrown at them, even being held at gunpoint” amid the protests, Viaud  said. 

“To avoid having our teams venture out of the facilities, we need to ensure that we have food, clean water and a shelter, to keep them safe. Additional security will need to be implemented at the facilities,” she said. 

The Hospital of the State University of Haiti, in the capital of Port-au-Prince, is Haiti’s largest public hospital and has been closed during the protests. Its closure means the PIH-supported, 300-bed University Hospital of Mirebalais, about 30 miles north of the capital, is Haiti’s only facility of its size currently operating. 

“We need to ensure that services for our operating rooms, maternity wards and emergency rooms are well staffed and supplied,” Viaud said. “In areas where we are able to get around the protests, reaching our patients remains a challenge, as there are only four working ambulances for the 12 sites.”

Viaud said PIH medical staff were “stopped by an armed gang” Wednesday in the lower Artibonite, where their PIH vehicle was stolen. None of the staff members were injured physically in the jarring incident.
 
At least eight people have died across Haiti since Feb. 7 in violent clashes between police and demonstrators, according to the Miami Herald. Schools, businesses, and public transportation have mostly remained closed in the wake of the political and economic crisis largely sparked by skyrocketing prices, a rapidly devalued currency, and chronic fuel shortages. Blockades prevent travel, and residents are reluctant to leave their homes.

Temporary reprieves in recent days have not enabled medical staff to catch up with shortages. 

“While there have been windows of opportunity to restock the shelves of our 12 health facilities and hospitals, fuel for generators continues to be a major challenge,” Viaud said. “And when we can secure fuel, it is often as much as six times the price of what it cost just a few weeks ago. At some sites where there is electricity, the grid has been down for days, placing an even heavier burden on generators that are already struggling.”

The crisis is not limited to the capital and large cities. 

“We continue to see a number of areas where we work—including Thomonde, Mirebalais, Verrettes and Petit Riviere—facing constant obstacles," she said. "This week, we have seen protests erupt along the border of the Dominican Republic and Haiti where we support a hospital at Belladere, one of the only facilities for miles in an area often forgotten by many donors and organizations.” 
 
Shortages of medicines are compounding the problem—as are concerns that many people needing care, especially pregnant women, may be unable to reach health facilities because of roadblocks and other obstacles.

“We’ve seen a decline in deliveries at our facilities, which is very concerning given that such a high population of Haitian women give birth at home, with no trained medical personnel,” Viaud said. “Roughly 30 percent of women in Haiti require emergency cesarean sections due to complications.”

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Irene Murungi is a technical advisor for gender at The AIDS Support Organization (TASO) Uganda and the Uganda AIDS Commission. In 2018, she participated in the Global Health Delivery Leadership Program (GHLDP) 2.0 at the University of Global Health Equity in northern Rwanda. The intensive, six-month executive education course helps global health leaders address complex challenges in their fields, share experiences and strategies, and create solutions. The program includes a two-week residency on campus, six months of distance coaching to support the execution of a breakthrough project, and then a final, three-day reconvening in Rwanda, where country delegations present their projects. 

Can you share some of your reflections from your time in Rwanda, during GHDLP 2.0?

First, GHDLP 2.0 was great exposure. Getting to challenge myself and see what my peers from other countries were doing. Learning from them, and comparing with what is happening in my own country, helped me relate to what we were learning. 

Second, it was an opportunity to do an on-site check of my leadership skills and interpersonal skills, vis-a-vis what I thought I really had. So it was a time for me to really learn about myself, and to reflect on what I've been doing, how I've been doing it and how I can do it better. 

Third, it was a value addition. Because I believe that I really didn't remain the same after leaving Rwanda. Most importantly, I had an issue with trusting people—I think it's something on which I scored lowest when we were doing a personal assessment. But recently, I think I've really tried to pull through. Now, I give a benefit of the doubt in whatever I do. And I think it is improving my work relationships. 

How are you applying some of the skills you learned when you were in Rwanda, now that you're back home? 

One is on trust, which I've just talked about. Two is the fact that as we're making decisions at the leadership level, we'll always have to disagree. But I think, from Rwanda, I learned that even when I disagree, I should be able to offer solutions. 

What were some other things that you learned when you were in Rwanda?

I learned more about the different interventions that Rwanda as a country has taken up, compared to Uganda, where—in a closely related setting—we have the same challenges. But I realized and learned that, depending on how the government provides assistance, it can be really hard to deal with some of the so-called challenges now in our country. From the interactions we had in Rwanda, I realized that their success has had a lot to do with integrity—where there is zero corruption, because of the systems in place. 

I also appreciated the effectiveness of Rwanda’s community-based structure—that is, getting to the household, including for treatment of malaria, testing, and many health interventions. In Uganda, it's only counseling and referrals. Looking at our village health teams that are really not doing the same as their counterparts in Rwanda. I think I learned that there is need for community health workers to be self-driven, and for communities to do more to appreciate their contributions.

The idea of being self-driven—and not just looking up to an implementing partner to keep on pushing for results—really is key.

And then, also realizing how social determinants affect health outcomes. You find that children and wives have been abandoned. So you realize that gender issues are really affecting the systems put in place. Coming back to Uganda, I’ve started really looking at how best I can focus on changing the gender-interrelated challenges that affect successful implementation of the different projects at hand. 

Can you talk a little about your breakthrough project?

Initially, when my colleague and I left Rwanda, our breakthrough project was looking at hearing loss among patients with multi-drug-resistant tuberculosis (MDR-TB). As we began the research for our project and consulted our mentor, we realized that we really needed to focus on defaulting; on the lost-to-follow-up patients on MDR (multi-drug-resistant) treatment.

So we changed our project, which now is focusing more drug-resistant TB patients who become lost to follow-up. We are focusing on the period from June 1, 2015, to June 1, 2018, to look at those who defaulted and what was the cause, as well as comparing with those that stayed in treatment—what was so special that kept them in treatment?

What have you learned in your research?

Our suspicion as we set out for the project was that there likely would be factors relating to finances, in terms of patients lost to follow up. While we found that financial factors can be involved, the majority of factors really are social problems. People who are feeling frustrated and take to drug or substance abuse, for example, such as alcohol and smoking habits.

We also realized that there are aspects of co-infection, such as HIV and TB. That can be associated with loss of immunity and other factors, relating to waiting times at hospitals and limited transportation, among others. 

We found those are really critical issues that are leading to MDR-TB patients becoming lost to follow up.

How has your UGHE advisor, Dr. Paul Pierre of Haiti, helped you through this process?

He has really been helpful. We had so many ambitions and we kind of had failed to zero down to what we really wanted to do. He helped us focus. He also provided technical assistance when we were developing the tools to submit for ethical review and approval. He gave us the guidance to help us prepare for that submission. He has really been supportive. 

Is there anything specific that you've learned from him, apart from mentorship and guidance?

I think, giving time to my mentees. Although he was busy, he made sure that he gave us time. There was a time when he had to go to Congo, but he made sure that at least if we could not do calls, that we could email, and we were exchanging emails every other day. And when he returned, he continued to support us. He made sure that we were on the same page. I learned that prioritizing my mentees is key, as I grow to be a mentor in the future.

Also, having a wide wealth of knowledge is vital. He is well-informed. I learned that every time I’m presenting something, I must have enough information to fully inform my discussions, rather than just citing hearsay or making sweeping statements. Those are just some of the lessons and attributes I learned from our mentor, Dr. Paul Pierre. 

A mother recently carried her feverish 3-year-old boy two hours into Dambe Health Center in the hills of the remote district of Neno in southern Malawi. She left with medication for his new diagnosis, one Malawians hear often: Malaria. They’d caught it early this time.

If the boy had been sick several years earlier, before the clinic’s opening, the scenario would have played out much differently. The mother might not have been able to take her son to the doctor in the first place. It would’ve taken her an entire day to walk to the nearest free care at Neno District Hospital and back home, and that’s if she could’ve afforded to miss a day’s labor. 

On average, Malawians live on just $586 a year, one of the lowest per capita incomes in sub-Saharan Africa. For the more than 170,000 people living in Neno, one of the poorest regions of the country, it’s even lower. 

“Mothers will often wait until a child has a seizure from cerebral malaria,” says Dr. Luckson Dullie, executive director of Abwenzi Pa Za Umoyo, as Partners In Health is known in Malawi. That’s because families must travel long distances to clinics and fear the potential cost of care. Yet Dullie knows that a child faces a 70 percent chance of death when care is delayed. 

Families shouldn’t have to debate whether they can afford to seek care for sick children. There is a better way, backed by common sense and solid research.

Research published by a team of PIH staff in Malawi and collaborators at the University of Warwick details how poor patients suffer when faced with long distances to care and the prospect of paying high user fees. Simply put, when health care is a morning’s walk away and care is free, exponentially more patients arrive at clinics and diagnoses rise for infectious diseases, such as malaria, HIV, and tuberculosis.

While Malawi has resisted international pressures and provided free public health care since 1964, about one-fourth of its health centers are operated privately and still charge user fees. In Neno there were four such centers when PIH began supporting the Ministry of Health in 2007. At that time, there was no district hospital, and the 10 health centers had fallen into disrepair. 

Over the past 12 years, PIH built Neno District Hospital, a community hospital, and two health centers, and revitalized two more centers. Clinicians have focused on reducing maternal deaths, treating severely malnourished children, and providing preventative care and treatment for HIV, tuberculosis, malaria, and noncommunicable diseases (NCDs). Meanwhile, staff have provided financial support to Neno’s most vulnerable patients by helping them access safe housing, pay for children’s school fees, and train for local jobs. 

Since 2007, PIH-supported clinicians at health centers and the district hospital have tended to a steady flow of patients eager to access free services. As in other communities around the world where PIH works, patients arrive when facilities are staffed, well-stock with essential medicines, and provide reliable quality care.

Seeing these results, Dullie and his team realized they had a natural experiment in their backyard. They wanted to see whether their belief was true: that user fees discouraged patients from seeking services. If they analyzed historical data from the district health system, where some health centers have required fees and others haven’t, they knew they could test their hypothesis.

The team compared outpatient attendance and new diagnoses of HIV and malaria between July 2012 and October 2015 across health centers that charged fees and those that did not. Sure enough, there had been a 70 percent drop in attendance when patients were charged fees and a 50 percent reduction in HIV diagnoses in the district. When the fees were subsequently removed at these centers, the team documented a 350 percent increase in outpatient visits, and a case identification for malaria saw a similar increase. 

Dullie and his colleagues carefully chronicled how charging patient fees obstructed access to health care, particularly for sick children. The lack of affordable care has a way of proliferating the spread of disease, which in Neno and many poor settings includes HIV, malaria, and tuberculosis, putting especially infants and mothers at high risk of preventable death.

Following the paper’s publication three years ago, Dullie and his team worked with the Ministry of Health to remove user fees in three of four health care centers still charging the equivalent of a few dollars for each visit. The continued advocacy has resulted in the removal of user fees in all four of the privately operated facilities in Neno.

“Now, without user fees, patients can come in every time they have an issue,” he says. “Parents don’t wait too long and kids come in with less severe forms of illness.”

The study also helped Dullie and his team see a vast need for care in the remote, rural region of Dambe. They advocated for building a new health center to meet potential patient demand. And their work prevailed. 

In 2016, Dambe Health Center opened to great local fanfare and large crowds. Luckily, for the toddler with malaria and his mother who visited recently, it was ready to receive them with a cure.

When Anne Marie Nyiranshimiyimana began working as a mason, she was met with staunch criticism.

“They told me, ‘No woman builds, no woman climbs.’ They told me, ‘Women can’t do a lot of things,’” Anne Marie said. 

Despite that resistance, Anne Marie persevered and became not only one of 200 female workers on the construction site for the new University of Global Health Equity campus, but also a dynamic presence, role model and mentor. Her work helped draw international attention to the northern Rwanda site in late January, when government officials, global health leaders, educators and dignitaries gathered to formally inaugurate the campus, in the community of Butaro, with a celebratory ribbon-cutting and weekend symposium.

The job wasn't Anne Marie's first in the area. She began her masonry training during construction of the Partners In Health-supported Butaro District Hospital, just across the valley from UGHE. The university also is an initiative of PIH, which is known locally as Inshuti Mu Buzima.    

Anne Marie's training and work experience has given her a passion for masonry. She's risen to the rank of master mason, while inspiring her peers along the way.

That growth was evident on the UGHE construction site. Using her knowledge to mentor and encourage others, Anne Marie quickly became a role model to women and girls in her community. Her nickname, Kankwanzi, loosely translates to “rising star that refuses to conform to society’s expectations.” That mentality is reflected by her success in encouraging females to go into masonry, a traditionally male-dominated industry. Despite a huge stigma in Rwanda around women who are employed as construction workers, Anne Marie continues to advocate for their increased involvement.

“[Women] bring great value to construction sites. They are better implementers, and more equipped to budget time and resources,” she said. “Hiring [women] supports the whole family.”

Before she developed her masonry skills, Anne Marie struggled to provide for her family. Having only been educated through primary school, she found it difficult to find a job. But equipped with a new skill set and income, her position has enabled her to buy health insurance and send her children to school.

Beyond having a ripple effect on her family and community at large, Anne Marie’s vocation also has given her an increased sense of identity and confidence.

“Women look up to [me] so much when they hear about me," she said. "They want to come work with Kankwanzi."

This story and photo originally appeared on the UGHE website, here. 

Elizabeth Campa, senior health and policy advisor for Zanmi Lasante, as Partners In Health is known in Haiti, writes below how the organization is “entering a new normal for operations in Haiti,” where a 12-day lockdown paralyzed the country, closing banks, schools, and businesses and halting all public transportation. Violence and unrest across the country resulted in 26 deaths and dozens of injuries, according to reports by UNICEF. 

During that time, PIH staff and clinicians maintained all 12 of its facilities open and operational, serving patients and working round-the-clock shifts to meet need.  

The most recent national crisis that began close to three weeks ago on February 7th, but dates back to the summer of 2018, is far from over. While the national protests that choked Haiti into 12 days of consecutive lockdown have declined to more localized events, the unknown of ‘what is next’ is on the minds of all Haitians. 

Zanmi Lasante maintained all its 12 facilities, opened, powered up, and receiving patients, while the challenges on the ground continued to make everyday activities more difficult. At University Hospital of Mirebalais, a 300-bed facility and one of the largest public hospitals in the country, a marked decline in women seeking services in labor and delivery is heavy on the minds of the team there. The last two weeks has documented a 30 percent decline in the area of maternal health.  Women are too afraid to reach our sites. Regularly 40 percent of women come to University Hospital from outside the direct service area. Now, PIH is seeing considerably fewer women from the capital of Port-au-Prince or other areas. Where are these women going for labor? We do not know.  

Our staff continue to face harassment and armed gangs that now control countless areas around the country. Yet, they still come to work; they still are there for our patients to ensure that if they do come in, we will be there for them no matter the obstacles. Staff morale has suffered, as they struggle to make every moment count when they get to communities to extend assistance to the Haitians patients too sick to travel for an appointment or to make it to our health facilities.  

Haitians have seen a 30 percent increase in inflation in the past weeks. A cup of rice that previously cost 40 cents is now almost doubled at 75 cents. While this may not seem like a lot for many, for a population where 85 percent of individuals live on less than $2 dollars a day, this is devastating.  

Fuel, while more readily available, is still being sold at close to five times the prices of January. Fuel is the lifeline for PIH’s facilities, as all depend heavily on generators to produce electricity that keeps facilities running. This price increase has had a major impact on a budget that had already been stretched to its limits. Tens of thousands of Haitians depend on PIH and its services in health care, water, and sanitation, and nutritional programming each day to ease their suffering. Knowing this, we need to make sure we have the vehicles and ambulances to get out to the communities and bring our services to them if they cannot come to us.  

We need to continue to provide food, water, and shelter to our patients and staff. We need to continue to provide hope to those who are sick by ensuring our facilities stay stocked and powered. PIH in Haiti may be entering a new normal when it comes to a country under siege, but we will continue with our mission no matter the obstacles placed in front of us. 

A PIH staff member in Haiti, who preferred to remain anonymous, wrote this account describing the recent lockdown and its impact on co-workers, patients, and loved ones: 

It saddens me to see my country in this deteriorating state. Every day is a guessing game of whether or not another violent protest will take place. The 12-day lockdown was a reality check of the ongoing socio-political and economic challenges Haiti has been enduring for the past 200 years.  

During the crisis, basic commodities such as drinking water, gas, and cooking fuel were hard to come by, resulting in people scrambling to obtain whatever they could in the markets. Panic and fear permeated the country when people understood the gravity of the situation. It also made me question how it must be for the approximately 60 percent of Haitians living in poverty who are unable to pay for basic staples, such as rice and beans, with the rapid devaluation of the Haitian gourde.  

I thought about all the patients Zanmi Lasanate serves across its 12 sites, and about the staff who were unable to arrive to sites due to roadblocks. I commend my co-workers who worked eight days or more straight to provide services to the patients who were courageous enough to cross barricades and burning tires.  

Although I understand where the protestors’ frustration derives from, violence is not the answer. In order for the country to move forward, we need our kids going to school. We need hospitals to remain open. And we need people to work. For the time being, things seem a bit calmer compared to earlier this month. However, people are still on guard, and tensions remain present. From experiences past, anything could happen in Haiti. So, as we say in Creole, “Nap swiv,” or, “We will just wait and see.”